Alcohol and cannabis use among women with infertility: associations with psychiatric symptoms, attempts to conceive, and engagement in fertility treatment

Little is known about substance use among women with infertility, yet substance use has implications for fertility and pregnancy. The purpose was to estimate the prevalence of substance use among women with infertility and examine whether substance use was associated with psychiatric symptoms, active attempts to conceive, and engagement in fertility treatments. Eligible patients were from a single healthcare system who received a female infertility diagnosis within the past 2 years. Participants (n = 188) completed an online questionnaire regarding substance use, psychiatric symptoms, attempts to conceive, and fertility treatments. The prevalence of hazardous alcohol use, any cannabis use, and hazardous cannabis use were 30.3%, 30.9%, and 8.5%, respectively. Hazardous alcohol use was not associated with psychiatric symptoms (p > .05). Those with any cannabis use were more likely to have higher depression scores than those without (p = .02). Those with hazardous cannabis use were more likely to have higher depression scores (p = .001) and higher anxiety scores (p = .03). Substance use was not associated with actively trying to conceive. Those pursuing fertility treatments had a lower percentage engaging in hazardous alcohol use compared to those not pursuing fertility treatments (19.0% vs. 36.3%, p = .02). Substance use among women with infertility is common. Hazardous cannabis use was associated with greater psychiatric symptoms, suggesting that cannabis may be used to cope with distress. Pursuing fertility treatments may serve as a protective factor for hazardous alcohol use. Clinicians treating patients with infertility may want to screen for substance use.

Examining differences in long-term weight loss outcomes after bariatric surgery: The role of romantic relationship status

INTRODUCTION

This study tested for differences based on relationship status at the time of surgery in baseline body mass index (BMI), weight loss outcomes (change in BMI [ΔBMI], percent total weight loss [%TWL], percent excess weight loss [%EWL]), and rates of successful weight loss (defined as ≥ 50%EWL) up to 4-year postbariatric surgery.

METHOD

Data came from a secondary analysis of patients (N = 492) who were up to 4-year postsurgery and completed a presurgical psychological evaluation and postsurgical survey.

RESULTS

Sixty-nine percent of participants were patients in committed relationships and 31% were single/divorced/widowed patients. Single patients had higher presurgical BMIs than those who were partnered (t = 2.28, p = .02). There were no differences between those who were partnered and singles regarding ΔBMI and %TWL, although singles had smaller %EWL (t = -2.08, p = .04), which became nonsignificant after controlling for covariates. Most participants had successful weight loss (76.8%); however, this was not related to romantic relationship status.

DISCUSSION

The results suggest those who were partnered undergo surgery at better-starting weights than singles and maintain this advantage in the long term. Providers working with patients considering bariatric surgery could inquire about how their romantic and social relationships play a part in their decision-making process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adequacy of prenatal care utilisation and gestational weight gain among women with depression

BACKGROUND

Depression is common during pregnancy, can elevate risk for excessive or inadequate gestational weight gain (GWG), and is associated with both underutilisation and overutilisation of prenatal care. Whether GWG is associated with adequacy of prenatal care among women with and without depression in the United States is unknown. This study evaluated whether adequacy of prenatal care differed by depression status and GWG.

METHODS

Data from the Pregnancy Risk Assessment Monitoring System from 1,379,870 women who were pregnant with a singleton and delivered at 37-42 weeks gestation during 2016 to 2018 were included. Depression was self-reported. The Kotelchuck index was used to evaluate adequacy of prenatal care. Maternal weight gain was compared to GWG guidelines.

RESULTS

Approximately 13.1% of the sample experienced depression during pregnancy. Although those with depression had increased odds of both inadequate and above adequate levels of prenatal care, this association was no longer significant after accounting for demographics, medical comorbidities, and socioeconomic factors. Individuals with inadequate levels of prenatal care with a normal pre-pregnancy body mass index gained less weight during pregnancy.

CONCLUSIONS

The association between depression and prenatal care utilisation seems driven by demographic, medical comorbidity, and socioeconomic variables. Weight outcomes were associated with inadequate prenatal care utilisation.

