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1.
N Engl J Med ; 381(25): 2440-2450, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31851800

RESUMO

BACKGROUND: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity. METHODS: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes. RESULTS: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2). CONCLUSIONS: Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).


Assuntos
Obesidade Mórbida/epidemiologia , Obesidade/epidemiologia , Adulto , Índice de Massa Corporal , Feminino , Previsões , Humanos , Renda , Masculino , Obesidade/etnologia , Obesidade Mórbida/etnologia , Prevalência , Autorrelato , Distribuição por Sexo , Estados Unidos/epidemiologia
2.
Hosp Pract (1995) ; 47(4): 181-185, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31580732

RESUMO

Purpose: There is limited clinical data evaluating anticoagulation with the direct oral anticoagulants (DOACs) in morbidly obese patients. We sought to examine the efficacy in preventing stroke or other systemic embolic events and safety of apixaban, dabigatran, and rivaroxaban, in comparison to warfarin in patients with either a body-mass index (BMI) over 40 kg/m2 and/or a weight over 120 kg.Methods: After approval from IRB, we collected retrospective data from our institution's records on 180 patients. We analyzed the rates of stroke and systemic embolic events as defined as ischemic stroke, pulmonary embolism (PE), deep vein thrombosis (DVT), and myocardial infarction (MI) as well as major bleeding in morbidly obese patients receiving apixaban, dabigatran, or rivaroxaban in comparison to warfarin for anticoagulation due to nonvalvular atrial fibrillation, postoperative thrombus prophylaxis, or DVT/PE treatment and/or reduction in risk for recurrence.Results: The final analysis included 90 patients in both arms. Fifty-two percent (n = 41) of patients in the DOAC group were on apixaban therapy, 12% (n = 11) on dabigatran, and 37% (n = 33) on rivaroxaban. The average BMI and weight in the DOAC group were 46.7 kg/m2 and 139.3 kg, respectively. In the warfarin group, average BMI and weight were 45.8 kg/m2 and 135.9 kg, respectively. There were 11 patients who developed a stroke or thromboembolic event in the DOAC group and 10 in the warfarin group (OR 1.11, 95% confidence interval [CI] 0.45-2.78; p = 0.82). The events in the DOAC group consisted of three patients who developed ischemic stroke, three patients who developed DVTs, one who developed a PE, and four patients who developed MIs. There were two major bleeding events in the DOAC group and three events in the warfarin group (p = 0.65).Conclusions: Anticoagulation therapy with DOACs in morbidly obese patients may be a safe and effective alternative to warfarin for prevention of stroke or systemic embolic events. However, additional studies are necessary to confirm these findings.


Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/classificação , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Obesidade Mórbida/epidemiologia , Varfarina/administração & dosagem , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Índice de Massa Corporal , Dabigatrana/administração & dosagem , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Embolia Pulmonar/epidemiologia , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Estudos Retrospectivos , Rivaroxabana/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Trombose Venosa/epidemiologia , Varfarina/uso terapêutico , Adulto Jovem
3.
Nord J Psychiatry ; 73(8): 527-531, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31502911

RESUMO

Background: It has been suggested that obese patients with binge eating disorder (BED) show higher levels of dissociation and childhood trauma. Aim: This study assesses childhood trauma history and dissociative symptoms in obese patients with BED compared to obese patients without BED. Methods: The 241 patients participating in the study had to meet obesity criteria. These patients were applicants for bariatric surgery and were consulted by a psychiatry service. Patients were separated into two groups that were accompanied by BED diagnoses according to structured clinical interviews administered according to the DSM-IV (SCID-I). Patients were assessed using the Dissociation Questionnaire (DIS-Q) and the Childhood Trauma Questionnaire (CTQ). The two groups of patients were compared. Results: A total of 75 (31.1%) of the 241 obese patients were diagnosed with BED. The study showed that obese patients with BED had higher dissociative scores than those without BED (p < .05). The results showed higher total scores and two different types of childhood trauma (physical abuse and emotional abuse) in BED patients compared to non-BED patients (p < .05). Conclusions: Clinicians should be fully aware of BED, dissociative symptoms and childhood traumatic experiences. These results show that, for at least a sub-group of obese patients, BED is associated with obesity and may be connected with dissociative symptoms and childhood physical abuse and emotional abuse.


