Unveiling the shadows: Investigating the interplay of stalking and sexual homicide-A case study.

Stalking can be defined as a pattern of fixated, repeated, and unwanted behaviours. Stalking is not an isolated incident and was associated to sexual violence. While the relationship between sexual violence and stalking is scarcely explored, no studies have tested the relationship between stalking and sexual homicide, which both involves elements of obsession. The aim of this paper was to study the relationship between stalking and sexual homicide using an exploratory case study analysis of 7 males convicted for sexual homicide. Results revealed: (1) The presence of obsession prior to the homicide; (2) The victims were ex-intimate partners or acquaintances; (3) The victims were followed several times prior to the index offence; (4) Stalking elements were not always considered by the authorities, which has led to an escalation of behaviours. This study expands our understanding between stalking and sexual violence, supporting the design of prevention and treatments.

Relationship Between Atypical Sexual Fantasies, Behavior, and Pornography Consumption.

Paraphilia is a condition in which the sexual excitement relies on fantasizing and/or participating in unusual sexual behaviors although the line between "normal" and "abnormal" has been disputed. The project aimed to explore which sexual fantasies and behaviors are common and uncommon in the general population. Furthermore, the relationship between sexual fantasies, sexual behaviors, and problematic pornography consumption was examined. Finally, the impact of gender was assessed. Analyses were conducted on a sample of 139 participants. Correlations were found between fantasies, behaviors, and problematic pornography consumption. Furthermore, gender differences were found for both sexual fantasies and problematic pornography consumption. Finally, multiple regression revealed that age, gender [Men], fantasies, and behaviors were significant predictor of problematic pornography consumption. Those findings are in-line with previous studies which highlighted that the threshold to consider a sexual practice as being abnormal needs to be reconsidered on the basis of self-reported fantasies and behaviors in the general population.

The Wheel of Change Moves On: Assessing the Severity of Stalking Behavior.

Stalking is a significant social issue. The inconsistency as to what defines stalking has resulted in the creation of different methods to measure the crime. However, there has been minimal work done that assesses the severity of individual stalking behaviors. The aim of the present study was to assess the level of stalking behavior in terms of severity within a randomly selected sample of 924 cases from the database of the National Stalking Helpline. Item response theory analyses were used to assist in developing a scale that displays the ranking order of each stalking behavior. These analyses were also used to examine whether the stalking behavioral items created a single continuum of severity of stalking. Results indicated that 16 stalking behavioral items of the 28 items present in the National Stalking Helpline, best represented the severity of stalking. Unwanted communication behaviors such as text messages and phone calls were located at the lower end of the severity scale, whereas criminal damage and death threats were mapped on the higher end of the continuum. The findings also revealed that the 16 items categorized under 6 factors. The findings of the present study provide many implications for stalking agency professionals and criminal justice responses.

Stalking Behaviors Presented by Ex-Intimate Stalkers: A Victim's Perspective.

Stalking can be defined as a pattern of repeated, unwanted behaviors by one person to another. These behaviors may take the form of communicative intrusion, third-party contact, and physical or sexual assault. The individual stalking behaviors experienced by victims have been found to differ in every case, specifically dependent on their stalker-victim relationship. Recent tragedies have shown that the police force generally underestimates the risk of ex-intimate stalking and harassment behaviors. This study aims to identify patterns of stalking behaviors from a victim's perspective, specifically, whether there are any patterns of behavior among the ex-intimate stalkers, in comparison with acquaintance or stranger stalkers. Information from the accounts of individuals who had reported unwanted experiences as a result of one of three stalker-victim relationships (ex-intimate, acquaintance, or stranger) was extracted from the National Stalking Helpline database. Analyses were conducted on a sample of 1,626 victims' reports. One-way analysis of variance (ANOVA) and multiple logistic regressions were conducted to establish any common patterns of behavior among the subgroups of stalkers and to ascertain which behaviors increased the odds of being categorized as an ex-intimate stalker. Results indicated that ex-intimate stalkers presented considerably more behaviors than acquaintance or stranger stalkers; some of which included third-party contact, criminal damage, physical assault, and sexual assault. Results also indicated that ex-intimate stalkers presented more severe behaviors than the other subgroups. The majority of stalking behaviors were found to produce a statistically significant predictive contribution to being classed as an ex-intimate stalker. The findings in this study highlight that common misconception surrounding ex-intimate stalking still exists at every level of the Criminal Justice System. Results and implications for future research are discussed.

