Problem gambling in psychotic disorders: A systematic review and meta-analysis of prevalence.

INTRODUCTION: Problem gambling (PBG) is more common in people with mental health disorders, including substance use, bipolar, and personality disorders, than in the general population. Although individuals with psychotic disorders might be expected to be more vulnerable to PBG, fewer studies have focused on this comorbidity. The aim of this review was to estimate the prevalence of PBG in people with psychotic disorders. METHODS: Medline (Ovid), EMBASE, PsycINFO (Ovid), CINAHL, CENTRAL, Web of science, and ProQuest were searched on November 1, 2023, without language restrictions. Observational and experimental studies including individuals with psychotic disorders and reporting the prevalence of PBG were included. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal for systematic reviews of prevalence data. The pooled prevalence of PBG was calculated using a fixed effects generalized linear mixed model and presented through forest plots. RESULTS: Of 1271 records screened, 12 studies (n = 3443) were included. The overall prevalence of PBG was 8.7% (95% CI = 7.8%-9.7%, I2 = 69%). A lower prevalence was found in studies with a low risk of bias (5.6%; 95% CI = 4.4%-7.0%) compared with studies with a moderate risk of bias (10.4%; 95% CI = 9.2%-11.7%). Different methods used to assess PBG also contributed to the heterogeneity found. CONCLUSION: This meta-analysis found substantial heterogeneity, partly due to the risk of bias of the included studies and a lack of uniformity in PBG assessment. Although more research is needed to identify those at increased risk for PBG, its relatively high prevalence warrants routine screening for gambling in clinical practice.

Problem gambling among people with first-episode psychosis: protocol for a prospective multicenter cohort study.

BACKGROUND: The limited available data suggest that the prevalence of problem gambling is increased among young adults with first-episode psychosis, possibly due in part to several risk factors for problem gambling that are common in this population. Aripiprazole, a widely used antipsychotic drug, has also been linked to cases of problem gambling, but causality remains uncertain. Although the consequences of problem gambling further hinder the recovery of people with first-episode psychosis, there is a paucity of research about this comorbidity and its risk factors. Additionally, to our knowledge, no screening instrument for problem gambling tailored to these individuals exists, contributing to its under-recognition. Further, treatment approaches for problem gambling adapted to this population are at an embryonic stage, while existing treatments effectiveness remains to be documented. Using an innovative screening and assessment procedure for problem gambling, this study aims to identify risk factors for problem gambling among people with first-episode psychosis and to document the effectiveness of standard treatment approaches. METHODS: This is a multicenter prospective cohort study conducted in two first-episode psychosis clinics, including all patients admitted between November 1st, 2019, and November 1st, 2023, followed for up to 3 years until May 1st, 2024. These 2 clinics admit approximately 200 patients annually, for an expected sample size of 800 individuals. The primary outcome is the occurrence of a DSM-5 diagnosis of gambling disorder. All patients are screened and evaluated for problem gambling using a systematic procedure at admission, and every 6 months thereafter. Socio-demographic and clinical variables are prospectively extracted from the patients' medical records. The nature and effectiveness of treatments for problem gambling offered to affected individuals are also documented from medical records. Survival analyses with Cox regression models will be used to identify potential risk factors for problem gambling. Descriptive statistics will document the effectiveness of treatments for problem gambling in this population. DISCUSSION: A better understanding of potential risk factors for problem gambling among people with first-episode psychosis will allow for better prevention and detection of this neglected comorbidity. Results of this study will also hopefully raise clinicians' and researchers' awareness and serve as the basis to adapted treatments that will better support recovery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05686772. Retrospectively registered, 9 January 2023.

Gaming Disorder and Psychotic Disorders: A Scoping Review.

