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Xu L, Lou Y, Willmer M, Engström M. Nursing Students' Self-rated Nurse Professional Competence at the End of an International Collaborative Education Program and Follow-up 1 Year Later. Nurse Educ 2023; 48:E141-E146. [PMID: 36916984 PMCID: PMC10467814 DOI: 10.1097/nne.0000000000001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND International collaborative programs and student active learning are encouraged; yet, little is known about them. PURPOSE To compare nursing students' self-rated nurse professional competence (NPC) and general self-efficacy between those enrolled in an international collaborative program, which focused on student active learning, and those enrolled in a traditional lecture-based program at the end of graduation and 1 year later. METHODS This prospective comparative study distributed a questionnaire to 137 nursing students enrolled in the 2 bachelor-level programs at a university in southeastern China. RESULTS At the end of graduation, students enrolled in the international collaborative program reported higher scores for NPC factors, medical and technical care and general self-efficacy, than those enrolled in the traditional lecture-based program. One year later, they reported higher scores for total NPC, value-based nursing care, medical and technical care, care pedagogics, documentation and administration of nursing care, and general self-efficacy than others. CONCLUSION This study found that the nursing students enrolled in the international collaborative program reported higher self-rated competence.
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Affiliation(s)
- Lijuan Xu
- Professor (Dr Xu), Teacher (Ms Lou), Medicine College, Lishui University, Lishui City, China; Associate Professor (Dr Willmer) and Professor (Dr Engström), Department of Caring Science, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Yan Lou
- Professor (Dr Xu), Teacher (Ms Lou), Medicine College, Lishui University, Lishui City, China; Associate Professor (Dr Willmer) and Professor (Dr Engström), Department of Caring Science, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Mikaela Willmer
- Professor (Dr Xu), Teacher (Ms Lou), Medicine College, Lishui University, Lishui City, China; Associate Professor (Dr Willmer) and Professor (Dr Engström), Department of Caring Science, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Maria Engström
- Professor (Dr Xu), Teacher (Ms Lou), Medicine College, Lishui University, Lishui City, China; Associate Professor (Dr Willmer) and Professor (Dr Engström), Department of Caring Science, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Willmer M, Westerberg Jacobson J, Lindberg M. An exploratory analysis of work engagement among women with and without disordered eating. BMC Womens Health 2021; 21:303. [PMID: 34407786 PMCID: PMC8371862 DOI: 10.1186/s12905-021-01429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Around 10% of the female population is estimated to have a subclinical eating disorder. Many of these women are of working age. Previous research has shown associations between unhealthy eating behaviors and occupational stress or burnout. However, no previous study has explored the association between disordered eating and work engagement, a positive, fulfilling, affective-cognitive state of mind which has been positioned as the conceptual opposite of burnout. Thus, that was the aim of the present study. METHODS In this cross-sectional study, a sample of 701 Swedish women completed the 9-item Utrecht Work Engagement Scale (UWES-9) and the Eating Disorder Examination Questionnaire (EDE-Q). They were divided into a Healthy Eating (HE) and a Disordered Eating (DE) group based on their EDE-Q scores. The Mann-Whitney U test was used to test the association between disordered eating and work engagement. The Kruskal Wallis test was used to assess the associations between educational level, marital status and age group, and work engagement. RESULTS Neither the UWES scores nor the EDE-Q scores were found to have a normal distribution. Non-parametric testing showed that the DE group reported significantly lower work engagement than the HE group (p = 0.016). There were no significant associations between education, marital status or age (independent variables) and work engagement (dependent variable) (p = 0.826, 0.309, and 0.349, respectively). CONCLUSION These findings indicate that work engagement may play a role in disordered eating, and that there is a need for future research to consider the workplace environment as a potential source for altering disordered eating behaviors.
