Eating Disorders in Adolescents

1988 ◽  
Vol 10 (2) ◽  
pp. 37-47
Author(s):  
George D. Comerci
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Health Care Providers ◽  
Role Models ◽  
Chronically Ill ◽  
Treatment Team ◽  
Care Providers ◽  
Personal Choice ◽  
Her Family ◽  
Chronically Ill Patients

Anorexia nervosa and bulimia nervosa must be understood and appreciated to be chronic disorders. Too often pediatricians and other health care providers expect that the patient with an eating disorder will be quickly cured. We anticipate and readily accept patient relapses in other chronic conditions such as diabetes, cystic fibrosis, or rheumatoid arthritis, but we do not expect, nor do we tolerate, relapses in patients with eating disorders! Rather, we perceive the relapse as a treatment failure, often blaming ourselves and our lack of knowledge and skills, our treatment team, and, of course, the patient and his or her family. During medical school and residency training there are few good role models for the care of chronically ill patients. We have not learned to enjoy caring for people who do not rapidly improve and recover, especially when the illness is their "personal choice." Little wonder that so many pediatricians reject the responsibility to care for patients with an eating disorder and elect to refer them to others.

Preanalytical Challenges During Capillary Fingerstick Sampling Preclude Its Widespread Use in Adult Hospitalized Patients

2020 ◽  
Author(s):  
Christopher A Jankowski ◽  
Anthony M Casapao ◽  
Sandra Siller ◽  
Carmen Isache ◽  
Kelia V Cani ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Treatment Plan ◽  
Venous Blood ◽  
Chronically Ill ◽  
Capillary Blood ◽  
Care Providers ◽  
Paired Samples ◽  
Capillary Sample ◽  
Blood Specimens ◽  
Chronically Ill Patients

Abstract Objectives Patient compliance with laboratory testing is one of the most underrecognized challenges in developing a treatment plan for acute and chronically ill patients. The ability to offer alternatives to standard venipuncture blood draws would greatly increase a laboratory’s ability to provide testing to patients and health care providers. Methods We performed a prospective observational study on paired venous and fingerstick capillary blood samples from admitted patients undergoing vancomycin therapy. Paired specimens were analyzed for vancomycin and a basic metabolic panel (BMP: calcium, carbon dioxide, chloride, potassium, sodium, creatinine, glucose, serum urea nitrogen) on the core laboratory’s automated chemistry and immunochemistry platforms. Results A total of 59 paired fingerstick and venous blood specimens from 56 unique inpatients were analyzed. Paired samples were comparable for all the analytes tested with the exception of bicarbonate and potassium, which were significantly different among the capillary sample group. Patients required multiple fingers be lanced in 15% of cases to obtain sufficient blood to carry out the testing. Capillary sample rejection rates due to insufficient volumes were as high as 30% in the initial 30 patients enrolled in the study. Conclusions Vancomycin and the BMP, with the exception of potassium and bicarbonate, were determined to be analytically comparable. However, significant preanalytical issues should preclude laboratories and providers from more widespread adoption of fingerstick-derived capillary blood as an alternative sampling method except in the most extenuating of circumstances.

Engagement patterns of users and providers: a study of messaging on app usage in a smartphone app for the treatment of eating disorders (Preprint)

2020 ◽  
Author(s):  
Jane Kim ◽  
Jisung Park ◽  
Jenna Tregarthen
Keyword(s):  
Eating Disorders ◽  
Health Care Providers ◽  
Digital Health ◽  
Communication Styles ◽  
Care Providers ◽  
Digital Tool ◽  
Self Monitoring ◽  
Multiple Phenotypes ◽  
Monitoring Tools ◽  
Level Data

BACKGROUND By offering the ability to immediately communicate with health care providers, digital health apps may significantly bolster the therapeutic relationship. Increasing opportunities of engagement with a digital tool, self-monitoring tools show confer promise in allowing patients to go through periods in between in-clinic visits. Little is known however, regarding the usage of the apps and whether communication between providers and app users in fact encourages usage. OBJECTIVE The objective of this study was to investigate the users of an app for eating disorders and summarize the characteristics of usage, characteristics of communication (i.e. messages sent and received), and assess whether the degree of communication and the degree of app usage (of the main features of the app precluding provider contact) were related. METHODS Users of an app for eating disorders (Tregarthen et al) consented for their de-identified, aggregate level data to be utilized for research. Records of five hundred users were randomly sampled from May 2017 to July 2017. All users in the sampled cohort were linked to a clinician. Raw data included 97,732 observations of meal logs submitted via app across 500 individuals. RESULTS Our data demonstrated a high degree of variability across users in their engagement patterns of the app. Receiving more messages on average had a greater effect on usage than sending messages, implying that being checked in on by clinicians may encourage users to engage more with their app. Data also demonstrated that there were multiple phenotypes in terms of preferences regarding communication – while a portion of users seemed to benefit, a large minority did not demonstrate a change in usage based on the frequency of communication. CONCLUSIONS Understanding usage phenotypes can be instrumental in helping clinician and apps understand who their user is. This work demonstrates that variability among the user population in terms of usage and communication styles, as well as usage and behavior. This information can ultimately be leveraged for guiding effective treatment delivery.

