Should doctors around the country use e-prescribing to decrease prescription errors? A study led by physician-scientists from Weill Cornell Medical College found that health care providers using an electronic system to write prescriptions were seven times less likely to make errors than those writing their prescriptions by hand. The study appears today in the online edition of the Journal of General Internal Medicine.

There is currently a strong push in the United States to encourage doctors to write electronic prescriptions in the ambulatory setting, where an estimated 2.6 billion drugs are provided, prescribed or continued. According to the study’s authors, demonstrating improvements in safety with electronic prescribing is important to encourage its use, especially among community providers in solo and small group practices who mostly write prescriptions by hand.

“We found nearly two in five handwritten prescriptions in these community practices had errors,” says Dr. Rainu Kaushal, the study’s lead author and associate professor of pediatrics, medicine and public health, and chief of the Division of Quality and Medical Informatics at Weill Cornell Medical College. “Examples of the types of errors we found included incomplete directions and prescribing a medication but omitting the quantity. A small number of errors were more serious, such as prescribing incorrect dosages.”

“Although most of the errors we found would not cause serious harm to patients, they could result in callbacks from pharmacies and loss of time for doctors, patients and pharmacists,” says senior author Dr. Erika Abramson, assistant professor of pediatrics at Weill Cornell Medical College and a pediatrician at the Komansky Center for Children’s Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. “On the plus side, we found that by writing prescriptions electronically, doctors can dramatically reduce these errors and therefore these inefficiencies.”

“At a time when the federal government and many state governments, led by New York state, are pushing for increased use of information technology to improve the delivery of health care, it is important that physicians are aware of how technology like electronic prescribing systems can improve the safety and value of care they give patients,” says Dr. Kaushal, who is also director of pediatric quality and safety for the Komansky Center for Children’s Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. “It is also important that electronic prescribing systems are easy for health care providers to use, fit well into their workflow, and that providers have technical assistance to help them install and maintain these systems.”

To evaluate the effects of e-prescribing on medication safety, researchers looked at prescriptions written by health care providers at 12 community practices in the Hudson Valley region of New York. The authors compared the number and severity of prescription errors between 15 health care providers who adopted e-prescribing and 15 who continued to write prescriptions by hand.

The providers who adopted e-prescribing used a commercial, stand-alone system that provides dosing recommendations and checks for drug-allergy interactions, drug-drug interactions and duplicate drugs. All the practices that adopted e-prescribing received technical assistance from MedAllies, a health information technology service provider. The study noted that, without extensive technical support, it is difficult for physician practices to achieve high rates of use of electronic prescribing and subsequent improvements in medication safety.

In total, the authors reviewed 3,684 paper-based prescriptions at the start of the study and 3,848 paper-based and electronic prescriptions written one year later. After one year, the percentage of errors dropped from 42.5 percent to 6.6 percent for the providers using the electronic system. For those writing prescriptions by hand, the percentage of errors increased slightly from 37.3 percent to 38.4 percent. Illegibility problems were completely eliminated by e-prescribing.

Additional co-authors were Drs. Lisa Kern (assistant professor of public health and medicine at Weill Cornell Medical College and a physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center), Yolanda Barrón (research associate in biostatistics at Weill Cornell Medical College), and Jill Quaresimo, R.N., J.D., of Taconic IPA, Fishkill, N.Y. The study was supported by funding from the Agency for Healthcare Research and Quality.

Source
Weill Cornell Medical College

Winter statistically represents a time when older people are more susceptible to slips, trips and falls. However, Balance Master’s Peter Hope argues that fall prevention is better than cure. In fact, Peter believes that by increasing awareness of and access to advice and exercise; older people are more likely to maintain their health and independence for longer; resulting in human benefits such as increased mobility, confidence and independence.

A recent study of the over 60′s concluded that it’s never too late to exercise and that even light exercise can successfully build muscle – as Peter explains: ‘Exercise has an important part to play in staying fit and active as we get older. Gentle activity has also been proven to reduce disability from certain disease, promote muscle activity and prevent weight gain’.

