This study examined 135 males treated for eating disorders between 1980-1994 at Massachusetts General Hospital. The most common diagnoses were bulimia nervosa (46%), eating disorder not otherwise specified (32%), and anorexia nervosa (22%). There were differences between groups in sexual orientation and weight histories. Bulimic patients were more likely to be homosexual/bisexual and report a history of obesity. Many patients had comorbid psychiatric disorders like depression. The study provides insight into the characteristics and clinical course of eating disorders in males.
This curriculum vitae summarizes the professional experience and qualifications of Sally Elizabeth Jensen, Ph.D. It outlines her educational background, including a Ph.D. in Clinical Psychology from the University of Florida. Her areas of specialization include clinical health psychology, surgical outcomes, transplant, and psycho-oncology. She is currently a Research Assistant Professor at Northwestern University Feinberg School of Medicine.
This curriculum vitae summarizes the career and qualifications of Dr. David S. Baskin. It details his education, including degrees from Swarthmore College and Mt. Sinai School of Medicine. It outlines his medical training and licensure, as well as his extensive faculty positions at institutions including Baylor College of Medicine, University of Houston, and Weill Cornell Medical College. The CV also lists numerous honors, awards, visiting professorships, committee memberships, and roles in medical societies that demonstrate his expertise and leadership in neurosurgery over several decades.
Theodore Shively's curriculum vitae summarizes his clinical and teaching experience. He has over 30 years of experience as a family practice physician and currently works at PrimeCare of Novi. He also has extensive experience teaching as a clinical professor and residency program director. His objective is to use his skills and talents for the betterment of others through clinical work, teaching, research, and leadership.
History taking a complete guide for all systems (clinical history & examinati...Updesh Yadav
This document provides guidance for medical students on taking clinical histories and performing physical examinations. It outlines the key components of a thorough history, including the presenting complaint, history of present illness, past medical history, family history, and social history. It then describes the steps of a full physical examination, with sections focused on examining each body system. The document aims to equip students with the skills needed to properly evaluate patients and identify signs and symptoms that may indicate underlying medical conditions.
Maggie Beerley Toner has over 15 years of experience as a registered nurse and family nurse practitioner. She received her MSN from UCLA School of Nursing in 2010 and her BSN from University of Pennsylvania School of Nursing in 2002. Her professional experience includes working as a nurse practitioner at UCLA Kidney and Pancreas Transplant from 2010-2012 where she evaluated and treated adult transplant patients. She has also worked as a critical care nurse through various contract positions in Los Angeles hospitals. She is certified as a family nurse practitioner and maintains memberships in professional organizations.
This document provides the education, experience, honors, professional affiliations, certifications, and references of Dr. Marirose F. Cutillar. It details her medical education and residencies in anesthesia, internal medicine, and geriatrics fellowship. Her experience includes working as a geriatrician, primary care physician, and instructor. She has been board certified in family medicine and geriatrics and licensed to practice in Nevada. References are provided from her time working in geriatrics in Florida.
Dr. Anil Potti is an extensively experienced and popular clinician who takes care of patients suffering from cancer. He studied at the Christian Medical College & Hospital Vellore, India and received his M.B.B.S. (Bachelor of Medicine & Surgery) degree in 1995.
Este documento describe los pasos que Marina Macías seguirá para realizar su actividad de evaluación de ALFIN sobre la prevención de los desórdenes alimenticios en adolescentes. Primero, ella define su tema y estrategia de búsqueda. Luego, exportará los 10 artículos más citados de la base de datos Scopus a Mendeley Deskopt. Finalmente, generará la bibliografía de los artículos en formato Vancouver copiándola desde Mendeley a un documento de Word.
This curriculum vitae summarizes the professional experience and qualifications of Sally Elizabeth Jensen, Ph.D. It outlines her educational background, including a Ph.D. in Clinical Psychology from the University of Florida. Her areas of specialization include clinical health psychology, surgical outcomes, transplant, and psycho-oncology. She is currently a Research Assistant Professor at Northwestern University Feinberg School of Medicine.
This curriculum vitae summarizes the career and qualifications of Dr. David S. Baskin. It details his education, including degrees from Swarthmore College and Mt. Sinai School of Medicine. It outlines his medical training and licensure, as well as his extensive faculty positions at institutions including Baylor College of Medicine, University of Houston, and Weill Cornell Medical College. The CV also lists numerous honors, awards, visiting professorships, committee memberships, and roles in medical societies that demonstrate his expertise and leadership in neurosurgery over several decades.
Theodore Shively's curriculum vitae summarizes his clinical and teaching experience. He has over 30 years of experience as a family practice physician and currently works at PrimeCare of Novi. He also has extensive experience teaching as a clinical professor and residency program director. His objective is to use his skills and talents for the betterment of others through clinical work, teaching, research, and leadership.
History taking a complete guide for all systems (clinical history & examinati...Updesh Yadav
This document provides guidance for medical students on taking clinical histories and performing physical examinations. It outlines the key components of a thorough history, including the presenting complaint, history of present illness, past medical history, family history, and social history. It then describes the steps of a full physical examination, with sections focused on examining each body system. The document aims to equip students with the skills needed to properly evaluate patients and identify signs and symptoms that may indicate underlying medical conditions.
Maggie Beerley Toner has over 15 years of experience as a registered nurse and family nurse practitioner. She received her MSN from UCLA School of Nursing in 2010 and her BSN from University of Pennsylvania School of Nursing in 2002. Her professional experience includes working as a nurse practitioner at UCLA Kidney and Pancreas Transplant from 2010-2012 where she evaluated and treated adult transplant patients. She has also worked as a critical care nurse through various contract positions in Los Angeles hospitals. She is certified as a family nurse practitioner and maintains memberships in professional organizations.
This document provides the education, experience, honors, professional affiliations, certifications, and references of Dr. Marirose F. Cutillar. It details her medical education and residencies in anesthesia, internal medicine, and geriatrics fellowship. Her experience includes working as a geriatrician, primary care physician, and instructor. She has been board certified in family medicine and geriatrics and licensed to practice in Nevada. References are provided from her time working in geriatrics in Florida.
Dr. Anil Potti is an extensively experienced and popular clinician who takes care of patients suffering from cancer. He studied at the Christian Medical College & Hospital Vellore, India and received his M.B.B.S. (Bachelor of Medicine & Surgery) degree in 1995.
Este documento describe los pasos que Marina Macías seguirá para realizar su actividad de evaluación de ALFIN sobre la prevención de los desórdenes alimenticios en adolescentes. Primero, ella define su tema y estrategia de búsqueda. Luego, exportará los 10 artículos más citados de la base de datos Scopus a Mendeley Deskopt. Finalmente, generará la bibliografía de los artículos en formato Vancouver copiándola desde Mendeley a un documento de Word.
Este documento describe los pasos para realizar una búsqueda en la base de datos PubMed sobre la prevención de la obesidad y el sobrepeso en niños y adolescentes. Primero, se seleccionan los conceptos clave y se traducen al inglés utilizando el tesauro DeCS. Luego, se genera una estrategia de búsqueda utilizando operadores booleanos. Finalmente, se realiza la búsqueda en PubMed aplicando filtros como fecha, idioma y tipo de artículo.
[Pdf] How to invest in Philippines Real Estate by dj dimaliuatDJ Dimaliuat, CIS
This document summarizes DJ Dimaliuat's career in real estate entrepreneurship and financial literacy. It discusses how he helped create 65 new millionaires in sales and his mission to spread financial education. Key advice provided includes only investing in real estate with positive cash flow from a business, choosing properties that offer steady income greater than expenses, and starting a business or sales career if the goal is financial freedom and passive real estate income.
Xin Kính Chào Quý Khách!
Công ty Cổ Phần Vách Ngăn Di Động Việt Nam là đơn vị chuyên hoạt động trong lĩnh vực Thiết Kế, Thi Công, Sản Xuất, Thi Công và Nhập Khẩu các loại Vách Ngăn Di Động Gỗ, Vách Ngăn Di Động Kính, Vách Ngăn Di Động Nhập Khẩu Cao Cấp của các hãng nổi tiếng như : Dorma, Hufcor, Parthos,…….
Cung cấp giải pháp vách ngăn di động toàn diện cho các công trình : nhà hàng, văn phòng, khách sạn, trung tâm thương mại, tổ chức sự kiện, tiệc cưới, ………
Nhằm mang đến cho Quý khách hàng sản phẩm chất lượng nhất với giá thành tốt nhất chúng tôi luôn không ngừng học hỏi, đầu tư máy móc trang thiết bị hiện đại phục vụ cho công việc sản xuất, thi công giảm thiểu sức lao động, thời gian và chi phí.
Cung cấp vách ngăn di động tại tất cả các tỉnh thành Việt Nam với mọi số lượng. Đặt hàng nhanh chóng, thi công chuyên nghiệp.
Un accidente de trabajo es un evento inesperado que le causa lesiones, perturbaciones o invalidez a un trabajador, y puede ocurrir durante el transporte o actividades organizadas por la empresa. Las causas de los accidentes pueden ser factores básicos como la capacitación o factores de trabajo como la falta de supervisión, y causas inmediatas como actos o condiciones inseguras. Para prevenir accidentes, los empleadores deben asegurar capacitación adecuada, equipos y lugares de trabajo seguros, y uso de equipo de protección.
Este documento presenta información sobre circuitos eléctricos y energía. Explica las partes de un circuito eléctrico como generadores, conductores, receptores, elementos de control y protección. También describe cortocircuitos, clases de circuitos, y el impacto de la energía en el medio ambiente y la vida humana. El documento concluye que se investigaron los diferentes aspectos de los circuitos eléctricos y la influencia de la energía.
