Biomedical subjects

C L Birmingham

Publications and source records attributed to C L Birmingham.

At least 19 recordsLinked to original sources

PubMed2006

Rumination in eating disorders: literature review.

Rumination is defined as regurgitation of partially digested food that is subsequently re-chewed and then swallowed or ejected by mouth. We report a case of rumination and a review of selected literature to emphasize: 1. Risk factors for rumination in eating disorders are unknown, 2. A history of rumination must be taken routinely because shame prevents patients from volunteering this history, 3. Rumination usually lessens with improvement of the eating disorder, but other methods including behavior modification, breathing techniques, and gum chewing have shown success in individual cases or small case series. There have been no controlled trials published of any treatment for rumination in eating disorders.

Adolescent↗

PubMed2006

Using the glucagon test to predict hypoglycemia in anorexia nervosa.

BACKGROUND: Hypoglycemia is an important but uncommon complication of anorexia nervosa (AN) that usually occurs when refeeding begins. The response to an iv bolus of glucagon has been used to investigate hypoglycemia, but not in AN. There are no published standards in AN to screen for hypoglycemia, to treat hypoglycemia, or for the response of the fasting blood sugar to an intravenous bolus of glucagon. METHOD: We report the change in blood glucose that resulted from bolus iv injection of glucagon in a case series of 9 patients with AN who were suspected of having experienced hypoglycemia. Our standard protocol for the glucagon test in AN is measurement of blood sugar at baseline, 10 minutes, and 20 minutes following a 1.0 mg iv bolus of glucagon in the fasting state. We take as normal any blood glucose measurement of 7.0 mmol/l or greater. RESULTS: Five of nine patients had abnormal tests. The body mass index (BMI) was not different in those who had normal compared to those who had abnormal tests. CONCLUSION: The glucagon test may be of use to predict the likelihood of developing hypoglycemia in AN. However, a larger study is required to define the normal response to the glucagon test in AN.

Adult↗

PubMed2005

The agreement between the MedGem indirect calorimeter and a standard indirect calorimeter in anorexia nervosa.

OBJECTIVES: Measurement of the basal metabolic rate (BMR) can be used to estimate the calories required for weight gain during refeeding in anorexia nervosa (AN). The reference method for measuring the BMR is indirect calorimetry. MedGem has developed a new indirect calorimeter that calculates the metabolic rate much more quickly than standard indirect calorimeters. This study compared the BMR measured by the MedGem and standard indirect calorimetry in an AN population. METHODS: We measured the BMR using the Deltatrac metabolic cart followed immediately by the MedGem indirect calorimeter in 27 subjects (12 patients and 15 controls). RESULTS: Bland-Altman plots show that there is poor agreement between the BMR reported by the MedGem compared to the Deltatrac. DISCUSSION: Until better agreement with standard indirect calorimetry can be shown the MedGem should not be used for calorimetry in AN. Possible factors that may limit the MedGem's reliability include patient discomfort with the mouthpiece, use of a fixed RQ, and the short sampling period.

Adult↗

PubMed2005

Pilot treatment program for shoplifting in eating disorders.

OBJECTIVE: There are no established treatment programs for shoplifting in eating disorder patients. Our objective was to observe the effect of an established behavioural treatment program in a series of eating disorder patients. METHODS: Patients with eating disorders who shoplift voluntarily took part in an 8-week behavioral treatment program at the Elizabeth Fry Society of Greater Vancouver, British Columbia. They completed assessments at the first session, last session, and at 1 and 6 months post intervention. RESULTS: Six patients enrolled in the study and three patients completed the treatment program. Only one patient reported a decrease in shoplifting frequency. All subjects reported an increase in self-esteem and ability to control shoplifting impulses. DISCUSSION: Our findings suggest that behavioral therapy may be effective in treating shoplifting in eating disorders, but that longer sessions and follow-up may be necessary to show benefit. A randomized control trial with longer-term follow-up is needed to determine whether there is a benefit.

Adult↗

PubMed2005

Measuring change in parotid gland size: test-retest reliability of a novel method.

