Development and validation of the Emotional Climate Change Stories (ECCS) stimuli set.

Climate change is widely recognised as an urgent issue, and the number of people concerned about it is increasing. While emotions are among the strongest predictors of behaviour change in the face of climate change, researchers have only recently begun to investigate this topic experimentally. This may be due to the lack of standardised, validated stimuli that would make studying such a topic in experimental settings possible. Here, we introduce a novel Emotional Climate Change Stories (ECCS) stimuli set. ECCS consists of 180 realistic short stories about climate change, designed to evoke five distinct emotions-anger, anxiety, compassion, guilt and hope-in addition to neutral stories. The stories were created based on qualitative data collected in two independent studies: one conducted among individuals highly concerned about climate change, and another one conducted in the general population. The stories were rated on the scales of valence, arousal, anger, anxiety, compassion, guilt and hope in the course of three independent studies. First, we explored the underlying structure of ratings (Study 1; n = 601). Then we investigated the replicability (Study 2; n = 307) and cross-cultural validity (Study 3; n = 346) of ECCS. The collected ratings were highly consistent across the studies. Furthermore, we found that the level of climate change concern explained the intensity of elicited emotions. The ECCS dataset is available in Polish, Norwegian and English and can be employed for experimental research on climate communication, environmental attitudes, climate action-taking, or mental health and wellbeing.

Promoting electricity conservation through behavior change: A study protocol for a web-based multiple-arm parallel randomized controlled trial.

BACKGROUND AND AIMS: As a part of the framework of the EU-funded Energy efficiency through Behavior CHANge Transition (ENCHANT) project, the present paper intends to provide a "Research Protocol" of a web-based trial to: (i) assess the effectiveness of behavioral intervention strategies--either single or in combination--on electricity saving, and (ii) unravel the psychological factors contributing to intervention effectiveness in households across Europe. METHODS AND MATERIALS: Six distinct interventions (i.e., information provision, collective vs. individual message framing, social norms, consumption feedback, competitive elements, and commitment strategies) targeting electricity saving in households from six European countries (i.e., Austria, Germany, Italy, Norway, Romania, and Türkiye) are evaluated, with an initial expected samples of about 1500 households per country randomly assigned to 12 intervention groups and two control groups, and data is collected through an ad-hoc online platform. The primary outcome is the weekly electricity consumption normalized to the last seven days before measurement per person per household. Secondary outcomes are the peak consumption during the last day before measurement and the self-reported implementation of electricity saving behaviors (e.g., deicing the refrigerator). The underlying psychological factors expected to mediate and/or moderate the intervention effects on these outcomes are intentions to save electricity, perceived difficulty of saving energy, attitudes to electricity saving, electricity saving habit strength, social norms to save electricity, personal norms, collective efficacy, emotional reaction to electricity consumption, and national identity. The intervention effectiveness will be evaluated by comparing psychological factors and consumption variables before and after the intervention, leading to a 14 (groups including 2 control groups) × 6 (time) mixed factorial design, with one factor between (group) and one factor within subjects (time)-6 measurements of the psychological factors and 6 readings of the electricity meters, which gives then 5 weeks of electricity consumption. RESULTS: Data collection for the present RCT started in January 2023, and by October 2023 data collection will conclude. DISCUSSION: Upon establishing feasibility and effectiveness, the outcomes of this study will assist policymakers, municipalities, NGOs, and other communal entities in identifying impactful interventions tailored to their unique circumstances and available resources. Researchers will benefit from a flexible, structured tool that allows the design, implementation and monitoring of complex interventions protocols. Crucially, the intervention participants will benefit from electricity saving strategies, fostering immediate effectiveness of the interventions in real-life contexts. TRIAL REGISTRATION: This trial was preregistered in the Open Science Framework: https://osf.io/9vtn4.

Emotional responses to climate change in Norway and Ireland: a validation of the Inventory of Climate Emotions (ICE) in two European countries and an inspection of its nomological span.

