Identifying potential cases of eating disorders in an acute medical hospital.

OBJECTIVE: To identify patients presenting to an acute medical hospital with common signs and symptoms that occur in people with eating disorders (EDs), and determine by retrospective file audit if these are diagnosed cases of an ED. METHOD: The investigators screened electronic medical records of people 16 years and older for common signs and symptoms of an ED such as hypokalemia, in patients presenting to an acute hospital in Sydney, Australia from 2018 to 2020. Cases where the clinical finding was unexplained had their file audited. Cases with a known ED diagnosis or coded with an ED were also retrieved to audit. RESULTS: Investigators identified 192 definite ED cases with a total of 598 episodes of care from 2018 to 2020 presenting to the hospital. Eighty-three cases were identified as possible EDs due to unexplained clinical signs consistent with an ED, but were not confirmed cases due to lack of clinical history in the file. Only 19.1% of presentations were diagnostically coded with an ED in the electronic medical record. DISCUSSION: Our study revealed a large number of definite ED cases presenting to an acute medical hospital via the emergency department, who were not recognized as having an ED. Greater awareness of clinical signs and symptoms of an ED, such as unexplained low body mass index and hypokalemia, is necessary among acute care clinicians. Correctly identifying EDs in those seeking somatic care should be a public health priority, to facilitate timely and equitable access to diagnostic assessment and evidence based treatment. PUBLIC SIGNIFICANCE: People with eating disorders (EDs) present to acute care settings and have a relatively high utilization of generalist health services with nonspecific problems such as abdominal pain. An enhanced understanding of healthcare utilization by people with EDs, who may not disclose their symptoms, is crucial for improving access to treatment.

Challenges and priorities for researching the gut microbiota in individuals living with anorexia nervosa.

OBJECTIVE: The gut microbiota is implicated in several symptoms and biological pathways relevant to anorexia nervosa (AN). Investigations into the role of the gut microbiota in AN are growing, with a specific interest in the changes that occur in response to treatment. Findings suggest that microbial species may be associated with some of the symptoms common in AN, such as depression and gastrointestinal disturbances (GID). Therefore, researchers believe the gut microbiota may have therapeutic relevance. Whilst research in this field is rapidly expanding, the unique considerations relevant to conducting gut microbiota research in individuals with AN must be addressed. METHOD: We provide an overview of the published literature investigating the relationship between the gut microbiota and symptoms and behaviors present in AN, discuss important challenges in gut microbiota research, and offer recommendations for addressing these. We conclude by summarizing research design priorities for the field to move forward. RESULTS: Several ways exist to reduce participant burden and accommodate challenges when researching the gut microbiota in individuals with AN. DISCUSSION: Recommendations from this article are foreseen to encourage scientific rigor and thoughtful protocol planning for microbiota research in AN, including ways to reduce participant burden. Employing such methods will contribute to a better understanding of the role of the gut microbiota in AN pathophysiology and treatment. PUBLIC SIGNIFICANCE: The field of gut microbiota research is rapidly expanding, including the role of the gut microbiota in anorexia nervosa. Thoughtful planning of future research will ensure appropriate data collection for meaningful interpretation while providing a positive experience for the participant. We present current challenges, recommendations for research design and priorities to facilitate the advancement of research in this field.

Impact of patient characteristics on clinicians' decisions to involve dietitians in eating disorder treatment.

BACKGROUND: Dietetic involvement in eating disorder (ED) treatment is often initiated by other members of a patient's treating team. The present study aimed to examine the impact of patient characteristics on clinicians' decisions to involve a dietitian in a patient's ED treatment, as well as the influence of clinician characteristics on their decision-making. METHODS: ED clinicians were recruited to complete an online survey, which used case vignettes to assess their likelihood of referring patients to a dietitian or consulting with a dietitian for guidance. Questions were also included that measured clinician anxiety, beliefs about the therapy they deliver, beliefs about dietitians and views on evidence-based practice to determine whether these were related to their responses to case vignettes. RESULTS: Fifty-seven clinicians completed the survey, with the largest group being clinical psychologists (n = 22, 39%). ED diagnosis, weight status, medical co-morbidities and progress in treatment were all shown to be influential on whether clinicians involved dietitians in ED treatment. Clinician characteristics and their beliefs about dietitians were generally not correlated with the likelihood of seeking dietetic input. CONCLUSIONS: The present study indicates that clinicians' decisions to involve dietitians in ED treatment are systematic rather than random decisions influenced by individual clinician characteristics. Clinicians require further education on the potential for malnutrition regardless of patients' ED diagnosis or weight status, and the dietitian's role in addressing this.