BACKGROUND: There is currently no convenient method for measuring parotid gland hypertrophy, a common condition among patients with bulimia nervosa (BN) and anorexia nervosa (AN). OBJECTIVE: To develop a technique for reliably estimating change in parotid gland size. METHODS: A method for measuring facial width as a surrogate marker of parotid gland size was developed using calipers to measure between defined reference points located on the parotid gland region. The method was tested for reliability when performed by a single operator and used to determine face width measurements of 15 control subjects. RESULTS: Face width measurements were reliable when performed by a single operator. Face width measurements of control subjects ranged from 9.1 cm to 15.3 cm. DISCUSSION: The caliper method of measuring changes in parotid size is a novel method of measurement of parotid hypertrophy. It is quick, non-invasive and inexpensive and is highly reliable in the hands of a single operator.

Adolescent↗

PubMed2005

The relationship between self-rated health, stress, health care, overall quality of life and weight in a rural population.

OBJECTIVE: To determine if there is a relationship between self-rated health, stress, health care, satisfaction, overall quality of life scores and weight. DESIGN: A mailed survey and retrospective chart review of people living in the Bella Coola Valley who attend the Bella Coola Medical Clinic. STUDY POPULATION: Adults living in the Bella Coola Valley who are registered with the Bella Coola Medical Clinic. MAIN OUTCOME MEASURES: Self-rated health, stress, health care received, satisfaction with health, happiness, overall quality of life scores and weight (body mass index). RESULTS: An estimated 1734 residents live in the Bella Coola and are registered with the clinic. A total of 968 useable surveys were returned for a response rate of 56% (968/1734). Nine hundred and eighteen survey respondents had a recent weight in kilograms documented; 803 survey respondents had a height documented. A higher weight was associated with poorer self-rated health, higher stress levels, and lower satisfaction with health. It was also associated with lower self-esteem and satisfaction scores, particularly in younger obese people. A higher weight was not correlated with spirituality, overall quality of life, health care rating, or happiness scores. CONCLUSION: Increasing weight may contribute to poorer health, higher stress, lower satisfaction with health and poorer self-esteem. However, we found no evidence that increased weight impairs happiness or overall quality of life. This may be one reason for the lack of success of weight loss strategies that focus on happiness and overall quality of life to increase readiness and motivation. Alternatively, focussing on secondary medical benefits and self-esteem may be useful.

Body Weight↗

PubMed2005

Caloric requirement for refeeding inpatients with anorexia nervosa: the contribution of anxiety exercise, and cigarette smoking.

BACKGROUND: Refeeding inpatients with anorexia nervosa (AN) is costly, stressful, and can precipitate the refeeding syndrome. Caloric intake is usually increased gradually from a low starting point until a steady weight gain is achieved. There is no reliable equation that predicts the number of calories required for a weight gain. It was our clinical suspicion that anxiety, exercise, and cigarette smoking might increase the caloric need for refeeding. METHOD: We conducted an observational cohort study of 17 females with AN admitted to an inpatient eating disorder unit for refeeding. We estimated the energy intake by observation, the caloric expenditure due to exercise with a triaxial accelerometer, the number of cigarettes smoked by history, and the anxiety by the Beck Anxiety Inventory (BAI). RESULTS: Neither anxiety, exercise, or cigarette smoking predicted the caloric requirement for refeeding, individually or in combination. DISCUSSION: Our data suggest that the caloric requirement for weight gain during refeeding is not predicted by the patient's anxiety, exercise or smoking habits. The standard methods of estimating caloric requirements for refeeding remain indirect calorimetry and previous history.

Adult↗

PubMed2004

Unreported sauna use in anorexia nervosa: evidence from the world-wide-web.

Weight loss methods employed in anorexia nervosa (AN) are vomiting, laxatives, diuretics, enemas, suppositories, ipecac, weight loss medications and inadequate insulin in diabetics. Some methods result in weight loss from fluid depletion and not a reduction in body fat. Sauna use causes rapid fluid loss, but has not been reported in the medical literature as a weight loss strategy used in AN. We found reports of sauna use in AN on the world-wide-web are rare. We hypothesize that the warming caused by the use of sauna, may result in physical improvement in AN and thereby reduce its acceptability as a weight loss strategy.

