Tag: prevention

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30 days, decreases quality of life, and increases pain, morbidity and mortality.4

On international level, hospital- acquired PUs (some- times called decubitus ulcers) are very common.5 Although many of these cases are preventable, their point prevalence in Canadian hospitals for example is measured to be 25.1%.6 Unfortunately, the high rates of such condi- tion are associated with subsequent high burden on the healthcare system and the national economy considering the high cost of their management, and the frequent occurrence of associated significant morbidity and mortality.5 According to the Ontario Case Costing Initia- tive database in 2013 using the European Pressure Ulcer Advisory Panel (EPUAP) staging system, it was estimated that the cost of management of stage II ulcer is up to US$40 000 and can reach more than double this price for managing a single case of stage IV ulcer.7 A good example of the burden that PU add to the national economy was measured in USA; it was estimated that hospital acquired PUs increase the financial expenses on healthcare systems between US$6 and US$15 billion annually.8

The National Pressure Ulcer Advisory Panel (NPUAP), the EPUAP and the Pan Pacific Pressure Injury Alliance (PPPIA)9 have defined PU as a ‘lesion or a trauma to the skin and/or underlying tissue usually over a bony promi- nence and is the result of undiminished pressure, or pres- sure combination with shear, friction and moisture’. It is a degenerative progress attributable to biological tissues (skin and underlying tissues) being exposed to pressure and shearing forces. The pressure constrains the proper blood circulation and causes cell death, tissue necrosis and the development of ulcers.9 While the quality of PU prevention and treatment has increased considerably over the past years, PUs remains a global concern because of its frequency of occurrence and negative consequences for patients and families as well as for the healthcare system.10 Incidence of PUs for hospitalised patients ranges from 9% to 18%, among which the elderly popu- lation appears to be the most common group to develop the ulcers.11 At the same time, many elderly patients are more vulnerable to be ‘stuck’ at a certain stage of PU for a long period of time and sometimes for the remainder of their lives.12 This may result in longer length of hospital stay, heavier burdens for the healthcare system and family members, worst quality of life for elderly patients, which may also influence their mental health such as emotional stability.13 14

NPUAP, EPUAP and PPPIA9 developed the Pressure Ulcer Prevention Practice Guideline (PUPPG), which involves a range of evidence- based recommendations for PUs prevention that could be applied by healthcare profes- sionals globally. Frequently used PU prevention strategies recommended in this guideline includes PU risk assess- ment, regular repositioning, prevention management plan, appropriate use of support surfaces and protection, continence management, patient education, skin protec- tion, nutritional assessment and adequate nutrition.15 It also includes some recommendations specifically for

elderly people—‘protect aged skin from skin injury asso- ciated with pressure and shear forces’, taking into consid- eration that an aged person’s skin is vulnerable.15

A number of studies have been conducted on the implementation of PU prevention strategies among hospitalised patients. One cluster randomised trial conducted in Canada revealed that multidisciplinary PU prevention groups are more cost effective than usual care and yields no significant improvement in the treatment of PUs.16 Despite the existence of the guidelines on the prevention of PU, their effective utilisation in preventing PUs among hospitalised elderly patients varies in settings and countries. Also, although a number of studies have assessed strategies used in preventing PUs, there appears to be little or no information on systematic reviews that have assessed the effectiveness of guidelines used in PU prevention for elderly patients in hospitals. This study, therefore, aims to systematically review studies imple- menting PU prevention strategies recommended in the PUPPG for the prevention of PUs among hospitalised elderly patients globally.

OBJECTIVE The objective of this review is to assess the effectiveness of each of the strategies included in the PUPPG guide- line in reducing the incidence and prevalence of hospital acquired PUs in hospitalised elderly patients in compar- ison to no strategy (usual practice), or other strategies. The review question is: what is the effectiveness of imple- menting each of the PU prevention strategies included in the PUPPG in decreasing the incidence and prevalence of PUs among hospitalised elderly patients compared with no strategies (basic usual care) or different preven- tion strategies?

METHODS Study design This will be a systematic review and meta- analysis of published and unpublished studies that have assessed the use of PU prevention strategies in hospital settings among hospitalised elderly patients. The systematic review protocol has been developed and reported following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) criteria (see online supple- mental appendix 1).17

Inclusion criteria Population included This systematic review will focus on studies that involved all vitally stable (not admitted in the intensive care unit) bed ridden hospitalised patients aged 60 or above.

Interventions All studies that assessed the effect of PU preventive strat- egies found in the PUPPG, that were implemented on vitally stable bed ridden hospitalised patients aged 60 and

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above with an aim to decrease the occurrence of PUs, will be included in this review. Interventions will be limited to use of risk assessment, skin assessment, skin care, nutri- tion, position and repositioning, education and training, and medical devices care.

Comparator Interventions will be compared with other strategies to identify the most effective among them and/or will also be compared with no interventions (regular basic management).

Outcomes In this study, the primary outcome will be directly related to the incidence of the disease among elderly hospitalised patients (incidence shall be considered as the propor- tion of hospitalised patients who developed PUs while in hospital). Included studies must measure study duration related incidence of the disease and/or its point preva- lence and /or stage of PU (severity) as a measure of the effectiveness of the preventive strategies.

Types of studies We will focus only on Quantitative studies—experimental and quasi- experimental studies. These might include randomised and non- randomised controlled trials in addition to comparative and before- and- after studies.

Language Only studies written in English will be included in this systematic review.

