APa

H

B

P

S48 Poster Abstracts / 48 (2011) S18–S120

with sexuality issues and skin problems comprising the mostfrequent entries 49% and 20% respectively. Straightforwardinformation and specific suggestions regarding the healthquestions were provided for 60% of the entries. In 21% of theinquiries, referral to the primary care physician or to special-ized clinicswas necessary, and in 19% a conditional advicewasoffered, with a suggestion to consult a physician if that advicedid not alleviate the health problem. No significant differenceswere noted in the referral rates among the six respondingphysicians.Conclusions: This survey, demonstrates that in an internetsetup adolescents seek health professionals’ advice mainlyconcerning sexuality issues. Among the multiple other healthissues skin problems are of the most frequent concern. Sur-prisingly, mood and psychosocial issues are scarcely repre-sented in this survey. The internet service is limited in itscapacity to address health issues and referral to clinical care isfrequently warranted.Sources of Support: None.

59.

WORKINGWITH YOUNG PEOPLE: EVALUATION OF ANEDUCATION INTERVENTION TO IMPROVE SKILLS ANDCONFIDENCELee Hudson, MBChB2, Susan Sawyer, MBBS,MD4, Jennifer Conn, MBBS, FRACP, BSc(Hons),MClinED DipEd3, Katharine Reid, MPsych/PhD1,gnes Dodds1, Michele Yeo, MBBS, FRACp, PhD4,roimos Jenny4. 1Faculty of Medicine, Dentistry,nd Health Sciences 2Institute of Child Health

3Medical Education Unit 4Royal Children’sospital

Purpose: The Royal Australasian College of Physicians hasrecently commissioned a training resource entitled Workingwith Young People to equip physicians in training with coreknowledge and skills around adolescent health and medicineas a foundation for subsequent learning. The resource consistsof printed instructional materials and an accompanying DVDand focuses on 6 key areas of adolescent health andmedicine:adolescent development; ethical and legal issues in adolescenthealth care; therapeutic engagement with the adolescent pa-tient; psychosocial assessment of the adolescent patient; ap-proaches to promoting self-management in young peoplewith chronic illness; and aspects of transition to adult healthcare. Training in Australia and New Zealand is split into basicand advanced levels of training. The purpose of this study wasto evaluate the self-directed teaching resourcewith bothAdultMedical trainees and Pediatric Medicine trainees at basic andadvanced levels of training.Methods: Specialist medicine trainees were invited to com-plete a pre-evaluation questionnaire to assess their baselineattitudes and confidence in working with young people. Theywere then provided with a copy of the printed teaching re-source. Six weeks later, they completed a post-evaluationquestionnaire that included additional questions about howthey used the resource and their opinions of it. Repeatedmea-sures analyses of variance were used to assess changes inattitudes, knowledge, and confidence, by trainee type, with

effect size measured as partial eta-squared (hp

2). The �2 tests

were used to compare variation in use and opinions of theresource.Results: Thirty-two trainees (20 Pediatric, 12 Adult; 17 basic,15 advanced) completed the evaluation. After using the re-source, awareness of the health issues that affect youngpeople(F [1, 30] � 26.47, p � .000, hp

2 � .47), confidence in workingwith young people (F [1, 30] � 20.79, p � .000, hp

2 � .41), andconfidence in knowledge about the content of the resourcegreatly improved. Before using the resource, Adult Medicinetrainees scored lower than Pediatric trainees; a relativelyhigher rate of improvement resulted in similar scores betweenAdultMedicine and Pediatric trainees after using the resource.There were no differences between basic and advanced train-ees in how they used the resource or in their opinions about it.Conclusions: These data show that this resource improvedtrainee’s knowledge, skills, and confidence in working withyoung people. The resource had the most marked impact onAdult Medicine trainees, bringing their confidence to a similarlevel to that of pediatric trainees. A high proportion of respon-dents suggested that some structured teaching would be apositive adjunct to the Working with Young People resource.An internet-based version of the resource is now being devel-oped.Sources of Support: None.

