Showing papers by "Norwegian Institute of Public Health published in 2011"
TL;DR: The GRADE process begins with asking an explicit question, including specification of all important outcomes, and provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect.
6,093 citations
McMaster University1, Norwegian Institute of Public Health2, University of Basel3, University of London4, Oregon Health & Science University5, Autonomous University of Barcelona6, Bond University7, University at Buffalo8, University of Florida9, Health Canada10, Medical Research Council11, Case Western Reserve University12
TL;DR: Credibility is increased if subgroup effects are based on a small number of a priori hypotheses with a specified direction; subgroup comparisons come from within rather than between studies; tests of interaction generate low P-values; and have a biological rationale.
1,535 citations
TL;DR: The raising of awareness and implementation of effective interventions for modifiable risk factors, such as overweight, obesity, maternal age, and smoking, are priorities for stillbirth prevention in high-income countries.
1,053 citations
McMaster University1, Norwegian Institute of Public Health2, University of Florida3, Bond University4, University at Buffalo5, Autonomous University of Barcelona6, United States Department of Veterans Affairs7, University of Basel8, Mayo Clinic9, Harvard University10, University of Freiburg11, Agency for Healthcare Research and Quality12, Oregon Health & Science University13, Case Western Reserve University14
TL;DR: Systematic review authors and guideline developers may also consider rating up quality of evidence when a dose-response gradient is present, and when all plausible confounders or biases would decrease an apparent treatment effect, or would create a spurious effect when results suggest no effect.
873 citations
University of Queensland1, University of Adelaide2, University of Cambridge3, Centers for Disease Control and Prevention4, University of Groningen5, Boston Children's Hospital6, University of Liverpool7, Imperial College London8, Australian National University9, Harvard University10, Norwegian Institute of Public Health11
TL;DR: The present variation in stillbirth rates across and within high-income countries indicates that further reduction inStillbirth is possible, and international consensus on definition and classification related to stillbirth is a priority.
375 citations
TL;DR: It is concluded that MBSR is an effective treatment for anxiety disorders and related symptomatology and mediation analyses indicated that mindfulness fully mediated changes in acute anxiety symptoms, and partiallymediated changes in worry and trait anxiety.
321 citations
TL;DR: This first paper of The Lancet's Stillbirths Series explores the present status of stillbirths in the world-from global health policy to a survey of community perceptions in 135 countries, highlighting the need for a strong call for action.
312 citations
TL;DR: In this paper, the relative importance of different exposure pathways of PFCs in a group of Norwegians and compare estimated intakes with internal doses obtained through biomonitoring was assessed.
308 citations
TL;DR: A staged model where different risk and protective factors contribute to the onset of psychiatric disorders in the working population, the onsetof short-term sickness absence, and the transition from short- to long-term absence is proposed.
Abstract: Psychiatric disorders are now the most common reason for long-term sickness absence. The associated loss in productivity and the payment of disability benefits places a substantial burden on the economies of many developed countries. The occupational dysfunction associated with psychiatric disorders can also lead to poverty and social isolation. As a result the area of work and psychiatric disorders is a high priority for policymakers. There are two main agendas: for many researchers and clinicians the focus is on the need to overcome stigma and ensure people with severe psychiatric disorders have meaningful work; however the public health agenda predominantly relates to the more common disorders such as depression and anxiety, which contribute a greater burden of disability benefits and pensions. In this review we attempt to address this second agenda. The relatively sparse evidence available reveals a complex field with significant interplay between medical, psychological social and cultural factors. Sick leave can be a 'process' as well as an 'event'. In this review we propose a staged model where different risk and protective factors contribute to the onset of psychiatric disorders in the working population, the onset of short-term sickness absence, and the transition from short- to long-term absence. We also examine strategies to manage psychiatric disorder in the workforce with a view towards returning the employee to work. Our aim in this review is to highlight the complexity of the area, to stimulate debate and to identify important gaps in knowledge where further research might benefit both patients and wider society.
298 citations
TL;DR: The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks and prevalence ratios were adjusted for cluster effects and sites.
247 citations
TL;DR: Evidence is provided that brain swelling triggers Ca2+ signaling in astrocytes and that deletion of the Aqp4 gene markedly interferes with these events, suggesting that AQP4 not only serves as an influx route for water but also is critical for initiating downstream signaling events that may affect and potentially exacerbate the pathological outcome in clinical conditions associated with brain edema.
