Corrigendum: Severe and enduring' stage in anorexia nervosa: comparing eating attitudes, impairment and associated psychopathology.

[This corrects the article DOI: 10.3389/fnut.2022.867401.].

The mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and difficulties in emotion regulation.

OBJECTIVE: Difficulties in emotion regulation are thought to play a transdiagnostic role across eating disorders (ED). In the current study, we explored with a path analysis the mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation. METHOD: Participants were 103 female outpatients recruited at a Portuguese ED hospital unit, diagnosed with an ED, aged 14-60 years old (M = 28.0, SD = 10.5), body mass index (BMI) ranging from 11.72 to 39.44 (M = 20.1, SD = 5.4). RESULTS: The path analysis resulted in a model with an adequate fit to the data (SRMR = 0.05; RMSEA = 0.07 [0.00, 0.12], PCLOSE = 0.269; TLI = 0.97; IFI = 0.99; GFI = 0.95). A final model in which the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation was mediated by self-criticism, experiential avoidance and negative urgency, accounted for a variance of 71% for strategies, 57% for non-acceptance, 62% for impulses, 56% for goals and 20% for clarity. CONCLUSION: Results suggest that self-criticism, experiential avoidance and negative urgency, combined, are relevant in the relationship between ED-related symptoms and difficulties in emotion regulation. ED treatment and emotion regulation skills may be enhanced through the inclusion of specific components that target self-criticism, experiential avoidance and negative urgency, as they become prominent during the therapeutic process.

Severe and Enduring' Stage in Anorexia Nervosa: Comparing Eating Attitudes, Impairment and Associated Psychopathology.

This study aimed to assess differences in eating attitudes, impairment, and related psychopathology at treatment presentation for patients with "Non-severe and enduring Anorexia Nervosa" (illness duration of <7 years) and patients with "severe and enduring Anorexia Nervosa" (illness duration of 7 years or more). One hundred and thirty-nine patients diagnosed with Anorexia Nervosa participated in this study. Participants were interviewed with the Eating Disorder Examination (EDE) and asked to complete several questionnaires at the end of the first treatment appointment. We also explored differences at treatment presentation by considering alternative criteria to define groups, namely a composite of illness duration and clinical impairment (≥16 CIA total score). No differences were found when comparing participants based on illness duration. However, when participants were classified into a different classification scheme: "Non-severe and enduring Anorexia Nervosa" (illness duration <7 years and a CIA total score <16) vs. "severe and enduring Anorexia Nervosa" (illness duration ≥7 years and CIA total score ≥16), significant differences were found in terms of eating pathology, depressive symptomatology, psychological distress, and emotion dysregulation. Further research is needed to better understand the role of illness duration and clinical impairment in informing the course of AN.

The factorial structure and psychometric properties of the Committed Action Questionnaire (CAQ-8) in a Portuguese clinical sample with eating disorders.

The Committed Action Questionnaire (CAQ-8) is an instrument developed to measure committed action, an adaptive psychological process. The main goal in the current study was to confirm the factorial structure of the Portuguese version of the CAQ-8 in a transdiagnostic clinical sample of participants diagnosed with an eating disorder (ED). Participants were 102 female outpatients (Mage = 28.1, SD = 10.6; MBMI = 20.0, SD = 5.5) recruited from a clinical setting specialized in the treatment of ED. Confirmatory factor analysis (CFA) was used to confirm the CAQ-8's factorial structure. Both first- and second-order models revealed adequate goodness-of-fit indices (e.g. χ2 /df = 1.545, p = .06; SRMR = 0.049; RMSEA = 0.073; CFI/TLI > 0.95). A moderation model revealed that the conditional effect of weight, shape and eating concerns on experiential avoidance was significantly moderated by increased levels of committed action, F(3, 97) = 23.79, p < .001, accounting for 42% of the final variance. The present study supports the usefulness of the CAQ-8 as a measure of levels of committed action with patients diagnosed with an ED.

Neuromuscular Choristoma: Report of Five Cases With CTNNB1 Sequencing.