Diabetes and Eating Disorders

2017 ◽  
pp. 221-234
Author(s):  
Liana Abascal ◽  
Ann Goebel-Fabbri
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Eating Behaviors ◽  
Diabetes Management ◽  
Treatment Team ◽  
Disordered Eating Behaviors ◽  
Subclinical Eating Disorders ◽  
Treat Population

Rates of eating disorders are higher in patients with type 1 and type 2 diabetes than in the general population. Types of eating disorders include anorexia; bulimia; binge-eating disorder; subclinical eating disorders; and an eating disorder unique to type 1 diabetes, intentionally restricting insulin doses as a calorie purge—often referred to by laypeople as “diabulimia.” Women with diabetes and eating disorders (including disordered eating behaviors) have significantly elevated blood glucose ranges, higher rates of hospitalization, higher rates of diabetes complications, and, in some cases, higher mortality rates. This chapter discusses risk factors, presentation, and identification of eating disorders within the diabetes population. Specific recommendations are given for this difficult-to-treat population, including the need for an expanded treatment team as well as the need to establish mutually agreed upon and incremental diabetes management goals.

“My Whole World Fell Apart”: Parents Discovering Their Child Has Anorexia Nervosa

2020 ◽  
Vol 30 (12) ◽  
pp. 1821-1832
Author(s):  
Emily P. Williams ◽  
Shelly Russell-Mayhew ◽  
Nancy J. Moules ◽  
Gina Dimitropoulos
Keyword(s):  
Health Care ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Health Care Providers ◽  
Family Dynamics ◽  
Vital Role ◽  
Care Providers ◽  
Critical Gap ◽  
Hermeneutic Inquiry ◽  
Difficult Times

This was the first study to examine the experience of parents who discover their child was living with anorexia nervosa (AN), thus fulfilling a critical gap in the eating disorder literature. Gadamerian hermeneutic inquiry was the guiding philosophy and method used to investigate this topic. Dialogues with parents revealed the ambiguity inherent within discovery; the isolation, betrayal, and loss felt by parents; and the complicated family dynamics occurring during the process of discovering one’s child has AN. As such, when discoveries are made, parents play a vital role in the development and functioning of the family’s response to the situation. This research offers health care providers a better understanding of the difficult times parents and caregivers experience when discovering their child has AN.

scholarly journals Level of and associated factors for non-adherence to anti-tuberculosis treatment among tuberculosis patients in Gamo Gofa zone, southern Ethiopia: cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dessalegn Ajema ◽  
Tamiru Shibru ◽  
Temesgen Endalew ◽  
Selamawit Gebeyehu
Keyword(s):  
Adverse Events ◽  
Health Care Providers ◽  
Associated Factors ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Sectional Study ◽  
Cross Sectional ◽  
Her Family ◽  
Tb Treatment ◽  
Gamo Gofa

Abstract Background Non-adherence to anti-TB treatment is one of the crucial challenges in improving tuberculosis (TB) treatment outcomes and reducing healthcare costs. The poor adherence to anti-TB treatment among patients with TB is a major problem in Ethiopia. This study aimed to assess the level of and associated factors for non-adherence to anti-TB therapy among patients with tuberculosis in the Gamo Gofa Zone. Methods A cross-sectional study was conducted at Gamo Gofa Zone from July 20 – August 30, 2017. A multi-stage sampling technique was used. The study included 289 patients who were on anti-TB treatment. Data were collected by trained data collectors using a structured and pre-tested questionnaire through interviews. A multiple logistic regression model was fitted using SPSS 23 to identify factors associated with non-adherence to anti-TB treatment at a 5% significance level. Results We found that 16.5% of the participants were non-adherent for anti-TB treatment. Failure to disclose one’s TB status to his or her family (AOR = 31.7; 95% CI: 9.1–111.1), having no information on the expected adverse events (AOR = 31.1; 95% CI: 7.5–128.3), past anti-TB treatment history (AOR = 5.3; 95% CI: 1.5–18.8) and a smoking cigarette (AOR = 11.7; 95% CI: 3.2–43.03) were found to be associated with a higher odds of being non-adherent to anti-TB treatment. Conclusions The level of non-adherence to anti-TB treatment among TB patients was high. Health care providers should counsel TB patients on the expected adverse events and measures to be taken when patients face the expected adverse events. They should also counsel their patients to disclose their TB status to his or her family and for ceasing cigarette smoking.

