Natural history of morbid obesity without surgical intervention.

BACKGROUND: To study the mortality among morbidly obese patients qualifying for bariatric surgery. Mortality from bariatric surgery for morbid obesity has been widely reported; however, little is known about the mortality in morbidly obese patients who defer surgery. METHODS: Consecutive patients evaluated for bariatric surgery with an initial encounter between 1997 and 2004 were identified. The Social Security Death Index and office records were used to identify mortality through 2006. We conducted telephone interviews to determine whether the 305 patients who did not undergo bariatric surgery at our institution had undergone the surgery elsewhere. Using Cox proportional hazards models, we compared the mortality in patients undergoing surgery with that of those who did not. To evaluate bias resulting from missing data, we conducted analyses assuming that all patients with missing data had (1) undergone surgery and (2) not undergone surgery. RESULTS: A total of 908 patients underwent bariatric surgery (880 patients at our institution and 28 patients elsewhere). A total of 112 patients did not undergo surgery. Data regarding surgery on 165 patients could not be obtained. The mortality in those patients who did not undergo surgery was 14.3% compared with 2.9% for those who did undergo surgery. Adjusting for age, gender, and body mass index, patients who had undergone surgery had an 82% reduction in mortality (hazard ratio 0.18, 95% confidence interval 0.09-0.35, P <.0001). Sensitivity analysis, assuming that all patients with missing data received surgery resulted in an 85% mortality reduction (P <.001) and assuming that patients did not receive surgery resulted in a 50% mortality reduction (P = .04). CONCLUSIONS: Mortality among morbidly obese patients without surgery was 14.3% during the study period. Surgical intervention offered a 50%-85% mortality reduction benefit.     

Primary and secondary sexual abstinence in high school students.

PURPOSE: To assess reasons for choosing not to have sexual intercourse among two groups: virgins (primary abstainers) and already sexually experienced youth (secondary abstainers). METHODS: 73,464 Minnesota ninth- and twelfth-grade adolescents completed the 1998 Minnesota Student Survey. Respondents identified reasons for abstinence from a checklist from which they could nominate all relevant items. Reasons for each group were analyzed using Chi-square with a conservative criterion value (p <.001) owing to large sample size. Logistic regression was used to examine the associations of gender, grade, and their interactions, with reasons for abstinence. RESULTS: Sixty-six percent reported never having had intercourse (primary abstainers). Among sexually experienced youth, 7.8% reported choosing not to have intercourse (secondary abstainers). Fear of pregnancy was the reason endorsed most often, more by girls than by boys (OR = 26 for primary abstainers, 6.9 for secondary abstainers). Fear of other adverse consequences, such as sexually transmitted infections, parental disapproval, or fear of getting caught, were generally selected by more girls than boys, and by more primary than secondary abstainers. Similarly, more girls and primary abstainers than boys or secondary abstainers generally selected statements reflecting normative beliefs on youth or their friends having intercourse. CONCLUSIONS: Fear of adverse consequences and normative beliefs about the appropriateness of having sexual intercourse were most frequently endorsed as important reasons by both groups of abstainers.     

The active ingredient in EMDR: is it traditional exposure or dual focus of attention?

Very little is known about the mechanisms that underlie the therapeutic effectiveness of eye movement desensitization and reprocessing (EMDR). This study tested whether the content of participants' responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing, which would be expected given Shapiro's proposal of dual process of attention. The responses made by 44 participants with post‐traumatic stress disorder (PTSD) were examined during their first EMDR treatment session. An independent rater coded these responses according to whether they were consistent with reliving, distancing or focusing on material other than the primary trauma. The coding system was found to have satisfactory inter‐rater reliability. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner. Cross‐lagged panel correlations suggest that processing in a more detached manner was a consequence of the EMDR procedure rather than a measure that covaried with improvement. Copyright © 2006 John Wiley & Sons, Ltd.