Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-13T18:36:38Z No. of bitstreams: 1 carolinaferreiraguarniericandido.pdf: 1306757 bytes, checksum: f424cb742d750709fa80cc252dfb911f (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-27T21:21:08Z (GMT) No. of bitstreams: 1 carolinaferreiraguarniericandido.pdf: 1306757 bytes, checksum: f424cb742d750709fa80cc252dfb911f (MD5) / Made available in DSpace on 2016-06-27T21:21:08Z (GMT). No. of bitstreams: 1 carolinaferreiraguarniericandido.pdf: 1306757 bytes, checksum: f424cb742d750709fa80cc252dfb911f (MD5) Previous issue date: 2015-02-10 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introdução: A cirurgia bariátrica é um tratamento legítimo da obesidade na atualidade e para sua eficácia é indispensável a aderência às modificações alimentares, comportamentais e de estilo de vida, a qual pode estar também associada a fatores psicossociais. Objetivo: Avaliar a aderência ao tratamento de pacientes submetidos à cirurgia bariátrica e sua associação com aspectos psicossociais (resiliência, auto-eficácia, suporte social). Métodos: Estudo transversal, realizado com 39 pacientes do Serviço de Controle da Hipertensão, Obesidade e Diabetes da cidade de Juiz de Fora, submetidos à cirurgia bariátrica, através de quatro instrumentos validados e entrevista. Resultados: A auto-eficácia e a resiliência se mostraram variáveis importantes frente ao estilo comportamental necessário para o sucesso do tratamento, para a adequação alimentar e aderência à atividade física. A atividade física ganha destaque frente às várias correlações obtidas, com variáveis clínicas, psicossociais e comportamentais. A atividade física e a alta auto-eficácia mostraram-se fatores de proteção em relação a um quadro depressivo. Conclusão: Faz-se necessário o acompanhamento de qualidade a longo prazo, assim como o desenvolvimento de mediadores importantes na manutenção dessas mudanças comportamentais, tais como a resiliência e a auto-eficácia. / Introduction: Nowadays, bariatric surgery is a legitimate obesity treatment and for real effectiveness is essential the adherence to dietary changes, behavioral changes and lifestyle, which can be associated with psychosocial factors. Objective: To evaluate the adherence to treatment of patients undergoing bariatric surgery and its association with psychosocial factors (resilience, self-efficacy, social support). Methods: Cross-sectional study with 39 patients, from Serviço de Controle da Hipertensão, Diabetes e Obesidade of Juiz de Fora, who are going through the process of bariatric surgery. For the study, four validated instruments were applied and the patients were interviewed. Results: Self-efficacy and resilience were important variables in the behavioral style for a successful treatment along with appropriate diet and adherence to physical activity. Physical activity is highlighted across the various correlations obtained with clinical, psychosocial and behavioral variables. Physical activity and high self-efficacy proved to be preventive factors to depression. Conclusion: It is necessary to make a quality monitoring in the long-term and also the development of important mediators in the maintenance of these behavioral changes, such as resilience and self-efficacy.

