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By: Denise H. Rhoney, PharmD, FCCP, FCCM
- Ron and Nancy McFarlane Distinguished Professor and Chair, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
https://pharmacy.unc.edu/news/directory/drhoney/
Of the 94 total doses given heart attack like symptoms order beloc 40mg overnight delivery, 64 percent were first doses while only 22 percent were second doses and 14 percent were third doses arrhythmia icd 9 generic beloc 40 mg fast delivery. Additionally heart attack ncla quality 20mg beloc, of the 94 total doses given in pharmacies prehypertension 30 years old generic beloc 20 mg on line, 37 percent (35 doses) were administered to adolescents in the 11 through 17 age range. One concern raised was that pharmacists are not comfortable administering vaccines to adolescents. Another concern was that parents may not feel comfortable 7 allowing pharmacists to immunize their children. Counties include Barry, Cass, Chippewa, Clare, Ionia, Kent, Macomb, Newaygo, Ottawa, Tuscola and Washtenaw. Those who said yes felt strongly that increasing access to the vaccine is in the best interest of public health, and pharmacies are a great way to increase that access. Select responses to additional questions are included in Tables 3, 4, 5 and 6 show the pharmacists’ perceptions of the impact of the pilot project on their communities. Starting conversations with parents is good even if they are not particularly interested yet. Education for myself because I felt a lot more confident about recommending the vaccine to patients. Pilot pharmacist responses to the question, “What kind of impact do you think you had on your patients and community as part of this projectfi A lot of patients had already received the vaccine, so I was surprised by the number of parents who had already taken those steps. I have mostly Medicaid patients so not able to vaccinate many who might have been interested. Not many patients were receptive, but some people did open their minds to consider new information. Based on my patient population, it would have been better timing for the pilot if students were on campus since we are across the street from Aquinas College. The 18 through 26 year old patients were not very educated about the vaccine but were also not interested in talking about it. We have a good pediatrician and physician assistant in our area that do a good job with vaccinations. I was surprised because the data for my county overall is really low, so I expected to encounter more patients without vaccinations. I think we may be missing people who do not seek any healthcare or even come to the pharmacy. Most of my patients are Medicaid and were therefore not able to receive the vaccine in the pharmacy. It was also hard to get follow-ups done, so it was good that a workflow was created to schedule follow-up vaccines as a prescription refill. Patients did them if I went through it with them, but if they took it home, they never brought it back. Anyone who wanted the vaccine either had no insurance or had to have the vaccine billed through a physician’s office. Fewer screening tools printed after May and June, so there were fewer triggers to talk to patients. I believe that eventually all immunizations will be done in pharmacies, but insurance coverage expansion would make this much better. If patients were willing to spend the time, they were much more open to discussing the vaccine. Pilot pharmacist responses to the question, “What other challenges did you experiencefi There were sometimes too many opportunities all at once and not enough time to help each patient. I was also participating in a naloxone pilot which put even greater stress on my time. The staff pharmacist filling in was not good at implementing the pilot, so I tried to get people more involved when I got back. Also, my primary pharmacy technician does not believe in the vaccine, so it was hard to get her engaged she believes in one partner for life). Medicaid patients seem to be getting a lot of preventative care and were already up-to-date. This ended up being a good thing for us now that they know we offer the vaccine because they will refer patients here as well. I also went to a community hospital health fair, but did not have much success in getting people interested. I offered to call the patients back with the information, and then followed up with them later, but this took a lot of time. Dealing with the public, patients not interested or had already received it elsewhere, repetition. It is difficult to counsel these patients on their prescriptions much less explain the importance of vaccinations. When they were able to hire new people, getting new staff members trained in the basic aspects of their jobs was challenging enough. Some stores were not able to fill the vacancies and were thus understaffed for the entirety of the project which made time and workflow challenges more significant. Three stores had a pharmacy staff member who did not believe in the vaccine for personal reasons. One store overcame this by having the technician refer any patient with the screening form to the pharmacist. One pharmacist was able to discuss the issue with the technician to overcome the objections and the technician was on board after that. The third store continued to experience a lack of engagement from the one technician, but other staff members were highly engaged. Seventeen individuals were able to participate in a meeting held on February 8, 2016, either live or via conference call, and one individual provided written comments prior to the meeting. Meeting Processes Advisory Committee participants were asked to consider three questions prior to the meeting all of which were placed as the first three agenda items during the meeting. The results of these discussions were captured on flip charts so participants could see identified information. All providers need to maintain a consistent message, ranging from the physician to the medical