<p><em> </em></p><p><em> </em></p><p> <em>Introduktion</em></p><p><em></em><em> </em><p> </p><p> </p><p> </p><p>Övervikt och fetma (BMI > 25 respektive BMI > 30) ökar i omfattning i hela världen och så även i Sverige. Prevalensen av övervikt/fetma i Sverige är ca 44 % och specifikt i Sandvikens kommun så är drygt hälften av den vuxna befolkningen överviktig/fet vilket ökar risken för ohälsa och sjukdom.</p><p>Det är angeläget att hitta de personer som löper risk att utveckla alternativt redan har övervikt/fetma för att kunna förebygga och behandla. Med tidig upptäckt och rätt behandling så gynnas förstås patienten i första hand, men även sjukvården och samhället i stort då detta i förlängningen minskar kostnaderna. I denna studie undersöktes hur ett vårdprogram som ska användas för upptäckt och behandling av övervikt/fetma tillämpades på tre hälsocentraler i Sandvikens kommun under två månader hösten 2005.</p><p>Metod</p><p>Utgångspunkten för vårdprogrammet med tillhörande flödesschema är att man mäter BMI först. Mätning ska ske på alla patienter som söker vård inom Primärvården Gästrikland – inte bara de patienter som specifikt söker för övervikt eller fetma. Kontroller gjordes först av hur många patienter som fick BMI uppmätt under vald tidsperiod och beroende på resultat av BMI-mätning kontrollerades därefter hur många patienter som fick behandling.</p><p>Resultat</p><p>Av totalt antal patienter som besökte hälsocentralerna under vald tidsperiod kontrollerades BMI på 6 %. Av dessa hade 38 % ett BMI som enligt vårdprogrammet skulle leda till erbjudande om behandling. Vid kontroll av behandling så hade i stort sett alla patienter fått någon form av behandling men med utgångspunkt från andra vårdprogram och orsaker än just övervikt och fetma. En femtedel av de 38 % fick behandling pga. sin övervikt/fetma och endast ett fåtal fick diagnos " övervikt/fetma".</p></p><p>Konklusion</p><p>Då så få patienter fick sitt BMI kontrollerat och därefter behandlades enligt vårdprogrammet finns misstanken att undersökt vårdprogram inte används överhuvudtaget. Detta skulle kunna bero på att personalen inte känner till dess existens alternativt inte finner vårdprogrammet användarvänligt. Det är synnerligen viktigt att använda sig av bevisat effektiva metoder för upptäckt och behandling av övervikt/fetma men oavsett metod så gäller förstås att de som ska använda sig av metoderna också känner till dem samt finner metoderna möjliga att använda i dagligt arbete.</p> / <p>Introduction</p><p> </p><p>The number of overweight (BMI > 25) and obese (BMI > 30) people is rising worldwide and also in Sweden where the prevalence is 44 %. In the municipality of Sandviken more than half of the population is overweight or obese and that could lead to poor health and/or sickness. It is important to find the persons in risk of developing overweight/obesity and the people who already are overweight/obese to be able to prevent or to give treatment. Early discovery and correct treatment will of course benefit the patient but it will also lower the costs for the healthcare system. The purpose of this study was to investigate the practical use of a program for identification and treatment of overweight/obesity in three health clinics in the municipality of Sandviken during two months in 2005.</p><p>Method</p><p>The starting-point of the program is to measure BMI. BMI should be measured on all patients who seek care and treatment at the health clinic – not just the ones who want help because of overweight or obesity. The first control was therefore to see how many of all the patients who visited the health clinic who got their BMI measured. The second control was to see how many of those patients who got treatment according to the program.</p><p>Results</p><p>BMI were measured on 6 % of all the patients who visited the health clinics. Out of these patients, 38 % had a BMI that should lead to an offer of treatment according to the program. Almost all of the 38 % did get treatment but for other reasons and diagnoses than overweight or obesity which only one fifth of the 38 % got. Very few got the diagnose "overweight/obesity".</p><p><em></em><p> </p></p><p>Conclusions</p><p>With such low figures of BMI-measuring and treatment according to the program, you could suspect that the program is not in use at all. The reason for this could be that the staff at the health clinics does not know that the program exists or that they do not find the program user-friendly. It is very important to use effective methods for identification and treatment of overweight/obesity, but no matter what method – the most important thing is that the staff who is supposed to adopt these methods is well acquainted with them and also finds them useful in their daily work.</p>

