High prevalence of neurodevelopmental problems in adolescents eligible for bariatric surgery for severe obesity.

AIM: To assess the prevalence of neurodevelopmental problems in adolescents with severe obesity and their associations with binge eating and depression. METHODS: Data were collected at inclusion in a randomised study of bariatric surgery in 48 adolescents (73% girls; mean age 15.7 ± 1.0 years; mean body mass index 42.6 ± 5.2 kg/m2 ). Parents completed questionnaires assessing their adolescents' symptoms of attention-deficit/hyperactivity disorder and autism spectrum disorder and reported earlier diagnoses. Patients answered self-report questionnaires on binge eating and depressive symptoms. RESULTS: The parents of 26/48 adolescents (54%) reported scores above cut-off for symptoms of the targeted disorders in their adolescents, but only 15% reported a diagnosis, 32% of adolescents reported binge eating, and 20% reported symptoms of clinical depression. No significant associations were found between neurodevelopmental problems and binge eating or depressive symptoms. Only a third of the adolescents reported no problems in either area. CONCLUSION: Two thirds of adolescents seeking surgical weight loss presented with substantial mental health problems (reported by themselves or their parents). This illustrates the importance of a multi-professional approach and the need to screen for and treat mental health disorders in adolescents with obesity

A randomized controlled trial comparing intensive non-surgical treatment with bariatric surgery in adolescents aged 13-16 years (AMOS2): Rationale, study design, and patient recruitment.

BACKGROUND: Previous non-randomized studies show similar outcomes in adolescents and adults after bariatric surgery. We describe the study protocol, recruitment, and selected baseline data of patients in a randomized multi-center study, the Adolescent Morbid Obesity Surgery 2 (AMOS2). METHODS: Three clinics in Sweden collaborated in designing the study and recruitment of patients from August 1, 2014 to June 30, 2017. Patients were selected among adolescents 13-16 years of age attending third-level obesity care for at least one year. Patients were randomized 1:1 to bariatric surgery (predominantly Roux-en-Y gastric bypass) or intensive non-surgical treatment starting with an eight-week low-calorie-diet. RESULTS: Fifty adolescents (37 girls) were randomized, 25 (19 girls) to bariatric surgery. Mean age was 15.7 years (range 13.3-16.9), weight 122.6 kg (range 95-183.3), Body Mass Index (BMI) 42.6 kg/m2 (range 35.7-54.9) and BMI-SDS 3.45 (range 2.9-4.1). One patient had type 2 diabetes mellitus, and 12/45 (27%) had elevated liver enzymes. There were no significant differences between the groups. For the 39 eligible patients who were offered but declined inclusion, BMI was not different from included patients. However, patients who declined were younger, 15.2 years (p = 0.021). A sex difference was also noted with more of eligible girls, 37/53 (69.8%), than boys, 13/36 (36.1%), wanting to participate in the study (p = 0.002). CONCLUSIONS: This clinical trial, randomizing adolescents with severe obesity to bariatric surgery or intensive non-surgical treatment, aims at informing about whether it is beneficial to undergo bariatric surgery in early adolescence. It will also enlighten the outcome of comprehensive non-surgical treatment. The study was registered at www.clinicalTrials.gov number NCT02378259

Wishing for deburdening through a sustainable control after bariatric surgery

The aim of this study was an in-depth investigation of the change process experienced by patients undergoing bariatric surgery. A prospective interview study was performed prior to as well as 1 and 2 years after surgery. Data analyses of the transcribed interviews were performed by means of the Grounded Theory method. A core category was identified: Wishing for deburdening through a sustainable control over eating and weight, comprising three related categories: hoping for deburdening and control through surgery, feeling deburdened and practising control through physical restriction, and feeling deburdened and trying to maintain control by own willpower. Before surgery, the participants experienced little or no control in relation to food and eating and hoped that the bariatric procedure would be the first brick in the building of a foundation that would lead to control in this area. The control thus achieved in turn affected the participants' relationship to themselves, their roles in society, and the family as well as to health care. One year after surgery they reported established routines regarding eating as well as higher self-esteem due to weight loss. In family and society they set limits and in relation to health care staff they felt their concern and reported satisfaction with the surgery. After 2 years, fear of weight gain resurfaced and their self-image was modified to be more realistic. They were no longer totally self-confident about their condition, but realised that maintaining control was a matter of struggle to obtaining a foundation of sustainable control. Between 1 and 2 years after surgery, the physical control mechanism over eating habits started to more or less fade for all participants. An implication is that when this occurs, health care professionals need to provide interventions that help to maintain the weight loss in order to achieve a good long-term outcome

När läsinlärningen inte går enligt mallen : Hur arbetar pedagoger med läsinlärning? Hur organiserar skolan särskilt stöd?