There is an increasing research interest in emotional responses to climate change and their role in climate action and psycho-social impacts of climate change. At the same time, emotional experience of climate change is multidimensional and influenced by a variety of factors, including the local cultural context. Here, we contribute to the scientific debate about this topic with original quality-controlled data from the general populations in Norway (N = 491) and Ireland (N = 485). We investigate the cross-cultural validity and the nomological span of eight distinct emotional responses to climate change - climate anger, climate contempt, climate enthusiasm, climate powerlessness, climate guilt, climate isolation, climate anxiety, and climate sorrow - measured using the recently introduced Inventory of Climate Emotions. We first validate the 8-factor structure of the Norwegian and English language versions of the ICE. Subsequently, we demonstrate a high degree of cross-cultural measurement invariance for these eight climate emotions. Finally, we explore the relationships between these emotional responses and a range of theoretically relevant variables. In this final step, we show that climate emotions are differentially linked to climate change perceptions, support for mitigation policies, socio-demographic factors, feelings of loneliness and alienation, environmental activism, and the willingness to prioritize the natural environment over one's immediate self-interests. Some of these links are also differentiated by the cultural context. This research presents further evidence for the structural, cross-cultural, and concurrent validity of climate emotions as postulated in the ICE framework. Moreover, it provides tools in the form of validated Norwegian and English language versions of the ICE, the complete R code for the validation analysis, as well as an informed basis for cross-cultural research on emotional responses to climate change.

Is environmental behavior related to economic risk preferences? An exploratory case by case analysis.

Do risk preferences play a role when deciding whether to act pro-environmentally? Looking at 28 different behaviors case by case - including recycling, waste reduction, energy and water conservation, consumer behavior, and environmental policy support - our data suggest no relation between most of the behaviors and economic risk preferences. However, economic risk preferences appear to have some relevance for travel mode choice and for specific consumer preferences (eco-friendly detergents, organic food, and single-use plastics), perhaps because people are better able to appreciate aspects of these behaviors related to risk (e.g., possibility of traffic accidents, health risks).

Drunk or Sober? Number of alcohol units perceived to be safe before riding e-scooter.

Riding an e-scooter under the influence of alcohol is one of the most frequently reported risky behaviours among riders in various countries, especially in the Nordic countries. What is the Number of Alcohol Units perceived to be Safe (NAUS) before riding an e-scooter? Who is more likely to report higher perceived alcohol tolerance before riding an e-scooter? What is the level of risk perception in this transport domain? The current study advances the literature by aiming to address these questions. Using a cross-sectional survey (n = 395) in Trondheim, Norway we developed an integrated model combining a path analysis with negative binomial regression to predict NAUS before riding an e-scooter. Results show that (i) around 56 % of participants reported that it is safe to consume one or more units of alcohol prior to riding an e-scooter, (ii) younger people, frequent users of e-scooters, individuals with low education, and people with lower perceived risks of an accident were more likely to report higher NAUS. Alcohol health warnings and random blood alcohol concentration tests on e-scooter sites could be prioritised among these segments of the population, and (iii) there is a rather high risk perception in this transport domain. We found that there are strong connections between higher risk perception, worry and fewer NAUS. Policymakers could highlight risks of accidents by e-scooters under the influence of alcohol.

Norms, prices, and commitment: A comprehensive overview of field experiments in the energy domain and treatment effect moderators.

This paper provides a comprehensive overview of field experiments utilizing social norms, commitment and price-based interventions to promote energy conservation, load shifting, and energy efficiency behaviors. Treatment effects reported in the extant literature, as well as the factors that may strengthen or dampen these effects are reviewed. We find that social norm and incentive-based interventions mostly achieve small reductions in energy consumption, and that the effects of commitment-based interventions are essentially zero for the most part. Incentive effects on energy efficiency investments are mostly non-existent, safe for a few exceptions. One gap that we identify is the almost complete absence of field experiments leveraging social norms or commitment to promote energy efficiency investments. We discuss a broad range of (mostly under-researched) plausible moderators of the interventions' effects. Crucially, a more careful attention to moderators in future research can highlight instances in which interventions can be effective, notwithstanding their modest or non-existent average treatment effects. Our review offers a starting point in this regard.

Psychological Predictors of Energy Saving Behavior: A Meta-Analytic Approach.

Understanding how psychological processes drive human energy choices is an urgent, and yet relatively under-investigated, need for contemporary society. A knowledge gap still persists on the links between psychological factors identified in earlier studies and people's behaviors in the energy domain. This research applies a meta-analytical procedure to assess the strength of the associations between five different classes of individual variables (i.e.,: attitudes, intentions, values, awareness, and emotions) and energy-saving behavioral intentions and behaviors (self-reported and actual). Based on a systematic review of studies published between 2007 and 2017, we estimate the average effect size of predictor-criterion relations, and we assess relevant moderators and publication bias, drawing on data obtained from 102 independent samples reported in 67 published studies (N = 59.948). Results from a series of five single meta-analyses reveal a pattern of significant positive associations between the selected psychological determinants and energy-saving indicators: associations between individual-level predictors and energy-saving outcomes are positive and moderate in size, ranging from large effects for emotions to small-moderate effects for pro-environmental values. Interestingly, moderation analysis reveals, among other things, that attitude-behavior links are not statistically significant when actual behavior is considered as an outcome. Implications for policy interventions are discussed.