Our bodies are in a state of physiological decline from the mid 30′s; which adversely affects strength, power, flexibility and balance so it is vital to sustain a level of exercise and activity to maintain health and function. Recent initiatives for older people such as GP referral schemes, chair based exercise programs and postural stability courses have sought to address this issue. By offering older people access to exercises designed to reinstate power, strength and balance fitness can be improved and functional capacity maintained in even the less mobile.

The advantage of exercise has also been highlighted in the Department of Health’s National Service Framework for the Elderly. With a population bubble moving into older age, a fitter, more independent aging population could save the NHS significantly; as falls currently cost the NHS an estimated £1 billion per year.

The BalanceMaster lower limb exercised is ideal for older and less mobile people, because it does not have the perceived barriers to exercise that some traditional exercise machines do. The machine provides an important adjunct in rehabilitation; gradually improving patients’ functional capacity and balance confidence.

“Experts agree that improving balance reduces the risk factors for falls, while regular, gentle exercise, such as going for short walks or gardening, can help manage weight and benefit all-round health,” Peter says. “Supervised work on a BalanceMaster machine at a fitness center or hospital physiotherapy department can also create more flexible joints, improve balance and increase functional muscle strength,” states Peter, who has worked with leading exercise therapists for many years.

“Bearing in mind the proven link between exercise and health; exercising should be an enjoyable and productive part of every older person’s life; contributing to healthier and more independent old age. With increased education and awareness, even the less mobile should be able to participate in mild exercise; thereby improving the quality of life” concludes Peter.

Source
BalanceMaster

The Royal College of Nursing (RCN) today joined forces with almost 40 of the UK’s leading health organizations to warn that cutting specialist nurse services for people with long term conditions would be a “false economy”, as they began a campaign for guaranteed access to specialist nursing care for all patients with long term conditions.

Specialist nurse posts, many of which were lost during the deficits crisis of 2006, save millions of pounds from health budgets through reduced complications, fewer hospital re-admissions and the expert long term management of conditions. They also provide many patients and families with a lifeline which no other service can offer.

The RCN has conducted a survey of 60 of the leading health organizations, and almost 300 of the specialist nurses they represent in order to assess the value and availability of specialist nursing to patients with a wide range of long term conditions. Only 36% of respondents felt that everyone who needed specialist nursing currently received it.

Of those who identified problems accessing specialist care (48.8%), the overwhelming majority (69.1%) reported that specialist nurse services are already overloaded and do not have capacity for new referrals.

More than a third of respondents have seen cuts in services over the last 12 months, and 57% are concerned that posts will be threatened in the near future. 95% of the respondents who have seen cuts in services say it is the NHS who have cut or reduced funding for specialist nurses. This raises significant concerns that posts and services could be lost altogether as funding streams dry up.

Examples of savings which can be delivered by specialist nurses include -

- £56 million a year on care for people with Parkinson’s
- £180 million could be saved by treating Multiple Sclerosis flare ups at home rather than in hospital
- £84 million could be saved by using nurse specialists for epilepsy rather than GPs to manage the condition

Ahead of the general election, the RCN is calling for every patient with a long term condition to have guaranteed access to specialist nursing care. In addition, the RCN is calling for specialist posts to be supported by guaranteed funding, underwritten by the NHS, to ensure that short term cutbacks do not jeopardize these valuable skills in the long term. Specialist nurses also need to be given the time they need to treat patients, provide expertise and lead teams in delivering the best care.

Specialist nurses are dedicated clinical experts who are able to spend time with patients with a particular condition, and help them with everything from drug treatments to exercise plans, and help to ensure that patients have the highest possible quality of life. The RCN, along with many of the UK’s leading health organizations, value the role of the specialist nurse as crucial to saving money and preventing complications, and also urges employers not to lose their unparalleled skills and experience.

