Objective
This study aimed to investigate the clinical presentation of binge‐eating disorder (BED) in a Japanese sample and to examine the relationship between subtypes of BED differing in onset ...patterns and those differing in prior history of another eating disorder (ED).
Methods
The study participants were 137 adults who met the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) criteria for BED. We subtyped participants based on prior history of another ED: 55 (40.1%) participants with a history of another ED (BED ED+) and 82 participants without such a history (BED ED–).
Results
Unlike in some Western studies, approximately three quarters of participants had a body mass index of <25 kg/m2. None of the participants reported a history of another ED with purging or excessive exercise. All BED ED+ participants transitioned to BED from anorexia nervosa restricting type (AN‐R) or from atypical AN‐R. BED ED+ participants reported more severe psychopathology than BED ED‐participants. Only 20% had a treatment history for BED. Dieting preceded their first binge eating in 55 participants (DIET‐first BED), and binge eating preceded their first dieting in 82 participants (BINGE‐first BED). Regarding the relationship between the two different subtypes, all DIET‐first BED participants were in the BED ED+ group, whereas all BINGE‐first BED participants were in the BED ED‐group.
Discussion
Present findings revealed the clinical presentation of BED in a Japan‐based study and suggested that subtypes of BED differing in the prior history of another ED yielded an accurate prediction of onset patterns (dieting first vs. binge eating first).
Public Significance
This study highlights the need for clinicians to consider subtype differences in onset patterns and clinical features of BED to treat and prevent this disorder. This study revealed that, although individuals with BED in Japan have severe symptoms and a long duration of illness, only 20% have received BED treatment. The results indicate a need to disseminate knowledge about BED to the Japanese public and healthcare providers.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Abstract To study transcultural differences in eating disorders, we examined eating disorder symptoms and point prevalence of eating disorders among Japanese female students in 1982, 1992 and 2002. ...In 1982, 1992 and 2002, a total of 10,499 Japanese female students, aged 16–23 years, were asked to complete a self-administered questionnaire. Diagnosis of an eating disorder was made on the basis of DSM-IV criteria. On almost all measures, there were significant increases of a disordered attitude about fear of gaining weight, body perception disturbance and problematic eating behaviors over time. The point prevalence of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified significantly increased over time. These results suggest that the prevalence of eating disorder symptoms and the point prevalence of eating disorders were increasing among Japanese female students in 2002. Changing socio-cultural factors in Japan may explain the dramatic increase of eating disorders over time.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Glioblastoma (GBM) is well known to have one of the poorest prognoses among all cancers. Patients with GBM in progression-free survival (PFS) may be relatively stable and can often maintain their ...quality of life. Thus, PFS is a desirable goal. In Japan, the median PFS is 11 months. It is difficult to grasp a patient's thoughts and hopes when, after PFS, they are readmitted due to recurrence or acute deterioration. Therefore, this study aimed to describe the lived experience of illness in patients with recurrent GBM, focusing on PFS. We enrolled five patients into the study; however, only four patients completed data collection. Data were collected using semi-structured interviews. We also conducted a thematic narrative analysis. As a result, we generated one overall theme: Even in vulnerable and constrained daily lives, the aim was gaining a sense of stabilityand maintaining it steadilyas far as possible, on their own. That sense of stability is fragile so that maintaining equilibrium is a precarious enterprise. Moreover, in PFS, participants were trying to maintain equilibrium by reevaluating themselves and sometimes giving up something, although they received support from people around them. We infer that it is important for nurses to assess and understand the fluctuations in that sense of stability through continuous involvement with patients. An interdisciplinary approach and lateral integration of care are important to meet the needs of GBM patients. This understanding will lead to nursing supports that help patients live with stability, pride, and dignity.
Aim: Patient education that enhances one's self‐management ability is of utmost importance for improving patient outcomes in chronic diseases. We developed a 12 month self‐management education ...program for type 2 diabetes, based on a previous 6 month program, and examined its efficacy.
Methods: A randomized controlled trial was carried out on outpatients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate. They were randomly divided into an intervention group that followed the program and a control group that followed usual clinical practise. The intervention group received <30 min of monthly interviews based on the program's textbook and biweekly telephone calls from a nurse educator throughout the 12 months.
Results: Of the 50 participants in the intervention group and the 25 participants in the control group, 42 and 23, respectively, completed the program (a completion rate of 84.0%). The body weight, HbA1c, self‐efficacy, dietary and exercise stages, quality of life, diastolic blood pressure, and total cholesterol level were significant by two‐way repeated‐measures anova. As for changes over time within the groups, only the intervention group showed significant differences by Friedman's test. The complication prevention behaviors showed a high implementation rate in the intervention group. The overall evaluation of this program by the participants was very high and, therefore, they highly recognized the need for this type of program.
