Sensitivity for Change Analyses of the Patient-Reported Outcomes in Obesity (PROS) Questionnaire: A Prospective Cohort Study.

Purpose: Many patients seeking bariatric surgery experience reduced health-related quality of life (HRQOL). A simple clinical tool, the Patient-Reported Outcomes in Obesity (PROS), was developed to address patients' HRQOL concerns during clinical consultations and facilitate meaningful dialogue. The present study aims to explore its sensitivity to change. Patients and Methods: A prospective study of patients undergoing bariatric surgery was conducted. The patients responded to items on the PROS and the Obesity-related Problems Scale (OP) before surgery and three, 12 and 24 months after surgery. Longitudinal mixed-effects models were applied to estimate the change in PROS and OP scores over time. Results: Thirty-eight patients were included. A significant change over time was detected for the PROS with the largest effect size at 24 months (effect size -1.34, p ˂ 0.001), while the corresponding effect size for the OP was -1.32 (p ˂ 0.001). In all items of the PROS, the majority of patients responded not bothered at 24 months. The items physical activity, pain, sleep and self-esteem showed the largest change in the percentage of patients reporting not bothered from baseline to 24 months after surgery. Conclusion: The PROS is sensitive to change over time and may be used as a brief, easy to administer tool to facilitate a conversation about obesity-specific quality of life in clinical consultations.

Experiences and results from using a novel clinical feedback system in routine stoma care nurse follow-up of patients with an ostomy: a longitudinal study.

BACKGROUND: A faecal or urinary ostomy may be lifesaving. However, it involves significant bodily change, and the adjustment process to life with an ostomy includes a broad spectre of physical and psychosocial challenges. Thus, new interventions are needed to improve adaptation to living with an ostomy. This study aimed to examine experiences and outcomes using a new clinical feedback system with patient-reported outcome measures in ostomy care. METHODS: In this longitudinal explorative study, 69 ostomy patients were followed by a stoma care nurse in an outpatient clinic, using a clinical feedback system postoperatively at 3, 6 and 12 months. The patients responded electronically to the questionnaires before each consultation. The Generic Short Patient Experiences Questionnaire was used to measure patient experiences and satisfaction with follow-up. The Ostomy Adjustment Scale (OAS) measured adjustment to life with an ostomy, and the Short Form-36 (SF-36) assessed the patient's health-related quality of life. Longitudinal regression models with time as an explanatory (categorical) variable were used to analyse changes. The STROBE guideline was applied. RESULTS: The patients were satisfied with their follow-up (96%). Especially, they felt they received sufficient and individualised information, were involved in treatment decisions, and benefited from the consultations. The OAS subscale scores for 'daily activities', 'knowledge and skills' and 'health' improved over time (all p < 0.05), as did the physical and mental component summary scores of the SF-36 (all p < 0.05). Effect sizes of changes were small (0.20-0.40). Sexuality was the most challenging factor reported. CONCLUSIONS: The clinical feedback system could be helpful because outpatient follow-ups for ostomy patients may be more tailored when clinicians use clinical feedback systems. However, further development and testing are needed.

Effect of Optimal Alcohol-Based Hand Rub among Nurse Students Compared with Everyday Practice among Random Adults; Can Water-Based Hand Rub Combined with a Hand Dryer Machine Be an Alternative to Remove E. coli Contamination from Hands?

Efficient hand hygiene is essential for preventing the transmission of microorganisms. Alcohol-based hand rub (ABHR) is a recommended method. We compared health personnel (skilled nurse students) with random adults to study the effect of an ABHR procedure. A water-based hand rub (WBHR) procedure, using running tap water and a hand-drying machine, was also investigated. The study included 27 nurse students and 26 random adults. Hands were contaminated with Escherichia coli, and concentrations of colony forming units (CFU/mL) were determined before and after ABHR or WBHR. Concentrations after ABHR were 1537 CFU/mL (nurse students) and 13,508 CFU/mL (random adults) (p < 0.001). One-third of participants reported skin irritation from daily ABHR. Concentrations after WBHR were 41 CFU/mL (nurse students) and 115 CFU/mL (random adults) (p < 0.011). The majority of participants (88.5%) preferred the WBHR method. Results from 50 air samples from filtered air from the hand dryer outlet showed no CFU in 47 samples. A significant difference between the two groups was shown for the ABHR method, indicating that training skills are important for efficient hand hygiene. Surprisingly, the WBHR method seemed to have a significant effect in largely removing transient bacteria from hands.

