EATING DISORDERS

Uvod: Nezdrave prehrabene navike kao i poremećaji u prehrani datiraju od davnina, a danas su zbog posljedica na zdravlje postale zabrinjavajuće. Najčešće bolesti koje se tretiraju kao poremećaji u prehrani su anoreksija, bulimija i kaheksija te u novije vrijme ortoreksija. Osim ovih sve značajnije su „binge eating“, sindrom noćnog prejedanja koji se zbog svojih posljedica mogu klasificirati kao bolesti. Cilj i zadatak rada: Prikupiti i analizirati podatke o vrstama poremećaje u prehrani i njihovoj identifikaciji kao bolesti. Rezultati: Anoreksija i bulimija uz problem gojaznosti predstavljaju ozbiljne i kompleksne poremećaje neuro-psihološkog, bihevioralnog i fiziološkog funkcionisanja organizma pa su se 1980. godine prvi put pojavile u klasifikaciji bolesti DSM – III, kao podvrsta poremećaja djetinjstva i adolescencije. Posljednjih desetljeća sve je više i drugih poremećaja prehrane naročito onih koji povećavaju tjelesnu masu. Nezdrave prehrambene navike nastaju usljed jednoličnog, prekomjernog i čestog unosa ali i odricanja hrane. Takve osobe su njačešće pod kroničnim stresom, ne mogu drugačije kontrolirati svoje stanje nego im jedino ostaje da to konpeziraju prehranom. Danas je identificran čitav niz poremećaja u prehrani koji trebaju dobiti svoju klasifikaciju bolesti kao što su: ortoreksija, bigoreksija, drankoreksija, dijabulimija ali i sindrom noćnog prejedanja, „binge eating“ i druge. Ortoreksija je prisutna kod osoba koje su opsjednute dijetama i zdravom prehranom, bigoreksija se javlja kod osoba koje jedu sastojke za izgradnju mišića, a uobičajeno unose anaboličke steroide. Drunkoreksičari piju alkohol koji im smanjuje potrebe za raznolikom prehranom te se kod njih pojavljuju različite malnutricije. Dijabulimija se javlja kod oboljelih od dijabetesa, a takve osobe sebi uskraćuju inzulin. Zakluučak: Nezdrave navike i poremećaji prehrane kao što su: restriktivne dijete, prejedanje i korištenje tvari koji utiču na kontroliranje tjelesne mase, danas predstavljaju zdravstveni problem. Ove pojave i stanja da bi dobile pravi tretman trebaju biti diferencirane i klasificirane kao bolest. To bi omogućilo bolji pristup liječenju takvih stanja i bolesti.Introduction: Unhealthy eating habits as well as nutritional disorders date back to ancient times, and today due to the effects on health have become worrisome. The most common diseases that are treated as eating disorders are anorexia, bulimia and cachexia, and in recent times is orthorexia. In addition to these, all the more important are "binge eating," night overeating syndrome that can be classified as a disease due to its consequences. Goal and task: To collect and analyze data related to types of nutritional disorders and their identification as a disease. Results: Anorexia and bulimia with the problem of obesity are serious and complex disorder of the neuro-psychological, behavioral and physiological functioning of the organism, and in 1980 they first appeared in the classification of DSM-III disease, as a subtype of childhood and adolescent disorders. Over the past decade, more eating disorders are increasing, especially those that increase body mass. Unhealthy eating habits arise due to a uniform, excessive and frequent intake of foods as well renunciation of food. Such persons are the most often under chronic stress, can not control their condition, and only remains it by compensate with eating. Today, a number of nutritional disorders have been identified and need to be classified like diseases such as orthorexia, bigorexia, drankorexia, diabulimia, but also syndrome night overeating, binge eating and others. Orthorexia is present in people who are obsessed with diets and healthy eating, bigorexia occurs in people who eat ingredients for muscle building, and usually intake anabolic steroids. Drunkorexists alcohol drinking wich reduces the need for diverse nutrition and gives rise to various malnutrition. Diabulimia occurs in people with diabetes, and such people deny themselves insulin. Conclusion: Unhealthy habits and eating disorders such as restrictive diet, overeating and using substances that influence the control of body mass, today present a health problem. These phenomena and conditions to get the right treatment should be differentiated and classified as a disease. This would allow better access to the treatment of such illnesses