Orientador: Ronis Magdaleno Júnior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T22:18:51Z (GMT). No. of bitstreams: 1 Sampaio_AnnaBeatrizRibeiroFerreira_M.pdf: 1517421 bytes, checksum: 77934d71d276c29b7828986fa52c3fff (MD5) Previous issue date: 2013 / Resumo: A obesidade vem crescendo, ano a ano, mundialmente, sendo vista pelas autoridades de saúde como um grave problema de saúde pública e um grande desafio para o século XXI. A consequência direta do aumento dessa população obesa e da falta de tratamentos adequados é a elevação do número de cirurgias bariátricas realizadas mundialmente. Essas cirurgias trazem consequências para o paciente operado, consequências essas que não são totalmente conhecidas. Metodologia: Utilizamos o Método Clínico-Qualitativo. A amostra foi intencional e fechada pelo critério de saturação, composta por sete mulheres candidatas à cirurgia bariátrica para tratamento de obesidade mórbida. A coleta de dados foi realizada por meio de entrevistas semidirigidas de questões abertas realizada pelo pesquisador gravadas, transcritas e analisadas em profundidade. Os dados foram submetidos à análise de conteúdo e validação externa pelos pares do Laboratório de Pesquisa Clínico-Qualitativa do Departamento de Psicologia Médica e Psiquiatria da Unicamp. Discussão e resultados: a Cirurgia Bariátrica traz a essas mulheres uma nova esperança de vida, mas as expectativas são irreais. Elas depositam todas as suas expectativas na cirurgia, acreditando que serão reinseridas no mercado de trabalho e na sociedade. Acreditam também que terão uma melhora de suas relações afetivas. Deixam de pensar nas dificuldades que irão enfrentar após a cirurgia. Nas falas dessas pacientes evidenciamos um forte mecanismo de negação quanto às dificuldades que decorrem da cirurgia, sendo ressaltadas as possíveis aquisições pessoais após a perda de peso e, assim, deixam de olhar para os problemas que terão de enfrentar. Buscam, através da cirurgia, renascer e tornar-se outra pessoa. Muitas dessas pacientes encaram a cirurgia como certeza de profundas mudanças de identidade. Apesar das fantasias idealizadas de resolução dos problemas da vida após a CB, há um forte sentimento de desafio a ser enfrentado. A obesidade para essas mulheres sempre foi um desafio a ser vencido e, com a possibilidade de uma mudança, este sentimento fica mais aflorado e gera apreensões e angústias. O medo da morte permeia toda a experiência dessas mulheres. Elas se veem numa encruzilhada onde podem morrer se não fizerem a cirurgia ou morrer fazendo a cirurgia. Outro elemento com o qual nos deparamos durante as entrevistas é o medo da morte simbólica do corpo obeso e das satisfações narcísicas que estão ligadas a esse corpo. Conclusão: Ao analisarmos as vivências dessas pacientes diante da cirurgia bariátrica notamos que este procedimento traz grandes expectativas de mudanças a essas mulheres. Em função disso, a equipe multidisciplinar, sobretudo o psicólogo deve estar atento aos aspectos psicossociais que mobilizam essas pacientes e que possam interferir negativamente no resultado da cirurgia. Quem lida com essa população deve estar instrumentalizado para compreender e atuar de modo eficiente neste importante processo. Acreditamos que os resultados obtidos com esse trabalho possam colaborar com o manejo desse grupo de pacientes pela equipe de saúde, possibilitando assim um melhor cuidado clínico, que deve ser necessariamente multidisciplinar. Esses profissionais devem conhecer as particularidades emocionais dessas pacientes para, assim, poderem ajudá-las fazendo com que os resultados e a adesão sejam mais eficazes / Abstract: Obesity is growing from year to year, globally, and has already been seen as a serious public health problem and a major challenge for the XXI century. A direct consequence of the increase in the obese population and also the lack of appropriate treatments is the increased number of bariatric surgeries performed in the country. These surgeries carry consequences for the patient to be operated, and are not yet fully known. Methods: We used the Clinical-Qualitative Method. The sample was intentional and closed by the saturation criterion, composed of seven women candidates for bariatric surgery (BS) for morbid obesity. The interviews were semi-structured open-ended questions, conducted by the researcher recorded, transcribed and analyzed in depth. The data were submitted to the categorization, content analysis and external validation by peers Laboratory of Clinical-Qualitative Research, Department of Medical Psychology and Psychiatry at Unicamp. Discussion and results: Bariatric Surgery brings these women a new life expectancy, but unreal. They lay all your expectations in surgery, believing they will be re-inserted in the labor market and in the society. They also believe they will have improves in relationships. They don't think about the difficulties that will face in post-surgery. In the speech of these patients, we observed a strong denial mechanism