Factors associated with leakage in patients with an ostomy: A cross-sectional study.

AIMS: To explore the associations between sociodemographic and clinical data, the patient's knowledge and skills, and relationship to healthcare professionals with leakage from an ostomy. DESIGN: Cross-sectional. METHODS: This study included 160 patients with a colostomy, ileostomy, or urostomy. Leakage was the dependent variable and was assessed by self-report. Sociodemographic and clinical data and the Ostomy Adjustment Scale subscores, 'knowledge and skills' and 'health care professionals' were independent variables. Spearman's rho and multivariate partial least squares regression analysis were used to estimate possible factors associated with leakage. RESULTS: Of the participants, 13.8% had leakage weekly or more often, 16.3% more often than once a month and 37, 5% had leakage more seldom than once a month. The most important risk factors for leakage were (1) having an ostomy placement that does not meet international guidelines, (2) not having an optimal relationship with health professionals, (3) having a diagnosis other than cancer, (4) not having proper knowledge and skills in ostomy care, (5) not having a colostomy, (6) having a convex baseplate, (7) having an oval ostomy, and (8) being dependent on others for ostomy care. The independent variables in the PLS- model explained 31% of the variance in leakage. PATIENT OR PUBLIC CONTRIBUTION: We thank the patients in the user panel for their help during the study.

The impact of educational concerns and satisfaction on baccalaureate nursing students' distress and quality of life during the Covid-19 pandemic; a cross-sectional study.

BACKGROUND: High levels of psychological distress and poor overall quality of life (QOL) have been identified among nursing students during the COVID-19 pandemic. The pandemic necessitated improvised reconstructions of educational curriculums and restrictions in clinical placement and training at campuses, possibly reducing educational quality. OBJECTIVES: We explored whether baccalaureate nursing students' concerns and satisfaction with the educational curriculum, focusing on the conduct of clinical training, were associated with perceived psychological distress and overall QOL. METHODS: Baccalaureate nursing students (N=6088) from five Norwegian universities were invited to an internet-based, cross-sectional survey during the second wave of the pandemic. The survey included COVID-19 specific questions on health, education and clinical training, the Fear of COVID-19 scale (FCV-19S), The Hopkins Symptom Checklist (SCL-5) and overall QOL. Data from national surveys on satisfaction with the educational curriculum, before and during the pandemic were used for comparison. RESULTS: In total, 2605 (43%) students responded, of whom 1591 (61%) had been engaged in clinical training during the pandemic. Overall, 53% were either satisfied or fully satisfied with their educational curriculum, with the level of satisfaction being significantly lower than pre-pandemic reference values. Also, 79% were concerned or highly concerned about the educational quality. In multiple regression analyses for all students, lower levels of satisfaction and higher levels of quality concerns were associated with worse SCL-5 scores. Furthermore, satisfaction with the educational curriculum was positively associated with overall QOL. For students engaged in clinical training, only concerns about infecting others were additionally associated with psychological distress. None of the items related to clinical training were associated with overall QOL. CONCLUSION: Nursing students' educational satisfaction and quality concerns may significantly impact perceived psychological distress and overall QOL during a pandemic. However, with necessary adaptations implemented, concerns regarding the conduct of clinical training account for little of these associations.

Outcomes of the first global multidisciplinary consensus meeting including persons living with obesity to standardize patient-reported outcome measurement in obesity treatment research.

Quality of life is a key outcome that is not rigorously measured in obesity treatment research due to the lack of standardization of patient-reported outcomes (PROs) and PRO measures (PROMs). The S.Q.O.T. initiative was founded to Standardize Quality of life measurement in Obesity Treatment. A first face-to-face, international, multidisciplinary consensus meeting was conducted to identify the key PROs and preferred PROMs for obesity treatment research. It comprised of 35 people living with obesity (PLWO) and healthcare providers (HCPs). Formal presentations, nominal group techniques, and modified Delphi exercises were used to develop consensus-based recommendations. The following eight PROs were considered important: self-esteem, physical health/functioning, mental/psychological health, social health, eating, stigma, body image, and excess skin. Self-esteem was considered the most important PRO, particularly for PLWO, while physical health was perceived to be the most important among HCPs. For each PRO, one or more PROMs were selected, except for stigma. This consensus meeting was a first step toward standardizing PROs (what to measure) and PROMs (how to measure) in obesity treatment research. It provides an overview of the key PROs and a first selection of the PROMs that can be used to evaluate these PROs.

