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  • 1.
    Berglind, Daniel
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Nyberg, Gisela
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Persson, Margareta
    Department of Nursing, Umeå Universiy, Umeå, Sweden.
    Wells, Michael
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Forsell, Yvonne
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    An eHealth program versus a standard care supervised health program and associated health outcomes in individuals with mobility disability: study protocol for a randomized controlled trial.2018In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 19, no 1, article id 258Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Young adults with mobility disability (MD) are less likely to engage in regular physical activity (PA) compared with their able-bodied peers and inactive adults with a MD are more likely to report one or more chronic diseases compared to those who are physically active. Despite the vast amount of research published in the field of PA interventions over the past decades, little attention has been focused on interventions aiming to increase PA among individuals with MD. Thus, we propose to compare the effects of an eHealth program compared to a usual care supervised health program on levels of PA and other health behaviors.

    METHODS: The current intervention will use a randomized controlled trial (RCT) design with two treatment groups (an eHealth program and a usual care supervised health program) in young adults with newly acquired MD. In total, 110 young adults (aged 18-40 years) with a MD, acquired within the past 3 years, will be recruited to participate in a 12-week intervention. The primary study outcome is accelerometer-measured time spent in moderate to vigorous PA. Secondary outcomes includes health-related quality of life, depression, stress, fitness, body composition, diet, musculoskeletal pain, motivation to exercise and work ability.

    DISCUSSION: There is a lack of RCTs investigating effective ways to increase levels of PA in young adults with MD. Increased levels of PA among this physically inactive population have the potential to substantially improve health-related outcomes, possibly more so than in the general population. The trial will put strong emphasis on optimizing exercise adherence and investigating feasibility in the two treatment programs. The Ethical Review Board (EPN) at Karolinska Institutet has approved the study (2017/1206-31/1).

    TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN), reference number ISRCTN22387524 . Prospectively registered February 4, 2018.

  • 2.
    Bjuhr, Marie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Westerberg Jacobson, Josefin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Lindberg, Magnus
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Women with disturbed eating behavior rate less work engagement2016Conference paper (Refereed)
    Abstract [en]

    There is a lack of research exploring emotional commitment to work in relation to eating attitudes. Since eating disorders are associated with adverse psychological and social consequences, work engagement could be affected. The purpose was to compare work engagement among women with and without disturbed eating (DE).

    A cross-sectional survey using the Utrecht Work Engagement Scale and the Eating Disorder Examination Questionnaire in a general population cohort of 26-36-year-old women (n=847). Threshold for DE was 1 SD above general population mean. Independent t-test was used to compare work engagement. Ethical approval (reg no:2014/401)

    The level of work engagement was lower (p=0.02) among women with DE (mean 3.69 +-1.43) than women without DE (mean 4.06 +-1.18). The score for dedication was also lower (p=0.02) within the DE group (mean 3.74+-1.57 vs 4.22 +-1.26). However, vigour and absorption were not different.

    The work engagement in the cohort was within the average range although women with DE had significantly lower emotional commitment to work. As work engagement is linked to business success, workplace growth and sustainability it seems important to explore tailored strategies to improve work engagement among women with DE.

  • 3.
    Lennernäs Wiklund, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Gard, Gunvor
    Hälsovetenskaper, Medicinska fakulteten Lunds Universitet .
    Lindberg, Per
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Olofsson, Niclas
    Region Västernorrland FoU.
    Risberg, Anitha
    Institutionen för Hälsovetenskap, Luleå Tekniska Universitet.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Hann du äta?: En enkät och intervjustudie av arbetsmåltidens förutsättningar och betydelse för hälsa och välbefinnande vid skift- och schemalagt arbete med nattarbete2018In: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö?   10-12 juni 2018 Gävle: Program och abstracts / [ed] Per Lindberg, Gävle: Gävle University Press , 2018, p. 129-Conference paper (Refereed)
    Abstract [sv]