Abstract: Aquaporin-4 (AQP4) is a primary influx route for water during brain edema formation. Here, we provide evidence that brain swelling triggers Ca2+ signaling in astrocytes and that deletion of the Aqp4 gene markedly interferes with these events. Using in vivo two-photon imaging, we show that hypoosmotic stress (20% reduction in osmolarity) initiates astrocytic Ca2+ spikes and that deletion of Aqp4 reduces these signals. The Ca2+ signals are partly dependent on activation of P2 purinergic receptors, which was judged from the effects of appropriate antagonists applied to cortical slices. Supporting the involvement of purinergic signaling, osmotic stress was found to induce ATP release from cultured astrocytes in an AQP4-dependent manner. Our results suggest that AQP4 not only serves as an influx route for water but also is critical for initiating downstream signaling events that may affect and potentially exacerbate the pathological outcome in clinical conditions associated with brain edema.
TL;DR: Maternal use of folic acid supplements in early pregnancy was associated with a reduced risk of severe language delay in children at age 3 years, among this Norwegian cohort of mothers and children.
Abstract: other supplements, but no folic acid (n=2480 [6.6%], with severe language delay in 22 children [0.9%]; OR, 1.04; 95% CI, 0.62-1.74); (2) folic acid only (n=7127 [18.9%], with severe language delay in 28 children [0.4%]; OR, 0.55; 95% CI, 0.35-0.86); and (3) folic acid in combination with other supplements (n=19 005 [50.5%], with severe language delay in 73 children [0.4%]; OR, 0.55; 95% CI, 0.39-0.78). Conclusion Among this Norwegian cohort of mothers and children, maternal use of folic acid supplements in early pregnancy was associated with a reduced risk of severe language delay in children at age 3 years.
TL;DR: In this paper, the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders was determined and a four-factor model was used to identify clusters of disorders and account for comorbidity within and between axes.
Abstract: The Diagnostic and Statistical Manual (4th ed. [DSM-IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM-IV Personality (SIDP-IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM-IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM.
TL;DR: The age of the residence is found to be a predictor of PFC concentrations in both indoor air and house dust, supporting the hypothesis that FOSA/FOSEs may be transformed to PFSAs.
Abstract: Per- and polyfluorinated compounds (PFCs) have been found to be ubiquitously distributed in human populations, however the sources of human exposure are not fully characterized. A wide range of PFCs were determined in paired samples of indoor air and dust from 41 Norwegian households. Up to 18 ionic and 9 neutral PFCs were detected. The concentrations found are comparable to or lower than what has previously been reported in North America, Europe, and Asia. The highest median concentrations in dust were observed for perfluorohexanoic acid (28 ng/g), perfluorononanoic acid (23 ng/g), perfluorododecanoic acid (19 ng/g), and perfluorooctanoic acid (18 ng/g). However, perfluoroalkyl sulfonic acids (PFSAs) were also frequently detected. Fluortelomer alcohols were the most prominent compounds found in indoor air, with median concentrations for 8:2 fluortelomer alcohol, 10:2 fluortelomer alcohol, and 6:2 fluortelomer alcohol of 5173, 2822, and 933 pg/m(3) air, respectively. All perfluoroalkyl sulfonamides and sulfonamidoethanols (FOSA/FOSEs) were detected in more than 40% of the air samples. For the first time, significant positive correlations (p < 0.05) between PFSAs in house dust and FOSA/FOSEs in the indoor air have been shown, supporting the hypothesis that FOSA/FOSEs may be transformed to PFSAs. Further, we found the age of the residence to be a predictor of PFC concentrations in both indoor air and house dust. These results are important for estimating the exposure to PFCs from the indoor environment and for characterization of exposure pathways.
TL;DR: The approach used in this study, a multi-source analysis, proved useful to assess alterations in tick distribution and found I. ricinus is currently found further north and at higher altitudes than described in historical records.