Neuromuscular choristoma (NMC) are lesions of the peripheral nervous system characterized by an admixture of skeletal muscle fibers and nerves fascicles that are frequently associated with desmoid fibromatosis (DF). Mutations in CTNNB1, the gene for ß-catenin protein, are common in DF and related to its pathogenesis. They are restricted to exon 3, with 3 point mutations: T41A, S45F, and S45P. To understand the pathogenesis of NMC, we tested CTNNB1 status in 5 cases of NMC whether or not they were associated with DF. The screening of mutations in CTNNB1 gene was based on amplicon deep sequencing using the ION Proton platform. Three patients had the S45F mutation; in 2 the mutation was common to both lesions and in one the DF was wild type while the NMC had the S45F mutation. One patient had a T41A mutation in the NMC and no associated DF. In the last patient, the DF lesion had a T41A mutation; there was no lesion with the S45P mutation. The presence of similar CTNNB1 mutations in NMC/DF-associated lesions and sporadic DF reinforces the relationship between both lesions and points to a common pathogenic mechanism.

Emotional processing in recovered anorexia nervosa patients: A 15 year longitudinal study.

OBJECTIVE: This 15 years longitudinal study aimed to examine whether difficulties in cognitive processing of emotions persisted after long-term recovery from anorexia nervosa (AN), and its link to anxiety and depression. METHOD: Twenty-four females, who were tested longitudinally during their acute and recovered AN phases, and 24 healthy control (HC) women, were screened for anxiety, depression, alexithymia, emotion regulation difficulties (ER; only assessed in recovery phase), and completed an experimental task to analyse emotional experience. RESULTS: In spite of significant improvement in alexithymia, anxiety, and depression with AN recovery, some emotion functioning difficulties did not normalize. The occurrence of comorbid anxiety and depression explained the reduced ability to identify, understand, and accept emotions in long-term recovery (relative to controls), but not the increased global difficulty in using ER strategies, which revealed a more stable nature of deficit. With recovery, negative emotions linked to situations addressing food and body weight are felt more intensely. CONCLUSIONS: Managing emotions, especially the negative ones, remains a challenge for individuals recovered from AN. Under this circumstance, maladaptive eating behaviour can serve as an affect regulatory function, increasing the risk of relapse. Emotional education is an important avenue in protecting long-term AN relapse.

Understanding Uncontrolled Eating after Bariatric Surgery: The Role of Excessive Skin and Body Image Shame.

Excess skin and disordered eating behaviors are referred to as some of the major negative consequences of bariatric surgery as well as body image shame. This study sought to explore how discomfort with excessive skin, body image shame, psychological distress, eating-related psychopathology, and negative urgency interact to understand uncontrolled eating among woman submitted to bariatric surgery. A cross-sectional sample of 137 women was evaluated postoperatively through self-report questionnaires assessing discomfort with excess skin, body image shame, eating-related psychopathology, negative urgency, and uncontrolled eating in a hospital center in the north of Portugal. Pearson correlations and Structural Equation Modeling (SEM) were performed. Body image shame mediated the relationship between discomfort with excess skin and eating-related psychopathology. In turn, the relationship between eating-related psychopathology and uncontrolled eating was mediated by negative urgency. This study highlights the impact of excess skin and body image shame on eating behavior post-bariatric-surgery. Considering the proven impact of uncontrolled eating on weight-loss results post-surgery, understanding the mechanisms underlying this problem is highly important. Our findings provide helpful insight for multidisciplinary teams committed to providing care to bariatric patients struggling with body image and eating difficulties.

Nonsuicidal self-injury, difficulties in emotion regulation, negative urgency, and childhood invalidation: A study with outpatients with eating disorders.

OBJECTIVES: Among outpatients with eating disorders (ED), we compared participants without nonsuicidal self-injury (non-NSSI group), with NSSI over a year ago (past NSSI group) and with NSSI in the previous year (current NSSI group) regarding different variables, and examined whether difficulties in emotion regulation and negative urgency moderated the relationship between maternal/paternal invalidation and NSSI. METHOD: The sample included 171 outpatients (94.2% female; Mage = 28.78, SDage = 11.19). RESULTS: Fifty-four participants (31.6%) had NSSI in the previous year. This group showed higher eating pathology, difficulties in emotion regulation, negative urgency, and maternal/paternal invalidation than the non-NSSI group. Analyses revealed an adequate fit to the data for the model that included moderating effects of emotional awareness and negative urgency in the relationship between maternal/paternal invalidation and increased likelihood of NSSI in the previous year. CONCLUSIONS: Interventions for NSSI and ED should include emotion regulation, impulse control, and validation strategies.

Eating disorders and psychosis: a review and case report.

