Inequalities in bariatric surgery in Australia: findings from 49,364 obese participants in a prospective cohort study

OBJECTIVES: To investigate variation, and quantify socioeconomic inequalities, in receipt of primary bariatric surgery in an obese population. DESIGN, SETTING AND PARTICIPANTS: Prospective population-based cohort study of 49,364 individuals aged 45-74 with body mass index (BMI) ≥30kg/m2, with questionnaire (2006-09) linked to hospital and death data to July 2010. Sample drawn from the 45 and Up Study (~10% of NSW population aged ≥45 included, response rate ~18%). MAIN OUTCOME MEASURES: Rates of bariatric surgery and adjusted rate ratios (RR) in relation to health and sociodemographic characteristics. RESULTS: Over 111,757 person-years (py) of follow-up, 312 participants underwent bariatric surgery, a rate of 27.92/10,000 py (95%CI: 24.91-31.19). Rates were highest in women, people living in major cities and those with diabetes, and increased significantly with increasing body-mass-index and number of chronic health conditions. Adjusted RRs were: 5.27 (3.18-8.73) for annual household-income ≥$70,000 versus <$20,000; and 4.01 (2.41-6.67) for those living in areas in the least- versus most-disadvantaged quintile. Private health insurance (PHI) coverage (age-sex adjusted RR: 9.25; 5.70-15.00) partially explained the observed socioeconomic inequalities. CONCLUSIONS: Bariatric surgery has been shown to be cost-effective in treating severe obesity and associated illnesses. While bariatric surgery rates in Australia are higher in those with health problems, large socioeconomic inequalities are apparent. Our findings suggest these procedures are largely available to those who can afford PHI and associated out-of-pocket costs, with poor access in populations who are most in need. Continuing inequalities in access are likely to exacerbate existing inequalities in obesity and related health problems.National Health and Medical Research Council (NHMRC

Quota discarding and distributive justice: The case of the under-10m fishing fleet in Sussex, England

Marine fish discarding has become a contentious environmental issue, but little attention has been paid to the moral grievances that sometimes underlie discarding practices. This article explores such a moral grievance through a case study of the under-10. m fishery in Sussex, England, where discarding of cod (Gadus morhua) has become a highly charged issue, skippers blaming it on unjust quota allocations. The moral claim to a greater quota allocation is analysed using two conceptions of distributive justice, entitlement and desert. The conclusion reached is that the under-10. m fleet's entitlement arguments for a higher quota are weaker than their desert arguments, but that entitlement arguments weigh more heavily than desert arguments with government when it allocates quota

Integration or separation? The future of the English small-scale coastal fishery

The decline of inshore or small-scale coastal fisheries (SSCF) in many countries across the world has been well-documented in major studies published during the last 10 years. Researchers report decreasing stocks of marketable fish, inadequate fish quota allocations, and virtual exclusion from fisheries management decision-making bodies. The situation in England is a case in point, where many SSCF are subject to these pressures to the point that their livelihoods are threatened. A recent initiative sponsored by an industry agency to safeguard the position of the inshore sector aims to protect SSCF in England from decline and possible extinction by integrating it into the mainstream fishing industry and ensuring its representation on a proposed co-management body which would share decision-making between industry and government. However, drawing on the literature, archival documents, newspaper articles, and personal communications, we conclude that integrating all parts of the fleet together and setting up shared co-management arrangements is not a guarantee of SSCF survival because integration would tie SSCF down to the agenda of the large-scale fisheries (LSF) sector with no certainty that the special needs of SSCF would be met if they conflicted with the interests of LSF. Instead, our findings lead us to recommend forging a separatist path for SSCF, recognising its distinctive identity as an inshore fishery closely connected with coastal communities. We propose, therefore, two independent fisheries each with its own mode of management: SSCF governed by a regime of community quotas and exclusive spatial access to inshore waters; and LSF governed by a regime of individual transferable quotas (ITQs)

Prospective cohort study of body mass index and the risk of hospitalisation: findings from 246 361 participants in the 45 and Up Study.

