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  • 1.
    Bergh, Anne-Louise
    et al.
    School of Health Sciences, University of Borås, Borås, Sweden.
    Johansson, Inger
    Department of Nursing, University College Gjøvik, Gjøvik, Norway; Department of Nursing, University of Karlstad, Karlstad, Sweden.
    Persson, Eva
    School of Health Sciences, University of Borås, Borås, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Friberg, Febe
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Health Studies, University of Stavanger, Stavanger, Norway.
    Nurses' Patient Education Questionnaire - development and validation process2015In: Journal of Research in Nursing, ISSN 1744-9871, E-ISSN 1744-988X, Vol. 20, no 3, p. 181-200Article in journal (Refereed)
    Abstract [en]

    Conditions for nurses' daily patient education work are unclear and require clarification. The aim was to develop and validate the Nurses' Patient Education Questionnaire, a questionnaire that assesses nurses' perceptions of appropriate conditions for patient education work: what nurses say they actually do and what they think about what they do. The questionnaire was developed from a literature review, resulting in the development of five domains. This was followed by 'cognitive interviewing' with 14 nurses and dialogue with 5 pedagogical experts. The five domains were identified as significant for assessing nurses' beliefs and knowledge; education environment; health care organisation; interdisciplinary cooperation and collegial teamwork; and patient education activities. A content validity index was used for agreement of relevance and consensus of items by nurses (n = 10). The total number of items in the final questionnaire is 60, consisting of demographic items, what nurses report they do and perceptions about patient education in daily work. The questionnaire can be used by managers and nurses to identify possibilities and barriers to patient education in different care contexts.

  • 2.
    Bergh, Anne-Louise
    et al.
    Sch Hlth Sci, Univ Borås, Borås, Sweden.
    Persson, Eva
    Sch Hlth Sci, Univ Borås, Borås, Sweden; Dept Hlth Sci, Fac Med, Lund Univ, Lund, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Inst Hlth & Care Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Friberg, Febe
    Dept Hlth Studies, Fac Social Sci, Univ Stavanger, Stavanger, Norway.
    Registered nurses' perceptions of conditions for patient education - focusing on aspects of competence2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 523-536Article in journal (Refereed)
    Abstract [en]

    Background: It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. Aim: The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. Methods: The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. Results: Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. Conclusions: Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital.

  • 3.
    Berghammer, Malin
    et al.
    Inst Hlth & Care Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Inst Hlth & Care Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Ekman, Inger
    Inst Hlth & Care Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Ctr Person Ctr Care, Univ Gothenburg, Gothenburg, Sweden.
    Eriksson, Peter
    Inst Med, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Dellborg, Mikael
    Inst Med, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Self-reported health status (EQ-5D) in adults with congenital heart disease2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 165, no 3, p. 537-543Article in journal (Refereed)
    Abstract [en]

    Purpose: Today, more patients with congenital heart disease (CHD) reach adulthood. There are conflicting findings concerning the relationship between quality of life (QoL) or health state for adults with CHD and the complexity of their CHD. The aim of the study was, firstly, to compare the reported health status and health perception of adult patients with CHD and, secondly, to investigate what variables influenced the patients' health status and health perception. Methods: Data from 1435 patients completing the EQ-5D questionnaire, which includes reported health status and health perception, were analyzed. Results: Valid EQ-5D data were reported by 1274 patients, showing overall results indicating a good health status. Problems were most frequently reported in the dimension "pain/discomfort" (31.9%) and "anxiety/depression" (29.8%). Higher occurrence of problems were reported by patients with complex disease i.e. single ventricle (p<0.001) and by female patients (p<0.0001). Symptomatic patients reported a lower health status (p<0.0001) and a lower perceived health on EQ-VAS (p<0.0001). Of the asymptomatic patients, 20.5% nevertheless reported problems in "pain/discomfort" and 22.2% in the "anxiety/depression" dimension. Conclusion: The health status of adults with CHD is influenced by symptoms, NYHA-classification, age and gender. Adults with CHD report a lower occurrence of problems in comparison to previously published results from a general population, but the importance of actively asking about the patient's experience is demonstrated by the high degree of asymptomatic patients reporting problems on EQ-5D. (c) 2011 Elsevier Ireland Ltd. All rights reserved.

