•BMI positively correlates with the presence of weight stigma.•The presence of weight stigma does not exert a significant influence on weight loss.•Inflammatory markers are greater with the presence ...of weight stigma among subjects living with obesity.
Weight stigma (WS) and prejudice are one of the most prevalent ways of discrimination among adults, comparable with rates of racial discrimination. Exposure to WS among patients with obesity (PWO) may make the adoption of healthy dietary patterns and regular physical activity even more challenging and, therefore, the achievement of weight loss. Additionally, WS could also induce physiological responses such as increased levels of inflammatory markers, due to stress exposure.
Subjects attending two obesity clinics were evaluated at baseline and after a minimum follow-up of six months. The weight Bias Internalization Scale (WBIS) and the Stigmatizing Situations Inventory (SSI) were administered to evaluate WS. Also, anthropometric and inflammatory markers, including cortisol, ferritin and C-reactive protein (CRP), were recorded at baseline.
79 PWO (87.3%♀, 45.5 ± 1.3 years, 35.9 ± 6.3 kg/m2) were included. At baseline, 72.2% started liraglutide as anti-obesity drug. Baseline body mass index (BMI) correlated positively with both WBIS (r = 0.23; p = 0.03) and SSI (r = 0.25; p = 0.02) scores. Mean percentual weight loss after a mean follow-up of six months was -7.28%. However, there was a negative, but not statistically significant, correlation between weight loss and both WBIS (r=-0.14; p = 0.2) and SSI (r=-0.19; p = 0.08). Regarding inflammatory markers, plasma cortisol levels at baseline correlated positively with WBIS (p = 0.005) and SSI (p = 0.02). CRP at baseline also presented a positive correlation with SSI (p = 0.03). No significant correlations were found for stigma tests and ferritin levels.
As weight increases among PWO, so does stigma. Despite we did not find a significant negative association between the presence of WS and weight loss outcomes, there was an increase in inflammatory markers among PWO who experienced higher levels of WS.
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Objetivo: describir los pacientes con egreso inoportuno de origen no médico, sus características sociodemográficas, clínicas y estimar los costos derivados, durante el 01 de junio y el 31 de agosto ...de 2017, en una institución de salud de alto nivel de complejidad. Material y métodos: estudio observacional, retrospectivo. La definición operativa de egreso inoportuno correspondía a pacientes que desde el punto de vista clínico podían ser dados de alta, pero continuaban ocupando una cama por problemas no médicos. Los datos fueron tomados de las historias clínicas y para el análisis de costo, se tuvieron en cuenta el total de los costos generados por la estancia inapropiada, incluyendo el costo día de hospitalización, insumos, medicamentos y evaluaciones médicas. La perspectiva del costo fue desde el pagador. Resultados: de los 3273 egresos durante el periodo analizado, se presentaron 79 casos de egresos inoportunos (2.4%). La edad media de los pacientes fue de 49 años. El 62% eran del régimen subsidiado; 60.7% eran procedentes de otros departamentos o municipios lejanos. El total de días hospitalización perdidos por esta causa fue de 547, con una media de 6.6 días por paciente. Los servicios más afectados fueron medicina interna y cuidados paliativos. Las principales causas fueron: necesidad de tiquetes para retornar al lugar de procedencia, alta temprana por medicamentos o insumos para el egreso y necesidad de oxígeno. El costo total que se generó por egreso inoportuno fue US$83 935, con un valor promedio de US$1062.47 por paciente. Conclusión: el egreso inoportuno es un problema evidente en la atención. Las principales causas que encontramos fueron problemas sociales y traslados regionales. Además genera un gasto adicional importante de recursos materiales y económicos tanto para las instituciones como para el sistema. (Acta Med Colomb 2020; 45. DOI: Palabras clave: utilización inadecuada de la hospitalización, egreso inoportuno, costos. Objective: to describe the sociodemographic and clinical characteristics of patients with nonclinical delayed discharge and estimate the resulting costs in a tertiary healthcare facility from June 1 to August 31, 2017. Materials and methods: a retrospective observational study. The working definition of delayed discharge was patients who, from a clinical perspective, could be discharged but who continued to occupy a bed due to nonclinical problems. The data were taken from the medical charts, and the total costs incurred by the inappropriate length of stay were used for the cost analysis, including the cost per inpatient day, supplies, medications and medical assessments, from the payer's cost perspective. Results: of the 3,273 discharges during the study period, there were 79 cases of delayed discharge (2.4%). The mean age of the patients was 49 years. Sixty-two percent had subsidized medical insurance; 60.7% came from other departments or distant towns. The total number of inpatient days lost due to this cause was 547, with a me of 6.6 days per patient. The departments which were most affected were internal medicine and palliative care. The main causes were: the need for tickets to return to their place of origin, early discharge due to medications or discharge supplies and the need for oxygen. The total cost incurred due to delayed discharge was USD 83,935, with an average of USD 1,062.47 per patient. Conclusion: delayed discharge is an evident healthcare problem. The main causes found in this study were social and regional transport issues. Delayed discharge also causes a significant additional expense in material and financial resources for both the institutions and the system. (Acta Med Colomb 2020; 45. DOI: Key words: inappropriate use of hospitalization, delayed discharge, costs.
