Although adolescent girls with elevated dietary restraint scores are at increased risk for future binge eating and bulimic pathology, they do not eat less than those with lower restraint scores. The fact that only a small proportion of individuals with elevated dietary restraint scores develop bulimic pathology suggests that some extreme but rare form of dietary restriction may increase risk for this disturbance. We tested the hypothesis that fasting (going without eating for 24-hours for weight control) would be a more potent predictor of binge eating and bulimic pathology onset than dietary restraint scores using data from 496 adolescent girls followed over 5-years. Results confirmed that only 23% of participants with elevated dietary restraint scores reporting fasting. Furthermore, fasting generally showed stronger and more consistent predictive relations to future onset of recurrent binge eating and threshold/subthreshold bulimia nervosa over 1-to 5-year follow-up relative to dietary restraint, though the former effects were only significantly stronger than the latter for some comparisons. Results provide preliminary support for the hypothesis that fasting is a stronger risk factor for bulimic pathology than is self-reported dieting. Keywords dietary restraint; binge eating; bulimia nervosaTheorists posit that dieting increases risk for binge eating and bulimia nervosa onset. Dieting refers to intentional restriction of caloric intake for the purposes of weight loss (Wilson, 2002). According to Polivy and Herman (1985), "Successful dieting produces weight loss, which in turn might create a state of chronic hunger, especially if such weight loss leaves the dieter at a weight below the set-point weight that is defended physiologically " (p. 196). They also postulate that a reliance on cognitive controls over eating leaves dieters vulnerable to uncontrolled eating when these cognitive processes are disrupted. In support, relative to their non-dieting counterparts, adolescent girls with elevated dietary restraint scores are at increased risk for future bulimic symptom onset (Neumark-Sztainer et al., 2006;Stice, Killen, Hayward, & Taylor, 1998), increases in bulimic symptoms (Johnson & Wardle, 2005;Stice, 2001;Wertheim et al., 2001), and threshold and subthreshold bulimia nervosa onset (Killen et al., 1996) over 1-4 year follow-up periods. However, randomized trials indicate that assignment to a weight loss diet, versus an assessment-only control condition, results in decreases in binge (Goodrick, Poston, Kimball, Reeves & Foreyt, 1998;Klem, Wing, Simkin-Silverman, & Kuller, 1997) and decreases in bulimic symptoms for normal weight young women (Groesz & Stice, 2007;Presnell & Stice, 2003) and women with threshold and subthreshold bulimia nervosa (Burton & Stice, 2006).These contradictory findings are troubling because they have opposing public health implications. If dieting increases bulimic symptoms, prevention and treatment interventions should seek to decrease dieting and alternative non-dieting trea...

The purpose of this study was to explore facilitators and barriers that may contribute to, or prevent, the engagement and retention of Latinos in eating disorders (EDs) treatment. Objective The main objective of this investigation was to explore more fully the facilitators and barriers that may contribute to or prevent the engagement and retention of Latinos/as in EDs treatment. Methods A qualitative design based on grounded theory was used to guide in-depth interviews with 5 Latinas (mean age 31.2 years) with history of EDs and with 5 Latino mental health providers (mean age 36.4 years). Results Six main themes were found in the discussion with patients and mental health providers: immigration stress, treatment experience in the U.S., facilitators of help seeking, barriers to help seeking, treatment needs, and facilitators of treatment retention. For patients, lack of information about EDs and lack of bilingual treatment were identified as practical barriers. Other emotional factors such as stigma, fear of not being understood, family privacy and not being ready to change were identified as barriers to seeking help. Among facilitator factors that encouraged patients to seek help, the most salient were the perception of the severity of the ED and emotional distress. For treatment retention, family support was a key element among patients. For providers, offering short-term treatment and directive treatment were seen as relevant factors for treatment retention in Latinos. Conclusions A culturally sensitive intervention model for Latinas with EDs in the U.S. is discussed addressing four levels: patient; family; providers; and system.

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As the demand for health-care services continues to increase, clinically efficient and cost-effective patient monitoring takes on a critically important role. Key considerations inherent to this area of concern include patient safety, reliability, ease of use, and cost containment. Unfortunately, even the most modern patient monitoring systems carry significant drawbacks that limit their effectiveness and/or applicability. Major opportunities for improvement in both equipment design and monitor utilization have been identified, including the presence of excessive false and nuisance alarms. When poorly optimized, clinical alarm activity can affect patient safety and may have a negative impact on care providers, leading to inappropriate alarm response time due to the so-called alarm fatigue (AF). Ultimately, consequences of AF include missed alerts of clinical significance, with substantial risk for patient harm and potentially fatal outcomes. Targeted quality improvement initiatives and staff training, as well as the proactive incorporation of technological improvements, are the best approaches to address key barriers to the optimal utilization of clinical alarms, AF reduction, better patient care, and improved provider job satisfaction.