BACKGROUND: There is a growing interest in understanding the impact of video games in the clinical field, given that their excessive use could be associated with health issues. Particularly, gaming disorder (GD) is considered as an addictive behavioral disorder. Clinicians widely recognize the comorbidity of gaming and psychotic disorders (PDs). Furthermore, association between addictive (i.e., substance use disorders) and PDs are well recognized by clinicians. It seems of high interest to explore GD among people with PDs. To this day, little is known about the consequences of GD in vulnerable populations. OBJECTIVES: The aim of this scoping review was to summarize the available research on the comorbidity between GD and PD and to identify the knowledge gaps in this field. METHODS: We used Levac's six-stage methodology for scoping review. Two-hundred and forty-two articles from seven databases were identified. Eight articles respected our inclusion and exclusion criteria. RESULTS: No available study has assessed the prevalence or incidence of GD among patients with PDs. The cases reported highlight the possibility that excessive video gameplay or abrupt gaming disruption could trigger psychosis in some patients. CONCLUSION: The results highlight a significant lack of knowledge concerning PDs associated with GD as only a few reported cases and one empirical study exposed the potential association between those conditions.

Facteurs influençant l'apport alimentaire en rations des soldats canadiens dans l'Arctique : un sondage national.

Purpose: To document Canadian Armed Forces (CAF) soldiers' perceptions of factors influencing their dietary intake of combat rations during Arctic field training.Methods: A bilingual digital questionnaire was sent nationally to soldiers who trained in the Arctic between 2015 and 2018. It consisted of 6 open-ended and 33 closed-ended questions on factors influencing ration intake and acceptability.Results: Of the 54 completed questionnaires (response rate: 31%), 6 were incomplete and were excluded. The final sample consisted of 48 military personnel from nine provinces with an average of 12.1 ± 6.8 years of CAF experience. Factors with the greatest negative impact on dietary intake were food temperature, eating on the move, exercise and activity schedules, and equipment needed for preparation and eating. Participants reported consuming between 61% and 71% of their rations. They noted that a considerable amount of time was required to prepare the rations since they were frozen. Sixty-five percent of soldiers reported weight loss while training in the Arctic.Conclusions: Multiple factors influenced soldiers' dietary intake and practices. These results will guide future research and assist in decision-making regarding possible changes to Arctic rations.

Objectif. Documenter la perception des soldats des Forces armées canadiennes (FAC) quant aux facteurs influençant leur apport alimentaire en rations de combat durant leur travail en Arctique.Méthodes. Un questionnaire bilingue électronique a été envoyé nationalement à des soldats s'étant entraînés dans l'Arctique entre 2015 et 2018. Il comportait 6 questions ouvertes et 33 fermées sur les facteurs influençant l'apport alimentaire et l'acceptabilité des rations.Résultats. Parmi les 54 questionnaires remplis (taux de réponse : 31 %), 6 étaient incomplets et ont été exclus. L'échantillon final était composé de 48 militaires de neuf provinces ayant en moyenne 12,1 ± 6,8 années d'expérience dans les FAC. Les facteurs ayant le plus d'effets négatifs sur l'apport alimentaire étaient la température des aliments, le fait de manger en se déplaçant, l'horaire des exercices et activités, ainsi que l'équipement nécessaire à la préparation et à la consommation. Les participants ont déclaré avoir consommé entre 61 et 71 % des rations. Ils ont noté qu'un temps considérable était nécessaire pour préparer les rations puisqu'elles étaient congelées. Soixante-cinq pour cent des soldats ont rapporté une perte de poids durant leur travail dans l'Arctique.Conclusions. Une multitude de facteurs a influencé l'apport et les pratiques alimentaires des soldats. Ces résultats guideront les recherches futures et aideront à la prise de décisions concernant de possibles changements aux rations en Arctique.

Weight Communication: How Do Health Professionals Communicate about Weight with Their Patients in Primary Care Settings?

This study aimed to investigate how health professionals (HPs) communicate about weight with their patients. Semi-structured interviews were conducted with 33 health professionals (7 family physicians, 13 nurse practitioners, and 13 dietitians) working in multidisciplinary healthcare settings in Canada. Thematic analysis revealed four main approaches used by HPs to communicate about weight: 1) Analyzing patient perspectives, 2) focusing on overall health rather than weight, 3) directly addressing the topic, and 4) avoiding the topic. The approach chosen was influenced by HPs' outlook on obesity; for example, those who believed obesity to be a chronic disease did not hesitate to communicate about weight. However, some HPs who reported having obesity mentioned avoiding the topic of weight with their patients and emphasized the importance of establishing a trusting relationship with patients before addressing the topic. The approach chosen by HPs also seemed to be influenced by patient receptiveness, level of readiness, and motivation. Weight communication can be sensitive and the approach used to begin the topic of weight may differ based on patient- and HP factors. Future clinical practice guidelines may benefit from shifting toward communicating about modifiable risk factors rather than weight.