    Bakgrund

    Ohälsosamma matvanor och stress bidrar till sjukskrivningar och nedsatt arbetsförmåga genom övervikt, hjärtkärlsjukdom, diabetes typ 2 och psykisk ohälsa. Slimmade organisationer och flexibla arbetstider begränsar möjligheten att äta hälsosamt i samband med arbete. Särskilt utsatt är personal med skift- och schemalagt arbete. Att inte kunna på-verka när man äter under arbetspasset kan öka stress och irritation, med risk för sänkt prestations- och koncentrationsförmåga. Arbetsmiljöverkets föreskrifter om organisatorisk och social arbetsmiljö (AFS 2015:4) syftar till att främja en god arbetsmiljö och förebygga ohälsa på grund av organisatoriska och sociala förhållanden i arbetsmiljön. Det finns ingen lagstiftning angående matrastens längd eller utformningen av matrum. Arbetsgivaren har rätt att byta ut raster mot måltidsuppehåll, det senare innebär måltid om arbetssituationen medger det. Personal med ständig larmberedskap kan arbeta en hel natt utan möjlighet att äta. Detta är tveksamt med hänsyn till hälsa, säkerhet och arbetsförmåga.

    Syfte

    Studiens syfte är 1) att få en bättre förståelse av de faktorer som påverkar möjligheten och formerna för att äta i samband med natt- och skiftarbete och de val anställda gör utifrån de förutsättningar som finns 2) att öka förståelsen av hur arbetsmåltiden påverkas av organisatoriska och psykosociala förhållanden, och måltidens betydelse för återhämtning, välbefinnande och hälsa.

    Frågeställningar

    Hur gestaltas arbetsmåltider för personal med skift- och schemalagt arbete? Vilka strat-egier och handlingsutrymmen har personalen för att planera sina arbetsmåltider? Vi kommer särskilt att uppmärksamma vad personalen äter, under vilka omständigheter de äter samt vilken betydelse måltiden har för välbefinnande och gemenskap.

    Urval och metod

    Enkät riktas till anställda med dag-, skift- och schemalagt arbete inom industri och hemtjänst. Intervjuer genomförs med chefer inom dessa verksamheter.

    Resultat

    Studien startar våren 2018 med inledande intervjuer och test av enkät till målgrupper efter arbetsplatsbesök. Under konferensen kommer vi att kortfattat sammanfatta den forskning som finns inom ramen för våra frågeställningar samt att redovisa resultat från några intervjuer med chefer.

    Genom vårt deltagande vill vi bidra till att sätta arbetsmåltiden på agendan inom arbetsmiljöforskning och diskutera med andra forskare hur de ser på arbetsmåltiden ur ett arbetsmiljöperspektiv.

  • 4.
    Sellberg, Fanny
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Social Medicine, Stockholm, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Ghaderi, Ata
    epartment 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.
    Tynelius, Per
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Berglind, Daniel
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Change in Children's Self-Concept, Body-Esteem, and Eating Attitudes Before and 4 Years After Maternal RYGB2018In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, no 10, p. 3276-3283Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The aim of the present study was to look at longitudinal changes in children's self-concept, body-esteem, and eating attitudes before and 4 years after maternal RYGB surgery.

    METHODS: Sixty-nine women and 81 appurtenant children were recruited from RYGB waiting lists at 5 hospitals in Sweden. Families were visited at home pre-surgery, 9 months, and 4 years post-maternal RYGB to measure BMI. Furthermore, all participating family members completed questionnaires. Mothers' questionnaires measured eating behavior, depression, anxiety, and sleep quality, and children's questionnaires measured body-esteem, self-concept, and eating attitudes.

    RESULTS: Thirty-five/sixty-nine mothers and 43/81 children participated in all 3 measurements. Mothers reduced their BMI from pre-surgery (39.2) to 9 months (27.0) and 4 years post-surgery (27.4). Children's prevalence of overweight/obesity was lower 9 months post-surgery (48.8%) but at the same levels again 4 years post-surgery (58.1%), compared to pre-surgery (58.1%). The same rebound pattern was seen among children's eating attitudes, mothers' symptoms of depression and anxiety, and sleep quality. We found no correlations between mothers' BMI or eating behavior and children's BMI or eating behavior.

