Publications by authors named "John R Andersen"

10 Publications

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IPSS "bother question" score predicts health-related quality of life better than total IPSS score.

World J Urol 2022 Jan 9. Epub 2022 Jan 9.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Objective: The objective of this study was to investigate the role of bothersomeness of urinary symptoms on the general health-related quality of life (HRQoL) of patients with benign prostatic hyperplasia. We hypothesised that a higher International Prostate Symptom Score (IPSS) would be associated with a higher score on the IPSS bother question (IPSS-BQ), and a higher IPSS-BQ score would be the dominant factor associated with poorer general HRQoL.

Materials And Methods: A case-control, cross-sectional study design was used. Patients were selected according to strict inclusion and exclusion criteria and stratified by IPSS severity group (controls: IPSS < 8; moderately symptomatic: IPSS = 8-18; and severely symptomatic: IPSS > 18). The IPSS-BQ was used to analyse bothersomeness of urinary symptoms. A standardised, multidimensional measure of HRQoL (RAND-36) was used. Data were collected on prostate size, uroflowmetry parameters, prostate specific antigen and comorbidities that were quantified using the Charlson Index and the American Association of Anaesthesiologists (ASA) score. Multiple linear regression models were used to assess the impact of bothersomeness of urinary symptoms on physical and mental HRQoL. Cohen's d was used to determine the effect size.

Results: We included 83 patients in the statistical analysis. Linear regression analyses showed that the IPSS was not an independent predictor of HRQoL. Only the highest IPSS-BQ score was associated with both worse physical (P = 0.021) and mental (P = 0.011) HRQoL in the final model. The effect sizes were small to moderate.

Conclusion: The IPSS-BQ score is an important predictor of HRQoL. The IPSS-BQ score as a proxy should be regarded as a standard outcome measure and reported in all LUTS-related research.
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January 2022

Eating self-efficacy as predictor of long-term weight loss and obesity-specific quality of life after sleeve gastrectomy: A prospective cohort study.

Surg Obes Relat Dis 2019 Feb 15;15(2):161-167. Epub 2018 Dec 15.

Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Førde, Norway; Center of Health Research, Førde Hospital Trust, Førde, Norway.

Background: A person's confidence to control eating, eating self-efficacy (ESE), has been identified as a target for long-term weight management in nonsurgical weight loss interventions, but has to a limited extent been studied after bariatric surgery.

Objective: We investigated the association between ESE, weight loss, and obesity-specific quality of life (QOL) after sleeve gastrectomy (SG).

Setting: A single-center longitudinal study.

Methods: Data from adult patients were collected before SG, and at mean 16 months (±standard deviation 4 mo) and 55 (±4) months postoperatively. ESE was measured by the Weight Efficacy Lifestyle Questionnaire Short-Form. Multiple regression analyses were performed with excess body mass index loss (%EBMIL) and obesity-specific QOL as dependent variables. Age, sex, and other preoperative values were covariates in all models.

Results: Of 114 preoperative patients, 91 (80%) and 84 (74%) were available for follow-up 16 and 55 months after SG, respectively. Mean %EBMIL from baseline to 16 and 55 months was 76% (95% confidence interval: 71.9, 79.6) and 67% (95% confidence interval: 61.9, 72.2), respectively. Preoperative ESE scores improved significantly at both 16 and 55 months (P = .002) but did not predict postoperative %EBMIL or QOL at 55 months (β = -.08, P = .485). Greater change in ESE from 0 to 16 months predicted higher %EBMIL (β = .34, P = .013) at 55 months, and improvements in ESE from 0 to 55 months were significantly associated with higher %EBMIL (β = .46, P = .001) and obesity-specific QOL (β = .50, P < .001) 55 months after SG.

Conclusion: Significant improvements in ESE were seen at 16 months, and remained high at 55 months after SG in this cohort. Patients who improved their ESE the most also experienced the highest weight loss and obesity-specific QOL 5 years postoperatively. Future research should address whether enhancement of ESE corresponds to sustained improvements in eating behavior after bariatric surgery.
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February 2019

Executive Function, Behavioral Self-Regulation, and School Related Well-Being Did Not Mediate the Effect of School-Based Physical Activity on Academic Performance in Numeracy in 10-Year-Old Children. The Active Smarter Kids (ASK) Study.

Front Psychol 2018 28;9:245. Epub 2018 Feb 28.

Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway.

