Internetized obesity treatment : from recruitment to practice

Background: The prevalence of obesity is reaching alarming altitudes worldwide, and the current healthcare systems face challenges to treat everyone. Thus, new strategies are of high priority. The Internet, for instance, has the potential to reach individuals irrespective of geographical location. Consequently, the overall aim of this thesis was to gain further understanding of the Internet’s applicability in obesity treatment, targeting lifestyle-related health aspects. Methods: This thesis has been built on four studies (I, II, III & IV). Study I used a prospective cohort design, examining members’ program performance in an Internet-based weight loss club during six months of participation (n=23,233, 20% males), focusing on “active members” (n= 4,440, 18% males). Study II characterized a randomized intervention study (n= 3,876, 67% males) in which the participants received either Internet-based counseling (personalized automated health feedback) with or without added telephone counseling, compared with no counseling, on health behavior improvements. Study III was a validation study evaluating the ability of our newly designed Internet-based virtual food plate (with pictures of food items) to assess food intake (lunch meal). We compared the results with participants’ (n=55, 100% males) composed meal of real food items on a real food plate. Lastly, study IV was a descriptive study of the effects of reminders (emails, flyers, oral presentations etc.) on overall participation in study II. Results: The findings from study I suggest that older members (≥ 65 years) performed equally well or better than younger members (< 65 years). They logged-in and recorded their health more frequently, and reported a higher total weight loss (women: 5.6kg, 6.8%; men: 6.4kg, 6.8%). The results from study II indicate an overall health improvement from the intervention per se, rather than for specific interventions. However, those participants who received personalized automated feedback enhanced their motivation to change health habits at follow-up. Study III supports the validity of our Internet-based virtual food plate, with Spearman and concordance correlations ranging between 0.58-0.70 and 0.59-0.81 for energy intake and nutritional components, respectively. A slight overestimation using our virtual food plate was found (+310kJ), but less among overweight participants (+147 kJ). Finally, study IV completes this thesis concluding that a high number of reminders were effective on response rate, predominantly for those with high Internet availability. The participants’ characteristics (age, BMI, motivation etc.), nonetheless, did not influence when they participated. Conclusions: The Internet possesses unique potentials in obesity treatment. This thesis presents valuable effects on health improvements primarily on middle-aged or older, overweight men – a subgroup known to be challenging to include in health promoting activities. This work is only one of the building blocks in the investigation of the Internet’s applicability in medicine. Future research is urged to continue searching the needs and preferences of Internet-based strategies targeting obesity