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Affiliation(s)
- Mikaela Willmer
- Department of Caring Sciences, University of Gävle, 801 76, Gävle, Sweden.
| | - Josefin Westerberg Jacobson
- Department of Caring Sciences, University of Gävle, 801 76, Gävle, Sweden
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
| | - Magnus Lindberg
- Department of Caring Sciences, University of Gävle, 801 76, Gävle, Sweden
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Wising J, Mattsson G, Rambaree K, Willmer M, Wallhagen M, Magnusson P. 'Life with a device': the octogenarians' experiences with an implantable cardioverter-defibrillator-a qualitative study. Eur J Cardiovasc Nurs 2021; 21:161-168. [PMID: 33928354 DOI: 10.1093/eurjcn/zvab033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/23/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022]
Abstract
AIMS Implantable cardioverter-defibrillator (ICD) treatment has expanded due to its effectiveness. However, there are concerns about complications, and use in the most elderly has been questioned. There is scarce data on qualitative aspects regarding experiences of living with an ICD among patients above the age of 80 years. The aim of this study was to explore octogenarians' experience, knowledge, and attitude of living with an ICD. METHOD AND RESULTS We used semi-structured interviews to collect data from 20 patients, aged 80-89 years (90% men). The data were then structured and analysed through deductive thematic analysis network approach using the ATLAS.ti v.8.4 software. The framework of the analysis was based on the Successful Aging Theory. Three main themes emerged regarding the patients' experiences: Life goes on; Their Health, The Janus-Faced Device; Their attitudes, and Mind the gap; Their knowledge. None of the octogenarians regretted receiving their ICD, instead, they presented with feelings such as gratitude towards the device. However, a lack of knowledge about the devices was expressed, which can be a risk for potential complications, in turn causing suffering and unnecessary concerns. CONCLUSION Overall, the ICD did not pose a threat towards successful ageing. It was mainly considered a life-saving device. However, the lack of knowledge might hinder informed choices close to death and contribute to ethical dilemmas when deactivation of the ICD is a reasonable option.
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Affiliation(s)
- Jenny Wising
- Centre for Research and Development, Region Gävleborg, Uppsala University, Lasarettsvägen 1, Gävle SE-80187, Sweden
| | - Gustav Mattsson
- Centre for Research and Development, Region Gävleborg, Uppsala University, Lasarettsvägen 1, Gävle SE-80187, Sweden
| | - Komalsingh Rambaree
- Department of Social Work and Criminology, University of Gävle, Kungsbäcksvägen 47, Gävle SE-80176, Sweden
| | - Mikaela Willmer
- Department of Caring Sciences, University of Gävle, Kungsbäcksvägen 47, Gävle SE-80176, Sweden
| | - Marita Wallhagen
- Department of Building Engineering, Energy Systems and Sustainability Science, University of Gävle, Kungsbäcksvägen 47, Gävle SE-80176, Sweden
| | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg, Uppsala University, Lasarettsvägen 1, Gävle SE-80187, Sweden.,Department of Caring Sciences, University of Gävle, Kungsbäcksvägen 47, Gävle SE-80176, Sweden.,Department of Medicine, Solna, Cardiology Research Unit, Karolinska Institutet, Karolinska University Hospital D1:04, Stockholm SE-171 76, Sweden
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Possmark S, Sellberg F, Willmer M, Tynelius P, Persson M, Berglind D. Accelerometer-measured versus self-reported physical activity levels in women before and up to 48 months after Roux-en-Y Gastric Bypass. BMC Surg 2020; 20:39. [PMID: 32103734 PMCID: PMC7045736 DOI: 10.1186/s12893-020-00699-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/14/2020] [Indexed: 01/07/2023] Open
Abstract