OBJECTIVE: To quantify the risk of hospital admission in relation to fine increments in body mass index (BMI). DESIGN, SETTING AND PARTICIPANTS: Population-based prospective cohort study of 246 361 individuals aged X45 years, from New South Wales, Australia, recruited from 2006–2009. Self-reported data on BMI and potential confounding/mediating factors were linked to hospital admission and death data. MAIN OUTCOMES: Cox-models were used to estimate the relative risk (RR) of incident all-cause and diagnosis-specific hospital admission (excluding same day) in relation to BMI. RESULTS: There were 61 583 incident hospitalisations over 479 769 person-years (py) of observation. In men, hospitalisation rates were lowest for BMI 20–o25 kgm2 (age-standardised rate:120/1000 py) and in women for BMI 18.5–o25 kgm2 (102/1000 py); above these levels, rates increased steadily with increasing BMI; rates were 203 and 183/1000 py, for men and women with BMI 35–50 kgm2, respectively. This pattern was observed regardless of baseline health status, smoking status and physical activity levels. After adjustment, the RRs (95% confidence interval) per 1 kgm2 increase in BMI from X20 kgm2 were 1.04(1.03–1.04) for men and 1.04(1.04–1.05) for women aged 45–64; corresponding RRs for ages 65–79 were 1.03(1.02–1.03) and 1.03(1.03–1.04); and for agesX80 years, 1.01(1.00–1.01) and 1.01(1.01–1.02). Hospitalisation risks were elevated for a large range of diagnoses, including a number of circulatory, digestive, musculoskeletal and respiratory diseases, while being protective for just two—fracture and hernia. CONCLUSIONS: Above normal BMI, the RR of hospitalisation increases with even small increases in BMI, less so in the elderly. Even a small downward shift in BMI, among those who are overweight not just those who are obese, could result in a substantial reduction in the risk of hospitalisatio

Autologous Stem Cells in Achilles Tendinopathy (ASCAT): protocol for a phase IIA, single-centre, proof-of-concept study

Introduction: Achilles tendinopathy (AT) is a cause of pain and disability affecting both athletes and sedentary individuals. More than 150 000 people in the UK every year suffer from AT. While there is much preclinical work on the use of stem cells in tendon pathology, there is a scarcity of clinical data looking at the use of mesenchymal stem cells to treat tendon disease and there does not appear to be any studies of the use of autologous cultured mesenchymal stem cells (MSCs) for AT. Our hypothesis is that autologous culture expanded MSCs implanted into an area of mid-portion AT will lead to improved pain-free mechanical function. The current paper presents the protocol for a phase IIa clinical study. // Methods and analysis: The presented protocol is for a non-commercial, single-arm, open-label, phase IIa proof-of-concept study. The study will recruit 10 participants and will follow them up for 6 months. Included will be patients aged 18–70 years with chronic mid-portion AT who have failed at least 6 months of non-operative management. Participants will have a bone marrow aspirate collected from the posterior iliac crest under either local or general anaesthetic. MSCs will be isolated and expanded from the bone marrow. Four to 6 weeks after the harvest, participants will undergo implantation of the culture expanded MSCs under local anaesthetic and ultrasound guidance. The primary outcome will be safety as defined by the incidence rate of serious adverse reaction. The secondary outcomes will be efficacy as measured by patient-reported outcome measures and radiological outcome using ultrasound techniques. // Ethics and dissemination: The protocol has been approved by the National Research Ethics Service Committee (London, Harrow; reference 13/LO/1670). Trial findings will be disseminated through peer-reviewed publications and conference presentations. // Trial registration number: NCT02064062

Role of organic carbon and nitrogen of mineral waters in their metabolic effects at female rats