<p>Ormarsdóttir, S. 2001. Osteoporosis in Chronic Liver Disease. Acta Universitatis Upsaliensis. <i>Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine</i> 1037. 60 pp. Uppsala. ISBN 91-554-5021-0. </p><p>Osteoporosis is a well-known and frequently reported complication of chronic liver disease (CLD) with a high fracture rate contributing to significant morbidity after liver transplantation. The pathogenesis is unknown and controversy exists about many risk factors for osteoporosis in CLD. </p><p>In the present thesis, bone mineral density (BMD) was found to be significantly lower at the lumbar spine (<i>p</i><0.01) in a cohort of patients with CLD compared with age- and gender -matched individuals. Osteoporosis was found in 30% of the patients and 15% of the controls, respectively. Low body mass index (BMI), corticosteroid treatment, prothrombin time, age and female gender were independent risk factors for osteoporosis in the patients. </p><p>In a follow-up study, 43 of 72 patients were available for a second BMD measurement 25 months (median) after the first. Bone loss at the femoral neck was 1.5 ± 2.4% in females and 2.9 ± 2.0% in males with a significant decrease in BMD Z-score over time (<i>p</i>=0.005 and <i>p</i>=0.02 for females and males, respectively), indicating increased bone loss at this site. Hyperbilirubinaemia and low circulating levels of 25-hydroxy vitamin D₃ predicted increased bone loss at the femoral neck. These findings suggest that cortical bone, in addition to trabecular bone, may be affected in CLD and bilirubin and vitamin D₃ may be involved in the pathophysiology of osteoporosis in CLD. </p><p>In order to elucidate the suggested role of insulin-like growth factors (IGFs) and leptin in the pathophysiology of osteoporosis in CLD, we studied the relationship between these factors and BMD. Levels of IGFs were extremely low (<i>p</i><0.0001 compared with the controls) and related to liver function but no correlation was found between the IGFs and BMD. Serum leptin adjusted for BMI correlated negatively with BMD in female patients (<i>p</i>=0.003 and <i>p</i>=0.04 at the lumbar spine and the femoral neck, respectively) and in male patients at the femoral neck (<i>p</i>=0.04). Thus, the IGFs appear not to be involved in the pathophysiology of osteoporosis in CLD but a role of circulating leptin is possible. </p>

<p>The overall aims of our studies were to identify risk factors for respiratory symptoms and asthma in indoor environment but even to look at some personal risk factors such as body mass index and gastroesophageal reflux. The study population is based on participants of the European Community Respiratory Health Survey I and II. </p><p> In the first study, water damage and visible moulds were reported in 7.4% and 17% of the homes respectively. The combination of water damage and visible moulds was independently associated with attacks of breathlessness when resting and after activity and also to long term cough. In the second study, the prevalence of nocturnal GER increased with higher BMI and the same pattern could be seen for habitual snoring. Reported onset of asthma, wheeze and night-time symptoms increased in prevalence along with the BMI gradient. In the multivariable analysis, obesity and nocturnal GER were independent risk factors for onset of asthma, wheeze and night-time symptoms. Habitual snoring was an independent risk factor for onset of wheeze and night-time symptoms, but not for onset of asthma. In the third study, a total of 18% of the subjects reported indoor dampness in the last 12 months and 27% of the subjects reported indoor dampness since the previous survey. Respiratory symptoms and asthma were significantly more prevalent in individuals exposed to indoor dampness and indoor dampness was a risk factor for respiratory symptoms and asthma after adjusting for possible confounders. Indoor dampness was an independent risk factor for onset of respiratory symptoms but not for asthma onset. Remission of respiratory symptoms was less likely to occur if subjects reported indoor dampness. In the fourth study, the lowest prevalence of atopy and the lowest levels of all indoor allergens, bacteria and moulds were found in Iceland. A positive association was found, between cat allergen exposure and asthma symptoms and between bronchial hyperresponsiveness and the amount of viable mould in indoor air.</p>

