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Bédard A, Bernard C, Meilleur D, Taddeo D, Pesant C, Di Meglio G, Gingras N, Thibault I, Agostino H, Bélanger R, Nadeau PO, Frappier JY, Stheneur C, Dufresne L, Bégin C. Recovery Trajectories in Adolescent Girls with Anorexia Nervosa. J Clin Med 2024; 13:778. [PMID: 38337472 PMCID: PMC10856320 DOI: 10.3390/jcm13030778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Background: This study aimed to document recovery trajectories among adolescents with anorexia nervosa (AN) based on three markers of remission, namely changes in body weight, food restriction, and excessive exercise, and to identify predictors of these trajectories. Methods: One hundred twenty-six adolescent girls (14.7 ± 1.3 years) were recruited during initial assessment visits at specialized eating disorder (ED) programs in five University Health Centers across the province of Quebec, Canada. z-BMI and AN symptom severity (food restriction and excessive exercise) were assessed at initial assessment visits and subsequently reassessed at each quarterly follow-up over a 12-month period to identify recovery trajectories. Results: Considering the three markers of remission, three distinct trajectories emerged: Group 1, rapid responders; Group 2, gradual responders; and Group 3, unstable responders. At initial visits, a difference between groups was found regarding the type of treatment (p = 0.01) and weight suppression (p = 0.02). Group 1 had a higher number of youths hospitalized than Group 2 and Group 3, and a greater weight suppression than Group 3. Furthermore, individuals with atypical AN were more likely to belong to Group 2 than to Group 1 and Group 3 (p < 0.0001). Conclusions: This study contributes to a better understanding of the heterogeneity of recovery trajectories in adolescent girls with AN.
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Affiliation(s)
- Alexandra Bédard
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
| | - Catherine Bernard
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada; (C.B.); (L.D.)
| | - Dominique Meilleur
- Département de Psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada;
| | - Danielle Taddeo
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
| | - Caroline Pesant
- Hôpital Fleurimont, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada;
| | - Giuseppina Di Meglio
- Hôpital de Montréal pour Enfants/Montreal Children’s Hospital, Centre Universitaire de Santé McGill, Montréal, QC H4A 3J1, Canada; (G.D.M.); (H.A.)
| | - Nathalie Gingras
- Centre de Pédopsychiatrie, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec, QC G1N 2W1, Canada;
- Département de Psychiatrie et de Neurosciences, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Isabelle Thibault
- Département de Psychoéducation, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada;
| | - Holly Agostino
- Hôpital de Montréal pour Enfants/Montreal Children’s Hospital, Centre Universitaire de Santé McGill, Montréal, QC H4A 3J1, Canada; (G.D.M.); (H.A.)
| | - Richard Bélanger
- Département de Pédiatrie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre Hospitalier Universitaire de Québec, Québec, QC G1V 4G2, Canada
| | - Pierre-Olivier Nadeau
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
| | - Jean-Yves Frappier
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Chantal Stheneur
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Laurie Dufresne
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada; (C.B.); (L.D.)
| | - Catherine Bégin
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada; (C.B.); (L.D.)
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Thibault I, Pascuzzo K, Pesant C, Bégin C, Bédard A, Di Meglio G, Meilleur D, Taddeo D, Gingras N. Anorexia Nervosa in Adolescence: A Comprehensive Study of Multidimensional Factors Associated with Symptom Severity 1 Year Following the Diagnosis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01599-6. [PMID: 37725233 DOI: 10.1007/s10578-023-01599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/21/2023]
Abstract
The overarching goal of this study was to examine the unique contribution of psychological, familial, and friendship factors in explaining anorexia nervosa (AN) symptom severity 1 year following diagnosis among a sample of adolescent girls. A second objective was to determine whether friendship factors mediated the association between psychological and/or familial factors and AN symptom severity. This study included 143 adolescent girls under the age of 18 diagnosed with AN (M = 14.84, SD = 1.31). Participants were recruited from specialized eating disorder treatment programs. At admission (T1), participants completed a set of self-report questionnaires measuring psychological, familial, and friendship factors. AN symptom severity was assessed 1 year later (T2). Results of hierarchical regression analysis revealed that greater general psychological maladjustment at T1 (b = .26; se = .03; p = .00) was associated with greater AN symptom severity at T2. Greater alienation from friends at T1 (b = 1.20, se = .53, p = .03) also predicted greater AN symptom severity at T2, above and beyond the influence of adolescent girls' general psychological maladjustment. Finally, the mediating role of alienation from friends in the association between general psychological maladjustment at T1 and AN symptom severity at T2 was also identified. AN is a multidimensional disorder with a prognosis that involves both psychological and social factors. The results stemming from the present study shed light on the role of peer as a mechanism through which general psychological maladjustment is linked to AN symptom severity 1 year following diagnosis.
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Affiliation(s)
- Isabelle Thibault
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, QC, Canada.
| | - Katherine Pascuzzo
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Caroline Pesant
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Catherine Bégin
- Department of Psychology, Université Laval, Quebec, QC, Canada
| | | | - Giuseppina Di Meglio
- Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | | | - Danielle Taddeo
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Nathalie Gingras
- Centre Hospitalier Universitaire de Québec Université Laval, Quebec, QC, Canada
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Moubayed D, Piché-Renaud PP, Provost C, Faure C, Taddeo D, Jamoulle O, Frappier JY, Stheneur C. Faecal calprotectin: Marker of intestinal inflammatory process in anorexia nervosa? A preliminary study. Eur Eat Disord Rev 2023. [PMID: 37194134 DOI: 10.1002/erv.2983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Anorexia Nervosa (AN) is a serious and potentially lethal mental disorder characterised by a deliberate quest to reduce one's weight. It can have multiple physical and psychological consequences. The clinical presentation of AN can include gastrointestinal symptoms, however, the pathophysiology of these symptoms in the context of AN remains uncertain. It is hypothesised that patients with AN may have an increase in intestinal permeability, which could lead to an increase in faecal calprotectin (fCP), a marker of intestinal inflammation. No relation between AN and elevation of fCP has been previously described in literature. METHODS Eight patients hospitalised for AN have a dosage of fCP. RESULTS Calprotectine was found to be elevated in 50% of cases, with or without any underlying comorbid gastrointestinal disease. Only the duration of illness tended to be associated with the increase in fCP suggesting a greater alteration as a function related to the time of denutrition. CONCLUSION Although these findings provide insights in the potential pathophysiology of gastrointestinal symptoms in AN, further studies that evaluate the factors associated with elevated fCP in patients with AN are needed.