This document provides information about the Sichuan province of China. It includes pictures of geographical features found in Sichuan such as mountains, valleys, and waterfalls. It also includes a map of Sichuan and questions about the places of interest, history, food, and nature found there. Specifically, it mentions the Himalaya mountains to the west, carved lions outside palaces, and beautiful scenery and lakes at Jiuzhaigou Valley. It notes that Chengdu is the capital and that Sichuanese cooking uses a lot of chili peppers and garlic. It also provides vocabulary about comparing adjectives and asks questions about visiting Sichuan.
El documento describe el universo y su origen según la ciencia actual. Explica que el universo contiene toda la materia, energía, espacio y tiempo, y se rige por leyes físicas constantes. La teoría más aceptada sobre su formación es el modelo del Big Bang, que propone que el universo surgió de una singularidad hace 13,800 millones de años y desde entonces se ha estado expandiendo.
This document provides information about consultancy in Nepal, including defining consultancy, an overview of educational consulting, and how to become a consultant. It defines a consultant as a professional who provides expert advice in a specialized field. There are estimated to be 1,500-3,000 educational consultants in the US who help students and families with education programs and stay up to date on market changes. Consultants can be internal, working within an organization, or external, working independently for clients. The document advises establishing expertise over time by sharing ideas online, finding a passionate area of specialization, and focusing on enjoyment rather than immediate monetization.
Este documento discute cómo la inteligencia artificial se aplica a la robótica. Explica que la IA da vida a los robots creados para diferentes fines al proporcionarles sistemas inteligentes. Detalla la evolución de la IA en la robótica desde los manipuladores de la década de 1950 hasta los robots inteligentes autónomos de hoy. Concluye que la IA se aplica a la robótica al agregarle la capacidad de pensar y comportarse como seres vivos, lo que hace que los robots se conviertan en máquinas inteligentes.
Este documento describe el proceso de potabilización del agua. Explica que el proceso consiste en varias etapas como la captación del agua, canalización, floculación, decantación, filtración, cloración y distribución. También describe los tipos de tratamiento del agua según los contaminantes a eliminar y los parámetros de calidad del agua. Finalmente, explica los diferentes grados de tratamiento del agua tipo A1, A2 y A3.
Stephen Krashen developed the Natural Approach method of language teaching in the late 1970s. The Natural Approach aims to foster naturalistic language acquisition in the classroom by emphasizing communication over explicit grammar study and correction. It also strives to create a low-anxiety environment by not forcing language output and allowing students time to absorb language through comprehensible input. Key principles of the Natural Approach include the acquisition-learning hypothesis, the monitor hypothesis, the input hypothesis, the natural order hypothesis, and the affective filter hypothesis. Krashen believes that language acquisition occurs most effectively through meaningful communication and comprehension, not through direct instruction.
The 25 Most Beautiful Places on the PlanetRayna Tours
The world has a whole lot of jaw-dropping places. But have you ever thought of them all at the same time? We decided to bring you with the list of 25 most insanely beautiful places in the world.
The document announces several upcoming opportunities and deadlines for students. It notes that the US Naval Academy is accepting applications for its Summer Seminar program until that day and that the University of Hawaii Manoa is accepting admission applications until the next day. It also advertises an upcoming national college fair with over 200 colleges in attendance and two scholarship opportunities with April 21st deadlines. Various clubs are noted to be meeting that day and information is provided about tryouts for cheerleading and an FBI project taking place that week.
El documento habla sobre el arte del dibujo. Explica que el dibujo es la representación de algo mediante herramientas como lápices. Describe diferentes tipos de dibujo como el dibujo artístico y técnico. También presenta técnicas de dibujo y materiales utilizados. Finalmente, incluye los resultados de una encuesta sobre preferencias en el dibujo.
Prescription opioid use among adults with mental health disorders in the US.Paul Coelho, MD
This study analyzed nationally representative health survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other health factors.
Prescription Opioid Use Among Adults with Mental Health Disorders in the USPaul Coelho, MD
This study used nationally representative survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder, such as depression or anxiety, was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other factors.
O Biostatistics is the application of statistics to biological and medical data. It plays an integral role in modern medicine by analyzing data to determine treatment efficacy and develop clinical trials. A landmark study in biostatistics was the Framingham Heart Study, which through longitudinal data collection and analysis identified major risk factors for cardiovascular disease and influenced our current understanding of heart disease as a leading cause of death. Biostatistics obtains, analyzes, and interprets quantitative medical data to further human health.
An Epidemiologic Study of Gilles de la Tourette's Syndrome in IsraelAlfred Cohen
This study aimed to estimate the lifetime prevalence of Gilles de la Tourette's syndrome (GTS) in adolescents aged 16-17 in Israel. Over 28,000 adolescents were screened using a 4-item questionnaire followed by examination by a psychiatrist. 12 individuals met diagnostic criteria for GTS, yielding a point prevalence of 4.3 per 10,000. Rates of obsessive-compulsive disorder (OCD) were higher in those with GTS (41.7%) compared to the general population (3.4%), but rates of attention deficit hyperactivity disorder were similar. This study provides prevalence estimates for GTS in line with previous studies and highlights the high comorbidity between GTS and OCD.
Hospital Care for Mental Health and Substance Abuse ConditionsLizbethQuinonez813
Hospital Care for Mental Health and Substance Abuse Conditions in
Parkinson’s Disease
Allison. W. Willis, MD, MSCI,1,2,3,4* Dylan P. Thibault, MS,1 Peter N. Schmidt, PhD,5 E. Ray Dorsey, MD, MBA,6 and
Daniel Weintraub, MD1,7,8
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
2
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
3
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
5
National Parkinson’s Foundation, Miami, Florida, USA
6Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
7
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
8
Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia,
Pennsylvania, USA
A B S T R A C T : O b j e c t i v e : The objective of this
study was to examine mental health conditions among
hospitalized individuals with Parkinson’s disease in the
United States.
M e t h o d s : This was a serial cross-sectional study of
hospitalizations of individuals aged �60 identified in the
Nationwide Inpatient Sample dataset from 2000 to
2010. We identified all hospitalizations with a diagnosis
of PD, alcohol abuse, anxiety, bipolar disorder, depres-
sion, impulse control disorders, mania, psychosis, sub-
stance abuse, and attempted suicide/suicidal ideation.
National estimates of each mental health condition
were compared between hospitalized individuals with
and without PD. Hierarchical logistic regression models
determined which inpatient mental health diagnoses
were associated with PD, adjusting for demographic,
payer, geographic, and hospital characteristics.
R e s u l t s : We identified 3,918,703 mental health and sub-
stance abuse hospitalizations. Of these, 2.8% (n 5 104,
437) involved a person also diagnosed with PD. The major-
ity of mental health and substance abuse patients were
white (86.9% of PD vs 83.3% of non-PD). Women were
more common than men in both groups (male:female
prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-
0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34),
psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar
disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse
control disorders (adjusted odds ratio 1.51, 1.31-1.75),
and mania (adjusted odds ratio 1.43, 1.18-1.74) were more
likely among PD patients, alcohol abuse was less likely
(adjusted odds ratio 0.26, 0.25-0.27). We found no PD-
associated difference in suicide-related care.
C o n c l u s i o n s : PD patients have unique patterns of
acute care for mental health and substance abuse.
Research is needed to guide PD treatment in individuals
with ...
Rates and Predictors of Suicidal Ideation During the FirstYe.docxaudeleypearl
Rates and Predictors of Suicidal Ideation During the First
Year After Traumatic Brain Injury
Jessica L. Mackelprang, PhD, Charles H. Bombardier, PhD, Jesse R. Fann, MD, MPH, Nancy R. Temkin, PhD,
Jason K. Barber, MS, and Sureyya S. Dikmen, PhD
Suicide is a major public health problem among
the 1.7 million people who sustain traumatic
brain injury (TBI) each year in the United
States.1 People with a history of TBI in both
civilian and military populations are 1.55 to
4.05 times more likely to die by suicide than
the general population.2---5 In a study of
Australian outpatients with a history of TBI,
the majority of whom had no preinjury history
of suicide attempts, suicide attempts were
reported by 17.4% (30 of 172) of the sample
over a 5-year period.6 Nearly half of the
individuals who attempted suicide had made
multiple attempts.6,7 The Centers for Disease
Control and Prevention recently called for
investigations of individual-level risk and
protective factors for self-directed violence
among people with TBI as an important com-
ponent of improving long-term outcomes.8
Rates of suicidal ideation (SI) after TBI
have been found to exceed 20% in some
studies6,9---14; however, in a recent systematic
review of SI and behavior after TBI, Bahraini
et al. highlighted the paucity of research in
this area.15 They concluded that additional
research is needed to determine the prevalence
of SI and behavior after brain injury, as well as
to ascertain patient-level factors that may be
associated with increased suicide risk. Studies
examining whether injury severity predicts
post-TBI suicidality have yielded inconclusive
findings.6,13,16,17 In perhaps the most thorough
study on this topic to date, Tsaousides et al.12
surveyed 356 community-dwelling adults with
a self-reported history of TBI and found that
preinjury substance abuse was the only corre-
late of current SI. Risk factors for SI after TBI
have been underinvestigated. Research in this
area has been limited by reliance on retro-
spective reporting and self-reported history of
TBI,12,18---20 with only a few studies including
objective indicators of TBI severity.6 Most
studies have involved cross-sectional designs
and have included participants whose time
since injury varied from several months to
many years.12,21 Finally, because most existing
studies have included relatively small, poten-
tially biased samples21 recruited from outpa-
tient clinics or TBI survivor programs,6,7,12 they
may not be representative of the population of
people who sustain TBI.