  • 4.
    Dahlin Redfors, Ylva
    et al.
    Department of Otorhinolaryngology Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Science, Sahl grenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Olaison, Sara
    Audiological Research Center, Örebro University Hospital, Örebro, Sweden; School of Medicine and Health Science, Örebro University, Örebro, Sweden; Swedish Institute of Disability Research, Örebro University, Örebro, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Centre for Health Care Sciences Örebro University Hospital, Örebro, Sweden; School of Medicine and Health Science, Örebro University, Örebro, Sweden .
    Hellgren, Johan
    Department of Otorhinolaryngology Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Audiological Research Center, Region Örebro County, Örebro, Sweden.
    Hearing-related, health-related quality of life in patients who have undergone otosclerosis surgery: a long-term follow-up study2015In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 54, no 2, p. 63-69Article in journal (Refereed)
    Abstract [en]

    Objectives: The aims of the study were to assess health-related quality of life and hearing-related disability in subjects with otosclerosis 30 years after surgery.

    Design: An observational study was performed. Medical records were reviewed, a clinical examination as well as audiometric assessments were performed. Generic health-related quality of life was assessed by the SF-36v2 and hearing disability by a shortened version of SSQ (speech spatial and qualities of hearing scale).

    Study sample: Sixty-fi ve individuals, who had undergone stapedectomy in 1977-79 at a tertiary referral center.

    Results: Generic health-related quality of life according to SF-36 subscale scores was comparable to that of an age- and sex-matched reference population. The SF-36 mental component summary score (MCS) was, however, significantly better than that of the reference population. The mental and physical summary component scores correlated significantly to hearing disability measured by the SSQ but not to hearing impairment. Hearing disability was displayed in all SSQ sub-scores, especially in more complex listening situations and in the localization of sounds.

    Conclusions: This study shows that individuals with otosclerosis, 30 years after surgery, have a good generic health-related quality of life, despite moderate to severe hearing loss and significant hearing disabilities.

  • 5.
    Engström, My
    et al.
    Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden .
    Forsberg, Anna
    Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Department of thoracic transplantation, Skåne University Hospital, Lund, Sweden.
    Søvik, Torgeir T.
    Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway .
    Olbers, Torsten
    Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden .
    Lönroth, Hans
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden .
    Karlsson, Jan
    Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden .
    Perception of Control Over Eating After Bariatric Surgery for Super-Obesity-a 2-Year Follow-Up Study2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 6, p. 1086-1093Article in journal (Refereed)
    Abstract [en]

    Physiological and psychosocial factors might contribute to differences in weight loss, eating behaviour and health-related quality of life (HRQoL) after bariatric surgery. The aim of this study was to investigate how perceived control over eating changes after bariatric surgery and whether it affects outcome in super-obese patients.

    In a retrospective analysis of a prospective study (n = 60), 49 patients were divided into two groups based on eating control 2 years after surgery, as assessed by the Three-Factor Eating Questionnaire-R21 (TFEQ-R21): 29 with good eating control (GC) and 20 patients with poor eating control (group PC). Eating behaviour and generic and condition-specific HRQoL was assessed by questionnaires.

    There were significant differences in all TFEQ-R21 domains 2 years after surgery in favour of group GC; uncontrolled eating p < 0.001, emotional eating p < 0.001 and for cognitive restraint p = 0.04. The improvement in HRQoL 2 years after surgery was significantly less in group PC compared to group GC in 7 of 8 SF-36 domains (p < 0.05). Mean (SD) percentage of excess body mass index lost was similar between groups, 71.2 (17.8) in group GC versus 65.4 (17.4) in group PC 2 years after surgery (p = 0.27). However, group GC had a significant weight loss between first and second year after surgery (p < 0.001) compared to group PC (p = 0.15). In super-obese patients, perceived poor control over eating 2 years after bariatric surgery was associated with lower HRQoL and more emotional and cognitive restraint eating, than good control overeating.