Sex differences in sleep and influence of the menstrual cycle on women's sleep in junior endurance athletes.

Previous research shows that female athletes sleep better according to objective parameters but report worse subjective sleep quality than male athletes. However, existing sleep studies did not investigate variations in sleep and sleep stages over longer periods and have, so far, not elucidated the role of the menstrual cycle in female athletes' sleep. To address these methodological shortcomings, we investigated sex differences in sleep and sleep stages over 61 continuous days in 37 men and 19 women and examined the role of the menstrual cycle and its phases in 15 women. Sleep was measured by a non-contact radar, and menstrual bleeding was self-reported. Associations were investigated with multilevel modeling. Overall, women tended to report poorer subjective sleep quality (p = .057), but objective measurements showed that women obtained longer sleep duration (p < .001), more light (p = .013) and rapid eye movement sleep (REM; hours (h): p < .001, %: p = .007), shorter REM latency (p < .001), and higher sleep efficiency (p = .003) than men. R2 values showed that sleep duration, REM and REM latency were especially affected by sex. Among women, we found longer time in bed (p = .027) and deep sleep (h: p = .036), and shorter light sleep (%: p = .021) during menstrual bleeding vs. non-bleeding days; less light sleep (h: p = .040), deep sleep (%: p = .013) and shorter REM latency (p = .011) during the menstrual than pre-menstrual phase; and lower sleep efficiency (p = .042) and more deep sleep (%: p = .026) during the follicular than luteal phase. These findings indicate that the menstrual cycle may impact the need for physiological recovery, as evidenced by the sleep stage variations. Altogether, the observed sex differences in subjective and objective sleep parameters may be related to the female athletes' menstrual cycle. The paper provides unique data of sex differences in sleep stages and novel insights into the role of the menstrual cycle in sleep among female athletes.

Validation of the WHOQOL-Bref: psychometric properties and normative data for the Norwegian general population.

BACKGROUND: The World Health Organization's Quality of Life Questionnaire (WHOQOL-Bref) is a frequently used instrument to assess the quality of life in both healthy and ill populations. Inquiries of the psychometric properties of the WHOQOL-Bref report that the validity and reliability is generally satisfactory. However, some studies fail to support a four-factor dimensionality; others report poor reliability of the social and environmental domain; and there may be some challenges of supporting construct validity across age. This paper evaluates the psychometric properties of the Norwegian WHOQOL-Bref and extends previous research by testing for measurement invariance across age, gender and education level. In addition, we provide updated normative data for the Norwegian population. METHODS: We selected a random sample of the Norwegian population (n = 654) aged 18-75 years. Participants filled out the WHOQOL-Bref, the Utrecht Work Engagement Scale and various sociodemographic variables. RESULTS: We found an acceptable convergent and discriminate validity and internal consistency of the physical, psychological and environmental domains, but a marginal reliability was found for the social domain. The factor loadings were invariant across gender, education and age. Some items had low factor loadings and explained variance, and the model fit for the age group 60-75 years were less satisfactory. CONCLUSIONS: The original four-factor dimensionality of the WHOQOL-Bref displayed a better fit to the data compared to the one-factor solution and is recommended for use in the Norwegian population. The WHOQOL-Bref is suitable to use across gender, education and age, but for assessment in the oldest age group, the WHOQOL-Old module could be a good supplementary, but further studies are needed.

Reciprocal Associations Between Sleep, Mental Strain, and Training Load in Junior Endurance Athletes and the Role of Poor Subjective Sleep Quality.

