Attachment style and post-bariatric surgery health behaviours:the mediating role of self-esteem and health self-efficacy

Background: Attachment avoidance and anxiety have been linked to overweight and poor health behaviours, yet the mechanisms that underpin the relationship between attachment and health behaviours are not fully understood. Self-esteem and self-efficacy have been found to differ between attachment styles, rendering these variables potential mediators of the relationship. This longitudinal study investigated the serial mediation between preoperative attachment and 2-year post-operative health behaviours through self-esteem and health self-efficacy. Methods: Participants were 263 bariatric surgery patients (75.7% females, aged 47.7 ± 10.4 years, BMI 38.9 ± 3.6 kg/m2) assessed before the operation and again one and two years after the surgery. Patients completed the Experiences for Close Relationships Brief Scale, Rosenberg Self-esteem scale, Weight Efficacy Lifestyle Questionnaire, Bariatric Surgery Self-Management Questionnaire, Exercise Self-Efficacy Scale and the Exercise Behaviour Scale. Results: Higher preoperative attachment anxiety and avoidance were associated with lower self-esteem one year after bariatric surgery and poorer health self-efficacy two years after the surgery. Self-esteem and health self-efficacy mediated the relationships between preoperative anxious and avoidant attachment and 2- year post-operative diet adherence and physical activity. Conclusions: Helping patients to feel more worthy and reinforcing their beliefs about their own competences could lead to higher engagement with healthy lifestyle and adherence to treatment protocols, ultimately helping patients to achieve their goals for bariatric surgery. Clinical trial registration: BARIA: Netherlands Trial Register: NL5837 (NTR5992) https://www.trialregister.nl/trial/5837 . Diabaria: ClinicalTrials.gov identifier (NCT number): NCT03330756.</p

Comment: Does L-thyroxine prevent or cause stroke in hypothyroidism?

The association between overt hypothyroidism and atherosclerotic risk factors, especially hypertension and dyslipidemia, is clear. To date, only a few small and methodologically flawed epidemiologic studies have investigated the relationship between hypothyroidism and stroke, precluding definitive conclusions. In the current issue of Neurology\uae, Karch and Thomas(1) present a large well-designed case-control study investigating this relationship. They compared 34,907 patients with autoimmune thyroiditis on treatment with l-thyroxine and 149,632 matched individuals without autoimmune thyroiditis from a UK primary care electronic health record system. They found a slight increase in the risk of stroke in patients with autoimmune thyroiditis (adjusted relative risk = 1.10, 95% confidence interval: 1.01-1.20) compared with controls. Some of this increased risk of stroke was independent of cardiovascular risk factors

Willingness for Medical Screening in a Dental Setting-A Pilot Questionnaire Study

An important way to manage noncommunicable diseases (NCDs) is to focus on prevention, early detection, and reducing associated risk factors. Risk factors can be detected with simple general health checks, which can also be performed in dental clinics. The purpose of this study was to investigate participants' willingness to participate in general health checks at the dentist, in particular the difference in opinion between medical patients and random healthy dental attendees. A total of 100 medical patients from an outpatient internal medicine clinic and 100 dental clinic attendees were included (total of 200 participants). The participants were asked for their opinion using six closed-ended questions. Overall, 91.0% of participants were receptive to information about the risk of diabetes mellitus (DM) and cardiovascular diseases (CVD). The majority (80-90%) was receptive to screening for DM and CVD risk, such as weight and height measurements, blood pressure measurement, saliva testing for CVD and to measure glucose and cholesterol via finger stick. No significant differences were found in the frequencies of the responses between the different groups based on health status, age, sex, or cultural background. This study shows that most participants are willing to undergo medical screening at the dentist for early detection and/or prevention of common NCDs.</p

Cardiovascular risk assessment in periodontitis patients and controls using the European Systematic COronary Risk Evaluation (SCORE) model. A pilot study.

