Mortality rate after open Roux-in-Y gastric bypass: a 10-year follow-up

The prevalence of obesity has increased to epidemic status worldwide. Thousands of morbidly obese individuals undergo bariatric surgery for sustained weight loss; however, mid- and long-term outcomes of this surgery are still uncertain. Our objective was to estimate the 10-year mortality rate, and determine risk factors associated with death in young morbidly obese adults who underwent bariatric surgery. All patients who underwent open Roux-in-Y gastric bypass surgery between 2001 and 2010, covered by an insurance company, were analyzed to determine possible associations between risk factors present at the time of surgery and deaths related and unrelated to the surgery. Among the 4344 patients included in the study, 79% were female with a median age of 34.9 years and median body mass index (BMI) of 42 kg/m2. The 30-day and 10-year mortality rates were 0.55 and 3.34%, respectively, and 53.7% of deaths were related to early or late complications following bariatric surgery. Among these, 42.7% of the deaths were due to sepsis and 24.3% to cardiovascular complications. Male gender, age ≥50 years, BMI ≥50 kg/m2, and hypertension significantly increased the hazard for all deaths (P<0.001). Age ≥50 years, BMI ≥50 kg/m2, and surgeon inexperience elevated the hazard of death from causes related to surgery. Male gender and age ≥50 years were the factors associated with increased mortality from death not related to surgery. The overall risk of death after bariatric surgery was quite low, and half of the deaths were related to the surgery. Older patients and superobese patients were at greater risk of surgery-related deaths, as were patients operated on by less experienced surgeons.

Lifestyle factors, direct and indirect costs for a Brazilian airline company

OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

Estudo da ação do moluscocida (Bayluscide-SRB) da Dynatech R/D Company em lagos do nordeste brasileiro - Sergipe, Brasil

To study the action of molluscicide nine ponds were selected: 3 of them lying in Maruim municipality, 29 km far from north Aracaju, the State capital, and 6 ponds in Itabaianinha municipality, 118 km far from south Aracaju. This study was carried out for 16 months. Environmental parameters observed were those thought to have any influence on the planorbids and/or the molluscicide: water temperature, transparence, salinity, pH, dissolved oxygen, CO2, and the nutrients-phosphorus, nitrogen, potassium and calcium. Plancton microorganisms were also considered to observe Bayluscide action on them. SRB was used in a concentration of 6.25 kg per 1.000 [cubic metres] water, to achieve 1.0 ppm Bayluscide concentration according to the producer's instruction in Massachussett-USA.

Origin of oil in the Wilmington field in California

No presente trabalho, o autor trata da formação de campo petrolífero que se teria formado às expensas de organismos planctónicos, misturados com areia das dunas, material esse que teria sido transportado pelo vento. Refere-se, assim, o autor, ao campo petrolífero de "Wilmington", situado na Ilha Terminal, ao sul de Los Angeles, California. Esse campo, que já fora descrito, em 1943, por GILLULY & GRANT, faz parte do Mioceno e do Plioceno inferior, achando-se separado dos schistos Jurássicos metamórficos, por uma discordância localizada a 6.000 pés de profundidade. O conjunto das camadas petrolíferas alcança espessura de 1 .500 pés, sendo cada uma delas separada das outras por estratos do "siltstone" (siltito). O tamanho dos grãos, nos dois tipos de rochas, é o de depósitos eólicos, mas, ao contrário do que acontece em depósitos sub-aéreos, esses grãos são angulosos ou sub-angulosos. De acordo com MCNAUGHTON , esses depósitos se teriam formado em profundidade crescente, de 200 a 5.000 pés; esse fato, relacionado com as dimensões dos grãos, leva a crer que o material tenha sido transportado pelo vento. A sedimentação deu-se longe da costa, de maneira muito lenta, provavelmente em consequência de tempestades de excepcional intensidade. O petróleo teria sido produzido por organismos planctónicos que se teriam misturado com areia das dunas, sendo a velocidade da sedimentação desta, muito menor. Os cálculos indicam que foram armazenados somente 23% dos hidrocarbonetos que caíram sobre a areia de sedimentação, sob a forma de organismos mortos. M. V.

Sensibilidade e especificidade do "California Mastitis Test" como recurso diagnóstico da mastite subclínica em relação à contagem de células somáticas

O "California Mastitis Test" (CMT) estima o conteúdo de células somáticas no leite e é interpretado subjetivamente, estabelecendo-se escores que, na maioria dos casos, variam de 1 a 5. O escore 1 indica uma reação completamente negativa e os de 2-5 indicam graus crescentes de resposta inflamatória do úbere, sendo normalmente considerados como indicativos de mastite subclínica. Dependendo da interpretação dos escores, o CMT pode produzir resultados falso-positivos ou falso-negativos. Esse trabalho teve o objetivo de avaliar a sensibilidade e a especificidade do CMT em relação à contagem de células somáticas (CCS). Foram utilizadas 3.012 amostras de leite provenientes de 760 vacas Holandesas ou mestiças Holandês-Zebu, pertencentes a 15 rebanhos. Todas as amostras foram submetidas ao CMT e processadas para CCS em equipamento Fossomatic 90. Os valores médios de CCS (x 1.000 células/ml) obtidos para os escores de CMT foram 1 (79,9), 2 (333,5), 3 (670,3), 4 (1.354,0) e 5 (4.455,6). Três opções de interpretação (doente/não-doente) para o CMT foram testadas, em relação aos valores de CCS, iniciando com 100.000 células/ml: (a) 1 versus 2, 3, 4, e 5; (b) 1 e 2 versus 3, 4 e 5; (c) 1, 2, 3 versus 4 e 5. As sensibilidades do CMT em identificar corretamente quartos mamários acima de 200.000 células/ml foram 79%, 61% e 34%, para as opções a, b e c, respectivamente. Para identificar corretamente contagens acima de 500.000 células/ml, as sensibilidades do CMT, para as opções a, b e c, foram, respectivamente: 93%, 82% e 54%. A sensibilidade do CMT em identificar quartos mamários com mastite subclínica foi adequada (acima de 80%) quando a interpretação do teste foi mais rigorosa (opções a e b). A interpretação da reação 3 como negativa (opção c) só alcançou sensibilidade de 80% para contagens entre 1.200.000 e 1.400.000 células/ml. As especificidades do CMT, para CCS de 200.000 e 500.000 foram, respectivamente, 90% e 80% (opção a), 97% e 90% (opção b) e 99% e 97% (opção c).