Background Roux-en-Y Gastric Bypass (RYGB) patients overestimate their time spent in moderate-to-vigorous physical activity (MVPA) to a greater extent post-surgery than pre-surgery. However, there is no data on discrepancy between self-reported and accelerometer-measured MVPA beyond nine months post-RYGB. The aim was to investigate how the duration of MVPA (main outcome) differs when comparing a self-administered questionnaire to accelerometer-data from pre-surgery and up to 48 months post-RYGB. Methods Twenty-six (38%) RYGB-treated women with complete data from the original cohort (N = 69) were included. Participants were recruited from five Swedish hospitals. Mean pre-surgery BMI was 38.9 (standard deviation (SD) = 3.4) kg/m2 and mean age 39.9 (SD = 6.5) years. MVPA was subjectively measured by a self-administered questionnaire and objectively measured by the ActiGraph GT3X+ accelerometer at 3 months pre-RYGB and 9- and 48 months post-RYGB. Means and SD were calculated at 3 months pre- and 9- and 48 months post-RYGB. We calculated the P-values of the differences with Wilcoxon Signed-Rank test. For correlations between the self-administered questionnaire and the accelerometers, Spearman’s rank correlation was used. Results Participants significantly overestimated (i.e. self-reported more time spent in MVPA compared to accelerometry) their MVPA in a higher degree post- compared to pre-RYGB surgery. Compared to pre-surgery, self-reported MVPA increased with 46.9 and 36.5% from pre- to 9- and 48 months, respectively, whereas changes were a 6.1% increase and 3.5% decrease with accelerometers. Correlations between self-reported and accelerometer-measured MVPA-assessments were poor at all measurement points (r = 0.21–0.42) and only significant at 48 months post-RYGB (P = 0.032). Conclusions The discrepancy between self-reported and objectively assessed MVPA within the same individual is greater up to 48 months post-RYGB compared to before surgery. To help bariatric patients understand and hopefully increase their physical activity behaviors post-surgery, objective measures of physical activity should be used.
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Affiliation(s)
- Sofie Possmark
- Department of Global Public Health, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden.
| | - Fanny Sellberg
- Department of Global Public Health, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, 801 76, Gävle, Sweden
| | - Per Tynelius
- Department of Global Public Health, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden
| | | | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden
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Willmer M, Westerberg Jacobson J, Lindberg M. Exploratory and Confirmatory Factor Analysis of the 9-Item Utrecht Work Engagement Scale in a Multi-Occupational Female Sample: A Cross-Sectional Study. Front Psychol 2019; 10:2771. [PMID: 31866921 PMCID: PMC6909847 DOI: 10.3389/fpsyg.2019.02771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/25/2019] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of the present study was to use exploratory and confirmatory factor analysis (CFA) to investigate the factorial structure of the 9-item Utrecht work engagement scale (UWES-9) in a multi-occupational female sample. Methods A total of 702 women, originally recruited as a general population of 7-15-year-old girls in 1995 for a longitudinal study, completed the UWES-9. Exploratory factor analysis (EFA) was performed on half the sample, and CFA on the other half. Results Exploratory factor analysis showed that a one-factor structure best fit the data. CFA with three different models (one-factor, two-factor, and three-factor) was then conducted. Goodness-of-fit statistics showed poor fit for all three models, with RMSEA never going lower than 0.166. Conclusion Despite indication from exploratory factor analysis (EFA) that a one-factor structure seemed to fit the data, we were unable to find good model fit for a one-, two-, or three-factor model using CFA. As previous studies have also failed to reach conclusive results on the optimal factor structure for the UWES-9, further research is needed in order to disentangle the possible effects of gender, nationality and occupation on work engagement.
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Affiliation(s)
- Mikaela Willmer
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Josefin Westerberg Jacobson
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Lindberg
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Sellberg F, Ghaderi A, Willmer M, Tynelius P, Berglind D. Change in Children's Self-Concept, Body-Esteem, and Eating Attitudes Before and 4 Years After Maternal RYGB. Obes Surg 2019; 28:3276-3283. [PMID: 29911273 PMCID: PMC6153582 DOI: 10.1007/s11695-018-3348-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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. Electronic supplementary material The online version of this article (10.1007/s11695-018-3348-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fanny Sellberg
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1E, 113 65, Stockholm, Sweden.
