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Objective: To investigate the availability of resources at an Australian university workplace to support the health, wellbeing, and transition to parenthood of female employees working during the preconception, pregnancy, and postpartum periods. Type of program or service: Workplace health promotion for female employees of reproductive age., Methods: A survey of female employees aged 18-45 years evaluated participant health practices, availability of work and parenting supports, and access to health and wellbeing resources in the workplace. Additionally, an environmental assessment was completed by employees with a knowledge of local healthy lifestyle supports and a minimum of 2 years' employment. The assessment documented site characteristics and availability of wellbeing facilities across 10 campuses., Results: There were 241 valid survey responses. Of 221 respondents to a question about workplace support, 76% (n = 168) indicated that the workplace should play a role in supporting the transition to parenthood and in health promotion, with 64.1% of 223 participants disagreeing with the statement "my health is not the responsibility of the university". Both the survey and environmental assessment revealed that access to parenting resources to support employee health and wellbeing were suboptimal., Lessons Learnt: There is a misalignment between the needs of female employees working during these health-defining life stages, and the availability of resources to support those needs. Regulatory guidance may be required to navigate resource gaps within the work environment and address factors impacting the health and wellbeing of employees of reproductive age., Competing Interests: KA and AH are employees of the University of Tasmania. SM is a PhD candidate at the University of Tasmania.

Objective: The aim of this study was to collect prospective national data on early-onset eating disorders (EOEDs) in children in Australia to document changes in clinical presentations, medical complications, management, and incidence since initially described in 2002-2005., Method: Each month pediatricians reported children aged 5-13 years newly diagnosed with an eating disorder to the Australian Paediatric Surveillance Unit and provided de-identified clinical data., Results: Between 2016 and 2018, 184 children were confirmed with EOED with a minimum estimated national incidence of 2.79 per 100,000 children aged 5-13 years (95% confidence interval [CI] 2.40-3.23), nearly double the previously recorded incidence. The mean age at diagnosis was 12.2 years; 43(24%) were boys who were younger than girls (11.85 vs. 12.33 years; p = .03). All had food avoidance. Common symptoms included fear of weight gain 140 (76%), preoccupation with body weight 134 (73%), and misperception of body size 116 (63%). Bradycardia was present in 83 (45%) and 117 (64%) who required hospital admission. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5) criteria for anorexia nervosa were met for 144 (78%)., Discussion: Children with eating disorders continue to present with severe illness. Near doubling in incidence in just over a 10-year period highlights the need for increased clinical resourcing and comparable international data., Public Significance: The incidence of new presentations of eating disorders in children aged 5-13 years has nearly doubled since a similar study was conducted over 10 years ago. Children were unwell for an average of 8 months before diagnosis; approximately 80% had a clear diagnosis of anorexia nervosa and 64% needed hospital admission due to medical complications. This highlights the need for improvements in education and clinical resources for this age group., (© 2022 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Organ donation networks audit and report on national or regional organ donation performance, however there are inconsistencies in the metrics and definitions used, rendering comparisons difficult or inappropriate. This is despite multiple attempts exploring the possibility for convergently evolving audits so that collectives of donation networks might transparently share data and practice and then target system interventions. This paper represents a collaboration between the United Kingdom and Australian organ donation organisations which aimed to understand the intricacies of our respective auditing systems, compare the metrics and definitions they employ and ultimately assess their level of comparability. This point of view outlines the historical context underlying the development of the auditing tools, demonstrates their differences to the Critical Pathway proposed as a common tool a decade ago and presents a side-by-side comparison of donation definitions, metrics and data for the 2019 calendar year. There were significant differences in donation definition terminology, metrics and overall structure of the audits. Fitting the audits to a tiered scaffold allowed for reasonable comparisons however this required substantial effort and understanding of nuance. Direct comparison of international and inter-regional donation performance is challenging and would benefit from consistent auditing processes across organisations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Milross, Brown, Gladkis, Downes, Goodwin, Madden, McDonald, Barry, Opdam, Manara and Gardiner.)

Background: Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN., Method: We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12-18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT)., Results: The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group., Conclusions: Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.

Objectives: This study examined the feasibility of conducting a randomized controlled trial of acupuncture compared with an active control in an inpatient setting, to examine individuals' experience of the interventions, clinical outcomes from the trial, and to integrate data to explain the trial findings., Design: This was a pilot randomized controlled trial with in-depth interviews with trial participants., Setting: The study was conducted at a private medical facility in Sydney, Australia., Subjects: Twenty-six (26) patients with anorexia nervosa who were medically stable were the subjects., Interventions: Treatment as usual was administered, and the intervention was delivered twice a week for the first 3 weeks, followed by weekly treatment for three weeks. The acupuncture group received acupuncture at the points Hegu (LI4), Zusanli (ST36), Neiguan (PC6), Taichong (LR3), Yanglingquan (GB34), and additional points based on the Traditional Chinese Medicine diagnosis. The control group received acupressure and massage. Acupressure involved consciously and gradually directing pressure to the center of the point being worked on., Outcome Measures: Clinical outcomes were measured at baseline and at 6 weeks following completion of the intervention. The primary outcome measure was body-mass index (BMI), and secondary outcomes included eating disorder psychopathology, anxiety, and depression. A semistructured interview was conducted asking questions about their interaction with the practitioner, what happened, how they felt, whether it made them feel differently, and what they attributed any change to., Results: We found timely recruitment with the population recruited within a 5-month period. Study dropouts were 23% and treatment compliance was moderate, but acceptable for this challenging population. Participants in the control group demonstrated reduced eating concerns. Participants described both interventions positively, and experienced a sense of calmness and relaxation., Conclusions: Acupuncture and acupressure and massage may improve the patient's subjective sense of wellbeing, and further research is needed.