Correlated physical and mental health composite scores for the RAND-36 and RAND-12 health surveys: can we keep them simple?

BACKGROUND: The RAND-36 and RAND-12 (equivalent to versions 1 of the SF-36 Health Survey and SF-12 Health Survey, respectively) are widely used measures of health-related quality of life. However, there are diverging views regarding how to create the physical health and mental health composite scores of these questionnaires. We present a simple approach using an unweighted linear combination of subscale scores for constructing composite scores for physical and mental health that assumes these scores should be free to correlate. The aim of this study was to investigate the criterion validity and convergent validity of these scores. METHODS: We investigated oblique and unweighted RAND-36/12 composite scores from a random sample of the general Norwegian population (N = 2107). Criterion validity was tested by examining the correlation between unweighted composite scores and weighted scores derived from oblique principal component analysis. Convergent validity was examined by analysing the associations between the different composite scores, age, gender, body mass index, physical activity, rheumatic disease, and depression. RESULTS: The correlations between the composite scores derived by the two methods were substantial (r = 0.97 to 0.99) for both the RAND-36 and RAND-12. The effect sizes of the associations between the oblique versus the unweighted composite scores and other variables had comparable magnitudes. CONCLUSION: The unweighted RAND-36 and RAND-12 composite scores demonstrated satisfactory criterion validity and convergent validity. This suggests that if the physical and mental composite scores are free to be correlated, the calculation of these composite scores can be kept simple.

Effects of a school-based intervention on levels of anxiety and depression: a cluster-randomized controlled trial of the MindPower program in ten high schools in Norway.

BACKGROUND: The previous decades have shown increased symptoms of depression and anxiety among adolescents. To promote mental health and reduce mental illness, the government of Norway has, as in other countries, pledged that all schools must incorporate life-skills education. We report results from an evaluation of MindPower, a modification of the Coping With Depression (CWD) course, delivered universally in the classroom to secondary high school students, aged 15-16 years, in one county in Norway. The aim of the study was to evaluate the effect of MindPower on symptoms of depression and anxiety. METHODS: We utilized a two-groups` delayed intervention design where 110 first year high school classes were randomized into one of two intervention groups (IG1 and IG2). IG1 participated in MindPower while IG2 served as a control group for four months until the intervention started also in this group. IG1 and IG2 responded to questionnaires before and after the eight weeks course, at the start of the first and the second booster session, and at the five months follow up. Questionnaires, including online versions of the Hopkins Symptom Checklist (SCL-8) and the Reynolds Adolescent Depression Scale (RADS-2:SF), were administered to 1673 out of a total of 2384 students. SCL-levels were also compared with those from a large population study (UngData). RESULTS: According to mixed model analyses, SCL-8 and RADS-2:SF showed significant baseline differences between IG1 and IG2. In IG1 and IG2, both SCL-8 and RADS-2:SF showed a small but significant increase in mean scores throughout the study period, with markedly lower mean scores among boys. The SCL-levels were first lower for both girls and boys and then after the completion of MindPower the SCL-levels, equal to the SCL-levels in UngData. CONCLUSIONS: No effects of the intervention were found. This large universal school-based trial suffered from considerable drop-out of participants. Experiences from implementation and evaluation of universal mental health promotion and preventive school interventions are thoroughly discussed, including, preparation, resources, support, time, realistic expectations, teacher selection and training, implementation, research designs and more. Several empirically based, practical advices are presented. Clinical Trial registration 27/08/2018. Registration number NCT03647826.

Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy.

BACKGROUND/OBJECTIVES: There is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities. We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB. SUBJECTS/METHODS: Patients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015. Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril's ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates. RESULTS: Of 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m2) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5-7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up. CONCLUSION: In routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB.

The Norse Feedback in a population of patients undergoing bariatric surgery-Psychometric properties of a digital computer-adaptive questionnaire assessing mental health.

