BackgroundWe sought to identify factors associated with participant retention in a 2-year, physician-lead, multidisciplinary, clinical weight management program that employs meal replacements to produce weight loss and intensive behavioral interventions and financial incentives for weight loss maintenance. We studied 270 participants enrolled in 2010 and 2011. Sociodemographic factors, health insurance, distance traveled, body mass index, comorbidities, health-related quality-of-life, and depression were explored as potential predictors of retention.ResultsMean age was 49 ± 8 years and BMI was 41 ± 5 kg/m2. Retention was excellent at 3 months (90%) and 6 months (83%). Attrition was greatest after participants were transitioned to regular foodstuffs and fell to 67% at 12 months and 51% at 2 years. Weight decreased by 15 ± 12 kg and BMI decreased by 5.1 ± 4.0 kg/m2 in 2-year completers. Older age, lower baseline BMI, and financial incentives for program participation were independently associated with retention. Fewer depressive symptoms at baseline were associated with retention.ConclusionsThis multidisciplinary, clinical, weight management program demonstrated high retention and excellent outcomes. Older age at baseline, less extreme obesity, and financial incentives were associated with program retention.

BackgroundThe long-term effect of weight reduction on skeletal health is not well understood. The purpose of this study was to examine the impact of an intensive medical weight loss intervention using very low energy diet (VLED) (~ 800 cal/day) that result in significant changes in body weight, on total body bone mineral density (BMD) over 2 years.MethodsWe examined the impact of VLED-induced weight loss on BMD and FFM (Fat-free Mass) after 3–6 months and again while in weight maintenance at 2 years in 49 subjects. The effects of absolute and relative rate of weight reduction assessed by change in weight in kilograms were assessed using general linear modeling, with baseline BMD (or FFM) as a covariate, and age, sex and changes in body weight as primary model predictors.ResultsAt the end of 2 years, the average weight loss was greater for men (weight: 23.51 ± 12.5 kg) than women (weight: 16.8 ± 19.2 kg) and BMD loss was greater among women (0.03 ± 0.04 g/cm2 vs 0.01 ± 0.04 g/cm2) (all p < 0.05). After adjusting for baseline BMD, age, and sex, there was a small but significant association between total weight loss and 2-year BMD (β = − 0.001 g/cm2; p = 0.01). Similarly, there was a significant independent association between total weight loss and 2-year FFM (β = − 116.5 g; p < 0.01).ConclusionsDespite significant weight loss with VLED, there was only a small loss is BMD.

Objective To explore knowledge about the human papillomavirus (HPV), HPV vaccination, barriers to vaccination and acceptance of the HPV vaccine in the highest‐risk and most‐impacted population in Ghana. Methods A survey was administered to 100 women with histologically confirmed cervical cancer at a teaching hospital in Ghana. Results Participants had a mean age of 59 (±14.3) years, 65.0% had a parity of five or higher and 89.0% had a monthly income less than 500 Ghana cedis ($63 USD). Seventy‐nine percent of participants had a diagnosis of stage III or greater cervical cancer. Only 8.0% had heard of HPV and 4.0% knew that HPV caused cervical cancer. Fifty‐five percent had not heard of vaccines, in general; of the remainder, the majority endorsed that vaccines, in general, were effective (89.0%) and safe (95.0%). No participants had received the HPV vaccine. After a brief education session, 94% believed the HPV vaccine was effective and 65.0% were categorised as having ‘high vaccine acceptance’ after responding ‘definitely yes’ to recommending the HPV vaccine to female relatives, male relatives and the community. There were no significant differences in demographic variables or cervical cancer disease characteristics between the ‘high vaccine acceptance’ and ‘some vaccine hesitancy’ groups. Conclusion Although women with cervical cancer in Ghana have low awareness of HPV and HPV vaccination, they demonstrate high vaccine acceptability and low hesitancy.

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Standard treatment for severe anemia in pregnancy is allogeneic blood transfusion, but this is not acceptable to all patients. Options for alternative anemia treatment are available. In this case report, a 32-year-old G2P1 woman who was a Jehovah's Witness presented at 27 weeks gestation with dyspnea, palpitations, and severe anemia (hemoglobin 2.8 g/dL) related to chronic rectal bleeding. She declined blood transfusion. An anemia management protocol (high-dose erythropoietin-stimulating agent, iron, vitamin D, vitamin C, folate, vitamin B12) rapidly increased endogenous erythropoiesis. After 12 days, hemoglobin increased to 8 g/dL. A bovine hemoglobin-based oxygen carrier was available for acute bleeding but was not used. This case highlights that early initiation of multimodal therapy can adequately increase endogenous erythropoiesis to treat life-threatening anemia in antepartum patients who do not accept blood transfusion.