"We Boil at Different Degrees": Factors Associated With Severity of Attack in Sexual Killing.

Degree of injury, as measured by the Homicide Injury Scale (HIS), was examined to advance understanding of the dynamics of sexual killing. A total of 350 nonserial, male sexual killers were included, and the different ways that the sexual element of their offenses and the act of killing were connected was accounted for by determining that cases were either directly sexual (the sexual element and killing were closely bound), or indirectly sexual (killing was not a source of sexual stimulation). The two groups, direct and indirect sexual killers, were each subjected to multiple linear regression analyses to examine the group-specific relationship between level of injury and predictor variables previously found to be associated with increased severity of attack. No differences in the mean total HIS scores between the indirect and the direct cases were found, suggesting a comparable emotional intensity between the groups. However, given that the groups differed in terms of the functional role of fatal violence, severity of attack could not be sufficiently explained as driven by anger. In line with this hypothesis, different predictors appeared to be associated with increased degree of injury sustained by victims of indirect compared with direct sexual killers. As such, situational components appear to play a role in the behavior of indirect sexual killers, whereas the behavior of direct perpetrators tends to be linked with the enactment of existing deviant fantasies. The role of anger in sexual homicide is discussed further, and overall, it is argued that irrespective of whether violence was initially driven by anger, evidence of sexual arousal to severe violence must be scrutinized within sexual homicide research as well as in psycholegal contexts.

Effect of dietary components and nutritional status on the development of pre-school children.

Background: The preschool period is a time of intensive changes: physical, motoric, cognitive, emotional and social development of the child. The diet should provide optimal energy andnutrient levels. Due to their properties, some of the dietary components may be particularly important in child development procesess. These include omega-3 fatty acids, B vitamins, vitamin D, antioxidants, iron, calcium, magnesium, zinc and copper. Objective: The aim of the study was to determine the effect of selected dietary components, the nutritional status and sleep duration in children at pre-school ages (3-6-years old) on their emotional sphere, as well as the cognitive, physical and social development. Material and methods: Anonymous research was carried out among 75 randomly selected children aged 3-6 years old in the Municipal Kindergarten in Ruciane-Nida. Research methods consited of a questionnaire, a 3-day food record, growth charts, and standardized development observation sheets. Software used for evaluation and analysis of obtained results was Diet 5.0. and Statistica 13. Result: It was observed that the increase of the BMI percentile correlated with a lesser social development of children. Children who slept a recommended number of hours presented higher level of cognitive developmnent. High level of cognitive development was more common in children supplementing vitamin D. Higher intake of folates, vitamin D, vitamin E, magnesium, zinc and copper correlated positively with a higher level of cognitive development. Conclusions: Application of the proper nutrition and healthy lifestyle principles supports a proper child development. All dietary components should be balanced, however some nutrients are of especial significance during the childhood development and therefore their optimal intake is essential for this developmental period.

Does the usual dietary intake of schizophrenia patients require supplementation with vitamins and minerals? / Czy zwyczajowy sposób zywienia pacjentów z rozpoznaniem schizofrenii wymaga suplementacji witaminami i skladnikami mineralnymi?

OBJECTIVES: The aim of the study was to assess the supply of selected vitamins and minerals in the daily food rations of patients diagnosed with schizophrenia. METHODS: 62 schizophrenia patients (32 women and 30 men aged 21-64, the mean age of women was 41.3 ± 11.2, the mean age of men was 36.1 ± 9.7) took part in the study. A 24-hour diet recall from 3 weekdays and 1 weekend day was used for quantitative assessment of the diet. RESULTS: In the conducted research, it was shown that, despite ensuring the average supply of energy required for a given age and sex group, the food rations of patients of both sexes were characterized by a deficiency of vitamin D, folates, potassium, calcium, and also vitamins E and C, magnesium in men as well as iron and iodine in women. Excessive amounts of vitamins B2, B6, sodium, and phosphorus were found in food rations of persons of both sexes and vitamins A, B1, niacin in food rations of women and also vitamin B12 in food rations of men. CONCLUSIONS: No supplementation of schizophrenia patients' diet is recommended; it is only justified in individual cases of patients in whom vitamin and mineral deficiencies were found on the basis of analysis of their food habits. However, it is necessary to provide each schizophrenia patient with appropriate food education that will allow them to choose products that contain all nutrients needed for proper functioning of the body, including the central nervous system.

