Avaliação da qualidade de vida de pacientes com obesidade grave submetidos à cirurgia bariátrica em um sistema público de saúde

OBJECTIVES: To assess QoL of obese patients in the Brazilian public healthcare system, before and after bariatric surgery, and to determine the appropriateness of the Moorehead-Ardelt Questionnaire II (M-A-QoLQII) compared with the Short-Form Health Survey (SF-36). SUBJECTS AND METHODS: Forty-one severe obese patients in a waiting-list, and 84 patients who underwent bariatric surgery were included. Correlations were tested and reliability determined by the Cronbach's coefficient. RESULTS: BMI differed between the pre- and post-surgery groups (52.3 ± 8.3 kg/m² vs. 32.5 ± 6.4 kg/m², p < 0.001). The latter showed better scores in the SF-36 domains than in the pre-surgery. SF-36 and M-A-QoLQII categories were correlated (r = 0.53, 0.49 and 0.47, for vitality, mental health, and general health domains, p < 0.001). In the logistic regression, age, previous BMI, and loss of excess weight were associated with functional capacity. CONCLUSIONS: The outcomes of bariatric surgery obtained in a Brazilian public healthcare center were successful. M-A-QoLII represents a useful tool to assess surgery outcomes, including QoL.OBJETIVOS: Avaliar a qualidade de vida de pacientes obesos do sistema público de saúde brasileiro antes e após cirurgia bariátrica e a adequação do questionário Moorehead-Ardelt II (M-A-QoLQII) em relação ao SF-36. SUJEITOS E MÉTODOS: Quarenta e um pacientes obesos graves em lista de espera e 84 submetidos à cirurgia bariátrica foram incluídos. Correlações foram testadas e confiabilidade determinada pelo coeficiente de Cronbach. RESULTADOS: O IMC diferiu entre os grupos pré- e pós-cirurgia (52,3 ± 8,3 kg/m² vs. 32,5 ± 6,4 kg/m², p < 0,001). O último apresentou melhores escores nos domínios do SF-36 que o pré-cirurgia. As categorias do SF-36 e M-A-QoLQII se correlacionaram (r = 0,53; 0,49; 0,47 para vitalidade, saúde mental e saúde geral, p 0,001). Na regressão logística, idade, IMC prévio e excesso de peso perdido associaram-se independentemente à capacidade funcional. CONCLUSÕES: Resultados da cirurgia bariátrica em centro de saúde público brasileiro foram promissores. O M-A-QoLQII representa ferramenta útil para avaliar seus resultados, inclusive a QV.Federal University of São Paulo Internal Medicine Department Division of EndocrinologyUNIFESP São Paulo Center for Health Economics Internal Medicine DepartmentUniversity of São Paulo School of Public Health Nutrition DepartmentUNIFESP, Internal Medicine Department Division of EndocrinologyUNIFESP, São Paulo Center for Health Economics Internal Medicine DepartmentSciEL