Ormarsdóttir, S. 2001. Osteoporosis in Chronic Liver Disease. Acta Universitatis Upsaliensis. Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1037. 60 pp. Uppsala. ISBN 91-554-5021-0. Osteoporosis is a well-known and frequently reported complication of chronic liver disease (CLD) with a high fracture rate contributing to significant morbidity after liver transplantation. The pathogenesis is unknown and controversy exists about many risk factors for osteoporosis in CLD. In the present thesis, bone mineral density (BMD) was found to be significantly lower at the lumbar spine (p&lt;0.01) in a cohort of patients with CLD compared with age- and gender -matched individuals. Osteoporosis was found in 30% of the patients and 15% of the controls, respectively. Low body mass index (BMI), corticosteroid treatment, prothrombin time, age and female gender were independent risk factors for osteoporosis in the patients. In a follow-up study, 43 of 72 patients were available for a second BMD measurement 25 months (median) after the first. Bone loss at the femoral neck was 1.5 ± 2.4% in females and 2.9 ± 2.0% in males with a significant decrease in BMD Z-score over time (p=0.005 and p=0.02 for females and males, respectively), indicating increased bone loss at this site. Hyperbilirubinaemia and low circulating levels of 25-hydroxy vitamin D3 predicted increased bone loss at the femoral neck. These findings suggest that cortical bone, in addition to trabecular bone, may be affected in CLD and bilirubin and vitamin D3 may be involved in the pathophysiology of osteoporosis in CLD. In order to elucidate the suggested role of insulin-like growth factors (IGFs) and leptin in the pathophysiology of osteoporosis in CLD, we studied the relationship between these factors and BMD. Levels of IGFs were extremely low (p&lt;0.0001 compared with the controls) and related to liver function but no correlation was found between the IGFs and BMD. Serum leptin adjusted for BMI correlated negatively with BMD in female patients (p=0.003 and p=0.04 at the lumbar spine and the femoral neck, respectively) and in male patients at the femoral neck (p=0.04). Thus, the IGFs appear not to be involved in the pathophysiology of osteoporosis in CLD but a role of circulating leptin is possible.

The overall aims of our studies were to identify risk factors for respiratory symptoms and asthma in indoor environment but even to look at some personal risk factors such as body mass index and gastroesophageal reflux. The study population is based on participants of the European Community Respiratory Health Survey I and II. In the first study, water damage and visible moulds were reported in 7.4% and 17% of the homes respectively. The combination of water damage and visible moulds was independently associated with attacks of breathlessness when resting and after activity and also to long term cough. In the second study, the prevalence of nocturnal GER increased with higher BMI and the same pattern could be seen for habitual snoring. Reported onset of asthma, wheeze and night-time symptoms increased in prevalence along with the BMI gradient. In the multivariable analysis, obesity and nocturnal GER were independent risk factors for onset of asthma, wheeze and night-time symptoms. Habitual snoring was an independent risk factor for onset of wheeze and night-time symptoms, but not for onset of asthma. In the third study, a total of 18% of the subjects reported indoor dampness in the last 12 months and 27% of the subjects reported indoor dampness since the previous survey. Respiratory symptoms and asthma were significantly more prevalent in individuals exposed to indoor dampness and indoor dampness was a risk factor for respiratory symptoms and asthma after adjusting for possible confounders. Indoor dampness was an independent risk factor for onset of respiratory symptoms but not for asthma onset. Remission of respiratory symptoms was less likely to occur if subjects reported indoor dampness. In the fourth study, the lowest prevalence of atopy and the lowest levels of all indoor allergens, bacteria and moulds were found in Iceland. A positive association was found, between cat allergen exposure and asthma symptoms and between bronchial hyperresponsiveness and the amount of viable mould in indoor air.

