Psychosocial Support Programme Improves Adherence and Health Systems Experiences for Adolescents on Antiretroviral Therapy in Mpumalanga Province, South Africa.

(1) Background: Psychosocial support (PSS) plays a significant role in persistent adherence to and retention in antiretroviral therapy (ART) for adolescents living with the human immunodeficiency virus (ALHIV). This paper qualitatively explores the experiences of ALHIV on ART, who participated in a PSS programme in five public primary healthcare facilities in Mpumalanga Province in South Africa during the COVID-19 pandemic. (2) Methods: Data were collected through 24 focus group discussions with 173 ALHIV on ART and subjected to inductive thematic analysis. Informed consent was obtained before all data collection. (3) Results: The PSS programme facilitated the process of full HIV disclosure to these adolescents with the support of parents/guardians while motivating adherence through peer support groups and health education for improved treatment literacy. Participants reported positive health systems experiences, improved healthcare provider-client relations, and prompt access to health services. (4) Conclusions: The PSS programme successfully kept ALHIV engaged in ART care despite the health service disruptions encountered during the COVID-19 pandemic. We recommend rigorous evaluation of the effects of the PSS intervention on adherence to and retention in ART among ALHIV in HIV-endemic settings.

Implementation of a Psychosocial Support Intervention for Adolescents on Antiretroviral Treatment: Challenges and Experiences from Ehlanzeni District, South Africa.

Adolescents living with HIV (ALHIV) need support from family, peers and health workers to remain on antiretroviral therapy and achieve and sustain viral suppression. This paper qualitatively explores the implementation of a psychosocial support intervention (PSS) in five primary health care facilities in the Ehlanzeni district, South Africa. Data were collected through key informant interviews and focus group discussions with ALHIV on ART. Data analysis employed inductive thematic analysis. Informed consent was obtained prior to all data collection. The PSS intervention facilitated full disclosure of HIV status to adolescents, supported treatment adherence through health education, peer support, health care provider- and client relations, and quick access to health service delivery. However, COVID-19 restrictions and regulations challenged the implementation of the intervention. The PSS intervention showed promise to support adolescent's adherence and retention in care. We recommend innovative approaches to account for systemic disruptions, as evidenced by the COVID-19 pandemic.

Comparative Study of the Antioxidant Constituents, Activities and the GC-MS Quantification and Identification of Fatty Acids of Four Selected Helichrysum Species.

Helichrysum Mill. (Asteraceae) is a plant genus comprising distinctively of aromatic plants of about 500-600 species. Since most of these plants have not been previously studied, extensive profiling helps to validate their folkloric uses and determine their potential value as sources of plant-derived drug candidates. This study, therefore, aims to investigate the antioxidant activity (DPPH, NO, FRAP); total antioxidant capacity, total phenolic, total flavonoid, and fatty acid compositions of the aqueous acetone extracts from four Helichrysum plants namely, Helichrysum pandurifolium, Helichrysum foetidum, Helichrysum petiolare, and Helichrysum cymocum. The results obtained showed that the H. cymocum extract had the best DPPH radical scavenging activity (IC50 = 11.85 ± 3.20 µg/mL) and H. petiolare extract had the best nitric oxide scavenging activity (IC50 = 20.81 ± 3.73 µg/mL), while H. pandurifolium Schrank extract (0.636 ± 0.005 µg/mL) demonstrated the best ferrous reducing power, all of which are comparable with results from ascorbic acid used as the standard. The IC50 values of the radical scavenging activity ranged from 11.85-41.13 µg/mL (DPPH), 20.81-36.19 µg/mL (NO), and 0.505-0.636 µg/mL (FRAP), for all the plants studied. The H. petiolare has the highest total antioxidant capacity (48.50 ± 1.55 mg/g), highest total phenolic content (54.69 ± 0.23 mg/g), and highest total flavonoid content (56.19 ± 1.01 mg/g) compared with other species. The fatty acid methyl esters were analysed using gas chromatography-mass spectrometry (GC-MS). The results obtained showed variations in the fatty acid composition of the plant extracts, with H. petiolare having the highest saturated fatty acid (SFA) content (7184 µg/g) and polyunsaturated fatty acid (PUFA) content (7005.5 µg/g). In addition, H. foetidum had the highest monounsaturated fatty acid (MUFA) content (1150.3 µg/g), while H. cymocum had the highest PUFA:SFA ratio of 1.202. In conclusion, the findings from this study revealed that H. pandurifolium Schrank, H. foetidum, H. petiolare, and H. cymocum are repositories of natural bioactive compounds with potential health-promoting benefits that need to be investigated, for both their antioxidant activity in a number of disease conditions and for further exploration in drug discovery and development projects.

