Obesity bias: How can this underestimated problem affect medical decisions in healthcare? A systematic review.

INTRODUCTION: Obesity is often labeled as a physical characteristic of a patient rather than a disease and it is subject to obesity bias by health providers, which harms the equality of healthcare in this population. OBJECTIVE: Identifying whether obesity bias interferes in clinical decision-making in the treatment of patients with obesity. METHODS: A systematic review of observational studies published between 1993 and 2023 in MEDLINE, Embase, and Cochrane Library on obesity bias and therapeutic decisions was carried out. The last search was conducted on June 30, 2023. The main outcome was the difference between clinical decisions in the treatment of individuals with and without obesity. The Newcastle-Ottawa scale for observational studies was used to assess for quality. After the selection process, articles were presented in narrative and thematic synthesis categories to better organize the descriptive analysis. RESULTS: Of the 2546 records identified, 13 were included. The findings showed fewer screening exams for cancer in patients with obesity, who were also susceptible to less frequent pharmacological treatment intensification in the management of diabetes. Women with obesity received fewer pelvic exams and evidence of diminished visual contact and physician confidence in treatment adherence was reported. Some studies found no disparities in treatment for abdominal pain and tension headaches between patients presented with and without obesity. CONCLUSION: The presence of obesity bias has negative effects on medical decision-making and on the quality of care provided to patients with obesity. These findings reveal the urgent necessity for reflection and development of strategies to mitigate its adverse impacts. (The protocol was registered with the international prospective register of systematic reviews, PROSPERO, under the number CRD42022307567).

Adjusting to the "new normal": How were mental health and self-care affected in patients with diabetes mellitus 1 year into the COVID-19 crisis? A longitudinal study.

This study aimed to assess the long-term effect of the pandemic on mental health and self-care parameters in patients with diabetes during the COVID-19 pandemic in Brazil. After 18 months of pandemic, 118 participants remained in the study (mean age of 56.6 ± 13.4 years, 66.7% were women). We observed no change in the scores for mental health disorders screening. Regarding self-care, patients with type 1 diabetes showed an improvement in the adherence score compared to those found at the beginning of the pandemic (variation + 3.5 (-6.0 to +15.8) points, p = 0.02), and also compared to those with type 2 diabetes. Although the pandemic have negatively affected many people's mental health, especially in those with chronic diseases, our results show that patients with diabetes may have developed good coping and adaptive strategies to maintain diabetes control and symptom pattern of mental health disorders over the course of the pandemic.

Lifestyle pattern changes, eating disorders, and sleep quality in diabetes: how are the effects of 18 months of COVID-19 pandemic being felt?

AIMS: The pandemic resulted in a lifestyle crisis which may negatively affect patients with diabetes. Despite current knowledge, there is a lack of longitudinal studies evaluating this effect. To assess patients' perceptions about changes in lifestyle, and eating and sleeping patterns after 18 months of the COVID-19 pandemic, and to identify if aspects related to the pandemic (social distancing, COVID-19 infection, behavioral changes, and financial difficulties) are predictors of worsening in eating and sleeping parameters. METHODS: This was a longitudinal study that followed patients with diabetes from April 2020 to July 2021 in Southern Brazil. Individuals with type 1 or type 2 diabetes, aged ≥ 18 years, were included. The outcome of this study was the assessment of daily habits during a 18-month period of the COVID-19 pandemic. Specific questionnaires were applied once participants were included in this study (3 months after the onset of the pandemic) and at the 18-month follow-up, which included the Eating Attitudes Test-26 (EAT-26), the Mini-Sleep Questionnaire (MSQ), and a specific questionnaire on diet, physical activity, and sleep pattern. Data were compared within and between groups (type 1 and type 2 diabetes), and multivariable models were used to identify subgroups of worse outcomes. RESULTS: A total of 118 (78.6%) participants remained in the study at follow-up (mean age 54.6 ± 13.9 years, 41.3% male). In total, 33.9% of participants perceived weight gain during the pandemic, especially those with type 1 diabetes (43.1% vs 25.0% in type 2 diabetes, P = 0.04). About one in four participants reported emotional eating and changes in their eating habits for financial reasons. Regarding sleep patterns, more than half the participants reported taking naps during the day, out of which 30.5% of them perceived worse sleep quality, with no difference between type 1 and type 2 diabetes groups. There were no within-group differences in MSQ and EAT-26 scores. Among participants with type 2 diabetes, age ≥ 60 years (OR 27.6, 95%CI 2.2-345.7), diabetes duration ≥ 15 years (OR 28.9, 95%CI 1.4-597.9), and perceived emotional eating (OR 10.9, 95%CI 1.1-107.5) were associated with worsened food quality. Worse sleep quality during the pandemic was associated with age ≥ 60 years for both type 2 diabetes (OR 5.6, 95%CI 1.1-31.5) and type 1 diabetes (OR 5.5, 95%CI 1.0-29.9). CONCLUSIONS: Follow-up data from a cohort of patients with diabetes indicate that at the end of 18 months of social distancing, some lifestyle aspects worsened and some improved, showing that these patients responded differently to the adversities of this period. The evidence of clinical features associated with worsening in food and sleep quality provides new insights to prioritizing actions in crisis situations.

