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To understand the transmission dynamics of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in a hospital outbreak to inform infection control actions.
Retrospective cohort study.
General medical and elderly inpatient wards in a hospital in England.
Coronavirus disease 2019 (COVID-19) patients were classified as community or healthcare associated by time from admission to onset or positivity using European Centre for Disease Prevention and Control definitions. COVID-19 symptoms were classified as asymptomatic, nonrespiratory, or respiratory. Infectiousness was calculated from 2 days prior to 14 days after symptom onset or positive test. Cases were defined as healthcare-associated COVID-19 when infection was acquired from the wards under investigation. COVID-19 exposures were calculated based on symptoms and bed proximity to an infectious patient. Risk ratios and adjusted odds ratios (aORs) were calculated from univariable and multivariable logistic regression.
Of 153 patients, 65 were COVID-19 patients and 45 of these were healthcare-associated cases. Exposure to a COVID-19 patient with respiratory symptoms was associated with healthcare-associated infection irrespective of proximity (aOR, 3.81; 95% CI, 1.6.3–8.87). Nonrespiratory exposure was only significant within 2.5 m (aOR, 5.21; 95% CI, 1.15–23.48). A small increase in risk ratio was observed for exposure to a respiratory patient for >1 day compared to 1 day from 2.04 (95% CI, 0.99–4.22) to 2.36 (95% CI, 1.44–3.88).
Respiratory exposure anywhere within a 4-bed bay was a risk, whereas nonrespiratory exposure required bed distance ≤2.5 m. Standard infection control measures required beds to be >2 m apart. Our findings suggest that this may be insufficient to stop SARS-CoV-2 transmission. We recommend improving cohorting and further studies into bed distance and transmission factors.
DSM-V describes three eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder), three feeding disorders (avoidant/restrictive food intake disorder, pica, and rumination disorder), and two residual feeding and eating disorder categories (APA, 2013). Although these disorders contain some overlapping features, an individual can receive just one feeding or eating disorder diagnosis at a time. The only exception is pica, which can be diagnosed concurrently with another feeding or eating disorder if the pica behavior is severe enough to warrant additional clinical attention.
This chapter provides a basic introduction to the relationship between thoughts, feelings, and behaviors, and introduces our cognitive-behavioral model of ARFID. We return to the case examples from Chapter 1 to illustrate a cognitive-behavioral understanding of sensory sensitivity, fear of aversive consequences, and lack of interest in eating or food.
This chapter explains what avoidant/restrictive food intake disorder (ARFID) is and provides diverse and relatable case examples of each of the three prototypical ARFID presentations, including sensory sensitivity, fear of aversive consequences, and lack of interest in eating or food.
This chapter will help the reader assess the adequacy of his of her current diet and determine which module(s) (described in chapters 6, 7, and 8) is/are most appropriate to complete as next steps. Key components of this chapter will include:
Information about common nutrition deficiencies observed in ARFID
The five basic food groups (from US MyPlate schematic) and the importance of eating a varied diet
Strategically selecting fruits, vegetables, proteins, dairy, and grains to learn about that will support resolution of nutrition deficiencies, encourage further weight gain (if needed), and/or reduce psychosocial impairment
Selecting whether to tackle sensory sensitivity, fear of aversive consequences, and/or lack of interest in eating or food, and in what order