scholarly journals Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mary Ellen Gilder ◽  
Nay Win Tun ◽  
Annabelle Carter ◽  
Ferdinand Frederik Som Ling Tan ◽  
Aung Myat Min ◽  
...  
Keyword(s):  
Weight Loss ◽  
Post Partum ◽  
Tubal Ligation ◽  
Significant Weight Loss ◽  
Lactating Women ◽  
Resource Limited ◽  
Intravenous Diazepam ◽  
Increased Risk ◽  
Clinically Significant ◽  
Oral Diazepam

Abstract Background Anesthesia in lactating women is frequently indicated for time-sensitive procedures such as postpartum tubal ligation. Ketamine and diazepam are two of the most commonly used anesthetic agents in low resource settings, but their safety profile in lactating women has not been established. Methods Medical records of post-partum tubal ligations between 2013 and 2018 at clinics of the Shoklo Malaria Research Unit were reviewed for completeness of key outcome variables. Logistic regression identified presence or absence of associations between drug doses and adverse neonatal outcomes: clinically significant weight loss (≥95th percentile) and neonatal hyperbilirubinemia requiring phototherapy. Results Of 358 records reviewed, 298 were lactating women with singleton, term neonates. There were no severe outcomes in mothers or neonates. On the first postoperative day 98.0% (290/296) of neonates were reported to be breastfeeding well and 6.4% (19/298) had clinically significant weight loss. Phototherapy was required for 13.8% (41/298) of neonates. There was no association between either of the outcomes and increasing ketamine doses (up to 3.8 mg/kg), preoperative oral diazepam (5 mg), or increasing lidocaine doses (up to 200 mg). Preoperative oral diazepam resulted in lower doses of intraoperative anesthetics. Doses of intravenous diazepam above 0.1 mg/kg were associated with increased risk (adjusted odds ratio per 0.1 mg/kg increase, 95%CI) of weight loss (1.95, 95%CI 1.13–3.35, p = 0.016) and jaundice requiring phototherapy (1.87, 95%CI 1.11–3.13, p = 0.017). Conclusions In resource-limited settings ketamine use appears safe in lactating women and uninterrupted breastfeeding should be encouraged and supported. Preoperative oral diazepam may help reduce intraoperative anesthetic doses, but intravenous diazepam should be used with caution and avoided in high doses in lactating women.

scholarly journals Early weight loss in parkinsonism predicts poor outcomes

Neurology ◽  
2017 ◽  
Vol 89 (22) ◽  
pp. 2254-2261 ◽  
Author(s):  
Kirsten Cumming ◽  
Angus D. Macleod ◽  
Phyo K. Myint ◽  
Carl E. Counsell
Keyword(s):  
Weight Loss ◽  
Weight Change ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Atypical Parkinsonism ◽  
Significant Weight Loss ◽  
North East ◽  
Increased Risk ◽  
Clinically Significant ◽  
Early Weight Loss

Objective:To compare weight change over time in patients with Parkinson disease (PD), those with atypical parkinsonism, and matched controls; to identify baseline factors that influence weight loss in parkinsonism; and to examine whether it predicts poor outcome.Methods:We analyzed data from the Parkinsonism Incidence in North-East Scotland (PINE) study, an incident, population-based prospective cohort of parkinsonian patients and age- and sex-matched controls with annual follow-up. Mixed-model analysis described weight change in patients with PD, those with atypical parkinsonism, and controls. Baseline determinants of sustained clinically significant weight loss (>5% loss from baseline) and associations between early sustained weight loss and death, dementia, and dependency in parkinsonism were studied with Cox regression.Results:A total of 515 participants (240 controls, 187 with PD, 88 with atypical parkinsonism) were followed up for a median of 5 years. At diagnosis, atypical parkinsonian patients had lower body weights than patients with PD, who were lighter than controls. Patients with PD lost weight more rapidly than controls, and weight loss was most rapid in atypical parkinsonism. After multivariable adjustment for potential confounders, only age was independently associated with sustained clinically significant weight loss (hazard ratio [HR] for 10-year age increase 1.83, 95% confidence interval [CI] 1.44–2.32). Weight loss occurring within 1 year of diagnosis was independently associated with increased risk of dependency (HR 2.11, 95% CI 1.00–4.42), dementia (HR 3.23, 95% CI 1.40–7.44), and death (HR 2.23, 95% CI 1.46–3.41).Conclusion:Weight loss occurs in early parkinsonism and is greater in atypical parkinsonism than in PD. Early weight loss in parkinsonism has prognostic significance, and targeted dietary interventions to prevent it may improve long-term outcomes.

