New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Behovsbedömningssamtal mellan biståndshandläggare och personer med demenssjukdom : Medborgarskap i praktiken

This thesis deals with encounters between persons living with dementia and care managers. Dementia often results in progressive care needs that must be met by different social care services. The person’s care needs are assessed in an assessment meeting where the person and their relatives meet with a care manager to negotiate needs and social care services. The assessment is conducted through one or several conversations where the person with dementia meets the care manager; relatives are often present in the meetings. Dementia is a syndrome that involves a cognitive decline and a decreased ability to communicate and interact with others. It may therefore be difficult for a person with dementia to take part in discussions about their care needs and social care services. 15 audio recorded meetings have been studied to explore and understand how persons with dementia use their remaining communicative, cognitive and linguistic resources to invoke, negotiate, and use their rights as citizens in the institutional context where their care needs are assessed. The analysis concerns the organization of talk as a joint activity; the production of social actors in talk-in-interaction; the relation to institutional features of discourse. This dissertation concludes that the practice of citizenship is situation based and varies depending on the participants present. Care managers can facilitate for persons with dementia to overcome communication problems by using different discursive strategies and to make it possible for them to participate or at least be included in the negotiation. Persons with dementia are positioned as less competent than other persons participating in the assessment meeting. This might have an impact on the participation of people with dementia in negotiations regarding their future care. Furthermore, stories told in assessment meetings often position the person as dependent on others, which could undermine the identity and sense of self of the person with dementia.Den här avhandlingen berör möten mellan personer med demenssjukdom och biståndshandläggare. Demenssjukdomar medför ofta komplexa omsorgsbehov, vilka kan mötas med hjälp av olika stödinsatser. Personens omsorgsbehov bedöms i ett biståndshandläggningssamtal där personen och dennes anhöriga träffar en biståndshandläggare för att förhandla dennes behov och eventuella insatser. Konversation är centralt i dessa möten. Demenssjukdomar medför kognitiva nedsättningar och nedsatt förmåga att kommunicera och interagera med andra. Det kan därför vara svårt för personer med demenssjukdom att deltaga i diskussioner om behov och insatser. 15 ljudinspelade samtal har studerats för att förstå hur personer med demens använder sina kvarvarande kommunikativa, kognitiva och språkliga resurser för att åberopa, förhandla och använda sina rättigheter som medborgare i den institutionella kontext där deras omsorgsbehov bedöms. I samtalet medverkar personen med demens, handläggaren samt ofta någon familjemedlem. Analysen fokuserar på organiseringen av samtal som en gemensam aktivitet; hur sociala aktörer skapas i samtal; hur det institutionella samtalets särdrag påverkar konversationen. Sammanfattningsvis visar denna avhandling på att hur medborgarskap praktiseras är situationsbaserat och varierar beroende på vilka som deltar i mötet. Biståndshandläggare kan underlätta för personer med demenssjukdom att övervinna kommunikativa problem genom att använda olika samtalsstrategier och göra det möjlig för dem att delta eller att åtminstone inkluderas i förhandlingen angående olika stödinsatser. Personer med demenssjukdom positioneras ofta som mindre kompetenta än andra personer som deltar i behovsbedömningssamtal, vilket kan medföra konsekvenser på personens delaktighet i planerandet av framtida insatser. Berättelser i dessa samtal positionerar ofta personen med demenssjukdom som beroende av andra, vilket kan underminera deras identitet och uppfattning av sig själva

Att engagera sig, organisera sig och skapa guldkant för äldre : Volontärorganisationen Resurspoolen som en mångsidig aktör för att förebygga och bryta ofrivillig ensamhet i det lokala samhället

Denna rapport har tagits fram på uppdrag av Resurspoolen – Frivilliga uppdrag i Linköping. Uppdraget bestod i att dokumentera volontärernas erfarenhet av vilken betydelse äldre medborgare, som organiserar sig i Resurspoolens verksamhet, kan ha för att förebygga ofrivillig ensamhet och social isolering bland äldre personer. Uppdraget hade också en framåtsyftande ansats gällande hur Resurspoolen kan komma att utvecklas utifrån volontärernas perspektiv. Civilsamhällets betydelse inom välfärdssamhället är högaktuell i nationell politik där frivilligorganisationer lyfts fram som en central aktör för att hantera välfärdssystemets utmaningar och ansträngda situation. Medborgare som organiserar sig gemensamt antas fylla en allt större roll i gränsytan mot det offentliga stödsystemet. Samtidigt har ofrivillig ensamhet bland äldre personer lyfts fram av staten som särskilt allvarlig, varför statsbidrag har riktats till kommuner och det civila samhället för att förebygga och bryta ofrivillig ensamhet. Rapporten har särskilt fokus på de äldre frivilliga volontärerna som engagerar sig. En viktig komponent är deras arbete, intresse och fortsatta engagemang för att skapa en kontinuitet i genomförandet av olika insatser och i den ömsesidiga relationen – vid aktiviteter mellan äldre, inom organisationen och mellan volontärorganisationen och andra aktörer. Rapporten belyser också arbetet med att skapa aktiviteter och mötesplatser för äldre personer, varav många lever i social ensamhet. Rapporten kan således sättas in i ett större sammanhang genom att bidra med kunskap om hur en volontärorganisation – Resurspoolen – har en mångsidig funktion för det lokala samhället i att uppmärksamma och ge socialt stöd, sällskap, skapa gemenskap och social hållbarhet bland Linköpings medborgare.This report has been written on behalf of Resurspoolen - Frivilliga uppdrag i Linköping. The aim was to document the volunteers' experience of the importance of older citizens, who organise themselves in the Resurspoolen’s activities, in preventing loneliness and social isolation among older people. The project also had a forward-looking approach regarding how the work by Resurspoolen can be further developed and improved. The importance of civil society in the welfare society has been raised in Swedish national politics, where voluntary organisations have been highlighted as a key player in managing the challenged situation that the welfare system is facing. Citizens who organise themselves are assumed to play an increasingly important role at the interface with the public support system. At the same time, preventing loneliness among older people has been highlighted as a prioritised area by the state where municipalities and civil society have been pointed out as key actors to prevent loneliness.  The report focuses on the older volunteers who get involved, get organised with the effort to give “an extra flavour to older people’s life”. An important component is their work, interest, and continued commitment to create activities targeting older people, many of whom live in social isolation. and to create collaboration, between older people within the organisation, and between the volunteer organisation and other actors in the local society.  The report can also be placed in a broader context as it contributes with knowledge about how a volunteer organisation – Resurspoolen – has a versatile function for the local community, providing social support, social inclusion and shaping social sustainability among Linköping’s citizens