Gastrointestinal symptoms following treatment for anorexia nervosa: A systematic literature review.

OBJECTIVE: Gastrointestinal (GI) disturbances are a frequent and burdensome experience for patients with anorexia nervosa (AN). How GI symptoms respond to current interventions is not well characterized, yet is critical to facilitate treatment success, and to inform the development of new treatments for AN. Therefore, the aim of this systematic review was to identify which treatments are effective in improving GI symptoms in patients with AN. METHOD: A systematic search for studies of AN treatments measuring GI symptoms pre- and post-treatment was conducted in May 2020 (PROSPERO ID: CRD42020181328). After removal of duplicates, title and abstracts of 3,370 studies were screened. Methodological quality was assessed using National Institute of Health Quality Assessment Tool. RESULTS: Following full-text screening, 13 studies (12 observational studies and 1 randomized double-blind placebo-controlled trial) with 401 participants met eligibility criteria and were included. All observational studies included a component of nutritional rehabilitation, with half (n = 6) involving concurrent psychological treatment. The randomized controlled trial reported a drug therapy. Eleven studies reported an improvement in all (n = 6) or at least one (n = 5) patient-reported GI symptom following treatment. Two studies reported no change. Methodological quality was fair or poor across all studies. DISCUSSION: This is the first systematic review to synthesize available evidence on the trajectory of patient-reported GI symptoms from commencement to end of treatment for AN. The results suggest that most studies showed improvement in one or more GI symptom in response to current treatments. Future therapeutic approaches should consider GI symptoms within their design for optimal treatment adherence and outcomes.

OBJETIVO: Las alteraciones gastrointestinales (GI) son una experiencia frecuente y gravosa para los pacientes que padecen anorexia nerviosa (AN). La forma en que los síntomas gastrointestinales responden a las intervenciones actuales no está bien caracterizada, sin embargo es fundamental para facilitar el éxito del tratamiento, e informar el desarrollo de nuevos tratamientos para la AN. Por lo tanto, el objetivo de esta revisión sistemática fue identificar qué tratamientos son eficaces para mejorar los síntomas gastrointestinales en pacientes que padecen AN. MÉTODO: En mayo de 2020 se llevó a cabo una búsqueda sistemática de estudios de tratamientos para AN que midieron los síntomas gastrointestinales antes y después del tratamiento (PROSPERO ID: CRD42020181328). Después de la eliminación de duplicados, se examinaron el título y los resúmenes de 3370 estudios. La calidad metodológica fue evaluada utilizando la Herramienta de Evaluación de la Calidad del Instituto Nacional de Salud. RESULTADOS: Después de la detección completa de texto, 13 estudios (12 estudios observacionales y un ensayo aleatorizado doble ciego controlado con placebo) con 401 participantes cumplieron con los criterios de elegibilidad y fueron incluidos. Todos los estudios observacionales incluyeron un componente de rehabilitación nutricional, con la mitad (n=6) involucrando un tratamiento psicológico simultáneo. El ensayo controlado aleatorizado reportó tratamiento farmacológico. Once studies informaron de una mejora en todos (n=6) o al menos un (n=5) paciente reportó síntomas gastrointestinales después del tratamiento. Dos estudios no reportaron ningún cambio. La calidad metodológica fue justa o pobre en todos los estudios. DISCUSIÓN: Esta es la primera revisión sistemática que sintetiza la evidencia disponible sobre la trayectoria de los síntomas GI notificados por el paciente desde el inicio hasta el final del tratamiento para la AN. Los resultados sugieren que la mayoría de los estudios mostraron mejoría en uno o más síntomas gastrointestinales en respuesta a los tratamientos actuales. Los futuros abordajes terapéuticos deben considerar los síntomas gastrointestinales dentro de su diseño para una adherencia y resultados óptimos en el tratamiento.

