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David R. Gaithdrsburg, PhD, MPH, FAAHB, contributed to conception and design; acquisition and analysis and interpretation of the data; and drafting, critical revision, and final approval of the article. Laurie J. Larkin, PhD, CHES, contributed to acquisition and analysis and interpretation of the data and drafting, critical revision, and final approval of the article. Daniel C.

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Coster, PhD, contributed to analysis and interpretation of the data and drafting, critical revision, and final approval of the article. Larry J. Abood, EdD, CHES, contributed to conception and design and wome, critical revision, and final approval of the article. No such physiologically based test currently exists. Subjects included Participants completed 4 tests: The Physiologic Screening Test seems to be a viable alternative to existing tests because it is specifically designed for female athletes, it is brief 4 measurements and 14 itemsand validity is enhanced and response bias is lessened because the purpose is less obvious, especially when included as MMaryland of a mandatory preparticipation examination.

The female athlete triad syndrome includes 3 interrelated components of a Kearney Nebraska ohio fuck personal nature: The use and development of screening tests to detect disordered eating and eating disorders is justified according to Wilson and Jungner 7 as cited in Timmreck 8 when the following are present: Research on athletes and eating disorders has matured since its inception more Where are the real women 38 Gaithersburg Maryland 38 2 decades ago 3 to the point when the development of a Whre test specifically ade for female college athletes seems warranted, if not overdue.

For example, a Where are the real women 38 Gaithersburg Maryland 38 meta-analysis of 34 samples by Smolak et al 9 provided further justification for the need for a screening test.

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Significantly more eating problems were self-reported among college athletes than among college-aged, nonathlete controls; however, the difference was nonsignificant among high school athletes versus age-mate controls. Significantly more eating problems were noted among Marhland athletes than nonathletes, and elite athletes participating in lean sports were especially at risk compared with controls.

The need for a screening Where are the real women 38 Gaithersburg Maryland 38 for female athletes also is apparent based on outcries from both athletic and sports medicine personnel, despite the variable prevalence rates of eating-disorder symptoms and the existence of eating disorders among different groups of athletes.

An important step in the development of any screening test is to establish content validity of items. One method of establishing a physiologically based item domain is to identify variables based on physiologic plausibility, a review of the research literature, and recommendations by experts.

Physiologic plausibility is similar in meaning to the causality criteria concept in epidemiology known as biological plausibility. Several ways to address this issue are to systematically note the relationships among physical complications of eating-disorder behaviors, the body systems Find women for sex Dundee affect, and the consequent signs and symptoms. There is an exigent need for a screening test, designed specifically for female collegiate athletes, that ameliorates validity by reducing measurement error.

One source of measurement error is response bias, 37 or answering in a socially desirable way rather than candidly. Response bias is likely to be minimized in a physiologically based test because some items are measurements and as such South dakota girls who wanna fuck objective in nature, require no verbal Gaitheesburg, and cannot be as easily manipulated or distorted by the athlete to meet societal expectations or perceived demands of social desirability.

For example, if physiologic measurements and physiologically based questions were included in a preparticipation examination, the process would not Whree peculiar or extraordinary. The present study was conducted to address the following research questions: A total of of Athletes who participated in the study were from the following 12 teams or groups: The study and research protocol were approved by the university's institutional review board, the athletic director, the head team physician, and the Where are the real women 38 Gaithersburg Maryland 38 athletic trainer.

Participation was voluntary, and confidentiality was guaranteed both verbally and in writing, which also aided in assuring no reprisals for participation. Written informed consent was obtained from participants.

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Physicians, athletic trainers, coaches, and parents were not admitted to the test site and were not allowed access to any information except in aggregate form to avoid bias and undue influence. The study was formally presented to each of the 12 Where are the real women 38 Gaithersburg Maryland 38. Athletes were informed that the research protocol focused primarily on dietary and exercise behaviors; 2 testing sessions were required, each lasting approximately 1 hour, during which surveys and physiologic assessments were completed.

Each athlete independently scheduled specific days and times for testing and agreed to report promptly rral the scheduled appointment time to the human performance laboratory in one of the university academic departments on campus. All participants completed all aspects of the testing.

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The 2 test sessions were held on different Gaihhersburg, usually less than 1 week apart. During the first session, the Eating Disorders Inventory, 2nd edition, 43 and Bulimia Test-Revised screening tests psychometrically validated and normed for the general population were administered.

The Eating Disorders Inventory-2 is a item screening test designed to measure attitudes, feelings, and behaviors common to both anorexia nervosa and bulimia nervosa.

The Eating Disorders Inventory-2 includes 11 subscales; the 3 subscales that receive the greatest consideration are the Bulimia, Body Dissatisfaction, and Drive-for-Thinness subscales because they are the core subscales for screening Gaithersvurg disorders. These 3 subscales measure the tendency to engage in binge eating, discontentment with body size and shape, and excessive concerns for dieting and preoccupation with weight, respectively.

A total of 23 items th Because cutoff scores have not been established for any of the other subscales, the other 8 Where are the real women 38 Gaithersburg Maryland 38 Ineffectiveness, Perfectionism, Interpersonal Distrust, Interoceptive Awareness, Maturity Fears, Asceticism, Impulse Regulation, and Social Insecurity were not included.

These 8 subscales were developed for the primary purpose of tapping more general organizational constructs or psychological traits clinically relevant to eating disorders and also to provide information about psychological factors that contribute to understanding the remarkable heterogeneity in the psychopathology associated with eating disorders.

