Background: Bariatric surgery has emerged as the most effective treatment for class III obesity (body mass index, Ն40). The number of operations continues to increase. We measured case fatality and death rates by time since operation, sex, age, specific causes of death, and mortality rates. Design and Setting: Data on all bariatric operations performed on Pennsylvania residents between January 1, 1995, and December 31, 2004, were obtained from the Pennsylvania Health Care Cost and Containment Council. Matching mortality data were obtained from the Division of Vital Records, Pennsylvania State Department of Health. Outcome Measures: Age-and sex-specific death rates after bariatric surgery. Results: There were 440 deaths after 16 683 operations (2.6%). Age-specific death rates were much higher in men than in women and increased with age. Age-and sexspecific death rates after bariatric surgery were substantially higher than comparable rates for the age-and sexmatched Pennsylvania population. The 1-year case fatality rate was approximately 1% and nearly 6% at 5 years. Less than 1% of deaths occurred within the first 30 days. Fatality increased substantially with age (especially among those Ͼ65 years), with little evidence of change over time. Coronary heart disease was the leading cause of death overall, being cited as the cause of death in 76 patients (19.2%). Therapeutic complications accounted for 38 of 150 natural deaths within the first 30 days, including pulmonary embolism in 31 (20.7%), coronary heart disease in 26 (17.3%), and sepsis in 17 (11.3%). Conclusions: There was a substantial excess of deaths owing to suicide and coronary heart disease. Careful monitoring of bariatric surgical procedures and more intense follow-up could likely reduce the long-term case fatality rate in this patient population.

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The Women on the Move through Activity and Nutrition (WOMAN) study was designed to test whether a nonpharmacological intervention including qualitative and quantitative dietary changes to induce weight loss and increased physical activity levels would reduce blood triglyceride levels and number of low-density lipoprotein particles (LDL-P). Such decreases in lipoproteins and other risk factors could reduce or slow progression of subclinical cardiovascular disease (CVD). Study participants were randomized to either the intervention (Lifestyle Change) or assessment (Health Education) group. Most of the intervention ended at the 30-month visit. The last 48-month examination was completed in 9/2008. There was very substantial weight loss and increased exercise during the first 30 months of the trial resulting in significant decreases in CV risk factors. Most of the intervention effect was lost through 48 months. Weight loss was 3.4 kg in Lifestyle Intervention and 0.2 kg in the Health Education at 48 months (P = 0.000). There were no significant changes at 48 months in lipid levels, blood pressure (BP), glucose, insulin, or in the subclinical measures of coronary calcium, carotid intima media thickness, or plaque. There was a significant decrease in long-distance corridor walk time in the Lifestyle vs. Health Education groups. Significant lifestyle changes can be achieved that result in decreases in CV risk factors. Whether such changes reduce CV outcomes is still untested in clinical trials of weight loss or exercise. Long-term maintenance of successful lifestyle changes, weight loss and reduced risk factors is the hurdle for lifestyle interventions attempting to prevent CV and other chronic diseases.

Twenty percent of deaths in the United States occur in nursing homes, yet less than 1% come to autopsy. The current study analyzed causes and manners of death in all nursing homes between 1993 and 2003, investigated by the coroner of Allegheny County, PA, which has the second highest elderly population in the United States. Two hundred eight decedents were identified, aged 19 to 91 years, 58% women and 42% men, 88% Caucasian and 22% African-American. Fifty-eight percent were accidental and 38.5% were natural manners of death, with 2 homicides, 2 suicides, and 3 undetermined cases. The manner of death was significantly different between Caucasians and African-Americans, with 92.6% of accidental deaths occurring in Caucasians and 6.6% in African-Americans (P < 0.1). Most common natural deaths were arteriosclerotic cardiovascular disease, nonarteriosclerotic cardiovascular disease, pneumonia, pulmonary thromboembolism, chronic obstructive pulmonary disease (COPD), seizure disorder, and atraumatic intracranial hemorrhage. Blunt force trauma was the single most commonly identified traumatic accidental death. Accidental deaths were more common in Caucasians than African-Americans. Homicides and suicides were rare events (<2%). Blunt force trauma is a major autopsy finding in accidental nursing home deaths, and a root-cause analysis may be helpful in developing policies and procedures to decrease the incidence of blunt force trauma.

