BACKGROUND: Bariatric surgery is effective for weight loss, but is associated with deficiencies of several micronutrients. Among these, deficiencies in iron and vitamin B12 have been well-described in the literature. While it is known that blood levels of several micronutrients differ between racial groups, it is currently unknown whether the impact of bariatric surgery on micronutrient levels is also race-specific. We addressed this question in reference to vitamin B12 and iron because of the known racial differences in these micronutrients and their impact on red blood cell indices. The aim of our study was to determine whether there are differences in levels of ferritin and vitamin B12, as well as in hemoglobin (HGB) and hematocrit (HCT) levels, between African-Americans (AA), Hispanic-Americans (HA), and Caucasian-Americans (CA) after Roux-en-Y gastric bypass (RYGB) surgery. METHODS: A retrospective medical record review of 1,046 (201 AA, 106 HA, and 344 CA), who underwent bariatric surgery at Boston Medical Center (BMC) between 2004 and 2015 was conducted. Analysis of variance and linear mixed modeling was used to compare adjusted mean changes in biomarkers of anemia, vitamin B12, and ferritin between racial groups before RYGB and up to a period of 4+ years after the surgery. RESULTS: There were significant decreases in all racial/ethnic groups in mean HCT and HGB within the first year following surgery. Mean HCT from baseline to time point 1 (6months-1 year post-operatively) decreased by 3.3% for AA’s (p<0.001), 3.2% for HA’s (p<0.001), and 5% (p<0.001) for CA’s. Mean HCT and mean HGB for the entire sample decreased from baseline to the end of the observation period by 4.4% and 1.45 g/L, respectively. AA's had lower levels of HCT and HGB throughout the observation period compared to HA's and CA's in both the unadjusted and adjusted models. CA's had the highest levels of these blood markers. Decreases in ferritin were also significant, with a decrease from baseline to the end of the observation period of 27.8 μg/L for AA's (p=0.004), a decrease of 49.6 μg/L for HA's (p<0.001), and 54.5 μg/L (p<0.001) for CA's. In comparison with HA's and AA's, CA's had a higher ferritin level at baseline (p=0.715 and p=0.028, respectively). However, when adjusted for age, sex, and initial BMI, CA's had lower ferritin levels throughout much of the observation period compared to HA's and AA's. After an initial increase at 6 months- 1 year post-operatively (time point 1), mean B12 levels remained fairly stable throughout the observation period with levels only slightly declining for AA’s and HA’s over the observation period. Levels remained higher than baseline for all racial/ethnic groups with mean B12 levels at the end increasing by 144.6 ng/L for AA’s (p<0.001), 70.4 ng/L for HA’s (p=0.186), and 182.2 ng/L for CA’s (p<0.001). Though CA’s saw the greatest increase in mean B12 levels from baseline, AA’s had the highest mean B12 levels over the entire observation period, with significantly different levels compared to HA’s and CA’s at time points 1 (p=0.003 and p=0.028, respectively) and 3 (p=0.050 and p=0.042, respectively). Additionally, when other factors significantly affecting mean HCT, HGB, ferritin, and B12 were analyzed and adjusted for in the mixed model, AA’s continued to have the lowest HCT and HGB levels throughout much of the observation period, with CA's having the highest mean levels. For mean B12, even after adjusting for pre-BMI and sex, levels remained highest in AA’s compared to HA’ and CA’s. CONCLUSIONS: Our data demonstrate that ferritin levels, as well as red blood cell indices, decrease after RYGB and blood markers of anemia occur despite supplementation and post-operative follow-up care. We also show that ethnic minorities exhibit more exaggerated decreases in HCT and HGB, suggesting greater risk of anemia after RYGB in these groups. Thus, it is critical to consider race/ethnicity when providing treatment for patients undergoing gastric bypass surgery. However, future prospective studies are needed to further the preliminary results of this study.

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: School of Allied Health Professions. Bibliography: leaves 140-150.

Thesis--University of Oklahoma. / Bibliography: leaves 125-129.

No description available.

BACKGROUND: Post-bariatric hypoglycemia (PBH), a complication of gastric bypass surgery, is characterized by postprandial hyperinsulinemic hypoglycemia. To date, the etiology of PBH has not been fully elucidated. OBJECTIVE: To develop a murine model of PBH by experimentally modifying candidate molecules identified in humans with PBH. METHODS: Gastric bypass patients were assigned to groups based on whether or not they suffered from hypoglycemia (PBH, n = 11; asymptomatic, n = 7). Patients underwent a mixed meal tolerance test with blood draws at baseline, 30 minutes, and 120 minutes postprandially. SOMAscan (Somalogic) was used to evaluate serum for protein levels. In parallel, mass spectrometry (Metabolon) was used to examine metabolite levels. Mice were treated with the Farnesoid X Receptor (FXR) agonist, fexaramine (Fex), or vehicle for 5 days before undergoing a glucose tolerance test (GTT). Mice were sacrificed with tissues collected immediately thereafter. PCR was performed to quantify expression of FXR target genes. A separate cohort of mice was treated with adenine or vehicle for 2 days before undergoing a GTT or an insulin tolerance test. RESULTS: FGF19 was the most significantly upregulated protein in the PBH group at all time points. At 120 minutes postprandially, FGF19 was 2.1-fold higher in the PBH group (p < 1x10-5). Adenine was >2-fold higher at all time points (p < 1x10-8). Treatment with Fex did not result in significant differences during GTT or in expression of FXR target genes. Treatment with adenine did not significantly impact glucose tolerance or insulin sensitivity between groups. CONCLUSIONS: The results of the human serum analyses established a strong foundation on which to develop a murine model of PBH. Though the mouse experiments failed to induce postprandial hypoglycemia, they have directed future experiments toward developing a murine model of PBH. / 2018-07-11T00:00:00Z

