<p>Fetman i Sverige har under de senaste två decennierna ökat kraftigt. Till följd av detta är hälsokostnaderna relaterat till fetma ansenliga och förväntas öka ytterligare om ingenting görs åt problemet. I denna studie studeras prevention och gastric bypass som alternativa behandlingsmetoder mot fetma sett ur ett samhällsekonomiskt perspektiv. Tre hypotetiska kohorter utvecklas; status quo, effektiv prevention i ungdomsåren samt individer som utvecklar svår fetma opereras med gastric bypass. Dessa kohorter följs under åldern 20-64 år där kostnader och effekter observeras med hjälp av en beslutsträdsmodell. Både gastric bypass och prevention påvisas vara kostnadseffektiva behandlingsmetoder mot fetma. Gastric Bypass visas vara mer effektiv än en studerad befolkningsinriktad preventionsåtgärd. Slutligen påvisas att effektiva högriskpreventioner kan bidra med en högre samhällsnytta än gastric bypass operationer.</p><p> </p><p>Nyckelord: Fetma, Gastric Bypass, Prevention</p><p> </p> / <p>The prevalence of obesity has increased rapidly the past two decades. As a consequence the health expenditures related to obesity are high and are expected to increase if nothing is done.</p><p>The objective of this thesis was to study whether prevention in early years or gastric bypass is the preference from a societal perspective as an intervention to obesity. I develop three hypothetical cohorts; status quo, effective prevention in early years and people whom develop obesity have gastric bypass surgery. The cohorts are followed from age 20 to age 64 where costs and effects are observed using a decision tree model. The results were that both gastric bypass and prevention in early years are found to be cost-effective treatments to obesity. Gastric bypass is found being more effective than a studied population-based prevention. Effective high-risk preventive methods can contribute to a higher benefit to society than a gastric bypass surgery.</p><p> </p><p>Keyword: Obesity, Gastric Bypass, Prevention</p><p> </p>

Thesis (M.Sc.)--Memorial University of Newfoundland, 2005. / Bibliography: leaves 68-79.

Fetman i Sverige har under de senaste två decennierna ökat kraftigt. Till följd av detta är hälsokostnaderna relaterat till fetma ansenliga och förväntas öka ytterligare om ingenting görs åt problemet. I denna studie studeras prevention och gastric bypass som alternativa behandlingsmetoder mot fetma sett ur ett samhällsekonomiskt perspektiv. Tre hypotetiska kohorter utvecklas; status quo, effektiv prevention i ungdomsåren samt individer som utvecklar svår fetma opereras med gastric bypass. Dessa kohorter följs under åldern 20-64 år där kostnader och effekter observeras med hjälp av en beslutsträdsmodell. Både gastric bypass och prevention påvisas vara kostnadseffektiva behandlingsmetoder mot fetma. Gastric Bypass visas vara mer effektiv än en studerad befolkningsinriktad preventionsåtgärd. Slutligen påvisas att effektiva högriskpreventioner kan bidra med en högre samhällsnytta än gastric bypass operationer.   Nyckelord: Fetma, Gastric Bypass, Prevention / The prevalence of obesity has increased rapidly the past two decades. As a consequence the health expenditures related to obesity are high and are expected to increase if nothing is done. The objective of this thesis was to study whether prevention in early years or gastric bypass is the preference from a societal perspective as an intervention to obesity. I develop three hypothetical cohorts; status quo, effective prevention in early years and people whom develop obesity have gastric bypass surgery. The cohorts are followed from age 20 to age 64 where costs and effects are observed using a decision tree model. The results were that both gastric bypass and prevention in early years are found to be cost-effective treatments to obesity. Gastric bypass is found being more effective than a studied population-based prevention. Effective high-risk preventive methods can contribute to a higher benefit to society than a gastric bypass surgery.   Keyword: Obesity, Gastric Bypass, Prevention

Syftet var att beskriva sjuksköterskors erfarenheter och upplevelser av att vårda gastric bypass (GBP) opererade patienter inom slutenvården. Studien hade en beskrivande design med kvalitativ ansats. Sex sjuksköterskor från kirurgiska vårdavdelningar på två olika sjukhus i Mellansverige deltog. Semistrukturerade intervjuer användes och analyserades med kvalitativ innehållsanalys. Resultatet presenteras utifrån fyra kategorier och åtta subkategorier. Kategorierna Vikten av noggranna förberedelser inför operation, Viktigt att patienten är i psykisk balans inför och efter operation, Sjuksköterskans kluvna syn på GBP-operation som viktminskningsalternativ samt Vikten av sjuksköterskans kunskap och professionella förhållningssätt beskrev nödvändigheten av att grundlig utredning och tydlig information givits till patienten pre-operativt samt att tidigare viktminskningsförsök hade utretts, då allt yngre opereras. Helhetssyn på patientens hälsostatus ansågs ha stor betydelse, viktigt att patienten var i psykisk balans före och efter operationen, vilket underlättade anpassning till den nya livsstilen och ansågs kunna motverka ånger av ingreppet. Sjuksköterskorna hade en kluven syn på GBP-operationer; en lyxoperation, ett problem som patienten ådragit sig själv vs. en nödvändig operation för att förebygga följdsjukdomar, GBP-operation skulle erbjudas om andra viktminskningsalternativ hade misslyckats. Frustrationer uppstod när kostrekommendationer inte följdes och skapade oro för re-operationer eller framtida okända konsekvenser. Patienterna upplevdes lättvårdade och beskrevs bemötas på ett respektfullt sätt. / The aim was to describe nurses’ experiences of caring for gastric bypass (GBP) operated patients in institutional care. The study had a descriptive design with a qualitative approach. Six nurses from surgical wards and two hospitals in central Sweden were interviewed. Semi-structured interviews were used and the material was analyzed with qualitative content analysis. Results are presented in four categories and eight subcategories. The categories; The importance of careful preparation before operation, Important with a patient in mental balance before and after operation, Ambivalence among nurses in relation to GBP-operation as a weight loss alternative and The importance of nurses’ knowledge and professional approach described the importance of careful pre-operative investigation, information about the operation and investigation of previous weight loss attempts due to the increasing number of younger GBP-operated patients. Holistic approach to the patients’ health status was considered necessary, as were a patient in mental balance since that enabled an adaption to the new living situation and probably prevented regrets of the operation. Nurses were ambivalent to GBP-operations; a luxury operation, a problem the patient had contracted itself VS a necessary operation to prevent secondary diseases, GBP-operations could be provided if other weight loss options had failed. Frustrations occurred when dietary recommendations were not followed, led to concerns for re-operation or future unknown consequences. Patients were described easy to care for and reported treated in a respectful way.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Kalp Damar Cerrahisi Anabilim Dalı, 2006. / Bibliyografya var.