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Affiliation(s)
- Dina Moubayed
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | | | | | - Christophe Faure
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | - Danielle Taddeo
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | - Olivier Jamoulle
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | - Jean-Yves Frappier
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | - Chantal Stheneur
- Paris Saclay University, UVSQ, INSERM, CESP, Villejuif, France
- Clinique FSEF Varennes Jarcy, Varennes Jarcy, France
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Novack K, Dufour R, Picard L, Taddeo D, Nadeau PO, Katzman DK, Booij L, Chadi N. Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: a mixed-methods approach to understanding clinicians' perspectives. Ann Gen Psychiatry 2023; 22:16. [PMID: 37101241 PMCID: PMC10132795 DOI: 10.1186/s12991-023-00443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/26/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND As a result of the public health measures put in place during the COVID-19 pandemic in Canada, many health services, including those for the treatment of eating disorders, were provided at a distance. This study aims to describe the adaptations made in specialized pediatric eating disorder programs in Canada and the impact of these adaptations on health professionals' experience of providing care. METHODS A mixed-methods design was used to survey healthcare professionals working in specialized pediatric eating disorder programs about adaptations to treatment made during the pandemic and the impact of these adaptations on their experience of providing care. Data were collected between October 2021 and March 2022 using a cross-sectional survey comprising 25 questions and via semi-structured interviews. Quantitative data were summarized using descriptive statistics and qualitative data were interpreted using qualitative content analysis. RESULTS Eighteen healthcare professionals in Canada completed the online survey, of whom six also participated in the semi-structured interviews. The cross-sectional survey confirmed that, unlike in pre-pandemic times, the majority of participants provided medical care (15/18) and mental health care (17/18) at a distance during the pandemic, with most participants using telephone (17/18) and videoconferencing (17/18). Most (16/18) health professionals indicated that virtual care would continue to be used as a tool in pediatric ED treatment after the pandemic. Participants used a combination of virtual and in-person care, with most reporting weighing patients both in clinic (16/18) and virtually (15/18). Qualitative content analysis generated five themes: (1) responding to increased demand with insufficient resources; (2) adapting to changes in care due to the COVID-19 pandemic; (3) dealing with uncertainty and apprehension; (4) virtual care as an acceptable and useful clinical tool, and (5) optimal conditions and future expectations. Most interview participants (5/6) had globally positive views of virtual care. CONCLUSIONS Providing virtual multidisciplinary treatment for children and adolescents with eating disorders seemed feasible and acceptable to professionals during the pandemic. Moving forward, focusing on health professionals' perspectives and providing appropriate training in virtual interventions is essential given their central role in successful implementation and continued use of virtual and hybrid care models.
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Affiliation(s)
- Kaylee Novack
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Rachel Dufour
- Department of Psychology, Concordia University, Montreal, Canada
| | - Louis Picard
- Department of Psychology, Sainte-Justine University Hospital Centre, Montreal, Canada
| | - Danielle Taddeo
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Université de Montréal, 3175 Chemin de la Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada
| | | | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Linda Booij
- CHU Sainte-Justine Hospital Research Centre, Montreal, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Université de Montréal, 3175 Chemin de la Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada.
- CHU Sainte-Justine Hospital Research Centre, Montreal, Canada.
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Dufresne L, Meilleur D, Gingras N, Di Meglio G, Pesant C, Taddeo D, Nadeau PO, Bélanger R, Lavoie E, Thibault I, Agostino H, Stheneur C, Frappier JY, Bédard A, Bégin C. Personality heterogeneity in adolescents with anorexia nervosa: a factor-mixture analysis. Curr Psychol 2023. [DOI: 10.1007/s12144-022-04216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Lachal J, Carretier E, Prevost C, Nadeau PO, Taddeo D, Fortin MC, Blanchet C, Amirali L, Wilhelmy M, Frappier JY, Moro MR, Ben Amor L. The experience of healthcare professionals treating adolescents with eating disorders in psychiatric and pediatric inpatient units for adolescents: A qualitative study. Encephale 2022:S0013-7006(22)00076-8. [PMID: 35725521 DOI: 10.1016/j.encep.2022.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The recommended treatment for Eating Disorders (EDs) is multidisciplinary and multimodal. Nonetheless, the complex linkage of the different disciplines involved is not necessarily simple. We analyzed the experience of healthcare professionals faced with psychiatric and psychological symptoms in adolescents with EDs in two "multidisciplinary" inpatient units embedded predominantly in different paradigms - one pediatric and one psychiatric. METHODS Qualitative analysis of 20 healthcare staff members' interviews from different professional backgrounds working in inpatient units for EDs in Montreal (Canada) and Paris (France). RESULTS The "Complex patients" theme discusses the need for a global approach to the multiplicity of symptoms presented by these patients. "Management and its limits" describes the daily management of psychiatric symptoms in both units. "Psychiatry and Adolescent medicine: from opposition to collaboration" describes the different levels at which these disciplines work together and how this cooperation may be evolving. CONCLUSIONS The complex entanglement intrinsic in EDs of the patients' somatic, psychosocial, psychiatric, and adolescent problems requires collaboration between disciplines, but the modalities of this collaboration are multiple and evolve non-linearly in specialized treatment units. A multilevel approach must be offered, with the degree of collaboration (multidisciplinary, interdisciplinary and transdisciplinary) appropriate to the complexity of each adolescent's issues.
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Affiliation(s)
- J Lachal
- Service de psychiatrie de l'enfant et de l'adolescent, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France.
| | - E Carretier
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; AP-HP, hôpital Cochin, Maison de Solenn, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France
| | - C Prevost
- AP-HP, hôpital Cochin, Maison de Solenn, 75014 Paris, France
| | - P-O Nadeau
- Département de psychiatrie, université de Montréal, Montréal, Canada
| | - D Taddeo
- Adolescent Medicine Division, CHU Sainte-Justine, 3175 Ch Cote Ste-Catherine, H3T1C5 Montreal, Canada
| | - M-C Fortin
- Adolescent Medicine Division, CHU Sainte-Justine, 3175 Ch Cote Ste-Catherine, H3T1C5 Montreal, Canada
| | - C Blanchet
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; AP-HP, hôpital Cochin, Maison de Solenn, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France
| | - L Amirali
- Département de psychiatrie, université de Montréal, Montréal, Canada
| | - M Wilhelmy
- Département de psychiatrie, université de Montréal, Montréal, Canada
| | - J-Y Frappier
- Adolescent Medicine Division, CHU Sainte-Justine, 3175 Ch Cote Ste-Catherine, H3T1C5 Montreal, Canada
| | - M R Moro
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; AP-HP, hôpital Cochin, Maison de Solenn, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France
| | - L Ben Amor
- Département de psychiatrie, université de Montréal, Montréal, Canada
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Proulx-Cabana S, Metras ME, Taddeo D, Jamoulle O, Frappier JY, Stheneur C. To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol. Nutrients 2022; 14:nu14010229. [PMID: 35011105 PMCID: PMC8747364 DOI: 10.3390/nu14010229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN.
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Affiliation(s)
- Stephanie Proulx-Cabana
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada; (D.T.); (O.J.); (J.-Y.F.)
- Correspondence: (S.P.-C.); (C.S.)
| | - Marie-Elaine Metras
- Pharmacy Department, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada;
| | - Danielle Taddeo
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada; (D.T.); (O.J.); (J.-Y.F.)
| | - Olivier Jamoulle
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada; (D.T.); (O.J.); (J.-Y.F.)
| | - Jean-Yves Frappier
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada; (D.T.); (O.J.); (J.-Y.F.)
| | - Chantal Stheneur
- CESP, UVSQ, INSERM U 1178, Paris-Saclay University, 94805 Villejuif, France
- Clinique FSEF Varennes Jarcy, Fondation Sante des Etudiants de France, 91480 Varennes-Jarcy, France
- Simone Veil Health Science Training and Research Unit, Saint-Quentin-en-Yvelines University, 78180 Montigny-le-Bretonneux, France
- Correspondence: (S.P.-C.); (C.S.)