Anxiety, depression, and infertility-specific distress among women with female factor infertility

This study aimed to evaluate whether anxiety, depression, and infertility-specific distress differ among women with female infertility who are trying to conceive and/or seeking infertility treatment. Women with diagnosed female factor infertility in the past 2 years (N = 188) completed demographic questions, and measures of infertility-specific distress, anxiety, and depression. The majority of the sample were actively trying to conceive (78.7%, n = 148) and approximately one third (33.5%, n = 63) were undergoing fertility treatment. Anxiety and depression scores did not differ based on trying to conceive or treatment-seeking, although these subgroups reported higher levels of need for parenthood and rejection of a childfree lifestyle. High levels of mood and anxiety are experienced by women with female infertility. Although infertility-specific distress is experienced more so by women with anxiety and depression, a substantial proportion of those without mental health conditions had high levels of distress, underscoring the need for screening and treatment.

Cannabis use following bariatric surgery is associated with anxiety and maladaptive eating

BACKGROUND

There are limited data regarding the association of cannabis use with outcomes after bariatric surgery. As such, it is challenging to know how to counsel patients using cannabis.

OBJECTIVES

The purpose of this study was to examine whether postsurgical cannabis use was associated with psychiatric symptoms and maladaptive eating among individuals up to 4 years after bariatric surgery.

SETTING

Single health system.

METHODS

All patients who underwent bariatric surgery over a 4-year period were invited to participate. Participants (N = 765) completed questionnaires online regarding postsurgical cannabis use, psychiatric symptoms, and maladaptive eating.

RESULTS

Any cannabis use after bariatric surgery was associated with increased likelihood of having elevated symptoms of anxiety (odds ratio [OR] = 1.88, P = .003; 37.8% versus 24.4%), increased likelihood of grazing behaviors (OR = 1.77, P = .01; 71.2% versus 58.2%), and higher scores for eating in response to depression (P = .01; 12.13 versus 10.75). Weekly cannabis use was associated with loss of control eating (OR = 1.81, P = .04; 37.2% versus 24.7%), binge eating (OR = 2.16, P = .03; 20.0% versus 10.4%), and night eating behaviors (OR = 2.11, P = .01; 40.0% versus 24.0%). Cannabis use was not associated with depression (P > .05).

CONCLUSIONS

Cannabis use after bariatric surgery was associated with anxiety symptoms and engaging in maladaptive eating behaviors. Frequent cannabis use (i.e., ≥1 per week) was associated with additional types of maladaptive eating. Clinicians involved in presurgical and postsurgical care may want to counsel patients currently using cannabis, especially those who are engaging in frequent use.

Preventing alcohol use post-bariatric surgery: patient perspectives on a technology-based approach

BACKGROUND

Nearly two-thirds of patients engage in alcohol use after bariatric surgery, while a substantial number meet criteria for alcohol use disorder after their procedure. Given that pre-surgical education may not be sufficient, alternative methods of preventing post-surgical drinking are needed. We sought feedback on a proposed technology-based intervention to reduce alcohol use for individuals who have undergone bariatric surgery.

METHODS

Twenty patients who consumed alcohol post-surgery completed qualitative interviews where they provided opinions on sample intervention content, delivery method, timing, and other aspects of a two-session web-based intervention followed by tailored text messaging for 6 months. Interviews were recorded, transcribed, and coded using thematic analysis principles.

RESULTS

Participants strongly endorsed using technology to deliver an alcohol intervention, citing the interactivity and personal tailoring available in the proposed software. Education about the effects of post-surgical drinking and learning new coping strategies for social situations were the two most salient themes to emerge from questions about intervention content. Throughout the interviews, participants strongly highlighted the importance of measuring patient readiness to change alcohol use and matching intervention content to such motivation levels. Respondents felt that text messages could extend what they had learned, but also requested additional non-alcohol content (e.g., recipes, exercise tips). Most participants agreed that an online forum consisting of peers and professionals with whom they could ask questions and interact would be useful.

CONCLUSION

Web- and text message-based interventions may be an acceptable approach to prevent alcohol use post-bariatric surgery.

Factors associated with suicide mortality among reproductive age women: a case-control study

OBJECTIVE

Examine demographic, psychosocial, pregnancy-related, and healthcare utilisation factors associated with suicide mortality among reproductive age women.