Dr. Peter Carter, RCN Chief Executive & General Secretary, said:

“Nurses realize that whoever wins the next election will be looking to make savings and to deliver more for less. While the temptation may be to cut or downgrade specialist nursing roles, this would be a false economy which would only add to the growing cost of treating long term conditions. In fact, specialist nurses save money through the better management of conditions, keeping patients out of hospital, and advising on the best drug and other treatments.

“Specialist nurses are a unique lifeline for patients and families, who are unequivocal in saying that the specialist nurse is the key factor in preserving their quality of life. It would be disastrous if these posts were put at risk, not just for these patients but for the health service as a whole. Helping with everything from accessing the most appropriate drugs to giving advice on maintaining good health and well-being, specialist nurses are always there for the patients they care for. For example, if community based care for people with Parkinson’s Disease alone could save the government £56 million a year, not to mention reducing the distress to patients and families, then it cannot be right to cut or freeze these posts as a short term fix.

“Whoever wins the next election will need to demonstrate a commitment to save not just these posts, but the skills and experience of the people who fill them. The RCN is calling on government, policy makers and employers to commit to preserving and expanding these roles so that all patients have access and all specialist nurses have the time to use their skills.”

The RCN is concerned that during the deficits crisis in 2006, many specialist roles were lost, frozen or downgraded, breaking a vital link for patients and in many cases losing skills from the health service permanently. An RCN survey has revealed that -

- More than a third of specialist nurses reported their organizations had a vacancy freeze in place
- 47% reported that their roles were at risk of being downgraded
- 68% reported having to see more patients

The Parkinson’s Disease Society is one of the organizations backing the RCN’s recommendations. Lesley Carter, Head of Influence and Service Development, said: “Parkinson’s Disease Nurse Specialists are critical to the care of people living with the condition, but the current postcode lottery of care means that many people with Parkinson’s are missing out. At the Parkinson’s Disease Society we are passionate about making sure that everyone with Parkinson’s has access to a Nurse Specialist wherever they live in the UK. Specialist nurses help people manage their medication, offer advice and information about living with Parkinson’s and give emotional support to both the patient and their carer. They also offer the local health organization opportunities to innovate how care is delivered.”

Linda McGuinness, who has Multiple Sclerosis and receives care from MS Nurse Specialist Carrie Dobson said:

“Unless you’re going through it you don’t know how it will affect you. When you’re sitting there and suddenly your feet don’t work or your legs don’t work it’s very frightening and you want help there and then. You can’t always get the doctor, although he’s very good, you need to have somebody there you can ring up and say ‘help, this is happening, what should I do about it?’ It’s like a safety rope, like a life belt to know there is somebody there.”

The RCN has also produced a film setting out the value of specialist nurses and featuring interviews with nurses and patients. You can view the film from Wednesday February 24th via the Nursing Counts website – http://www.rcn.org.uk/generalelection

Notes

Organizations who have signed up to the RCN’s policy recommendations include the Parkinson’s Disease Society, Macmillan Cancer Support, Epilepsy Action, Breakthrough Breast Cancer, Terrence Higgins Trust, MS Society and The Roy Castle Lung Cancer foundation.

The Parkinson’s Society estimates that by developing and funding community-based treatment services the savings in health costs could be around £56 million, or 30% of the money spent on supporting people in care homes.

Source
Royal College of Nursing (RCN)

A panel of experts that advises the US Centers for Disease Control and Prevention (CDC) on vaccine issues, voted this week to recommend that all persons aged 6 months and over receive annual influenza vaccinations.

The effect of the CDC’s Advisory Committee on Immunization Practices (ACIP) recommendation is to expand the proportion of people recommended to have flu shots from the current 85 per cent of the population (the higher risk groups) to virtually 100 per cent. Exceptions include babies under 6 months old and people with egg allergies (the vaccine is cultured in eggs) and other unusual conditions.

The panel voted 11 to 0 with one abstention, on Wednesday in Atlanta. According to a report in the Washington Post, when the vote was cast, there was a short round of applause in the public meeting room, reflecting the fact some public health experts and doctors have been pushing for everyone to be included the annual flu shot recommendation for more than 10 years.