scholarly journals Susceptibility to Eating Disorders Among Collegiate Female Student–Athletes

2014 ◽  
Vol 49 (3) ◽  
pp. 406-410 ◽  
Author(s):  
Cherilyn N. McLester ◽  
Robin Hardin ◽  
Stephanie Hoppe
Keyword(s):  
Health Care ◽  
Eating Disorders ◽  
Body Image ◽  
Health Care Providers ◽  
Student Athletes ◽  
Female Student ◽  
Self Esteem ◽  
The Body ◽  
Self Concept ◽  
Care Providers

Context: Research has suggested that the prevalence of young women with eating disorders (EDs) is increasing, but determining the exact prevalence of EDs within the female student–athlete (FS-A) population is difficult. Looking at certain traits may help us to identify their level of susceptibility to developing an ED. Objective: To determine the susceptibility of FS-As to EDs in relation to self-concept, including self-esteem and body image. Design: Cross-sectional study. Setting: Athletic training and health centers at National Collegiate Athletic Association Division I, II, and III institutions via e-mail questionnaire correspondence. Patients or Other Participants: A total of 439 FS-As from 17 participating institutions completed the questionnaires. The sample was primarily white (83.1%) and underclass (61.8%). Main Outcome Measure(s): The questionnaire consisted of 4 parts: 3 subscales of the Eating Disorder Inventory-2, the Rosenberg Self-Esteem Scale, the Body Cathexis Scale, and demographic items. Results: A total of 6.8% of FS-As were susceptible to anorexia and 1.8% were susceptible to bulimia. The majority of FS-As (61%) reported normal self-esteem levels, whereas 29.4% had high self-esteem. Overall, 64.5% were satisfied and 23% were very satisfied with their body image. Conclusions: These results are generally positive in that they suggest FS-As have high levels of self-concept and are at low risk to develop EDs. However, these findings do not mean that all concerns should be dismissed. Although more than 90% of the respondents were not susceptible to an ED, there are still FS-As who may be. Athletic departments should evaluate their FS-As' levels of self-concept so that their susceptibility to EDs can be addressed. The emotional aspect of health care should be included in providing holistic care for student–athletes. Athletic trainers often are the primary health care providers for FS-As, so they should be made aware of this concern.

scholarly journals Proposing an Ecosystem of Digital Health Solutions for Teens With Chronic Conditions Transitioning to Self-Management and Independence: Exploratory Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Emre Sezgin ◽  
Monica Weiler ◽  
Anthony Weiler ◽  
Simon Lin
Keyword(s):  
Health Care Providers ◽  
Chronic Conditions ◽  
Access To Health Care ◽  
Environmental Changes ◽  
Digital Health ◽  
Chronically Ill ◽  
Care Providers ◽  
Component Solution ◽  
Access To Health ◽  
Transition To Independence

BACKGROUND Chronic disease management is critical to quality of life for both teen patients with chronic conditions and their caregivers. However, current literature is largely limited to a specific digital health tool, method, or approach to manage a specific disease. Guiding principles on how to use digital tools to support the transition to independence are rare. Considering the physiological, psychological, and environmental changes that teens experience, the issues surrounding the transition to independence are worth investigating to develop a deeper understanding to inform future strategies for digital interventions. OBJECTIVE The purpose of this study was to inform the design of digital health solutions by systematically identifying common challenges among teens and caregivers living with chronic diseases. METHODS Chronically ill teens (n=13) and their caregivers (n=13) were interviewed individually and together as a team. Verbal and projective techniques were used to examine teens’ and caregivers’ concerns in-depth. The recorded and transcribed responses were thematically analyzed to identify and organize the identified patterns. RESULTS Teens and their caregivers identified 10 challenges and suggested technological solutions. Recognized needs for social support, access to medical education, symptom monitoring, access to health care providers, and medical supply management were the predominant issues. The envisioned ideal transition included a 5-component solution ecosystem in the transition to independence for teens. CONCLUSIONS This novel study systematically summarizes the challenges, barriers, and technological solutions for teens with chronic conditions and their caregivers as teens transition to independence. A new solution ecosystem based on the 10 identified challenges would guide the design of future implementations to test and validate the effectiveness of the proposed 5-component ecosystem.