Allergy in dogs - owner knowledge and compliance

Förekomsten av allergier ökar i samhället, både hos människor och våra husdjur. Anledningarna kan vara många och både genetik och miljön vi lever i kan vara orsaker till detta. För att ta reda på vilken eller vilka allergier en hund lider av krävs olika utredningar. Dessa kan vara både långdragna och kostsamma vilket betyder att det krävs ett stort engagemang från hundägarna. För att ta reda på om en hund lider av foderallergi, och mot vad, krävs att den genomgår en eliminationsdiet. Detta tar flera månader och görs uteslutande i hemmet. När det gäller atopi görs utredningen av en veterinär på klinik. Efter utredningarna är klara är det upp till djurägaren att behandla sin hund och se till att den får adekvat vård. Syftet med detta arbete är att ta reda på vilken kunskap ägarna till allergiska hundar har om sitt djurs allergi samt undersöka hur väl de följer veterinärens ordinationer, det vill säga compliance. Vidare syfte är att ta reda på hur kontakten ser ut mellan djurägare och djurhälsopersonal efter en allergiutredning genomförts. Med denna information sammantagen är syftet att undersöka om det finns något samband mellan djurägarnas kunskap om deras hundars allergi samt den kontakt de har med djurhälsopersonalen och hur väl de följer veterinärens ordinationer. För att ta reda på detta sammanställdes en enkät som skickades till 60 djurägare vars hundar var patienter på hudmottagningen på Djurakuten i Stockholm. Hundarna hade genomgått en allergiutredning och alla hade besökt mottagningen under de senaste tre månaderna. Trettiotre av de inbjudna hundägarna valde att svara på enkäten och deras hundars journaler granskades för att undersöka vilka likheter och skillnader det fanns mellan enkätsvaren och journalerna. Parametrarna som jämfördes var bland annat vad hundarna var allergiska mot, hur allergin konstaterats och vilken behandling de fick för sin allergi. Resultatet, som baserades på både enkätsvar och journaler, visade att majoriteten av de svarande hade tät kontakt med sin hunds hudmottagning. De var även nöjda med den information, stöd och hjälp de fått från personalen. Svaren visade även att dessa djurägare hade god kunskap om sina hundars allergier. Gällande atopi följde enkätsvaren och journalerna varandra relativt väl, men när det kom till födoämnesallergi hade hundägarna mer kunskap än den information som stod att finna i journalerna. Konklusionen var att de som valt att svara på enkäten hade stort engagemang för sina hundars allergier. Det fanns inte tillräckligt många svarande som hade en mindre tät kontakt med sin hunds veterinär eller som var missnöjda med bemötandet de fått för att kunna dra några slutsatser från om detta skulle kunna ha ett samband med lägre compliance. Den enda slutsatsen som gick att dra var att de djurägare som svarat på enkäten visade relativt hög compliance och var även nöjda med den kontakten de hade med sin hunds hudspecialister. Studien har dock en låg representativet av ägare till allergiska hundar.The frequency of allergy increases in our society, among both humans and our pets. There can be a number of reasons for this, both genetics and the environment can have an impact. To determine what type of allergy or allergies a dog suffers from, different medical examinations are required. These examinations can be both protracted and costly which means a huge commitment from the dog owners. For example, to determine if a dog suffers from food allergy and which type of food this concerns, an elimination diet is required. This can take several of months and is done exclusively in the home environment. Atopy investigation is done by a veterinary at the clinic. After the allergy investigations, it is the dog owners’ responsibility to treat the dog and make sure it gets the required care. The purpose of this thesis is to find out what knowledge the owners to allergic dogs have about their pet´s allergy and also how well they follow the veterinarian´s recommendations, i.e. compliance. A further purpose is to investigate the contact between the owners and the staff at the clinic after an allergy investigation is done. With this information, all together, the purpose is to see if there is any connection between the owners' knowledge about their dogs' allergy, the contact they have with the veterinary staff at the clinic and how well they follow the recommendations given by the veterinarian. A questionnaire was sent to 60 dog owners, who were consulting skin specialists at a veterinary clinic in Stockholm. All the dogs have had an allergy investigation and had visited the skin specialist within the last 3 months. Thirty-three dog owners answered the questionnaire. The respondents´ dog´s clinical records were investigated to find out the differences and similarities between the journals and the answers in the questionnaires. The result, based on both the questionnaires and the clinical records, showed that the majority of those who answered the questionnaire, had a very good and frequent contact with the clinic. They were satisfied with the help and support they got from the staff. The answers also showed that the dog owners had good knowledge about their dogs' allergies. Concerning atopy, the answers and the journals were similar, but when it came to food allergies, the dog owners had more knowledge than reflected in the journals. The conclusion was that those who choose to answer the questionnaire also had a big interest and engagement about their dog´s allergies. There were too few respondent who had less frequent contact with the veterinary or where dissatisfied with the contact at the clinic to draw any conclusions if this could have a connection to a lower compliance. The only conclusion made was that the dog owners who choose to answer the questionnaire, also followed the advices and descriptions given by the specialists. This stud has a low representativeness of owners to allergic dogs

