School Health Infrastructure and Students’ Elevated Body Mass Index

School-age children with overweight or obesity continue to be problematic in the United States, and are associated with many health, social, and financial problems. Schools provide an excellent venue in which to promote healthy weight in students, and school nurses are well-positioned to play an essential role in controlling obesity. The number of studies reporting relationships among school health infrastructure and prevalence of elevated Body Mass Index (BMI) is limited. The present study explored associations between three components of school health infrastructure (staff, services, budget) and the proportion overweight or obese 1st, 3rd, and 6th grade students, after controlling for selected factors (race, county education level, county poverty level, rurality). Study results supported an independent association between elevated BMI and school health staff. Additionally, independent associations between elevated BMI and the following covariates were supported: household income, race, and parents’ educational level. There is an ultimate need for well-designed studies addressing these associations.

Numbers and Mortality Risk of Hypertensive Patients with or without Elevated Body Mass Index in China

Objective: Our study aimed to estimate the number of hypertension patients with or without elevated body mass index (BMI), and assess their mortality risk. Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS) to estimate the population of hypertensive patients with or without elevated BMI. The mortality risk of hypertension with elevated BMI was estimated by using the China Health and Nutrition Survey (CHNS) data. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals (CI). Results: In total, 23.02% of adults, representing 117.74 (95% CI: 108.79, 126.69) million, had both high BMI and hypertension. Among them, 38.53 (95% CI: 35.50, 41.56) million were recommended to initiate antihypertensive medication but did not take it. Moreover, there were 38.40 (95% CI: 35.50, 41.56) million hypertensive patients with elevated BMI who did not achieve the goal of blood pressure control. All-cause mortality and premature death mortality, especially for the elderly, were significantly and positively associated with the severity of the hypertensive condition (p for trend = 0.001). Conclusion: In China, there were a huge number of patients with hypertension and elevated BMI, and the treatment and control rates for them were low. The more severe the degree of hypertension, the higher risk of all-cause death and premature death in these patients.

Elevated body mass index impairs cumulative live birth rate and obstetric safety of younger women undergoing in-vitro fertilization/intracytoplasmic sperm injection treatment: A retrospective study

Objective: To evaluate the impact of elevated body mass index (BMI) on short- and long-term outcomes of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments. Design: Retrospective cohort study. Setting: Teaching hospital. Population: Overall, 7229 patients undergoing IVF/ICSI fresh cycles and subsequent frozen embryo transfer cycles during 2014-2020. Methods: The patients were divided into normal (18.5–24.9 kg/m2) and high BMI (≥ 25 kg/m2) groups. Subgroup analyses were performed based on the boundary of 38 years old. Multivariate analysis was used to determine whether BMI was associated with live birth rate (LBR) or cumulative live birth rate (CLBR). Main Outcome Measure: Ovarian response, pregnancy outcomes, and safety for both mother and fetus. Results: For younger women (< 38y), CLBR was significantly reduced in the high BMI subgroup compared to the normal BMI control (73.7% vs 76.8%, p = 0.008) and was accompanied by fewer retrieved oocytes and available embryos. Meanwhile, the incidences of cesarean section (92.9% vs 87.1%, p < 0.001), hypertensive disorders of pregnancy (6.7% vs 3.1%, p < 0.001), fetal macrosomia (4.7% vs 2.8%, p = 0.002) and birth defects involving cleft lip and palate (0.4% vs 0.1%, p = 0.030) were significantly higher than the normal BMI group. However, no such differences were observed among older women (≥ 38y). Multivariate analysis revealed that high BMI was a risk factor for CLBR (OR = 0.837, 95% CI: 0.729–0.96). Conclusions: Elevated BMI has a greater adverse impact on younger women.