INTRODUCTION: The interplay between eating disorders and psychosis is a challenging field to which little attention has been paid. Its study raises conceptual and methodological questions in both areas, making the diagnosis and management of patients difficult. Such questions are addressed and illustrated with a review and case report. METHODS: The authors present the case of a woman with Anorexia Nervosa and with comorbid Shared Psychotic Disorder, based on a literature review regarding the comorbidity between eating disorders and psychosis. The authors conducted a non-systematic review by searching the PubMed database, using the Mesh Terms "anorexia nervosa", "bulimia nervosa", "comorbidity" and "psychotic disorders". RESULTS: The findings suggest that studies on the subject are limited by issues regarding data on the prevalence of comorbidities, phenomenological aspects of eating disorders, and the interface and integration with psychotic symptoms. CONCLUSIONS: The case presented illustrates the difficulties in managing a patient with a comorbid eating disorder and psychosis. In order to ensure a rigorous assessment of both psychotic and eating disorder symptoms, the focus should be on the pattern of appearance or emergence of symptoms, their phenomenology, clinical and family background of the patient, and clinical status on follow-up.

Impact of COVID-19 lockdown measures on a cohort of eating disorders patients.

BACKGROUND: Lockdown implemented to prevent the COVID-19 spread resulted in marked changes in the lifestyle. The objective of the current study was to assess the impact of lockdown measures on a cohort of eating disorder (ED) patients being followed as part of an ongoing naturalistic treatment study. METHODS: Ninety-nine patients aged 18 or older, currently or previously, in treatment at a Portuguese specialized hospital unit were contacted by phone and invited to participate in the current survey. Fifty-nine agreed to be interviewed by phone, and 43 agreed to respond to a set of self-report measures of ED symptoms, emotion regulation difficulties, clinical impairment, negative urgency, and COVID-19 impact, during the week after the end of the lockdown period. RESULTS: Data showed that of the 26 patients currently in treatment: 8 remained unchanged (31%), 7 deteriorated (27%), and 11 reliably improved (42%). Of the 17 participants not currently in treatment: 3 deteriorated (18%), 9 remained unchanged (53%), and 5 (29%) improved after the lockdown period. The Coronavirus Impact Scale showed that most patients considered their routines moderately or extremely impacted, experienced stress related to coronavirus, and showed difficulty in maintaining physical exercise and feeding routines. Results suggest that higher impact of COVID-19 lockdown was significantly correlated with eating disorder symptoms and associated psychopathology, impulsivity, difficulties in emotion regulation and clinical impairment measured at post-lockdown. In addition, the impact of COVID-19 and lockdown measures on clinical impairment was mediated by difficulties in emotion regulation. CONCLUSIONS: Findings suggest that some ED patients may experience worsening of their condition, especially if associated with difficulties in emotion regulation, and these difficulties might be exacerbated in the context of a stressful crisis and lockdown measures, highlighting the need for intervention strategies to mitigate its negative impact.

Eating disorders and psychosis: a review and case report

SUMMARY INTRODUCTION: The interplay between eating disorders and psychosis is a challenging field to which little attention has been paid. Its study raises conceptual and methodological questions in both areas, making the diagnosis and management of patients difficult. Such questions are addressed and illustrated with a review and case report. METHODS: The authors present the case of a woman with Anorexia Nervosa and with comorbid Shared Psychotic Disorder, based on a literature review regarding the comorbidity between eating disorders and psychosis. The authors conducted a non-systematic review by searching the PubMed database, using the Mesh Terms "anorexia nervosa", "bulimia nervosa", "comorbidity" and "psychotic disorders". RESULTS: The findings suggest that studies on the subject are limited by issues regarding data on the prevalence of comorbidities, phenomenological aspects of eating disorders, and the interface and integration with psychotic symptoms. CONCLUSIONS: The case presented illustrates the difficulties in managing a patient with a comorbid eating disorder and psychosis. In order to ensure a rigorous assessment of both psychotic and eating disorder symptoms, the focus should be on the pattern of appearance or emergence of symptoms, their phenomenology, clinical and family background of the patient, and clinical status on follow-up.

