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  • 1.
    Browaldh, Nanna
    et al.
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Nerfeldt, Pia
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Lysdahl, Michael
    Aleris Fysiolog Lab, Sleep Division, Stockholm, Sweden .
    Bring, Johan
    Statisticon AB, Uppsala, Sweden .
    Friberg, Danielle
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    SKUP3 randomised controlled trial: polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea2013In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 68, no 9, p. 846-853Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the 6-month efficacy of uvulopalatopharyngoplasty (UPPP) compared with expectancy in selected patients with obstructive sleep apnoea syndrome (OSAS).

    DESIGN: A prospective single-centre randomised controlled trial with two parallel arms stratified by Friedman stage and body mass index (BMI).

    PARTICIPANTS: 65 consecutive patients with moderate to severe OSAS (apnoea-hypopnoea index (AHI) ≥15 events/h sleep), BMI <36 kg/m(2), Epworth sleepiness scale ≥8, Friedman stage I or II.

    INTERVENTION: Surgical treatment with UPPP. The control group underwent UPPP after a delay of 6 months.

    OUTCOMES: Changes in AHI and other polysomnography parameters at baseline compared with the 6-month follow-up.

    RESULTS: All patients (32 in the intervention group and 33 in the control group) completed the trial. The mean (SD) AHI in the intervention group decreased significantly (p<0.001) by 60% from 53.3 (19.7) events/h to 21.1 (16.7) events/h . In the control group the mean AHI decreased by 11% from 52.6 (21.7) events/h to 46.8 (22.8) events/h, with a significant difference between the groups (p<0.001). The mean time in the supine position and the BMI were unchanged in both groups. Subgroup analyses for Friedman stage, BMI group and tonsil size all showed significant reductions in AHI in the intervention group compared with controls. There were no severe complications after surgery.

    CONCLUSIONS: This trial demonstrates the efficacy of UPPP in treating selected patients with OSAS with a mean reduction in AHI of 60% compared with 11% in controls, a highly significant and clinically relevant difference between the groups.

    TRIAL REGISTRATION NUMBER: NCT01659671.

  • 2.
    Nordström, Sara
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Berglund, Anna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Patienters erfarenhet av kostvanor efter Gastric Bypass-operation: Litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Obesity and being overweight is a globally increasing problem and can cause other health related diseases, such as diabetes type II. Gastric bypass (GBP) is the most performed kind of bariatric surgery in treatment for obesity and overweight. There are not enough studies on, and knowledge about, patients’ postoperative food habits for the nurse to be able to provide with the help and aid the patients will need after the GBP-operation.

    Aim: To describe GBP-patients’ experiences of postoperative food habits and which methods of sampling that have been used in the studies on which we base our results.

    Method: A descriptive literature study including eleven scientific studies.

    Results: Many of the participating patients described that their food habits had changed after their GBP-operation. Foods that consisted mainly of carbohydrates were excluded and vegetables were the only type of food that had not been excluded. The GBP-patients described that they had developed a low tolerance mainly towards meat and milk based products. The daily number of meals had increased and the servings of food were smaller than before the surgery. This mainly depends on the decreased volume in the gastric pouch.

    Conclusion: Almost every participating GBP-patient’s food habit had changed. The daily energy intake was at its lowest during the first time after the operation, but the patients learned how and what to eat in the course of time which would gradually lead to an increased energy intake. Few GBP-patients described that they had undergone professional counseling regarding food and food habits. The nurse must be able to teach the patients about food habits and give adequate answers to questions regarding changes in food habits so that the patients may achieve good health after the GBP-operation.

  • 3.
    Robinson, Yohan
    et al.
    Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Olerud, Claes
    Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Willander, Johan
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Psychology.
    Do biological disease-modifying antirheumatic drugs reduce the spinal fracture risk related to ankylosing spondylitis?: A longitudinal multiregistry matched cohort study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e016548Article in journal (Refereed)
    Abstract [en]

    Objectives: Ankylosing spondylitis (AS) is associated with an increased spinal fracture risk due to the loss of elasticity in spinal motion segments. With the introduction of biological disease-modifying antirheumatic drug (bDMARD) treatment for AS, the individual course of the disease has been ameliorated. This study aims to examine the association of bDMARD treatment and risk of spinal fracture.

    Design: Longitudinal population-based multiregistry observational matched cohort study.

    Setting: Swedish Patient Registry 1987-2014 and Swedish Prescribed Drugs Registry 2005-2014.

