Ingela Lundin Kvalem

• Sommerfeldt, Bente; Skårderud, Finn; Kvalem, Ingela Lundin; Gulliksen, Kjersti Solhaug & Holte, Arne (2022). Bodies out of control: Relapse and worsening of eating disorders in pregnancy. Frontiers in Psychology. ISSN 1664-1078. doi: 10.3389/fpsyg.2022.986217. Show summary

  Background: Being pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant. Method: We interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE). Results: On becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.” Conclusion: Pregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention.

• Træen, Bente & Kvalem, Ingela Lundin (2022). Gender differences in sending nude pictures and videos across multiple relationship contexts in the adult Norwegian population. Sexuality & Culture. ISSN 1095-5143. doi: 10.1007/s12119-022-10028-0. Show summary

  This paper aims to determine the prevalence of sending nude pictures/videos in the Norwegian population and investigates gender differences regarding consensual, unsolicited, and coerced experiences. Data were obtained from a probability-based web survey of 2,181 men and 1,967 women between 18 and 89 years old. The majority of participants expressed relatively accepting attitudes toward sending nude pictures/videos, and men expressed more positive attitudes than women. Twenty-nine percent of participants reported having lifetime experience with sending nude pictures/videos, and sending nude pictures/videos was more common in younger individuals than older individuals. More women than men claimed that they sent their most recent nude picture to a committed partner, and twice as many men than women had sent a nude picture to a stranger or a person they only had contact with on the Internet. In addition, more than twice as many women than men reported consensual sending nude pictures/videos, and more men than women sent unsolicited pictures/videos. Consensual sending nude pictures/videos was characterized by the presence of men and women within committed relationships. In Norway, sending nude pictures/videos seems to be a way of being sexual in the context of committed relationships.

• Buer, Liliana; Kvalem, Ingela Lundin; Bårdstu, Silje Kvam & Mala, Tom (2022). Comparing Bariatric Surgery Patients Who Desire, Have Undergone, or Have No Desire for Body Contouring Surgery: a 5-Year Prospective Study of Body Image and Mental Health. Obesity Surgery. ISSN 0960-8923. 32(9), p. 2952–2959. doi: 10.1007/s11695-022-06117-6. Show summary

  Abstract Purpose After bariatric surgery, body contouring surgery (BCS) is thought to improve body image, weight loss, and mental health. Many patients desire but do not undergo BCS after bariatric surgery. This patient subset has rarely been studied. The present study compares bariatric surgery patients that, at 5 years after surgery, desires, have undergone or have no desire for BCS regarding pre- and post-surgery body image and mental health, including within-group changes over time. Materials and Methods Data were collected from participants (N=216) pre-bariatric surgery and at 1- and 5-year post-surgery. Health care providers measured body mass index (BMI). All other data were collected via self-report (questionnaires). Results At 5-year post-surgery, 30.6% had undergone BCS, 17.1% did not desire it, and 52.3% desired BCS. Patients who subsequently desired BCS scored lower on body satisfaction pre-surgery than the other groups. They also reported less resilience pre-surgery and more depressive symptoms at all times compared to participants with BCS. For fve-year postsurgery, patients who desired BCS had lower body satisfaction levels than patients with BCS and were more bothered with excess skin relative to the two other groups. Body satisfaction improved in all three groups from baseline to fve years and in most patients with BCS. Mental health improved only in patients with BCS. Conclusion This study emphasizes the relevance of identifying participants who desire but have not undergone BCS. The study suggests that BCS is associated with improved body image and mental health.

• Træen, Bente & Kvalem, Ingela Lundin (2022). Satisfaction with Singlehood and Sexual Activity. Sexuality & Culture. ISSN 1095-5143. doi: 10.1007/s12119-022-09961-x. Full text in Research Archive Show summary

  The purpose of this paper is to examine the extent to which Norwegians are satisfied with their singlehood, and to determine the association between being single and sexual activity. Data were obtained from a questionnaire survey of a representative web sample of 1,076 unpartnered individuals (568 women, 508 men) aged 18–89 years. A total of 45.2% of the single respondents reported being satisfied with being single, while 33.9% reported being unsatisfied. There was no difference between the age groups in men, but more women aged 45 years or older than women under the age of 45 were satisfied with being single. A higher percentage of gay, bisexual, and transmen than heterosexual men was satisfied with being single. More women who had not been sexually active with a partner in the past year were satisfied with being single than were women who had been sexually active. The men who were most satisfied with being single were those who had masturbated and/or had sexual intercourse, and least satisfied were those with no sexual activity, or exclusively masturbation activity. The results are discussed in terms of biological, psychological, and social positions.

• Kvalem, Ingela Lundin; Gabrielsen, Louise; Eribe, Inger; Kristinsson, Jon Adalsteinn & Mala, Tom (2022). Predicting satisfaction with outcome and follow‐up care five years after bariatric surgery: a prospective evaluation. Obesity Science & Practice. ISSN 2055-2238. doi: 10.1002/osp4.594. Full text in Research Archive Show summary

  Patient satisfaction is viewed as essential for a successful outcome of bariatric surgery. Few studies have explored long-term satisfaction prospectively. This study aimed to examine pre- and post-surgery predictors for satisfaction with follow-up care, and change in outcome satisfaction from one to five years after bariatric surgery. A sample of 210 participants was recruited from a single treatment center. Self-reported and medical record data regarding mental and somatic health, body image, follow-up attendance, and weight loss were obtained before, one year, and five years after surgery. Over 90% of the participants were satisfied with the results and treatment one year after surgery, while 69% had their outcome expectations fulfilled and 62% were satisfied with the follow-up five years after surgery. A shift from initial satisfaction to unfulfillment of expectations was predicted by baseline body dissatisfaction, greater percentage of weight regain after initial weight loss, and more discomfort from somatic symptoms five years after surgery. In addition to symptom discomfort, worry about surgery predicted satisfaction with follow-up care. At five years, one-fifth of those initially satisfied reported that bariatric surgery had failed to meet their expectations. This suggests that outcome expectations related to weight loss, somatic symptoms, and body image need to be addressed both before and after bariatric surgery.

• Zelihić, Deniz; van Dalen, Marije; Kling, Johanna; Pripp, Are Hugo; Nordengren, Tine & Kvalem, Ingela Lundin [Show all 14 contributors for this article] (2022). Reducing social anxiety in adolescents distressed by a visible difference: Results from a randomised control trial of a web-based intervention. Body image. ISSN 1740-1445. 40, p. 295–309. doi: 10.1016/j.bodyim.2022.01.008. Show summary

  A visible difference to the face or body may challenge adolescents’ adjustment and engagement in life activities, where some require psychosocial support. However, evidence is limited for whether existing interventions for this adolescent group reduce social or appearance-related distress. We therefore conducted a parallel-group, randomised control trial to evaluate the effectiveness of Young Person’s Face IT, a self-guided web-based psychosocial intervention developed for adolescents with a visible difference who experience distress. Adolescents (N = 189, aged 11–18) from two countries (Norway and the Netherlands), were randomly allocated to an intervention group or care as usual (CAU). Outcomes were body esteem, social anxiety, perceived stigmatisation, and life disengagement. Compared with CAU, participants who completed Young Person’s Face IT showed reductions in social anxiety symptoms ( = 0.06). No significant improvements were found for the other outcomes. This study endorses web-based psychosocial support in reducing social anxiety in adolescents distressed by a visible difference. Future studies are needed to confirm the effectiveness of Young Person’s Face IT and to explore potential long-term effects.

• Kling, Johanna; Nordgreen, Tine; Kvalem, Ingela Lundin; Williamson, Heidi & Feragen, Kristin Judith Billaud (2021). Recruiting hard-to-engage groups to online psychosocial interventions: Experiences from an RCT study targeting adolescents with a visible difference (2021). . Contemporary Clinical Trials Communications. ISSN 2451-8654. 24, p. 1–7. doi: 10.1016/j.conctc.2021.100869.
• Træen, Bente; Fischer, Nantje & Kvalem, Ingela Lundin (2021). Sexual Variety in Norwegian Men and Women of Different Sexual Orientations and Ages. Journal of Sex Research. ISSN 0022-4499. 59(2), p. 238–247. doi: 10.1080/00224499.2021.1952156. Full text in Research Archive Show summary

  The purpose of the paper was to examine Norwegians’ incorporation of seven varied sexual acts. Data were obtained from a questionnaire survey of a probability-based web sample of 2,181 men and 1,967 women aged 18–89 years. Among seven acts of sexual variety, the most common sexual experiences were trying to watch pornography with a partner, engaging in sex in unusual places, and using sex toys. Older age was negatively associated with all acts of sexual variety. Regarding more unorthodox acts of sexual variety, heterosexual men’s sexual preferences involved having and desiring group sex, whereas heterosexual women’s sexual experiences and desires involved having sex in unusual places. Lesbian, gay, bisexual (LGB) individuals generally showed greater curiosity or experience of having group sex and engaging in BDSM (bondage, discipline, dominance and submission, and sadomasochism) activities than heterosexual adults. However, while LGB men had a high preference for group sex activities, LGB women had more positive attitudes towards BDSM activity. Individuals appear to accumulate more acts of sexual variety over time, thus making the incorporation of sexual variety a function of age. This study supports the idea that sexual variety has expanded among those born from 1960 onwards.

