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The Essentials: Upskilling a National Health Workforce in the Identification and Treatment of Eating Disorders 要点:提高全国卫生工作者识别和治疗饮食失调症的能力。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-10-09 DOI: 10.1002/eat.24297
Danielle Maloney, Shu Hwa Ong, Jane Miskovic-Wheatley, Kelly M. Dann, Morgan Sidari, Ashlea Hambleton, Peta Marks, Sarah Maguire

Objective

Health practitioners report limited skills and lack of confidence in managing and treating people with eating disorders. The purpose of this study was to evaluate the national rollout of comprehensive basic training in identification, assessment, treatment, and management of people with eating disorders to clinicians.

Methods

The Essentials: Training Clinicians in Eating Disorders is a core competency eLearning program. As part of a nation-wide multidisciplinary workforce training strategy, 7500 course places were provided free of charge to public and private health care professionals across all jurisdictions of Australia between January 2020 and March 2022.

Results

A total of 7370 health professionals enrolled during the study period. All learning outcomes showed improvement with large effect (Cohen's d = 1.2–2), with the largest improvements for self-reported knowledge of requirements for working with children and adolescents. Effects did not depend on years of working with eating disorders suggesting that the training was beneficial across levels of experience. Those who started with very low knowledge of eating disorders or higher willingness to treat eating disorders were most likely to complete the course. Most participants reported that the course was relevant to their clinical practice, that they expected their clinical practices to change, and that they would recommend the course to other health professionals.

Discussion

The strategy to provide government-funded core competency training in eating disorder care to healthcare professionals met key objectives by reaching health professionals eligible to provide government-rebated services in public and private settings across all jurisdictions including regional and remote areas.

目的:医疗从业人员表示在管理和治疗进食障碍患者方面技能有限且缺乏信心。本研究旨在评估在全国范围内对临床医生开展的有关饮食失调症患者的识别、评估、治疗和管理的综合基础培训:方法:《要点》:方法:《要点:饮食失调症临床医师培训》是一项核心能力电子学习计划。作为全国多学科劳动力培训战略的一部分,在2020年1月至2022年3月期间,向澳大利亚所有辖区的公共和私人医疗保健专业人员免费提供了7500个课程名额:结果:在研究期间,共有 7370 名医护人员报名参加。所有学习成果均有显著提高(Cohen's d = 1.2-2),其中自我报告的有关儿童和青少年工作要求的知识提高幅度最大。效果与从事饮食失调工作的年限无关,这表明培训对不同经验水平的人都有益处。开始时对饮食失调症了解甚少或治疗饮食失调症意愿较高的学员最有可能完成课程。大多数参与者表示,该课程与他们的临床实践相关,他们希望自己的临床实践会有所改变,并且他们会向其他医疗专业人员推荐该课程:讨论:由政府出资为医护专业人员提供饮食失调护理核心能力培训的策略达到了主要目标,它覆盖了所有辖区(包括地区和偏远地区)有资格在公共和私营机构提供政府补贴服务的医护专业人员。
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引用次数: 0
A Longitudinal Network Analysis of Emotion Regulation, Interpersonal Problems, and Eating Disorder Psychopathology in Chinese Adolescents 中国青少年情绪调节、人际关系问题和进食障碍心理病理学的纵向网络分析。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-10-04 DOI: 10.1002/eat.24292
Jihong Zhang, Shuqi Cui, Hana F. Zickgraf, Wesley R. Barnhart, Yinuo Xu, Ziyue Wang, Feng Ji, Gui Chen, Jinbo He

Objective

The present longitudinal study examined sex-specific, symptom-level relationships among emotion regulation (ER), interpersonal problems (IP), and eating disorder (ED) psychopathology in a large sample of Chinese adolescents.

Method

Data were from a project with four waves of data collection (N = 1540; 710 boys and 830 girls) at 6-month intervals over 18 months. Questionnaires assessed ED psychopathology, ER, and IP at each wave of data collection. Longitudinal network analyses were conducted separately for boys and girls. Sex differences in the network structures were also examined.