assistant who often administers the vaccines to the pharmacist in the community making vaccination recommendations and administering vaccines. Messaging also needs to increase awareness of vaccination as prevention for both males and females. Importance of well-child visits within the medical home Because well-child visits are no longer required for school attendance, many children are not visiting their primary care physicians on a regular basis. Mandatory vaccinations bring those children into the family medicine or pediatrician offices, and changes that decrease this contact between physician and child threaten the medical practices and the health of the children. Increasing the rates of first dose administration, along with the other recommended adolescent vaccines, is an important part of well-child visits. Public awareness of pharmacists’ training and knowledge of vaccination Pharmacists have increased influenza vaccination rates throughout the country, but other healthcare providers, patients and parents may not understand the full capabilities of pharmacists. Pharmacists are knowledgeable about all vaccines, not just influenza, and have the training and ability to immunize children, adolescents and adults. Third party reimbursement for vaccination within pharmacies While pharmacies typically have better abilities to obtain vaccines quickly and store them properly than small physician practices, third-party reimbursement for vaccination within the pharmacy continues to be limited. Pharmacies can bill the medical benefit in some instances, but there is no guarantee of payment, and the patient could receive a bill if his or her plan does not cover the cost. There is no consistency across plans and knowing which plans will cover which vaccines for which patients is a challenge. Because it is not required, some providers may not routinely have it available in their practice or provide the same strength of recommendation as the required vaccines. First dose versus series completion First dose vaccination rates are higher than series completion rates in both males and females. This is a challenge because it indicates children are being lost to follow-up, but it is also an opportunity for community pharmacies to make an impact. The assessments were created as electronic surveys, and the links to the surveys were sent through a variety of electronic channels. Respondents had to meet qualifying criteria for the survey including living or practicing in Michigan to ensure consistency of healthcare practice laws. Common Questions the first question asked respondents to use a sliding scale from zero through 100 percent to indicate how important they felt vaccination was in general. Many pharmacists felt vaccinations were important, but approximately 30% rated the overall importance of vaccines at 60% or less.
Another outbreak in 2009–2010 affected more than 3500 people heart attack nursing diagnosis buy beloc toronto, primarily members of traditional observant communities in New York and New Jersey hypertension readings 40mg beloc overnight delivery. Because 2 doses of mumps-containing vaccine are 1 not 100% effective arrhythmia junctional order beloc 40 mg, in settings of high immunization coverage such as the United States hypertension knee purchase beloc with paypal, most mumps cases likely will occur in people who have received 2 doses. The period of maximum communicability is considered to be several days before and after parotitis 1 Centers for Disease Control and Prevention. People with parotitis without other apparent cause should undergo diagnostic testing to confrm mumps virus as the cause or to diagnose other etiologies (eg, infuenza A virus, parainfuenza viruses 1 and 3, and bacterial causes). Confrming the diagnosis of mumps in highly immunized populations is challenging, because the IgM response may be absent or short lived; acute IgG titers already might be high, so no signifcant increase can be detected between acute and convalescent specimens; and mumps virus might be present in clinical specimens only during the frst few days after illness onset. Mumps vaccine has not been demonstrated to be effective in preventing infection after exposure. A second dose may be considered for preschool-aged children and other adults depending on outbreak epidemiology. Adequate immunization is 2 doses of mumps-containing vaccine for school-aged children and adults at high risk (ie, health care personnel, students at post-high school educational institutions, and international travelers), and a single dose of mumps-containing vaccine for other adults born in or after 1957. Orchitis, parotitis, and low-grade fever have been reported rarely after immunization. Allergic reactions also are rare (see Measles, Precautions and Contraindications [p 497], and Rubella, Precautions and Contraindications [p 634]). People who have experienced anaphylactic reactions to gelatin or topically or systemically administered neomycin should receive mumps vaccine only in settings where such reactions could be managed and after consultation with an allergist or immunologist. The risk of mumps exposure for patients with altered immunity can be decreased by immunizing their close susceptible (ie, household) contacts. This interval is based on the assumptions that immunologic responsiveness will have been restored in 3 months and the underlying disease for which immunosuppressive therapy was given is in remission or under control. For patients who have received high doses of corticosteroids (2 mg/kg/day or greater or greater than 20 mg/day of prednisone or equivalent) for 14 days or more and who otherwise are not immunocompromised, the recommended interval is at least 1 month after corticosteroids are discontinued (see Immunocompromised Children, p 74). Conception should be avoided for 28 days after mumps immunization because of the theoretical risk associated with live-virus vaccine. Susceptible postpubertal females should not be immunized if they are known to