Metabolic status is not associated with job stress in individuals with obesity: the ELSA-Brasil baseline.

PURPOSE: Job stress has proven to be a relevant cause of stress for adults, but its effect on the development of metabolic alterations in individuals with obesity is still poorly explored. We aimed to investigate the association between job stress and metabolically unhealthy obesity (MUO) phenotype in participants with obesity at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. METHODS: This study analyzed data collected at the baseline examination between 2008 and 2010. A total of 2371 individuals with obesity were included. Two metabolic phenotypes were characterized based on the US National Health and Nutrition Examination Survey criteria. The job stress scale was based on the Brazilian version of the Swedish Demand-Control-Support Questionnaire. The association between job stress domains and MUO phenotype was assessed by binary logistic models. RESULTS: In our sample, 1297 (54.7%) participants were women, mean age was 49.6 ± 7.1 years and 1696 (71.5%) had MUO. Low skill discretion was associated with MUO after adjustment for age, sex and race. However, in fully-adjusted models, the MUO phenotype was not associated with high job demand (odds ratio [OR] = 1.05; 95% confidence interval [95%CI] 0.82-1.35), low skill discretion (OR = 1.26; 95%CI 0.95-1.68), low decision authority (OR = 0.94; 95%CI 0.70-1.25) nor low social support (OR = 0.93; 95%CI 0.71-1.20). CONCLUSION: We found a significant association between low skill discretion and an adverse metabolic profile in models adjusted for age, sex and race. No associations were significant between job stress domains and the metabolic profile of individuals with obesity in full models.

Federal university hospitals: heterogeneity in the coordination of clinical trials authorized by the National Health Surveillance Agency

Introduction: This study aimed to describe clinical trials approved by the Brazilian Health Surveillance Agency (ANVISA) and coordinated by federal university hospitals (FUHs), as well as to investigate the relationship between the number of clinical trials and the assistance provided by these FUHs. Methods: This is a cross-sectional study based on data obtained from the ANVISA clinical trial consultation system. The National Register of Health Care Facilities and the Ambulatory Care Information System of the Unified Health System (SUS) were used as sources of information on the assistance provided by FUHs, such as the mean number of specialized medical consultations and the number of beds. Scatter plot and Spearman's correlation coefficient analyses were used to verify the association between these aspects of FUHs and the number of clinical trials. Results: Between 2012 and 2013, ANVISA authorized 209 trials to be coordinated by 23 FUHs; 75% of the trials were coordinated by 7 FUHs, 69.8% were phase III trials, and 94% were multicenter studies. The number of clinical trials presented positive and statistically significant associations with the mean number of specialized medical consultations and the number of beds (Spearman's correlation coefficients r = +0.70 and r = +0.64, respectively). Conclusion: FUHs have a leadership role in the conduction of clinical trials in Brazil, but showed heterogeneity regarding their assistance capacities and the number of clinical trials. A predominance of phase III trials may be interpreted as a low use of the scientific potentiality of these facilities. (AU)

BARIATRIC SURGERY AND BINGE EATING DISORDER: SHOULD SURGEONS CARE ABOUT IT? A LITERATURE REVIEW OF PREVALENCE AND ASSESSMENT TOOLS.

BACKGROUND: Eating pathologies among bariatric surgery candidates are common and associated with adverse surgical outcomes, including weight regain and low quality of life. However, their assessment is made difficult by the great variety and inconsistent use of standardized measures. OBJECTIVE: The purpose of this review was to synthesize current knowledge on the prevalence of binge eating disorder (BED) in presurgical patients and to make a critical appraisal of assessment tools for BED. METHODS: A search was conducted on PubMed, Scopus, and Web of Science databases from January 1994 to March 2017. Data were extracted, tabulated and summarized using a narrative approach. RESULTS: A total of 21 observational studies were reviewed for data extraction and analysis. Prevalence of BED in bariatric populations ranged from 2% to 53%. Considerable variation in patient characteristics and in BED assessment measures was evident among the studies. In addition, several methodological weaknesses were recognized in most of the studies. Ten different psychometric instruments were used to assess BED. Clinical interviews were used in only 12 studies, though this is the preferred tool to diagnose BED. CONCLUSION: Study heterogeneity accounted for the variability of the results from different centers and methodological flaws such as insufficient sample size and selection bias impaired the evidence on the magnitude of BED in surgical settings. For the sake of comparability and generalizability of the findings in future studies, researchers must recruit representative samples of treatment-seeking candidates for bariatric surgery and systematically apply standard instruments for the assessment of BED.

