Distúrbios alimentares e seus fatores genéticos: revisão de literatura / Eating disorders and their genetic factors: literature review / Trastornos alimentarios y sus factores genéticos: revisión de la literatura

Diversas condições psiquiátricas apresentam influência de fatores genéticos, e dentre essas condições encontram-se os distúrbios alimentares: anorexia nervosa, bulimia nervosa e transtorno de compulsão alimentar. Os distúrbios previamente citados apresentam influência genética ligadas à hereditariedade, sendo que cada um deles apresenta características distintas quanto às suas manifestações clínicas, tratamento e diagnóstico. A importância da investigação deste tema e seu objetivo relaciona-se com o propósito de contribuir para elucidar quanto às características gerais dos principais distúrbios alimentares e seus fatores genéticos através da: etiologia, sinais e sintomas, diagnóstico e tratamento e que venha a possibilitar, futuramente, novos estudos com resultados para novas medidas terapêuticas. Como base da pesquisa, foi levantada a seguinte problemática: "Quais as características gerais dos principais distúrbios psiquiátricos, etiologia, sinais e sintomas, diagnóstico e tratamento?". Portanto, realizou- se uma uma busca ativa através dos descritores: "transtorno de compulsão alimentar"; "distúrbios alimentares"; "bulimia nervosa" e "anorexia nervosa", adquiriu-se material pelas fontes: SciELO, ELSEVIER, GOOGLE ACADÊMICO, PUBMED, MEDSCAPE e pelo periódico Arquivos e Ciências da Saúde da UNIPAR. Com isso, foi adquirido material suficiente para concluir a influência genética perante tais distúrbios, além de elucidar suas principais características, tendo assim caráter educativo e científico.

Several psychiatric conditions have genetic factors influence, and among these conditions are eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder. The previously mentioned disorders have a genetic influence linked to heredity, each one of them having different characteristics as to their clinical manifestations, treatment and diagnosis. The importance of research on this topic and its objective is related to the purpose of contributing to elucidate the general characteristics of the main eating disorders and their genetic factors through: etiology, signs and symptoms, diagnosis and treatment and that will make possible, in the future, new studies with results for new therapeutic measures. As a basis for the research, the following issue was raised: "What are the general characteristics of the main psychiatric disorders, etiology, signs and symptoms, diagnosis and treatment?". Therefore, an active search was carried out through the descriptors: "binge eating disorder"; "eating disorders"; " nervous bulimia" and " nervous anorexia", material was acquired by the sources: SciELO, ELSEVIER, GOOGLE ACADEMIC, PUBMED, MEDSCAPE and by UNIPAR's Archives and Health Sciences. With this, sufficient material was acquired to conclude the genetic influence in the face of such disturbances, besides elucidating its main characteristics, thus having an educational and scientific character.

Varios trastornos psiquiátricos tienen factores genéticos que influyen, y entre estos trastornos se encuentran los trastornos de la alimentación: anorexia nerviosa, bulimia nerviosa y trastorno por atracón. Los trastornos mencionados tienen una influencia genética vinculada a la herencia, cada uno de ellos con características diferentes en cuanto a sus manifestaciones clínicas, tratamiento y diagnóstico. La importancia de la investigación sobre este tema y su objetivo se relaciona con el propósito de contribuir a dilucidar las características generales de los principales trastornos de la conducta alimentaria y sus factores genéticos a través de: etiología, signos y síntomas, diagnóstico y tratamiento y que posibilitarán, en el futuro, nuevos estudios con resultados para nuevas medidas terapéuticas. Como base para la investigación se planteó la siguiente cuestión: "¿Cuáles son las características generales de los principales trastornos psiquiátricos, etiología, signos y síntomas, diagnóstico y tratamiento?". Por lo anterior, se realizó una búsqueda activa a través de los descriptores: "trastorno por atracón"; "trastornos de la conducta alimentaria"; "bulimia nerviosa" y "anorexia nerviosa", material adquirido por las fuentes: SciELO, ELSEVIER, GOOGLE ACADEMIC, PUBMED, MEDSCAPE y por Archivos y Ciencias de la Salud de UNIPAR. Con ello, se adquirió material suficiente para concluir la influencia genética ante tales alteraciones, además de dilucidar sus principales características, teniendo así un carácter educativo y científico.

Capacidad e internamiento involuntario de pacientes con anorexia nerviosa: un estudio cualitativo sobre percepciones y actuación de psiquiatras y psicólogos clínicos / Competence and Involuntary Commitment of Patients with Anorexia Nervosa: A Qualitative study on the Perceptions and Performance of Psychiatrists and Clinical Psychologists

RESUMEN Introducción: La anorexia nerviosa plantea un importante problema bioético, ya que los pacientes, a menudo, rechazan el tratamiento a pesar del peligro que ello supone para su salud, y no está claro que su decisión sea autónoma. El objetivo de este trabajo es investigar las percepciones/actuación de psiquiatras y psicólogos clínicos ante la capacidad y el internamiento involuntario de pacientes con anorexia nerviosa. Métodos: Se entrevistó a 7 psiquiatras, 4 psicólogas clínicas y 1 psicóloga residente de tercer año. Se utilizó un enfoque de investigación cualitativa basado en la teoría fundamentada. Resultados: El análisis de datos mostró que estos profesionales articulan la atención del paciente en torno a una categoría principal, a saber, el internamiento como último recurso y la búsqueda de la voluntariedad, lo que implica un cambio en la dinámica asistencial habitual. En torno a esa categoría central, se erigen algunos conceptos importantes; estrés de rol, coerción informal, peso, familia y cronicidad. Conclusiones: La dificultad de conciliar demandas profesionales puede suponer un menoscabo en la calidad de la asistencia y en la propia satisfacción laboral, lo que pone en evidencia la necesidad de reflexionar e investigar sobre los fundamentos de las atribuciones asumidas.