The CDC usually follows the advice of its advisory panels, so the recommendation is likely to be adopted and then it will be communicated to all doctors and hospital throughout the US. A statement on the CDC website said that the expanded recommendation is to take effect in the 2010 – 2011 flu season and that it seeks to:

“Remove barriers to influenza immunization and signals the importance of preventing influenza across the entire population.”

A CDC flu specialist, Dr. Anthony Fiore, told the Washington Post that:

“Now no one should say ‘Should I or shouldn’t I?’”

The ACIP meeting focused on the value of protecting people aged 19 to 49 (the group not included in the current recommendation). This group was hit hard by the 2009 H1N1 pandemic virus, which experts predict is likely to continue circulating in the next flu season and even after that.

Another reason given for moving to universal vaccination, apart from the simple practicality of giving out an all inclusive message, is that many people currently advised to have the flu shot are not aware that they are at higher risk and should have the vaccine.

Also, new data gathered during the 2009 H1N1 shows that some people who are currently not covered by a specific recommendation to receive an annual flu shot may also be at higher risk of flu-related complications. These groups include people who are obese, certain racial/ethnic minorities and women who have just had babies.

The panel recognized that more doses will be needed to cover the coming season’s requirement, but based on current projections, the CDC statement said that:

“More licensed types and brands of seasonal influenza vaccines will be available in the 2010-11 influenza season than has ever been available before.”

CDC records from past years show that less than half the number of people recommended for vaccination actually get their flu shot.

The CDC stressed that although the annual flu vaccine is a safe and preventive health action that benefits everyone, we must not forget that some groups are still at higher risk of flu complications. These include people aged 65 and over, children under 6 months, pregnant women, and anyone with certain chronic medical conditions.

The main focus of a vaccination campaign, even if it is universal, should be to ensure these groups, and the people they come into close contact with, get their annual shots, said the CDC.

Source:
MedicalNewsToday

Anorexia nervosa is an eating disorder characterized by extremely low body weight, distorted body image and an obsessive fear of gaining weight.

The term anorexia nervosa was established in 1873 by Sir William Gull, one of Queen Victoria’s personal physicians. The term is of Greek origin: a (α, prefix of negation), n (ν, link between two vowels) and orexis (ορεξις, appetite), thus meaning a lack of desire to eat.

Contents

Signs and Symptoms
Causes
Prognosis
Treatment
Complications
References

Definitions

A definition of anorexia nervosa was established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD).

DSM-IV-TR criteria are:

• Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
• Intense fear of gaining weight or becoming fat, even though underweight.
• Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
• Amenorrhea (at least three consecutive cycles) in postmenarchal girls and women. Amenorrhea is defined as periods occurring only following hormone (e.g., estrogen) administration.

Furthermore, the DSM-IV-TR specifies two subtypes:

• Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, or the misuse of laxatives, diuretics, or enemas). Weight loss is accomplished primarily through dieting, fasting, or excessive exercise.
• Binge-Eating Type or Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge-eating or purging behavior (that is, self-induced vomiting, or the misuse of laxatives, diuretics, or enemas).

The ICD-10 criteria are similar, but in addition, specifically mention

1. The ways that individuals might induce weight-loss or maintain low body weight (avoiding fattening foods, self-induced vomiting, self-induced purging, excessive exercise, excessive use of appetite suppressants or diuretics).
2. Certain physiological features, including “widespread endocrine disorder involving hypothalamic-pituitary-gonadal axis is manifest in women as amenorrhea and in men as loss of sexual interest and potency. There may also be elevated levels of growth hormones, raised cortisol levels, changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion”.
3. If onset is before puberty, that development is delayed or arrested.

The distinction between the diagnoses of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified (EDNOS) is often difficult to make in practice and there is considerable overlap between patients diagnosed with these conditions. Furthermore, seemingly minor changes in a patient’s overall behavior or attitude can change a diagnosis from “anorexia: binge-eating type” to bulimia nervosa. It is not unusual for a person with an eating disorder to “move through” various diagnoses as his or her behavior and beliefs change over time.