Aim: To investigate the use of the European SCORE model in a dental setting by exploring the frequency of a ‘high’ and ‘very high’ 10-year CVD mortality risk in patients with and without periodontitis. The secondary aim was to investigate the association of SCORE with various periodontitis parameters adjusting for remaining potential confounders. Material and methods: In this study, we recruited periodontitis patients and non-periodontitis controls, all aged ≥40 years. We determined the 10-year CVD mortality risk per individual with the European Systematic Coronary Risk Evaluation (SCORE) model by using certain patient characteristics and biochemical analyses from blood by finger stick sampling. Results: In total, 105 periodontitis patients (61 localized, 44 generalized stage III/IV) and 88 non-periodontitis controls were included (mean age: 54.4 years). The frequency of a ‘high’ and ‘very high’ 10-year CVD mortality risk was 43.8% in all periodontitis patients and 30.7% in controls (p =.061). In total, 29.5% generalized periodontitis patients had a ‘very high’ 10-year CVD mortality risk, compared to 16.4% in localized periodontitis patients and 9.1% in controls (p =.003). After adjustment for potential confounders, the total periodontitis group (OR 3.31; 95% CI 1.35–8.13), generalized periodontitis group (OR 5.32; 95% CI 1.90–14.90), lower number of teeth (OR.83; 95% CI.73–1.00) and higher number of teeth with radiographic bone loss ≥33% (OR 1.06; 95% CI 1.00–1.12) were associated with a “very high” SCORE category. In addition, various biochemical risk markers for CVD were more frequently elevated in periodontitis compared to controls (e.g., total cholesterol, triglycerides, C-reactive protein). Conclusion: The periodontitis group as well as the control group had a sizable frequency of a ‘high’ and ‘very high’ 10-year CVD mortality risk. The presence and extent of periodontitis, lower number of teeth and higher number of teeth with bone loss ≥33% are significant risk indicators for a ‘very high’ 10-year CVD mortality risk. Therefore, SCORE in a dental setting can be a very useful tool to employ for primary and secondary prevention of CVD, especially among the dental attenders who have periodontitis

Cardiovascular risk assessment in periodontitis patients and controls using the European Systematic COronary Risk Evaluation (SCORE) model. A pilot study.

Aim: To investigate the use of the European SCORE model in a dental setting by exploring the frequency of a ‘high’ and ‘very high’ 10-year CVD mortality risk in patients with and without periodontitis. The secondary aim was to investigate the association of SCORE with various periodontitis parameters adjusting for remaining potential confounders. Material and methods: In this study, we recruited periodontitis patients and non-periodontitis controls, all aged ≥40 years. We determined the 10-year CVD mortality risk per individual with the European Systematic Coronary Risk Evaluation (SCORE) model by using certain patient characteristics and biochemical analyses from blood by finger stick sampling. Results: In total, 105 periodontitis patients (61 localized, 44 generalized stage III/IV) and 88 non-periodontitis controls were included (mean age: 54.4 years). The frequency of a ‘high’ and ‘very high’ 10-year CVD mortality risk was 43.8% in all periodontitis patients and 30.7% in controls (p =.061). In total, 29.5% generalized periodontitis patients had a ‘very high’ 10-year CVD mortality risk, compared to 16.4% in localized periodontitis patients and 9.1% in controls (p =.003). After adjustment for potential confounders, the total periodontitis group (OR 3.31; 95% CI 1.35–8.13), generalized periodontitis group (OR 5.32; 95% CI 1.90–14.90), lower number of teeth (OR.83; 95% CI.73–1.00) and higher number of teeth with radiographic bone loss ≥33% (OR 1.06; 95% CI 1.00–1.12) were associated with a “very high” SCORE category. In addition, various biochemical risk markers for CVD were more frequently elevated in periodontitis compared to controls (e.g., total cholesterol, triglycerides, C-reactive protein). Conclusion: The periodontitis group as well as the control group had a sizable frequency of a ‘high’ and ‘very high’ 10-year CVD mortality risk. The presence and extent of periodontitis, lower number of teeth and higher number of teeth with bone loss ≥33% are significant risk indicators for a ‘very high’ 10-year CVD mortality risk. Therefore, SCORE in a dental setting can be a very useful tool to employ for primary and secondary prevention of CVD, especially among the dental attenders who have periodontitis