RESUMO INTRODUÇÃO: A interface entre perturbação do comportamento alimentar e psicose é um campo desafiador para o qual pouca atenção foi direcionada. O seu estudo levanta algumas questões conceituais e metodológicas em ambas as áreas, dificultando o diagnóstico e o manejo dos pacientes. Essas questões são abordadas e ilustradas neste trabalho com uma revisão e um relato de caso. MÉTODOS: Os autores apresentam o caso de uma mulher com anorexia nervosa e perturbação psicótica partilhada comórbida, com base numa revisão da literatura sobre a comorbilidade entre perturbação do comportamento alimentar e psicose. Os autores realizaram uma revisão não sistemática, por meio de pesquisa no banco de dados PubMed, utilizando os termos "anorexia nervosa", "bulimia nervosa", "comorbilidade" e "perturbações psicóticas". RESULTADOS: Os resultados sugerem que os estudos sobre o tema são limitados por questões inerentes a escassos dados sobre prevalência de comorbilidades, aspectos fenomenológicos das perturbações alimentares, e sua interface e integração com sintomas psicóticos. CONCLUSÕES: O caso apresentado ilustra as dificuldades no manejo de uma paciente com perturbação alimentar e psicose. A fim de garantir uma abordagem rigorosa dos sintomas psicóticos e alimentares, a avaliação do paciente deve focar o padrão de emergência dos sintomas, a sua fenomenologia, antecedentes clínicos e familiares e o seu status clínico.

[First Psychotic Episode in a Patient with DiGeorge Syndrome and Selective Mutism]. / Primeiro Episódio Psicótico em Doente com Síndrome de DiGeorge e Mutismo Seletivo.

DiGeorge Syndrome is a group of diseases caused by a microdeletion, and some of its most frequent symptoms are those related with development and behavior. We present the case of a female patient with DiGeorge Syndrome and selective mutism since childhood, evaluated for the first time in a psychiatry consultation at the age of 18 for inaugural psychotic symptomatology. We describe the psychopathology, the diagnostic investigation, the treatment, and the clinical evolution. In the future, it will be important to better characterize patients with this syndrome who present psychiatric disease.

A síndrome de DiGeorge consiste num conjunto de doenças causadas por uma microdeleção, sendo alguns dos seus sintomas mais frequentes os ligados ao desenvolvimento e ao comportamento. Apresentamos o caso clínico de uma doente com síndrome de Di-George e história de mutismo seletivo desde a infância, avaliada pela primeira vez em consulta de psiquiatria aos 18 anos de idade por sintomatologia psicótica inaugural. Descrevemos a psicopatologia, o estudo realizado, o tratamento instituído e a evolução clínica. No futuro será importante uma melhor caraterização da abordagem dos doentes com esta síndrome que apresentam perturbação psiquiátrica.

Impact of Depression on Weight Variation after Bariatric Surgery: A Three-Year Observational Study.

INTRODUCTION: The association between obesity and depression has been repeatedly established. However, little is known about the impact that the diagnosis of depression before bariatric surgery (DDBS) may have on weight loss. OBJECTIVE: To evaluate the impact of DDBS on weight outcomes. METHODS: Retrospective study of patients submitted to BS. Patients with no weight, no current medication data, or those submitted to revision surgery were excluded. Patients were considered to have DDBS based on taking antidepressants prior to BS or if there was a medical history of past or current depression. Patients with and without a depression history were compared using independent t test. A multivariate logistic regression model was created to evaluate predictors of weight variation (variables included: age, sex, and type of surgery). RESULTS: A total of 616 patients did not have a history of depression and 230 had DDBS. There was a statistically significant difference in the BMI variation between groups. On average, individuals with DDBS lost 1.4 kg/m2 less than those without DDBS. In the multivariate analysis, the group with DDBS, compared with the group without DDBS, presented on average less -0.9 kg/m2 (95% CI -1.7 to -0.2, p = 0.018) BMI variation. CONCLUSION: DDBS is a predictor of lower weight loss after the surgical procedure. Even after adjusting for confounding variables such as age, sex, and BS type, this effect remains.

Psychometric properties of the Portuguese version of the Invalidating Childhood Environment Scale.

PURPOSE: The current study aimed to examine the psychometric properties of the Portuguese version of the invalidating childhood environment scale (ICES) in a non-clinical and clinical sample of eating disorder (ED) patients. This study also investigated the between-sample differences regarding invalidating parental behaviors and family styles and explored the associations between invalidating childhood environments and eating pathology. METHODS: A sample of 410 high school and college students and 101 patients with a diagnosis of ED completed self-report measures. Principal component analyses and confirmatory factor analyses were conducted to examine the factor structure of the ICES. The internal consistency and the between-sample differences and associations between invalidating childhood environments and eating pathology were also tested. RESULTS: Principal component analyses and confirmatory factor analyses indicated a two-factor solution for each parent. The ICES demonstrated high internal consistency and was able to differentiate between non-clinical and clinical samples. The perception of parental invalidation was higher in ED patients, and the clinical sample presented higher scores in the chaotic and perfect family styles and lower scores in the validating family style, in comparison with the non-clinical sample. Both maternal invalidation and invalidating styles were significantly associated with a higher ED symptomatology. CONCLUSIONS: The Portuguese version of the ICES revealed adequate psychometric properties. Considering the relationship between invalidation in family and eating pathology, the ICES may be useful in clinical practice, especially among ED patients. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Using hydrodynamic and water quality variables to assess eutrophication in a tropical hydroelectric reservoir.

