• A systematic review of enteral feeding by nasogastric tube in young people with eating disorders

      Hindley, Kristen; orcid: 0000-0002-0001-5056; email: kristen.hindley@student.manchester.ac.uk; Fenton, Clare; McIntosh, Jennifer (BioMed Central, 2021-07-22)
      Abstract: Background: Adolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment. Nasogastric feeding (NG) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement poor oral intake or to increase nutritional intake. This systematic review sets out to describe current practice of NG in young people with eating disorders. Methods: A systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000 to 2020. Inclusion terms were: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: psychiatric disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and participants over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles. Quality assessment, including risk of bias, was conducted by all authors. Results: Twenty-nine studies met the full criteria. 86% of studies were deemed high or medium risk of bias due to the type of study: 34.4% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) a wide range of refeeding regimes depending on country, settings, and the reason for initiation; 2) standard practice is to introduce Nasogastric feeds (NG) if medically unstable or oral intake alone is inadequate; 3) NG may enable greater initial weight gain due to increased caloric intake; 4) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 5) complications included nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 6) where NG is routinely implemented to increase total calorie intake, length of stay in hospital may be reduced; however where NG is implemented in correlation to severity of symptoms, it may be increased; 7) both medical and psychiatric wards most commonly report using NG in addition to oral intake. Conclusions: NG feeding is a safe and efficacious method of increasing total calorie intake by either supplementing oral intake or continuously. There are currently no direct comparisons between continuous, nocturnal or bolus regimes, which may be used to direct future treatment for YP with ED.
    • Uneven solidarity: the school strikes for climate in global and intergenerational perspective

      Walker, Catherine; orcid: 0000-0003-3390-9272; email: catherine.walker-2@manchester.ac.uk (BioMed Central, 2020-05-29)
      Abstract: Background: The school strikes for climate (henceforth, the school strikes) initiated by Greta Thunberg have brought young people’s environmental concerns to the global stage. However, there is a danger of considering youth environmental concerns only through the actions of highly mobilised young people who are heavily concentrated in the urban Global North. This article revisits qualitative data collected before the school strikes to consider how 11–14-year-olds in India and England interpreted and responded to environmental hazards and degradation in their everyday lives, and connected their situated experiences to narratives of global environmental crisis. The young people occupied a range of socio-economic positions and were experiencing different degrees of vulnerability to environmental hazards. Results: All of the research participants were concerned about the future of the planet and their immediate environments. However, for the most environmentally vulnerable participants, future- and globally-oriented environmental concerns were overpowered by more immediate concerns. Although the young people were engaged in responses to environmental concerns, they did not see themselves as acting alone but rather with others around them, often adults. Some young people expressed doubt about the extent to which they as generationally-positioned individuals could make a difference to the problems discussed. These findings in many ways anticipate the school strikes, wherein young people are taking action to call upon adults to respond to environmental problems that young people recognise are beyond their individual capacities to resolve. Conclusion: The environmental activism of a significant minority of young people is to be applauded, however, the interest in youth activism prompted by the school strikes runs the risk of flattening global inequalities in young people’s exposure to environmental hazards, access to education and global knowledge networks. There is a need to look beyond such high-profile activities to understand how young people around the world are interpreting and responding to environmental concerns as generationally-positioned individuals operating within broader regimes of power.