• Træen, Bente; Fischer, Nantje & Kvalem, Ingela Lundin (2021). Sexual intercourse activity and activities associated with sexual interaction in Norwegians of different sexual orientations and ages. Sexual and Relationship Therapy. ISSN 1468-1994. doi: 10.1080/14681994.2021.1912316. Full text in Research Archive
• Ivanova, Anna & Kvalem, Ingela Lundin (2021). Psychological predictors of intention and avoidance of attending organized mammography screening in Norway: applying the Extended Parallel Process Model. BMC Women's Health. ISSN 1472-6874. 21. doi: 10.1186/s12905-021-01201-y.
• Walø-Syversen, Gro; Kvalem, Ingela Lundin; Kristinsson, Jon Adalsteinn; Eribe, Inger; Rø, Øyvind & Brunborg, Cathrine [Show all 7 contributors for this article] (2021). Visual, verbal and everyday memory 2 years after bariatric surgery: Poorer memory performance at 1-year follow-up. . Frontiers in Psychology. ISSN 1664-1078. 11:607834, p. 1–10. doi: 10.3389/fpsyg.2020.607834. Full text in Research Archive Show summary

  Severe obesity has been associated with reduced performance on tests of verbal memory in bariatric surgery candidates. There is also some evidence that bariatric surgery leads to improved verbal memory, yet these findings need further elucidation. Little is known regarding postoperative memory changes in the visual domain and how patients subjectively experience their everyday memory after surgery. The aim of the current study was to repeat and extend prior findings on postoperative memory by investigating visual, verbal, and self-reported everyday memory following surgery, and to examine whether weight loss and somatic comorbidity predict memory performance. The study was a prospective, observational study in which participants (n = 48) underwent cognitive testing at baseline, 1 and 2 years after bariatric surgery. Repeated measures analyses of variance revealed significantly poorer visual and verbal memory performance at the 1-year follow-up, with performance subsequently returning to baseline levels after 2 years. Verbal learning and self-reported everyday memory did not show significant postoperative changes. Memory performance at 1 year was not significantly predicted by weight loss, changes in C-reactive protein levels or postoperative somatic comorbidity (Type 2 diabetes, sleep apnea, and hypertension). The study demonstrated poorer visual and verbal memory performance at 1-year follow-up that returned to baseline levels after 2 years. These findings are in contrast to most previous studies and require further replication, however, the results indicate that postoperative memory improvements following bariatric surgery are not universal. Findings suggest that treatment providers should also be aware of patients potentially having poorer memory at 1 year following surgery.

• Swami, Viren; Tran, Ulrich S; Barron, David; Afhami, Reza; Aime, Aine & Almenara, Carlos [Show all 83 contributors for this article] (2020). The Breast Size Satisfaction Survey (BSSS): Breast size dissatisfaction and its antecedents and outcomes in women from 40 nations. Body image. ISSN 1740-1445. 32, p. 199–217. doi: 10.1016/j.bodyim.2020.01.006.
• Walø-Syversen, Gro; Kvalem, Ingela Lundin; Kristinsson, Jon Adalsteinn; Eribe, Inger; Rø, Øyvind & Brunborg, Cathrine [Show all 7 contributors for this article] (2020). Preoperative inhibitory control predicts weight loss 1 year after bariatric surgery. European Eating Disorders Review. ISSN 1072-4133. 29(1), p. 123–132. doi: 10.1002/erv.2801.
• Schaller, Sidsel; Træen, Bente & Kvalem, Ingela Lundin (2020). Barriers and Facilitating Factors in Help-Seeking: A Qualitative Study on How Older Adults Experience Talking about Sexual Issues With Healthcare Personnel. International Journal of Sexual Health. ISSN 1931-7611. doi: 10.1080/19317611.2020.1745348.
• Kvalem, Ingela Lundin; Bårdstu, Silje Kvam; Bergh, Irmelin; Nordvik, Thomas; Sogg, Stephanie & Mala, Tom (2020). Associations between perceived somatic symptoms and mental health after Roux-en-Y gastric bypass: a 3-year prospective cohort study. Surgery for Obesity and Related Diseases. ISSN 1550-7289. p. 1–7. doi: 10.1016/j.soard.2019.12.018. Full text in Research Archive
• Kvalem, Ingela Lundin; Graham, Cynthia; Hald, Gert Martin; Carvalheira, Ana Alexandra; Janssen, Erick & Stulhofer, Aleksandar (2019). The role of body image in sexual satisfaction among partnered older adults: a population‐based study in four European countries. European Journal of Ageing. ISSN 1613-9372. doi: 10.1007/s10433-019-00542-w. Show summary

  Body image issues can affect all domains of sexual functioning. The aim of this study was to examine how, in a sociocultural context where physical and sexual attractiveness is equated with young and slim body ideals, appearance dissatisfaction and importance are related to sexual satisfaction in older adults in four European countries. A cross-sectional survey with probability samples of the population aged 60–75 years was used. Only respondents with a partner were included in this paper, and the countries included Norway (n = 957), Denmark (n = 846), Belgium (n = 612), and Portugal (n = 367). Sexual satisfaction, appearance dissatisfaction, and importance were assessed, and frequency of intercourse/kissing and cuddling, relationship satisfaction, age, and body mass index were all used as control variables. Belgian men scored significantly lower on sexual satisfaction, while there was no difference in sexual satisfaction in women. Appearance dissatisfaction was lower in Scandinavian women and men, and in Belgian men, and appearance salience was lower in Norwegian men and women, and in Portuguese women. Linear regression analysis revealed that, adjusting for confounders, appearance dissatisfaction was significantly related to sexual satisfaction in Scandinavian women and men, as well as in Belgian men. Compared to research on younger adults, appearance evaluation appeared to play an equally important role in sexual satisfaction in older adults in our study. The variation in appearance dissatisfaction in older adults across European countries is a novel finding that needs to be examined further.

• Carrard, Isabelle; Argyrides, Marios; Ioannou, Xaris; Kvalem, Ingela Lundin; Waldherr, Karin & Harcourt, Diana [Show all 7 contributors for this article] (2019). Associations between body dissatisfaction, importance of appearance, and aging anxiety with depression, and appearance-related behaviors in women in mid-life. Journal of Women & Aging. ISSN 0895-2841. p. 1–14. doi: 10.1080/08952841.2019.1681882. Full text in Research Archive
• Træen, Bente; Kvalem, Ingela Lundin; Hald, Gert Martin & Graham, Cynthia (2019). Extradyadic Activity in European Older Adults. Sexual and Relationship Therapy. ISSN 1468-1994. 37(1), p. 125–138. doi: 10.1080/14681994.2019.1685085.
• Syversen, Gro; Kvalem, Ingela Lundin; Kristinsson, Jon Adalsteinn; Eribe, Inger; Rø, Øyvind & Dahlgren, Anna Maria Camilla Lindvall (2019). Executive Function, Eating Behavior, and Preoperative Weight Loss in Bariatric Surgery Candidates: An Observational Study. Obesity Facts. ISSN 1662-4025. p. 1–13. doi: 10.1159/000502118. Full text in Research Archive
• Træen, Bente; Kvalem, Ingela Lundin & Ohnstad, Ingrid (2019). Experiences of Non-Consensual Sex in Older Adult Men and Women in Norway, Denmark, Belgium and Portugal. Sexuality & Culture. ISSN 1095-5143. 24, p. 113–139. doi: 10.1007/s12119-019-09630-6. Full text in Research Archive
• Træen, Bente; Carvalheira, Ana; Hald, Gert Martin; Lange, Theis & Kvalem, Ingela Lundin (2019). Attitudes Towards Sexuality in Older Men and Women Across Europe: Similarities, Differences, and Associations with Their Sex Lives. Sexuality & Culture. ISSN 1095-5143. 23(1), p. 1–25. doi: 10.1007/s12119-018-9564-9. Show summary

  The aim of the study was to explore attitudes towards sexuality and sexual behavior in older adults in Norway, Denmark, Belgium, and Portugal. A cross-sectional survey with representative samples of the population aged 60–75 years recruited through phone registers in Norway (676 men and 594 women), Denmark (530 men and 515 women), Belgium (318 men and 672 women), and Portugal (236 men and 273 women) was conducted. The data collection was carried out using an anonymous postal questionnaire. Four dimensions of attitudes towards sexuality were identified: ‘sex for love’, ‘sexual pressure in society’, ‘sex for well-being’, and ‘sexual changes and ageing’. Discriminant analyses identified three discriminant attitude functions: sex for well-being, sexual changes due to ageing, and sex for love. Portuguese men had positive attitudes towards sex as good for well-being in older adults but believed ageing was an obstacle to being sexual at this stage of life. Portuguese women believed sex was good for well-being and did not consider ageing an obstacle to sexual enjoyment. Norwegian men and Danish women believed changes in sexuality due to ageing were no obstacle to being sexual but did not believe that sex was good for well-being. The attitudes of Belgian and Danish men were largely inclined in the direction that sex is not particularly important for elderly people and that changes in sexuality occur due to the ageing process. Men and women were committed to the attitude of sex for love, although this was observed most in Belgian participants and least in Danish men. Positive attitudes towards sex for wellbeing and towards ageing and sexual changes correlated with less change in sexual interest and sexual enjoyment, and with increased frequency of intercourse and masturbation. To tailor successful sexual health interventions, attitudes of sexuality in older people should be addressed.