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Agostino H, Burstein B, Moubayed D, Taddeo D, Grady R, Vyver E, Dimitropoulos G, Dominic A, Coelho JS. Trends in the Incidence of New-Onset Anorexia Nervosa and Atypical Anorexia Nervosa Among Youth During the COVID-19 Pandemic in Canada. JAMA Netw Open 2021; 4:e2137395. [PMID: 34874405 PMCID: PMC8652595 DOI: 10.1001/jamanetworkopen.2021.37395] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has had considerable mental health consequences for children and adolescents, including the exacerbation of previously diagnosed eating disorders. Whether the pandemic is a factor associated with the concomitant increase in new-onset anorexia nervosa or atypical anorexia nervosa remains unknown. OBJECTIVE To assess the incidence and severity of newly diagnosed anorexia nervosa or atypical anorexia nervosa in a national sample of youth before and during the first wave of the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study analyzed new eating disorder assessments that were conducted at 6 pediatric tertiary-care hospitals in Canada between January 1, 2015, and November 30, 2020. Patients aged 9 to 18 years with a new anorexia nervosa or atypical anorexia nervosa diagnosis at the index assessment were included. EXPOSURES COVID-19-associated public health confinement measures during the first wave of the pandemic (March 1 to November 30, 2020). MAIN OUTCOMES AND MEASURES Primary outcomes were the incidence and hospitalization rates within 7 days of de novo anorexia nervosa or atypical anorexia nervosa diagnosis. Event rate trends during the first wave were compared with trends in the 5-year prepandemic period (January 1, 2015, to February 28, 2020) using an interrupted time series with linear regression models. Demographic and clinical variables were compared using a χ2 test for categorical data and t tests for continuous data. RESULTS Overall, 1883 children and adolescents with newly diagnosed anorexia nervosa or atypical anorexia nervosa (median [IQR] age, 15.9 [13.8-16.9] years; 1713 female patients [91.0%]) were included. Prepandemic anorexia nervosa or atypical anorexia nervosa diagnoses were stable over time (mean [SD], 24.5 [1.6] cases per month; β coefficient, 0.043; P = .33). New diagnoses increased during the first wave of the pandemic to a mean (SD) of 40.6 (20.1) cases per month with a steep upward trend (β coefficient, 5.97; P < .001). Similarly, hospitalizations for newly diagnosed patients increased from a mean (SD) of 7.5 (2.8) to 20.0 (9.8) cases per month, with a significant increase in linear trend (β coefficient, -0.008 vs 3.23; P < .001). These trends were more pronounced in Canadian provinces with higher rates of COVID-19 infections. Markers of disease severity were worse among patients who were diagnosed during the first wave rather than before the pandemic, including more rapid progression (mean [SD], 7.0 [4.2] months vs 9.8 [7.4] months; P < .001), greater mean (SD) weight loss (19.2% [9.4%] vs 17.5% [9.6%]; P = .01), and more profound bradycardia (mean [SD] heart rate, 57 [15.8] beats per minute vs 63 [15.9] beats per minute; P < .001). CONCLUSIONS AND RELEVANCE This cross-sectional study found a higher number of new diagnoses of and hospitalizations for anorexia nervosa or atypical anorexia nervosa in children and adolescents during the first wave of the COVID-19 pandemic in Canada. Research is needed to better understand the drivers and prognosis for these patients and to prepare for their mental health needs in the event of future pandemics or prolonged social isolation.
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Affiliation(s)
- Holly Agostino
- Division of Adolescent Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Dina Moubayed
- Section of Adolescent Medicine, Department of Pediatrics, Sainte Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Danielle Taddeo
- Section of Adolescent Medicine, Department of Pediatrics, Sainte Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Rosheen Grady
- Division of Adolescent Medicine, Department of Pediatrics, McMaster’s Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Ellie Vyver
- Section of Adolescent Medicine, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, Departments of Pediatrics and Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Anna Dominic
- Division of Adolescent Medicine, Department of Pediatrics, Janeway Children’s Hospital, Memorial University, St John’s, Newfoundland, Canada
| | - Jennifer S. Coelho
- Department of Psychiatry, University of British Columbia, and Provincial Specialized Eating Disorders Program for Children and Adolescents, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
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Proulx-Cabana S, Taddeo D, Jamoulle O, Frappier JY, Tremblay-Racine F, Stheneur C. Initial inpatient management of adolescents and young adults admitted with severe malnutrition due to anorexia nervosa: protocol for a systematic review. J Eat Disord 2021; 9:36. [PMID: 33691797 PMCID: PMC7944889 DOI: 10.1186/s40337-021-00389-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a highly prevalent disease in adolescents and young adults (AYAs). The quality of initial inpatient medical management in a patient with severe malnutrition due to AN is crucial to prevent further medical instability. This review aims to inventory evidence regarding initial refeeding and management of AYAs with AN in an inpatient setting, in order to avoid medical complications. METHODS A systematic review will be conducted using PubMed, MEDLINE, All EBM Reviews, Embase, PsycINFO, Cochrane Database and CINAHL. The search strategy consists of terms related to anorexia, hospitalization and Pediatrics. Randomized controlled trials, case-control studies, cross-sectional and cohort studies will be included. Participants will include adolescents and adults 18-24 years old diagnosed with AN and meeting criteria for severe disease. The primary outcome will be any of the following complications: hypophosphatemia, refeeding syndrome, hypoglycemia, cardiac arrythmia, hepatic cytolysis or death. Data will be extracted and the risk of bias will be assessed by one author and reviewed by a second author. Results will be presented in a systematic narrative synthesis format. The quality of evidence for all outcomes will be evaluated using the GRADE methodology. DISCUSSION This systematic review will examine current evidence on initial inpatient refeeding and help to document effectiveness of initial inpatient management in AYAs with severe AN in avoiding further medical complications. TRIAL REGISTRATION This study is registered on PROSPERO under the reference number CRD42019123608 .
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Affiliation(s)
- Stéphanie Proulx-Cabana
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada.
| | - Danielle Taddeo
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada
| | - Olivier Jamoulle
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada
| | - Jean-Yves Frappier
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada
| | - Fannie Tremblay-Racine
- Librarian, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada
| | - Chantal Stheneur
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], 94805, Villejuif, France.,Clinique FSEF Varennes Jarcy, Fondation Sante des Etudiants de France, 91480, Varennes-Jarcy, France.,UFR des Sciences de la Santé Simone Veil [Simone Veil Health Science Training and Research Unit], Université de Versailles Saint-Quentin-en-Yvelines [Versailles Saint-Quentin-en-Yvelines University], Versailles, France
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10
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Ante Z, Luu TM, Healy-Profitós J, He S, Taddeo D, Lo E, Auger N. Pregnancy outcomes in women with anorexia nervosa. Int J Eat Disord 2020; 53:403-412. [PMID: 32100355 DOI: 10.1002/eat.23251] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Birth outcomes of women with anorexia nervosa are poorly understood. We hypothesized that hospitalization for anorexia nervosa before or during pregnancy is associated with an elevated risk of adverse maternal and infant birth outcomes. METHOD We performed a retrospective cohort study of 2,134,945 pregnancies in Quebec, Canada, from 1989 to 2016. The main exposure measure was anorexia nervosa requiring hospital treatment before or during pregnancy. Outcome measures included stillbirth, preterm birth, low birth weight, small-for-gestational age birth, preeclampsia, gestational diabetes, cesarean delivery, and other pregnancy disorders. We computed risk ratios and 95% confidence intervals (CI) for the association between anorexia nervosa and birth outcomes adjusted for maternal characteristics. RESULTS Compared with no hospitalization, anorexia nervosa hospitalization was associated with 1.99 times the risk of stillbirth (95% CI 1.20-3.30), 1.32 times the risk of preterm birth (95% CI 1.13-1.55), 1.69 times the risk of low birth weight (95% CI 1.44-1.99), and 1.52 times the risk of small-for-gestational age birth (95% CI 1.35-1.72). The associations with low birth weight and small-for-gestational age birth were more prominent in women hospitalized for anorexia nervosa during pregnancy or within 2 years of delivery. Hospitalization for anorexia nervosa was associated with certain maternal outcomes, including precipitate labor, acute liver failure, and admission to an intensive care unit. DISCUSSION Hospitalization for anorexia nervosa before or during pregnancy is associated with adverse infant and maternal outcomes. Infants are primarily at risk of stillbirth, preterm birth, low birth weight, and small-for-gestational age birth.