A review of treatment manuals for adults with an eating disorder: nutrition content and consistency with current dietetic evidence.

PURPOSE: This study aimed to summarise the nutrition and food-related content of treatment manuals for adults with eating disorders (EDs) and assess the degree to which this information conforms with current guidelines and literature. METHODS: Treatment manuals for adults with an ED were identified by conducting an online search of Internet book dealer Amazon and University of Sydney library catalogue as per methods used in previous reviews of self-help patient resources. The nutrition and food-related content of these manuals was extracted and reviewed independently by two reviewers using a criteria based on current best evidence to date regarding dietetic treatment for EDs. RESULTS: Twenty-two manuals met inclusion criteria, 20 (91%) of which contained some degree of nutrition and food-related content. Two manuals (9%) included content written by a dietitian, six (27%) included citation of dietetic literature to support the recommendations made and eight (36%) recommended a dietitian be consulted as part of a multidisciplinary approach to treatment. Thirteen manuals (60%) contained nutrition and food-related information not substantiated by current evidence. CONCLUSION: It is common for treatment manuals for EDs to contain nutrition and food-related content. However, most of the authors of the 22 manuals identified did not appear to collaborate with a dietitian in writing this content or cite peer-reviewed literature to substantiate dietary advice given. Consistent with current clinical practice guidelines, greater collaboration between dietitians and clinicians is required to develop, evaluate and disseminate evidence-based approaches to dietetic management. LEVEL OF EVIDENCE: Level V, narrative review.

Rationale and development of a manualised dietetic intervention for adults undergoing psychological treatment for an eating disorder.

PURPOSE: Due to the current dearth of literature regarding dietetic treatment for patients with an eating disorder (ED), no manualised dietetic interventions exist to enable the testing of dietetic treatments in this population. This paper aims to: (1) describe the rationale and development of a manualised dietetic intervention for adults undergoing concurrent psychological treatment for an ED; and (2) provide an overview of the feasibility testing of this intervention. METHODS: Current best evidence to date for dietetic treatment in EDs was utilised to develop a manualised dietetic intervention for feasibility testing alongside outpatient psychological 'treatment as usual'. RESULTS: The developed intervention consists of five, dietitian-delivered outpatient sessions: (1) getting started; (2) mechanical eating and dietary rules; (3) estimating portion sizes and social eating; (4) maximising your meal plan and meal preparation; and (5) review and treatment planning as well as pre- and post-intervention assessments. CONCLUSION: This paper is intended as a resource for clinicians and researchers in the conduct of future studies examining dietetic treatment for patients with an ED. LEVEL OF EVIDENCE: Level V, description of a new manualised, reproducible dietetic intervention.

Development of consensus-based guidelines for outpatient dietetic treatment of eating disorders: A Delphi study.

OBJECTIVE: To generate consensus-based guidelines for outpatient dietetic treatment of patients with an eating disorder (ED) using Delphi methodology. METHOD: A modified Delphi method was used to develop consensus-based guidelines in several categories: referral to a dietitian; essential components of outpatient dietetic treatment; strategies to promote collaboration between dietitians and other healthcare professionals; and skills dietitians should possess if treating patients with an ED. Participants (n = 162) were coded into three panels: ED specialists (n = 79), non-ED specialists (n = 28), and consumers and carers with lived experience of an ED (n = 55). A total of 122 statements were rated across three rounds. RESULTS: Eighty-one statements reached consensus level (66.4%). A high proportion of endorsed statements were consistent with current guidelines for ED treatment, though some statements for which evidence exists were not endorsed as essential components of dietetic treatment. Compared to consumers and carers, ED specialists were less likely to endorse assessment or involvement by a dietitian as a standard component of treatment, and a number of discrepancies between ED specialists and consumers and carers were observed regarding essential components of dietetic treatment. DISCUSSION: This study provides consensus-based guidelines in the current absence of clinical practice guidelines for dietetic treatment of EDs. It also highlights the importance of further research into: (a) the effectiveness of different components of dietetic intervention in this population and (b) how dietetic assessment and intervention is best incorporated into outpatient treatment.

