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1.	Berglind, Daniel, et al. (author) 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. 2018 In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 19:1 Journal article (peer-reviewed)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.
2.	Berglind, Daniel, et al. (author) Longitudinal assessment of physical activity in women undergoing Roux-en-Y gastric bypass 2015 In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 25:1, s. 119-125 Journal article (peer-reviewed)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.
3.	Bjuhr, Marie, et al. (author) Women with disturbed eating behavior rate less work engagement 2016 Conference paper (peer-reviewed)abstract There is a lack of research exploring emotional commitment to work in relation to eating attitudes. Since eating disorders are associated with adverse psychological and social consequences, work engagement could be affected. The purpose was to compare work engagement among women with and without disturbed eating (DE).A cross-sectional survey using the Utrecht Work Engagement Scale and the Eating Disorder Examination Questionnaire in a general population cohort of 26-36-year-old women (n=847). Threshold for DE was 1 SD above general population mean. Independent t-test was used to compare work engagement. Ethical approval (reg no:2014/401)The level of work engagement was lower (p=0.02) among women with DE (mean 3.69 +-1.43) than women without DE (mean 4.06 +-1.18). The score for dedication was also lower (p=0.02) within the DE group (mean 3.74+-1.57 vs 4.22 +-1.26). However, vigour and absorption were not different.The work engagement in the cohort was within the average range although women with DE had significantly lower emotional commitment to work. As work engagement is linked to business success, workplace growth and sustainability it seems important to explore tailored strategies to improve work engagement among women with DE.
4.	Doring, Nora, et al. (author) 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 2014 In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14:335 Journal article (peer-reviewed)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.
5.	Hansson, Lena M., et al. (author) Associations Between Swedish Mothers' and 3-and 5-Year-Old Children's Food Intake 2016 In: Journal of nutrition education and behavior. - : Elsevier BV. - 1499-4046 .- 1878-2620. ; 48:8, s. 520-529.e1 Journal article (peer-reviewed)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.
6.	Kristiansen, Lisbeth Porskrog, 1965-, et al. (author) Strengthening adolescent well-being project - Qualitative outcomes from a pilot in a Swedish upper-secondary school 2019 In: British Journal of School Nursing. - London : Magnolia Press. - 1752-2803 .- 2052-2827. ; 14:8, s. 390-397 Journal article (peer-reviewed)abstract While a majority of Swedish school children enjoy a good health, mental health problems are increasing among young people in Sweden. According to Swedish law all school staff members (teachers and student health professionals) have mutual responsibility to provide a safe school environment and health. Since 2010, there is an emphasis on health promotion in schools. The aim of this study is to qualitatively describe the feasibility of a health-promoting intervention targeting healthy high school students (the Strengthening Adolescent Wellbeing [SAW] project). A descriptive design was used with an intervention group that was assessed before and after the implementation of the programme using quantitative methods. The study was based on the Medical Research Council Framework. The study and the data collection were performed during the autumn of 2016 and the early spring of 2017. Public high school students' health professionals (school nurses), student counsellors and specialist educators, facilitated a research-based intervention consisting of eight sessions with education and mind-body practices. Pre- and post-testing were carried out. The main findings showed that participating students and staff members were satisfied that the content and the implementation of the intervention were meaningful.