Cirurgia bariátrica e transtorno de compulsão alimentar: os cirurgiões devem se preocupar com isso? Uma revisão da literatura sobre a prevalência e os métodos de diagnóstico / Bariatric surgery and binge eating disorder: should surgeons care about it? a literature review of prevalence and assessment tools

ABSTRACT BACKGROUND: Eating pathologies among bariatric surgery candidates are common and associated with adverse surgical outcomes, including weight regain and low quality of life. However, their assessment is made difficult by the great variety and inconsistent use of standardized measures. OBJECTIVE: The purpose of this review was to synthesize current knowledge on the prevalence of binge eating disorder (BED) in presurgical patients and to make a critical appraisal of assessment tools for BED. METHODS: A search was conducted on PubMed, Scopus, and Web of Science databases from January 1994 to March 2017. Data were extracted, tabulated and summarized using a narrative approach. RESULTS: A total of 21 observational studies were reviewed for data extraction and analysis. Prevalence of BED in bariatric populations ranged from 2% to 53%. Considerable variation in patient characteristics and in BED assessment measures was evident among the studies. In addition, several methodological weaknesses were recognized in most of the studies. Ten different psychometric instruments were used to assess BED. Clinical interviews were used in only 12 studies, though this is the preferred tool to diagnose BED. CONCLUSION: Study heterogeneity accounted for the variability of the results from different centers and methodological flaws such as insufficient sample size and selection bias impaired the evidence on the magnitude of BED in surgical settings. For the sake of comparability and generalizability of the findings in future studies, researchers must recruit representative samples of treatment-seeking candidates for bariatric surgery and systematically apply standard instruments for the assessment of BED.

RESUMO CONTEXTO: Os transtornos alimentares entre os candidatos à cirurgia bariátrica são comuns e estão associados a resultados cirúrgicos adversos, incluindo recuperação de peso e baixa qualidade de vida. No entanto, sua avaliação é difícil pela grande variedade e uso inconsistente de métodos de avaliação padronizados. OBJETIVO: O objetivo desta revisão foi sintetizar o conhecimento atual sobre a prevalência do transtorno de compulsão alimentar (TCA) em pacientes pré-cirúrgicos e fazer uma avaliação crítica dos instrumentos de avaliação para TCA. MÉTODOS: A busca foi realizada nas bases de dados PubMed, Scopus e Web of Science de janeiro de 1994 a março de 2017. Os dados foram extraídos, tabulados e resumidos usando uma abordagem narrativa. RESULTADOS: Um total de 21 estudos observacionais foram revisados para extração e análise de dados. A prevalência de TCA nas populações bariátricas variou de 2% a 53%. Variações consideráveis nas características dos pacientes e nas medidas de avaliação do TCA foram evidentes entre os estudos. Além disso, várias fragilidades metodológicas na maioria dos estudos foram reconhecidas. Estudos utilizaram 10 diferentes instrumentos psicométricos para avaliar a TCA. Entrevistas clínicas foram utilizadas em 12 estudos, embora seja a ferramenta preferencial para diagnosticar o TCA. CONCLUSÃO: A heterogeneidade dos estudos foi responsável pela variabilidade dos resultados nos diferentes centros e falhas metodológicas, como tamanho insuficiente da amostra e viés de seleção, prejudicaram a estimativa da magnitude do TCA em cenários cirúrgicos. Para fins de comparabilidade e generalização dos achados em estudos futuros, os pesquisadores devem recrutar amostras representativas de candidatos à cirurgia bariátrica e fazer a aplicação sistemática de instrumentos padronizados para a avaliação do TCA.

Prospective study of hepatitis C viral infection as a risk factor for subsequent B-cell neoplasia.

Several case-control studies have found increased prevalence of hepatitis C virus (HCV) in patients with non-Hodgkin lymphoma (NHL) and other B-cell lymphoproliferative disorders. We examined whether HCV infection preceded the development of these neoplasms in a prospective cohort study of 48 420 individuals in northern California. Stored sera from 95 subjects with NHL (n = 57), multiple myeloma (n = 24), or Hodgkin disease (n = 14) diagnosed a mean of 21 years after phlebotomy were screened for antibodies to HCV as well as viral RNA, based on previous reports of antibody-negative viremia. Sera from 4 cases and one of 95 age-, sex-, and race-matched controls were repeatedly reactive by enzyme immunoassay, but none were confirmed by recombinant immunoblot assay; none of the case sera had HCV RNA by reverse transcription- polymerase chain reaction. Although acquisition in later life cannot be ruled out, these prospective data do not support a substantial role of chronic HCV infection in the etiology of B-cell neoplasia.