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BAKGRUNN Forskning viser at det er økt risiko for alkoholbrukslidelser etter fedmekirurgi. Hensikten med studien var å få innsikt i hva fedmeopererte i rusbehandling selv tenker om mulige årsaker til utvikling av problematisk alkoholbruk etter fedmekirurgi. MATERIALE OG METODE Ti dybdeintervju med pasienter i rusbehandling i 2020 som tidligere hadde gjennomgått fedmekirurgi (seks menn og fire kvinner), ble gjennomført. Materialet ble transkribert og analysert ved hjelp av en stegvis deduktiv-induktiv (SDI) metode. RESULTATER Deltakerne opplevde problematisk alkoholbruk først etter fedmeoperasjonen. De beskrev nye intense rusopplevelser og at kroppen responderte annerledes på alkohol. Alkohol fikk nye funksjoner, som appetittvekker, smertedemper og materstatter. De fleste hadde positive erfaringer fra den første tiden etter operasjonen, men deltakerne beskrev samtidig en ambivalent kroppsomstilling og økt psykisk sårbarhet i årene etter. FORTOLKNING Alkoholens nye virkning og funksjon etter inngrepet kan ha gjort deltakerne mer sårbare for utvikling av problematisk alkoholbruk. HOVEDFUNN Et problematisk forhold til alkohol utviklet seg først etter fedmekirurgi. Studiedeltakere beskrev nye og intense rusopplevelser ved alkoholinntak etter operasjonen. Alkohol fikk nye funksjoner knyttet til appetitt, smerter, erstatning for mat og psykiske helseutfordringer.

Einar Furulund,1– 3 Mitra Bemanian,2,3 Nina Berggren,3 Tesfaye Madebo,2,4 Sara Hydle Rivedal,3 Torgeir Gilje Lid,1,5 Lars Thore Fadnes2,3 1Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway; 2Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway; 3Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; 4Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway; 5Department of Public Health, University of Stavanger, Stavanger, NorwayCorrespondence: Einar FurulundCentre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, NorwayTel +4751518000Email Einar.Furulund@sus.noBackground: The role of nutrition and dietary patterns has been widely investigated in cancer, cardiovascular disease, and diabetes, but there are limited data on nutritional impact on COPD. This systematic review (PROSPERO-reg. no: CRD42020172712) aimed to investigate the effect of nutritional interventions on pulmonary and physical function, inflammation, and health-related quality of life among individuals with COPD.Methods: Systematic searches were conducted in Medline, Embase, and Cochrane, resulting in 3861 references. Studies focusing exclusively on inpatient-stays, underweight or obese patients were excluded. Double screening, extraction and bias assessment were conducted. Bias was assessed according to the Cochrane risk of bias tool for randomized controlled trials. Thirteen randomized controlled trials with 916 participants were included.Results: These trials investigated effects of protein supplementation, beetroot juice, increased fruit and vegetable intake, black seed oil, Tualang honey, Chlorella vulgaris-extract, whey-peptide containing nutritional drink, and increased macronutrient intake. The durations of the interventions were from weeks to a few months, and only one with duration > 1 year (investigating increased fruit/vegetable intake). The intervention increasing fruit/vegetables found improvement in pulmonary function tests. Some interventions observed effects on systemic inflammation, health-related quality of life and physical function, although with some mixed results. Five were classified as poor, five as fair, and three as good in terms of risk of bias and quality.Conclusion: Increasing intake of fruits and vegetables over prolonged periods might have positive effects on lung function in individuals with COPD. Some nutritional interventions also observed effects on systemic inflammation, health-related quality of life, and physical function, although with some mixed results. Many of the trials were underpowered, had high dropout rates, or had a high risk of bias. Further research should investigate effect of prolonged dietary interventions.Keywords: nutrition, lung function, inflammation, physical function, health-related quality of life