7.	Lennernäs Wiklund, Maria, 1956-, et al. (author) Hann du äta? : En enkät och intervjustudie av arbetsmåltidens förutsättningar och betydelse för hälsa och välbefinnande vid skift- och schemalagt arbete med nattarbete 2018 In: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö? 10-12 juni 2018 Gävle. - Gävle : Gävle University Press. - 9789188145284 ; , s. 129- Conference paper (peer-reviewed)abstract BakgrundOhälsosamma matvanor och stress bidrar till sjukskrivningar och nedsatt arbetsförmåga genom övervikt, hjärtkärlsjukdom, diabetes typ 2 och psykisk ohälsa. Slimmade organisationer och flexibla arbetstider begränsar möjligheten att äta hälsosamt i samband med arbete. Särskilt utsatt är personal med skift- och schemalagt arbete. Att inte kunna på-verka när man äter under arbetspasset kan öka stress och irritation, med risk för sänkt prestations- och koncentrationsförmåga. Arbetsmiljöverkets föreskrifter om organisatorisk och social arbetsmiljö (AFS 2015:4) syftar till att främja en god arbetsmiljö och förebygga ohälsa på grund av organisatoriska och sociala förhållanden i arbetsmiljön. Det finns ingen lagstiftning angående matrastens längd eller utformningen av matrum. Arbetsgivaren har rätt att byta ut raster mot måltidsuppehåll, det senare innebär måltid om arbetssituationen medger det. Personal med ständig larmberedskap kan arbeta en hel natt utan möjlighet att äta. Detta är tveksamt med hänsyn till hälsa, säkerhet och arbetsförmåga.SyfteStudiens syfte är 1) att få en bättre förståelse av de faktorer som påverkar möjligheten och formerna för att äta i samband med natt- och skiftarbete och de val anställda gör utifrån de förutsättningar som finns 2) att öka förståelsen av hur arbetsmåltiden påverkas av organisatoriska och psykosociala förhållanden, och måltidens betydelse för återhämtning, välbefinnande och hälsa.Frågeställningar Hur gestaltas arbetsmåltider för personal med skift- och schemalagt arbete? Vilka strat-egier och handlingsutrymmen har personalen för att planera sina arbetsmåltider? Vi kommer särskilt att uppmärksamma vad personalen äter, under vilka omständigheter de äter samt vilken betydelse måltiden har för välbefinnande och gemenskap.Urval och metodEnkät riktas till anställda med dag-, skift- och schemalagt arbete inom industri och hemtjänst. Intervjuer genomförs med chefer inom dessa verksamheter.ResultatStudien startar våren 2018 med inledande intervjuer och test av enkät till målgrupper efter arbetsplatsbesök. Under konferensen kommer vi att kortfattat sammanfatta den forskning som finns inom ramen för våra frågeställningar samt att redovisa resultat från några intervjuer med chefer.Genom vårt deltagande vill vi bidra till att sätta arbetsmåltiden på agendan inom arbetsmiljöforskning och diskutera med andra forskare hur de ser på arbetsmåltiden ur ett arbetsmiljöperspektiv.
8.	Paul, Rebecca, 1978- (author) Obesity and Effects of Bariatric Surgery - with a Certain Focus on Women's Health 2023 Doctoral thesis (other academic/artistic)abstract Severe obesity influences sex hormone levels in women, which may result in subfertility, menstrual disturbances, anovulation and hyperandrogenism as well as increased risk for complications during pregnancy and birthing. Bariatric surgery leads to long-term weight loss and resolution of several comorbidities including hormone imbalance. However, the impact of altered sex hormones in women with obesity is insufficiently understood. Little is known concerning potential influences of changed sex hormone levels on women's function and quality of life following bariatric surgery and subsequent weight loss. This thesis aims to understand sex hormone balance in women with severe obesity and after bariatric surgery and to explore women’s experiences of changes in life after bariatric surgery and weight loss. Study I included 100 women and utilized blood assay to investigate changes in serum sex- hormone levels and questionnaires concerning sexual function and health-related quality of life (HRQoL) in women with severe obesity before and one year after bariatric surgery. Findings from Study I indicated that testosterone and sex hormone binding globulin normalized, and questionnaires showed improvements in several domains of sexual function, psychological well-being and general health in women one year after surgery. Study II used a qualitative method, specifically thematic analysis, to explore women's pre- and postoperative experiences, indicating that increased fertility and achieved motherhood were motivating factors to undergo bariatric surgery. Fourteen women were interviewed, and the themes of “Experiencing Motherhood and Femininity” and “Achieving a Normal Life” emerged from the data. Study III applied the qualitative method with Gadamer’s hermeneutic analysis to understand the lived experiences of premenopausal women with obesity before and after having undergone bariatric surgery. A focus was on influences of altered sex hormones and potential restoration of levels after surgery. Ten women were included, and analysis of the horizons created the fusions of “Recognition of Unhealthy Body Weight”, “Dealing with Other People’s Opinions and Society’s Norms”, “Life has Changed in a Positive Way” and “Accepting Inner Self and Bodily Changes”. Finally, to elaborate on previous studies' findings and better understand the current knowledge base, a systematic review and interpretative meta-synthesis of published literature involving qualitative methods concerning women’s experiences of womanliness related to changes after undergoing bariatric surgery was conducted in study IV. Ten relevant studies were included, and a meta-synthesis, according to Gadamer’s hermeneutics, created the fusions of “Womanliness,” “A Healthy and Functioning Body,” and “Mind and Body Connection.” This thesis provides a clearer understanding of the experiences of living with obesity that motivate premenopausal women to seek bariatric surgery. The importance of postoperative benefits such as restored function, health and womanliness are illustrated as well as clarifying difficulties involving adaptations to life after surgery. These findings may inform potential bariatric surgery candidates and healthcare professionals of the experiences of women living with obesity, as well as expectations, postoperative experiences and challenges. These findings promote patient-centred guidance prior to surgery and during postoperative follow-up.