One of the potential negative effects of a lockdown are changes in dietary and lifestyle patterns, which can lead to weight gain. Our objective was to assess the changes on dietary habits and eating ...patterns in a lockdown situation and their impact on weight. We aimed to determine whether the treatment with GLP1 analogues (aGLP1) could impact on these parameters.
100 overweight/obese patients were consecutively recruited for a review at the end of the lockdown. A structured interview was designed to see changes in dietary habits, routines and exercise.
52% patients gained weight during lockdown. The percentage of subjects with an active history of depression or anxiety was higher among the group of patients who gained weight. The percentage of patients who worsened their hyperphagia was higher in those who gained weight (71.2% vs. 10.6%; P<0.0001); similar results were observed with binge eating (92% vs. 10.6%; p<0.0001) and cravings, both sweet and salty (69.2% vs. 21.3% and 69.2% vs. 14.9%; p<0.0001 and p<0.0001 respectively). Of the 48 patients who did not gain weight, 30 were under aGLP1 treatment (61.7%). The worsening of abnormal eating patterns was lower among patients treated with aGLP-1.
A lockdown is a vulnerable period to gain weight, especially in those patients with a psychopathological history. aGLP1 manage to control emotional eating, making them a valuable therapeutic option.
One of the potential negative effects of a lockdown are changes in dietary and lifestyle patterns, which can lead to weight gain. Our objective was to assess the changes on dietary habits and eating ...patterns in a lockdown situation and their impact on weight. We aimed to determine whether the treatment with GLP1 analogues (aGLP1) could impact on these parameters.
100 overweight/obese patients were consecutively recruited for a review at the end of the lockdown. A structured interview was designed to see changes in dietary habits, routines and exercise.
52% patients gained weight during lockdown. The percentage of subjects with an active history of depression or anxiety was higher among the group of patients who gained weight. The percentage of patients who worsened their hyperphagia was higher in those who gained weight (71.2% vs 10.6%; P < .0001); similar results were observed with binge eating (92% vs 10.6%; P < .0001) and cravings, both sweet and salty (69.2% vs 21.3% and 69.2% vs 14.9%; P < .0001 and P < .0001 respectively). Of the 48 patients who did not gain weight, 30 were under aGLP1 treatment (61.7%). The worsening of abnormal eating patterns was lower among patients treated with aGLP-1.
A lockdown is a vulnerable period to gain weight, especially in those patients with a psychopathological history. aGLP1 manage to control emotional eating, making them a valuable therapeutic option.
Uno de los potenciales efectos negativos de un confinamiento son los cambios en los patrones dietéticos y de estilo de vida, que pueden conllevar a una ganancia de peso. El objetivo fue ver los cambios sobre los hábitos higiénico-dietéticos y de patrones de ingesta en una situación de confinamiento y el impacto sobre el peso. Asimismo, ver si el estar bajo tratamiento con análogos de GLP1 (aGLP1) modificó estos parámetros.
Se reclutaron de forma consecutiva 100 pacientes con sobrepeso/obesidad que acudieron a revisión al finalizar el confinamiento. Se diseñó una entrevista estructurada para ver los cambios en los hábitos dietéticos, rutinas y ejercicio.
El 52% pacientes ganaron peso durante el confinamiento. El porcentaje de sujetos con historia activa de depresión o ansiedad fue superior entre el grupo de pacientes que ganó peso. El porcentaje de pacientes que empeoraron su hiperfagia ansiosa fue superior en aquellos que ganaron peso (71,2% vs 10,6%; P < ,0001); lo mismo ocurrió con los atracones (92% vs 10,6%; P < ,0001) y los cravings, dulces y salados (69,2% vs 21,3% y 69,2% vs 14,9%; P < ,0001 y P < ,0001 respectivamente). De los 48 pacientes que no ganaron peso, 30 estaban bajo tratamiento con aGLP1 (61,7%). El empeoramiento de los patrones anómalos de ingesta fue inferior entre los pacientes bajo tratamiento con aGLP-1.
Un confinamiento es un período vulnerable para ganar peso, especialmente en aquellos pacientes con antecedentes psicopatológicos. Los aGLP1 consiguen controlar la ingesta emocional convirtiéndolos en una opción terapéutica valiosa.