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Purpose/Objective To examine the prevalence of depressive symptoms in adults with spina bifida and identify contributing factors for depressive symptomatology. Research Method/Design Retrospective Cohort Study. Data collection was conducted at a regional adult spina bifida clinic. A total of 190 charts from adult patients with spina bifida were included. The main outcome measures were the Beck Depression Inventory-II (BDI-II) and the mobility domain of the Craig Handicap Assessment Reporting Technique Short Form (CHART-SF). Results Of the 190 participants, 49 (25.8%) had BDI-II scores (14+) indicative of depressive symptomatology. Sixty-nine (36.3%) of all participants were on antidepressants for the purpose of treating depressive symptoms, and 31 (63.3%) of those with clinical symptoms of depression were on antidepressants. The total number of participants with a history of depressive symptoms may be as high as 45.7% if both participants with BDI-II scores 14+ and those with antidepressant use specifically for the purposes of depression treatment are combined. In this population, lower CHART-SF mobility score, expressing “emotional concerns” as a reason for the visit on an intake sheet, and use of antidepressant medications were significantly associated with depressive symptoms. Conclusions/Implications Depressive symptomatology appears to be common and undertreated in this cohort of adults with spina bifida, which may warrant screening for emotional concerns in routine clinic appointments. Significant depressive symptoms are associated with fewer hours out of bed and fewer days leaving the house. Additional research is needed to assess the impact of interventions directed towards mobility on depression and in the treatment of depression in this patient population.

Purpose-The goal of this study was to determine the impact of age, gender and race on the prevalence and severity of hearing loss in elder adults, aged 72-96 years, after accounting for income, education, smoking, and clinical and subclinical cardiovascular disease.Methods-Air-conduction thresholds for standard and extended high-frequency puretones were obtained from a cohort of 548 (out of 717) elderly adults (ages 72-96 years) who were recruited during the Year 11 clinical visit (1999)(2000) of the Cardiovascular Health Study (CHS) at the Pittsburgh, Pennsylvania site. Participant smoking, income, education, and cardiovascular disease histories were obtained from the CHS database and were included as factors.Results-Hearing loss was more common and more severe for the participants in their 80s than those in their 70s, the men more than the women, and the White participants more than the Black participants. The inclusion of education, income, smoking and cardiovascular disease (clinical and subclinical) histories as factors did not substantively impact the overall results.Conclusion-Although the data reported in this paper were cross-sectional and a cohort phenomenon might have been operational, they suggested that hearing loss is more substantive in the eighth than the seventh decade of life, and that race and gender influence this decline in audition. Given the high prevalence in the aging population and the differences across groups there is a clear need to understand the nature and causes of hearing loss across various groups in order to improve prevention and develop appropriate interventions.Hearing loss is very common in the general population. Approximately 16% of adults in the United States report some difficulty with hearing, and after arthritis and hypertension, hearing impairment is the third most commonly reported chronic condition in persons over 65 (National Center for Health Statistics, 1982; Pleis & Coles, 2003). By age 70 years, approximately 30% of the population perceives themselves as being hearing impaired, and by 80 years, 50% report being hearing impaired (Desai, Pratt, Lentzner, & Robinson, 2001). There also is indication that the prevalence of hearing impairment in persons 45-69 years of age is increasing, especially among men (Wallhagen, Strawbridge, Cohen, & Kaplan, 1997). Men have consistently reported more hearing problems than women regardless of race. Furthermore, White adults have reported hearing impairment more than Black adults (Desai et al., 2001; Pleis & Lethbridge-Çejku, 2006 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThe prevalence of self-reported hearing impairment not only varies by race but also by ethnicity. For example, the 1999 National Health Interview Survey (Pleis & Coles, 2003) found that adults from Asian and African decent were less likely to experience hearing problems (7.8% and 7.4% respectively) than Whites or Native Americans (17.2 and 20.1, respectively). Whereas 15% of non-Hispanic White adults reported some form...