SEARCH STRATEGY We will use a three- step strategy to find published and unpublished studies on PUs and their management. First, we will conduct an initial search through the Medline Ovid database using an analysis of text words found in the title and abstract, and the index terms used to describe the article. Second, we will use identified keywords and index terms to search for studies in identified databases. Finally, we will use the reference list of selected studies from the first and second searches to look for additional studies not found in the databases. For this study, we will consider only studies either published or unpublished in English.

The databases that shall be searched for this review will include Medline Ovid, Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, Cochrane library, Scopus and Web of Science. See online supple- mental appendix 2 for the example searching strategy and results in Medline (Ovid). All these databases will provide published studies. To find unpublished studies on our topic, we will use Google, Grey Literature reports and the Centers for Disease Control and Prevention.

The keywords we will use for our initial searches in Medline Ovid will include ‘pressure ulcers’, ‘pressure sore’, ‘bed sore’, ‘pressure injuries’, ‘prevention strate- gies’, ‘elderly patients’ and ‘hospital’.

Study screening and selection The titles, abstracts and full text of studies selected for this study will be reviewed by two independent researchers to identify studies that potentially meet the inclusion criteria outlined above. The Covidence software will be used for title, abstract and full- text screening. After importing references and inclusion/exclusion criteria into the Covi- dence software, two independent reviewers will screen titles of included studies according to the eligible criteria. Conflicts between those two reviewers will be resolved through discussion with a third reviewer. The same proce- dures shall be used for abstract screening. Following the abstract screening, full texts of these potentially eligible studies will be retrieved and independently assessed for eligibility by two reviewers. Any disagreement between the two reviewers over the eligibility of a particular study will also be resolved through discussion with the third reviewer. The process of study selection will be reported using the PRISMA flow diagram.17

Assessment of methodological quality Two independent reviewers will be used to assess the methodological validity of the quantitative papers that will be selected for retrieval prior to their inclusion in the review using standard critical appraisal tools from the Joanna Briggs Institute for Meta- Analysis of Statistics Assessment and Review Instrument (see online supple- mental appendix 3). All disagreement between the two reviewers shall be settled through discussions.

Data extraction After screening and selecting studies, key information from those studies will be extracted into an excel sheet for further analysis. We shall use a data extraction tool adapted from the standardised data extraction tool from the Joanna Briggs Institute Meta- Analysis of Statistics Assessment and Review Instrument (JBI- MAStARI). Considering the infor- mation, we will need for the data synthesis of our study, we shall use the JBI- MAStARI to develop a data extraction tool specifically for quantitative research data extraction (see online supplemental appendix 4). The tool will be used to extract: (1) Study characteristics of reviewed papers, such as authors, year of publication, journal; (2) Methods of the study, including study design (randomised control trial (RCT), quasi- RCT, longitudinal, retrospective), research purpose and/or questions; (3) participant characteristics, country where the study took place, setting, population, sample size, age, sex, ethnicity, socioeconomic status and/ or education level; (4) PU prevention strategies used in experimental group and control group (if applicable), (5) outcome measures and results and (6) conclusions of reviewed papers and any comments from reviewers. Two reviewers will independently perform data extraction. Authors of reviewed papers will be contacted in case of any missing details about their studies.

Data synthesis A meta‐analysis of outcomes combining various studies included in the review shall be done. We will assess

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statistical heterogeneity with I2, which will indicate the percentage of the total variation across studies: 0%–40% low heterogeneity, 30%–60% moderate heterogeneity, 50%–90% may represent substantial heterogeneity and 75%–100% is considerable heterogeneity. If there is a substantial amount of heterogeneity (75%), then sources of heterogeneity will be examined through subgroup and sensitivity analyses. We will also use χ2 test to test the heterogeneity and consider p<0.05 as statistically signifi- cant. A fixed‐effects model will be selected for significant homogeneous studies; otherwise we will apply a random‐ effects model. All outcomes will be summarised using ORs and 95% CI. An OR <1 will represent a lower rate of outcome among the group of patients who were treated following the guidelines. Publication bias will be assessed by visual inspections of funnel plots and Egger’s test.

We will also provide a narrative synthesis of the find- ings from the included studies. The narrative synthesis shall be structured by describing the studies according to the type of intervention used. This will include the three categories of interventions recommend in the PUPPG guideline9: 1. Prevention of PUs, including risk factors and risk as-

sessment, skin and tissue assessment, preventive skin care and emerging therapies for prevention of PUs.

2. Interventions for prevention and treatment of PUs, such as nutrition in PU prevention and treatment, re- positioning and early mobilisation, repositioning to prevent and treat PUs, support surface and medical device- related PUs.

3. Treatment of PUs, for example, assessment of PUs and monitoring of healing, pain assessment and treatment, wound care, assessment and treatment of infection and biofilms, wound dressings for treatment of PUs and surgery for PUs. Results will be presented in tables, figures and graphs, followed by discussion. Publication bias will be assessed in all analyses synthe- sising 10 or more studies to ensure adequate power in the analysis.18 For investigation of the effect of small studies and publication bias, data from included stud- ies will be entered into a funnel plot asymmetry test if we have at least 10 studies in the meta- analysis. Egger’s statistical test will be implemented using STATA/SE V.13 (StataCorp). The quality of supporting evidence will be assessed by the Grades of Recommendation, Assessment, Development and Evaluation.19

Patient and public involvement No patient involved.

Ethics and dissemination This review will only use published literature and will not recruit participants. Therefore, no formal ethical approval or consent is necessary. It is anticipated that this systematic review will provide a detailed summary of the evidence of the effectiveness of the PUPPG in preventing the occurrence of PUs among elderly patients in hospital. It is also expected that the study will provide

recommendations on the best PU preventive strategies applicable in healthcare settings. We aim to publish the research findings in a peer- reviewed scientific journal to promote knowledge transfer, as well as in various media, such as: conferences, seminars, congresses or symposia in a traditional manner.