ABSTRACT Introduction: Anorexia nervosa poses an important bioethical quandary, since patients often refuse treatment despite the danger that this poses to their health, and it is not clear that their decision is autonomous. The aim of this study was to investigate the perceptions/performance of psychiatrists and clinical psychologists regarding the capacity and involuntary hospitalisation of patients with anorexia nervosa. Methods: Seven psychiatrists, four clinical psychologists, and one third-year resident psychologist were interviewed. A qualitative research approach based on grounded theory was used. Results: The data analysis showed that these professionals articulate patient care around one main category - hospitalisation as a last resort and the search for voluntariness, which implies a change in the usual healthcare dynamics. Around this central category, some important concepts emerge: role stress, informal coercion, weight, family and chronicity. Conclusions: The difficulty of reconciling professional demands can undermine the quality of care and job satisfaction itself, which highlights the need for reflection and research into the foundations of the responsibilities assumed.

Competence and Involuntary Commitment of Patients with Anorexia Nervosa: A Qualitative study on the Perceptions and Performance of Psychiatrists and Clinical Psychologists.

INTRODUCTION: Anorexia nervosa poses an important bioethical dilemma, since patients often refuse treatment despite the danger that this poses to their health, and it is not clear that their decision is autonomous. The aim of this study was to investigate the perceptions/performance of psychiatrists and clinical psychologists regarding the capacity and involuntary hospitalisation of patients with anorexia nervosa. METHODS: Seven psychiatrists, four clinical psychologists, and one third-year resident psychologist were interviewed. A qualitative research approach based on grounded theory was used. RESULTS: The data analysis showed that these professionals articulate patient care around one main category - hospitalisation as a last resort and the search for voluntariness, which implies a change in the usual healthcare dynamics. Around this central category, some important concepts emerge: role stress, informal coercion, weight, family and chronicity. CONCLUSIONS: It is concluded that the difficulty of reconciling professional demands can undermine the quality of care and job satisfaction itself, which highlights the need for reflection and research into the foundations of the responsibilities assumed.

Relación del acoso escolar y conductas de riesgo a trastornos de la alimentación en escolares mexicanos / Relationship of school bullying and risk behaviors to eating disorders in Mexican schoolchildren

Fundamentos: El objetivo de la presente investigación fue determinar la prevalencia entre el acoso escolar obullying y las conductas de riesgo a trastornos de la conducta alimentaria (TCA), en escolares mexicanos dequinto y sexto grado escolar. Cuyos resultados aporten al programa en línea que se va diseñar para suprevención.Métodos: Se obtuvo una muestra de 3641 escolares mexicanos entre 9-14 años a los cuales, se les aplicó laencuesta Health Behaviour in School-aged Children (HBSC) y el CBCAR, cuestionario diseñado y validado enadolescentes mexicanos, para evaluar las conductas de riego a TCA. Se aplicó la encuesta en línea, con elformato del programa “NutriNet” del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán(INCMYNSZ), protocolo con el visto bueno de los comités del Instituto y del Hospital General de México.Resultados: Se observó una mayor incidencia de presentar conductas alimentarias de riesgo en escolares queson acosados tanto en los escolares abusadores y en los escolares que participan en pleitos o peleas,observándose diferencia estadística significativa (p ≥ 0,05).Conclusiones: El bullying constituye un factor de riesgo a padecer un trastorno de la conducta alimentaria. (AU)

Background: The aim of this research was to determine the prevalence of bullying and risk behaviors foreating disorders in Mexican schoolchildren in 5th and 6th grade. Whose results contribute to the onlineprogram that will be designed for its prevention.Methods: A sample of 3,641 Mexican schoolchildren between 9-14 years old was obtained. To whom, theHealth Behavior in School-aged Children (HBSC) survey and the CBCAR, a questionnaire designed andvalidated in Mexican adolescents were applied to evaluate risk behaviors to eating disorders. The onlinesurvey was applied, with the format of the "NutriNet" program of the National Institute of Medical Sciencesand Nutrition Salvador Zubiran (INCMYNSZ), protocol with the approval of the committees of the Instituteand the General Hospital of Mexico.Results: A higher incidence of presenting risky eating behaviors was observed in schoolchildren who arebullied both in abusive schoolchildren and in schoolchildren who participate in fights, observing a statisticallysignificant difference (p ≥ 0.05).Conclusions: Bullying is a risk factor for developing an eating disorder. (AU)

Considerações sobre a busca por muscularidade entre homens gays / Considerations about drive for muscularity among gay men

Apresenta-se um manuscrito no formato de "carta ao editor", em que é abordada a busca por muscularidade por homens gays e suas possíveis funções, como reparação da autoestima danificada por exposição crônica a experiências de homofobia, necessidade ou desejo de uma aparência mais masculina, sensação de força e capacidade de autoproteção e evitação da constatação da própria fragilidade psíquica. São apresentadas indicações a profissionais de saúde mental que cuidam dessa população. Alguns fragmentos da experiência clínica do primeiro autor são apresentados a título de ilustração. (AU)

A manuscript in the form of a "letter to the editor" is presented, in which the search for muscularity by gay men and its possible functions is addressed, such as repairing self-esteem damaged by chronic exposure to experiences of homophobia, need or desire for a more masculine appearance, feeling of self-confidence and capacity for self-protection and avoidance of the realization of one's own psychic fragility. Indications are presented to mental health professionals who care for this population. Some fragments of the first author's clinical experience are presented by way of illustration.(AU)

Se presenta un manuscrito en forma de "carta al editor", en el que se aborda la búsqueda de la musculatura por parte de los hombres homosexuales y sus posibles funciones, como reparar la autoestima dañada por la exposición crónica a experiencias de homofobia, necesidad o deseo de apariencia más masculina, sentimiento de fortaleza y capacidad de autoprotección y evitación de la realización de la propia fragilidad psíquica. Se presentan indicaciones a los profesionales de la salud mental que atienden a esta población. A modo de ilustración se presentan algunos fragmentos de la experiencia clínica del primer autor.(AU)

Avaliação de ortorexia nervosa e satisfação com aparência muscular no extremo sul catarinense / Evaluation of nervous orthorexy and satisfaction with muscle appearance in the extreme southern catarinian / Evaluación de la ortorexia nerviosa y satisfacción con la apariencia muscular en el extremo sur de Santa Catarina

Objetivo: medir a prevalência de ortorexia e avaliar a satisfação com a aparência muscular em indivíduos residentes do Extremo Sul Catarinense. Método: estudo quantitativo e exploratório realizado através de pesquisa de campo e corte transversal. Os pesquisadores chegaram até a amostra através de e-mails, assim como divulgação em redes sociais e em grupos de mensagens. Por meio de um link foi encaminhado o formulário do Google forms e o termo de aceite da pesquisa. O questionário foi constituído por 3 partes: um questionário; questionário do estado de saúde SF-36V2; e os questionários validados no Brasil referentes a Ortorexia (Orto-15) e escala de satisfação com a aparência muscular (MASS). Resultados: A avaliação da satisfação da musculatura, através do questionário MASS, 77,2% (n=180) dos indivíduos classificam-se como totalmente satisfeito com a aparência muscular. A média das idades foi de 25,9± 7,9 e IMC 23,3±3,6. Conclusão: São necessários novos estudos com a temáticas abordadas para melhor compreensão da dimensão destes resultados a nível estadual e nacional.