Dietetic Students' Perceptions of Learning Professional Competencies with Four Simulations Throughout a Semester.

In nursing and medicine, taking part in simulation activities has been shown to be beneficial for students' learning; however, little has been documented in dietetics. This study aimed to document the perceived effect of 4 simulations on development of professional competencies by dietetic students. A mixed-method convergent approach was used with pre- and post-questionnaires, interviews, and a focus group discussion to look at dietetic students' perceptions of learning as part of a Nutrition Assessment course. Nonparametric tests for questionnaires and theme analysis for transcripts were used to examine data. After analysis, data were compared and merged for interpretation. Results showed that participants perceived a significant increase in comprehension of various competencies with simulations. In interviews and a focus group, a participant subgroup (n = 7) perceived an enriched understanding of some dietetic competencies compared with pre-simulations. Simulations seemed to have transformed classroom concepts to a more practical understanding of dietetic practice. More studies are needed to identify if these results could be replicated in different settings. Simulations had a positive effect on students' perception of competencies development and may be an andragogical tool of choice to support preparing future dietitians for entry to practice.

Changes in Adolescents' Dietary Intake Following the Initiation of an 8-Week Exercise Program.

Purpose: To assess changes in dietary intake of adolescents following an 8-week aerobic exercise program.Methods: Twenty-six adolescents (14-18 years) participated in an 8-week aerobic exercise program on cycle ergometer at their high school in Quebec, Canada. Twenty-four hour recalls were collected pre- and post-intervention. A two-way repeated measures ANOVA and paired sample t-tests were used to assess differences in energy and dietary intake parameters (food quantity, diet quality, eating patterns) between pre- and postintervention.Results: A decrease in total daily energy intake (-287.8 kcal, P = 0.007), in meal size at lunch (-110.1 g, P = 0.02) and dinner (-143.7 g, P = 0.03), in food density at breakfast (-1.8 kcal/g, P = 0.04), in daily carbohydrate intake (-56.1 g, P = 0.005), and in percentage of energy intake consumed at school (-5.1%, P = 0.04) were observed following initiation of an aerobic exercise program. No change in healthy eating index scores or percentage of energy from processed foods was observed.Conclusions: Changes in energy intake, food quantity, and eating pattern but not diet quality (Healthy Eating Index or food processing scores) were observed following the initiation of an aerobic exercise program. Nutrition interventions may be needed, in addition to an exercise program, to target diet quality and promote healthy eating habits in adolescents.

Maternal perceptions and concerns about children's weight status and diet quality: a study among Black immigrant families.

OBJECTIVE: To identify factors influencing Black immigrant mothers' perceptions and concerns about child weight and to compare children's diet quality according to these perceptions and concerns. DESIGN: Mothers' perceptions and concerns about child weight were assessed with sex-specific figure rating scales and the Child Feeding Questionnaire, respectively. Participants' weights and heights were measured and characterised using WHO references. Children's dietary intakes were estimated using a 24-h dietary recall. Children's diet quality was evaluated using the relative proportion of their energy intake provided by ultra-processed products, which were identified with the NOVA classification. χ2 tests, multivariate logistic regressions and t tests were performed. SETTING: Ottawa, Ontario, Canada. PARTICIPANTS: Black immigrant mothers of Sub-Saharan African and Caribbean origin (n 186) and their 6-12-year-old children. RESULTS: Among mothers, 32·4 % perceived their child as having overweight while 48·4 % expressed concerns about child weight. Girls and children with overweight or obesity were significantly more likely to be perceived as having overweight by their mothers than boys and normal-weight children, respectively. Mothers of children living with obesity, but not overweight, were significantly more likely to be concerned about their child's weight than mothers of normal-weight children. Children's diet quality did not differ according to mothers' perceptions and concerns. CONCLUSIONS: Children's gender and weight status were major determinants of perceptions and concerns about child weight among Black immigrant mothers. Including knowledge about mothers' perceptions and concerns about child weight will help nutrition professionals develop interventions tailored to specific family needs within the context of their cultural backgrounds.