• Reas, Deborah; Dahlgren, Anna Maria Camilla Lindvall; wonderlich, joseph; Syversen, Gro & Kvalem, Ingela Lundin (2019). Confirmatory factor analysis and psychometric properties of the Norwegian version of the Repetitive Eating Questionnaire: Further evidence for two distinct subtypes of grazing behaviour. European Eating Disorders Review. ISSN 1072-4133. 27(2), p. 205–211. doi: 10.1002/erv.2631. Full text in Research Archive
• Træen, Bente; Carvalheira, Ana; Kvalem, Ingela Lundin & Hald, Gert Martin (2018). European Older Adults’ Use of the Internet and Social Networks for Love and Sex. Cyberpsychology : Journal of Psychosocial Research on Cyberspace. ISSN 1802-7962. 12(3). doi: 10.5817/CP2018-3-1. Show summary

  What is the prevalence of using the Internet for love and sexual activities among older adults across Europe, and what predicts such use? Data were collected in probability samples among populations aged 60–75 years in Norway (N = 1271), Denmark (N = 1045), Belgium (N = 991), and Portugal (N = 509) using postal questionnaires. A total of 36% of men and 15% of women reported having used the Internet for sex and love purposes, most often to watch pornography. The use of the Internet for various love and sex purposes was higher in participants who had a partner, who had masturbation activity and who were satisfied with their current level of sexual activity. Multivariate logistic regression analyses showed that use of the Internet to find committed partners, watch pornography, buy sex products or seek information or advice was lower in Portuguese men than men in Norway, Denmark, and Belgium. Tailored websites to promote both sexuality and how to preserve a committed relationship are likely to prove important for the aging population.

• Schaller, Sidsel; Træen, Bente; Kvalem, Ingela Lundin & Hinchliff, Sharron (2018). Linking the past and the present: constructing meaning from childhood emotional and sexual experiences towards present sexual well-being in older adults. Sexual and Relationship Therapy. ISSN 1468-1994. doi: 10.1080/14681994.2018.1539227.
• Kvalem, Ingela Lundin; Træen, Bente; Markovic, Aleksandra & von Soest, Tilmann (2018). Body Image Development and Sexual Satisfaction: A Prospective Study From Adolescence to Adulthood. Journal of Sex Research. ISSN 0022-4499. 56(6), p. 791–801. doi: 10.1080/00224499.2018.1518400. Full text in Research Archive Show summary

  The aim of the current study was to explore whether developmental trajectories of body satisfaction from adolescence to young adulthood predicted measures of sexual satisfaction in young adulthood, even when controlling for important covariates such as gender, weight development, relationship status, mental health, and frequency of sexual intercourse and masturbation. Data were collected from a population-based prospective cohort of Norwegian adolescents (n = 2,587) over a period of 13 years in four waves (1992, 1994, 1999, and 2005; mean age = 14.9 in 1992, 57.3% women). Latent growth curves were estimated for body satisfaction and Body Mass Index (BMI). Men reported higher sexual satisfaction, sexual activity, baseline body satisfaction, and BMI than women. The developmental trajectories revealed a slight increase in body satisfaction and BMI from adolescence to young adulthood in both genders. Moreover, structural equation models showed that baseline body satisfaction in both genders predicted sexual satisfaction as a young adult, independent of relationship status and frequency of sexual activity. Neither the development of BMI nor of body satisfaction predicted sexual satisfaction. The results elucidate the vital role of body satisfaction in sexual satisfaction in adults and the importance of addressing body dissatisfaction in childhood.

• von Soest, Tilmann; Torgersen, Leila & Kvalem, Ingela Lundin (2018). Mental health and psychosocial characteristics of breast augmentation patients. Journal of Health Psychology. ISSN 1359-1053. 25(9), p. 1270–1284. doi: 10.1177/1359105318754645. Full text in Research Archive
• Buer, Liliana; Anderssen, Norman; Malterud, Kirsti & Kvalem, Ingela Lundin (2017). Self-esteem Among Young Bisexual Women in Norway: A 13-year Longitudinal Study. Journal of Bisexuality. ISSN 1529-9716. 17(4), p. 487–507. doi: 10.1080/15299716.2017.1394245.
• Kvalem, Ingela Lundin; Bergh, Irmelin; Sogg, Stephanie & Mala, Tom (2017). Psychosocial characteristics associated with symptom perception one year after gastric bypass surgery – A prospective study. Surgery for Obesity and Related Diseases. ISSN 1550-7289. 13(11), p. 1908–1913. doi: 10.1016/j.soard.2017.06.008. Full text in Research Archive Show summary

  Background The experience of symptoms after bariatric surgery such as pain, dumping, and fatigue, may affect behavior, quality of life, and the need for health care consultations. Attention to and interpretation of symptoms are influenced by psychological and contextual factors. Prospective studies of psychological factors predicting physical symptom perception after bariatric surgery are scarce. Objectives To explore the association of preoperative negative affect, history of traumatic sexual and violent events, with frequency and intensity of self-reported symptoms, one year after Roux-en-Y gastric bypass (RYGB). Setting University hospital Methods Questionnaire data were collected before and one year after RYGB from 230 patients. Negative affect and stressful negative life events were measured preoperatively. The participants reported the number and degree of impact of various physical symptoms postoperatively. Results The most common symptoms reported to have a high impact on behavior were fatigue (32.8%), and dumping (28.4%). Reporting more symptoms was associated with preoperative anxiety (r = .22, p = .001), and number of stressful life events (r = .21, p = .002). Participants with a probable preoperative anxiety disorder reported higher impact of fatigue, pain, dumping, and diarrhea after surgery, while those with a probable mood disorder and history of traumatic events reported higher impact of dumping. Conclusion Preoperative anxiety symptoms and stressful experiences were associated with higher perceived impact of symptoms, such as dumping, fatigue, and pain after RYGB. Evaluation of psychological characteristics associated with symptom perception may be relevant during handling of symptoms not responsive to other treatment measures.

• Bergh, Irmelin; Kvalem, Ingela Lundin; Mala, Tom; Hansen, Bjørge Hermann & Sniehotta, Falko F. (2017). Predictors of physical activity after gastric bypass : a prospective study. Obesity Surgery. ISSN 0960-8923. 27(8), p. 2050–2057. doi: 10.1007/s11695-017-2593-x. Full text in Research Archive Show summary

  Background: Most patients do not meet the recommended level of physical activity after bariatric surgery, and psychological factors underlying postoperative physical activity remain poorly understood. This study aimed at identifying self-regulatory predictors of physical activity after bariatric surgery. Methods: Questionnaire data including self-regulation variables and the short-version of the International Physical Activity Questionnaire were obtained in a prospective cohort of 230 patients 1 year after Roux-en-Y gastric bypass. The study sample consisted of participants consenting to wear an ActiGraph GT3X+ accelerometer for seven consecutive days, 18–24 months after surgery (n = 120). Results: A total of 112 participants with complete self-report data provided valid accelerometer data. Mean age was 46.8 years (SD = 9.3), and 81.3% was women. Preoperative and postoperative BMI was 44.8 ± 5.5 and 30.6 ± 5.0 kg/m2, respectively. Total weight loss was 28.9% (SD = 7.5). By objective measures, 17.9% of the participants met the recommended level of moderate-to-vigorous-intensity of physical activity of ≥150 min/week, whereas 80.2% met the recommended level according to self-reported measures. Being single, higher education level, and greater self-regulation predicted objective physical activity in multivariate regression analysis. Greater self-regulation also predicted self-reported physical activity. Weight loss 1 year after surgery was not associated with self-reported or objectively measured physical activity. Conclusions: Despite large differences between accelerometer-based and subjective estimates of physical activity, the associations of self-regulatory factors and weight loss with postoperative physical activity did not vary depending on mode of measurement. Self-regulation predicted both objective and self-reported physical activity. Targeting patients’ self-regulatory ability may enhance physical activity after gastric bypass.

• Træen, Bente; Carvalheira, Ana; Kvalem, Ingela Lundin; Stulhofer, Aleksandar; Janssen, Erick & Graham, Cynthia [Show all 8 contributors for this article] (2017). Sexuality in Older Adults (65+)—An Overview of the Recent Literature, Part 2: Body Image and Sexual Satisfaction. International Journal of Sexual Health. ISSN 1931-7611. 29(1), p. 11–21. doi: 10.1080/19317611.2016.1227012.
• Træen, Bente; Hald, Gert Martin; Graham, Cynthia; Enzlin, Paul; Janssen, Erick & Kvalem, Ingela Lundin [Show all 8 contributors for this article] (2017). Sexuality in Older Adults (65+)?An Overview of the Literature, Part 1: Sexual Function and its Difficulties. International Journal of Sexual Health. ISSN 1931-7611. 29(1), p. 1–10. doi: 10.1080/19317611.2016.1224286.
• Feragen, Kristin Judith Billaud; Stock, Nicola Marie; Sharratt, Nicholas David & Kvalem, Ingela Lundin (2016). Self-perceptions of romantic appeal in adolescents with a cleft lip and/or palate. Body image. ISSN 1740-1445. 18, p. 143–152. doi: 10.1016/j.bodyim.2016.06.009. Show summary

  During adolescence, romantic relationships are a key developmental milestone. Coupled with the increasing salience of appearance and social acceptance, adolescents with an appearance-altering condition may feel particularly vulnerable when it comes to romantic relationships. This study aimed to explore the prevalence of romantic experiences among adolescents with a cleft lip and/or palate (CL/P), and to investigate how these experiences could be related to depressive symptoms and global self-worth. The study included 661 Norwegian adolescents with CL/P, who were compared to a large national sample. The prevalence of romantic relationships was lower among adolescents with CL/P compared to the reference group, although the overall impact on depressive symptoms and global self-worth appeared to be low. This study is one of few to explore the impact of a congenital visible condition on experiences of romantic relationships and provides preliminary insight into a significant, yet complex topic.