Few studies have examined the influence of reservoir hydrodynamics on the water quality of its limnological zones. In this study, the relationships between the operational phases and the water quality of the limnological zones were assessed for the Amazonian reservoir Tucuruí. Limnological zones were clustered by means of an artificial neural network technique, and inputs used were water quality variables, measured at twelve stations between 2006 and 2016. Generalized Linear Models (GLMs) were then used to identify the influence of the operational phases of the reservoir on the water quality of its limnological zones. The GLM with a gamma-distributed response variable indicated that Chlorophyll-a concentrations in the riverine and transitional zones differed notably from those observed in the lacustrine zone. Chlorophyll-a concentrations were significantly lower during the operational falling water phase than in the low water phase (p < 0.05). The GLM with an inverse Gaussian-distributed response variable indicated that Secchi depth was significantly lower in the riverine than in the lacustrine limnological zone (p < 0.05). Our results suggest that more eutrophic conditions occur during the operational rising water phase, and that the area most vulnerable to eutrophication is the transitional zone. We demonstrate that the use of GLMs is suitable for determining areas and operational phases most vulnerable to eutrophication. We envisage that this information will be useful to decision-makers when monitoring the water quality of hydroelectric reservoirs with dendritic patterns and dynamic operational phases.

Weight loss trajectories and psychobehavioral predictors of outcome of primary and reoperative bariatric surgery: a 2-year longitudinal study.

BACKGROUND: Long-term behavioral and psychological aspects associated with weight outcomes after reoperative bariatric surgery have rarely been investigated. OBJECTIVES: This study sought (1) to identify differences in weight loss trajectories during the first 24 months in reoperative bariatric surgery (R group) and primary bariatric surgery (P group) and (2) to investigate pre- and postsurgery psychobehavioral predictors of weight loss and weight regain for both groups. SETTING: Hospital center and university, Portugal. METHODS: This longitudinal study compared an R group (n = 157) and a P group (n = 216). Patients were assessed at presurgery and at 6, 12, 18, and 24 months postsurgery. Assessment included the Eating Disorder Examination-Questionnaire and Repetitive Eating Questionnaire diagnostic interviews and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and impulsive behavior. RESULTS: The P and R groups presented a similar trajectory for the percentage of total weight loss (%TWL) (ß = 1.46, standard error = 1.96; Wald χ2 = .55, P = .457) and weight regain (ß = 1.66, standard error = 2.72; Wald χ2 = .24, P = .622). No significant presurgery predictors of weight loss and weight regain were found for the P and R groups. Regarding postsurgery predictors, higher Eating Disorder Examination-Questionnaire scores (Wald χ2(1) = 6.88, P = .009) and grazing behavior (Wald χ2(1) = 8.30, P = .004) were associated with less %TWL for both groups. Belonging to the P group emerged as a significant predictor of more weight loss (Wald χ2(1) = 7.25, P = .007). Postsurgery anxiety predicted less %TWL in R group (Wald χ2(1) = 3.89, P = .043). Considering weight regain, higher postoperative disordered eating (global Eating Disorder Examination-Questionnaire; Wald χ2(1) = 4.66, P = .031) was associated with increased weight regain for the P and R groups. CONCLUSIONS: Problematic eating behaviors and psychological distress are significant predictors of poor weight outcomes for both groups.

Factorial Validity of the Toronto Alexithymia Scale (TAS-20) in Clinical Samples: A Critical Examination of the Literature and a Psychometric Study in Anorexia Nervosa.

There is extensive use of the 20-item Toronto Alexithymia Scale (TAS-20) in research and clinical practice in anorexia nervosa (AN), though it is not empirically established in this population. This study aims to examine the factorial validity of the TAS-20 in a Portuguese AN sample (N = 125), testing four different models (ranging from 1 to 4 factors) that were identified in critical examination of existing factor analytic studies. Results of confirmatory factor analysis (CFA) suggested that the three-factor solution, measuring difficulty identifying (DIF) and describing feelings (DDF), and externally oriented thinking (EOT), was the best fitting model. The quality of measurement improves if two EOT items (16 and 18) are eliminated. Internal consistency of EOT was low and decreased with age. The results provide support for the factorial validity of the TAS-20 in AN. Nevertheless, the measurement of EOT requires some caution and may be problematic in AN adolescents.