Factors associated with feeding practices of black immigrant mothers of African and Caribbean origin living in Ottawa, Canada.

In Canada, Black immigrant women and their children are at higher risk of developing obesity. Factors that could influence children's weight status include parental feeding practices. Feeding practices such as monitoring, restriction and pressure to eat, are well studied among non-Hispanic White and Latinos groups, however, little is known about the feeding practices of Black immigrant parents of African and Caribbean origin. The aim of this study was to identify factors associated with feeding practices of Black immigrant mothers in Ottawa, Canada. The sample includes 188 Black mothers of African and Caribbean origin and their 6-12-year-old children. The Child Feeding Questionnaire was used to assess mothers' feeding practices. Demographic and socioeconomic data were collected using questionnaires. All participants' weight status was determined from measured weight and height. Pearson Chi-square tests and multivariate logistic regressions were performed. Results showed that mothers who felt responsible for feeding their children were more likely to monitor their children's food intake (p < 0.05). While mothers of children with underweight or normal weight were more like to use pressure to eat (p < 0.01), mothers of children with overweight or obesity were more like to use restriction (P < 0.05). Recent immigrant mothers were also more likely to use pressure to eat (P < 0.05). This study also provides evidence for associations between maternal feeding practices and mothers' weight status, household income and food security status. Findings build on previous research suggesting that parental feeding practices vary based on parents' and children's characteristics. Longitudinal studies are needed to assess the directionality of the association between mothers' feeding practices, and children's weight, diet quality and health in this population.

Problem Gambling Associated With Aripiprazole in First-Episode Psychosis Patients: A Series of 6 Case Reports.

BACKGROUND: Aripiprazole (ARI), an antipsychotic drug used to treat various mental health disorders, has recently been associated with the emergence of problem gambling (PBG). However, few cases have been reported in the schizophrenia-related psychotic disorders population, and even fewer provided sufficient details to systematically assess the causality of the association. METHODS: This article describes 6 cases with first-episode psychosis in whom PBG emerged while on ARI. Detailed information was gathered from clinical staff and patients' families to systematically assess the causal link between ARI and the emergence of PBG using the Naranjo and Liverpool Adverse Drug Reaction scales. FINDINGS: Five of these cases were previously diagnosed with a substance use disorder and/or cluster B personality traits. Five had received a more potent dopaminergic antagonist treatment before being switched to ARI. Two of them had presented PBG before being diagnosed with a psychotic disorder. The level of certainty about the causal role of ARI varied from possible to certain, and in 4 cases, the 2 scales yielded different ratings. IMPLICATIONS: Although these cases suggest that ARI may be associated with the emergence of PBG in the early course of schizophrenia-related psychotic disorders, they cannot prove the causality or the strength of this association. They provide the impetus to perform adequately powered and well-controlled prospective studies to draw more definite conclusion about the causality of this association and, in the meantime, further emphasize the need to carefully assess PBG in this population.

Are pre-pregnancy weight fluctuations and adherence to prenatal nutrition and exercise recommendations related to excessive gestational weight gain?

Women who have an overweight or obese pre-pregnancy body mass index (BMI) may be recommended to lose weight before pregnancy, however the association of preconception weight fluctuations and prenatal adherence to nutrition and exercise recommendations with gestational weight gain (GWG) have not been assessed. One hundred women with a pre-pregnancy BMI ≥ 25.0 kg/m2 who participated in the Nutrition and Exercise Lifestyle Intervention Program (NELIP) were included and stratified as gained weight excessively (n = 47) or not (n = 53) using the 2009 Institute of Medicine GWG guidelines. Participants completed a Weight Health History Questionnaire providing information about weight loss prior to the index pregnancy. Adherence was scored based on meeting six nutrition and exercise goals for the NELIP (/6). More women who gained excessively reported that they had actively tried to lose weight a year before the current pregnancy (61%) than women who did not gain excessively (39%; p = 0.02). Of the women attempting preconception weight loss, those who gained excessively lost more weight (6.7 ± 10.2 kg) than women who did not (2.1 ± 3.8 kg; p = 0.003). Adherence to the NELIP was lower among women who gained excessively (3.3 ± 0.8; 55%) than those who did not (4.4 ± 0.9;73%; p < 0.001). Program adherence (p < 0.001) was related to excessive GWG.