Interpretation of laboratory results after gastric bypass surgery: the effects of weight loss and time on 30 blood tests in a 5-year follow-up program

Background: Long-term follow-up with blood tests is essential for bariatric surgery to be a successful treatment for obesity and related co-morbidities. Adverse effects, deficiencies, and metabolic improvements need to be controlled. Objective: We investigated the effects of time and weight loss on laboratory results in each postoperative phase after laparoscopic Roux-en-Y gastric bypass (LRYGB). Setting: Bariatric center of excellence, general hospital, Netherlands. Methods: We retrospectively evaluated results of 30 blood tests, preoperatively and at 6 months, 1 year, 2 years, and 5 years after LRYGB. The 2019 Dutch bariatric chart was used to define weight loss responses as outstanding (>p[percentile curve]+1 SD), average (p+1 SD to p−1 SD), and poor (<p−1 SD). Results are presented with fifth and 95th percentile cutoff values per blood test for each of these 3 weight loss responses at each of the 4 postoperative time intervals. We used ANOVA to determine mutual relations. Results: Results of 4835 patients were analyzed. Five-year follow-up was 58%. Blood levels of ferritin, mean-corpuscular-volume, thrombocytes, vitamin D, parathyroid-hormone, glycated hemoglobin (HbA1C), triglyceride, total-cholesterol, C-reactive-protein, gamma-glutamyl-transferase, alkaline-phosphatase, creatinine, vitamin B1, and total protein were related with weight loss response. All 30 blood tests were also related with time. For several blood tests, weight loss and time did not only influence median results, but also fifth and 95th percentile cutoff values. Many patients had better vitamin levels after the operation. We observed an increase of parathyroid-hormone and ongoing iron depletion up to 5 years post surgery. Conclusions: Presenting results of 30 routine blood tests, including cutoff values based on fifth and 95th percentile, grouped by weight loss response and postoperative time interval after gastric bypass surgery is new. The elaborate tables and graphs could serve as practical guide for proper interpretation of laboratory results in postbariatric surveillance. Results underline the need for long-term follow-up, including blood tests

Effects of mineralocorticoid receptor antagonists on the risk of thrombosis, bleeding and mortality: A systematic review and meta-analysis of randomized controlled trials

Introduction: Aldosterone seems to influence the haemostatic system by several mechanisms and to increase the risk of thrombosis. The objective of this meta-analysis was to assess the impact of inhibition of the mineralocorticoid receptor due to the use of mineralocorticoid receptor antagonists (MRAs) on venous and arterial thrombosis, bleeding events and mortality. Materials and methods: We systematically searched PubMed and EMBASE through August 1, 2014, without language restrictions. Randomised controlled trials (RCTs) that tested the effect of MRAs versus active control/no treatment and reported data on thrombotic or bleeding events or mortality in patients with common causes of secondary hyperaldosteronism were included. Results: 20 published RCTs reported in 19 papers for a total of 17,610 patients met inclusion criteria. Of these, all reported data on mortality, 15 on cardiovascular mortality, 14 on thrombotic events and 12 reported data on bleeding events. No RCTs investigated patients with primary hyperaldosteronism. 19 RCTs were performed in patients with hypertension and heart failure. In general, the heterogeneity was low. No differences were observed in arterial thrombotic and bleeding events. Patients treated with MRAs had 20% lower odds of total mortality and 23% of cardiovascular mortality compared with controls (odds ratio (OR) 0.80, 95% confidence interval (CI) 0.73-0.87 and OR 0.77, 95% CI 0.70-0.85, respectively). Conclusion: Inhibition of the mineralocorticoid receptor with MRAs in patients with hypertension and heart failure does not change the risk of myocardial infarction, stroke and bleeding events. Ourmeta-analysis confirms the favourable effects of MRAs on total and cardiovascular mortality. These data suggest that MRAs can be considered as safe regarding their effects on haemostasis in patients with hypertension and heart failure

Prolactin and Venous Thrombosis

Clinical epidemiolog