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Early pancreatectomy experiments performed in ducks and pigeons at the end of the 19th century revealed that avians, unlike mammals, do not display signs of diabetes. Relative to mammals, birds are considered hyperglycemic, displaying fasting blood glucose concentrations twice that of a normal human. While circulating levels of insulin are similar in avians and mammals, and structure and function of the insulin receptor are also conserved among vertebrate species, birds do not experience deleterious effects of chronic hyperglycemia as observed in mammals. Understanding avian glucose homeostasis, particularly in chickens, has both agricultural and biomedical implications. Improvement of feed efficiency and accelerated growth in poultry may come from a greater understanding of the physiological processes associated with glucose utilization in muscle and fat. The chicken has also recently been recognized as an attractive model for human diabetes, where there is a great need for preventative and therapeutic strategies. The link between type 2 diabetes and obesity, coupled with the inherent hyperglycemic nature of chickens, make chickens artificially selected for juvenile low (LWS) and high (HWS) body weight a favorable model for investigating glucose regulation and pancreas physiology. Oral glucose tolerance and insulin sensitivity tests revealed differences in threshold sensitivity to insulin and glucose clearance rate between the lines. Results from real-time PCR showed greater pancreatic mRNA expression of four glucose regulatory genes (preproinsulin, PPI; preproglucagon, PPG; glucose transporter 2, GLUT2; and pancreatic duodenal homeobox 1, Pdx1) in LWS, than HWS chickens. Histological analysis of pancreas revealed that HWS chickens have larger pancreatic islets, less pancreatic islet mass, and more pancreatic inflammation than LWS chickens, all of which presumably contribute to impaired glucose metabolism. In summary, results suggest that at selection age, there are differences in pancreas physiology that may explain the differences in glucose regulation between LWS and HWS. These data pave the way for future studies aimed at understanding the developmental regulation of endocrine pancreas function in chickens, as well as how aging affects homeostatic control of blood glucose in chickens. / Ph. D.

Weight management is problematic among Americans, as the number of overweight adults has risen to two-thirds of the population (1). Without the identification of successful approaches to promote weight stability, it is predicted that 86% of American adults will be overweight or obese by 2030 (2). Body-weight influenced diseases, such as diabetes and cardiovascular disease, are now leading causes of death (3). Annually, adult Americans are thought to increase their body weight by 0.5-0.9 kg (4). Of this gain, 52% is believed to occur during the winter holiday period of mid-late November to early January (5). Unfortunately, obesity research specific to this high-risk period is limited. Older adults and weight-reduced individuals are thought to be highly susceptible to significant holiday body weight gains (1, 6). To date, little research has investigated effective interventions that may be used to assist in successful body weight maintenance during the winter holiday period. Therefore, our purpose was to determine if daily self-monitoring of body weight, physical activity, and step counts is a feasible and effective tool to prevent weight gain in older, weight-reduced adults during the winter holiday period. This intervention represents a holiday weight maintenance approach that may be translatable to larger, more diverse populations. / Master of Science

This thesis investigates the complexity of the obesity phenotype by characterizing the inflammatory status of Metabolically Healthy Obese (MHO) individuals. More specifically, this work has examined circulating inflammatory markers in MHO individuals and compared it to Lean Healthy (LH) and Metabolically Abnormal Obese (MAO) subjects. Thirty participants (n=10/group) were recruited as part of the Diabetes Risk Assessment (DRA) study, and classified according to adiposity and metabolic status. Despite a similar level of adiposity compared to MAO individuals, MHO subjects presented a more favourable inflammatory profile. Specifically, MHO individuals had levels of hsCRP and IL-6 comparable to LH subjects and lower than MAO subjects. Also, MHO subjects presented similar levels of high molecular weight adiponectin as the MAO group, but PDGF-ββ levels were intermediate to those of the LH and MAO groups. Overall, the distinct inflammatory profile observed in MHO subjects demonstrates the unique status of these individuals, reinforcing that obesity is a complex and heterogeneous phenotype. / Public Health Agency of Canada, Ontario Graduate Scholarships, Queen Elizabeth II Graduate Scholarships in Science and Technology, Canada Foundation for Innovation

Formation of atelectasis, defined as reversible collapse of aerated lung, often occurs after induction of anaesthesia with mechanical ventilation. As a consequence, there is a risk for hypoxemia, altered hemodynamics and impaired respiratory system mechanics. In certain situations, the risk for atelectasis formation is increased and its consequences may also be more difficult to manage. Anesthesia for bariatric surgery in morbidly obese patients and surgery requiring one-lung ventilation (OLV) with capnothorax are examples of such situations. In Paper I (30 patients with BMI > 40 kg/m2 scheduled for bariatric surgery) a recruit­ment maneuver followed by positive end-expiratory pressure (PEEP) re­duced the amount of atelectasis and improved oxygenation for a prolonged period of time. PEEP or a recruitment maneuver alone did not reduce the amount of atelectasis. In paper II we investigated whether it is possible to predict respiratory function impairment in morbidly obese patients without pulmonary disease from a preoperative lung function test. Patients with mild signs of airway obstruction (reduced end-expiratory flow) in the preoperative spirometry developed less atelectasis during anaesthesia. In paper III we developed an experimental model of sequential OLV with capnothorax using electrical impedance tomography (EIT) that in real-time detected lung separation and dynamic changes in pulmonary ventilation and perfusion distributions. OLV to the left side caused a decrease in cardiac output, arterial oxygenation and mixed venous saturation. In paper IV we used our model of OLV with capnothorax and applied a CO2-insufflation pressure of 16 cm H2O. We demonstrated that a PEEP level of 12-16 cm H2O is needed for optimal oxygenation and lowest possible driving pressure without compromising hemodynamic variables. Thus, the optimal PEEP was closely related to the level of the capnothorax insufflation pressure. With insufficient PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the non-ventilated lung occurred.

