Nexus (Brazil)

Although bariatric surgery is today's gold standard treatment for obesity, weight regain affects the success rate of the procedure. Recent studies have identified psychiatric and neurological factors as possible causes. The aim of this study was to evaluate the influence of psychiatric diseases on the outcome and long-term success of bariatric surgeries and find a weight regain threshold that has an acceptable sensibility to mental health-related issues to be used in research and clinical studies. This is a observational study of bariatric patients submitted to Roux-en-Y bypass or sleeve gastrectomy, with a postoperative time of 2-10 years to access weight regain, depression, and binge-eating disorder. Of 217 patients studied, 163 were women and 54 were men, with an average postoperative time of 5.2±2.6 years. Weight regain was experienced in 35% of the patients, binge-eating disorder in 24.9%, and depression in 24%. The greater weight before surgery, body mass index (BMI), percentage increase to maximum weight loss, and time postoperatively all have a significant positive correlation with weight regain (p=0.045, p=0.026, p<0.001, and p<0.001, respectively). A significant association between binge-eating disorder, depression, and anxiety with weight regain (p=0.004, p=0.008, and p=0.001, respectively) was found. The significant weight regain rates with significant impact on psychiatric disorders highlight the need for continuous postoperative monitoring focused on the psychiatric aspects of obesity to aid surgeries' long-term success.

A 35-year-old woman, G2P1, 12 weeks and 6 days, previous Caesarean section 2 years before, at first trimester ultrasound screening presented placenta previa that severely invaded the uterine scar, impossible to define limits between the invasive placenta, myometrium and bladder serosa. The fetus evidenced wide opened thoracoabdominal defect, ectopia cordis and bilateral choroid plexus cysts, representing high risk for trisomies 18 (1:4) and 13 (1:10). A multidisciplinary protocol was elaborated to ensure suitable support for the patient considering the high mortality related to abnormal placental implantation (API). Termination of pregnancy was suggested, followed by abortion induction ensuring hemodynamic support if necessary. After family's consent, pregnancy interruption was performed by abdominal ultrasound guided puncture followed by abortion induction. After delivering, the patient presented increased transvaginal bleeding, stabilised with crystalloids resuscitation and uterine balloon tamponade. Conservative follow-up with the vascular surgery follow-up was suggested. Ultrasound control was performed for four months without changes of the hypervascularisation on the Caesarean scar. Considering uterus preservation, an embolisation of the heterogeneous mass was performed. Despite the success of the procedure, there was no significant involution of the mass. 12 days after embolisation, the patient presented significant transvaginal bleeding and hemodynamic instability. After discussion with the multidisciplinary team and family, a total abdominal hysterectomy was indicated. The high number of Caesarean sections in Brazil and the high mortality rate from API shows the importance of early ultrasonographic diagnosis and multidisciplinary follow-up in specialised centres for a better maternal-fetal outcome. Despite the mother's desire to preserve her fertility, all actions should converge to the maternal safety in case of uncontrolled bleeding.

This study compares the health status, preventive behaviour and risk factors of female nurses with those of other employed postsecondary-educated women. DATA AND METHODS; Cross-sectional data from the 2003 Canadian Community Health Survey were analyzed. Multiple logistic regression analyses were conducted to adjust for potential confounding by demographic and socio-economic characteristics. When confounding by demographic and socioeconomic characteristics was taken into account, nurses were more likely than other employed postsecondary-educated women to report back problems, that most work days were "quite a bit" or "extremely" stressful, and having had flu immunizations and cervical cancer screening. They were less likely to report insufficient consumption of vegetables and fruit or heavy alcohol use. Canadian nurses' occupation may account for their higher prevalence of back problems and work stress. At the same time, their occupation may motivate flu immunization, cervical cancer screening, and vegetable and fruit consumption. Some problematic aspects of nurses' health profile are similar to those of other educated women.

Erectile dysfunction (ED) is a complex condition, which is variously influenced by physical, emotional, societal, and relationship factors. ED has serious implications for the quality of life (QoL) enjoyed by an affected male and his partner. It is very important, therefore, to understand the impact of ED on the QoL of those affected by it. Our objective was to determine if the eight-question Patient Reported Erectile Function Assessment (PREFA) could act as an independent, comprehensive disease-specific instrument in the assessment of QoL as it is impacted by ED. During the development and validation of the Erectile Function-Visual Analog Scale (EF-VAS) (14), a new ED-specific preference-based instrument, a series of questions were included at the beginning of the assessment that would act as a way to encourage respondents to focus on their own experience with ED. Upon analysis of the EF-VAS data, it became apparent that the eight-question "warm up" section might act as a stand-alone assessment. Accordingly, the eight questions were named PREFA, and a validation analysis was undertaken to determine their consistency, feasibility, reliability, validity, and responsiveness. The PREFA questionnaire was found to be feasible and simple to complete, reliable, and valid, with excellent responsiveness. Overall, the PREFA has demonstrated that it can perform as a stand alone, validated assessment of the impact of ED on QoL, assessing areas of QoL not previously captured in existing instruments. The PREFA is suitable for use in clinical and research settings as a disease-specific QoL assessment tool.