Värde och upplevelser av vardagliga aktiviteter

Bakgrund: Omkring 3 % av Sveriges befolkning vårdar dagligen en anhörig. Vardagen styrs av den anhöriges behov vilket gör att anhörigvårdarna får mindre tid för sig själva. Syfte: Studiens syfte var att undersöka anhörigvårdares värde och upplevelse av aktiviteter i vardagen . Undersökningsgruppen bestod av sju stycken anhörigvårdare i västra Sverige. Metoden: Både en kvalitativ och en kvantitativ ansats användes. Datainsamlingen genomfördes med fokusgruppsintervju samt ett enskilt skattningsformulär (OVal-Pd). Resultat: Skattningen mellan de olika aktivitetsvärdena var jämn hos anhörigvårdarna. Det framkom däremot att aktiviteter som görs består främst av vårdarbete och/eller hushållsarbete. Slutsats: Anhörigvårdarnas upplever sina vardagliga aktiviteter som produktiva och att de har ett konkret värde för individen. De skattar inte värdet av sina dagliga aktiviteter som höga. Detta resultat kan uppmuntra fler arbetsterapeuter att uppmärksamma dessa individer samt deras behov av stöd till en mer meningsfull vardag. Studien kan även bidra till en ökad förståelse för dessa individers krävande vardag

Kroppsspråkets påverkan i intervjusituationer

Syftet med studien var att undersöka hur intervjudeltagare påverkades av intervjuledarens kroppsspråk, på vilket sätt detta visade sig samt bakomliggande orsaker till påverkan. Genom att skapa manipulerade intervjusituationer var målet att undersöka skillnaderna mellan deltagarnas reaktioner på ett bekräftande beteende och ett icke-bekräftande beteende hos intervjuledaren. I samband med varje intervju delades en enkät ut som ämnade undersöka intervjudeltagarnas upplevelser av intervjusituationen och intervjuledaren. Sammanlagt deltog tio personer, varav fem blev tilldelade bekräftande beteenden och fem blev tilldelade icke-bekräftande beteenden. Resultatet visade på att kroppsspråket hos deltagarna varierade mer under de icke-bekräftande intervjuerna jämfört med de bekräftande. Överlag visade dock kroppsspråket sig mest som en spegling av intervjuledarens beteende. Resultatet visade en större förändring i deltagarnas subjektiva uppfattning av situationen, vilket ledde oss till slutsatsen att individerna i vår studie inte visade upp sina känslor i lika stor utsträckning som de upplevde dem.The purpose of this study was to investigate how the participants of the interview were influenced by the interview leader's body language, the way this turned out as well as the underlying causes of impact. By creating manipulated interview situations, the goal was to examine differences between the reactions of a confirmatory conduct and non-confirmatory conduct from the leader. In addition to each interview a questionnaire was assigned to all participants that aimed to examine the participants' perceptions of the interview situation and the leader. A total of ten people participated in this study, five of whom were assigned confirmatory behaviors and five were assigned non-confirmatory behaviors. The results showed that the body language of the participants varied more in the non-confirmatory interviews compared to the affirmative. However, the body language showed itself mostly as a reflection of the leader's behavior. The results showed a significant change in participants' subjective perception of the situation, which led us to conclude that the individuals in our study did not show their emotions to the same extent as they experienced them

Are you environmentally concerned when choosing car insurance? : a study among Folksam's car insurance customers