Background. Organic substances, despite their presence in all drinking mineral waters, are still considered to be active only in the water of Naftussya type (which, due to mineralization less than 1 g/L, are not formally mineral), whereas the physiological activity of true mineral waters (which mineralization is greater than 1-2 g/L) are associated with electrolytes and trace elements. The purpose of this study was to clarify the role of organic carbon and nitrogen of mineral waters in their effects on certain parameters of metabolism. Material and Methods. Experiment was performed on 48 healthy female Wistar rats 240-290 g divided into 5 groups. Animals of the first group for 6 days administered a single tap water through the probe at a dose of 1,5 mL/100 g of body mass. In the second group we administered the water Naftussya from the Truskavets’ layer, in the third group the water Sophiya of the Truskavets’ field. The rats of the fourth group received the native water from the Gertsa (Bucovyna) field, and the last group its artificial salt analogue. The day after the completion of the drinking course in all rats some metabolic parameters were registered. Results. On the basis of the correlation analysis with step-by-step exclusion, four metabolites of blood as well as five metabolites of urine are included in the regressive model for organic carbon (R=0,697; R2=0,486; Adjusted R2=0,347; F(10,4)=3,5; p=0,0025). Organic nitrogen of mineral waters affects five metabolic parameters of urine only, but with approximately the same force (R=0,621; R2=0,385; Adjusted R2=0,312; F(5,4)=5,3; p=0,0008). Conclusion. Organic substances of mineral waters play an essential role in their effects on the parameters of metabolism

General non-specific metabolic, neuroendocrine and immune reactions to various water-salt loads in female rats

Background. This article begins with a series of articles on the effects on parameters of water-salt, nitrous and lipid metabolism, as well as the neuroendocrine-immune complex of mineral water, extracted from the bore located in the city Gertsa (Bukovyna, Ukraine). The chemical analysis prompted us to use waters Sophiya and Naftussya from spa Truskavets’ as a reference as well as an artificial salt analogue of Gertsa water, which contains no organic matter or trace elements. Materials and methods. Experiment was performed on 58 healthy female Wistar rats 240-290 g divided into 6 groups. Animals of the first group remained intact, using tap water from drinking ad libitum. Instead, the other rats received the same tap water as well as waters Sophiya, Naftussya, Gertsa and its artificial salt analogue through the probe at a dose of 1,5 mL/100 g of body mass for 6 days. The day after the completion of the drinking course in all rats the parameters of metabolism and neuroendocrine-immune complex were registered. Results. Screening registered parameters found 42 among them who in rats subjected to water-salt loads, significantly different from that of intact rats, but on average the same group of animals that received liquids with different mineralization and chemical composition. Conclusion. Takes place nonspecific (general) reaction neuroendocrine-immune complex and metabolism in water-salt load as such, regardless of the specific chemical composition of fluids applied

Gestational diabetus mellitus and its complications, role of desynchronosis in pathogenesis (a review)

Diabetes mellitus is the most common metabolic disorder during pregnancy. The International Diabetes Federation estimates that one in six pregnant women (16.8 %) has diabetes. The prevalence of this disease in the human population is striking and, according to various sources, accounts for 14–25 % of all pregnant women. Most cases of hyperglycemia during pregnancy (75–90 %) is due to gestational diabetes mellitus (GDM). Risk factors, etiology and pathophysiology of GDM are being actively studied, but there are still some controversial issues. For example, the development of GDM in the aspect of circadian rhythm disorders. This problem is especially relevant in connection with pregnancy. After all, there is a two-way relationship here – circadian rhythm disorders affect the course of pregnancy, and pregnancy can be the cause of these disorders. In addition, this problem is relevant for women with a history of endocrine disorders, including diabetes mellitus, as there is a clear link between circadian rhythms and the production of hormones, including insulin. The aim of this review was to show the relationship between the development of GDM, its complications, and circadian rhythm disorders in women. Pregnancy complicated by GDM can have a negative effect on the myocardium and liver. Moreover, this disease has a significant impact on the myocardium of the offspring. GDM also can cause other complications for the mother’s health and fetus or newborn. Scientists have identified a fairly significant number of risk factors for GDM. However, circadian rhythm disorders accompanying pregnancy are often underestimated as a risk factor. In general, there are many controversies regarding the relationship between long / short sleep duration and quality and the risk of developing diabetes, as well as how melatonin and its precursor serotonin affect metabolism in critical organs. Thus, the role of circadian rhythm disorders in the development of diabetes and its consequences is not yet fully understood. It is likely that solving the problem of circadian rhythm disorders will be the key to overcoming a significant proportion of cases of GDM. Therefore, there is an urgent need for further, larger-scale studies to investigate the causal links between circadian rhythm disorders, diabetes mellitus, and pregnancy