be pregnant. Mumps immunization during pregnancy has not been associated with congenital malformations (see Measles, p 489, and Rubella, p 629). Bullous myringitis, once considered pathognomonic for mycoplasma, now is known to occur with other pathogens as well. Approximately 10% of infected school-aged children will develop pneumonia with cough and widespread rales on physical examination within days after onset of constitutional symptoms. Bilateral diffuse infltrates or focal abnormalities, such as consolidation, effusion, or hilar adenopathy can occur. Several other Mycoplasma species colonize mucosal surfaces of humans and can produce disease in children. Mycoplasma hominis infection has been reported in neonates (especially at scalp electrode monitor site) and children (both immunocompetent and immunocompromised). Intra-abdominal abscesses, septic arthritis, endocarditis, pneumonia, meningoencephalitis, brain abscess, and surgical wound infections all have been reported. The diagnosis should be considered in children with a bacterial culturenegative purulent infection. M pneumoniae is a leading cause of pneumonia in school-aged children and young adults and less frequently causes pneumonia in children younger than 5 years of age. Immunofuorescent tests and enzyme immunoassays that detect M pneumoniae-specifc immunoglobulin (Ig) M and IgG antibodies in sera are available commercially. IgM antibodies generally are not detectable within the frst 7 days after onset of symptoms. False-negative results also occur frequently with single specimen testing, with sensitivity ranging from 50% to 60%. The diagnosis of mycoplasma-associated central nervous system disease (acute or postinfectious) is controversial because of the lack of a reliable cerebrospinal fuid test for Mycoplasma. Because mycoplasmas lack a cell wall, they inherently are resistant to beta-lactam agents. Pulmonary or disseminated disease most commonly is caused by the Nocardia asteroides complex, which includes Nocardia cyriacigeorgica, Nocardia farcinica, and Nocardia nova. Stained smears of sputum, body fuids, or pus demonstrating beaded, branched, weakly gram-positive, variably acid-fast rods suggest the diagnosis. Linezolid is highly active against all Nocardia species in vitro; case series including a small number of patients demonstrated that linezolid may be effective for treatment of some invasive infections. Subcutaneous, nontender nodules that can be up to several centimeters in diameter containing adult worms develop 6 to 12 months after initial infection. The infection is not transmissible by person-to-person contact or blood transfusion. Because low levels of drug are found in human milk after maternal treatment, some experts recommend delaying maternal treatment until the infant is 7 days of age, but risk versus beneft should be considered. Safety and effectiveness in pediatric patients weighing less than 15 kg have not been established. This approach may provide adjunctive therapy for children 8 years of age or older and nonpregnant adults (see Antimicrobial Agents and Related Therapy, Tetracyclines, p 801). This treatment should be initiated several days after treatment with ivermectin, because there are no studies of the safety of simultaneous treatment. Diethylcarbamazine is contraindicated, because it may cause adverse ocular reactions. They usually are painless and multiple, occurring commonly on the hands and around or under the nails. Flat warts (“juvenile warts”) commonly are found on the face and extremities of children and adolescents. Anogenital warts, also called condylomata acuminata, are skin-colored warts with a caulifower-like surface that range in size from a few millimeters to several centimeters. In males, these warts may be found on the penis, scrotum, or anal and perianal area. This condition is diagnosed most commonly in children between 2 and 5 years of age and manifests as a voice change, stridor, or abnormal cry. Most appear during the frst decade of life, but malignant transformation, which occurs in 30% to 60% of affected people, usually is delayed until adulthood. More than 14 high-risk types are recognized, with types 16 and 18 most frequently being associated with cervical cancer and type 16 most frequently being associated with other anogenital cancers and oropharyngeal cancers. Types 6 and 11 frequently are associated with condylomata acuminata, recurrent respiratory papillomatosis, and conjunctival papillomas. The incubation period is unknown but is estimated to range from 3 months to several years. Most nongenital warts eventually regress spontaneously but can persist for months or years. Sexually active female adolescents who have had an organ transplant or are receiving long-term corticosteroid therapy also should undergo similar cervical Pap test screening. If cytologic screening has been initiated before 21 years of age, patients with abnormal Pap test results should be cared for by a physician who is knowledgeable in the management of cervical dysplasia. Local recurrence is common, and repeated surgical procedures for removal often are necessary. In addition, use of latex condoms has been associated with a decrease in the risk of genital warts and 1 American College of Obstetricians and Gynecologists. Sex partners of people with genital warts may beneft from examination to assess for the presence of anogenital warts or other sexually transmitted infections. Long-term follow-up studies are being conducted to determine the duration of effcacy for both vaccines. Vaccine also is recommended for females 13 through 26 years of age not previously immunized. The immune response and vaccine effcacy in immunocompromised people might be less than that in immunocompetent people. If a dose has been administered inadvertently during pregnancy, no action is recommended. Clinical patterns are categorized as an acutesubacute form that predominates in childhood and a chronic form that is the typical clinical pattern in adults.
