Healthcare Professionals and Extreme Risk Protection Orders: A Concise Review.

BACKGROUND: Extreme risk protection orders (ERPOs) are one policy mechanism to address the critical public health problem of gun violence. The inclusion of healthcare professionals with ERPOs is a promising approach to expanding ERPO utilization, yet early evidence has not been examined. OBJECTIVE: The purpose of this study was to synthesize the current research on healthcare professionals and ERPOs. DATA SOURCES: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Academic Search Complete, and Web of Science were searched. STUDY SELECTION: Studies examined healthcare professionals' role and function within the context of ERPOs. DATA EXTRACTION: Relevant studies were reviewed and included through consensus of the authors. Data extracted included authors, objective, design, states, healthcare professional type, mental health professional type, healthcare professional roles/involvement and key outcomes. DATA SYNTHESIS: There is unfamiliarity with ERPOs among healthcare professionals. Healthcare professionals lack ERPO knowledge and are unclear about ethical and legal ERPO liability. CONCLUSION: The available evidence suggests that healthcare professionals have an important role in ERPOs, but critical gaps in ERPO knowledge, training/resources, and liability will limit use and effectiveness of healthcare professionals, including nurses, in the role of ERPO petitioner.

California Hospice Ownership Changes From 2018-2020: A Spatial Analysis and Case Illustration.

Hospices in California have undergone significant and complicated ownership changes in recent years. Little is known about the impact of these ownership changes on hospices. The purpose of our longitudinal, retrospective descriptive study was to describe the ownership changes impacting hospices 2018 to 2021 in California. Using descriptive statistics, we measured characteristics of hospices with and without ownership changes employing public data from the California Home Health Agencies and Hospice Annual Utilization Report. Ownership change characteristics were measured via publicly available hospice provider and facility data. Spatial characteristics were additionally measured via latitude and longitude publicly available data. Our findings showed that ownership changes were significant and complicated. An influx of for-profit organizations into the California market was primarily responsible for these changes. Additionally, lack of corporate financial public disclosure and voluntary hospice accreditation, certification, and reporting result in a lack of free, publicly available, definitive comprehensive data on for-profit hospice ownership. This hinders information gathering on and provider/familial choice-making regarding hospices. Our study provides critical insight into the impact of ownership changes and lack of definitive, free, publicly available information on adult hospices in California caring for children and has important clinical, research, and policy implications.

Eating disorder-related functional impairment predicts greater depressive symptoms across one semester of college.

Eating disorder (ED) behaviors and depression are associated with numerous negative outcomes, including lower quality of life and functional impairment. College women are at elevated risk for both. Prior research indicates ED behaviors, including binge eating, self-induced vomiting, and fasting, predict increases in future depressive symptoms. However, symptom heterogeneity in EDs is common, and all disordered eating, or its associated distress, cannot be captured by the endorsement of behaviors. Impairment that results from ED behaviors may be a comparable, or stronger, predictor of depressive symptoms. We sought to characterize the longitudinal relationship between ED-related functional impairment, ED behaviors, and depressive symptoms. College-aged women [N = 304; 72 % white, mean (SD) age = 18.45 (0.88)] completed an online survey in August (baseline), and then three months later in November (follow-up). Baseline ED-related functional impairment, but not baseline ED behaviors, significantly predicted depressive symptoms at follow-up, controlling for baseline depressive symptoms, negative affect, and body mass index. Findings indicate ED-related functional impairment is a risk factor for increases in depressive symptoms across one semester of college, irrespective of ED behavior engagement, weight status, and dispositional negative affect. Intervening upon ED-related functional impairment may reduce or prevent future depressive symptoms among college-aged women.

LGBTQ+ outpatients present to eating disorder treatment earlier and with more severe depressive symptoms than cisgender heterosexual peers.