The importance of adequate sleep for athletic functioning is well established. Still, the literature shows that many athletes report sleep of suboptimal quality or quantity. To date, no research has investigated how bidirectional variations in mental and physiological states influence sleep patterns. The present study, therefore, investigates reciprocal associations between sleep, mental strain, and training load by utilizing a prospective, observational design. In all, 56 junior endurance athletes were followed over 61 consecutive days. Unobtrusive, objective measurements of sleep with novel radar technology were obtained, and subjective daily reports of mental strain and training load were collected. The role of subjective sleep quality was investigated to identify whether the reciprocal associations between sleep, mental strain, and training load depended on being a good versus poor sleeper. Multilevel modeling with Bayesian estimation was used to investigate the relationships. The results show that increases in mental strain are associated with decreased total sleep time (TST, 95% CI = -0.12 to -0.03), light sleep (95% CI = -0.08 to -0.00), and sleep efficiency (95% CI = -0.95 to -0.09). Further, both mental strain and training load are associated with subsequent deceased rapid eye movement (REM, respectively, 95% CI = -0.05 to -0.00 and 95% CI = -0.06 to -0.00) sleep. Increases in TST, light, deep, and REM sleep are all associated with subsequent decreased training load (respectively, 95% CI = -0.09 to -0.03; 95% CI = -0.10 to -0.01; 95% CI = -0.22 to -0.02; 95% CI = -0.18 to -0.03). Finally, among poor sleepers, increases in sleep onset latency are associated with increases in subsequent mental strain (95% CI = 0.09-0.46), and increases in deep sleep are associated with decreases in subsequent training load (95% CI = -67.65 to 11.43). These results offer novel insight into the bidirectional associations between sleep, mental strain, and training load in athletes and demonstrate the detrimental effects of mental strain on sleep, likely caused by mental activation incompatible with sleep. An increased need for recovery, suggested by increased TST and time in different sleep stages, is associated with subsequent self-regulatory reduction of training loads by the athletes. In poor sleepers, increases in deep sleep may suggest an elevated need for physiological recovery.

Mediating Mechanisms of the Incredible Years Teacher Classroom Management Program.

This study examined whether, and the extent to which, the Incredible Years Teacher Classroom Management program predicted positive development of children's emotional, behavioral, and social adjustment through changes in the child-teacher relationship. Using data from a longitudinal quasi-experimental intervention trial with a matched control condition, including 1,085 children (49.7% girls, meanage = 4.22 years; SDage = 0.88 years), the potential associations were tested by means of multilevel path modeling. The mediation model demonstrated that (1) children in the intervention condition achieved more favorable changes in the child-teacher relationship than the control condition; (2) changes in the child-teacher relationship were associated with changes in the target outcomes; and (3) the intervention effects were mediated via changes in the child-teacher relationship.

Social Desirability in Environmental Psychology Research: Three Meta-Analyses.

That social desirability might be a confounder of people's survey responses regarding environmental actions has been discussed for a long time. To produce evidence for or against this assumption, we conducted meta-analyses of correlations between social desirability scales and self-reports of environmentally relevant behaviors, intentions, and (broadly defined) attitudes, based on data from 29 previously published papers. The pooled correlations with social desirability are generally small, ranging from 0.06 to 0.11 (0.08-0.13 when correcting for measurement error attenuation). However, our results do not lead to the conclusion that social desirability can be completely disregarded by environmental psychologists as a potential confounder. For example, we found evidence of substantial heterogeneity across studies, so the effect of social desirability may be more pronounced in specific cases. Continued attention to social desirability bias is needed to fully understand its possible subtle effects.

Intravenous Iron Treatment in the Prevention of Iron Deficiency and Anaemia After Roux-en-Y Gastric Bypass.

BACKGROUND: Iron absorption is disturbed after Roux-en-Y gastric bypass (RYGB) and iron deficiency with or without anaemia affects almost half of all patients. Intravenous iron is an option when per oral iron is insufficient or not tolerated. This study explores whether routinely offering intravenous iron treatment when iron stores are empty can prevent anaemia and iron deficiency after RYGB. METHODS: This is a study of prospectively registered data on clinical information, haematological tests and intravenous iron treatment from 644 RYGB patients who underwent surgery between 2004 and 2013, postoperatively followed more than 5 years. Intravenous iron treatment was offered to patients with ferritin ≤ 15 µg/L. RESULTS: Clinical information was available for all patients at baseline and for 553/644 patients at 5 years; laboratory results were available for 540/644 patients at baseline and 411/644 patients after 5 years. The mean age was 39.8 (± 9.7) years. Overall, 187/483 (38.7%) women and 9/161 (5.6%) men were given intravenous iron treatment in the observation period. From baseline to 5 years, mean haemoglobin decreased by 0.3 g/dL in both men and women. Anaemia occurred in 18/311 (5.8%) women and 9/100 (9%) men at 5 years. Depleted iron stores (ferritin ≤ 15 µg/L) were seen among 44/323(13.6%) women and 3/102 (2.9%) men, and low iron stores (ferritin 16-50 µg/L) occurred in 144/326 (44.6%) women and 38/102 (37.3%) men 5 years after RYGB. CONCLUSION: By routinely offering intravenous iron treatment to patients with depleted iron stores after RYGB, haemoglobin levels were preserved. Half of the patients experienced low or depleted iron stores at 5 years.