Given these gaps in the existing literature,
our objectives were (1) to investigate rates of SI
during the first year after complicated mild to
severe TBI in a representative sample of adults
who had been admitted to a level I trauma
center and (2) to investigate whether demo-
graphic characteristics, preinjury psychiatric
history, or injury-related factors predicted SI.
METHODS
This study was part of the recruitment phase
of a clinical trial ...
Este documento describe los pasos para realizar una búsqueda en la base de datos PubMed sobre la prevención de la obesidad y el sobrepeso en niños y adolescentes. Primero, se seleccionan los conceptos clave y se traducen al inglés utilizando el tesauro DeCS. Luego, se genera una estrategia de búsqueda utilizando operadores booleanos. Finalmente, se realiza la búsqueda en PubMed aplicando filtros como fecha, idioma y tipo de artículo.
[Pdf] How to invest in Philippines Real Estate by dj dimaliuatDJ Dimaliuat, CIS
This document summarizes DJ Dimaliuat's career in real estate entrepreneurship and financial literacy. It discusses how he helped create 65 new millionaires in sales and his mission to spread financial education. Key advice provided includes only investing in real estate with positive cash flow from a business, choosing properties that offer steady income greater than expenses, and starting a business or sales career if the goal is financial freedom and passive real estate income.
Xin Kính Chào Quý Khách!
Công ty Cổ Phần Vách Ngăn Di Động Việt Nam là đơn vị chuyên hoạt động trong lĩnh vực Thiết Kế, Thi Công, Sản Xuất, Thi Công và Nhập Khẩu các loại Vách Ngăn Di Động Gỗ, Vách Ngăn Di Động Kính, Vách Ngăn Di Động Nhập Khẩu Cao Cấp của các hãng nổi tiếng như : Dorma, Hufcor, Parthos,…….
Cung cấp giải pháp vách ngăn di động toàn diện cho các công trình : nhà hàng, văn phòng, khách sạn, trung tâm thương mại, tổ chức sự kiện, tiệc cưới, ………
Nhằm mang đến cho Quý khách hàng sản phẩm chất lượng nhất với giá thành tốt nhất chúng tôi luôn không ngừng học hỏi, đầu tư máy móc trang thiết bị hiện đại phục vụ cho công việc sản xuất, thi công giảm thiểu sức lao động, thời gian và chi phí.
Cung cấp vách ngăn di động tại tất cả các tỉnh thành Việt Nam với mọi số lượng. Đặt hàng nhanh chóng, thi công chuyên nghiệp.
Un accidente de trabajo es un evento inesperado que le causa lesiones, perturbaciones o invalidez a un trabajador, y puede ocurrir durante el transporte o actividades organizadas por la empresa. Las causas de los accidentes pueden ser factores básicos como la capacitación o factores de trabajo como la falta de supervisión, y causas inmediatas como actos o condiciones inseguras. Para prevenir accidentes, los empleadores deben asegurar capacitación adecuada, equipos y lugares de trabajo seguros, y uso de equipo de protección.
Este documento presenta información sobre circuitos eléctricos y energía. Explica las partes de un circuito eléctrico como generadores, conductores, receptores, elementos de control y protección. También describe cortocircuitos, clases de circuitos, y el impacto de la energía en el medio ambiente y la vida humana. El documento concluye que se investigaron los diferentes aspectos de los circuitos eléctricos y la influencia de la energía.
This document provides information about the Sichuan province of China. It includes pictures of geographical features found in Sichuan such as mountains, valleys, and waterfalls. It also includes a map of Sichuan and questions about the places of interest, history, food, and nature found there. Specifically, it mentions the Himalaya mountains to the west, carved lions outside palaces, and beautiful scenery and lakes at Jiuzhaigou Valley. It notes that Chengdu is the capital and that Sichuanese cooking uses a lot of chili peppers and garlic. It also provides vocabulary about comparing adjectives and asks questions about visiting Sichuan.
El documento describe el universo y su origen según la ciencia actual. Explica que el universo contiene toda la materia, energía, espacio y tiempo, y se rige por leyes físicas constantes. La teoría más aceptada sobre su formación es el modelo del Big Bang, que propone que el universo surgió de una singularidad hace 13,800 millones de años y desde entonces se ha estado expandiendo.
This document provides information about consultancy in Nepal, including defining consultancy, an overview of educational consulting, and how to become a consultant. It defines a consultant as a professional who provides expert advice in a specialized field. There are estimated to be 1,500-3,000 educational consultants in the US who help students and families with education programs and stay up to date on market changes. Consultants can be internal, working within an organization, or external, working independently for clients. The document advises establishing expertise over time by sharing ideas online, finding a passionate area of specialization, and focusing on enjoyment rather than immediate monetization.
Este documento discute cómo la inteligencia artificial se aplica a la robótica. Explica que la IA da vida a los robots creados para diferentes fines al proporcionarles sistemas inteligentes. Detalla la evolución de la IA en la robótica desde los manipuladores de la década de 1950 hasta los robots inteligentes autónomos de hoy. Concluye que la IA se aplica a la robótica al agregarle la capacidad de pensar y comportarse como seres vivos, lo que hace que los robots se conviertan en máquinas inteligentes.
Este documento describe el proceso de potabilización del agua. Explica que el proceso consiste en varias etapas como la captación del agua, canalización, floculación, decantación, filtración, cloración y distribución. También describe los tipos de tratamiento del agua según los contaminantes a eliminar y los parámetros de calidad del agua. Finalmente, explica los diferentes grados de tratamiento del agua tipo A1, A2 y A3.
Stephen Krashen developed the Natural Approach method of language teaching in the late 1970s. The Natural Approach aims to foster naturalistic language acquisition in the classroom by emphasizing communication over explicit grammar study and correction. It also strives to create a low-anxiety environment by not forcing language output and allowing students time to absorb language through comprehensible input. Key principles of the Natural Approach include the acquisition-learning hypothesis, the monitor hypothesis, the input hypothesis, the natural order hypothesis, and the affective filter hypothesis. Krashen believes that language acquisition occurs most effectively through meaningful communication and comprehension, not through direct instruction.
The 25 Most Beautiful Places on the PlanetRayna Tours
The world has a whole lot of jaw-dropping places. But have you ever thought of them all at the same time? We decided to bring you with the list of 25 most insanely beautiful places in the world.
The document announces several upcoming opportunities and deadlines for students. It notes that the US Naval Academy is accepting applications for its Summer Seminar program until that day and that the University of Hawaii Manoa is accepting admission applications until the next day. It also advertises an upcoming national college fair with over 200 colleges in attendance and two scholarship opportunities with April 21st deadlines. Various clubs are noted to be meeting that day and information is provided about tryouts for cheerleading and an FBI project taking place that week.
El documento habla sobre el arte del dibujo. Explica que el dibujo es la representación de algo mediante herramientas como lápices. Describe diferentes tipos de dibujo como el dibujo artístico y técnico. También presenta técnicas de dibujo y materiales utilizados. Finalmente, incluye los resultados de una encuesta sobre preferencias en el dibujo.
Prescription opioid use among adults with mental health disorders in the US.Paul Coelho, MD
This study analyzed nationally representative health survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other health factors.
Prescription Opioid Use Among Adults with Mental Health Disorders in the USPaul Coelho, MD
This study used nationally representative survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder, such as depression or anxiety, was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other factors.
O Biostatistics is the application of statistics to biological and medical data. It plays an integral role in modern medicine by analyzing data to determine treatment efficacy and develop clinical trials. A landmark study in biostatistics was the Framingham Heart Study, which through longitudinal data collection and analysis identified major risk factors for cardiovascular disease and influenced our current understanding of heart disease as a leading cause of death. Biostatistics obtains, analyzes, and interprets quantitative medical data to further human health.
An Epidemiologic Study of Gilles de la Tourette's Syndrome in IsraelAlfred Cohen
This study aimed to estimate the lifetime prevalence of Gilles de la Tourette's syndrome (GTS) in adolescents aged 16-17 in Israel. Over 28,000 adolescents were screened using a 4-item questionnaire followed by examination by a psychiatrist. 12 individuals met diagnostic criteria for GTS, yielding a point prevalence of 4.3 per 10,000. Rates of obsessive-compulsive disorder (OCD) were higher in those with GTS (41.7%) compared to the general population (3.4%), but rates of attention deficit hyperactivity disorder were similar. This study provides prevalence estimates for GTS in line with previous studies and highlights the high comorbidity between GTS and OCD.
Hospital Care for Mental Health and Substance Abuse ConditionsLizbethQuinonez813
Hospital Care for Mental Health and Substance Abuse Conditions in
Parkinson’s Disease
Allison. W. Willis, MD, MSCI,1,2,3,4* Dylan P. Thibault, MS,1 Peter N. Schmidt, PhD,5 E. Ray Dorsey, MD, MBA,6 and
Daniel Weintraub, MD1,7,8
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
2
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
3
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
5
National Parkinson’s Foundation, Miami, Florida, USA
6Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
7
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
8
Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia,
Pennsylvania, USA
A B S T R A C T : O b j e c t i v e : The objective of this
study was to examine mental health conditions among
hospitalized individuals with Parkinson’s disease in the
United States.
M e t h o d s : This was a serial cross-sectional study of
hospitalizations of individuals aged �60 identified in the
Nationwide Inpatient Sample dataset from 2000 to
2010. We identified all hospitalizations with a diagnosis
of PD, alcohol abuse, anxiety, bipolar disorder, depres-
sion, impulse control disorders, mania, psychosis, sub-
stance abuse, and attempted suicide/suicidal ideation.