Community evidence indicates high eating disorder (ED) and comorbid symptom severity among LGBTQ+ compared to cisgender heterosexual (CH) individuals. Little is known about such disparities in ED treatment samples, especially in outpatient treatment. We aimed to descriptively characterize and investigate baseline group differences in symptom severity between LGBTQ+ and CH ED outpatients at treatment intake. Data from 60 (22.3%) LGBTQ+ and 209 (77.7%) CH ED outpatients were used to examine: (1) demographic and diagnostic differences; (2) differences in ED, depressive, and emotion dysregulation symptoms. Objectives were tested using Fisher-Freeman-Halton exact and independent samples t-tests, and analyses of covariance adjusted for age and diagnosis, respectively. Most LGBTQ+ outpatients were bisexual (55.2%), and 6.5% identified as transgender and non-binary. LGBTQ+ outpatients presented to treatment at younger ages (Mean Difference [MD] = -3.39, p = .016) and reported more severe depressive symptoms (MD = 5.73, p = .004) than CH patients, but endorsed similar ED symptom and emotion dysregulation severity. Groups did not differ in other demographic or diagnostic characteristics. LGBTQ+ individuals may develop more severe depression and similarly severe EDs at earlier ages but seek outpatient care sooner than CH peers. Managing depressive symptoms may be particularly important for LGBTQ+ ED patients.

A case for integrating self-compassion interventions targeting shame and self-criticism into eating disorder treatment: Commentary on Paranjothy and Wade.

Paranjothy and Wade's (2024) meta-analysis revealed that disordered eating was robustly and consistently associated with greater self-criticism and lower self-compassion across samples. It is well known that even evidence-based treatments for eating disorders (EDs) do not produce long-lasting effects for many patients. Additionally, it is unclear whether existing "mainstream" evidence-based ED treatments effectively reduce shame and self-criticism and increase self-compassion, even when they intend to do so. In this commentary, we assert that Paranjothy and Wade's (2024) findings should inform the integration of self-compassion interventions within ED treatment. We argue that shame, a related but distinct construct, should be strongly considered as a primary intervention target in ED interventions that seek to reduce self-criticism and increase self-compassion. We hypothesize that directly addressing shame and bolstering self-compassion at the start of ED treatment may foster higher engagement and more durable effects. We introduce the potential for adjunctive self-compassion interventions to reduce shame and self-criticism, and enhance self-compassion, alongside or within existing ED treatments. Because self-criticism and shame are shared correlates of EDs and commonly co-occurring psychopathology, we contend with the possibility that self-compassion interventions may produce transdiagnostic effects. Shame, self-criticism, and self-compassion are important intervention targets to explore in future research.

Preliminary associations of body weight, weight bias, and dietary restriction with eating disorder diagnosis in women experiencing food insecurity.

Understanding the co-occurrence of food insecurity and eating disorders is a pressing concern. Several factors have been hypothesized to increase risk for eating disorders in women with food insecurity including dietary restriction, body weight, and weight-related bias, but few studies have tested these factors simultaneously to determine which are associated most strongly with eating disorder status. We tested cross-sectional associations of dietary restriction, current body mass index (BMI), weight suppression (i.e. the difference between current weight and highest weight), and weight bias with eating disorder diagnosis in a sample of 99 self-identified women with current food insecurity (54% White; mean [SD] age = 40.26 [14.33] years). Participants completed two virtual study visits consisting of electronic questionnaires and interviews. A binary logistic regression model was conducted to test relations between the hypothesized correlates and eating disorder diagnostic status in the past 12 months, controlling for age, food insecurity severity, and body dissatisfaction. Higher levels of weight suppression and weight bias, but not current BMI, were significantly associated with the presence of an eating disorder. Contrary to our hypothesis, greater dietary restriction was associated with lower likelihood of eating disorder diagnosis. Results suggest high levels of weight bias and weight suppression characterize women with food insecurity who meet criteria for an eating disorder. Women who experience food insecurity and have lost a relatively great deal of weight and/or hold biases about high weight should be screened for eating pathology in clinical settings.

East Tennessee older women's perceptions of Medicare, Medicaid, and related health policies.