Introduktion        Övervikt och fetma (BMI &gt; 25 respektive BMI &gt; 30) ökar i omfattning i hela världen och så även i Sverige. Prevalensen av övervikt/fetma i Sverige är ca 44 % och specifikt i Sandvikens kommun så är drygt hälften av den vuxna befolkningen överviktig/fet vilket ökar risken för ohälsa och sjukdom. Det är angeläget att hitta de personer som löper risk att utveckla alternativt redan har övervikt/fetma för att kunna förebygga och behandla. Med tidig upptäckt och rätt behandling så gynnas förstås patienten i första hand, men även sjukvården och samhället i stort då detta i förlängningen minskar kostnaderna. I denna studie undersöktes hur ett vårdprogram som ska användas för upptäckt och behandling av övervikt/fetma tillämpades på tre hälsocentraler i Sandvikens kommun under två månader hösten 2005. Metod Utgångspunkten för vårdprogrammet med tillhörande flödesschema är att man mäter BMI först. Mätning ska ske på alla patienter som söker vård inom Primärvården Gästrikland – inte bara de patienter som specifikt söker för övervikt eller fetma. Kontroller gjordes först av hur många patienter som fick BMI uppmätt under vald tidsperiod och beroende på resultat av BMI-mätning kontrollerades därefter hur många patienter som fick behandling. Resultat Av totalt antal patienter som besökte hälsocentralerna under vald tidsperiod kontrollerades BMI på 6 %. Av dessa hade 38 % ett BMI som enligt vårdprogrammet skulle leda till erbjudande om behandling. Vid kontroll av behandling så hade i stort sett alla patienter fått någon form av behandling men med utgångspunkt från andra vårdprogram och orsaker än just övervikt och fetma. En femtedel av de 38 % fick behandling pga. sin övervikt/fetma och endast ett fåtal fick diagnos " övervikt/fetma". Konklusion Då så få patienter fick sitt BMI kontrollerat och därefter behandlades enligt vårdprogrammet finns misstanken att undersökt vårdprogram inte används överhuvudtaget. Detta skulle kunna bero på att personalen inte känner till dess existens alternativt inte finner vårdprogrammet användarvänligt. Det är synnerligen viktigt att använda sig av bevisat effektiva metoder för upptäckt och behandling av övervikt/fetma men oavsett metod så gäller förstås att de som ska använda sig av metoderna också känner till dem samt finner metoderna möjliga att använda i dagligt arbete. / Introduction   The number of overweight (BMI &gt; 25) and obese (BMI &gt; 30) people is rising worldwide and also in Sweden where the prevalence is 44 %. In the municipality of Sandviken more than half of the population is overweight or obese and that could lead to poor health and/or sickness. It is important to find the persons in risk of developing overweight/obesity and the people who already are overweight/obese to be able to prevent or to give treatment. Early discovery and correct treatment will of course benefit the patient but it will also lower the costs for the healthcare system. The purpose of this study was to investigate the practical use of a program for identification and treatment of overweight/obesity in three health clinics in the municipality of Sandviken during two months in 2005. Method The starting-point of the program is to measure BMI. BMI should be measured on all patients who seek care and treatment at the health clinic – not just the ones who want help because of overweight or obesity. The first control was therefore to see how many of all the patients who visited the health clinic who got their BMI measured. The second control was to see how many of those patients who got treatment according to the program. Results BMI were measured on 6 % of all the patients who visited the health clinics. Out of these patients, 38 % had a BMI that should lead to an offer of treatment according to the program. Almost all of the 38 % did get treatment but for other reasons and diagnoses than overweight or obesity which only one fifth of the 38 % got. Very few got the diagnose "overweight/obesity".   Conclusions With such low figures of BMI-measuring and treatment according to the program, you could suspect that the program is not in use at all. The reason for this could be that the staff at the health clinics does not know that the program exists or that they do not find the program user-friendly. It is very important to use effective methods for identification and treatment of overweight/obesity, but no matter what method – the most important thing is that the staff who is supposed to adopt these methods is well acquainted with them and also finds them useful in their daily work.

Thesis--University of Oklahoma. / Includes bibliographical references (leaves 75-79).

Thesis (Ph. D.)--University of Washington, 2003. / Includes bibliographical references (leaves 101-113).