Nature in Your Face - Disruptive Climate Change Communication and Eco-Visualization as Part of a Garden-Based Learning Approach Involving Primary School Children and Teachers in Co-creating the Future.

The paper describes an innovative structured workshop methodology in garden-based-learning (GBL) called "Nature in Your Face" (NiYF) aimed at provoking a change in citizens behavior and engagement as a consequence of the emotional activation in response to disruptive artistic messages. The methodology challenges the assumption that the change needed to meet the carbon targets can be reached with incremental, non-invasive behavior engineering techniques such as nudging or gamification. Instead, it explores the potential of disruptive communication to push citizens out of their comfort zones and into creative modes of re-creating futures. This is done by confronting us with consequences of consumption by means of art and eco-visualizations. The aim being to achieve awareness, mental flexibility, and spurring debate. Thus, we invite them to react - and act upon these reactions by communicating their feelings or thoughts. This is used as an entrance point for broader and/or deeper engagement in a structured three-step methodology; (1) Framing: A disruptive element is introduced into the local environment. This triggers an emotional reaction, which then is taken up in a process of framing the problem and working with solutions. (2) Twisting: in a guided process, the initial energy from the emotional confrontation is twisted into a creative exploration of innovative solutions, from the perspective of the children. (3) Using: The last stage is using the developed solutions in the local social system (or refining them further). The methodology is being applied in cooperation with a primary school, and is iteratively adjusted and evaluated in a formative, action-research based approach scenario. NiYF is to stimulate societal engagement through deliberately confronting stakeholders with unexpected and potentially upsetting appearances of nature, climate effects, or carbon-neutral lifestyle scenarios. We have verified the practical usefulness and potential of the methodology and found that NiYF triggers societal engagement and transition, negotiating responsibilities and unlocking action potentials. We also found that eco-anxiety, denial, self-efficacy and cognitive dissonance form children's understanding of plastic. The project marks a paradigm shift from creating knowledge to using knowledge to create action, and a focus on learning from evaluating and adapting the approach in the field.

The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up.

PURPOSE: To investigate, in adolescents referred for psychiatric services, the associations of initial self-esteem and family functioning with level and change of quality of life (QoL) over a 3-year period, over and above the effect of their emotional problems. METHODS: Of 1648 eligible 13-18 years old patients attending the child and adolescent psychiatric clinic (CAP) at least once, 717 (54.8% females) were enrolled at baseline (a response rate of 43.5%). Self- and parent reports on the McMaster Family Assessment Device were obtained. Adolescents reported self-esteem on the Rosenberg Scale, and emotional problems on the Symptom Check List-5. Adolescents completed the Inventory of Life Quality in Children and Adolescents (ILC). After 3 years, 570 adolescents again completed the ILC, and for 418 adolescents parent information was available. The longitudinal analysis sample of 418 adolescents was representative of the baseline sample for age, gender, emotional problems, and QoL. We used modified growth-model analysis, adjusted for SES, age, gender and time of contact with CAP, where residual variances for ILC at baseline and follow-up were fixed to 0. RESULTS: A poorer family functioning at baseline, reported by parents, was significantly associated with worsening QoL during the 3 years follow-up period (p = 0.001). CONCLUSIONS: Parents have important knowledge about their families that may reflect long-term influences on QoL development in adolescent psychiatric patients. Health care providers and policy makers should optimize treatment outcomes by addressing family functioning in adolescents with emotional problems.

Does the working alliance mediate the effect of routine outcome monitoring (ROM) and alliance feedback on psychotherapy outcomes? A secondary analysis from a randomized clinical trial.