Anorexia Nervosa↗

PubMed2004

A blinded laxative taper for patients with eating disorders.

OBJECTIVE: To evaluate a blinded laxative taper, supervised entirely by pharmacists, in eating disorder patients with laxative dependency. METHODS: All subjects received a blinded laxative taper according to a set protocol, in addition to the usual treatment for their eating disorder. No specific treatment was given for laxative dependency other than the pharmacist's supervisions of the blinded taper. RESULTS: Ten patients were enrolled, of whom seven completed the study. Five of the seven patients (71%) decreased their laxative intake by at least 50%. Of these seven patients, three withdraw completely from laxative use. DISCUSSION: A standardized blinded laxative taper shows promise as a treatment option for laxative dependency in patients with eating disorders. The laxative taper may be less costly and more available than inpatient or psychologically based treatment because it can be given on an outpatient basis under the supervision of a pharmacist.

Adult↗

PubMed2004

Hypomagnesemia during refeeding in anorexia nervosa.

BACKGROUND: Magnesium deficiency can cause weakness, constipation, seizures and arrhythmias. We frequently observe hypomagnesemia during refeeding in AN. OBJECTIVE: To determine the incidence and time of onset of hypomagnesemia during refeeding in anorexia nervosa (AN). DESIGN: Observational cohort study. SETTING: University teaching hospital in Vancouver, Canada. PATIENTS: Patients with AN (DSM-IV criteria) admitted for refeeding. INTERVENTION: All patients were admitted for supervised refeeding by meal support, in conjunction with our standard medical and psychological treatment. MEASUREMENTS: Serum magnesium was measured daily for 5 days and then 3 times a week. RESULTS: Fifty patients were admitted for an average of 24 days. Sixty percent (30/50) had low serum magnesium during their admission. Hypomagnesemia was present on admission in 16% but as late as the third week of refeeding in others. CONCLUSION: Serum magnesium should be measured on admission and rechecked weekly for the first 3 weeks of refeeding as a minimum.

Adult↗

PubMed2004

Disordered eating attitudes and behaviours in the high-school students of a rural Canadian community.

BACKGROUND: Most surveys of disordered eating attitudes in teenagers target females in urban areas. To help plan the distribution of treatment resources for eating disorders in British Columbia we studied male and female students in all of the high schools of a rural community. METHODS: Three hundred and ninety-six of the 2,589 students attending the four high schools within the rural community completed the EAT-26 and a demographic questionnaire. RESULTS: Three hundred and eighty-one of the 396 students (96%) satisfactorily completed and returned the survey. Their ages ranged from 12 to 19 years with a mean of 15.2 years (SD=1.5 years). Fifty-nine percent of participants were female. On average, males wanted to be 6.2 kg (SD=1.2 kg) heavier and females wanted to be 2.8 kg (SD=6.5 kg) lighter and 8.3 percent of males and 17.3 percent of females scored twenty or above on the EAT-26. INTERPRETATION: The prevalence of disordered eating attitudes and behaviours in this rural setting was similar to that reported in urban communities in Canada. Disordered eating attitudes and behaviours were common in males. We conclude that there is need for treatment resources for males and that the need for treatment is as great in rural as urban communities.

Adolescent↗

PubMed2004

British Columbia Provincial Eating Disorders Program: an organizational description.

The British Columbia Provincial Eating Disorders Program (BCEDP) is a small government funded body that communicates eating disorder treatment needs to the government, helps communication between primary, secondary, and tertiary care givers, gives treatment advice and teaching to primary and secondary care givers, and assists the Provincial Eating Disorders Resource Centre in decision making and communication with government. The program deals with anorexia nervosa and bulimia nervosa, but not obesity, for budgetary reasons.

Adolescent↗

PubMed2003

Anorexia nervosa: the cost of long-term disability.

