| 1. |
- Almqvist, Kerstin, et al.
(författare)
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Lyssna bättre på barnen som drabbas av familjevåld
- 2007
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Ingår i: DN Debatt, 2007-08-18.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Rädda Barnen och en rad experter slår larm: Socialtjänst och domstolar tar inte barnens rätt på tillräckligt stort allvar. När barn drabbas av våld och övergrepp i familjen bortser myndigheterna från barnens egna berättelser och upplevelser. Deras rätt till stöd och behandling fungerar inte i praktiken. Socialtjänst och domstolar tar inte sina arbetsuppgifter på tillräckligt stort allvar. Ansvariga myndigheter sätter vuxnas rättigheter före barnens och ser inte problemen ur de drabbades perspektiv. Det skriver en lång rad experter som arbetar med barn som utsatts för våld i familjen.
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| 2. |
- Ekbom, Kerstin
(författare)
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Intravenous access in distressed children : effects of midazolam and nitrous oxide on success rate, hormone and metabolic stress responses
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and Aims: Intravenous (IV) access has demonstrated high levels of pain and distress in children. A stress full IV access should be avoided, primarily by the children, but also for the parents and staff. When testing children with suspected endocrine and metabolic disorders there is a substantial risk that a stressful IV access influences the hormone releases and metabolic response. The aims of this thesis were to facilitate painful procedures and IV access in children at a paediatric outpatient clinic. To study the feasibility, effects and stress response of Nitrous Oxide (N2O) compared to Midazolam and EMLA alone in children with endocrine disorders and obesity. Material and Methods: Children with anxiety or previous difficulties establishing IV access were included (n=140). 50 children were openly randomised to EMLA (n=25) or EMLA+ N2O (n=25). 90 children (60 obese and 30 growth retarded) were double blinded randomised to; midazolam, 0.3mg/kg, max 15 mg, (n=30), 50% N2O (n=30), and to 10% N2O (n=30). A subgroup of 20 anxious children undergoing repeatedly painful procedures was also included. These children underwent two procedures with EMLA and EMLA+N2O, the order of priority being randomised. Measurments: Number of attempts; defined both as the number required to succeed in setting up double IV lines, and as a successful IV line procedure with 2 attempts for two iv lines vs >2 attempts, IV access time; defined as time from start of setting up the IV lines until two IV lines were established. Recovery time; defined as the time from establishment of the IV lines until regained alertness. Total procedure time; defined as IV access time plus recovery time. Evaluations; children’s, parents’ and nurses’ satisfaction of the IV line procedure, Pain; evaluated by the child. Sedation levels; assessed using the Observer’s Assessment of Alertness/Sedation Score. Blood samples were obtained during 30 minutes at four time points after achieving venous access and, if possible, after 24 hours. 1; 0−1 min, 2; 5−6 min, 3; 14−15 min, and 4; 29−30 min. Analyses were compared between treatments and treatments over time. 60 children (40 obese and 20 growth retarded), served as controls. Results: Comparing all study children together with IV access problems, a significant difference in number of attempts between the treatments groups were seen (P<0.001) with differences between midazolam compared with 50% N2O and EMLA compared with midazoalm, 10%, 50% N2O. The percentage of successfully IV line procedures were 70% using 50% N2O. The children’s evaluations were significantly more positive for 50% N2O during IV access and painful procedures. 50% N2O was more efficient measured as total procedure time (P<0.001) and especially in obese children an unfavourable long procedure time was observed after midazolam. Significantly lower cortisol levels were detected when midazolam was used compared to both 50% and 10% N2O and to unstressed controls. Glucose levels among growth retarded children increased from 0 to 30 min, whereas the opposite was found in obese children regardless of treatment. The growth hormone levels decreased with time in the midazolam group compared to 50% and 10% N2O, where the effect of time was reversed. Conclusion: 50% N2O in combination with EMLA, was in all aspects superior to midazolam for facilitation of IV access for distressed children. The IV access procedure was more efficient, with a shorter total procedure time and an increased number of successful IV lines. Midazolam should only be used exceptionally in obese children due to the long recovery time. Treatment with N2O and midazolam influence the results of hormone analyses in the form of different levels and trends in glucose and stress hormones.
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| 3. |
- Ekstedt, Mirjam, et al.
