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  • 1.
    Galavazi, Marije
    et al.
    Örebro University, School of Medical Sciences.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Jendle, Johan
    Örebro University, School of Medical Sciences.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Long-term effects of low energy diet combined with CBT-based group treatment of patients with obesity on weight, quality of life and eating behaviour: a 2-year intervention study2018Conference paper (Other academic)
  • 2.
    Järvholm, Kajsa
    et al.
    Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden; Department of Psychology, Lund University, Lund, Sweden; Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Olbers, Torsten
    Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Peltonen, Markku
    National Institute for Health and Welfare, Helsinki, Finland.
    Marcus, Claude
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Dahlgren, Jovanna
    Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Flodmark, Carl-Erik
    Department of Pediatrics, Skåne University Hospital, Malmö, Sweden.
    Henfridsson, Pia
    Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Gronowitz, Eva
    Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Binge eating and other eating-related problems in adolescents undergoing gastric bypass: results from a Swedish nationwide study (AMOS)2018In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 127, p. 349-355Article in journal (Refereed)
    Abstract [en]

    Bariatric surgery is established as a treatment option for adolescents with severe obesity. Little is known about binge eating (BE) and other eating-related problems in adolescents undergoing bariatric surgery. BE, emotional eating, uncontrolled eating, and cognitive restraint were assessed at baseline, and one and two years after gastric bypass using questionnaires in 82 adolescents (mean age 16.9 years, 67% girls). BE was assessed with the Binge Eating Scale (BES) and other eating-related problems with the Three Factor Eating Questionnaire. Change in eating-related problems over time, along with the relationship between eating behaviors and other aspects of mental health and weight outcome, were analyzed. At baseline, 37% of the adolescents reported BE (defined as a BES score >17). Two years after gastric bypass, adolescents reported less problems related to BE, emotional eating, and uncontrolled eating. Improvements were moderate to large. Adolescents reporting BE at baseline, also reported more general mental health and psychosocial weight-related problems before and/or two years after surgery, compared to adolescents with no BE. After surgery adolescents with BE before surgery reported more suicidal ideation than those with no BE at baseline. None of the eating-related problems assessed at baseline was associated with weight outcome after surgery. More binge eating, emotional eating, and uncontrolled eating two years after surgery were associated with less weight loss. In conclusion, eating-related problems were substantially reduced in adolescents after undergoing gastric bypass. However, pre-operative BE seem to be associated with general mental health problems before and two years after surgery, including suicidal ideation. Pre-operative eating-related problems did not affect weight outcome and our results support existing guidance that BE should not be considered an exclusion criterion for bariatric surgery in adolescents.

  • 3.
    Ohlsson Nevo, Emma
    et al.
    Örebro University, School of Health Sciences. School of Health Sciences, Department of Surgery, Örebro University Örebro, Örebro, Sweden; Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Impact of health-related stigma on psychosocial functioning in the general population: Construct validity and Swedish reference data for the Stigma-related Social Problems scale (SSP)2019In: Research in Nursing & Health, ISSN 0160-6891, E-ISSN 1098-240X, Vol. 42, no 1, p. 72-81Article in journal (Refereed)
    Abstract [en]

    Felt stigma is an internalized sense of shame about having an unwanted condition, along with fear of discrimination. The Stigma-related Social Problems (SSP) scale was constructed to measure the impact of health-related stigma on psychosocial functioning in people with different diseases and disorders. The performance of the SSP scale was tested in 3,422 subjects from the general population (Mid-Swed Health Survey) and in subgroups according to gender, age, occupation, and education. The homogeneity and construct validity of the Distress and Avoidance scales were confirmed by exploratory factor analysis and the two factors were accurately reproduced across gender and age subgroups. The internal consistency reliability was high for both the Distress and Avoidance scales. Reliability coefficients were above the 0.90 standard for the Distress scale in all subgroups and for the Avoidance scale in most subgroups. The SSP scale is an instrument with sound psychometric properties that can be used to identify psychosocial disturbances.