Healthy lifestyle gone bad: effect of the COVID-19 pandemic on the daily habits of children and adolescents with type 1 diabetes.

Objective: To assess caregivers' perception about the changes in the daily habits of children and adolescents with type 1 diabetes during the COVID-19 pandemic. Subjects and methods: Primary caregivers of youth aged ≤18 with or without type 1 diabetes were selected for the diabetes and the control groups. Caregivers estimated the youth's time (hours) of physical activity and screen time before and during the pandemic, and rated the quality of eating habits and medication adherence from 0 to 10. The primary outcome was the change in physical activity time, screen time, and eating habits scores during isolation. Between-group analyses and within-group comparisons were conducted. A post hoc analysis was performed using logistic regression to correct for confounding factors. Results: In total, 764 participants were included (381 diabetes group vs. 383 control group). Before the pandemic, the diabetes group presented a reduced median of physical activity (P < 0.001) and screen time (P < 0.001). During the pandemic, the difference between both groups remained similar (P = 0.58). Scores of quality of eating habits were similar in both groups before the pandemic [8.0 (7.0-9.0) vs. 8.0 (7.0-9.0), P = 0.31] but decreased during the pandemic [7.0 (5.1-8.1) vs. 8.0 (6.0-9.0), P < 0.001]. The diabetes group had a significantly worse change in eating habits scores (P < 0.01). Conclusion: During the pandemic, eating habits were significantly worse in youth with diabetes than in those without diabetes.

Healthy lifestyle gone bad: effect of the COVID-19 pandemic on the daily habits of children and adolescents with type 1 diabetes

ABSTRACT Objective: To assess caregivers' perception about the changes in the daily habits of children and adolescents with type 1 diabetes during the COVID-19 pandemic. Subjects and methods: Primary caregivers of youth aged ≤18 with or without type 1 diabetes were selected for the diabetes and the control groups. Caregivers estimated the youth's time (hours) of physical activity and screen time before and during the pandemic, and rated the quality of eating habits and medication adherence from 0 to 10. The primary outcome was the change in physical activity time, screen time, and eating habits scores during isolation. Between-group analyses and within-group comparisons were conducted. A post hoc analysis was performed using logistic regression to correct for confounding factors. Results: In total, 764 participants were included (381 diabetes group vs. 383 control group). Before the pandemic, the diabetes group presented a reduced median of physical activity (P < 0.001) and screen time (P < 0.001). During the pandemic, the difference between both groups remained similar (P = 0.58). Scores of quality of eating habits were similar in both groups before the pandemic [8.0 (7.0-9.0) vs. 8.0 (7.0-9.0), P = 0.31] but decreased during the pandemic [7.0 (5.1-8.1) vs. 8.0 (6.0-9.0), P < 0.001]. The diabetes group had a significantly worse change in eating habits scores (P < 0.01). Conclusion: During the pandemic, eating habits were significantly worse in youth with diabetes than in those without diabetes.

Central nervous system high-grade neuroepithelial tumor with BCOR alteration: a short report

Central nervous system high-grade neuroepithelial tumors with BCOR alteration are rare. Currently, there are only 24 cases reported in the literature. These tumors are characterized by a change involving the BCOR gene and have a poor prognosis. Studies are needed to improve the current therapy and outcomes of these neoplasms. This case report describes the clinical history of a patient with this disease and aims to contribute to the current knowledge about this new entity.