Abstract: There is increasing evidence for a latitudinal and altitudinal shift in the distribution range of Ixodes ricinus. The reported incidence of tick-borne disease in humans is on the rise in many European countries and has raised political concern and attracted media attention. It is disputed which factors are responsible for these trends, though many ascribe shifts in distribution range to climate changes. Any possible climate effect would be most easily noticeable close to the tick's geographical distribution limits. In Norway- being the northern limit of this species in Europe- no documentation of changes in range has been published. The objectives of this study were to describe the distribution of I. ricinus in Norway and to evaluate if any range shifts have occurred relative to historical descriptions. Multiple data sources - such as tick-sighting reports from veterinarians, hunters, and the general public - and surveillance of human and animal tick-borne diseases were compared to describe the present distribution of I. ricinus in Norway. Correlation between data sources and visual comparison of maps revealed spatial consistency. In order to identify the main spatial pattern of tick abundance, a principal component analysis (PCA) was used to obtain a weighted mean of four data sources. The weighted mean explained 67% of the variation of the data sources covering Norway's 430 municipalities and was used to depict the present distribution of I. ricinus. To evaluate if any geographical range shift has occurred in recent decades, the present distribution was compared to historical data from 1943 and 1983. Tick-borne disease and/or observations of I. ricinus was reported in municipalities up to an altitude of 583 metres above sea level (MASL) and is now present in coastal municipalities north to approximately 69°N. I. ricinus is currently found further north and at higher altitudes than described in historical records. The approach used in this study, a multi-source analysis, proved useful to assess alterations in tick distribution.
TL;DR: Investigating whether lymphoma patients undergoing rituximab-containing treatment regimens or having received such regimens within the past 6 months were able to mount protective antibody responses to the influenza A(H1N1) 2009 virus vaccine Pandemrix during the 2009 "swine flu" pandemic found none of the 67 patients achieved protective antibody titers.
TL;DR: It is hypothesized that the induced mitotic arrest and following cell death was due to a premature chromosome condensation caused by a combination of DNA, mitochondrial and spindle damage.
Abstract: Airborne particulate matter (PM) is considered to be an important contributor to lung diseases. In the present study we report that Milan winter-PM2.5 inhibited proliferation in human bronchial epithelial cells (BEAS-2B) by inducing mitotic arrest. The cell cycle arrest was followed by an increase in mitotic-apoptotic cells, mitotic slippage and finally an increase in "classical" apoptotic cells. Exposure to winter-PM10 induced only a slight effect which may be due to the presence of PM2.5 in this fraction while pure combustion particles failed to disturb mitosis. Fewer cells expressing the mitosis marker phospho-histone H3 compared to cells with condensed chromosomes, suggest that PM2.5 induced premature mitosis. PM2.5 was internalized into the cells and often localized in laminar organelles, although particles without apparent plasma membrane covering were also seen. In PM-containing cells mitochondria and lysosomes were often damaged, and in mitotic cells fragmented chromosomes often appeared. PM2.5 induced DNA strands breaks and triggered a DNA-damage response characterized by increased phosphorylation of ATM, Chk2 and H2AX; as well as induced a marked increase in expression of the aryl hydrocarbon receptor (AhR)-regulated genes, CYP1A1, CYP1B1 and AhRR. Furthermore, some disturbance of the organization of microtubules was indicated. It is hypothesized that the induced mitotic arrest and following cell death was due to a premature chromosome condensation caused by a combination of DNA, mitochondrial and spindle damage.
TL;DR: For most substances, higher ORs were found when studying drivers involved in single vehicle accidents than for those involved in multiple vehicle accidents, but confidence intervals were wider.
TL;DR: Development of gut microbiota in infants not exposed to medical interventions and the role of antibiotics and other interventions in this development is investigated.
Abstract: Knowledge of the composition of a normal healthy gut microbiota during infancy is important for understanding the role of gut microbiota in disease. A limitation of previous studies is that they are based on infants who have been subject to factors, which can have a profound disruptive effect on the natural colonization process. We describe the colonization process, during the first 4 months after birth, in 85 infants who have experienced no major medical or dietary interventions. They were all vaginally delivered, healthy, term infants, who were not exposed to antibiotics, exclusively breastfed during their first month of life and at least partially breastfed up to 4 months. Selected microbial groups were identified by targeting small subunit microbial ribosomal RNA genes. In contrast to more recent studies, but in agreement with older studies, almost all our infants harbored γ-Proteobacteria and Bifidobacterium. Yet undefined non-cultivable species belonging to Bacteroides, as well as microbes identified as Lachnospiraceae 2, were common. Strong associations were observed between some specific constituents of microbiota at day 4 and the concentration of specific microbial groups at day 120, indicating that early gut microbiota may influence later microbiota. Novel information of the undisturbed composition of early gut microbiota in babies is presented.