The assessment of satisfaction of energy demand and of chosen macro - and micro-element content in the daily food rations of women diagnosed with schizophrenia with varied nutritional states. / Ocena realizacji potrzeb energetycznych oraz udzialu wybranych makro- i mikroskladników w calodziennych racjach pokarmowych kobiet z rozpoznaniem schizofrenii o zróznicowanym stopniu odzywienia.

OBJECTIVES: The aim of the study was to assess the degree of satisfaction of the daily demand for energy and chosen nutrients in the diets of women with schizophrenia, depending on the nutritional state of the subjects, assessed on the basis of the chosen anthropometric and metabolic parameters. METHODS: The study covered 102 women aged 21-64 (50 women diagnosed with schizophrenia and 52 healthy volunteers) aged 21-64 years. A 24-hour diet recall was used in the quantitative nutritional assessment. The anthropometric and biochemical measurements and the body composition analysis were used in the assessment of the nutritional state. RESULTS: The food rations of patients diagnosed with schizophrenia were characterized by a significantly higher intake of saturated fatty acids and a lower intake of vitamin C, B12, folates, and sodium as compared to healthy women. It was noted at the same time that the food rations of patients from both groups provided too low amounts of polyunsaturated fatty acids, vitamin D, folates, potassium, calcium, iron, and dietary fiber. Too high intake was observed in the case of vitamin A, B2, B6, sodium, and phosphorus in both groups. Total fat body mass of women with schizophrenia was significantly correlated with intake of saturated fatty acids, whereas the visceral adipose tissue content was significantly correlated with the carbohydrate intake, and the subcutaneous adipose tissue content - with the total fat and saturated fatty acids intake. CONCLUSIONS: The diet of women diagnosed with schizophrenia did not deviate from the diet of healthy persons, although the nutritional mistakes that were made by them suggest to choose the nutritional therapy individually for each patient, after carrying out a detailed nutritional interview.

Whiter Than White: The Art of Delaying Detection in Sexual Killers.

The study investigated whether different types of sexual homicide perpetrators are more or less skilled at delaying detection. A newly proposed direct/indirect typology was used alongside information about the time of arrest, the frequency of specific precautions as well as the impact of forensic strategies used by the perpetrators to examine skill at delaying detection. The results indicated that the time from the killing to the arrest, as measured in days, was longer for the direct than the indirect sexual killers. Despite the fact that the direct aggressors were better at delaying detection, overall the indirect and the direct offenders did not differ in the frequency of use of most of the precautions. However, different forensic awareness strategies were more efficacious for the direct and the indirect offenders. These results are discussed in relation to the crime scripts for the two perpetrator groups.

Sadism among sexual homicide offenders: Validation of the Sexual Sadism Scale.

Sexual sadism is assumed to be a crucial factor in sexual homicide. Prevalence estimates vary greatly due to differences in the definition of sexual sadism. A nationwide sample of 350 male perpetrators who had committed a sexual homicide offense against a female 14 years of age or above in England or Wales was assessed based on archival records. Sexual sadism was assessed using the Sexual Sadism Scale (SeSaS). Item response theory (IRT) analyses were conducted focusing on the 2-parameter logistic model. The single-factor structure of the SeSaS Part 1 was tested using confirmatory factor analysis. Estimates of both internal consistency and interrater agreement were satisfactory to substantial. IRT analysis showed that the Part 1 items captured moderate to severe levels of the latent construct (i.e., theta levels >0). Based on the Posterior Probability of Diagnosis index, the prevalence of the disorder was estimated at 37% in the sample. The substantial correlation between the SeSaS Part 1 total score and original clinical diagnoses of sadism confirms the criterion validity of the scale. Exertion of control and infliction of torture were among the more informative items. In sum, the results support the usefulness of the SeSaS instrument for assessing forensically relevant forms of sadism. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The assessment of the nutritional value of meals consumed by patients with recognized schizophrenia