Author affiliations 1Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada 2School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada 3School of Nursing, University of Ottawa, Ottawa, Ontario, Canada 4Xiangya School of Nursing, Central South University, Changsha, Hunan, China 5Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada 6Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Acknowledgements The authors would like to thank Lindsey Sikora (librarian) for counselling in developing the searching strategies.

Contributors AWB, HM and WC contributed to the conception of the research question and writing of the protocol. HM, AWB, WC, MDFM and DAF contributed to the development of search strategies, eligibility criteria and methodology for data synthesis. HM, AWB, WC, MDFM and DAF contributed to drafting of the protocol and provided approval for the final version of this protocol. HM, AWB and WC will work in duplicate to screen the titles and abstracts of all the materials obtained using the search strategy to exclude the articles that do not meet the eligibility criteria. HM, AWB and WC will evaluate the potentially eligible studies with the full text and further exclude studies with documentation of the reason for exclusion. All authors will contribute to the bias assessment strategy and data extraction criteria. HM, AWB and WC will independently extract data from the included studies. HM, AWB and WC will analyse the data and draft the manuscript. All authors will read, provide feedback and approve the final manuscript.

Funding This work was supported by Hunan Provincial Key Laboratory of Nursing, grant number (2017TP1004), Hunan Provincial Science and Technology Department, China.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer- reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.

ORCID iDs Wenjun Chen http:// orcid. org/ 0000- 0001- 5398- 8508 Dean A Fergusson http:// orcid. org/ 0000- 0002- 3389- 2485

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Effects of implementing Pressure Ulcer Prevention Practice Guidelines (PUPPG) in the prevention of pressure ulcers among hospitalised elderly patients: a systematic review protocol
- Abstract
- Background
- Objective
- Methods
  - Study design
  - Inclusion criteria
    - Population included
    - Interventions
    - Comparator
    - Outcomes
    - Types of studies
    - Language
- Search strategy
  - Study screening and selection
  - Assessment of methodological quality
  - Data extraction
  - Data synthesis
  - Patient and public involvement
  - Ethics and dissemination
- References
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Males and gender minorities in eating disorder prevention

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Eating Disorders The Journal of Treatment & Prevention

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Including the excluded: Males and gender minorities in eating disorder prevention

Leigh Cohn, Stuart B. Murray, Andrew Walen & Tom Wooldridge

To cite this article: Leigh Cohn, Stuart B. Murray, Andrew Walen & Tom Wooldridge (2016) Including the excluded: Males and gender minorities in eating disorder prevention, Eating Disorders, 24:1, 114-120, DOI: 10.1080/10640266.2015.1118958

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Including the excluded: Males and gender minorities in eating disorder prevention Leigh Cohn, Stuart B. Murray, Andrew Walen, and Tom Wooldridge

National Association for Males with Eating Disorders, Naples, Florida, USA

By operating under the outdated premise that eating disorders (ED) predo- minantly affect females, prevention efforts have been disproportionately aimed at girls and young women. This article will show how one-sided the research and program development has been, and present recommendations for how to expand curricula and policy to be more gender inclusive. Ultimately, ED and related issues (e.g., body image dissatisfaction, obesity, comorbid conditions, weight prejudice, etc.) cannot be expected to decrease unless everyone is involved, regardless of gender. We wouldn’t only inoculate girls for measles—preventing ED across the board is the only fully effective approach.

Adolescent girls: The face of a disorder

Try telling a stranger that you specialize in “males and eating disorders,” and the typical response is, “You mean like those poor starving girls. I didn’t know guys got eating disorders.” It’s infuriating, but somehow worse when it is members of the ED field thinking that way. This kind of ignorance starts with inaccuracies. Since the 1980s, the oft-repeated, not-cited statistic has been that 10% of individuals with ED are male. Erroneous to begin with, the number originated from a study that counted 241 people referred for ED at one hospital over a period of 3.5 years, prior to 1985. Twenty-four were males, some of which didn’t meet ED criteria, but because it wasn’t clear how many of the women fully met the criteria, the 10% is somewhat vague (Andersen, 1985). The figure does not represent other treatment providers’ admissions or the general population, and it was not replicated. Further, few physicians or members of the general public knew much about ED in the early 80s, and the admissions in those years predated the field’s emergence that soon followed. It is likely that the actual male prevalence at that time was much higher, as became evident in later studies.

Nonetheless, 10% has been parroted in books, professional articles, on ED organizations’ websites, and in popular media for the nearly 30 years, and it

CONTACT Leigh Cohn Leigh@gurze.net Eating Disorders: The Journal of Treatment and Prevention, P.O. Box 2238, Carlsbad, CA 92018, USA.

