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Internal herniation (IH) is a common problem after laparoscopic Roux-en-Y gastric bypass surgery (RYGB). Routine closure of the mesenteric defects (MDs) reduces the risk of IH. Only very few articles report on risk factors for IH or describe detailed closing techniques. There is no consensus yet on the best closing method. The objective of this study is to determine the optimal stapling method for closure of MDs after RYGB. All performed RYGB procedures in our high-volume bariatric institute were included. Quality of the closure was scored in the categories poor, sub-optimal, and optimal, to see if the quality of the closure would predict the chance of reopening of the MDs and, therefore, the chance of IH. During any type of laparoscopy in the follow-up of the patient, the conditions of the MDs were stated, for example during diagnostic laparoscopy in symptomatic patients suspicious for IH or during laparoscopic cholecystectomy. Technically well-executed closure of Petersen's space (PS) with two rows of staples had a greater chance of still being closed upon re-inspection compared to closure with one row (odds ratio = 8.1; 95% confidence interval [1.2–53.2], p = 0.029). Optimal closure of the MD at the jejuno-jejunostomy (JJ-space, JJS) resulted in more closed JJSs upon re-inspection compared to sub-optimal closure (odds ratio = 3.6 [CI 95% 0.8–16.1], p = 0.099). Non-optimally closed MDs had higher reopening rates and, therefore, pose an additional risk for IH. Our classification provides a quality assessment of MD closure during RYGB and gives insight into how to optimize surgical technique. [ABSTRACT FROM AUTHOR]

Purpose: Bariatric surgery is the most effective treatment for severe obesity in adults and has shown promising results in young adults. Lack of insight regarding efficacy and safety outcomes might result in delayed bariatric surgery utilization in young adults. Therefore, this study aimed to assess the efficacy and safety of bariatric surgery in young adults compared to adults. Methods: This is a nationwide population-based cohort study utilizing data from the Dutch Audit Treatment of Obesity (DATO). Young adults (aged 18–25 years) and adults (aged 35–55 years) who underwent primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were included. Primary outcome was percentage total weight loss (%TWL) until five years postoperatively. Results: A total of 2,822 (10.3%) young adults and 24,497 (89.7%) adults were included. The follow-up rates of the young adults were lower up to five years postoperatively (46.2% versus 56.7% three years postoperatively; p < 0.001). Young adults who underwent RYGB showed superior %TWL compared to adults until four years postoperatively (33.0 ± 9.4 versus 31.2 ± 8.7 three years after surgery; p < 0.001). Young adults who underwent SG showed superior %TWL until five years postoperatively (29.9 ± 10.9 versus 26.2 ± 9.7 three years after surgery; p < 0.001). Postoperative complications ≤ 30 days were more prevalent among adults, 5.3% versus 3.5% (p < 0.001). No differences were found in the long term complications. Young adults revealed more improvement of hypertension (93.6% versus 78.9%), dyslipidemia (84.7% versus 69.2%) and musculoskeletal pain (84.6% versus 72.3%). Conclusion: Bariatric surgery appears to be at least as safe and effective in young adults as in adults. Based on these findings the reluctance towards bariatric surgery in the younger age group seems unfounded. [ABSTRACT FROM AUTHOR]

Background Studies investigating the association between treatment for precancerous changes in the cervix and risk of preterm birth have used a variety of comparison groups. Objectives To investigate whether treatment for precancerous changes in the cervix is associated with preterm birth (<37 weeks) and to examine the impact of the type of comparison group on estimates of risk. Search strategy PubMed, Embase and CENTRAL were searched for studies pubished between 1950 and 2009. Selection criteria Eligible studies were those that reported preterm birth outcomes for excisional and ablative treatments separately and included a comparison group. Data collection and analysis Pooled relative risks (RR) and 95% confidence intervals were computed using a random effects model. Main results Thirty eligible studies were located. Excisional treatment was associated with an increased odds of preterm birth, when compared with an external (RR 2.19, 95% CI 1.93-2.49) or internal (RR 1.96, 95% CI 1.46-2.64) comparison group. In comparison with women who were assessed but not treated, the risk estimate was smaller (RR 1.25, 95% CI 0.98-1.58). Ablative treatment was associated with an increased risk of preterm birth when an external comparison group (RR 1.47, 95% CI 1.24-1.74) but not an internal comparison group (RR 1.24, 95% CI 0.73-2.10) or untreated comparison group (RR 1.03, 95% CI 0.90-1.18) was used. Authors' conclusions Excisional treatment was associated with a significantly increased risk of preterm birth. It provides new evidence that some types of ablative treatment may also be associated with a small increased risk. The type of comparison group used is an important consideration when comparing the outcomes of studies. [ABSTRACT FROM AUTHOR]

Energy planning refers to providing sufficient power to human societies while at the same time underlies resource, economic environmental, social and technological constraints. The complexity of the task renders multi-criteria decision analysis techniques a useful tool in the decision process. Multi-criteria decision analysis techniques offer a transparent way of elaborating on decision problems, which include many criteria and different decision-makers. This article presents the MCDA-RES multi-criteria decision-analysis software and its application in a case-study regarding a wind-hydro hybrid energy project for an island in Greece where the performance of alternatives on a set of different criteria and the preference of the decision-makers is assessed. The analysis showed that no group consensus could be directly established; still some alternatives performed better than others and a way towards a compromise solution could be revealed. [ABSTRACT FROM AUTHOR]