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

EATING DISORDERS

Uvod: Nezdrave prehrabene navike kao i poremećaji u prehrani datiraju od davnina, a danas su zbog posljedica na zdravlje postale zabrinjavajuće. Najčešće bolesti koje se tretiraju kao poremećaji u prehrani su anoreksija, bulimija i kaheksija te u novije vrijme ortoreksija. Osim ovih sve značajnije su „binge eating“, sindrom noćnog prejedanja koji se zbog svojih posljedica mogu klasificirati kao bolesti. Cilj i zadatak rada: Prikupiti i analizirati podatke o vrstama poremećaje u prehrani i njihovoj identifikaciji kao bolesti. Rezultati: Anoreksija i bulimija uz problem gojaznosti predstavljaju ozbiljne i kompleksne poremećaje neuro-psihološkog, bihevioralnog i fiziološkog funkcionisanja organizma pa su se 1980. godine prvi put pojavile u klasifikaciji bolesti DSM – III, kao podvrsta poremećaja djetinjstva i adolescencije. Posljednjih desetljeća sve je više i drugih poremećaja prehrane naročito onih koji povećavaju tjelesnu masu. Nezdrave prehrambene navike nastaju usljed jednoličnog, prekomjernog i čestog unosa ali i odricanja hrane. Takve osobe su njačešće pod kroničnim stresom, ne mogu drugačije kontrolirati svoje stanje nego im jedino ostaje da to konpeziraju prehranom. Danas je identificran čitav niz poremećaja u prehrani koji trebaju dobiti svoju klasifikaciju bolesti kao što su: ortoreksija, bigoreksija, drankoreksija, dijabulimija ali i sindrom noćnog prejedanja, „binge eating“ i druge. Ortoreksija je prisutna kod osoba koje su opsjednute dijetama i zdravom prehranom, bigoreksija se javlja kod osoba koje jedu sastojke za izgradnju mišića, a uobičajeno unose anaboličke steroide. Drunkoreksičari piju alkohol koji im smanjuje potrebe za raznolikom prehranom te se kod njih pojavljuju različite malnutricije. Dijabulimija se javlja kod oboljelih od dijabetesa, a takve osobe sebi uskraćuju inzulin. Zakluučak: Nezdrave navike i poremećaji prehrane kao što su: restriktivne dijete, prejedanje i korištenje tvari koji utiču na kontroliranje tjelesne mase, danas predstavljaju zdravstveni problem. Ove pojave i stanja da bi dobile pravi tretman trebaju biti diferencirane i klasificirane kao bolest. To bi omogućilo bolji pristup liječenju takvih stanja i bolesti.Introduction: Unhealthy eating habits as well as nutritional disorders date back to ancient times, and today due to the effects on health have become worrisome. The most common diseases that are treated as eating disorders are anorexia, bulimia and cachexia, and in recent times is orthorexia. In addition to these, all the more important are "binge eating," night overeating syndrome that can be classified as a disease due to its consequences. Goal and task: To collect and analyze data related to types of nutritional disorders and their identification as a disease. Results: Anorexia and bulimia with the problem of obesity are serious and complex disorder of the neuro-psychological, behavioral and physiological functioning of the organism, and in 1980 they first appeared in the classification of DSM-III disease, as a subtype of childhood and adolescent disorders. Over the past decade, more eating disorders are increasing, especially those that increase body mass. Unhealthy eating habits arise due to a uniform, excessive and frequent intake of foods as well renunciation of food. Such persons are the most often under chronic stress, can not control their condition, and only remains it by compensate with eating. Today, a number of nutritional disorders have been identified and need to be classified like diseases such as orthorexia, bigorexia, drankorexia, diabulimia, but also syndrome night overeating, binge eating and others. Orthorexia is present in people who are obsessed with diets and healthy eating, bigorexia occurs in people who eat ingredients for muscle building, and usually intake anabolic steroids. Drunkorexists alcohol drinking wich reduces the need for diverse nutrition and gives rise to various malnutrition. Diabulimia occurs in people with diabetes, and such people deny themselves insulin. Conclusion: Unhealthy habits and eating disorders such as restrictive diet, overeating and using substances that influence the control of body mass, today present a health problem. These phenomena and conditions to get the right treatment should be differentiated and classified as a disease. This would allow better access to the treatment of such illnesses