of the difficulties caused by the surgery and the highlighted possible personal purchases after weight loss and thus, fail to look at the problems they will face. Seek, through surgery, reborn and become another person. Many of these patients face the surgery as sure of profound change of identity. Despite the idealized fantasies of solving the problems of life after BS, there is a strong sense of challenge to be faced. Obesity for these women has always been a challenge to be overcome and the possibility of a change this feeling gets touched and this creates apprehensions and anxieties. The fear of death permeates the experience of these women. They find themselves at a crossroads where they can die if they do not do surgery or die doing surgery. Another element that we observed during interviews is the fear of the symbolic death of the obese body and narcissistic satisfactions that are attached to this body. Conclusion: Analyzing the experiences of these patients before bariatric surgery we notice that this procedure has great expectations of changes to these women. As a result, the multidisciplinary team, especially the psychologist must be aware of the psychosocial factors that mobilize these patients and can negatively impact the outcome of the surgery. Those who deal with this population should be able to understand and act effectively in this important process. We believe that the results obtained from this study can assist in the management of this group of patients by health professionals, enabling better clinical care, which must necessarily be multidisciplinary. These professionals should know the emotional particularities of these patients, so they can help them making the results more effective / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Bakgrund: Fetma är ett ökande folkhälsoproblem som kan åtgärdas med överviktskirurgi. Överviktskirurgi leder till en övergång från ett stadium/tillstånd i livet till ett annat som medför att personens sociala status förändras. Personer som genomgått en överviktskirurgi är mer förberedda på de fysiska förändringarna än de psykosociala. Syfte: Att beskriva personers upplevelser efter en överviktskirurgi med fokus på den psykosociala situationen. Samt att beskriva de valda artiklarnas undersökningsgrupp. Metod: En beskrivande litteraturstudie baserad på tolv vetenskapliga artiklar. Datainsamling har skett från databaserna PsycINFO och CINAHL. Huvudresultat: Deltagarna uppgav att de kände sig mer normala och accepterade i sociala sammanhang då omgivningens uppmärksamhet förändrades efter överviktsoperationen. De sociala relationerna antog ofta en ny riktning då deltagarna tenderade att ta mer plats i livet. Det framkom att befintliga relationer var viktiga och vårdades men även att de påverkades negativt på grund av slitningar och oro. Skilsmässa uppgavs i flera fall då livet gått i olika riktning. Det framkom även att stöd från anhöriga och supportergrupper var viktiga för att få hjälp med att flytta fokus från invanda tankar och mönster. Slutsats: Att genomgå en överviktskirurgi innebär en livsomställning som påverkar den psykosociala situationen, vilket deltagarna inte alltid kände sig tillräckligt förberedda på. Utifrån den föreliggande litteraturstudien kan sjuksköterskan med ökad förståelse och kunskap bättre bemöta, informera och stödja personer som genomgått överviktskirurgi. / Introduction: Obesity is a public health problem on the increase that can be addressed with bariatric surgery. Bariatric surgery leads to a transition from one stage to another, which causes the person's social status to change. People undergoing bariatric surgery are more prepared for the physical changes than the psychosocial. Aim: The purpose was to describe person’s experiences following a bariatric surgery focusing on the psychosocial situation, and to describe the selected articles study group. Method: A descriptive literature study based on twelve scientific articles. Data was collected from the databases PsycINFO and CINAHL. Result: The participants stated that they felt more normal and accepted in social contexts when the attention of the surroundings changed after the bariatric surgery. Social relations often assumed a new direction when participants tended to take more space in their lives. It was found that existing relationships were important and cared for, but also that they were adversely affected by wear and tear and worries. Divorce was reported in several cases when life went in different directions. It was also found that support from relatives and support groups was important in helping move the focus from ingrained thoughts and patterns. Conclusion: Undergoing a bariatric surgery involves a life adjustment that affects the psychosocial situation, which participants did not always feel sufficiently prepared for. Based on the current literature study, the nurse with better understanding and knowledge can better respond, inform and support people who have undergone bariatric surgery.