METHODS

Data from nine health care systems in the Mental Health Research Network were included. A case-control study design was used in which 290 reproductive age women who died by suicide (cases) from 2000 to 2015 were matched with 2,900 reproductive age women from the same healthcare system who did not die by suicide (controls). Conditional logistic regression was used to analyse associations between patient characteristics and suicide.

RESULTS

Women of reproductive age who died by suicide were more likely to have mental health (aOR = 7.08, 95% CI: 5.17, 9.71) or substance use disorders (aOR = 3.16, 95% CI: 2.19, 4.56) and to have visited the emergency department in the year prior to index date (aOR = 3.47, 95% CI: 2.50, 4.80). Non-Hispanic White women (aOR = 0.70, 95% CI: 0.51, 0.97) and perinatal (pregnant or postpartum) women were less likely to have died by suicide (aOR = 0.27, 95% CI: 0.13, 0.58).

CONCLUSIONS

Reproductive age women with mental health and/or substance use disorders, prior emergency department encounters, or who are of racial or ethnic minority status were at increased risk of suicide mortality and may benefit from routine screening and monitoring. Future research should further examine the relationship between pregnancy-related factors and suicide mortality.

Post-surgical cannabis use is associated with weight loss among individuals up to 4 years after bariatric surgery

INTRODUCTION

Although cannabis is known to stimulate appetite, it is not clear whether cannabis use may impact weight loss outcomes following bariatric surgery. Although some work has suggested that pre-surgical cannabis use is not associated with post-surgical weight loss, the role of post-surgical cannabis use has not yet been examined. The purpose of this study was to measure pre- and post-surgical cannabis use and determine whether cannabis use was associated with weight loss outcomes following bariatric surgery.

METHODS

Patients who underwent bariatric surgery over a 4-year period at a single health care system were invited to complete a survey regarding pre- and post-surgical cannabis use and report their current weight. Pre-surgical weight and BMI were extracted from medical records to calculate change in BMI (ΔBMI), percent total weight loss (%TWL), percent excess weight loss (%EWL), whether participants experienced a successful weight loss outcome, and whether participants had weight recurrence.

RESULTS

Among all participants (N = 759), 10.7% and 14.5% engaged in pre- and post-surgical cannabis use, respectively. Pre-surgical cannabis use was not associated with any weight loss outcomes (p > 0.05). Any post-surgical cannabis use was associated with lower %EWL (p = 0.04) and greater likelihood of weight recurrence (p = 0.04). Weekly cannabis use was associated with lower %EWL (p = 0.003), lower %TWL (p = 0.04), and a lower likelihood of having a successful weight loss outcome (p = 0.02).

CONCLUSIONS

Although pre-surgical cannabis use may not predict weight loss outcomes, post-surgical cannabis was associated with poorer weight loss outcomes. Frequent use (i.e., weekly) may be especially problematic. Providers should consider screening patients for cannabis use and educate them about the potential impact of postoperative cannabis use on weight loss following bariatric surgery.

Patient perceptions regarding alcohol use after bariatric surgery

INTRODUCTION

Patients who have undergone bariatric surgery are at increased risk of an alcohol use disorder. Though patients understand this risk, the majority engage in post-surgical alcohol use. This suggests that education alone is not sufficient to reduce post-surgical drinking. To prevent development of post-surgical alcohol use disorders, we need better understanding of the reasons patients use alcohol following surgery. The purpose of this study was to identify factors associated with post-surgical alcohol use.

METHOD

Patients (N = 20) who were 1-3 years post-bariatric surgery and were consuming alcohol at least twice monthly participated in a 60-min interview. Participants responded about their knowledge regarding risk of post-surgical alcohol use and reasons why patients may start drinking. Deductive and inductive coding were completed by two independent raters.

RESULTS

Although nearly all participants were aware of the risks associated with post-surgical alcohol use, most believed that lifelong abstinence from alcohol was unrealistic. Common reasons identified for using alcohol after bariatric surgery included social gatherings, resuming pre-surgical use, and addiction transfer. Inductive coding identified three themes: participants consumed alcohol in different ways compared to prior to surgery; the effect of alcohol was substantially stronger than pre-surgery; and beliefs about why patients develop problematic alcohol use following surgery.

CONCLUSION

Patients consume alcohol after bariatric surgery for a variety of reasons and they do not believe recommending abstinence is useful. Understanding patient perceptions can inform interventions to minimize alcohol use after bariatric surgery. Modifications to traditional alcohol relapse prevention strategies may provide a more robust solution to decreasing negative outcomes experienced by individuals undergoing bariatric surgery.

