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This chapter presents the ICECAP-O, a measure of capability tailored for older people. It briefly presents the original version of the ICECAP-O. In addition, it describes the work that has been done concerning the translation and cross-cultural adaptation of the ICECAP-O to the Swedish context. Finally, the chapter contains arguments for the use of the Swedish version of the ICECAP-O in health and social care, and in the evaluation of interventions and longitudinal research studies where older people’s capabilities are a focus.

The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.

Skolmästare Bero Andreæ Ekegren var född cirka 1655 i Ormestorp, Häggesleds socken, Kållands härad i Västergötland, och dog därstädes 1719. Han var pedagog i Hova skola, Hova socken i Vadsbo härad, under 1700-talets första decennium. Här redovisas resultatet av en utredning om skolmästarens liv, vilken bland annat belyser detaljer från hans studietid vid Kungliga Akademien i Åbo och tjänstgöring i Hova skola. Artikeln redogör även för Bero Andreæ Ekegrens familj, hans ursprung och anfäder, vilka var hemmahörande i Häggesleds socken.

A guidance document for the identification of endocrine disruptors (EDs) in the regulatory assessment of plant protection products (PPP) and biocidal products (BP) has been published by the European Chemical Agency (ECHA) and the European Food Safety Authority (EFSA). The ECHA/EFSA guidance, mainly addressing EATS (estrogen, androgen, thyroid, steroidogenesis) modalities, is intended to guide applicants and assessors of the competent regulatory authorities on the implementation of the scientific criteria for the determination of ED properties pursuant to the recently implemented PPP ( EU 2018/605 ) and BP ( EU 2017/2100 ) EU Regulations. In this study, a search filter for targeted literature search in context of assessing if a substance can be identified as an ED relevant for human health was developed and validated. Development of the search filter was based on the search strategy presented in the ECHA/EFSA guidance and using the estrogenic chemical Bisphenol AF (BPAF) as a model substance. Information specialists from two independent institutions developed refined search filters based on the suggested original search strategy published (ECHA/EFSA guidance - Appendix F). Articles identified by a systematic literature search for BPAF were screened for relevance with inclusion and exclusion criteria by two independent reviewers obtaining positive (relevant) and negative (irrelevant) controls. The developed search filter was quantitatively evaluated in terms of sensitivity, specificity and precision based on the positive and negative controls. The developed filter was then validated for T modality by its application to the known thyroid-disruptor perchlorate. The result is a sensitive search filter with sufficient specificity, which can be applied for all chemicals where a targeted literature search is needed to assess and identify ED properties of chemicals with relevance for humans. Future application of the filter to a broader range of chemicals may identify further points of improvement.

Background: Welfare Technology (WT) can promote participation in activity. Thus, initiatives to support the implementation of WT products and services in municipality care settings needs to be developed and evaluated to benefit end-users. Objective: To evaluate an interactive showroom of WT. Material and method: Municipal employees (n = 217) filled in a questionnaire before and after they visited an interactive showroom of WT. Findings: The number of participants confirming WT’s potential to contribute to municipal operation areas increased in seven out of eight areas after their visits (p < 0.05). A statistically significant increase was also found regarding general knowledge of and confidence in WT and its potential value. Conclusion: A visit to the interactive showroom increased the perceived general knowledge and appreciated value of WT. The perception of the possibility of implementing WT in various municipal operation areas also increased, which may contribute to the implementation of WT in municipal care settings. AllAgeHub