Signs and Symptoms

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• Weight changes
• Weight loss
• Thinness
• Low body weight
• Emaciation
• Obsession with food and eating
• Unusual eating habits
• Eating rituals
• Excessive care in eating
• Playing with food
• Weighing foods
• Intentional starvation
• Cooking – some anorexics will prepare food for others but not eat it themselves
• Obsession with weight
• Fear of gaining weight
• Desire to lose weight
• Denial of hunger
• Intense body dissatisfaction
• Repeatedly checking weight
• Distortion of body image
• Believing too fat even when thin
• Denial of low body weight
• Wearing layered clothing – used to hide weight loss
• Abusing other weight control methods
• Excessive exercise
• Purging
• Vomiting
• Laxative abuse
• Enema abuse
• Diuretic abuse
• Menstrual abnormalities
• Irregular menstrual periods
• Absent menstrual periods
• Delayed first period
• Physical symptoms – mainly from malnutrition and starvation
• Esophagus inflammation – from purging or vomiting
• Dry skin
• Thinning hair
• Cold sensitivity
• Vulnerable to infections
• Anemia
• Heart palpitations
• Bone loss
• Tooth decay
• Soft body hair (lanugo)
• Excess body hair
• Excess facial hair
• Hair loss
• Balding scalp
• Low breathing rate
• Slow pulse
• Low blood pressure
• Low thyroid function
• Low body temperature
• Excessive thirst
• Excessive urination
• Dehydration
• Constipation
• Muscle mass loss
• Swollen joints
• Light-headedness
• Emotional symptoms
• Low self-esteem
• Withdrawal
• Isolation
• Secrecy
• Interpersonal conflict
• Resistance to treatment
• Denial that they are ill
• Suicidal tendency
• Excessive preoccupation with food
• Consider themselves overweight despite being the contrary
• Self-starvation
• Binge eating
• Absence of menstruation
• Hyperactivity
• Depression
• Malnutrition

Causes

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Genetics

Twin studies have estimated a high heritability of anorexia nervosa, ranging from 56% to as high as 84%. Subsequent association studies have shown polymorphisms in genes involved in regulation of eating behavior, motivation and reward mechanics, personality and emotion to be associated with the development of Anorexia Nervosa. Due to the low prevalence of anorexia nervosa, association studies published commonly have problems with low power due to small sample sizes. However, confirmed and consistent results have been published showing associations to polymorphisms associated with the genes encoding agouti related peptide, brain derived neurotrophic factor, catechol-o-methyl transferase, SK3 and opioid receptor delta-1. In one study, variations in the norepinephrine transporter gene promoter were associated with restrictive anorexia nervosa, but not binge-purge anorexia (though the latter may have been due to small sample size).

Neurobiological

Anorexia may be linked to a disturbed serotonin system, particularly to high levels at areas in the brain with the 5HT1A receptor – a system particularly linked to anxiety, mood and impulse control. Starvation has been hypothesized to be a response to these effects, as it is known to lower tryptophan and steroid hormone metabolism, which might reduce serotonin levels at these critical sites and ward off anxiety. Other studies of the 5HT2A serotonin receptor (linked to regulation of feeding, mood, and anxiety), suggest that serotonin activity is decreased at these sites. There is evidence that both personality characteristics and disturbances to the serotonin system are still apparent after patients have recovered from anorexia.

Changes in brain structure and function are early signs often to be associated with starvation, and is partially reversed when normal weight is regained. Anorexia is also linked to reduced blood flow in the temporal lobes. It is possible that it is a risk trait rather than an effect of starvation.

Anorexia may be linked to an autoimmune response to melanocortin peptides which influence appetite and stress responses.

Nutrition

Zinc deficiency may play a role in Anorexia. It is not thought responsible for causation of the initial illness but there is evidence that it may be an accelerating factor that deepens the pathology of the anorexia. A 1994 randomized, double-blind, placebo-controlled trial showed that zinc (14 mg per day) doubled the rate of body mass increase compared to patients receiving the placebo.

