242 research outputs found
Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management
Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations
Effects of an intensive inpatient rehabilitation program in elderly patients with obesity
Objective: The aim of this study was to assess the short-term effectiveness of an intensive inpatient multidimensional rehabilitation program (MRP), including diet, exercise, and behavioral therapy, in elderly patients with severe obesity. Methods: Forty-four elderly patients (old; age 69.3 \ub1 3.5 years, BMI 41.9 \ub1 14.9) were analyzed against 215 younger patients (young; age 48.2 \ub1 18.5 years, BMI 43.9 \ub1 9.4), who were used as controls. All patients underwent MRP, based on group therapy guided by a multidisciplinary team (physicians, dietitians, exercise trainers, psychologists). We evaluated changes in anthropometry, cardiovascular risk factors, physical fitness, quality of life, and eating behavior. Results: After 3 weeks of MRP, we observed a reduction in body weight (old -3.8%, young -4.3%), BMI (old -3.9%, young -4.4%), waist circumference (old -3.4%, young -4.1%), total cholesterol (old -14.0%, young -15.0%), and fasting glucose (old -8.3%, young -8.1%), as well as improved performance in the Six-Minute-Walk Test (old +28.7%, young +15.3%), chair-stand test (old +24.8%, young +26.9%), and arm-curl test (old +15.2%, young +27.3%). Significant improvement was registered in all other analyzed domains. Conclusion: Our 3-week MRP provided significant clinical and functional improvement, which was similar between elderly and younger patients with severe obesity. In the long-term, this may be translated into better quality of life, through better management of obesity-associated morbidities and reduced frailty
The ABCD of obesity: An EASO position statement on a diagnostic term with clinical and scientific implications
Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents
a major public health problem. The coining of obesity as an adiposity-based chronic disease
(ABCD) is of particular relevance being in line with EASO’s proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique
measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass
disease) as well as endocrine and immune responses (sick fat disease), which are embedded in
a cultural and physical context leading to a specific ABCD stage
European association for the study of obesity position statement on the global COVID-19 pandemic
COVID-19, the infectious disease caused by the coronavirus SARS-CoV-2, was declared a pandemic by the World Health Organization on March 12, 2020. The European Association for the Study of Obesity (EASO), as a scientific and medical society dedicated to the promotion of health and well-being, is greatly concerned about this global health challenge and its significant impacts on individuals, families, communities, health systems, nations, and wider society
Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP
Background:
Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery.
Methods:
A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards.
Results:
Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-to-decision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure.
Conclusion:
This document summarizes the latest evidence on bariatric surgery through state-of-the art guideline development, aiming to facilitate evidence-based clinical decisions
Quality of life and treatment satisfaction in adults with Type 1 diabetes: A comparison between continuous subcutaneous insulin infusion and multiple daily injections
Aims: The aim of this case-control study was to compare quality of life (QoL) and treatment satisfaction in adults with Type 1 diabetes (T1DM) treated with either continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Methods: Consecutive patients aged between 18 and 55 years, and attending diabetes clinics for a routine visit, completed the Diabetes-Specific Quality-of-Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the SF-36 Health Survey (SF-36). Case (CSII) and control subjects (MDI) were recruited in a 1 : 2 ratio. Results: Overall, 1341 individuals were enrolled by 62 diabetes clinics; 481 were cases and 860 control subjects. Cases had a longer diabetes duration and were more likely to have eye and renal complications. Age, school education, occupation and HbA1c were similar. Of control subjects, 90% followed glargine-based MDI regimens and 10% used NPH-based MDI regimens. On multivariate analysis, after adjusting for socioeconomic and clinical characteristics, scores in the following areas of the DSQOLS were higher in cases than control subjects: diet restrictions (β = 5.96; P < 0.0001), daily hassles (β = 3.57; P = 0.01) and fears about hypoglycaemia (β = 3.88; P = 0.006). Treatment with CSII was also associated with a markedly higher DTSQ score (β = 4.13; P < 0.0001) compared with MDI. Results were similar when CSII was compared separately with glargine- or NPH-based MDI regimens. Conclusions: This large, non-randomized, case-control study suggests quality of life gains deriving from greater lifestyle flexibility, less fear of hypoglycaemia, and higher treatment satisfaction, when CSII is compared with either glargine-based or NPH-based MDI regimens. © 2008 The Authors
