The Effects of the COVID-19 Pandemic Lockdown on Eating, Body Image, and Social Media Habits Among Women With and Without Symptoms of Orthorexia Nervosa

The COVID-19 pandemic is negatively impacting people’s mental health worldwide. The current study examined the effects of COVID-19 lockdown on adult women’s eating, body image, and social media habits. Furthermore, we compared individuals with and without signs of orthorexia nervosa, a proposed eating disorder. Participants were 143 women, aged 17–73 years (M = 25.85, SD = 8.12), recruited during a COVID-19 lockdown in Canada from May-June 2020. Participants completed self-report questionnaires on their eating, body image, and social media habits during the pandemic. The Eating Habits Questionnaire (EHQ) assessed symptoms of orthorexia nervosa. Compared to the period prior to lockdown, women with higher total orthorexia nervosa scores reported eating a lot more than usual, feeling greater pressure to diet and lose weight, thinking about food more often than usual, experiencing greater weight gain, and perceiving more pressure from social media specifically to lose weight and to exercise, compared to their healthy counterparts. We examined associations between individual EHQ subscales and perceived changes to eating and weight. Women who scored high on EHQ-Problems reported seeing more weight loss content on their social media than those who reported fewer orthorexia nervosa symptoms. Conversely, those who scored low on EHQ-Feelings reported feeling a lot less pressure to lose weight, somewhat less or a lot less pressure to lose weight or to exercise from social media specifically, and trended toward less laxative use during lockdown, compared to those who scored higher on orthorexia nervosa. And those who scored low on EHQ-Knowledge reported feeling somewhat less or a lot less pressure to lose weight than those who reported more orthorexia nervosa symptoms. Together, the findings suggest that women with symptoms of orthorexia nervosa are experiencing an exacerbation of disordered eating thoughts and behaviors during COVID-19, and that social media may be a contributing factor.

Predictors of laxative use in inpatients with schizophrenia on clozapine

Objectives: Constipation, a clinical manifestation of gastrointestinal hypomotility, is a common and potentially serious complication of clozapine therapy, requiring laxatives for its prevention and treatment. We explored the predictive factors of the increased laxative use in inpatients receiving a long-term clozapine therapy. Methods: In the cross-sectional study of 93 patients in a psychiatric rehabilitation hospital, we examined a four-week prevalence of laxative use and a range of demographic and clinical factors associated with the number of prescribed laxatives. Results: Seventy-four percent of inpatients with schizophrenia were prescribed laxatives, and they were statistically significant older and taking higher daily doses of clozapine. In generalized Poisson regression analysis, the clozapine dose, age, and comorbid diabetes mellitus and hypothyroidism were independently associated with the number of concurrently used laxatives. No association was found between the laxatives and gender, duration of clozapine treatment, and the number of other medications with a potential to cause constipation. Conclusion: The clozapine dose, age, diabetes mellitus, and hypothyroidism were shown to be the independent predictors of the increased laxative use among inpatients on clozapine and might be associated with the increased risk of clozapine-induced constipation and gastrointestinal hypomotility.

A national cross-sectional survey of constipation in patients attending cancer centres in Ireland

Background: The prevalence of constipation in patients with cancer is estimated at 50-90%. It is often associated with pain, anorexia, nausea and vomiting and impacts negatively on quality of life. Despite its common occurrence, it is often poorly recognised and treated by healthcare professionals. Methods: A national cross-sectional survey was conducted in Ireland to describe constipation prevalence and severity in patients attending cancer centres and to evaluate management efficacy. In-patients or patients attending day oncology wards in any of the country’s eight designated cancer centres were eligible to participate. Participants were shown the Bristol Stool Chart and answered questions regarding stool appearance and sensation of incomplete defecation; they completed the Constipation Assessment Scale. Data on pain character and intensity, opioid use, and prescribed and over-the-counter laxative use were collected. Data were summarised using descriptive statistics. Significance of variations for continuous data were determined using t-tests. Conditional ordered logistic regression was undertaken to determine factors associated with constipation. Results: The dataset comprised 491 patients. 24.8% had been reviewed by specialist palliative care; 14.5% by the anaesthetic pain team. In total, 42.2% of respondents were taking step 2 or step 3 opioids. Constipation prevalence was 67.6%; 19.4% of patients had Constipation Assessment Scale scores indicating severe constipation. A total of 46% of the respondents were not taking any laxatives. Of those who were taking laxatives, 54.8% reported constipation symptoms. While opioid use was strongly associated with participants reporting higher scores, this association was not seen in those patients receiving specialist palliative care. Conclusions: Constipation remains a clinical problem in Irish cancer centres. Despite increased opioid use, patients receiving specialist palliative care were more likely to take laxatives and reported less constipation. Specialist palliative care practice should be studied in order to identify what are the transferable ‘ingredients’ of effective constipation management.

