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Uncovering Barriers and Facilitators of Weight Loss and Weight Loss Maintenance: Insights from Qualitative Research. Nutrients 2023; 15:nu15051297. [PMID: 36904294 PMCID: PMC10005538 DOI: 10.3390/nu15051297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
Long-term weight loss maintenance is often difficult to achieve. This review analysed qualitative data on self-perceived barriers and facilitators of weight loss and weight loss maintenance among weight loss intervention participants. A literature search was conducted using electronic databases. Qualitative studies written in English and published between 2011-2021 were eligible for inclusion if they explored the perspectives and experiences of individuals who received standardised dietary and behavioural support for weight loss. Studies were excluded if weight loss was achieved through self-directed methods, only increasing physical activity, or surgical or pharmacological interventions. Fourteen studies were included, totaling 501 participants from six countries. Thematic analysis was used to identify four aggregate themes: internal factors (i.e., motivation and self-efficacy), programme-specific factors (i.e., the intervention diet), social factors (i.e., supporters and saboteurs), and environmental factors (i.e., an obesogenic environment). Our findings demonstrate that internal, social, and environmental factors all influence weight loss success, as well as the acceptability of the weight loss intervention. Future interventions may be more successful if they prioritise participant acceptability and engagement by, for example, providing tailored interventions, a structured relapse management plan, strategies to enhance autonomous motivation and emotional self-regulation, and extended contact during weight loss maintenance.
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Toft BS, Galvin K, Nielsen CV, Uhrenfeldt L. Being active when living within a large body: experiences during lifestyle intervention. Int J Qual Stud Health Well-being 2020; 15:1736769. [PMID: 32156205 PMCID: PMC7144297 DOI: 10.1080/17482631.2020.1736769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: In-depth understanding of the experiences of both well-being and suffering in relation to being severely obese and becoming active through lifestyle intervention is lacking.Aim: to explore and describe adults' existential experiences of being active, when living within a large body-before and during a lifestyle intervention.Methods: A longitudinal design of repeated individual interviews with 16 adults with BMI ≥40, based on hermeneutic phenomenology, existential philosophy and a theory of well-being was performed. The study was approved by the Danish health authorities.Results: Two dimensions of experiences were found; "Living within a downward spiral" and "Striving for enjoyment and settlement". The themes describing suffering were: 'Sense of being thwarted and defeated ' and "Tackling energy depletion and impact of sense of self". The themes describing well-being were: "Hoping for renewal and energised resoluteness" and "Enduring discomfort and feeling safe".Conclusions: Interacting existential experiences can be facilitators or barriers for physical activity. It seems relevant for health care providers to address the individual's lifeworld experiences of well-being, lack of well-being and suffering. Well-being as a sense of feeling "at home" when physically active may break down an inactivity spiral. Promoting well-being is a legitimate aim of lifestyle intervention.
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Affiliation(s)
- Bente Skovsby Toft
- Department of Lifestyle Rehabilitation, Horsens Regional Hospital, Brædstrup, Denmark
| | - Kathleen Galvin
- School of Health Sciences, University of Brighton, Brighton, UK
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Participant experiences of a low-energy total diet replacement programme: A descriptive qualitative study. PLoS One 2020; 15:e0238645. [PMID: 32898176 PMCID: PMC7478843 DOI: 10.1371/journal.pone.0238645] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/20/2020] [Indexed: 02/02/2023] Open
Abstract
Introduction The participants’ experience of low-energy total diet replacement (TDR) programmes delivered by lay counsellors in the community for the routine treatment of obesity is currently unclear. We interviewed a sample of twelve participants who took part in the Doctor Referral of Overweight People to Low-Energy total diet replacement Treatment (DROPLET) trial and were randomised to the TDR programme. Methods We purposively sampled twelve patients who took part in the DROPLET trial, and conducted in-depth telephone interviews, which were audio-recorded and transcribed verbatim. Interview questions focused on participants’ experiences and perceptions of the TDR programme. We conducted a thematic analysis, actively developing themes from the data, and used the one sheet of paper (OSOP) technique to develop higher-level concepts. Results Nine key themes were identified; Reasons for taking part, Expectations, Support and guidance from the counsellor, Time to build a personal relationship, Following the TDR Programme, Adverse events, Outcomes from the TDR, Weight Loss Maintenance, Recommending TDR to others. The relationship between participants and the counsellor was central to many of the themes. Close relationships with counsellors facilitated TDR adherence through providing one-to-one support (including during difficult times), sharing expert knowledge, and building a close relationship. Adherence was also supported by the rapid weight loss that patients reported experiencing. Overall participants reported positive experiences of the TDR, and emphasised the positive impact on their wellbeing. Discussion Patients reported that a TDR programme delivered by lay counsellors in the community was a positive experience and effective in helping them to lose weight. Future trials should consider the central role of the person providing support and advice as a key component in the programme.