Little is known about the mechanisms through which routine outcome monitoring (ROM) influences psychotherapy outcomes. In this secondary analysis of data from a randomized clinical trial (Brattland et al., 2018), we investigated whether the working alliance mediated the effect of the Partners for Change Outcome Monitoring System (PCOMS), a ROM system that provides session-by-session feedback on clients' well-being and the alliance. Adult individuals (N = 170) referred for hospital-based outpatient mental health treatment were randomized to individual psychotherapy either with the PCOMS ROM system, or without (treatment as usual [TAU]). Treatment was provided by the same therapists (N = 20) in both conditions. A multilevel mediation model was developed to test if there was a significant indirect effect of ROM on client impairment at posttreatment through the alliance at 2 months' treatment controlled for first-session alliance. Alliance ratings increased more from session 1 to 2 months' treatment in the ROM than TAU condition, and alliance increase was associated with less posttreatment impairment. A significant indirect effect of ROM on treatment outcomes through alliance increase (p = .043) explained an estimated 23.0% of the effect of ROM on outcomes. The results were consistent with a theory of the alliance as one mechanism through which ROM works. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Gaming Green: The Educational Potential of Eco - A Digital Simulated Ecosystem.

Research into the use of videogames in education is on the rise, and they are cementing their position as part of the modernized, digital classroom. Sustainability education has also become a subject of interest among environmentally minded game developers and understanding the educational impact of such games is rapidly becoming an important field. This study examined the educational potential of the digital simulated ecosystem known as Eco, in order to reveal how playing Eco might promote environmental consciousness surrounding ecosystems. Qualitative data from seven respondents were subjected to a thematic analysis, revealing two main themes that highlight both game-based learning outcomes as well as barriers against learning. The findings indicate that Eco is a viable tool for promoting some aspects of environmental consciousness about ecosystems, and suggestions for future implementation of Eco are provided.

Categorisation of Colour Terms Using New Validation Tools: A Case Study and Implications.

This article elaborates on the results of a field experiment conducted among speakers of the Chakali language, spoken in northern Ghana. In the original study, the Color-aid Corporation Chart was used to perform the focal task in which consultants were asked to point at a single colour tile on the chart. However, data from the focal task could not be analysed since the Color-aid tiles had not yet been converted into numerical values set forth by the Commission internationale de l'éclairage (CIE). In this study, the full set of 314 Color-aid tiles were measured for chromaticity and converted into the CIE values at the Daylight Laboratory of the Norwegian University of Science and Technology. This article presents the conversion methodology and makes the results of the measurements, which are available in the Online Appendix. We argue that some visual-perception terms cannot be reliably ascribed to colour categories established by the Color-aid Corporation. This suggests that the ideophonic expressions in the dataset do not denote 'colours', as categorised in the Color-aid system, as it was impossible to average the consultants' data into a CIE chromaticity diagram, illustrate the phenomena on the Natural Colour System (NCS) Circle and Triangle diagrams, and conduct a statistical analysis. One of the implications of this study is that a line between a visual-perception term and a colour term could be systematically established using a method with predefined categorical thresholds.

High-Frequency of Computer Tomography and Surgery for Abdominal Pain After Roux-en-Y Gastric Bypass.

INTRODUCTION: Acute, intermittent, and chronic abdominal pain is a common complaint after Roux-en-Y gastric bypass (RYGB). OBJECTIVES: The aim of the study was to evaluate the use of medical imaging and the need for surgery treating abdominal pain after RYGB in a cohort with long-term follow-up. METHODS: Data from 569 patients who underwent RYGB as the primary bariatric procedure at a public hospital in Norway between April 2004 and June 2011 were prospectively registered in a local quality registry for bariatric surgery. All abdominal imaging and abdominal surgical procedures were registered until August 2017. RESULTS: Mean follow-up was 100 months (61-159). During the observation period, 22% had one CT, 9% had two CTs, 4% had three CTs, and 5% had four or more CTs for abdominal pain. Twenty-two percent underwent abdominal surgery, as 16% had one and 6% had two or more operations and gynecological procedures excluded. The purpose of operation was postoperative complications (1.4%), suspected internal herniation (9.3%), cholecystectomy (9.3%), appendectomy (2.3%), hernias (3.2%), and perforated ulcer in the gastrojejunal anastomosis (0.7%). Mean time interval was 42 ± 27 months from RYGB to cholecystectomy and 51 ± 26 months for suspected IH. CONCLUSION: With a mean follow-up period of more than 8 years after RYGB, 40% of the patients suffered from abdominal pain, needing one or more CT scans. The need for surgery treating suspected internal hernia and cholecystectomy was equal, at 9.3% for both procedures, but the mean time from RYGB to operation was shorter for cholecystectomies.