Assuntos
Transtorno da Compulsão Alimentar/psicologia , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/tendências , Transtornos Dissociativos/psicologia , Obesidade Mórbida/psicologia , Adulto , Transtorno da Compulsão Alimentar/diagnóstico , Transtorno da Compulsão Alimentar/epidemiologia , Criança , Estudos Transversais , Transtornos Dissociativos/diagnóstico , Transtornos Dissociativos/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/psicologia , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Inquéritos e Questionários
4.
Medicine (Baltimore) ; 98(32): e16687, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393370

RESUMO

Obstructive sleep apnea (OSA) has a high prevalence in patients with obesity. Only patients with clinical symptoms of OSA are admitted to polysomnography; however, many patients with OSA are asymptomatic. We aimed to create and validate a population-based risk score that predicts the severity of OSA in patients with obesity.We here report the cross-sectional analysis at baseline of an ongoing study investigating the long-term effect of bariatric surgery on OSA. One-hundred sixty-one patients of the Obesity Center of the Catholic University Hospital in Rome, Italy were included in the study. The patients underwent overnight cardiorespiratory monitoring, blood chemistry analyses, hepatic ultrasound, and anthropometric measurements. The patients were divided into 2 groups according OSA severity assessed by the apnea-hypopnea index (AHI): AHI < 15 = no or mild and AHI ≥ 15 moderate to severe OSA. A statistical prediction model was created and validated. C statistics was used to evaluate the discrimination performance of the model.The prevalence of OSA was 96.3% with 74.5% of the subjects having moderate/severe OSA. Sex, body mass index, diabetes, and age were included in the final prediction model that had excellent discrimination ability (C statistics equals to 83%). An OSA risk chart score for clinical use was created.Patients with severe obesity are at a very high risk for moderate or severe OSA in particular if they are men, older, more obese, and/or with type 2 diabetes. The OSA risk chart can be useful for general practitioners and patients as well as for bariatric surgeons to select patients with high risk of moderate to severe OSA for further polysomnography.


Assuntos
Obesidade Mórbida/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Obesidade Mórbida/epidemiologia , Prevalência , Curva ROC , Análise de Regressão , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais
5.
S Afr J Surg ; 57(2): 20-26, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31342680

RESUMO

BACKGROUND: In South Africa, 42.0% of adult females and 13.5% of adult males are classified as obese, the highest recorded numbers in Sub-Saharan Africa. Metabolic surgery has been proven to be a safe and effective treatment, yet due to demand on government resources has only been performed to a limited extent in public hospitals. The aim of this study was to describe the safety and efficacy of performing metabolic surgery at a single academic hospital in South Africa. METHOD: This was a single centre retrospective review of 57 metabolic surgery procedures performed from October 2011 to September 2017 at Tygerberg Hospital, Cape Town, South Africa. The primary outcome was safety including mortality and adverse events. Secondary outcomes included effect of surgery on weight and diabetes resolution. RESULTS: A total of 57 patients underwent laparoscopic metabolic surgery, of which 44 (83.0%) were female with a mean age (standard deviation) of 42.8 (8.0) years. Fifty-six patients (98%) underwent Roux-and-Y gastric bypass and one (2%) had a sleeve gastrectomy performed. There were no mortalities and overall morbidity was 14.0%, with 3 (5.3%) classified as major and 5 (8.8%) as minor. The follow-up rate at 1 year was 100%. Mean preoperative body mass index (BMI) was 58.8 kg/m2, and comorbidities included hypertension (59.6%), Type 2 Diabetes (42.1%), and dyslipidaemia (36.8%). There were no conversions to open surgery and at one year the mean (95% confidence interval) percentage excess body mass index loss was 50.4% (44.0-56.8%). CONCLUSION: Metabolic surgery can be performed safely in the public sector in South Africa, with short-term safety and efficacy outcomes comparable to international reports. Larger scale studies are needed to determine long-term outcomes and cost-effectiveness.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Adulto , Índice de Massa Corporal , Comorbidade , Feminino , Humanos , Masculino , Obesidade Mórbida/epidemiologia , África do Sul/epidemiologia
6.
Nutrients ; 11(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31288401

RESUMO

Vitamin B12 (cobalamin) is an essential cofactor in the one-carbon metabolism. One-carbon metabolism is a set of complex biochemical reactions, through which methyl groups are utilised or generated, and thus plays a vital role to many cellular functions in humans. Low levels of cobalamin have been associated to metabolic/reproductive pathologies. However, cobalamin status has never been investigated in morbid obesity in relation with the reduced semen quality. We analysed the cross-sectional data of 47-morbidly-obese and 21 lean men at Careggi University Hospital and evaluated total cobalamin (CBL) and holotranscobalamin (the active form of B12; holoTC) levels in serum and semen. Both seminal and serum concentrations of holoTC and CBL were lower in morbidly obese compared to lean men, although the difference did not reach any statistical significance for serum holoTC. Seminal CBL and holoTC were significantly higher than serum levels in both groups. Significant positive correlations were observed between seminal holoTC and total sperm motility (r = 0.394, p = 0.012), sperm concentration (r = 0.401, p = 0.009), total sperm number (r = 0.343, p = 0.028), and negative correlation with semen pH (r = -0.535, p = 0.0001). ROC analysis supported seminal holoTC as the best predictor of sperm number (AUC = 0.769 ± 0.08, p = 0.006). Our findings suggest that seminal rather than serum levels of holoTC may represent a good marker of semen quality in morbidly obese subjects.