Objective: to measure the prevalence of orthorexia and to evaluate the satisfaction with muscle appearance in individuals living in the Extreme South of Santa Catarina. Method: quantitative and exploratory study carried out through field research and cross-sectional. The researchers reached the sample through e-mails, as well as dissemination on social networks and in groups of messages. Through a link, the Google forms form and the search acceptance term were submitted. The questionnaire consisted of 3 parts: a questionnaire; Health status questionnaire SF-36V2; and the questionnaires validated in Brazil regarding Orthorexia (Ortho-15) and muscle appearance satisfaction scale (MASS). Results: The assessment of muscle satisfaction, through the MASS questionnaire, 77.2% (n=180) of the individuals are classified as totally satisfied with the muscular appearance. The mean age was 25.9± 7.9 and BMI 23.3±3.6. Conclusion: Further studies are needed with the themes addressed to better understand the dimension of these results at the state and national level.

Objetivo: medir la prevalencia de ortorexia y evaluar la satisfacción con la apariencia muscular en individuos que viven en el Extremo Sur de Santa Catarina. Método: estudio cuantitativo y exploratorio realizado a través de investigación de campo y transversal. Los investigadores llegaron a la muestra a través de correos electrónicos, así como de difusión en redes sociales y en grupos de mensajes. A través de un enlace, se enviaron el formulario de formularios de Google y el término de aceptación de la búsqueda. El cuestionario constaba de 3 partes: un cuestionario; Cuestionario de estado de salud SF-36V2; y los cuestionarios validados en Brasil sobre Ortorexia (Ortho-15) y escala de satisfacción de la apariencia muscular (MASS). Resultados: La evaluación de la satisfacción muscular, a través del cuestionario MASS, el 77,2% (n=180) de los individuos se clasifican como totalmente satisfechos con el aspecto muscular. La edad media fue de 25,9± 7,9 y el IMC de 23,3±3,6. Conclusión: Se necesitan más estudios con los temas abordados para comprender mejor la dimensión de estos resultados a nivel estatal y nacional.

Abuso sexual infantil y adolescente y su relación con trastornos alimentarios / Child and adolescent sexual abuse and its relationship with eating disorders

ANTECEDENTES: El antecedente de abuso sexual (AS) en la infancia o adolescencia en los trastornos alimentarios (TCA) está documentado en la experiencia clínica y en la literatura. Sin embargo, las complejas relaciones entre ambas condiciones no han sido sistematizadas. OBJETIVO: Describir la relación clínica y neurobiológica entre AS y TCA. MÉTODO: Se analizó exhaustivamente la literatura especializada en textos y artículos incluidos en Medline/PubMed, SciELO. Se perfilaron los conceptos centrales y se redactó la información buscando didáctica cohesión incluyendo un caso clínico ilustrativo. RESULTADOS: Aunque el AS es un factor inespecífico para el desarrollo de trastornos mentales, constituye un fenómeno significativo predisponente, desencadenante y perpetuante para la emergencia de un TCA, principalmente bulimia nerviosa. Se describen los factores de riesgo, mediadores, predictores, protectores y de resiliencia. Ambas condiciones poseen correlatos neurobiológicos y clínicos análogos (síntomas nucleares y funciones adaptativas). Existen disfunciones similares en los circuitos de recompensa y regulación emocional, con alteraciones estructurales distintas en áreas prefrontales. CONCLUSIONES: Existe contundente evidencia de la co-existencia de AS en los TCA. No obstante, es necesario continuar desarrollando modelos de investigación que integren realmente los procesos genéticos, hormonales, neurotransmisores, de personalidad y socioculturales de riesgo.

BACKGROUND: A history of childhood sexual abuse (SA) or adolescence in eating disorders (ED) is documented in clinical experience and in the literature. However, the complex relationships between both conditions have not been systematized. OBJECTIVE: To describe the clinical and neurobiological relationship between SA and ED. METHOD: The specialized literature in texts and articles included in Medline/PubMed, SciELO was thoroughly analysed. Central concepts were outlined and information was written seeking didactic cohesion, including an illustrative clinical case. RESULTS: Although SA is a nonspecific factor for the development of mental disorders, it constitutes a significant predisposing, triggering and perpetuating phenomenon for the emergence of ED, mainly bulimia nervosa. Risk, mediator, predictor, protective and resilience factors are described. Both specific conditions show analogous neurobiological and clinical correlates (core symptoms and adaptive functions). Similar dysfunctions exist in reward and emotional regulation circuits, with limited structural disturbances in prefrontal areas. CONCLUSIONS: There is strong evidence of the coexistence of SA in ED. However, it is necessary to develop research models that truly integrate genetic, hormonal, neurotransmitter, personality and sociocultural risk processes.