  • 6.
    Franzén, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Karlsson, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Validation of the Swedish version of the incontinence impact questionnaire and the urogenital distress inventory2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 5, p. 555-561Article in journal (Refereed)
    Abstract [en]

    Objective. To validate the Swedish versions of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6). Design and setting. Prospective study, university hospital. Population and method. We analyzed reliability, validity, and responsiveness in a clinical sample of 96 women with urinary incontinence. Main outcome measures. Construct and criterion validity, reliability via test-retest and internal consistency. Responsiveness via calculation of effect size. Result. Test-retest reliability ranged from moderate to almost perfect. Cronbach's alpha was 0.39 (UDI-6) and 0.83 (IIQ-7). Effect size calculation of change after treatment demonstrated good responsiveness. The effect size at six months was moderate in the Stress Urinary Incontinence group and small in the Urge Urinary Incontinence + Mixed Urinary Incontinence group. There was a moderate to strong correlation between UDI-6 and IIQ-7 and treatment satisfaction at six, 12, and 24 months for both groups. Conclusion. The UDI-6 scale did not produce the same solid result in the psychometric analysis as the IIQ-7 scale, but these newly translated Swedish forms of UDI-6 and IIQ-7 show good responsiveness and are easy to administer and to fill out.

  • 7.
    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)
  • 8. Hua, Håkan
    et al.
    Karlsson, Jan
    Örebro University Hospital.
    Widén, Stephen
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Lyxell, Björn
    Quality of life, effort and disturbance perceived in noise: a comparison between employees with aided hearing impairment and normal hearing2013In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 52, no 9, p. 642-649Article in journal (Refereed)
    Abstract [en]

    Objectives: The aims were to compare health-related quality of life (HRQOL) and hearing handicap between two groups of employees with normal hearing and aided hearing impairment (HI). HRQOL was also compared to a normative population. The second aim was to compare perceived effort (PE) and disturbance after completing a task in office noise between the two study groups. Design: A Swedish version of the short form-36 (SF-36) and the hearing handicap inventory for adults (HHIA) was used to determine HRQOL and hearing handicap. The Borg-CR 10 scale was used to measure PE and disturbance. Study sample: Hearing impaired (n = 20) and normally hearing (n = 20) participants. The normative sample comprised of 597 matched respondents. Results: Hearing-impaired employees report relatively good HRQOL in relation to the normative population, but significantly lower physical functioning and higher PE than their normally-hearing peers in noise. Results from the HHIA showed mild self-perceived hearing handicap. Conclusions: The current results demonstrate that physical health status can be negatively affected even at a mild-moderate severity of HI, and that a higher PE is reported from this group when performing a task in noise, despite the regular use of hearing aids.

  • 9.
    Jarvholm, Kajsa
    et al.
    Childhood Obes Unit, Skåne Univ Hosp, Malmö, Sweden; Dept Psychol, Lund Univ, Lund, Sweden.
    Karlsson, Jan
    Fac Med & Hlth, Ctr Hlth Care Sci, Univ Örebro, Örebro, Sweden.
    Olbers, Torsten
    Dept Surg, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Peltonen, Markku
    Natl Inst Hlth & Welf, Helsinki, Finland.
    Marcus, Claude
    Dept Clin Sci Intervent & Technol, Karolinska Inst, Stockholm, Sweden.
    Dahlgren, Jovanna
    Dept Pediat, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Gronowitz, Eva
    Dept Pediat, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Johnsson, Per
    Dept Psychol, Lund Univ, Lund, Sweden.
    Flodmark, Carl-Erik
    Childhood Obes Unit, Skåne Univ Hosp, Malmö, Sweden.
    Two-year trends in psychological outcomes after gastric bypass in adolescents with severe obesity2015In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 23, no 10, p. 1966-1972Article in journal (Refereed)
    Abstract [en]

    ObjectiveThis study aimed to evaluate changes in mental health over 2 years in adolescents undergoing gastric bypass. MethodsEighty-eight adolescents (65% girls) aged 13 to 18 years were assessed at baseline and 1 and 2 years after surgery. Generic and obesity-specific questionnaires were used to evaluate outcomes in mental health, also in relation to age- and gender-specific norms. ResultsSymptoms of anxiety (P=0.001), depression (P=0.001), anger (P=0.001), and disruptive behavior (P=0.022) were significantly reduced at 2 years after surgery, as were obesity-related problems (P<0.001). Self-esteem (P<0.001), self-concept (P<0.001), and overall mood (P=0.025) improved significantly. Improvements were mainly observed during the first year after surgery. The second year was characterized by stabilization. Symptoms of anxiety, depression, anger, disruptive behavior, and self-concept were at normative levels after surgery. However, 19% of the adolescents had depressive symptoms in the clinical range. ConclusionsA substantial improvement in mental health in adolescents over the first 2 years after gastric bypass was found. Most adolescents had a level of mental health and self-concept similar to norms, but a marked subgroup showed substantial depressive symptoms 2 years after surgery.

