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Objective: This study examined rates of suicide and hospitalization with psychiatric diagnoses after sleeve gastrectomy compared with gastric bypass and restrictive procedures (gastric banding/gastroplasty). Methods: This was a longitudinal retrospective cohort study comprising all patients who underwent primary bariatric surgery in New South Wales or Queensland, Australia, between July 2001 and December 2020. Hospital admission records, death registration, and cause of death records (if applicable) within these dates were extracted and linked. Primary outcome was death by suicide. Secondary outcomes were admissions with self‐harm; substance‐use disorder, schizophrenia, mood, anxiety, behavioral, and personality disorders; any of these; and psychiatric inpatient admission. Results: A total of 121,203 patients were included, with median follow‐up of 4.5 years per patient. There were 77 suicides, with no evidence of difference in rates by surgery type (rates [95% CI] per 100,000 person years: 9.6 [5.0–18.4] restrictive, 10.8 [8.4–13.9] sleeve gastrectomy, 20.4 [9.7–42.8] gastric bypass; p = 0.18). Rates of admission with self‐harm declined after restrictive and sleeve procedures. Admission with anxiety disorders, any psychiatric diagnosis, and as a psychiatric inpatient increased after sleeve gastrectomy and gastric bypass, but not restrictive procedures. Admissions with substance‐use disorder increased after all surgery types. Conclusions: Variable associations between bariatric surgeries and hospitalization with psychiatric diagnoses might indicate distinct vulnerabilities among patient cohorts or that differing anatomical and/or functional changes may contribute to effects on mental health. [ABSTRACT FROM AUTHOR]

The Pfizer/BioNtech BNT162b2 is a major vaccine used in the Australian COVID‐19 immunisation programme. We report on BNT162b2 safety in the observation period in a dedicated vaccination clinic linked to a quaternary teaching hospital. We performed a retrospective review of medical records for 57 842 vaccinations, and describe the model of care and adverse event rate at the clinic during its first 2 months of operation. A total of 243 adverse events following immunisation (0.42% of total vaccine doses) were recorded in the immediate observation period post‐vaccination, which were predominantly immunisation stress‐related responses. Of the 110 patients who experienced an adverse event with their first dose of the vaccine, 90% returned for their second dose of the vaccine, with 87% not reporting any further adverse reaction with the subsequent dose. Nineteen (0.03% of total doses) people were reviewed for an allergic reaction, of which 10 (53%) reported a history of prior allergies. A female predominance was present in both total adverse reactions (70%) and allergic vaccine reactions (79%). Only two patients experienced anaphylaxis (0.003% of total doses), in keeping with low rates of adverse reactions to the BNT162b2 vaccine in the current literature. Overall, the present study reinforces the safety of BNT162b2 in the Australian population, describes vaccination completion rates after adverse events and identifies predisposing factors for rare allergic reactions to the vaccine. [ABSTRACT FROM AUTHOR]

Background: Shifts in the gastrointestinal microbiome have been shown to contribute to the progression of metabolic diseases including prediabetes and type 2 diabetes mellitus. Research suggests that in-vivo modulation of the gut microbiome by specific probiotic microorganisms may improve insulin sensitivity and blood sugar management, preventing or delaying the development of type 2 diabetes mellitus. However, further research is needed to understand the effect of probiotics as a therapy for the treatment of metabolic diseases. An evidence-based multi-species probiotic was developed to encourage a shift in the gastrointestinal bacterial cohort from a disease-prone to a balanced state with the aim of improving metabolic markers associated with type 2 diabetes mellitus.Methods: Sixty adults with a body mass index ≥25 kg/m2 with prediabetes or type 2 diabetes mellitus (diagnosed within the previous 12 months) will be enrolled in a double-blind, placebo-controlled pilot study. Participants will be randomized to a multi-species probiotic or placebo for 12 weeks. Both groups will receive lifestyle and nutritional advice. The primary outcome measure is the change between groups in fasting plasma glucose levels from baseline to 12 weeks. Secondary outcome measures include, but are not limited to, the change in lipid profile, systemic inflammation, gut permeability, and faecal microbial and metabolomic profiles. Blood and stool samples are collected at baseline and 12 weeks after treatment.Discussion: Intentional manipulation of gastrointestinal microbial profiles may be useful for preventing and controlling type 2 diabetes mellitus and its associated metabolic complications.Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12613001378718 . Registered on 16 December 2013. [ABSTRACT FROM AUTHOR]