National estimates of each mental health condition
were compared between hospitalized individuals with
and without PD. Hierarchical logistic regression models
determined which inpatient mental health diagnoses
were associated with PD, adjusting for demographic,
payer, geographic, and hospital characteristics.
R e s u l t s : We identified 3,918,703 mental health and sub-
stance abuse hospitalizations. Of these, 2.8% (n 5 104,
437) involved a person also diagnosed with PD. The major-
ity of mental health and substance abuse patients were
white (86.9% of PD vs 83.3% of non-PD). Women were
more common than men in both groups (male:female
prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-
0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34),
psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar
disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse
control disorders (adjusted odds ratio 1.51, 1.31-1.75),
and mania (adjusted odds ratio 1.43, 1.18-1.74) were more
likely among PD patients, alcohol abuse was less likely
(adjusted odds ratio 0.26, 0.25-0.27). We found no PD-
associated difference in suicide-related care.
C o n c l u s i o n s : PD patients have unique patterns of
acute care for mental health and substance abuse.
Research is needed to guide PD treatment in individuals
with ...
Rates and Predictors of Suicidal Ideation During the FirstYe.docxaudeleypearl
Rates and Predictors of Suicidal Ideation During the First
Year After Traumatic Brain Injury
Jessica L. Mackelprang, PhD, Charles H. Bombardier, PhD, Jesse R. Fann, MD, MPH, Nancy R. Temkin, PhD,
Jason K. Barber, MS, and Sureyya S. Dikmen, PhD
Suicide is a major public health problem among
the 1.7 million people who sustain traumatic
brain injury (TBI) each year in the United
States.1 People with a history of TBI in both
civilian and military populations are 1.55 to
4.05 times more likely to die by suicide than
the general population.2---5 In a study of
Australian outpatients with a history of TBI,
the majority of whom had no preinjury history
of suicide attempts, suicide attempts were
reported by 17.4% (30 of 172) of the sample
over a 5-year period.6 Nearly half of the
individuals who attempted suicide had made
multiple attempts.6,7 The Centers for Disease
Control and Prevention recently called for
investigations of individual-level risk and
protective factors for self-directed violence
among people with TBI as an important com-
ponent of improving long-term outcomes.8
Rates of suicidal ideation (SI) after TBI
have been found to exceed 20% in some
studies6,9---14; however, in a recent systematic
review of SI and behavior after TBI, Bahraini
et al. highlighted the paucity of research in
this area.15 They concluded that additional
research is needed to determine the prevalence
of SI and behavior after brain injury, as well as
to ascertain patient-level factors that may be
associated with increased suicide risk. Studies
examining whether injury severity predicts
post-TBI suicidality have yielded inconclusive
findings.6,13,16,17 In perhaps the most thorough
study on this topic to date, Tsaousides et al.12
surveyed 356 community-dwelling adults with
a self-reported history of TBI and found that
preinjury substance abuse was the only corre-
late of current SI. Risk factors for SI after TBI
have been underinvestigated. Research in this
area has been limited by reliance on retro-
spective reporting and self-reported history of
TBI,12,18---20 with only a few studies including
objective indicators of TBI severity.6 Most
studies have involved cross-sectional designs
and have included participants whose time
since injury varied from several months to
many years.12,21 Finally, because most existing
studies have included relatively small, poten-
tially biased samples21 recruited from outpa-
tient clinics or TBI survivor programs,6,7,12 they
may not be representative of the population of
people who sustain TBI.
Given these gaps in the existing literature,
our objectives were (1) to investigate rates of SI
during the first year after complicated mild to
severe TBI in a representative sample of adults
who had been admitted to a level I trauma
center and (2) to investigate whether demo-
graphic characteristics, preinjury psychiatric
history, or injury-related factors predicted SI.
METHODS
This study was part of the recruitment phase
of a clinical trial ...
This study examined antidepressant use among 3,226 elderly patients receiving home healthcare. Over one-third of patients were taking antidepressants, including 29.15% without a documented depression diagnosis. Blacks used antidepressants less than whites even after controlling for other factors. Increased antidepressant use was associated with younger age, more disabilities, use of other psychotropics like benzodiazepines, and higher overall medication counts. The high rates of antidepressant use without depression raise questions about appropriate prescribing in this vulnerable population.
This document outlines the sixth version of the Standards of Care published by the Harry Benjamin International Gender Dysphoria Association for the treatment of gender identity disorders. It covers diagnostic concepts and nomenclature, treatment approaches for children and adults, and guidelines for hormone therapy and gender-affirming surgeries. The overarching treatment goal is helping individuals find lasting comfort with their gender identity to maximize well-being. Flexibility is emphasized to meet patients' unique needs within clinical guidelines.
The Mental Health of Federal Offenders A SummativeReview of.docxoreo10
The Mental Health of Federal Offenders: A Summative
Review of the Prevalence Literature*
Philip R. Magaletta,1 Pamela M. Diamond,2,5 Erik Dietz,3 and Stephen Jahnke4
To date, only a small number of government and peer-reviewed studies have examined the
mental health of federal offenders. Although these studies provide isolated bits of
information they have yet to be organized into a coherent body of knowledge from which
clinicians, administrators and policy makers can inform their work. As a first step in
constructing this knowledge and understanding the possible mental health needs of this
population (currently America’s largest correctional population), this paper delineates the
available government and peer-reviewed studies on federal offenders, highlights their
convergent findings, and suggests opportunities for growth in research, administration and
policy.
KEY WORDS: offenders; federal prisons; service utilization; diagnoses.
There is an increasing demand for effective,
empirically informed, prison-based mental health
services in America. It is a demand driven by the
needs of the offender population, the clinicians who
serve them, and the public’s expectation of
accountability. It is the product of multiple factors:
courts mandating that mentally ill persons receive
treatment while in custody; national mental health
screening and treatment standards being rigorously
applied; and increasingly porous boundaries be-
tween the mental health and criminal justice systems
(Fisher et al., 2002; Jemelka, Trupin, & Chiles,
1989). Furthermore, growth in the offender popu-
lation has remained mostly constant (Harrison &
Beck, 2005) and little debate remains that the
prevalence of mental illness in prison populations is
higher than that of the general population (Dia-
mond, Wang, Holzer, Thomas, & Cruser, 2001;
Jemelka et al., 1989). Finally, among community
mental health providers there is an increasing rec-
ognition that many patients have histories of crimi-
nality, incarceration, and prison-based mental health
treatment (Jemelka et al., 1989; Manderschied,
Gravesande, & Goldstrom, 2004; Morgan, Beer,
Fitzgerald, & Mandracchia, in press).
Far beyond the application of mental health
principles to those who ‘‘simply’’ happen to be
incarcerated, the provision of mental health services
in corrections remains a complex enterprise. It re-
quires strong clinicians, administrators who have a
keen and sensitive understanding of the multiple
systems comprising the correctional environment,
and policy makers who can draw upon an empirical
understanding of the population’s needs. To inform
the effective deployment of mental health resources
to this growing population it is imperative that this
*The views expressed in this paper are those of the authors (Philip
R. Magaletta and Erik Dietz) only and do not necessarily rep-
resent the policy or opinions of the Federal Bureau of Prisons,
the Department of Justice, or their academic affiliates.
1
Psycholo ...
Association between moderate intensity physical activity and inflammatory mar...José Hernández Soto
Background Moderate-intensity physical activity has been associated with a lower risk of chronic diseases such as breast cancer. Low-grade chronic inflammation is associated with metabolic disorders and cancer.
Purpose We evaluated the association between self-reported moderate-intensity physical activity and serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) in women with and without breast cancer.
Methods We studied a random subsample of 352 cases and 381 controls obtained from a large population based case-control study. An in-person interview, anthropometric measurements and blood samples were obtained. For the analyses, multiple linear regression models were used.
Results In controls, there was a negative association between moderate-intensity physical activity and serum levels of IL-6 and CRP (β = -0.0041, 95% CI -0.0079 to -0.0003; β = -0.0088, 95% CI -0.0172 to -0.0005, respectively); no association was found with serum TNF-α levels. In cases, no statistically significant associations were found.
Conclusions Engaging in moderate-intensity physical activity was independently associated with lower serum concentrations of IL-6 and CRP only in women without breast cancer. Prospective studies are required in order to understand in which moment this association is lost.
This study examined health insurance claims data from over 10 million patients who were prescribed opioids to evaluate how opioid receipt differed based on preexisting psychiatric conditions and medications. The study found that patients with a variety of psychiatric conditions and those prescribed various psychoactive medications were more likely to receive opioids, particularly long-term opioid therapy. The increased risk for long-term opioid therapy ranged from 1.5 times higher for those previously prescribed ADHD medications, to over 8 times higher for those with prior opioid use disorder diagnoses. The results provide evidence that commercially insured patients with psychiatric conditions receive opioids more than those without such conditions.
This study assessed resilience, depressed mood, and menopausal symptoms in 169 postmenopausal women aged 48-68 years. 45% of women had depressed mood and 35% had severe menopausal symptoms. Women with less resilience had higher depressed mood scores and more severe menopausal symptoms. Multiple regression identified two models: 1) Resilience scores correlated inversely with depressed mood and positively with regular exercise. 2) Depressed mood scores correlated positively with somatic and psychological menopausal symptom scores and inversely with resilience. This study suggests depressed mood and menopausal symptoms are associated with lower resilience in postmenopausal women, while exercise is linked to higher resilience.