Síndrome de Edorexia: un posible problema mental de la autorregulación del apetito en obesidad / Edorexia syndrome: a possible mental problem of appetite autoregulation in obesity

Fundamentos: En este trabajo, se aborda el problema de la obesidad desde una perspectiva biopsicosocial. Definiendo la obesidad como una consecuencia de la autorregulación del apetito y cuyas conductas tienen una finalidad psicológica relacionada con el alivio de emociones y situaciones aversivas. Basándose en la autorregulación del apetito, se observa el Síndrome de Edorexia y se analiza su relación con la obesidad, personalidad y estilos de afrontamiento. Métodos: La muestra se constituyó por 111 individuos universitarios (29 individuos con edoréxicos y 82 sinedoréxicos) que no realizaban actividad física intensa en gimnasios y no presentaban un trastorno mental severo. Se administraron a todos los participantes el Cuestionario del Síndrome de Edorexia (CSE), el Cuestionario de Personalidad (BFQ) y el Cuestionario de Respuesta de afrontamiento (CRI-A).Resultados: Se observa que el Síndrome de Edorexia guarda relación con el abuso y evitación de los alimentos. Además, predice mejor la obesidad en comparación con otras conductas. Conclusiones: Los estudios recientes vinculan la obesidad con un problema relacionado con la autorregulación del apetito y desde este enfoque, el Síndrome de Edorexia parece ser un buen predictor de la obesidad. Según estos trabajos, la inhibición y la desinhibición del consumo de alimentos pueden ser la estrategia empleada por el organismo para solventar una situación aversiva. Por este motivo, la obesidad puede entenderse como una consecuencia del conjunto de síntomas y conductas al que se denomina Síndrome de Edorexia y resultado de una situación en la cual el individuo no dispone de otras conductas, habilidades y recursos para afrontarlo de una manera más saludable. (AU)

Background: In this article, we approach the problem of obesity from a biopsychosocial perspective. Obesity is defined as a consequence of self-regulation of appetite and such that its’ behaviors have a psychological purpose related to the relief of emotions and aversive situations. Based on self-regulation of appetite, we describe Edorexia Syndrome and we analyze its relationship with obesity, personality and coping. Methods: The sample was constituted by 111 university students (29 edorexic and 82 non-edorexic) who didn’t practice intense physical activity in gyms and didn’t present a severe mental disorder. A battery of psychological tests was applied to the whole sample. This battery consisted of Edorexia Syndrome Questionnaire (CSE), Big Five Personality Questionnaire (BFQ) and the Coping Response Inventory (CRI-A). Results: The results showed that the Edorexia Syndrome is related to the abuse and avoidance of food. It also showed that Edorexia predicts obesity better than other behaviors. Conclusions: Recent studies related obesity with a problem of self-regulation of appetite and from this perspective, Edorexia Syndrome seems to be a good predictor of obesity. According to these articles, the inhibition and disinhibition of food consumption may be the strategy used by the organism to resolve an aversive situation. For this reason, obesity can be comprehended as a consequence of the set of symptoms and behaviors called Edorexia Syndrome and the result of a situation in which the individual does not have other behaviors, skills and resources to confront it in a healthier way. (AU)

Disordered eating behaviors and experiences of violence among Mexican youth with different sexual orientations: A population-based study / Conductas alimentarias de riesgo y experiencias de violencia entre jóvenes mexicanos con diferentes orientaciones sexuales: Un estudio de base poblacional

Abstract Introduction In high-income countries, sexual minorities are at a higher risk for disordered eating behaviors. It is not known whether these findings can be extrapolated to Mexico. Objective Determine whether there are any differences in disordered eating behaviors among Mexican youth according to sexual orientation and analyze the potential role of experiences of violence and discrimination as mediators of these differences. Method Data from a representative sample of Mexican youth (12 to 29 years old, n = 27,876) were analyzed. Three groups were identified: young people who were not in love (NIL), who were in love with people of the opposite sex (ILOS), or in love with people of the same sex (ILSS). Restrictive behaviors, secret eating, and self-induced vomiting were identified through a scale created for the survey. Results ILSS men had a higher risk of restrictive thoughts and behaviors (B = .31), secret eating (OR = 2.21), and self-induced vomiting (OR = 3.65) than ILOS youth. Among women, there was only a difference in self-induced vomiting (RM = 2.49). In both sexes, being a young ILSS had an indirect effect on restrictive behaviors through its association with experiences of violence, discrimination at school, and sexual violence. Discussion and conclusion . Mexican sexual minority men are at a higher risk of disordered eating behaviors, whereas sexual minority women are at a higher risk of purging. Part of the differences in restrictive behaviors were explained by the increased risk for experiences of prejudice faced by sexual minority youth.

Resumen Introducción En países de alto ingreso, las minorías sexuales tienen mayor riesgo de conductas alimentarias de riesgo. Se desconoce si esos hallazgos pueden ser extrapolados a México. Objetivo Determinar si existen disparidades en las conductas alimentarias de riesgo entre los jóvenes mexicanos según la orientación sexual y analizar el papel potencial de las experiencias de violencia y discriminación como mediadoras de tales disparidades. Método Se analizaron datos de una muestra representativa de jóvenes mexicanos (12 a 29 años, n = 27,876). Se identificaron tres grupos: jóvenes sin enamoramiento (sE), con enamoramiento por personas del otro sexo (cEOS) o con enamoramiento por personas del mismo sexo (cEMS). Las conductas restrictivas, comer a escondidas e inducirse vómito se identificaron a través de una escala creada para la encuesta. Resultados Los hombres cEMS tuvieron mayor riesgo de pensamientos y comportamientos restrictivos (B = .31), comer a escondidas (RM = 2.21) e inducirse vómito (RM = 3.65) en comparación con los jóvenes cEOS. Entre las mujeres, solo hubo diferencia en inducirse vómito (RM = 2.49). En ambos sexos, ser un joven cEMS tuvo un efecto indirecto sobre las conductas restrictivas a través su asociación con experiencias de violencia y discriminación escolares y violencia sexual. Discusión y conclusión Los hombres de minorías sexuales mexicanas tienen mayor riesgo de conductas alimentarias de riesgo, y las mujeres de minorías sexuales tienen mayor riesgo de una conducta de tipo purgativo. Parte de las disparidades en conductas restrictivas se explicaron por el mayor riesgo de experiencias de prejuicio que enfrentan los jóvenes de minorías sexuales.

Competence and Involuntary Commitment of Patients with Anorexia Nervosa: A Qualitative study on the Perceptions and Performance of Psychiatrists and Clinical Psychologists. / Capacidad e internamiento involuntario de pacientes con anorexia nerviosa: un estudio cualitativo sobre percepciones y actuación de psiquiatras y psicólogos clínicos.