Background: As studies show, changes in diet - so important in the therapy of psychiatric disorders and related to changes in appetite and nutritional preferences, including avoiding of the consumption of specific groups of products and dishes - are much more frequent among patients affected by schizophrenia. Objective: The aim of the study was to assess the chosen nutritional habits, including the number and type of meals usually consumed during a day, snacking between meals and the energy value and content of the chosen nutrients in the diets of persons with recognized schizophrenia. Material and methods: The study was carried out in a group of 85 patients with recognized schizophrenia, and 70 healthy volunteers ranging in age from 18-65 years without mental or nutritional disorders. For the purpose of the study, we used a questionnaire containing questions on nutritional habits. A 24-hour diet recall was used in the quantitative nutritional assessment with the use of the computer program Dieta 5.0. Results: Female patients with recognized schizophrenia were having 3 meals a day significantly more frequently as compared to healthy women. They were also having an afternoon snack much more frequently as compared to the control group. The food rations of female patients were characterized by a significantly higher energy value and the content of most of the assessed nutrients as compared to the food rations of healthy women. The food rations of men with recognized schizophrenia were characterized by a much lower energy intake and the content of the majority of assessed nutrients as compared to the food rations of healthy men. In all compared groups, we observed an energetic structure of food rations with the breakdown by specific meals that was inconsistent with the applicable recommendations. Conclusions: Despite of differences between the nutritional value of the meals of patients with recognized schizophrenia and those of healthy subjects, it seems advisable to involve patients with recognized schizophrenia in the education of forming appropriate nutritional habits.

Influence of selected dietary components on the functioning of the human nervous system

The diet is directly connected not only with the physical status but also with the functioning of the brain and the mental status. The potentially beneficial nutrients with a protective effect on the nervous system function include amino acids (tryptophan, phenylalanine, tyrosine, taurine), glucose and vitamins C, E, D and beta-carotene, B group vitamins (vitamin B12, vitamin B6, vitamin B4, vitamin B1) and minerals (selenium, zinc, magnesium, sodium, iron, copper, manganese, iodine). The presence of antioxidants in the diet protects against oxidative damage to nervous system cells. Biochemical data indicate that polyunsaturated fatty acids such as arachidonic acid (AA), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and gamma-linolenic acid (GLA) as structural components of the nervous system play a key role in its function. The nutrition of the entire body also influences the production of neurotransmitters in the brain. A diet without an appropriate supply of protein, mineral nutrients or vitamins may result in a failure to form appropriately balanced numbers of neurotransmitters, which, as a result, may lead to neurotransmission dysfunction. This is the reason why proper nutrition is based on vegetables, fruits, whole-grain cereal products supplemented with products providing full-value protein (dairy products, fish, lean meat) and high-quality fat products (vegetable oils, fish fats).

Assessment of dietary habits and nutritional status of depressive patients, depending on place of residence.

INTRODUCTION AND OBJECTIVES: An increased incidence of depressive disorders observed in recent years in the Polish and world population is a serious health problem. The aim of the study was to compare dietary habits and nutritional status of patients with recurrent depressive disorders, depending on their place of residence. Their impact on selected metabolic parameters was also considered. MATERIAL AND METHODS: The study group comprised 96 women and 84 men reporting to the Outpatient Mental Health Clinic at the Department of Psychiatry, Medical University of Bialystok in north-eastern Poland. The average age of the women was 46.7±11.7 years, and of men 47.0±11.3 years. In the quantitative assessmentof diets, 24-hour food recall interviews were conducted. Assessment of the nutritional status of the respondents consisted of anthropometric measurements, body composition analysis and biochemical parameters. RESULTS: It was show that the diets of female urban inhabitants were characterized by a significantly lower energy value and total fat content, compared to their rural counterparts. The food rations of men living in the city had a significantly higher energy value, protein content and total FAT, compared to rural residents. It was also noted that urban residents of both genders were characterized by a lower percentage of body fat, both visceral and subcutaneous (women), and a higher water content than rural residents. CONCLUSIONS: The study showed dietary errors in all compared groups, regardless of place of residence, which was reflected in the nutritional status of the respondents. The results also indicated that during the declared change in dietary habits, the treatment of depressive patients should include dietary instructions in order to ensure an optimum supply of nutrients.

The Role of OmpR in the Expression of Genes of the KdgR Regulon Involved in the Uptake and Depolymerization of Oligogalacturonides in Yersinia enterocolitica.