Psychological

Anorexic eating behavior is thought to originate from an obsessive fear of gaining weight due to a distorted self image and is maintained by various cognitive biases that alter how the affected individual evaluates and thinks about their body, food and eating. This is not a perceptual problem, but one of how the perceptual information is evaluated by the affected person. People with anorexia nervosa seem to more accurately judge their own body image while lacking a self-esteem boosting bias.

People with anorexia nervosa also have other psychological difficulties and mental illness. Clinical depression, obsessive compulsive disorder, substance abuse and one or more personality disorders may be the most likely conditions to be comorbid with anorexia. High-levels of anxiety and depression are likely to be present regardless of whether they fulfill diagnostic criteria for a specific syndrome.

Research into the neuropsychology of anorexia has indicated that many of the findings are inconsistent across studies and that it is hard to differentiate the effects of starvation on the brain from any long-standing characteristics. One finding is that those with anorexia have poor cognitive flexibility.

Other studies have suggested that there are some attention and memory biases that may maintain anorexia.

Social and environmental

Sociocultural studies have highlighted the role of cultural factors, such as the promotion of thinness as the ideal female form in Western industrialized nations, particularly through the media (see article). A recent epidemiological study of 989,871 Swedish residents indicated that gender, ethnicity and socio-economic status were large influences on the chance of developing anorexia, with those with non-European parents among the least likely to be diagnosed with the condition, and those in wealthy, white families being most at risk. People in professions where there is a particular social pressure to be thin (such as models and dancers) were much more likely to develop anorexia during the course of their career, and further research has suggested that those with anorexia have much higher contact with cultural sources that promote weight-loss.

There is a high rate of reported child sexual abuse experiences in clinical groups of who have been diagnosed with anorexia. Although prior sexual abuse is not thought to be a specific risk factor for anorexia, those who have experienced such abuse are more likely to have more serious and chronic symptoms.

Relationship to autism

Following an initial suggestion of relationship between anorexia nervosa and autism, a longitudinal study of 102 participants into teenage onset anorexia nervosa conducted in Sweden found that 23% of people with a long-standing eating disorder are on the autism spectrum. Those on autism spectrum tend to have a worse outcome, but may benefit from the combined use of behavioral and pharmacological therapies tailored to ameliorate autism rather than anorexia nervosa per se. Other studies may suggest that autistic traits are common in people with anorexia nervosa. However, in one report it was concluded that these findings need to be replicated using larger samples with more sensitive measures.

It is also proposed that conditions on the autism spectrum make up the cognitive endophenotype underlying anorexia nervosa and appealed for increased interdisciplinary collaboration (see figure below). A pilot study into the effectiveness Cognitive Behavior Therapy, which based its treatment protocol on the hypothesized relationship between anorexia nervosa and an underlying autistic like condition, reduced perfectionism and rigidity in 17 out of 19 participants although further evaluation is needed.

A summary of the strategy Zucker et al. (2007) used to assess the relationship between anorexia nervosa and the autism spectrum.

Prognosis

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Anorexia is thought to have the highest mortality rate of any psychiatric disorder, with anywhere from 6-20% of those who are diagnosed with the disorder eventually dying from related causes. The suicide rate of people with anorexia is also higher than that of the general population. In a longitudinal study women diagnosed with either DSM-IV anorexia nervosa (n = 136) or bulimia nervosa (n = 110) respectively who were assessed every 6 – 12 months over an 8 year period are at a considerable risk of committing suicide. Clinicians were warned of the risks as 15% of subjects reported at least one suicide attempt. It was noted that significantly more anorexia (22.1%) than bulimia (10.9%) subjects made a suicide attempt.

Treatment

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Treatment for anorexia nervosa tries to address three main areas. 1) Restoring the person to a healthy weight; 2) Treating the psychological disorders related to the illness; 3) Reducing or eliminating behaviors or thoughts that originally led to the disordered eating.