Conjunctive use of in situ gas sampling and chromatography with geospatial analysis to estimate greenhouse gas emissions of a large Amazonian hydroelectric reservoir.

Hydroelectric power reservoirs are considered potential contributors to the greenhouse effect in the atmosphere through the emittance of methane and carbon dioxide. We combined in situ sampling and gas chromatography with geostatistical and remote sensing approaches to estimate greenhouse gas (GHG) emissions of a large hydropower reservoir. We used remote sensing data to estimate the water surface and geospatial interpolation to calculate total emissions as a function of reservoir surface area. The CH4 and CO2 gas concentrations were linearly correlated to sampling time, confirming the adequacy of the in situ sampling method to measure GHG diffusive fluxes from reservoir water surfaces. The combination of high purity (99.99%) ISO-norm gas standards with a gas chromatograph, enabled us to achieve low measurement detection limits of 0.16 and 0.60 µmol mol-1, respectively, for CH4 (using a flame ionization or FID detector) and CO2 (using a thermal conductivity or TCD detector). Our results show that CO2 emissions are significantly (an order of 5.102-103) higher than those of CH4 in both the spatial and temporal domain for this reservoir. The total diffusive GHG emissions over a year (June 2011 to May 2012) of the Tucuruí hydropower reservoir being in operation, in units of tons of carbon, added up to 6.82 × 103 for CH4 and 1.19 × 106 for CO2. We show that in situ GHG sampling using small floating gas chambers and high precision gas chromatography can be combined with geospatial interpolation techniques and remote sensing data to obtain estimates of diffusive GHG emissions from large water bodies with fluctuating water surfaces such as hydropower reservoirs. We recommend that more measurements and observations on these emissions are pursued in order to support and better quantify the ongoing discussions on estimates and mitigation of GHG emissions from reservoirs in the Amazon region and elsewhere in the world.

Medication and test prescription by nurses: contributions to advanced practice and transformation of care.

OBJECTIVE: To carry out a documentary study on the rules, guidelines, policies and institutional support for the nurse to prescribe medicines and request tests with a view to the advanced practice in the scope of Primary Health Care. METHODS: Documentary research using open-access institutional documents - Federal Nursing Council (COFEN), its regional representations in the respective Brazilian states (COREN) and the Brazilian Nursing Association (ABEN). RESULTS: Most of the news/notices were issued by the Regional Nursing Councils in the different Federative Units. The argumentation regarding the prescription of medicines and request for tests by nurses is based on three categories: Autonomy and competencies for the prescription of medicines and/or request of tests; Corporate policies that undermine the full exercise of nursing; and Transformation of health and nursing care in Primary Health Care. CONCLUSION: The prescriptive practice by nurses integrates health care and has been defended by the institutions that represent the category. It emerges as an important element of advanced practice and in the transformation of care in the context of health teams.

Eating disorders-Related hospitalizations in Portugal: A nationwide study from 2000 to 2014.

INTRODUCTION: Recent evidence suggests that incidence of Anorexia nervosa (AN) has remained stable over the last decades in Western Europe, while decreasing for Bulimia nervosa (BN). It is well-known that most individuals with an ED (Eating disorder) do not seek medical treatment. OBJECTIVE: The present study analyses hospitalizations related with EDs held in mainland Portuguese public hospitals between 2000 and 2014. METHOD: A retrospective observational study was performed gathering all inpatient episodes with primary or secondary diagnosis of ED. Number of patients, gender, mean age at discharge, suicide-attempts related hospitalizations, in-hospital mortality, length of stay, and mean charges were analyzed. RESULTS: There were a total of 4,485 hospitalizations with an associated ED. AN was the most frequent ED (n = 2,806). Suicide attempt-related hospitalizations were most common among patients with BN (10.1% of BN hospitalizations) or AN (5.2% of AN hospitalizations). DISCUSSION: AN has higher in-hospital mortality than BN. We observed a higher proportion of suicide related hospitalizations in BN when compared to AN. Although pica, rumination disorder, and psychogenic vomiting represent a smaller portion of all EDs, this study was the first to describe hospitalization trends for this set of EDs for a 15-year period, to the best of our knowledge.