• Kvalem, Ingela Lundin; Bergh, Irmelin; von Soest, Tilmann; Rosenvinge, Jan H; Johnsen, Tina & Martinsen, Egil Wilhelm [Show all 8 contributors for this article] (2016). A comparison of behavioral and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity. BMC Obesity. ISSN 2052-9538. 3(6). doi: 10.1186/s40608-016-0084-6. Full text in Research Archive Show summary

  Background Little is known about the psychological prerequisites for weight loss maintenance after bariatric surgery. A first step in investigating whether existing knowledge of conservative weight loss treatment is applicable for lifestyle interventions postoperatively is to compare specific psychological characteristics at baseline. The aim of this study was to compare patients scheduled for bariatric surgery with patients receiving conservative treatment for morbid obesity on measures of behavioral and psychosocial characteristics considered predictors of their adoption of and adherence to long-term lifestyle recommendations. Methods Baseline clinical and questionnaire data from the prospective “Oslo Bariatric Surgery Study” were used to examine potential differences between bariatric surgery patients (n = 301) and patients receiving conservative weight loss treatment (n = 261). Results The surgical group was characterized by their younger age (43.8 vs. 46.2 years, p <0.01), higher percentage of women (79.1 vs. 70.1 %, p <0.05), and higher Body Mass Index (BMI; 45.0 vs. 41.9 kg/m2, p <0.001). A multiple logistic regression analysis, adjusting for group differences in BMI, gender, and age, showed that the surgical group had higher self-efficacy (Odds ratio; OR = 3.44, 95 % Confidence interval; CI 1.65, 7.14), more positive outcome expectations (OR = 1.53, 95 % CI 1.23, 1.89), and plans that were more explicit for changing their eating behaviors (OR = 1.80, 95 % CI 1.06, 1.93). The surgical patients were also less ready to change physical activity levels (OR = 0.59, 95 % CI 0.48, 0.73), had tried more types of unhealthy weight loss methods in the past (OR = 1.16, 95 % CI 1.01, 1.33), drank soda more frequently (OR = 1.24, 95 % CI 1.02, 1.50), had fewer binge eating episodes (OR = 0.38, 95 % CI 0.20, 0.71), and had more depressive symptoms (OR = 1.19, 95 % CI 1.09, 1.29). Conclusions Patients opting for bariatric surgery had more positive expectations of the treatment outcomes and stronger beliefs in their ability to achieve these outcomes. Those starting conservative treatment had stronger beliefs in readiness to change physical activity levels. Future studies should explore the effect of interventions for bariatric surgery patients, promoting postoperative physical activity and stress realistic outcome expectations. The potential effects of incorporating this knowledge in intervention strategies remain to be explored.

• Bergh, Irmelin; Kvalem, Ingela Lundin; Risstad, Hilde & Sniehotta, Falko F. (2016). Preoperative predictors of adherence to dietary and physical activity recommendations and weight loss one year after surgery. Surgery for Obesity and Related Diseases. ISSN 1550-7289. 12(4), p. 910–918. doi: 10.1016/j.soard.2015.11.009. Show summary

  ackground: Weight loss and weight loss maintenance vary considerably between patients after bariatric surgery. Postoperative weight gain has partially been explained by lack of adherence to postoperative dietary and physical activity recommendations. However, little is known about factors related to postoperative adherence. Objectives: The aim of this study was to examine psychological, behavioral, and demographic predictors of adherence to behavior recommendations and weight loss 1 year after bariatric surgery. Setting: Oslo University Hospital. Methods: In a prospective cohort study, 230 patients who underwent Roux-en-Y gastric bypass were recruited from Oslo University hospital from 2011 to 2013. They completed a comprehensive questionnaire before and 1 year after surgery. Weight was measured preoperatively, on the day of surgery, and 1-year postoperatively. Results: Mean body mass index was 44.9 kg/m 2 (standard deviation [SD] ¼ 6.0) preoperatively and 30.6 kg/m 2 (SD ¼ 5.2) 1 year after surgery. Patients lost on average 29.2 % (SD ¼ 8.2) of their initial weight. Predictors of dietary adherence were years with dieting experience, readiness to limit food intake, and night eating tendency. Preoperative physical activity and planning predicted postoperative physical activity whereas predictors of weight loss were higher frequency of snacking preoperatively, greater past weight loss, and lower age. Conclusion: Several preoperative psychological predictors were related to postoperative adherence to dietary and physical activity recommendations but were not associated with weight loss. Inter- ventions targeting psychological factors facilitating behavior change during the initial postoperative phase are recommended as this might improve long-term outcomes.

• von Soest, Tilmann; Wichstrøm, Lars & Kvalem, Ingela Lundin (2016). The development of global and domain-specific self-esteem from age 13 to 31. Journal of Personality and Social Psychology. ISSN 0022-3514. 110(4), p. 592–608. doi: 10.1037/pspp0000060. Full text in Research Archive
• Træen, Bente; Markovic, Aleksandra & Kvalem, Ingela Lundin (2016). Sexual satisfaction and body image: a cross-sectional study among Norwegian young adults. Sexual and Relationship Therapy. ISSN 1468-1994. 31(2), p. 123–137. doi: 10.1080/14681994.2015.1131815. Show summary

  Abstract Objective: To study the relationship between age, gender, body mass index (BMI), body image, and perceived intimacy with partner and sexual satisfaction in young Norwegian adults. Methods: A questionnaire survey was completed online by 27.2 % (n = 568) of a representative national web sample of 2,090 persons aged 18–29 years. Results: Women were more dissatisfied with their body than men and BMI increased with age. A negative body image correlated with BMI, particularly among women. There was no gender difference in reported sexual satisfaction and perceived intimacy with partner. The most important direct path leading to increased sexual satisfaction was from perceived intimacy with partner, followed by body image and age. By influencing body image, BMI and gender influenced sexual satisfaction indirectly. Being male increased the likelihood of having a positive body image, which in turn increased the likelihood of reporting being sexually satisfied. Additionally, a lower BMI increased the likelihood of being satisfied with one’s body, which in turn increased sexual satisfaction. Conclusion: Body image is clearly related to sexual satisfaction, particularly in women. However, body image is not associated with the perception of intimacy with one’s partner, which is the most important factor for feeling sexually satisfied.

• Kvalem, Ingela Lundin; Træen, Bente & Iantaffi, Alex (2016). Internet Pornography Use, Body Ideals, and Sexual Self-Esteem in Norwegian Gay and Bisexual Men. Journal of Homosexuality. ISSN 0091-8369. 63(4), p. 522–540. doi: 10.1080/00918369.2015.1083782.
• Hauge, Hilde; Kvalem, Ingela Lundin; Enders-Slegers, Marie-José; Berget, Bente & Braastad, Bjarne (2015). Persistence during tasks with horses in relation to social support, general self-efficacy and self-esteem in adolescents. Anthrozoos. ISSN 0892-7936. 28(2), p. 333–347. doi: 10.1080/08927936.2015.11435406. Show summary

  In young people, interactions with horses may contribute to the development of social skills and self-efficacy. Our aim was to identify relationships between psychological variables and young people’s experience of activities with horses. Participants in this study were 13–15-year-old adolescents (n = 25), given a 4-month intervention consisting of weekly sessions of stable work and horse-back riding. We investigated the relationship between psychological variables from survey data with video-recorded behavioral observations during tasks and contact with horses. From the behavioral data, we calculated the frequency per hour of “trying again” when met with a challenge, as a measure of participants’ persistence in horse-related tasks. The number of times per hour that that participant initiated contact with the horse was used as a measure of frequency of physical contact (petting). We examined correlations between the change from early to late stages of the intervention in trying again during horse-related tasks and for physical contact and three psychological variables measured prior to the intervention: perceived social support, self-esteem, and general self-efficacy. We detected an association between lower pretest levels of perceived social support and general self-efficacy, and an increase during the intervention in persistence of trying again when met with challenges during tasks with the horse. In a linear regression analysis, controlling for initial levels of persistence during horse-related tasks, self-esteem, and self-efficacy, social support was the only unique predictor of an increase in persistence during the intervention. No association was found between the psychological variables and change in frequency of petting the horse. The results indicate that adolescents with lower levels of perceived social support at the start of the intervention showed greater increases in their persistence in trying again after being met with challenges during horse-related tasks. Since persistence is a central aspect in the development of mastery of tasks, the possible positive social impact of the horse/stable environment should be given more attention in future intervention research. Keywords: adolescents, animal-assisted activities, animal-assisted interventions, equine-assisted activities, social support