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Affiliation(s)
- Zharmaine Ante
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Jessica Healy-Profitós
- Institut national de santé publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Siyi He
- Institut national de santé publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Danielle Taddeo
- Department of Adolescent Medicine - Eating Disorders, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Ernest Lo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nathalie Auger
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Institut national de santé publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.,School of Public Health, University of Montreal, Montreal, Quebec, Canada
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11
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Blondin S, Meilleur D, Taddeo D, Frappier JY. Caregiving experience and expressed emotion among parents of adolescents suffering from anorexia nervosa following illness onset. Eat Disord 2019; 27:453-470. [PMID: 30612513 DOI: 10.1080/10640266.2018.1553431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to better understand the relationship between parents' experience of caregiving and expressed emotion during the early stage of their child's eating disorder. Fifty mothers and 38 fathers of adolescents suffering from anorexia nervosa and hospitalized for the first time participated in this study. They completed the Experience of Caregiving Inventory, a measure of the negative and positive aspects of the caregiving experience, and the Family Questionnaire, which measured the different dimensions of expressed emotion, namely emotional over-involvement and critical comments. Results showed that caregiving experience is significantly and positively correlated to expressed emotion. Among the negative aspects of caregiving, sense of loss contributed most to emotional over-involvement, while difficult behaviours contributed most to critical comments. The results suggest that parents' perceptions of their child and child's future are strongly related to their tendency to be over-involved. The perception of disruptive behaviours in their child could be one of the principal triggers or exacerbating factors of parents' critical attitudes.
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Affiliation(s)
- Soline Blondin
- Department of Psychology, Adolescence and Eating Disorders Research Laboratory, Montreal University , Montreal , Quebec , Canada
| | - Dominique Meilleur
- Department of Psychology, Adolescence and Eating Disorders Research Laboratory, Montreal University , Montreal , Quebec , Canada
| | - Danielle Taddeo
- Division of Adolescent Medicine, Sainte-Justine Hospital Center , Montreal , Quebec , Canada
| | - Jean-Yves Frappier
- Division of Adolescent Medicine, Sainte-Justine Hospital Center , Montreal , Quebec , Canada
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12
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Paquin Hodge C, Meilleur D, Taddeo D, Frappier JY. The behavioral and affective profile of inpatient adolescent girls with restrictive anorexia nervosa. Eat Weight Disord 2019; 24:645-649. [PMID: 31218659 DOI: 10.1007/s40519-019-00727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/04/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A better understanding of the individual difficulties reported by adolescents presenting with anorexia nervosa seems like an interesting avenue to refine our understanding of their psychological functioning. OBJECTIVE This study aimed to: (1) describe the behavioral and affective profile of difficulties of inpatient adolescent girls presenting a restricting type of anorexia (ANR); and (2) investigate the presence of a relationship between behavioral and affective problems and severity of the disorder. METHODS The sample consisted of 52 inpatient adolescent girls presenting an ANR. The youth self report assessed the behavioral and emotional profile of difficulties of participants while the Eating Disorder Risk Composite of the Eating Disorder Inventory measured the symptomatology of the disorder. A ratio between body mass index at admission and at the end of the treatment served as an indicator of weight gain. RESULTS The sample presented an internalized profile of problems. Individual differences were found and three profiles of difficulties were present in the sample: normative, pure internalizing and mixed (clinical on the internalizing and externalizing clusters). CONCLUSION This study provides information on the heterogeneity of this specific population otherwise quite similar and demonstrates how severity of the disorder can be associated with a wide range of other behavioral and affective difficulties. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
| | | | - Danielle Taddeo
- Sainte-Justine University Health Center Mother and Child, Montreal, QC, Canada
| | - Jean-Yves Frappier
- Sainte-Justine University Health Center Mother and Child, Montreal, QC, Canada
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13
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Stheneur C, Bergeron SJ, Frappier JY, Jamoulle O, Taddeo D, Sznajder M, Lapeyraque AL. Renal injury in pediatric anorexia nervosa: a retrospective study. Eat Weight Disord 2019; 24:323-327. [PMID: 28550606 DOI: 10.1007/s40519-017-0401-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/11/2017] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Although primarily a mental health disorder, anorexia nervosa (AN) has many physical consequences. Among them, the consequences on kidney function are often underestimated. We evaluated renal function in adolescent AN inpatients and investigated the correlation between the GFR and intrinsic patient characteristics. METHODS A single-center retrospective study was conducted on 51 patients hospitalized for the restrictive type of AN in 2013. Data were divided into: (1) medical history of AN; (2) growth parameters and vital signs upon admission; and (3) blood tests. The glomerular filtration rate (GFR) was calculated using the Cockroft-Gault, MAYO Clinical Quadratic (MCQ), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the Modification of Diet in Renal Disease (MDRD), and Schwartz equations. RESULTS The calculated percentages of patients with a GFR below 90 mL/min/1.73 m2 according to the different equations were as follows: Cockroft-Gault, 45%; MDRD, 28%; CKD-EPI, 14%; MCQ, 12%, and Schwartz, 4%. There was a strong association between the body mass index (BMI) and the GFR according to all equations (p < 0.0001). The lowest heart rate was significantly associated with a reduced GFR according to the Cockroft-Gault equation (p = 0.03). The GFR values did not differ significantly after rehydration. CONCLUSION Clinicians should evaluate AN patients for renal complications, especially when the BMI and heart rate are very low. Dehydration was not solely responsible for renal impairment. LEVEL OF EVIDENCE Level III, single-center retrospective cohort study.