SESSION I: EATING DISORDERS AND OBESITY

60.

MEDICAL COMPROMISE AND INITIAL MANAGEMENT OFYOUNG ADOLESCENTS AND CHILDRENWITH EARLY ONSETEATING DISORDERS: A NATIONAL STUDY FROM THE UNITEDKINGDOMLee Hudson, MBChB2, Dasha Nicholls, MBBSMD1, Richard Lynn, BSc MSc3, Russell Viner, MBS PhD4. 1Great Ormond Street Hospital

2Institute of Child Health 3Royal College ofediatrics and Child Health 4UCL Institute of

Child Health

Purpose: To describe the medical status at presentation of allincident cases of Eating Disorders in children less than 13 yearolds (EOED) over a 15 month year period in the UK.Methods: We identified all incident cases of EOED in the UKbetweenMarch 2005 toMay 2006 through high quality estab-lished national surveillance systems (British Pediatric Surveil-lance Unit (BPSU) and the Child and Adolescent PsychiatricSurveillance System (CAPSS). Eligibility by diagnosiswas iden-tified with modified DSM-IV and ICD-10 criteria. Notifyingpediatricians and psychiatrists provided detailed data on eli-gible cases. Of 505 notifications, we identified 208 discretecases after removal of duplicates, reporting errors or thosewith insufficient data. Here we present data on medical com-promise and initial management.Results: Pediatricians notified 24% of cases, with 76% notifiedby psychiatrists. Estimated incidence of EOED was 3.01/100,000 (95%CI 2.6-3.5). Incidence increasedwith age,with nocases aged 5 years or below. 43% of cases were classified asEating Disorder Not Otherwise Specified (EDNOS); 37% as An-

orexia Nervosa; 1% as Bulimia Nervosa. 82% of cases were

CC

aidtraAdtytya

smMt2aEtMabsTrBiRsRancwacmCpwalofmS

M

S49Poster Abstracts / 48 (2011) S18–S120

female and 18% male, with more females in the AnorexiaNervosa group (88%). Mean agewas 11.5 years (SD 1.3). A totalof 59% of cases were pre-pubertal. Menarchal status wasknown in 161 of female cases, most of whom were pre-men-archal (76%). Onehundred four cases (50%) required admissionto hospital, most frequently to a pediatric medical ward (73%)rather than apsychiatricward. Elevenpercent of patientswerefed by NG tube. Sixty-five cases (31%) were identified as med-ically compromised at presentation. Medically compromisedcases had lower BMI z-scores (median difference 0.9, 95% CI0.54, 1.35; Mann-Whitney p � .0001), but 61% of medicallycompromised cases had a BMI above the 0.4th centile and 42%had a BMI above the 2nd centile. The most frequent clinicalparameters of medical instability were hypotension (54%);bradycardia (46%) and hypothermia (26%); 11% presentedwith all three features. Cases with Anorexia Nervosa weremore likely to be medical compromised compared to EDNOS(Relative Risk 1.84, 95% CI 1.18 to 1.84). Mean duration ofillness prior to presentationwas 8.3months; durationwas notassociated with medical compromise. Mean height was 49th

centile (SD 32), suggesting no growth compromise was yetapparent for the group as a whole. Rate of weight loss (avail-able for 62 cases)was greater in thosemedically compromised(median loss 0.29 Kg/week compared with 0.19 Kg/week inthose not compromised; Mann-Whitney p � .01; 95% CI 0.03to 0.26).Conclusions: A third of EOED cases were medically compro-mised at presentation. Rapid weight loss and underweighteach increased the risk of medical compromise. While eatingdisorders in the UK are managed largely within mental healthservices, cases of EOED commonly present to pediatricians andare most commonly admitted onto pediatric wards undertheir care. Improvement in pediatric training and service pre-paredness for managing EOED are important, even in systemswhere ED is managed in mental health.Sources of Support: None.

61.

