RESUMEN
OBJECTIVE: Evaluate whether the polymorphism rs17782313 near MC4R gene influences long-term outcomes after bariatric surgery. METHODS: The rs16782313 polymorphism was genotyped in 217 individuals undergoing bariatric surgery and analyzed in detail in 141 women. Data for comorbidities, BMI, excess weight loss (EWL), and body composition were obtained before and during 60 months after surgery. RESULTS: The risk allele was found in 65 (47%) of the 141 women. Pre-surgical body weight and BMI were higher in carriers of the rs17782313 polymorphism (CC + CT group) than in non-carriers (TT group) (p = 0.039 and 0.047, respectively). The number of women who acquired surgical success (EWL > 50%), was lower in CC + CT group compared to TT group (p = 0.015). The minimum BMI seen during the 60 months of follow-up was higher in CC + CT group compared to TT group (p = 0.028). The number of women who presented BMI < 30 kg/m2 (no longer classified as obesity) after 24 months of surgery was inferior in CC + CT group (6 out 35 patients - 17%) than in TT group (19 out 49 patients - 37%, p = 0.043). Moreover, the number of patients maintaining BMI > 35 kg/m2 were higher carriers (18 out 35 patients - 51%) compare to non-carriers (16 out 49 patients - 32%, p = 0.045). CONCLUSION: Women with extreme obesity carrying rs17782313 MC4R polymorphism present a higher pre-surgical BMI, are more unlikely to reach non-obesity BMI (<30 kg/m2) and tend to maintain a BMI > 35 kg/m2 that characterize treatment failure.
Asunto(s)
Obesidad , Receptor de Melanocortina Tipo 4/genética , Pérdida de Peso/genética , Adulto , Cirugía Bariátrica , Índice de Masa Corporal , Femenino , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/genética , Obesidad/cirugía , Polimorfismo de Nucleótido Simple/genética , Estudios RetrospectivosRESUMEN
RESUMO A privatização é frequentemente mencionada como uma potencial solução para os problemas dos serviços de abastecimento de água. Todavia, são raros os estudos sobre os reais impactos da privatização, sobretudo no Brasil. O objetivo deste trabalho foi comparar o desempenho dos prestadores públicos e privados no Brasil entre 2003 e 2013. A metodologia baseou-se na análise dos indicadores do Sistema Nacional de Informações sobre Saneamento, por meio de análises fatoriais e testes não paramétricos. Também testou-se a aplicação de modelos de regressão linear, embora sem sucesso. A análise visual dos boxplots sugeriram diferenças no desempenho entre prestadores público e privado em anos específicos. Essa situação foi confirmada por meio dos testes não paramétricos. Todavia, os serviços privatizados já tinham o melhor desempenho desde o início do período de análise, o que corrobora o argumento de que a privatização tende a ocorrer em municípios que já apresentam condições favoráveis de abastecimento de água. Estudos futuros são, finalmente, sugeridos.
ABSTRACT Privatization is often mentioned as a potential solution to water supply problems. However, few studies have addressed the real impacts of privatization, particularly in Brazil. The objective of this study was to compare the performance of public and private water supply services in Brazil between 2003 and 2013. The methodology was based on the analysis of the indicators of the Brazilian National Information System on Sanitation, through factor analyses and nonparametric tests. The study also conducted linear regression models, without success. The visual analysis of the boxplots suggested significant differences in the overall performance of public and private groups in specific years. This situation was confirmed in nonparametric tests. However, privatized services had the best performance since the beginning of the analysis period, a fact that corroborates the argument that privatization tends to occur in municipalities with more favorable water supply services. Future studies are, finally, suggested.