Inconsistent findings exist for the effect of school-based physical activity interventions on academic performance. The Active Smarter Kids (ASK) study revealed a favorable intervention effect of school-based physical activity on academic performance in numeracy in a subsample of 10-year-old elementary schoolchildren performing poorer at baseline in numeracy. Aiming to explain this finding, we investigated the mediating effects of executive function, behavioral self-regulation, and school related well-being in the relation between the physical activity intervention and child's performance in numeracy. An ANCOVA model with latent variable structural equation modeling was estimated using data from 360 children (the lower third in academic performance in numeracy at baseline). The model consisted of the three latent factors as mediators; executive function, behavioral self-regulation, and school related well-being. We found no mediating effects of executive function, behavioral self-regulation or school related well-being in the relationship between the ASK intervention and academic performance in numeracy ( ≥ 0.256). Our results suggest that the effect of the intervention on performance in numeracy in the present sample is not explained by change in executive function, behavioral self-regulation, or school related well-being. We suggest this finding mainly could be explained by the lack of effect of the intervention on the mediators, which might be due to an insufficient dose of physical activity. registry, trial registration number: NCT02132494.
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February 2018

Inflammatory markers, the tryptophan-kynurenine pathway, and vitamin B status after bariatric surgery.

PLoS One 2018 5;13(2):e0192169. Epub 2018 Feb 5.

KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway.

Objective: Obesity is associated with increased inflammation and insulin resistance. In conditions with chronic immune activation, low plasma vitamin B6-levels are described, as well as an increased kynurenine:tryptophan-ratio (KTR). We investigated circulating tryptophan, kynurenine and its metabolites, neopterin, B-vitamins, CRP, and HbA1c in individuals with obesity before and after bariatric surgery.

Methods: This longitudinal study included 37 patients with severe obesity, scheduled for bariatric surgery. Blood samples were taken at inclusion and at three months and one year postoperatively.

Results: We observed significant positive correlations between HbA1c and both 3-hydroxy-kynurenine and 3-hydroxyanthranilic acid at inclusion. After surgery, fasting glucose, HbA1C and triglycerides decreased, whereas HDL-cholesterol increased. Tryptophan, kynurenine and its metabolites, except for anthranilic acid, decreased during weight loss. The KTR and CRP decreased while vitamin B6 increased during the year following operation, indicating reduced inflammation (all p<0.05).

Conclusions: In patients with obesity subjected to bariatric surgery, levels of 3-hydroxykynurenine and 3-hydroxyanthranilic acid seemed to be positively correlated to impaired glucose tolerance. One year following surgery, plasma levels of the kynurenine metabolites were substantially decreased, along with a metabolic improvement. The relation of circulating kynurenine pathway metabolites with biomarkers of metabolic impairment in patients with obesity needs further evaluation.
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March 2018

Five-Year Outcomes After Vertical Sleeve Gastrectomy for Severe Obesity: A Prospective Cohort Study.

Obes Surg 2017 08;27(8):1944-1951

Department of Surgery, Voss Hospital, Haukeland University Hospital/The Western Norway Health Region Authority, Sjukehusvegen 16, 5704, Voss, Norway.

Background: We present 5-year outcomes after vertical sleeve gastrectomy (VSG), including complications and revisions, weight change, obesity-related diseases and health-related quality of life (HRQOL).

Methods: Patients operated from December 2005 to November 2010 were included. All variables except HRQOL (obtained using Short Form-36) were assessed prospectively. HRQOL data was assessed cross-sectionally, comparing 5-year results to both a baseline cohort of severely obese patients prior to bariatric surgery and to Norwegian norms.

Results: Of 168 operated patients (mean age, 40.3 ± 10.5 years; 71% females), 92% completed 2-year and 82% 5-year follow-up. Re-intervention for complications occurred in four patients, whereas revision surgery was performed in six patients for weight regain and in one patient for gastroesophageal reflux disease (GERD). Mean body mass index (BMI) decreased from 46.2 ± 6.4 kg/m at baseline to 30.5 ± 5.8 kg/m at 2 years and 32.9 ± 6.1 kg/m at 5 years. Remission of type 2 diabetes mellitus (T2DM) and hypertension occurred in 79 and 62% at 2 years, and 63 and 60% at 5 years, respectively. The percentage of patients treated for GERD increased from 12% preoperatively to 29% at 2 years and 35% at 5 years. The physical and mental SF-36 summary scores showed significantly better HRQOL at 5 years compared with the baseline cohort, but did not reach population norms.

Conclusion: The majority of VSG patients maintained successful weight loss and improvement of T2DM, hypertension and HRQOL at 5 years. Preventing weight regain and GERD are important considerations with this procedure.
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August 2017

Effects of physical activity on schoolchildren's academic performance: The Active Smarter Kids (ASK) cluster-randomized controlled trial.

Prev Med 2016 10 7;91:322-328. Epub 2016 Sep 7.

Sogn og Fjordane University College, Faculty of Teacher Education and Sports, Sogndal, Norway; Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway. Electronic address:

Objective: To investigate the effect of a seven-month, school-based cluster-randomized controlled trial on academic performance in 10-year-old children.