TL;DR: In this paper, the authors examined physician burnout in association with individual factors, work characteristics and work-home interaction (job performance-based self-esteem, goal orientation, value congruency, workload, autonomy, work home conflict and work home facilitation).
Abstract: The purpose of this study was to examine physician burnout in association with individual factors, work characteristics and work–home interaction (job performance-based self-esteem, goal orientation, value congruency, workload, autonomy, work–home conflict and work–home facilitation). This two-wave panel study includes a sample of Norwegian physicians collected in 2003 (N = 683) and 2005 (N = 523). Hierarchical multiple regression analysis was used to test the assumed effects in male and female physicians separately. The results imply that many of the assumed predictors play significant parts in physician burnout. A noticeable finding was that the pattern and strength of significant effects differed within the separate analyses of men and women. Work–home conflict was a particularly strong burnout predictor in female physicians whereas workload was the strongest burnout predictor in male physicians. The findings may have implications when planning future interventions. Copyright © 2010 John Wiley & Sons, Ltd.
TL;DR: Pre-eclampsia is a disease of many risk factors and theoretical speculations and it is, for unknown reasons, more prevalent among primiparous women, while a change of sexual partner before the next pregnancy increases the risk.
Abstract: Pre-eclampsia is a disease of many risk factors and theoretical speculations. It is, for unknown reasons, more prevalent among primiparous women. Some observations show that a change of sexual partner before the next pregnancy increases the risk, but this association disappears when correction is made for time interval since the last birth. Risk factors may be pregnancy-specific, such as twinning or mole, whereas others are linked to the woman, such as obesity and diabetes. Genetic risk factors are being searched for, but as yet with relatively little success. A previous pregnancy complicated by pre-eclampsia is probably the strongest risk factor. For practical purposes, women at increased risk can be identified and should be followed closely. No effective primary preventative action is available. Prevention of the serious consequences of pre-eclampsia still relies on early detection of increases in blood pressure and proteinuria.
TL;DR: It is suggested that regular consumption of milk-based probiotics could be associated with lower risk of preeclampsia in primiparous women.
Abstract: Probiotics have been suggested to modify placental trophoblast inflammation, systemic inflammation, and blood pressure, all potentially interesting aspects of preeclampsia. The authors examined the association between consumption of milk-based probiotic products in pregnancy and development of preeclampsia and its subtypes. The study was performed in the Norwegian Mother and Child Cohort Study by using a prospective design in 33,399 primiparous women in the years 2002–2008. The intake of milk-based products containing probiotic lactobacilli was estimated from a self-reported food frequency questionnaire. Preeclampsia diagnoses were obtained from the Norwegian Medical Birth Registry. Intake of probiotic milk products was associated with reduced risk of preeclampsia. The association was most prominent in severe preeclampsia (adjusted odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.66, 0.96). With probiotic intakes divided into categories representing no, monthly, weekly, or daily intake, a lower risk for preeclampsia (all subtypes) was observed for daily probiotic intake (OR = 0.80, 95% CI: 0.66, 0.96). Lower risks for severe preeclampsia were observed for weekly (OR = 0.75, 95% CI: 0.57, 0.98) and daily (OR = 0.61, 95% CI: 0.43, 0.89) intakes. These results suggest that regular consumption of milk-based probiotics could be associated with lower risk of preeclampsia in primiparous women.
TL;DR: In this article, the authors sequenced the genomes of five ETEC isolates obtained from children in Guinea-Bissau with diarrhea, and compared the two previously generated ETEC genomes.
