health status

Bariatric surgery is associated with sustained weight loss and improved physical health status for severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery; however, the prevalence of these conditions and whether they are associated with postoperative outcomes remains unknown.

OBJECTIVE:

To determine the prevalence of mental health conditions among bariatric surgery candidates and recipients, to evaluate the association between preoperative mental health conditions and health outcomes following bariatric surgery, and to evaluate the association between surgery and the clinical course of mental health conditions.

DATA SOURCES:

We searched PubMed, MEDLINE on OVID, and PsycINFO for studies published between January 1988 and November 2015. Study quality was assessed using an adapted tool for risk of bias; quality of evidence was rated based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.

FINDINGS:

We identified 68 publications meeting inclusion criteria: 59 reporting the prevalence of preoperative mental health conditions (65,363 patients) and 27 reporting associations between preoperative mental health conditions and postoperative outcomes (50,182 patients). Among patients seeking and undergoing bariatric surgery, the most common mental health conditions, based on random-effects estimates of prevalence, were depression (19% [95% CI, 14%-25%]) and binge eating disorder (17% [95% CI, 13%-21%]). There was conflicting evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Neither depression nor binge eating disorder was consistently associated with differences in weight outcomes. Bariatric surgery was, however, consistently associated with postoperative decreases in the prevalence of depression (7 studies; 8%-74% decrease) and the severity of depressive symptoms (6 studies; 40%-70% decrease).

CONCLUSIONS AND RELEVANCE:

Mental health conditions are common among bariatric surgery patients-in particular, depression and binge eating disorder. There is inconsistent evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Moderate-quality evidence supports an association between bariatric surgery and lower rates of depression postoperatively.

Author/s:

Dawes, AJ, Maggard-Gibbons, M, Maher, AR, Booth, MJ, Miake-Lye, I, Shekelle, PG

Can We Say What Diet Is Best for Health?

John Bayhi — Thu, 16 Jan 2020 16:26:48 +0000

Date Added:

January 16, 2020

Journal/Publication:

Annual Review of Public Health

Publisher:

Annual Reviews

Publication Date:

March 1, 2014

Volume:

Pages:

83-103

URL:

Can we say what diet is best for health?

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1146/annurev-publhealth-032013-182351

Keywords

PMID (1):

24641555

MeSH

Dietary Carbohydrates

An evidence-based review of what we currently know about what we should be eating. It appears that Michael Pollan was right when he wrote, in The Omnivore’s Dilemma, “Eat good food, not too much, mostly vegetables.” The only thing he left out was to try to avoid highly processed food of any kind. James W. Mold, MD, MPH

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Diet is established among the most important influences on health in modern societies. Injudicious diet figures among the leading causes of premature death and chronic disease. Optimal eating is associated with increased life expectancy, dramatic reduction in lifetime risk of all chronic disease, and amelioration of gene expression. In this context, claims abound for the competitive merits of various diets relative to one another. Whereas such claims, particularly when attached to commercial interests, emphasize distinctions, the fundamentals of virtually all eating patterns associated with meaningful evidence of health benefit overlap substantially. There have been no rigorous, long-term studies comparing contenders for best diet laurels using methodology that precludes bias and confounding, and for many reasons such studies are unlikely. In the absence of such direct comparisons, claims for the established superiority of any one specific diet over others are exaggerated. The weight of evidence strongly supports a theme of healthful eating while allowing for variations on that theme. A diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention and is consistent with the salient components of seemingly distinct dietary approaches. Efforts to improve public health through diet are forestalled not for want of knowledge about the optimal feeding of Homo sapiens but for distractions associated with exaggerated claims, and our failure to convert what we reliably know into what we routinely do. Knowledge in this case is not, as of yet, power; would that it were so.

