An intervention of sustainable weight change : Influence of self-help group and expectations

BACKGROUND: Obesity is one of the most challenging public health problems in Western societies. Group activities are a way to empower individuals to make sustainable lifestyle changes. Self-help groups enable individuals to share expectations and experiences on an equal basis. OBJECTIVE: The aim was to find a model for sustainable weight reduction for people with obesity and to evaluate the importance of expectations before entering the weight reduction programme. METHODS: Persons with a BMI &gt;30 and aged over 30 years were recruited. Weekly seminars for 6 months with discussions concerning physical activity, eating habits and how to change one's lifestyle occurred. After the seminars, a self-help group was initiated. The participants were encouraged to express their expectations before each step in the study. RESULTS: Our findings showed that those who had joined a self-help group had reduced their weight significantly (-6.0 kg) compared with those who had not (-1.4 kg). Further, those who expressed a more mature expectation of the coming change in behaviour towards a healthy lifestyle showed slightly larger weight reduction (-6.1 kg) than those who expressed low expectations (-3.7 kg). PATIENT OR PUBLIC CONTRIBUTION: Participants expressed their thoughts and views, which were considered and included in the programme. CONCLUSIONS: Our findings indicate that the self-help group can be an essential part of a weight reduction programme. The self-help group is a novel strategy to strengthen sustainability in reducing weight. The study also highlights the importance of identifying behaviour change expectations before participating in a programme.CC BY 4.0Corresponcence: Kristina Carlén, School of Health Sciences, University of Skövde, Sweden. Email: [email protected] research was supported by grants from The Skaraborg Institute for Research and Development, Skövde, Sweden</p

Expansion of the Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding into Neonatal Intensive Care: Expert Group Recommendations

In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up

Expansion of the Ten Steps to Successful Breastfeeding into Neonatal Intensive Care: Expert Group Recommendations for Three Guiding Principles

The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose, an expert group from the Nordic countries and Quebec, Canada, prepared a draft proposal, which was discussed at an international workshop in Uppsala, Sweden, in September 2011. The expert group suggests the addition of 3 "Guiding Principles" to the Ten Steps to support this vulnerable population of mothers and infants: 1. The staff attitude to the mother must focus on the individual mother and her situation. 2. The facility must provide family-centered care, supported by the environment. 3. The health care system must ensure continuity of care, that is, continuity of pre-, peri-, and postnatal care and post-discharge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care