INTRODUCTION: Anorexia nervosa poses an important bioethical quandary, since patients often refuse treatment despite the danger that this poses to their health, and it is not clear that their decision is autonomous. The aim of this study was to investigate the perceptions/performance of psychiatrists and clinical psychologists regarding the capacity and involuntary hospitalisation of patients with anorexia nervosa. METHODS: Seven psychiatrists, four clinical psychologists, and one third-year resident psychologist were interviewed. A qualitative research approach based on grounded theory was used. RESULTS: The data analysis showed that these professionals articulate patient care around one main category - hospitalisation as a last resort and the search for voluntariness, which implies a change in the usual healthcare dynamics. Around this central category, some important concepts emerge: role stress, informal coercion, weight, family and chronicity. CONCLUSIONS: The difficulty of reconciling professional demands can undermine the quality of care and job satisfaction itself, which highlights the need for reflection and research into the foundations of the responsibilities assumed.

El fonoaudiólogo en los trastornos de alimentación Más allá de la alimentación / The speech language pathologist in pediatric feeding disorders Beyond swallowing

Este articulo surge a partir de la necesidad de generar espacios de reflexión sobre el rol del fonoaudiólogo en las dificultades de alimentación infantil. Se debe tener en cuenta que la alimentación es un proceso natural que trasciende a la cultura. En el ámbito pediátrico son cada vez más frecuentes las consultas por dificultades de esta índole. La fonoaudiología, estudia e interviene las alteraciones de la deglución y alimentación en diferentes rangos etarios. Particularmente, en bebés y niños pequeños, estas problemáticas pueden deberse a múltiples condicionantes que alteren o dificulten la seguridad y eficacia deglutoria; como también el confort durante la alimentación. A lo largo del manuscrito se intentan revisar ejes centrales en estrecha relación a este tema que posee múltiples aristas y como parte final en la discusión se aborda la complejidad que plantean los desafíos de la alimentación con especial énfasis en la necesidad del trabajo interdisciplinario. Por lo que se busca como meta final dar a conocer el rol del fonoaudiólogo en los trastornos de alimentación a la comunidad científica a través de un artículo de reflexión

This article arises from the need to generate reflection spaces of the (SLP) speech and language pathology ́s role in pediatric feeding disorders. It should be taken into account that feeding is a natural process that transcends culture. In the pediatric field, consultations for difficulties of this nature are frequent increasingly. SLP assess and rehab feeding and swallowing disorders in all range age. Particularly in babies and young children, these problems may be due to multiple conditions that alter or hinder swallowing safety and efficacy, as well as comfort during feeding. Throughout the manuscript, an attempt is made to review central themes closely related to this topic, which has multiple edges, and as a final part of the discussion, the complexity posed by the challenges of nutrition is addressed with special emphasis on the need for interdisciplinary work. Therefore, the final goal is to make the role of the speech

Does coping mediate the relationship between competitive anxiety and eating disorders in athletes? / O Coping medeia a relação entre ansiedade competitiva e transtornos alimentares em atletas? / Coping media la relación entre la ansiedad competitiva y los trastornos de la alimentación en los atletas?

The competitive anxiety shows positive and linear relationship with risk behaviors for eating disorders (RBED). The competitive anxiety shows negative and linear relationship with coping strategies. Perhaps the coping strategies can mediate the relationship between competitive anxiety and RBED in athletes. The aim of this study was to analyze the coping mediation between competitive anxiety and RBED in Brazilian male athletes. 739 athletes from various sports participated. To assess the RBED frequency, the Disordered Eating in Sports Scale was adopted. The Brazilian version of the Competitive State Anxiety Inventory was used to evaluate competitive anxiety. Athletic Coping Strategies Inventory was used to evaluate coping strategies. The findings revealed a direct relationship between competitive anxiety and RBED (p = .01). The results indicated that coping strategies potentiated the relationship between competitive anxiety and RBED (p = .01). It was concluded that coping can be considered a psychological determinant in the relationship between competitive anxiety and RBED.

A ansiedade competitiva possui relação positiva e linear com a frequência de comportamentos de risco para os transtornos alimentares (CRTA). A ansiedade competitiva apresenta relação negativa e linear com as estratégias de coping. Talvez o coping possa mediar a relação entre a ansiedade competitiva e a frequência de CRTA em atletas. O objetivo do estudo foi analisar a mediação do coping entre a ansiedade competitiva e os CRTA em atletas brasileiros do sexo masculino. Participaram 739 atletas. Para avaliação da frequência de CRTA, foi adotada a Disordered Eating in Sports Scale. Utilizou-se a versão brasileira do Competitive State Anxiety Inventory (CSAI-2R) para avaliar a ansiedade competitiva. Foi utilizado o Athletic Coping Strategies Inventory para avaliar as estratégias de coping. Os achados revelaram relação direta entre a ansiedade competitiva e os CRTA (p = .01). Os resultados indicaram que as estratégias de coping potencializaram a relação entre a ansiedade competitiva e os CRTA (p = .01). Concluiu-se que o coping pode ser considerado uma variável psicológica determinante na relação entre a ansiedade competitiva e os CRTA.

No se sabe si el afrontamiento media la relación entre la ansiedad y los comportamientos de riesgo para los trastornos de la alimentación (CRTA) en atletas. El objetivo del estudio fue analizar la mediación de afrontamiento entre la ansiedad competitiva y CRTA en los atletas masculinos brasileños. Participaron 739 atletas. Para evaluar la frecuencia de los CRTA se adoptó Disordered Eating in Sports Scale. Se utilizó la versión brasileña del Competitive State Anxiety Inventory para evaluar la ansiedad competitiva. Se utilizó el Athletic Coping Strategies Inventory para evaluar las estrategias de afrontamiento. Los resultados revelaron una relación directa entre la ansiedad competitiva y CRTA (p = .01). Los resultados indicaron que las estrategias de afrontamiento potenciaron la relación entre la ansiedad competitiva y CRTA (p = .01). Se concluyó que el afrontamiento se puede considerar una variable psicológica decisiva en la relación entre la ansiedad competitiva y CRTA.

Eating disorders in patients with irritable bowel syndrome.