The Norse Feedback (NF) is a questionnaire developed for patient-reported outcome monitoring with a clinical feedback system (PRO/CFS). As mental health is a concern after bariatric surgery, the use of the NF as part of PRO/CFS may be beneficial. The aim of this study is to test the reliability and validity of the NF in patients who have been accepted for or have undergone bariatric surgery. We performed separate robust confirmatory factor analyses (CFAs) to test the unidimensionality on 19 of the NF scales. We also performed correlation analyses on 19 of the NF scales with the Obesity-related Problems scale (OP). We included 213 patients. In the CFA analyses, three out of 12 scales with four or more items showed satisfactory psychometric properties in all goodness of fit indices (Suicidality, Need for Control and Self-Criticism). Four scales showed satisfactory psychometric properties in all indices but RMSEA (Somatic Anxiety, Substance Use, Social Safety and Cognitive Problems). Several of the scales demonstrated floor effects. In the correlation analyses, 18 of the 19 scales showed small-to-moderate correlation coefficients with the OP. Our demonstration of satisfactory psychometric properties on several important scales of the NF suggests that this tool may prove valuable in the routine follow-up of mental health in this population. However, further work is needed to innovate the NF for patients undergoing bariatric surgery.

Psychometric Properties of New Subscales of the Ostomy Adjustment Scale: A Cross-Sectional Study.

BACKGROUND: The Ostomy Adjustment Scale (OAS), which consists of an overall sum score along with 34 single-item scores, has been frequently used to measure self-reported adjustment to life with an ostomy. However, it is unknown whether the OAS can be divided into meaningful thematic subscales that may make it easier to administer and to apply in a clinical feedback system. PURPOSE: The purpose of this study was to specify thematic OAS subscales and evaluate their psychometric properties. PATIENTS AND METHODS: A cross-sectional study was conducted with 302 patients across Norway having colostomy, ileostomy, or urostomy. The OAS items were divided into different subscales by expert nurses and patients based on clinical and theoretical considerations. The overall structural validity of this analysis of the OAS was examined using robust confirmatory factor analysis. We evaluated the overall goodness of fit using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker-Lewis index (TLI). Factor loadings from the confirmatory factor analysis were used to calculate composite reliability values for the new OAS scales. RESULTS: The OAS was divided into seven subscales. The overall structure validity was acceptable with RMSEA = 0.053 (90% CI, 0.045-0.060), CFI = 0.913 and TLI = 0.904. The composite reliability values of all scales were >0.70. CONCLUSIONS: The OAS can be divided into seven clinically meaningful subscales with acceptable psychometric properties. TRIAL REGISTER: ClinicalTrials.gov Registration Number: NCT03841071. Date 18. February 2019 retrospectively registered.

The association between aspects of carer distress and time until nursing home admission in persons with Alzheimer's disease and dementia with Lewy bodies.

OBJECTIVE: The aim of this study was to explore the association between specific aspects of carer distress and time until nursing home admission (NHA) in people with mild dementia. DESIGN: Prospective cohort study. SETTING: Participants were recruited from the Dementia Study of Western Norway (DemVest). PARTICIPANTS: This study included 107 participants admitted to a nursing home who were diagnosed with Alzheimer's disease (AD, n = 64) and dementia with Lewy bodies (DLB, n = 43) and their primary carers. MEASUREMENTS: The Relative Stress Scale (RSS) was used to assess the level of reported distress in carers. Adjusted partial least square (PLS) prediction analysis of baseline items of the RSS was used to study the associations between individual items of the RSS and time until NHA. RESULTS: Carer distress is an important contributor to early NHA, explaining 19.3% of the total variance of time until NHA in the model without covariates. In the adjusted PLS model, the most important RSS predictors of time until NHA were feeling frustrated (estimate = -137; CI, -209, -64.5), having limitations on social life (estimate = -118; CI, -172, -64), not being able to get away on vacation (estimate -116; CI, -158.3, -73.7), and feeling unable to cope with the situation (estimate = -63; CI, -122.6, -3.4). CONCLUSIONS: Preservation of the informal care capacity represents important steps for improving the management of resources in dementia care. This study identifies aspects of carer distress associated with a shorter time until NHA. Looking beyond the sum score of the RSS helps promote the development of flexible and tailored interventions and perhaps delay NHA.

A novel patient-reported outcome monitoring with clinical feedback system in bariatric surgery care: study protocol, design and plan for evaluation.