Background: Referral for both lifestyle and surgical interventions are recommended as part of the clinical management of obesity in general practice. However, current practice falls short of this. This qualitative study aimed to describe the factors influencing general practitioners' (GPs) referral intentions for their obese patients. Methods: Semi-structured qualitative interviews were conducted with 24 GPs from four geographically different areas in New South Wales, Australia about the management of their obese patients. A qualitative analysis was applied using inductive thematic analysis. Results: The predominant factors influencing GPs' referral were their own attitudes and experience, and their patient's motivation. Lifestyle intervention Referrals were usually initiated by GPs and influenced by their patients and the local health system. Referrals to conduct bariatric surgery were frequently initiated by the patient and influenced by GPs' limited previous experience, patients' expectations and ability to pay, as well as professional and legal issues. There was no strong link between referral and the remoteness of areas or the availability of surgical referral services. Conclusion: There were differences between GPs reported referral behaviour for lifestyle and surgical interventions. GPs' attitudes to referral were often formed by their limited case experience rather than by a review of more systematic evidence, especially for surgical interventions. These patterns may be improved by educating and better communicating with GPs about the outcomes for their patients when they are referred. [ABSTRACT FROM AUTHOR]

Childhood obesity remains one the most important public health challenges globally, potentially affecting 60 million children by 2020. Increasingly, children are becoming overweight at a relatively young age, which affects metabolic health, both in childhood and later life. In New South Wales NSW, Australia, one in four school-aged children and adolescents are overweight or have obesity. Noticeably, the prevalence of severe obesity continues to increase in this age group. Despite this prevalence, weight issues are rarely recognised or managed when patients attend clinical services and there are few appropriate clinical services available. Several Local Health Districts LHDs, across socio-economic and culturally diverse populations, are implementing a new service aiming to deliver integrated weight management services for children and adolescents. This presents a unique opportunity to research the implementation and integration of these new services alongside established services to determine the clinical effectiveness and impact of the services. No such research has been undertaken previously in Australia. Methods: This study will ascertain what factors affect acceptability, reach, and participation and retention rates and measure clinical effectiveness through changes in child weight outcomes. The study aims to: Audit existing tertiary and secondary care models for managing children above a healthy weight. Evaluate the newly established secondary care clinics, models of care and healthcare pathways. Determine what factors, including acceptability, reach, participation and retention rates, effectiveness and sustainability, are important for different models of care through focus groups and stakeholder interviews. Undertake economic analysis to determine cost of services. A range of process and economic cost measures will be collected from: i routinely collected data; ii document review; and iii surveys, key informant interviews and focus groups with clinical staff, health service managers, and patients and families. For the clinical effectiveness component, the primary outcome will be change in body mass index, adjusted for age and sex, at 6 months from baseline. The secondary outcomes will be change in key food and physical activity behaviours at 6 months from baseline. The study has successfully secured funding through the NSW Health Translational Research Grant Scheme. Outcomes: The findings will provide an understanding of the most effective design and delivery of local services, enhancing the accessibility, acceptability, reach and impact of paediatric weight management services. This will enable recommendations to be made for future services planning to optimise scalability and sustainability of integrated, responsive and effective care of paediatric patients with overweight or obesity. [ABSTRACT FROM AUTHOR]

Abstract: Our aim was to design a selection of foods with differing proportions of protein but equal palatability in two settings, Sydney Australia and Kingston Jamaica. The foods were manipulated to contain 10, 15 or 25% E as protein with reciprocal changes in carbohydrate to 60, 55 or 45% E and dietary fat was kept constant at 30%. Naïve participants did not identify a difference in protein between the versions. On average, the versions were rated equal in pleasantness (Sydney-10%: 44±2, 15%: 49±2 and 25%: 49±2 Kingston-10%: 41±3, 15%: 41±3 and 25%: 37±3). [Copyright &y& Elsevier]

