| 1. |
- Fredriksson, Fanny, 1985-, et al.
(författare)
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Sutures impregnated with carbazate-activated polyvinyl alcohol reduce intraperitoneal adhesions
- 2017
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Ingår i: Journal of Pediatric Surgery. - : Elsevier BV. - 0022-3468 .- 1531-5037. ; 52:11, s. 1853-1858
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intraperitoneal adhesions cause significant morbidity. They occur after peritoneal trauma, which induces oxidative stress with production of inflammatory cytokines, peroxidized proteins (carbonyls) and lipids (aldehydes). This study aimed to investigate if carbazate-activated polyvinyl alcohol (PVAC), an aldehyde-carbonyl inhibitor, can reduce intraperitoneal adhesions in an experimental model.Material and methods: Male Sprague-Dawley rats (n = 110) underwent laparotomy, cecal abrasion and construction of a small bowel anastomosis. They either were treated with intraperitoneal instillation of PVAC or were sutured with PVAC-impregnated sutures. Thromboelastography analysis was performed using human blood and PVAC. The lipid peroxidation product malondialdehyde (MDA) and inflammatory cytokines IL-1 beta and IL-6 were quantified in peritoneal fluid. At day 7, bursting pressure of the anastomosis was measured and adhesions were blindly scored.Results: PVAC in human blood decreased the production of the fibrin-thrombocyte mesh without affecting the coagulation cascade. MDA, IL-1 beta and IL-6 were increased after 6 h without significant difference between the groups. PVAC-impregnated sutures reduced intraperitoneal adhesions compared to controls (p = 0.0406) while intraperitoneal instillation of PVAC had no effect. Anastomotic bursting pressure was unchanged.Conclusions: Intervention with an aldehyde-carbonyl inhibitor locally in the wound by PVAC-impregnated sutures might be a new strategy to reduce intraperitoneal adhesions.
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| 2. |
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| 3. |
- Nowicka, Paulina, 1974-, et al.
(författare)
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Systematic Development of National Guidelines for Obesity Care : the Swedish Approach
- 2024
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Ingår i: Obesity Facts. - : S. Karger. - 1662-4025 .- 1662-4033. ; 17:2, s. 183-190
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: With the rapid development of treatment modalities for obesity management, there is a growing need for guidelines. This was acknowledged by the Swedish National Board of Health and Welfare and in 2020 the process of producing the first national guidelines for obesity care, including both children and adults, was initiated. The main aim was to ensure equal high standard care throughout Sweden by supporting decision makers to allocate resources to the best knowledge-based care.METHODS: The standardized procedures of the National Board of Health and Welfare were applied to construct guidelines in a systematic and transparent way, including priority setting of recommendations and quality indicators to evaluate the progress of implementation. The process involved independent expert committees including professionals and patient representatives, and the guidelines were reviewed through an open public consultation.RESULTS: In total, 20 recommendations were issued encompassing a broad scope, from identification and diagnosis to multiple treatment modalities, embedded in a life course perspective from pregnancy to the elderly, as well as highlighting the need for improved knowledge and competence of health care providers.CONCLUSIONS: National guidelines for improved standard care and evidence based and efficient use of health care resources for obesity treatment can be developed in a systematic way with professionals and patient representatives.
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| 4. |
- Nowicka, Paulina, 1974-, et al.
(författare)
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Systematic Development of National Guidelines for Obesity Care: The Swedish Approach
- 2024
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Ingår i: OBESITY FACTS. - : S. Karger. - 1662-4025 .- 1662-4033. ; 17:2, s. 183-190
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: With the rapid development of treatment modalities for obesity management, there is an increasing demand for guidance to facilitate the prioritization of interventions. In 2020, the Swedish National Board of Health and Welfare started the process of producing the first national guidelines for obesity care directed to decision makers who allocate resources to the best knowledge-based care. The main aim of this paper was to describe the systematic development of these guidelines, designed to guarantee uniformly high standards of care throughout the whole country. Methods: The standardized procedures of the National Board of Health and Welfare were applied to construct guidelines in a systematic and transparent way, including priority setting of recommendations and quality indicators to evaluate the progress of implementation. The process involved independent expert committees including professionals and patient representatives, and the guidelines were reviewed through an open public consultation. Results: National guidelines were issued in 2023, encompassing a broad scope, from identification and diagnosis to multiple treatment modalities, embedded in a life-course perspective from pregnancy to the elderly, as well as highlighting the need for improved knowledge and competence of health care providers. Conclusions: National guidelines for improved standard care and evidence-based and efficient use of health care resources for obesity treatment can be developed in a systematic way with professionals and patient representatives.
