Trends in Morbid Obesity and in Bariatric Surgeries Covered by the Brazilian Public Health System

Obesity is an increasingly serious public health problem on a global level. Morbid obesity, defined as a body mass index greater than 40 kg/m(2), is associated with increased mortality and a high burden of obesity-related morbidities. To study the prevalence of morbid obesity in Brazil, three national anthropometric surveys were reanalyzed. Data about bariatric surgeries were obtained from the Ministry of Health Hospital Information System, which is available online. A 255% rise in the prevalence of morbid obesity was observed, starting at 0.18% in 1975-1976 and growing to 0.33% in 1989 and 0.64% in 2002-2003. There was a higher rate in the South in the first two surveys, but the prevalence in the Southeast rose steadily, reaching 0.77% in 2002-2003 and overtaking the South. Since 1999, the Brazilian Unified Health System has covered surgical treatment for morbid obesity. From 2000 to 2006, there was a sixfold increase in the number of surgeries, which topped the 2,500 mark in 2006. The geographic distribution of these surgeries is heavily concentrated in the Southeast, the most developed region of Brazil, where there is also the highest prevalence of morbid obesity. This was followed by the Southern region. The figures for the rise in morbid obesity in Brazil are startling, especially the increase among men. This is a situation that calls for further study, alongside measures to encourage the adoption of healthy lifestyles. Preventive measures aimed at slowing down or reversing the obesity epidemic are urgently required.

Automated two-dimensional separation flow system with electrochemical preconcentration, stripping, capillary electrophoresis and contactless conductivity detection for trace metal ion analysis

This paper describes the automation of a fully electrochemical system for preconcentration, cleanup, separation and detection, comprising the hyphenation of a thin layer electrochemical flow cell with CE coupled with contactless conductivity detection (CE-C(4)D). Traces of heavy metal ions were extracted from the pulsed-flowing sample and accumulated on a glassy carbon working electrode by electroreduction for some minutes. Anodic stripping of the accumulated metals was synchronized with hydrodynamic injection into the capillary. The effect of the angle of the slant polished tip of the CE capillary and its orientation against the working electrode in the electrochemical preconcentration (EPC) flow cell and of the accumulation time were studied, aiming at maximum CE-C(4)D signal enhancement. After 6 min of EPC, enhancement factors close to 50 times were obtained for thallium, lead, cadmium and copper ions, and about 16 for zinc ions. Limits of detection below 25 nmol/L were estimated for all target analytes but zinc. A second separation dimension was added to the CE separation capabilities by staircase scanning of the potentiostatic deposition and/or stripping potentials of metal ions, as implemented with the EPC-CE-C(4)D flow system. A matrix exchange between the deposition and stripping steps, highly valuable for sample cleanup, can be straightforwardly programmed with the multi-pumping flow management system. The automated simultaneous determination of the traces of five accumulable heavy metals together with four non-accumulated alkaline and alkaline earth metals in a single run was demonstrated, to highlight the potentiality of the system.