  • 10.
    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.

  • 11.
    Konttinen, Hanna
    et al.
    Department of Social Research, University of Helsinki, Helsinki, Finland .
    Peltonen, Markku
    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland .
    Sjöström, Lars
    Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .
    Carlsson, Lena
    Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .
    Karlsson, Jan
    Örebro University Hospital. Center for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Department of Medical Sciences, Örebro University, Örebro, Sweden.
    Psychological aspects of eating behavior as predictors of 10-y weight changes after surgical and conventional treatment of severe obesity: results from the Swedish Obese Subjects intervention study2015In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 101, no 1, p. 16-24Article in journal (Refereed)
    Abstract [en]

    Background: There is a need for a better understanding of the factors that influence long-term weight outcomes after bariatric surgery.

    Objective: We examined whether pretreatment and posttreatment levels of cognitive restraint, disinhibition, and hunger and 1-y changes in these eating behaviors predict short- and long-term weight changes after surgical and conventional treatments of severe obesity.

    Design: Participants were from an ongoing, matched (nonrandomized) prospective intervention trial of the Swedish Obese Subjects (SOS) study. The current analyses included 2010 obese subjects who underwent bariatric surgery and 1916 contemporaneously matched obese controls who received conventional treatment. Physical measurements (e.g., weight and height) and questionnaires (e.g., Three-Factor Eating Questionnaire) were completed before the intervention and 0.5, 1, 2, 3, 4, 6, 8, and 10 y after the start of the treatment. Structural equation modeling was used as the main analytic strategy.

    Results: The surgery group lost more weight and reported greater decreases in disinhibition and hunger at 1- and 10-y follow-ups (all P < 0.001 in both sexes) than the control group did. Pretreatment eating behaviors were unrelated to subsequent weight changes in surgically treated patients. However, patients who had lower levels of 6-mo and 1-y disinhibition and hunger (beta = 0.13-0.29, P < 0.01 in men; beta = 0.11-0.28, P < 0.001 in women) and experienced larger 1-y decreases in these behaviors (beta = 0.31-0.48, P < 0.001 in men; beta = 0.24-0.51, P < 0.001 in women) lost more weight 2, 6, and 10 y after surgery. In control patients, larger 1-y increases in cognitive restraint predicted a greater 2-y weight loss in both sexes.

    Conclusion: A higher tendency to eat in response to various internal and external cues shortly after surgery predicted less-successful short- and long-term weight outcomes, making postoperative susceptibility for uncontrolled eating an important indicator of targeted interventions.

  • 12.
    Laurenius, Anna
    et al.
    Dept Gastrosurg Res & Educ, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Olbers, Torsten
    Dept Gastrosurg Res & Educ, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Näslund, Ingmar
    Örebro University Hospital. Dept Upper Gastrosurg Res.
    Karlsson, Jan
    Örebro University Hospital. Inst Hlth & Care Sci, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Ctr Hlth Care Sci, Örebro University Hospital, Örebro, Sweden.
    Dumping Syndrome Following Gastric Bypass: Validation of the Dumping Symptom Rating Scale2013In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 23, no 6, p. 740-755Article in journal (Refereed)
    Abstract [en]