Assuntos
Obesidade Mórbida , Sêmen , Transcobalaminas/análise , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/metabolismo , Obesidade Mórbida/fisiopatologia , Projetos Piloto , Sêmen/química , Sêmen/fisiologia , Análise do Sêmen
8.
BMC Public Health ; 19(Suppl 4): 541, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196019

RESUMO

BACKGROUND: Socioeconomic factors and nutritional status have been associated with childhood cognitive development. However, previous Malaysian studies had been conducted with small populations and had inconsistent results. Thus, this present study aims to determine the association between socioeconomic and nutritional status with cognitive performance in a nationally representative sample of Malaysian children. METHODS: A total of 2406 Malaysian children aged 5 to 12 years, who had participated in the South East Asian Nutrition Surveys (SEANUTS), were included in this study. Cognitive performance [non-verbal intelligence quotient (IQ)] was measured using Raven's Progressive Matrices, while socioeconomic characteristics were determined using parent-report questionnaires. Body mass index (BMI) was calculated using measured weight and height, while BMI-for-age Z-score (BAZ) and height-for-age Z-score (HAZ) were determined using WHO 2007 growth reference. RESULTS: Overall, about a third (35.0%) of the children had above average non-verbal IQ (high average: 110-119; superior: ≥120 and above), while only 12.2% were categorized as having low/borderline IQ (< 80). Children with severe obesity (BAZ > 3SD), children from very low household income families and children whose parents had only up to primary level education had the highest prevalence of low/borderline non-verbal IQ, compared to their non-obese and higher socioeconomic counterparts. Parental lack of education was associated with low/borderline/below average IQ [paternal, OR = 2.38 (95%CI 1.22, 4.62); maternal, OR = 2.64 (95%CI 1.32, 5.30)]. Children from the lowest income group were twice as likely to have low/borderline/below average IQ [OR = 2.01 (95%CI 1.16, 3.49)]. Children with severe obesity were twice as likely to have poor non-verbal IQ than children with normal BMI [OR = 2.28 (95%CI 1.23, 4.24)]. CONCLUSIONS: Children from disadvantaged backgrounds (that is those from very low income families and those whose parents had primary education or lower) and children with severe obesity are more likely to have poor non-verbal IQ. Further studies to investigate the social and environmental factors linked to cognitive performance will provide deeper insights into the measures that can be taken to improve the cognitive performance of Malaysian children.


Assuntos
Transtornos Cognitivos/epidemiologia , Obesidade Mórbida/psicologia , Pobreza/psicologia , Classe Social , Índice de Massa Corporal , Criança , Desenvolvimento Infantil , Pré-Escolar , Cognição , Transtornos Cognitivos/etiologia , Feminino , Humanos , Renda , Testes de Inteligência/estatística & dados numéricos , Malásia/epidemiologia , Masculino , Inquéritos Nutricionais , Estado Nutricional , Obesidade Mórbida/epidemiologia , Pais , Prevalência , Inquéritos e Questionários
9.
J Laparoendosc Adv Surg Tech A ; 29(8): 1011-1015, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31107145

RESUMO

Background: Our previous study demonstrated that lower level of education was associated with increased rates of postoperative hospital visits following bariatric surgery, potentially secondary to decreased understanding of postoperative expectations. Our follow-up study seeks to evaluate whether patients with lower level of education and health literacy have decreased weight loss success and resolution of comorbidities after bariatric surgery. Methods: Bariatric surgery patients presenting between October 2015 and December 2016 were administered a preoperative questionnaire, which reported education level and contained the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) health literacy test. The percentage of excess weight loss (EWL) and improvement of hypertension and diabetes mellitus at 6 months were compared across education level (≤12th grade versus >12th grade) and health literacy score (≤8th grade versus high school level) using Fisher's exact and Wilcoxon tests. Results: Seventy-eight patients were followed until their 6-month postoperative appointment (median 7 months, range 4-12 months); 6 scored ≤8th grade for health literacy on the REALM-SF (8%); and 21 had a ≤12th grade level education (27%). Patients with ≤8th grade on REALM-SF health literacy test lost 35% EWL versus 44% EWL by those with high school level health literacy score (P = .03). There was no significant difference in EWL compared across education level (44% versus 43%, P = .63). There were no significant differences in comorbidity improvement. Conclusions: The few patients in our cohort with a low health literacy level had a significantly lower EWL following bariatric surgery, and no differences were seen across education level. Increased vigilance in patients with low health literacy may be warranted to ensure excellent outcomes.