Många människor är inte medvetna om försäkringsbolagens ambitioner att påverka och förbättra miljön. Försäkringsbolaget Folksam arbetar aktivt med miljö inom företaget men har inte engagerat sig i att kommunicera sitt miljömässiga budskap till sina kunder. Syftet med denna uppsats är att undersöka om Folksams bilförsäkringskunder är intresserade av miljöfrågor. Det undersöks även om en profiliering inom miljöområdet skulle skapa ett mervärde hos Folksams bilförsäkringskunder. Studien är baserad på en enkätstudie som skickades till Folksams bilförsäkringskunder i åldern 20-30 år. Denna urvalsgrupp delades upp i två geografiska områden där 250 enkäter skickades till kunder i Stockholm stad och 250 skickades till kunder på landsbygden. Analysen baserar sig på teorier kring miljökommunikation, grön konsumtion, grön marknadsföring, drivkrafter och mervärde. Svaren från enkäten gav intressant information om kundernas intresse för miljö och visade att Folksams miljöarbete skulle innebära ett mervärde. Det visade sig också att män är mer miljöintresserade på landsbygden jämfört med kvinnor. Utbildning visade sig inte ha någon större påverkan för hur miljömedvetna Folksams bilförsäkringskunder är oavsett geografiskt område. En annan intressant faktor är att personer med barn på landsbygden tenderar att vara mindre miljömedvetna än de utan barn. Många är dock omedvetna om deras miljöarbete vilket kan tyda på en bristande kommunikation mellan företaget och kunderna. I slutet av arbetet diskuteras några förslag på möjliga åtgärder Folksam kan använda sig av för att kommunicera sitt miljöarbete och nyttja miljön som drivkraft.Society isn’t aware of how environmentally engaged insurance companies are today. The insurance company Folksam is working actively with environmental issues, although they are facing difficulties being related to environmental work and how to communicate their message. The purpose of this essay is to investigate whether Folksams car insurance customers are interested in environmental issues. This study is also made to see if environmental profiling would create an added brand value for the company’s customers. This study is based on a questionnaire that was sent to Folksams car insurance customers between the age of 20 and 30. The selection was divided into two geographic areas. 250 questionnaires where sent to customers in Stockholm and 250 to customers in the rural area. The analysis is based on the following theories: environmental communication, green consumption, green marketing, companies’ driving forces and added brand value. The answers from the questionnaire gave some interesting information concerning the customer’s environmental interest and whether Folksams environmental work would create an added brand value. The results showed for instance that men from the rural area were more interested in the safety of the environment compared to women. Education on the other hand, didn’t seem to have any greater effect on people’s environmental awareness. Another interesting factor is that people with children in rural areas tend to be less environmentally concerned compared to people without children. However, the customers’ unawareness shows that Folksams environmental communication isn’t reaching out properly. In the end of the essay a few possible measures is presented that Folksam could use to communicate their environmental work and use it as a driving force

Effects of prolonged and acute muscle pain on the force control strategy during isometric contractions

Musculoskeletal pain is associated with multiple adaptions in movement control. This study aimed to determine whether changes in movement control acquired during acute pain are maintained over days of pain exposure. On day 0, the extensor carpi radialis brevis muscle of healthy participants was injected with nerve growth factor (NGF) to induce persistent movement-evoked pain (n\ua0=\ua013) or isotonic saline as a control (n\ua0=\ua013). On day 2, short-lasting pain was induced by injection of hypertonic saline into extensor carpi radialis brevis muscles of all participants. Three-dimensional force components were recorded during submaximal isometric wrist extensions on day 0, day 4, and before, during, and after saline-induced pain on day 2. Standard deviation (variation of task-related force) and total excursion of center of pressure (variation of force direction) were assessed. Maximal movement-evoked pain was 3.3\ua0±\ua0.4 (0–10 numeric scale) in the NGF-group on day 2 whereas maximum saline-induced pain was 6.8\ua0±\ua0.3\ua0cm (10-cm visual analog scale). The difference in centroid position of force direction relative to day 0 was greater in the NGF group than in the control group (P\ua

Microclimatological consequences for plant and microbial composition in Sphagnum-dominated peatlands

In three Scandinavian peatlands we studied to what extent plant and microbial community compositions are governed by local-scale microhabitat, with a special interest in the effect of aspect (i.e. exposition of slopes). Despite differences in solar irradiance between the south- and north-facing slopes, maximum temperature was elevated in the south-facing slopes at the most northern site only. Pore-water nutrient concentrations were not affected by aspect, yet dissolved organic carbon concentrations were higher in the south-facing microhabitats. This was likely caused by higher vascular plant biomass. Plant and microbial community composition clearly differed among sites. In all three sites, microhabitat (i.e. prevailing water-table depth) affected the plant and microbial community compositions. Aspect, however, did not affect community composition, even though microclimate significantly differed between the south- and the north-facing aspects at the northernmost site. Our results highlight the complex link between plant community composition, microbial community and environmental conditions, which deserves much more attention than currently in order to fully understand the effects of climate change on peatland ecosystem function.I

Pressure pain sensitivity maps of the neck-shoulder and the low back regions in men and women