Oligogalacturonide (OGA)-specific porins of the KdgM family have previously been identified and characterized in enterobacterial plant pathogens. We found that deletion of the gene encoding response regulator OmpR causes the porin KdgM2 to become one of the most abundant proteins in the outer membrane of the human enteropathogen Yersinia enterocolitica. Reporter gene fusion and real-time PCR analysis confirmed that the expression of kdgM2 is repressed by OmpR. We also found that kdgM2 expression is subject to negative regulation by KdgR, a specific repressor of genes involved in the uptake and metabolism of pectin derivatives in plant pathogens. The additive effect of kdgR and ompR mutations suggested that KdgR and OmpR regulate kdgM2 expression independently. We confirmed that kdgM2 occurs in an operon with the pelP gene, encoding the periplasmic pectate lyase PelP. A pectinolytic assay showed strong upregulation of PelP production/activity in a Y. enterocolitica strain lacking OmpR and KdgR, which corroborates the repression exerted by these regulators on kdgM2. In addition, our data showed that OmpR is responsible for up regulation of the kdgM1 gene encoding the second specific oligogalacturonide porin KdgM1. This indicates the involvement of OmpR in the reciprocal regulation of both KdgM1 and KdgM2. Moreover, we demonstrated the negative impact of OmpR on kdgR transcription, which might positively affect the expression of genes of the KdgR regulon. Binding of OmpR to the promoter regions of the kdgM2-pelP-sghX operon, and kdgM1 and kdgR genes was confirmed using the electrophoretic mobility shift assay, suggesting that OmpR can directly regulate their transcription. We also found that the overexpression of porin KdgM2 increases outer membrane permeability. Thus, OmpR-mediated regulation of the KdgM porins may contribute to the fitness of Y. enterocolitica in particular local environments.

Diet for women with irritable bowel syndrome - a preliminary study

Background: Irritable Bowel Syndrome (IBS) is one of the most frequent digestive system diseases, of various medical signs. It is assumed that proper life style, including appropriate, rational diet is a factor helpful for treating such a disorder. Objective: The purpose of this paper was to assess the selected dietary habits, and to evaluate the nutritional value of daily food rations for patients with a mixed type of Irritable Bowel Syndrome. Material and Methods: The questionnaire survey involved a group of 32 women suffering from a mixed type of Irritable Bowel Syndrome (The Rome III Diagnostic Criteria were used to diagnose the disease). The control group was comprised of 32 healthy women. The methods used to assess the diet were divided into quantitative and qualitative ones. Results: The most frequent dietary mistakes among patients with IBS were associated with snacking sweets (83.0% of the subjects) and fruit (17.0% of the subjects) between the meals. A higher intake of sucrose was found amongst women with IBS, than in the case of the control group (p=0.0169). The analysis of the results demonstrated a significantly higher intake of water (derived from drinks and foods) amongst patients with IBS, than in the case of women of the control group (p=0.0267). An insufficient intake of plant proteins and polyunsaturated fatty acids was recorded in both groups. The supply of protein in general, animal protein, fat in general, saturated fatty acids and sodium, exceeded the recommended norm, both amongst women with IBS and women of the control group. Conclusions: The obtained examination results showed that there are significant dietary improprieties in the diet of women suffering from IBS. In order to eliminate these mistakes in the future, it seems justified to extend the knowledge on rational nutrition amongst patients with IBS.

The Use of Crime Scene and Demographic Information in the Identification of Non-Serial Sexual Homicide.

As with other sexual offenders, sexual homicide perpetrators can be reluctant to talk about their criminal behavior. Therefore, in homicide cases, forensic practitioners frequently rely on crime scene information to identify any sexual behavior associated with the offense. This study aims to identify objective and readily available crime scene information, alongside information about victims and perpetrators, based on 65 cases from England and Wales in the United Kingdom of men convicted of homicide who had committed a non-serial sexual homicide and 64 cases of men convicted of homicide where the available evidence indicated that it was a non-serial non-sexual homicide. Chi-square tests and logistic regression were used to analyze the data. There were few differences in terms of demographic information and criminal histories between the two perpetrator groups. There were crime scene indicators supporting the use of Ressler et al.'s definition of sexual homicide. The victims of sexual homicide were generally found in their home with the lower half of the body exposed and with evidence of vaginal sex. Furthermore, extreme injuries and strangulation were more frequent in sexual homicides. Use of weapon was associated with a non-sexual homicide. Victims of sexual homicide were as likely to know the perpetrator as not. Potential benefits of the characteristics reported to investigators and forensic practitioners tasked with identifying sexual homicides are discussed and areas for further research suggested.

Eating habits and nutritional status of patients with affective disorders and schizophrenia. / Sposób zywienia a stan odzywienia pacjentów z zaburzeniami afektywnymi i schizofrenia.