Older women face unique challenges regarding health disparities. This study aims to provide an understanding of older women's perceptions and situated experiences regarding the gendered health disparities they face, which are characterized by the policies related to older women's health and the geopolitical and social norms in which they live. The purpose of this project is to provide policy and decision-makers with insights and a better understanding of older women's experiences and perceptions of the policies that impact their health and healthcare. The data for this study was collected through semi-structured interviews with twelve women in Appalachian East Tennessee. Areas examined include: the women's perceived impact of federal, state, and local policies on the participants, particularly of Medicare and Medicaid; the role of social norming and health narratives, particularly stigmatization, discrimination, and health marginalization of older women; and the role of place and place-based drivers on these areas. This study sought to determine if these factors impact the participants' awareness or lack of awareness of policies related to older women. Findings showed that older women in East Tennessee lacked knowledge of health policies, that older women perceive systemic and individual discrimination in policymaking, clinical care, and health research, and that they perceive that place-based drivers have impacted their access to healthcare. These findings have implications for policymaking and intervention design in co-production with older women in order to mitigate older women's health disparities.

Longitudinal transactions between negative urgency and fasting predict binge eating.

Fasting and negative urgency (the disposition to act rashly when distressed) are risk factors for binge eating. It may be that each influences the other over time to predict binge eating. OBJECTIVE: This study tested whether (1) fasting predicts binge eating through negative urgency, and (2) negative urgency predicts binge eating through fasting. METHOD: Path analysis and mediation tests were used to investigate objectives in n = 302 college women assessed three times over eight months. We controlled for each variable at the previous time point, and concurrent negative affect and body mass index at each time point. RESULTS: Time 1 (T1) fasting predicted elevated negative urgency three months later at Time 2 (T2) and T2 negative urgency predicted increases in binge eating five months later at Time 3 (T3). T2 negative urgency mediated the relationship between T1 fasting and T3 binge eating. T1 negative urgency predicted increases in T2 fasting, which then predicted increases in T3 binge eating. T2 fasting mediated the relationship between T1 negative urgency and T3 binge eating. DISCUSSION: Findings suggest fasting and negative urgency transact to predict binge eating among college women. Interventions targeting negative urgency may prevent or reduce both fasting and binge eating.

A longitudinal test of problematic alcohol use and binge eating among college women: The moderating role of shame.

Problematic alcohol use and binge eating frequently co-occur. High levels of negative affect, negative urgency, and/or shame may increase the likelihood that problematic alcohol use and binge eating co-occur over time. OBJECTIVE: Examine (1) the temporal relationship between problematic alcohol use and binge eating among college women, who are at high risk for both, and (2) the additive and moderating effects of shared, emotion-based risk factors in models involving both problematic alcohol use and binge eating. METHOD: In n = 302 college women assessed at two time points across 8 months, we used hierarchical linear regression to investigate our objectives. RESULTS: Baseline problematic alcohol use and baseline shame independently predicted increases in follow-up binge eating, controlling for baseline binge eating. In addition, the interaction between problematic alcohol use and shame accounted for further variance in subsequent binge eating (the influence of baseline problematic alcohol use on follow-up binge eating was stronger at higher levels of baseline shame). The reciprocal relationship was not significant: baseline binge eating did not predict follow-up problematic alcohol use independently or in conjunction with risk factors. Neither negative affect nor negative urgency showed predictive effects beyond prior behavior and shame. Results support (1) problematic alcohol use as a prospective risk factor for binge eating, (2) shame as an additive predictor of binge eating, and (3) shame as a positive moderator of prediction from problem drinking. CONCLUSION: Addressing shame and problematic alcohol use may be warranted in binge eating interventions for college women.

Understanding Adult Hospices Caring for Children in California, 2018-2021.

In areas where there are absences of pediatric hospice care, adult hospices are often asked to provide hospice care for children. Little is known about these adult hospices. The purpose of our study was to describe the characteristics of adult hospices in California that provided care to children from 2018 to 2021. Using public data from the California Home Health Agencies and Hospice Annual Utilization Report, we conducted a longitudinal, retrospective descriptive study to examine the effects of hospice characteristics on adult hospices which provide care to children. Market, mission, operational, and financial characteristics were measured via the California utilization data using descriptive statistics. Service area was measured via latitude and longitude public data. Hospice location maps were generated for year 2018 and year 2021. The 148 hospices in the study had distinct organizational profiles, mainly small, with broad service coverage areas, in rural and urban communities with predominantly nurses visiting children. There was a significant decline (32%) in availability of adult hospices caring for children between 2018 and 2021, particularly in northern California. Hospice economics, lack of familiarity with Medicaid, and staff comfortability with caring for children in hospice, were not driving this decline. Our study provides critical insight into the characteristics of adult hospices in California providing care for children and has important policy implications.