Results

The results revealed pronounced heterogeneity in the presentation of ED psychopathology, ER, and IP across Chinese adolescent boys and girls longitudinally and intra-individually. For example, weight/shape preoccupation in ED psychopathology and awareness in ER emerged as important nodes in the temporal network for boys. However, weight/shape preoccupation and dissatisfaction in ED psychopathology were identified as the most important nodes in the temporal network for girls. Regarding bridge strength, awareness in ER emerged as the node with the highest connectivity in the temporal network for boys. At the same time, weight/shape dissatisfaction in ED psychopathology was the node with the highest connectivity for girls.

Discussion

The current study extended network theory to better understand the longitudinal interplay among ER, IP, and ED psychopathology in Chinese adolescents and their sex differences in the importance of symptoms. Such insights may pave the way for developing targeted prevention and treatment strategies for adolescent boys and girls in China.

目的:本纵向研究探讨了中国青少年情绪调节(ER)、人际关系问题(IP)和进食障碍(ED)心理病理学之间的性别特异性症状水平关系:本纵向研究调查了中国青少年大样本中情绪调节(ER)、人际关系问题(IP)和进食障碍(ED)心理病理学之间的性别特异性症状水平关系:数据来自一个项目,该项目在18个月内每隔6个月收集四次数据(样本数=1540;男生710人,女生830人)。在每一波数据收集过程中,调查问卷都会对ED心理病理学、ER和IP进行评估。对男生和女生分别进行了纵向网络分析。同时还研究了网络结构的性别差异:结果:研究结果表明,纵向和个体内部的中国男女青少年在 ED 心理病理学、ER 和 IP 方面存在明显的异质性。例如,ED心理病理学中的体重/体形先入为主和ER意识是男孩时间网络中的重要节点。然而,在女孩的时间网络中,ED 心理病理学中的体重/体形先入为主和不满意被认为是最重要的节点。就桥接强度而言,ER 意识是男生时间网络中连接性最高的节点。同时,ED心理病理学中的体重/体形不满意是女生连接性最高的节点:讨论:本研究扩展了网络理论,以更好地理解中国青少年ER、IP和ED心理病理学之间的纵向相互作用及其在症状重要性方面的性别差异。这些见解可为中国青少年制定有针对性的预防和治疗策略铺平道路。
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引用次数: 0
The Relationship Between Racial Attitudes and Disordered Eating Behaviors in Black Men and Black Women 黑人男性和黑人女性的种族态度与饮食紊乱行为之间的关系。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-10-02 DOI: 10.1002/eat.24290
Adwoah B. Yeboah, Jordan E. Parker, Leezet M. Matos, Patrick A. Wilson, A. Janet Tomiyama

Objective

Black individuals remain underrepresented in disordered eating research, despite evidence that both Black men and women present with disordered eating behaviors. Culturally-informed theoretical frameworks suggest that these behaviors may be linked to race-related sociocultural experiences, such as aspects of racial identity. While studies have focused on racial identity commitment, the association between attitudes toward one's racial identity and disordered eating remains underexplored. The present study examines whether positive attitudes toward one's Blackness and Black culture are associated with disordered eating.

Method

In a cross-sectional online sample of Black men and women (N = 458), we measured self-reported attitudes toward Blackness (i.e., centrality and private regard) and disordered eating behaviors (i.e., purging, binge eating, excessive exercise, and drive for thinness).

Results

In pre-registered linear regression models, private regard was negatively associated with purging and binge eating. Across all models, centrality was not associated with disordered eating. On average, Black women reported greater drive for thinness whereas Black men reported higher excessive exercise scores.

Discussion

This is the first study to demonstrate associations between racial attitudes and disordered eating among Black men and women. Our findings affirm unique correlates of disordered eating among Black people and suggest that positive attitudes toward one's Blackness and Black culture may be a protective factor against the development of disordered eating.