    There is a lack of prevalent data for dumping syndrome (DS) and methods discriminating between different symptoms of the DS. A self-assessment questionnaire, the Dumping Symptom Rating Scale (DSRS), was developed. The aim was to measure the severity and frequency of nine dumping symptoms and to evaluate the construct validity of the DSRS. Pre- and 1 and 2 years after Roux-en-Y gastric bypass surgery, 47 adults and 82 adolescents completed the DSRS. Cognitive interview was performed. Reliability and construct validity were tested. Effect sizes (ES) of changes were calculated. Patients found the questionnaire relevant. A high proportion of the respondents reported no symptoms affecting them negatively at all (floor effects). However, 12 % stated, quite severe, severe, or very severe problems regarding fatigue after meal and half of them were so tired that they needed to lie down. Nearly 7 % reported quite severe, severe, or very severe problems dominated by nausea and 6 % dominated by fainting esteem. The internal consistency reliability was adequate for both severity (0.81-0.86) and frequency (0.76-0.84) scales. ES were small, since some subjects experienced symptoms already preoperatively. Although most patients reported no or mild dumping symptoms 1 and 2 years after gastric bypass surgery, around 12 % had persistent symptoms, in particular, postprandial fatigue, and needed to lie down. Another 7 % had problems with nausea and 6 % had problems with fainting esteem. The DSRS is a reliable screening tool to identify these patients.

  • 13.
    Mar, Javier
    et al.
    Clin Management Serv, Arrasate, Spain; Hlth Res Unit West Gipuzkoa, Arrasate, Spain.
    Karlsson, Jan
    Örebro University Hospital. Dept Med, Ctr Hlth Care Sci.
    Arrospide, Arantzazu
    Hlth Res Unit AP OSIs Gipuzkoa, Alto Deba Hosp, Arrasate, Spain.
    Mar, Blanca
    Dept Surg, Donostia Hosp, Donostia San Sebastian, Spain.
    Martinez de Aragon, Gabriel
    Dept Surg, Txagorritxu Hosp, Vitoria, Spain.
    Martinez-Blazquez, Candido
    Dept Surg, Txagorritxu Hosp, Vitoria, Spain.
    Two-year changes in generic and obesity-specific quality of life after gastric bypass2013In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 18, no 3, p. 305-310Article in journal (Refereed)
    Abstract [en]

    The study objectives were to assess 2-year changes in health-related quality of life (HRQL) after gastric bypass in patients with severe obesity and to analyze HRQL improvements in relation to weight loss after bariatric surgery. This was a prospective intervention study with consecutive patients referred to two bariatric surgical units in the Basque Country. We used both generic (Short Form Health Survey, SF-36 and EuroQol, EQ-5D), and specific questionnaires (Moorehead-Ardelt, MA II and Obesity-related Problems Scale, OP). Effect sizes and receiver operating characteristic (ROC) curves were calculated to assess the change in quality of life. Spearman's correlation coefficient was calculated to assess whether there was an association between changes in body mass index (BMI) and HRQL. Of 82 patients who underwent surgery, 79 were followed-up for 2 years. Mean weight loss was 37 % of body weight (49 kg) and BMI fell from 50.6 to 31.8. The initial problems and final improvements were greater in the physical dimensions. Considerable benefits were observed in assessments with all the instruments used. However, the changes in weight/BMI and HRQL were not linear. The comparison with general population showed a similar profile in SF-36 dimensions after surgery. Severely obese patients have lower perceived health across all dimensions of quality of life. Moreover, the impact on functioning is so important that severe obesity can be described as a cause of disability that disappears 2 years after surgical treatment. ROC curves indicate that most of the HRQL measures are poor predictors of change in terms of reduction in body weight or BMI.

  • 14.
    Nordanstig, Joakim
    et al.
    Dept Vasc Surg, Univ Hosp, Sahlgrenska Acad, Gothenburg, Sweden; Inst Med, Dept Mol & Clin Med, Univ Hosp, Sahlgrenska Acad, Gothenburg, Sweden.
    Wann-Hansson, Christine
    Dept Vasc Dis, Malmö Univ, Skåne Univ Hosp, Malmö, Sweden; Fac Hlth & Soc, Dept Care Sci, Malmö Univ, Malmö, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Ctr Hlth Care Sci, Örebro Univ Hosp, Örebro, Sweden; Inst Hlth & Care Sci, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Gothenburg, Sweden.
    Lundstrom, Mats
    Inst Clin Sci, Dept Ophthalmol, EYENET Sweden, Lund, Sweden..
    Pettersson, Monica
    Dept Vasc Surg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Gothenburg, Sweden; Inst Med, Dept Mol & Clin Med, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Gothenburg, Sweden; Inst Hlth & Care Sci, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Gothenburg, Sweden.
    Morgan, Mark B. F.
    Bay Plenty Clin Sch, Tauranga, New Zealand.
    Vascular Quality of Life Questionnaire-6 facilitates health-related quality of life assessment in peripheral arterial disease2014In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 59, no 3, p. 700-U492Article in journal (Refereed)
    Abstract [en]