Objective The aims of this study were (i) to examine whether women referred for assessment of precancerous changes in the cervix had higher rates of preterm birth compared with those in the general population and (ii) to compare preterm birth rates for treated and untreated women adjusting for possible confounding factors. Design Retrospective cohort design. Setting Teaching hospital. Population All women referred to the Royal Women’s Hospital, Melbourne (1982–2000), who subsequently had a birth recorded on the Victorian Perinatal Data Collection system ( n= 5548). Methods Record linkage of hospital dysplasia clinic records and population-based birth records. Main outcome measures Total preterm delivery (<37 weeks of gestation) and subtypes. Results Both treated and untreated women were at a significantly increased risk for preterm birth compared with those in the general population: treated—standardised prevalence ratio (SPR) 2.0, 95% CI 1.8–2.3 and untreated—SPR 1.5, 95% CI 1.4–1.7. Within the cohort, the treated women were significantly more likely to give birth preterm (adjusted OR 1.23, 95% CI 1.01–1.51). An increased risk of preterm birth was also associated with a history of induced or spontaneous abortions, illicit drug use during pregnancy or a major maternal medical condition. Cone biopsy, loop electrosurgical excision procedure and diathermy were associated with preterm birth. After adjusting for possible confounding factors, only diathermy remained significant (adjusted OR 1.72, 95% CI 1.36–2.17). Women treated using laser ablation were not at an increased risk for preterm birth (adjusted OR 1.1, 95% CI 0.8–1.4). Conclusions Diagnosis of precancerous changes in the cervix (regardless of the treatment) was associated with an increased risk of preterm birth. Consideration should be given to the preferential use of ablative treatments. [ABSTRACT FROM AUTHOR]

Background: Risks associated with IVF and related assisted reproduction technologies include complications of ovarian stimulation, surgical procedures and pregnancy itself. Serious complications are uncommon but may be potentially life threatening. The aims of this study were to compare the mortality rates of women who received IVF treatment, as well as those who were referred but were not treated, with the mortality rate in the general female population, to determine the maternal mortality rate following IVF conception and to establish whether any deaths had occurred as a result of treatment complications.Methods: Deaths were identified in a cohort of 29 700 Australian IVF patients by record-linkage with the National Death Index and a cancer registry.Results: The all-cause mortality rates in IVF patients (treated and untreated) were significantly lower than in the general female population of the same age. In treated women, 72 deaths were observed and 125 deaths were expected giving an age-standardized mortality ratio of 0.58 (95% confidence interval 0.48-0.69). Two maternal deaths were identified in the 42 days of the puerperium. Complications of ovarian hyperstimulation syndrome could not be directly related to any of the deaths identified in this cohort.Conclusions: As well as providing some reassurance about the safety of IVF treatments, the findings point to the existence of a 'healthy patient effect' whereby the unhealthiest women in the population are deterred from pregnancy and infertility treatment. [ABSTRACT FROM AUTHOR]

Evaluation of the long-term health of children born using in-vitro fertilization (IVF) provides important information to clinicians and consumers. Until very recently, there have been no published data on the incidence of cancer in children conceived as a result of IVF, despite a number of case reports of neuroblastoma in children conceived using fertility drugs. This study used a record-linkage cohort design to investigate the incidence of cancer in children born after IVF. The study included all conceptions using assisted reproductive technologies between 1979 and 1995 at two clinics in Victoria, Australia that resulted in a live birth. Data on births were linked with a population-based cancer registry to determine the number of cases of cancer that occurred. The standardized incidence ratio (SIR) was calculated by comparing the observed number of cases to the expected number of cases. The final cohort included 5249 births. The median length of follow-up was 3 years, 9 months (range 0-15 years). In all, 4.33 cases of cancer were expected and six were observed, giving a SIR of 1.39 (95% CI 0.62-3.09). This study found that children conceived using IVF and related procedures did not have a significantly increased incidence of cancer in comparison to the general population. [ABSTRACT FROM AUTHOR]

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Presents an overview of measures employed to determine and measure the accessibility of cities, while highlighting studies conducted within European cities. Findings of studies conducted; Focus of the infrastructure policy during the 20th century; Details on surveys conducted; Definitions of accessibility.

A response by F. Bruinsma and colleagues to a letter to the editor about their article "Precancerous changes in the cervix and risk of subsequent preterm birth" in the 2007 issue is presented.

A response by F. Bruinsma and colleagues to a letter to the editor about their article "Precancerous changes in the cervix and risk of subsequent preterm birth" is presented .

A letter to the editor is presented in response to the article "Treatment of cervical cancer precursors: influence of age, completeness of excision and cone depth on therapeutic failure, and on adverse obstetric outcomes," by P. Martin-Hirsch, C. Ang, A. Mukhopadhyay, C. Burnley, K. Faulkner, P. Cross, and R. Naik in the 2011 issue.