The Impact of Health Disparities on COVID-19 Outcomes: Early Findings from a High-Income Country and Two Middle-Income Countries.

The SARS-CoV-2 infection, which causes the coronavirus disease (COVID-19), has affected lives, with very adverse outcomes in specific populations in the United States of America (USA), a high-income country, and two middle-income countries, Brazil and South Africa. This paper aims to discuss the relationship of race/ethnicity with COVID-19-associated factors in the three countries. The information is based on data collected from infectious disease/epidemiological centers in the USA, Brazil, and South Africa. Adverse COVID-19 outcomes have been associated with the burden of exposure and disease, linked to socioeconomic determinants, among specific ethnicities in all three countries. The prevalence of comorbidities before and the likelihood of work-related exposure in the context of COVID-19 infection puts ethnic minorities in the USA and some ethnic majorities and minorities in Brazil and South Africa at greater risk. We envisage that this work will contribute to ongoing discussions related to addressing socioeconomic determinants of health, and the need for stakeholders in various sectors to work on addressing observed health disparities for overall improvement in health and healthcare given the current pandemic.

Cost of Traditional Herbal Medicines for Noncommunicable Diseases in Rural and Urban Communities in South Africa.

OBJECTIVES: This study assessed traditional herbal medicine (THM) and conventional medicine (CM) utilization among participants with noncommunicable disease in South Africa. METHODS: A cross-sectional study of the Prospective Urban and Rural Epidemiological study collected data through face-to-face interviews using structured questionnaires in 2014. Descriptive, bivariate, and multivariate logistic regression were used to determine the effect of sociodemographic and economic factors on THM and CM use. All statistical analyses were conducted using the statistical computing and graphics language "R." RESULTS: Of the total 417 randomly selected participants in this study, 85% were females, 95% with no health insurance, and 81% with monthly incomes of <2000 rand (R) ($137 equivalent) per month. Moreover, 73% spend 5% of their income on THM, and 10% say they are willing to pay >R500 per year on THM to feel better. Age was significantly associated with different spending patterns after controlling for other demographic factors, given that older adults were 82% (odds ratio 0.18; 95% confidence interval 0.02-0.93) less likely to pay >R100 for THM whereas younger adults were 59% (odds ratio 0.41; 95% confidence interval 0.17-0.97) less likely to pay for CM. CONCLUSIONS: The cost of using THM and CM largely differed by age. The economic insight into this study reveals individuals more willing to pay for THM to payors, which can ultimately clue payors into areas for medication optimization from potential drug-drug interactions and adverse events and, therefore, reduce healthcare costs.

Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis.

BACKGROUND: Achieving undetectable viral load is crucial for the reduction of HIV transmissions, AIDS-related illnesses and death. Adolescents (10 to19 years) living with HIV (ALHIV) on antiretroviral treatment (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among ALHIV in the Ehlanzeni district, Mpumalanga in South Africa. METHODS: A cross-sectional analysis was conducted with 9386 ALHIV, aged 10 to 19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). ALHIV were categorised as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression. RESULTS: The mean age of the participants was 14.75 years (SD = 2.9), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9386 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among ALHIV who were: female (AOR = 1.21, 95% CI 1.05-1.39), and had most recent CD4 count > 200 (AOR = 2.53, 95% CI 2.06-3.11). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count > 200 at baseline (AOR = 0.73, 95% CI 0.61-0.87), and who were switched to second line regimen (AOR = 0.41, 95% CI 0.34-0.49). CONCLUSIONS: Viral suppression amongst ALHIV at 74% is considerably lower than the WHO target of 95%. Of particular concern for intervention is the lower rates of viral suppression amongst male ALHIV. Greater emphasis should be placed to early enrolment of ALHIV on ART and keeping them engaged in care (beyond 6 months). Furthermore, improved and regular viral load monitoring will help to adequately identify and manage ALHIV with unsuppressed viral load and subsequently switching to second line treatment.

