Typescript (photocopy). / Digitized by Kansas Correctional Industries

Este estudo tem como objetivo investigar a presença de disfunção temporomandibular (DTM) em pacientes previamente diagnosticados com transtorno alimentar (bulimia nervosa, anorexia nervosa ou anorexia nervosa purgativa), classificá-la em intra e extra-articular, investigar a possível correlação entre diagnósticos de transtorno alimentar e DTM e a correlação entre o tempo de duração do TA e o tempo de dor devido à DTM. O grupo estudado foi formado por 31 pacientes com transtorno alimentar (TA) composto quase pela totalidade (96,8%, 30/31) de mulheres, com idade média de 30,7 ± 6,7 (de 18 a 48 anos). Na primeira consulta, todos os participantes preencheram os questionários de saúde geral e o questionário de critérios diagnósticos em pesquisa da disfunção temporomandibular (RDC/TMD), foram entrevistados e examinados clinicamente para os sinais e sintomas de DTM. Os sinais clínicos contabilizados foram movimentos mandibulares, dor à palpação muscular e articular, sons articulares e dor espontânea contabilizada pela Escala Visual Analógica (EVA). Após o resumo de todas as variáveis do estudo, foram feitas as análises relacionadas à correlação dos dados obtidos. Para isso foram utilizados os seguintes testes: exato de Fisher, t-Student, Mann-Whitney,e teste de correlação de Pearson, conforme a natureza das variáveis. A significância estatística foi indicada para valores de p < 0,05. A maioria dos pacientes deste estudo, (83,9%, 26/31), foram diagnosticados com DTM, sendo 67,7% (21/31) intra-articular e 74,2% (23/31) extra-articular. Apresentaram os dois diagnósticos 54,8% (17/31) dos pacientes. A correlação entre o tempo do transtorno alimentar e o tempo de dor orofacial foi estatisticamente significativa, concluindo-se que quanto maior o tempo do TA, maior o tempo de dor orofacial caudada pela DTM. A correlação entre a classificação de DTM, intra e extra-articular, e os diagnósticos de TA, bulimia e anorexia nervosa, não foram significantes para este grupo estudado. / This study aims to investigate the presence of temporomandibular disorders (TMD) in patients previously diagnosed with eating disorders (bulimia nervosa , anorexia nervosa or purgative anorexia nervosa ), to categorize the TMD into intra- and extra articular and to investigate the possible correlation between eating disorders diagnoses and TMD as well as the correlation between the longevity of TA and the longevity of pain due to TMD. The study group consisted of 31 patients with eating disorders (ED) and was mainly composed by women ( 96.8 % , 30/31 ) with a mean age of 30.7 ± 6.7 ( 18-48 years) At the first visit all participants completed the general health questionnaire and the research diagnostic criteria for temporomandibular disorders questionnaire (RDC / TMD ), they were also interviewed and clinically examined for signs and symptoms of TMD. The recorded clinical signs were jaw movements , pain upon palpation of muscles and temporomandibular joints , joint sounds and spontaneous pain recorded by the Visual Analogic Scale (VAS ). After the summary of all study variables, the analyses related to the correlation of the data were made. The following tests were used: Fisher \'s exact test, t- Student , Mann -Whitney , and Pearson correlation test , according to the nature of the variables. Statistical significance was indicated for p values < 0.05. Most patients in this study ( 83.9 % , 26/31 ) were diagnosed with TMD, of which 67.7 % ( 21/31 ) presented intra -articular and 74.2 % ( 23/31 ) extra -articular .while 54.8 % ( 17/31 ) presented both diagnoses. The correlation between the duration of the eating disorder and the duration of orofacial pain due to TMD was statistically significant , it was concluded that the longer the TA , the longer the pain. The correlation between TMD classification , intra- and extra -articular , and TA diagnostics, bulimia and anorexia nervosa , was not significant for this studied group.