A reflexive thematic analysis of #WhatIEatInADay on TikTok.

Eating-related content is common on TikTok, a popular video-based social media platform, but studies of eating-related content on TikTok are limited. Given the documented association between social media use and disordered eating, investigation of eating-related content on TikTok is needed. One subset of popular eating-related content is "What I Eat in a Day" (#WhatIEatInADay), in which a creator documents the food they eat over the assumed span of a single day. We sought to evaluate the content of TikTok #WhatIEatInADay videos (N = 100) using reflexive thematic analysis. Two primary types of videos emerged. First, Lifestyle videos (N = 60), which included aesthetic elements, presentations of clean eating, stylized meals, promotion of weight loss and the thin ideal, normalization of eating as a fat woman, and disordered eating content. Second, Eating Only videos (N = 40), which were primarily focused on food, and included upbeat music, an emphasis on highly palatable foods, displays of irony, emojis, and excessive consumption of food. Because viewing eating-related social media content has been associated with disordered eating, both types of TikTok #WhatIEatInADay videos may be harmful to vulnerable youth. Given the popularity of TikTok and #WhatIEatinADay, clinicians and researchers should consider the potential impact of this trend. Future research should examine the impact of viewing TikTok #WhatIEatInADay videos on disordered eating risk factors and behaviors.

Examining the role of urgency in predicting binge size in bulimia nervosa.

Greater binge size within bulimia nervosa is associated with elevated distress and impairment. Theoretical models posit that emotion dysregulation predicts binge eating, but little research has investigated the potential for dispositional traits that reflect difficulty in emotion regulation to predict binge size among women with bulimia nervosa. Research supports that negative urgency, the tendency to act rashly when feeling distressed, is associated with binge eating behavior among individuals with bulimia nervosa. Relatively fewer studies have explored associations between binge eating and positive urgency, the tendency to act rashly when feeling extreme positive affect. The urgency traits may predict greater binge size within bulimia nervosa. The current study sought to examine negative urgency and positive urgency as predictors of test meal intake in a sample of 50 women, n = 21 with bulimia nervosa and n = 29 healthy controls. Dispositional levels of positive urgency, negative urgency, positive affect, and negative affect were measured prior to a laboratory binge eating paradigm. Participants in the bulimia nervosa group scored higher on negative urgency, positive urgency, and negative affect than participants in the control group. Across participants, lower levels of negative affect were associated with greater test meal intake. Elevated levels of positive urgency predicted significantly greater test meal intake, but only for participants with bulimia nervosa. No other dispositional traits predicted test meal intake when the interaction of positive urgency and group was included in the model. Findings suggest positive urgency is an underappreciated, but potentially important, risk factor for greater binge size in bulimia nervosa.

Health literacy and eating disorder pathology in women with food insecurity: A preliminary cross-sectional study.

Food insecurity (FI), or limited consistent access to food, is associated with eating disorder (ED) pathology; however, the underlying mechanisms of this relationship remain unclear. Health literacy, or the ability to comprehend and apply health-related information to decision making, is linked to FI and has implications for outcomes across a broad range of diagnoses. The purpose of this study was to examine associations between health literacy and ED symptoms in a sample of 99 women with FI. Linear regression tested cross-sectional associations between scores on The Newest Vital Sign (NVS), a measure of health literacy, and scores on the Eating Pathology Symptom Inventory (EPSI) and behaviors reported in the Eating Disorder Diagnostic Interview (EDDI). Logistic regression examined the likelihood of ED diagnosis in relation to NVS score. The sample mean (SD) age was 40.3 (14.3) years, and participants self-identified as 54.5 % White, 30.3 % Black, and 13.8 % other. Respondents self-reported 13.1 % marginal, 28.3 % low, and 58.6 % very low food security. Mean NVS score was 4.45, and significantly higher for White compared to Black individuals (F = 3.96, p = .02, η2 = 0.76), but not between other groups. No difference in NVS score by FI status was observed. EPSI Body Dissatisfaction was positively associated with NVS score. No associations were found between remaining EPSI subscales, eating behaviors, or ED diagnosis. White women, but not other groups, were found to have significant negative relationship between NVS and EPSI restricting. Future longitudinal research including components of health literacy related to eating in individuals with FI is warranted.