Abstract: Enterotoxigenic Escherichia coli (ETEC) is a major cause of diarrheal illness in children less than 5 years of age in low- and middle-income nations, whereas it is an emerging enteric pathogen in industrialized nations. Despite being an important cause of diarrhea, little is known about the genomic composition of ETEC. To address this, we sequenced the genomes of five ETEC isolates obtained from children in Guinea-Bissau with diarrhea. These five isolates represent distinct and globally dominant ETEC clonal groups. Comparative genomic analyses utilizing a gene-independent whole-genome alignment method demonstrated that sequenced ETEC strains share approximately 2.7 million bases of genomic sequence. Phylogenetic analysis of this "core genome" confirmed the diverse history of the ETEC pathovar and provides a finer resolution of the E. coli relationships than multilocus sequence typing. No identified genomic regions were conserved exclusively in all ETEC genomes; however, we identified more genomic content conserved among ETEC genomes than among non-ETEC E. coli genomes, suggesting that ETEC isolates share a genomic core. Comparisons of known virulence and of surface-exposed and colonization factor genes across all sequenced ETEC genomes not only identified variability but also indicated that some antigens are restricted to the ETEC pathovar. Overall, the generation of these five genome sequences, in addition to the two previously generated ETEC genomes, highlights the genomic diversity of ETEC. These studies increase our understanding of ETEC evolution, as well as provide insight into virulence factors and conserved proteins, which may be targets for vaccine development.
TL;DR: The use of (13)C and (2)H labelled ISs for the determination of amphetamine and methamphetamine by UPLC-MS/MS was investigated and an improved ability to compensate for ion suppression effects were observed.
TL;DR: The use of ADHD drugs in the Nordic countries is a population‐based comparison study and shows clear differences in the use of these drugs among the countries studied.
Abstract: Use of medication to treat attention-deficit⁄hyper-activity disorder (ADHD) in children has increasedover the past two decades (1–7). In more recentyears, adults have also increasingly been treatedwith stimulants for the disorder, which historicallywas thought to only exist among children (8, 9).Zoe¨ga H, Furu K, Halldo´rsson M, Thomsen PH, Sourander A,Martikainen JE. Use of ADHD drugs in the Nordic countries:a population-based comparison study.Objective: To compare national use of attention-deficit⁄hyperactivitydisorder (ADHD) drugs between five Nordic countries.Method: A population-based drug utilisation study based onnationwide prescription databases, covering in total 24 919 145individuals in 2007. ADHD drugs defined according to the WorldHealth Organization Anatomic Therapeutic Chemical classificationsystem as centrally acting sympathomimetics (N06BA).Results: The 2007 prevalence of ADHD drug use among the totalNordic population was 2.76 per 1000 inhabitants, varying from 1.23per 1000 in Finland to 12.46 per 1000 in Iceland. Adjusting for age,Icelanders were nearly five times more likely than Swedes to have usedADHD drugs (Prev.Ratio = 4.53, 95% CI: 4.38–4.69). Prevalenceamong boys (age 7–15) was fourfold the prevalence among girls(Prev.Ratio = 4.28, 95% CI: 3.70–4.96). The gender ratio wasdiminished among adults (age 21 +) (Prev.Ratio = 1.24, CI:1.21–1.27).Conclusion: A considerable national variation in use of ADHD drugsexists between the Nordic countries.
Pasteur Institute1, Erasmus University Rotterdam2, Instituto Nacional de Saúde Dr. Ricardo Jorge3, Karolinska Institutet4, University of Sarajevo5, Aristotle University of Thessaloniki6, Carlos III Health Institute7, National Institutes of Health8, University College Dublin9, Istituto Superiore di Sanità10, Institute of Tropical Medicine Antwerp11, Norwegian Institute of Public Health12, Medical University of Vienna13, University of Ljubljana14, Slovak Academy of Sciences15, World Organisation for Animal Health16, Spiez Laboratory17, University of Helsinki18
TL;DR: An overview of the progression of human cases in the period from 2005 to 2010 is presented and an update on the available diagnostic methods and endemic regions in their countries is provided, with an emphasis on occurring virus types and reservoirs.
Abstract: Hantavirus infections are reported from many countries in Europe and with highly variable annual case numbers. In 2010, more than 2,000 human cases were reported in Germany, and numbers above the baseline have also been registered in other European countries. Depending on the virus type human infections are characterised by mild to severe forms of haemorrhagic fever with renal syndrome. The member laboratories of the European Network for diagnostics of Imported Viral Diseases present here an overview of the progression of human cases in the period from 2005 to 2010. Further we provide an update on the available diagnostic methods and endemic regions in their countries, with an emphasis on occurring virus types and reservoirs.
