Fertility, pregnancy and post partum management after bariatric surgery: a narrative review

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Of the women who gave birth in Australia in 2018, 47% had overweight or obesity, with obesity being associated with both maternal and fetal complications.

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Bariatric surgery improves fertility and some pregnancy‐related outcomes.

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Following bariatric surgery, pregnancy should be delayed by at least 12–18 months due to adverse pregnancy outcomes associated with rapid weight loss.

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Contraception should be prescribed after bariatric surgery, although the effectiveness of the oral contraceptive pill may be reduced due to malabsorption and contraceptive devices such as intrauterine devices should be considered as first line therapy.

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After bariatric surgery, women should undergo close monitoring for nutritional insufficiencies before, during and after pregnancy. Expert opinion recommends these women undergo dietary assessment and supplementation to prevent micronutrient deficiencies.

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Bariatric surgeons, bariatric medical practitioners, bariatric dieticians, the patient’s usual general practitioner, obstetricians, and maternity specialists should be involved to assist in the multidisciplinary management of these complex patients.

Differences in Accessibility of Public Health Facilities in Hierarchical Municipalities and the Spatial Pattern Characteristics of Their Services in Doumen District, China

This study used the two-step floating catchment area method and potential model to calculate facility accessibility and potential service scope of public health infrastructure distribution, and to evaluate its spatial equity. We applied the Gini coefficient to measure the spatial equilibrium at each level of public health infrastructure in Doumen District, Guangdong, China, from different perspectives. The following results were obtained: (1) Significant spatial differences were observed in the accessibility of public health facilities among different levels; the higher the health facility level, the greater the difference in spatial accessibility. Spatial differences in the accessibility of public health infrastructure at the primary level and higher were distributed in a block-like pattern, while spatial differences in the accessibility of rural health stations were distributed in a circular pattern. Administrative villages tended to have the highest and lowest accessibility of tertiary and secondary hospitals, but not of primary hospitals and rural health stations. The frequencies for administrative villages with the highest and lowest accessibility were 32.8% and 49.6% of the total number of villages in the district, respectively, for tertiary hospitals; 39.2% and 48.8% for secondary hospitals; 19.2% and 24.8% for primary hospitals; 16.8% and 21.6% for rural health stations. (2) The potential service scope was spatially dissociative for tertiary hospitals, and differed more significantly in terms of space for secondary hospitals; the potential service scope of the two overlapped. The potential service scope of primary hospitals was relatively balanced, with strong spatial continuity, while that of rural health service centers was spatially fragmented. The service scope of rural health service centers was mostly consistent with their respective village-level administrative divisions. (3) The higher the level of public health infrastructure, the less balanced its spatial layout. Conversely, the lower the level of public health infrastructure, the more balanced its spatial layout.

Clinical Leadership and Management Perceptions of Inpatients with Obesity: An Interpretative Phenomenological Analysis

While obesity is recognized as a key global public health issue, there has been no research to date on the perceptions of care for people with this condition held by individuals in positions of organizational power. The aim of this study was therefore to describe the perceptions and experiences of clinical leaders and managers of providing care to inpatients with obesity at a metropolitan public health service. This study applied an interpretative phenomenological analysis (IPA) approach to qualitative research, conducting interviews with 17 participants. Their perceptions of care for inpatients with obesity encompassed both their personal understanding as an individual, and their observations about the organizational, patient and carer perspectives. Three overall themes were identified: (1) the problem of inpatients with obesity, (2) inpatients with obesity as sources of risk and (3) personal and professional perceptions of inpatients with obesity. While clinical leaders and managers were aware of the potential impact of stigma and weight bias on care given to this cohort, elements of implicit bias, stereotyping, "othering" and ambivalence were frequently present in the data. Ongoing efforts to improve care for patients with obesity must therefore include efforts to address perceptions and attitudes at all organisational levels of the workforce.

Bariatric surgery revisions and private health insurance

OBJECTIVE

To identify: 1. The percentage of bariatric procedures that are revisions; 2. What proportion of bariatric revision procedures in public hospitals are for patients whose primary weight loss procedure occurred in a private hospital; 3. The age, sex and level of socioeconomic disadvantage of patients needing revisions.

METHODS

An analysis of patient level admission data from the Integrated South Australian Activity Collection (ISAAC) was performed. Data were collected on all revisions for weight loss related procedures at all South Australian public and private hospitals, between 2000-2015 using the ISAAC codes for revision procedures.

RESULTS

12,606 bariatric procedures occurred in hospitals; ∼27% of which represent a revision (n=3366). Of these revisions, ∼82% occurred in a private hospital (n=2771), and ∼18% occurred in a public hospital (n=595). Of the 595 revisions in a public hospital, 51% of patients had their original bariatric procedure performed in a private hospital. The majority of patients who had a revision procedure are female (≥82%) with a mean age of ∼45. Individuals from the lowest 2 IRSD quintiles were over-represented for public hospital revisions and primary bariatric procedures.

CONCLUSION

Further investigation is needed to identify: 1. Why 27% of bariatric procedures are revisions; 2. Why at least 51% of revisions in public hospitals are on patients whose original primary bariatric procedure was done in a private hospital; 3. The impact that revision procedures in public hospitals, particularly for originally private weight loss procedures, is having on public hospital wait times; 4. The impact of socioeconomic disadvantage on weight loss procedure outcomes.