This study was performed to estimate the cost of long-term disability in people who have anorexia nervosa (AN) that live in the province of British Columbia (BC), Canada. Canada provides universal socialized health and welfare services, and each of the 10 provinces is responsible for its own funding. As the provincial government of BC does not categorize its disability payments by the cause of the disability, a survey was used to determine the rate of disability from AN. A sensitivity analysis was performed to assess the influence of variations on the yearly cost of disability in BC: the number of patients with AN was varied between 1.0 and 2.0% of the female and 0.05 and 0.1% of the male population; the percentage of patients with AN receiving disability payments was determined by the survey to be 35%; the cost of these payments was varied between the lowest and highest benefits a single person can receive from the BC provincial government; and finally, to allow for possible sampling bias and a possible lower prevalence of AN, the lower limit of the sensitivity analysis was derived by dividing the lowest estimate above by seven. The sensitivity analysis revealed that the total estimated cost of long-term disability in BC could be as low as $2.5 million (Canadian) or as high as $101.7 million per year, which is a cost of up to 30 times the total yearly cost of all tertiary care services for the treatment of eating disorders in BC. In view of this finding, an increase in funding is warranted for primary, secondary and tertiary prevention programs for AN in BC.

Adolescent↗

PubMed2003

The management of adult obesity.

Obesity is Canada's most prevalent metabolic disease: one-third of Canadians are obese. It is a major cause of type 2 diabetes, hypertension, hyperlipidaemia, and atherosclerosis. The treatment of disease caused by obesity accounts for an estimated 2.4 percent of Canada's health care expenditures for all diseases (1.8 billion dollars in 1997). This article presents a treatment algorithm based on a number of international guidelines and aimed to help physicians play a more active role in the management of adult obesity. Two problems are briefly examined: pregnancy and stopping cigarettes smoking.

Adult↗

PubMed2003

Directives in anorexia nervosa: use of the "Ulysses Agreement".

The course of anorexia nervosa frequently has episodes of exacerbation during which motivation and insight are reduced, cognition is impaired and treatment resistance is increased. Formalizing a directive to be used during these episodes when the patient has greater motivation and insight is one way of reducing treatment resistance. We describe a form of directive, called the "Ulysses Agreement".

Adult↗

PubMed2003

Differential diagnoses to consider at an eating disorders clinic.

OBJECTIVE: To determine the reasons for referral of patients without eating disorders who were within a cohort of patients referred to an adult tertiary care eating disorders program. METHODS: Cases were obtained by retrospectively reviewing all the charts of patients who had been referred to a single eating disorders program over a 20-year period from 1981 to 2000. All referred cases had been screened by a nurse using a telephone or written questionnaire. RESULTS: Thirty-three out of 987 patients (3.3%) were identified as having no eating disorders. Four subjects were males (12.1%) and 29 were females (87.9%). After investigation, 16 were found to have a psychiatric diagnosis, 8 had a medical diagnosis, and 8 had no identifiable diagnosis. CONCLUSIONS: This study shows that the screening process for referral to a tertiary care eating disorders program is highly reliable and suspicion for a patient without an eating disorder should be low; in comparison with the eating disorder population, these patients are more likely to be male and psychiatric illnesses are twice more likely than medical disorders to be diagnosed.

Adult↗

PubMed2003

Kidney stones in anorexia nervosa: a case report and review of the literature.

Nephrolithiasis (kidney stones) is a recognized complication of anorexia nervosa (AN). We present the case of a 41-year-old woman with a 25-year history of AN. Between 1978 and 1986, she had two episodes of calcium oxalate kidney stones. Proper management of kidney stones in AN requires collection of the stone, laboratory analysis of the stone to determine its composition, and laboratory evaluation of the urine and blood to determine what treatment is necessary to prevent recurrent kidney stone formation.

Adult↗

PubMed2003

Self-phlebotomy in eating disorders.

We present the case of a health-care professional with anorexia nervosa who used self-phlebotomy as a form of purge. Self-phlebotomy is most prevalent in young females employed in medical or paramedical professions. The occurrence in eating disorders of severe, unexplained, or rapidly appearing anemia; unexplained needle tracks, or past or present employment as a health-care worker should raise suspicion of self-phlebotomy.

Adult↗