Ability to Discriminate Online Poker Tilt Episodes: A New Way to Prevent Excessive Gambling?

Tilt is a very common term in online poker players' vocabulary, it describes a state where the player is no longer able to make rational decisions because they are overwhelmed by strong emotions. This study aims to explore the relation existing between the frequency of Tilt episodes, the player's perception of these episodes and excessive gambling in online poker. The sample is composed of 291 adult French-speaking online poker players. All participants completed an online self-assessment questionnaire. The results of the classification analysis showed that the sample could be divided into three groups. The first group, named ''players in control'' included low excessive gambling tendencies with low perceived and measured Tilt frequencies. The two other groups showed high measured tilt levels, with perceived tilt levels that were different from the measured levels. Furthermore, these two groups present a moderate usage risk of developing an excessive gambling tendency in a money-based game of chance. These results show the existence of a relation between the player's capacity to perceive tilt and the online poker player's behavior.

Gambling Phenotypes in Older Adults.

Participation in gambling is rising in older adults. Indeed, in the coming years, engagement in gambling as a social activity is expected to increase more sharply in the elderly than in any other age group. Due to their exposure to powerful age-specific risk factors such as isolation, inactivity and failing health, older people are highly vulnerable to gambling-related problems. This study aimed to explore the existence of empirical clusters related to gambling habits in a sample of elderly participants from the general population. The sample included n = 361 participants, age range 50-90 years (mean 73.8, SD 8.4). Empirical clusters were identified through a two-step clustering analysis based on a broad set of indicators, including sociodemographic features, psychopathological state, substance use, life events, gambling preferences and scores on screening measures of gambling severity. The prevalence of GD in the study was 1.4%. Two clusters were identified: (a) cluster 1 (labeled as "low risk of gambling problems", n = 265, 73.4%), which included the higher proportion of non-gamblers or individuals who engage only in non-strategic gambling, women, widowed, and lower levels of education (no individual into this group met criteria for GD); and (b) cluster 2 (labeled as "higher risk of gambling problems", n = 96, 26.6%), which included the higher proportion of men, who reported both non-strategic and strategic gambling preferences (all participants diagnosed of GD were grouped into this cluster), older age, longer history of gambling, higher gambling severity, higher use of substances and worse psychopathological state. The elderly constitute a heterogeneous group with regard to gambling phenotypes. The results of this study may prove particularly useful for developing reliable screening tools able to identify older patients at a high risk of gambling problems, and for designing effective prevention and intervention programs.

[Apprentissage par simulation : activité novatrice de formation interprofessionnelle sur la gestion de la dysphagie].

Interprofessional patient simulations are an emerging pedagogical approach that is increasingly being used in the education of health professionals. Although the benefits of patient simulations have been widely documented in the fields of medicine and nursing, few studies have explored the potential of this approach in educating future dietitians. This article describes 4 patient simulations, including 2 interprofessional simulations, focused on the management of dysphagia, which were carried out as part of an Honours Bachelor in Nutrition Sciences program and discusses the potential merits of this teaching method in educating future dietitians.

Les simulations interprofessionnelles sont une approche pédagogique émergente de plus en plus utilisée dans la formation des professionnels de la santé. Bien que les avantages des simulations soient documentés exhaustivement dans le domaine de la médecine et des sciences infirmières, peu d'études ont exploré le potentiel de cette approche dans la formation des futurs diététistes. Cet article décrit quatre simulations, dont deux interprofessionnelles, axées sur la gestion des soins de la dysphagie qui ont été réalisées dans le cadre d'un programme de baccalauréat spécialisé en sciences de la nutrition et discute les mérites potentiels de cette approche pédagogique dans la formation des futurs diététistes.

Dietitians' Perspectives on the Impact of Multidisciplinary Teams and Electronic Medical Records on Dietetic Practice for Weight Management.