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, 801 76, Gävle, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden
| | - Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden
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Sellberg F, Possmark S, Willmer M, Tynelius P, Berglind D. 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 trial. Surg Obes Relat Dis 2019; 15:1731-1737. [PMID: 31427224 DOI: 10.1016/j.soard.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 01/17/2023]
Abstract
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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Affiliation(s)
- Fanny Sellberg
- Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
| | - Sofie Possmark
- Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden
| | - Mikaela Willmer
- University of Gävle, Department of Health and Caring Sciences, Gävle, Sweden
| | - Per Tynelius
- Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Daniel Berglind
- Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden
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Willmer M, Salzmann-Erikson M. 'The only chance of a normal weight life': A qualitative analysis of online forum discussions about bariatric surgery. PLoS One 2018; 13:e0206066. [PMID: 30359394 PMCID: PMC6201906 DOI: 10.1371/journal.pone.0206066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/06/2018] [Indexed: 01/08/2023] Open
Abstract
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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Affiliation(s)
- Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
- * E-mail:
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Sellberg F, Possmark S, Ghaderi A, Näslund E, Willmer M, Tynelius P, Thorell A, Sundbom M, Uddén J, Szabo E, Berglind D. 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 trial. BMC Surg 2018; 18:25. [PMID: 29743040 PMCID: PMC5944022 DOI: 10.1186/s12893-018-0358-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/02/2018] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Fanny Sellberg
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden.
| | - Sofie Possmark
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Erik Näslund
- Division of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, SE-801 76, Gävle, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, SE-104 31, Stockholm, Sweden
| | - Anders Thorell
- Department of Clinical Science at Danderyd Hospital, Karolinska Institutet, SE-116 91, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, SE-116 91, Stockholm, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Joanna Uddén
- Department of Medicine, Karolinska Institutet, SE-141 86, Stockholm, Sweden.,Department of Endocrine and Obesity, Capio st Görans Hospital, SE-141 86, Stockholm, Sweden
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden
| | - Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden
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Berglind D, Nyberg G, Willmer M, Persson M, Wells M, Forsell Y. 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. Trials 2018; 19:258. [PMID: 29703242 PMCID: PMC5923004 DOI: 10.1186/s13063-018-2646-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
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 Electronic supplementary material The online version of this article (10.1186/s13063-018-2646-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Gisela Nyberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | | | - Michael Wells
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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11
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Sellberg F, Willmer M, Tynelius P, Berglind D. Four years' follow-up changes of physical activity and sedentary time in women undergoing roux-en-Y gastric bypass surgery and appurtenant children. BMC Surg 2017; 17:133. [PMID: 29228941 PMCID: PMC5725979 DOI: 10.1186/s12893-017-0318-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/20/2017] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
- Fanny Sellberg
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, 801 76, Gävle, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden
| | - Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, K9, Social Medicin, SE-171 77, Stockholm, Sweden.
