Screening, assessment and diagnosis in the eating disorders : findings from a rapid review

Background: Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems. Methods: This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review. Results: Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males. Conclusions: A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many

Orientation, Form and Stroke Patterns in Children's Slope Drawings

PHDPsychologyUniversity of Michiganhttps://deepblue.lib.umich.edu/bitstream/2027.42/150879/1/psychdiss041.pd

Transitions to adulthood and the changing body mass index of adolescent girls in Zambia

Adolescent girls in low‐ and middle‐income countries often experience several important life transitions, including school‐leaving, marriage, and childbearing. Understanding how these transitions are associated with changes in the nutritional status of adolescent girls and young women (AGYW) is crucial for programs that aim to improve nutritional outcomes among youth and promote healthy transitions to adulthood. We investigated the associations between adolescent transitions and body mass index (BMI) among a cohort of 4887 adolescent girls in Zambia aged 10–19 years when first interviewed in 2013. Estimating fixed‐effects models controlling for constant and time‐varying confounders, we found that school‐leaving, marital status, and childbearing are associated with the nutritional status of AGYW in diverse ways. School‐leaving was associated with higher BMI and increased odds of overweight/obesity. Marriage was not only associated with increased odds of undernutrition, particularly in rural areas, but also with increased odds of overweight/obesity among older girls. Motherhood was associated with lower BMI and lower odds of overweight/obesity, particularly among breastfeeding mothers. Our results provide evidence of characteristics of AGYW that would be useful for targeted nutritional interventions and behavior change programming, including girls leaving school, recently married, and young women undergoing a marital separation, as well as young mothers and their children

Co-designing a point-of-care Digital Decision Support Tool for GPs to better identify and support people with an eating disorder in primary care.

Background: Eating Disorders (EDs) are common and can be difficult to identify and treat. General Practitioners (GPs) report feeling out of their depth with this client group and don’t have access to the specialist supports required. Clinical Decision Support Tools (CDST) can synthesise and simplify evidence for busy practitioners at the point of care; evidence is emerging for their use in a range of settings. InsideOut Institute is undertaking an Australian government funded project to develop a CDST for GPs to better identify and treat people with EDs using evidence-based information. Aims: This presentation will outline the agile development process of a CDST that provides evidence-based feedback to GPs and integrates with GP workflows and technology.Methods: Process Analysis included nationwide consultation & participatory human-centred co-design process with GPs and consumers/carers, plus review of GP workflow and practice software systems. Six key elements were identified for development using agile methodology (user testing incorporated at all stages to gain feedback and insight on use/further development of the tool). Results: The CDST is in the final stage of development, due for completion June 2022. Roll-out and evaluation will then be required. The Process Analysis phase identified a clear need for decision support for GPs to better identify, diagnose and manage people with EDs using evidence-based information; and the need for a solution to ensure integration of the CDST with practice software and workflow processes to optimise ease of uptake. Conclusions: Clarification of content and context will help ensure the CDST will be useful, adaptable and fully integrate

From Morbidity and Mortality to Quality Improvement

Objective Measure the effects of a structured morbidity and mortality conference format on the attitudes of resident and faculty participants. Study Design Prospective cohort study. Setting Otorhinolaryngology–head and neck surgery residency training program. Subjects and Methods Two changes were implemented to the structure of our morbidity and mortality conference: (1) we adopted a recently described presentation framework called situation-background-assessment-recommendation and (2) appointed a faculty moderator to lead the conference. Surveys were distributed to residents and faculty before and after these modifications were implemented to measure changes in attitude of conference attendees. Results After implementing the above changes to the morbidity and mortality conference, participant engagement increased from “moderately engaged” to “extremely engaged” ( P < .01). Among both faculty and residents, the perceived educational value of conference also improved from “moderately educational” to “extremely educational” ( P < .01). Finally in the attending cohort, the impact on future patient care increased from “no change” to “greatly enhanced” ( P < .01). Conclusion By implementing the situation-background-assessment-recommendation framework and appointing a faculty moderator to morbidity and mortality conference, participants reported significantly enhanced engagement during the conference, increased educational value of the session, and a positive impact on future patient care

Farmer adoption of plot- and farm-level natural resource management practices: between rhetoric and reality

There is a significant gap between the rhetoric of claims about adoption of farm-level natural resource management practices and the reality. New empirical evidence of low adoption from several developing countries suggests that on-farm natural resource management practices face significant constraints to adoption, and that they deliver heterogeneous private and public benefits. Five recommendations are given to the research community related to: targeting; scaling-up; the proper role of research; trajectories of diffusion; and measurement of environmental impacts

Detecting non-multiplicative genotype relative risks from transmissions of parental alleles to affected children

The differential transmission of alleles from parents to affected children indicates that the locus under investigation is either directly involved in the occurrence of the disease or that there are allelic associations with other loci that are directly involved. Conditional logistic regression applied to a diallelic locus leads to a test with two degrees of freedom. The power of a single degree of freedom test to detect non-multiplicative allelic effects is discussed here