Comorbid eating, depressive, and anxiety psychopathology is associated with elevated shame in women with food insecurity.

OBJECTIVE: To compare participants with current food insecurity and different psychopathology profiles on shame, guilt, anxiety, and depression using a cross-sectional design. METHOD: Women with current food insecurity (n = 99; 54% White) were placed into four groups based on their endorsement of symptoms of psychopathology: eating disorder with depression/anxiety comorbidity (ED-C group; n = 17), depression/anxiety only (Depression/anxiety group; n = 34), eating disorder only (ED group; n = 12), and No-diagnosis group (n = 36). Groups were compared on self-report measures of shame, guilt, depression, and anxiety using analysis of covariance. RESULTS: The presence of an eating disorder was associated with quadruple the risk of screening positive for comorbid depression and anxiety. The ED-C group reported elevated shame relative to the ED and No-diagnosis groups. The ED-C group reported the highest levels of anxiety, followed by the Depression/anxiety group, and the ED and No-diagnosis groups. DISCUSSION: The presence of an eating disorder with comorbidity among women with food insecurity is associated with heightened shame. Given shame's status as a transdiagnostic predictor of psychopathology, it may serve as a putative mechanism underlying the relationship between food insecurity and eating disorder comorbidity. PUBLIC SIGNIFICANCE STATEMENT: Women with food insecurity and an ED were more likely to also screen positive for depression and/or anxiety than women with food insecurity and no ED. Overlap between ED, depression, and anxiety was associated with elevated shame, a harmful, maladaptive emotion with negative psychosocial consequences.

Selective Serotonin Reuptake Inhibitor Use in Pregnancy and Protective Mechanisms in Preeclampsia.

Depression and preeclampsia share risk factors and are bi-directionally associated with increased risk for each other. Despite epidemiological evidence linking selective serotonin reuptake inhibitors (SSRIs) in pregnancy to preeclampsia, serotonin (5-HT) and vasopressin (AVP) secretion mechanisms suggest that SSRIs may attenuate preeclampsia risk. However, there is a need to clarify the relationship between SSRIs and preeclampsia in humans to determine therapeutic potential. This retrospective cohort study included clinical data from 9558 SSRI-untreated and 9046 SSRI-treated pregnancies. In a subcohort of 233 pregnancies, early pregnancy (< 20 weeks) maternal plasma copeptin, an inert and stable AVP prosegment secreted 1:1 with AVP, was measured by enzyme-linked immunosorbent assay. Diagnoses and depression symptoms (Patient Health Questionnaire-9 [PHQ-9]) were identified via medical records review. Descriptive, univariate, and multivariate regression analyses were conducted (α = 0.05). SSRI use was associated with decreased preeclampsia after controlling for clinical confounders (depression severity, chronic hypertension, diabetes, body mass index, age) (OR = 0.9 [0.7-1.0], p = 0.05). Moderate-to-severe depression symptoms were associated with significantly higher copeptin secretion than mild-to-no depression symptoms (240 ± 29 vs. 142 ± 10 ng/mL, p < 0.001). SSRIs significantly attenuated first trimester plasma copeptin (78 ± 22 users vs. 240 ± 29 ng/ml non-users, p < 0.001). In preeclampsia, SSRI treatment was associated with significantly lower copeptin levels (657 ± 164 vs. 175 ± 134 ng/mL, p = 0.04). Interaction between SSRI treatment and preeclampsia was also significant (p = 0.04). SSRIs may modulate preeclampsia risk and mechanisms, although further studies are needed to investigate the relationships between 5-HT and AVP in depression and preeclampsia.

Need for Improved Collection and Harmonization of Rural Maternal Healthcare Data.

Representation in data sets is critical to improving healthcare for the largest possible number of people. Unfortunately, pregnancy is a very understudied period of time. Further, the gap in available data is wide between pregnancies in urban areas versus rural areas. There are many limitations in the current data that is available. Herein, we review these limitations and strengths of available data sources. In addition, we propose a new mechanism to enhance the granularity, depth, and speed with which data is made available regarding rural pregnancy.

Increases in shame following binge eating among women: Laboratory and longitudinal findings.