An Outcome Study of the CASA-CHESS Smartphone Relapse Prevention Tool for Latinx Spanish-Speakers with Substance Use Disorders.

Background: Hispanic/Latinx persons with alcohol and other drug disorders (AOD) have limited access to culturally competent continuity of care. To address this, the evidence-based smartphone recovery application Addiction-Comprehensive Health Enhancement Support System (A-CHESS) was translated and adapted for Latinx Spanish-speakers with AOD, developing CASA-CHESS. Objectives: This study examined the AOD and mental health outcomes for Latinx Spanish-speaking clients using the CASA-CHESS smartphone tool over a 6-month period, post-residential treatment. This single group, pre-post study design included seventy-nine male and female Spanish-speaking Latinx clients, equipped with CASA-CHESS as they completed residential AOD treatment. Primary outcome measures at baseline and 6-month follow-up included substance use and other mental health symptoms. Results: While over 70% of the sample reported past heroin use and alcohol use, clients had low baseline rates of substance use, depression and anxiety and elevated social support scores as they graduated from residential treatment. Overall participants maintained their relatively low baseline rates during the 6-month post-residential period while using the CASA-CHESS relapse prevention tool. Those who discontinued using CASA-CHESS within the first 4 months after leaving residential treatment reported higher rates of substance use as well as anxiety and depression symptoms than those using it for 4 or more months, suggesting that continued use of CASA-CHESS may contribute to maintenance of successes gained in treatment. Conclusions/Importance: CASA-CHESS may reduce the risk of relapse for Latinx Spanish-speakers following residential services and extend needed access to culturally and linguistically competent aftercare services for those with AOD.

Pathogenesis of Renal Injury and Gene Expression Changes in the Male CD-1 Mouse Associated with Exposure to Empagliflozin.

An increased incidence of renal tubular adenomas and carcinomas was identified in the 2-year CD-1 mouse carcinogenicity study with empagliflozin (sodium-glucose transporter 2 inhibitor) in high dose (1,000 mg/kg/day) male mice. A 13-week mouse renal investigative pathogenesis study was conducted with empagliflozin to evaluate dose dependency and temporal onset of nonneoplastic degenerative/regenerative renal tubular and molecular (genes, pathways) changes which precede neoplasia. Male and female CD-1 mice were given daily oral doses of 0, 100, 300, or 1,000 mg/kg/day (corresponding carcinogenicity study dose levels) for 1, 2, 4, 8, or 13 weeks. The maximum expected pharmacology with secondary osmotic diuresis was observed by week 1 at ≥100 mg/kg/day in both genders. Histopathologic kidney changes were first detected after 4 weeks of dosing in the male 1,000 mg/kg/day dose group, with progressive increases in the incidence and/or number of findings in this dose group so that they were more readily detected during weeks 8 and 13. Changes detected starting on week 4 consisted of minimal single-cell necrosis and minimal increases in mitotic figures. These changes persisted at an increased incidence at weeks 8 and 13 and were accompanied by minimal to mild tubular epithelial karyomegaly, minimal proximal convoluted tubular epithelial cell hyperplasia, and a corresponding increase in Ki-67-positive nuclei in epithelial cells of the proximal convoluted tubules. There were no corresponding changes in serum chemistry or urinalysis parameters indicative of any physiologically meaningful effect on renal function and thus these findings were not considered to be adverse. Similar changes were not identified in lower-dose groups in males nor were they present in females of any dose group. RNA-sequencing analysis revealed male mouse-specific changes in kidney over 13 weeks of dosing at 1,000 mg/kg/day. Treatment-related changes included genes and pathways related to p53-regulated cell cycle and proliferation, transforming growth factor ß, oxidative stress, and renal injury and the number of genes with significant expression change dramatically increased at week 13. These treatment-related changes in genes and pathways were predominant in high-dose males and complemented the observed temporal renal tubular changes. Overall, these mouse investigative study results support the role of early empagliflozin-related degenerative/regenerative changes only observed in high-dose male CD-1 mice as a key contributing feature to a nongenotoxic mode of renal tumor pathogenesis.