Objective: In Sweden, cyclists, pedestrians, and moped riders share the space on combined pedestrian and cycle paths, and their speeds may differ greatly. Both actual speed and speed differences can potentially influence the number of accidents on the shared paths. As a starting point, this article studies the speed component and how cyclists’ speed varies at pedestrian and cycle paths depending on the day, week, and year; road user composition; and road design. Methods: Three data sources were used: Existing measurements of cycle speed and flow in 3 different Swedish municipalities, Eskilstuna (1 site, January–December 2015), Linköping (6 sites, 4 weeks in September–October 2015), and Stockholm (10 sites, 1–5 days in August–September 2015); complementary measurements of cycle speed and flow in Linköping (4 sites, 1–10 days in August–September 2016) and Stockholm (1 site, only part of 2 days in August 2016) were also conducted within the project, in addition to roadside observations of bicycle types at the 5 new sites. Results: The average speed of cyclists on the paths varied between 12.5 and 26.5 km/h. As expected, the lower average speeds were found in uphill directions, near intersections, and on paths with high pedestrian flows. The higher speeds were found in downhill directions and on commuter routes. In all, 70%–95% of road users observed on pedestrian and cycle paths were cyclists, and 5%–30% were pedestrians. The most common type of bicycle was a comfort bike, followed by a trekking bike. Electric-assisted bicycles and racer bikes occurred at all sites, with proportions of 1%–10% and 1%–15%, respectively. The 2 sites with the highest proportion of electric-assisted bicycles and racer bicycles also had the highest average speeds. The differences in average speed throughout the day, week, and year could only be assessed at one of the sites. Only small differences were found, with the most noticeable being that the average speed was lower in January and February (13.8 km/h) compared to the rest of the year (15.3–16.1 km/h). The average speed was also lower during daytime (14.7 km/h) than during other parts of the day (15.4–15.8 km/h). Conclusions: The relationship between bicycle type and measured speed was not entirely clear, but the results suggest that paths with higher proportions of electric and racer bicycles have higher average speeds. There also appears to be a connection between average speed and the width of the distribution; that is, the higher the average speed, the wider the speed distribution. More research is needed on how speed levels and speed variance affect accident risk.

Background: Frailty is considered highly prevalent among the aging population. Fruit and vegetable intake is associated with positive health outcomes across the life-span; however, the relationship with health benefits among older adults has received little attention. Aim: The aim was to examine if a relationship exists between meal frequency or frequency of vegetable intake and the development of frailty in a population of older adults. Methods: A total of 371 individuals, 80 years or older, from the study ‘Elderly Persons in the Risk Zone’ were included. Data was collected in the participants’ home by face-to-face interviews up to 24 months after the intervention. Baseline data were calculated using Chi2-test; statistical significance was accepted at the 5% level. Binary logistic regression was used for the relationship between meal frequency or vegetable intake and frailty. Results: Mean meal frequency was 4.2 ± 0.9 meals per day; women seem to have a somewhat higher meal frequency than men (p=0.02); 57% of the participants had vegetables with at least one meal per day. No significant relationship was found between meal frequency or vegetable intake and frailty at 12 or 24 months follow-ups. Conclusions: Among this group of older adults (80+), meal frequency was slightly higher among women than men, and just over half of the participants had vegetables with at least one meal a day. The risk of developing frailty was not associated with meal frequency or vegetable intake. The questions in this study were meant as indicators for healthy food habits.

The potential to influence the design of one's local environment is especially important to older people since age-related problems, in combination with a less supportive environment, can prevent the performance of meaningful activities. It is unclear how best to tailor a participatory approach to support the task of collaborating with older persons about their local environment. Life filming was used in such a project.To describe Life filming as a means of participatory approach in relation to older community-dwelling persons and the design of their local environment.A descriptive single case study. Data were generated through field notes and memos, and analyzed utilizing thematic analysis. Participants have validated the findings.Five themes describe central aspects of Life filming in the given context: Anchoring the concept of participation, Practical application of Life filming, The film as a product, Making a real difference, and An identity as a capable older person.Life filming supported participation, both as a process and an outcome. It had benefits on multiple levels: for the individual person, for older persons as a group, and for the municipality. Life filming could constitute a useful digital tool for practice when a participatory approach is desired.