Risk factors for thromboembolic complications in patients with elevated body mass index during the perioperative period of laparoscopic myomectomy

Background. Uterine fibroid is one of the most common diseases in gynaecological practice accounting from 32 to 70 % according to various authors. In 80 % of cases, fibroids are observed in women of reproductive age. Laparoscopic myomectomy is one of the main methods of surgical treatment for uterine fibroids in wo­men of reproductive age. A large number of advantages of this method of surgical treatment in many cases lead to underestimation of the existing risks such as the risk of thrombosis in women with elevated body mass index (BMI). The purpose of this study is to detect the risk of thrombosis in adequate comprehensive thromboprophylaxis of patients with elevated BMI in the perioperative period of laparoscopic myomectomy using an instrumental method of diagnosis such as low-frequency piezoelectric blood viscometer. Materials and methods. Patients aged 30–45 years undergoing laparoscopic myomectomy (n = 60) were exa­mined. They were divided into 3 groups depending on the BMI and thromboprophylaxis method. Group 1 (n = 16) included women with the BMI < 30 kg/m2, who did not receive thromboprophylaxis. Group 2 (n = 18) consisted of patients with the BMI > 30 kg/m2, who were treated with enoxaparin thromboprophylaxis at a dose of 2,000 anti-Xa IU/0.2 ml subcutaneously (at the BMI of 30–40 kg/m2) and 4,000 anti-Xa IU/0.4 ml subcutaneously (at the BMI > 40 kg/m2). Third group (n = 26) included individuals with the BMI > 30 kg/m2 who received enoxaparin and pentoxifylline for thromboprophylaxis. Results. The low-frequency piezoelectric blood viscometry revealed statistically significant (p < 0.05) deviations from the reference values of the coagulogram towards structural (increased maximum clot density) and chronometric hypercoagulation (acceleration of the time of formation of fibrin-platelet structure T5, shift of the blood clotting time T3 to the left, an increase in the intensity of coagulation drive), elevated thrombin activity (an increase in the constant of thrombin activity, a decrease in T2 time), activation of vascular-platelet hemostasis (reduced period of T1 reaction onset, increased intensity of contact coagulation), inhibition of the lytic activity (a decrease in the intensity of retraction and lysis of the clot) in groups 2 and 3. On the first day after surgery in groups 2 and 3, there was a significant increase (compared to preoperative indicators) in the chronometric indicators such as T1, T2 and T5; a decrease in the structural indicator of maximum clot density, as well as a significant decrease in the constant of thrombin activity, intensity of contact coagulation, which confirms the effectiveness of antithrombotic therapy. However, group 2 reported an increase in the activity of vascular-platelet hemostasis, higher intensity of contact coagulation compared to group 3, shorter T1 and T2 time, and the constant of thrombin activity was higher. On the 5th day after surgery, a normocoagulation trend of hemostatic potential was observed in all groups of patients. Conclusions. The use of low-frequency piezoelectric blood viscometry allows reliably and quickly assessing the kinetics of thrombosis formation.

OSA: Special suspected in spontaneous cerebrospinal fluid leakage

Objectives: Loss of Cerebrospinal Fluid (CSF-L) results from a rupture of the skull base and overlying meninges, and pathological communication between the subarachnoid space and the nasal or middle ear cavity. Recently, the pathogenesis has been linked with Intracranial Hypertension (IIH), elevated Body Mass Index (BMI) and Obstructive Sleep Apnea (OSA). Methods: A single institution retrospective study was conducted on 14 patients from our spontaneous CSFL series, which included 167 patients over a 15-year period from 2004 to 2019. All patients underwent to home respiratory polygraphy. Epidemiological and clinical data were reviewed. For the statistical analysis, the confidence interval for a proportion was defined, according to the methods described by RG Newcombe. Results: 14 patients, previously operated on duraplasty in our ENT department, were enrolled. They underwent to polygraphy. The data were compared with those derived from the literature and the results are neither in the range of the general population nor in the non-spontaneous CSFL Conclusion: OSA can increase Intracranial Pressure (ICP) and thus spontaneous CSF losses. However, OSA and BMI may not be independent. Therefore, further studies are needed to analyze the data in detail.