"Healing Can Be a Very Jagged Line": Reflections on Life as a COVID-19 Long Hauler

"Long COVID" - a term referring to COVID-19-associated symptoms and conditions (ie, sequelae) that remain or emerge after resolution of a SARS-CoV-2 infection - is a multifaceted condition about which little is known. As part of formalized patient-engaged research at a large Midwestern health system, patient stakeholders with long COVID (N=5) wrote stories based on their lived experience, as this was their preferred format for detailing their experience with the condition. These patient stakeholders reviewed one another's stories, identified relevant quotes, and provided opportunities for elaboration. Independently, a trained researcher extracted quotes from the stories, identified themes, and wove the quotes together to share the independent, yet similar, stories. Emergent themes were that of uncertainty about the symptomatology of long COVID and its effects on patients' mental health, physical functioning, family unit, self-identity, and future outlook. Further patient-engaged research on understanding the lived experience of long COVID may serve to advance knowledge and treatment. Health care providers caring for those with long COVID can benefit from listening and validating the stories of individuals suffering from this condition.

A Brief Psychological Intervention for Chronic Pain in Primary Care: Examining Long-term Effects from a Pilot Randomized Clinical Trial

BACKGROUND

Despite the existence of evidence-based psychological interventions for pain management, there are barriers that interfere with treatment engagement. A brief intervention integrated into primary care reduced barriers and showed promising benefits from pre- to post-intervention. However, it is unknown whether a brief intervention can provide long-term effects. The purpose of this study was to examine whether a brief psychological intervention offered benefits in pain severity, pain interference, pain catastrophizing, and depressive symptoms at 1- and 6-month follow-ups.

METHODS

The majority of participants who enrolled in a pilot randomized clinical trial of a 5-session psychological intervention for chronic pain in primary care completed the 1-month (n= 54; 90%) and 6-month follow-ups (n= 50; 83.3%). Participants completed measures of pain severity, pain interference, pain catastrophizing, and depressive symptoms.

RESULTS

From baseline to the 6-month follow-up, those in the intervention group had significantly better outcomes for pain severity (p= .01) and pain catastrophizing (p= .003) compared to the control group. There were no significant differences between the intervention and control groups for pain interference and depression. The percentage of patients in the intervention experiencing clinically significant improvement across all outcomes was higher than the control group.

CONCLUSIONS

Findings suggest that a brief psychological intervention for chronic pain in primary care may offer longer-term benefits similar to that of lengthier interventions. Future studies should examine this through a randomized clinical trial with a larger sample size.

Disordered eating and eating disorders among women seeking fertility treatment: A systematic review

The purpose of this systematic review is to evaluate the prevalence of disordered eating and eating disorders among women seeking fertility treatment.Observational studies were searched in Ovid MEDLINE, Web of Science, Embase, and PsycInfo. Studies published prior to September 2020 when the search was conducted were considered. Inclusion criteria included (1) original and empirical research, (2) published in a peer-reviewed journal, and (3) reported on disordered eating among women seeking fertility treatment in the sample or reported on prevalence of eating disorders among women seeking fertility treatment in the sample. Independent screening of abstracts was conducted by two authors (LH and AH). Ten studies met the inclusion criteria. Sample size, study location, measures, and results for each study in this review were reported.Among women pursuing fertility treatment, rates of current eating disorders ranged from 0.5 to 16.7%, while past eating disorder prevalence rates ranged from 1.4 to 27.5%. Current anorexia nervosa or bulimia nervosa was reported by up to 2% and 10.3% of women, respectively, while history of anorexia nervosa or bulimia nervosa was reported by up to 8.5% and 3.3% of women, respectively. Binge eating disorder or other eating disorders were reported by up to 18.5% and 9.1% of women, respectively. Disordered eating pathology was endorsed by 1.6 to 48% of women seeking fertility treatment. Endorsement of pathological eating attitudes was generally higher among women seeking fertility treatment with current or past eating disorders as compared to community samples, with the exception of dietary restraint. Rates of current and past eating disorders are higher among women seeking fertility treatment than in the general population. Providers treating women with infertility should be cognizant of these prevalence rates and consider screening for eating pathology in their patients as this may contribute to their likelihood of successful conception and/or subsequent pregnancy outcomes.