Aims: The aims of this study were to evaluate and compare popular beliefs and attitudes regarding alcohol conversations in healthcare in Sweden and Norway; and to explore which factors were associated with different levels of support for alcohol-prevention work in the two countries. Methods: Population-based cross-sectional surveys were conducted in Sweden (n = 3000) and Norway (n = 1208). Logistic regression was used to identify the characteristics of participants who were supportive of routine alcohol screening and brief intervention delivery. Results: A higher proportion of Swedish respondents agreed to a large extent that healthcare professionals should routinely ask about alcohol consumption. In addition, a higher proportion of Swedish respondents compared to respondents from Norway agreed that healthcare providers should only ask about patient’s alcohol consumption if this was related to specific symptoms. There were similar correlates of being supportive of routine alcohol screening and brief intervention delivery in both countries. Support was lower in both countries amongst moderate and risky drinkers, and among single adults or those on parental leave, but higher amongst older individuals. Having had an alcohol conversation in healthcare increased the level of support for alcohol prevention in routine healthcare among risky drinkers. Conclusions: There is a high level of support for preventative alcohol conversations in routine healthcare in Norway and Sweden, although there was a lower proportion of respondents who were positive to alcohol prevention in routine healthcare in Norway compared to Sweden. Experiencing alcohol conversation may positively affect risky drinkers’ attitudes towards and support for alcohol prevention. Thus, more frequent alcohol conversations in routine healthcare may also result in increased level of support for alcohol prevention among risky drinkers.

Alcohol use is integrated in many cultural settings, and the positive functions of alcohol as experienced by users are numerous. The Norwegian community has undergone major changes in the past two decades, with an increase in consumption of more than one third. Alcohol is potentially relevant for many medical conditions and health problems. While addiction is a serious problem for those afflicted, many more experience negative health effects from their own or from a significant other’s alcohol consumption. Risky or harmful alcohol consumption is frequently not recognized in health care, and efforts to improve recognition of and treatment for alcohol-related health problems have not been very successful. The aim of my PhD is to contribute to increased awareness and understanding among general practitioners regarding the relevance of alcohol in clinical situations, and to contribute to development of better strategies to address alcohol. The first study was a focus group study where we explored general practitioners’ experiences from addressing alcohol. We focused on why they asked about alcohol, how they did it and what happened. We analysed interview data from 13 general practitioners. Sometimes asking was triggered by specific symptoms or health problems, by negative changes in the patient’s condition or by a family member expressing concern. In other situations they asked because of routine, as with certain health certificates, a general check-up, meeting a new patient or because of pregnancy. They adapted their asking to their personal style, the patient and the situation. The main finding of this study was that they in many situations addressed alcohol based on clinical relevance, and in certain routine consultations they addressed alcohol as part of that routine. We have coined this pragmatic case finding. In the second study we explored facilitating and hampering factors for the implementation of pragmatic case finding. This focus group study was performed in the context of a four-session seminar in group practices. Fourteen doctors participated in the focus group interviews, and an additional interview with five general practitioners from other surgeries was later performed. We explored both individual and system factors. An important individual factor was time, perceived as both a challenge and an opportunity. Even though pressed for time, they could also plan for lengthier or more frequent consultations when necessary. The dual nature of alcohol as both normal and a potentially shameful individual problem was a challenge, but focusing on the normal aspects made it easier to talk about alcohol. Addressing alcohol was also easier when they focused on relevance for the patient’s health problem. The main system factor regarding implementation of pragmatic case finding was a tension between the mutual commitments in the surgery and the individual doctor’s need for autonomy. Younger doctors emphasized the mutual commitments and reported more collective strategies for learning. The aim of the third study was to explore whether historical data in electronic patient records might aid in earlier recognition of alcohol-related health problems. Nine surgeries with 36 doctors were recruited, and data from 20764 patients on classified non-narcotic medications, new sick leaves, elevated blood tests of gamma-glutamyl transferase or mean corpuscular volume, and potentially alcohol-related diagnoses in ICPC-2 and ICD-10 were collected and analyzed. The observation period was four to 21 years. Adjusted Cox-regressions revealed a significantly increased risk for alcohol use disorder for all variables, with strongest effect for elevated blood tests and weakest for classified non-narcotic medications. The results were not strong enough to enable the development of a clinically useful tool, but they emphasize the relevance of alcohol for many frequent health problems in general practice. My thesis indicates that an identification strategy based on clinical relevance and targeted screening is feasible in general practice. Pragmatic case finding is a framework enabling improvement by expanding knowledge on the multitude of clinical situations where alcohol may be relevant. Many frequent events in general practice may indicate vulnerability for developing an alcohol related health problem, and thus should prompt the GP to explore whether alcohol might be relevant for the patient’s health. Group practices with collective strategies for learning and quality improvement are well suited for improving knowledge and skills in identifying when and how alcohol may be relevant for a patient.