Bariatric, or weight loss, surgery (WLS) is known as the most effective treatment for severe obesity, and the number of bariatric surgeries performed in the United States has more than tripled over the past two decades. Despite the potential health benefits of WLS (i.e., reversal of type 2 diabetes), research has revealed problematic alcohol use among WLS patients, in part associated with the following risk factors: the prevalence of a lifetime alcohol use disorder (AUD), the Roux-en-Y gastric bypass (RYGB) procedure, younger age, and an increased post-surgical sensitivity to alcohol. There is reason to believe both (a) young adult and (b) racial/ethnic minority bariatric surgery patients could be particularly prone to problematic drinking post-surgery, as both demographic groups represent an elevated risk of problematic alcohol use in the general population. Despite this, to date, there has been no in-depth assessment of alcohol use among young adult WLS patients. This dissertation utilized a sequential exploratory mixed methods design to examine alcohol use among young adult, racially/ethnically diverse WLS patients. Descriptive and inferential analyses examined alcohol use patterns and predictors of problematic alcohol use for 69 young adults who had WLS. Nearly one quarter of the sample (24.6%, n=17) reported an increase in alcohol use after WLS. Age, time since surgery, the RYGB procedure, and having a pre-operative alcohol use disorder (AUD) when entered into the model together, were not a predictive model of frequency of alcohol use or problematic alcohol use after WLS (F [4, 64] = 2.3, p=.067). However, the diagnosis of a pre-operative AUD was associated with an increased frequency of alcohol use post WLS, holding all other predictors constant (p

Obesity levels are increasing worldwide, and in the United Kingdom the prevalence of overweight and obesity is amongst the highest in the developed world. Obesity is associated with reduced physical function and health-related quality of life, as well as an increased risk of co-morbidities such as type 2 diabetes and hypertension. As a result of high levels of morbid obesity and a failure of conventional methods of weight loss, more people are resorting to invasive weight loss techniques such as bariatric surgery. Bariatric surgery combined with lifestyle modification is currently the most successful weight loss intervention for the treatment of obesity and its associated co-morbidities. However, weight regain is becoming more apparent, generally occurring between 12 and 24 months after surgery. Weight regain is generally attributed to the failure of individuals to adopt or maintain the necessary lifestyle changes. The most common factors leading to weight regain after bariatric surgery are insufficient exercise and returning to pre-operative eating behaviours. Increasing physical activity after surgery positively affects weight loss and physical function outcomes; therefore, adopting an active lifestyle is fundamental. This thesis combines three research studies which collectively provide evidence for understanding the importance of physical activity for optimising physical function and facilitating the prevention of weight regain. Study one is a systematic review and meta-analysis which assessed pre to post-operative changes in physical activity behaviour and physical function outcomes among obese adults receiving bariatric surgery. This demonstrates improvements in objective and self-reported activity and function by 12 months. Study two is an analysis of body mass, co-morbidity and physical function data from pre to post bariatric surgery. This retrospective NHS dataset analysis aimed to identify if and when weight regain occurs, the proportion of co-morbidity resolution, and physical function patterns in patients after bariatric surgery. Weight loss patterns indicate weight stability from 12 to 24 months and weight regain 24 months post-surgery. Study three is a randomised controlled trial, The MOTION Study, which examined the effect of a 12 week exercise intervention on physical function and body composition in patients 12-24 months post bariatric surgery. This trial also examined maintenance of effects at six months. Findings suggest that implementing exercise at the point of weight regain is effective, notably for improving physical function and body composition in this population. This thesis therefore contributes to advancing the understanding of the role of physical activity in enhancing long-term outcomes after bariatric surgery and to informing future post-operative bariatric care.

