Mattke, Angela

ABSTRACTObjectiveTo examine the outcomes of a clinical sample of young patients with restrictive eating disorders who received Family‐Based Treatment for Primary Care (FBT‐PC).MethodsParticipants were 134 youth (mean age = 15.7 years) and their caregiver(s). Participants and caregivers completed measures of eating disorder symptomatology, quality of life, and caregiver self‐efficacy.ResultsOf the 134 patients who received at least one session of FBT‐PC, 55.9% completed treatment, 20.1% were followed until they began a higher level of care, and 23.8% were non‐completers. Weekly measures for the full sample were evaluated using intention‐to‐treat analyses. Patient‐reported scores on the ED‐15 improved by −0.1 (SE = 0.02, F (1,133)= 26.4, p < 0.0001) per week, and caregivers' ratings of patient symptoms also improved by 0.85 (SE = 0.2, F (1,133)=13.1, p = 0.0003) per week. Patient's BMI percentile increased by 1.25 points per week (SE = 0.14, F (1,133) = 83.9, p < 0.0001). For patients who completed FBT‐PC, eating disorder symptoms, per patient‐ (M = −1.43, p < 0.0001) and caregiver‐report (M = −1.33 p < 0.0001) decreased significantly from baseline to end of treatment. Patient's quality of life increased significantly from baseline to end of treatment (M = 21.6, p < 0.0001) and caregivers showed significant increases in self‐efficacy (M = 3.41, p < 0.0001, d = 0.856). At the end of treatment, 62.5% of patients with complete data met criteria for full research remission, and 44.6% met criteria for full clinical remission.DiscussionFindings provide preliminary support for FBT‐PC as an effective treatment for youth with restrictive eating disorders. Additional research is needed to replicate these findings in other primary care settings and to understand the durability of treatment effects.

Background: Urine mast cell mediator levels have found significant clinical utility in supporting the diagnosis of various allergic disorders in the adult population. There are few studies on the range of these mediator levels in the children and its clinical utility. Objectives: We determined the range of the urine mast cell mediator levels in children. Methods: Pediatric allergy and community-based pediatric clinics including children with and without an allergic disorder, respectively, served as the source of the study. Baseline urine mast cell mediator levels were obtained for all children. Demographics, atopic disorders, clinical symptoms and response to medication were documented. Results: Urine 2,3-Dinor-11Beta-Prostaglandin F2 Alpha (BPG) values were significantly higher in children with an underlying allergic disorder when compared to those without. Stratification based on age, sex and allergic disorder was performed in patients with an allergic disorder. Urine Leukotriene E 4 (LTE 4 ) and n-Methylhistamine (NMH) were significantly correlated with age (Spearman’s rho -0.4874 and -0.6902 respectively). With every year of age, the level of the urine NMH decreased by 18 units and urine LTE 4 by 3 units approximately. Urine LTE 4 and NMH levels were significantly higher in males when compared to females. Urine BPG levels were not significantly affected by age or sex. Conclusion: Distribution of urine mast cell mediator levels are slightly different from the values derived from studies in the adult population. Urine mast cell mediators may provide clinical utility in the diagnosis and management of allergic disorders. Further large-scale studies are warranted to validate clinical utility.

The striking rise in adolescent eating disorders since the severe acute respiratory coronavirus syndrome 2 pandemic has amplified demands for specialty eating disorders services and contributed to protracted delays in care. In the context of these delays, patients are at risk for increased weight loss, medical instability, escalating disease progression and poor prognosis. Primary care providers (PCPs) are frequently the first point of contact for young patients with eating disorders and are often left to bridge the gap while families struggle to establish specialty care. Yet, beyond case detection and medical comanagement, there are no evidence-based guidelines that can assist PCPs to prepare families for treatment, halt disease progression, and begin the lengthy process of weight and nutritional restoration in efforts to reduce medical complications and support a favorable prognosis. We present the case of a 13-year-old girl with a restrictive eating disorder to illustrate how PCPs can use intervention principles and strategies derived from evidence-based eating disorder treatment to successfully manage adolescent patients until they can access specialty treatment. We offer concrete guidelines for decision-making, as well as suggested behavioral and medical interventions for the PCP. With evidence-based tools, PCPs are well-positioned to support young patients with restrictive eating disorders and their family members as they begin the process of recovery from an eating disorder.