The thin body has long been considered ‘normal' in Western culture, whereas the anorexic body has been framed as pathological despite the fact that both bodies often engage in regimes of undereating and extreme exercising which dovetail with one another. Pro-anorexia (or ‘pro-ana') online spaces, which emerged in the late twentieth century, have been criticised for their espousal of anorexia even though much of the advice they provide and the images they collate, derive from mainstream culture. Censorship and vilification by the media have meant that since their inception these spaces have undergone a number of changes. This thesis therefore investigates the thin ideal in pro-ana online spaces at a time when the boundaries between the mainstream espousal of thinness and the body image promoted in pro-ana culture are becoming increasingly blurred. Drawing on empirical research across a range of websites, forums, and social media which identify as pro-ana, I employ textual analysis to explore how thinness is constructed in these spaces. My investigation produced a set of themes which shape this thesis. Central were: the denial and disguise of disordered-eating practices; the pre-eminence of the white, middle-class, heterofeminine body; and the importance of pain in realising the thin ideal. The central claim of this thesis is that pro-ana online spaces expose the extent to which normative femininity is underpinned by practices which may be deeply disordered, but they are viewed as normal by mainstream culture. Pro-ana culture illustrates an extreme response to achieving thinness but it also critiques the ideal to which it aspires. Hence, this thesis concludes by turning to the potential for resistance in pro-ana online spaces and arguing that although they do not uncritically conform to the culture of compulsory thinness, they are nonetheless postfeminist enclaves which perpetuate the primacy of the individual.

Multifamiljeterapi (MFT) är en relativt ny metod för att behandla ungdomar med anorexia nervosa (AN) i Sverige. Syftet med denna pilotstudie var att undersöka hur patienter, mammor och pappor upplevde behandlingsinterventioner inom MFT samt om familjeklimatet förändrades efter genomförd behandling. Totalt undersöktes 14 patienter, 14 mammor och 14 pappor utifrån självskattningsformulären Behandlingstillfredsställelse och Familjeklimat (FCS). Resultatet visade att behandlingsinterventionerna storgruppsdiskussioner, smågruppsdiskussioner, gemensamma måltider samt övningar, lekar och rollspel, upplevdes vara hjälpsamma för samtliga grupper. Familjeklimatet förbättrades signifikant över tid avseende dimensionerna närhet och distans. En skillnad påfanns mellan patienter och mammor i upplevelsen av närhet då mammorna skattade lägre på dimensionen närhet än patienterna. Gällande kaos påfanns en interaktionseffekt då patienternas och mammornas upplevelse av kaos minskade medan pappornas ökade något. Resultatet tyder på att samtliga behandlingsinterventioner inom MFT är hjälpsamma och att familjeklimatet i stort förbättras efter behandling. Vidare forskning med större urval behövs för att bekräfta fynden. / Multi-family therapy (MFT) is a relatively new treatment for adolescents with anorexia nervosa (AN) in Sweden. The aim of this pilot study was to investigate how patients, mothers and fathers perceived interventions in MFT and if there was a change in family climate after treatment. In total 14 patients, 14 mothers and 14 fathers were examined with the two questionnaires Behandlingstillfredsställelse and Family climate scale (FCS). The results showed that the following interventions in MFT were perceived as helpful for all groups; discussions in large and small groups, group meals, exercises, games and role play. Family climate was significantly improved over time regarding the dimensions closeness and distance. A difference between patients and mothers was found in how they experienced closeness as mothers reported lower closeness than patients. An interaction effect was found regarding chaos as the patients and mothers reported a decrease in chaos while the fathers reported a slight increase. The results indicate that all the interventions in MFT are helpful and that, by and large, family climate improves after treatment. Further research with a larger sample is required to confirm these findings. / Multifamiljeterapi vid anorexia nervosa