Abstract #615: Hispanic People Achieve Clinically Significant Weight loss with Liraglutide 3.0 Mg for Weight Management

2015 ◽  
Vol 21 ◽  
pp. 121
Author(s):  
Patrick O’Neil ◽  
W. Timothy Garvey ◽  
J. Michael Gonzalez-Campoy ◽  
Pablo Mora ◽  
Rafael Violante Ortiz ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Significant Weight Loss ◽  
Hispanic People ◽  
Clinically Significant

scholarly journals Combining ecological momentary assessment, wrist-based eating detection, and dietary assessment to characterize dietary lapse: A multi-method study protocol

2021 ◽  
Vol 7 ◽  
pp. 205520762098821
Author(s):  
Stephanie P Goldstein ◽  
Adam Hoover ◽  
E Whitney Evans ◽  
J Graham Thomas
Keyword(s):  
Weight Loss ◽  
Eating Behavior ◽  
Ecological Momentary Assessment ◽  
Structured Interview ◽  
Self Report ◽  
Significant Weight Loss ◽  
Clinically Significant ◽  
Ecological Momentary ◽  
Momentary Assessment ◽  
Lapse Behavior

Objectives Behavioral obesity treatment (BOT) produces clinically significant weight loss and health benefits for many individuals with overweight/obesity. Yet, many individuals in BOT do not achieve clinically significant weight loss and/or experience weight regain. Lapses (i.e., eating that deviates from the BOT prescribed diet) could explain poor outcomes, but the behavior is understudied because it can be difficult to assess. We propose to study lapses using a multi-method approach, which allows us to identify objectively-measured characteristics of lapse behavior (e.g., eating rate, duration), examine the association between lapse and weight change, and estimate nutrition composition of lapse. Method We are recruiting participants (n = 40) with overweight/obesity to enroll in a 24-week BOT. Participants complete biweekly 7-day ecological momentary assessment (EMA) to self-report on eating behavior, including dietary lapses. Participants continuously wear the wrist-worn ActiGraph Link to characterize eating behavior. Participants complete 24-hour dietary recalls via structured interview at 6-week intervals to measure the composition of all food and beverages consumed. Results While data collection for this trial is still ongoing, we present data from three pilot participants who completed EMA and wore the ActiGraph to illustrate the feasibility, benefits, and challenges of this work. Conclusion This protocol will be the first multi-method study of dietary lapses in BOT. Upon completion, this will be one of the largest published studies of passive eating detection and EMA-reported lapse. The integration of EMA and passive sensing to characterize eating provides contextually rich data that will ultimately inform a nuanced understanding of lapse behavior and enable novel interventions. Trial registration: Registered clinical trial NCT03739151; URL: https://clinicaltrials.gov/ct2/show/NCT03739151

307-OR: Mean Blood Beta-Hydroxybutyrate Predicts Clinically Significant Weight Loss following 90 Days Carbohydrate-Restricted Nutrition Therapy

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 307-OR
Author(s):  
AMY L. MCKENZIE ◽  
SHAMINIE J. ATHINARAYANAN ◽  
REBECCA N. ADAMS ◽  
BRITTANIE M. VOLK ◽  
STEPHEN PHINNEY ◽  
...  
Keyword(s):  
Weight Loss ◽  
Nutrition Therapy ◽  
Significant Weight Loss ◽  
Clinically Significant ◽  
Beta Hydroxybutyrate

scholarly journals Is 5% weight loss a satisfactory criterion to define clinically significant weight loss?

Obesity ◽  
2015 ◽  
Vol 23 (12) ◽  
pp. 2319-2320 ◽  
Author(s):  
Donald A. Williamson ◽  
George A. Bray ◽  
Donna H. Ryan
Keyword(s):  
Weight Loss ◽  
Significant Weight Loss ◽  
Clinically Significant

scholarly journals Outcomes of retained and disengaged pregnant women living with HIV in Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251413
Author(s):  
Agnes N. Kiragga ◽  
Ellon Twinomuhwezi ◽  
Grace Banturaki ◽  
Marion Achieng ◽  
Juliet Nampala ◽  
...  
Keyword(s):  
Post Partum ◽  
Urban Environments ◽  
Hiv Viral Load ◽  
Viral Loads ◽  
Women Living With Hiv ◽  
Resource Limited ◽  
Increased Risk ◽  
Exposed Infant ◽  
Public Clinics ◽  
Living With Hiv

Introduction Loss-to-follow-up among women living with HIV (WLWHIV) may lead to unfavorable outcomes for both mother and exposed infant. This study traced WLWHIV disengaged from care and their infants and compared their outcomes with those retained in care. Methods The study included WLWHIV who initiated ART during pregnancy at six public clinics in Uganda. A woman was defined as disengaged (DW) if she had not attended her 6-week post-partum visit by 10 weeks after her estimated date of delivery. DW were matched with retained women (RW) by age and duration on ART. Nurse counselors traced all selected DW via telephone and community visits to assess vital status, infant HIV sero-status and maternal HIV viral load through blood draws. Results Between July 2017 and July 2018, 734 women (359 DW and 375 RW) were identified for the study. Tracing was attempted on 349 DW and 160 (44.6%) were successfully located and enrolled in the study. They were matched with 162 RW. Among DW, 52 (32.5%) transferred to another health facility. Very few DW, 39.0% were HIV virally suppressed (<1000 copies/ml) compared to RW 89.5%, P<0.001). Among 138 babies born to DW, 4.3% tested positive for HIV compared to 1.4% among babies born to RW (P = 0.163). Conclusion Pregnant and breastfeeding WLWHIV who disengage from care are difficult to find in urban environments. Many have detectable viral loads, leading to the potential for an increased risk of MTCT. Efforts to reduce disengagement from care are critical for the successful elimination of MTCT in resource-limited settings.