BACKGROUND: Consultations before and after bariatric surgery should include structured assessments of patients' health-related quality of life (HRQOL) and mental health. One way to conduct this assessment is to implement patient-reported outcome monitoring with a clinical feedback system (PRO/CFS). AIM: We will explore patients' and healthcare professionals' experiences when a PRO/CFS is an integrated part of bariatric surgery care. METHODS AND ANALYSES: This is a design paper in which a PRO/CFS will be implemented in two bariatric outpatient clinics. All patients who have an appointment with a healthcare professional prior to, and 3 and 12 months after surgery, will be asked to complete six digital questionnaires measuring HRQOL, mental health, bowel symptoms and eating self-efficacy prior to each consultation. A digital summary report generated from the patient's responses will form the basis for the clinical consultation. A team of patient representatives, healthcare professionals and researchers will be involved in all phases of designing the PRO/CFS to ensure its relevance for clinical consultations. The patients' experiences will be explored with a generic 12-item questionnaire, developed for use in outpatient clinics, prior to and 12 months after bariatric surgery. We will conduct focus-group interviews with patients and healthcare professionals to explore their experiences when PRO/CFS is integrated into the consultations. ETHICS AND DISSEMINATION: Written informed consent will be obtained for all participants in the study. The project is approved by the Norwegian Centre for Research Data, Department of Data Protection Services (ref. no. 282738). The project has also undergone Data Protection Impact Assessments, both at Førde Hospital Trust and at St. Olav Hospital (registration no. 2016/3912). Data from the qualitative and quantitative studies will be kept in de-identified form in a secured research database, and the findings will be published in international peer-reviewed journals and presented at scientific conferences.

Cognitive behavioral group therapy for panic disorder in a general clinical setting: a prospective cohort study with 12 to 31-years follow-up.

BACKGROUND: The long-term prognosis after cognitive behavioral therapy (CBT) in outpatient groups for panic disorder and agoraphobia is not well known. The purpose of this study was to assess long-term outcomes in terms of psychological health, health-related quality of life (HRQoL), quality of life (QoL) and treatment satisfaction after CBT for panic disorder and agoraphobia. METHODS: The sample consisted of 68 patients (61% response rate), who were assessed at pretreatment; at the start and end of treatment; and after 3 months, after 1 year, and over the long term (M = 24 years; SD = 5.3; range: 12 to 31 years). The main outcome was the total score on the Phobic Avoidance Rating Scale (PARS-total). At long-term follow-up, HRQoL was measured with the RAND-12 questionnaire, and QoL was measured with two questions from the "Study on European Union Statistics on Income and Living Conditions". Patient experiences and treatment satisfaction were assessed by the Generic Short Patient Experiences Questionnaire. A marginal longitudinal model was applied to study the main outcome. RESULTS: The effect size of the long-term change (mean change/ pooled SD) in the PARS-total score was (- 1.6, p < 0.001) and was stable over time. A PARS-total score reduction of 50% was found in 98% of patients at the long-term follow-up. The patients' HRQoL and QoL were similar to the expected scores for the general Norwegian population. Of the patients, 95% reported high to very high satisfaction with the CBT, and 93% reported large treatment benefits. CONCLUSIONS: To the best of our knowledge, this study has the longest follow-up after group CBT for panic disorder and agoraphobia, showing a good prognosis in ≥93% of the participating patients.

A new model of patient-reported outcome monitoring with a clinical feedback system in ostomy care: rationale, description and evaluation protocol.

BACKGROUND: Living with an ostomy can be challenging and adapting to life with an ostomy can be particularly complex, with regard to both the physical and psychosocial aspects. Follow-up with a stoma care nurse (SCN) is usually performed after surgery to support the adaptation process. In the present paper, we describe a new model of ostomy care, where a clinical feedback system (CFS) is implemented in order to improve the adaption process of patients with an ostomy. We also present a plan for evaluating patients experience with the CFS and their clinical outcomes. METHODS: In this study, we include patients who had recently performed colostomy, ileostomy, or urostomy surgery. The intervention includes self-reported measures for adaptation to life with an ostomy and health-related quality of life (HRQoL), as well as patient experiences and satisfaction recorded by the clinical feedback system. The measures are electronically assessed before each clinical consultation at 3, 6, and 12 months after surgery. The scores are instantly analysed and graphically presented for use during the consultation and the patient and the SCN can discuss the findings. Patient experiences and satisfaction with care will be measured with the Generic Short Patient Experiences Questionnaire. Adaptation to the life with ostomy will be measured with the Ostomy Adjustment Scale, and HRQoL with the Short Form 36. DISCUSSION: This study presents a novel approach that could lead to improved consultation, more patient involvement, and better adaptation to life with an ostomy. TRIAL REGISTER: ClinicalTrials.gov Registration Number: NCT03841071. Date 18. February 2019 retrospectively registered.