Syfte: Syftet är att undersöka vilka åtgärder och förutsättningar som ges till elever som inte följer mallen vid läsinlärning. Arbetet har utgått från frågeställningarna: - Hur arbetar pedagoger med läsinlärning? - Hur organiserar skolan särskilt stöd? Metod: Studien är en kvalitativ studie i form av intervjuer. Intervjuer har genomförts med tre pedagoger och tre rektorer. Samtliga intervjuer spelades in på band. Resultat: Utifrån min undersökning kan jag se att pedagogerna använder sig av många olika metoder när de arbetar med läsinlärning. De blandar traditionellt med nytt. I arbetet när läsinlärningen inte går enligt mallen förändrar de sin undervisning efter bästa förmåga. Andra metoder, en-till-en undervisningsmetoder, använder pedagogerna i samarbete med skolans specialpedagog. De organisatoriska förutsättningarna ser från grunden olika ut bland annat beroende på elevantal. Vid organisation av särskilt stöd förlitas det mycket på att pedagogerna själva förändrar undervisningen. Ibland sätts extra resurser in i form av ytterligare en pedagog. Betydelse för läraryrket: Arbetet har stor betydelse för läraryrket, både för färdiga och blivande pedagoger, då alla sannolikt någon gång kommer att möta elever som inte följer mallen vid läsinlärning

Work conditions influencing professional development of specialist nurses in surgical care explored using the Job Demand-Resources theory : A qualitative study

AIM: The aim of the study was to explore the work conditions that influence the opportunities for professional development of specialist nurses in surgical care. DESIGN: A qualitative descriptive design was used. METHODS: With a purposeful sampling procedure, 14 specialist nurses in surgical care were included. Four focus-group interviews were conducted during November to December 2021 and deductively analysed using the Job Demand-Resource theory as a guiding framework. Reporting adheres to COREQ guidelines. FINDINGS: Work conditions that were identified as job demands and that inhibited nurses' opportunities for professional development were mainly found at an organizational and leadership level. Primarily, those conditions included role ambiguity and time constraints caused by uncompensated nursing shortages that restricted the nurses from exercising their role. Such conditions could also discourage other nurses from further education. Job demands were seen as largely compensated for by work conditions identified as job resources and located mainly at an individual level, for example finding the work interesting and multifaceted. Most prominent was the participants' inner motivation to work with surgical patients and to continue to develop themselves and other nurses professionally. CONCLUSIONS: A prerequisite for professional development is that the specialist role is clearly defined in collaboration with representatives from the nursing profession and universities. Hence, hospital organizations need to reflect on how to utilize the competence. Also, it is important that nurse leaders promote the specialist nurses' motivation by supporting them in the exercise of their role. IMPACT: Findings from this study revealed work conditions that need to be acknowledged during hospital organizations' endeavours to maintain and enhance nursing competence. PATIENT OR PUBLIC CONTRIBUTION: Patient or public contribution was not applicable since the study focused on specialist nurses' working conditions

Patients' perspective on obesity surgery - expectations, experiences and self-reported outcomes