Development, Disappearance, and Clinical Course of Melanosis Coli: Sex Differences in Progression of Severity

Background Melanosis coli (MC) is an acquired colorectal disorder visualized as colonic mucosa pigmentation. Disease severity is confirmed based on MC depth, shape, and coloration, although the clinical course is not fully understood. This study sought to clarify characteristics of MC development and disappearance and to demonstrate its clinical course and severity. Contributors to progression of MC grade were also explored. Methods To investigate the patient and clinical features of developing and disappearing MC, this study reviewed colonoscopy cases at a single institution over a 10-year period. The clinical course of MC grade was evaluated to explore the predictive factors of progressive MC. Kaplan–Meier analysis was used to determine the probability of disease progression, and the log-rank test was used to calculate equality of the clinical course. Results Of all MC cases, 17 developing and 11 disappearing cases were detected. Anthranoid laxative use was a key factor: 29.4% of developing cases used this agent before initial diagnosis of MC, whereas 27.2% of disappearing cases discontinued anthranoids before detection of MC disappearance. Among 70 grade I cases, progression to grade II occurred in 16 cases during mean follow-up of 3.67 ± 2.1 years. Male sex was more frequent in progressive than stable cases, and probability of progression was higher for male versus female cases. Conclusions An association between anthranoid administration and MC presence was detected; a sex difference in the clinical course was confirmed; and mild MC was found to progress in severity over 5 years.

Melanosis coli: a case report

Background Melanosis coli is a benign condition characterized by deposition of lipofuscin in colonic mucosa due to long-term laxative use. Case presentation Here I am reporting a case of an 85-year-old man who presented with constipation, with a history of long-term herbal medication intake as laxatives, and upon evaluation, he was found to have melanosis coli. Conclusion Melanosis coli is a common adverse effect of chronic laxative use which is more common in elderly population with constipation.