EATING DISORDERS 2016, VOL. 24, NO. 1, 114–120 http://dx.doi.org/10.1080/10640266.2015.1118958

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has minimized the drive for gender equality within the ED field. Usually, the National Eating Disorders Association (NEDA) is attributed as the source, because up until 2015—when Leigh Cohn updated their website’s statistics on males—they published this prevalence figure, although without a refer- ence. Had anyone dug deeper, they would have discovered that, not only was the 10% figure dated and misrepresented (instead of referring to males in treatment, as the study indicated, sometimes it is incorrectly used to indicate general prevalence), it was also always wrong for reasons that persist today. Oftentimes, men do not seek treatment because they are reluctant to ask for help; but beyond that, they are consistently stigmatized by the idea that they might have an adolescent girl’s problem. Men and boys are less educated about ED, so they might not even consider that their behavior (e.g., extreme weight loss, purging, binge eating, compulsive exercise, etc.) is on the ED spectrum. They might actually suffer from a diagnosable ED and think that it is normal behavior. In one study, male patients with anorexia nervosa emphasized the lack of gender-appropriate information and resources for men as an impediment to seeking treatment (Räisänen & Hunt, 2014). Additionally, assessment tests underscore males because they have been written for females (Darcy & Lin, 2012). For example, the Eating Disorders Inventory has a question, “I think my thighs are too large,” which resonates far less for men than women, whereas the Eating Disorders Assessment for Males (EDAM) uses a statement “I check my body several times a day for muscularity,” which is more oriented toward the concerns of males (Stanford & Lemberg, 2014). However, the EDAM was not available back in the 80s and the EDI was the standard. So, let’s forget about that 10% number once and for all!

The best data available (Hudson, Hiripi, Pope, & Kessler, 2007) indicate that males account for 25% of individuals with anorexia nervosa and bulimia nervosa and 36% with binge eating disorder. Further data from pre-adolescent samples illustrates that up to half of those with selective eating are boys (Nicholls & Bryant-Waugh, 2009), which is significant when considering the evidence suggesting that selective eating is often a precursor to the develop- ment of full-blown ED psychopathology in adolescence (Nicholls, Christie, Randall, & Lask, 2001). When it comes to subclinical eating disordered beha- viors, according to a review of numerous studies (Mond, Mitchison, & Hay, 2014), the percentages are even higher for males in subclinical ED (42–45% binge eat, 28–100% regularly purged, 40% endorsed laxative abuse and fasting for weight loss). Perhaps the most illustrative recent data point to disordered eating practices in the community, for the very first time, increasing at a rate faster in males than females (Mitchison, Mond, Slewa-Younan, & Hay, 2013). Okay, if this rising prevalence now means that about 25–50% of individuals with ED are male, shouldn’t we see at least a similar distribution of prevention studies? Doesn’t the absence of prevention studies continue to marginalize the

EATING DISORDERS 115

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male experience of disordered eating, and continue to propagate the notion that eating disorders just don’t bother the boys?

A 2007 meta-analysis described 32 prevention studies, only four (12.5%) of which included boys (Stice, Shaw, & Marti, 2007). Eating Disorders: The Journal of Treatment and Prevention has published 69 articles focused on prevention prior to this current issue, and 54% were exclusively female, and 39% of those that mentioned gender included males. None addressed gender minorities. Only one, “Beauty Myth and the Beast: What Men Can Do and Be to Help Prevent Eating Disorders” by Michael Levine (1994)—in the journal’s second issue—solely addressed males, but only within the context of how they can help females not to develop ED. Actually, when Levine’s contributions are removed, only 34% of this journal’s articles have included males. The authors of a university prevention study summed up the popular thinking of researchers, “Men were not recruited because women are much more likely than men to develop body image disturbances and eating dis- orders (Ridolfi & Vander Wal, 2008).” In other words, the 25–50% of males with disordered eating are insignificant—or the investigators were stuck with the 10% figure.

Incidentally, overall research shows a similar bias. At a session on males and ED at the International Conference on Eating Disorders in 2013, Mark Warren reported that a PubMed search for papers on anorexia nervosa between 1900–2010 showed that men were included in 26% of them. Speaking on the same panel, Cohn stated that “males” were found in fewer than 7% of abstracts between 2000–2012 that referenced “eating disorders.”

This current special issue of this journal includes 12 articles besides this one, and no one else is addressing the importance of including males. Although the authors, many of whom are the field’s foremost experts, offer excellent ideas, they are all overlooking the needs and roles that males play in the ED continuum. Only four even mention males (two of which added information about male prevention after being queried editorially), and the others either ignore gender, which is fine, or use offer feminine examples (e.g., Girls Scouts, sororities, school-based programs for girls, etc.). Again, no one mentions gender minorities.

Prevention amongst high-risk male groups

Male eating disorders and related issues are multi-cultural and exist across age groups, but there are certain specific populations that are particularly at high risk. The types of universal and selected prevention strategies that are described elsewhere in this journal should be gender inclusive, but beyond that, special attention needs to be focused on certain groups. Most school programs have been developed in consideration of risks for girls (e.g., pressure to be thin), but they also need to take into account the concerns

116 L. COHN ET AL.

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of boys (e.g., pressure to be lean and muscular); and, lessons, about media literacy for example, should be gender inclusive (e.g., show before and after computer-altered images of women and men). Additionally, there are a few specific populations in which non-female members should be reached.

People who identify as lesbian, gay, bisexual, transgender, and questioning (LGBTQ) are at higher risk of developing an ED (Brown & Keel, 2012). While approximately 3% of men in the general population identify as gay or bisexual, studies show that they comprise as high as 42% of men in treat- ment. Although globally more heterosexual males have ED, there are a higher percentage of gay males (15%) who are diagnosed (Feldman & Meyer, 2007). The idealized body type of being lean and muscular is particularly desired by gay men, many of whom suffer from body dissatisfaction, anxiety about appearance, excessive body checking, and negative physical-self evaluation, which all are risk factors for developing an ED. The LBGTQ community is proactive in seeking equal rights and recognition, and concerted efforts within the ED prevention community should be integrated into existing avenues for information and education. For example, university advocates who organize eating disorders awareness education and prevention efforts should coordinate with the LBGTQ Center on campus. Also, beginning at the pre-elementary level, putting an end to bullying (an identified precursor to ED behaviors) and teaching acceptance about gender diversity (including stereotypes as they relate to sexuality) should be a part of every prevention curricula.