Virtual Reality for Neuroarchitecture: Cue Reactivity in Built Spaces

Domestic and urban environments are associated to our life experiences and behaviors. These environments may acquire an emotional and motivational value and, in turn, shape our behaviors. Although there is a well-established knowledge of the effects of built space features on perception, feelings, and affective responses (Ulrich, 1991), only a limited attention has been however paid to physical space-induced motivated behaviors. There is still a strong attitude to consider the control of motivated behaviors as a matter of individual desires, free will, moral choices, executive control, etc.—and not as the interaction between environment and personality, genetics, and brain mechanisms. Recently, there has been a convergent agreement from architects, designers, psychologists, and neuroscientists about the multifactorial nature of the reciprocal interaction between humans and built space, and how it could impact on well-being psychological distress and risky behaviors (Sternberg, 2009). The emerging interdisciplinary field of “neuroarchitecture” developed conceptual paradigms and empirical frameworks based on the interaction between brain and built spaces (see Academy of Neuroscience for Architecture; www.anfarch.org). Within this framework, we would like to propose the “Cue Reactivity” phenomenon as a paradigmatic example of such as interaction. Cue reactivity (C-R) is the adaptive response to salient information in the environment (Niaura et al., 1988). Salient information is that associated to drugs, sex, palatable food, and to a variety of natural and non-natural rewards (such as gambling, shopping, etc.). Drug C-R manifests itself as an array of responses to stimuli previously associated to drug effect. The detrimental consequence of C-R is relapse to drug-seeking and drug-taking (Rohsenow et al., 1991). On the other hand, C-R is an evolutionary phenotype of the interaction with the environment: in fact, spatial context rich of reward-related cues may stimulate both positive and risky motivated behaviors. In this Opinion paper, we will show that identification and design of specific physical space features may affect mental health, and that indoor and furniture of drinking venues are associated to alcohol use. Based on what we know about C-R, and on the effects of built spaces on psychological and behavioral processes, we think that more research is now possible to plan and design research-based “C-R-free situations.” For instance, investigations on outdoor and indoor features associated to C-R may help to develop “motivational safer built environments.” The complexity of real world investigations is not however easily modeled in the laboratory, but technologies like virtual reality may offer the possibility to increase subject's presence in a spatial context simulation and, in the meantime, the control of the experimental parameters (García-Rodríguez et al., 2012). For these reasons, we propose virtual reality as a methodological approach in-between naturalistic and experimental lab setting for a better understanding of built space features affecting C-R.The “5per mille 2012” research grant by the Italian Cancer League (Lega Italiana Lotta per i Tumori, LILT) supported the study (PI: CC) and research grant for GB. LILT also supported CC and SF with educational grants

Investigation of the Defatted Colostrum 1H-NMR Metabolomics Profile of Gilts and Multiparous Sows and Its Relationship with Litter Performance

The aim of the study was to characterize the soluble metabolomics profile of defatted colostrum of sows at different parity number (PA) and to correlate the metabolomics profile with the Brix percentage estimate of colostrum immunoglobulin G (IgG) and sow productive traits. A total of 96 Meidam (crossbreed Large White 7 Meishan) sows of PA from 1-4 (PA1: 28; PA2:26; PA3:12; PA4:26) were included, and their productive traits were recorded at 10 days post-farrowing. Colostrum IgG was quantified using a Brix refractometer, and metabolomics profile was assessed using 1H-NMR spectroscopy. Sows' PA slightly influenced the metabolomics profile of colostrum. lactose and glycine were higher in PA1 compared with PA4 (p 0.05) and N-acetylglucosamine (GlcNAc) tended to be higher in PA2 than PA3 and PA4 (p &lt; 0.10). The Brix percentage of IgG was negatively associated with lactose and positively with creatine, myo-inositol, and O-phosphocholine (p &lt; 0.05). Taurine was positively related to litter weight at birth. GlcNAc and myo-inositol were linked to piglet mortality at day 10 with a negative and positive trend, respectively. In conclusion, colostrum of gilts and multiparous sows had a similar metabolomics profile. Specific metabolites contributed to explanation of the variability in colostrum Brix percentage estimate of IgG concentration and the sows' productive performance

Effects of a prevention program on multiple health-compromising behaviours in adolescence: A cluster randomized controlled trial.

We aimed to assess the effectiveness of 'Paesaggi di Prevenzione', a school-based prevention program delivered by trained teachers and designed to tackle smoking, alcohol misuse, dietary risks, and physical inactivity in adolescence. We evaluated the program between 2010 and 2013 with a two-arm, parallel-group, multicentre cluster randomized controlled trial in which schools were the units of randomization. We collected data on health-compromising behaviours using self-reported measurements of behaviour frequency administered before and after program implementation. We used multivariable mixed-effects logistic regression models to estimate program effects on health-compromising behaviours. The analysis sample included 3410 middle school students and 1651 high school students. Among middle school students, mean age at baseline was 12 years (standard deviation [SD] 0.5 years), 51% were boys, and 41% had high socioeconomic status [SES] (defined as having at least one parent/guardian with university level education). In high school students, mean age at baseline was 14 years (SD 0.7 years), 56% were boys, and 31% had high SES. The program did not have effects on smoking, alcohol misuse, and physical activity. The program had iatrogenic effects in regard to some eating behaviours, resulting in (i) lower odds of fruit consumption among middle-school students (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.68-0.99) and (ii) lower odds of having breakfast every day in high-school students at the post-intervention measurement (OR 0.76; 95%CI 0.58-0.99) but not at one-year follow-up (OR 0.94; 95%CI 0.69-1.28). Due to the possibility of unintended effects, we advise against disseminating 'Paesaggi di Prevenzione' in its present form. TRIAL REGISTRATION: ISRCTN00953701