551 EASING THE STRAIN OF CONSTIPATION IN CARE HOMES

Introduction Older individuals are particularly prone to constipation with a reported prevalence of up 50% for those living in community with the prevalence rising to 70% within nursing homes (De Giorgio et al, 2015 1). Objectives To assess impact of staff education & pharmacist intervention on appropriateness of laxative use: Staff education: Examine the baseline knowledge of care home staff on constipation and laxative use: Formulate an education package to deliver to care home staff on key aspects of laxative use: Evaluate the staff knowledge, post the educational intervention.: Impact of pharmacist medication review on laxative use: Evaluate impact of pharmacist review on appropriateness of laxative use in care Homes. Method Three BHSCT Care Homes being case managed by the Medicines Optimisation Pharmacist were included in the study. Staff Education: The baseline knowledge of care home staff was examined by questionnaire, pre- and post-educational intervention on key aspects of laxative use. Staff directly administering medication or directly impacting on patients’ care in were included. An education package on key aspects of laxative use for delivery in nursing homes was designed and implemented. Impact of Pharmacist medication review on laxative use: We retrospectively examined if 30 patients were prescribed multiple laxatives from the same group as an indicator of inappropriate laxative use, pre and post pharmacist intervention. Results Staff education: Thirty-three staff completed the questionnaires. The educational package developed on laxative use had a positive impact on the knowledge of the staff on constipation and laxative use with statistically significant improvements in staff knowledge post education, with p-value <0.05. Healthcare assistants’ mean percentage increase in knowledge following education mirrored that of nursing staff at almost 50%. Impact of Pharmacist medication review on laxative use: There was a statistically significant improvement in appropriateness of laxative prescribing following the pharmacist led medication review of 30 residents. Fewer patients were prescribed laxatives from the same class following medication reviews with a p value of < 0.00001, the result is significant at p < 0.05. Discussion The positive impact of this study supports the conclusion by Chen et al 2 (2014) that patient and carer education should be first line treatment for non-severe constipation. Shen Q et al 3 (2018) suggested that educational intervention for patients can effectively improve constipation symptoms, treatment and result in improved health habits however this study provides further evidence that the education of care home staff plays a significant role in improving the appropriate management of constipation for care home residents. Pharmacist-led review of laxatives has the potential to improve a Care Home resident’s quality of life, as previously suggested by Dennison et al 4 (2005), with the potential to reduce the risk of complications or hospital admissions from ineffective treatment of chronic constipation. Conclusion The development & delivery of a bespoke laxative educational package along with pharmacist medication review of residents’ current laxatives regimes resulted in a statistically improved appropriateness in laxative use. The education package developed will be shared with Medicines Optimisation for Older People (MOOP) Care Home Pharmacists for delivery in NI trusts. References 1. De Giorgio et al. 2015. Chronic constipation in the elderly: a primer for gastroenterologist. BMC Gastroenterology, 14:130. 2. Dennison, C et al. 2005. the health-related quality of life and economic burden of constipation. Pharmaceoconmics 23 (5), 461–476. 3. Chen I. C. et al. (2014). Prevalence and effectiveness of laxative use among elderly residents in a regional hospital affiliated nursing home in Hsinchu County. Nursing and Midwifery Studies, 3(1), e13962. 4. Shen Q et al. (2018) Nurse-Led Self-Management Educational Intervention Improves Symptoms of Patients With Functional Constipation. West J Nurs Res. 2018 Jun;40(6):874–888. 5. Dennison et al. (2005) The Health-Related Quality of Life and Economic Burden of Constipation. Pharmacoeconomics, 23 (5), 461–476.

The long-term impact of an eating disorder prevention program for elite athletes: a follow-up study

Elite athletes involved in weight-based sports are at increased risk of developing eating disorders (EDs). While the utility of ED prevention programs has been assessed up to three years post-intervention, it is unclear whether participation in such interventions promotes any resilience against EDs in the long-term. To address this, the current study assessed self-reported disordered eating and body dissatisfaction in ballet dancers 15 or more years after participating in a reportedly successful ED prevention program at a professional ballet school. Graduates of the school before, during, and after the intervention were surveyed, and scores were compared across groups. Results revealed dancers who participated in the intervention and those who attended post-intervention endorsed fewer thoughts and behaviours associated with bulimia, had lower lifetime prevalence of laxative use, and showed a trend toward lower lifetime rates of vomiting to control weight than those who attended the ballet school prior to the intervention.

The long-term impact of an eating disorder prevention program for elite athletes: a follow-up study

Elite athletes involved in weight-based sports are at increased risk of developing eating disorders (EDs). While the utility of ED prevention programs has been assessed up to three years post-intervention, it is unclear whether participation in such interventions promotes any resilience against EDs in the long-term. To address this, the current study assessed self-reported disordered eating and body dissatisfaction in ballet dancers 15 or more years after participating in a reportedly successful ED prevention program at a professional ballet school. Graduates of the school before, during, and after the intervention were surveyed, and scores were compared across groups. Results revealed dancers who participated in the intervention and those who attended post-intervention endorsed fewer thoughts and behaviours associated with bulimia, had lower lifetime prevalence of laxative use, and showed a trend toward lower lifetime rates of vomiting to control weight than those who attended the ballet school prior to the intervention.