Overall Treatment Satisfaction 5 Years After Bariatric Surgery.

INTRODUCTION: Up to 30 % of patients undergoing bariatric surgery are dissatisfied with treatment outcomes in the long term. The aim of this study was to examine overall satisfaction with treatment 5 years after bariatric surgery and its association with body mass index (BMI) and health-related quality of life (HRQOL). METHODS: Patients were surveyed 5 years after bariatric surgery; 108 patients had duodenal switch (DS) and 153 patients had laparoscopic sleeve gastrectomy (LSG). The main outcome was overall treatment satisfaction, assessed by a single question, and analyzed by multiple logistic regression. Estimates for continuous independent variables represent the odds ratios (OR) for a 2-standard deviation difference. RESULTS: Five years after surgery, 82.4 % of the patients were very satisfied or satisfied, whereas 17.6 % were unsure or dissatisfied. The following variables assessed at 5 years were associated with being dissatisfied/unsure: a higher BMI (OR = 6.1, 95 % CI = 2.7-14.0, p < 0.001), reduced obesity-specific HRQOL (OR = 3.0, 95 % CI = 1.1-7.8, p = 0.03), and reduced mental HRQOL (OR = 0.3, 95 % CI = 0.1-0.8, p = 0.02). We also found that a higher proportion of patients who underwent LSG, compared to DS, reported being dissatisfied/unsure (OR = 3.3, 95 % CI = 1.3-8.8, p = 0.01). CONCLUSION: Reduced mental HRQOL and obesity-related HRQOL, as well as higher BMI, were associated with less satisfaction with overall treatment outcomes 5 years after bariatric surgery. Differences in overall treatment satisfaction by type of operation warrant further investigation.

An Experientially Derived Model of Flexible and Intentional Actions for Weight Loss Maintenance After Severe Obesity.

BACKGROUND: Knowledge about non-surgical weight loss (WL) is scarce among people with severe obesity (SO). Lifestyle changes are primarily self-driven, occasionally accompanied by professional guidance and weight-management support. Weight regain and intervention discontinuation are common challenges among guidance and support programmes. In the current study, we describe a model of meaningful strategies for maintaining WL after SO based on the experiences of successful cases. METHODS: Aiming to investigate the experiences of WL and weight loss maintenance (WLM) (≥5 years) following SO, we designed a qualitative study. Ten adults of Norwegian ethnicity, eight women and two men aged from 27 to 59, participated in individual in-depth interviews. We recruited participants living in rural districts and cities across all four regions of Norway. The interviews concentrated on participants' experiences of losing weight and maintaining a lower weight over the long term. The transcripts were analysed with a rigorous method for thematic cross-case analysis, namely, systematic text condensation (STC). RESULTS: Participants identified four experiential themes at the core of long-term WLM: (a) Owning the decision, (b) Creating self-reinforcement, (c) Sustaining a lifestyle-forming identity, and (d) Selecting support appropriate to one's own situation. These core themes represent the intentional level, functioning both as the foundation of and the momentum for sustaining WL. On the behavioural level, participants continued to take action for change, obtain results, record and reflect on their efforts and milestones, observe what worked and felt good, and receive recognition from others, thereby realising changes. CONCLUSION: Based on these results, we propose a model of WLM after SO, suggesting that practices toward WLM on the behavioural level achieve meaning and sustainability through their relationship with a core intentional level found across participants' experiences. One implication is that the relationship between the intentional and behavioural levels might be more meaningful when discussing long-term WLM than the behaviours themselves.

Changes in quality of life 5 years after sleeve gastrectomy: a prospective cohort study.

