Birthe Stenbæk Hansen

Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge: a randomized controlled trial

Objective: To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients’ home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality. Design: Twelve-week single-blind randomized controlled study. Setting and subjects: Geriatric medical patients (65+ years) at nutritional risk. Interventions: Participants were randomly allocated to receive a visit in their homes, either three individualized nutritional counselling by a registered dietitian complemented with three follow-up visits by general practitioners or three follow-up visits by general practitioners alone. Main measures: Primary outcome was risk of re-admissions. Secondary outcomes were functional status (hand grip strength, chair stand, mobility, disability and tiredness in daily activities, rehabilitation capacity), nutritional status (weight, BMI, energy and protein intake), need of social services (home care, home nursing, meals-on-wheels) and mortality. Results: One hundred and fifty-two patients were included; 132 (87%) completed the first and 124 (82%) the second data collection after 12 weeks. Ten per cent of the participants had three contacts with their general practitioner, while compliance with the dietetic intervention was almost 100%. Odds ratio for re-admission and mortality after 26 weeks was 1.62 (95% confidence interval (CI) 0.85 to 3.10) and 0.60 (95% CI 0.17 to 2.13). The intervention had a positive effect on functional status (i.e. mobility, P = 0.029), and nutritional status (i.e. weight, P = 0.035; energy intake, P < 0.001; protein intake, P = 0.001) and the use of meals-on wheels was reduced (P = 0.084). Conclusion: Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge.

Multidisciplinary nutritional support for undernutrition in nursing home and home-care: A cluster randomized controlled trial.

OBJECTIVE To assess the effect of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care identified with the validated Eating Validation Scheme (EVS). METHODS An 11 wk cluster randomized trial with a home-care (3 clusters) or nursing home (3 clusters) setting as the unit of randomization. Before starting the study, a train-the-trainer course was performed to educate the nutrition coordinators. In addition to the nutrition coordinator, the participants assigned to the intervention group strategy received multidisciplinary nutrition support. Focus was on treatment of the potentially modifiable nutritional risk factors identified with the EVS, by involving the physiotherapist, registered dietitian, and occupational therapist, as relevant and independent of the municipalitys ordinary assessment and referral system. Outcome parameters were quality of life (by means of EuroQol-5D-3L), physical performance (30-seconds chair stand), nutritional status (weight and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (participants from home-care), and mortality. RESULTS Respectively, 55 (46 from 2 home-care clusters) and 40 (18 from 1 home-care cluster) were identified with the EVS and comprised the intervention and control group. A difference after 11 wk in quality of life (0.758 [0.222] versus 0.534 [0.355], P = 0.001), 30-seconds chair stand (47% versus 17% improved, P = 0.005) and oral care (1.1 [0.3] versus 1.3 [0.5], P = 0.021) was observed. There was a almost significant difference in mortality (2% versus 13%, P = 0.079). CONCLUSIONS Multidisciplinary nutritional support in older adults in nursing home and home-care could have a positive effect on quality of life, muscle strength, and oral care.

Globalization and European State Formation 1900-2000

The article deals with the impact that the globalization process has had on European state formation in the period 1900-2000. Hypotheses are derived from the emerging schools of globalization: the hyperglobalists, the transformationalists and the sceptics. Is state formation hindered or stimulated by level of economic globalization? Indeed, does economic globalization have any effect at all? It is found that the still growing number of European states were formed in clusters following systemic change, that the probability of state formation increased in the case of candidates situated in zones of defeat, that nationalism did not play a decisive role, and that there was no connection between fluctuations in the globalization process and state formation. The hyperglobalist hypothesis is thus rejected, little support is found for the transformationalist hypothesis, but the sceptic hypothesis matches the findings. In addition, the article offers an explanation for the residual patterns found.

Europe in the American world order: balancing or socialization?

The transatlantic relationship has always been characterized by a combination of cooperation and competition. After the end of the Cold War and the terrorist attacks on New York and Washington on 11 September 2001, this dual nature of the transatlantic relationship has continued. Europeans and Americans have successfully maintained and even strengthened the cooperative aspects of their relationship on some issues. Yet, at the same time, competition, disagreement and even crisis have characterized the transatlantic relationship on other issues. This section seeks to make sense of the current relationship between Europe andAmerica by exploring European policies and strategies in the American world order in political economy and security affairs. On the one hand, Europeans use diplomacy and institutions to balance the dominant power in security affairs and political economy. On the other hand, Europe after the Cold War seems to defy expectations from traditional balance of power theory as Europeans have been socialized to many aspects of the American world order. Europeans have worked closely with the Americans to reform and enlarge the North Atlantic Treaty Organization (NATO), and the European Security Strategy expresses many of the same goals and visions as the American National Security Strategy. European states have cooperated with the United States on military action in Afghanistan and former Yugoslavia, but Iraq caused a serious split across the Atlantic and between the European states. The authors of this section discuss these issues by exploring European balancing and bandwagoning in the American world order, the security policies of small European states and globalization discourses in Europe, thereby providing new empirical findings and theoretical insights on Europe in the American world order.