Assuntos
Cirurgia Bariátrica , Escolaridade , Alfabetização em Saúde , Obesidade Mórbida/cirurgia , Adulto , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade Mórbida/epidemiologia , Período Pós-Operatório , Inquéritos e Questionários , Resultado do Tratamento , Perda de Peso
10.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30988024

RESUMO

BACKGROUND AND OBJECTIVES: Youth with cognitive impairment or developmental disability (CI/DD) face higher rates of obesity and secondary medical issues. Bariatric surgery may be a helpful tool for health improvement because it has been shown efficacious for adolescents. We aim to contribute to literature regarding bariatric surgery for adolescents with CI/DD and explore the association between cognitive functioning and weight loss outcomes. METHODS: Adolescents (N = 64) received a preoperative psychological evaluation, including cognitive assessment, and bariatric surgery at 1 weight loss program between 2010 and 2017. For these adolescents with measured cognitive performance, CI/DD was defined by an IQ <80 or previous diagnosis. In analyses, we compared adolescents with and without CI/DD. Structural equation modeling was used to assess the impact of cognitive functioning on weight loss 3 to 24 months postsurgery. RESULTS: There were no significant differences between adolescents with or without CI/DD in terms of preoperative BMI, age, and sex. Having CI/DD did not significantly impact weight loss or weight loss trajectory in the 2 years after surgery, although modeling revealed a trend toward individuals with CI/DD losing more weight over time. Similarly, intelligence scores did not predict weight loss after surgery. CONCLUSIONS: Bariatric surgery may be a helpful tool for adolescents with severe obesity and CI/DD. They could benefit from the surgery as much as those with typical development, and having CI/DD should not be used as a criterion to deny surgery. Continuing research with this population can be used to determine long-term outcomes in addition to defining best practices.


Assuntos
Cirurgia Bariátrica/métodos , Disfunção Cognitiva/cirurgia , Deficiências do Desenvolvimento/cirurgia , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Adolescente , Índice de Massa Corporal , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Feminino , Seguimentos , Humanos , Masculino , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/psicologia , Cuidados Pré-Operatórios , Adulto Jovem
11.
Wien Klin Wochenschr ; 131(Suppl 1): 221-228, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30980153

RESUMO

Metabolic diseases dramatically affect the life of men and women from infancy up to old age in different and manifold ways and are a major challenge for the healthcare system. The treating physicians are confronted with the different needs of women and men in the clinical routine. Gender-specific differences affect screening, diagnostic and treatment strategies as well as the development of complications and mortality rates. Impairments in glucose and lipid metabolism, regulation of energy balance and body fat distribution and therefore the associated cardiovascular diseases, are greatly influenced by steroidal and sex hormones. Furthermore, education, income and psychosocial factors play an important role in the development of obesity and diabetes differently in men and women. Males appear to be at greater risk of diabetes at a younger age and at a lower body mass index (BMI) compared to women but women feature a dramatic increase in the risk of diabetes-associated cardiovascular diseases after the menopause. The estimated future years of life lost owing to diabetes is somewhat higher in women than men, with a higher increase in vascular complications in women but a higher increase of cancer deaths in men. In women prediabetes or diabetes are more distinctly associated with a higher number of vascular risk factors, such as inflammatory parameters, unfavorable changes in coagulation and higher blood pressure. Women with prediabetes and diabetes have a much higher relative risk for vascular diseases. Women are more often morbidly obese and less physically active but may have an even greater benefit in health and life expectation from increased physical activity than men. In weight loss studies men often showed a higher weight loss than women; however, diabetes prevention is similarly effective in men and women with prediabetes with a risk reduction of nearly 40%. Nevertheless, a long-term reduction in all cause and cardiovascular mortality was so far only observed in women. Men predominantly feature increased fasting blood glucose levels, women often show impaired glucose tolerance. A history of gestational diabetes or polycystic ovary syndrome (PCOS) as well as increased androgen levels in women and the presence of erectile dysfunction or decreased testosterone levels in men are important sex-specific risk factors for the development of diabetes. Many studies showed that women with diabetes reach their target values for HbA1c, blood pressure and low-density lipoprotein (LDL)-cholesterol less often than their male counterparts, although the reasons are unclear. Furthermore, sex differences in the effects, pharmacokinetics and side effects of pharmacological treatment should be taken more into consideration.


Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus , Obesidade Mórbida/epidemiologia , Guias de Prática Clínica como Assunto , Estado Pré-Diabético , Índice de Massa Corporal , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Obesidade Mórbida/complicações , Síndrome do Ovário Policístico/epidemiologia , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais
12.
Am Heart J ; 212: 113-119, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30981035

RESUMO

BACKGROUND: There are limited data regarding clinical outcomes and healthcare resource utilization of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) who are morbidly obese (body mass index >40 kg/m2 or body weight >120 kg). METHODS: Using data from 2 US healthcare claims databases, we identified patients initiating rivaroxaban or warfarin who had ≥1 medical claim with an AF diagnosis, a diagnostic code for morbid obesity (ICD-9: 278.01, V85.4%; ICD-10: E66.01%, E66.2%, Z68.4%), and a minimum continuous enrollment of 12 months before and 3 months after treatment initiation. Patients were excluded if they had mitral stenosis, a mechanical heart valve procedure, an organ/tissue transplant, or an oral anticoagulant prescription prior to the index date. Rivaroxaban and warfarin patients were 1:1 propensity score matched. Conditional logistic regression was used to compare ischemic stroke/systemic embolism and major bleeding risk. Generalized linear models were used to compare healthcare resource utilization and costs. RESULTS: A total of 3563 matched pairs of morbidly obese AF patients treated with rivaroxaban or warfarin were identified. The majority (81.4%) of patients in the rivaroxaban cohort were receiving the 20 mg dose. The rivaroxaban and warfarin cohorts were well balanced after propensity score matching. The risks of ischemic stroke/systemic embolism and major bleeding were similar for rivaroxaban and warfarin users (stroke/systemic embolism: 1.5% vs 1.7%; odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.60, 1.28; P = .5028; major bleeding: 2.2% vs 2.7%; OR: 0.80; 95% CI: 0.59, 1.08; P = .1447). Total healthcare costs including medication costs per patient per year (PPPY) were significantly lower with rivaroxaban versus warfarin ($48,552 vs $52,418; P = .0025), which was primarily driven by lower hospitalization rate (50.2% vs 54.1%; P = .0008), shorter length of stay (7.5 vs 9.1 days; P = .0010), and less outpatient service utilization (86 vs 115 visits PPPY; P < .0001). CONCLUSIONS: Morbidly obese AF patients treated with rivaroxaban had comparable risk of ischemic stroke/systemic embolism and major bleeding as those treated with warfarin, but lower healthcare resource utilization and costs.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Custos de Medicamentos , Obesidade Mórbida/complicações , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico , Anticoagulantes/economia , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Inibidores do Fator Xa/economia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Obesidade Mórbida/epidemiologia , Estudos Retrospectivos , Rivaroxabana/economia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Varfarina/economia
13.
Aust J Rural Health ; 27(2): 164-169, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30950131

RESUMO

OBJECTIVE: To assess the prevalence of overweight and obese women in the antenatal and perinatal periods, in rural hospitals; and to evaluate neonatal and maternal outcomes, including transfer to larger birthing centres. DESIGN: A retrospective clinical chart audit. SETTING: Rural maternity services in five Queensland rural hospitals. PARTICIPANTS: Data were collected from 250 women presenting to participating rural hospitals, with an estimated due date in 2016. MAIN OUTCOME MEASURES: Obstetric and neonatal data, whether transfer occurred, mode of delivery and any complications, and neonatal outcomes including birth weight and complications were collected. Demographic information collected included maternal age, gravidity and parity, race, smoking status and pre-pregnancy body mass index. The main outcome measures of interest were birth weight, Caesarean rate, transfer rate and diagnosis of gestational diabetes in relation to the body mass index. RESULTS: Over 50% of women were overweight or obese while entering pregnancy, with 5.2% of mothers in the morbidly obese category. There was an increase in the birth weight of mothers with a body mass index of more than 25. The increasing body mass index was associated with an increased likelihood of transfer, diagnosis of gestational diabetes, elective and, especially, emergency Caesareans performed at the hospital. Twenty-four percent of women continued to smoke throughout pregnancy. CONCLUSION: A high prevalence of obesity was found in the rural obstetric population. As the body mass index increases, so too does birth weight, gestational diabetes, transfer rate and Caesarean section rate. The rates of smoking throughout pregnancy were higher than the average metropolitan rates. These findings have implications not just for rural hospital operation and resources, but also for preventive health activities in rural communities.