Certain athletes are at higher risk for an ED. For example, wrestlers, boxers, jockeys, gymnasts, and long distance runners often lose weight by purging, fasting, and excessively exercising. Some football linemen force feed themselves to gain weight, and many athletes binge and exercise to work off the calories, unaware that their behavior might be considered bulimia ner- vosa. Through decades of prevention work with the NCAA and Olympic Committee, Ron Thompson and Roberta Sherman have led the way toward educating coaches at the college level. They’ve collaborated with adminis- trators, coaches, athletes, and cheerleaders; and, in this journal’s first issue, they contributed an article, “Reducing the Risk of Eating Disorders in Athletics” (1993) in which they outlined risk reduction strategies including deemphasize weight, eliminate group weigh ins, and stop dangerous “weight cutting” behaviors. In 1998, Thompson wrote a “Last Word” editorial in this journal after three wrestlers had died from exercising in saunas—two were wearing plastic suits at the time. He indicated that the NCAA was moving to adopt new restrictions on the use of destructive weight loss techniques, and shortly afterward the NCAA implemented prohibited practices that are still enforced, “The use of laxatives, emetics, excessive food and fluid restriction, self-induced vomiting, hot rooms, hot boxes, and steam rooms is prohibited for any purpose. The use of a sauna is prohibited at any time and for any

EATING DISORDERS 117

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purpose, on or off campus (NCAA, 2013).” In the 16 years after these rules were put into effect, no collegiate wrestler died as a result of unsafe weight cutting practices (Rosenfeld, 2014). While this is evidence that prevention efforts can save lives, the same ideas Thompson and Sherman voiced 24 years ago still need to be more widely implemented from elite levels down to children’s teams. Furthermore, prevention programs must be repeated reg- ularly due to the high turnover rate among coaches, especially in youth leagues, where many of the parents who coach are uneducated about body image issues, teasing, and other risk factors for ED, especially among males.

In the related demographic of body builders, increased research, educa- tion, and prevention surrounding muscle dysmorphia is crucial. The drive for muscularity becomes a compulsion for some men (and some women), who spend excessive hours in the gym and abuse steroids or performance enhan- cing supplements like creatine and protein powders, which are typically increased over time. Trainers, lifters, and fitness club staff, should be edu- cated about harmful consequences (e.g., kidney or liver problems, distorted body image, body objectification, social isolation) and the difference between healthy and unhealthy exercise and eating.

Last but not least, more research and prevention must be devoted to binge eating disorders. The most common ED and affecting far more males than anorexia and bulimia combined, BED, especially how it presents in males, is understudied clinically and is virtually absent in the prevention literature. Many men who can be classified with BED don’t even realize that bingeing isn’t normal guy behavior. Too often it is lumped together with obesity, even when the prevention field is perfectly aware that not everyone who is obese binges and not everyone who binges is obese. The insecurities that men have about their weight and body, sex and money, global fears and archaic definitions about what it means to be a man can result in binge eating for emotional comfort, so men need to be educated about feelings, commu- nication, community, and other areas that may be unfamiliar to them. They also must learn about principles of healthy living, because, frankly, a lot of men have misconceptions about nutrition, fat versus fit, and body/self- empowerment—to name just a few.

Transforming beauty and the beast

Levine’s aforementioned article was directed at how fathers, husbands, broth- ers, and other men can help women. In the abstract, he writes, “Eating disorders are in part created and maintained by the inter-related phenomena of male-female relationships…” but he is clearly most concerned about the women, “I am frightened—for my daughter, my wife, my female colleagues…” instead of men, including his sons. Although the article is monumental as the only prevention article that purely spoke to men—even though he ignored

118 L. COHN ET AL.

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those with ED—it misses an important point: when males are more sensitive to the needs of females, the better it will be for both sexes, and visa versa.

This is certainly not a revolutionary concept—compassion for everyone— but the ED prevention field has been too female centric. If it is good prevention strategy to teach a class of high school girls that pictures of thin models are digitally enhanced, can lead to poor body image, and are emo- tionally manipulative; then, shouldn’t boys be instructed in the same lessons too? In that instance, boys would discover that these kinds of sexually objectifying images are not only demeaning and harmful for the girls, but that their own preconceptions about beauty were being influenced. And, shouldn’t they all be shown how the men on magazine covers have their muscles highlighted with body makeup and Photoshop, and that those models were possibly abusing anabolic steroids or supplements in the pursuit of those six-pack abs and ripped chests? Shouldn’t women be told that men are insecure about their bodies in profound ways, that they engage in stigmatized behaviors that fill them with shame and other feelings that they have difficulty expressing in words. Women are learning to become empow- ered with tools like mindfulness, self acceptance, body love, media literacy, and self-respect; but, their insights to self awareness are only going to be truly effective if men learn these same methods for their own benefit, as well as for the women in their lives. That’s how both men and women can find support, eliminate stigmas surrounding ED, and experience an overall better life.