Orientador: Egberto Ribeiro Turato / Tese (doutorado) - Universidade EStadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T12:18:02Z (GMT). No. of bitstreams: 1 MagdalenoJunior_Ronis_D.pdf: 2731308 bytes, checksum: 8ebca8702c1a9bcf508be125634537e7 (MD5) Previous issue date: 2009 / Resumo: Este estudo teve por objetivo compreender as vivências emocionais de mulheres obesas mórbidas submetidas à cirurgia bariátrica. A obesidade tornou-se, globalmente, um grave problema de saúde pública e, em função disto, tem crescido de modo expressivo o número de cirurgias bariátricas como opção de tratamento para a obesidade mórbida. Contudo, é um procedimento que implica em importantes modificações físicas e psicossociais para o paciente. Metodologia: Aplicamos o Método Clínico Qualitativo a uma amostra intencional e fechada pelo critério de saturação, composta por sete mulheres operadas num período de um ano e meio a três anos no Hospital das Clínicas da UNICAMP. Entrevistas semidirigidas de questões abertas foram realizadas pelo pesquisador, gravadas, transcritas e analisadas em profundidade, tendo emergido deste procedimento categorias que serviram como base para sustentação e discussão dos resultados. Resultados e Discussão: a cirurgia bariátrica está relacionada com uma importante melhora da aceitação social das pacientes, elevação da auto-estima e recuperação da identidade que esteve cronicamente encoberta pelo excesso de gordura corporal. Existe um risco de desilusão com a cirurgia no, caso das expectativas em relação a ela sejam irreais no pré-operatório. Nestes casos ocorre frequentemente uma desmotivação do desafio de manter a perda de peso. A perda massiva de peso também está relacionada com sentimentos de desproteção, sobretudo naqueles casos onde a obesidade desempenhava uma função defensiva em relação aos outros e a própria sexualidade. A fome sofre transformações importantes após a cirurgia, tanto qualitativas como quantitativas, o que facilita a luta em favor da perda de peso. Contudo, o procedimento cirúrgico afeta diretamente a experiência de saciedade, mas não a satisfação alimentar, o que pode levar a uma sensação de intensa insatisfação pessoal. Esta insatisfação é vivida como angústia e, pode levar à transformação da compulsão alimentar em direção a outras compulsões ou mesmo ao desenvolvimento de novas estratégias alimentares que permitam a ingestão de quantidades aumentadas de calorias, levando ao re-ganho de peso. Como o procedimento cirúrgico provoca uma restrição volumétrica do estômago, a paciente se vê rapidamente impedida de lidar com a ansiedade ingerindo alimentos. Este impedimento expõe a impossibilidade que têm em encontrar referenciais simbólicos para a angústia, mostrando que a fome para o obeso mórbido é uma área de déficit representacional psíquico, o que os impossibilita elaborar psiquicamente a angústia, restando a via de descarga corporal como única possível. Conclusões: A cirurgia bariátrica é um procedimento que traz importantes transformações psíquicas, sociais e físicas para a mulher portadora de obesidade mórbida. Em função disto, a equipe de saúde que lida com esta população deve estar instrumentalizada para compreender e atuar de modo eficiente tanto no pré como no pós-operatório. Trata-se de um procedimento médico que gera fortes demandas psíquicas para o paciente e, consequentemente, para a equipe de saúde, devendo esta contar, necessariamente, com profissionais da área de saúde mental que estejam preparados para intervir psicologicamente tanto com os pacientes, como com os movimentos emocionais da equipe. / Abstract: This study aims at understanding the emotional experiences of morbidly obese women who have undergone bariatric surgery. Obesity has become a serious public health problem worldwide and, due to this, the number of bariatric surgeries, as an option