目的:尽管有证据表明黑人男性和女性都存在饮食失调行为,但黑人在饮食失调研究中的代表性仍然不足。以文化为基础的理论框架表明,这些行为可能与种族相关的社会文化经历有关,如种族认同的各个方面。虽然研究主要集中在种族身份承诺方面,但对个人种族身份的态度与饮食失调之间的关联仍未得到充分探讨。本研究探讨了对黑人和黑人文化的积极态度是否与饮食失调有关:方法:在黑人男性和女性的横截面在线样本(N = 458)中,我们测量了自我报告的对黑人的态度(即中心地位和私人关注)和饮食失调行为(即清肠、暴饮暴食、过度运动和追求瘦):结果:在预注册线性回归模型中,"私人关注 "与 "清食 "和 "暴饮暴食 "呈负相关。在所有模型中,中心性与饮食失调无关。平均而言,黑人女性报告的瘦身驱动力更大,而黑人男性报告的过度运动得分更高:讨论:这是第一项证明黑人男性和女性的种族态度与饮食失调之间关系的研究。我们的研究结果证实了黑人饮食失调的独特相关性,并表明对黑人和黑人文化的积极态度可能是防止饮食失调发展的保护因素。
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引用次数: 0
Long-Term Outcome and Mortality in Adolescent Girls 8 Years After Treatment for Anorexia Nervosa 青春期少女厌食症治疗 8 年后的长期效果和死亡率。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-09-27 DOI: 10.1002/eat.24299
Norbert Quadflieg, Silke Naab, Manfred Fichter, Ulrich Voderholzer

Objective

Assessment of the longer-term outcome of anorexia nervosa (AN) in female adolescent inpatients (N = 132).

Method

A follow-up (mean 8.2 years) after treatment was conducted. A subsample of 39 patients with at least 10 years of follow-up (mean 14 years) was defined.

Results

Over the 8-year follow-up period, the body mass index (BMI) increased from 14.33 (1.65) to 19.04 kg/m2 (2.97; t[112] = 17.33, p < 0.001, d = 1.63), and BMI percentiles increased from 0.50 (1.14) to 24.96 (26.81; t[112] = 9.83, p < 0.001, d = 0.92). Remission was found in 32.5% (8-year total sample) and 48.6% (14-year subsample). In the 8-year total sample, 15.1% still had AN or had relapsed (8.1% in the 14-year subsample). A cross-over from AN to binge-eating disorder was rare. The main cross-over occurred from AN to an eating disorder not otherwise specified (37.5% and 27.0%, respectively). The standardized mortality ratio was 21.7.

Discussion

In the long run, eating disorder diagnoses decreased significantly. Although a considerable proportion of patients recovered from their eating disorder, the number of recovered patients remained limited, with long-term negative consequences in a large proportion of patients. Standardized mortality was excessive, calling for ever-better therapies. Additional studies are needed to show if improved therapies lead to a better long-term outcome.

目的:评估女性青少年厌食症住院患者(132 人)的长期疗效:评估住院女性青少年厌食症患者(132 人)的长期疗效:方法:进行治疗后的随访(平均 8.2 年)。方法:对治疗后进行随访(平均 8.2 年),对随访至少 10 年(平均 14 年)的 39 名患者进行子样本界定:结果:在 8 年的随访期间,体重指数(BMI)从 14.33(1.65)升至 19.04 kg/m2(2.97;t[112] = 17.33,p 讨论:从长远来看,饮食失调的诊断率明显下降。虽然有相当一部分患者从饮食失调中康复,但康复的患者人数仍然有限,而且很大一部分患者长期受到负面影响。标准化死亡率过高,这就要求我们不断改进治疗方法。还需要进行更多的研究,以证明改进后的疗法是否会带来更好的长期效果。
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引用次数: 0
Negative Affect as a Mediator Between Exposure to Fitspiration and Thinspiration and Disordered Eating Behaviors: An Ecological Momentary Assessment Study 消极情绪是 "健美启示 "和 "瘦身启示 "与饮食紊乱行为之间的中介:生态学瞬间评估研究》。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-09-26 DOI: 10.1002/eat.24291
Kara A. Christensen Pacella, Kelsie T. Forbush, Yiyang Chen, Maegan B. Nation, Christopher C. Cushing, Rebecca E. Swinburne Romine

Objective

Although social media use, such as Instagram, has been associated with ED pathology, mechanisms connecting social media use to disordered eating behaviors (DEBs) remain largely unevaluated. Based on Dual Process, Tripartite, and Affect Regulation models of ED pathology, we proposed a moderated mediation model evaluating impacts of exposure to fitspiration/thinspiration on Instagram.

Method

We evaluated a hypothesized pathway from exposure to fitspiration/thinspiration (i.e., ED-salient content) on Instagram to disordered eating mediated by negative affect and tested individual differences in weight bias internalization, trait self-esteem, and trait self-comparison as moderators. We recruited 173 undergraduate women who reported engaging in DEBs on average at least once per week over the past 3 months. Participants completed a seven-day ecological momentary assessment protocol, during which they reported their ED-salient content exposure on Instagram, affect, and engagement in DEBs.