Purpose: To understand the perception of dietitians regarding the effects of multidisciplinary settings and Electronic Health Records (EHRs) on their dietetic practice for weight management. Methods: Individual semi-structured interviews were conducted with 14 dietitians working in multidisciplinary settings in Ontario. All interviews were audio recorded and transcribed verbatim. Two researchers coded the data independently using a thematic analysis approach. All themes emerged inductively and were refined iteratively. Results: Most dietitians believed that working in a multidisciplinary setting allowed for interprofessional collaboration and time-effective referrals. Multidisciplinary clinics were perceived to improve patient care due to convenient scheduling, consistent messaging, and ongoing support. However, some dietitians reported instances of conflicting approaches and beliefs regarding weight management across health professionals. Dietitians suggested ways to address these conflicting approaches through clinical meetings and education. EHRs were perceived to allow for collaboration through facilitated communication and knowledge exchange; however, lack of interoperability between EHR platforms across different types of health care settings was perceived to be a barrier for optimal care. Conclusions: Overall, multidisciplinary settings were perceived to positively impact dietitians' practices for weight management as they allow for interprofessional collaboration. Consistency in health messaging across health professionals should be emphasized through knowledge exchange.

Participant Evaluation of a Prediabetes Intervention Program Designed for Rural Adults.

The type 2 diabetes epidemic is a global crisis threatening the health and economies of many nations. This study aimed to evaluate a prediabetes intervention program designed for rural adults in southwestern Ontario based on the feedback of participants. Rural adults with prediabetes were referred by physicians to an intervention program developed to assist with unique barriers rural adults face related to the built environment and socioeconomic status when adopting a healthy lifestyle. After 6 monthly education sessions offered by a dietitian and a nurse, participants completed a questionnaire to share their program experience. In addition, 6 focus groups consisting of 5-9 participants were conducted to assess program acceptability, feasibility, and practicality. Of 49 enrolled, 35 participants aged 60.8 ± 7.1 (mean ± SD) evaluated the program. Participants reported finding the program to be acceptable, feasible, and practical due to the interactive nature of the sessions, the group setting and the availability of health professionals. This prediabetes lifestyle intervention program was perceived as successfully addressing rural adults' needs in terms of adopting a healthy lifestyle. Feedback received through program evaluation, which included a participant experience survey and focus groups has helped improve this program and may benefit other prediabetes education intervention programs.

Simulation in Learning and Using the Nutrition Care Process/Terminology: Experiences and Perceptions of Dietitians in Canada.

Purpose: To investigate experiences with, and perceptions of, simulation in learning and using the Nutrition Care Process/Terminology (NCP/T) of dietitians in Canada. Methods: In February-March 2017, a convenience sample of 382 dietitians in Canada (71.8% in clinical practice) completed an online survey regarding the type(s), setting(s), and perceptions of the simulations in which they engaged in learning and using the NCP/T. Results: A majority (76.7%) of respondents had engaged in NCP/T-related simulation, most commonly case studies (85.3%) and role-play (42.0%), as part of workplace/volunteer training (51.4%) and undergraduate internship/stage/practicum (34.2%). Nearly half (49.5%) of respondents learned all 4 NCP components via simulation, with Nutrition Diagnosis being the most common individual component (57%). Over three-quarters of respondents agreed/strongly agreed that simulation helped them better understand/use the NCP/T and that NCP/T-related knowledge/skills gained through simulation are transferable to the clinical setting/dietetic practice. Conclusions: Dietitians in Canada perceive simulation to have helped them learn and use the NCP/T. Resources should be directed at further developing simulation for teaching the NCP/T in dietetics education and training. Research investigating characteristics, barriers, and facilitators of effective NCP/T-simulation, using objective (vs. perceived) learning outcome measures is needed.

Glycated hemoglobin measurements at three, 12 and 24 months postpartum after gestational diabetes.