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In the case of surrogacy blood pressure medication you can take while pregnant purchase beloc with paypal, it could be argued that a careful identification of those detrimental conditions that render a surrogate negatively vulnerable could constructively inform regulatory interventions to pulse pressure 100 buy beloc with amex prevent exploitation blood pressure medication kosar discount beloc 40mg without a prescription. The vulnerability construct for surrogacy in this paper could be considered a situational one on the whole: A surrogacy arrangement marks a very context-specific vulnerability hypertension of the lungs 20mg beloc free shipping. Our own categorization of vulnerability involves a distinction between intrinsic, extrinsic and relational vulnerabilities that a surrogate mother could be subjected to. A further refinement and legitimization of our classification are possible by recourse to biomedical research on human subjects, in which the measurement of vulnerability of the subject has been largely guided by universal ethical principles formulated by the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research. Today, it is the apex body in India 87 Chapter 4 28 in its Ethical Guidelines for Biomedical Research on Human Participants, 2000. In the year 2000, the practice of surrogacy was likened to biomedical research being conducted on the human subject, and we argue that the surrogate mother and her vulnerabilities should therefore be visibilised similarly. These may arise in doctor/patient relationships or husband/wife relationships where one person feels obligated to follow the advice of the other. As surrogates are not receiving medical treatment for any of their own ailments, such a category of vulnerability would not usually apply to the surrogate. It would include participants who do not have the legal right to consent or who may be concerned that consenting could have legal repercussions for them. As this is specific to medical research studies, it is not immediately applicable to the surrogate in our general assessment of her vulnerabilities. Section D will elaborate further on the connection between these types of vulnerabilities and the classification we develop. In 2017, the President of India reiterated once again that this is not an abstract ideal and has to be made meaningful to the lives of ordinary people in every street, village and mohalla [neighborhood] of India. Law is what bridges the gap between the ideals of the constitution and reality by ensuring that every legislation in India mirrors these ideals or 34 standards, converts them to rules and reduces discrimination. Reducing discrimination is a direct mandate of the Constitution of India, which provides that the State shall not discriminate against any citizen on grounds of religion, race, caste, sex or 35 place of birth. The Constitution inherently recognizes structural discrimination, which refers to rules, norms, generally accepted approaches and behaviors in institutions and other social structures that constitute obstacles for subordinate groups to enjoying the equal rights and 36 37 opportunities possessed by dominant groups. Clause 4 of Article 15 was added in the first amendment to the Constitution in 1951 as a consequence of a Supreme Court judgment on equality to clarify that the State can make special provisions for the educational, economic, or social advancement of any backward class of citizens and not be challenged on grounds of being discriminatory. The Constitution in its original form recognized in Article 15(3) the inherent vulnerability of women and children, thus providing as an express exception that nothing in Article 15 shall prevent the State from making special provisions for women and children. Article 8 of the Declaration lays down a categorical respect for human vulnerability and personal integrity and states, “In applying and time, India scores a level of income equality lower than Russia, the United States, China and Brazil, and more egalitarian than only South Africa. Nothing in this article or in clause (2) of Article 29 shall prevent the State from making any special provision for the advancement of any socially and educationally backward classes of citizens or for the Scheduled Castes and the Scheduled Tribes. Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals respected. In order to reduce discrimination, however, every legislation under the Constitution of India needs to first recognize discrimination, and acknowledge possibilities, and constantly strive to identify areas in which discrimination can take place. We would argue that an analysis of vulnerability becomes a necessary exercise preceding any legislation on surrogacy – to adhere to constitutional standards as well as universal commitments. Intrinsic signifies something that is part of essential nature or possibly biology. Characteristics such as education, previous employment, household income are all identified as extrinsic characteristics of a surrogate. Regarding relational characteristics, the term relational is borrowed from concepts and theories on interpersonal communication in the study of 42 relationship development as propounded by D. Ranjana Kumari, ‘Surrogate Motherhood: Ethical or Commercial’ Centre for Social Research 39 It may occur as the frst symptom as the condition develops hypertension united states cheap beloc 20 mg visa, and the clinician should therefore look carefully for suggestive symptoms blood pressure chart with age and weight buy beloc 20 mg. It may also be present in the established case and will then show characteristic schizophrenic symptomatology xylazine arrhythmia cheap generic beloc canada. I will have to hypertension questionnaires purchase beloc 40 mg with visa look beautiful, I don’t feel beautiful at the moment, I don’t look nice enough. I’ll have a nice face, nice teeth, red eyebrows, red eyes, pupils red and smooth red lips. I’ll have long fngernails, a smaller waist, bigger breasts and my legs will be a bit shapelier. There is emerging evidence that visual processing of faces and objects may be impaired in individuals with dysmorphic disorder. Abnormalities include inability to identify faces with emotional expressions under experimental conditions (Feusner et al. Impairments of face processing appear to correlate with demonstrable abnormalities in frontostriatal systems (Feusner et al. These fndings suggest that, despite the absence of gross abnormalities of perception, face and visual object processing impairments may underlie the negative evaluations of the body that are characteristic of dysmorphophobia. Patients have a strong desire to change the physical body so that it coincides with the body image. The most common desire is to amputate a major limb or to sever the spinal cord in order to become paralyzed. Patients are reported as saying ‘I can feel exactly where my leg should end and my stump should begin. Sometimes this line hurts or feels numb’ or ‘my limbs do not feel like they belong to me, and should not be there’ (Blom et al. Reports suggest that surgery is followed by a feeling of completeness, wholeness and satisfaction. It is perhaps signifcant that approximately half of a cohort of patients studied said that they felt sexually aroused when they saw a disabled person resembling their own desired disability or felt sexually aroused when imagining themselves being disabled (Blom et al. In transsexualism, wearing clothing of the opposite sex (transvestism) occurs, usually, as a means of personal gratifcation without genital excitement. It is much commoner in biological males than in females, but it occurs in both sexes. The sufferer of this anomaly feels he should have been of the other gender, ‘a female spirit trapped in a male body’ (Morris, 1974). In adults, the disturbance is manifested by preoccupation with getting rid of primary and secondary sexual characteristics and the request for hormone therapy or surgery or other means of simulating the required gender (Green, 2000). The strength of this conviction is described in Conundrum by Jan Morris (1974) with literary eclat: ‘I was three or perhaps four years old when I realized that I had been born into the wrong body, and should really be a girl through each year my every instinct seemed to become more feminine, my entombment within the male physique more terrible to me. I think as a woman and have female feelings and interests, and am only comfortable when wearing women’s clothes and in a feminine job. So, genuinely, I am a woman I am not against homosexuals although I am not one myself. Transsexuals describe their feelings about their body as having been present from early childhood: the feeling of comfort and ‘rightness’ they experienced when wearing their sister’s dress, how they ‘fell naturally’ into female pursuits and interests. The difference of self-image from the biological sex is usually, in their own account, clearly established before puberty. Blanchard in a series of papers (1989, 1991, 1993) proposed that individuals presenting with male-to-female transsexualism and were characterized as having autogynephilia (sexually aroused by the thought or image of themselves as women) were distinct from others who were homosexual in orientation. Structural imaging has demonstrated increased cortical thickness in male-to-female transsexuals but the signifcance of these fndings is yet to be determined (Luders et al. Notwithstanding the fact that the biological basis of transsexualism is yet to be elucidated, what is incontrovertible is that the dissatisfaction with the body and with secondary sexual characteristics and genitalia is rooted in brain mechanisms that underlie gender identity. Once again, it is the subjective aspects, the effect on self-image, that concerns us here and not the physical aspects. Both in Europe