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Affiliation(s)
- Chantal Stheneur
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Sebastien J Bergeron
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Jean-Yves Frappier
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Olivier Jamoulle
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Danielle Taddeo
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Marc Sznajder
- Department of Pediatrics, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92100, Boulogne, France
| | - Anne-Laure Lapeyraque
- Department of Nephrology, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
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14
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Meierer K, Hudon A, Sznajder M, Leduc MF, Taddeo D, Jamoulle O, Frappier JY, Stheneur C. Anorexia nervosa in adolescents: evolution of weight history and impact of excess premorbid weight. Eur J Pediatr 2019; 178:213-219. [PMID: 30397823 DOI: 10.1007/s00431-018-3275-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
Abstract
The purpose of our study is to establish if the proportion of patients diagnosed with anorexia nervosa that have a history of excess weight has increased over a 10-year period and to study how different premorbid weight groups vary in terms of clinical characteristics. We performed a single-center, retrospective cohort study of all new patients presenting with anorexia nervosa, restrictive and binge/purge subtypes, in 2004 and 2014 at the Adolescent Medicine Clinic of Sainte-Justine University Health Centre (n = 172). The prevalence of excess premorbid weight was similar in both cohorts (32% in 2004 versus 29.5% in 2014). The historically overweight subgroup had a lower heart rate at intake (64.77 versus 69.75, p = 0.03). Patients with excess premorbid weight lost an average of 1 kg more per month than their historically thinner counterparts (2.6 kg versus 1.6 kg/month, p = 0.0011). The total decrease in BMI was much greater in patients with a history of excess weight (7 BMI points versus 3.8, p = 0.0001).Conclusion: Since overweight and obese patients present with significant weight suppression values, our study stresses the importance of screening for AN in all patients rather than in only the noticeably underweight. What is Known: • More than one third of patients presenting with AN have a history of overweight or obesity, which is comparable to the general population. • A delay between AN onset and diagnosis has been described in overweight adolescents. What is New: • Historically overweight patients presenting with AN demonstrate increased speed of weight loss, greater drop in BMI, and lower heart rate at presentation. • For patients with a history of excess weight considered as having recovered from AN, the average BMI at discharge was within normal limits.
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Affiliation(s)
- Klara Meierer
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Alexandre Hudon
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Marc Sznajder
- Department of Pediatrics, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Marie-France Leduc
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Danielle Taddeo
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 CH Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Olivier Jamoulle
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 CH Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Jean-Yves Frappier
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 CH Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Chantal Stheneur
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada.
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 CH Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
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15
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Pelletier Brochu J, Meilleur D, DiMeglio G, Taddeo D, Lavoie E, Erdstein J, Pauzé R, Pesant C, Thibault I, Frappier JY. Adolescents' perceptions of the quality of interpersonal relationships and eating disorder symptom severity: The mediating role of low self-esteem and negative mood. Eat Disord 2018; 26:388-406. [PMID: 29683772 DOI: 10.1080/10640266.2018.1454806] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Few studies have examined how the perceived quality of multiple interpersonal relationships is related to eating disorder (ED) symptom severity in adolescents and how psychological variables might influence these associations. The aim of this study is to determine whether the perceived level of trust, communication, and alienation in the relationship with one's mother, father, and peers are predictive of ED severity in adolescent females and to test the mediating effects of low self-esteem and negative mood on these associations. Adolescent females aged 12 to 18 (N = 186) with a diagnosis of Anorexia Nervosa (Restrictive; AN-R or Binge/Purge; AN-B/P) completed self-report measures evaluating the perceived quality of interpersonal relationships, ED symptom severity, low self-esteem, and negative mood. Multiple regressions revealed that the level of perceived alienation in the relationship with one's mother and peers was positively associated with ED symptom severity. Low self-esteem and negative mood acted as mediators of these associations. Considering that a high level of perceived alienation in the relationship with one's mother and peers appears to be associated with more severe ED symptoms through its impact on self-esteem and mood, improvements in the quality of these interactions are likely to be an effective target of intervention among adolescents.
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Affiliation(s)
- Jade Pelletier Brochu
- a Department of Psychology, Adolescence and Eating Disorders Research Laboratory , Montreal University , Montreal , Quebec , Canada
| | - Dominique Meilleur
- a Department of Psychology, Adolescence and Eating Disorders Research Laboratory , Montreal University , Montreal , Quebec , Canada
| | - Giuseppina DiMeglio
- b Division of Adolescent Medicine and Pediatric Gynecology , Montreal Children's Hospital, McGill University , Montreal , Quebec , Canada
| | - Danielle Taddeo
- c Division of Adolescent Medecine , Sainte-Justine University Hospital Center , Montreal , Quebec , Canada
| | - Eric Lavoie
- d Eating Disorders Clinic, Sherbrooke University Hospital Center , Sherbrooke , Quebec , Canada
| | - Julius Erdstein
- b Division of Adolescent Medicine and Pediatric Gynecology , Montreal Children's Hospital, McGill University , Montreal , Quebec , Canada
| | - Robert Pauzé
- e Department of Psychoeducation , Sherbrooke University , Sherbrooke , Quebec , Canada
| | - Caroline Pesant
- d Eating Disorders Clinic, Sherbrooke University Hospital Center , Sherbrooke , Quebec , Canada
| | - Isabelle Thibault
- e Department of Psychoeducation , Sherbrooke University , Sherbrooke , Quebec , Canada
| | - Jean-Yves Frappier
- c Division of Adolescent Medecine , Sainte-Justine University Hospital Center , Montreal , Quebec , Canada
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Proulx-Cabana S, Picard L, Fortin MC, Couillard JA, Taddeo D, Jamoulle O, Frappier JY, Stheneur C. PRISE EN CHARGE MULTIDISCIPLINAIRE D’ADOLESCENTS AVEC SYMPTÔMES DOULOUREUX FONCTIONNELS RÉFRACTAIRES. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
La douleur chronique, d’origine organique ou somatique, représente un fardeau financier important au niveau du système de santé. L’intervention multidisciplinaire a été démontrée efficace pour améliorer cliniquement l’impact fonctionnel de cette condition.
OBJECTIVES
Étude de l’impact d’une prise en charge multidisciplinaire pédiatrique et psychologique sur les symptômes douloureux fonctionnels et leur retentissement dans une population adolescente référée pour échec de prise en charge nitiale.
DESIGN/METHODS
Analyse rétrospective de dossiers d’adolescents, de 14 à 18 ans, suivis en clinique des adolescents pour des symptômes douloureux fonctionnels entre janvier 2016 et juin 2017. L’équipe multidisciplinaire est composée de pédiatre, psychologue en suivi individuel ou lors du groupe d’intervention en gestion de la douleur, physiothérapeute et infirmière.
RESULTS
24/36 adolescents ayant des symptômes réfractaires avaient des dossiers exploitables. L’âge médian était de 15,9 ans [14,9; 16,3] avec 87,5% de filles dans l’échantillon. Les principales plaintes rapportées étaient des céphalées (50%), nausées/vomissements (50%), douleurs abdominales (37,5%), douleurs musculo-squelettiques (37,5%), fatigue (37,5%) et symptômes neurologiques (20,8%). Le nombre médian de plaintes étaient de 2 par patient. À la consultation initiale, pour le symptôme principal, la durée médiane écoulée depuis l’apparition était de 13 mois [3,75; 34,5], l’intensité médiane de 6/10 et la fréquence médiane de 7 jours/semaine. Le nombre médian de consultations médicales avant la prise en charge spécialisée était de 3 [2; 5], dont 76,6% d’entre elles en surspécialité pédiatrique. Les patients avaient un nombre médian d’intervenants psychosociaux impliqués au dossier initial de 1, dont un psychologue dans 42,4%. Initialement, 83,3% des patients présentaient un absentéisme scolaire significatif. Suite à la prise en charge, nous avions une amélioration des symptômes pour 70,8% et de l’absentéisme scolaire pour 63,6%. Les symptômes de nausées/vomissements étaient les plus persistants. Sur notre petit groupe d’adolescents, il n’a pas été possible de mettre en évidence de différence significative entre ceux qui avaient bénéficié du groupe d’intervention et les autres.
