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Aims:Ultrasound is a non-invasive, non-ionising radiation modality which is highly successful at soft tissue imaging. Groin pain from an occult hernia can be a difficult clinical diagnosis made easier by good imaging. The aim of this study was to demonstrate the accuracy of ultrasound in diagnosing and typing the groin hernia, which could lead to its justification of use in the imaging of the occult hernia. Patients and Methods: A total of 118 patients with a clinical diagnosis of a groin hernia, prospectively underwent a blinded, ultrasound examination of the groin. All patients underwent surgery and these findings were compared with the ultrasound results. Results: 120 symptomatic groins in 118 patients underwent surgery. Ultrasound diagnosed 118 hernias and there were two normal ultrasound examinations. Surgery confirmed the same two patients to be normal -ultrasound sensitivity for all hernias was 100% with 100% specificity. Two femoral hernias were seen in this study, both correctly identified at ultrasound. Of the inguinal hernias, ultrasound identified 36 of 42 direct hernias (sensitivity 86%, specificity 97%) and 72 of 74 indirect hernias (sensitivity 97%, specificity 87%) Conclusions: This study confirms that ultrasound can accurately diagnose groin hernias and this may justify its use in the assessment of the occult hernia.

Objectives To calculate socioeconomic and health status measures for the primary care groups in London and to examine the association between these measures and hospital admission rates. Design Cross sectional study. Setting 66 primary care groups in London, total list size 8.0 million people. Main outcome measures Elective and emergency standardised hospital admission ratios; standardised admission rates for diabetes and asthma. Results Standardised hospital admission ratios varied from 74 to 116 for total admissions and from 50 to 124 for emergency admissions. Directly standardised admission rates for asthma varied from 152 to 801 per 100 000 (mean 364) and for diabetes from 235 to 1034 per 100 000 (mean 538). There were large differences in the mortality, socioeconomic, and general practice characteristics of the primary care groups. Hospital admission rates were significantly correlated with many of the measures of chronic illness and deprivation. The strongest correlations were with disability living allowance (R = 0.64 for total admissions and R = 0.62 for emergency admissions, P < 0.0001). Practice characteristics were less strongly associated with hospital admission rates. Conclusions It is feasible to produce a range of socioeconomic, health status, and practice measures for primary care groups for use in needs assessment and in planning and monitoring health services. These measures show that primary care groups have highly variable patient and practice characteristics and that hospital admission rates are associated with chronic illness and deprivation. These variations will need to be taken into account when assessing performance.

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IMPORTANCEObesity is associated with an increased prevalence of psychiatric disorders. The association of bariatric surgery with mental health outcomes is poorly understood. OBJECTIVE To investigate the association of bariatric surgery with the incidence of outpatient, emergency department (ED), and inpatient mental health service use. DESIGN, SETTING, AND PARTICIPANTSThis statewide, mirror-image, longitudinal cohort study used data from Western Australian Department of Health Data Linkage Branch records from all patients undergoing index (ie, first) bariatric surgery in Western Australia over a 10-year period (January 2007-December 2016), with mean (SD) follow-up periods of 10.2 (2.9) years before and 5.2 (2.9) years after index bariatric surgery. The data analysis was performed between November 2018 and March 2019.EXPOSURES Index bariatric surgery. MAIN OUTCOMES AND MEASURESThe incidence and predictors for mental health presentations, deliberate self-harm, and suicide in association with the timing of bariatric surgery.RESULTS A total of 24 766 patients underwent index bariatric surgery; of these, the mean (SD) age was 42.5 (11.7) years and 19 144 (77.3%) were women. Use of at least 1 mental health service occurred in 3976 patients (16.1%), with 1401 patients (35.2%) presenting only before surgery, 1025 (25.8%) presenting before and after surgery, and 1550 patients (39.0%) presenting only after surgery. There was an increase in psychiatric illness presentations after bariatric surgery (outpatient clinic attendance: incidence rate ratio [IRR], 2.3; 95% CI, 2.3-2.4; ED attendance: IRR, 3.0; 95% CI, 2.8-3.2; psychiatric hospitalization: IRR, 3.0; 95% CI, 2.8-3.1). There was also a 5-fold increase in deliberate self-harm presentations to an ED after surgery (IRR, 4.7; 95% CI, 3.8-5.7), with 25 of 261 postoperatives deaths (9.6%) due to suicide. Complications after bariatric surgery requiring further surgical intervention and a history of mental health service provision before surgery were the most important associations with subsequent mental health presentations after surgery. Deliberate self-harm and mental and behavioral disorders due to psychoactive substance use before bariatric surgery were the main associations with subsequent deliberate self-harm or suicide after surgery. CONCLUSIONS AND RELEVANCEWe observed an increase in mental health service presentations after bariatric surgery, particularly among those who had prior psychiatric illnesses or developed surgical complications requiring further surgery. These findings caution the hypothesis that weight reduction by bariatric surgery will improve mental health in patients with obesity.

When measured against long-term safety outcomes, bariatric surgery has low mortality and morbidity associated with a significant reduction in subsequent hospitalizations.

Hospitalization for deliberate self-harm in bariatric patients was more common than the general population, but an increased incidence of deliberate self-harm after bariatric surgery was not observed. Hospitalization for depression before surgery and major postoperative gastrointestinal complications after bariatric surgery are potentially modifiable risk factors for deliberate self-harm after bariatric surgery.