Exercising self-determination in daily life is highly valued by older people. However, being in the hands of other people may challenge the older people’s possibilities to exercise self-determination in their daily life. Among frail older people living in Sweden, risk for depression is highly predominant. There is a knowledge gap regarding if, and how having a risk of depression affects older people’s self-determination. The objective was, therefore, to explore if, and in that case how, frail older people’s self-determination is affected by the risk of depression. In this cross-sectional, secondary data analysis, with 161 communitydwelling frail older people, simple logistic regression models were performed to explore the association between self-determination, the risk of depression and demographic variables. The findings showed that risk for depression and reduced self-determination were significantly associated in the dimensions: use of time (P=0.020), social relationship (P=0.003), help and support others (P=0.033), and the overall self-determination item (P=0.000). Risk for depression significantly affected self-determination in use of time (OR=3.04, P=0.014), social relationship (OR=2.53, P=0.011), and overall self-determination (OR=6.17, P=0.000). This point out an increased need of strengthening healthcare professionals’ perspectives, and attitudes towards a self-determined, friendly, and person-centred dialogue.

This study is part of a project that aims to culturally adapt the Investigating Choice Experiments for the Preferences of Older People-CAPability Index (ICECAP-O) for use in research and health and social care in Sweden. The objective was to evaluate face and content validity and acceptability. Eighteen 70-year-old community-dwelling persons participated in cognitive interviews. A standardized classification scheme was used to quantify any identified response problems, and a thematic analysis was applied to capture participants’ perceptions of included attributes and experiences of completing the measure. The results show that three participants (18%) had problems completing ICECAP-O, and that judged problems occurred for five (6 %) of participants responses in the standardized classification scheme. Most participants perceived the attributes as understandable even though the meaning of Control brought some uncertainty. ICECAP-O seems to measure what it is supposed to measure, quality of life (QoL) with a capability approach, and acceptability is satisfactory. ICECAP-O has potential for becoming a valuable addition to the supply of QoL measures in research and health and social care in Sweden. However, we recommend further research on more diverse groups of older persons.

The aim was to evaluate the 6-month and 1-year effects of a person-centered group-based health-promoting intervention on independence in daily activities and self-rated health. The study was an RCT with follow-ups at 6 months and 1 year. A total of 131 independent living people (70+) who have migrated to Sweden from Finland or Western Balkan region were included. Participants were independent in activities of daily living and cognitively intact. They were randomized to an intervention group receiving four weekly group-meetings and a follow-up home visit, or a control group (no intervention). An overall chi-squared test was performed and the odds ratio calculated. A high proportion of the participants maintained independence in activities of daily living and improved or maintained self-rated health. However, no significant differences were found between the groups. The result indicates that the intervention was offered too early in the aging process to be able to detect effects. Methodological challenges were met during both the recruitment and implementation phases. In response to lessons learned, a multicenter design is recommended for future research in order to strengthen the findings. Furthermore, this study has contributed with experiences on both opportunities and challenges in terms of research with and about older people aging in the context of migration, as is discussed.

Rationale, aims and objectives Improving the possibilities for ageing persons to take control over their health is an increasingly important public health issue. Health promotion has previously been visualized to succeed with this goal, but research has primarily focused on ageing persons who are native-born, leaving the generalizability to persons who are foreign-born unexplored. Therefore, as part of the development of a larger health promotion initiative for ageing persons who have experienced migration, this study aimed to assess the feasibility of an adapted protocol. The specific feasibility objectives were to assess recruitment procedure, retention rates, study questionnaire administration and variability of collected data. Method Forty persons who were ≥70 years, and who had migrated from Finland, Bosnia and Herzegovina, Croatia, Montenegro or Serbia to Sweden were randomly allocated to a health promotion programme or a control group. The programme was linguistically adapted with regard to translated information material, bilingual health professionals and evaluators, and a person-centred approach was applied to both programme development and provision. The data analysis was explorative and descriptive. Results The results visualized structural and linguistic barriers to recruitment and study questionnaire administration, and describe strategies for how to bridge them. Retention rates and data variability were satisfying. Conclusions Calling for iterative and pragmatic programme design, the findings describe how to move towards a more inclusive health care environment. Person-centred and bilingual approaches with attention to the possibilities for building authentic relationships between participants and providers are emphasized, and a structured methodology for developing study questionnaires is suggested.