    Participants: Included were patients ≥18 years of age receiving treatment at a healthcare facility for the primary diagnosis of AS. About 1352 patients received more than one prescription of bDMARD from 2005 to 2014. An untreated control group was created by propensity score matching for age, sex, comorbidity, antirheumatic prescriptions and years with AS (n=1352).

    Main Outcome Measures: Spinal fracture-free survival.

    Results: No bDMARD treatment-related effect on spinal fracture-free survival was observed in the matched cohorts. Male gender (HR=2.54, 95% CI 1.48 to 4.36) and Charlson Comorbidity Index score (HR=3.02, 95% CI 1.59 to 5.75) contributed significantly to spinal fracture risk.

    Conclusion: bDMARD had no medium-term effect on the spinal fracture-free survival in patients with AS.

    Trial Registration Number: NCT02840695

  • 4.
    Robinson, Yohan
    et al.
    Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Sheta, Reda
    Department of Orthopaedic Surgery, Al Ahrar Specialised Hospital Zagazig, Zagazig, Egypt.
    Salci, Konstantin
    Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.
    Willander, Johan
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Psychology.
    Blood loss in surgery for aggressive vertebral haemangioma with and without embolisation2015In: Asian Spine Journal, ISSN 1976-1902, E-ISSN 1976-7846, Vol. 9, no 3, p. 483-491Article, review/survey (Refereed)
    Abstract [en]

    Despite their benign nature some symptomatic aggressive vertebral haemangiomas (AVH) require surgery to decompress spinal cord and/or stabilise pathological fractures. Preoperative embolisation may reduce the considerable blood loss during surgical decompression. This systematic review investigated whether preoperative embolisation reduced surgical blood loss during treatment of symptomatic AVH. PubMed Medline, Web of Science, and Ovid Medline were searched for case reports and clinical studies on surgical AVH treatment. Included were cases from all publications on surgical treatment of AVH where the amount of surgical blood loss and the use of preoperative embolisation were documented. 51 cases with surgically treated AVH were retrieved from the included studies. Blood loss in the embolised treatment group (980±683 mL) was lower than the non-embolised control group (1,629±946 mL). This systematic review found that embolisation prior to AVH resection reduced surgical blood loss (level of evidence, very low) and can be recommended (strong recommendation).

  • 5.
    Sellberg, Fanny
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Social Medicin, Stockholm, Sweden.
    Possmark, Sofie
    Department of Public Health Sciences, Karolinska Institutet, Social Medicin, Stockholm, Sweden.
    Ghaderi, Ata
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Näslund, Erik
    Division of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Tynelius, Per
    Department of Public Health Sciences, Karolinska Institutet, Social Medicin, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Thorell, Anders
    Department of Clinical Science at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Stockholm, Sweden.
    Sundbom, Magnus
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Uddén, Joanna
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Endocrine and Obesity, Capio st Görans Hospital, Stockholm, Sweden.
    Szabo, Eva
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Berglind, Daniel
    Department of Public Health Sciences, Karolinska Institutet, Social Medicin, Stockholm, Sweden.
    A dissonance-based intervention for women post roux-en-Y gastric bypass surgery aiming at improving quality of life and physical activity 24 months after surgery: study protocol for a randomized controlled trial2018In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 18, no 1, article id 25Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is the most common bariatric procedure in Sweden and results in substantial weight loss. Approximately one year post-surgery weight regain for these patient are common, followed by a decrease in health related quality of life (HRQoL) and physical activity (PA). Our aim is to investigate the effects of a dissonance-based intervention on HRQoL, PA and other health-related behaviors in female RYGB patients 24 months after surgery. We are not aware of any previous RCT that has investigated the effects of a similar intervention targeting health behaviors after RYGB.

    METHODS: The ongoing RCT, the "WELL-GBP"-trial (wellbeing after gastric bypass), is a dissonance-based intervention for female RYGB patients conducted at five hospitals in Sweden. The participants are randomized to either control group receiving usual follow-up care, or to receive an intervention consisting of four group sessions three months post-surgery during which a modified version of the Stice dissonance-based intervention model is used. The sessions are held at the hospitals, and topics discussed are PA, eating behavior, social and intimate relationships. All participants are asked to complete questionnaires measuring HRQoL and other health-related behaviors and wear an accelerometer for seven days before surgery and at six months, one year and two years after surgery. The intention to treat and per protocol analysis will focus on differences between the intervention and control group from pre-surgery assessments to follow-up assessments at 24 months after RYGB. Patients' baseline characteristics are presented in this protocol paper.