9.	Possmark, Sofie, et al. (author) Accelerometer-measured versus selfreported physical activity levels in women before and up to 48months after Roux-enY Gastric Bypass 2020 In: BMC Surgery. - : BioMed Central. - 1471-2482. ; 20:1 Journal article (peer-reviewed)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.
10.	Possmark, Sofie, et al. (author) 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 In: PLOS ONE. - : Public Library of Science (PLOS). - 1932-6203. ; 16:11 Journal article (peer-reviewed)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.
11.	Rambaree, Komalsingh, 1970-, et al. (author) Youth health, gender, and social media: Mauritius as a glocal place 2020 In: Cogent Social Sciences. - : Taylor & Francis Group. - 2331-1886. ; 6:1 Journal article (peer-reviewed)abstract The aim of this study was to investigate associations between social media use, self-reported health, dietary behaviours, and gender among young people living in Mauritius. For this cross-sectional study, questionnaires were distributed to a sample of 492 individuals (of which 64% were females) aged 14–29 year. A linear regression analysis investigating the associations between health problems and social media use, a number of dietary choices and behaviours, and gender was found to explain 49.9% of the variance in the prevalence of health problems, with social media use making the largest unique contribution (beta = 0.48). A MANOVA analysis found that there were significant gender differences in social media use, unhealthy food consumption, and self-reported health problems. This article concludes that the clash between gender, fast technological developments, and the influx of unhealthy foods in a glocal place has effects on young people through social media, and need to be monitored closely by youth and health policy-makers and researchers.
12.	Sellberg, Fanny, et al. (author) 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 In: BMC Surgery. - : BioMed Central. - 1471-2482. ; 18:1 Journal article (peer-reviewed)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.
13.	Sellberg, Fanny, et al. (author) A dissonance-based randomized intervention study to improve quality of life and physical activity 24 months post roux-en-Y gastric bypass surgery 2018 In: Obesity Surgery. - 0960-8923 .- 1708-0428. ; 28:S2, s. 224-224 Journal article (peer-reviewed)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.
14.	Sellberg, Fanny, et al. (author) Change in Children's Self-Concept, Body-Esteem, and Eating Attitudes Before and 4 Years After Maternal RYGB 2018 In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 28:10, s. 3276-3283 Journal article (peer-reviewed)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.
15.	Sellberg, Fanny, et al. (author) Four years' follow-up changes of physical activity and sedentary time in women undergoing roux-en-Y gastric bypass surgery and appurtenant children 2017 In: BMC Surgery. - : Springer Science and Business Media LLC. - 1471-2482. ; 17:1 Journal article (peer-reviewed)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.