Assuntos
Diabetes Gestacional/epidemiologia , Obesidade Mórbida/epidemiologia , Sobrepeso/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , População Rural/estatística & dados numéricos , Adulto , Feminino , Humanos , Gravidez , Prevalência , Queensland/epidemiologia , Estudos Retrospectivos
14.
Intern Med J ; 49(3): 391-395, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30897666

RESUMO

Inequitable access to bariatric surgery by geographical region has been reported internationally, but comparable data on provision of bariatric surgery have not previously been reported in New Zealand. We examined allocated funding and provision of bariatric surgery amongst different regions in New Zealand in the 2013/14 year, and found that there was large variation in both. This highlights that public funded bariatric surgery needs to take into account population prevalence of morbid obesity to reduce inequities by geographical region.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Feminino , Humanos , Masculino , Nova Zelândia/epidemiologia , Prevalência
15.
J Coll Physicians Surg Pak ; 29(4): 309-312, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30925950

RESUMO

OBJECTIVE: To investigate whether restless leg syndrome (RLS) symptoms improved and treatment requirement decreased through weight loss on postoperative follow-ups of the patients who underwent laparoscopic sleave gastrectomy (LSG) due to obesity and who were started medical therapy due to RLS. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: General Surgery Outpatient Clinics of Research and Training Hospital of Medical School, Adiyaman, Turkey, from May 2014 to December 2017. METHODOLOGY: A total of 14 patients who underwent LSG due to morbid obesity and who received medical treatment due to RLS were retrospectively included in the study. The improvement of the symptoms and no need for medical treatment were considered as treatment or recovery criterion. Those who were not diagnosed with RLS before the operation or who did not receive medical treatment due to RLS were excluded. RESULTS: The study subjects comprised 6 females (42.9%) and 8 males (57.1%). Mean BMI was 46.50 ±3.43 Kg/m² before LSG and 28.28 ±2.26 Kg/m² on months 12 after LSG. Mean BMI values 12 months after LSG were significantly reduced compared to preoperative BMI (p=0.001). Out of the 14 patients who had been receiving medical therapy before LSG, 12 patients (85.7%) had discontinued medical therapy 12 months after LSG. A statistically significant difference was detected between the number of the patients who were receiving medical therapy due to RLS on month 12 after LSG and the number of the patients who were receiving medical therapy before LSG (p=0.001). CONCLUSION: Treatment requirements of morbid obese patients who were receiving medical therapy due to RLS significantly decreased through weight loss following RLS.


Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Perda de Peso , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias , Síndrome das Pernas Inquietas/complicações , Síndrome das Pernas Inquietas/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Resultado do Tratamento
16.
Ann Hematol ; 98(6): 1427-1434, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30834954

RESUMO

Pre-existing pulmonary disease may affect treatment choices, toxicity, and survival of patients with multiple myeloma (MM). However, data on the prognostic value of pulmonary function tests (PFTs) in myeloma patients' outcome, at the time of initial assessment of newly diagnosed patients, are scarce. Here, we prospectively performed PFTs in 121 newly diagnosed MM patients, before initiation of treatment, and we evaluated possible associations of lung function with their outcomes. Fifty-four patients (44.63%) had either obstructive or restrictive pulmonary function defects, even among those not reporting a history of lung disease. The survival was significantly worse in those with obstructive pulmonary defect (median OS 32.8 months) vs. those with restrictive (median OS 52.5 months) or normal lung function (median not reached, 3-year survival 76%) (p = 0.013), independently of other myeloma-related factors. Forced vital capacity (FVC) (lt) (p = 0.012), forced expiratory volume in 1 s (FEV1) (lt) (p = 0.018), peak expiratory flow (PEF) (lt/min) (p = 0.008), carbon monoxide diffusion capacity (DLCO) (p = 0.012), and expiratory/inspiratory pressures (Pe) (kPa) (p = 0.032)/(Pi) (kPa) (p = 0.023) were significantly associated with OS. Myeloma-related factors associated with survival included ISS stage (p = 0.008), hypercalcemia (p = 0.064), and high-risk cytogenetics (p = 0.004). In the multivariate analysis, only the presence of high-risk cytogenetics and presence of either or both PEF and DLCO < 65% of predicted were independent prognostic factors. We conclude that PEF and DLCO could be useful in the initial assessment of newly diagnosed MM patients as significant predictors of survival. Further research is needed to evaluate if respiratory screening should be included in the routine initial evaluation of myeloma patients, despite the presence or absence of respiratory symptoms or abnormal clinical respiratory examination.