Avaliação da qualidade de vida de pacientes com obesidade grave submetidos à cirurgia bariátrica em um sistema público de saúde

Objectives: To assess QoL of obese patients in the Brazilian public healthcare system, before and after bariatric surgery, and to determine the appropriateness of the Moorehead-Ardelt Questionnaire II (M-A-QoLQII) compared with the Short-Form Health Survey (SF-36). Subjects and methods: Forty-one severe obese patients in a waiting-list, and 84 patients who underwent bariatric surgery were included. Correlations were tested and reliability determined by the Cronbach's coefficient. Results: BMI differed between the pre- and post-surgery groups (52.3 +/- 8.3 kg/m(2) vs. 32.5 +/- 6.4 kg/m(2), p &lt; 0.001). The latter showed better scores in the SF-36 domains than in the pre-surgery. SF-36 and M-A-QoLQII categories were correlated (r = 0.53, 0.49 and 0.47, for vitality, mental health, and general health domains, p &lt; 0.001). In the logistic regression, age, previous BMI, and loss of excess weight were associated with functional capacity. Conclusions:The outcomes of bariatric surgery obtained in a Brazilian public healthcare center were successful. M-A-QoLII represents a useful tool to assess surgery outcomes, including QoL. Arq Bras Endocrinol Metab. 2012;56(1):33-8Objetivos: Avaliar a qualidade de vida de pacientes obesos do sistema público de saúde brasileiro antes e após cirurgia bariátrica e a adequação do questionário Moorehead-Ardelt II (M--A-QoLQII) em relação ao SF-36. Sujeitos e métodos: Quarenta e um pacientes obesos graves em lista de espera e 84 submetidos à cirurgia bariátrica foram incluídos. Correlações foram testadas e confiabilidade determinada pelo coeficiente de Cronbach. Resultados: O IMC diferiu entre os grupos pré- e pós-cirurgia (52,3 ± 8,3 kg/m2 vs. 32,5 ± 6,4 kg/m2 , p < 0,001). O último apresentou melhores escores nos domínios do SF-36 que o pré-cirurgia. As categorias do SF-36 e M-A-QoLQII se correlacionaram (r = 0,53; 0,49; 0,47 para vitalidade, saúde mental e saúde geral, p 0,001). Na regressão logística, idade, IMC prévio e excesso de peso perdido associaram-se independentemente à capacidade funcional. Conclusões: Resultados da cirurgia bariátrica em centro de saúde público brasileiro foram promissores. O M-A-QoLQII representa ferramenta útil para avaliar seus resultados, inclusive a QV. Arq Bras Endocrinol Metab. 2012;56(1):33-

Effectiveness of a school-based multi-component smoking prevention intervention: the LdP cluster randomized controlled trial.

OBJECTIVE: We assessed the effectiveness of the Luoghi di Prevenzione-Prevention Grounds school-based smoking prevention programme. METHODS: We undertook a cluster randomized controlled trial of 989 students aged 14-15 years in 13 secondary schools located in Reggio Emilia, Italy. The intervention consisted of the "Smoking Prevention Tour" (SPT) out-of-school workshop, one in-depth lesson on one Smoking Prevention Tour topic, a life-skills peer-led intervention, and enforcement surveillance of school antismoking policy. Self-reported past 30-day smoking of ≥ 20 or 1-19 days of cigarette smoking (daily or frequent smoking, respectively) was recorded in 2 surveys administered immediately before and 18 months after the beginning of the programme. Analysis was by intention to treat. The effect of the intervention was evaluated using random effects logistic regression and propensity score-matching analyses. RESULTS: Past 30-day smoking and daily cigarette use at eighteen months follow-up were 31% and 46% lower, respectively, for intervention students compared to control students. Taking into account non-smokers at baseline only, daily smoking at eighteen months follow-up was 59% lower in intervention students than in controls. Past 30-day smoking in school areas was 62% lower in intervention students compared to controls. CONCLUSIONS: The Luoghi di Prevenzione-Prevention Grounds programme was effective in reducing daily smokers and in reducing smoking in school areas.This study was supported by Lega contro i Tumori (LILT), Reggio Emilia, Italy, by Public Health Service, Emilia-Romagna Region, and by Mental Health and Drug Addiction Service, Emilia-Romagna Regio