• Brechan, Inge & Kvalem, Ingela Lundin (2015). Relationship between body dissatisfaction and disordered eating: Mediating role of self-esteem and depression. Eating Behaviors. ISSN 1471-0153. 17(1), p. 49–58. doi: 10.1016/j.eatbeh.2014.12.008. Show summary

  The purpose of this study was to investigate the hypothesis that the effect of body dissatisfaction on disordered eating behavior is mediated through self-esteem and depression. If the effect of body dissatisfaction on disordered eating can be explained by self-esteem and depression, treatment may benefit from focusing more on self-esteem and depression than body dissatisfaction. We also hypothesized body image importance to be associatedwith lower self-esteem, stronger symptomsof depression, andmore disordered eating. The results showed that the effect of body dissatisfaction on disorder eating was completely mediated, whereas the effect of body image importance was partly mediated. Both self-esteem and depression were significant mediators. Body image importance and self-esteem had a direct effect on restrained eating and compensatory behavior. Depression had a direct effect on binge eating. This effectwas significantly stronger amongwomen. Depression also had a direct effect on restrained eating. This effect was positive among women, but negative among men. The results support emotion regulation and cognitive behavioral theories of eating disorders, indicating that self-esteemand depression are the most proximal factors, whereas the effect of body dissatisfaction is indirect. The results point out the importance of distinguishing between different symptoms of bulimia. Depression may cause binge eating, but compensatory behavior depends on self-esteemand body image importance. The results suggest that women may turn to both binge eating and restrained eating to escape awareness of negative emotions, whereas men focus on eating to a lesser extent than women. Existing treatment focuses on eating behavior first and mechanisms such as self-esteem and depression second. The results from this study suggest that an earlier focus on self-esteem and depression may be warranted in the treatment of disordered eating.

• Bergh, Irmelin; Kvalem, Ingela Lundin; Risstad, Hilde; Cameron, Linda D. & Sniehotta, Falko F. (2015). Predictors of preoperative weight loss in morbidly obese adults waiting for bariatric surgery: A prospective cohort study. Obesity Surgery. ISSN 0960-8923. 25(9), p. 1610–1617. doi: 10.1007/s11695-015-1569-y.
• Feragen, Kristin Billaud; Stock, Nicola Marie & Kvalem, Ingela Lundin (2015). Risk and protective factors at age 16: Psychological adjustment in children with a cleft lip and/or palate. The Cleft Palate-Craniofacial Journal. ISSN 1055-6656. 52(5), p. 555–573. doi: 10.1597/14-063. Show summary

  Objective:  Explore psychological functioning in adolescents with a cleft at age 16 from a broad perspective, including cognitive, emotional, behavioral, appearance-related, and psychosocial adjustment. High-risk groups were identified within each area of adjustment to investigate whether vulnerable adolescents were found across domains or whether risk was limited to specific areas of adjustment. Methods:  Cross-sectional data based on psychological assessments at age 16 (N = 857). The effect of gender, cleft visibility, and the presence of an additional condition were investigated on all outcome variables. Results were compared with large national samples. Measures:  Hopkins Symptom Checklist, Harter Self-Perception Scale for Adolescents, Child Experience Questionnaire, and Satisfaction With Appearance scale. Results:  The main factor influencing psychological adjustment across domains was gender, with girls in general reporting more psychological problems, as seen in reference groups. The presence of an additional condition also negatively affected some of the measures. No support was found for cleft visibility as a risk factor except for dissatisfaction with appearance. Correlation analyses of risk groups seem to point to an association between social and emotional risk and between social risk and dissatisfaction with appearance. Associations between other domains were found to be weak. Conclusions:  The results point to areas of both risk and strength in adolescents born with a cleft lip and/or palate. Future research should investigate how protective factors could counteract potential risk in adolescents with a cleft.

• Strandbu, Åse & Kvalem, Ingela Lundin (2014). Body Talk and Body Ideals Among Adolescent Boys and Girls: A Mixed-Gender Focus Group Study. Youth & society. ISSN 0044-118X. 46(5), p. 623–641. doi: 10.1177/0044118X12445177. Show summary

  This study explores how body ideals are discussed among adolescent boys and girls in 5 mixed-gender focus groups (n = 37). The ways in which boys and girls talk about bodies differed clearly within the focus group conversations as well as in the everyday situations described in the interviews. The boys were more concrete in their description of ideal bodies in the focus groups but reported less engagement in everyday body talk. The study demonstrates that self-derogating “fat talk” is normative in the meaning “easy to fall into” but not normative in the meaning “approved of”: Fat talk is more or less required in some situations but not really appreciated. Both girls and boys agreed on this description of fat talk among girls. They also agreed that fat talk rarely occurred among boys. It was a general consensus that body issues are more sensitive and problematic for girls than for boys.

• Kvalem, Ingela Lundin; Træen, Bente; Lewin, Bo & Stulhofer, Aleksandar (2014). Self-perceived effects of Internet pornography use, genital appearance satisfaction and sexual self-esteem among Young Scandinavian adults. Cyberpsychology : Journal of Psychosocial Research on Cyberspace. ISSN 1802-7962. 8(4). doi: 10.5817/cp2014-4-4.
• Kvalem, Ingela Lundin; Træen, Bente; Lewin, Bo & Alexandar, Stulhofer (2014). Self-perceived effects of Internet pornography use, genital appearance satisfaction, and sexual self-esteem among young Scandinavian adults. Cyberpsychology : Journal of Psychosocial Research on Cyberspace. ISSN 1802-7962. 8(4). doi: 10.5817/CP2014-4-4. Show summary

  This study examined the associations among the frequency of viewing Internet pornography, beliefs about how realistically pornography portrays sex, self-perceived effects of one’s pornography use, genital appearance satisfaction, and sexual self-esteem in young adults. Online data were collected from four convenience samples of university students from Norway and Sweden, members of a queer youth organization, and readers of an erotic magazine. Because of cultural similarities and the comparable magnitude and patterns of the bivariate correlations among the samples on the study variables, they were pooled into a single sample (N = 1,274). The majority of men (81.1%) and a minority of women (18.1%) reported at least weekly use of Internet pornography on their personal computers, whereas using a mobile phone or tablet was less common. Most of the participants had sought mainstream pornographic content. Those with a stronger belief in pornographic realism were more likely to perceive the effect of pornography use positively. A hypothesized relationship between self-perceived positive effects of pornography use and a higher level of sexual self-esteem was found for men but not for women. This result was partially due to higher satisfaction with genital appearance among the men who mainly watched mainstream pornography. Genital appearance satisfaction was linked to higher sexual self-esteem for women, but it was not related to the self-perceived effect of pornography use. The results indicate that pornography may expand personal sexual scripts for both men and women, and may have a positive, although modest, influence on the sexual self-esteem of young male adults.

• Hauge, Hilde; Kvalem, Ingela Lundin; Berget, Bente; Enders-Slegers, Marie-José & Braastad, Bjarne Olai (2014). Equine-assisted activities and the impact on perceived social support, self-esteem and self-efficacy among adolescents – an intervention study. International Journal of Adolescence and Youth. ISSN 0267-3843. 19(1), p. 1–21. doi: 10.1080/02673843.2013.779587.
• Kvalem, Ingela Lundin & Strandbu, Åse (2013). Body Talk-Group Specific Talk? A Focus Group Study of Variations in Body Ideals and Body Talk among Norwegian Youth. Young - Nordic Journal of Youth Research. ISSN 1103-3088. 21(4), p. 327–346. doi: 10.1177/1103308813506147. Show summary

  The study investigates how body ideals are discussed and conceptualized among groups of Norwegian youth. Altogether 48 girls and 15 boys, most aged 17 years, took part in nine focus groups, in order to study subcultural body ideals. Major differences were found between east-end and west-end boys (representing socioeconomic differences), where the former were more concerned about being big. Even though the ideals were more or less the same across the groups, the ways of addressing, conceptualizing and discussing body ideals clearly differed between the groups. The analyses reveal that body talk within peer groups seems to contribute to define adequate levels of effort that should be put into reaching the dominating body ideal.

• Wichstrøm, Lars; Soest, Tilmann M von & Kvalem, Ingela Lundin (2013). Predictors of Growth and Decline in Leisure Time Physical Activity From Adolescence to Adulthood. Health Psychology. ISSN 0278-6133. 32(7), p. 775–784. doi: 10.1037/a0029465.
• Hauge, Hilde; Kvalem, Ingela Lundin; Pedersen, Ingeborg & Braastad, Bjarne Olai (2013). Equine-Assisted Activities for Adolescents: Ethogram-based behavioral analysis of persistence during horse-related tasks and communication patterns with the horse. Human-Animal Interaction Bulletin. ISSN 2333-522X. 1(2), p. 57–81. doi: 10.1037/e634302013-006. Show summary

  Earlier studies have indicated that learning to handle a horse through tasks and activities can lead to a feeling of mastery which may have an impact on self-efficacy. The aim of this study was to examine how adolescents conducted horse-related tasks presented to them in an intervention in a farm environment, and whether there was a change during the intervention in persistence on tasks with the horse. Furthermore, we wanted to examine the behavior of the adolescents towards the horse and the response from the horse. Each participant was given an intervention once a week for approximately 16 weeks consisting of tasks with the horse, riding, grooming, and stable work. The sample presented in this study consisted of 29 participants who were successfully video-recorded in the beginning and at the end of the intervention. Petting the horse was the most frequent way of initiating contact with the horse, and the distributions of contact behaviors were the same at both time spots. The response of the horse was mainly neutral or positive. When participants did not succeed at their first attempt when trying to solve a horse-related task or an exercise during riding, their subsequent behavior was recorded as either trying again or not trying again. Early in the intervention, these two options were chosen with about the same frequency, while at the end of the intervention trying again was chosen significantly more often than not trying again. This was operationalized as an increase in persistence when having difficulties in solving tasks with the horse. The increased persistence late in the intervention in retrying tasks may indicate that the adolescents developed a feeling of mastery, which is an important factor in development of self-efficacy.