The objective was to investigate definitions of frailty used in studies of multi-component health promotion and disease-preventive (HPDP) intervention programmes for community-dwelling frail elderly persons and to review the content, organisation and effects of HPDP interventions. A systematic review of 19 articles was made, and the International Classification of Functioning, Disability and Health (ICF) was used as a structural framework for the analysis. The result shows that a consensus was reached on including various aspects of impairments in body functions and structures as an integral part of the frailty concept, with the exception of one subgroup: mental/cognitive functions. Additionally, opinions varied quite consistently regarding aspects of activity limitations and participation restrictions, personal and environmental factors. Ten of the 14 HPDP programmes covered various intervention elements referring to all four ICF components. Eleven programmes involved registered personnel only, while a more divergent pattern was seen in the remaining organisational aspects of the interventions: length of interventions and location plus age segments, participatory approach and contextual information, as well as the theoretical foundation of the interventions. Measures of body functions and structures were significantly improved in 5 out of 17 (29%) targeted aspects. For activity and participation, 12 out of 32 (38%) targeted aspects were positively changed, while the score for environmental factors was 7 out of 22 (32%), and for personal factors 8 out of 22 (36%). Our review suggests that further research is needed to explore and disentangle the complex interrelationships between various interventions and outcomes.

Investigating Choice Experiments for the Preferences of Older People-CAPability index (ICECAP-O) is one of few Quality of Life measures that tap into the concept of capability, i.e. genuine opportunities to ‘do’ and ‘be’ the things that a person deems important in life. This presentation includes test-retest reliability, item relevance, face- and content validity, and accessibility of the ICECAP-O in a Swedish context. Thirty-nine 70-year-olds completed the Swedish version of ICECAP-O on two occasions. Test-retest reliability was analyzed for the index and separate items, and participants rated item relevance on a Visual Analogue Scale. Eighteen additional persons filled in the ICECAP-O during cognitive interviews and a standardized classification scheme was used to quantify response problems. Thematic analysis was applied to capture participants’ experiences of completing the measure and perceptions of included attributes. Test-retest showed that the index score had good stability, ICC of 0.80 (95 % CI 0.62–0.90). However, Kappa values for the individuals items were low, ranging from 0.18 (Control) to 0.41 (Role). Participants gave their highest relevance rating to Attachment and the lowest to Enjoyment. In the cognitive interviews, three participants (18%) had problems completing ICECAP-O, and 5 of 80 question segments (6%) were found to be problematic. Most participants perceived the attributes as understandable even though the meaning of Control brought some uncertainty. Our findings suggest that the Swedish version of the ICECAP-O requires further refinement. Problems identified in our study point to areas requiring special attention by the developers of ICECAP-O versions working in other language contexts.

In Sweden, a joint action method called SMADIT is in use, where the police quickly offer help from the social services or the dependency care and treatment service to suspected drink drivers. The objective of this article is to analyze the experiences of suspected drink drivers who accepted the offer of help and what it meant for them. The knowledge can be used to improve procedures and consultations. Furthermore, it can allow the basic premises of the method to be examined; for example, the importance of offering help quickly.To enable comparisons over time, in-depth interviews were conducted with 12 suspected drink drivers on 2 occasions with 1 year between.To varying degrees the informants knew about their alcohol problems but were unsure whether they would have sought help by themselves. Therefore, the original ideas of the method with an initial contact with the social services or the dependency care and treatment service within 24 h was found to be important. However, the results also showed that some of the informants needed some time before the first meeting because they were in shock from the drink driving incident or in need of sleep. Therefore, the drink driver's situation and individual wishes always have to be considered. The article also shows that an encouraging attitude among the police, the social services, and the dependency care and treatment service is important for the success of the SMADIT method. The informants are satisfied with the method and in retrospect the incident and the SMADIT offer of help are described as a turning point in their lives. One year after being offered help the informants were no longer focused solely on the personal consequences of drink driving, as they were shortly after the incident. Instead, they had gained insights into the harm they could have done to other road users when they drove while drunk.One conclusion from this article is that SMADIT, as an innovative method that can be deployed more rapidly than other alcohol-impaired driving countermeasures, should be considered as a good complement to conventional methods to deal with drink driving. Based on the results, we recommend a trial of the joint action method against drink driving in other jurisdictions.