Övervakning av metaller och organiska miljögifter i marin biota, 2015

The environmental toxicants examined in this report can be classified into five groups – heavy metals, chlorinated compounds, brominated flame retardants, polyaromatic hydrocarbons and perfluorinated compounds. Each of these contaminants have been examined from various sites for up to six different fish species, in blue mussels, and in guillemot eggs, for varying lengths of time. The following summary examines overall trends, spatial and temporal, for the five groups. Condition and Fat Content Condition and fat content in different species tended to follow the same pattern at the same sites, with a few exceptions. Most of the fish species generally displayed a decreasing trend in both condition and fat content at most sites examined. Exceptions to this were increases in condition factor seen in cod liver at Fladen, perch muscle at Kvädöfjärden, and for herring at Ängskärsklubb in spring. Also, an increase in fat content was seen during the most recent ten years for herring at Ängskärsklubb in spring. There were also some sites where no log linear trends were seen. Heavy Metals Due to a change in methods for metal analysis (not mercury) in 2004, values between 2003 and 2007 should be interpreted with care. From 2009 metals are analyzed at ACES, Stockholm University. Generally, higher mercury concentrations are found in the Bothnian Bay, but also from one station in the Northern parts of Baltic Proper, compared to other parts of the Swedish coastline. The time series show varying concentrations over the study period. The longer time series in guillemot egg and spring-caught herring from the southern Bothnian Sea and southern Baltic Proper show significant decreases of mercury. On the other hand, increasing concentrations are seen in e.g., cod muscle, but the concentrations are fairly low compared to measured concentrations in perch from fresh water and coastal sites. In most cases, the mercury concentrations are above the EQSbiota of 20 ng/g wet weight. Lead is generally decreasing over the study period (in time series of sufficient length), supposedly due to the elimination of lead in gasoline. The highest concentrations are seen in the southern part of the Baltic Sea. Elevated lead concentrations between 2003 and 2007 (e.g. Harufjärden) should be viewed with caution (see above regarding change in analysis methods). Lead concentrations are below the suggested target level at all stations. Cadmium concentrations show varying non-linear trends over the monitored period. It is worth noting that despite several measures taken to reduce discharges of cadmium, generally the most recent concentrations are similar to concentrations measured 30 years ago in the longer time series. Cadmium concentrations in herring and perch are all below the suggested target level of 160 μg/kg wet weight. The reported nickel concentrations show no consistent decreasing trends. Some series begin with two elevated values that exert a strong leverage effect on the regression line and may give a false impression of decreasing trends. Chromium generally shows decreasing concentrations, possibly explained by a shift in analytical method. The essential trace metals, copper and zinc, show no consistent trends during the monitored period. Generally higher concentrations of arsenic and silver are found along the west coast compared to other parts of the Sweadish coast line. However for silver a few stations in the Bothnian Sea and Bothnian Bay show comparable concentrations to the west coast stations. Chlorinated Compounds Generally, a decreasing concentrations were observed for all compounds (DDT’s, PCB’s, HCH’s, HCB) in all species examined, with a few exceptions, such as no change in TCDD-equivalents being seen in herring muscle (except at Änskärsklubb where very high concentrations at the beginning of the sampling period were seen and also at the west coast station Fladen). The longer time-series in guillemot also show a marked decrease in TCDD-equivalents from the start in the late 1960s until about 1985 from where no change occurred for many years, however, during the most recent ten years a decrease in the concentration is seen. Concentrations of DDE and CB-118 are for some species and sites still above their respective target levels. The chlorinated compounds generally show higher concentrations in the Bothnian Sea and/or Baltic Proper when compared to the Bothnian Bay and the Swedish west coast. Brominated Flame Retardants Elevated levels of HBCDD are seen in sites from the Baltic Proper, while the investigated PBDEs show higher concentrations in the Bothnian