TL;DR: There was a strong, graded but J-shaped univariable relationship between BMI and CVD mortality in both genders and this increases the public health importance of BMI as both a simple indicator and mediator of CVD risk.
Abstract: Background: Although cardiovascular disease (CVD) is the biggest global cause of death, CVD mortality is falling in developed countries. There is concern that this trend may be offset by increasing levels of obesity.Design: We used the Systematic Coronary Risk Evaluation (SCORE) data set to examine relationships between body mass index (BMI), conventional risk factors and CVD mortality.Methods: The SCORE data set comprises data from 12 European cohort studies. The relationship between BMI and CVD mortality was examined in each BMI category using univariable and multivariable (Cox) analyses. The SCORE population was also divided into gender and age strata: under 40, 40–49, 50–59, and over 60. The rate of CVD mortality in each BMI category was calculated within each gender and age stratum. Relationships between BMI and other CVD risk factors were also examined.Results: There was a strong, graded but J-shaped univariable relationship between BMI and CVD mortality in both genders. Each 5-unit increase in BMI ...
TL;DR: An ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS) method for screening of drugs in whole blood has been developed and validated and recoveries from whole blood were > 50% except for morphine and THC.
Abstract: An ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS) method for screening of drugs in whole blood has been developed and validated. Samples were prepared by supported liquid-liquid extraction on ChemElute(®) columns with ethyl acetate/heptane (4:1). LC separation was achieved with an Acquity HSS T3-column (2.1 100 mm, 1.8-μm particle). Mass detection was performed by positive ion mode electrospray MS-MS and included the following drugs/metabolites: morphine, codeine, ethyl morphine, oxycodone, buprenorphine, methadone, cocaine, methylphenidate, amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), Δ(9)-tetrahydrocannabinol (THC), fentanyl, alprazolam, bromazepam, clonazepam, diazepam, nordiazepam, 3-OH-diazepam, fenazepam, flunitrazepam, lorazepam, nitrazepam, oxazepam, zopiclone, zolpidem, carisoprodol, and meprobamate. The cycle time was 9 min, and within- and between-day relative coefficients of variation varied from 1% to 33% and 2% to 58%, respectively. Extraction recoveries from whole blood were > 50% except for morphine and THC. The limit of quantitation was 0.1 to 521 ng/mL, depending on the drug.
TL;DR: The GMI members reviewed global meningococcal disease epidemiology, immunization strategies, and research needs, and found innovative approaches are needed to introduce and sustain menedococcal vaccination programs in resource-poor settings with a high incidence of meningitis disease.
TL;DR: It is indicated that cosmetic surgery has positive long-term effects on appearance-related variables, however, surgeons should be particularly aware of patients with psychological problems, as these may compromise patient satisfaction with the effects of cosmetic surgery.
Abstract: Background: Most studies examining psychosocial changes after cosmetic surgery have short follow-up periods and therefore provide limited information about long-term effects of such surgery. Moreover, studies that identify whether preexisting patient characteristics are associated with poor psychosocial outcomes after cosmetic surgery are lacking. The current study provides information about both of these issues. Methods: Questionnaire data from 130 female Norwegian cosmetic surgery patients were obtained before and 5 years after surgery. The questionnaire consisted of measures on appearance satisfaction, self-esteem, psychological problems, and patients' evaluation of the outcome of surgery. Data from a representative sample of 838 Norwegian women, aged 22 to 55 years, were used for comparison purposes. Results: Analyses revealed an improvement in both general appearance satisfaction and satisfaction with the body part operated on 5 years after surgery. A small increase in self-esteem was observed as well. High rates of preoperative psychological problems and low self-esteem were related to more negative changes in some of the psychosocial measures after surgery compared with patients with better psychological health. Furthermore, factors associated with the actual decision to undergo surgery were related to changes in psychological health and patients' evaluation of the outcome of surgery. Conclusions: This study indicates that cosmetic surgery has positive long-term effects on appearance-related variables. However, surgeons should be particularly aware of patients with psychological problems, as these may compromise patient satisfaction with the effects of cosmetic surgery. Factors affecting the decision itself to undergo cosmetic surgery may also be relevant for subsequent psychosocial outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.