Utilizing Primary Care to Engage Patients on Opioids in a Psychological Intervention for Chronic Pain

INTRODUCTION

Given the risks of opioids for pain management, we need nonpharmacological interventions that patients will engage in and that can reduce opioid use. The purpose was to examine whether offering a psychological intervention in primary care can engage patients receiving opioids for pain management and to explore whether the intervention influences opioid use.

METHODS

This was a secondary analysis of a pilot randomized controlled trial (RCT) of a 5-session psychological intervention in primary care for chronic pain. Patients with chronic pain (N = 220) were approached to enroll in the RCT. Electronic health records were reviewed to determine whether patients were prescribed opioids or pain medications at the time they were approached about the RCT and the 6-months following the intervention.

RESULTS

Enrollees and non-enrollees had similar rates of opioid prescriptions, morphine milligram equivalent dose of opioids, and rates of other pain medication prescriptions (p> .05). However, no males with an opioid prescription enrolled. Though not significant, those in the intervention had lower odds of having an opioid prescription 6 months following the intervention (p= .09, OR= .32). Those randomized to the intervention had lower odds of having a non-opioid pain medication prescription (p= .01, OR= .17).

CONCLUSIONS

Having an opioid prescription did not interfere with enrollment, suggesting that primary care may be useful for engaging patients on opioids in a psychological treatment for chronic pain. However, this may be true for women, and not men. This intervention also showed promise for decreasing opioid use and warrants further study.

Nutrition knowledge moderates the association between perfectionism and shape/weight concerns

Perfectionistic traits have been associated with stronger weight and diet concerns. Maladaptive perfectionism is tied to critical evaluation tendencies such as excessive concern about making mistakes, increasing one's risk for eating disorder pathology. Knowledge about healthy diet and nutrition may be one factor influencing associations between perfectionistic tendencies, as individuals with eating disorders may be more attuned to sources of nutrients. The current study examined whether nutrition knowledge moderates the association between one facet of perfectionism, concern over mistakes, and shape/weight concerns and the association between concern over mistakes and global eating pathology. College women (N = 122) completed questionnaires on disordered eating attitudes, nutrition knowledge, and perfectionism. Concern over mistakes was positively related to shape/weight concerns and global eating pathology. Nutrition knowledge significantly moderated the association between concerns over mistakes and shape/weight concerns, such that the association was stronger among those with higher levels of nutrition knowledge. Furthermore, nutrition knowledge displayed trend-level significance for the moderation of the association between concern over mistakes and global eating pathology. College women displaying high levels of concern over mistakes who are more informed about nutrition knowledge may be more vulnerable to developing concerns about body shape/weight and eating disorder pathology.

Weighing the Association Between BMI Change and Suicide Mortality

OBJECTIVE

Suicide rates continue to rise, necessitating the identification of risk factors. Obesity and suicide mortality rates have been examined, but associations among weight change, death by suicide, and depression among adults in the United States remain unclear.

METHODS

Data from 387 people who died by suicide in 2000-2015 with a recorded body mass index (BMI) in the first and second 6 months preceding their death ("index date") were extracted from the Mental Health Research Network. Each person was matched with five people in a control group (comprising individuals who did not die by suicide) by age, sex, index year, and health care site (N=1,935).

RESULTS

People who died by suicide were predominantly male (71%), White (69%), and middle aged (mean age=57 years) and had a depression diagnosis (55%) and chronic health issues (57%) (corresponding results for the control group: 71% male, 66% White, 14% with depression diagnosis, and 43% with chronic health issues; mean age=56 years). Change in BMI within the year before the index date statistically significantly differed between those who died by suicide (mean change=-0.72±2.42 kg/m²) and the control group (mean change=0.06±4.99 kg/m²) (p<0.001, Cohen's d=0.17). A one-unit BMI decrease was associated with increased risk for suicide after adjustment for demographic characteristics, mental disorders, and Charlson comorbidity score (adjusted odds ratio=1.11, 95% confidence interval=1.05-1.18, p<0.001). For those without depression, a BMI change was significantly associated with suicide (p<0.001).