Medicinal Properties and In Vitro Biological Activities of Selected Helichrysum Species from South Africa: A Review.

The genus Helichrysum Mill comprises hundreds of species that are mostly flowering perennial shrubs. Some of these plants that belong to the Helichrysum species are used in traditional medicine to treat cough, back pain, diabetes, asthma, digestive problems, menstrual pain, chest pain, kidney disorders, skin disorders, wounds, open sores, among other conditions, but, only a few scientific studies are reported in the literature with sufficient information that validates the acclaimed folkloric benefits of these plants. This review, therefore, provides a comprehensive update of the available information on the cytotoxicity, genotoxicity, anti-proliferative, anti-bacterial, anti-fungal, anti-viral, anti-HIV, anti-malarial, anti-ulcerogenic, anti-tyrosinase, anti-inflammatory, and anti-oxidant activities of selected Helichrysum species of interest: H. petiolare, H. cymocum, H. foetidum, and H. pandurifolium Schrank, using scientific databases as well as electronic and print sources. The ethnobotanical and morphological characteristics as well as the phytochemical composition and biological activities of these plants are elucidated. The scientific rationale for their current use is discussed based on the evidence in the literature. This review highlights the putative use of the Helichrysum species as a reliable source of bioactive compounds for the production of standard commercial drugs to treat many ailments, including those reported in folkloric uses. Further research on the many plants in the genus Helichrysum is recommended to explore their economic importance both as edible crops and medicinal botanicals.

Comparative Analysis of the Constitution and Implementation of Race/Skin Color Field in Health Information Systems: Brazil and South Africa.

The inclusion of race/skin color in Health Information Systems makes it possible to measure health inequities. Brazil and South Africa correspond to countries marked by profound inequalities, multiracial constituted that suffered from the historical process of colonization, and had racism legitimized as a structuring model of state development. The objective is to compare the information systems of Brazil and South Africa regarding the configuration and implementation of the item race/skin color. This is a qualitative, descriptive study, based on the content analysis proposed by Bardin. A survey on race/skin color was carried out in health department documents and ministerial sites in both countries. The collected material was processed and analyzed utilizing the IRAMUTEQ R software, version 0.7 alpha 2, with a test × 2 > 3.80 (p < 0.05), and by the TABNET application version 4.14 and Excel software, version 2016. In Brazil and Africa South, several health information systems did not include race/skin color. In both countries, health information systems were boosted in the mid-1990s. In Brazil, of the systems that provide data by race/skin color, the inclusion occurred after claims by the black movement. In South Africa, through the creation of the respective systems. The historical configuration of the question of race/skin color in both countries was guided by political and ideological references. In multiracial and unequal countries, race/skin color is a central political category to promote health equity.

In Vitro Evaluation of the Anti-Diabetic Potential of Aqueous Acetone Helichrysum petiolare Extract (AAHPE) with Molecular Docking Relevance in Diabetes Mellitus.

Diabetes mellitus (DM) is a chronic metabolic condition that can lead to significant complications and a high fatality rate worldwide. Efforts are ramping up to find and develop novel α-glucosidase and α-amylase inhibitors that are both effective and potentially safe. Traditional methodologies are being replaced with new techniques that are less complicated and less time demanding; yet, both the experimental and computational strategies are viable and complementary in drug discovery and development. As a result, this study was conducted to investigate the in vitro anti-diabetic potential of aqueous acetone Helichrysum petiolare and B.L Burtt extract (AAHPE) using a 2-NBDG, 2-(N-(7-Nitrobenz-2-oxa-1,3-diazol-4-yl) amino)-2-deoxy-d-glucose uptake assay. In addition, we performed molecular docking of the flavonoid constituents identified and quantified by liquid chromatography-mass spectrometry (LC-MS) from AAHPE with the potential to serve as effective and safe α-amylase and α-glucosidase inhibitors, which are important in drug discovery and development. The results showed that AAHPE is a potential inhibitor of both α-amylase and α-glucosidase, with IC50 values of 46.50 ± 6.17 (µg/mL) and 37.81 ± 5.15 (µg/mL), respectively. This is demonstrated by a significant increase in the glucose uptake activity percentage in a concentration-dependent manner compared to the control, with the highest AAHPE concentration of 75 µg/mL of glucose uptake activity being higher than metformin, a standard anti-diabetic drug, in the insulin-resistant HepG2 cell line. The molecular docking results displayed that the constituents strongly bind α-amylase and α-glucosidase while achieving better binding affinities that ranged from ΔG = -7.2 to -9.6 kcal/mol (compared with acarbose ΔG = -6.1 kcal/mol) for α-amylase, and ΔG = -7.3 to -9.0 kcal/mol (compared with acarbose ΔG = -6.3 kcal/mol) for α-glucosidase. This study revealed the potential use of the H. petiolare plant extract and its phytochemicals, which could be explored to develop potent and safe α-amylase and α-glucosidase inhibitors to treat postprandial glycemic levels in diabetic patients.