Assuntos
Pulmão/fisiopatologia , Mieloma Múltiplo/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Antineoplásicos/uso terapêutico , Caquexia/etiologia , Comorbidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Pneumopatias Obstrutivas/epidemiologia , Pneumopatias Obstrutivas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/mortalidade , Obesidade Mórbida/epidemiologia , Osteólise/etiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Curva ROC , Testes de Função Respiratória , Fatores de Risco , Fumar/epidemiologia , Espirometria , Resultado do Tratamento
17.
Am J Obstet Gynecol ; 221(1): 57.e1-57.e7, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30849351

RESUMO

BACKGROUND: Surgical site infections are associated with significant healthcare cost and burden. Silver-impregnated dressings have been associated with a decrease in surgical site infections in select populations, but it is unknown whether the benefit can be observed after cesarean deliveries. OBJECTIVE: We sought to evaluate the impact of silver nylon dressings in reducing superficial surgical site infections after cesarean delivery. MATERIALS AND METHODS: A blinded randomized clinical trial of women undergoing scheduled or unscheduled cesarean delivery at a single site was conducted. Women were recruited for participation from September 2013 to June 2016. Women with vertical skin incisions were excluded. Enrolled participants were randomized to silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient office at 1 week and 6 weeks after delivery. The primary outcome was superficial surgical site infection as defined by Centers for Disease Control criteria at any time within the first 6 weeks after cesarean delivery. A sample size of 330 per group (n = 660) was planned to compare the 2 arms. Data were analyzed using the χ2, Fisher exact test, Student t test, Mann-Whitney U test, and logistic regression where appropriate, and a value of P < .05 was considered significant. RESULTS: Among the 657 participants, overall, the primary outcome was similar between the 2 groups (4.6% in the silver nylon group vs 4.2% in the gauze group, P = .96). Women allocated to silver nylon, when compared to those who were allocated to gauze, had similar rates of superficial surgical site infection within 1 week (1.2% vs 0.9%) and within 6 weeks ( 4.6% vs 4.2%) after delivery (P >.99). The 2 groups were similar in age (30.9 ± 5.6 vs 31.0 ± 5.5 years, P = .95), body mass index (36.2 ± 8.7 vs 35.3 ± 8.2 kg/m2, P = .19), pregestational diabetes (6.2% vs 3.4%, P = .14), gestational diabetes (7.9% vs 7.3%, P = .88), cesarean delivery after labor (31.9% vs 31.1%, P = .86), presence of chorioamnionitis (5.2% vs 2.1% P = .06), and operative time (56.4 ± 20.6 vs 55.9 ± 17 minutes, P = .69). After adjusting for clinical and sociodemographic confounding variables, current smoking (adjusted odds ratio, 4.9; 95% confidence interval, 1.8-13.4) body mass index ≥40 kg/m2 (adjusted odds ratio, 3.08; 95% confidence interval, 1.3-6.8), and surgery length (minutes) (adjusted odds ratio, 1.02; 95% confidence interval, 1.002-1.04), but not use of gauze dressing, were associated with superficial surgical site infections. CONCLUSION: Among women undergoing cesarean delivery, silver nylon dressing was not more effective than gauze in reducing the risk of superficial surgical site infections.


Assuntos
Bandagens , Cesárea , Compostos de Prata/uso terapêutico , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Índice de Massa Corporal , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Obesidade Mórbida/epidemiologia , Duração da Cirurgia , Gravidez , Gravidez em Diabéticas/epidemiologia , Fatores de Risco , Fumar/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
18.
Medicine (Baltimore) ; 98(9): e14735, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817626

RESUMO

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) are common weight loss procedures. Our meta-analysis compared these procedures for the treatment of morbid obesity and related diseases. METHODS: We systematically searched the PubMed, Embase, and the Cochrane Library through January 2018. The percentage of excess weight loss (%EWL), improvement or remission of type 2 diabetes mellitus (T2DM) and hypertension were analyzed and compared. RESULTS: Thirty-three studies with 4109 patients were included. Greater decreases in excess weight were found in patients who received LSG at 6 months (weighted mean difference (WMD) -9.29, 95% confidence interval (CI): -15.19 to -3.40, P = .002), 12 months (WMD -16.67 95% CI: -24.30 to -9.05, P < .0001), 24 months (WMD -19.63, 95% CI: -29.00 to -10.26, P < .0001), and 36 months (WMD -19.28, 95% CI: -27.09 to -11.47, P < .0001) than in patients who received LAGB. However, there were no significant differences in the 3-month outcomes between the 2 groups (WMD -1.61, 95% CI: -9.96 to 6.73, P = .70). T2DM patients after LSG experience more significant improvement or remission of diabetes (odds ratio (OR): 0.22, 95% CI: 0.06-0.87, P = .03). The 2 groups did not significantly differ regarding improvement or remission of hypertension (OR 0.80, 95% CI: 0.46-1.38, P = .42). CONCLUSION: LSG is a more effective procedure than LAGB for morbidly obese patients, contributing to a higher %EWL and greater improvement in T2DM.