Aims
Data regarding the prevalence of eating disorders (ED) and their influence on clinical outcomes among patients with type 2 diabetes (T2DM) are scarce. Our aim is to investigate the frequency of ...positive screening for ED, specifically binge eating disorder (BED), in a T2DM sample and analyze whether there are any differences among T2DM subjects with a positive screening for ED or BED.
Methods
Three hundred and twenty subjects with T2DM were recruited randomly. All participants were evaluated for the presence of ED by completing the “Eating Attitudes Test-26” (EAT-26). In addition, the “Questionnaire of Eating and Weight Patterns–Revised” (QEWP-R) for the screening of BED was also implemented. Sociodemographic, clinical and biochemical parameters were also recorded.
Results
According to EAT-26, 14 % of subjects screened positive for ED. Regarding QEWP-R, 16 % had a positive screening for ED, with BED having a frequency of 12.2 %, being the most prevalent one. There was a positive correlation between the scores obtained with the EAT-26 and the Beck Depression Inventory (
p
= 0.0014). Patients with BED were younger (57.5 ± 11.1 vs 63.3 ± 10.3 years;
p
= 0.004), with a lesser T2DM duration (8.5 ± 6.1 vs 12.1 ± 9.6 years;
p
= 0.002). Weight and BMI among subjects with BED were greater (89.1 ± 1.3 vs 82.4 ± 16.7 kg;
p
= 0.04 and 39.4 ± 10.3 vs 30.7 ± 5.5 kg/m
2
;
p
= 0.01). The frequency of subjects with one admission related to T2DM or any other condition during the last year was higher (10 vs 3 %;
p
= 0.04 and 33 vs 21 %;
p
= 0.01).
Conclusions
ED among T2DM are frequent. Due to their deleterious effect on different metabolic and psychological outcomes, they should be diagnosed promptly, especially BED.
After bariatric surgery, de novo eating patterns can develop, such as grazing. Although grazing has been associated with poorer weight loss, it has received minimal attention. We aimed to assess the ...influence of grazing in clinical, biochemical and psychological outcomes in a bariatric surgery sample.
Sixty patients (78.3%♀, age 46.35±9.89, months since BS 46.28±18.1) who underwent BS were evaluated cross-sectionally. Clinical, biochemical and psychological parameters were recorded. A pattern of grazing was assessed in this group of patients through interview.
41.7% met criteria for grazing. Mean time since BS was greater in the group with grazing (57.64±23.7months vs 38.8±26.44months; p=0.008). Although there were no differences in initial and current BMI, the percentage of patients with weight regain was greater among patients with grazing (72% vs 11.7%; p<0.0001) and the percentage of excess weight loss was lower (28.15±6.96% vs 33.35±11.9%; p=0.05). There were more difficulties in following the standardized visits according to our hospital's protocol (17.6% vs 56%; p=0.009). No significant differences were found when assessing presurgical psychiatric comorbidity among patients with a grazing pattern and individuals without this condition (68% vs 55.9%; p=0.423). When assessing quality of life only mental health was lower among patients with grazing (49.6±22.7 vs 64.2±23.3; p=0.02).
Development of grazing is frequent after BS, especially when weight loss has reached a plateau. Due to its potential association with weight regain, systematic screening of grazing after BS is warranted.
•After bariatric surgery, de novo eating patterns can develop, such as grazing•One aim of the study is to analyze the frequency of grazing among patients who undergo bariatric surgery.•We also wanted to assess the influence of such eating pattern in different outcomes.•Abnormal eating patterns should be monitored after surgery to prevent weight regain or unsuccessful results.
We wanted to assess the prevalence of individuals with food addiction (FA) among bariatric surgery (BS) patients at long term and to determine if there was any relationship between FA and both ...clinical and psychological outcomes at the time of the evaluation.
Participants were evaluated for the presence of FA with the Yale Food Addiction Scale 2.0.
Of 134 subjects, 32 (23.9%) included met criteria for FA. The frequency of patients with depression at the time of the evaluation was greater among subjects with FA (34.4% vs. 11.8%;
= 0.006). The score obtained with the Beck Depression Inventory at the time of the evaluation was greater among subjects with FA (14.8 ± 11.5 vs. 6 ± 6.5;
< 0.0001). The frequency of subjects with FA who had criteria for binge eating disorder at the time of the evaluation was significantly greater (56.3% vs. 20.5%;
< 0.001). Patients with FA scored higher in the Lattinen index for chronic pain at the time of the evaluation (8.7 ± 5.9 vs. 5.8 ± 5.4;
= 0.014). However, clinical outcomes were similar between the two groups.
Routine screening for FA at long term postoperatively should be recommended to improve psychological outcomes of BS.