This multi-method, two-study investigation tested the hypothesis that, controlling for guilt and negative affect, shame increases following binge eating. Support for this hypothesis constitutes the first step in testing the theory that shame mediates the link between binge eating and comorbid psychopathology. Study 1 employed a laboratory binge-eating paradigm in n = 51 women [21 with bulimia nervosa, 30 controls]. Study 2 employed a naturalistic test of prospective relationships among binge eating, shame, guilt, and negative affect in n = 302 college women over three months. In Study 1, women with bulimia nervosa reported increases in shame that were not explained by changes in guilt or negative affect, following laboratory binge eating, compared with controls. In Study 2, baseline binge eating predicted increased shame at follow-up independently of guilt and negative affect. Should shame prove to mediate the link between binge eating and comorbid disorders, interventions to reduce shame may be useful for those who binge.

Implementation of a Maternal Child Knowledgebase.

To advance the application of clinical data to address maternal health we developed and implemented a Maternal Child Knowledgebase (MCK). The MCK integrates data from every pregnancy that received care at the University of Iowa Hospitals & Clinics (UIHC) and links information from the pregnancy episode to the delivery episode and between the mother and child. This knowledgebase contains integrated information regarding diagnoses, medications, mother and child vitals, hospital admissions, depression screenings, laboratory value results, and procedure information. It also collates information from the electronic health record (EPIC), the Social Security Death Index, and the Medication Administration Record into one knowledgebase. To enhance usability, we designed a custom viewer with several pre-designed queries and reports that eliminates the need for users to be proficient in SQL coding. The recent implementation of the MCK has supported multiple projects and reduced the number of Obstetrics-related data queries to the Biomedical Informatics group.

Barriers and solutions to developing and maintaining research networks during a pandemic: An example from the iELEVATE perinatal network.

Introduction: To improve maternal health outcomes, increased diversity is needed among pregnant people in research studies and community surveillance. To expand the pool, we sought to develop a network encompassing academic and community obstetrics clinics. Typical challenges in developing a network include site identification, contracting, onboarding sites, staff engagement, participant recruitment, funding, and institutional review board approvals. While not insurmountable, these challenges became magnified as we built a research network during a global pandemic. Our objective is to describe the framework utilized to resolve pandemic-related issues. Methods: We developed a framework for site-specific adaptation of the generalized study protocol. Twice monthly video meetings were held between the lead academic sites to identify local challenges and to generate ideas for solutions. We identified site and participant recruitment challenges and then implemented solutions tailored to the local workflow. These solutions included the use of an electronic consent and videoconferences with local clinic leadership and staff. The processes for network development and maintenance changed to address issues related to the COVID-19 pandemic. However, aspects of the sample processing/storage and data collection elements were held constant between sites. Results: Adapting our consenting approach enabled maintaining study enrollment during the pandemic. The pandemic amplified issues related to contracting, onboarding, and IRB approval. Maintaining continuity in sample management and clinical data collection allowed for pooling of information between sites. Conclusions: Adaptability is key to maintaining network sites. Rapidly changing guidelines for beginning and continuing research during the pandemic required frequent intra- and inter-institutional communication to navigate.

Reciprocal relations between body dissatisfaction and excessive exercise in college women.

OBJECTIVE: Body dissatisfaction elevates the risk for disordered eating behaviors. Excessive exercise is prevalent among college women and associated with harm. Risk theory posits a bidirectional relationship between risk factors for disordered eating behaviors and the behaviors themselves. This study investigated the longitudinal, reciprocal relationship between body dissatisfaction and excessive exercise. PARTICIPANTS AND METHODS: College women (n = 302) assessed in August (baseline) and November (follow-up). RESULTS: Baseline body dissatisfaction significantly predicted increases in excessive exercise endorsement at follow-up, controlling for baseline excessive exercise endorsement and body mass index (BMI). Baseline excessive exercise endorsement predicted increases in body dissatisfaction at follow-up, controlling for baseline body dissatisfaction and BMI. CONCLUSIONS: Findings support the presence of a positive feedback loop between body dissatisfaction and excessive exercise; both predict increases in risk for the other, regardless of weight status. Future research should test whether this process is ongoing and predicts further distress.