Background The increasing burden of multimorbidity and its socioeconomic gradient poses unique challenges to the provision and structure of health care. We aimed to describe inequalities and trends over time in multimorbidity prevalence, incidence, and case fatality among adults of all ages in England using primary care electronic health records. MethodsWe used a random sample of 991 243 individuals from the Clinical Practice Research Datalink Aurum database registered at participating general practices within England between Jan 1, 2004, and Dec 31, 2019, linked to the 2015 English Index of Multiple Deprivation (IMD). We used the following two outcome measures: basic multimorbidity, comprising two or more chronic conditions; and complex multimorbidity, comprising at least three chronic conditions affecting at least three body systems. We calculated crude, age-standardised, and age-sexstandardised annual incidence, prevalence, and case fatality rates, along with median age of onset for both multimorbidity types. We calculated absolute and relative inequalities for each outcome.Findings In 2004, 30•8% of our study population had basic multimorbidity and 15•1% had complex multimorbidity. This increased to 52•8% and 32•7%, respectively, in 2019. Although the overall incidence of basic multimorbidity remained stable over the 16-year study period, the incidence among people of working age and the incidence of complex multimorbidity increased gradually. Socioeconomic deprivation was associated with an increased incidence of both multimorbidity types in working-age adults. The median age at onset of complex multimorbidity was 7 years younger for the most deprived quintile of the IMD compared with the least deprived quintile.Interpretation The burden of multimorbidity in England has increased substantially over the past 16 years with persistent inequalities, which are worse in working-age adults and for complex multimorbidity. Prevention efforts to reduce the onset and slow the progression of multimorbidity are essential to reduce the increasing impact on patients and health systems alike.

Objective To provide perinatal mortality and congenital anomaly rates for babies born to women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland.

Introduction Dietitians involved in eating disorder treatment are viewed as important members of the multidisciplinary team. However, the skills and knowledge that they require are not well characterised. Therefore, as part of a broader project to identify the key principles and clinical practice and training standards for mental health professionals and dietitians providing eating disorder treatment, the Australia & New Zealand Academy for Eating Disorders (ANZAED) sought to identify the key practice and training standards specific to dietitians. An expert working group of dietitians was convened to draft the initial dietetic standards. After expert review, feedback on the revised standards was then provided by 100 health professionals working within the eating disorder sector. This was collated into a revised version made available online for public consultation, with input received from treatment professionals, professional bodies and consumer/carer organisations. Recommendations Dietitians providing treatment to individuals with an eating disorder should follow ANZAED’s general principles and clinical practice standards for mental health professionals and dietitians. In addition, they should also be competent in the present eating disorder-specific standards based around the core dietetic skills of screening, professional responsibility, assessment, nutrition diagnosis, intervention, monitoring and evaluation. Conclusions These standards provide guidance on the expectations of dietetic management to ensure the safe and effective treatment of individuals with an eating disorder. Implications for professional development content and training providers are discussed, as well as the importance of clinical supervision to support professional self-care and evidence-informed and safe practice for individuals with an eating disorder.

Introduction Eating disorders are complex to manage, and there is limited guidance around the depth and breadth of knowledge, skills and experience required by treatment providers. The Australia & New Zealand Academy for Eating Disorders (ANZAED) convened an expert group of eating disorder researchers and clinicians to define the clinical practice and training standards recommended for mental health professionals and dietitians providing treatment for individuals with an eating disorder. General principles and clinical practice standards were first developed, after which separate mental health professional and dietitian standards were drafted and collated by the appropriate members of the expert group. The subsequent review process included four stages of consultation and document revision: (1) expert reviewers; (2) a face-to-face consultation workshop attended by approximately 100 health professionals working within the sector; (3) an extensive open access online consultation process; and (4) consultation with key professional and consumer/carer stakeholder organisations. Recommendations The resulting paper outlines and describes the following eight eating disorder treatment principles: (1) early intervention is essential; (2) co-ordination of services is fundamental to all service models; (3) services must be evidence-based; (4) involvement of significant others in service provision is highly desirable; (5) a personalised treatment approach is required for all patients; (6) education and/or psychoeducation is included in all interventions; (7) multidisciplinary care is required and (8) a skilled workforce is necessary. Seven general clinical practice standards are also discussed, including: (1) diagnosis and assessment; (2) the multidisciplinary care team; (3) a positive therapeutic alliance; (4) knowledge of evidence-based treatment; (5) knowledge of levels of care; (6) relapse prevention; and (7) professional responsibility. Conclusions These principles and standards provide guidance to professional training programs and service providers on the development of knowledge required as a foundation on which to build competent practice in the eating disorder field. Implementing these standards aims to bring treatment closer to best practice, and consequently improve treatment outcomes, reduce financial cost to patients and services and improve patient quality of life.

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