A school-based peer-led smoking prevention intervention with extracurricular activities: the LILT-LdP cluster randomized controlled trial design and study population.

AIMS AND BACKGROUND: Few school programs are effective in preventing adolescents' tobacco smoking initiation. The "Lega contro i Tumori - Luoghi di Prevenzione" is a cluster randomized controlled trial designed to evaluate a school-based peer-led smoking prevention intervention with extracurricular activities for students aged 14-15 years. This paper presents the study design and the baseline characteristics of the study population. METHODS AND STUDY DESIGN: Twenty secondary schools located in the Reggio Emilia province took part in the study. Five schools were excluded because they already participated in smoking prevention interventions. The schools were randomized to control or intervention arms. The study population consisted of students attending the first grade. Components of the intervention included 1) the out-of-school "Smoking Prevention Tour" (SPT) at the "Luoghi di Prevenzione" Center, a 4-hour (4 sessions) extracurricular activity; 2) the "Smoke-free Schools" intervention, combining a life-skills-based peer-led intervention at school, an in-depth lesson on one of the SPT sessions, and enforcement surveillance of the school antismoking policy. Tobacco use was studied through a questionnaire administered before and 6 months after the intervention. RESULTS: Eleven high schools and 9 vocational secondary schools took part in the study for a total of 2,476 out of 3,050 eligible students (81.2%). The proportions of respondents in high schools and vocational secondary schools were 90.9% and 64.5%, respectively (P <0.001). Intervention and control arms showed a different distribution of gender and school type, whereas no difference was observed in any tobacco-use characteristic. CONCLUSIONS: This study is one of the few Italian trials to evaluate the effectiveness of a school-based program for preventing smoking initiation.This study was supported by Lega Italiana per la Lotta contro i Tumori (LILT) di Reggio Emilia, onlus, Reggio Emilia, Italy, by Public Health Service, Emilia-Romagna Region, and by Mental Health and Drug Addiction Service, Emilia-Romagna Regio

A prevention program for multiple health-compromising behaviors in adolescence: baseline results from a cluster randomized controlled trial.

OBJECTIVE: To describe the design and present the baseline findings of the evaluation study of 'Paesaggi di Prevenzione', a school-based prevention program tackling smoking, alcohol misuse, dietary risks, and physical inactivity in 12- to 14-year-olds. METHODS: The program was implemented from January 2011 to April 2012 in Emilia-Romagna, Italy, and comprised classroom activities and school-wide policies. A two-arm cluster randomized controlled trial was designed. Schools were the units of randomization and were matched by socioeconomic status, size, and type. RESULTS: Data from 4700 middle school students and 2952 high school students were collected anonymously from October to December 2010. Past-30-day smoking prevalence was 1.9% among middle school students and 20.8% among high school students. Past-30-day prevalence of alcohol intoxication was 2.2% among middle school students and 11.4% among high school students. A total of 39.7% of middle school students and 48.0% of high school students drank sugar-sweetened beverages four or more times per week; 7.5% of middle school students and 7.1% of high school students had intense physical activity every day. CONCLUSIONS: This study seems adequately powered and baseline variables appear evenly distributed between study groups. Findings are in line with those of the WHO Health Behaviour in School-Aged Children study.No specific funding was available for this study. The design and analysis of the study were assigned to external contractors, Avogadro University and the Cancer Prevention and Research Institute (ISPO), supported by the Italian League against Cancer (LILT), Reggio Emilia, Italy