CONCLUSION
Dans une population d’adolescents avec symptômes douloureux fonctionnels dont la prise en charge en première ligne n’a pas été efficace, une prise en charge multidisciplinaire spécialisée permet une amélioration des symptômes et de la fréquentation scolaire dans 2/3 des cas.
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Thibault I, Pauzé R, Bravo G, Lavoie É, Pesant C, Di Meglio G, Frappier JY, Meilleur D, Nadeau PO, Stheneur C, Taddeo D. [What Are the Individual, Family, and Social Characteristics Differentiating Prepubertal from Pubertal Anorexia Nervosa?]. Can J Psychiatry 2017; 62:837-844. [PMID: 28834466 PMCID: PMC5714118 DOI: 10.1177/0706743717727239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Prepubertal anorexia nervosa may entail multiple physical effects. When the onset occurs before puberty, the disorder might be associated with a poorer prognosis and a greater resistance to treatment. Until now, prepubertal anorexia nervosa studies have mostly dealt with symptomatology, but rarely with associated factors. OBJECTIVE: This study aims to differentiate prepubescent from pubescent anorexia nervosa regarding individual, family and social characteristics. METHOD: At admission in programs specialized in eating disorders, female patients (n = 19 prepubertal and 126 pubertal) and their parents filled in questionnaires (EDI-3, BDI II, IPPA, FACES IV, IDPESQ) on key individual, family and social characteristics associated with anorexia nervosa. Prepubertal and pubertal patient results were compared for each measured variable. Pubertal development and anorexia presence were assessed by a paediatrician in all patients. RESULTS: Prepubertal patients account for 13.8% of all cases and have a lower percentile rank than pubertal patients. The many questionnaire results showed little or no difficulty at personal, family or social level and no difference with older patients. CONCLUSIONS: These results contribute to challenge our current understanding of prepubertal anorexia nervosa and the prepubescent patient capacity to report their difficulties, which highlights the importance of using several respondents when defining clinical profiles.
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Affiliation(s)
- Isabelle Thibault
- 1 Département de psychoéducation, Faculté d'Éducation, Université de Sherbrooke, Sherbrooke, Québec
| | - Robert Pauzé
- 1 Département de psychoéducation, Faculté d'Éducation, Université de Sherbrooke, Sherbrooke, Québec
| | - Gina Bravo
- 2 Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec
| | - Éric Lavoie
- 3 Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec
| | - Caroline Pesant
- 3 Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec
| | - Giuseppina Di Meglio
- 4 Hôpital de Montréal pour Enfants du Centre universitaire de Santé McGill, professeure agrégée, Université McGill, Montréal, Québec
| | - Jean-Yves Frappier
- 5 Centre hospitalier universitaire Sainte-Justine, professeur titulaire, Université de Montréal, Montréal, Québec
| | | | - Pierre-Olivier Nadeau
- 5 Centre hospitalier universitaire Sainte-Justine, professeur titulaire, Université de Montréal, Montréal, Québec
| | - Chantal Stheneur
- 5 Centre hospitalier universitaire Sainte-Justine, professeur titulaire, Université de Montréal, Montréal, Québec
| | - Danielle Taddeo
- 5 Centre hospitalier universitaire Sainte-Justine, professeur titulaire, Université de Montréal, Montréal, Québec
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Caudron M, Gosselin-Papadopoulos R, Jamoulle O, Swaleh S, Taddeo D, Frappier JY. Characteristics and Trends in Intentional Acetaminophen Intoxication in Adolescents Over Two Decades. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Acetaminophen is a common drug used for self-poisoning in adolescents, and an important cause of acute liver failure in the pediatric population. Data regarding intentional acetaminophen intoxication in Canadian youths is limited.
OBJECTIVES: The purpose of the study was to describe the characteristics of intentional acetaminophen intoxications in Canadian adolescents and evaluate its evolution over two decades.
DESIGN/METHODS: We performed a retrospective chart review of intentional acetaminophen ingestions in adolescents (11-18 years old) hospitalized at a Canadian pediatric tertiary care centre between 1989 and 2009. We recorded the patients’ sociodemographic data, as well as the characteristics, complications and treatments of the intoxications. Data was compared across approximately five year periods as a group, then in both sexes separately.
RESULTS: A total of 383 cases were examined, 53 of which were in male patients and 330 in female patients. Given the small number of male patients, only female patients were included in this analysis. There were 200 cases within the time intervals 1 and 2 (1989-1993, 1994-1998) and 130 cases within the time intervals 3 and 4 (1999-2003, 2004-2009). Demographics were relatively constant across the time periods. Impulsive gestures were indicated as the motivation in almost 80% of cases, which remained stable over time (p=0.56). The ingestion of additional substances and the quantity of acetaminophen also remained constant over time (p=0.79 and p=0.46). Mean time to physician consultation significantly increased in time from 6h in interval 1 to 13.4h in interval 4 (p=0.0001). The proportion of ICU admissions, coagulopathy and multiple organ failures also increased across time intervals (p=0.01, 0.03 and 0.03 respectively). There was no definitive linear trend in cases of hepatitis, encephalopathy or acute kidney injury (p=0.26, 0.81 and 0.27 respectively). There were two deaths, and one liver transplant over the 21-year period. Treatment significantly changed over time with progressive increase in N-acetylcysteine use from 47.4% to 81.1% (p=<0.0001) and progressive decline in charcoal use from 70.2% to 17.6% (p<0.0001) in intervals 1 to 4. Poison centre consultations significantly increased in time from 14.4% in interval 1 to 67.7% in interval 4 (p<0.0001).
CONCLUSION: We suggest that the apparent severity increase in adolescent acetaminophen intoxication is related to the progressive increase in time to physician consultation with associated delays in treatment. The changes in management observed over the 21-year period is likely reflective of the evolution and availability of treatment protocols. Furthermore, the increase in poison centre consultations may account for part of the decrease in treatment variability across patients.
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Landoni G, Greco M, Francesca I, Taddeo D, Saleh O, Belletti A, Putzu A, Lembo R, Zangrillo A. Epidural analgesia reduces perioperative myocardial infarction and all-cause mortality after cardiac surgery: but at least 25 epidural hematomas have already happened. Crit Care 2014. [PMCID: PMC4070009 DOI: 10.1186/cc13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Waitzer E, Taddeo D, Brault D, Berube M. Promoting smoking cessation following cardiac surgery: A nurse-led initiative. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Taddeo D, Harvey J, Boutin A. Health hazards related to energy drinks: Are we looking for them? Paediatr Child Health 2013; 17:101. [PMID: 23372403 DOI: 10.1093/pch/17.2.101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2012] [Indexed: 11/14/2022] Open
Affiliation(s)
- Danielle Taddeo
- Department of Paediatrics, Sainte-Justine University Hospital Centre, Montréal
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Taddeo D, Boutin A, Harvey J, Frappier J. Energy Drinks in Children and Teenagers: A Cpsp Survey. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.10a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Taddeo D, Stanwick R. Interdire aux enfants et aux adolescents de moins de 18 ans l’accès aux établissements commerciaux de bronzage. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Abstract
Cutaneous malignant melanoma has increased more than three-fold in the past 35 years. Because damage is cumulative, exposure to ultraviolet radiation early in life elevates a risk that is increased further as individuals use artificial sources of ultraviolet radiation. The full impact and scope of damage caused by year-round indoor tanning may take years to appreciate given the long latency period for most skin cancers. Teenagers are frequent visitors to tanning parlours, with girls being more frequent and sustained users. The tanning industry disputes the World Health Organization's and the International Agency for Research on Cancer's classification of their product as a Class 1 physical carcinogen. Tanning parlours have sought to establish and maintain a client-base among teenagers. Consequently, the Canadian Paediatric Society is joining other prominent health organizations in support of a ban on the use of commercial tanning facilities by Canadian children and youth younger than 18 years of age.
