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- 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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- Klang, Nina, 1978-, et al.
(författare)
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Barn med flerfunktionsnedsättning - samspel och social inkludering : Rapport från ett samverkansprojekt
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Vi presenterar en rapport från ett samarbetsprojekt mellan lärare från en skola i Uppsala och forskare från Uppsala och Stockholms universitet. Idén till projektet uppkom i samband med en AIMday funktionshinder, då lärarna i en grundsärskoleklass med elever med flerfunktionsnedsättning kom med frågan “Hur främjar man inkludering?” Några år innan projektet startade flyttades grundsärskolan till lokaler som är avgränsade från resten av skolan. Skolgårdarna låg inte nära varandra vilket innebar att eleverna från grundsärskolan och grundskolan inte möttes naturligt på rasterna. Organisationen förändrades också så att olika rektorer ansvarade för grundsärskolan och grundskolan. Lärarna på grundsärskolan upplevde att deras elever var isolerade och att de skulle ha glädje av mer kontakt med elever från grundskolan. För att få till stånd en förändring påbörjade de ett samarbete med förskoleklassen där eleverna från förskoleklassen besökte grundsärskoleklassen. Lärarna ville ha stöd från forskare i projektet. Ett samarbete startade och lekaktiviteter för att främja samspelet mellan barn med och utan funktionsnedsättningar prövades. Forskarna deltog som bollplank, följde lekaktiviteterna med hjälp av videoobservationer och intervjuer. Forskarna och lärarna diskuterade och dokumenterade de rutiner lärarna redan påbörjat. Projektet genomfördes med stöd från Vinnova Step-up och Forum för samverkan vid Uppsala universitet.
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- 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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