Results

Multilevel modeling was used to assess moderated mediation. Negative affect partially mediated associations between viewing ED-salient content and subsequent engagement in objective binge eating and restricting but did not mediate the pathway to purging or excessive exercise. Higher weight bias internalization intensified the association between viewing ED-salient content and negative affect.

Discussion

The association between viewing ED-salient content and engaging in objective binge eating and restricting may be a partial consequence of elevated negative affect; however, effects were small. Individuals with higher weight bias internalization may be more vulnerable to negative consequences from viewing ED-salient content. Findings suggested that reducing negative affect responses (e.g., via emotion regulation) could reduce negative consequences of viewing ED-salient content.

目的:尽管社交媒体(如 Instagram)的使用与 ED 病理学有关,但社交媒体的使用与饮食失调行为(DEB)之间的关联机制在很大程度上仍未得到评估。基于ED病理学的双重过程模型、三方模型和情感调节模型,我们提出了一个调节中介模型,评估在Instagram上接触fitpiration/thinspiration的影响:我们评估了从接触 Instagram 上的 "合身"/"励志"(即诱发 ED 的内容)到由负性情感介导的饮食失调的假设路径,并测试了体重偏差内化、特质自尊和特质自我比较作为调节因子的个体差异。我们招募了 173 名本科女生,她们表示在过去 3 个月中平均每周至少进行一次 DEB。参与者完成了一项为期七天的生态瞬间评估协议,在此期间,她们报告了自己在 Instagram 上的 ED 信号内容暴露、情感以及参与 DEBs 的情况:结果:多层次建模用于评估调节中介。消极情绪在部分程度上调节了观看对性欲有愉悦感的内容与随后参与客观暴饮暴食和限制饮食之间的关联,但并没有调节清肠或过度运动的途径。体重偏差内化程度越高,观看对性欲有愉悦感的内容与负面情绪之间的关联性就越强:讨论:观看对性欲有吸引力的内容与客观暴饮暴食和限制饮食之间的关联可能是负面情绪升高的部分结果;然而,影响很小。体重偏差内化程度较高的个体可能更容易因观看具有教育价值的内容而受到负面影响。研究结果表明,减少消极情绪反应(如通过情绪调节)可减少因观看具有教育价值的内容而产生的消极后果。
{"title":"Negative Affect as a Mediator Between Exposure to Fitspiration and Thinspiration and Disordered Eating Behaviors: An Ecological Momentary Assessment Study","authors":"Kara A. Christensen Pacella,&nbsp;Kelsie T. Forbush,&nbsp;Yiyang Chen,&nbsp;Maegan B. Nation,&nbsp;Christopher C. Cushing,&nbsp;Rebecca E. Swinburne Romine","doi":"10.1002/eat.24291","DOIUrl":"10.1002/eat.24291","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Although social media use, such as Instagram, has been associated with ED pathology, mechanisms connecting social media use to disordered eating behaviors (DEBs) remain largely unevaluated. Based on Dual Process, Tripartite, and Affect Regulation models of ED pathology, we proposed a moderated mediation model evaluating impacts of exposure to fitspiration/thinspiration on Instagram.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We evaluated a hypothesized pathway from exposure to fitspiration/thinspiration (i.e., ED-salient content) on Instagram to disordered eating mediated by negative affect and tested individual differences in weight bias internalization, trait self-esteem, and trait self-comparison as moderators. We recruited 173 undergraduate women who reported engaging in DEBs on average at least once per week over the past 3 months. Participants completed a seven-day ecological momentary assessment protocol, during which they reported their ED-salient content exposure on Instagram, affect, and engagement in DEBs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multilevel modeling was used to assess moderated mediation. Negative affect partially mediated associations between viewing ED-salient content and subsequent engagement in objective binge eating and restricting but did not mediate the pathway to purging or excessive exercise. Higher weight bias internalization intensified the association between viewing ED-salient content and negative affect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The association between viewing ED-salient content and engaging in objective binge eating and restricting may be a partial consequence of elevated negative affect; however, effects were small. Individuals with higher weight bias internalization may be more vulnerable to negative consequences from viewing ED-salient content. Findings suggested that reducing negative affect responses (e.g., via emotion regulation) could reduce negative consequences of viewing ED-salient content.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51067,"journal":{"name":"International Journal of Eating Disorders","volume":"57 12","pages":"2504-2515"},"PeriodicalIF":4.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Psychophysiological Investigation of Mechanisms Underlying “Feeling Fat” in Women With and Without Binge Eating 对暴食和不暴食女性 "感觉自己胖 "的心理生理学机制进行调查。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-09-26 DOI: 10.1002/eat.24293
Adrienne Mehak, Samantha Wilson, Sarah E. Racine