Bay. In addition, lower concentrations of all investigated PBDEs and HBCDD are seen on the Swedish west coast compared to the east coast. Temporally, significant increases in BDE-47, -99 and -100 have been seen in guillemot eggs since the late 1960s until the early 1990s, where concentrations then began to show decreases. Also, the concentration of HBCDD in guillemot eggs shows a decrease during the most recent ten years. For fish and blue mussels, BDE-47, -99, and -153 decreased at some sites and showed no trend at other sites. The concentration of HBCDD in fish and blue mussels showed inconsistent trends. The concentration of HBCDD is below the EQSbiota of 167 μg/kg wet weight for all fish species from all areas, while the concentration of BDE-47 alone is above the EQSbiota for sumPBDE of 0.0085 ng/g wet weight. PAHs Only blue mussels have been examined for spatial differences in PAH concentrations. Concentration of ΣPAH was found to be higher from Kvädöfjärden in the Baltic Proper compared to stations at the West coast, but individual PAHs showed varying spatial patterns. Over time, acenaphthalene was rarely found above the detection limit. Significant decreasing trends were observed for ΣPAH, chrysene, fluoranthene and pyrene at Fjällbacka; for naphthalene at Kvädöfjärden; and for pyrene at Fladen. All time series where concentrations of various PAHs were compared with the target value based on OSPAR Ecological Assessment Criteria, or EC Environmental Quality Standards were below the target value. PFASs PFHxS and PFOS show a similar spatial pattern, but PFOS concentrations were approximately 25 times higher than PFHxS levels. The distribution of PFOS is quite homogenous along the Swedish coast but with somewhat higher concentrations in the Baltic Proper. PFOS concentrations in guillemot eggs are about 100-200 times higher than in herring liver. An overall increasing concentration of PFOS in guillemot eggs has been observed throughout the whole time period, however, during the most recent ten years, a change of direction is detected. The longer herring time series from Harufjärden, Landsort, and Utlängan show increasing concentrations for PFOS and most carboxylates. For FOSA, on the other hand, decreasing concentrations are seen during the most recent ten years. Organotin compounds The majority of the analysed tinorganic compounds showed concentrations below LOQ. However TBT and DPhT showed concentrations above LOQ at all stations with highest reported concentrations in fish from Örefjärden in the northern part of Bothnian Sea.De miljögifter som undersökts i denna rapport kan delas in i fem miljögiftsgrupper - tungmetaller, klorerade föreningar, bromerade flamskyddsmedel, polyaromatiska kolväten och perfluorerade föreningar. Var och en av dessa föroreningar har undersökts från olika lokaler i upp till sex olika fiskarter, samt i blåmussla och sillgrissleägg. Undersökningarna har pågått under varierande antal år. Följande sammanfattning undersöker övergripande trender, geografiska och tidsmässiga, för de fem grupperna. Kondition och fetthalt Kondition och fetthalten i de olika arterna tenderade att följa samma mönster i samma lokaler, med några få undantag. De flesta fiskarter visade generellt en minskande trend i både kondition och fetthalt i de flesta undersökta lokalerna med undantag för en ökning i kondition i torsklever från Fladen, abborrmuskel från Kvädöfjärden och sill från Ängskärsklubb (vår). Dessutom ses en ökning av fetthalt de senaste tio åren för sill från Ängskärsklubb (vår). Det fanns också några platser där inga log-linjära trender observerades. Tungmetaller På grund av en förändring i metoderna för metallanalys (inte kvicksilver) år 2004 bör värden mellan 2003 och 2007 tolkas med försiktighet. Från och med 2009 analyseras metaller vid ACES, Stockholms universitet. Generellt ses högre halter kvicksilver i Bottenviken, men också från en station i de norra delarna av Östersjön, jämfört med andra delar av den svenska kusten. Tidsserien visar varierande koncentrationer under studieperioden. De längre tidsserierna som finns för sillgrissleägg och vårfångad strömming från södra Bottenhavet och södra Östersjön visar signifikanta minskningar av kvicksilver. Å andra sidan, ökande koncentrationer ses i bl.a. torskmuskel, men halterna är relativt låga om man jämför med uppmätta halter i abborre från insjöar och kustnära platser. I de flesta fall ligger kvicksilverkoncentrationerna över EQSbiota på 20 ng /g våtvikt. Blyhalterna minskar generellt över tid (i tidsserier av tillräcklig längd), förmodligen på grund av avskaffandet av bly i bensin. De högsta halterna ses i södra delen av Östersjön. Förhöjda