    Background: Most commonly used outcome measures in peripheral arterial disease (PAD) provide scarce information about achieved patient benefit. Therefore, patient-reported outcome measures have become increasingly important as complementary outcome measures. The abundance of items in most health-related quality of life instruments makes everyday clinical use difficult. This study aimed to develop a short version of the 25-item Vascular Quality of Life Questionnaire (VascuQoL-25), a PAD-specific health-related quality of life instrument. Methods: The study recruited 129 individuals with intermittent claudication and 71 with critical limb ischemia from two university hospitals. Participants were a mean age of 70 +/- 9 years, and 57% were men. All patients completed the original VascuQoL when evaluated for treatment, and 127 also completed the questionnaire 6 months after a vascular procedure. The VascuQoL-25 was reduced based on cognitive interviews and psychometric testing. The short instrument, the VascuQoL-6, was tested using item-response theory, exploring structure, precision, item fit, and targeting. A subgroup of 21 individuals with intermittent claudication was also tested correlating the results of VascuQoL-6 to the actual walking capacity, as measured using global positioning system technology. Results: On the basis of structured psychometric testing, the six most informative items were selected (VascuQoL-6) and tested vs the original VascuQoL-25. The correlation between VascuQoL-25 and VascuQoL-6 was r = 0.88 before intervention, r = 0.96 after intervention, and the difference was r = 0.91 (P < .001). The Cronbach alpha for the VascuQoL-6 was .85 before and .94 after intervention. Cognitive interviews indicated that the responders considered all six items to be relevant and comprehensible. Rasch analysis was used to reduce response options from seven (VascuQoL-25) to four (VascuQoL-6). VascuQol-6 was shown to have high precision and discriminative properties. Item fit was excellent, with both "infit" and "outfit" between 0.7 and 1.3 for all six items. The standardized response mean after intervention was 1.15, indicating good responsiveness to clinical change. VascuQoL-6 results correlated strongly (r = 0.72; P < .001) with the actual measured walking ability (n = 21). Conclusions: VascuQoL-6 is a valid and responsive instrument for the assessment of health-related quality of life in PAD. The main advantage is the compact format that offers a possibility for routine use in busy clinical settings.

  • 15.
    Norden, J.
    et al.
    Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Gronberg, A. M.
    Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Bosaeus, I.
    Dept Internal Med & Clin Nutr, Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden.
    Forslund, H. Berteus
    Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Hulthen, L.
    Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Rothenberg, E.
    Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Centre for Health Care Sciences, Region Örebro County, Örebro, Sweden.
    Wallengren, O.
    Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Slinde, F.
    Dept Internal Med & Clin Nutr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Nutrition impact symptoms and body composition in patients with COPD2015In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 69, no 2, p. 256-261Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Anorexia or lack of appetite is common in chronic obstructive pulmonary disease (COPD) and may be caused or augmented by several symptoms affecting appetite and eating. We aimed to investigate and quantify the extent of nutrition impact symptoms (NIS) in patients with COPD and to explore relationships between NIS and fat-free mass depletion.

    SUBJECTS/METHODS: The results in this cross-sectional study are based on 169 COPD patients (62% female subjects). Body composition was assessed using bioelectrical impedance spectroscopy and the patients reported NIS by two newly developed questionnaires: the Eating Symptoms Questionnaire (ESQ) and the Disease-Related Appetite Questionnaire (DRAQ).

    RESULTS: Symptoms with the highest prevalence were dry mouth (71%), stomach ache (39%), pain or aches affecting appetite (36%) and constipation (35%). Problems with diarrhoea and feeling affected by smells were more severe among women compared with men (P < 0.05). Thirty-six percent of the patients were depleted (fat-free mass index (FFMI) < 15 kg/m(2) for women and FFMI < 16 kg/m(2) for men). Depleted patients had more NIS (P < 0.05) and also rated appetite and taste of food as worse compared with non-depleted patients (P < 0.05).