INTRODUCTION: Eating disorders (ED) constitute an important group of conditions that commonly occur in adolescents. Gastrointestinal complaints are frequently reported in ED patients. Few studies assessed the association of irritable bowel syndrome (IBS) with ED. The aim of the current study is to determine the prevalence of ED in a group of IBS patients and compare it with a healthy control group and assess the relationship of IBS sub-types, it's duration and severity with ED. PATIENTS AND METHODS: 100 IBS patients diagnosed according to the Rome-IV criteria and a control group consisting of 100 healthy adults, between 18 and 65 years old, were enrolled in this study. Sub-type, duration and severity of IBS were determined. All participants were requested to fill questionnaires to screen for ED. RESULTS: 200 subjects participated in the study. 118(59%) were female and 92(41%) were male. The Eating Attitudes Test (EAT) score was significantly higher in the IBS group (Odds ratio: 5.3 CI 95%:4.3-9.3; p<0.001). The number of subjects with EAT score >30 was significantly higher in the IBS group (p<0.001). EAT scores were significantly higher in female IBS patients and in younger patients (p=0.013 and p=0.043; respectively). No significant association between the IBS sub-type and EAT score was found (p>0.05). However, IBS severity and duration positively correlated with EAT scores. DISCUSSION: ED should be considered in the management of IBS patients. Since many psychological factors can exacerbate IBS symptoms a multidisciplinary approach consisting of medical and behavioral therapeutic modalities should be employed for a better management of these patients.

Implementación de una guía de práctica clínica para la detección oportuna y el diagnóstico de trastornos de la conducta alimentaria en adolescentes y adultos en el servicio de consulta externa y prioritaria de un hospital mental público de Colombia / Implementation of clinical practice guidelines for the timely detection and diagnosis of eating disorders in adolescents and adults in the outpatient and priority department of a public psychiatric hospital in Colombia

RESUMEN Objetivo: Implementar una guía de práctica clínica para la detección oportuna y el diagnóstico de los trastornos de la conducta alimentaria en adolescentes y adultos en los servicios de consulta prioritaria y consulta externa de un hospital mental público de Barranquilla, Colombia. Se identificaron barreras para el acceso a la guía implementada. Métodos: Para identificar guías de práctica clínica basadas en la evidencia que implementar, se hicieron búsquedas sistemáticas en bases de datos internacionales de organismos desarrolladores o compiladores de guías de práctica clínica y en bases de datos que recogieran literatura científica sobre temas relacionados con trastornos de la conducta alimentaria. Conclusiones: Las dos guías para realizar la selección final por consenso de un equipo multidisciplinario del hospital fueron: «Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders¼ y «Guía de práctica clínica sobre trastornos de la conducta alimentaria de Catalunya¼, que finalmente fue la elegida por consenso. No existe aún para los profesionales de la salud una guía de práctica clínica implementada en el servicio de consulta externa y prioritaria de los hospitales colombianos para los trastornos de la conducta alimentaria.

ABSTRACT Objective: To implement clinical practice guidelines (CPGs) for the timely detection and diagnosis of eating disorders in adolescents and adults in the priority outpatient department of a public psychiatric hospital in Barranquilla, Colombia. Barriers to access to the implemented guidelines were identified. Methods: For the identification of evidence-based CPGs to be implemented, systematic searches were carried out in international databases of development agencies or compilers of clinical practice guidelines, and in databases that contained scientific literature on issues related to eating disorders. Conclusions: The two guidelines shortlisted for the final selection by consensus of a multidisciplinary team at the hospital were the "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders" and the "Guía de práctica clínica sobre trastornos de la conducta alimentaria de Catalunya", the latter being finally chosen by consensus. There are not yet CPGs implemented for health professionals in the priority outpatient department of Colombian hospitals for eating disorders.

Implementation of clinical practice guidelines for the timely detection and diagnosis of eating disorders in adolescents and adults in the outpatient and priority department of a public psychiatric hospital in Colombia. / Implementación de una guía de práctica clínica para la detección oportuna y el diagnóstico de trastornos de la conducta alimentaria en adolescentes y adultos en el servicio de consulta externa y prioritaria de un hospital mental público de Colombia.

OBJECTIVE: To implement clinical practice guidelines (CPGs) for the timely detection and diagnosis of eating disorders in adolescents and adults in the priority outpatient department of a public psychiatric hospital in Barranquilla, Colombia. Barriers to access to the implemented guidelines were identified. METHODS: For the identification of evidence-based CPGs to be implemented, systematic searches were carried out in international databases of development agencies or compilers of clinical practice guidelines, and in databases that contained scientific literature on issues related to eating disorders. CONCLUSIONS: The two guidelines shortlisted for the final selection by consensus of a multidisciplinary team at the hospital were the "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders" and the "Guía de práctica clínica sobre trastornos de la conducta alimentaria de Catalunya", the latter being finally chosen by consensus. There are not yet CPGs implemented for health professionals in the priority outpatient department of Colombian hospitals for eating disorders.

Disfagia orofaríngea y neumopatías en la infancia / Oropharyngeal dysphagia and childhood pneumopathies

OBJETIVOS: Presentar brevemente las principales patologías pulmonares y sus interferencias en la alimentación de niños. MÉTODOS: Se trata de una Actualización, basada en referencias bibliográficas actuales y referencias en pediatría. RESULTADOS: Se presentaron las posibles alteraciones de deglución en niños con: Bronquilitis Viral Aguda, Displasia Broncopulmonar, Enfermedades Intersticiales Pulmonares y Neumonias Aspirativas. CONCLUSIONES: Este material sirve para dirigir la atención del público de atención en salud en general, para trastornos de deglución niños neumópatas.

OBJECTIVES: Present briefly the main pulmonary pathologies and their interferences in the feeding of children. METHODS: This is an Update, based on current bibliographical references and references in pediatrics. RESULTS: Possible alterations of swallowing were presented in children with: Acute Viral Bronchitis, Bronchopulmonary Dysplasia, Pulmonary Interstitial Diseases and Aspirative Pneumonia. CONCLUSIONS: This material serves to direct the attention of the health care public in general, for children swallowing disorders pneumatics.