<p>Abstract</p> <p>Background</p> <p>Musculoskeletal pain in the low back and neck-shoulder regions is a major problem among the working population all over the world. The prevalence of musculoskeletal pain is found to be higher among women. Women also have lower pressure pain thresholds (PPTs) than men. Pressure pain topography aims at mapping the spatial distribution of PPT within a muscle in an attempt to track changes in mechanical sensitivity. In order to assess gender differences in the pain topography, it is necessary to map the distribution in both healthy men and women. The aim of this study was to assess PPT maps from the cervico-thoracic and lumbar regions in men and women.</p> <p>Methods</p> <p>Eleven men and eleven women without any known musculoskeletal disorders participated in the study. PPT was measured twice at 36 points over the trapezius muscle of the dominant arm, at 36 points over the trapezius muscle on the contralateral side and at 12 points over the spine between the left and right trapezius. Further, 11 points were measured over the erector spinae muscle on the left side of the spine between the first and the fifth lumbar vertebrae, 11 on the right side and 5 points on the spine itself. The measurements on each trapezius muscle were divided according to anatomical subdivisions. Three-way and two-way ANOVAs were used to analyse the differences in PPTs with the following factors: gender, locations and sub-divisions (only for cervico-thoracic region).</p> <p>Results</p> <p>There were no differences between left and right side in neither the cervico-thoracic nor the lumbar region, but there were (large effect) differences between the subdivisions in the trapezius with the lowest values in the upper part (P < 0.001; partial η²= 0.19). Women had (small effect) lower PPT in both cervico-thoracic and lumbar regions (P ≤ 0.001; partial η²= 0.02 for both regions), but gender had no effect on neither location nor subdivisions.</p> <p>Conclusions</p> <p>The pain topography was not found to be different between genders in the cervico-thoracic and lumbar regions. This study can be used as basis for further clinical studies on musculoskeletal disorders.</p

Experimental neck muscle pain impairs standing balance in humans

Impaired postural control has been reported in patients with chronic neck pain of both traumatic and non-traumatic etiologies, but whether painful stimulation of neck muscle per se can affect balance control during quiet standing in humans remains unclear. The purpose of the present experiment was thus to investigate the effect of experimental neck muscle pain on standing balance in young healthy adults. To achieve this goal, 16 male university students were asked to stand upright as still as possible on a force platform with their eyes closed in two conditions of No pain and Pain of the neck muscles elicited by experimental painful electrical stimulation. Postural control and postural performance were assessed by the displacements of the center of foot pressure (CoP) and of the center of mass (CoM), respectively. The results showed increased CoP and CoM displacements variance, range, mean velocity, and mean and median frequencies in the Pain relative to the No pain condition. The present findings emphasize the destabilizing effect of experimental neck muscle pain per se, and more largely stress the importance of intact neck neuromuscular function on standing balance

Effects of the noradrenergic agonist clonidine on temporal and spatial attention

Rationale: Recent theories posit an important role for the noradrenergic system in attentional selection in the temporal domain. In contrast, the spatially diffuse topographical projections of the noradrenergic system are inconsistent with a direct role in spatial selection. Objectives: To test the hypotheses that pharmacological attenuation of central noradrenergic activity should (1) impair performance on the attentional blink task, a task requiring the selection of targets in a rapid serial visual stream of stimuli; and (2) leave intact the efficiency of the search for a target in a two-dimensional visuospatial stimulus array. Materials and methods: Thirty-two healthy adult human subjects performed an attentional blink task and a visual search task in a double-blind, placebo-controlled, between-subject study investigating the effects of the α2 adrenoceptor agonist clonidine (150 μg, oral dose). Results: No differential effects of clonidine vs placebo were found on the attentional blink performance. Clonidine slowed overall reaction times in the visual search task but did not impair the efficiency of the visual search. Conclusions: The attentional blink results are inconsistent with recent theories about the role of the noradrenergic system in temporal filtering and in mediating the attentional blink. This discrepancy between theory and data is discussed in detail. The visual search results, in combination with previous findings, suggest that the noradrenergic system is not directly involved in spatial attention processes but instead can modulate these processes in an indirect fashion. © 2007 Springer-Verlag