Adults who were born preterm are at increased risk of hypertension and cardiovascular disease in later life. Infants born late preterm are the majority of preterm births; however, the effect of late preterm on risk of cardiovascular disease is unclear. The objective of this study was to assess whether vascular health and cardiac autonomic control differ in a group of late preterm newborn infants compared to a group of term-born infants.A total of 35 healthy late preterm newborn infants, with normal growth (34-36 completed weeks' gestation) and 139 term-born infants (37-42 weeks' gestation) were compared in this study. Aortic wall thickening, assessed as aortic intima-media thickness (IMT) by high-resolution ultrasound, and cardiac autonomic control, assessed by heart rate variability, were measured during the first week of life. Postnatal age of full-term and late preterm infants at the time of the study was 5 days (standard deviation [SD] 5) and 4 days (SD 3), respectively.Infants born late preterm show reduced aortic IMT (574 μm [SD 51] vs. 612 μm [SD 73]) and reduced heart rate variability [log total power 622.3 (606.5) ms2 vs. 1180. 6 (1114.3) ms2], compared to term infants. These associations remained even after adjustment for sex and birth weight.Infants born late preterm show selective differences in markers of cardiovascular risk, with potentially beneficial differences in aortic wall thickness in contrast to potentially detrimental differences in autonomic control, when compared with term-born control infants. These findings provide pathophysiologic evidence to support an increased risk of hypertension and sudden cardiac death in individuals born late preterm.

Importance: Severely energy-restricted diets are the most effective dietary obesity treatment. However, there are concerns regarding potential adverse effects on body composition., Objective: To compare the long-term effects of weight loss via severe vs moderate energy restriction on lean mass and other aspects of body composition., Design, Setting, and Participants: The Type of Energy Manipulation for Promoting Optimum Metabolic Health and Body Composition in Obesity (TEMPO) Diet Trial was a 12-month, single-center, randomized clinical trial. A total of 101 postmenopausal women, aged 45 to 65 years with body mass index (calculated as weight in kilograms divided by height in meters squared) from 30 to 40, who were at least 5 years after menopause, had fewer than 3 hours of structured physical activity per week, and lived in the Sydney metropolitan area of New South Wales, Australia, were recruited between March 2013 and July 2016. Data analysis was conducted between October 2018 and August 2019., Intervention: Participants were randomized to either 12 months of moderate (25%-35%) energy restriction with a food-based diet (moderate intervention) or 4 months of severe (65%-75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for an additional 8 months (severe intervention). Both interventions had a prescribed protein intake of 1.0 g/kg of actual body weight per day, and physical activity was encouraged but not supervised., Main Outcomes and Measures: The primary outcome was whole-body lean mass at 12 months after commencement of intervention. Secondary outcomes were body weight, thigh muscle area and muscle function (strength), bone mineral density, and fat mass and distribution, measured at 0, 4, 6, and 12 months., Results: A total of 101 postmenopausal women were recruited (mean [SD] age, 58.0 [4.2] years; mean [SD] weight, 90.8 [9.1] kg; mean [SD] body mass index, 34.4 [2.5]). Compared with the moderate group at 12 months, the severe group lost more weight (effect size, -6.6 kg; 95% CI, -8.2 to -5.1 kg), lost more whole-body lean mass (effect size, -1.2 kg; 95% CI, -2.0 to -0.4 kg), and lost more thigh muscle area (effect size, -4.2 cm2; 95% CI, -6.5 to -1.9 cm2). However, decreases in whole-body lean mass and thigh muscle area were proportional to total weight loss, and there was no difference in muscle (handgrip) strength between groups. Total hip bone mineral density (effect size, -0.017 g/cm2; 95% CI, -0.029 to -0.005 g/cm2), whole-body fat mass (effect size, -5.5 kg; 95% CI, -7.1 to -3.9 kg), abdominal subcutaneous adipose tissue (effect size, -1890 cm3; 95% CI, -2560 to -1219 cm3), and visceral adipose tissue (effect size, -1389 cm3; 95% CI, -1748 to -1030 cm3) loss were also greater for the severe group than for the moderate group at 12 months., Conclusions and Relevance: Severe energy restriction had no greater adverse effect on relative whole-body lean mass or handgrip strength compared with moderate energy restriction and was associated with 2-fold greater weight and fat loss over 12 months. However, there was significantly greater loss of total hip bone mineral density with severe vs moderate energy restriction. Therefore, caution is necessary when implementing severe energy restriction in postmenopausal women, particularly those with osteopenia or osteoporosis., Trial Registration: anzctr.org.au Identifier: 12612000651886.