As alterações orais nos pacientes com transtornos alimentares (TAs) são estudadas na literatura, porém poucos artigos abrangem a relação entre as alterações orais, candidose bucal e avaliação sociodemográfica. O presente estudo avaliou as características sociodemográficas, orais e a prevalência de Candida spp em pacientes com TAs. Foram avaliados 14 pacientes, destes 6 possuíam o diagnóstico estabelecido de Anorexia purgativa, 7 de Bulimia Nervosa e 1 TANE (transtorno alimentar não especificado). A idade média dos pacientes do estudo foi de 30,7 anos e todos eram do sexo feminino. Os pacientes responderam a um questionário elaborado pela pesquisadora e em seguida foram submetidos ao exame clínico inicial, para avaliação geral da saúde bucal, com enfoque na presença de lesões de mucosa, cáries, erosões e candidose. Também foi coletado saliva para a avaliação do fluxo salivar. As seguintes características sociodemográficas foram encontradas: 28,4% exerciam atividade remunerada; 42,8% possuíam terceiro grau completo e 78,6% eram solteiras; o tempo médio do transtorno alimentar foi de 14,8 anos e o tempo de diagnóstico médico foi de 8,07 anos. Na avaliação odontológica foram encontrados: CPO-d (dentes-cariados, perdidos e obturados) médio de 10,57; IHOS (índice de higiene oral) médio de 1,3; 71,4% das pacientes possuíam perda de brilho na face palatina dos dentes e 14,2% apresentaram perimólise. As pacientes purgativas apresentaram um índice CPO-d maior que as pacientes restritivas, a classe social mais prevalente foi a classe média. A Candida spp foi mais isolada em pacientes do serviço público e a xerostomia não foi um fator predisponente à colonização de Candida spp. A perimólise teve relação com o tempo de TAs das pacientes. Os resultados obtidos demonstram a necessidade de acompanhamento odontológico regular em pacientes com TAs. / The oral changes in patients with eating disorders (ED) are studied in literature, but few articles disclose the connection between oral changes, oral candidiasis and sociodemographic characteristics. This study evaluated the sociodemographic characteristics, oral changes and the prevalence of Candida spp. Fourteen patients were evaluated. Six subjects were diagnosed with Anorexia (purging subtype), seven with Bulimia and one with EDNOS (eating disorders no specified). Every subject included was female with a mean age of 30,7 years. All of them answered a questionnaire and passed through a clinical exam to evaluate the oral health focusing on oral lesions, erosion, decayed and candidiasis. Saliva was collected for analysis. The social demographics characteristics were observed 28.4% of subjects exercise a paid activity, 42.8% had college degree and 78.5% were single. The mean time of ED was 14.8 years and mean time of medical diagnosis was 8.07 years. The clinical exam revealed the following data: DMFT mean of 10.57; Plaque index (oral hygiene) mean of 1.3; 71.4% of subjects showed tooth wear in enamel on palatine surface and 14,2%, perimolysis. This results suggest that patients with purging habits had higher DMFT than restrictive patients, the social class can be a predisposing factor for ED, the local where treatment was done influenced in isolation of Candida spp; and xerostomia did not influence in colonization of the fungus. The perimolysis presented relation with time of manifestation ED. This results showed the importance of concomitant treatment with dentistry.