• Soest, Tilmann M von; Kvalem, Ingela Lundin & Wichstrøm, Lars (2012). Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females. Psychological Medicine. ISSN 0033-2917. 42(3), p. 617–626. doi: 10.1017/S0033291711001267.
• von Soest, Tilmann; Kvalem, Ingela Lundin; Skolleborg, Knut Christian & Roald, Helge E (2011). Psychosocial changes after cosmetic surgery: A 5-Year follow-up study. Plastic and Reconstructive Surgery. ISSN 0032-1052. 128(3), p. 765–772. doi: 10.1097/PRS.0b013e31822213f0.
• Kvalem, Ingela Lundin; von Soest, Tilmann; Træen, Bente & Singsaas, Kjetil S (2011). Body evaluation and coital onset: A population-based longitudinal study. Body image. ISSN 1740-1445. 8(2), p. 110–118. doi: 10.1016/j.bodyim.2011.02.001.
• Bergh, Irmelin; Kvalem, Ingela Lundin; Aass, Nina Kathrine & Hjermstad, Marianne Jensen (2011). What does the answer mean? A qualitative study of how palliative cancer patients interpret and respond to the Edmonton Symptom Assessment System. Palliative Medicine. ISSN 0269-2163. 25(7), p. 716–724. doi: 10.1177/0269216310395985.
• Billaud Feragen, Kristin; Kvalem, Ingela Lundin; Borge, Anne Inger Helmen & Rumsey, Nichola (2010). Adolescents with and without a facial difference: The role of friendships and social acceptance in perceptions of appearance and emotional resilience. Body image. ISSN 1740-1445. 7(4), p. 271–279. doi: 10.1016/j.bodyim.2010.05.002.
• von Soest, Tilmann; Kvalem, Ingela Lundin; Skolleborg, Knut Chr. & Roald, Helge Einar (2009). Cosmetic surgery and the relationship between appearance satisfaction and extraversion: Testing a transactional model of personality. Journal of Research in Personality. ISSN 0092-6566. 43, p. 1017–1025. doi: 10.1016/j.jrp.2009.07.001. Show summary

  Few studies have tested potential explanatory mechanisms for the high stability of extraversion. In this study, the relationship between extraversion, appearance evaluation, and cosmetic surgery was investigated to examine such mechanisms. The ‘‘Big Five” personality traits were assessed in 155 female cosmetic surgery patients prior to and 6 months after surgery, as well as from a representative sample of 907 women. Patients showed higher extraversion scores prior to surgery than were found in the representative sample; further, extraversion scores increased after surgery, while the increase diminished when controlled for appearance evaluation. The results are in accordance with a transactional model, whereby extraverts engage in actions that reinforce extravert tendencies, which may account for the high stability of extraversion.

• Von soest, Tilmann; Kvalem, Ingela Lundin; Roald, Helge Einar & Skolleborg, Knut Chr. (2009). The effects of cosmetic surgery on body image, self-esteem, and psychological problems. Journal of Plastic, Reconstructive & Aesthetic Surgery. ISSN 1748-6815. 62(10), p. 1238–1244. doi: 10.1016/j.bjps.2007.12.093. Show summary

  Background: This study aims to investigate whether cosmetic surgery has an effect on an individual’s body image, general self-esteem, and psychological problems. Further tests were conducted to assess whether the extent of psychological problems before surgery influenced improvements in postoperative psychological outcomes. Methods: Questionnaire data from 155 female cosmetic surgery patients from a plastic surgery clinic were obtained before and approximately 6 months after surgery. The questionnaire consisted of measures on body image, self-esteem, and psychological problems. Pre- and postoperative values were compared. Pre- and postoperative measures were also compared with the data compiled from a representative sample of 838 Norwegian women, aged 22e55, with no cosmetic surgery experience. Results: No differences in psychological problems between the presurgery patient and comparison sampleswere found,whereas differences in body image and self-esteembetween the sample groups were reported in an earlier publication. Analyses further revealed an improvement in body image (satisfactionwith ownappearance) after surgery. A significant but rather small effect on self-esteem was also found, whereas the level of psychological problems did not change after surgery. Postoperative measures of appearance satisfaction, self-esteem, and psychological problems did not differ from values derived from thecomparison sample. Finally, fewpsychological problems before surgery predicted a greater improvement in appearance satisfaction and self-esteem after surgery. Conclusions: The study provides evidence of improvement in satisfaction with own appearance after cosmetic surgery, a variable that is thought to play a central role in understanding the psychology of cosmetic surgery patients. The study also points to the factors that surgeons should be aware of, particularly the role of psychological problems, which could inhibit the positive effects of cosmetic surgery.

• Kvalem, Ingela Lundin (2008). Fakta og myter om effekt av seksualundervisning i skolen. Tidsskrift for Norsk Psykologforening. ISSN 0332-6470. p. 743–747.
• Kvalem, Ingela Lundin (2007). Ungdom og kroppsbilde. In Kvalem, Ingela Lundin & Wichstrøm, Lars (Ed.), Ung i Norge – psykososiale utfordringer. Cappelen Damm Akademisk. ISSN 978-82-02-26288-4. p. 33–50.
• Kvalem, Ingela Lundin & Wichstrøm, Lars (2007). Utvikling i tenårene: pubertet, kognisjon, seksualitet, selvbilde og sosiale relasjoner. In Kvalem, Ingela Lundin & Wichstrøm, Lars (Ed.), Ung i Norge – psykososiale utfordringer. Cappelen Damm Akademisk. ISSN 978-82-02-26288-4. p. 17–32.
• Strandbu, Åse; Storvoll, Elisabet & Kvalem, Ingela Lundin (2007). Endringer fra 1992 til 2002 i selvrapportert slanking og problematiske spisemønster blant ungdom. Tidsskrift for Norsk Psykologforening. ISSN 0332-6470. 44(1), p. 4–10.
• Soest, Tilmann von; Kvalem, Ingela Lundin; Skolleborg, Knut Chr. & Roald, Helge Einar (2006). Psychosocial factors predicting the motivation to undergo cosmetic surgery. Plastic and Reconstructive Surgery. ISSN 0032-1052. 117(1), p. 51–62. Show summary

  Background. The present study investigates psychological factors expected to predict the motivation to undergo cosmetic surgery. It is hypothesized that body image, self-esteem, teasing history, acceptance of cosmetic surgery in the individual’s envi¬ronment and self-monitoring relate to cosmetic surgery motivation. Methods. Questionnaire data were obtained from 907 participants who responded to a survey distributed to a representative sample of Norwegian women aged 22 to 55. A second sample of 195 female pro¬spective cosmetic surgery patients was recruited from a plastic surgery clinic. Measures of the hypothesized predictor variables were obtained from both samples. Surgery motivation was operationalized in two different ways. First, the women in the first sample were asked to indicate if and they wished to undergo cosmetic surgery, such that women who wished to have surgery could be compared to those who did not. Second, prospective patients were compared to women from the first sample who indicated that they did not wish to have cosmetic surgery. Results. Analyses revealed all predictor variables but self-esteem to be related to either the wish or the decision to undergo surgery, or to both. Social acceptance of cosmetic surgery and body image showed to be the strongest predictors of cosmetic surgery motivation. Conclusion. The study gives new insights into psychological factors predicting cosmetic surgery motivation. Further, the influence of social factors on cosmetic surgery motivation is emphasized and it is suggested that these factors be included in future research designs.

• Kvalem, Ingela Lundin; Von soest, Tilmann; Roald, Helge Einar & Skolleborg, Knut Chr. (2006). The interplay of personality and negative comments about appearance in predicting body image. Body image. ISSN 1740-1445. 3, p. 263–273. doi: 10.1016/j.bodyim.2006.04.002.
• Von soest, Tilmann; Kvalem, Ingela Lundin; Roald, Helge Einar & Skolleborg, Knut Chr. (2004). Kosmetisk kirurgi blant norske kvinner. Tidsskrift for Den norske legeforening. ISSN 0029-2001.
• Hamilton, Linn; Berg, Anne Kullseng ; Træen, Bente & Kvalem, Ingela Lundin (2001). Self-reported frequency of feeling sexual desire among a representative sample of 18-49 year old men and women in Oslo, elucidated by epidemiological data. Scandinavian Journal of Sexology. ISSN 1398-2966. 4(1), p. 25–42. Show summary

  The purpose of the study was to describe and analyse the relationship between self-reported degree of sexual desire and selected social background factors, sexual experience and attitudes towards sexuality. In 1997, a random sample of 5000 persons (18-49 years) in Oslo was drawn from the population register to participate in a sexual behavior survey. Data collection was carried out by means of postal questionnaires. The response rate was 48%. More men than women reported that they felt sexual desire often. Self-reported degree of sexual desire was associated with gender, age, level of education, coital frequency, frequency of masturbation, erotic self-perception and attitudes towards sexuality. Pregnancy and breast-feeding were not associated with self-reported degree of sexual desire in this study. It is discussed how these results may be used in clinical treatment of patients with problems related to sexual desire.