Methods: In total, 1129 fifth-grade children from 57 elementary schools in Sogn og Fjordane County, Norway, were cluster-randomized by school either to the intervention group or to the control group. The children in the 28 intervention schools participated in a physical activity intervention between November 2014 and June 2015 consisting of three components: 1) 90min/week of physically active educational lessons mainly carried out in the school playground; 2) 5min/day of physical activity breaks during classroom lessons; 3) 10min/day physical activity homework. Academic performance in numeracy, reading and English was measured using standardized Norwegian national tests. Physical activity was measured objectively by accelerometry.

Results: We found no effect of the intervention on academic performance in primary analyses (standardized difference 0.01-0.06, p>0.358). Subgroup analyses, however, revealed a favorable intervention effect for those who performed the poorest at baseline (lowest tertile) for numeracy (p=0.005 for the subgroup∗group interaction), compared to controls (standardized difference 0.62, 95% CI 0.19-1.07).

Conclusions: This large, rigorously conducted cluster RCT in 10-year-old children supports the notion that there is still inadequate evidence to conclude that increased physical activity in school enhances academic achievement in all children. Still, combining physical activity and learning seems a viable model to stimulate learning in those academically weakest schoolchildren.
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October 2016

Active Smarter Kids (ASK): Rationale and design of a cluster-randomized controlled trial investigating the effects of daily physical activity on children's academic performance and risk factors for non-communicable diseases.

BMC Public Health 2015 Jul 28;15:709. Epub 2015 Jul 28.

Faculty of Teacher Education and Sports, Sogn og Fjordane University College, Sogndal, Norway.

Background: Evidence is emerging from school-based studies that physical activity might favorably affect children's academic performance. However, there is a need for high-quality studies to support this. Therefore, the main objective of the Active Smarter Kids (ASK) study is to investigate the effect of daily physical activity on children's academic performance. Because of the complexity of the relation between physical activity and academic performance it is important to identify mediating and moderating variables such as cognitive function, fitness, adiposity, motor skills and quality of life (QoL). Further, there are global concerns regarding the high prevalence of lifestyle-related non-communicable diseases (NCDs). The best means to address this challenge could be through primary prevention. Physical activity is known to play a key role in preventing a host of NCDs. Therefore, we investigated as a secondary objective the effect of the intervention on risk factors related to NCDs. The purpose of this paper is to describe the design of the ASK study, the ASK intervention as well as the scope and details of the methods we adopted to evaluate the effect of the ASK intervention on 5 (th) grade children.

Methods & Design: The ASK study is a cluster randomized controlled trial that includes 1145 fifth graders (aged 10 years) from 57 schools (28 intervention schools; 29 control schools) in Sogn and Fjordane County, Norway. This represents 95.3 % of total possible recruitment. Children in all 57 participating schools took part in a curriculum-prescribed physical activity intervention (90 min/week of physical education (PE) and 45 min/week physical activity, in total; 135 min/week). In addition, children from intervention schools also participated in the ASK intervention model (165 min/week), i.e. a total of 300 min/week of physical activity/PE. The ASK study was implemented over 7 months, from November 2014 to June 2015. We assessed academic performance in reading, numeracy and English using Norwegian National tests delivered by The Norwegian Directorate for Education and Training. We assessed physical activity objectively at baseline, midpoint and at the end of the intervention. All other variables were measured at baseline and post-intervention. In addition, we used qualitative methodologies to obtain an in-depth understanding of children's embodied experiences and pedagogical processes taking place during the intervention.

Discussion: If successful, ASK could provide strong evidence of a relation between physical activity and academic performance that could potentially inform the process of learning in elementary schools. Schools might also be identified as effective settings for large scale public health initiatives for the prevention of NCDs.

Trial Registration: ID nr: NCT02132494 . Date of registration, 6(th) of May, 2014.
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July 2015

Translation, adaptation, validation and performance of the American Weight Efficacy Lifestyle Questionnaire Short Form (WEL-SF) to a Norwegian version: a cross-sectional study.

PeerJ 2014 16;2:e565. Epub 2014 Sep 16.

Department of Global Public Health and Primary Care, University of Bergen , Bergen , Norway.