Exploring the perceived usefulness of practical food groups in day treatment for individuals with eating disorders.

BACKGROUND/AIM: Recovery from eating disorders is a challenging process. Emerging literature suggests that occupational therapists may provide a useful contribution in delivering purposeful eating-related interventions as a potential treatment to support sustained cognitive and behavioural changes for individuals with eating disorders. This study aimed to evaluate participants' perceptions of the contribution of occupational therapy practical food groups (food based outings and cooking groups) in supporting their functional recovery. METHODS: Individuals attended practical food groups as part of standard treatment at an outpatient eating disorders day program. Ninety-nine participants completed questionnaires at discharge and up to three follow-up points (6, 12 and 24 months). Questions related to practical food groups were analysed, exploring participants' experiences and perceived usefulness of groups using rating-scale and open-ended questions. Open-ended responses were analysed using thematic analysis. Descriptive statistics were calculated for responses to rating-scale questions. RESULTS: At discharge, participants rated the importance and usefulness of practical food groups as high (4.73 and 4.43 on 5-point scales, respectively), but tended to rate their enjoyment of the groups lower (3.50 on a 5-point scale). Some skill transfer was typically reported by participants at discharge (3.92 on a 5-point scale). One core theme, 'success through participation', emerged from qualitative comments. Six subthemes were also identified: helpful components of practical food groups; perceived benefit of exposure; impact of applying cognitive and behavioural skills; challenges affecting participation; facilitating adaptation; and influence of eating disorders on challenging feared foods. CONCLUSION: This study highlights that participation in practical food groups was perceived as useful in assisting individuals to improve eating behaviours and, in some circumstances, transfer these skills into their lives outside of day program. Results suggest that occupational therapists may have an important contribution in delivering these interventions to support recovery and facilitate application of adaptive coping strategies.

Use of a Smartphone Recovery Tool for Latinos with Co-Occurring Alcohol and Other Drug Disorders and Mental Disorders.

OBJECTIVE: Addressing alcohol and other drug disorders and other mental disorders among adult Hispanics/Latinos is of critical concern, as they are one of the fastest-growing ethnic groups with a disproportionate rate of disease, mental disorders, and poverty. Although improvement in outcomes is associated with sustained participation in ongoing treatment for co-occurring alcohol and other drug disorders/mental disorders, continuing care is rare for these chronic conditions, especially for Latinos with more limited access to culturally and linguistically competent services. METHODS: The evidence-based smartphone recovery application Addiction-Comprehensive Health Enhancement Support System (A-CHESS) was translated and adapted for Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders, thus developing CASA-CHESS to address a high level of need for services, high rates of relapse, and lack of existing culturally competent services for Latinos. RESULTS: Of the 79 Latino clients who completed residential treatment and received a smartphone equipped with CASA-CHESS, 26.6% discontinued using CASA-CHESS and 73.4% remained active for four or more months. CASA-CHESS usage was sustained over the four months across all three tenets of self-determination theory (competence, relatedness, and autonomy), with the most commonly utilized services being relevant to relatedness (e.g., messaging, discussion boards). CASA-CHESS clients demonstrated a similar pattern of usage to A-CHESS clients. CONCLUSIONS: Findings illustrate that Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders will use a smartphone application to assist with their recovery, continuing their access to resources, case management, and quality information after leaving residential treatment. Consistent with previous findings, our results also emphasize the importance of social support during the four months post-discharge. Such evidence-based, theory-driven digital interventions may extend access to culturally and linguistically competent services.

The household economic burden of eating disorders and adherence to treatment in Australia.