Author/s:

Katz, DL, Meller, S

Association of household secondhand smoke exposure and mortality risk in patients with heart failure

John Bayhi — Fri, 03 Jan 2020 17:30:23 +0000

Date Added:

January 3, 2020

Journal/Publication:

BMC Cardiovascular Disorders

Publisher:

BioMed Central Ltd

Publication Date:

December 2, 2019

Issue:

Volume:

URL:

Association of household secondhand smoke exposure and mortality risk in patients with heart failure

Type:

Clinical Research Results

DOI (1):

10.1186/s12872-019-1269-y

Keywords

heart failure

mortality

secondhand smoke

PMID (1):

31791236

MeSH

Adult

Humans

self report

Proportional Hazards Models

risk factors

Tobacco Smoke Pollution

Nutrition Surveys

cardiovascular diseases

follow-up studies

Odds Ratio

health status

Surveys and Questionnaires

Prognosis

heart failure

Socioeconomic Factors

Second-hand smoke exposure appears to hasten death in patients with CHF. James W. Mold, MD, MPH

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BACKGROUND:

Secondhand smoke (SHS) exposure is a well-established cardiovascular risk factor, yet association between SHS and prognosis of heart failure remains uncertain.

METHOD:

Data were obtained from the US National Health and Nutrition Examination Surveys III from 1988 to 1994. Currently nonsmoking adults with a self-reported history of heart failure were included. Household SHS exposure was assessed by questionnaire. Participants were followed up through December 31, 2011. Cox proportional-hazards models were used to assess the association of household SHS exposure and mortality risk. Potential confounding factors were adjusted.

RESULTS:

Of 572 currently nonsmoking patients with heart failure, 88 were exposed to household SHS while 484 were not. There were totally 475 deaths during follow-up. In univariate analysis, household SHS was not associated with mortality risk (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.76-1.26, p = 0.864). However, after adjustment for demographic variables, socioeconomic variables and medication, heart failure patients in exposed group had a 43% increase of mortality risk compared with those in unexposed group (HR: 1.43, 95% CI: 1.10-1.86, p = 0.007). Analysis with further adjustment for general health status and comorbidities yielded similar result (HR: 1.47, 95% CI: 1.13-1.92, p = 0.005).

CONCLUSION:

Household SHS exposure was associated with increased mortality risk in heart failure patients.

Author/s:

He, X, Zhao, J, He, J, Dong, Y, Liu, C

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

John Bayhi — Thu, 11 Jul 2019 19:47:05 +0000

Date Added:

July 11, 2019

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

July 11, 2019

Issue:

Volume:

381

Pages:

111-120

URL:

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1803185

Keywords

C-reactive protein

primary care

chronic obstructive pulmonary disease

copd

CRP

randomized control trial

antibiotics

PMID (1):

31291514

MeSH

Point-Of-Care Testing

anti-bacterial agents

technology assessment, biomedical

Wales

follow-up studies

random allocation

pulmonary disease, chronic obstructive

health status

Surveys and Questionnaires

primary health care

referral and consultation

England

In adults with acute COPD exacerbations, serum CRP-based decision-making led to fewer antibiotic prescriptions with no adverse consequences. Physicians and patients in the intervention group were advised to consider all clinically relevant information. However, they were advised to consider that CRP levels < 4omg/L indicated that antibiotics were probably not needed, levels between 20 and 40 mg/L were indeterminant, and levels above 40 mg/L suggested that antibiotics were probably necessary. Note: In this study, physicians were able to obtain CRP levels at the point of care. James W. Mold, MD, MPH

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BACKGROUND

Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).

METHODS

We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority).

RESULTS

A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was −0.19 points (two-sided 90% CI, −0.33 to −0.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation.

CONCLUSIONS

CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm. (Funded by the National Institute for Health Research Health Technology Assessment Program; PACE Current Controlled Trials number, ISRCTN24346473.)

Author/s:

Butler, Christopher C., Gillespie, David, White, Patrick, Bates, Janine, Lowe, Rachel, Thomas-Jones, Emma, Wootton, Mandy, Hood, Kerenza, Phillips, Rhiannon, Melbye, M., Llor, Carl, Cals, Jochen W.L.