Is teenage obesity associated with depression and low self-esteem?: A pilot study

Objectives: A pilot study to explore the impact of perceived and actual overweight on self-esteem and depression in Hong Kong teenagers. Methods: A cross-sectional questionnaire study on 152 Chinese adolescents aged 12-16 was conducted in a secondary school in Hong Kong. Overweight was defined as a body mass index (BMI) above 90 percentile of age-adjusted BMI reference. The short form Beck Depression Inventory (BDI-13) and the Chinese version of Piers-Harris 2 Self-Concept Scale were used to measure depression and self-esteem respectively. Results: Our results showed that perceived overweight but not actual overweight female subjects had statistically significantly lower Piers-Harris score and higher depression score. Kruskal-Wallis test showed that depression was significantly more common in female teenagers who perceived themselves as being overweight but who were not actually overweight compared to those with normal BMI and body image. On the contrary, male teenagers who perceived themselves as thin were more at risk for lower Piers-Harris subscale scores. Conclusions: Our findings suggest that perceived body image has more detrimental impact on depression and self-esteem than actual body mass index in both male and female Hong Kong teenagers. This may reflect a probable influence from the mass media, advertisement, or prevailing societal values in over-promoting a slim body-image which may result in self-depreciating tendencies if female teenagers perceived themselves as being overweight. Health care professionals need to pay attention to body image perception rather than focusing solely on the physical build of teenagers.link_to_subscribed_fulltex

Emergency surgical treatment for nonvariceal bleeding of the upper part of the gastrointestinal tract

Endoscopic and biochemical data were collected prospectively from 1,530 patients admitted with nonvariceal bleeding of the upper part of the gastrointestinal tract between September 1985 and June 1989. Therapeutic endoscopy was done for 93 patients who underwent emergency surgical treatment for bleeding, subsequently required in 29 patients with seven postoperative fatalities. In contrast, 31 (15.7 per cent) of 198 patients (mortality rate of 9.6 per cent at 30 days) died in the hospital who had undergone emergency operation in whom therapeutic endoscopy had not been performed; data for this latter group is now presented. At admission, a greater likelihood of emergency operation was associated with a systolic blood pressure of 100 millimeters of mercury and endoscopic stigmatas of recent hemorrhage (ESRH) (p<0.001). Rebleeding rates for the presence of fresh blood, active spurting and oozing hemorrhage or visible vessel in an ulcer base were 26.5, 28.9 and 35.9 per cent, respectively. Endoscopic stigmatas were thus associated with an increased risk of rebleeding (p<0.0001) and rebleeding led to a sixfold increase in the mortality rate. Congestive cardiac failure, chronic obstructive airway disease, chronic renal failure and a history of previous malignant disease were each associated with postoperative mortality rates of more than 50 per cent. An increased risk of mortality after emergency operation was related to age (p<0.0001), preoperative (p<0.002) and total (p<0.0001) blood transfusion requirement. Immediate operation after resuscitation and endoscopy was required in 87 patients; 11 deaths (hospital mortality rate of 12.7 per cent and 9.2 per cent at 30 days) occurred in this group compared with 20 fatalities (18.0 per cent) documented in 111 patients (9.9 per cent at 30 days) who underwent surgical treatment for rebleeding. We conclude that age, concomitant medical illness and preoperative and total transfusion requirements are each related to outcome after emergency operations. Such urgent intervention is best avoided if at all possible in patients with severe concomitant medical illness.link_to_subscribed_fulltex