and in North America, the prevalence of obesity has increased considerably since the mid-1970s. Between 1976 and 1980 in the United States of America, 15 per cent of the adult population aged 20 to 74 were obese, whereas by 2003 to 2004 the prevalence had risen to 33 per cent. These trends are also replicated in Europe (World Health Organization Regional Offce for Europe). Obesity is defned as a body mass index of greater than 30 kilograms per metre squared; being overweight is a body mass index of between 25 and 29. The concern about obesity derives from the associated health risks; hyperlipidaemia, insulin resistance, diabetes, hypertension, morbidity and premature death are recognized complications. Thus, there are national and international health programmes to combat the apparent unrelenting rise in the prevalence of obesity. Obesity in adolescents in diet-conscious Western societies results in self-loathing and self-denigration. The presence of any physical deformity at this stage of life is likely to provoke revulsion from the self-image; individuals feel especially physically loathsome with regard to the opposite sex. There is also present a distortion of body size in that they often overestimate their size. This is interesting in comparison with anorexia nervosa patients, who also often overestimate their size and whose behaviour of dieting and food rejection may start when they are mildly obese at the time of puberty. Anorexia Nervosa this is a condition that in the past was misplaced diagnostically; initially, sufferers were usually thought to be physically ill. Anorexia nervosa is an illness that occurs mainly in young women; the proportion of male cases seen ranges from one in 20 to about one in ten in different series (Dally and Gomez, 1979) and the proportion of boys is higher in childhood. It has been considered by Crisp (1975) that the disorder is primarily a weight phobia, a fear of increasing body weight, and not only a feeding disorder similar to those of childhood. Prominent is the fear of loss of control; if one eats normally, one will be unable to stop and therefore become fat. As well as an abnormal self-image, there are also abnormal attitudes towards food, gender and sex. It is in part a narcissistic disorder according to Bruch (1965), who has called it ‘the pursuit of thinness’. The other features are: body weight at least 15 per cent below that expected weight loss is self-induced amenorrhoea delayed or arrested puberty. Anorexia nervosa became more common in the United Kingdom in the latter part of the twentieth century (Kendell et al. This apparent difference in prevalence suggests that it may well be linked to social attitudes towards thinness, dieting and slimming. In the Western world, slimness is regarded as beautiful, and dieting may become a social norm that acts as a persuasive pressure on an impressionable adolescent female whose body weight has increased a little more than average at puberty. If there are other psychological diffculties and social conficts, the slimming may get out of control. In other parts of the world, where the aesthetic norms of feminine beauty are based on a fulsome body, the pressure towards thinness is less but the pressure towards obesity may be greater. Even in Western society, the prevalence of anorexia nervosa is not uniform within society but rather is determined by gender, age, socioeconomic class and ethnicity. Patients with anorexia nervosa often deny their thinness and sometimes claim to be too fat. Because of their extreme concern over their physical size and weight, a technique was devised by Slade and Russell (1973) to investigate bodily perception in anorexics. This involved comparing real size in subjects (measured by an anthropometer) and perceived size, which was measured by the observer moving horizontal lights to a distance that the subject estimated as the width across four body regions: face, chest, waist and hips. When compared with an age-matched normal control group, anorexic patients signifcantly overestimated their own perceived width at all regions, with the face being overestimated by more than 50 per cent. Although actually thinner at the chest, waist and hips, anorexic patients saw themselves as fatter than normal women. They tended to overestimate the width of other people, but not by as much as themselves. The body image distortion tended to lessen as patients put on weight, especially if they did so slowly. Slade and Russell (1973) considered that ‘patients with anorexia nervosa show a faulty appreciation of their own body image in the sense that they perceive their bodies as possessing an exaggerated girth’. This fnding has now been confrmed in a large meta-analysis by Cash and Deagle (1997). Body image disturbance does not appear to be associated with other features of either anorexia nervosa or bulimia nervosa and does not help to differentiate normal women from patients with eating disorder.