(författare)
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Sleep differences in one-year-old children were related to obesity risks based on their parents' weight according to baseline longitudinal study data
- 2017
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 106:2, s. 304-311
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Parental obesity is the predominant risk factor for child obesity. We compared sleep in one-year-old children with different obesity risks, based on parental weight, and explored associations with weight, parental sleep and family factors.METHODS: Baseline data from 167 families participating in a longitudinal obesity prevention programme was used. Sleep patterns were compared between groups with high and low obesity risks, based on parental weight, and associations between child sleep and weight status, family obesity risk and parental sleep were explored. Sleep was assessed using child sleep diaries and standard parental questionnaires.RESULTS: Later bedtime, longer sleep onset latency and lower sleep efficiency were observed among children in the high-risk group. Child sleep onset latency was associated with the family obesity risk (β = 0.25, p = 0.001), child bedtime with both maternal (β = 0.33, p < 0.01) and paternal bedtime (β = 0.22, p < 0.05) and child sleep efficiency with maternal sleep quality (β = 0.20, p < 0.01). The child's bedtime was weakly associated with their body mass index (β = 0.17, p < 0.05).CONCLUSION: Sleep differed between one-year-old children with high or low obesity risks, based on their parents' body mass index, and was associated with the family obesity risk and parental sleep. The child's bedtime was weakly associated with their weight status.
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| 4. |
- Göthberg, Gunnar, et al.
(författare)
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Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid obesity-Surgical aspects and clinical outcome.
- 2014
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Ingår i: Seminars in pediatric surgery. - : Elsevier BV. - 1532-9453 .- 1055-8586. ; 23:1, s. 11-16
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we address surgical aspects on bariatric surgery in adolescents from a nationwide Swedish study. Laparoscopic gastric bypass surgery was performed for 81 adolescents with morbid obesity (13-18 years), while 81 adolescents with obesity-matched by age, sex, and BMI received conventional care. Another comparison group was adults undergoing gastric bypass at the same institution during the same time period. This report addresses the 2-year clinical outcome and five-year surgical adverse event rate. Body weight decreased from 133kg (SD = 22) at inclusion to 92kg (SD = 17) after 1 year and was 89 (SD = 18) after 2 years (p < 0·001) representing a 32% (-35 to -30) weight loss after 2 years, corresponding to 76% (-81 to -71) excess weight loss. Weight loss was similar in the adult gastric bypass patients (-31%) while weight gain (+3%) was seen in the conventionally treated obese adolescents. Significant improvement in cardiovascular and metabolic risk factors and inflammation was seen after surgery. The treatment was generally well tolerated and quality of life improved significantly. The surgical adverse events included cholecystectomies (10%) and operations for internal hernia (9%) but no postoperative mortality. Adolescents undergoing laparoscopic gastric bypass surgery achieve similar weight loss to adults. Improvements in risk factors and quality of life were substantial. There were surgical complications similar to the adult group, which may be preventable.
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| 5. |
- Hagman, Emilia, et al.
(författare)
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Oral intake of mesoporous silica is safe and well tolerated in male humans
- 2020
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:10
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Tidskriftsartikel (refereegranskat)abstract
- Background Precisely engineered mesoporous silica has been shown to induce weight loss in mice, but whether it is safe to use in humans have not investigated.Objective The aim was to determine whether oral dosing, up to 9 grams/day, of precisely engineered mesoporous silica as a food additive can be used safely in male humans.Design This single blinded safety study consisted of two study arms including 10 males each (18-35 years). One arm consisted of participants with normal weight and one with obesity. After a placebo run-in period, all subjects were given porous silica three times daily, with increasing dose up to 9 grams/day (Phase 1). Subjects with obesity continued the study with highest dose for additional 10 weeks (Phase 2).Results All participants completed Phase 1 and 90% completed Phase 2, with approximately 1% missed doses. Participants reported no abdominal discomfort, and changes in bowel habits were minor and inconsistent. The side effects observed were mild and tolerable, biomarkers did not give any safety concern, and no severe adverse events occurred.Conclusion Mesoporous silica intake of up to 9 grams/day can be consumed by males without any major adverse events or safety concerns.
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| 7. |
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| 8. |
- Nordin, Karin, et al.