CLINICAL OUTCOMES OF A NOVEL, FAMILY-CENTEREDPARTIAL HOSPITALIZATION PROGRAM FOR YOUNG PATIENTSWITH EATING DISORDERSRollyn Ornstein, MD2, Susan Lane-Loney, PhD2,hristopher Hollenbeak, PhD1. 1Penn Stateollege of Medicine 2Penn State Hershey

Medical Center

Purpose: Eating disorders (EDs) in children and adolescentsre a serious cause ofmorbidity andmortality, and are becom-ng more evident in younger patients. There is very little evi-ence-base for their management, especially in this popula-ion. While family-based therapy has proven efficacious, itequires a large time commitment on the part of the family,nd there are a limited number of trained providers available.s adequate inpatient management of EDs has become moreifficult due to insurance constraints, as well as resistance onhe part of patients/families, novel treatment strategies forounger patients with EDs are necessary. We hypothesizedhat a unique, family-centered partial hospital program forounger patientswould be effective in promotingweight gain,

s well as improvement in psychiatric symptoms. We also

ought to examine factors thatmight be associatedwith treat-ent success.ethods:A retrospective chart reviewof 61 patients admitted

o the program between August 4, 2008, and November 10,009, was performed. Historical data, anthropometric vari-bles, and scores from psychological instruments (Children’sating Attitudes Test [ChEAT], Children’s Depression Inven-ory [CDI], and Revised Children’s Manifest Anxiety Scale [RC-AS]) were collected. After exclusion, 30 patients were avail-ble for statistical analysis, which included comparisons ofaseline and discharge anthropometric variables, as well ascores on the psychological instruments, using paired t tests.he two main outcome variables were change in weight pa-ameters (absolute weight, % Ideal Body Weight [IBW], andMI) and change in total ChEAT score. Secondary outcomesncluded changes on the ChEAT subscales and the CDI andCMAS scores. Multivariate analysis included linear regres-ion models that controlled for patient-specific fixed effects.esults: The patients examined were 87% female with a meange of 12.8�/- 2 years. One-thirdwas diagnosedwith anorexiaervosa and 60% with Eating Disorder NOS. Two-thirds had ao-existing depressive and/or anxiety disorder. Weight gainas significant, with improvements in absolute weight, BMI,nd % IBW (all p2 � .26). No historical or family factors wereorrelated with improvement, nor was use of psychotropicedications.onclusions: Young ED patients treated in a family-centeredartial hospital program had significant improvements ineight and psychological parameters, with the large majorityttaining a recommended weight at discharge. Despite theimitations of a small sample size and the retrospective naturef the data, we feel that this level of care, with an emphasis onamily involvement, holds significant promise for themanage-ent of young ED patients.ources of Support: None.

62.

COMPARISON OF FAMILY-BASED VS. INDIVIDUAL THERAPYIN ADOLESCENTS WITH ANOREXIA NERVOSA: ARETROSPECTIVE COHORTWITH HISTORIC CONTROLClaire Norton, RD, MS1, Laura Pinkston Koenigs,MD1, Jennifer Friderici, MS2, Nancy H. Miller,D, MPH1. 1Baystate Children’s Hospital

2Baystate Health Systems

Purpose: To compare weight gain in adolescents with an-orexia nervosa (AN) treated with guardian-focused therapy(Family Based Therapy, FBT) versus patient-focused therapy(Individual Therapy IT). We hypothesized more rapid weightgain in FBT than IT.Methods: Percent increase in ideal weight (PIDW) was mea-sured over time for an average of 9.7 (SD 3.4) months in 34adolescents treated for anorexia nervosa (AN) and eating dis-orders not otherwise specified, anorexic type (EDNOS-AN), atan adolescentmedicine clinic. In this study, the treatment goalweight in kilograms was calculated for each patient using theBMI at 50% of the CDC BMI charts, and using the patient’s ageand height. Excluded were patients with fewer than 3 visits.The EDNOS-AN subgroup met all of the criteria for AN but

denied a distorted body image or had a weight between 85%-