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

Psychiatrische und psychosomatische Tageskliniken in Österreich

In der vorliegenden Arbeit zu psychiatrischen und psychosomatischen Tageskliniken in Österreich wurde einerseits die Gesamtsituation österreichischer Tageskliniken erfasst und andererseits psychiatrische und psychosomatische Tageskliniken voneinander unterschieden. Zu diesem Zweck wurde ein Fragebogen entwickelt und an alle psychiatrischen und psychosomatischen Tageskliniken in Österreich gesendet. In einem ersten Teil wurden mit geschlossenen Fragen die Bereiche Rahmenbedingungen, Funktion und Aufgabe, therapeutische Paradigmen, Indikation und Kontraindikation, Diagnostik, Organisation, interdisziplinäre Zusammenarbeit und das Angebot an den Tageskliniken erfasst und ausgewertet. In einem zweiten Teil wurden mit offenen Fragen Wirkfaktoren, Schwierigkeiten, Besonderheiten und Zukunftswünsche tagesklinischer Behandlung erfasst und ausgewertet. Die Ergebnisse zeigen, dass es einen Trend zu mehr Tageskliniken gibt. Im Vergleich zu psychiatrischen Tageskliniken sind psychosomatische Tageskliniken ein noch neues Phänomen. Die Unterscheidung zwischen psychiatrischen und psychosomatischen Tageskliniken ist wichtig, um Patienten zukünftig unterscheidbare Behandlungsoptionen bieten zu können. Es zeigt sich, dass psychiatrische und psychosomatische Tageskliniken einen starken psychotherapeutischen Schwerpunkt haben und die Wirkfaktoren der Psychotherapie nach Grawe erfüllen.This paper on psychiatric and psychosomatic day hospitals in Austria first looks at the overall situation of Austrian day clinics then, in a second step, compares psychiatric and psychosomatic day hospitals. For this purpose, a questionnaire was developed and sent to all psychiatric and psychosomatic day hospitals in Austria. The first part consisted of closed questions and was used to gather and evaluate the categories: general conditions for treatment in day hospitals, tasks of day hospitals, therapeutic paradigms, indication and contraindication, diagnostics, day hospital organisation, interdisciplinary cooperation and the offering in day hospitals. The second section consisted of open questions which were used to gather and evaluate active factors, difficulties, specifics and requests for future treatment in day hospitals. The results show that there is a trend towards more day hospitals. Psychosomatic day hospitals are a rather new phenomenon. Furthermore, the distinction between psychiatric and psychosomatic day hospitals is important in order to offer patients distinguishable treatment options in future. The results show that psychiatric and psychosomatic day hospitals both have a strong focus on psychotherapy and both fulfill the active factors for psychotherapy by Grawe.(VLID)450441

Consolidation of working hours and work-life balance in anaesthesiologists - A cross-sectional national survey.

Currently, healthcare management fosters a maximization of performance despite a relative shortage of specialists. We evaluated anaesthesiologists' workload, physical health, emotional well-being, job satisfaction and working conditions under increased pressure from consolidated working hours. A nationwide cross-sectional survey was performed in Austrian anaesthesiologists (overall response rate 41.0%). Three hundred and ninety four anaesthesiologists (280 specialists, 114 anaesthesiology trainees) participated. Anaesthesiologists reported frequently working under time pressure (95%CI: 65.6-74.6), at high working speed (95%CI: 57.6-67.1), with delayed or cancelled breaks (95%CI: 54.5-64.1), and with frequent overtime (95%CI: 42.6-52.4). Perceived work climate correlated with task conduct (manner of work accomplishment, the way in which tasks were completed), participation (decision-making power in joint consultation and teamwork), psychosocial resources, uncertainty, task variability and time tolerance (authority in time management and control over operating speed) (all P <0.001). Having not enough time for oneself (95%CI: 47.6-57.4), for sleep (95%CI: 45.6-55.4) or for one's partner and children (95%CI: 21.8-30.4) was common. One-third of the participants reported frequent feelings of being unsettled (95%CI: 33.4-43.0) and difficulty talking about their emotions (95%CI: 27.3-36.5). Frequent dissatisfaction with life was reported by 11.4% (95%CI: 8.7-14.9) of the respondents. Strong time pressure and little decision-making authority during work along with long working hours and frequent work interruptions constitute the basis for occupational stress in anaesthesiologists. We conclude that increased pressure to perform during work hours contributes to emotional exhaustion and poor work-life balance. Changes in the work schedule of anaesthesiologists are required to avoid negative effects on health and emotional well-being

Prevalence of eating disorders in middle-aged women

Objective: Little is known about the prevalence and correlates of eating disorders (ED) in middle-aged women. Method: We mailed anonymous questionnaires to 1,500 Austrian women aged 40-60 years, assessing ED (defined by DSM-IV), subthreshold ED, body image, and quality of life. We broadly defined "subthreshold ED" by the presence of either (1) binge eating with loss of control or (2) purging behavior, without requiring any of the other usual DSM-IV criteria for frequency or severity of these symptoms. Results: Of the 715 (48%) responders, 33 [4.6%; 95% confidence interval (CI): 3.3-6.4%] reported symptoms meeting full DSM-IV criteria for an ED [bulimia nervosa = 10; binge eating disorder = 11; eating disorder not otherwise specified (EDNOS) = 12]. None displayed anorexia nervosa. Another 34 women (4.8%; CI: 3.4-6.6%) displayed subthreshold ED. These women showed levels of associated psychopathology virtually equal to the women with full-syndrome diagnoses. Discussion: ED appear common in middle-aged women, with a preponderance of binge eating disorder and EDNOS diagnoses as compared to the "classical" diagnoses of anorexia and bulimia nervosa. Interestingly, middle-aged women with even very broadly defined subthreshold ED showed distress and impairment comparable to women with full-scale ED. (c) 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:320-324

Obesity Management Task Force of the European Association for the Study of Obesity Released \u201cPractical Recommendations for the Post-Bariatric Surgery Medical Management\u201d

Bariatric patients may face specific clinical problems after surgery, and multidisciplinary long-term follow-up is usually provided in specialized centers. However, physicians, obstetricians, dieticians, nurses, clinical pharmacists, midwives, and physical therapists not specifically trained in bariatric medicine may encounter post-bariatric patients with specific problems in their professional activity. This creates a growing need for dissemination of first level knowledge in the management of bariatric patients. Therefore, the Obesity Management Task Force (OMTF) of the European Association for the Study of Obesity (EASO) decided to produce and disseminate a document containing practical recommendations for the management of post-bariatric patients. The list of practical recommendations included in the EASO/OMTF document is reported in this brief communication