• Kvalem, Ingela Lundin & Træen, Bente (2000). Self-Efficacy, Scripts of Love and Intention to use Condoms among Norwegian Adolescents. Journal of Youth and Adolescence. ISSN 0047-2891. 29(3), p. 337–353. Show summary

  The knowledge of how self-efficacy works within sexual scripts is limited. In the context of sexual script theory, this paper aims at focusing on the relationship between contraceptive self-efficacy and the intention to use condoms among Norwegian adolescents. The data is based on a stratified sample of 920 adolescents aged 16-20 years in a Norwegian county. Data were collected by means of questionnaires. Fifty-two percent of girls and 41.4% of the boys had had coital experience. Girls reported somewhat higher contraceptive self-efficacy than boys did. This gender difference was mostly represented by the girls' belief in their capability to prevent undesired sexual intercourse, and their capability to use contraception in a situation where they were very sexually aroused. There was a clear connection between the adolescents' actual use of condoms at the most recent occasion of sexual intercourse and their intention to do so the next time. Boys who were in love with their partner were more likely to perceive themselves as capable of communicating with their partner about contraception in the sexual context, which in turn increased their intention of using condoms the next time. This may reflect boys acting in accordance with their sexual script. The girls' intention to use condoms the next time was not influenced by their contraceptive self-efficacy to the same degree as the boy's intention was. Acting within their sexual script and using oral contraceptives had greater influence on the girl's contraceptive self-efficacy than using a condom did. This study points to the importance of anchoring health preventive messages in the social and sexual realities of adolescents by focusing on the positive sides of sexuality.

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• Kvalem, Ingela Lundin & Wichstrøm, Lars (2007). Ung i Norge – psykososiale utfordringer. Cappelen Damm Akademisk. ISBN 978-82-02-26288-4. 198 p.

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• van Dalen, Marije; Zelihic, Deniz; Kling, Johanna; Pripp, Are Hugo; Nordgreen, Tine & Kvalem, Ingela Lundin [Show all 14 contributors for this article] (2022). An online psychological intervention for adolescents with a visible difference: Acceptability, feasibility and effectiveness of YP Face IT. Show summary

  Background/Objective: Adolescents with a visible difference can experience challenging social situations, (e.g., people staring or making unwanted comments) and are at risk for mental health problems. Interventions for adolescents with a visible difference experiencing appearance-related distress are scarce and lack an evidence-base. Therefore, YP Face IT was developed. This psychosocial eHealth intervention combines social skills training and cognitive behavioural therapy to help adolescents cope with challenging social situations and difficult thoughts. Method: To assess acceptability and feasibility 15 Dutch adolescents aged 12-17 completed YP Face IT and participated in in-depth interviews. Responses were analysed using thematic analysis. To assess effectiveness 189 Dutch and Norwegian adolescents participated in a Randomised Controlled Trial and were randomly allocated to YP Face IT or Care As Usual (CAU). Outcomes were body esteem, social anxiety, perceived stigmatisation, and life disengagement. Outcomes were measured at baseline and direct follow-up. Results: Acceptability and feasibility: Most adolescents appreciated the intervention and all would recommend it to other adolescents with a visible difference experiencing appearance-related distress. Effectiveness: Compared to CAU, participants who completed YP Face IT showed reductions in social anxiety. No significant results were found for the other outcomes. Conclusions: Both studies show that YP Face IT is acceptable, feasible and effective for adolescents with a visible difference. Dutch adolescents endorsed YP Face IT and its components. International results show that YP Face IT reduces social anxiety. Future studies are needed to confirm the effectiveness of YP Face IT and to explore potential long-term effects.

• Nygård, Stine & Kvalem, Ingela Lundin (2021). De usynlige ofrene for nakenbildespredning. VG : Verdens gang. ISSN 0805-5203.
• Zelihić, Deniz; Williamson, Heidi; Nordgreen, Tine; Kvalem, Ingela Lundin & Feragen, Kristin Judith Billaud (2021). “I am afraid of making her feel worse”: A qualitative exploration of parents’ perceptions of talking with their adolescents about their visible condition .
• Ivanova, Anna & Kvalem, Ingela Lundin (2020). Påvirkningsfaktorer for mammografiscreening i Norge. En oversiktsrapport til Kreftregisteret.
• Feragen, Kristin Judith Billaud; Zelihic, Deniz; Nordgreen, Tine; Kvalem, Ingela Lundin & Williamson, Heidi (2019). Supporting adolescents who struggle with appearance-altering conditions: Evaluating an online psychosocial intervention (Ung Face IT).
• Nygård, Stine & Kvalem, Ingela Lundin (2018). Ikke si til ungdommen: «Ikke send nakenbilder» . Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116.
• Reas, Deborah; Johansen, Judita; Alshus, Ingvild; Mala, Tom & Kvalem, Ingela Lundin (2018). Stability and impact of pre- and post-operative binge-eating behavior on weight loss outcome at 1- and 3-years following bariatric surgery .
• Kvalem, Ingela Lundin; Carvalheira, Ana & Træen, Bente (2018). Healthy sexual aging: Body image and sexual satisfaction - A comparison across four European countries.
• Schaller, Sidsel; Træen, Bente & Kvalem, Ingela Lundin (2018). Barriers and facilitating elements in help seeking in Norwegian interviewees' accounts.
• Kvalem, Ingela Lundin; Bergh, Irmelin & Mala, Tom (2016). Family support for changing eating habits three years after bariatric surgery.
• Bergh, Irmelin; Kvalem, Ingela Lundin & Mala, Tom (2016). Psychological predictors of adherence to dietary recommendations after Roux-en-Y gastric bypass.
• Kvalem, Ingela Lundin; von Soest, Tilmann; Bergh, Irmelin & Mala, Tom (2016). Wanting body contouring after weight loss following obesity surgery – the role of body image before and after surgery.
• Bergh, Irmelin; Kvalem, Ingela Lundin; Risstad, Hilde & Sniehotta, Falko F. (2015). Perceived food triggers related to change in frequency of snacking one year after bariatric surgery. Surgery for Obesity and Related Diseases. ISSN 1550-7289.
• Bergh, Irmelin; Kvalem, Ingela Lundin; Risstad, Hilde & Sniehotta, Falko F. (2015). Perceived food triggers related to change in frequency of snacking one year after bariatric surgery.
• Kvalem, Ingela Lundin; Bergh, Irmelin; Risstad, Hilde & Mala, Tom (2015). A183 - Preoperative Psychosocial Factors Associated with Symptom Perception one Year after Bariatric Surgery.
• Hauge, Hilde; Braastad, Bjarne Olai; Kvalem, Ingela Lundin & Berget, Bente (2012). The effect of the horse on adolescents’ self-efficacy, self esteem and social skills- a four-year project with a cross-over design and control group.
• Bergh, Irmelin; Kvalem, Ingela Lundin; Aass, Nina Kathrine & Hjermstad, Marianne Jensen (2011). What does the answer mean? A qualitative study of how palliative cancer patients interpret and respond to the Edmonton Symptom Assessment System (ESAS). European Journal of Palliative Care. ISSN 1352-2779. p. 78–78.
• Hauge, Hilde; Kippenes, Jorid R.; Kvalem, Ingela Lundin; Berget, Bente & Braastad, Bjarne Olai (2011). Videoregistreringer av samspillet mellom ungdom og hest- etologiske metoder i et psykologisk perspektiv.
• Hauge, Hilde; Kippenes, Jorid R.; Kvalem, Ingela Lundin; Berget, Bente & Braastad, Bjarne Olai (2011). Videoregistreringer av samspillet mellom ungdom og hest - etologiske metoder i et psykologisk perspektiv. In Brodin, Janne Karin & Fog, Megumi Ohta (Ed.), Husdyrforsøksmøtet 2011. Universitetet for miljø- og biovitenskap. ISSN 978-82-7479-024-7. p. 216–219.
• Kvalem, Ingela Lundin & Von soest, Tilmann (2010). Body dissatisfaction and overweight - a longitudinal study.
• Kvalem, Ingela Lundin & Von soest, Tilmann (2008). The effect of media exposure on eating problems - a longitudinal study.
• Kvalem, Ingela Lundin & von Soest, Tilmann (2008). The effect of media exposure on adolescent body image - a longitudinal study.
• Isaksen, Kim & Kvalem, Ingela Lundin (2008). Body satisfaction among gay and straight men: Effects of femininity, masculinity, sexual orientation and same gender sexual experiences.
• Kvalem, Ingela Lundin (2006). Effekt av fedmeoperasjoner på kroppsbilde.
• von Soest, Tilmann; Kvalem, Ingela Lundin; Roald, Helge Einar & Skolleborg, Knut Chr. (2006). Changes in extroversion after cosmetic surgery.
• Kvalem, Ingela Lundin; Von soest, Tilmann; Skolleborg, Knut Chr. & Roald, Helge Einar (2006). Breast reduction and breast augmentation surgery – effect on body image.
• von Soest, Tilmann; Kvalem, Ingela Lundin; Roald, Helge Einar & Skolleborg, Knut Chr. (2005). Kosmetisk kirurgi - ut av kontroll? Dagbladet. ISSN 0805-3766.
• soest, Tilmann Von & Kvalem, Ingela Lundin (2003). Kosmetisk kirurgi i Norge: Omfang og karakteristika ved pasientene.
• Kvalem, Ingela Lundin; Soest, Tilmann Von; Skolleborg, Knut Chr. & Roald, Helge Einar (2003). Body image and self-esteem in Norwegian women. Show summary