Feeding difficulties and eating disorders in pediatric patients with cancer / Trastornos y dificultades en la alimentación en pacientes pediátricos con cáncer

Abstract Background Feeding difficulties and disorders are a common problem in the pediatric population, which involve a series of deficient behaviors about nutrition processes that can adversely affect psychomotor, psychosocial, and physical development of children. This study aimed to describe the frequency of feeding difficulties or disorders in pediatric patients with cancer. Methods A prospective study which included 125 children from 1-19 years treated at the Department of Oncology of the Instituto Nacional de Pediatría, Mexico City, was conducted. The diagnosis of eating disorders and feeding difficulties was determined during the first 48 h since admission, and the age of the patient influenced the type of disorder and feeding difficulties. Results Children older than 11 years presented more frequently an intense resistance of feeding because of discomfort pain (fear of feeding) than younger children (11.4 ± 4.7 vs. 7.4 ± 4.9, p ≤ 0.001). The most frequent alteration associated with malnutrition was loss of appetite (odds ratio [OR]: 8.8, confidence interval [CI] 95% 2.9-26.9, p<0.001), followed by fear of feeding (OR: 3.14, CI 95% 1.24-7.9, p=0.015), and the organic causes showed the highest risk for malnutrition (OR: 3.1, CI 95% 0.98-9.7, p=0.054). Conclusions Over 90% of the studied population demonstrated at least one eating disorder or feeding difficulty. The principal effect is inadequate nutritional intake due to limited appetite and fear of feeding, which can result in undernutrition. For this reason, the identification of alterations in nutrition processes should be part of the comprehensive assessment of cancer patients.

Resumen Introducción Los trastornos y dificultades para la alimentación son problemas comunes en la edad pediátrica. Estas situaciones conllevan una serie de comportamientos inadecuados respecto de los procesos de nutrición que pueden afectar de manera adversa el desarrollo psicomotor, psicosocial y físico del niño. El objetivo de este trabajo fue describir la frecuencia de desórdenes y dificultades en la alimentación en niños con cáncer a través de un estudio prospectivo. Métodos Se incluyeron 125 niños de 1 a 19 años de edad del Servicio de Oncología del Instituto Nacional de Pediatría, Ciudad de México. El diagnóstico de desorden y dificultad en la alimentación se determinó en las primeras 48 horas del ingreso. Resultados Los niños mayores de 11 años presentan con mayor frecuencia resistencia a comer debido a dolor o malestar (miedo a comer) (11.4±4.7 años versus 7.4±4.9 años; p≤0.001). La alteración más frecuente asociada a malnutrición fue la disminución del apetito (razón de momios [RM]: 8.8; intervalo de confianza [IC] 95%: 2.9-26.9; p<0.001), seguido del miedo a comer (RM: 3.14; IC 95%: 1.24-7.9; p=0.015) y las causas con mayor riesgo de malnutrición fueron las orgánicas (RM: 3.1; IC 95%: 0.98-9.7; p=0.054). Conclusiones Se encontró que en más del 90% de esta población se presentó por lo menos un desorden alimentario o dificultad al alimentarse. El principal efecto es la ingesta nutricional inadecuada debida al apetito limitado y al miedo a alimentarse, lo que puede resultar en desnutrición. Por esta razón, la identificación de alteraciones en los procesos de nutrición deben ser parte de la valoración integral de los pacientes con cáncer.

Feeding difficulties and eating disorders in pediatric patients with cancer.

Background: Feeding difficulties and disorders are a common problem in the pediatric population, which involve a series of deficient behaviors about nutrition processes that can adversely affect psychomotor, psychosocial, and physical development of children. This study aimed to describe the frequency of feeding difficulties or disorders in pediatric patients with cancer. Methods: A prospective study which included 125 children from 1-19 years treated at the Department of Oncology of the Instituto Nacional de Pediatría, Mexico City, was conducted. The diagnosis of eating disorders and feeding difficulties was determined during the first 48 h since admission, and the age of the patient influenced the type of disorder and feeding difficulties. Results: Children older than 11 years presented more frequently an intense resistance of feeding because of discomfort pain (fear of feeding) than younger children (11.4 ± 4.7 vs. 7.4 ± 4.9, p ≤ 0.001). The most frequent alteration associated with malnutrition was loss of appetite (odds ratio [OR]: 8.8, confidence interval [CI] 95% 2.9-26.9, p<0.001), followed by fear of feeding (OR: 3.14, CI 95% 1.24-7.9, p=0.015), and the organic causes showed the highest risk for malnutrition (OR: 3.1, CI 95% 0.98-9.7, p=0.054). Conclusions: Over 90% of the studied population demonstrated at least one eating disorder or feeding difficulty. The principal effect is inadequate nutritional intake due to limited appetite and fear of feeding, which can result in undernutrition. For this reason, the identification of alterations in nutrition processes should be part of the comprehensive assessment of cancer patients.

Introducción: Los trastornos y dificultades para la alimentación son problemas comunes en la edad pediátrica. Estas situaciones conllevan una serie de comportamientos inadecuados respecto de los procesos de nutrición que pueden afectar de manera adversa el desarrollo psicomotor, psicosocial y físico del niño. El objetivo de este trabajo fue describir la frecuencia de desórdenes y dificultades en la alimentación en niños con cáncer a través de un estudio prospectivo. Métodos: Se incluyeron 125 niños de 1 a 19 años de edad del Servicio de Oncología del Instituto Nacional de Pediatría, Ciudad de México. El diagnóstico de desorden y dificultad en la alimentación se determinó en las primeras 48 horas del ingreso. Resultados: Los niños mayores de 11 años presentan con mayor frecuencia resistencia a comer debido a dolor o malestar (miedo a comer) (11.4±4.7 años versus 7.4±4.9 años; p≤0.001). La alteración más frecuente asociada a malnutrición fue la disminución del apetito (razón de momios [RM]: 8.8; intervalo de confianza [IC] 95%: 2.9-26.9; p<0.001), seguido del miedo a comer (RM: 3.14; IC 95%: 1.24-7.9; p=0.015) y las causas con mayor riesgo de malnutrición fueron las orgánicas (RM: 3.1; IC 95%: 0.98-9.7; p=0.054). Conclusiones: Se encontró que en más del 90% de esta población se presentó por lo menos un desorden alimentario o dificultad al alimentarse. El principal efecto es la ingesta nutricional inadecuada debida al apetito limitado y al miedo a alimentarse, lo que puede resultar en desnutrición. Por esta razón, la identificación de alteraciones en los procesos de nutrición deben ser parte de la valoración integral de los pacientes con cáncer.