OBJECTIVES: Sleeve gastrectomy (SG) is the most frequently performed bariatric surgery procedure worldwide, but reports on long-term quality of life (QOL) outcomes are scarce. We investigated 5-year trajectories in QOL and their associations with weight loss after SG. DESIGN: A prospective cohort study. SETTING: The study was conducted in a single Norwegian bariatric surgery centre. PARTICIPANTS: Out of 150 operated patients, 127 were included. Mean age was 41 years, 68% were women and the follow-up rate at 1 year was 85% and 64% at 1 and 5 years, respectively. OUTCOME MEASURES: Data were collected preoperatively, and 1 and 5 years after surgery assessing three different levels of QOL. The main exposure was weight loss after SG, assessed as per cent excess body mass index (kg/m2) loss (%EBMIL). The Obesity-Related Problem (OP) scale was used to measure obesity-specific health-related QOL (HRQOL). Physical (PCS) and mental (MCS) composite summary scores of the Short Form 36 Health Survey were used to capture generic HRQOL and Cantril Ladder was used to assess overall QOL. RESULTS: All HRQOL/overall QOL measures significantly improved at 1 year, followed by modest decline from 1 to 5 years after surgery. Greater %EBMIL 5 years after surgery was significantly associated with improvements in OP and PCS scores, but not with MCS and Cantril Ladder scores. Although significant (p<0.001) and clinically relevant improvements in HRQOL/overall QOL outcomes were observed at 5 years, scores were still below the general population norms. CONCLUSION: Most patients undergoing SG experience substantial weight loss accompanied by statistically significant and clinically relevant long-term improvements in HRQOL/overall QOL. However, an important minority of patients still report low HRQOL/overall QOL 5 years after SG. Further research should aim to identify other factors that contribute to impaired QOL after bariatric surgery, even in the presence of successful weight control.

Patient-reported quality of life with obesity - development of a new measurement scale. / Pasientrapportert livskvalitet ved fedme ­ utvikling av nytt måleinstrument.

BACKGROUND: Many questionnaires for measuring the quality of life for patients with obesity require comprehensive calculation before they are used. There is a need for questionnaires that permit simple assessment of the responses during a patient consultation. We have developed the questionnaire Patient-Reported Outcomes in Obesity (PROS). The objective of the study was to test the reliability and validity of the questionnaire. MATERIAL AND METHOD: The questionnaire was used to ask patients about the extent to which they perceived their weight or body shape as bothersome. A group of patients with an average body mass index (BMI) of 42 (n = 109) completed the PROS questionnaire and The Impact of Weight Quality of Life questionnaire (IWQOL-Lite) before undergoing obesity surgery. Another group with an average body mass index of 29 (n = 95) completed the PROS questionnaire 1-5 years after having undergone obesity surgery. 67,7 % of the patients were > 40 years and 79 % were women. For the statistical analysis we used Cronbach's alpha, factor analysis, Spearman's rank test and independent t-test. RESULTS: Cronbach's alpha for the total PROS score was 0.90, and the factor analysis showed a significant factor (eigenvalue = 4.7) that explained 58.4 % of the variance. The test-retest correlation was 0.93 (p < 0.001). The correlation coefficients between the PROS score, the total IWQOL-Lite score (rs = -0.91) and body mass index (rs = 0.60) were all significant (p < 0.001). The t-test showed an effect size (difference in standard deviation) between the non-surgery and the surgery groups of 1.9 (95 % CI 1.6-2.5) for the PROS questionnaire and 2.1 (95 % CI 1.7-2.5 for the total IWQOL-Lite score. INTERPRETATION: The PROS questionnaire is a reliable and valid questionnaire for measurement of obesity-specific quality of life.

The association between specific neuropsychiatric disturbances in people with Alzheimer's disease and dementia with Lewy bodies and carer distress.

OBJECTIVE: Neuropsychiatric symptoms (NPSs) are identified as important care-recipient variables in terms of the impact on carer distress. The aim of this study was to determine whether specific neuropsychiatric disturbances in people with Alzheimer disease (AD) and dementia with Lewy bodies (DLB) differentially impact carer distress. METHODS: This was a cross-sectional study of people diagnosed with AD and DLB and their primary carers. The Relatives' Stress Scale (RSS) was used to assess the level of reported distress in carers, and the Neuropsychiatric Inventory (NPI) was used to assess NPSs. The effect of NPSs on carer distress was analyzed using correlation analysis and partial least squares regression. RESULTS: This study included 159 participants diagnosed with AD (n = 97) and DLB (n = 62) and their primary carers (spouses and adult children). The majority of people diagnosed with dementia were women (64.2%), with a mean age of 75.9 years (SD, 7.4) and a mean Mini-Mental State Examination (MMSE) score of 23.5 (SD, 2.9). The main analysis identified apathy as the most important NPS contributing to carer distress. Compared with AD, the explained variance in the DLB group was higher (r2  = 37.3 vs r2  = 53.7). In addition, more NPSs were considered clinically important in the DLB group. CONCLUSION: The findings of this study identify apathy as the most important NPS contributing to carer distress among carers of people with AD and DLB. These findings help us identify the support needs of families dealing with dementia.