CONCLUSIONS

An increased suicide mortality rate was associated with weight loss in the year before a suicide after analyses accounted for general and mental health indicators.

A Brief Psychological Intervention for Chronic Pain in Primary Care: A Pilot Randomized Controlled Trial

OBJECTIVE

Although evidence-based psychological interventions improve chronic pain, many patients do not engage in behavioral health services. Offering a brief intervention in a medical setting may provide benefits to patients with chronic pain. The purpose of this study was to examine preliminary outcomes of a brief psychological intervention for chronic pain delivered in primary care.

DESIGN

Pilot randomized controlled trial.

SETTING

Primary care clinic.

SUBJECTS

Sixty participants with chronic pain were randomized to a 5-session psychological intervention or treatment-as-usual control group.

METHODS

Participants completed pre- and post-intervention measures assessing pain severity, pain interference, pain catastrophizing, depression, and anxiety.

RESULTS

Most participants (76.7%) randomized to the intervention completed all sessions. Compared to the control group, those in the intervention had decreases in pain severity (P = .048), pain catastrophizing (P = .04), and depression (P = .01) from pre- to post-intervention. Within the intervention group, there was a significant improvement in pain interference scores (P = 0.02). Within the intervention group, effect sizes were medium to large for changes in pain severity, pain interference, pain catastrophizing, and depression scores. There were no significant changes in anxiety scores.

CONCLUSION

Results suggest that delivery of a brief psychological intervention for chronic pain in primary care appears to offer improvements in pain severity, pain interference, pain catastrophizing, and depression. Findings suggest that shorter-term psychological interventions may offer similar benefits as longer-term ones. Furthermore, offering a brief intervention in primary care may increase access and engagement in behavioral pain management services. Future research should examine this through a fully-powered trial with longer-term outcomes.

Hazardous Alcohol Use in the Four Years Following Bariatric Surgery

The purpose of this study was to estimate the prevalence of hazardous drinking in the four years after bariatric surgery and investigate whether there are differences between those undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. Participants (N = 564) who underwent bariatric surgery between 2014 and 2017 completed a survey regarding post-surgical alcohol use. The rate of alcohol use following bariatric surgery was significantly higher among those between 1- and 4-years post-surgery compared to those less than 1-year post-surgery. Of those who were consuming alcohol at the time of participation, 16.1% had scores indicative of hazardous drinking. The rate of hazardous drinking among those 3-4 years post-surgery was greater than those less than 1-year post-surgery with 33.3% of patients engaging in hazardous drinking at 3-4 years post-surgery. Patients undergoing sleeve gastrectomy had similar rates of hazardous drinking as RYGB (16.3% vs. 15.7%). Thus, findings showed that rates of hazardous drinking were higher among those further removed from bariatric surgery and patients undergoing sleeve gastrectomy appeared to have similar rates of hazardous drinking as those who underwent RYGB. Results suggest a need for monitoring of alcohol use for all patients pursuing bariatric surgery, regardless of surgery type.

Acceptance of Illness Among Patients Pursuing Transplantation or Left Ventricular Assist Device

Acceptance of illness is related to better mental health among patients with chronic illness; however, this construct has not been evaluated as part of routine transplantation evaluations. The purpose of this study was to create a brief measure of acceptance of illness for patients pursuing organ transplantation and examine how acceptance is related to distress. Retrospective medical record reviews were conducted for 290 patients who completed a routine psychosocial evaluation prior to transplant listing which included the Illness Acceptance Scale (IAS). Internal consistency for the IAS was excellent (Cronbach's alpha = .92). Illness acceptance was negatively correlated with depression, anxiety, and catastrophizing and was not related to health literacy or health numeracy. The IAS is a reliable and valid measure for patients who are pursuing thoracic transplant or left ventricular assist device. Clinicians may want to screen transplant candidates for illness acceptance and refer those with lower levels to psychological interventions.

The association between number of children and weight loss outcomes among individuals undergoing bariatric surgery

BACKGROUND

Existing research demonstrates that parity is associated with risk for obesity. The majority of those who undergo bariatric surgery are women, yet little is known about whether having children before bariatric surgery is associated with pre- and postsurgical weight outcomes.

OBJECTIVES

We aim to evaluate presurgical body mass index (BMI) and postsurgical weight loss among a racially diverse sample of women with and without children.