Conclusions: Self‐management education works successfully in relation to patients' behavior modification skills, degree of goal attainment, and self‐efficacy, consequently improving their health outcomes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Objective
The purpose of this study was to investigate possible changes in the demographic and clinical characteristics of Japanese patients with eating disorders using a consecutive series of ...patients who presented at Kyoto University Hospital between 1963 and 2004. We also studied cultural factors related to eating disorders over time.
Method
We completed a retrospective review of a cohort of patients using a checklist based on the DSM‐5 diagnostic criteria. Patients seen from 1963 to 1974 (Period I, n = 26), 1975 to 1984 (Period II, n = 97), 1985 to 1994 (Period III, n = 540), and 1995 to 2004 (Period IV, n = 700) were compared.
Results
In this study, patients with restrictive eating appeared in the early 1960s. Patients with binge eating and purging behaviors appeared in the mid‐1970s and thereafter increased over time. The number of patients with anorexia nervosa and bulimia nervosa dramatically increased in Period III. The proportion of patients with binge eating increased, while the proportion of patients with restrictive eating decreased over time. All patients with anorexia nervosa in the 1960s had fat phobia and disturbed body image, but none of them reported dieting for slimness.
Discussion
The prevalence and clinical characteristics of patients with eating disorders significantly changed across the four time periods. In terms of cultural factors, present findings suggest that factors beyond industrialization, modernization and westernization may be necessary for the development of eating disorders, and these factors may change with the times.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Objective
To examine the impact of the DSM‐5 on the diagnoses and severity indicators of eating disorders, we conducted a comparative study on the classification of eating disorders including ...subtypes of anorexia nervosa (AN) between the DSM‐IV and DSM‐5 criteria. In addition, we studied the association of the DSM‐5 severity criteria and clinical variables.
Method
Participants were 304 outpatients, aged 16–45 years, with eating disorders, diagnosed using semi‐structured clinical interviews and the eating disorder examination questionnaire (EDE‐Q). The severity of AN, bulimia nervosa (BN), and binge‐eating disorder (BED) was rated from mild to extreme using the DSM‐5 severity criteria.
Results
The DSM‐5 remarkably reduced the number of diagnoses in the residual category from 37.5% to 9.2% and effectively differentiated the diagnostic groups in eating disorder psychopathology. Unexpectedly, however, the scores of all the EDE‐Q subscales significantly decreased as severity ratings increased in the DSM‐5 AN. Furthermore, while the AN binge‐eating/purging group reported significantly lower severity ratings than the AN restricting group, the former displayed more severe eating disorder psychopathology than the latter. In the BN and BED groups, the level of eating concern increased as severity ratings increased, but the severity groups did not differ on other eating pathology variables.
Discussion
The DSM‐5 effectively reduced the reliance on residual categories and differentiated the diagnostic groups in eating disorder psychopathology. However, our findings show limited support for the DSM‐5 severity specifiers for eating disorders. It is necessary to test additional clinical or functional variables for severity specifiers across eating disorders.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
The effect of smoking on leptin regulation is controversial. Smoking may induce low-grade inflammation. Recent series of studies indicated the critical role of macrophage migration in the ...establishment of adipose tissue inflammation. In this study, we aimed to see the effects of smoking and inflammation on leptin regulation both at cellular and epidemiological levels.
We compared the concentration of inflammatory markers and serum leptin levels among Japanese male subjects. Additionally, leptin and intercellular adhesion molecule (ICAM) -1 gene expression was assessed in adipocytes co-cultured with or without macrophages in the presence or absence of nicotine and/or lipopolysaccharide (LPS).
In subjects with BMI below 25 kg/m2, both WBC counts and soluble-ICAM-1 levels are significantly higher in smokers than in non-smokers. However, leptin concentration did not differ according to smoking status. However, in subjects with BMI over 25 kg/m2, smokers exhibited significantly lower serum leptin level as well as higher WBC counts and s-ICAM-1 concentration as compared with non-smokers. Leptin gene expression was markedly suppressed in adipocytes co-cultured with macrophages than in adipocyte culture alone. Furthermore, nicotine further suppressed leptin gene expression. ICAM-1 gene expression was markedly up-regulated in adipocytes co-cultured with macrophages when stimulated with LPS.
Adipose tissue inflammation appears to down-regulate leptin expression in adipose tissues. Nicotine further suppresses leptin expression. Thus, both smoking and inflammation may diminish leptin effect in obese subjects. Therefore, obese, but not normal weight, smokers might be more resistant to weight loss than non-smokers.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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