Overweight and obesity constitute a major challenge to human health worldwide, involving over 1.4 billion people. In Sweden, more than a third (36%) of the population is overweight, and 13% are obese. For the vast majority of morbidly obese patients, conventional treatment (e.g. dieting, pharmacotherapy and behavioural therapy) often fails in the long-term. Bariatric surgery is currently the only successful treatment. In 2011, 8,600 patients underwent such surgery in Sweden. In bariatric surgery research, the patient's perspective is rarely highlighted, which means that there is a lack of knowledge about problems that patients might experience, how they address them and whether these problems affect the outcome. Aim: To explore patients’ expectations, experiences and self-reported outcomes in connection with bariatric surgery in order to determine whether or not and how these aspects affect HRQoL, everyday life, weight loss, eating behaviour and gastrointestinal side-effects. Methods: The effort to acquire scientific knowledge included seeking the unique in each individual case as well as group correlations and differences. For this reason, the data collection methods were both inductive and deductive, comprising interviews and questionnaires. Results: Eating behaviour, HRQoL and everyday life were reported to be very poor before surgery. The patients viewed bariatric surgery as the last resort to regain control over eating and weight and thereby their overall health. The surgery per se was considered the control mechanism and few patients felt that they were involved in the treatment. In the first year after the procedure, overall health, eating behaviour and social life were improved dramatically due to the physiological restriction brought about by surgery and subsequent weight loss. In the second year, the patients reported good but slightly decreased HRQoL, eating behaviour and everyday life compared to the previous year. During this year most patients experienced a weaker physiological restriction and were aware that willpower was essential in order to maintain what they had achieved. A small group of patients experienced loss of control over eating, leading to a negative self-image and fear of future weight gain. Several patients viewed dumping as something positive and wished for it to return when it ceased. Surplus skin was a major concern for the majority of patients two years after surgery, something they wished to correct by means of plastic surgery. Comparison of laparoscopic Gastric Bypass (GBP) and Duodenal Switch (DS) surgery for super-obesity two years after the operation revealed that DS patients had significantly more gastrointestinal problems (diarrhoea; p=0.002, anal leakage of stool; p=0.015, and daytime defecation; p=0.007) than GPB patients. Both groups reported a significant improvement in psychosocial function, eating behaviour and HRQoL after surgery and no significant difference between the groups was evident. Patients who experienced poor control over eating two years after surgery had significantly lower HRQoL in seven out of eight domains in the SF-36 Health Survey questionnaire (p <0.05) compared to those who had control over eating. They also reported more Emotional (p <0.001) and Cognitive Restraint eating (p<0.05) and did not exhibit a significant weight loss between the first and second year after surgery (p=0.15) in contrast to patients who experienced being able to control their eating (p<0.001). Conclusion: From the patients’ perspective, the issue of controlling food intake seems to play an important role for surgery outcome as well in their everyday lives. This knowledge can be used to make the patients more involved in their treatment and strengthen their belief in their own ability to influence the outcome as opposed to solely relying on the physiological constraint created by the operation, which seems to decrease over time. Healthcare resources would probably be better employed by identifying the small group of patients with poor post-operative control at an early stage and providing extra interventions for them. Keywords: Bariatric surgery, patients’ perspective, loss of control, eating behaviour, health related quality of life, well-being, surgery outcome, patient reported outcomes, gastrointestinal function

Factors related to a successful professional development for specialist nurses in surgical care : a cross-sectional study

BACKGROUND: A high level of competence among staff is necessary for providing patient-safe surgical care. Knowledge regarding what factors contribute to the professional development of specialist nurses in surgical care and why they choose to remain in the workplace despite high work requirements is needed. To investigate and describe the organizational and social work environment of specialist nurses in surgical care as part of studying factors that impact on professional development. METHOD: This was a cross-sectional study with a strategic convenience sampling procedure that recruited 73 specialist nurses in surgical care in Sweden between October to December 2021. The study was guided by STROBE Statement and checklist of cross-sectional studies. The validated Copenhagen Psychosocial Questionnaire was used, and additional demographic data. Descriptive statistics were performed and the comparison to the population benchmarks was presented as the mean with a 95% confidence interval. To study potential differences among the demographic and professional characteristics, pairwise t tests were used with Bonferroni adjustment for multiple comparisons with a significance level of 5%. RESULTS: Five domains were identified as factors related to success, as they received higher scores in relation to population benchmarks: quality of leadership, variation of work, meaning of work and work engagement as well as job insecurity. There was also a significant association between a having a manager with low nursing education and job insecurity (p = 0.021). CONCLUSIONS: Quality of leadership is important for the professional development of specialist nurses in surgical care. Strategic work seems to include managers with a higher nursing education level to prevent insecure professional working conditions