    CONCLUSION: Children's prevalence of overweight/obesity and eating attitudes improves soon after their mothers' RYGB, but then return to pre-surgery levels at 4 years post-surgery, as do mothers' sleep quality and symptoms of depression and anxiety, even though their weight loss was maintained.

  • 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 1878-7533Article 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.

  • 8.
    Sellberg, Fanny
    et al.
    Department of Public Health Sciences (PHS), Karolinska Institutet, Stockholm, Sweden.
    Possmark, Sofie
    Department of Public Health Sciences (PHS), Karolinska Institutet, Stockholm, Sweden.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Tynelius, Per
    Department of Public Health Sciences (PHS), Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Persson, Margareta
    Department of Nursing, Umeå University, Umeå, Sweden.
    Berglind, Daniel
    Department of Public Health Sciences (PHS), Karolinska Institutet, Stockholm, Sweden.
    Meeting physical activity recommendations is associated with health-related quality of life in women before and after Roux-en-Y gastric bypass surgery2019In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 28, no 6, p. 1497-1507Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Meeting physical activity (PA) recommendations is positively associated with health-related quality of life (HRQoL), but it is still unclear whether PA (specifically objectively measured) is associated with HRQoL in bariatric surgery candidates, both before and after surgery. Thus, the aim of this study was to examine the cross-sectional association between meeting objectively measured PA recommendations and HRQoL before and after Roux-en-Y gastric bypass (RYGB) surgery.

    METHODS: Sixty-six women undergoing RYGB with pre-surgery and 62 women with post-surgery valid PA and HRQoL data were included from the control group of a RCT study aiming at improving HRQoL and PA post-RYGB surgery. Measures before and 12 months after RYGB included the Short Form Health Survey (SF-36) and objectively measured PA, sedentary time (ST), and step counts with GT3X+ accelerometers. Multiple linear regression models were used to analyze the associations between PA and HRQoL.

    RESULTS: Participants who engaged in more than 150 min of moderate to vigorous PA (MVPA)/week (PA recommendations) had considerably higher SF-36 scores (HRQoL) than those who did not, both pre and 12-month post-surgery, with greatest difference in the subscale bodily pain, 15.5 (p = 0.021) higher score (higher scores means less pain) pre-surgery and a 19.7 (p = 0.004) higher score post-surgery. Higher LPA and step counts and lower ST also showed positive associations in some of the subscales of SF-36.

    CONCLUSIONS: Meeting the PA recommendations and overall engaging in more PA was associated with higher HRQoL, pre-, and post-RYGB surgery, highlighting the importance of PA both pre- and post-surgery.

  • 9.
    Sellberg, Fanny
    et al.
    Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, 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, K9, Social Medicin, Stockholm, Sweden; Centre for Sellberg etal.BMCSurgery (2017) 17:133 Page 6 of 7 Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Berglind, Daniel
    Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, Stockholm, Sweden.
    Four years' follow-up changes of physical activity and sedentary time in women undergoing roux-en-Y gastric bypass surgery and appurtenant children2017In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 17, no 1, article id 133Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Objectively measured levels of physical activity (PA) in patients undergoing Roux-en-Y Gastric Bypass (RYGB) surgery remain essentially unchanged from before to one year after surgery. Effects from RYGB on objectively measured levels of PA among women undergoing RYGB and appurtenant children beyond one year post-surgery are unknown. The aim of the present study was to objectively assess longitudinal changes in PA and sedentary time (ST), among women undergoing RYGB and appurtenant children, from three months before to nine and 48 months after maternal surgery.

    METHODS: Thirty women undergoing RYGB and 40 children provided anthropometric measures during home visits and valid accelerometer assessed (Actigraph GT3X+) PA data, three months before and nine and 48 months after maternal RYGB surgery.

    RESULTS: Women undergoing RYGB decreased time spent in moderate to vigorous PA (MVPA) with 2.0 min/day (p = 0.65) and increased ST with 14.4 min/day (p = 0.35), whereas their children decreased time spent in MVPA with 13.2 min/day (p = 0.04) and increased ST with 110.5 min/day (p < 0.001), from three months before to 48 months after maternal surgery. Twenty, 27 and 33% of women, and 60, 68 and 35% of children reached current PA guidelines three months before and nine and 48 months after maternal RYGB, respectively.