Heterotopia pancreática em vesícula biliar: um relato de caso / Heterotopic pancreas in the gallbladder: a case report

A heterotopia pancreática é definida como a presença de tecido pancreático em localização topográfica anômala. Essa patologia pode acometer variadas estruturas da cavidade abdominal, mas raramente manifesta-se na vesícula biliar. Até o momento, menos de 40 casos de heterotopia pancreática em vesícula biliar foram relatados na literatura médica. Apresentamos um caso de uma mulher de 25 anos, que realizou uma colecistectomia videolaparoscópica por colelitíase, com exame anatomopatológico que identificou uma heterotopia pancreática. Apesar de rara, a doença deve ser considerada em pacientes com sintomatologia de doenças da via biliar e de doenças pancreáticas e sem diagnóstico após uma investigação de rotina, tendo em vista que o tecido pancreático ectópico está sujeito às mesmas alterações patológicas, manifestações clínicas e complicações encontradas no próprio pâncreas. (AU)

Heterotopic pancreas is defined as the presence of pancreatic tissue at an anomalous location. This condition may affect multiple structures in the abdominal cavity but rarely appears in the gallbladder. To date, fewer than 40 cases of heterotopic pancreas in the gallbladder have been reported in the medical literature. We present a case of a 25 year-old woman who underwent a laparoscopic cholecystectomy for cholelithiasis, with a pathology test that detected heterotopic pancreas. Despite its rarity, this disease must be considered in cases of corresponding symptoms without a diagnosis after a routine evaluation, considering that ectopic pancreatic tissue is exposed to the same pathological alterations, clinical manifestations, and complications found in the pancreas. (AU)

Analysis of HIV/Aids notifications in a municipality of national health between 2007 and 2017: gender, age, race, schooling, neighborhood of origin, notifying units and treatment units / Análise de notificações de HIV/Aids em um município polo de saúde nacional entre 2007 e 2017: sexo, idade, raça, escolaridade, bairro de origem, unidades notificadoras e unidades de tratamento

Introduction: Both human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are part of the National List of Compulsory Notification of Diseases. Despite the compulsory reporting of HIV infection from 2014, there has been a drop in the detection of new cases in the last five years. Objective: Analyze the epidemiological data of HIV/AIDS case reports in the city of Passo Fundo, Rio Grande do Sul, from 2007 to 2017 in relation to gender, neighborhoods, notifying units and treatment units. Methods: Retrospective descriptive study, accomplished at the Health Surveillance Sector from the compulsory notifications available in the Information System of Notifiable Diseases (Sistema de Informação de Agravos de Notificação ­ SINAN). A spreadsheet was made in the Microsoft Excel® Program (2016). Data were analyzed using the SPSS® Program, descriptively through measures of prevalence, incidence and distribution. Results: There were 1,068 notifications. There was a predominance of males (55.5%) and in the age group from 27 to 43 years. Of the 31 notifying health units, three concentrated 95% of the cases: Specialized Care Service (74.7%); Hospital São Vicente de Paulo (16%); and Hospital das Clínicas of Passo Fundo (4%). The same three units concentrated 98.0% of the treatments: 88, 9 and 1%, respectively. The primary care accounted for 5.0% of the notifications. Conclusion: The higher prevalence in young adult men denotes the importance of prevention aimed at this audience. Notifications were mostly from hospitals and a public referral center, with little involvement of primary care in reporting HIV/AIDS.

Introdução: Tanto a infecção pelo vírus da imunodeficiência humana (HIV) quanto a síndrome da imunodeficiência adquirida (AIDS) fazem parte da Lista Nacional de Notificação Compulsória de doenças. Apesar da compulsoriedade da notificação pela infecção pelo HIV a partir de 2014, nota-se uma queda na detecção de novos casos nos últimos cinco anos. Objetivo: Analisar os dados epidemiológicos das notificações dos casos de HIV/AIDS no município de Passo Fundo, Rio Grande do Sul, entre os anos de 2007 e 2017 em relação ao sexo, bairros, unidades notificadoras e unidades de tratamento. Métodos: Estudo documental, descritivo e retrospectivo, realizado no Setor de Vigilância em Saúde a partir das notificações compulsórias disponibilizadas no Sistema de Informação de Agravos de Notificação (SINAN). Foi construída uma planilha no Programa Microsoft Excel® (2016). Os dados foram analisados no Programa SPSS®, de forma descritiva através de medidas de prevalência, incidência e distribuição. Resultados: Foram 1.068 notificações. Houve predomínio de indivíduos do sexo masculino (55,5%) e na faixa etária dos 27 aos 43 anos. Das 31 unidades de saúde notificadoras, três concentraram 95% dos casos: Serviço de Atendimento Especializado (74,7%); Hospital São Vicente de Paulo (16%); e Hospital das Clínicas de Passo Fundo (4,0%). As mesmas três unidades concentravam 98,0% dos tratamentos: 88, 9 e 1%, respectivamente. A atenção primária foi responsável por 5% das notificações. Conclusão: A maior prevalência em homens adultos jovens denota a importância de prevenção voltada para esse público. As notificações ocorreram majoritariamente por hospitais e um centro público de referência, com pequena participação da atenção básica na notificação do HIV/AIDS.