Dairy Products and Metabolic Effects : A Nordic Multicentre Study - Norwegian Part

BACKGROUND: Some epidemiologic studies have suggested inverse relations between intake of dairy products and components of the metabolic syndrome. OBJECTIVE: The objective was to investigate the effects of an increased intake of dairy products in persons, with a habitually low intake of dairy products and with traits of the metabolic syndrome, on body composition and factors related to the metabolic syndrome. STUDY DESIGN: Middle-aged overweight subjects (n = 36) with traits of the metabolic syndrome were recruited at the Lipid Clinic, Rikshospitalet Oslo University and randomly assigned into milk or control groups. The milk group was instructed to consume at least 3 portions of low- to moderate-fat dairy products daily. The control group maintained their habitual diet. Clinical investigations were conducted at baseline and after the six months intervention period. RESULTS: There were no significant differences between changes in body weight or body composition, blood pressure, markers of inflammation, adiponectin, or oxidative stress between the milk and the control groups. There was a significantly decrease in E-selectin, a marker of endothelial function in the milk group at the end of the study compared to the control group (P = 0.008). Among participants with a low calcium intake at baseline (<700 mg/d), there was a significant treatment effect for waist circumference (P = 0.023). CONCLUSIONS: This study gives no clear support to the hypothesis that a moderately increased intake of dairy products beneficially affects aspects of the metabolic syndrome. The apparently positive effects on waist circumference in subjects with a low calcium intake suggest a possible threshold in relation to effects on body composition

Staying on track in changing landscapes: mapping complex projects in health services

Background: Projects initiated to transform and develop health services have to account for a variety of complex factors. There is a need to develop methods to handle this complexity, and in this article we present a flexible and adaptable framework for mapping projects that focus on involvement of persons receiving care and other stakeholders, with an integrated support structure. The method also considers elements in the local context. Aims: To present examples of project mapping, and to explore how the process can enhance quality in complex projects in healthcare services. Methods: The project mappings have been co-designed in processes of deliberate dialogue between the authors of this article, with involvement from other researchers and stakeholders. A three- dimensional version of project mapping was developed, and further refined by introducing a two-dimensional version and testing the framework in various settings such as a project leader course and the 2018 Enhancing Practice Conference in Basel. Analysis continued through the whole process as preliminary ideas were discussed and documented. We reflected, wrote notes, talked to people, took part in workshops that included a variety of creative methods, and did a qualitative content analysis of key findings to develop themes. Results: The examples of project mapping show that the process of mapping is as important as the map itself. The maps are flexible and can be combined. Project mapping can contribute to quality in projects by helping project facilitators and participants to stay on track. It can also enable co-creation and guide facilitation processes. Conclusion: Engaging in mapping processes represents an approach that can contribute to a shift in thinking and help even out power imbalances between project participants, as well as influencing the working culture in a health service. Mapping can facilitate transformation of practice while simultaneously creating new knowledge about that transformation

Staying on track in changing landscapes: mapping complex projects in health services

Background: Projects initiated to transform and develop health services have to account for a variety of complex factors. There is a need to develop methods to handle this complexity, and in this article we present a flexible and adaptable framework for mapping projects that focus on involvement of persons receiving care and other stakeholders, with an integrated support structure. The method also considers elements in the local context. Aims: To present examples of project mapping, and to explore how the process can enhance quality in complex projects in healthcare services. Methods: The project mappings have been co-designed in processes of deliberate dialogue between the authors of this article, with involvement from other researchers and stakeholders. A three- dimensional version of project mapping was developed, and further refined by introducing a two-dimensional version and testing the framework in various settings such as a project leader course and the 2018 Enhancing Practice Conference in Basel. Analysis continued through the whole process as preliminary ideas were discussed and documented. We reflected, wrote notes, talked to people, took part in workshops that included a variety of creative methods, and did a qualitative content analysis of key findings to develop themes. Results: The examples of project mapping show that the process of mapping is as important as the map itself. The maps are flexible and can be combined. Project mapping can contribute to quality in projects by helping project facilitators and participants to stay on track. It can also enable co-creation and guide facilitation processes. Conclusion: Engaging in mapping processes represents an approach that can contribute to a shift in thinking and help even out power imbalances between project participants, as well as influencing the working culture in a health service. Mapping can facilitate transformation of practice while simultaneously creating new knowledge about that transformation

Polypharmacy and potential drug–drug interactions in home-dwelling older people – a cross-sectional study

Background: Risks associated with polypharmacy and drug–drug interactions represent a challenge in drug treatment, especially in older adults. The aim of the present study was to assess the use of prescription and non-prescription drugs and the frequency of potential drug–drug interactions in home-dwelling older individuals. Methods: A cross-sectional study design was applied. Data were collected during preventive home visits among individuals aged ≥ 75 in three separate communities of Western Norway. A questionnaire, which was filled out by the individual, their next-of-kin, and the nurse performing the home visit was used for the collection of demographic and clinical data (age, sex, medication use, diagnoses, need of assistance with drug administration). Potential drug–drug interactions were identified electronically by IBM Micromedex Drug Interaction Checking. Point prevalence of potential drug–drug interactions and polypharmacy (≥ 5 drugs) were calculated. Binary logistic regression analyses were performed to assess factors potentially associated with polypharmacy or potential drug–drug interactions. Results: Among the 233 individuals (mean age 78± 3 years, 46% male) included in the study, 43% used ≥ 5 drugs, 3.4% ≥ 10 drugs, while 4.3% used no drugs. In 54% of the 197 individuals using two or more drugs, at least one potential drug–drug interaction was detected. Low-dose aspirin and simvastatin were most frequently involved in potential drug–drug interactions. In total, 25% of the individuals reported current use of drugs sold over the counter of which more than 95% were analgesic drugs. Potential drug–drug interactions involving ibuprofen were identified in nine of 11 (82%) individuals using over-the-counter ibuprofen. Conclusion: The study revealed a high prevalence of polypharmacy and potential drug–drug interactions with both prescription and non-prescription drugs in older home-dwelling individuals. Close monitoring of the patients at risk of drug–drug interactions, and increased awareness of the potential of over-the-counter drugs to cause drug–drug interactions, is needed