scholarly journals Living with a chronic disease: insights from patients with a low socioeconomic status

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lisa Van Wilder ◽  
Peter Pype ◽  
Fien Mertens ◽  
Elke Rammant ◽  
Els Clays ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Chronic Disease ◽  
Health Care Providers ◽  
Low Socioeconomic Status ◽  
Disease Burden ◽  
Chronically Ill ◽  
Low Ses ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Qualitative Interview Study

Abstract Background Little is known about how patients with low socioeconomic status (SES) experience their chronic disease, and how it impacts health-related quality of life (HRQoL). Compared to their more affluent counterparts, worse outcomes have been reported. A better understanding of the domains of HRQoL that are relevant to these specific populations is therefore needed. We explored the experiences of living with a chronic disease in low SES persons. Methods A qualitative interview study was performed in Flanders, Belgium. Semi-structured interviews were conducted in chronically ill patients, selected through purposive sampling. Interviews were audio-recorded and transcribed verbatim. Analysis followed an inductive and iterative approach. Results Fifteen patients were interviewed. Six major themes were identified: a heavy bag to carry, loss of autonomous life, inner and outer loneliness, emotional imbalance, unmet need for support, and coping strategies. Patients experienced their illness as an additional problem on top of all other problems (i.e. financial/social problems, traumatic life events). In general, the disease burden and non-disease burden were mutually reinforcing, resulting in greater dependency, greater risk of social isolation, greater psychological distress, and greater risk of impaired HRQoL. Conclusions This study is the first to provide detailed insight into the experiences of living with a chronic disease in low SES persons. A conceptual model is proposed that can be used in daily clinical practice to raise awareness among clinicians and health care providers that the patient’s needs go beyond the disease itself. Future research is needed to validate and test the model.

Development and Evaluation of a Web-Based Training Program for Oral Health Care Providers on Secondary Prevention of Eating Disorders

2009 ◽  
Vol 73 (6) ◽  
pp. 718-729 ◽  
Author(s):  
Rita D. DeBate ◽  
Herbert Severson ◽  
Marissa L. Zwald ◽  
Tracy Shaw ◽  
Steve Christiansen ◽  
...  
Keyword(s):  
Health Care ◽  
Eating Disorders ◽  
Oral Health ◽  
Secondary Prevention ◽  
Training Program ◽  
Health Care Providers ◽  
Oral Health Care ◽  
Care Providers ◽  
Web Based

Parent and Child Preferences and Styles of Communication About Cancer Diagnoses and Treatment

2019 ◽  
Vol 36 (6) ◽  
pp. 390-401
Author(s):  
Lauren E. Smith ◽  
Anna M. Maybach ◽  
Amanda Feldman ◽  
Austin Darling ◽  
Terrah Foster Akard ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care Providers ◽  
Professional Education ◽  
Emotional Regulation ◽  
Developmentally Appropriate ◽  
Chronically Ill ◽  
Future Research ◽  
Care Providers ◽  
Delivery Of Care

Communication challenges frequently occur among families and health care providers of children with life-threatening conditions. These obstacles compound concerns related to children’s diagnoses and treatment, the family’s quality of life, and delivery of care. Developmentally appropriate and validated methods of addressing the communication preferences of families with chronically ill children are limited. This study used six focus groups to determine child and parent preferences and styles of communication centering on new diagnoses and changes in prognosis. Hypothetical situations were used to minimize feelings of self-consciousness among school-aged and adolescent participants. Qualitative analyses (interrater reliability 75%) of child and parent responses revealed 3 categories and 11 subcategories or themes. The category of Characteristics of Communication Exchange included (1) how to tell, (2) who should tell, (3) when to tell, (4) who should be included, and (5) what to tell. The Knowledge and Understanding category included themes of (1) side effects of treatment, (2) what children understand, and (3) questions when being diagnosed. The category of Feelings and Emotions included themes of (1) feelings about changes in prognosis, (2) children’s feelings on being informed, and (3) coping and emotional regulation. Results reveal a need for developmentally appropriate, evidence-based education to inform parents on how, what, and when to communicate information concerning their child’s disease, as well as instructions around facilitating those discussions. Moreover, a need for professional education and training programs for providers is demonstrated by some parental dissatisfaction with bedside manner and disclosure of information. The data collected from this study lay a foundation for future research in communication as a principal factor in quality of life for pediatric patients and their families.

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