(författare)
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Adolescents’ experiences of obesity surgery : a qualitative study
- 2018
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289 .- 1878-7533. ; 14:8, s. 1157-1162
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:The positive effects of behavioural treatment and weight management in adolescents with severe obesity are modest. Obesity surgery can be an option for adolescents, but is not the first-hand choice of treatment. The knowledge about adolescents' own experiences of having undergone surgery and their thoughts and feelings of the follow-up period are limited.OBJECTIVES:To describe adolescents' decision to go through obesity surgery as teenager and their experiences of the follow-up period.SETTING:National Childhood Obesity Centre at Karolinska University Hospital in Stockholm, Sweden.METHODS:Phone interviews with 20 young adults that went through obesity surgery as teenagers. Interviews were analysed with qualitative systematic text condensation.RESULTS:"Lost in the healthcare system" and "A rough but well worth journey to a healthier life" were the categories that appeared in our analysis. The participant had a feeling of uncertainty about contacts with the healthcare system and the transition to primary care was confusing. Most of the participants were happy with the decision to go through obesity surgery as teenager, despite it had been a difficult time.CONCLUSIONS:Our results show implications for improving the clinical care of adolescents undergoing obesity surgery, which should be offered as a last choice. Information and individualized supports should be offered more often during first year postsurgery and should be given by a multidisciplinary team. This multifaceted population should be given priority for a successful transition.
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| 9. |
- Olbers, Torsten, 1964, et al.
(författare)
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Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS) : a prospective, 5-year, Swedish nationwide study
- 2017
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Ingår i: The Lancet Diabetes and Endocrinology. - 2213-8595. ; 5:3, s. 174-183
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Severe obesity in adolescence is associated with reduced life expectancy and impaired quality of life. Long-term benefits of conservative treatments in adolescents are known to be modest, whereas short-term outcomes of adolescent bariatric surgery are promising. We aimed to compare 5-year outcomes of adolescent surgical patients after Roux-en-Y gastric bypass with those of conservatively treated adolescents and of adults undergoing Roux-en-Y gastric bypass, in the Adolescent Morbid Obesity Surgery (AMOS) study.METHODS: We did a nationwide, prospective, non-randomised controlled study of adolescents (aged 13-18 years) with severe obesity undergoing Roux-en-Y gastric bypass at three specialised paediatric obesity treatment centres in Sweden. We compared clinical outcomes in adolescent surgical patients with those of matched adolescent controls undergoing conservative treatment and of adult controls undergoing Roux-en-Y gastric bypass. The primary outcome measure was change in BMI over 5 years. We used multilevel mixed-effect regression models to assess longitudinal changes. This trial is registered with ClinicalTrials.gov, number NCT00289705.FINDINGS: Between April, 2006, and May, 2009, 100 adolescents were recruited to the study, of whom 81 underwent Roux-en-Y gastric bypass (mean age 16·5 years [SD 1·2], bodyweight 132·8 kg [22·1], and BMI 45·5 kg/m(2) [SD 6·1]). 80 matched adolescent controls and 81 matched adult controls were enrolled for comparison of outcomes. The change in bodyweight in adolescent surgical patients over 5 years was -36·8 kg (95% CI -40·9 to -32·8), resulting in a reduction in BMI of -13·1 kg/m(2) (95% CI -14·5 to -11·8), although weight loss less than 10% occurred in nine (11%). Mean BMI rose in adolescent controls (3·3 kg/m(2), 95% CI 1·1-4·8) over the 5-year study period, whereas the BMI change in adult controls was similar to that in adolescent surgical patients (mean change -12·3 kg/m(2), 95% CI -13·7 to -10·9). Comorbidities and cardiovascular risk factors in adolescent surgical patients showed improvement over 5 years and compared favourably with those in adolescent controls. 20 (25%) of 81 adolescent surgical patients underwent additional abdominal surgery for complications of surgery or rapid weight loss and 58 (72%) showed some type of nutritional deficiency; health-care consumption (hospital attendances and admissions) was higher in adolescent surgical patients compared with adolescent controls. 20 (25%) of 81 adolescent controls underwent bariatric surgery during the 5-year follow-up.INTERPRETATION: Adolescents with severe obesity undergoing Roux-en-Y gastric bypass had substantial weight loss over 5 years, alongside improvements in comorbidities and risk factors. However, gastric bypass was associated with additional surgical interventions and nutritional deficiencies. Conventional non-surgical treatment was associated with weight gain and a quarter of patients had bariatric surgery within 5 years.FUNDING: Swedish Research Council; Swedish Governmental Agency for Innovation Systems; National Board of Health and Welfare; Swedish Heart and Lung Foundation; Swedish Childhood Diabetes Foundation; Swedish Order of Freemasons Children's Foundation; Stockholm County Council; Västra Götaland Region; Mrs Mary von Sydow Foundation; Stiftelsen Göteborgs Barnhus; Stiftelsen Allmänna Barnhuset; and the US National Institute of Diabetes, Digestive, and Kidney Diseases (National Institutes of Health).
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