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12
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Willmer M, Salzmann-Erikson M. “The Only Chance of a Normal Weight Life”
A qualitative analysis of online forum discussions about bariatric surgery. (Preprint). J Med Internet Res 2017. [DOI: 10.2196/jmir.9520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Thern E, Jia T, Willmer M, de Munter J, Norström T, Ramstedt M, Davey Smith G, Tynelius P, Rasmussen F. No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades: a natural experiment. J Epidemiol Community Health 2017; 71:1072-1077. [PMID: 28923835 DOI: 10.1136/jech-2017-209164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/17/2017] [Accepted: 09/01/2017] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Emelie Thern
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ting Jia
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Jeroen de Munter
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Mats Ramstedt
- The Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
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14
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Hansson LM, Heitmann BL, Larsson C, Tynelius P, Willmer M, Rasmussen F. Associations Between Swedish Mothers' and 3- and 5-Year-Old Children's Food Intake. J Nutr Educ Behav 2016; 48:520-529.e1. [PMID: 27422494 DOI: 10.1016/j.jneb.2016.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/23/2016] [Accepted: 05/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate associations between mothers' and children's food intake. DESIGN Cross-sectional study. Background variables collected through self-reports and from the register of the total population. Mothers recorded their own and their children's food intake in a diary during 2 4-day periods. SETTING Eight counties in mid Sweden. PARTICIPANTS Three- and 5-year-old children and their mothers were randomly selected from the register of the total population. A total of 2,045 families were invited, 355 of whom accepted. Mothers who accepted were older and to a larger extent born in Sweden. The final sample of mother-child pairs with complete food records was 189. MAIN OUTCOME MEASURES Mothers' and children's food intake (16 food items). ANALYSIS Spearman rank-order correlation with 95% confidence intervals (2-sided). Moderation was investigated using generalized estimation equations with robust variance. RESULTS The strongest correlations between mothers' and children's food intake were found for pizza and oily fish (r = .70-.80). The weakest correlations were found for sugared drinks and fruit and berries (r = .24-.26). Children's age moderated the relationship between mothers' and children's intake of savoury snacks, as did place of residence for pizza intake. CONCLUSIONS AND IMPLICATIONS There were substantial correlations between children's and mothers' intake of various foods. Modeling of mothers' intake might be more effective in influencing young children's intake of certain foods, whereas other strategies, such as encouraging parents to influence food availability (eg, gatekeeping), might be more useful for some foods.
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Affiliation(s)
- Lena M Hansson
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Berit L Heitmann
- Research Unit for Dietary Studies, Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark; Boden Institute of Obesity, Nutrition, Exercise, and Eating Disorders, University of Sydney, Sydney, Australia; National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christel Larsson
- Department of Food and Nutrition, Umeå University, Umeå, Sweden; Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Per Tynelius
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mikaela Willmer
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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15
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Berglind D, Müller P, Willmer M, Sinha I, Tynelius P, Näslund E, Dahlman-Wright K, Rasmussen F. Differential methylation in inflammation and type 2 diabetes genes in siblings born before and after maternal bariatric surgery. Obesity (Silver Spring) 2016; 24:250-61. [PMID: 26637991 DOI: 10.1002/oby.21340] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/20/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Siblings born before (BMS) and after (AMS) maternal biliopancreatic diversion (BPD) show differences in the methylome. The objective was to use a sibling-pair design to examine the effects from interpregnancy weight loss as a consequence of maternal bariatric surgery, other than BPD, on the methylome comparing BMS and AMS. METHODS Women with at least one child born before and one after bariatric surgery were identified in Swedish national registers. Whole blood samples from BMS (N = 31) and AMS (N = 31) siblings were collected for epigenetic methylation analysis while maternal information was collected from antenatal medical records. RESULTS In total 3,074 genes, with corresponding 23,449 CpG methylation sites, were differently methylated and associated with an overrepresentation of differently methylated CpG sites in genes involved with insulin receptor signaling, type 2 diabetes signaling, and leptin signaling in obesity, while the most significant differently methylated genes were HLA-DQA1, HLA-DQB1, and TSPAN18, when comparing BMS and AMS siblings. CONCLUSIONS These results suggest that maternal bariatric surgery, with subsequent weight loss between pregnancies, is associated with alterations in the methylome of genes involved in insulin receptor signaling, type 2 diabetes signaling, and leptin signaling in obesity in a comparison of BMS and AMS siblings.