The Framingham Heart Study is a long-running cardiovascular cohort study that began in 1948 with over 5,000 residents of Framingham, Massachusetts. It found that smoking, high cholesterol, high blood pressure, obesity, and other factors increase risk of cardiovascular disease. The Nurses' Health Study began in 1976 and includes over 120,000 female nurses who complete biennial questionnaires. It has investigated links between oral contraceptives, diet, lifestyle and disease risks like breast cancer. A second Nurses' Health Study began in 1989 with younger nurses to further study these relationships.
This document compares three regression methods - ordinary least squares (OLS), Poisson regression, and negative binomial regression - for analyzing count data from infrequently occurring health events. It uses data on adolescent pregnancies from the National Longitudinal Survey of Adolescent Health to illustrate the different approaches. OLS regression is found to be inappropriate for modeling count data that is highly skewed and clustered around low values. Poisson and negative binomial regression are identified as more suitable alternatives that do not assume a normal distribution of error terms or dependent variables. The strengths and limitations of each method are discussed to help researchers choose the most appropriate analysis.
Disparities in Access to Health Care Among US-Bornand Foreig.docxmadlynplamondon
Disparities in Access to Health Care Among US-Born
and Foreign-Born US Adults by Mental Health
Status, 2013–2016
Reema Dedania, MD, MPH, and Gilbert Gonzales, PhD, MHA
Objectives. To compare access to care between US-born and foreign-born US adults
by mental health status.
Methods. We analyzed data on nonelderly adults (n = 100 428) from the 2013–2016
National Health Interview Survey. We used prevalence estimates and multivariable lo-
gistic regression models to compare issues of affordability and accessibility between
US-born and foreign-born individuals.
Results. Approximately 22.2% of US-born adults and 18.1% of foreign-born adults
had symptoms of moderate to severe psychological distress. Compared with US-born
adults with no psychological distress, and after adjustment for sociodemographic
characteristics, US-born and foreign-born adults with psychological distress were much
more likely to report multiple emergency room visits and unmet medical care, mental
health care, and prescription medications because of cost.
Conclusions. Our study found that adults with moderate to severe psychological
distress, regardless of their immigration status, were at greater risk for reporting issues
of affordability when accessing health care compared with US-born adults with no
psychological distress.
Public Health Implications. Health care and mental health reforms should focus
on reducing health care costs and establishing innovative efforts to broaden access to
care to diverse populations. (Am J Public Health. 2019;109:S221–S227. doi:10.2105/
AJPH.2019.305149)
Health care access is an important factorassociated with mental illness pre-
vention, early-stage diagnosis and treatment,
and overall prognosis of psychiatric disorders.1
However, disparities in health care access and
health services utilization between immi-
grants and native-born populations in the
United States have been well documented for
a number of reasons, including stigmatization,
fear of deportation, challenges navigating a
complex health insurance system, and the
absence of culturally sensitive care and health
information.2,3 Studies show that, on average,
immigrants report better self-rated health and
less health services utilization compared with
native-born populations. However, consid-
erable debate remains over whether lower
utilization rates reflect a lesser need or an issue
of accessibility.4–7 This problem can be
unremitting and even aggravated in the
treatment of mental health disorders, which
are among the most expensive medical con-
ditions in the United States in recent years.8
There are a variety of factors that influence
the mental health of immigrants in particu-
lar. First, it is essential to recognize that
immigrants enter the United States through
a variety of means, including elective immi-
gration (e.g., family-based and employment-
based immigration) and forced migration
(e.g., refugees or asylees who are fleeing
persecution or are unabl ...
This document provides an introduction to biostatistics. It defines biostatistics as statistics arising from biological and medical sciences, particularly the fields of medicine and public health. The document outlines some key concepts in biostatistics including types of data, measures of central tendency and dispersion, and graphical representations of data. It discusses sources of uncertainty in medicine and how biostatistics can help manage these uncertainties in areas like clinical practice, preventive medicine, and medical research.
This study examined whether psychosocial factors like depression, anxiety, coping style, and social support influence survival outcomes in young women diagnosed with early-stage breast cancer. The study followed 708 Australian women under age 60 diagnosed with non-metastatic breast cancer for a median of 8.2 years. Psychosocial factors were assessed via questionnaires administered about 11 months after diagnosis. The study found no statistically significant associations between the measured psychosocial factors and distant disease-free survival or overall survival after adjusting for known prognostic factors like tumor characteristics and treatment. One unadjusted analysis found higher anxious preoccupation was linked to poorer outcomes, but this association was explained by its relationship to worse prognostic factors and disappeared after adjustment. The findings do not support
This study examined the relationship between psychosocial factors (depression, anxiety, coping style, social support) and survival outcomes in 708 young women with early-stage breast cancer in Australia. Psychosocial factors were assessed via questionnaires administered about 11 months after diagnosis on average. Over a median follow-up of 8.2 years, 33% experienced distant cancer recurrence and 24% died. No statistically significant associations were found between any psychosocial factors and distant disease-free or overall survival after adjusting for known prognostic factors like tumor characteristics and treatment. Higher levels of anxious preoccupation were marginally associated with poorer survival in unadjusted analyses but not after adjustment, and anxious preoccupation was also associated with worse tumor features. The findings do
Similar to ARTÍCULO: "Eating disorders in males: A report on 135 patients" (20)
Ejercicio correspondiente a los seminarios 7,8 y 9 (TICs)marmacfra
Este documento describe un estudio que examina cómo la información proporcionada por las enfermeras afecta los niveles de ansiedad de los pacientes antes y después de una transfusión de sangre. Se midieron dos variables: los niveles de ansiedad estado usando la escala STAI, y el nivel de satisfacción con la información recibida. La prueba t de Student se utilizó para comparar los resultados antes y después de la intervención de la enfermera. Los resultados mostraron que los niveles de ansiedad disminuyeron significativamente después de la intervención
Artículo: "La efectividad de una intervención enfermera sobre la ansiedad del...marmacfra
1) El estudio evalúa la efectividad de una intervención educativa de enfermería para reducir la ansiedad en pacientes que reciben transfusiones de concentrados de hematíes.
2) Los resultados mostraron que la ansiedad se redujo significativamente más en el grupo que recibió la intervención educativa en comparación con el grupo control.
3) La intervención, que incluyó información oral y escrita sobre la transfusión, aumentó la satisfacción de los pacientes con los cuidados recibidos y proporcionó una mayor seguridad.
Este documento resume los resultados de 6 tablas cruzadas realizadas con el software SPSS sobre una matriz de datos. Se cruzaron diferentes variables cualitativas y se aplicó la prueba de chi cuadrado para determinar si los resultados se daban por azar o se repetían en la población. En general, los valores obtenidos de chi cuadrado fueron mayores a 0.05, por lo que se concluyó que los resultados de cada tabla cruzada se daban por azar y no se repetían en la población.
Elaboración de tablas de contingencia y gráficos en SPSSmarmacfra
El documento describe los pasos para elaborar tablas de frecuencia, realizar análisis descriptivos de variables y hacer tablas cruzadas a partir de una matriz de datos. Se elaboran 4 tablas de frecuencia y gráficos, se analizan 3 variables y se hacen 3 tablas cruzadas entre diferentes pares de variables.
Familiarizándose con software estadistico SPSSmarmacfra
Este documento proporciona instrucciones sobre cómo crear tablas y recodificar variables en SPSS. Explica cómo añadir variables y datos, definir los tipos de variables y valores, y visualizar la tabla final. También describe el proceso de recodificar variables cuantitativas dividiéndolas en rangos y asignándoles nuevos valores de forma ordenada. El objetivo es familiarizar a los usuarios con las operaciones básicas en SPSS para crear y modificar bases de datos.
Búsqueda en bases de datos y creación de bibliografíamarmacfra
Este documento describe los pasos realizados para buscar información sobre cómo la intervención de enfermería afecta la calidad de vida de personas con esclerosis múltiple o lateral. Se identificaron las palabras clave relevantes en inglés y se realizó una búsqueda en las bases de datos Scopus y CINAHL. Los resultados encontrados entre 2004-2017 se guardaron en formato RIS y se creó una bibliografía en estilo Vancouver con Mendeley.
MISS TEEN LUCKNOW 2024 - WINNER ASIYA 2024DK PAGEANT
In the dynamic city of Lucknow, known for its wealthy social legacy and authentic importance, a youthful star has developed, capturing the hearts of numerous with her elegance, insights, and eagerness. Asiya, as of late delegated as the champ from Lucknow for Miss Youngster India 2024 by the DK Pageant, stands as a confirmation of the monstrous ability and potential dwelling inside the youth of India. This exceptional young lady is a signal of excellence and a paragon of devotion and aspiration.
Amid the constant barrage of distractions and dwindling motivation, self-discipline emerges as the unwavering beacon that guides individuals toward triumph. This vital quality serves as the key to unlocking one’s true potential, whether the aspiration is to attain personal goals, ascend the career ladder, or refine everyday habits.
Understanding Self-Discipline
At Affordable Garage Door Repair, we specialize in both residential and commercial garage door services, ensuring your property is secure and your doors are running smoothly.
Insanony: Watch Instagram Stories Secretly - A Complete GuideTrending Blogers
Welcome to the world of social media, where Instagram reigns supreme! Today, we're going to explore a fascinating tool called Insanony that lets you watch Instagram Stories secretly. If you've ever wanted to view someone's story without them knowing, this blog is for you. We'll delve into everything you need to know about Insanony with Trending Blogers!