Society must move away from the paternalistic hegemony, and nowhere is that more true than in the arena of ED. That women have been victimized by men is not breaking news. Most women with ED have had negative experi- ences with men (e.g., father hunger, cruel words, sexual abuse) in one way or another, but so have males with ED! While feminism has campaigned so ardently for gender equality, the continued focus on female approaches to ED prevention and treatment—at the exclusion of non-females—may be funda- mentally anti-feminist. Beyond that, a new paradigm must emerge that reflects a society with increasing gender equality. While the LGBTQ com- munity makes inroads in areas such as gay marriage, and women are making strides in corporate boardrooms, a new heterosexual male must also manifest itself. He has to give up the chauvinistic mentality and develop underutilized cognitions (i.e., his feminine side) to exist more evenly in the balanced utopian world we’d all like to see. While that world may not be realistically possible, we should, nevertheless, strive toward that goal.

References

Andersen, A. (1985). Anorexia nervosa and bulimia: Their differential diagnoses in 24 males referred to an eating and weight disorders clinic. Bulletin of the Menninger Clinic, 49(3), 227–235.

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Brown, T. A., & Keel, P. K. (2012). The impact of relationships on the association between sexual orientation and disordered eating in men. International Journal of Eating Disorders, 45, 792–799. doi:10.1002/eat.v45.6

Darcy, A., & Lin, I. H. (2012). Are we asking the right questions? A review of assessment of males with eating disorders. Eating Disorders, 20–5, 416–426. doi:10.1080/10640266.2012.715521

Feldman, M., & Meyer, I. (2007). Eating disorders in diverse, lesbian, gay, and bisexual populations. International Journal of Eating Disorders, 40, 218–226. doi:10.1002/(ISSN) 1098-108X

Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348–358. doi:10.1016/j.biopsych.2006.03.040

Levine, M. (1994). Beauty myth and the beast: What men can do and be to help prevent eating disorders. Eating Disorders, 2, 101–113. doi:10.1080/10640269408249106

Mitchison, D., Mond, J., Slewa-Younan, S., & Hay, P. (2013). The prevalence and impact of eating disorder behaviours in Australian men. Journal of Eating Disorders, 1(Suppl. 1), 023. Retrieved from http://www.jeatdisord.com/content/1/S1/O23

Mond, J. M., Mitchison, D., & Hay, P. (2014). Eating disordered behavior in men: Prevalence, impairment in quality of life, and implications for prevention and health promotion. In L. Cohn & R. Lemberg (Eds.), Current findings on males with eating disorders (pp. 195–215). Philadelphia, PA: Routledge.

National Collegiate Athletic Association. (2013). 9.3 prohibited practices. In Wrestling: 2013–14 and 2014–15 rules and interpretations (p. WR-80). Indianapolis, IN: Author.

Nicholls, D., & Bryant-Waugh, R. (2009). Eating disorders of infancy and childhood: Definition, symptomatology, epidemiology, and comorbidity. Child and Adolescent Psychiatric Clinics of North America, 18, 17–30. doi:10.1016/j.chc.2008.07.008

Nicholls, D., Christie, D., Randall, L., & Lask, B. (2001). Selective eating: Symptom, disorder or normal variant. Clinical Child Psychology and Psychiatry, 6, 257–270. doi:10.1177/ 1359104501006002007

Räisänen, U., & Hunt, K. (2014). The role of gendered constructions of eating disorders in delayed help-seeking in men: A qualitative interview study. BMJ Open, 4, e004342– e004342. doi:10.1136/bmjopen-2013-004342

Ridolfi, D., & Vander Wal, J. (2008). Eating disorders awareness week: The effectiveness of a one-time body image dissatisfaction prevention session. Eating Disorders, 16, 428–443. doi:10.1080/10640260802370630

Rosenfeld, V. (2014) Weight loss in wrestling: Current state of the science. Retrieved from http://www.ncaa.org/health-and-safety/sport-science-institute/weight-loss-wrestling-cur rent-state-science

Stanford, S., & Lemberg, R. (2014). Measuring eating disorders in men: Development of the Eating Disorder Assessment for Men (EDAM). In L. Cohn & R. Lemberg (Eds.), Current findings on males with eating disorders (pp. 93–102). Philadelphia, PA: Routledge.

Stice, E., Shaw, H., & Marti, C. N. (2007). A meta-analytic review of eating disorder prevention programs: Encouraging findings. Annual Review of Clinical Psychology, 3, 207–231. doi:10.1146/annurev.clinpsy.3.022806.091447

Thompson, R. (1998). Wrestling with death. Eating Disorders, 6–2, 207–210. doi:10.1080/ 10640269808251257

Thompson, R., & Sherman, R. T. (1993). Reducing the risk of eating disorders in athletics. Eating Disorders, 1, 65–78. doi:10.1080/10640269308248268

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Adolescent girls: The face of a disorder
Prevention amongst high-risk male groups
Transforming beauty and the beast
References

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explain the role of central service in the prevention of healthcare associated surgical infection

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1. explain the role of central service in the prevention of healthcare associated surgical infection

2. explain the principles, practices and the importance of personal hygiene and attire, including PPE

3.identity the hazard of bloodborne pathogens and how the occupational safety and health administration requirements impact the safety

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explain the role of central service in the prevention of healthcare associated surgical infection

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1. explain the role of central service in the prevention of healthcare associated surgical infection

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3.identity the hazard of bloodborne pathogens and how the occupational safety and health administration requirements impact the safety

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Crime Prevention Through Environmental Design

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You need to begin thinking about your Research Paper. The subject is CPTED (Crime Prevention Through Environmental Design) Best Practices. Please download the Research Paper Template and begin your research. Instructions are in the template. Need a paper in the below format.

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Health Promotion: Prevention of Disease

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Health Promotion: Prevention of Disease Case Study Module 12 Instructions: Read the following case study and answer the reflective questions. Please provide rationales for your answers. Make sure to provide citations/references for your answers in APA format. Deadline: Due by Sunday at 23:59 p.m.

