What are the key features of Orthorexia Nervosa and influences on its development? A qualitative investigation?

Orthorexia nervosa (ON) – a pathological obsession with healthy eating - is an emerging eating disorder. The precise nature of ON and its causes remain unclear, yet few published research studies speak directly to those with ON tendencies or professionals working with them. Our study redresses this gap in the literature by uncovering the defining ON features and the factors influencing its development. The exploratory qualitative research design included semi-structured interviews with those self-identifying as orthorexic or obsessively preoccupied with healthy eating (n=9); professionals working with ON and eating disorders - psychologists, dieticians and a family therapist (n=7). Data were analysed thematically. ON emerged as multifactorial, with a variety of interrelated influences needing to coalesce for ‘healthy eating’ to become pathological. Key features included rigidity and control (around food choices, routines and preparation) and moral judgements around food, along with a range of negative psychosocial and physical impacts. Influences on the development of ON were organised according to their occurrence at the individual (micro) level, external/relational (meso) level and societal (macro) level. Influences on the individual included health concerns, belief in food as medicine, past trauma, personality (e.g. obsessive, perfectionist), exposure to extreme views and behaviours while growing up and moral concerns. External influences included parents, partners and relational groups (e.g. fitness or clean eating groups). Societal influences included aestheticism, moral citizenship and social media. We conclude that ON is more than an individual pathology, it is symptomatic of our ‘orthorexic society’: where hyper-reflexivity around food choices, conflicting information what is the correct diet, preoccupation with appearance, and emphasis on individual (not collective) responsibility for health combine with individual susceptibilities and ecological/moral concerns, to predispose toward pathological ‘healthy’ eating

Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.

AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791

The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm

Aims To investigate whether aneurysm shape and extent, which indicate whether a patient with ruptured abdominal aortic aneurysm (rAAA) is eligible for endovascular repair (EVAR), influence the outcome of both EVAR and open surgical repair. Methods and results The influence of six morphological parameters (maximum aortic diameter, aneurysm neck diameter, length and conicality, proximal neck angle, and maximum common iliac diameter) on mortality and reinterventions within 30 days was investigated in rAAA patients randomized before morphological assessment in the Immediate Management of the Patient with Rupture: Open Versus Endovascular strategies (IMPROVE) trial. Patients with a proven diagnosis of rAAA, who underwent repair and had their admission computerized tomography scan submitted to the core laboratory, were included. Among 458 patients (364 men, mean age 76 years), who had either EVAR (n = 177) or open repair (n = 281) started, there were 155 deaths and 88 re-interventions within 30 days of randomization analysed according to a pre-specified plan. The mean maximum aortic diameter was 8.6 cm. There were no substantial correlations between the six morphological variables. Aneurysm neck length was shorter in those undergoing open repair (vs. EVAR). Aneurysm neck length (mean 23.3, SD 16.1 mm) was inversely associated with mortality for open repair and overall: adjusted OR 0.72 (95% CI 0.57, 0.92) for each 16 mm (SD) increase in length. There were no convincing associations of morphological parameters with reinterventions. Conclusion Short aneurysm necks adversely influence mortality after open repair of rAAA and preclude conventional EVAR. This may help explain why observational studies, but not randomized trials, have shown an early survival benefit for EVAR. Clinical trial registration: ISRCTN 48334791

Handbook of Regional and Urban Economics

This chapter discusses theoretical and applied research in urban economics on decentralized cities, i.e., cities in which employment is not restricted to the central business district. The first section discusses informally the incentives that firms face to suburbanize. The next section summarizes the theoretical literature on decentralized cities, including both models which solve for the optimal spatial pattern of employment and models in which the spatial pattern of employment is exogenously determined. In other sections, I discuss rent and wage gradients in decentralized cities and review the empirical literature testing whether, or not, wage gradients exist in urban areas. A section covers the question of whether people follow jobs or jobs follow people to the suburbs and the last section discusses the "wasteful" commuting controversy.

Emotional intelligence: relationship with traditional evaluation methods in nursing

Abstract Emotional intelligence (EI) is the ability to perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions so as to promote emotional and intellectual growth. EI is increasingly discussed in health care as having a potential role in nursing. The purpose of this descriptive study was to examine the causal relationship between EI scores and the traditional academic admission criteria (GPA) and evaluation methods of a baccalaureate nursing program. The sample included second semester upper division nursing students (n=85). EI was measured utilizing the Mayer- Salovey- Caruso Emotional Intelligence Test (MSCEIT). The results of the statistical analysis (MANOVA, ANOVA, and Pearson Correlational Coefficient) found no significant relationships or correlations with the current methods of evaluation for admission to nursing school or the evaluation methods used once students are in the nursing program. These results imply that assessing a nursing student's EI is measuring a different type of intelligence than that represented by academic achievement. (Published By University of Alabama Libraries