Objective

“Feeling fat”, the somatic experience of being overweight not fully explained by objective body weight, is considered to be an eating pathology maintenance factor. The traditional clinical understanding of “feeling fat” is based on the body displacement hypothesis, which suggests that negative emotions are projected onto the body and experienced as “feeling fat” in lieu of adaptive emotion regulation. A more recent theory suggests that “feeling fat” occurs in response to thought-shape fusion (TSF), a cognitive distortion in response to the imagined consumption of perceived fattening food. The present experimental study compared the roles of these two proposed mechanisms of “feeling fat” using self-report and psychophysiological measures.

Method

Eighty-two women (41 with binge eating, 41 control participants) self-reported “feeling fat” and had their heart rate variability (HRV), a physiological index of emotion regulation, measured before and after imagined inductions. Participants imagined either a personalized negative affective experience or consuming a preferred, so-called ‘fattening’ food.

Results

The TSF induction increased self-reports of “feeling fat” among participants with binge eating but not among control women. The negative affect induction did not increase self-reported “feeling fat” in either group. HRV did not significantly change in response to either induction for either group.

Discussion

TSF may be a more potent precursor to “feeling fat” than negative affect for individuals with binge eating. This may suggest new treatment directions, such as cognitive defusion from TSF when patients experience “feeling fat.” The utility of HRV in monitoring “feeling fat” is questionable.

目的:"感觉自己胖了 "是一种无法用客观体重完全解释的超重躯体体验,被认为是饮食病理学的一个维持因素。对 "感觉自己胖 "的传统临床理解是基于 "身体移位假说",即负面情绪被投射到身体上,并体验为 "感觉自己胖",以代替适应性情绪调节。最近的一种理论认为,"感觉自己胖了 "是对思维-形状融合(TSF)的一种反应,是对想象中吃了会发胖的食物的一种认知扭曲。本实验研究采用自我报告和心理生理测量方法,比较了这两种 "感觉胖 "机制的作用:82名女性(41名暴饮暴食者,41名对照组参与者)自我报告 "感觉自己胖了",并在想象诱导前后测量了她们的心率变异性(HRV),这是一种情绪调节的生理指标。参与者要么想象出一种个性化的负面情绪体验,要么想象出自己喜欢吃的所谓 "发胖 "食物:结果:TSF诱导增加了暴饮暴食参与者对 "感觉自己胖了 "的自我报告,而对照组女性的自我报告则没有增加。消极情绪诱导没有增加任何一组参与者的 "感觉自己胖了 "的自我报告。两组的心率变异对两种诱导的反应均无明显变化:讨论:对于暴饮暴食者来说,TSF 可能比负面情绪更能引起 "感觉自己胖了"。这可能暗示了新的治疗方向,如当患者出现 "感觉自己胖了 "的情况时,从认知上化解 TSF。心率变异在监测 "感觉肥胖 "方面的实用性值得商榷。
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引用次数: 0
Estimating Treatment Goal Weights in Adolescents With Anorexia Nervosa and Atypical Anorexia Nervosa: Comparison of the Median BMI and Historical BMI Percentile 估算神经性厌食症和非典型神经性厌食症青少年的治疗目标体重:BMI 中位数与历史 BMI 百分位数的比较。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-09-26 DOI: 10.1002/eat.24298
Jessica M. Jary (Franklin), Samantha L. Winnie, Natalie Prohaska, Terrill Bravender, Jessica L. Van Huysse

Background

Determining an accurate treatment goal weight (TGW) is critical for treating eating disorders requiring weight restoration. This is challenging in adolescents since body mass index (BMI) normally increases over time. Median BMI (mBMI) is often used to determine TGW, though use of historical growth trajectories is increasingly common. Using the appropriate method to set TGW may be particularly important in treating individuals with anorexia nervosa (AN) whose prior growth was substantially above or below the median, and in atypical anorexia (AAN) where prior growth is, by definition, above the median.