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Findlay S, Pinzon J, Taddeo D, Katzman D. Family-based treatment of children and adolescents with anorexia nervosa: Guidelines for the community physician. Paediatr Child Health 2011; 15:31-40. [PMID: 21197168 DOI: 10.1093/pch/15.1.31] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Anorexia nervosa (AN) is a serious life-threatening illness that typically has its onset during the adolescent years. Evidence regarding the optimal treatment of AN in children and teenagers is growing; however, much remains unknown. Although current treatment approaches vary in Canada and elsewhere, the evidence to date indicates that family-based treatment (FBT) is the most effective treatment for children and teenagers with AN. A key component of the FBT model is that the parents are given the responsibility to return their child to physical health and ensure full weight restoration. An understanding of the basic principles and philosophy underlying FBT allows the physician to initiate elements of this evidence-based intervention to young patients with AN and their families.
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Affiliation(s)
- S Findlay
- Canadian Paediatric Society, Adolescent Health Committee
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Katzman D, Taddeo D. Emergency contraception. Paediatr Child Health 2010; 15:363-72. [PMID: 21731419 PMCID: PMC2921734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Emergency contraception (EC) is an effective way to prevent an unintended or unplanned pregnancy. EC is available in two forms in Canada: a progestin-only method and a combined hormonal method, also known as the Yuzpe regimen. EC has been proven to be most effective within 72 h and up to 120 h after unprotected sexual intercourse. To date, the progestin-only method is the preferred method of EC recommended to teens because it is known for higher efficacy and fewer side effects, and is, therefore, more widely accepted over the combined method. Teens should also be counselled that the progestin-only method is widely available without a doctor's prescription across Canada.
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Katzman DK, Taddeo D. La contraception d'urgence. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.6.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Findlay S, Pinzon J, Taddeo D, Katzman DK. Le traitement familial des enfants et des adolescents anorexiques : Des lignes directrices pour le médecin communautaire. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Health care professionals must be alert to the high prevalence of low adherence to treatment during adolescence. Low adherence increases morbidity and medical complications, contributes to poorer quality of life and an overuse of the health care system. Many different factors have an impact on adherence. However, critical factors to consider in teens are their developmental stage and challenges, emotional issues and family dysfunction. Direct and indirect methods have been described to assess adherence. Eliciting an adherence history is the most useful way for clinicians to evaluate adherence, and could be the beginning of a constructive dialogue with the adolescent. Interventions to improve adherence are multiple - managing mental health issues appropriately, building a strong relationship, customizing the treatment regimen if possible, empowering the adolescent to deal with adherence issues, providing information, ensuring family and peer support, and motivational enhancement therapy. Evaluation of adherence at regular intervals should be an important aspect of health care for adolescents.
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Affiliation(s)
- Danielle Taddeo
- Adolescent Medicine Division, Sainte-Justine UHC, University of Montreal, Montreal
| | - Maud Egedy
- Adolescent Medicine, Quebec City, Quebec
| | - Jean-Yves Frappier
- Adolescent Medicine Division, Sainte-Justine UHC, University of Montreal, Montreal
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31
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Buselli R, Galli G, Cristaudo A, Franco F, Possemato A, Ansuini R, Taddeo D, Battaglia S, Roselli MG, Leoni MG, Reali A, Parducci D, Degaetano R, Fani F, Boccuzzi MT, Cassitto MG. [Risk assessment method for psychosocial factors at workplace: a North-West Tuscany area project]. G Ital Med Lav Ergon 2007; 29:360-362. [PMID: 18409725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The rising awareness of psychosocial risks at workplace means that it is ever more important to prepare methods to assess psychosocial factors in occupational environment. This project of north west tuscany area has the aim to realize an instrument for a gradual risk assessment for this kind of factors without the support of specialists. A decisional flow chart helps to approach the risk assessment step by step on the basis of company features, management and organization problems and company symptoms of stress. The final assessment combines the evaluation of perceived risks with job analysis realizing a matrix containing 5 risk levels, which suggests the priority of preventive measures. The intermediate level (level three) represents the activation level for the medical surveillance. This experience means a proposal for a quantitative assessment of psychosocial risks at workplace.
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Bottai M, Cini A, Talini D, Dini F, Berti S, Vincentini M, Cosentino E, Taddeo D. [Silica risk in construction industry: an investigation on raw materials]. G Ital Med Lav Ergon 2007; 29:738-739. [PMID: 18409933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Typical construction activities like demolition, excavation and sanding can expose workers to silica, but there are few investigations carried out with the aim of evaluating the silica content in raw materials used for these activities (mortars, plasters, cement...). Our intervention has been directed in looking for free crystalline silica in samples of raw materials. We have measured the silica content in these materials comparing declared and real composition found in the products. Our intent was to obtain more information about the working activities which expose workers to free crystalline silica in construction industry and to highlight the silica presence in raw materials also when the companies don't declare it, against labeling rules based on Italian law D.lgs 65/03.
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Affiliation(s)
- M Bottai
- UF. PSLL, Dipartimento della Prevenzione, ASL 5 di Pisa
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Taddeo D, Di Giammarco AM. [Occupational doctors in the public prevention services and qualified occupational doctors: their roles and forms of collaboration]. G Ital Med Lav Ergon 2006; 28:281-5. [PMID: 17144419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The occupational docters in public prevention and control services and the qualified occupational doctors who carry out functions of specialized doctors for enterprises, as well as operating according to their individual professional skills, are all part of the polydisciplinary system of collaboration that, while differing in methods, organizations and planning of their activities, have a shared aim: the safeguarding of the health and safety of the workers. The two systems have a mutual obligation to give information, foreseen also by several norms, that require common codes for evaluation and interpretation when exchanging communications, also for going beyond the simple conflictual relationship of "controller" and "controlled". In fact a shared commitment is necessary nowadays to face the lesser known and investigated risks and diseases, to promote the roles and rights of the workers, their representatives and also the employers of the micro-enterprises.
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Affiliation(s)
- D Taddeo
- UF PSLL ASL5 Pisa Presidente SNOP Società Nazionale Operatori della Prevenzione, Pontedera, Pisa, Italy
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Taddeo D. Point of view of Occupational Health Prevention Units. Med Lav 2006; 97:458-62. [PMID: 17009681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The regulations pertaining to the obligation of continuation of health surveillance of workers formerly exposed to asbestos are also examined from the point of view of clinical epidemiological usefulness. The outcomes of some types of campaigns of health surveillance of formerly exposed workers organized by the SSN (National Health Service) are also examined.