    CONCLUSIONS: NIS are common in patients with COPD, and depleted patients have more severe symptoms. To investigate how these symptoms are best prevented and/or managed and whether NIS prevention/treatment can affect development of malnutrition in patients with COPD is a challenge for the future.

  • 16.
    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.

  • 17.
    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%.

  • 18.
    Raoof, Mustafa
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Näslund, Ingmar
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Rask, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Department of Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden .
    Sundbom, Magnus
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Edholm, David
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Karlsson, F. Anders
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Svensson, Felicity
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Szabo, Eva
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden .
    Health-Related Quality-of-Life (HRQoL) on an Average of 12 Years After Gastric Bypass Surgery2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 7, p. 1119-1127Article in journal (Refereed)
    Abstract [en]

    It is evident that morbidly obese patients have a low health-related quality-of-life (HRQoL), and this low HRQoL has become a common reason for them to seek bariatric surgery. Several HRQoL studies demonstrate a dramatic postoperative improvement, but most of these have had a short follow-up period.

    An observational, cross-sectional study for HRQoL was conducted to study 486 patients (average age of 50.7 +/- 10.0 years, with 84 % of them being female) operated with gastric bypass (GBP) in the period 1993 to 2003 at the University Hospitals of A-rebro and Uppsala. Mean follow-up after gastric bypass was 11.5 +/- 2.7 years (range 7-17). Two HRQoL instruments were used, SF-36 and the Obesity-related Problems scale (OP). The study group was compared with two control groups, both matched for age and gender, one from the general population and one containing morbidly obese patients evaluated and awaiting bariatric surgery.

    The study group scored better in the SF-36 domains (all four physical domains and the vitality subscore) and OP scale compared to obese controls, but their HRQoL scores were lower than those of the general population. HRQoL was better among younger patients and in the following subgroups: men, patients with satisfactory weight loss, satisfied with the procedure, free from co-morbidities and gastrointestinal symptoms, employment, good oral status and those not hospitalised or regularly followed up for non-bariatric reasons.

    Long-term follow-up after GBP for morbid obesity showed better scores in most aspects of HRQoL compared to obese controls but did not achieve the levels of the general population. Patients with better medical outcome after gastric bypass operation had better HRQoL.

  • 19.
    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.

  • 20.
    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.

  • 21.
    Sovik, Torgeir T.
    et al.
    Dept Gastrointestinal Surg, Aker Hosp, Univ Oslo, Oslo, Norway.
    Karlsson, Jan
    Örebro University Hospital. Inst Hlth Care Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Ctr Hlth Care Sci, Örebro Univ Hosp, Örebro, Sweden.
    Aasheim, Erlend T.
    Dept Endocrinol, Aker Hosp, Univ Oslo, Oslo, Norway.
    Fagerland, Morten W.
    Unit Biostat & Epidemiol, Ulleval Hosp, Univ Oslo, Oslo, Norway.
    Bjorkman, Sofia
    Dept Clin Nutr, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Engstrom, My
    Dept Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Kristinsson, Jon
    Dept Morbid Obes & Bariatr Surg, Aker Hosp, Univ Oslo, Oslo, Norway.
    Olbers, Torsten
    Dept Gastrosurg Res & Educ, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Mala, Tom
    Dept Morbid Obes & Bariatr Surg, Aker Hosp, Univ Oslo, Oslo, Norway.
    Gastrointestinal function and eating behavior after gastric bypass and duodenal switch2013In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 9, no 5, p. 641-647Article in journal (Refereed)
    Abstract [en]