Background: Anorexia nervosa is a serious illness with significant morbidity. The evidence base for existing psychological and pharmacological interventions to manage anorexia nervosa is not strong, and use of new adjunctive therapies that improve the effectiveness of existing treatments, and lead to improved mental health outcomes for this patient group is highly desirable. This study investigates the views of patients with anorexia nervosa receiving an acupuncture or acupressure intervention., Method: A randomised controlled trial was conducted in Sydney, Australia. Twenty-six inpatients with a diagnosis of anorexia nervosa were randomised to a six week intervention of acupuncture or acupressure with light massage. Treatment was administered twice weekly for three weeks, then weekly for three weeks. A post treatment questionnaire was administered to explore participant views, of the study consultation. Questions examined important aspects of the clinical encounter including the, patient's perception of the practitioners' relational empathy (CARE), treatment perceptions and the, therapeutic relationship., Results: Participants in both groups scored highly on the CARE scale assessing empathy and the, therapeutic relationship. There was no difference in the mean CARE scores for the acupuncture group (50 (SD 0.0)) and the acupressure group (49.5 (SD 0.8)). Participants highly valued the therapeutic, encounter and in particular the characteristics of empathy, positive regard, acceptance, non, judgmental responses and trust. Having someone to talk to, being less stressed/relaxed and contact, with the study staff were also perceived to be important., Conclusion: Study participants perceive the therapeutic relationship and empathy as important qualities of the acupuncture or acupressure intervention as an adjunct therapy for the treatment of anorexia nervosa., (Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.)

Objective: This case series aims to describe the demographic and clinical features of male inpatients with early onset eating disorders., Method: Retrospective review was made of medical files of male patients treated for eating disorders at two children's hospitals over a 2 year period, with an onset of eating disorder before age 14 years, presenting for index admission. Demographic characteristics, DSM-IV diagnosis, clinical characteristics and treatment received were reviewed., Results: Ten male patients with a median age of 12.8 years (range 10.2 to 13.5) were identified; three met the full criteria for anorexia nervosa (AN) and four met all except the weight criterion. There was high psychiatric comorbidity: four with a major depressive episode, seven an anxiety disorder, three with obsessive-compulsive disorder (OCD) symptoms. Seven engaged in over-exercise. Seven were treated with an antidepressant, and five with an atypical antipsychotic; six required nasogastric tube (NGT) feeding., Conclusion: A minority of patients met full diagnostic criteria for AN, with many not meeting weight criteria despite medical instability. The main clinical features were food restriction, over-exercise and psychiatric comorbidity. Treatment with antidepressants, antipsychotics and NGT feeding was frequent. Future prospective studies could help identify gender-specific features as well as benefits and potential side effects of pharmacotherapy in this age group.

Objective: To collect nationally representative epidemiological data on early-onset eating disorders (EOEDs) in children., Design: Prospective, active surveillance using the Australian Paediatric Surveillance Unit with key informant design., Setting: Child health specialists in Australia (July 2002 to June 2005)., Patients: Incident cases of EOEDs in children aged 5-13 years., Main Outcome Measures: Disease rates, demographic characteristics, clinical features and complications, hospitalisation, psychological comorbidity, and concordance of clinical features with Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) criteria., Results: We identified 101 children aged 5-13 years with EOEDs (median age, 12.2 years; range, 5.5-13.9 years), of whom one in four were boys. Most were hospitalised (78%), and the mean duration of hospitalisation was 24.7 days (range, 1-75 days). More than 70% of inpatients were admitted to specialised eating disorder units in paediatric teaching hospitals. Among inpatients, 37% met DSM-IV diagnostic criteria for anorexia nervosa; although 61% had life-threatening complications of malnutrition, only 51% met weight criteria. Psychological symptoms were similar to those in adults with anorexia nervosa: 67% of inpatients met both psychological diagnostic criteria for anorexia nervosa (fear of weight gain/fatness and misperception of body shape). Of 19 postmenarchal girls, 18 had secondary amenorrhoea. Nasogastric feeding was used in 58% of inpatients, and 34% received psychotropic medications., Conclusions: This is the first prospective national study of EOEDs. It demonstrates the limitations of applying DSM-IV diagnostic criteria for anorexia nervosa to young children; the high proportion of boys affected by EOEDs; and the significant psychological comorbidity and high frequency of hospitalisation associated with EOEDs. Potentially life-threatening medical complications are common at presentation, suggesting possible missed diagnoses and a need for education of health professionals. The study underlines the severity of EOEDs and the need for joint medical and psychiatric specialist management.

Purpose: To clarify the effect of chronological age, height, lean tissue mass, and menstrual status on standard reported DXA (dual-energy x-ray absorptiometry) measures., Methods: Growth and DXA data from a retrospective longitudinal cohort of 30 adolescent females with anorexia nervosa (AN) were examined. Areal bone mineral density (aBMD), total body bone mineral content (BMC) and total body bone area were measured and standardized for age, height, lean tissue mass, and total bone area. We then examined the changes in these parameters after 12 months of multidisciplinary treatment., Results: The subjects had lower BMC and aBMD than the age- and height-matched reference population at baseline, there were further decreases in these parameters with treatment. BMC adjusted for lean tissue mass and bone area were normal at baseline and there was no significant change with treatment. Bone area adjusted for height was low at baseline and decreased despite treatment., Conclusion: Our data suggest that the low age- and height-adjusted bone mineral content and bone mineral density in females with AN is secondary to poor bone growth leading to low bone area. These subjects had relatively normal bone mineral content for their bone size and lean tissue mass. Changes in bone size were proportional to changes in lean tissue mass.