Objectives

(1) Compare differences between TGWs based on mBMI and historical BMI percentile (hBMI) in patients with AN and AAN. (2) Determine whether either TGW method better predicted scores on the Eating Disorder Examination (EDE), heart rate, and menstrual status during treatment.

Method

Retrospective chart review of 197 adolescents with AN or AAN completing a partial hospitalization program (PHP).

Results

For AN, the within-person variation between methods varied up to 11.3 kg, though the average TGW was similar if derived from the mBMI or hBMI. In AAN, the average hBMI TGW was higher than mBMI TGW, and within-person variation was up to 19.3 kg. Associations between hBMI TGW and mBMI with heart rate, menstrual status, and EDE scores varied.

Discussion

Within-person differences in TGWs derived from hBMI versus mBMI can be large, with prominent differences in AAN, where hBMI TGW is significantly higher.

背景:确定准确的治疗目标体重(TGW)对于治疗需要恢复体重的进食障碍至关重要。这对青少年来说具有挑战性,因为体重指数(BMI)通常会随着时间的推移而增加。体重指数中位数(mBMI)通常用于确定治疗目标体重,但使用历史增长轨迹的情况越来越普遍。目标:(1)比较基于 mBMI 和历史 BMI 百分位数(hBMI)的 TGW 在神经性厌食症(AN)和非典型厌食症(AAN)患者中的差异。(2) 确定任一种 TGW 方法是否能更好地预测进食障碍检查(EDE)的得分、心率以及治疗期间的月经状况:方法:对完成部分住院治疗计划(PHP)的197名患有进食障碍或厌食症的青少年进行回顾性病历审查:结果:对于自闭症和焦虑症患者,不同方法之间的人内差异高达 11.3 千克,尽管从 mBMI 或 hBMI 得出的平均总体重是相似的。在 AAN 中,hBMI TGW 的平均值高于 mBMI TGW,而人与人之间的差异高达 19.3 千克。hBMI TGW 和 mBMI 与心率、月经状况和 EDE 评分之间的关系各不相同:讨论:根据 hBMI 和 mBMI 得出的总胰岛素负荷在人体内的差异可能很大,在 AAN 中差异尤为明显,其中 hBMI 总胰岛素负荷明显更高。
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引用次数: 0
Postdischarge Mortality in a Cohort Hospitalized With Anorexia Nervosa 神经性厌食症住院病人出院后的死亡率。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-09-26 DOI: 10.1002/eat.24296
Scott B. Patten, Gina Dimitropoulos, Julia Hews-Girard, Amelia Austin, Vandad Sharifi, Jeanne Williams, Anees Bahji, Andrew Bulloch

Objective

To characterize mortality after hospital discharge in cohorts with and without anorexia nervosa (AN).

Methods

We obtained data for all hospitalizations for psychiatric reasons in Canada (except Quebec) between April 1, 2006, and March 31, 2021 (n = 1.3 million admissions). Cases of AN were identified using ICD-10 (F50.0 and F50.1) codes. First admissions during this interval for AN and other psychiatric conditions were linked to vital statistics data. Mortality was characterized through cross-tabulation, Cox proportional hazards models, and competing cause regression.

Results

After adjustment for age and sex, there was no significant difference in mortality between AN and those with other psychiatric conditions (HR = 1.04; p = 0.644). Among AN admissions, 25% (95% CI 18.6–31.4) of deaths were attributed to psychiatric conditions (ICD-F codes), with 88% of these (comprising 22% of all deaths in the AN group) having AN itself identified as the underlying cause of death. In contrast, only 8% of deaths among non-AN admissions were attributed to a mental disorder.

Discussion

Prevention of premature mortality in the general psychiatric population emphasizes modification of metabolic (e.g., hyperlipidemia) and lifestyle-related (e.g., sedentary behavior) risk factors. However, as AN itself makes a major contribution to mortality, specialized preventive strategies may be required.