Features of neuro-endocrine and immune reactions to various water-salt loads in female rats

Background. Previously, we have shown that the weekly load of rats with water-salt solutions of different chemical compositions causes both general and specific reactions of the parameters of metabolism. The purpose of this study is to identify under these conditions specific neuroendocrine and immune responses. Materials and methods. Experiment was performed on 58 healthy female Wistar rats 240-290 g divided into 6 groups. Animals of the first group remained intact, using tap water from drinking ad libitum. Instead, the other rats received the same tap water as well as waters Sophiya, Naftussya, Gertsa and its artificial salt analogue through the probe at a dose of 1,5 mL/100 g of body mass for 6 days. The day after the completion of the drinking course in all rats some neuroendocrine and immune parameters were registered. Results. The method of discriminant analysis revealed 29 parameters of the neuroendocrine-immune complex (10 of them reflect the neuroendocrine regulation, 4 thymus mass and thymocytogram elements, 5 elements of splenocytogram, 10 elements of immunocytogram and leukocytogram of blood and parameters of phagocytosis), according to which the reaction on various water-salt loads are identified with an accuracy of 98.3%. Conclusion. The peculiarities of the reactions of the parameters of the neuroendocrine-immune complex are due to the content of water in sulfate, bicarbonate and magnesium, as well as organic carbon and nitrogen

«ВІК ПАЦІЄНТОК ЯК ОДИН ІЗ ФАКТОРІВ РИЗИКУ НЕВДАЛИХ СПРОБ у ЦИКЛАХ ЕКСТРАКОРПОРАЛЬНОГО ЗАПЛІДНЕННЯ» (АНАЛІТИЧНИЙ ОГЛЯД ЛІТЕРАТУРИ)

Purpose: to analyze the sources of scientific literature on the influence of the patient's age on the results of in vitro fertilization.Materials and Methods. The study applied bibliosemantic method – 35 sources of scientific literature were analyzed.Results. At the heart of the positive result of ART programs is the timely diagnosis of infertility of a married couple, as well as the application of the correct treatment tactics. The algorithm of treatment of patients of advanced maternal age requires an integrated approach, since very often the cause of infertility is a number of interrelated factors at the level of functioning of individual body systems, and patients of this group have an increased risk of developing aneuploid embryos and early pregnancy interruptions.Conclusions. The results obtained in the course of the research should be used in choosing the tactics of treatment of patients of advanced maternal age for obtaining positive results in ART programs.Мета: проаналізувати джерела наукової літератури щодо впливу віку пацієнтки на результати запліднення in vitro.Матеріали і методи. У дослідженні застосовано бібліосемантичний метод – проаналізовано 35 джерел наукової літератури.Результати. В основі позитивного результату програм допоміжних репродуктивних технологій лежить своєчасна діагностика безпліддя подружньої пари, а також застосування правильної тактики лікування. Алгоритм лікування пацієнток старшого репродуктивного віку потребує комплексного підходу, оскільки дуже часто причиною безпліддя є низка взаємопов’язаних факторів на рівні функціонування окремих систем організму, також пацієнтки даної групи мають підвищений ризик розвитку анеуплоїдних ембріонів та переривань вагітності на ранніх термінах.Висновки. Отримані в ході досліджень результати можуть бути враховані при виборі тактики лікування пацієнток старшого репродуктивного віку для отримання позитивних результатів у програмах допоміжних репродуктивних технологій