for treating morbid obesity, has grown considerably. However, it is a procedure that involves significant physical and psychosocial changes for the patient. Methodology: We applied the Clinical Qualitative Method to an intentional sample, closed according to the criterion of saturation, of seven women operated on during a period of between one and a half and three years at the University Hospital of UNICAMP (the State University of Campinas, S.P., Brazil). Semidirected interviews with open-ended questions were carried out, recorded, transcribed and analyzed in-depth by the researcher. From this procedure there emerged categories that served as a basis to underpin the results and for the discussion of the material obtained. Results and Discussion: bariatric surgery is related to a substantial improvement in the social acceptance of these patients, increasing their self-esteem and recovering their identity which had been chronically concealed by the excess of body fat. There is a risk of disillusionment with the surgery when pre-operative expectations are unreal. In these cases, there is frequently a loss of motivation to keep up the weight loss. The massive weight loss is also related to feelings of helplessness, especially in those cases where obesity played a defensive role in regard to others and to their own sexuality. Hunger undergoes significant transformations after the surgery, both qualitative and quantitative, which make the struggle to lose weight easier. However, the surgical procedure directly affects the experience of satiety, but not of satiation, which can lead to a sensation of intense personal dissatisfaction. This dissatisfaction is experienced as anguish and may transform the eating compulsion into other compulsions or even lead to the development of new eating strategies that allow the ingestion of increased quantities of calories resulting in regaining weight. As the surgical procedure brings about a volumetric restriction of the stomach, the patient is soon unable to cope with anxiety by ingesting food. This exposes the impossibility of finding symbolic references for the anguish, showing that hunger for the morbidly obese is an area of psychic representational deficit, which makes it impossible to elaborate the anguish psychically, leaving the body as the only possible means of discharge. Conclusions: Bariatric surgery is a procedure that brings about significant psychic, social and physical transformations for women with morbid obesity. Due to this, the team dealing with this population should have the necessary training to understand and act efficiently both in the pre- and post-operative period. It is a medical procedure which generates huge demands on the patient and, consequently, on the health team, which should include mental health professionals who are prepared to intervene psychologically both with the patients as well as with the emotional movements of the team. / Doutorado / Saude Mental / Doutor em Ciências Médicas

Obesity is a multifactorial chronic disease, associated with increased cardiovascular risk, that produces hemodynamic changes, in cardiac structure and function, increasing the risk of heart failure, especially the diastolic; what is important to evaluate these patients more carefully. The aim of this study is to evaluate left ventricular diastolic function in severe obese in preoperative for bariatric surgery. This is an observational, prospective and analytical study. Were evaluated in 132 patients, severely obese, asymptomatic, with normal systolic function that were in the preoperative evaluation for bariatric surgery. Stratified into three groups, according to diastolic function, the group Nl comprised 61 patients with normal diastolic function, the group DD mild, consisted of 24 patients with mild diastolic dysfunction and the group DD M/S composed of 