Biography and career history of Bruno AmezcuaBruno Amezcua
Bruno Amezcua's entry into the film and visual arts world seemed predestined. His grandfather, a distinguished film editor from the 1950s through the 1970s, profoundly influenced him. This familial mentorship early on exposed him to the nuances of film production and a broad array of fine arts, igniting a lifelong passion for narrative creation. Over 15 years, Bruno has engaged in diverse projects showcasing his dedication to the arts.
MRS PUNE 2024 - WINNER AMRUTHAA UTTAM JAGDHANEDK PAGEANT
Amruthaa Uttam Jagdhane, a stunning woman from Pune, has won the esteemed title of Mrs. India 2024, which is given out by the Dk Exhibition. Her journey to this prestigious accomplishment is a confirmation of her faithful assurance, extraordinary gifts, and profound commitment to enabling women.
The Fascinating World of Bats: Unveiling the Secrets of the Nightthomasard1122
The Fascinating World of Bats: Unveiling the Secrets of the Night
Bats, the mysterious creatures of the night, have long been a source of fascination and fear for humans. With their eerie squeaks and fluttering wings, they have captured our imagination and sparked our curiosity. Yet, beyond the myths and legends, bats are fascinating creatures that play a vital role in our ecosystem.
There are over 1,300 species of bats, ranging from the tiny Kitti's hog-nosed bat to the majestic flying foxes. These winged mammals are found in almost every corner of the globe, from the scorching deserts to the lush rainforests. Their diversity is a testament to their adaptability and resilience.
Bats are insectivores, feeding on a vast array of insects, from mosquitoes to beetles. A single bat can consume up to 1,200 insects in an hour, making them a crucial part of our pest control system. By preying on insects that damage crops, bats save the agricultural industry billions of dollars each year.
But bats are not just useful; they are also fascinating creatures. Their ability to fly in complete darkness, using echolocation to navigate and hunt, is a remarkable feat of evolution. They are also social animals, living in colonies and communicating with each other through a complex system of calls and body language.
Despite their importance, bats face numerous threats, from habitat destruction to climate change. Many species are endangered, and conservation efforts are necessary to protect these magnificent creatures.
In conclusion, bats are more than just creatures of the night; they are a vital part of our ecosystem, playing a crucial role in maintaining the balance of nature. By learning more about these fascinating animals, we can appreciate their importance and work to protect them for generations to come. So, let us embrace the beauty and mystery of bats, and celebrate their unique place in our world.
Analysis and Assessment of Gateway Process – HemiSync(1).PDF
ARTÍCULO: "Eating disorders in males: A report on 135 patients"
1. Am J Psychiatry 154:8, August 1997CARLAT, CAMARGO, AND HERZOGEATING DISORDERS IN MALES
Eating Disorders in Males: A Report on 135 Patients
Daniel J. Carlat, M.D., Carlos A. Camargo, Jr., M.D., Dr.P.H., and David B. Herzog, M.D.
Objective: The goal of this study was to better understand the etiology, clinical character-
istics, and prognosis of eating disorders in males. Method: All males with eating disorders who
had been treated at Massachusetts General Hospital from Jan. 1, 1980, to Dec. 31, 1994, were
identified. Hospital charts and psychiatric departmental records were reviewed to verify that
the eating disorders met DSM-IV criteria and to abstract demographic and clinical data. Re-
sults: One hundred thirty-five males with eating disorders were identified, of whom 62 (46%)
were bulimic, 30 (22%) were anorexic, and 43 (32%) met criteria for an eating disorder not
otherwise specified. There were marked differences in sexual orientation by diagnostic group;
42% of the male bulimic patients were identified as either homosexual or bisexual, and 58%
of the anorexic patients were identified as asexual. Comorbid psychiatric disorders were com-
mon, particularly major depressive disorder (54% of all patients), substance abuse (37%), and
personality disorder (26%). Many patients had a family history of affective disorder (29%)
or alcoholism (37%). Conclusions: While most characteristics of males and females with eating
disorders are similar, homosexuality/bisexuality appears to be a specific risk factor for males,
especially for those who develop bulimia nervosa. Future research on the link between sexual
orientation and eating disorders would help guide prevention and treatment strategies.
(Am J Psychiatry 1997; 154:1127–1132)
The first report of an eating disorder in a male was
published in 1689 by Dr. Richard Morton (1). He
described a case of “nervous consumption” in the 16-
year-old son of a minister and prescribed a resting cure
of horseback riding and abstention from studies. Over
300 years later, information on eating disorders in
males remains limited to sporadic case reports, small
case series, and a few small case-control studies. None-
theless, eating disorders are not rare among males. In a
review of the literature (2), we concluded that males
account for 10%–15% of all bulimic patients, and that
0.2% of all adolescent and young adult males meet
stringent criteria for bulimia nervosa. Similar preva-
lence figures have been reported for male anorexic pa-
tients (3, 4).
Researchers have studied males with eating disorders
for both clinical and theoretical reasons. From a clinical
standpoint, there is a need for practical information on
males with eating disorders to help guide diagnostic
and treatment decisions. From a theoretical standpoint,
the study of males with eating disorders contributes
useful information to the question of eating disorder
etiology. If it is found that men with eating disorders do
not differ significantly from their female counterparts,
this finding may support a more biologically based view
of a discrete and relatively invariant disease entity, like
schizophrenia (5). However, if men with eating disor-
ders are found to share certain cultural or psychological
risk factors, then the sociocultural view of eating disor-
der etiology would gain support (6). In this study we
addressed both clinical and theoretical concerns by
compiling the largest case series to date and then focus-
ing on variables of particular clinical interest, such as
diagnostic distribution, age, sexuality, weight history,
psychiatric and medical comorbidity, family psychiatric
history, and clinical course.
METHOD
We identified all males with eating disorders who had been evalu-
ated at Massachusetts General Hospital, Boston, including its three
affiliated community clinics, from Jan. 1, 1980, to Dec. 31, 1994.
Massachusetts General Hospital is an 800-bed hospital that provides
both primary care to the local community of northern Boston and
tertiary care to patients from surrounding areas of New England. In
addition to its inpatient service, an active outpatient service supports
600,000 patient visits per year, many of them in the community clin-
Presented in part at the 148th annual meeting of the American Psy-
chiatric Association, Miami, May 20–25, 1995. Received Sept. 1,
1995; revisions received Sept. 9 and Dec. 5, 1996; accepted Feb. 27,
1997. From the Departments of Psychiatry and Emergency Medicine
and the Eating Disorders Unit, Massachusetts General Hospital; the
Channing Laboratory, Department of Medicine, Brigham and
Women’s Hospital, Boston; and Harvard Medical School and the De-
partment of Epidemiology, Harvard School of Public Health, Boston.
Address reprint requests to Dr. Carlat, Department of Psychiatry,
Anna Jaques Hospital, 25 Highland Ave., Newburyport, MA 01950.
Supported by NIH grant HL-03533 to Dr. Camargo and grants
from the Rubenstein Foundation and Eli Lilly and Company to Dr.
Herzog.
Am J Psychiatry 154:8, August 1997 1127
2. ics. In order to identify all males with eating disorders seen at Massa-
chusetts General Hospital over the study period, we began with a
manual search of patients’ files in the Eating Disorders Unit, a clinic
founded in 1981 to provide multidisciplinary evaluations and treat-
ment. We supplemented this list with computerized searches of sev-
eral Massachusetts General Hospital databases, including all inpa-
tient medical records, primary care outpatient medical records, and
hospital billing data for both inpatients and outpatients. Finally, we
concluded our search with informal case finding through the Massa-
chusetts General Hospital psychiatric community.
Once a potential case had been identified, the Massachusetts Gen-
eral Hospital medical record was abstracted onto a standardized form
that was created for this study; one of us (D.J.C.), a psychiatrist, per-
formed all of the chart reviews. DSM-IV criteria were used to confirm
eating disorder diagnoses. The DSM-IV criteria differ from the DSM-
III-R criteria in classifying anorexia as either a bulimic or nonbulimic
subtype, in specifying purging versus nonpurging subtypes of bulimia,
and in introducing binge eating disorder as a subtype of eating disor-
der not otherwise specified; binge eating disorder involves recurrent
binge eating without purging episodes. For data analysis, bulimic and
nonbulimic anorexic subtypes were combined into a single group
with “anorexia,” and binge eating disorder was combined with all
other examples of eating disorder not otherwise specified into a single
group with “eating disorder not otherwise specified.”
Diagnoses were based on clinical notes in the medical records.
When the Massachusetts General Hospital chart did not contain suf-
ficient information to establish the presence of DSM criterion symp-
toms, an attempt was made to review the clinic psychiatrist’s notes
and to interview the patient’s primary clinician. If this further review
did not provide sufficient data to confirm the diagnosis, the case was
excluded from the case series.
Information on demographic factors, sexuality, weight, psychiatric
and medical comorbidity, family history, referral source, and clinical
course were abstracted directly from clinical notes. Information was
classified as to whether it pertained to onset (date the patient first
developed an eating disorder), first treatment (date the patient was
first treated for an eating disorder), or entry (date the patient entered
the Massachusetts General Hospital system for treatment of an eating
disorder). Self-reported homosexuality and bisexuality were com-
bined for data analysis. Asexuality was defined as the lack of all sex-
ual interest for 1 year prior to assessment; if an asexual patient stated
an earlier sexual preference, this preference was recorded, but the
patient remained in the asexual category. Information on sexual ori-
entation was obtained primarily from detailed evaluation and prog-
ress notes from psychiatrists, psychologists, and social workers. Such
notes provided information on sexuality for 95% of the 122 patients
for whom such data were available. Most of these mental health notes
(70%) were from the Eating Disorders Unit, where practitioners are
trained to elicit detailed information on sexuality. For adults only (age
≥18 years), the Metropolitan Insurance Company height and weight
norms (7) were used to calculate the patients’ percentages of ideal
body weight. Information on psychiatric comorbidity was obtained
from clinicians’ written diagnoses, which may have been based on
DSM-III, DSM-III-R, or DSM-IV, depending on the patients’ date of
entry. Outcome information was based on a patient’s clinical status
1 year after entry; status was classified as full recovery (no symptoms
for at least 8 weeks), partial recovery (did not meet full criteria at least
once), or no recovery.