BACKGROUND: This study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia. METHODS: Multi-centre prospective observational study using a structured questionnaire. Ninety participants were recruited from two clinic settings in New South Wales, Australia and from the community using social media. The primary outcome measures were household economic burden of illness measured in terms of out-of-pocket expenditure, household economic hardship and cost-related non-adherence. RESULTS: The pattern of out-of-pocket expenditure varied by diagnosis, with Bulimia Nervosa associated with the highest total mean expenditure (per three months). Economic hardship was reported in 96.7% of participants and 17.8% reported cost-related non-adherence. Those most likely to report cost-related non-adherence had a longer time since diagnosis. Cost-related non-adherence and higher out-of-pocket expenditure were associated with poorer quality of life, a more threatening perception of the impact of the illness and poor self-reported health. CONCLUSIONS: This study is the first to empirically and quantitatively examine the household economic burden of eating disorders from the patient perspective. Results indicate that households experience a substantial burden associated with the treatment and management of an eating disorder. This burden may contribute to maintaining the illness for those who experience cost-related non-adherence and by negatively influencing health outcomes. Current initiatives to implement sustainable and integrated models of care for eating disorders should strive to minimise the economic impact of treatment on families.

Nonclinical safety of the sodium-glucose cotransporter 2 inhibitor empagliflozin.

Empagliflozin, a selective inhibitor of the renal tubular sodium-glucose cotransporter 2, was developed for treatment of type 2 diabetes mellitus. Nonclinical safety of empagliflozin was studied in a battery of tests to support global market authorization. Safety pharmacology studies indicated no effect of empagliflozin on measures of respiratory or central nervous system function in rats or cardiovascular safety in telemeterized dogs. In CD-1 mouse, Wistar Han rat, or beagle dogs up to 13, 26, or 52 weeks of treatment, respectively, empagliflozin exhibited a toxicity profile consistent with secondary supratherapeutic pharmacology related to glucose loss and included decreased body weight and body fat, increased food consumption, diarrhea, dehydration, decreased serum glucose and increases in other serum parameters reflective of increased protein catabolism, gluconeogenesis, and electrolyte imbalances, and urinary changes such as polyuria and glucosuria. Microscopic changes were consistently observed in kidney and included tubular nephropathy and interstitial nephritis (dog), renal mineralization (rat) and tubular epithelial cell karyomegaly, single cell necrosis, cystic hyperplasia, and hypertrophy (mouse). Empagliflozin was not genotoxic. Empagliflozin was not carcinogenic in female mice or female rats. Renal adenoma and carcinoma were induced in male mice only at exposures 45 times the maximum clinical dose. These tumors were associated with a spectrum of nonneoplastic changes suggestive of a nongenotoxic, cytotoxic, and cellular proliferation-driven mechanism. In male rats, testicular interstitial cell tumors and hemangiomas of the mesenteric lymph node were observed; both tumors are common in rats and are unlikely to be relevant to humans. These studies demonstrate the nonclinical safety of empagliflozin.

Psychometric properties of the Marschak Interaction Method of Psychometrics and the Assessment of Parent-Child Interaction within residential care and non-referred settings.

Introduction: Assessment and identification of children with developmental needs and their interaction with primary caregivers are critical for emotional and social development. However, to the best of our knowledge, there is a scarcity of valid observation-based tools that guide the work with family communication, which is essential for the child's healthy development. Method: The Marschak Interaction Method of Psychometrics (MIM-P) and Assessment of Parent-Child Interaction (APCI) are both interaction and observation-based assessment tool, and they were explored for their validity and reliability in assessing caregiver-child interaction. The study included 30 trained and certified professionals who recruited referred and non-referred caregiver-child dyads over 11 months. Assessment data was collected from 139 caregiver-child dyads for the MIM-P with 278 individuals (100 referred and 178 non-referred) and 129 caregiver-child dyads for the APCI with 257 individuals (95 referred and 162 non-referred). Results: The psychometric analyses show that both the MIM-P and APCI presents relevant sources of reliability and validity for assessing caregiver-child interaction including interrater reliability, internal consistency, test re-test reliability as well as concurrent and construct validity. Discussion and conclusion: The study highlights the need for observation-based assessment tools within social work and contributes to the understanding of the importance of relationships and interaction in children's emotional and social development. However, further research is needed to explore norms and further strengthen implementation and quality of the tools.