Assuntos
Gastrectomia/métodos , Gastroplastia/métodos , Obesidade Mórbida/cirurgia , Perda de Peso , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Laparoscopia/métodos , Obesidade Mórbida/epidemiologia
19.
Arch Orthop Trauma Surg ; 139(4): 553-560, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30778723

RESUMO

INTRODUCTION: The increasing prevalence of obesity has led to an increase in total knee arthroplasties (TKAs) being undertaken in patients with a higher body mass index (BMI). TKA in morbidly obese patients can be technically challenging due to numerous anatomical factors and patient co-morbidities. The long-term outcomes in this patient group are unclear. This systematic review aims to compare the long-term revision rates, functional outcomes and complication rates of TKAs in morbidly obese versus non-obese patients. METHODS: A search of PubMed, EMBASE and PubMed Central was conducted to identify studies that reported revision rates in a cohort of morbidly obese patients (BMI ≥ 40 kg/m2) that underwent primary TKA, compared to non-obese patients (BMI ≤ 30 kg/m2). Secondary outcomes included Knee Society Objective Scores (KSOS), Knee Society Functional Scores (KSFS), and complication rates between the two groups. The difference in revision rates was assessed using the Chi-squared test. The Wilcoxon signed-rank test was used to compare pre-operative and post-operative functional scores for each group. KSOS and KSFS for morbidly obese and non-obese patients were compared using the Mann-Whitney test. Statistical significance was defined as p ≤ 0.05. RESULTS: Nine studies were included in this review. There were 624 TKAs in morbidly obese patients and 9,449 TKAs in non-obese patients, average BMI values were 45.0 kg/m2 (range 40-66 kg/m2) and 26.5 kg/m2 (range 11-30 kg/m2) respectively. The average follow-up time was 4.8 years (range 0.5-14.1) and 5.2 years (range 0.5-13.2) respectively, with a revision rate of 7% and 2% (p < 0.001) respectively. All functional scores improved after TKA (p < 0.001). Pre- and post-operative KSOS and KSFS were poorer in morbidly obese patients, however, mean improvement in KSOS was the same in both groups and comparable between groups for KSFS (p = 0.78). Overall complication rates,  including infection, were higher in morbidly obese patients. CONCLUSIONS: This review suggests an increased mid to long-term revision rate following primary TKA in morbidly obese patients, however, these patients have a functional recovery which is comparable to non-obese individuals. There is also an increased risk of perioperative complications, such as superficial wound infection. Morbidly obese patients should be fully informed of these issues prior to undergoing primary TKA.


Assuntos
Artroplastia do Joelho , Obesidade Mórbida/epidemiologia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/estatística & dados numéricos , Estudos de Coortes , Humanos , Resultado do Tratamento
20.
BMJ Case Rep ; 12(1)2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642854

RESUMO

A 58-year-old morbidly obese male (body mass index: 38 kg/m2) with severe haemophilia A underwent total knee replacement surgery. Perioperatively, factor VIII (FVIII) levels were measured daily and maximum a posteriori (MAP) Bayesian estimation was used to calculate the individual pharmacokinetic (PK) parameters and doses required to obtain prescribed FVIII target levels. In the MAP Bayesian procedure, a population PK model was used in which PK parameters were normalised using body weight. In this specific case, ideal body weight was used to scale the PK parameters instead of actual body weight. Except for the preoperative FVIII level, adequate FVIII levels were achieved during the 10-day perioperative period. During follow-up visits, the knee prosthesis was reported to function adequately.


Assuntos
Artroplastia do Joelho/instrumentação , Fator VIII/farmacocinética , Hemofilia A/tratamento farmacológico , Assistência ao Convalescente , Artroplastia do Joelho/métodos , Coagulantes/farmacocinética , Fator VIII/uso terapêutico , Hemofilia A/prevenção & controle , Humanos , Prótese do Joelho/normas , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Procedimentos Ortopédicos , Período Perioperatório , Resultado do Tratamento
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