Background: Overweight and obesity has increased worldwide and is a leading cause of preventable death. This has led to the quantity of bariatric surgical procedures in Sweden increasing.  Research has identified significant medical benefits such as long-term weight loss, improved risk factors and significant reduction of mortality resulting from the surgery, however research focusing on the experiences of patients has not been undertaken to the same degree. The increasing incidence of overweight and obesity suggest that this patient group will continue to increase each year. Knowledge about the experience of bariatric surgery, including the challenges it represents from the patients’ perspective, is essential for nurses in order to provide the best possible care.                                                           Aim: The aim of the study was to investigate the patient’s experiences after undergoing bariatric surgery beyond the initial post-operative period of 6 months.                       Method: This study has been conducted as a literature review of nine qualitative scientific nursing articles. The data was analysed by conducting a manifest content analysis.        Result: The results found that experiences after bariatric surgery beyond the initial post-operative period were both positive and negative. How the individuals adapted to the changes the surgery entailed was found to be a strong factor in determining the nature of the experience. Two main categories emerged from the data; ‘Enforced Structure’ and ‘A Complete Transformation’.                                                                                   Conclusion: Undergoing bariatric surgery results in extensive and complex changes for this patient group to adapt to. Exploring their experiences has allowed factors for successful and challenging adaption to these changes to be identified. Nursing professionals can use this knowledge to help guide bariatric patients towards a successful adaption to the multitude of changes that surgery encompasses.

Undergraduate honors paper--Mount Holyoke College, 2007. Dept. of Mathematics and Statistics. / Includes bibliographical references (leaves 81-82).

Worldwide obesity has increased at an alarming rate since the 1970’s. It has become a considerable health issue in the United States. A third of the population currently qualifies as obese. These numbers strain the healthcare system and result in higher health care costs related to comorbidities such as type 2 diabetes mellitus, hypertension, and hyperlipidemia. Many individuals attempt to lose weight with dietary changes, physical activity, or medications. These strategies can be effective and assist with modest weight loss but they often fail to meet a patient’s expectations or achieve desired weight loss. Therefore, bariatric surgery becomes an attractive option for many people. There are several types available and significant weight loss is seen with some losing over one hundred pounds in the course of year. These dramatic weight losses improve quality of life and improve or eliminate some comorbid diseases. Unfortunately, research shows that about 1.5 to 2 years post operatively, a large proportion of these people experience a weight regain and results are usually not sustained. Seemingly, this weight regain starts to occur due to a lack of structure and support. Prior to bariatric surgery, there are requirements that one must complete including demonstrating weight loss on their own, attending sessions with a nutritionist, and undergoing a psychological evaluation. In contrast, few surgical programs provide patients with this type of structure post-surgically. Thus, this proposed study aims to incorporate a standardized online multi-disciplinary intervention to prevent weight regain after bariatric surgery. Information on weight trends will be recorded at regular follow up appointments and health related quality of life determined by surveys. After completing this intervention, it is predicted that patients will experience fewer weight fluctuations, limited to no recurrence of comorbidities and an improved quality of life.

No description available.

This dissertation studies the effect of star power among physicians on the diffusion of a medical technology. Studies of the diffusion of medical technologies document institutional and market level factors influencing diffusion rates and patterns. The role of the physician in the diffusion of medical technology in hospitals is not widely studied. This dissertation seeks to fill this gap. Certain "star" physicians and hospitals are recognized as highly attractive to patients. A star physician is defined as a physician who meets any of the following criteria: (i) completed residency training at top 30 ranked hospital, (ii) graduated from a top 30 medical school or (iii) is included in Castle & Connolly's Top Docs publications. A star hospital is defined as a member of the American Association of Medical Colleges' Council of Teaching Hospitals. Using quarterly data on all bariatric surgeries performed in the state of Pennsylvania from 1995 through 2007, I measure the effect of stars physicians and star hospitals on the diffusion of a surgical innovation in bariatric surgery called laparoscopic gastric bypass surgery. I use logistic and OLS regression to test for effects at both the hospital and physician level. At the hospital level, I find that having a star physician at a hospital raises the likelihood of that hospital diffusing laparoscopic gastric bypass from eleven percent to eighty-nine percent. I find that over the time period from first quarter 2000 to fourth quarter 2001, being a star hospital raises the likelihood of that hospital diffusing laparoscopic gastric bypass from thirteen percent to eighty-seven percent. At the physician level, the empirical results indicate that star physicians exert positive asymmetric influence on the adoption and utilization rates of non-stars at the same hospital. This dissertation supports earlier work in technology diffusion by finding a positive influence from key individuals. It adds to the literature on medical technology diffusion by testing a new data set for a chronic disease treatment. / Economics