Several factors that worsen the prognosis of the new coronavirus SARS-CoV-2 have been identified, such as obesity or diabetes. However, despite that nutrition may change in a lockdown situation, ...little is known about the influence of malnutrition among subjects hospitalized due to COVID-19. Our study aimed to assess whether the presence of malnutrition among patients admitted due to COVID-19 had any impact on clinical outcomes compared with patients with the same condition but well nourished.
75 patients admitted to hospital due to COVID-19 were analyzed cross-sectionally. Subjective Global Assessment (SGA) was completed by phone interview. Clinical parameters included were extracted from the electronic medical record.
According to the SGA, 27 admitted due to a COVID-19 infection had malnutrition. Patients not well nourished were older than patients with a SGA grade A (65 ± 14.1 vs 49 ± 15.1 years; p < 0.0001). Length of hospital stay among poorly nourished patients was significantly higher (18.4 ± 15.6 vs 8.5 ± 7.7 days; p = 0.001). Mortality rates and admission to ICU were greater among subjects with any degree of malnutrition compared with well-nourished patients (7.4% vs 0%; p = 0.05 and 44.4% vs 6.3%; p < 0.0001). CRP (120.9 ± 106.2 vs 60.8 ± 62.9 mg/l; p = 0.03), D-dimer (1516.9 ± 1466.9 vs 461.1 ± 353.7 ng/mL; p < 0.0001) and ferritin (847.8 ± 741.1 vs 617.8 ± 598.7mcg/l; p = 0.03) were higher in the group with malnutrition. Haemoglobin (11.6 ± 2.1 vs 13.6 ± 1.5 g/dl; p < 0.0001) and albumin 3.2 ± 0.7 vs 4.1 ± 0.5 g/dl; p < 0.0001) were lower in patients with any degree of malnutrition.
The presence of a poor nutritional status is related to a longer stay in hospital, a greater admission in the ICU and a higher mortality.
The walnut (Carya illinoinensis) is a key product for the Mexican commercial sector. In 2016, SAGARPA declared that the nut is among the top twenty most exported products to the United States, with a ...value of 212,119 thousand dollars. Weather, geography and market conditions has given the country certain advantage in production, causing an increase in exports and imports throughout the years with the United States and China (Alderete, 2018). The objective of this paper is to prove the comparative advantage theory by Heckscher and Ohlin applied to the Mexican walnut industry. In this investigation, we analyze the value of exports in the country, relative to the other country, and worldwide; the standard revealed comparative advantage measurements is used, following the method of measurement made by Yu et al., (2009) and the method of Clifton and Marxsen (1948), to measure relative abundance of factors and to measure the intensity of the use of facts, the procedure of Fernández and Subirà (2006), is utilised. In conclusion, there is consistent evidence with Heckscher and Ohlin for the case of Mexico, that is, labor-intensive goods are exported; opposite case is the United States.
The clinical spectrum of the SARS-CoV-2 infection is very broad, ranging from asymptomatic infection to severe pneumonia. However, the majority of fatalities related to COVID-19 have involved old, ...frail and patients with comorbidities, such as obesity, groups that also have high rates of a poor nutritional status. To assess the impact on clinical outcomes of the coexistence of any degree of obesity and low albumin levels on admission among patients with COVID-19.
This is a sub-analysis of a former study where 75 patients admitted due to COVID-19 were evaluated cross-sectionally. In this analysis, patients were divided in two groups, according to the presence of obesity and albumin levels on admission lower than 3.5 g/dl.
11 out 75 patients evaluated (14.7%) had obesity and albumin levels lower than 3.5 g/dl. Patients with obesity and hypoalbuminemia were older than patients without these two conditions (65.3 ± 7.7 vs 54.2 ± 17 years; p = 0.01). CRP (141.4 ± 47.9 vs 70.1 ± 60.6 mg/l; p = 0.002), D-dimer (2677.3 ± 2358.3 vs 521.7 ± 480.3 ng/ml; p = 0.001), fibrinogen (765.9 ± 123.9 vs 613.5 ± 158gr/L; p = 0.007) ferritin levels (903.1 ± 493 vs 531.4 ± 418.9 mcg/l; p = 0.01) and procalcitonin (3.5 ± 0.6 vs 1.1 ± 0.7 ng/ml; p = 0.009) were significantly higher in the group with obesity and hypoalbuminemia. Among patients with low albumin and obesity, length of hospital was higher (21.9 ± 18.7 vs 10.5 ± 9.5 days; p = 0.004) and the proportion of subjects admitted to ICU was greater (81.8% vs 11.5%; p < 0.0001). However, mortality rates were comparable between the two groups (3.8% vs 0%; p = 0.5).
The combination of obesity and hypoalbuminemia may worsen the prognosis of patients with a SARS-CoV-2 infection. Therefore, prompt identification and amelioration of nutritional status could be beneficial.
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