scholarly journals A Digital Health Weight Loss Program in 250,000 Individuals

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Conor Senecal ◽  
Robert Jay Widmer ◽  
Beth R. Larrabee ◽  
Mariza de Andrade ◽  
Lilach O. Lerman ◽  
...  
Keyword(s):  
Weight Loss ◽  
Mobile Application ◽  
Weight Control ◽  
Large Scale ◽  
Digital Health ◽  
Large Population ◽  
Weight Loss Program ◽  
Significant Weight Loss ◽  
Face To Face ◽  
Clinically Significant

Importance. Obesity is a worsening epidemic worldwide. Effective and accessible weight loss programs to combat obesity on a large scale are warranted, but a need for frequent face-to-face care might impose a limitation. Objective. To evaluate whether individuals following a weight loss program based on a mobile application, wireless scale, and nutritional program but no face-to-face care can achieve clinically significant weight loss in a large cohort. Design. Retrospective observational analysis. Setting. China from October 2016 to December 2017. Participants. Mobile application users with a minimum of 2 weights (baseline and ≥35 days). Intervention. A commercial (Weijian Technologies) weight loss program consisting of a dietary replacement, self-monitoring using a wireless home scale, and frequent guidance via mobile application. Main Outcome. Mean weight change around 42, 60, 90, and 120 days after program initiation with subgroup analysis by gender, age, and frequency of use. Results. 251,718 individuals, with a mean age of 37.3 years (SD: 9.86) (79% female), were included with a mean weight loss of 4.3 kg (CI: ±0.02) and a mean follow-up of 120 days (SD: 76.8 days). Mean weight loss at 42, 60, 90, and 120 d was 4.1 kg (CI: ±0.02), 4.9 kg (CI: ±0.02), 5.6 kg (CI: ±0.03), and 5.4 kg (CI: ±0.04), respectively. At 120 d, 62.7% of participants had lost at least 5% of their initial weight. Both genders and all usage frequency tertiles showed statistically significant weight loss from baseline at each interval (P<0.001), and this loss was greater in men than in women (120 d: 6.5 vs. 5.2 kg; P<0.001). The frequency of recording (categorized as high-, medium-, or low-frequency users) was associated with greater weight loss when comparing high, medium, and low tertile use groups at all time intervals investigated (e.g., 120 d: −8.6, −5.6, and −2.2 kg, respectively; P<0.001). Conclusions. People following a commercially available hybrid weight loss program using a mobile application, wireless scale, and nutritional program without face-to-face interaction on average achieved clinically significant short- and midterm weight loss. These results support the implementation of comparable technologies for weight control in a large population.

Mental illness as a predictor of patient attendance and anthropometric changes: observations from an Australian publicly funded obesity management service

2020 ◽  
pp. 103985622095371
Author(s):  
Louise Brightman ◽  
Alexandra Dunne ◽  
Hsin-Chia Carol Huang
Keyword(s):  
Mental Illness ◽  
Weight Loss ◽  
Depressive Disorders ◽  
Psychotic Disorders ◽  
Management Service ◽  
Obesity Management ◽  
Significant Weight Loss ◽  
Retrospective Audit ◽  
Schizophrenia Spectrum ◽  
Clinically Significant

Objective: Obesity is associated with co-morbid mental illness. The Canberra Obesity Management Service (OMS) supports adults with severe obesity who have the psychosocial capacity to engage. This study will determine whether mental illness is a predictor of OMS attendance and anthropometric changes. Method: A retrospective audit was performed from July 2016 to June 2017. Baseline characteristics, attendance and anthropometrics were stratified according to the presence of mental illness. Outcomes included weight stabilisation and clinically significant weight loss. Descriptive analyses were performed. Results: Mental illness was present in 60/162 patients (37%). Attendance was similar for those with and without mental illness. Patients with mental illness had twice as many co-morbidities ( p = .001). Depressive disorders were most common ( n = 28, 47%). Anxiety, schizophrenia spectrum and other psychotic disorders, and trauma- and stressor-related disorders also featured. Weight stabilisation was achieved by 25 patients (66%) with mental illness and 25 (35%) without. Clinically significant weight loss was observed in 10 patients (26%) with and 26 (40%) without mental illness. Conclusion: The presence of mental illness did not impact OMS attendance or weight stabilisation. The higher rate of co-morbidities in those with mental illness highlights the challenges faced by this vulnerable population.

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