CASE STUDY: Caregiver Role Strain: Ms. Sandra A.

Sandra, a 47-year-old divorced woman, received a diagnosis of stage 3 ovarian cancer 4 years ago, for which she had a total hysterectomy, bilateral salpingo- oophorectomy, omentectomy, lymphadenectomy, and tumor debulking followed by chemotherapy, consisting of cisplatin (Platinol), paclitaxel (Taxol), and doxorubicin (Adriamycin). She did well for 2 years and then moved back to her hometown near her family and underwent three more rounds of second- line chemotherapy. She accepted a less stressful job, bought a house, renewed old friendships, and became more involved with her two sisters and their families. Sandra developed several complications, including metastasis to the lungs. Then she could no longer work, drive, or care for herself. She had been told by her oncologist that there was nothing else that could be done and that she should consider entering a hospice. She met her attorney and prepared an advance directive and completed her will. She decided to have hospice care at home and, with the help of her family, set up her first floor as a living and sleeping area. She was cared for by family members around the clock for approximately 3 days. Sandra observed that she was tiring everyone out so much that they could not really enjoy each other’s company. At this time, she contacted the Visiting Nurse Association (VNA) to seek assistance. Her plan was to try to enjoy her family and friend’s visits. After assessment, the VNA nurse prioritized her problems to include fatigue and caregiver role strain. Other potential problem areas that may need to be incorporated into the care plan include anticipatory grieving and impaired comfort. Reflective Questions

1. What are some of the stresses on Sandra’s middle-aged sisters and their families? 2. What resources are available to manage these stresses and support the sisters while

caring for their dying sister Sandra? 3. Describe Sandra’s feelings about dependency and loss of autonomy because she is

unable to do her own activities of daily living any longer

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State Health Improvement Program- Obesity and Tobacco Prevention Program

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Clinical: State Health Improvement Program- Obesity and Tobacco Prevention Program Purpose: Students will be able to describe population health issues such as obesity and tobacco use. Students will identify strategies at the individual/family, community and systems level for a comprehensive community health plan.Directions: As part of your clinical experience you will explore the Statewide Health Improvement Program that focuses on policy, systems, and environmental changes as an evidenced-based approach to the population-based issues of obesity and tobacco use.1.) Explore the MN Department of Health Website about the State Health Improvement Partnership. Read the SHIP fact sheets and explore 2-3 science-based strategies. Minnesota Department of Health State Health Improvement Program 2.) Review examples in the MN State Health Improvement Partnership 2018- 2019 Report to the Legislature, beginning on page 29. Select one local community site participating in this program and identify an evidence-informed policy, program, or system’s change that is being used. 3.) Then submit 300-600 words with the following:

Describe in a paragraph one of the strategies that you identified at the community level of practice.
Then, describe a different strategy at the system’s level of practice, and explain in one paragraph why this strategy is a more effective way to impact population health than requiring change from every single individual in the community

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Does Implementation of Fall Prevention Programs Reduce Falls

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Change can be difficult to implement. Now that you are almost finished with your change project (Project topic: Does Implementation of Fall Prevention Programs Reduce Falls), if you were to implement your project in your clinical practice, what type of resistance do you expect from staff? List at least three ways that you can lessen the resistance you may encounter to help ensure the success of your project. You can use this as reference: American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author. Scope of Nursing Practice, pp. 28-30 Review Appendix D, pp. 99-174 Websites: Explore the quality and safety reports on the National Academies Website Health and Medicine Division (formerly known as the Institute of Medicine): http://www.nationalacademies.org/hmd/ Review the American Nurses Association (ANA) website on workplace safety (http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment). Textbook: Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International.

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Overcoming resistance to fall project implementation

Resistance to implementation of a fall project may be caused by the organizational culture(Dearholt& Dang, 2012).This is especially in a situation where there is no much teamwork, no incentives for good performance or low job satisfaction. A hospital that also starts projects without seeing them through may also lead to skepticism and cynicism(AHRQ, 2013).

Another impediment to the implementation of the fall project may also be lack of knowledge and motivation by the staff(American Nurses Association, 2015). Staff may not know their roles and responsibilities in the fall project, hence not being keen to be involved.The staff may also not appreciate the importance of the project and hence they may not be fully motivated in implementing it. That fall prevention is secondary healthcare may lead to some staff being dismissive of the project.

Staff resistance may also be caused by the increased workload and disrupted workflows (AHRQ, 2013). Staff at most health institutions are overwhelmed by the workload due to inadequate healthcare staff nationally. Such staff may resist extra roles and responsibilities, especially when these are not crucial in providing primary healthcare. The resistance may be enhanced by the fact that most staff have established workflows and hence may not welcome activities that disrupt their day-to-day activities.

Resistance to change may also be caused by lack of adequate resources(American Nurses Association, 2015).Apart from staff lacking time, lack of tangible resources such as new care products and communication tools will cause resistance to implementation of the fall project.

Ways to overcome resistance in the implementation of the fall project include having a champion in the hospital’s senior management (AHRQ, 2013). The change agent should get a champion for the project by presenting to them the business and clinical case for the project. Such a champion will be able to get the rest of the management and staff on board. They are also more likely to contribute to positive change in organizational culture through influence and or directives.

Resistance can also be overcome by constituting a unit to spearhead the changes(Dearholt& Dang, 2012).The unit should be constituted from members representing the various stakeholders involved in implementation of the fall project. These members will be able to communicate to the implementers the importan…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….. Fall Prevention Programs Reduce Falls ……….