41 patients with moderate diastolic dysfunction (pseudonormal pattern) and 06 patients with severe diastolic dysfunction (restrictive pattern). After stratification, we compared the clinical and echocardiographic characteristics among groups. Of the 132 patients, 97 (73.5%) were women. The mean age was 38.5 ± 10.5 years and average BMI was 43.7 ± 7.2 kg/m². 48 patients had obesity class II and 84 grade III obesity. The cardiovascular risk factors that showed significant differences between groups Nl vs DD mild and Nl vs DD M/G were: metabolic syndrome with 67.5% (81 patients), hypertension with 59.8% (79 patients) and diabetes mellitus with 25.2% (32 patients). Regarding clinical values we found significant differences among groups in age, waist circumference and systolic blood pressure. Regarding echocardiographic variables, we found a larger left atrial diameter, left ventricular diastolic diameter, left atrial volume at 4 and 2 chambers, index of left atrial volume, index of left ventricular mass to body surface, and this index for height, in the groups with DD mild and DD M/S vs Nl. The higher prevalence of left ventricular diastolic dysfunction in pre-clinical phase in severe obese patients justifies the need for a careful echocardiographic assessment using joint analysis of all available echocardiographic techniques, in order to identify individuals at high risk for heart failure, so that early intervention measures are adopted. / Obesidade é uma doença crônica, multifatorial, associada a aumento do risco cardiovascular e de insuficiência cardíaca, principalmente a diastólica, o que torna importante a avaliação mais criteriosa dos pacientes obesos. O objetivo deste estudo é avaliar a função diastólica do ventrículo esquerdo em obesos graves em pré-operatório para cirurgia bariátrica. Trata-se de um estudo observacional, transversal, prospectivo e analítico. Foram avaliados 132 pacientes obesos graves e assintomáticos, do ponto de vista cardiovascular, e que estavam em avaliação pré-operatória para cirurgia bariátrica. Estratificados em 3 grupos, de acordo com a função diastólica, sendo o grupo N1 constituído por 61 pacientes com função diastólica normal, o grupo DD leve constituído por 24 pacientes com disfunção diastólica leve e o grupo DD M/G constituído por 41 pacientes com disfunção diastólica moderada (padrão pseudonormal) e 06 pacientes com disfunção diastólica grave (padrão restritivo). Após estratificação, foram comparadas as características clínicas e ecocardiográficas entre os grupos. Dos 132 pacientes, 97 (73,5%) eram mulheres. A idade média foi de 38,5 ± 10,5 anos e o IMC médio foi de 43,7 ± 7,2 Kg/m², sendo 48 pacientes com obesidade grau II e 84 com obesidade grau III. Os fatores de risco cardiovascular que apresentaram diferença significativa entre os grupos Nl vs DD leve e Nl vs DD M/G foram: síndrome metabólica com 67,5% (81 pacientes), HAS com 59,8% (79 pacientes) e DM com 25,2% (32 pacientes). Quanto as variáveis clínicas, apresentaram diferença significativa entre os grupos foram a idade, a circunferência abdominal e a pressão arterial sistólica. Em relação às variáveis ecocardiográficas, encontrou-se um maior diâmetro do átrio esquerdo, diâmetro diastólico do ventrículo esquerdo, volume do átrio esquerdo em 4 e 2 câmaras, índice de volume atrial esquerdo, índice de massa do ventrículo esquerdo para superfície corpórea e esse índice para altura, nos grupos com DD leve e DD M/G vs o grupo Nl. A alta prevalência de disfunção diastólica do ventrículo esquerdo na fase pré-clínica em obesos graves justifica a necessidade de uma avaliação ecocardiográfica criteriosa, utilizando a análise conjunta de todas as técnicas ecocardiográficas disponíveis, com o objetivo de identificar indivíduos com maior risco de insuficiência cardíaca, para que medidas de intervenção precoce sejam adotadas.