  Objective The objective of this study is to investigate factors that affect the perception of physical appearance among Norwegian women. Attitude toward one�s own body can be divided in two parts: Body image orientation (cognitive/behavioral) is defined as how important one�s appearance is and Body image evaluation (affective) refers to the degree of satisfaction with own appearance (Cash, 1990). It is also hypothesized that evaluation of physical appearance will be closely connected to general self-esteem among women. Methods A random sample of n = 2,000 was drawn from all Norwegian women aged 22 to 55 years. The respondents received a questionnaire about cosmetic surgery, body image and several other psychological variables. Three subscales from the Multidimensional Body Self-Relations Questionnaire (Cash, 1990), containing body image orientation, body image evaluation and body area satisfaction were used in the analyses. Self-esteem was measured by using The Self-Esteem Scale (Rosenberg, 1965). Besides sociodemographic variables, the effect of BMI (Body Mass Index) and the degree of teasing about physical appearance as a child/teenager were used in the models. Results The response rate was 46 % (907 persons responded). Twenty-three percent had a negative body image evaluation. The respondents were most dissatisfied with their tummy and weight and most satisfied with their shoulders and hair. The body image evaluation got more positive with increased age and education, but there were no such differences in body image orientation. A linear multiple regression analysis was conducted with body image evaluation as the dependent variable. BMI and teasing were the most important predictors besides age and education. Body image orientation was not related to body image evaluation. In a final analysis self-esteem was introduced as the dependant variable. All the variables, except age, predicted self-esteem independently of body image evaluation, although the Beta�s were low. The best predictor was Body image evaluation (Beta= .49, p<.000). Discussion The results fit well to the stated hypothesis: Body image evaluation is closely connected to self-esteem. The thin body ideal in western society makes body weight an important factor in women�s evaluation in physical appearance and have a mediating effect on general self-esteem. Teasing about physical appearance in childhood and adolescence has a lasting effect on both the individuals� satisfaction with physical appearance and their general self-esteem. Women who views physical appearance as important can be both satisfied or dissatisfied with their appearance, explaining why these two domains are unrelated.

• Soest, Tilmann Von; Kvalem, Ingela Lundin; Roald, Helge Einar & Skolleborg, Knut Chr. (2003). Cosmetic surgery and perception of own appearance in Norwegian women. Show summary

  Introduction This study investigates the relation between Norwegian women�s perception of their appearance and their motivation to undergo cosmetic surgery. Perception of one�s appearance can be divided in two parts: Perceived importance of own appearance and satisfaction with own appearance. It has been suggested that women take cosmetic surgery only when they are dissatisfied with their body and when their appearance is important for them. There are relatively few studies that have investigated this relation, and these studies have methodological shortcomings that may have biased their results. Methods A random sample of n = 2,000 was drawn from all Norwegian women aged 22 to 55 years. The respondents received a questionnaire about cosmetic surgery and several psychological variables. This presentation focuses on the questions � Have you ever taken cosmetic surgery?� and �How much do you wish to undergo cosmetic surgery?� (from �not at all� to �very much�). In addition, two scales from the Multidimensional Body Self-Relations Questionnaire, which contain appearance importance and appearance satisfaction, are used in the analyses. Results The response rate was 46 % (907 persons responded). Sixty-nine persons (7,7 %) indicated that they had undergone one or more cosmetic operations, while 24 % (203) indicated that they had not taken any operation, but wished to undergo cosmetic surgery (from �little� to �very much�). A multiple logistic regression analysis revealed that appearance importance, but not appearance satisfaction, was statistically significantly related to whether persons had taken cosmetic surgery or not. In addition, a linear multiple regression analysis were conducted with surgery motivation as dependent variable. Both appearance importance and appearance satisfaction were statistically significant predictors of this variable. Discussion The results fit well to the stated hypothesis: Women who whish to take cosmetic surgery are more devoted to their appearance and less satisfied with appearance than average. That already operated persons do not differ in appearance satisfaction from average, may be explained by cosmetic surgery�s positive effect on appearance satisfaction.

• Kvalem, Ingela Lundin (2001). The effect of an intervention on the social environment among students at the basic psychology course at the University of Oslo. Show summary

  Social networks are an important part of social support, which in turn is a central factor in coping. By creating arenas for students to meet each other early in the new term and using smaller groups it was hoped to instigate larger and qualitative better social networks among students at PSY110. The 100 students who wanted to participate in the study filled out the pretest questionnaire before they were randomly assigned to the experiment group (38 (74 %) women and 13 (26 %) men) or the control group (44 (90 %) women and 5 (10 %) men). The students in the experiment group were offered different voluntary activities: a peer support group, outing to the student¿s cottage, writing exercise seminar with smaller groups and more hours and additional training in study technique and time planning (compared to the ordinary seminars). The students in the experiment group experienced more wellbeing with the social environment, established more close relationships and acquaintances among the students at basic psychology during the fall term than the control group had done. The also reported more perceived social support from their teachers and other students, but not from their family, compared to the control group. It is possible to change the social environment in a positive direction at the course in basic psychology by implementing activities that do not require the allocation of big economic and/or personnel resources.

• Olsen, Rune; Rosvold, Elin O.; Mogård, Rigmor; Kvalem, Ingela Lundin & Daae, Cecilie (2006). HELT-rapporten. Helse- og trivsel blant studenter ved Universitetet i Oslo. En spørreundersøkelse ved innføringen av Kvalitetsreformen ved UiO, 2003-2005. Studenthelsetjenesten ved Universitetet i Oslo.
• Albrecht, Hilje; Kvalem, Ingela Lundin & Ommundsen, Reidar (2004). "Brukerundersøkelsen" - Nyutdannede psykologers evaluering av profesjonsstudiet i Oslo. Del II. En analyse av åpne spørsmål. Universitetet i Oslo: Psykologisk institutt .
• Kvalem, Ingela Lundin (2002). Understanding and changing adolescent contraceptive behaviour. ISSN 82-569-2034-3. Show summary

  Det overordnede tema i avhandlingen er forståelse av ungdommens prevensjonsbruk og hvordan slik atferd kan påvirkes ved hjelp av skolebasert seksualundervisning. Et intervensjonsprogram med målsetting å hindre spredning av seksuelt overførte sykdommer og uønsket graviditet ble utviklet og testet ut på videregående skoler. Doktoranden beskriver seksualundervisning i et historisk perspektiv og hvordan HIV/AIDS-epidemien i midten av 80-tallet økte behovet av effektiv seksualundervisning samtidig som prevensjonsmetoder som kondom får en større rolle i de ulike strategier for ¿sikker sex¿ som utvikles. Forskningsfeltet som denne avhandlingen er skrevet innenfor har høy aktualitet både i Norden og internasjonalt. Avhandlingen viser effekten av et undervisningsopplegg på kondombruk. Ungdommer mellom 16 og 20 år på videregående skole deltok i studien og 124 klasser ble tilfeldig fordelt i 4 ulike grupper i et eksperimentelt oppsett. Ved hjelp av spørreskjema ble effekten av undervisningsopplegget som 30 klasser gjennomgikk undersøkt 6 og 12 måneder etterpå og sammenlignet med kontrollklassene. Resultatet viste at bare gruppen som hadde deltatt både på pretest og undervisningsopplegget hadde en signifikant økning i kondombruk etter et halvt år. Effekten var størst blant de ungdommene med få seksualpartnere. Avhandlingen tar også for seg ulike faktorer som har sammenheng med samleie og prevensjonsbruk. For eksempel er det en sammenheng mellom ungdommenes opplevelse av å mestre selve situasjonen og økt prevensjonsbruk. De vanligste motivene for å ha samleie var forelskelse, nysgjerrighet/spenning og seksuell opphisselse. .Det å være forelsket ga guttene en opplevelse av å være kompetente når det gjaldt å kommunisere om prevensjon i den seksuelle situasjonen, som i sin tur økte intensjonen om å bruke kondom neste gang. Hver femte ungdom hadde erfaring av samleie under alkoholpåvirkning. Av disse var det færre som hadde brukt kondom sammenlignet med de som ikke hadde vært påvirket av alkohol. Avhandlingen understreker betydningen av å forankre forebyggende informasjon i ungdommenes egen sosiale og seksuelle virkelighet og av å fokusere på seksualitetens positive sider.

• Kvalem, Ingela Lundin (2001). Effekten av tiltak på studieforhold og det sosiale miljøet på psykologi grunnfag. Universitetet i Oslo.

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