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Brown A, Leeds AR. Very low‐energy and low‐energy formula diets: Effects on weight loss, obesity co‐morbidities and type 2 diabetes remission – an update on the evidence for their use in clinical practice. NUTR BULL 2019. [DOI: 10.1111/nbu.12372] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- A. Brown
- Centre for Obesity Research University College London London UK
- National Institute of Health Research University College London Hospitals London UK
| | - A. R. Leeds
- Department of Nutrition, Exercise and Sports Faculty of Science University of Copenhagen Copenhagen Denmark
- Parker Institute Frederiksberg Hospital Copenhagen Denmark
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Bright D, O'Hare K, Beesley R, Tapp H. Tipping the scales: Provider perspectives on a multi-disciplinary approach to obesity. Exp Biol Med (Maywood) 2019; 244:183-192. [PMID: 30661395 DOI: 10.1177/1535370219825639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPACT STATEMENT Obesity is a major multi-faceted, chronic disease that increases the risk of morbidity and mortality of children and adults particularly impacting high-risk populations and those of lower socioeconomic status. Given provider time constraints, models of care to effectively and efficiently address obesity in primary care are key. Although physician recommendations can exert a powerful influence on behavior, providers often feel powerless to adequately address obesity due to the complexity of physical and behavioral health problems. This mini-review focuses on describing the feasibility and evidence for tackling obesity through provider-led multidisciplinary weight management programs.
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Affiliation(s)
- Dellyse Bright
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Katherine O'Hare
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Rebecca Beesley
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, NC 28207, USA
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Harper C, Maher J, Grunseit A, Seimon RV, Sainsbury A. Experiences of using very low energy diets for weight loss by people with overweight or obesity: a review of qualitative research. Obes Rev 2018; 19:1412-1423. [PMID: 30144269 DOI: 10.1111/obr.12715] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/18/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
Abstract
Although very low energy diets (VLEDs) are the most successful non-surgical, non-pharmacological treatment for obesity, they are underutilized, and little is known about experiences of people using VLEDs for weight loss. This systematic review synthesizes qualitative studies investigating participants' experiences of undertaking a VLED composed of total meal replacement products to lose weight. Of the 4,911 articles screened, three studies met criteria for inclusion. Thematic synthesis was used to analyse the study findings. Health and appearance were the main motivators to use a VLED for weight loss. Adherence was facilitated by group support meetings, rapid weight loss and ease of use of the diet. Being part of a clinical trial gave a sense of accountability and further reason to adhere to a VLED, and the VLED itself was well accepted by users. Barriers to adherence, such as temptations and social occasions, were overcome by avoidance and distraction strategies. In conclusion, this qualitative synthesis of users' experiences of VLEDs shows that VLEDs are well accepted and positively viewed by users. More in-depth research could facilitate understanding of how this weight loss strategy influences the weight maintenance period, in order to facilitate better long-term results.
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Affiliation(s)
- C Harper
- Faculty of Medicine and Health, The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - J Maher
- Faculty of Science, Health, Education and Engineering, School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - A Grunseit
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - R V Seimon
- Faculty of Medicine and Health, The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - A Sainsbury
- Faculty of Medicine and Health, The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
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Rehackova L, Araújo‐Soares V, Adamson AJ, Steven S, Taylor R, Sniehotta FF. Acceptability of a very-low-energy diet in Type 2 diabetes: patient experiences and behaviour regulation. Diabet Med 2017; 34:1554-1567. [PMID: 28727247 PMCID: PMC5656912 DOI: 10.1111/dme.13426] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 01/19/2023]
Abstract
AIMS To evaluate the acceptability of an 8-week very-low-energy diet for remission of Type 2 diabetes, and to identify barriers and facilitators of adherence and behaviour-regulation strategies used by participants in the Counterbalance study. METHODS Eighteen of 30 participants in the Counterbalance study (ISRCTN88634530) took part in semi-structured interviews. Of these, 15 participants were interviewed before and after the 8-week very-low-energy diet intervention. Thematic analysis was used to analyse the narratives. RESULTS The prospect of diabetes remission, considerable weight loss, and long-term health improvement provided participants with substantial initial motivation. This motivation was sustained through the experience of rapid weight loss, improvements in blood glucose levels, social support and increased physical and psychological well-being. Overall, adherence to the very-low-energy diet for 8 weeks was perceived as much easier than anticipated, but required personal effort. Participants addressed challenges by removing food from the environment, planning, avoidance of tempting situations or places, and self-distraction. Weight loss and improvements in blood glucose levels lead to a sense of achievement and improvements in physical and psychological wellbeing. CONCLUSIONS Dietary treatment for reversal of Type 2 diabetes is acceptable and feasible in motivated participants, and the process is perceived as highly gratifying. Research outside of controlled trial settings is needed to gauge the generalisability of these findings.