Drug treatments, such as SSRI or other antidepressant medication, have not been found to be generally effective for either treating anorexia, or preventing relapse although it has also been noted that there is a lack of adequate research in this area.

Family based treatment has also been found to be an effective treatment for adolescents with short term anorexia. At 4 to 5 year follow up one study shows full recovery rate of 60 – 90% with 10-15% remaining seriously ill. This compares favorable to other treatments such as inpatient care where full recovery rates vary between 33-55%.

Complications

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The list of complications that have been mentioned in various sources for Anorexia Nervosa includes:

• Weight loss
• Starvation
• Death
• Infections
• Kidney failure
• Cardiac arrest
• Electrolyte imbalance
• Suicide
• Osteoporosis
• Muscle wasting
• Delayed puberty
• Constipation
• Hyponatremia
• Hypokalemia
• Erectile dysfunction
• Female infertility
• Purpura
• Hypothermia
• QT lengthening
• Pathological fracture
• Hypercarotinemia
• Sex hormone binding globulin raised (serum)
• Amenorrhea
• Hypogonadotrophic hypogonadism
• Hypercholesterolemia
• Acanthocytosis

References

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1. “PsychiatryOnline, Anorexia Nervosa”

2. Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica) (1873) William Withey Gull, published in the ‘Clinical Society’s Transactions, vol vii, 1874, p22

3. Costin, Carolyn (1999). The Eating Disorder Sourcebook. Linconwood: Lowell House. p. 6. ISBN 0585189226.

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54. “WrongDiagnosis, Complications of Anorexia Nervosa”

UK psychiatrists have announced they are concerned about the harmful influence of the media on people’s body image and are calling for a new editorial code to stop the promotion of unhealthily thin bodies and making eating disorders appear glamorous.

The Royal College of Psychiatrists’ (RCPsychs’) Eating Disorders Section said the media should be portraying images of more diverse body shapes and helping people feel positive about their bodies.

They also want a kite mark scheme to be introduced whereby a symbol appears on images that have been digitally enhanced to make a model’s body appear more perfect.

The RCPsychs are urging the government to address the issue by establishing a new Forum with representatives from the media, advertisers, experts and organizations on eating disorders, regulatory bodies and politicians.

Dr. Adrienne Key, a consultant psychiatrist and member of the RCPsych Eating Disorders Section told the press earlier today that the aim of the Forum should be to:

“Collaboratively develop an ethical editorial code that realistically addresses the damaging portrayal of eating disorders, raises awareness of unrealistic visual imagery created through airbrushing and digital enhancement, and also addresses the skewed and erroneous content of magazines.”

She said there is a growing body of evidence that the media plays a role in the development of eating disorder symptoms, particularly among teenagers and young people.

“Eating disorders, such as anorexia nervosa and bulimia nervosa, are serious mental illnesses,” said Key.

“Although biological and genetic factors play an important role in the development of these disorders, psychological and social factors are also significant,” she added, saying that was why the RCPsych was urging the media “to take greater responsibility for the messages it sends out”.

However, Annabel Brog, editor of the best selling teen magazine Sugar, told the BBC that her magazine was already acting responsibly and found the announcement from the RCPsych “incredibly frustrating” and “disheartening”.

She challenged anyone to look at the past three years of issues of her magazine and find examples that support eating disorders.

She also said that putting a kitemark on images was impractical because it would be very difficult to know where to draw the line. She said most of the time images are digitally enhanced to brighten up colors rather than make models look more perfect.

In a statement released today, the RCPsych Eating Disorders Section said there were three things they were mainly concerned about:

1. Images of pre-teen and underweight models in the media and adverts that suggest the ideal body is a thin one, to the extent that airbrushing and digital enhancement is often used to portray an unrealistic image of “physical perfection”.
2. Magazine articles that give advice on dieting without balancing it with information about their long term effectiveness and the dangers of extreme dieting. Also, many articles criticize celebrities about being overweight, underweight or physically imperfect, creating an imbalanced message about what is “normal” such that readers feel dissatisfied with their own bodies.
3. Articles that glamorize weight loss and inaccurately portray eating disorders as personal weaknesses or mild disorders instead of treating them as serious mental illnesses that need specialist support.

beat, a leading UK charity that supports people with eating disorders and their families, welcomes the RCPsychs’ move. Chief executive Susan Ringwood said:

“The media is a powerful influence and we know how vulnerable some people at risk of eating disorders can be to its visual images in particular.”