Nursing students' knowledge, attitude and practices of infection prevention and control guidelines at a tertiary institution in the Western Cape: A cross sectional study.

BACKGROUND: Nurses in sub-Saharan Africa are particularly at a higher risk of acquiring nosocomial infections, considering the increased prevalence of infectious diseases. It is therefore imperative that these nurses have a sound knowledge and understanding of infection prevention procedures. OBJECTIVE: The main objective of this study was to describe the knowledge, attitudes and practices concerning infection prevention and control precautions among nursing students in a resource limited setting. METHOD: A cross sectional study design was employed. A self-administered questionnaire concerning infection prevention and control guidelines were made available to students enrolled in a mainstream programme for completion of an undergraduate nursing degree. SETTING AND PARTICIPANTS: A total of 301 students at second, third and final years of study from a tertiary institution in the Western Cape were invited to participate. RESULTS: The final cohort comprised of 301 students with the majority between the ages of 17-26 (88.2%), with a mean age of 23 ±â€¯4.7 (SD) years and the dominant gender being female (83.4%). According to the classification system used in this study, the majority of the students were overall evaluated as having good level of knowledge (47.4%) and poor attitude (41.7%) scores, with little difference in practice scores observed between different years of study. There was a positive correlation found between students' total attitude and total practice scores (r = 0.48 p < 0.01). Results showed that significant associations between gender and knowledge (p < 0.05), attitudes (p < 0.05) and practice (p < 0.05) exists. There was also a significant association between province and those who repeated a year with total knowledge scores (p < 0.05). CONCLUSION: Based on the results of this study, it is recommended that interactive infection control courses that promote critical thinking are implemented at undergraduate level along with more stringent forms of assessments focusing on infection prevention and control, during clinical training.

Tulbaghia--A Southern African Phytomedicine.

The phytomedicine Tulbaghia consists of the fresh or dried subterranean organs of various Tulbaghia species. The genus is endemic to Southern Africa and includes about 20 species, of which only T. alliacea and T. capensis are naturally found in the winter rainfall climate area (the Western Cape). The genus forms part of the Alliaceae family and is a geophyte (plants with an underground perennation organ and leaves that die back annually). Their habitat can range from semi-desert to wet and boggy terrain. Wild garlic is most commonly prepared as an infusion or boiled in water and taken orally. Externally, as a medicated bath, wild garlic is used to treat paralysis and rheumatism and to reduce the temperature in a feverish patient. Internally, rhizome or bulb preparations are taken orally to treat fever; as a remedy for colds and influenza, asthma, tuberculosis, and stomach problems; as an antihypertensive; or to expel intestinal worms. It is also used as a prophylactic against winter infections. Rhizome pieces are often placed in castor oil to make eardrops. For fever and high blood pressure, a tea is made from the bulbs or rhizomes and a small cup taken three times daily. The leaves of the plant are used to treat esophageal cancer and may also be eaten as a vegetable. The demand for Tulbaghia in both formal and informal markets has grown exponentially. Sustainable harvesting focuses on only harvesting enough of the plant so that it still has the capacity for self-renewal. However, because both the above-ground and underground parts of Tulbaghia are commonly used in African traditional medicine, destructive harvesting of the whole plant is inevitable, thus necessitating the large-scale organized propagation of these plants. It is therefore important to establish a new strategy for the sustainable harvesting of these plants as commercial crops.

The case for targeting community pharmacy-led health improvement: Findings from a skin cancer campaign in Wales.