Conhecimento e comportamento de risco para anorexia e bulimia em adolescentes / Conocimiento y comportamiento de riesgo correspondientes a la bulimia y la anorexia en adolescentes / Risk knowledge and behavior for anorexia and bulimia in adolescents

Objetivos descrever o conhecimento de adolescentes sobre anorexia e bulimia e identificar comportamentos alimentares de risco. Método estudo descritivo, corte transversal, abordagem quantitativa, realizada com 75 escolares. Utilizou-se questionário para avaliar conhecimento sobre anorexia e bulimia e o teste de atitudes alimentares (EAT-26). Resultados mais acertos referentes à anorexia, média de 88%, do que sobre bulimia. Em quase todas as questões, houve associação estatisticamente significante entre acertos e erros (p<0,05). As alunas do 9º ano fundamental e 2º ano ensino médio, ambos com 31%, e a faixa etária de 17-19 anos (39%) apresentaram mais risco. Entretanto, não houve associação estatisticamente significante entre comportamento de risco para o desenvolvimento de transtornos alimentares e faixa etária e série escolar (p=0,154 e p=0,748, respectivamente). Conclusão o conhecimento de adolescentes sobre anorexia e bulimia não estava totalmente esclarecido no ambiente escolar. Quanto aos comportamentos alimentares de risco, estavam presentes em todas as faixas etárias e séries participantes.

Objetivos describir el conocimiento de los adolescentes sobre la bulimia y la anorexia e identificar comportamientos de riesgo. Método estudio descriptivo de corte transversal, con enfoque cuantitativo, realizado con 75 estudiantes. Se utilizó un cuestionario para evaluar el conocimiento sobre la anorexia y la bulimia y la prueba de actitudes alimenticias (EAT-26). Resultados se registraron más respuestas correctas en lo referente a la anorexia, con un valor medio del 88%, que sobre la bulimia. En casi todas las preguntas se registró una asociación estadísticamente significativa entre aciertos y errores (p<0,05). Alumnas del 9º año de la enseñanza primaria y del 2º año de la escuela media, ambos grupos con el 31%, y grupo etario de 17 a 19 años (39%) presentaron más riesgo. Entretanto, no se registró ninguna asociación estadísticamente significativa entre el comportamiento de riesgo para desarrollar trastornos alimenticios y el grupo etario ni el grado escolar (p=0,154 y p=0,748, respectivamente). Conclusión el conocimiento de los adolescentes sobre la bulimia y la anorexia no estaba totalmente esclarecido en el ámbito escolar. En relación a los comportamientos alimenticios de riesgo, se hicieron presentes en todos los grupos etarios y grados participantes.

Objectives to describe adolescents' knowledge about anorexia and bulimia and to identify risky eating behaviors. Method a descriptive, cross-sectional study with a quantitative approach, performed with 75 students. A questionnaire was used to assess knowledge about anorexia and bulimia and the eating attitudes test (EAT-26). Results more correct answers regarding anorexia, an average of 88%, than about bulimia. In almost all questions, there was a statistically significant association between right and wrong answers (p<0.05). The students from the 9th grade and the second year of high school, both with 31%, and the age group of 17-19 years old (39%) were more at risk. However, there was no statistically significant association between risk behavior for the development of eating disorders and age and grade level (p=0.154 and p=0.748, respectively). Conclusion adolescents' knowledge about anorexia and bulimia was not fully understood in the school environment. Regarding risky eating behaviors, they were present in all age groups and participating grades.

Scales assessing eating behavior in autism spectrum disorder / Escalas de avaliação do comportamento alimentar de indivíduos com transtorno do espectro autista / Escalas de evaluación del comportamiento alimentario de individuos con trastorno del espectro autista

Autism Spectrum Disorder (ASD) is characterized by impaired social interaction, impaired verbal and nonverbal communication, and repetitive, stereotyped, and restricted patterns of behavior and interests. Mealtime behavioral problems related to food refusal and selectivity were found to affect the health of this population negatively. A systematic literature review was conducted regarding existing evaluation instruments by searching PubMed, Cochrane, SciELO, Lilacs, Science Direct, and Embase databases using combinations of the following Keywords: autism, autism spectrum disorder, eating disorders, selective eating, eating behavior, food selectivity, eating problems, sensory processing disorders, questionnaire, evaluation, scale, inventory, and screening tool. Fifty-two studies were found, five of which met the inclusion criteria. The review identified significant methodological limitations in the studies and revealed the need for a new instrument to take the parents' views and the severity of the disorder into consideration.

O transtorno do espectro autista (TEA) é caracterizado por déficits na interação social, comunicação verbal e não verbal, associados a padrões de comportamento repetitivos, estereotipados e interesses restritos nos comportamentos. Problemas comportamentais durante as refeições relacionados à recusa e seletividade alimentar são observados e impactam negativamente a saúde dessa população. Foi feita uma revisão sistemática dos instrumentos de avaliação disponíveis na literatura. Realizou-se busca no PubMed, Cochrane, SciELO, Lilacs, Science Direct e Embase com a combinação das palavras-chave: autismo, transtorno do espectro autista, distúrbios alimentares, comer seletivo, comportamento alimentar, seletividade alimentar, problemas de alimentação, distúrbios do processamento sensorial, questionário, avaliação, escala, inventário, ferramenta de rastreio. Foram encontrados 52 estudos, dos quais cinco satisfizeram os critérios de inclusão. Após a revisão, apontaram-se as limitações metodológicas nos trabalhos publicados e a necessidade de elaborar novo instrumento que contemple as impressões dos pais e a gravidade do transtorno.

El trastorno del espectro autista (TEA) se caracteriza por déficits en la interacción social, la comunicación verbal y no verbal, por un perfil de patrones de comportamiento repetitivos, estereotipados e intereses restringidos, y problemas de comportamiento durante las comidas, relacionados con la selectividad alimentaria. Para explorar el comportamiento alimentario en TEA se desarrolló una revisión sistemática de los instrumentos de evaluación en la literatura. Se realizó una búsqueda en PubMed, Cochrane, SciELO, Lilacs, Science Direct y Embase con la combinación de palabras clave: autismo, trastorno del espectro autista, trastornos de la alimentación, capricho para comer, comer, la selectividad de alimentos, problemas de alimentación, trastornos el procesamiento sensorial, cuestionario, la evaluación, la escala, la herramienta de seguimiento de inventario. Se encontraron 52 estudios de los cuales cinco satisfacían los criterios de inclusión, sin embargo, se encontraron limitaciones metodológicas en la obra publicada y la necesidad de desarrollar un nuevo instrumento.