Promoting Active and Healthy Ageing at Day Centers for Older People

Day centers provide opportunities for older people to achieve active and healthy aging. Staff play a significant role in day centers, although evidence is lacking concerning their role. To explore the experiences of staff in promoting active and healthy aging at social day centers, interviews with 12 staff working at day centers for older people were carried out. The findings present two categories: the actions of the staff and conditions affecting activities at the day centers. Staff at day centers may play an important role in providing opportunities for older people to maintain health and participation in meaningful activities.Funding Agencies|Linkoping university, unit of occupational therapy</p

How are decisions on care services for people with dementia made and experienced? : A systematic review and qualitative synthesis of recent empirical findings

Background: During recent decades, there has been a growing recognition that people cannot be assumed incapable of making decisions about their own care solely on the basis of a dementia diagnosis and international agreements and legislative changes have strengthened the formal right for people with dementia to participate in decisions on care services. This raises important questions about how these decisions are currently made and experienced in practice. In this review, we address this question and highlight directions for further research. METHODS: We searched CINAHL, PsycINFO, ASSIA, Social Services Abstracts, Science Direct, Academic Search Premier, and PubMed. Twenty-four pertinent articles were identified, all representing qualitative studies. Relevant findings were extracted and synthesized along dimensions of involvement of the person with dementia in decisions on care services, using an integrative approach to qualitative synthesis. RESULTS: We identified three overarching ways in which people with dementia are involved, primarily, in the informal part of a process of decisions: excluded, prior preferences taken into account, and current preferences respected. Several (10) articles seemed to be based on the assumption that decisions on care services are invariably and solely made within the family and without participation of the person with dementia. CONCLUSIONS: The review emphasizes the need for more updated research about international debates and agreements concerning capabilities and rights of people with dementia and about the (potential) formal contexts of care decisions in the country concerned. This, we argue, is vital for future knowledge production in the area.

How shall we handle this situation? Social workers discussions about risks during the COVID-19 pandemic in Swedish elder care

Within a context where New Public Management [NPM] has become increasingly influential in shaping everyday working practices, social workers often handle risks in their everyday work using formalised bureaucratic procedures, among other strategies. As the COVID-19 pandemic progressed, rapid changes occurred in Swedish elder care that social workers were required to address in their everyday work. Intra-professional case conferences amongst social workers provide one opportunity to discuss individual viewpoints and obtain suggestions from colleagues on how to proceed with a case. These discussions have so far received little scholarly attention. In this study we used a data set consisting of 39 audio-recorded case conferences to analyse social workers intra-professional discussions about risks during the COVID-19 pandemic. In the case conferences, social workers discussed the risks that were accentuated by the pandemic, such as the risk of spreading COVID-19 to clients, the risk of unmet care needs amongst clients, risks related to accountability, and the risks pertaining to blurred boundaries between different organisations. The collegial discussions in case conferences included opportunities for social workers to use their collective professional experience and competency to establish creative solutions on the go and to discuss various ways of handling and balancing different risks while continuing to carry out their work in the changing and unknown situation. Our findings highlight the importance of collegial support in social work in dealing with accentuated risks during the pandemic.Funding Agencies|FORTE [2019-00610]</p

Collaboration and coordination of health and care services for older people with dementia by multidisciplinary health and care providers: a scoping review protocol

IntroductionCollaboration and coordination of health and care services are key to catering for the diverse needs of a growing population of older people with dementia. When multidisciplinary health and care providers work together, they have the possibility to use resources in a fair, accurate and effective way and thereby do the right thing, at the right time, for the right individual. The aim of this scoping review is to map how different care-providing agencies collaborate and coordinate health and care services for older people with dementia. Methods and analysisA scoping review will be carried out following the proposed methodology by Joanna Briggs Institute and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Systematic searches will be carried out in scientific databases. Studies published within the last 10 years will be included based on certain eligibility criteria. All included studies will be critically appraised using the Research Pyramid. Data from included studies will be charted and subjected to content analysis. Ethics and disseminationEthics approval is not required for scoping reviews. The dissemination of findings will be conducted through conference presentations and publication in international scientific journals.Funding Agencies|Swedish Council for Working Life and Social Research [STY--2021/0005 Dnr: 2021/01786]</p