Bakgrund: Övervikt är ett tilltagande problem med sjukskrivningar som leder till ökade kostnader i samhället. Sjuksköterskor kommer ibland i kontakt med patienter med övervikt i olika vårdsammanhang. För att kunna hjälpa patienter med övervikt bör sjuksköterskor använda sig av en attityd utan att kränka patienten. Syfte: Syftet med studien var att undersöka sjuksköterskors attityder till patienter med övervikt inom sjukvården. Metod: Studien genomfördes som en litteraturstudie och baserades på tolv vetenskapliga artiklar varav åtta kvantitativa och fyra kvalitativa studier. Resultat: Fyra huvudkategorier och två underkategorier framträdde som essentiella för sjuksköterskors attityder till övervikt. Huvudkategorierna var: Sjuksköterskors attityd och erfarenhet av patienter med övervikt, Sjuksköterskors attityd till patienter i relation till sin egen vikt, Sjuksköterskors attityd på grund av osäkerhet och rädsla samt Sjuksköterskors attityd till att ta upp ämnet övervikt med patienter. Slutsats: Resultatet i denna studie visar att ökad kunskap och ökad reflektion kan hjälpa sjuksköterskor att vara professionella och neutrala i mötet med personer med övervikt. / Background: Overweight is a growing problem in society leading to increased work absences and increased cost to society. In their work situation nurses sometime meet patients with overweight. To be able to help patients with overweight nurses should approach patients with overweight with an attitude that doesn´t offend them. Aim: The aim of this literature review was to examine nurses attitudes towards patients with overweight in nursing care. Method: This study was carried out as a literature study based on twelve scientific articles where of four was qualitative articles and eight was quantitative articles. Result: Four main categories and two sub categories identified as essential for nurses attitudes towards patients with overweight. The main categories were: Nurse´s attitudes and experience of patient with overweight, Nurse´s attitude towards patient with overweight in relation to own weight, Nurse´s attitude based on insecurity and fear and Nurse´s attitude to take up the subject obesity. Conclusion: The result of this study show that increased knowledge and increased reflection can help nurses to be professional and neutral when meeting people who are overweight.

Bakgrund: BVC-sjuksköterskor har en unik möjlighet att identifiera de barn som ligger i riskzonen för att utveckla en övervikt eller fetma. I BVC-sjuksköterskors möte med föräldrar till barn med övervikt eller fetma, är en av de viktigaste uppgifterna att förmedla vad som är gynnande för barnets hälsa. Övervikt och fetma är en riskfaktor för kroniska följdsjukdomar och en sämre hälsa senare i livet, och därför behövs hälsofrämjande och förebyggande insatser tidigt i livet för att förhindra utveckling av övervikt. Syfte: Syftet med denna studie var att belysa BVC-sjuksköterskors erfarenheter av att möta föräldrar när barnet har övervikt eller fetma. Metod: I denna studie användes en induktiv ansats där datamaterialet analyserades med kvalitativ innehållsanalys. Datamaterialet utgörs av intervjuer med nio BVC-sjuksköterskor med specialistexamen som distriktssköterska verksamma inom barnhälsovård. Resultat: Ur analysen av datamaterialet framträdde fyra kategorier så som; Familjesituationen påverkar samtalet, Ge nödvändig vägledning, Pedagogisk strategi och Kommunikationsproblem, med nio underkategorier. Konklusion: Studien visar att BVC-sjuksköterskor identifierar förtroendet som en avgörande faktor i mötet med föräldrar. Förtroendet är av betydelse för att BVC-sjuksköterskor ska kunna stödja och vägleda föräldrar i arbetet kring barnets vikt. I mötet är det viktigt att BVC-sjuksköterskor tar hänsyn till familjesituationen och de omgivande faktorer som påverkar. / Background: A Child health care nurse has a unique opportunity to identify children at risk of becoming overweight or obese. During consultation with parents, one of the most important tasks of nurses is to effectively communicate ways to benefit the child's health. Overweight and obesity are well known risk factors for chronic health conditions and decreased general health later in life, thus making the implementation of health promotion and preventative measures early in life vital. Aim: To evaluate the experiences of Child health care nurses after consultation with parents of overweight or obese children. Method: Interviews with nine Child health care nurses working with children's health were performed.An inductive approach was applied where data was analyzed with qualitative content analysis. Result: Four main categories emerged from the analysis; Family situation affects the consultation, Giving necessary guidance, Pedagogic strategy and Problems in communication, and nine subcategories. Conclusion: This study reveals that Child health care nurses identify trust as a major factor in consultations with parents. Trust is important for the nurse to be able to support and guide parents concerning weight issues of their children. The nurse must keep the family situation and surrounding factors influencing the meeting in mind.