The Second Fermi Large Area Telescope Catalog of Gamma-Ray Pulsars
This catalog summarizes 117 high-confidence 0.1 GeV gamma-ray pulsar detections using three years of data
acquired by the Large Area Telescope (LAT) on the Fermi satellite. Half are neutron stars discovered using LAT
data through periodicity searches in gamma-ray and radio data around LAT unassociated source positions. The 117
pulsars are evenly divided into three groups: millisecond pulsars, young radio-loud pulsars, and young radio-quiet
pulsars. We characterize the pulse profiles and energy spectra and derive luminosities when distance information
exists. Spectral analysis of the off-peak phase intervals indicates probable pulsar wind nebula emission for four
pulsars, and off-peak magnetospheric emission for several young and millisecond pulsars.We compare the gammaray
properties with those in the radio, optical, and X-ray bands.We provide flux limits for pulsars with no observed
gamma-ray emission, highlighting a small number of gamma-faint, radio-loud pulsars. The large, varied gamma-ray
pulsar sample constrains emission models. Fermiメs selection biases complement those of radio surveys, enhancing
comparisons with predicted population distributions
Fermi Large Area Telescope First Source Catalog
We present a catalog of high-energy gamma-ray sources detected by the Large
Area Telescope (LAT), the primary science instrument on the Fermi Gamma-ray
Space Telescope (Fermi), during the first 11 months of the science phase of the
mission, which began on 2008 August 4. The First Fermi-LAT catalog (1FGL)
contains 1451 sources detected and characterized in the 100 MeV to 100 GeV
range. Source detection was based on the average flux over the 11-month period,
and the threshold likelihood Test Statistic is 25, corresponding to a
significance of just over 4 sigma. The 1FGL catalog includes source location
regions, defined in terms of elliptical fits to the 95% confidence regions and
power-law spectral fits as well as flux measurements in 5 energy bands for each
source. In addition, monthly light curves are provided. Using a protocol
defined before launch we have tested for several populations of gamma-ray
sources among the sources in the catalog. For individual LAT-detected sources
we provide firm identifications or plausible associations with sources in other
astronomical catalogs. Identifications are based on correlated variability with
counterparts at other wavelengths, or on spin or orbital periodicity. For the
catalogs and association criteria that we have selected, 630 of the sources are
unassociated. Care was taken to characterize the sensitivity of the results to
the model of interstellar diffuse gamma-ray emission used to model the bright
foreground, with the result that 161 sources at low Galactic latitudes and
toward bright local interstellar clouds are flagged as having properties that
are strongly dependent on the model or as potentially being due to incorrectly
modeled structure in the Galactic diffuse emission.Comment: 88 pages, 22 figures, submitted to Astrophysical Journal Supplement
Series. The 1FGL catalog is available at
http://fermi.gsfc.nasa.gov/ssc/data/access/lat/1yr_catalog
Molecular dynamics simulation of aqueous solutions of 26-unit segments of p(NIPAAm) and of p(NIPAAm) "doped" with amino acid based comonomers
We have performed 75-ns molecular dynamics (MD) simulations of aqueous solutions of a 26-unit NIPAAm
oligomer at two temperatures, 302 and 315 K, below and above the experimentally determined lower critical
solution temperature (LCST) of p(NIPAAm). We have been able to show that at 315 K the oligomer assumes
a compact form, while it keeps a more extended form at 302 K. A similar behavior has been demonstrated
for a similar NIPAAm oligomer, where two units had been substituted by methacryloyl-l-valine (MAVA)
comonomers, one of them being charged and one neutral. For another analogous oligomer, where the same
units had been substituted by methacryloyl-l-leucine (MALEU) comonomers, no transition from the extended
to the more compact conformation has been found within the same simulation time. Statistical analysis of the
trajectories indicates that this transition is related to the dynamics of the oligomer backbone, and to the formation
of intramolecular hydrogen bonds and water-bridges between distant units of the solute. In the MAVA case,
we have also evidenced an important role of the neutral MAVA comonomer in stabilizing the compact coiled
structure. In the MALEU case, the corresponding comonomer is not equally efficacious and, possibly, is
even hindering the readjustment of the oligomer backbone. Finally the self-diffusion coefficient of water
molecules surrounding the oligomers at the two temperatures for selected relevant times is observed to
characteristically depend on the distance from the solute molecules
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