blyhalter mellan 2003 och 2007 (t.ex. Harufjärden) bör tolkas med försiktighet (se ovan om förändring i analysmetoder). Blyhalterna ligger under det föreslagna gränsvärdet vid alla lokaler. Kadmiumhalterna visar varierande icke-linjära trender under övervakningsperioden. Det är värt att notera att trots att flera åtgärder har vidtagits för att minska utsläppen av kadmium, så är generellt de senaste årens koncentrationer i samma storleksordning som koncentrationerna som uppmättes för 30 år. Kadmiumhalterna i strömming och abborre ligger alla under det föreslagna gränsvärdet på 160 μg/kg våtvikt. De rapporterade nickelkoncentrationerna visar inga konsekventa minskande trender. Vissa serier börjar med två förhöjda värden som utövar en stark hävstångseffekt på regressionslinjen och kan ge ett felaktigt intryck av minskande trender. Krom visar generellt minskande koncentrationer, detta kan möligen förklaras av en förändring i analysmetoden. Koppar och zink visar inga konsekventa trender under övervakningsperioden. Det är generellt högre koncentrationer av arsenik och silver längs västkusten jämfört med andra delar av den svenska kusten, men för silver har några stationer i Bottenhavet och Bottenviken jämförbara koncentrationer med västkuststationerna. Klorerade föreningar Generellt ses minskande koncentrationer för alla föreningar (DDTer, PCBer, HCHer och HCB) i alla undersökta arter, med några få undantag, till exempel ses ingen förändring i TCDD-ekvivalenter i strömmingsmuskel (utom vid Ängskärsklubb där mycket höga koncentrationer i början av provtagningsperioden sågs och även på västkuststationen Fladen). De lägre tidsserierna i sillgrissla visar också en markant minskning av TCDD-ekvivalenter från slutet av 1960-talet fram till omkring 1985 och därefter sker ingen förändring under många år, men under de senaste tio åren ses en minskning av koncentrationen. Halterna av DDE och CB-118 är för vissa arter och lokaler fortfarande över, respektive gränsväde. De klorerade föeningarna visar generellt högre koncentrationer i Bottenhavet och / eller Östersjön jämfört med Bottenviken och den svenska västkusten. Bromerade flamskyddsmedel Föhöjda nivår av HBCDD ses på lokaler från Egentliga Östersjön, medan de undersökta PBDE・erna visar högre koncentrationer i Bottenviken. Dessutom ses lägre koncentrationer av alla undersökta PBDE・er och HBCDD på den svenska västkusten jämfört med ostkusten. Tidsmässigt har signifikanta ökningar av BDE-47, -99 och -100 setts i sillgrissleägg sedan slutet av 1960-talet fram till böjan av 1990-talet och därefter har koncentrationerna börjat minska. Även koncentrationen av HBCDD i sillgrissleägg minskar under de senaste tio åren. För fisk och blåmussla minskade BDE-47, -99 och -153 på vissa lokaler medan ingen trend ses på andra platser. Koncentrationen av HBCDD i fisk och blåmussla visar inga tydliga trender. Koncentrationen av HBCDD ligger under EQSbiota på167 μg/kg våtvikt för alla fiskarter från alla lokaler medan koncentrationen av BDE-47 ligger över EQSbiota på 0,0085 ng/g våtvikt som är satt för summan av PBDE. PAH Endast blåmussla har undersökts för koncentrationer av PAH’er. Koncentration av ΣPAH var högre vid Kvädöfjärden i Egentliga Östersjön jämfört med lokalerna vid västkusten, men enskilda PAH’er visade varierande spatiala mönster. Acenaftalen har med tiden sällan hittats över detektionsgränsen. Signifikanta minskande halter observerades för ΣPAH, krysen, fluoranten och pyren vid Fjällbacka; för naftalen vid Kvädöfjärden; och för pyren vid Fladen. Alla tidsserier där koncentrationerna av olika PAHer jämfördes med gränsvärden, antingen OSPAR EAC, eller EU Miljökvalitetsnormer låg under gränsvärdet. PFASs PFHxS och PFOS visar ett liknande spatialt mönster, men koncentrationen av PFOS var ungefär 25 gånger högre än PFHxS. Fördelningen av PFOS är ganska homogen längs den svenska kusten men med något högre koncentrationer i Egentliga Östersjön. Halten av PFOS i sillgrissleägg är cirka 100-200 gånger högre än i strömminglever. En övergripande ökande koncentration av PFOS i sillgrissleägg har observerats under hela tidsperioden, men under de senaste tio åren ses istället en minskning. De längre strömmingstidsserierna från Harufjärden, Landsort och Utlängan visar ökande koncentrationer av PFOS och de flesta karboxylsyror. För FOSA, å andra sidan, ses minskande koncentrationer under de senaste tio åren. Organiska tennföreningar Majoriteten av de analyserade tennorganiska föreningarna uppvisade koncentrationer under LOQ. Men TBT och DPhT visade koncentrationer över LOQ vid alla lokaler och den högsta rapporterade halten i fisk från Örefjärden i norra delen av Bottenhavet