SETTING

Metropolitan hospital system.

METHODS

Women (n = 246) who underwent bariatric surgery were included in this study. Participants self-reported their number of children. Presurgical BMI and postsurgical weight outcomes at 1 year, including change in BMI (ΔBMI), percentage excess weight loss (%EWL), and percentage total weight loss (%TWL) were calculated from measured height and weight.

RESULTS

Those with children had a lower presurgical BMI (P = .01) and had a smaller ΔBMI (P = .01) at 1 year after surgery than those without children, although %EWL and %TWL at 1 year did not differ by child status or number of children. After controlling for age, race, and surgery type, the number of children a woman had was related to smaller ΔBMI at 1 year post surgery (P = .01).

CONCLUSIONS

Although women with children had lower reductions in BMI than those without children, both women with and without children achieved successful postsurgical weight loss. Providers should assess for number of children and be cautious not to deter women with children from having bariatric surgery.

Predictors of Alcohol Use after Bariatric Surgery

Patients undergoing bariatric surgery are at risk for devloping an alcohol use disorder (AUD). The purpose of this study was to investigate pre-surgical psychosocial risk factors for post-surgical alcohol consumption and hazardous drinking. Participants (N = 567) who underwent bariatric surgery between 2014 and 2017 reported their post-surgical alcohol use. Information was collected from the pre-surgical evaluation including history of alcohol use, psychiatric symptoms, and maladaptive eating behaviors (i.e., binge eating, purging, and emotional eating). Younger age and pre-surgical alcohol use predicted post-surgical alcohol use and hazardous drinking. In addition, higher levels of depressive symptoms and maladaptive eating patterns predicted post-surgical binge drinking. Clinicians conducting pre-surgical psychosocial evaluations should be aware of the multiple risk factors related to post-surgical problematic alcohol use. Future research should evaluate whether preventive interventions for high-risk patients decrease risk for post-surgical alcohol misuse.

Eating pathology and depressive symptoms as predictors of excessive weight gain during pregnancy

Excessive gestational weight gain is associated with negative outcomes and the identification of contributing psychosocial factors may be useful in prevention and intervention. Pregnant women (N = 70) completed self-report measures of eating pathology, depressive symptomatology, and gestational weight gain. Global eating pathology was positively associated with overvaluation of shape and weight, dietary restraint, frequency of binge eating, and depressive symptoms. Depressive symptoms significantly predicted excessive gestational weight gain, while global eating pathology predicted excessive gestational weight gain at a trend level. Results suggest that depressive symptoms more strongly predict excessive gestational weight gain than eating pathology.

Relationship between polyadenylated and nonpolyadenylated herpes simplex virus type 1 latency-associated transcripts

RNA from the region of the genome encoding herpes simplex virus type 1 latency-associated transcripts (LATs) expressed during lytic infection yields low abundances of both polyadenylated and nonpolyadenylated forms. As has been previously shown for latent infection (A. T. Dobson, F. Sedarati, G. Devi-Rao, W. M. Flanagan, M. J. Farrell, J. G. Stevens, E. K. Wagner, and L. T. Feldman. J. Virol. 63:3844-3851, 1989), all lytic-phase expression of such transcripts requires promoter elements situated approximately 600 bases 5' of the previously mapped 5' end of the poly(A)- forms of LAT. Transient expression experiments revealed no other clear promoter elements within this region, and relatively small amounts of latent-phase transcripts initiating at the same site as observed for lytic-phase LAT could be detected by RNase protection assays. In the lytic phase of infection, the most abundant forms of polyadenylated LAT extended 1,600 bases from the initiation site near the LAT promoter to a potential splice donor site. Poly(A)- LAT species were not recovered in significant amounts from lytically infected neuroblastoma cells, but such RNA from lytically infected rabbit skin cells comapped with poly(A)- LAT from latently infected sensory neurons. Both map between canonical 5' splice donor and 3' splice acceptor site 1,950 bases apart. Poly(A)- LAT cochromatographed with uncapped rRNA on m-aminophenyl boronate agarose under conditions in which capped mRNA was bound. All of these data confirm the previously presented scheme for the expression of poly(A)- LAT as a stable intron derived from the splicing of a large primary transcript; however, we were unable to detect the spliced polyadenylated product of this splicing reaction.