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Affiliation(s)
- L. Rehackova
- Department of Health PsychologyNewcastle upon TyneUK
| | | | - A. J. Adamson
- Department of Health PsychologyNewcastle upon TyneUK
- Human Nutrition Research CentreInstitute of Health and SocietyNewcastle upon TyneUK
- Fuse the UK Clinical Research Collaboration Centre for Translational Research in Public HealthUK
| | - S. Steven
- Magnetic Resonance CentreInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - R. Taylor
- Magnetic Resonance CentreInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - F. F. Sniehotta
- Department of Health PsychologyNewcastle upon TyneUK
- Fuse the UK Clinical Research Collaboration Centre for Translational Research in Public HealthUK
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Rørtveit K, Furnes B, Dysvik E, Ueland V. Struggle for a Meaningful Life after Obesity Treatment—A Qualitative Systematic Literature Review. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.712103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jones N, Melville CA, Harris L, Bleazard L, Hankey CR. A qualitative study exploring why adults with intellectual disabilities and obesity want to lose weight and views of their carers. BMC OBESITY 2015; 2:49. [PMID: 26693285 PMCID: PMC4683767 DOI: 10.1186/s40608-015-0080-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/09/2015] [Indexed: 11/19/2022]
Abstract
Background Obesity is more prevalent in adults with intellectual disabilities (ID) compared to the general population. Motivations for weight loss may influence engagement with weight management programmes and have only been studied in adults without ID. Aims: To determine reasons given by adults with ID and obesity for seeking weight loss and whether these reasons differ from those of their carers. Methods Prior to a multi-component weight management intervention, participants were asked “why do you want to lose weight?” Carers were asked their views and these were compared to the answers given by the adult with ID. Responses were themed. The Fisher’s Exact analysis was used to test for any relationship between reasons for seeking weight loss and participants’ level of ID, age, gender and BMI. Results Eighteen men and 32 women; age 41.6 SD 14.6 years; BMI 40.8 SD 7.5 kg/m2; Level ID Mild (28 %), Moderate (42 %), Severe (22 %), Profound (8 %). Eleven were unable to respond. Six themes emerged; Health; Fitness / Activity / Mobility; Appearance / Clothes; Emotional / Happiness; For Others; Miscellaneous. The most frequent reason given overall and by women was “appearance.” Carers cited “health” most frequently and “appearance” least, rarely agreeing with participants. “Health” was given as a reason more from older adults and those with milder ID. No statistically significant associations were found between reasons for seeking weight loss and BMI age, gender or level of ID but the differing views of adults with ID and their carers were clear. Conclusions Views of adults with obesity and mild or moderate ID can be collected. The opposing views of adults and their carers may affect motivation for weight loss.