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Affiliation(s)
- Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Patrick Müller
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Indranil Sinha
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Erik Näslund
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Karin Dahlman-Wright
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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16
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Berglind D, Willmer M, Tynelius P, Ghaderi A, Näslund E, Rasmussen F. Accelerometer-Measured Versus Self-Reported Physical Activity Levels and Sedentary Behavior in Women Before and 9 Months After Roux-en-Y Gastric Bypass. Obes Surg 2015; 26:1463-70. [DOI: 10.1007/s11695-015-1971-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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17
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Berglind D, Willmer M, Eriksson U, Thorell A, Sundbom M, Uddén J, Raoof M, Hedberg J, Tynelius P, Näslund E, Rasmussen F. Longitudinal assessment of physical activity in women undergoing Roux-en-Y gastric bypass. Obes Surg 2015; 25:119-25. [PMID: 24934315 DOI: 10.1007/s11695-014-1331-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients undergoing bariatric surgery do not seem to increase objectively measured physical activity (PA) after surgery, despite substantial weight loss. The aims of the present study were (i) to objectively characterize 3 months pre-surgery to 9 months postsurgery PA and sedentary behavior changes in women undergoing Roux-en-Y gastric bypass (RYGB) using tri-axial accelerometers and (ii) to examine associations between pre-surgery versus postsurgery PA and sedentary behavior with anthropometric measures taken in home environment. METHODS Fifty-six women, with an average pre-surgery body mass index (BMI) of 37.6 (SD 2.6) and of age 39.5 years (SD 5.7), were recruited at five Swedish hospitals. PA was measured for 1 week by the Actigraph GT3X+ accelerometer, and anthropometric measures were taken at home visits 3 months pre-surgery and 9 months postsurgery, thus limiting seasonal effects. RESULTS Average BMI loss, 9 months postsurgery, was 11.7 (SD 2.7) BMI units. There were no significant pre- to postsurgery differences in PA or sedentary behavior. However, pre-surgery PA showed negative association with PA change and positive association with postsurgery PA. Adjustments for pre-surgery BMI had no impact on these associations. CONCLUSIONS No significant differences were observed in objectively measured changes in PA or time spent sedentary from 3 months pre-surgery to 9 months postsurgery among women undergoing RYGB. However, women with higher pre-surgery PA decreased their PA postsurgery while women with lower pre-surgery PA increased their PA.
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Affiliation(s)
- Daniel Berglind
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Widerströmska Huset, 171 77, Stockholm, Sweden
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18
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Berglind D, Willmer M, Näslund E, Tynelius P, Sørensen TIA, Rasmussen F. Differences in gestational weight gain between pregnancies before and after maternal bariatric surgery correlate with differences in birth weight but not with scores on the body mass index in early childhood. Pediatr Obes 2014; 9:427-34. [PMID: 24339139 DOI: 10.1111/j.2047-6310.2013.00205.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/23/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Large maternal gestational weight gain (GWG) is associated with increased birth weight and increased risk of obesity in offspring, but these associations may be confounded by genetic and environmental factors. The aim was to investigate the effects of differences in GWG in all three trimesters on differences in birth weight and in body mass index (BMI) scores at 4 and 6 years of age, within siblings born before and after bariatric surgery. METHOD Women with at least one child born before and one after bariatric surgery were identified in national Swedish registers. Series of weight (and height) measurements were collected from antenatal medical records, with data on the nearest pregnancies before and after bariatric surgery. RESULTS The age-adjusted means of pre- and post-operative GWG of 124 women were 11.3 (standard deviation [SD] 7.2) and 8.3 (SD 6.4) kg, respectively (P = 0.01). Adjusted fixed effects regression models showed positive associations of differences in mean total GWG with differences in siblings' birth weight, 0.023 kg per 1-kg greater weight gain (95% confidence interval [CI]: 0.014-0.069) and for second trimester 0.53 kg for each 1-kg greater weight per week (95% CI: 0.32-1.61), whereas no associations were found with BMI in pre-school age. CONCLUSION This study showed positive associations between differences in total and second trimester maternal GWG and differences in children's birth weight, but no association with BMI scores in pre-school age. Maternal genetic, social and lifestyle factors fixed from one pregnancy to the next were taken into account in the analyses by the study design.