16.	Sellberg, Fanny, et al. (author) Meeting physical activity recommendations is associated with health-related quality of life in women before and after Roux-en-Y gastric bypass surgery 2019 In: Quality of Life Research. - : Springer. - 0962-9343 .- 1573-2649. ; 28:6, s. 1497-1507 Journal article (peer-reviewed)abstract PURPOSE: Meeting physical activity (PA) recommendations is positively associated with health-related quality of life (HRQoL), but it is still unclear whether PA (specifically objectively measured) is associated with HRQoL in bariatric surgery candidates, both before and after surgery. Thus, the aim of this study was to examine the cross-sectional association between meeting objectively measured PA recommendations and HRQoL before and after Roux-en-Y gastric bypass (RYGB) surgery.METHODS: Sixty-six women undergoing RYGB with pre-surgery and 62 women with post-surgery valid PA and HRQoL data were included from the control group of a RCT study aiming at improving HRQoL and PA post-RYGB surgery. Measures before and 12 months after RYGB included the Short Form Health Survey (SF-36) and objectively measured PA, sedentary time (ST), and step counts with GT3X+ accelerometers. Multiple linear regression models were used to analyze the associations between PA and HRQoL.RESULTS: Participants who engaged in more than 150 min of moderate to vigorous PA (MVPA)/week (PA recommendations) had considerably higher SF-36 scores (HRQoL) than those who did not, both pre and 12-month post-surgery, with greatest difference in the subscale bodily pain, 15.5 (p = 0.021) higher score (higher scores means less pain) pre-surgery and a 19.7 (p = 0.004) higher score post-surgery. Higher LPA and step counts and lower ST also showed positive associations in some of the subscales of SF-36.CONCLUSIONS: Meeting the PA recommendations and overall engaging in more PA was associated with higher HRQoL, pre-, and post-RYGB surgery, highlighting the importance of PA both pre- and post-surgery.
17.	Sellberg, Fanny, et al. (author) 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 2019 In: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 15:10, s. 1731-1737 Journal article (peer-reviewed)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.
18.	Thern, Emelie, et al. (author) No effects of increased alcohol availability during adolescence on alcohol-related morbidity and mortality during four decades : a natural experiment 2017 In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 71:11, s. 1072-1077 Journal article (peer-reviewed)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.
19.	Westerberg Jacobson, Josefin, 1970-, et al. (author) A wish to be thinner increases the odds for disturbed eating 20 years later 2016 Conference paper (peer-reviewed)abstract Background: Studies from various cultures show that a large number of adolescent girls have a wish to be thinner, and thus more often go on diets. The purpose of this longitudinal study was to examine if a wish to be thinner among Swedish girls contributes to the development of disturbed eating, and to describe motives for wishing to be thinner.Methods: Following ethical approval (reg. no: 258/94; 2014/401) the Demographic and Dieting Questionnaire and the Eating Disorder Examination Questionnaire were used in a general population cohort of 7-11year-old-girls (n=462), 20 years later in October 2015.Threshold for DE was 1 SD above general population mean. Chi-square tests providing OR were used.Results: A wish to be thinner during adolescence increases the likelihood 3-5 times to develop disturbed eating during the following 20-year period. Self-described motives for the wish to be thinner was to “correspond to the societal ideal” and to “dealing with difficulties”.Conclusions: For prevention, it is of importance to detect girls who wish to be thinner as early as possible. By considering the girls’ motives, preventive efforts might be perceived as more meaningful and relevant to the girls at risk of developing eating disorders.
20.	Willmer, Mikaela, et al. (author) An exploratory analysis of work engagement among women with and without disordered eating. 2021 In: BMC Women's Health. - : BMC. - 1472-6874. ; 21:1 Journal article (peer-reviewed)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.
21.	Willmer, Mikaela, et al. (author) Changes in BMI and Psychosocial Functioning in Partners of Women Who Undergo Gastric Bypass Surgery for Obesity 2015 In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 25:2, s. 319-324 Journal article (peer-reviewed)abstract There is very little research exploring the effects of Roux-en-Y gastric bypass surgery (RYGB) on the patient's partner. The aim of the present study was to investigate longitudinally whether male partners of female RYGB patients were affected in terms of BMI, sleep quality, body dissatisfaction, depression, and anxiety. Thirty-seven women, with partners who were willing to participate, were recruited from RYGB waiting lists at five Swedish hospitals. Data collection took place during two home visits, 3 months before and 9 months after RYGB surgery. Anthropometrical data were documented, and both women and men completed the Hospital Anxiety and Depression Scale (HADS) and the Karolinska Sleep Questionnaire (KSQ). The men also completed the Male Body Dissatisfaction Scale (MBDS). The men's BMI changes between the two time points that were analysed using general estimating equation (GEE) regression. Their BMI decreased significantly (beta = -0.9, p = 0.004). The change was more pronounced in the 26 men who had a baseline BMI of a parts per thousand yen25 (beta = -1.4, p < 0.001). Fixed-effects regression showed a statistically significant association between the men's weight loss and that of the women (beta = 0.3, p = 0.004). There were no significant changes in the men's HADS, KSQ, or MBDS scores. Overweight/obese male partners of RYGB patients also lose weight during the first 9 months post-operatively. However, symptoms of body dissatisfaction, anxiety, and depression remain unchanged, as does self-reported sleep quality.
