Anxiety and depressive symptoms in pregnant women during the COVID-19 pandemic in the Czech Republic-Broader sociodemographic causes, connections and implications.

INTRODUCTION: Our study (part of multicentric "MindCOVID") investigates risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic in the Czech Republic. MATERIAL AND METHODS: The study used a prospective cross-sectional design. Data was collected using an online self-administered questionnaire. Standardized scales, general anxiety disorder (GAD)-7 and patient health questionnaire (PHQ)-9 were administered online. Multivariate regression analysis was employed to evaluate the relationship between sociodemographic, medical and psychological variables. RESULTS: The Czech sample included 1830 pregnant women. An increase of depressive and anxiety symptoms measured by PHQ-9 and GAD-7 in pregnant women during the COVID-19 pandemic was associated with unfavorable financial situation, low social and family support, psychological and medical problems before and during pregnancy and infertility treatment. Fear of being infected and adverse effect of COVID-19, feeling of burden related to restrictions during delivery and organization of delivery and feeling of burden related to finances were associated with worse anxiety and depressive symptoms. CONCLUSIONS: Social and emotional support and lack of financial worries are protective factors against mood disorders in pregnant women in relation to COVID-19 pandemic. In addition, adequate information about organization of delivery and additional support from healthcare professionals during the delivery are needed. Our findings can be used for preventive interventions, given that repeated pandemics in the future are anticipated.

Obesity pharmacotherapy - update 2023.

The increasing prevalence of obesity and its associated complications leads to the need to intensify its prevention and treatment. The treatment of obesity is currently based on lifestyle modification, which often fails in the long term. For the next decade, the long-term administration of anti-obesity drugs, i.e. drugs that have a positive effect not only on the reduction of excess weight but also on the health risks associated with obesity, seems to be a necessary part of obesity treatment, along with surgical approaches. This text provides an overview of the current options for the pharmacotherapy of obesity, including their indications, appropriate patient selection and adverse effects of treatment. It also provides an overview of studies that demonstrate the long-term efficacy and safety of these treatments. Although effective and safe anti-obesity drugs are currently available, it is not even partially covered by general health insurance. However, the cost of treatment is unaffordable in the long term for a large proportion of the obese. The virtual unavailability of effective antiobesity drugs for indicated patients has serious health-economic consequences. Failure to take advantage of effective therapeutic options, confirmed by evidence-based medicine, results in a high prevalence of obesity-related diseases, which are even more costly to treat economically and, in the case of type 2 diabetes, even less effective. We consider at least partial reimbursement of antiobesity drugs from general health insurance for cooperating patients under clearly defined conditions to be a necessary step towards improving the situation, and clearly cost-effective in its consequences.

Recommendations for psychological assessment before bariatric surgery.

This document was created based on the need to standardize the psychological examination procedure prior to bariatric surgery. A valuable inspiration was the recommendations issued by the American Society for Metabolic and Bariatric Surgery. Bariatric or metabolic surgery has an undeniable positive effect in the treatment of obesity, in terms of improving somatic diseases, psychological disorders and psychosocial functioning. At the same time, it introduces major changes in the individual's life to which he or she must adapt. The treatment of obesity by surgery requires a fundamental change in lifestyle and the lifelong cooperation of the patient with the entire therapeutic team. Psychological care is a standard part of the entire treatment process. The role of the psychologist is not exclusively diagnostic. In indicated cases, it offers preoperative and postoperative psychological intervention, education and cooperation in the development of an individual treatment plan. Its aim is to deepen the patient's motivation to comply with dietary and regimen recommendations and to provide psychological support in the event of worsening psychological difficulties.

Psychological aspects of obesity.

Obesity is a metabolic disorder conditioned by several factors with the individual genetic proneness to accumulation of body fat with a positive energetic balance. If such definition describes the essential nature of obesity aptly, the treatment thereof ought to be the realm of somatic medicine and somatically oriented physicians, which is, unfortunately, frequently the case. Yet, not only being a disorder concerning improper body composition, but also a difference in cognitive processes and emotions of the obese, obesity needs to be considered in a more complex manner. The life of the obese consists of periods of strict, starvation diets on one hand and total loss of control and excessive calorie intake. Therefore, the corresponding therapy also needs to be provided in a more complex fashion, i.e. it is not solely the somatic disorder that should be addressed, but also the emotions and cognitions which induce the undesirable behaviour. Generally, it is possible to summarise that cognition and emotions are likely to be anticipated, directed and controlled by affecting the stimuli promoting the erratic attitude. Thanks to the achievements which relate not only to loss of weight, but also to higher self-esteem, more gratifying feelings aroused by the patients self, improvement of both physical and mental conditions and enhancement of the quality of life as a whole, the new behaviour patterns are established, strengthened and sustained on a long-term basis. Several psychotherapeutic attitudes/methods may be used with cognitive-behavioral therapy, existential therapy and, recently, psychodynamic approach. The psychologists role is essential and fundamental in both conservative and the metabolic-bariatric treatment of obesity. The most common character traits of obese patients include predominantly neuroticism, which comprises anxiety, depressions, impulsiveness, anger and hostility. Likewise, obesity is often suffered from by children and adolescents and its treatment relies on, in like manner as with adults, an active change of unsuitable dietary and movement habits with the family of the patient and their motivation of the patient to make the desirable change. It needs to be noted, however, that except for the changes in lifestyle, treatment of psychological difficulties accompanying obesity is a part of psychotherapy of such a group of young and adolescent patients.

Influence of vitamin A consumption on resting metabolic rate and fasting respiratory quotient in severely obese subjects.

OBJECTIVE: To study whether or not the amount of vitamin A consumed affects the resting metabolic rate (RMR) and fat oxidation at rest in severely obese subjects. MATERIALS AND METHODS: In 239 obese subjects, RMR and fasting respiratory quotient (RQ) were determined by indirect calorimetry. Vitamin A consumption was calculated by the Czech PC program 'Nutrition'. The relation between the intake of vitamin A and RMR and RQ was tested by simple regression. High and low vitamin A consumers were defined by an upper and a lower quintile of vitamin A intake (>842 vs. <382 IU/day). RESULTS: The RMR for high and low vitamin A consumers were 7,693.5 +/- 1,557 and 7,479.8 +/- 1,708 kJ/day, respectively, while the corresponding values for fasting RQ were 0.800 +/- 0.077 and 0.809 +/- 0.049, respectively. No significant correlation was found between vitamin A consumption and both RMR and RQ. Similarly, there was no significant difference in RMR and RQ, as well as weight, body mass index, body fat, waist girth and food quotient between the two groups characterized by high and low consumption of vitamin A. However, the energy intake of high vitamin A consumers was significantly higher than that of low vitamin A consumers, due to higher carbohydrate and protein intake. CONCLUSION: There was no significant correlation between the vitamin A intake and RMR or RQ in obese subjects determined in this study.