UNLABELLED: The use of community pharmacies to deliver health improvement campaigns is well established. Cancer incidence is closely related to increasing levels of deprivation. Because community pharmacies are more prevalent in deprived areas there is potential for them to make an important contribution to health improvement by delivering interventions aimed at reducing cancer incidence amongst those at greatest risk. OBJECTIVES: The aims of the study were: to examine the association between high risk behaviour and deprivation and contribute evidence to the case for or against targeting cancer prevention campaigns at specific risky behaviour in areas of high deprivation. METHODS: This study has an ecological design and involved retrospective analysis of data derived from 5739 sun-safety quizzes completed by pharmacy users at 714 community pharmacies in Wales during May 2014. RESULTS: Levels of participation in the campaign and high risk sun-safety behaviours were higher in more deprived areas. Respondents from deprived areas had significantly lower sun-safety knowledge. 3802 (66.2%) respondents reported 'excellent' or 'good' knowledge of behaviours which promote sun-safety but this did not necessarily translate into how individuals behaved. 3787 (66.1%) respondents considered community pharmacies an acceptable location for the campaign and for discussing the signs and symptoms of skin cancer. KEY FINDINGS: Results show association between high risk behaviour and geographically defined deprivation adding to the case for targeting cancer prevention campaigns at specific behaviours and geographies. CONCLUSIONS: Community pharmacies appear to be acceptable locations from which to deliver health improvement campaigns in terms of participant recruitment, ease of delivery, and pharmacy user feedback.

Characterizing Herbal Medicine Use for Noncommunicable Diseases in Urban South Africa.

Economic challenges associated with noncommunicable diseases (NCDs) and the sociocultural outlook of many patients especially in Africa have increased dependence on traditional herbal medicines (THMs) for these diseases. A cross-sectional descriptive study designed to determine the prevalence of and reasons for THM use in the management of NCDs among South African adults was conducted in an urban, economically disadvantaged area of Cape Town, South Africa. In a cohort of 1030 participants recruited as part of the existing Prospective Urban and Rural Epidemiological (PURE) study, 456 individuals were identified. The overall prevalence of THM use was 27%, of which 61% was for NCDs. Participants used THM because of a family history (49%) and sociocultural beliefs (33%). Hypertensive medication was most commonly used concurrently with THM. Healthcare professionals need to be aware of the potential dualistic use of THM and conventional drugs by patients, as this could significantly influence health outcomes. Efforts should be made to educate patients on the potential for drug/herb interactions.

Traditional health practitioners' perceptions, herbal treatment and management of HIV and related opportunistic infections.

BACKGROUND: In South Africa, traditional health practitioners' (THPs) explanatory frameworks concerning illness aetiologies are much researched. However there is a gap in the literature on how THPs understand HIV-related opportunistic infections (OIs), i.e. tuberculosis, candidiasis and herpes zoster. This study aimed to comprehend THPs' understandings of the aforementioned; to ascertain and better understand the treatment methods used by THPs for HIV and OIs, while also contributing to the documentation of South African medicinal plants for future conservation. METHODS: The study was conducted in two locations: Strand, Western Cape where THPs are trained and Mpoza village, Mount Frere, Eastern Cape from where medicinal plants are ordered or collected. Semi-structured interviews were conducted with 53 THPs of whom 36 were diviners (amagrirha: isangoma) and 17 herbalists (inyanga). THPs were selected through a non-probability "snowball" method. Data were analysed using a thematic content analysis approach. An ethnobotanical survey was conducted and plants used to manage HIV and OIs were collected. A complete set of voucher specimens was deposited at the University of the Western Cape Herbarium for identification. Plant names were checked and updated with Kew's online website http://www.theplantlist.org . RESULTS: THPs conceptualise the aetiology of HIV and OIs at two related levels. The first involves the immediate manifestation of the illness/condition because of a viral infection in the blood (HIV), the presence of bacteria in the lungs (tuberculosis), or weakened state of the body making it susceptible to OIs. The presence of OIs is indicative of the probable presence of HIV. The second level of causation affects the first, which includes pollution, changes in cultural sexual norms, witchcraft, environmental factors, and lack of adherence to ancestral rituals. THPs reported using 17 plants belonging to 12 families. Remedies included mixes of up to five plants. CONCLUSION: This study explored the THPs' perspectives on HIV and commonly associated OIs and their herbal treatment methods. THPs generally rely on biomedical diagnosis before treating a client. They also seek guidance from the ancestors for a particular diagnosis, the plants to use for a specific treatment, when to harvest, and how to administer herbal remedies.