Social-Emotional Learning for Whom? Implications of a Universal SEL Program and Teacher Well-being for Teachers' Interactions with Students.

Social-emotional learning interventions are intended to improve classroom dynamics and have the potential to enhance the well-being of students and their teachers. Using data drawn from an effectiveness trial of the Social Skills Improvement System SEL Edition Classwide Intervention Program (SSIS SEL CIP; Elliott and Gresham in SSIS SEL Edition Classwide Intervention Program manual, Pearson, Inc., 2017), the present quantitative study explored associations between classroom implementation of a universal SEL program, teachers' emotional well-being, and teacher-student interactions. The results from a sample of 80 first- and second-grade teachers located in three socioeconomically and geographically diverse regions of the USA indicated that implementation of the SSIS SEL CIP curriculum was positively associated with teachers' classroom organization skills at the end of the year. Findings also revealed an interaction between treatment condition and teacher emotional well-being such that control teachers with lower well-being also had lower quality classroom organization but this association did not exist for teachers in the intervention condition. Findings suggest that implementation of the SSIS SEL CIP may help to preserve positive teacher-student interactions even when teachers are reporting lower levels of emotional well-being.

Embedding community-engaged research principles in implementation science: The implementation science center for cancer control equity.

Gaps in the implementation of effective interventions impact nearly all cancer prevention and control strategies in the US including Massachusetts. To close these implementation gaps, evidence-based interventions must be rapidly and equitably implemented in settings serving racially, ethnically, socioeconomically, and geographically diverse populations. This paper provides a brief overview of The Implementation Science Center for Cancer Control Equity (ISCCCE) and describes how we have operationalized our commitment to a robust community-engaged center that aims to close these gaps. We describe how ISCCCE is organized and how the principles of community-engaged research are embedded across the center. Principles of community engagement have been operationalized across all components of ISCCCE. We have intentionally integrated these principles throughout all structures and processes and have developed evaluation strategies to assess whether the quality of our partnerships reflects the principles. ISCCCE is a comprehensive community-engaged infrastructure for studying efficient, pragmatic, and equity-focused implementation and adaptation strategies for cancer prevention in historically and currently disadvantaged communities with built-in methods to evaluate the quality of community engagement. This engaged research center is designed to maximize the impact and relevance of implementation research on cancer control in community health centers.

Discrepancies Between Australian Eating Disorder Clinicians and Consumers Regarding Essential Components of Dietetic Treatment.

BACKGROUND: A recent Delphi study indicated that, compared with eating disorder (ED) consumers and carers, ED specialists were less likely to endorse involvement of a dietitian as a standard component of treatment. In addition, there was disagreement between these groups regarding the inclusion of a number of components of dietetic treatment. OBJECTIVE: This study aimed to further investigate these data to identify areas of disagreement among ED specialist dietitians, ED specialist non-dietetic clinicians, consumers, and carers with regard to outpatient dietetic treatment. DESIGN AND PARTICIPANTS/SETTING: The ED specialists panel from a previous Delphi study was recoded into 2 panels: ED specialist dietitians (n = 31) and ED specialist non-dietetic clinicians (n = 48) to compare responses of these panels with responses from consumers (n = 32) and carers (n = 23). MAIN OUTCOME MEASURES: Statements in 7 categories relating to referral to dietitian, essential components of outpatient dietetic treatment regarding 4 ED patient populations, strategies to promote multidisciplinary collaboration, and skills dietitians should possess if treating patients with an ED were rated on a 5-point Likert scale. STATISTICAL ANALYSIS PERFORMED: One-way analysis of variance was conducted with post-hoc multiple comparisons to compare mean statement ratings. RESULTS: Thirty-seven statements (30%) showed statistically significant differences (P < .05) in responses between panels. Discrepancies were primarily observed for statements regarding how and when dietetics is included in treatment and essential components of dietetic treatment, particularly the use of behavioral tasks, such meal plans and self-monitoring. Results also highlighted deficits in participants' understanding of core responsibilities of dietitians in ED treatment and dietitians "drifting" from delivering evidence-based components of dietetic treatment. CONCLUSIONS: Results of this study show discrepancies among ED dietitians, clinicians, consumers, and carers regarding what dietetic treatment for people with EDs should encompass. It also indicates the need for further research into optimizing dietetic treatment for EDs that is conducted in collaboration with individuals with lived experience.