The data were summarized with the use of standard descriptive
statistics and 95% confidence intervals for proportions. The chi-
square test, Fisher’s exact test, Student’s t test, and one-way analysis
of variance (or the Kruskal-Wallis test, when appropriate) were used
to test a priori hypotheses. Two-sided p values less than 0.05 were
considered statistically significant.
RESULTS
We initially identified 176 males with a probable eat-
ing disorder; 135 diagnoses (77%) were confirmed by
DSM-IV criteria, whereas 41 cases were excluded be-
cause of insufficient chart data. Compared with the 135
subjects in the final case series, the excluded patients
were similar in average age at entry, year of entry, and
probable diagnostic distribution. Furthermore, similar
percentages of patients with confirmed (65%) and un-
confirmed (59%) diagnoses had been seen in the Eating
Disorders Unit. All further analyses were performed
with data from the 135 males who had a confirmed
eating disorder (table 1).
Bulimia nervosa was the most common diagnosis, af-
fecting 46% of the group (95% confidence interval=
38%–54%). Eating disorder not otherwise specified af-
fected 32% (95% confidence interval=24%–40%),
while anorexia nervosa affected 22% (95% confidence
interval=15%–29%). The most common subtype of
eating disorder not otherwise specified was binge eating
disorder, which affected 11 patients (26% of the group
with eating disorder not otherwise specified). The pa-
tients with other subtypes of this category included 10
(23%) with subdiagnostic anorexia, 10 (23%) with
self-induced vomiting without binge eating, six (14%)
with bulimia without excessive weight concerns, and
six (14%) in a miscellaneous subtype (e.g., one patient
regurgitated food secondary to a swallowing phobia).
The mean age at onset for all patients was 19.3 years,
(range=6–60), and there were no significant differences
between diagnostic groups (table 1). Significant differ-
ences did emerge, however, with respect to mean age at
first treatment and mean delay between onset of an eat-
ing disorder and its treatment: the bulimic patients were
significantly older at first treatment and had a longer
treatment delay. Of note, treatment delay also differed
significantly among DSM-IV subcategories (data not
shown); the patients with binge eating disorder waited
a mean of 13.7 years (SD=11.5) before initial treatment,
compared with 8.4 years (SD=8.2) for the bulimic pa-
tients, 4.3 years (SD=5.5) for the bulimic anorexic pa-
tients, and only 1.2 years (SD=1.4) for the nonbulimic
anorexic patients (F=5.6, df=4, 33, p<0.001).
At the time of their first treatment, 73% of the sub-
jects were single, 25% were either married or living
with a partner, and 2% were divorced or widowed.
Nearly all were Caucasian (N=131); there were two Af-
rican Americans, one Hispanic, and one Arab patient.
The subjects had an average of 1.6 years of college edu-
cation at the time of first treatment, and most were
either employed (46%) or students (32%).
Motivated by anecdotal reports that males with eating
disorders may be overrepresented in certain “high risk”
occupations, we categorized the 109 patients for whom
we had occupational data and found that 17 (16%) were
in potentially high-risk jobs; these included appearance-
based jobs (e.g., modeling, acting) (N=7), jobs tradition-
ally held by women (e.g., floriculture, nursing) (N=7),
and food-related jobs (e.g., catering, restaurant manag-
ing) (N=3). In several cases, the job was clearly related to
the onset of the eating disorder. One patient, for exam-
ple, ingested appetite suppressant pills in an effort to
keep slim for acting roles; within several months he be-
gan a pattern of binge eating and self-induced vomiting.
We ascertained the sexual orientation of 122 patients
EATING DISORDERS IN MALES
1128 Am J Psychiatry 154:8, August 1997
3. (90% of the entire study group). Of these patients, dur-
ing the active phase of their eating disorder, 41% were
heterosexual (95% confidence interval=32%–50%),
27% were homosexual or bisexual (95% confidence in-
terval=19%–35%), and 32% were asexual (95% con-
fidence interval=24% to 40%) (table 1). Among the 83
with a recorded interest in sex, 60% (N=50) were het-
erosexual and 40% (N=33) were homosexual or bisex-
ual. Of the 39 asexual subjects, 22 were aware of a spe-
cific sexual orientation; of these patients, 16 (73%)
were heterosexual and six (27%) were homosexual or
bisexual. Chi-square tests revealed that homosexuality/
bisexuality was significantly more common among the
bulimic patients, whereas asexuality was rare in bu-
limia but common in both anorexia and eating disorder
not otherwise specified (table 1).
Table 1 shows the weight histories of 103 patients,
60% (N=62) of whom reported having been over-
weight at some point before the onset of their disorder.
The bulimic men were significantly more likely to re-
port a history of premorbid obesity, and were heavier
at entry, at their highest lifetime weight, and at their
lowest lifetime weight; 74% of the bulimic subjects re-
ported a history of having dieted during the years pre-
ceding the onset of their disorder. Data on the desired
body weight of 48 patients were available; as expected,
the anorexic patients preferred a weight significantly
below their ideal body weight.
A lifetime history of major depressive disorder was com-
mon among all subjects across diagnoses (54%; 95%
confidence interval=46%–63%) (table 1). Substance
abuse (primarily alcohol and cocaine) and personality dis-
orders were also common, particularly among the bulimic
patients. Among those with a discrete personality disor-
der, the six anorexic men were evenly divided across DSM
clusters A, B, and C, whereas 10 (71%) of the 14 bulimic
men had cluster B personality disorders (particularly bor-
derline, antisocial, and narcissistic); this difference was
not statistically significant (p=0.16, Fisher’s exact test).
A parental history of being overweight was reported
by 53% of all subjects (95% confidence interval=42%–
65%) (table 1). The patients with bulimia were signifi-
TABLE 1. Characteristics of Male Patients With Eating Disorders (N=135)
Variable
All Patients
(N=135)a
Patients
With
Anorexia
Nervosa
(N=30)a
Patients
With
Bulimia
Nervosa
(N=62)a
Patients With
Eating
Disorder Not
Otherwise
Specified
(N=43)a Analysis
Mean SD Mean SD Mean SD Mean SD F df p
Age (years)
At onset 19.3 7.5 19.0 5.6 19.5 5.5 19.1 11.0 5.8 2, 125 0.94
At first treatment 25.9 8.6 20.3 6.0 28.0 6.0 26.9 11.0 8.5 2, 117 <0.001
Treatment delayb 6.7 8.0 2.1 3.4 8.4 8.2 7.6 9.1 6.5 2, 113 0.002
Percentage of ideal body weight
Premorbid 133 29 114 23 143 26 131 32 4.7 2, 40 0.01
At entry into Massachusetts
General Hospital system 108 33 79 10 118 24 115 41 19.0 2, 114 <0.001
Highest as an adult 137 36 106 22 145 30 144 44 9.8 2, 79 <0.001
Lowest as an adult 88 19 70 10 98 14 88 20 23.8 2, 79 <0.001
Weight fluctuationc 48 29 35 22 49 26 57 37 3.0 2, 74 0.05
Desired body weight 97 15 75 7 100 14 101 11 13.2 2, 45 <0.001
N % N % N % N % χ2
df p
Sexuality 26.8 4 <0.001
Heterosexual 50 41 11 42 26 46 13 33
Homosexual or bisexual 33 27 0 0 24 42 9 23
Asexual 39 32 15 58 7 12 17 44
Psychiatric comorbidity
Major depression 72 54 16 55 36 59 20 46 1.6 2 0.45
Alcohol abuse 38 29 4 14 28 46 6 14 16.6 2 <0.001
Cocaine abuse 15 11 1 3 12 20 2 5 8.0 2 0.02
Any substance abuse 49 37 5 17 37 61 7 16 27.5 2 <0.001
Anxiety disorder 23 17 1 3 12 20 10 23 5.2 2 0.07
Personality disorder 35 26 7 24 19 31 9 21 16.9 2 0.48
Family history
Parental overweight 40 53 7 37 23 72 10 40 8.3 2 0.02
Parental affective disorder 26 29 4 20 13 33 9 28 1.2 2 0.56
Parental alcohol abuse 34 37 4 20 18 45 12 37 3.6 2 0.16
Sibling eating disorder 16 18 2 10 6 16 8 24 1.7 2 0.43
aThe Ns on which means and percents are based vary because of missing data for some subjects on some variables.
bAge at first treatment minus age at onset.
cHighest adult weight minus lowest adult weight.
CARLAT, CAMARGO, AND HERZOG
Am J Psychiatry 154:8, August 1997 1129
4. cantly more likely to report a parental history of being
overweight than the patients with anorexia or an eating
disorder not otherwise specified. Parental histories of
affective disorder or alcoholism were also common
among the patients, as was a history of an eating disor-
der in a sibling.
The most common routes to treatment of eating dis-
orders were self-referral (36% of all 135 patients), re-
ferral by a primary care physician (22%), and referral
by a parent (18%); other sources included referral by a
psychiatrist or psychologist (13%) and by other clini-
cians or friends (11%). Referral sources varied by diag-
nostic group; compared with the bulimic subjects, the
anorexic subjects were more likely to be referred by
their primary care physician or their parents (28% ver-
sus 55%) (χ2=4.7, df=1, p=0.03).