“We know there is more that can be done to make that influence a positive one, and adopting the recommendations of the College’s statement would be an important step.”

Jo Swinson, a Liberal Democrat member of parliament, is proposing a parliamentary motion this week supporting the RCPsych move. She told the BBC that it was “crystal clear” that the media plays a “critical role in the development and maintenance of negative body image and eating disorders”.

Source:
MedicalNewsToday

Aedes aegypti

US and British researchers have genetically engineered a strain of flightless mosquito that may help curb the spread of Dengue fever, a flu-like disease that is endemic to over 100 countries and affects tens of millions of people every year.

The researchers, from the University of California, Irvine (UCI) in the US, the University of Oxford and Oxitec Limited in the UK, wrote about their work in a paper published online on 22 February in the Proceedings of the National Academy of Sciences, PNAS.

Dengue fever, which can cause mild to severe symptoms, is one of the world’s most pressing public health problems. There are up to 100 million cases worldwide every year, and according to the World Health Organization (WHO), one in five people in the world, or 2.5 billion people, are now at risk from Dengue fever.

The Dengue virus is spread through the bite of infected female Aedes aegypti mosquito and there is no vaccine or treatment.

Co-author Dr. Anthony James, an internationally recognized vector biologist and distinguished Professor of microbiology and molecular genetics and molecular biology and biochemistry at UCI, told the media that:

“Current Dengue control methods are not sufficiently effective, and new ones are urgently needed.”

“Controlling the mosquito that transmits this virus could significantly reduce human morbidity and mortality,” he added.

The researchers anticipate that flightless Aedes aegypti females will die quickly in the wild, thus cutting down the number of mosquitoes, reducing spread of Dengue and eventually even eliminating it.

Using methods designed by senior author Dr. Luke Alphey of Oxitec based on technology he developed when he was at Oxford University, the researchers genetically engineered the Aedes aegypti so that wing muscles don’t develop properly in female offspring rendering them unable to fly.

The idea is to introduce genetically altered males into the wild, they mate with wild females and the females of the next generation are rendered flightless. Males do not inherit the defect: they can fly as normal and show no ill effects from carrying the gene, said the researchers, but when they mate with females they pass on the gene.

The researchers wrote in their paper that they engineered “transgenic strains” of Aedes aegypti to have a “repressible female-specific flightless phenotype using either two separate transgenes or a single transgene, based on the use of a female-specific indirect flight muscle promoter from the Aedes aegypti Actin-4 gene”.

“The technology is completely species-specific, as the released males will mate only with females of the same species,” Alphey told the press.

The researchers estimated that if released, the new breed could sustainably suppress the wild mosquito population in six to nine months: “the strains are expected to facilitate area-wide control or elimination of dengue if adopted as part of an integrated pest management strategy”, they wrote.

Alphey suggested that this approach is:

“Far more targeted and environmentally friendly than approaches dependent upon the use of chemical spray insecticides, which leave toxic residue.”

“Another attractive feature of this method is that it’s egalitarian: all people in the treated areas are equally protected, regardless of their wealth, power or education,” he added.

The study is part of a research program sponsored by the Foundation for the National Institutes of Health through the Gates Foundation Grand Challenges for Global Health Initiative, which aims to support breakthrough advances for health challenges in the developing world.

James and Alphey are pioneers in the field of genetically altering mosquitoes to limit spread of disease. They hope that the approach they have developed for Dengue fever could be adapted to control other species of disease-spreading mosquito, including those that spread malaria and West Nile Virus.

Source:
MedicalNewsToday