Examining teacher approaches to implementation of a classwide SEL program.

Scale-up of universal social-emotional learning (SEL) programs has become a priority in schools to promote positive social outcomes for all students. Although studies have examined student outcomes associated with school-based SEL when extensive training and support are provided, research on teacher SEL implementation practices under typical conditions has received far less attention. As such, this study examined the first-year universal SEL implementation practices of 41 teachers across 13 schools in three states. School personnel made all decisions regarding approaches to training, support, and program implementation of a manualized program delivered at the classroom level to first- and second-grade students. Within this authentic context for implementation, variability was observed in selection of skills units, number of lessons taught, and adherence to lesson activities and scripts. Coding of teacher anecdotal reports revealed that perceived student needs, classroom context demands, and school-level factors informed teachers' implementation of the program. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Diet, Digestion, and the Dietitian: A Survey of Clinicians' Knowledge, Attitudes and Practices to Advance the Treatment of Gastrointestinal Disturbances in Individuals with Anorexia Nervosa.

Despite advances in treatment of anorexia nervosa (AN), current therapeutic approaches do not fully consider gastrointestinal disturbances (GID), often present in AN. Addressing GID, both symptoms and disorders, is likely to improve treatment adherence and outcomes in people with AN. GID are complex and are linked to a range of factors related to eating disorder symptomology and can be impacted by nutritional treatment. It is not known which dietetic practices are currently used to address GID in AN. Therefore, this survey aimed to explore the perceived knowledge, attitudes, and practices (KAP) of Australian dietitians treating AN and co-occurring GID. Seventy dietitians participated by completing an online survey. Knowledge scores were calculated based on correct responses to knowledge items (total: 12 points); and two groups were generated: higher knowledge (≥10 points, n = 31) and lower knowledge (≤9 points, n = 39). A greater proportion of dietitians with higher knowledge recognized the role of GID in pathogenesis of AN (p = 0.002) and its impact on quality of life (p = 0.013) and screened for GID (p ≤ 0.001), compared with those with lower knowledge. These results suggest that attitudes and practices toward patients presenting with AN and GID differ depending on level of knowledge. This may have important implications for treatment outcomes for individuals with AN and GID.

Implementing expanded COVID-19 testing in Massachusetts community health centers through community partnerships: Protocol for an interrupted time series and stepped wedge study design.

BACKGROUND: Community Health Centers (CHCs) are a critical source of care for low-income and non-privately insured populations. During the pandemic, CHCs have leveraged their infrastructure and role as a trusted source of care to engage the communities they serve in COVID-19 testing. METHODS: To directly address the impact that COVID-19 has had on historically marginalized populations in Massachusetts, we designed a study of community-engaged COVID-19 testing expansion: (1) leveraging existing partnerships to accelerate COVID-19 testing and rapidly disseminate effective implementation strategies; (2) incorporating efforts to address key barriers to testing participation in communities at increased risk for COVID-19; (3) further developing partnerships between communities and CHCs to address testing access and disparities; (4) grounding the study in the development of a shared ethical framework for advancing equity in situations of scarcity; and (5) developing mechanisms for communication and science translation to support community outreach. We use a controlled interrupted time series design, comparing number of COVID-19 tests overall and among people identified as members of high-risk groups served by intervention CHCs compared with six matched control CHCs in Massachusetts, followed by a stepped wedge design to pilot test strategies for tailored outreach by CHCs. CONCLUSIONS: Here, we describe a community-partnered strategy to accelerate COVID-19 testing in historically marginalized populations that provides ongoing resources to CHCs for addressing testing needs in their communities. The study aligns with principles of community-engaged research including shared leadership, adequate resources for community partners, and the flexibility to respond to changing needs over time.