  • 4.
    Ohlsson Nevo, Emma
    et al.
    Örebro University, School of Health Sciences.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Impact of health-related stigma on psychosocial functioning in the general population: construct validity of the Stigma-related Social Problems scale2018Conference paper (Refereed)
    Abstract [en]

    Background: Felt stigma is an internalized sense of shame about having an unwanted condition along with fear of discrimination due to imputed inferiority or unacceptability. Various illnesses and symptoms of disease are associated with health-related stigma and individuals may experience stigma that strongly affects their quality of life. The Stigmarelated Social Problems scale (SSP) was developed for measuring the impact of health-related stigma on social functioning in people with different diseases and disorders.

    Objective: The aim of the study was to evaluate the validity of SSP in the general Swedish population.

    Method: In 2015, SSP was sent to a random population sample (n=8140). Tests of the internal consistency reliability of scale scores (Cronbach’s alpha), the unidimensionality and homogeneity of scales (factor analysis), item-scale convergent validity, ceiling and floor effects, and known group analysis were conducted.

    Results: The response rate was 42%. Reliability coefficients were high (< 0.93) for both scales. Factor analyses confirmed the unidimensionality. Item-scale correlations for both scales indicated satisfactory item-scale convergent validity (r ≥ 0.40). The proportion of subjects scoring at the lowest possible score level (floor effect) was 25% for the Distress scale and 28% for the Avoidance scale, while ceiling effects were marginal (<1%). The proportion of missing items was generally low, ranging from 0.8-1.5%.

  • 5.
    Samano, Ninos
    et al.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Geijer, Håkan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Arbeus, Mikael
    Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Souza, Domingos
    Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Graft patency is associated with higher health-related quality of life after coronary artery bypass surgery2016In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 24, no 3, p. 388-394Article in journal (Refereed)
    Abstract [en]

    Objectives: The objective of this study was to investigate whether graft patency was associated with higher health-related quality of life in coronary artery bypass grafting patients and to compare this study with the general Swedish population.

    Methods: Patients were included from 3 randomized trials and 1 prospective cohort trial. The generic health-related quality of life instrument, EQ-5D (VAS and index) was used. Graft patency was assessed with computed tomography angiography. Patients were divided into 2 groups according to the number of occluded distal anastomosis: Group I with no to 1 occlusion (n = 209) and Group II with 2 to 4 occlusions (n = 24).

    Results: Two hundred and thirty-three patients underwent computed tomography angiography at a mean of 7.5 (1-18) years post-operatively. The mean difference in EQ-VAS and EQ-5D index between Groups II and I after model adjustment was -19.8 (95% CI -25.3 to -14.3; P < 0.001) and -0.13 (95% CI -0.19 to -0.08; P < 0.001), respectively. The EQ-5D index for the study population was similar compared with the Swedish population, 0.851 and 0.832, respectively, with an effect-size of 0.112 (trivial). The EQ-5D index of the study population was higher compared with the ischemic heart disease group in the Swedish population, 0.851 vs 0.60, with an effect-size of 0.999 (large).

    Conclusion: Graft patency was associated with higher health-related quality of life in coronary artery bypass patients. This patient group reported similar function and wellbeing compared to the general Swedish population and better health status than those in the same disease group in the general population.

    Clinical registration number: Clinicaltrials.gov: NCT02547194 and the Research and Development registry in Sweden: 167861.

  • 6.
    Skogsdal, Yvonne Rosalie Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Tydén, Tanja
    Department of Women's and Children's Health, Akademiska Sjukhuset, Uppsala, Sweden.
    An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 3, p. 203-212Article in journal (Refereed)
    Abstract [en]

    Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC.

    Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health.

    Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling.

    Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.