The aims of the studies were to assess body image perceptions, the role of stress and other possible associated psychopathologies within a non-clinical sample. The prevalence of body image concern is increasing and is widely considered as secondary to evolving socio-cultural trends. Negative self-perceptions about body image can be manifest as measurable indicators of physiological stress, or even psychopathology. This thesis describes two quantitative studies into the role and relevance of various causative factors in the development of negative body image in cohorts of volunteers drawn from the general population of the University of Bradford in West Yorkshire, UK. In Study One, subjects (n=360) completed a self-directed questionnaire that psychometrically measured satisfaction/dissatisfaction with personal appearance, queried which external sources influenced those opinions, and correlated these with demographic information. In particular, we sought to examine how a subject's opinion about their personal appearance varied with age, gender, ethnicity, mental health, relationship status, sexual orientation and Body Mass Index (BMI). Subjective views regarding personal appearance were determined by answers given to specific body image questions that revealed a subject's day-to-day appearance concerns, all preoccupations, and the extent to which these concerns resulted in distress, all social impairment. Overall, the results demonstrated that BMI values were positively correlated with personal appearance concerns. High BMI values correlated with greater dissatisfaction with personal appearance. Self ratings of appearance values were negatively correlated with BMI scores. Subjects who gave themselves high appearance ratings were relatively unaffected by media influence with regard to their image, compared to subjects rating themselves less attractive. These latter subjects also showed higher peer pressure scores in terms of both the amount of time they compared themselves to peers, and the degree to which peer comparisons affected their self-appearance ratings. Based on responses to the body image questions specifically, the entire cohort of subjects were categorised into principal clusters: those largely unaffected by any body image concerns; and those profoundly distressed by their self assessed body image. Perhaps the most interesting aspect of these findings is that the scores for this latter (n=17) group of subjects on the body image questions revealed a degree of personal distress this is almost identical to the scores expected from those people diagnosed with body dysmorphic disorder (BDD). Collectively, these results suggest that high BMI values in subjects negatively impact on self-appearance ratings, render subjects more prone to media messages that portray body image ideals, and elicit frequent comparisons with peers to validate self-image concerns. Furthermore, severely affected subjects with high BMI scores may show similar psychopathology to that of BDD sufferers. In Study Two, a small cohort of subjects (n=60) were given questionnaires and were interviewed to further investigate self-appearance ratings and mood/depressive traits. The body image questions used in Study One to assess image concerns and the magnitude of distress were repeated in Study Two. Mood and depressive state were measured using the validated Beck's Depression Inventory (BDI). In parallel, subjects completed the Derriford Appearance Scale 59 (DAS 59), which is a valid psychometric indication of an individual's perception of their appearance as 'normal' or 'disfigured', and used as a tool by plastic surgeons to inform decisions regarding the necessity for surgery to correct an individual's appearance. Physiological markers were recorded before and after exposure of subjects to a physical and a psychological stressor: these were saliva concentrations of cortisol and sIgA (an immune marker), blood glucose and blood pressure. The results of Study Two revealed no changes in scores for any of the physiological measures following stressors. BDI scores for most subjects fell within normal ranges, although females scored higher than males, but not at a pathological level. Those subjects with a history of mental illness or those who reported feeling a high degree of stress on a daily basis, or those who expressed greater self-appearance concerns, all had significantly elevated BDI values. Perhaps the most intriguing finding from Study Two, as in Study One, was that subjects again tended to fall within specific categories for body image concerns: those unaffected or minimally affected by body image concerns, and those (n=6) greatly and deleteriously affected by body image concerns. This subsection of subjects also scored very high on the DAS 59 for disfigurement. On the basis of these findings it would seem that body image concerns may be severe enough for some individuals for them to perceive themselves as actually being disfigured, or that the DAS 59 (a widely used assessment tool in plastic surgery), may not be entirely appropriate for assessment of an individual's need for surgery because it cannot distinguish between those genuinely disfigured and those merely expressing severe body image concerns.

The increased prevalence of obesity amongst adolescents is considered a worldwide epidemic. Within the black population of South Africa, obesity is significantly more prevalent amongst black girls than black boys. The high prevalence of obesity amongst children can be attributed to a combination of various lifestyle factors, namely a decrease in physical activity, an increase in television viewing, Westernization and increased food supply. The decrease in physical activity amongst adolescents over the last few decades has led to an increase in the number adolescents diagnosed with type 2 diabetes mellitus. Research has indicated that insulin sensitivity improves with regular physical endurance activity, irrespective of change in bodyweight. Regular physical exercise also lowers the risk of type 2 diabetes mellitus, and prevents the development of coronary heart diseases, hypertension and obesity. The primary goals of this study were two-fold: Firstly, to determine the relationship between BMI, percentage body fat and insulin sensitivity amongst black adolescents, and, secondly, to determine whether there exists a positive correlation between current cardiovascular fitness (V02-maximum),together with everyday physical activity status, and insulin sensitivity amongst black adolescents. One hundred and twenty-four (124) black boys and 148 black girls between the ages of 14 and 17 participated in the study. The BOD-POD was used to calculate percentage body fat, and blood analysis for fasting glucose and insulin were completed. Insulin sensitivity (QUIKI-index) and resistance (HOMA) were also calculated, and habitual physical activity was measured using the "Previous Day Physical Activity Recall" (pDPAR) questionnaire. Physical development was determined with the Tanner questionnaire, cardiovascular fitness (VO2-maximum) was determined using the "Bleep" test and anthropometry (mass, length, skin folds, waist and hip circumference) was measured to determine body composition. The results of this study found a statistically significant negative correlation between skin fold thickness, percentage body fat, BMI and insulin sensitivity in girls. A significant negative correlation between percentage body fat and V02-maximum was found in boys, while their self-reported activity (PDPAR) did not correlate with percentage body fat. Current cardiovascular fitness and habitual physical activity status (PDPAR) showed no significant relationship with insulin sensitivity. Amongst the girls there was however a tendency towards a positive correlation between insulin sensitivity and V02-maximum. / Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.