Journal Article Annotations
2022, 1st Quarter
Annotations by Katiuska Ramirez, MD, Carlos Fernandez-Robles, MD and Isabella Campusano, MD
This study assessed the prevalence of disordered eating behaviors (DEBs) using a longitudinal population-based study. The results demonstrate significant variability among prevalence rates for unhealthy weight control behaviors (UWCBs) and binge eating based on patient gender, ethnicity/race, and developmental period. Women were found to have higher rates of UCWBs and binge eating compared to men in all age groups studied. Among all women in the study, the prevalence of UWCBs and binge eating were highest in late adolescence and adulthood respectively. Rates of both UWCBs and binge eating were highest among men during adulthood.
There was an increased prevalence of DEBs among Hispanic/Latina adolescent girls, Black/African American women, and Hispanic/Latino men in the study. The prevalence of binge eating was found to be three times higher in Hispanic/Latina women compared to women in other ethnic/racial groups and developmental time periods. UWCB prevalence was twice as high among Asian American men and Hispanic/Latino men across each developmental period relative to Black/African American and white men. Binge eating prevalence among Hispanic/Latino men during adolescence and adulthood were found to be up to 10 times higher compared to men with any other ethnic/racial identity at any other time point.
Strength and weaknesses:
Strengths of the study include its longitudinal nature with four waves of data obtained over a 15-year period. The data examined multiple intersecting gender and ethnic/racial identities, allowing for comparison among different groups. Limitations of the study include relatively low sample sizes in specific groups. Data from Native American or Native Hawaiian or Pacific Islanders were collected but not analyzed due to small sample sizes in these groups resulting in low statistical power. Similarly, the sample size of adolescent Black/African American men who responded to binge eating assessments resulted in insufficient statistical power. The survey used in the study asked participants to identify as either male or female without providing additional gender identity response options. The study was not able to evaluate specific subtypes of UWCBs (e.g., fasting or use of laxatives or diuretics), again due to limited numbers of responses for individual behaviors.
Historically, studies investigating DEB prevalence over time have used samples which disproportionately include white women. This study demonstrates significant variability among prevalence rates for both UWCBs and binge eating based on patient gender, ethnicity/race, and developmental period. Gaining a better understanding of the trajectory of DEBs over time and the impact of ethnicity/race on this trajectory will help identify patients at elevated risk of these behaviors, inform when to screen for DEBs, and when to time preventative measures to decrease DEB prevalence.
During the early part of the COVID-19 pandemic-related interruptions in healthcare resulted in lower physical and psychological health scores, social relationships, and overall reduced quality of life for rheumatological patients in Mexico. These findings persisted six months later, despite re-establishing healthcare visits. Affected patients were most likely to be young, unemployed, have a diagnosis different from rheumatoid arthritis, be treated with corticosteroids, and have high pain scores and lower physical function. Also, they had more frequent comorbidities, higher anxiety, depression, distress related to traumatic events, and referred more frequently negative emotions.
Strength and weaknesses:
This well-designed study benefits from having a large number of participants and a low attrition rate. Using Spanish-validated versions of several tools improves reliability, validity, and breadth of nuance. However, while the study describes many variables, there are some notable absences among factors well known to impact QoL, such as exercise, nutritional state, coping skills, and relevant to the setting, COVID-19 vaccination status.
Healthcare interruptions were common during the early part of the COVID-19 pandemic due to lock downs and hospitals’ forced operational adjustments. This study shows the extent and impact of healthcare interruptions, even in tertiary care centers, for patients with rheumatological diseases. These patients experienced detrimental effects on their physical, psychological, and social well-being and their overall quality of life. Patients in less-resourced countries with more gaps in telemedicine access may experience even more pronounced negative outcomes from care interruptions. C-L psychiatrists can draw from these findings to consider the effect of healthcare interruptions on medically ill patients.