Over the course of their illness, 68% (N=79 of 116)
of the study group had suffered some medical compli-
cation as a result of their eating disorder. Myriad com-
plications were reported, but not in a consistent man-
ner, thereby precluding statistical analyses. Frequent
findings in the anorexic patients were osteoporosis, ane-
mia, and hypotension, and the bulimic patients were
commonly diagnosed with dental enamel erosion, pa-
rotid gland swelling, electrolyte disturbances, leg cramp-
ing (usually secondary to hypokalemia), esophagitis,
and obesity. While 30% (N=39) of 130 patients were
hospitalized for either medical or psychiatric reasons
during their illness, the anorexic patients had a dispro-
portionate number of the medical admissions: 19% had
medical admissions, compared with 1.7% of the bu-
limic patients and 2.3% of those with an eating disor-
der not otherwise specified (χ2=22.8, df=6, p<0.001).
Chart review revealed 1-year follow-up data for only
40% (N=54) of the patients in our case series. Lack of
follow-up was primarily due to insufficient documenta-
tion in the medical record or to patients leaving Massa-
chusetts General Hospital for further treatment. None-
theless, 1 year after initial treatment, 22% (N=12) of
the 54 patients had achieved full recovery (95% confi-
dence interval=11%–33%), 19% (N=10) were partially
recovered (95% confidence interval=8%–29%), and
59% (N=32) continued to suffer their full eating disor-
der syndrome (95% confidence interval=46%–72%).
DISCUSSION
This study was undertaken to better characterize eat-
ing disorders in males. Studies to date have had rela-
tively small group sizes that have precluded meaningful
statistical analyses. Furthermore, most studies have in-
cluded only males referred to specialty eating disorder
clinics or inpatient units; such patients may not be char-
acteristic of patients seen in community mental health
clinics or those seen by primary care physicians. This
study is the first in which a large series of patients were
located by searching all clinical units of a general hos-
pital, rather than the psychiatric department alone.
Over one-third (35%) of our study group were never
seen in the Eating Disorders Unit and would have been
missed if our search had been limited to that venue.
Thus, our group is more likely to represent males seen
primarily by general physicians as well as those treated
by mental health professionals.
In general, our data suggest that the characteristics of
males with eating disorders are similar to those seen in
females with eating disorders. The diagnostic distribu-
tion of our case series is similar to figures reported for
females, among whom prevalence rates for bulimia are
estimated to be five to 10 times greater than those for
anorexia (8). However, 32% of our series met the cri-
teria for an eating disorder not otherwise specified, a
figure which is higher than the 10% reported by Mitch-
ell et al. (9) in their series of 25 women, suggesting that
atypical eating disorders may be a particular problem
in males.
The typical age at onset of eating disorders among our
patients was late adolescence to early adulthood, consis-
tent with reports regarding females (10). While age at
onset did not differ significantly among diagnostic
groups, age at first treatment was significantly later and
treatment delay was significantly longer among the bu-
limic subjects than among the anorexic subjects. Ano-
rexic males entered treatment an average of 2.1 years af-
ter onset, which is a shorter treatment delay than has
been reported for women in our eating disorders clinic
(11). This relatively brief delay between onset and treat-
ment is consistent with our observation that anorexic
men (as compared with bulimic men) were more likely to
be referred by a primary care physician or by a parent.
The extreme weight loss caused by their self-starvation
attracts the attention of family and caregivers in a way
that the private behaviors of persons with bulimia do not.
In general, the bulimic men in our study group felt
ashamed of having a stereotypically “female” disorder,
which may explain their atypically long treatment delay.
With regard to core concerns about body image and
weight, male anorexic patients may be more similar to
their female counterparts than to male bulimic patients.
Our male patients with anorexia clearly feared weight
gain, as is implied by their desired body weight of only
75% of their ideal body weight. Our male patients with
bulimia were more overweight before their illness than
the typical female bulimic patient (12, 13), and their
average desired body weight of 100% of ideal body
weight was higher than the reported desired body
weights of 80%–90% among female bulimic patients
(13, 14). These data imply that bulimic males may be
less concerned with strict weight control than their fe-
male counterparts. Our finding that bulimic men had
the highest rate of parental obesity is intriguing, espe-
cially given recent data indicating that obesity may be
partially under genetic control (15). To our knowledge,
there is little (if any) published research on genetic vul-
nerability to obesity among bulimic patients.
Consistent with prior studies of males with eating dis-
orders (16–19), our study group exhibited high rates of
comorbid major depression, substance abuse, anxiety
disorders, and personality disorders. This same pattern
EATING DISORDERS IN MALES
1130 Am J Psychiatry 154:8, August 1997
5. of comorbidity has been reported in females with eating
disorders (10, 11, 20), although the high proportion of
substance abuse among our bulimic males (61%) is
higher than comparable estimates in bulimic females, a
difference that may reflect the higher prevalence of sub-
stance abuse among males in the general population
(DSM-IV). The high prevalence of family psychopa-
thology in our study group is also similar to published
figures for females with eating disorders (21). While in-
formation on outcome was limited by the nature of the
retrospective design, we found that over one-half of the
54 men for whom we had such data were doing poorly
at 1-year follow-up; similar outcome figures have been
reported for women with eating disorders (22).
Without question, the most striking finding concerns
sexual orientation. We found that 27% of our study
group reported being primarily homosexual or bisex-
ual, and 32% were asexual. Most prior studies also
have reported unexpectedly high rates of homosex-
uality and bisexuality (12, 14, 18, 23), but study groups
have generally been too small to either confirm or refute
this finding. For example, a recent study reported in this
journal (19) found a lower prevalence of homosex-
uality/bisexuality—12%—among 25 males with eating
disorders recruited through college newspaper adver-
tisements. This figure is lower than those from many
other studies (12, 14, 18, 23) and may reflect the fact
that the subjects were volunteers from the community,
only four of whom had ever sought treatment for their
disorder. Concurrent homosexuality may aggravate the
course of eating disorders in males, leading to their
overrepresentation in treatment centers. Alternatively,
the 12% finding may be simply an imprecise estimate
because of the small size of the study group; the 95%
confidence interval is quite broad (3%–31%) and actu-
ally encompasses our estimated prevalence of 27%.
In assessing the significance of our data on sexuality,
it is important to estimate the prevalence of homosex-
uality both in the healthy male population and in fe-
males with eating disorders. Recent data on sexuality in
the general population indicate a 1%–6% prevalence of
homosexuality in healthy males (24) and a 2% preva-
lence of homosexuality in females with eating disorders
(25), both far below the 27% prevalence reported by
our male patients. The high prevalence of asexuality in
our anorexic group is similar to reports of anorexic
women (26, 27) and probably reflects the testosterone-
lowering effect of protein-calorie malnutrition (28–30)
combined with active repression of sexual desire, as ob-
served in other case series of anorexic males (23, 31).
Homosexuality/bisexuality was particularly common
among the bulimic males in this study (42%). We have
discussed some of the implications of this finding in an
earlier review (2). In general, survey studies of homo-
sexual men have shown that they are more dissatisfied
with their body weight and shape than heterosexual
men and that they consider their physical appearance to
be more important to their sense of self (32–34), thus
potentially increasing their vulnerability to developing
eating disorders. In our case series, many subjects re-
ported that their sexuality played an important role in
the development of their eating disorder, and five
homosexual men explicitly stated that their eating dis-
order began in response to pressures toward thinness in
the gay subculture.
There are several limitations of this study, including
potential problems with selection and information bias.
Since our study subjects were identified at a tertiary
care institution, their conditions may have been more
serious than those of males treated at private offices or
community clinics. This problem is to some extent miti-
gated by our identification of patients in all of the com-
munity-based clinics affiliated with Massachusetts
General Hospital, a route of entry for several of the sub-
jects in our study. Another potential concern is our re-
liance on data compiled from chart review, a method
that often results in incomplete and inconsistently col-
lected information. We attempted to overcome these
problems by using a standardized chart review form
and by contacting patients’ primary clinicians to clarify
any ambiguous information. In addition, we had a sin-
gle psychiatrist review all of the charts. Finally, the use
of a case series precludes direct comparison with unaf-
fected subjects or female patients. The primary goal of
this study, however, was to better characterize males
with eating disorders, about whom very little is known.
When we examined risk factors that might predispose
to the condition, we relied on published literature on
healthy males and females with eating disorders.
The results of this study, combined with other find-
ings from the small but growing research literature on
eating disorders in men, indicate that eating disorders
appear quite similar in both sexes but point to homo-
sexuality/bisexuality as a specific risk factor for males,
especially in bulimia nervosa. The high rate of homo-
sexuality and bisexuality among males with eating dis-
orders can serve equally as evidence for psychosocially
or biologically based views of the etiology of eating dis-
orders. For those who believe that cultural pressures
toward thinness cause eating disorders, homosexuality
can be seen as a risk factor which puts males in a sub-
cultural system that places the same premium on ap-
pearance in men as the larger culture places on women.
Those seeking support for a biological etiology can
point to research implying similarities in brain structure
between homosexual men and heterosexual women
(35) and argue that homosexual men may react to en-
vironmental stressors in a biologically feminine way,
thereby increasing their risk of eating disorders. Future
research on the nature of the link between sexual pref-
erence and eating disorders in men would be useful,
both for answering such theoretical questions and for
guiding prevention and treatment strategies.
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