Thesis (M.N.)--Memorial University of Newfoundland, 2004. / Bibliography: leaves 96-101.

The purpose of this study W8S to explore and describe the experience of waiting for coronary artery bypass graft (CABG) surgery from the perspective of the individual who h8s a prolonged wait for this surgery. A phenomenological approach was used to guide the study. Data were collected through 17 semi-structured, audio-taped interviews with 7 men and 2 women awaiting CABG surgery. Analysis occurred concurrently with data collection. It was found that there were three interrelated core facets of the experience: the illness, the prospective surgery, and the wait. Each facet held distinct meaning: the illness represented a loss of normalcy and a threat to life; the surgery, both an opportunity to regain normalcy and a threat; and the wait, a "no control" situation which enhanced the losses and threats of the other facets, engendered further losses, and delayed the expected gain from surgery. Within each facet, representative emotional reactions, and coping strategies were identified. The findings indicate that these clients require regular contact and that nursing care must address all three facets of the experience. / Applied Science, Faculty of / Nursing, School of / Graduate

Bakgrund: Enligt forskning finns en ökad risk att utveckla alkoholbrukssyndrom efter en gastric bypass operation. Detta har även uppmärksammats inom den beroendemedicinska vården. För att få en ökad förståelse för dessa patienter och kunna utveckla vården behöver patienternas egna upplevelser lyftas. Syfte: Syftet med denna studie är att beskriva hur personer med alkoholbrukssyndrom som genomgått gastric bypass upplever skillnader i sitt alkoholbruk före och efter det kirurgiska ingreppet och deras beskrivning av behov av stöd. Metod: Semistrukturerade intervjuer genomfördes med tio personer som genomgått en gastric bypass-operation och även fått behandling för alkoholbrukssyndrom. En kvalitativ innehållsanalys med manifest inriktning användes. Resultat: I analysen av insamlat intervjumaterial framkom åtta underteman som resulterade i två huvudteman, Operationens påverkan på alkoholkonsumtion och Önskan om förbättrad eftervård. Resultatet visade att det är skillnader för patienter före och efter operation gällande sin alkoholkonsumtion. Det framkom även tydligt att uppföljningar efter operation var bristande. Slutsats: Det beskrivs skillnad i alkoholens effekter efter en genomgången gastric bypass operation, många upplever snabbare berusning av en mindre mängd alkohol som i sin tur ökar suget efter mer. Många upplever att det faller mellan stolarna efter operationen. De få uppföljningar som blir av är inte vad patienterna önskar, de berör ingen del av det psykiska måendet eller den identitetskris denna kroppsliga förändring innebär. Det efterfrågas även ett bättre samarbete mellan olika vårdinstanser som kan bidra med tydligare information, där sjuksköterskan kan identifiera omvårdnadsåtgärder för varje unik patient. / Background: According to research, there is an increased risk of developing alcohol use syndrome after gastric bypass surgery. This has also been noticed in addiction medicine care. To gain an increased understanding of these patients and be able to develop care, the patients' own experiences need to be highlighted. Aim: The purpose of this study is to describe how people with alcohol use syndrome who have undergone gastric bypass experience differences in their alcohol use before and after the surgical intervention and their description of the need for support. Method: Semi-structured interviews were conducted with ten persons who underwent gastric bypass surgery and received treatment for alcohol use syndrome. A qualitative content analysis with manifest orientation was used. Results: In the analysis of collected interview material, eight subthemes emerged that resulted in two main themes, the operation's impact on alcohol consumption and the desire for improved aftercare. The results showed that there are differences for patients before and after surgery regarding their alcohol consumption. It also became clear that follow-ups after surgery were lacking. Conclusion: There is a difference in the effects of alcohol after gastric bypass surgery, several persons experience faster intoxication from a smaller amount of alcohol, which increases the desire for more. Several persons feel neglected after the operation. The few follow-ups that do occur are not what the patients desire, due to the lack of interest regarding the mental state or the identity crisis this bodily change entails. There is also a demand for better collaboration between different care agencies that can contribute with clearer information, where the nurse can identify nursing measures for each unique patient.

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