Os transtornos alimentares (TA) são doenças graves de etiologia multifatorial, que cursam com alterações importantes no comportamento alimentar e complicações clínicas como desnutrição e distúrbios hidroeletrolíticos, além de comorbidades psiquiátricas. A hospitalização integral é uma modalidade terapêutica indicada quando o seguimento ambulatorial não atinge resultados satisfatórios associados à piora dos sintomas. O objetivo deste estudo foi descrever as características e resultados da hospitalização dos pacientes com TA atendidos pelo Grupo de Assistência em Transtornos Alimentares do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Dados antropométricos, bioquímicos e clínicos foram coletados a partir da revisão de prontuários dos pacientes internados durante o período de 1982 a 2011. Como resultado, observou-se que das 186 pessoas que receberam atendimento pelo serviço, 44,6% deles (n=83) necessitaram de no mínimo, uma internação durante o tratamento. A predominância foi do sexo feminino (95,2%), da raça branca (94%), solteira (76%) e sem filhos (78,3%). Cursavam o ensino médio (50,6%) com idade de 23,3±10,8 anos. O diagnóstico era de anorexia do tipo restritivo (AN-R) para 54,2% (n=45) deles, 31,3% (n=.26) apresentavam anorexia do subtipo compulsão periódica/purgativo (AN-CP) e 14,5% (n=12) tinham bulimia nervosa (BN). A média de internações foi de 1,9±3,9 vezes sendo que 73,5% (n=61) dos pacientes foram internados apenas uma vez, por 41,2±37,6 dias. Para aqueles que precisaram dessa modalidade de tratamento por mais de uma vez, a duração da hospitalização, considerando todas as internações, foi de 70,6±115,9 dias com extensa variação (3 a 804 dias). Não foi observada associação entre o número de internações com o Índice de Massa Corporal (IMC) e com o tempo de sintomas antes do diagnóstico. O IMC dos pacientes mudou significativamente (p<0,05) durante a internação (para o grupo com AN-R: de 13,5kg/m2 para 14,8kg/m2 ; para os com AN-CP: de 15,7kg/m2 para 16,9kg/m2 ; naqueles com BN: de 22,0kg/m2 para 21,0kg/m2 ). A amenorréia esteve presente em 69% (n=45) das mulheres, sendo mais frequente naquelas com AN-R (65,1%). Dos 23 pacientes (27,7%) que realizaram o exame de densitometria óssea, 44,4% (n=10) apresentam osteopenia e 29,7% (n=7) osteoporose. Os valores médios da maioria dos parâmetros bioquímicos avaliados estavam dentro da normalidade, com exceção do beta-caroteno, que encontrava-se elevado, tanto no início quanto no final da internação. A Nutrologia foi a enfermaria na qual a maioria das internações ocorreu (79,5%) e a necessidade de terapia nutricional foi a indicação mais frequente (62,3%). A via de administração de nutrientes preferencialmente utilizada foi a via oral (67,5%), apesar de ter sido observado aumento de 2,3 vezes na escolha da terapia nutricional enteral exclusiva nos pacientes que foram internados mais de uma vez. O acompanhamento multidisciplinar foi evidenciado, pois além do médico, houve a participação maciça de nutricionistas (87,9%) e psiquiatras (72,3%). Como conclusão, a hospitalização integral é uma modalidade bastante indicada no tratamento de pacientes com TA, mas sua duração é prolongada e requer a assistência de diversos profissionais. No entanto, quando indicada a partir de critérios bem estabelecidos proporciona melhora no estado nutricional. Futuros estudos são necessários para ampliar e aprofundar os resultados encontrados possibilitando o aprimoramento de condutas terapêuticas. / Eating disorders (ED) are serious diseases with multiple etiologies that course with major changes in eating behavior and clinical complications such as malnutrition and electrolyte disturbances, and also psychiatric comorbidities. Inpatient treatment is a modality of treatment used when the outpatient follow-up did not reach satisfactory results associated with worsening of clinical status. The aim of this study was to describe the characteristics and outcomes of the hospitalization in patients with ED who were treated by Assistance Group on Eating Disorders from the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP. Anthropometric, biochemical and clinical data were collected from the medical records of patients admitted between 1982 and 2011. It was observed that among 186 patients attended by the service, 44.6% (n = 83) required at least one inpatient treatment. Most patients were female (95.2%) and white (94%). The majority was single (76%), with no children 78.3%) and were high school students (50.6%). The mean age was 23.3± 10.8 years old. According to the diagnosis, 54.2% of patients had anorexia nervosa, restricting subtype (AN-R), 31.3% had anorexia nervosa binge-eating/purging subtype (AN-CP) and 14.5% had bulimia nervosa (BN). The mean age at admission was 23.3 ± 10.8 years (range 8-58 years), 73.5% of patients were hospitalized only once. The mean number of admissions was 1.9 ± 3.9 times and 73.5% (n=61) were hospitalized only once, during 41.2 ± 37.6 days. For those who needed this type of treatment more than once, the length of stay, considering all admissions, was 70.6 ± 115.9 days with extensive variation (3-804 days). No associations were observed between the number of hospitalizations and Body Mass Index (BMI) and duration of symptoms before diagnosis. The BMI of the patients changed significantly (p <0.05) during hospitalization (for the group with AN-R, from 13.5 kg/m2 to 14.8 kg/m2 ; for AN-CP: 15.7 kg/m2 to 16.9 kg/m2 , those with BN: from 22.0 kg/m2 to 21.0 kg/m2 ). Amenorrhea was present in 69% (n = 45) women, most frequently in those with AN-R (65.1%). According to exam of bone densitometry of 23 patients (27.7%), 44.4% (n=10) had osteopenia and 29.7% (n=7) had osteoporosis. The mean values of most biochemical parameters were within normal limits, except for beta- carotene, which was above the normal range, both in admission and discharge. The Nutrology was the infirmary where the majority of hospitalizations occurred (79.5%), nutritional support was the most frequent indication for hospitalization (62.3%). The route of administration of nutrients preferably used was oral (67.5%), although it has been observed an increase at 2.3 times on exclusively enteral feeding in patients admitted more than once. The multidisciplinary team reveals, besides the doctor, the massive presence of dietitians (87.9%) and extensive involvement of psychiatrists (72.3%). It is concluded that inpatient treatment is needed in patients with ED, often shows prolonged duration and requires the assistance of various professionals. However, when indicated based on criteria well established can provide improvement in nutritional status. Future studies are needed to broaden the results enabling the improvement of therapeutic approaches.