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| 5. |
- Possmark, Sofie, et al.
(författare)
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Accelerometer-measured versus selfreported physical activity levels in women before and up to 48months after Roux-enY Gastric Bypass
- 2020
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Ingår i: BMC Surgery. - : BioMed Central. - 1471-2482. ; 20:1
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Tidskriftsartikel (refereegranskat)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 48months 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 selfadministered questionnaire and objectively measured by the ActiGraph GT3X+ accelerometer at 3months pre-RYGB and 9- and 48months post-RYGB. Means and SD were calculated at 3months pre- and 9- and 48months postRYGB. 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, selfreported MVPA increased with 46.9 and 36.5% from pre- to 9- and 48months, respectively, whereas changes were a 6.1% increase and 3.5% decrease with accelerometers. Correlations between self-reported and accelerometermeasured MVPA-assessments were poor at all measurement points (r=0.21–0.42) and only significant at 48months post-RYGB (P=0.032).Conclusions: The discrepancy between self-reported and objectively assessed MVPA within the same individual is greater up to 48months 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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| 6. |
- Possmark, Sofie, et al.
(författare)
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Physical activity in women attending a dissonance-based intervention after Roux-en-Y Gastric Bypass : A 2-year follow-up of a randomized controlled trial
- 2021
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Ingår i: PLOS ONE. - : Public Library of Science (PLOS). - 1932-6203. ; 16:11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The majority of Roux-en-Y gastric bypass (RYGB) patients are not sufficiently physically active post-surgery, yet little support from the Swedish healthcare system is offered. We investigated if a dissonance-based group intervention, aiming to increase health-related quality of life after surgery, had any effect on patients' physical activity two years post-RYGB.METHODS: Women undergoing RYGB surgery were recruited from five Swedish hospitals and randomized to intervention or control group (standard post-surgery care). The dissonance-based intervention was conducted three months post-RYGB and consisted of four group sessions, each with a specific topic, of which one addressed physical activity. ActiGraph GT3X+ accelerometers were used to measure physical activity at pre-RYGB, one- and two-years post-surgery.RESULTS: At pre-RYGB, 259 women were recruited and randomized (intervention n = 156 and control n = 103). Participants had a mean age of 44.7 years (SD 10.3) and pre-RYGB body mass index of 40.8 (SD 4.5) kg/m2. At two-years follow-up, 99 participants (63.5%) in intervention group and 68 (66.0%) in control group had valid accelerometer-measurements. Pre- to post-surgery increases were seen in all physical activity outcomes, but no statistically significant differences between the groups were observed at the two-years follow-up, and intervention effects were poor (d = 0.02-0.35).CONCLUSION: To our knowledge, this is the first dissonance-based intervention targeting women undergoing RYGB surgery. At two-years follow-up, we did not observe any differences in physical activity levels between the intervention group and control group.Trial registration number: ISRCTN16417174.
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| 7. |
- Possmark, Sofie, et al.
(författare)
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To be or not to be active – a matter of attitudes and social support? : Women’s perceptions of physical activity five years after Roux-en-Y Gastric Bypass surgery
- 2019
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Despite positive health advantages of post-surgery physical activity (PA) for bariatric surgery patients, the majority is not sufficiently physically active. The aim was to explore women’s perceptions and experiences concerning PA five years after Roux-en-Y Gastric Bypass (RYGB) surgery.Methods: Eleven women were interviewed five years post-surgery. Grounded Theory approach was applied.Results: The core-category “Attitudes and surrounding environment influence activity levels” includes three attitudes towards PA: “Positive attitudes”, “Shifting attitudes” and “Negative attitudes”. Participants with a positive attitude were regularly physically active, felt supported and proud of their achievements. Contrary, participants with a negative attitude didn’t prioritize PA, didn’t feel supported and saw no need or benefit of PA. Some participants revealed an on-off behaviour, hovering between the attitudes of vigorous PA and sedentary lifestyle, without sustainable balance. The majority mostly viewed PA as a mean to lose weight.Conclusion: The level of perceived post-surgery PA was related to the participants’ attitudes towards PA and whether or not they had a supportive environment. These findings might explain why bariatric surgery patients often fail to be sufficiently active post-surgery, and highlight the need for prolonged support and motivational interventions to promote sustainable PA post-bariatric surgery.
