Bowel habits and fecal incontinence in patients with obesity undergoing evaluation for weight loss: the importance of stool consistency.

BACKGROUND: Fecal incontinence is highly prevalent in the general population and especially in risk groups. Obesity is also common and is associated with comorbidities that impair general health and interfere with daily activities. Identifying mutable factors for fecal incontinence, such as stool consistency, is of paramount importance to improve quality of life. OBJECTIVE: The aim of this study was to estimate the prevalence of fecal incontinence in patients with obesity undergoing evaluation for weight loss, its relationship with bowel habits, and its impact on quality of life. DESIGN: This investigation is a cross-sectional observational study. SETTINGS: This study was conducted in patients with obesity who were undergoing evaluation for weight loss. MAIN OUTCOME MEASURES: Fecal incontinence was defined as loss of flatus or liquid/solid stool occurring at least monthly. Data on comorbidities, BMI, quality of life, bowel habits including stool consistency measured with the Bristol Stool Form Scale, and symptoms of fecal incontinence were collected. RESULTS: Fifty-two patients were included, with a mean BMI of 39.6 kg/m2. Symptoms of fecal incontinence were found in 17 patients (32.7%): flatus in 9 of 17 (52.9%), liquid stool in 6 of 17 (35.2%), and solid stool in 2 of 17 (11.7%). No differences were found between patients with and without fecal incontinence in age, sex, comorbidities, or BMI. Health-related quality of life was lower in patients with fecal incontinence than in those without, but this difference was not significant, with the exception of the dimensions of role-physical (p = 0.03) and social functioning (p = 0.04). Patients with incontinence reported significantly higher percentages of altered bowel habits with nonformed stools (p = 0.004). LIMITATIONS: The cross-sectional design hampered identification of the time at which the impact of obesity occurred. CONCLUSIONS: Fecal incontinence is common in patients with obesity. Stool consistency was significantly different in these patients. This study supports the possibility of improving incontinence during weight loss by modifying stool consistency.

Myocardial infarction and alcohol consumption: a population-based case-control study.

BACKGROUND AND AIM: Coronary heart disease (CHD) is the leading cause of death in industrialized societies. Identifying and characterizing modifiable variables associated with CHD is an important issue for health policy. The aim of the present study was to analyze the association of non-fatal myocardial infarction with total alcohol consumption and type of alcoholic beverage consumed. Preference of the subjects' consumption for beer, wine, or spirits was set at 80% or more of total alcoholic beverage consumption. METHODS AND RESULTS: A population-based case-control study (244 subjects and 1270 controls) was conducted. Male patients aged 25 to 74 years with first myocardial infarction (MI) were recruited in the same region as the healthy male controls, who were taken from a random sample representative of the Gerona population. Alcoholic beverage consumption during the preceding week was recorded. Multiple logistic regression analysis was performed to determine the association of alcohol consumption and non-fatal MI. Total alcohol consumption up to 30 g per day, adjusted for lifestyle and cardiovascular risk factors, was inversely associated (Odds ratio 0.14; 95% confidence interval 0.06-0.36) with the risk of non-fatal MI. Drinking up to 20 g of alcohol through wine, beer and spirits significantly decreased the adjusted risk of MI. Higher alcohol intake did not substantially reduce the risk. A preference for spirits was correlated with a significantly increased risk of non-fatal MI (P<0.05). CONCLUSION: Moderate alcohol consumption, independent of the type of alcoholic beverage, was associated with non-fatal MI risk reduction.

Diferencias en la morbilidad neonatal entre neonatos magrebíes y autóctonos / Differences in neonatal morbidity rates between native and magrebi newborns

Fundamento. Alto porcentaje de nacimientos de inmigrantesen nuestro entorno e impresión de mayor morbilidadperinatal. Objetivo. Valorar si existen diferencias entre la morbilidadneonatal de dos poblaciones y posibles factoresmodificables.Método. Estudio descriptivo retrospectivo a partir derevisiones de historias clínicas correspondientes a los partosdel año 2000 (596 partos) en el Hospital de Palamós.Análisis estadístico del resultado del parto en 115 gestantesmagrebíes y 115 autóctonas; y de la morbilidad neonatalen 114 neonatos magribíes y 457 autóctonos.Resultados. -Parto: En el grupo magrebí, mayor númerode partos eutócicos, menor de cesáreas y menor usode analgesia durante el parto (p<0,01). -Neonatal: En elgrupo magrebí, mayor porcentaje de ingresos neonatales(p<0,01). Los principales motivos de ingreso en los dos gruposson el riesgo de infección (50,9% entre los autóctonosy 73,07% entre los magrebíes, p<0,01) y la hiperbilirrubinemia(15,45% y 19,23% respectivamente). El índice deriesgo por madre portadora de estreptococo β hemolíticodel grupo B o desconocido es el resultado con mayor diferenciaentre los dos grupos (p<0,01), por encima de la roturaprolongada de membranas (p<0,05). Más neonatoscon peso por encima del percentil 90 (p<0,05).Conclusiones. Las diferencias halladas en el análisis delparto deben atribuirse a la mayor paridad de las magribins.En lo referente a la morbilidad neonatal es difícil igualarlos dos grupos dado que hay factores sobre los que no sepuede incidir. Creemos sería útil aplicar medidas especialessobre el grupo de inmigrantes y evaluar los resultados

Background. In recent years, there has been a significantincrease in the percentage of births from immigrantpopulation, with a perceived increased perinatal morbidity.Objective. To compare neonatal morbidity rates betweenimmigrant population of Magrebi origin and nativepopulation, and to determine possible modifiable factors.Method. Historical descriptive study based on a reviewof clinical records of infants born in 2000 (596 deliveries) atthe Palamos Hospital. The outcome of the pregnancies of115 Magrebi and 115 native women, and the neonatal morbidityin 114 and 457 native newborns, were compared.Results. Deliveries: In the Magrebi group, a higher proportionof eutocic deliveries, fewer cesarean sections, andless use of analgesics during the labour, were found(p<0.01). Neonatal morbidity: In the Magrebi group, wefound a higher percentage of neonatal admissions (p<0.01).In both groups, the main reasons for admission were therisk of infection (50.9% and 73.0% in the native and Magrebipopulations, respectively, p<0.01) and hyperbilirrubinemia(15.4% and 19.2%, respectively). The greatest difference in risk index in the Magrebi population was for mothers carryinggroup B β hemolytic streptococcus or with unknowncarrier status, (p<0.01), followed by prolonged membranerupture (p<0.05). A greater proportion of Magrebi newbornshad birth weight above the 90th percentile (p<0.05).Conclusions. The differences in the analysis of the deliveriesare probably related to the higher parity amongthe Magrebi families. Regarding the differences in neonatalmorbidity rates, interventions aiming at decreasing thisgap are challenging, given the disparities between bothpopulations. We suggest that special measures are appliedto the immigrant group