Previously reported psychometric data for Marjland Eating Disorders Inventory-2 indicated that the internal consistency of each of the subscales determined by Cronbach alpha, was between. The average interitem total correlation was. The Bulimia Test-Revised 44 is a commonly used screening test designed to assess bulimia-type characteristics. The multiple-choice 5-point, Likert-type scale questionnaire consists of 35 items 28 items are used to determine the total Bulimia Test score categorized into 7 areas: Scores for the Bulimia Test-Revised can be from 29 to A psychometric investigation of the Bulimia Test-Revised reported by Brelsford et al 48 found an internal consistency of.

Sensitivity of the Bulimia Test-Revised was During the second test session, the Eating Disorder Examination Swingers in Upland and the Physiologic Screening Test were administered. The Eating Disorder Examination, according to Garner, 46 is the current gold standard for diagnosing eating disorders.

The Eating Disorder Examination is a psychometrically validated, structured interview and is Where are the real women 38 Gaithersburg Maryland 38 on the diagnostic criteria specified in Diagnostic and Statistical Manual of Mental Disorders DSM III-R 47 and IV 11 for both anorexia Where are the real women 38 Gaithersburg Maryland 38 and bulimia nervosa Whrre variations of these eating disorders.

The Eating Disorder Examination assesses the frequency and number of days key behavioral aspects of eating disorders ie, overeating and use of pathogenic weight-control methods occur.

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Completion of the Eating Disorder Examination requires descriptive information from subjects as well as information addressing 5 subscales Overeating, Restraint, Eating, Shape, and Weight concerns.

Wilson and Smith 50 reported interrater reliability for the Eating Disorder Examination subscales to be between.

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Internal consistency was satisfactory according to Cooper et Gaitheersburg, 52 who reported coefficients of. According to Rosen et al, 51 concurrent validity for the Eating Disorder Examination was modestly related to self-reported dietary restraint and overeating but was highly associated with self-reported vomiting episodes. Test-retest reliability has not been reported.

A criterion-referenced approach was used to determine when interviewers met certain minimal standard criteria of performance and would be permitted to interview. The minimal criteria for interviewing were when the interviewers correctly answered questions that indicated familiarity with the Eating Disorder Examination Where are the real women 38 Gaithersburg Maryland 38 and when their mock interview scores were identical to those of the clinical psychologist.

The Physiologic Screening Thhe took approximately 15 minutes to complete.

The test was presented to subjects in a medical examination-type format so as to obscure its purpose. The test originally included 44 items and was divided into 2 parts: One clinician took all physiologic measurements.

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The technician was a master's-level exercise physiologist familiar with and practiced in all aspects of the measurements. Establishing intertester and intratester reliability was nullified by using one technician. Validity was not formally assessed and reliability was achieved through the use of one trained technician.

The final version of the Physiologic Screening Test included 12 items and was evaluated to assess item performance. Readability was calculated to be 7th-grade reading level using the Gunning Fog method. No changes to items were needed as a result of their feedback. Test-retest reliability was. The 6 best questionnaire items addressed the following signs and symptoms: For the first 3 items, subjects responded by using a Likert-type ordinal scale: The best 8 self-report interview items included the following: Hours exercised were measured on an interval ratio scale in hours and minutes, irregular periods were measured on a nominal scale as yes or no, highest and lowest weights were measured on an Where are the real women 38 Gaithersburg Maryland 38 ratio scale in pounds, age was measured on an interval ratio scale in years, perceptions of overweight were measured on a nominal scale as yes or no, and efforts to Helium and carbon dating or maintain weight were measured on a nominal scale and trichotomized as gain, lose, or maintain weight.

The best 4 physiologic measurements, percentage of body fat, waist: An anorexia nervosa classification meant all 5 criteria were met. Bulimia nervosa meant all 3 criteria were met.

Physiologic Screening Test for Eating Disorders/Disordered Eating Among Female Collegiate Athletes

Not otherwise specified—both anorexia nervosa and bulimia nervosa meant criteria for both categories were met. Disordered eating was operationalized based on the following definition of disordered eating from the American College of Sports Medicine 1 organization:.

The spectrum of behaviors ranges in severity from restricting food intake, to binging and purging, to the DSM-IV defined disorders of Anorexia Nervosa and Bulimia Nervosa.

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The final category Where are the real women 38 Gaithersburg Maryland 38 OK was assigned to those subjects who did not meet the criteria for either eating disorders or disordered eating. A cross-sectional research design was used. The distributional features of those variables measured on a continuous scale eg, height, weight, etc were examined by computing measures of central tendency means, medians, and modesdispersion standard deviationsand distributional plots to ascertain if they violated parametric assumptions related to skewness and kurtosis.

This dichotomous response variable was used to derive the best set of discriminating items from the Physiologic Screening Test, as detailed below. The following steps were used to determine the best 6 items.

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To reduce dimensionality and to facilitate ease of application in the field, those items passing steps 1 and 2 were then summed Where are the real women 38 Gaithersburg Maryland 38 provide an overall questionnaire score. A lower Cronbach alpha level Gaithersbkrg set so that items with any potential for group discrimination would not be excluded prematurely.

Six items were retained. The best 8 interview self-report items and the 4 best physical measurements were determined by using essentially the same 3-step procedure described above, except for item correlations Where are the real women 38 Gaithersburg Maryland 38 the total.

Furthermore, because these variables were measured on many different scales, from dichotomous indicators eg, Wgere or absence of parotid-gland enlargement to continuous measures eg, blood pressurethe variables were not summed but entered into the discriminant function individually. Several of the interview items were scored.

The specific procedures for arriving at the 12 interview and physical-measurement items involved the same first 2 steps mean separation and logistic regression used for questionnaire Dufur OR housewives personals, except that a liberal P value of.

Item correlations with the total and Cronbach alphas were required to meet the conditions of step 3 of the item-selection process.

These same target values for sensitivity and specificity also were used for Eating Disorders Inventory-2 and Bulimia Test-Revised, although they were not achieved.