The prevalence of traditional herbal medicine use among hypertensives living in South African communities.

BACKGROUND: In South Africa, over 6 million people are hypertensive and the burden of disease shows that cardiovascular diseases (CVDs) are the leading cause of death among adults. Although treatments exist, few people comply or adhere to recommended treatment due to side effects or costs of the drugs, hence the reliance on alternative forms of treatment. Traditional herbal medicines (THM) are used for the management of hypertension but the prevalence of its use among hypertensive patients living in South African communities is not sufficiently known. METHODS: This was a cross-sectional descriptive study to determine the prevalence of THM use for hypertension, among 135 purposefully selected South African participants of the Prospective Urban and Rural Epidemiological (PURE) study, who are THM users. Data on THM use were collected by way of face to face interviews using structured questionnaires administered by trained field workers. Standard descriptive measures were used to characterize the study sample and responses to the questionnaire. Chi-square test was used when making comparisons between groups. RESULTS: There were 135 THM users, 21% of whom used THM to treat hypertension. Majority (82.1%) of the hypertensive THM users were females, only 29% were married or co-habitating, virtually all (96%) were unemployed and 86% were Christians. More than half (56%) of the respondents were aged between 55 and 64 years. THM was occasionally used (51.9%) as a combination of tea and other mixtures (63%) and prescribed by family/ friends/self-administered. There was a significant difference in the age, marital and employment status, as well as the form and frequency of THM use of hypertensive THM users compared to other THM users. CONCLUSIONS: The study gives an insight into the prevalence of THM use by hypertensive patients in selected South African communities. The practice of self-medication was also observed which raises concern regarding the safety of medications taken by the participants. Health care providers should however be more aware of THM use and counsel patients regarding the combination of prescribed treatment regimen and herbal medicines and the potential of herb-drug interactions.

Herbal medicine, randomised controlled trials and global core competencies.

Despite widespread use, few empirical data on the efficacy of traditional medicine are available. We conducted systematic reviews of eight widely used African medicines and identified only one plant, Pelargonium sidoides, which has been extensively studied (including in a Cochrane systematic review). To address the need for rigorous science to underpin traditional medicine claims, the South African Herbal Science and Medicine Institute at the University of Western Cape launched the Multi-disciplinary University Traditional Health Initiative (MUTHI) in 2011. The European Union-funded initiative aims to build sustainable research capacity on plants for better public health in Africa. A 2011 needs analysis of clinicians and scientists from 14 African countries confirmed a lack of clinical trial methodology, knowledge and experience. In response, MUTHI deliverables include annual clinical trial methodology workshops in host countries and development of e-learning modules. The initiative provides a unique opportunity for developing African capacity to discover new medicinal products.

Demographics and outcomes at American Society for Metabolic and Bariatric Surgery Centers of Excellence.

INTRODUCTION: Surgery is currently an effective long-term therapy for morbid obesity and its complications. A variety of surgical procedures can now offer durable and safe weight control as well as previously unrealized full remission of costly comorbidities. This is a preliminary investigation of patient characteristics and outcomes at Bariatric Surgery Centers of Excellence) (BSCOE) hospitals. METHODS AND PROCEDURES: Data were analyzed from 235 American Society for Metabolic and Bariatric Surgery (ASMBS) BSCOE hospitals receiving Full Approval status from August 2005 to May 2007. Metrics for the 66,339 bariatric surgeries performed at these hospitals included type, volume and distribution of various bariatric surgical procedures performed at each hospital, patient demographics, payer information, and adverse outcomes. RESULTS: Data from these analyses demonstrate significant differences in terms of surgical procedure selection (laparoscopic gastric bypass 61%), patient demographics (females 83%, White 60%, mean age 43 years) and type of payer (private insurance 78%), and adverse outcomes (readmission 5%, re-operation 2%, mortality 0.36%). CONCLUSIONS: The collective performance of ASMBS BSCOE hospitals in bariatric outcomes of readmissions, re-operations, and mortality are equivalent to, or more favorable, than currently reported outcomes. However, risk assessment and risk adjustment of the patients and each of the bariatric procedures will be necessary to appropriately evaluate these rates.