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Affiliation(s)
- D Berglind
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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19
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Willmer M, Berglind D, Thorell A, Sundbom M, Uddén J, Raoof M, Hedberg J, Tynelius P, Ghaderi A, Näslund E, Rasmussen F. Changes in BMI and Psychosocial Functioning in Partners of Women Who Undergo Gastric Bypass Surgery for Obesity. Obes Surg 2014; 25:319-24. [DOI: 10.1007/s11695-014-1398-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Döring N, Hansson LM, Andersson ES, Bohman B, Westin M, Magnusson M, Larsson C, Sundblom E, Willmer M, Blennow M, Heitmann BL, Forsberg L, Wallin S, Tynelius P, Ghaderi A, Rasmussen F. Primary prevention of childhood obesity through counselling sessions at Swedish child health centres: design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised trial. BMC Public Health 2014; 14:335. [PMID: 24717011 PMCID: PMC3995501 DOI: 10.1186/1471-2458-14-335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/02/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. METHODS/DESIGN The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children's body mass index and waist circumference at four years. Secondary outcomes are children's and mothers' eating habits (assessed by a food frequency questionnaire), and children's and mothers' physical activity (measured by accelerometer and a validated questionnaire), and mothers' body mass index and waist circumference. DISCUSSION The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control group, before they reached 10 months of age). The food frequency questionnaire showed acceptable relative validity when compared with an 8-day food diary. We are not aware of any previous RCT, concerned with the primary prevention of childhood obesity through sessions at CHC that addresses healthy eating habits and physical activity in the context of a routine child health services programme. TRIAL REGISTRATION ISRCTN16991919.
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Affiliation(s)
- Nora Döring
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Lena M Hansson
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Elina Scheers Andersson
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychology, Stockholm, Sweden
| | - Maria Westin
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Margaretha Magnusson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Christel Larsson
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
- Department of Food and Nutrition, Umeå University, Umeå, Sweden
| | - Elinor Sundblom
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Margareta Blennow
- Department of Clinical Science and Education, Child Health Services, Södersjukhuset, Stockholm, Sweden
| | - Berit L Heitmann
- Research Unit for Dietary Studies, Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorder, University of Sydney, Sydney, Australia
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institutet, Centre of Psychiatry Research, Stockholm, Sweden
| | - Sanna Wallin
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychology, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet, Child and Adolescent Public Health Epidemiology, Tomtebodavägen 18A, Stockholm SE-171 77, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Health Care Services, Stockholm, Sweden
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Willmer M, Szardien S, Kraft D, Voss S, Troidl C, Hoffmann J, Liebetrau C, Nef H, Hamm C, Moellmann H. Extracellular matrix remodeling in early cardiac fibrosis and diastolic dysfunction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Liebetrau C, Doerr O, Moellmann H, Szardien S, Troidl C, Gaede L, Willmer M, Rixe J, Hamm C, Nef H. Release kinetics of circulating micrornas in patients undergoing transcoronary ablation of septal hypertrophy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Leick J, Liebetrau C, Szardien S, Gross S, Blumenstein J, Willmer M, Nef H, Rolf A, Hamm C, Moellmann H. Extracorporeal life support in patients with in-hospital cardiac arrest. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hoffmann J, Ospelt M, Troidl C, Voss S, Willmer M, Szardien S, Liebetrau C, Hamm C, Nef H, Moellmann H. Monocyte subset kinetics in a mouse model of myocardial infarction: impact of inter-individual heterogeneity and sham surgery procedures. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Doerr O, Liebetrau C, Moellmann H, Rixe J, Troidl C, Hecker F, Szardien S, Willmer M, Hamm C, Nef H. Soluble fms-like tyrosine kinase-1 (sFLT-1) and endothelial Adhesion Molecules (ICAM-1 and VCAM-1) as predictive markers for blood pressure reduction after renal sympathetic denervation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Möllmann H, Nef HM, Voss S, Troidl C, Willmer M, Szardien S, Rolf A, Klement M, Voswinckel R, Kostin S, Ghofrani HA, Hamm CW, Elsässer A. Stem cell-mediated natural tissue engineering. J Cell Mol Med 2011; 15:52-62. [PMID: 19941631 PMCID: PMC3822493 DOI: 10.1111/j.1582-4934.2009.00972.