OBJECTIVES: The aim of the study was to assess the nutritional value of the food intake in the group of men and women suffering from recurrent affective disorders and schizophrenia, and also to determine the relation between selected nutritional parameters with anthropometric indices defining the nutritional status of the subjects. METHODS: 219 persons participated in the study (61 patients with recurrent depressive disorders, 60 patients with schizophrenia and 98 healthy volunteers). A24-hour dietary recall was used in the quantitative assessment of the diet. Anthropometric and biochemical measurements as well as body composition analysis were used to assess the nutritional status. RESULTS: It was shown that women with depression and schizophrenia had a significantly higher content of both visceral adipose tissue and subcutaneous adipose tissue as compared with the control group. A diet with a higher content of energy from protein, a higher supply of calcium promoted a lower fat content in the bodies of women suffering from depression (no such relationship was observed in the group of men). In the group of patients with schizophrenia, a diet with a lower supply of energy promoted a lower BMI value, waist circumference, lower waist-hip ratio and a lower fat content in the body. CONCLUSIONS: An improper energy structure and an improper content of nutrients can, in the future, contribute to the development of many somatic diseases, thus leading to deterioration of life quality of subjects and preventing the maintenance of mental health.

Toward Identification of the Sexual Killer: A Comparison of Sexual Killers Engaging in Post-Mortem Sexual Interference and Non-Homicide Sexual Aggressors.

Establishing a model of sexual assault reflecting psychosocial and behavioral characteristics of perpetrators of sexual killing and rape is necessary for development in risk assessment and intervention. Methodological variations in defining sexual killing have amalgamated serial and non-serial offenders and perpetrators with direct and indirect associations between killing and sexual arousal. This study defined sexual killing specifying that killing should be directly linked to sexual arousal, and sampled 48 sexual killers, operationalized to include only those engaging in post-mortem sexual interference, with one or two known female victims (non-serial), from prison service national (England and Wales) databases. These sexual killers were compared with 48 non-homicide, life or indeterminately sentenced sexual aggressors on psychological and crime scene characteristics. Contrary to previous research, fatal outcomes were associated with neither stranger victims nor weapon presence; sexual killing was characterized by severity of violence less so than non-fatal assault. Sexual killers more often reported problems with emotional loneliness, empathic concern, and sexual entitlement than the sexual aggressors. Theoretical and applied implications are discussed.

The effectiveness of a weight loss diet in a group of overweight and obese women with recurrent depressive disorders.

INTRODUCTION: The research conducted among patients with depression shows that such patients commit a range of nutritional mistakes which may predispose them to the development of many diseases including obesity and its complications. AIM OF THE STUDY: Aim of the study was to assess the effectiveness of a balanced weight loss diet in a group of women with recurrent depressive disorders. MATERIAL AND METHODS: 60 women suffering from depression, aged 41-64 (mean 52 ±5.3) on a six-month weight loss diet took part in the study. The patients' nutrition was assessed both in terms of quality and quantity, they were also subjected to anthropometric tests and their body composition was analysed. RESULTS: An average reduction in the women's body weight was 4.1 ±3.1 kg. The percentage content of the fatty tissue was reduced by 2.5 ±1.1% on average after modification of the nutrition (a statistically significant decrease in the frequency of wheat bread, cream, fat pork and eggs was observed). A considerable reduction in the mean energy value of the diet and a decrease in the total fat supply was also implemented. CONCLUSIONS: It seems that the dietary procedure which is aimed at obtaining the most advantageous effects of the reduction in the body mass of obese patients suffering from depression should be based not only on proper selection of food products and reduction in the energy value of the diet, but it should also take into account actions aimed at introducing permanent lifestyle changes including increased motivation of the patients to undertake physical activity.

The use of contraception for patients after bariatric surgery.

Obesity in women of reproductive age is a serious concern regarding reproductive health. In many cases of infertility in obese women, reduction of body weight may lead to spontaneous pregnancy, without the need for more specific methods of treatment. Bariatric surgery is safe and is the most effective method for body weight reduction in obese and very obese patients. In practice there are two bariatric techniques; gastric banding, which leads to weight loss through intake restriction, and gastric bypass, leads to weight loss through food malabsorption. Gastric bypass surgery (the more frequently performed procedure), in most cases, leads to changes in eating habits and may result in vomiting, diarrhea and rapid body mass reduction. There are reliable data describing the continuous increase in the number of women who are trying to conceive, or are already pregnant, following bariatric surgery. Most medical specialists advise women to avoid pregnancy within 12-18 months after bariatric surgery. This allows for time to recover sufficiency from the decreased absorption of nutrients caused by the bariatric surgery. During this period there is a need for the use of reliable contraception. As there is a risk for malabsorption of hormones taken orally, the combined and progestogen-only pills are contraindicated, and displaced by non-oral hormonal contraception or non-hormonal methods, including intrauterine devices and condoms.