Nutrient removal from the effluent of an anaerobic moving bed biofilm reactor (AnMBBR) treated with microalgae was evaluated. Algal treatment was highly efficient in removal of nutrients and discharge limits were met after 3days. Extending the cultivation time from 3 to 5days resulted in a large increase in biomass, from 233.3±49.3 to 530.0±72.1mgL(-1), despite nutrients in the water being exhausted after 3days (ammonium 0.04mgL(-1), orthophosphate

Although the need to make health services more accessible to persons who have migrated has been identified, knowledge about health-promotion programs (HPPs) from the perspective of older persons born abroad is lacking. This study explores the design experiences and content implemented in an adapted version of a group-based HPP developed in a researcher–community partnership. Fourteen persons aged 70–83 years or older who had migrated to Sweden from Finland or the Balkan Peninsula were included. A grounded theory approach guided the data collection and analysis. The findings showed how participants and personnel jointly helped raise awareness. The participants experienced three key processes that could open doors to awareness: enabling community, providing opportunities to understand and be understood, and confirming human values and abilities. Depending on how the HPP content and design are being shaped by the group, the key processes could both inhibit or encourage opening doors to awareness. Therefore, this study provides key insights into how to enable health by deepening the understanding of how the exchange of health-promoting messages is experienced to be facilitated or hindered. This study adds to the scientific knowledge base of how the design and content of HPP may support and recognize the capabilities of persons aging in the context of migration.Key words: Immigrant, emigrant, occupation, group intervention, person-centeredness, grounded theory, health-promoting messages (Published: 8 December 2015)Citation: Int J Qualitative Stud Health Well-being 2015, 10: 29013 - http://dx.doi.org/10.3402/qhw.v10.29013

Very old persons (80+) are often described as "frail", implying that they are particularly vulnerable to adverse health outcomes. Elderly Persons in the Risk Zone was designed to determine whether a preventive home visit or multiprofessional senior group meetings could postpone deterioration in frailty if the intervention is carried out when the person is not so frail.The study was a RCT with follow-ups at 1 and 2 years. A total of 459 persons (80+), still living at home, were included. Participants were independent in activities of daily life and cognitively intact.Frailty was measured in two complementary ways, with the sum of eight frailty indicators and with the Mob-T Scale measuring tiredness in daily activities.Both interventions showed favorable effects in postponing the progression of frailty measured as tiredness in daily activities for up to 1 year. However, neither of the two interventions was effective in postponing frailty measured with the sum of frailty indicators.The results in this study show the potential of health promotion to older persons. The multiprofessional approach, including a broad spectrum of information and knowledge, might have been an important factor contributing to a more positive view of aging.

Improving the possibilities for ageing persons to take control over their health is an increasingly important public health issue. Health promotion has previously been visualized to succeed with this goal, but research has primarily focused on ageing persons who are native-born, leaving the generalizability to persons who are foreign-born unexplored. Therefore, as part of the development of a larger health promotion initiative for ageing persons who have experienced migration, this study aimed to assess the feasibility of an adapted protocol. The specific feasibility objectives were to assess recruitment procedure, retention rates, study questionnaire administration and variability of collected data.Forty persons who were ≥70 years, and who had migrated from Finland, Bosnia and Herzegovina, Croatia, Montenegro or Serbia to Sweden were randomly allocated to a health promotion programme or a control group. The programme was linguistically adapted with regard to translated information material, bilingual health professionals and evaluators, and a person-centred approach was applied to both programme development and provision. The data analysis was explorative and descriptive.The results visualized structural and linguistic barriers to recruitment and study questionnaire administration, and describe strategies for how to bridge them. Retention rates and data variability were satisfying.Calling for iterative and pragmatic programme design, the findings describe how to move towards a more inclusive health care environment. Person-centred and bilingual approaches with attention to the possibilities for building authentic relationships between participants and providers are emphasized, and a structured methodology for developing study questionnaires is suggested.