目的:分析神经性厌食症(AN)患者和非厌食症患者出院后的死亡率特征:描述神经性厌食症(AN)患者和非厌食症患者出院后的死亡率特征:我们获得了 2006 年 4 月 1 日至 2021 年 3 月 31 日期间加拿大(魁北克除外)所有因精神疾病住院的数据(n = 130 万入院人数)。AN病例使用ICD-10(F50.0和F50.1)代码进行识别。在此期间因 AN 和其他精神疾病而首次入院的病例与生命统计数据相关联。通过交叉表、Cox比例危险模型和竞争原因回归分析了死亡率的特征:结果:在对年龄和性别进行调整后,躁狂症患者和其他精神疾病患者的死亡率没有明显差异(HR = 1.04; p = 0.644)。在入院的自闭症患者中,25%(95% CI 18.6-31.4)的死亡归因于精神疾病(ICD-F代码),其中88%(占自闭症组所有死亡人数的22%)的根本死因是自闭症。相比之下,在非焦虑症入院患者中,只有8%的死亡归因于精神障碍:讨论:预防普通精神病患者过早死亡的重点在于改变代谢(如高脂血症)和生活方式(如久坐不动)相关的风险因素。然而,由于焦虑症本身是导致死亡率的主要因素,因此可能需要专门的预防策略。
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引用次数: 0
Eating Disorders in Children, Adolescents, and Young Adults During and After the COVID-19 Pandemic: A Danish Nationwide Register-Based Study COVID-19 大流行期间和之后儿童、青少年和年轻人的饮食失调:一项基于丹麦全国登记册的研究。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-09-25 DOI: 10.1002/eat.24295
Heidi Sonne, Helene Kildegaard, Katrine Strandberg-Larsen, Lotte Rasmussen, Rikke Wesselhoeft, Mette Bliddal

Objective

To assess incidence rates of clinically diagnosed eating disorders among Danish youth before, during, and after the COVID-19 pandemic.

Method

This study used a population-based time series analysis with individual-level data from Danish healthcare registries. Participants included all Danish individuals aged 6–24 years from January 1, 2015, to December 31, 2023. Monthly incident cases of any eating disorder, anorexia nervosa, and bulimia nervosa were analyzed using interrupted time-series analysis. We estimated the cumulative number of excess cases of incident eating disorder diagnoses and risk ratios (RR) associated with the pandemic and post-pandemic periods compared with pre-pandemic predictions.

Results

The study population encountered a mean of 1,310,542 individuals during the study period. The study included 11,693 individuals diagnosed with an eating disorder, median age 17 (IQR 14–20 years). Incident cases increased during the pandemic (RR 1.29, 95% CI 1.15–1.45) and normalized post-pandemic (RR 1.07, 95% CI 0.91–1.25) compared with pre-pandemic predictions. Similar patterns were seen for anorexia and bulimia. Increases were significant for ages 13–16 (RR 1.19, 95% CI 1.02–1.38), 17–19 (RR 1.51, 95% CI 1.25–1.83), and 20–24 (RR 1.35, 95% CI 1.12–1.64). Post-pandemically, a continued increase was observed only for ages 20–24 (RR 1.32, 95% CI 1.02–1.71).

Conclusions

The study documents a temporary increase in diagnosed eating disorders among Danish youths during the COVID-19 pandemic, with rates later returning to pre-pandemic levels. These results provide insights into the pandemic's impact on adolescents and youths.