22.	Willmer, Mikaela, et al. (author) Exploratory and confirmatory factor analysis of the 9-Item Utrecht Work Engagement Scale in a multi-occupational female sample: a cross-sectional study 2019 In: Frontiers in Psychology. - : Frontiers. - 1664-1078. ; 10 Journal article (peer-reviewed)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.
23.	Willmer, Mikaela (author) Influences of major weight loss in women treated with bariatric surgery on their partners’ and children’s weight and psychosocial functioning 2014 Doctoral thesis (other academic/artistic)abstract The overall aim of the current PhD thesis was to explore how families of female bariatric surgery patients are affected by the surgery. The focus of the thesis was on differences in weight status in siblings born before and after maternal bariatric surgery, and on changes in weight and psychosocial functioning in partners and children of women undergoing Roux-en-Y gastric bypass (RYGB). Study I explored differences in BMI and prevalence of overweight and obesity at the ages of four, six and 10 in children born before and after maternal bariatric surgery. Results showed that at no age did the children born after surgery have a lower prevalence of overweight or obesity, and that there was no association between differences in maternal BMI at week 10 of the two pregnancies and differences in siblings’ BMI at age four. Study II focused on changes in female RYGB patients’ partners in terms of BMI, waist circumference, sleep quality, body dissatisfaction and symptoms of anxiety and depression. The results showed significant reductions in BMI and waist circumference in the partners. However, psychosocial variables, as measured by questionnaires, remained unchanged in the men. In Study III, differences in weight status, body esteem and self-concept in children of female RYGB patients were explored. It was found that the children had a reduced relative risk of overweight after maternal RYGB. The results also showed that the boys improved their age-adjusted body esteem slightly, whilst the girls did not. Study IV investigated changes in eating behaviour and food choices in female RYGB patients and their families. The women were shown to increase their cognitive restraint, decrease their uncontrolled and emotional eating, and reduce their intake frequency of soft drinks and sweets after surgery. Their partners, however, reported no changes in their eating behaviour and food choices. The boys’ eating behaviour improved following maternal RYGB, but the same was not true for the girls in the sample. The children who were overweight or obese at baseline also improved their eating behaviour in comparison to the normal weight children. In conclusion, this thesis shows that women’s gastric bypass surgery may be associated with positive changes in her partners’ and children’s weight, especially if they are themselves overweight. Changes in psychosocial functioning are smaller and more complex in the current sample, and require further study.
24.	Willmer, Mikaela, et al. (author) ‘The only chance of a normal weight life’ : A qualitative analysis of online forum discussions about bariatric surgery 2018 In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 13:10 Journal article (peer-reviewed)abstract BackgroundThe 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.ObjectiveThe objective of this study was to describe shared values, feelings, and thoughts among visitors to a web-based forum for those undergoing bariatric surgery.MethodsIn 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.ResultsFour 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.ConclusionProfessionals 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.
25.	Wising, Jenny, et al. (author) ‘Life with a device’ : the octogenarians’ experiences with an implantable cardioverter-defibrillator—a qualitative study 2021 In: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 21:2, s. 161-168 Journal article (peer-reviewed)abstract AimsImplantable 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 resultsWe 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.ConclusionOverall, 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.
26.	Xu, Lijuan, et al. (author) Nursing Students' Self-rated Nurse Professional Competence at the End of an International Collaborative Education Program and Follow-up 1 Year Later 2023 In: Nurse Educator. - : Wolters Kluwer. - 0363-3624 .- 1538-9855. ; 48:5, s. e141-e146 Journal article (peer-reviewed)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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