PURPOSE: To determine the associations between glycated hemoglobin (A1C) values at three, 12 and 24 months postpartum taken during the Families Defeating Diabetes trial. METHODS: The Families Defeating Diabetes trial was a randomized 12 month lifestyle intervention delivered in the first year postpartum. Women were reviewed at three, 6 12 and 24 months for body habitus, diet and lifestyle choices. Glycated hemoglobin levels were measured at three, 12 and 24 months. RESULTS: There were 170 randomization participants: 89 interventional (INT); and 81 control (CON). Of these 170 participants, 50 INT and 47 CON completed 12-month follow-up and 26 INT and 24 CON completed 24-month follow-up. Study outcomes did not differ between the cohorts. Combined intraclass correlation coefficients for reliability of repeated results showed substantial reliability: 0.74 (95% CI 0.63, 0.83) between three and 12 month A1C; and 0.72 (95% CI 0.51, 0.85) for three and 24 month A1C. Pearson correlations for three month vs 12 month A1C were r=0.745 (p.

Warfarin Dose Adjustment After Biliopancreatic Diversion/Duodenal Switch Bariatric Surgery.

BACKGROUND: The absorption of drugs and fat-soluble vitamins is impaired after bariatric surgery on which intestinal length and function are altered. In this context, the anticoagulant effect of warfarin is difficult to predict in the postoperative period. OBJECTIVE: This study aimed at describing the average weekly warfarin dose required to maintain a therapeutic international normalized ratio (INR) before and up to 1 year after sleeve gastrectomy with biliopancreatic diversion and duodenal switch (BPD/DS). Secondary end points included the number of patients requiring a minimal 20% reduction in their weekly dose of warfarin following the BPD/DS. METHODS: This descriptive and retrospective longitudinal population study included 20 patients using warfarin who underwent BPD/DS. An INR was considered nontherapeutic if it was below or above 15% of the targeted therapeutic range for any given patient. RESULTS: One month after the surgery, the median weekly dose of warfarin was 55% lower than the preoperative dose ( P < 0.0001). In the 9 patients with full follow-up data, the warfarin dose at 1 year was still 39% lower than the preoperative dose ( P < 0.05). At that time, all patients presented a minimal dose reduction of 20%. CONCLUSIONS: BPD/DS robustly reduced the requirement of warfarin, which resulted in lower doses after surgery. This persisted over the first year after the surgery, likely because of enhanced sensitivity. The mechanisms for this effect remain multifactorial, and the exact extent of change in dose cannot be predicted.

Nutrition care practices of primary care providers for weight management in multidisciplinary primary care settings in Ontario, Canada - a qualitative study.

BACKGROUND: Despite the recommended guidelines on addressing diet for the management and prevention of obesity in primary care, the literature highlights that their implementation has been suboptimal. In this paper, we provide an in-depth understanding of current nutrition-related weight management practices of primary care providers (PCPs) working in relatively new multidisciplinary health care settings in Ontario. METHODS: Three types of multidisciplinary primary care settings were included (2 Family Health Teams, 3 Community Health Centres and 1 Nurse Practitioner-Led Clinic). Participants (n = 20) included in this study were nurse practitioners (n = 13) and family physicians (n = 7) supporting care for adult patients (18 years or older). In-depth interviews were transcribed, coded and the content was analyzed using an integrated approach. RESULTS: Our analysis showed that most PCPs used anthropometric measures such as weight for screening patients who would benefit from nutrition counselling with a dietitian. The topic of nutrition was generally brought up either during physical examinations, when patients were diagnosed with a chronic disease, or when blood markers were out of normal range. Participants also mentioned that physical examinations are no longer occurring annually, with most PCPs offering episodic care. All participants reported utilizing dietetic referrals, noting the enablers for providing the referral, which included access to an on-site dietitian. Nonetheless, dietetic referrals were mostly used when patients had an obesity-related co-morbidity. Participants mentioned that healthy eating advice was reinforced during follow-up visits with patients only when there was enough time to do so. Electronic Health Records (EHRs) were utilized to facilitate message reinforcement by PCPs, who perceived EHRs to be helpful for viewing what was discussed in the session with the dietitian. CONCLUSIONS: PCPs mostly used objective measures to screen for patients who would benefit from nutrition counselling rather than diet assessment, which undermines the importance of dietary intake and overemphasizes weight. With physical examinations occurring less frequently, there will be additional missed opportunities for addressing nutrition-related concerns. The presence of a dietitian on site allowed for PCPs to refer patients to nutrition counselling. Having sufficient time during medical visits and EHRs seemed to facilitate message reinforcement by PCPs in follow-up visits with patients.