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Suicide Prevention, Forensic mental health expert in a prison

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Post date February 16, 2021
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Suicide prevention is an important responsibility for all correctional workers, especially the forensic mental health professional. Suicide prevention efforts include accurate assessment and effective intervention with offenders. In addition, they include the training of all correctional workers as potential \”assessors\” of suicide risk among offenders in a correctional setting.

Tasks:

Assume you are the forensic mental health expert in a prison. You have been asked to conduct training with various supervisors on the topic of suicide prevention.

Using at least three scholarly resources from the professional literature, research the prevalence of suicide in correctional institutions and the methods of accurate assessment and effective intervention with offenders. The literature may include the Argosy University online library resources; relevant textbooks; peer-reviewed journal articles; and websites created by professional organizations, agencies, or institutions (.edu, .org, or .gov).

Develop a 12- to 15-slide Microsoft PowerPoint presentation with detailed speaker notes to generate a training program for the supervisors in a prison. Your training program must include the following:

An explanation of the prevalence of suicide in correctional settings
A description of the common myths of suicide
Identification signs of increased suicide risk and how a forensic mental health professional can assess for such signs
An explanation of how suicide watch procedures should be structured so that the suicide watch is effective, safe, and ethical
Identification of three to five community resources that can assist offenders being released. Pick a major city (such as New York or Los Angeles) and search for community resources that have specific programs and services for offenders being released.
A comparison of the available services to help address both general and specialized needs. Be sure to cite your resources.
A summary and an explanation of the best possible case scenario for an offender being released to live in the major city you selected.
Give reasons and examples from your research to support your responses.

Be sure to include the following in your presentation:

1.) A title slide
2.) A reference slide
3.) Headings for each section
4.) Speaker notes to support the content on each slide

………………………………………………

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Suicide can be defined to include a range of activities such as thoughts and planning, self-harming, suicide attempts and harm to self that results in death (Tripodi & Bender, 2006). According to the authors, the rates of suicide among the incarcerated individuals in the United States is higher than that among the general population. The increase in the population from 1978 towards the current population was followed by an increase in the suicide rates in prisons and jails. However, the authors point that the rates of suicide among the incarcerated offenders in higher in local jails than that in state prisons. Most of the suicide cases that are reported in the correctional facilities occur through hanging, gas inhalation, ingestion of solid materials and drug over dose.

-Suicide common among the incarcerated offenders than among the common population (Tripodi & Bender, 2006). – Range between 6-9 times more than common population -As the prison population increased, the suicide rates also rose – Local jail suicide rates higher than in state prisons – Suicide assume several methods, such as gas inhalation, hanging, ingestion of solid materials and drug overdose……………………………………………………….

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Tags expert, forensic, health, mental, prevention, prison, suicide

Writers Solution

Prevention Program Design in Your Community

Post author By Smith Johnson
Post date February 12, 2021
No Comments on Prevention Program Design in Your Community

Introduction

Reflect on what you have learned throughout this course. You have analyzed models of addiction. You also have examined psychoanalytic, Gestalt, and evidence-based treatment models. Additionally, you considered how to develop treatment plans, provide for relapse prevention, and create successful addiction programs. Think about the information you will take away from this course and how it could be used in practice.

How do you create a prevention program that meets the particular needs of a community? How can you determine if a prevention program is successful? This week, you will work toward answering these questions.

Required Resources

Readings

National Institute on Drug Abuse (2003). Preventing drug use among children and adolescents: A research-based guide for parents, educators, and community leaders (2nd ed.). Retrieved from http://www.drugabuse.gov/publications/preventing-drug-abuse-among-children-adolescents
- Chapter 4, “Examples of Research-Based Drug Abuse Prevention Programs”

Optional Resources

Webcast: National Institute on Drug Abuse. (n.d.). Drug prevention specialists meet community leaders in NIDA-sponsored virtual town hall event. Retrieved from http://archives.drugabuse.gov/newsroom/09/townhall.html

Week 6 Discussion

Prevention Program Design in Your Community

Effective prevention programs should present long-term, repeated interventions to create effective family, school, and community programs. Some communities have already established and implemented a local prevention program, whereas others are still struggling to develop one. Consider your own community, and identify two addiction issues.

To prepare for this Discussion:.

Review Chapter 4, “Examples of Research-Based Drug Abuse Prevention Programs” in Preventing Drug Use Among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders.
Consider how you could create a research-based principles addiction prevention program for your community.
Reflect on how you will reach all students, families, and community members.

Postby Day 4 a response to the following:

Provide a brief description of your community and the addiction issue you identified. Describe a prevention program you would create to address the addiction issue. Given the demographics of your community, explain how you would get the message out to families, schools, and the community at large.

Be sure to support your postings and responses with specific references to the Learning Resources.

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Art: Prevention Program Design in the Community

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Brief Description of My Community

My community consists of diverse families, with an average youthful population. Majority of the families have average incomes and can afford majority of basic and luxuries necessities in life. Most of the youthful population is school-going children with an average age of about 15 years. Many of the youths struggle with alcohol abuse and violence associated with alcohol abuse. A prevention program that needs to be designed for my community must involve the parents and educators, since most of the drug abuse cases occur among the school going youth. Employing a program that involves the school, families and community, is pertinent in fighting alcohol abuse.

Prevention Program that Would be Created to Solve Alcohol Abuse in the Community The prevention program that would be ideal in tackling alcohol abuse in my community is the Project STAR program. According to (National Institut…………………………………………………………………………………………………………………………………………………………………………………………………………………………….

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