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Affiliation(s)
- D Taddeo
- National Association of Prevention Operating Technicians, Tuscany, Valdera
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Gauthier M, Chevalier I, Sterescu A, Bergeron S, Brunet S, Taddeo D. Treatment of urinary tract infections among febrile young children with daily intravenous antibiotic therapy at a day treatment center. Pediatrics 2004; 114:e469-76. [PMID: 15466073 DOI: 10.1542/peds.2004-0421] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Urinary tract infections (UTIs) are common among infants and toddlers. Children can be treated effectively with short courses (2-4 days) of intravenous (IV) therapy followed by oral therapy. If IV therapy is chosen, use of once-daily dosing may allow outpatient management instead of hospital admission. However, no description of ambulatory treatment with IV antibiotics of UTI among febrile children has been reported to date. We aimed to describe the feasibility and complications of outpatient management with IV antibiotics of UTI among febrile children, at the day treatment center (DTC) of a tertiary-care pediatric hospital. METHODS Between April 1, 2002, and March 31, 2003, a prospective cohort of patients 3 months to 5 years of age who were examined in the emergency department (ED) and diagnosed as having presumed febrile UTI were treated according to a clinical protocol. Patients were treated at the DTC unless they met exclusion criteria, in which case they were hospitalized. The DTC was open 7 days per week, including holidays, from 8:30 am to 4:30 pm. At the DTC, patients were initially treated with a daily dose of IV gentamicin, until the child had been afebrile for at least 24 hours, and with oral amoxicillin, until preliminary urine culture results were available. Children allergic to penicillin received gentamicin only. IV antibiotics were administered through peripheral IV access; the IV catheter's patency was maintained with injection of 50 U of heparin once daily throughout the treatment period. Parental satisfaction with the DTC experience was assessed with an anonymous, self-administered questionnaire. RESULTS Two hundred ninety-one episodes of presumed febrile UTI were diagnosed in the ED, of which 212 (72.9%) were sent to the DTC. There were 71 hospital admissions (24.4%); in 9 of these instances, the child was admitted because parents refused or were unable to comply with DTC treatment. Adherence to the treatment protocol in the ED was excellent; in 92.1% of presumed febrile UTI episodes (268 of 291 episodes), the patient was referred to the appropriate setting for treatment. In 8 instances, patients who met an exclusion criterion were sent to the DTC. They should have been hospitalized, according to the protocol. At the DTC, a final diagnosis of UTI was made in 178 of the 212 episodes (84%). Patients treated at the DTC, with a final diagnosis of UTI, had a median age of 12.0 months (range: 3-68 months), and their mean initial temperature was 39.2 degrees C (SD: 1.1 degrees C). Patients were afebrile by 24 hours in 52% of UTI episodes and by 48 hours in 82%. Minor problems with IV access occurred in 9.0% of cases. The duration of IV antibiotic therapy at the DTC was 1.9 days (SD: 0.9 day). The mean number of visits to the DTC, including appointments for renal ultrasound and voiding cystourethrography evaluations, was 3.5 (SD: 0.9). Parents were present at all scheduled visits in 98.9% of cases. Four patients needed to be hospitalized from the DTC, but in only 1 case was hospital admission related to UTI treatment. Four patients with UTI treated in the DTC had positive blood cultures, 2 with Escherichia coli (both successfully treated at the DTC) and 2 with contaminants. For 4 children treated at the DTC, UTI was caused by gentamicin-resistant E coli. One patient became afebrile within 24 hours after treatment initiation with IV gentamicin; he was then treated with oral cefixime. A second patient was treated with IV ceftriaxone, administered at the DTC once culture results were available, and remained febrile for <72 hours. The last 2 patients were hospitalized; one, who was also allergic to cephalosporins, had been febrile for 72 hours at the time of hospitalization (once hospitalized, he was treated with IV amikacin), and the other was admitted to the hospital for an unrelated problem, namely, scalp cellulitis. None of these 4 patients was initially bacteremic or became bacteremic during the treatment period. Repeat urine culture was performed within 14 days after treatment initiation in 146 instances, and results were negative in all cases. At telephone follow-up assessments 14 days after discharge, no patient had been rehospitalized because of UTI. Successful treatment at the DTC (defined as attendance at all visits, normalization of temperature within 96 hours, negative control urine cultures, if performed, and absence of hospitalization from the DTC) was observed in 96.6% of the 178 UTI episodes. Overall adherence of physicians to the protocol at the DTC was 87.1% (95% confidence interval: 82.2-92.0%). One hundred seventy-two satisfaction questionnaires were returned and revealed good, very good, or excellent parental satisfaction in 98.8% of cases. CONCLUSIONS Our data show that ambulatory treatment with IV antibiotics, at a DTC, may be used for at least three-fourths of UTIs among febrile children 3 months to 5 years of age. It is safe and feasible and appears very satisfactory to parents. Although ambulatory treatment with IV antibiotics is more invasive than oral therapy during the initiation of UTI treatment, it ensures almost full compliance, allows close medical supervision, and facilitates investigations related to the UTI. It is an interesting alternative to hospitalization.
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Affiliation(s)
- Marie Gauthier
- Department of Pediatrics, Hôpital Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, Canada H3T 1C5.
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Aznar FJ, Cappozzo HL, Taddeo D, Montero FE, Raga JA. Recruitment, population structure, and habitat selection of Corynosoma australe (Acanthocephala) in South American fur seals, Arctocephalus australis, from Uruguay. CAN J ZOOL 2004. [DOI: 10.1139/z04-044] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We analysed recruitment, population structure, and intestinal distribution of Corynosoma australe Johnston, 1937 in 27 South American fur seals, Arctocephalus australis (Zimmerman, 1783), collected in two Uruguayan localities during 1990 and 1991. Only heavy infections of C. australe were found in all intestines. High transmission rates might result from the massive concentration of fur seals in the study area and the ecological ubiquity of C. australe. Intestinal length (IL) accounted, through a cubic relationship, for most of the variation (74%) in parasite intensity. IL3 also predicted the percentage of juvenile females among hosts (an indicator of recruitment rate) better than intensity or host body size. Intestinal size might be a suitable surrogate of host metabolic rate, the potential factor influencing intensity. The percentages of females and gravid females significantly increased along the intestine, and the distribution of juvenile females, gravid females, and males significantly covaried after controlling for intensity effects. These patterns suggest that worms migrate towards the lower jejunum and ileum while they mature, copulate, and reproduce. Males and gravid females shifted their distribution anteriad, and gravid females expanded their distribution, with intensity. These patterns might result from recruitment dynamics, intraspecific competition, or both. We do not know why males, gravid females, and juvenile females respond differently to these factors.
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Sterescu A, Gauthier M, Chevalier I, Bergeron S, Brunet S, Taddeo D. Treatment of Febrile Urinary Tract Infections (Uti) in Young Children With Intravenous Antibiotics in a Day Treatment Center. Paediatr Child Health 2003. [DOI: 10.1093/pch/8.suppl_b.43b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Paggiaro PL, Loi AM, Toma G, Pagano G, Serretti N, Taddeo D. [Immunological aspects of respiratory pathology due to isocyanates]. Med Lav 1979; 70:97-104. [PMID: 470818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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