As alterações orais nos pacientes com transtornos alimentares (TAs) são estudadas na literatura, porém poucos artigos abrangem a relação entre as alterações orais, candidose bucal e avaliação sociodemográfica. O presente estudo avaliou as características sociodemográficas, orais e a prevalência de Candida spp em pacientes com TAs. Foram avaliados 14 pacientes, destes 6 possuíam o diagnóstico estabelecido de Anorexia purgativa, 7 de Bulimia Nervosa e 1 TANE (transtorno alimentar não especificado). A idade média dos pacientes do estudo foi de 30,7 anos e todos eram do sexo feminino. Os pacientes responderam a um questionário elaborado pela pesquisadora e em seguida foram submetidos ao exame clínico inicial, para avaliação geral da saúde bucal, com enfoque na presença de lesões de mucosa, cáries, erosões e candidose. Também foi coletado saliva para a avaliação do fluxo salivar. As seguintes características sociodemográficas foram encontradas: 28,4% exerciam atividade remunerada; 42,8% possuíam terceiro grau completo e 78,6% eram solteiras; o tempo médio do transtorno alimentar foi de 14,8 anos e o tempo de diagnóstico médico foi de 8,07 anos. Na avaliação odontológica foram encontrados: CPO-d (dentes-cariados, perdidos e obturados) médio de 10,57; IHOS (índice de higiene oral) médio de 1,3; 71,4% das pacientes possuíam perda de brilho na face palatina dos dentes e 14,2% apresentaram perimólise. As pacientes purgativas apresentaram um índice CPO-d maior que as pacientes restritivas, a classe social mais prevalente foi a classe média. A Candida spp foi mais isolada em pacientes do serviço público e a xerostomia não foi um fator predisponente à colonização de Candida spp. A perimólise teve relação com o tempo de TAs das pacientes. Os resultados obtidos demonstram a necessidade de acompanhamento odontológico regular em pacientes com TAs. / The oral changes in patients with eating disorders (ED) are studied in literature, but few articles disclose the connection between oral changes, oral candidiasis and sociodemographic characteristics. This study evaluated the sociodemographic characteristics, oral changes and the prevalence of Candida spp. Fourteen patients were evaluated. Six subjects were diagnosed with Anorexia (purging subtype), seven with Bulimia and one with EDNOS (eating disorders no specified). Every subject included was female with a mean age of 30,7 years. All of them answered a questionnaire and passed through a clinical exam to evaluate the oral health focusing on oral lesions, erosion, decayed and candidiasis. Saliva was collected for analysis. The social demographics characteristics were observed 28.4% of subjects exercise a paid activity, 42.8% had college degree and 78.5% were single. The mean time of ED was 14.8 years and mean time of medical diagnosis was 8.07 years. The clinical exam revealed the following data: DMFT mean of 10.57; Plaque index (oral hygiene) mean of 1.3; 71.4% of subjects showed tooth wear in enamel on palatine surface and 14,2%, perimolysis. This results suggest that patients with purging habits had higher DMFT than restrictive patients, the social class can be a predisposing factor for ED, the local where treatment was done influenced in isolation of Candida spp; and xerostomia did not influence in colonization of the fungus. The perimolysis presented relation with time of manifestation ED. This results showed the importance of concomitant treatment with dentistry.

No description available.

<p>Background: Anorexia nervosa is a disease that often strikes teenager girls. The causes of the disease are not entirely known, but there are redeemed and maintenanced factors. The factors describes as biological, psychological and sociocultural. Aim: The aim of the study was to illuminate the nurses problem in caring of girls that developed anorexia nervosa. Method: The method of this essay is a literature study. The essay is based up on scientific articles. Results: The care of the anorexics is affected by several different factors. The factors are the anorexics, the parents and the nurses. The anorexics describe the illness as a struggle to find out the meaning of the illness. Many of the girls do not feel confirmed, but they has a big need of this. The SAUK- model describes the need of confirmation. The anorexics parents often wanted to help but they felt excluded from the care of their daughters. This made them feel a sense of guilt. The biggest problem in giving a god care is the negative relation between the nurse and the anorexics. The findings in the essay shows that it was difficult to built therapeutic relationships because lack of empathy and engagement from the nurses.</p>

Background: Anorexia nervosa is a disease that often strikes teenager girls. The causes of the disease are not entirely known, but there are redeemed and maintenanced factors. The factors describes as biological, psychological and sociocultural. Aim: The aim of the study was to illuminate the nurses problem in caring of girls that developed anorexia nervosa. Method: The method of this essay is a literature study. The essay is based up on scientific articles. Results: The care of the anorexics is affected by several different factors. The factors are the anorexics, the parents and the nurses. The anorexics describe the illness as a struggle to find out the meaning of the illness. Many of the girls do not feel confirmed, but they has a big need of this. The SAUK- model describes the need of confirmation. The anorexics parents often wanted to help but they felt excluded from the care of their daughters. This made them feel a sense of guilt. The biggest problem in giving a god care is the negative relation between the nurse and the anorexics. The findings in the essay shows that it was difficult to built therapeutic relationships because lack of empathy and engagement from the nurses.