Este estudo teve como objetivo avaliar e comparar desgaste dentário e perda dentária de pacientes eutróficos, obesos mórbidos pré cirúrgico, operados com até 24 meses e operados com mais de 36 meses de cirurgia bariátrica. O estudo foi do tipo observacional transversal e analítico com pareamento de sexo e idade. A amostra foi composta por 240 pacientes, (GC) - pacientes eutróficos (N=60), (GO) - pacientes obesos mórbidos (N=60), (G24) - pacientes operados com menos de 24 meses (N=60) e (G36) - pacientes operados com mais de 36 meses (N=60). As variáveis que foram analisadas: sexo, raça, escolaridade, classe econômica, hipertensão, diabetes, triglicerídeos, colesterol, tabagismo, etilismo, idade, IMC, % de perda de peso, perda dentária, desgaste dentário e relação cintura-quadril. Foi aplicada a análise estatística descritiva para obter as frequências absolutas e relativas. Para verificar a associação entre obesidade e os desfechos bucais (desgaste dentário e perda dentária) foi usado o modelo de regressão linear multivariada, Odds ratio (OR) e o intervalo de confiança (IC) de 95%. Não houve diferenças estatisticamente significativas entre os grupos considerando etnia (p=0,135), escolaridade (p=0,108), triglicerídeos (p=0,078), tabagismo (p=0,568) etilismo (p=0,712), dentes perdidos (p=0,686) e o desgaste dentário tanto por sextantes, quanto total (p=0,448). Porém houve desgaste maior entre os sextantes II e V. O GO apresentou menor classe econômica (p=0,012), maior proporção de hipertensão (p<0,001), diabetes (p<0,001), colesterol (p=0,001), IMC (p<0,001) e relação cintura-quadril (p<0,001), % de perda de peso foi maior no G24 comparado ao G36 (p<0,001). Pode-se concluir que indivíduos submetidos à cirurgia Bypass Gástrico em Y de Roux, independente do período de cirurgia, apresentaram mais desgaste dentário nas superfícies incisais/oclusais, sendo que os dentes anteriores foram os mais afetados. O desgaste dentário esteve associado à idade e ao número de dentes perdidos. / The aim of this study was to evaluate and compare dental wear and tooth loss of eutrophic, preoperative, morbidly obese patients operated on for up to 24 months and operated with more than 36 months of bariatric surgery. The study was crosssectional and analytical with gender and age matching. The sample consisted of 240 patients (GC) - Eutrophic patients (N = 60), (GO) - morbidly obese patients (N = 60), (G24) - patients operated on less than 24 months (G36) - patients operated on for more than 36 months (N = 60). The variables that were analyzed were sex, race, schooling, economic class, hypertension, diabetes, triglycerides, cholesterol, smoking, alcoholism, age, BMI, weight loss, dental loss, dental wear and waist-to-hip ratio. The descriptive statistical analysis was applied to obtain the absolute and relative frequencies. The multivariate linear regression model, odds ratio (OR) and 95% confidence interval (CI) were used to verify the association between obesity and oral outcomes (dental wear and tooth loss). There were no statistically significant differences between groups (p=0,135), schooling (p=0.108), triglycerides (p=0.078), smoking (p=0.568) and dental wear by both sextants and total (p=0.448). However, there was greater wear among the II and V sextants. The GO presented lower economic class (p=0.012), higher proportion of hypertension (p<0.001), diabetes (p<0.001), cholesterol (p=0.001), BMI (p<0.001) and waist-hip ratio (p<0.001), % weight loss was higher in G24 compared to G36 (p<0.001). It can be concluded that individuals submitted to the Roux-en-Y obesity surgery, regardless of the surgery period, presented more tooth wear on the incisal / occlusal surfaces, and the anterior teeth were the most affected. Dental wear was more related to age and tooth loss.

Introduction Previous study investigating Emergency Department (ED) visits rate and admission rates in bariatric patients’ post-surgery shows a 2-year admission rate of 26%. Aim The primary aim of this study was to assess the number of ED visits and admissions as well as examine if there is a correlation with comorbidities, education level, quality of life, and image method used. The secondary aim was to compare the ED and admission rate between the cohort and the general population. Methods This retrospective study included a total of 190 patients. They were followed for 2 years. All the patients were operated on during 2017 in Region Örebro. The cohort and data were obtained from the Scandinavian Obesity Surgery Registry and data concerning ED visit and admittance rate was collected by reviewing medical records. Results The ED visit rate was 116 (61%) and the admittance rate was 76 (40%). Poor mental health, low education level and smoking were correlated to a higher degree of admittance and ED visit rate. There were more imagining used in the group that visited the ED or got admitted. The most common diagnoses were symptoms related to the digestive system and abdomen. The study population had a higher degree of admittance and ED visit rate than the general population. Conclusions Rate of admittance seem to be correlated to factors related to socioeconomic status. More research is needed to investigate what intervention would help this subgroup most, so they don’t have to seek medical care to the same degree.

No description available.