    CONCLUSIONS: Objectively measured PA in women remains unchanged, while appurtenant children decrease time spent in MVPA and increase ST, from three months before through nine and 48 months after maternal RYGB. The majority of both women undergoing RYGB and children are insufficiently active 48 months after maternal RYGB.

  • 10.
    Thern, Emelie
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Jia, Ting
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    de Munter, Jeroen
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Norström, Thor
    Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden.
    Ramstedt, Mats
    The Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden.
    Davey Smith, George
    MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
    Tynelius, Per
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden.
    Rasmussen, Finn
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden.
    No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 11, p. 1072-1077Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A strict high legal age limit for alcohol purchases decreases adolescents' access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality.

    METHODS: A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%-5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14-20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis.

    RESULTS: In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found.

    CONCLUSION: The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.

  • 11.
    Westerberg Jacobson, Josefin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Lindberg, Magnus
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Bjuhr, Marie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Willmer, Mikaela
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    A wish to be thinner increases the odds for disturbed eating 20 years later2016Conference paper (Refereed)
    Abstract [en]

    Background: Studies from various cultures show that a large number of adolescent girls have a wish to be thinner, and thus more often go on diets. The purpose of this longitudinal study was to examine if a wish to be thinner among Swedish girls contributes to the development of disturbed eating, and to describe motives for wishing to be thinner.

    Methods: Following ethical approval (reg. no: 258/94; 2014/401) the Demographic and Dieting Questionnaire and the Eating Disorder Examination Questionnaire were used in a general population cohort of 7-11year-old-girls (n=462), 20 years later in October 2015.Threshold for DE was 1 SD above general population mean. Chi-square tests providing OR were used.

    Results: A wish to be thinner during adolescence increases the likelihood 3-5 times to develop disturbed eating during the following 20-year period. Self-described motives for the wish to be thinner was to “correspond to the societal ideal” and to “dealing with difficulties”.

    Conclusions: For prevention, it is of importance to detect girls who wish to be thinner as early as possible. By considering the girls’ motives, preventive efforts might be perceived as more meaningful and relevant to the girls at risk of developing eating disorders.

  • 12.
    Willmer, Mikaela
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    ‘The only chance of a normal weight life’: A qualitative analysis of online forum discussions about bariatric surgery2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 10, article id e0206066Article in journal (Refereed)
    Abstract [en]

    Background

    The only effective weight loss treatment for severe obesity is bariatric surgery, with Roux-en-Y gastric bypass being the most common method. Patients often have unrealistic expectations of surgery and expect a “miracle cure” even though the procedure requires major lifelong lifestyle changes. Most patients access information about the procedure online, and come into contact with others who have had the surgery.

    Objective

    The objective of this study was to describe shared values, feelings, and thoughts among visitors to a web-based forum for those undergoing bariatric surgery.

    Methods

    In this cross-sectional observation study using qualitative contents analysis, the material consisted of an online discussion forum thread about bariatric surgery, with 498 posts. These were saved in a document, read and re-read. Through coding of meaningful units of text, themes were established.

    Results

    Four themes were constructed during data analysis: a) A new life-anticipating dramatic changes of body and mind; b) Negotiating the system and playing the waiting game; c) A means to an end-managing the pre-operative diet; and d) Managing the attitudes of others. Posters described the process of bariatric surgery as a journey, riddled with roadblocks, setbacks and trials, but also with joy and expectations of a new life.

    Conclusion

    Professionals who encounter this group should be aware of their need for support throughout the process, and investigate the possibility of both pre- and postoperative support groups, either online or face-to-face. The results also show that the posters on the forum had very high, and often unrealistic, expectations on how the surgery would change their lives. It is important for those who encounter this group before surgery to be aware of this tendency and to take measures to ensure that patients undergo the surgery with realistic expectations.

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