    Background: Duodenal switch provides greater weight loss than gastric bypass in severely obese patients; however, comparative data on the changes in gastrointestinal symptoms, bowel function, eating behavior, dietary intake, and psychosocial functioning are limited. Methods: The setting for the present study was 2 university hospitals in Norway and Sweden. Participants with a body mass index of 50-60 kg/m(2) were randomly assigned to gastric bypass (n = 31) or duodenal switch (n = 29) and followed up for 2 years. Of the 60 patients, 97% completed the study. Their mean weight decreased by 31.2% after gastric bypass and 44.8% after duodenal switch. At inclusion and 1 and 2 years of follow-up, the participants completed the Gastrointestinal Symptom Rating Scale, a bowel function questionnaire, the Three-Factor Eating Questionnaire-R21, a 4-day food record, and the Obesity-related Problems scale. Results: Compared with the gastric bypass group, the duodenal switch group reported more symptoms of diarrhea (P =.0002), a greater mean number of daytime defecations (P =.007), and more anal leakage of stool (50% versus 18% of participants, respectively; P =.015) after 2 years. The scores for uncontrolled and emotional eating were significantly and similarly reduced after both operations. The mean total caloric intake and intake of fat and carbohydrates were significantly reduced in both groups. Protein intake was significantly reduced only after gastric bypass (P =.008, between-group comparison). Psychosocial function was significantly improved after both operations (P =.23, between the 2 groups). Conclusion: Gastrointestinal side effects and anal leakage of stool were more pronounced after duodenal switch than after gastric bypass. Both procedures led to reduced uncontrolled and emotional eating, reduced caloric intake, and improved psychosocial functioning. (C) 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.

  • 22.
    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.

  • 23.
    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.

  • 24.
    Svantesson, Mia
    et al.
    Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro University, Örebro, Sweden; Karlskoga Hospital, Karlskoga, Sweden.
    Karlsson, Jan
    Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Boitte, Pierre
    Dept Eth, Ctr Med Eth, Catholic Univ, Lille, France.
    Schildman, Jan
    NRW Jr Res Grp Med Eth End Life Norm & Empiricism, Inst Med Eth & Hist Med, Ruhr Univ Bochum, Bochum, Germany.
    Dauwerse, Linda
    Med Ctr, Inst Hlth & Care Res, Vrije Univ, Amsterdam, Netherlands; Dept Sociol, Vrije Univ, Amsterdam, Netherlands.
    Widdershoven, Guy
    Med Ctr, Inst Hlth & Care Res, Vrije Univ, Amsterdam, Netherlands; Dept Sociol, Vrije Univ, Amsterdam, Netherlands.
    Pedersen, Reidar
    Inst Hlth & Soc, Ctr Med Eth, Univ Oslo, Oslo, Norway.
    Huisman, Martijn
    Dept Epidemiol & Biostat, Vumc & Emgo, Amsterdam, Netherlands; Dep Med Humanities, Vumc & Emgo, Amsterdam, Netherlands .
    Molewijk, Bert
    Med Ctr, Inst Hlth & Care Res, Vrije Univ, Amsterdam, Netherlands; Dept Sociol, Vrije Univ, Amsterdam, Netherlands; nst Hlth & Soc, Ctr Med Eth, Univ Oslo, Oslo, Norway .
    Outcomes of Moral Case Deliberation: the development of an evaluation instrument for clinical ethics support (the Euro-MCD)2014In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 15, article id 30Article in journal (Refereed)
    Abstract [en]

    Background: Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers' experiences and perceived importance of outcomes of Moral Case Deliberation.

    Methods: A multi-item instrument for assessing outcomes of Moral Case Deliberation (MCD) was constructed through an iterative process, founded on a literature review and modified through a multistep review by ethicists and health care providers. The instrument measures perceived importance of outcomes before and after MCD, as well as experienced outcomes during MCD and in daily work. A purposeful sample of 86 European participants contributed to a Delphi panel and content validity testing. The Delphi panel (n = 13), consisting of ethicists and ethics researchers, participated in three Delphi-rounds. Health care providers (n = 73) participated in the content validity testing through `think-aloud' interviews and a method using Content Validity Index.

    Results: The development process resulted in the European Moral Case Deliberation Outcomes Instrument (Euro-MCD), which consists of two sections, one to be completed before a participant's first MCD and the other after completing multiple MCDs. The instrument contains a few open-ended questions and 26 specific items with a corresponding rating/response scale representing various MCD outcomes. The items were categorised into the following six domains: Enhanced emotional support, Enhanced collaboration, Improved moral reflexivity, Improved moral attitude, Improvement on organizational level and Concrete results.

    Conclusions: A tentative instrument has been developed that seems to cover main outcomes of Moral Case Deliberation. The next step will be to test the Euro-MCD in a field study.

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