    DISCUSSION: A total of 259 RYGB female patients has been enrolled in the "WELL-GBP"-trial, of which 156 women have been randomized to receive the intervention and 103 women to control group. The trial is conducted within a Swedish health care setting where female RYGB patients from diverse geographical areas are represented. Our results may, therefore, be representative for female RYGB patients in the country as a whole. If the intervention is effective, implementation within the Swedish health care system is possible within the near future.

    TRIAL REGISTRATION: The trial was registered on February 23th 2015 with registration number ISRCTN16417174.

  • 6.
    Sellberg, Fanny
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Social Medicin, Stockholm, Sweden.
    Possmark, Sofie
    Department of Public Health Sciences, Karolinska Institutet, Social Medicin, Stockholm, Sweden.
    Ghaderi, Ata
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Berglind, Daniel
    Department of Public Health Sciences, Karolinska Institutet, Social Medicin, Stockholm, Sweden.
    A dissonance-based randomized intervention study to improve quality of life and physical activity 24 months post roux-en-y gastric bypass surgery2018In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, p. 224-224Article in journal (Refereed)
    Abstract [en]

    Background: Roux-en-Y gastric bypass (RYGB) surgery is usually followed by great weight loss and improved health related quality of life (HRQoL). However, weight regains are seen in some patients approximately 1-2 years post-surgery, associated with a decrease in HRQoL and physical activity (PA).

    Objectives: To investigate if a dissonance-based group intervention post RYGB surgery has an effect on women’s HRQoL, PA and other health-related behaviors: a protocol paper.

    Methods: The ongoing RCT is a dissonance-based intervention for female RYGB patients from five Swedish hospitals. Participants are randomized to either control (usual follow-up care) or intervention group (4 sessions, 3 months post-surgery). Main topics of intervention sessions are (1) PA, (2) eating behavior, (3) social and (4) intimate relationships. Participants are asked to wear an accelerometer and complete questionnaires measuring HRQoL (SF-36), social adjustment, eating behavior and body esteem, pre-surgery and 6, 12 and 24 months post-surgery. Planned analysis includes intention to treat and per protocol analysis on differences between intervention and control group. Trial registration number: ISRCTN16417174.

    Results: We recruited 259 women (156 intervention and 103 controls). Mean BMI was 40.9 ± 4.7, mean SF36 score was 42.1 ± 9.5 (physical component summary score) and 45.8 ± 11.1 (mental component summary score). Mean time spent in moderate to vigorous PA was 28.8 ± 19.4 min/day and sedentary was 458.3 ± 100.4 min/day.

    Conclusions: This trial aims to improve outcomes after RYGB. If the intervention is effective, implementation within the Swedish health care system is possible within the near future.

  • 7.
    Sellberg, Fanny
    et al.
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Possmark, Sofie
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Willmer, Mikaela
    Tynelius, Per
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden; c Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden .
    Berglind, Daniel
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, SwedenKarolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    One-year follow-up of a dissonance-based intervention on quality of life, wellbeing, and physical activity after Roux-en-Y gastric bypass surgery: a randomized controlled trial2019In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 15, no 10, p. 1731-1737Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health-related quality of life (HRQoL) peaks around 1 year after Roux-en-Y gastric bypass (RYGB) surgery, and thereafter, in many patients, slowly deteriorates.

    OBJECTIVES: The aim of the present study was to test early effects (study endpoint 2 years) of a dissonance-based group intervention on HRQoL (primary outcome) and wellbeing among women who underwent RYGB: a 1-year follow-up of the WELL-GBP trial.

    SETTING: Women were recruited from 5 different hospitals in Sweden pre-RYGB surgery. Participants were randomized to intervention or a control group (regular care).

    METHODS: The intervention consisted of 4 group sessions, 2 to 3 months post-surgery, comprising the following 4 different topics: (1) physical activity, (2) eating behavior, (3) social relationships, and (4) intimate relationships. Participants answered questionnaires about HRQoL (SF-36, Short-Form Health Survey), social adjustment, body esteem, eating behavior, and wore an accelerometer for 7 days at pre- and 1 year post-RYGB.

    RESULTS: Two hundred fifty-nine women were recruited and 203 (78%) completed 1-year follow-up measurements. Mean body mass index pre-surgery was 40.8 (standard deviation = 4.5), mean age 44.7 (standard deviation = 10.3) years, and 61 of 120 women in the intervention group received the intervention according to protocol (≥3 group sessions). We observed no difference between the intervention and the control group at 1-year post-RYGB surgery. All scales improved in both groups from pre- to 1 year post-surgery.

    CONCLUSIONS: We did not observe any 1-year early effects on HRQoL from a dissonance-based group intervention among female RYGB patients. Future studies may investigate long-term effects of the intervention.

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