Background. Researchers have emphasized a need to identify predictors that can explain the variability in weight management after bariatric surgery. Eating self-efficacy has demonstrated predictive impact on patients' adherence to recommended eating habits following multidisciplinary treatment programs, but has to a limited extent been subject for research after bariatric surgery. Recently an American short form version (WEL-SF) of the commonly used Weight Efficacy Lifestyle Questionnaire (WEL) was available for research and clinical purposes. Objectives. We intended to translate and culturally adapt the WEL-SF to Norwegian conditions, and to evaluate the new versions' psychometrical properties in a Norwegian population of morbidly obese patients eligible for bariatric surgery. Design. Cross-sectional Methods. A total of 225 outpatients selected for Laparoscopic sleeve gastrectomy (LSG) were recruited; 114 non-operated and 111 operated patients, respectively. The questionnaire was translated through forward and backward procedures. Structural properties were assessed performing principal component analysis (PCA), correlation and regression analysis were conducted to evaluate convergent validity and sensitivity, respectively. Data was assessed by mean, median, item response, missing values, floor- and ceiling effect, Cronbach's alpha and alpha if item deleted. Results. The PCA resulted in one factor with eigenvalue > 1, explaining 63.0% of the variability. The WEL-SF sum scores were positively correlated with the Self-efficacy and quality of life instruments (p < 0.001). The WEL-SF was associated with body mass index (BMI) (p < 0.001) and changes in BMI (p = 0.026). A very high item response was obtained with only one missing value (0.4%). The ceiling effect was in average 0.9 and 17.1% in the non-operated and operated sample, respectively. Strong internal consistency (r = 0.92) was obtained, and Cronbach's alpha remained high (0.86-0.92) if single items were deleted. Conclusion. The Norwegian version of WEL-SF appears to be a valid questionnaire on eating self-efficacy, with acceptable psychometrical properties in a population of morbidly obese patients.
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October 2014

Work participation among the morbidly obese seeking bariatric surgery: an exploratory study from Norway.

Obes Surg 2015 Feb;25(2):271-8

Department of Research and Development, Haukeland University Hospital, Postbox 1400, 5021, Bergen, Norway,

Background: The aim of this study is to assess the rate of work participation and disability pension, and identify predictors for sickness absence and disability pension, among morbidly obese individuals.

Methods: The data were collected from the Obesity Surgery Registry at Førde Central Hospital and consists of patients undergoing bariatric surgery between April 2001 and February 2013. Multivariate logistic regression was performed to identify predictors of sickness absence and disability pension.

Results: The sample consisted of 576 patients (63.9 % females) with a mean (range, SD) age of 41.7 (18-66, 10.6) and a mean body mass index (BMI) of 47.7 (32.5-80.8, 7.7). Patients working full- or part-time comprised 55.6 % of the sample and 29.7 % received a disability pension; only 46.4 % of the sample received an income from paid work without additional benefits. Having a BMI above 50, lower levels of education, and suffering from four or more comorbidities were significant predictors of sickness absence. Female gender, psychiatric disorders, lower levels of education, asthma, heart failure and suffering from four or more comorbidities were significant predictors of disability pension.

Conclusions: The proportion of the work participation and disability pension among this morbidly obese population is of substantial concern, as work participation has proven important for the health-related quality of life. This, combined with the fact that these patients are significantly less educated than the general population, can potentially have grave socioeconomic consequences. Increased knowledge of obesity development and the work history of these patients are needed to implement policies that ensure increased rates of work participation.
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February 2015

Associations between physical activity and quality of life outcomes in adults with severe obesity: a cross-sectional study prior to the beginning of a lifestyle intervention.

Health Qual Life Outcomes 2013 Nov 5;11:187. Epub 2013 Nov 5.

Faculty of Health Studies, Sogn og Fjordane University College, N-6803 Førde, Norway.

Background: Severely obese individuals who seek lifestyle interventions have impaired quality of life (QoL). Research suggests that physical activity (PA) plays a role in weight reduction and improved health in this group, but knowledge about the association of PA with QoL outcomes is sparse and inconsistent. The aim of this study was to investigate whether a higher level of PA was independently associated with higher QoL in severely obese individuals prior to the beginning of a lifestyle intervention.

Methods: During 2010, a total of 49 severely obese individuals who began a lifestyle intervention programme in Western Norway agreed to participate in the study. Data were collected prior to the beginning of the intervention. QoL was measured by a one-item scale on life satisfaction and the SF-36, PA was measured by an accelerometer, and clinical data were collected by health staff. Linear regression analyses were used to determine the associations between PA and QoL outcomes (life satisfaction, physical functioning, and mental health), adjusting for age, gender, and body mass index (BMI).

Results: In the adjusted analyses, we found positive relationships between PA and life satisfaction (Stand. coeff. 0.39, p = 0.024) and physical functioning (Stand. coeff. 0.34, p = 0.025). There was no association between PA and mental health (Stand. coeff. 0.15, p = 0.376).

Conclusion: This study detected associations between objectively measured PA and life satisfaction as well as physical functioning in a group of severely obese individuals before they began a lifestyle intervention programme.
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November 2013