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| 8. |
- Sellberg, Fanny, et al.
(författare)
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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
- 2018
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Ingår i: BMC Surgery. - : BioMed Central. - 1471-2482. ; 18:1
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Tidskriftsartikel (refereegranskat)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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| 9. |
- Sellberg, Fanny, et al.
(författare)
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A dissonance-based randomized intervention study to improve quality of life and physical activity 24 months post roux-en-Y gastric bypass surgery
- 2018
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Ingår i: Obesity Surgery. - 0960-8923 .- 1708-0428. ; 28:S2, s. 224-224
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Tidskriftsartikel (refereegranskat)abstract
- Background: Roux-en-Y gastric bypass (RYGB) surgery is usually followed by great weight loss and improved health related quality of life (HRQoL). However, weight regains are seen in some patients approximately 1-2 years post-surgery, associated with a decrease in HRQoL and physical activity (PA).Objectives: To investigate if a dissonance-based group intervention post RYGB surgery has an effect on women’s HRQoL, PA and other health-related behaviors: a protocol paper.Methods: The ongoing RCT is a dissonance-based intervention for female RYGB patients from five Swedish hospitals. Participants are randomized to either control (usual follow-up care) or intervention group (4 sessions, 3 months post-surgery). Main topics of intervention sessions are (1) PA, (2) eating behavior, (3) social and (4) intimate relationships. Participants are asked to wear an accelerometer and complete questionnaires measuring HRQoL (SF-36), social adjustment, eating behavior and body esteem, pre-surgery and 6, 12 and 24 months post-surgery. Planned analysis includes intention to treat and per protocol analysis on differences between intervention and control group. Trial registration number: ISRCTN16417174.Results: We recruited 259 women (156 intervention and 103 controls). Mean BMI was 40.9 ± 4.7, mean SF36 score was 42.1 ± 9.5 (physical component summary score) and 45.8 ± 11.1 (mental component summary score). Mean time spent in moderate to vigorous PA was 28.8 ± 19.4 min/day and sedentary was 458.3 ± 100.4 min/day.Conclusions: This trial aims to improve outcomes after RYGB. If the intervention is effective, implementation within the Swedish health care system is possible within the near future.
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| 10. |
- Sellberg, Felix, et al.
(författare)
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A novel polymer-based carbonyl scavenger for the detection of ischemic tissues
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- PurposePolyvinylalcohol-carbazate (PVAC) is a soluble functionalized polymer acting as a carbonyl scavenger. This study aimed to create a radiolabelled PVAC and investigate the pharmacokinetics and biodistribution of PVAC in naïve animals and ischemia models. MethodsPVAC was labelled using radionuclide [18F]FBA to track the substance with PET. Sprague Dawley rats underwent an ischemic event, either to the hind limb or to the kidney, while others served as controls. To study the pharmacokinetics rats were injected with radiolabelled or fluorochrome labelled PVAC. Radiolabelled PVAC was injected, and animals were followed by PET for 90 min, biodistribution ex vivo was finally examined. Injection of fluorochrome-labelled PVAC was followed by repeated blood sampling to measure the circulating concentration. ResultsIn control animals, PVAC was mainly confined to the bloodstream followed by elimination via kidneys and accumulation in the bladder. Ex vivo biodistribution of PVAC confirmed the highest uptake in urine followed by blood, kidneys and other well-perfused organs. The elimination of I.V. administered PVAC was split into a fast phase (t1/2 = 0.2 h) followed by a slow phase (t1/2 = 10.73 h), with near-complete elimination from blood after 48 h. Both the ischemic kidney (fourfold increase, p = <0.001) and limb models (threefold increase, p = <0.001) demonstrated a higher uptake of PVAC in ischemic tissues, ex vivo radioactivity detection.ConclusionLabelled PVAC, an aldehyde-carbonyl scavenger, is a promising new strategy to detect ischemic tissues. Potential therapeutic effects of PVAC on ischemic injuries should be investigated further.
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