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Recently, we demonstrated that a fully differentiated tissue developed on a ventricular septal occluder that had been implanted due to infarct-related septum rupture. We suggested that this tissue originated from circulating stem cells. The aim of the present study was to evaluate this hypothesis and to investigate the physiological differentiation and transdifferentiation potential of circulating stem cells. We developed an animal model in which a freely floating membrane was inserted into each the left ventricle and the descending aorta. Membranes were removed after pre-specified intervals of 3 days, and 2, 6 and 12 weeks; the newly developed tissue was evaluated using quantitative RT-PCR, immunohistochemistry and in situ hybridization. The contribution of stem cells was directly evaluated in another group of animals that were by treated with granulocyte macrophage colony-stimulating factor (GM-CSF) early after implantation. We demonstrated the time-dependent generation of a fully differentiated tissue composed of fibroblasts, myofibroblasts, smooth muscle cells, endothelial cells and new blood vessels. Cells differentiated into early cardiomyocytes on membranes implanted in the left ventricles but not on those implanted in the aortas. Stem cell mobilization with GM-CSF led to more rapid tissue growth and differentiation. The GM-CSF effect on cell proliferation outlasted the treat ment period by several weeks. Circulating stem cells contributed to the development of a fully differentiated tissue on membranes placed within the left ventricle or descending aorta under physiological conditions. Early cardiomyocyte generation was identified only on membranes positioned within the left ventricle.
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Affiliation(s)
- H Möllmann
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany.
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Troidl C, Möllmann H, Nef H, Masseli F, Voss S, Szardien S, Willmer M, Rolf A, Rixe J, Troidl K, Kostin S, Hamm C, Elsässer A. Classically and alternatively activated macrophages contribute to tissue remodelling after myocardial infarction. J Cell Mol Med 2009; 13:3485-96. [PMID: 19228260 PMCID: PMC4516503 DOI: 10.1111/j.1582-4934.2009.00707.x] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
An important goal in cardiology is to minimize myocardial necrosis and to support a discrete but resilient scar formation after myocardial infarction (MI). Macrophages are a type of cells that influence cardiac remodelling during MI. Therefore, the goal of the present study was to investigate their transcriptional profile and to identify the type of activation during scar tissue formation. Ligature of the left anterior descending coronary artery was performed in mice. Macrophages were isolated from infarcted tissue using magnetic cell sorting after 5 days. The total RNA of macrophages was subjected to microarray analysis and compared with RNA from MI and LV-control. mRNA abundance of relevant targets was validated by quantitative real-time PCR 2, 5 and 10 days after MI (qRT-PCR). Immunohistochemistry was performed to localize activation type-specific proteins. The genome scan revealed 68 targets predominantly expressed by macrophages after MI. Among these targets, an increased mRNA abundance of genes, involved in both the classically (tumour necrosis factor α, interleukin 6, interleukin 1β) and the alternatively (arginase 1 and 2, mannose receptor C type 1, chitinase 3-like 3) activated phenotype of macrophages, was found 5 days after MI. This observation was confirmed by qRT-PCR. Using immunohistochemistry, we confirmed that tumour necrosis factor α, representing the classical activation, is strongly transcribed early after ligature (2 days). It was decreased after 5 and 10 days. Five days after MI, we found a fundamental change towards alternative activation of macrophages with up-regulation of arginase 1. Our results demonstrate that macrophages are differentially activated during different phases of scar tissue formation after MI. During the early inflammatory phase, macrophages are predominantly classically activated, whereas their phenotype changes during the important transition from inflammation to scar tissue formation into an alternatively activated type.
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Affiliation(s)
- C Troidl
- Franz-Groedel-Institute of the Kerckhoff-Heart-Center, Bad Nauheim, Germany.
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