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Affiliation(s)
- N Jones
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - C A Melville
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - L Harris
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - L Bleazard
- Mental Health and Wellbeing, University of Glasgow, 1st Floor Admin Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - C R Hankey
- Human Nutrition Section, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER UK
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Ahlgren C, Hammarström A, Sandberg S, Lindahl B, Olsson T, Larsson C, Fjellman-Wiklund A. Engagement in New Dietary Habits—Obese Women’s Experiences from Participating in a 2-Year Diet Intervention. Int J Behav Med 2015; 23:84-93. [DOI: 10.1007/s12529-015-9495-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Yoong SL, Carey ML, Sanson-Fisher RW, D’Este CA. A cross-sectional study assessing Australian general practice patients' intention, reasons and preferences for assistance with losing weight. BMC FAMILY PRACTICE 2013; 14:187. [PMID: 24321022 PMCID: PMC4029270 DOI: 10.1186/1471-2296-14-187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 12/02/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The high prevalence of overweight and obesity in the population is concerning, as these conditions increase an individual's risk of various chronic diseases. General practice is an ideal setting to target the reduction of overweight or obesity. Examining general practice patients' intentions to lose weight and preferences for assistance with managing their weight is likely to be useful in informing weight management care provided in this setting. Thus, this study aimed to: 1) identify the proportion and characteristics of patients intending to change weight in the next six months; 2) reasons for intending to change weight and preferences for different modes of weight management assistance in overweight and obese patients. METHODS A cross-sectional study was conducted with 1,306 Australian adult general practice patients. Consenting patients reported via a touchscreen computer questionnaire their demographic characteristics, intention to lose weight in the next six months, reasons for wanting to lose weight, preferred personnel to assist with weight loss and willingness to accept support delivered via telephone, mobile and internet. RESULTS Fifty six percent (n = 731) of patients intended to lose weight in the next six months. Females, younger patients, those with a level of education of trade certificate and above or those with high cholesterol had significantly higher odds of intending to lose weight. "Health" was the top reason for wanting to lose weight in normal weight (38%), overweight (57%) and obese (72%) patients. More than half of overweight (61%) or obese (74%) patients reported that they would like help to lose weight from one of the listed personnel, with the dietitian and general practitioner (GP) being the most frequently endorsed person to help patients with losing weight. Almost 90% of overweight or obese participants indicated being willing to accept support with managing their weight delivered via the telephone. CONCLUSIONS Most overweight or obese general practice patients intended to lose their weight in the next six months for health reasons. Younger females, with higher level of education or had high cholesterol had significantly higher odds of reporting intending to lose weight in the next six months. An opportunity exists for GPs to engage patients in weight loss discussions in the context of improving health. Interventions involving GP and dietitians with weight management support delivered via telephone, should be explored in future studies in this setting.
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Affiliation(s)
- Sze Lin Yoong
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, W4 Hunter Medical Research Institute, University of Newcastle, Newcastle 2308, Callaghan, Australia
| | - Mariko Leanne Carey
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, W4 Hunter Medical Research Institute, University of Newcastle, Newcastle 2308, Callaghan, Australia
| | - Robert William Sanson-Fisher
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, W4 Hunter Medical Research Institute, University of Newcastle, Newcastle 2308, Callaghan, Australia
| | - Catherine Anne D’Este
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, W4 Hunter Medical Research Institute, University of Newcastle, Newcastle 2308, Callaghan, Australia
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Hights 2305, Australia
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Östberg AL, Bengtsson C, Lissner L, Hakeberg M. Oral health and obesity indicators. BMC Oral Health 2012; 12:50. [PMID: 23167443 PMCID: PMC3536576 DOI: 10.1186/1472-6831-12-50] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 11/16/2012] [Indexed: 11/30/2022] Open
Abstract
Background In western Sweden, the aim was to study the associations between oral health variables and total and central adiposity, respectively, and to investigate the influence of socio-economic factors (SES), lifestyle, dental anxiety and co-morbidity. Methods The subjects constituted a randomised sample from the 1992 data collection in the Prospective Population Study of Women in Gothenburg, Sweden (n = 999, 38- > =78 yrs). The study comprised a clinical and radiographic examination, together with a self-administered questionnaire. Obesity was defined as body mass index (BMI) > =30 kg/m2, waist-hip ratio (WHR) > =0.80, and waist circumference >0.88 m. Associations were estimated using logistic regression including adjustments for possible confounders. Results The mean BMI value was 25.96 kg/m2, the mean WHR 0.83, and the mean waist circumference 0.83 m. The number of teeth, the number of restored teeth, xerostomia, dental visiting habits and self-perceived health were associated with both total and central adiposity, independent of age and SES. For instance, there were statistically significant associations between a small number of teeth (<20) and obesity: BMI (OR 1.95; 95% CI 1.40-2.73), WHR (1.67; 1.28-2.19) and waist circumference (1.94; 1.47-2.55), respectively. The number of carious lesions and masticatory function showed no associations with obesity. The obesity measure was of significance, particularly with regard to behaviour, such as irregular dental visits, with a greater risk associated with BMI (1.83; 1.23-2.71) and waist circumference (1.96; 1.39-2.75), but not with WHR (1.29; 0.90-1.85). Conclusions Associations were found between oral health and obesity. The choice of obesity measure in oral health studies should be carefully considered.
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Affiliation(s)
- Anna-Lena Östberg
- Dept of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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