目的评估 COVID-19 大流行之前、期间和之后丹麦青少年中临床诊断为饮食失调症的发病率:本研究采用基于人群的时间序列分析法,并使用丹麦医疗保健登记处提供的个人数据。参与者包括 2015 年 1 月 1 日至 2023 年 12 月 31 日期间所有年龄在 6-24 岁之间的丹麦人。我们采用间断时间序列分析法对任何饮食失调症、神经性厌食症和神经性贪食症的每月发病病例进行了分析。与大流行前的预测相比,我们估算了大流行期间和大流行后与饮食失调症相关的累计超额诊断病例数和风险比(RR):在研究期间,研究对象的平均人数为 1,310,542 人。研究对象中有 11,693 人被诊断患有饮食失调症,中位年龄为 17 岁(IQR 14-20 岁)。与大流行前的预测相比,大流行期间的发病病例有所增加(RR 1.29,95% CI 1.15-1.45),大流行后则趋于正常(RR 1.07,95% CI 0.91-1.25)。厌食症和贪食症的情况也类似。13-16岁(RR 1.19,95% CI 1.02-1.38)、17-19岁(RR 1.51,95% CI 1.25-1.83)和20-24岁(RR 1.35,95% CI 1.12-1.64)的增幅明显。大流行后,仅在 20-24 岁年龄段观察到持续增长(RR 1.32,95% CI 1.02-1.71):这项研究表明,在 COVID-19 大流行期间,丹麦青少年中确诊为饮食失调症的人数出现了暂时性增长,但随后又恢复到了大流行前的水平。这些结果让我们了解了大流行对青少年的影响。
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引用次数: 0
Meaningful Associations Between Motivation for Treatment and Interpersonal Needs Within a Residential Sample of Women With Eating Disorders 在饮食失调症女性住院样本中,治疗动机与人际需求之间的意义关联。
IF 4.7 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-09-23 DOI: 10.1002/eat.24294
Marley G. Billman Miller, Ayla N. Gioia, Rachel E. Frietchen, William Grunewald, Lindsay Bodell, April R. Smith

Objective

Perceived burdensomeness (PB) and thwarted belongingness (TB), two proximal risk factors for suicide, may rise during residential eating disorder (ED) treatment when patients are separated from support and face exorbitant costs of care. In this setting, fostering motivation for treatment is challenging, and low motivation for treatment may exacerbate feelings of PB and TB. Simultaneously, PB and TB could reduce motivation for treatment, though no studies have explored this relationship longitudinally. Accordingly, this study examined associations between interpersonal needs (TB, PB) and motivation for treatment across the first 6 weeks of residential ED treatment.

Methods

Participants (n = 98) completed the Interpersonal Needs Questionnaire (INQ) and rated treatment motivation weekly. Pearson bivariate correlations examined the relationship between motivation and interpersonal needs at each timepoint. Two autoregressive cross-lagged panel models (AR-CLPMs) tested reciprocal relationships between these constructs longitudinally across the first 6 weeks of treatment.

Results

Motivation was significantly negatively correlated with PB and TB at all timepoints. In AR-CLPM 1, Week 2 Motivation predicted Weeks 3 PB, then Week 3 PB predicted Week 4 Motivation. In AR-CLPM 2, Week 2 TB predicted Week 3 Motivation, but Motivation did not predict TB at any timepoint.

Discussion

This study is the first to examine longitudinal relations between interpersonal needs and treatment motivation in residential ED care. PB and TB may influence one's motivation for treatment, although motivation and PB had a stronger reciprocal relationship than motivation and TB. Interpersonal needs should be addressed early in residential treatment to mitigate negative cycling.

目的:感知负担(PB)和归属感受挫(TB)是导致自杀的两个近端风险因素,在住院饮食失调症(ED)治疗期间,当患者与支持者分离并面临高昂的护理费用时,这两个因素可能会上升。在这种情况下,培养治疗动机具有挑战性,而治疗动机不足可能会加剧归属感和自杀风险。同时,PB 和 TB 可能会降低治疗的积极性,但目前还没有研究对这种关系进行纵向探讨。因此,本研究对ED住院治疗头6周的人际需求(TB、PB)和治疗动机之间的关系进行了研究:参与者(n = 98)填写了人际需求问卷(INQ),并每周对治疗动机进行评分。皮尔逊双变量相关性检验了每个时间点治疗动机与人际需求之间的关系。两个自回归交叉滞后面板模型(AR-CLPMs)在治疗的前 6 周纵向检验了这些结构之间的相互关系:结果:在所有时间点上,动机都与 PB 和 TB 呈明显负相关。在 AR-CLPM 1 中,第 2 周的动机预测第 3 周的 PB,然后第 3 周的 PB 预测第 4 周的动机。在 AR-CLPM 2 中,第 2 周的 TB 预测了第 3 周的动机,但在任何时间点,动机都不能预测 TB:本研究首次考察了ED住院治疗中人际需求与治疗动机之间的纵向关系。PB和TB可能会影响一个人的治疗动机,但动机和PB之间的相互关系要强于动机和TB之间的相互关系。应在住院治疗的早期解决人际需求问题,以减轻负循环。
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引用次数: 0
期刊
International Journal of Eating Disorders
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