  • 7.
    Strömbom, Ylva
    et al.
    Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Fredrikson, Mats
    Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Melin, Lennart
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Magnusson, Peter
    Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden; Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Cognitive behavioral therapy for frequent attenders in primary care2018In: Health science reports, ISSN 2398-8835, Vol. 1, no 9, article id e80Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study is to investigate if cognitive behavioral therapy given in a group setting affects anxiety and depression, stress, pain, coping strategies during daily life, and health-related quality of life (HRQoL), among frequent attenders (FAs) in primary care.

    Methods: Cognitive behavioral therapy was offered to 331 FAs between 18 and 65 years of age, of whom 89 accepted and 54 completed all steps in the protocol; patients were assigned to 1 of 3 groups: 0, 6, and 12-month waiting time. The therapy consisted of 12 sessions administered in group format. Outcome measures were Beck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Everyday Life Stress (ELS), Coping Strategy Questionnaire, Multidimensional Pain Inventory-Swedish version, and Short Form-36.

    Results: Mean age among patients who completed cognitive behavioral therapy was 49.9 years, with a female majority (79.6%). Anxiety and depression scores were reduced after treatment (BAI 16.7 vs 13.6; BDI 16.3 vs 15.7; HADS-Anxiety 8.41 vs 6.05; HADS-Depression 7.09 vs 5.69). Because waiting time itself did not affect symptoms, differences reflect treatment effects. Stress ratings were not affected by treatment. Use of nonadaptive coping strategies like praying and hoping and catastrophizing decreased. Frequent attenders experienced a higher sense of life control. Frequent attenders reported significantly lower HRQoL than general Swedish population norms in all 8 Short Form-36 domains including mental and physical component summary scores (MCS and PCS), and all domains were unaffected by treatment.

    Conclusion: Cognitive behavioral therapy exerts some beneficial effects in FAs. Content of treatment addressed musculoskeletal pain, stress, anxiety, and depression. This broad approach resulted in reduced anxiety, depression, and impact of pain because of enhanced life control.

  • 8.
    Strömbom, Ylva
    et al.
    Centre for Research and Development, Region Gävleborg, Gävle, Sweden; Department of Psychology, Uppsala Universitet, Uppsala, Sweden.
    Magnusson, Peter
    Centre for Research and Development, Region Gävleborg, Gävle, Sweden; Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Fredrikson, Mats
    Department of Psychology, Uppsala Universitet, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Health-related quality of life among frequent attenders in Swedish primary care: a cross-sectional observational study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e026855Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim was to examine health-related quality of life (HRQoL), patient characteristics and reasons for visits to general practitioners (GPs) by frequent attenders (FAs) and a comparison group (CG) in primary care.

    METHODS: Patients aged 18-64 years were eligible for the study. Medical records were scrutinised concerning reasons for visits. Questionnaires including short-form health survey (SF-36) were mailed to 331 FAs (≥5 visits at GPs during 2000) and 371 patients in a CG randomly selected from two healthcare centres and returned by 49% and 57%, respectively. FAs' SF-36 health profiles were compared both to CG and general Swedish population norms.

    RESULTS: FAs report lower HRQoL than CG and below the general Swedish population norms in all eight SF-36 domains including both mental and physical component summary scores (MCS and PCS). Effect sizes (ESs) for differences between FAs and norms ranged from 0.79 to 1.08 for specific domains and was 0.94 for PCS and 0.71 for MCS. ESs of FAs versus CG ranged between 0.60 and 0.95 for the domains and was 0.76 for PCS and 0.49 for MCS. There were no significant differences between the FAs and CG with regard to sex, being married or cohabiting, number of children in household or educational level. FAs were more often unemployed, obese, slightly older and used complementary medicine more frequently. Except for injuries, all health complaints as classified in 10 categories were more common among FAs than CG, particularly musculoskeletal pain and psychosocial distress related to compromised HRQoL.

    CONCLUSION: The HRQoL is compromised in FAs, both when compared with patients who do not often seek care and to general Swedish population norms. Commonly reported reasons for visiting GPs among FAs were musculoskeletal pain and psychosocial distress. Thus, perceived ill health, particularly pain and distress, seems important for high utilisation of healthcare resources.

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