A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2017 / Introduction. Eating disorders are an important group of mental illnesses in Psychiatry. The aetiology is multifactorial, developing from distorted beliefs around body image and shape, with resultant abnormal eating behaviours. This study explores the views and perceptions of a group of university students regarding their peers’ body image and shape and eating behaviours, which they experienced (at the time) during their senior high school years. The majority of these students attended high schools in Johannesburg. Method. This was an explorative, qualitative study using qualitative methods. A sample of 153 participants was voluntarily recruited from students in the Faculty of Health Sciences at the University of the Witwatersrand. A manually distributed anonymous questionnaire was used, with questions about their high school peers’ personality traits, early and late childhood experiences, eating behaviour, and the last three years of high school environment. Questions in each section were deconstructed and categorised into subthemes. Subthemes were further deconstructed into replicated ideas. These subthemes and ideas were presented in hierarchical tables. Findings in this study were compared with the literature. Results. The most commonly described subtheme of participants’ perceptions of high school peers’ personality traits was “poor self-confidence”. The most replicated subthemes of views on peers’ childhood experiences were “personal conflict with members of the family”, “a disruptive home environment” and “mother’s attitude”. In terms of peers’ eating behaviour, a subtheme on “body shapes” included “fat”, “skinny” and “fit” and “muscular” bodies. In terms of the high school environment, the subtheme of “bullying and peer discrimination” was regarded as important, while “the impact of media” was regarded as extremely important. Fifty percent of participants viewed body image to be important for social status. There were mixed views on whether specific programmes should be introduced to identify pupils at risk. Conclusion. Although bullying and peer pressure have been described as contributing factors in the development of eating behaviour problems in high school learners, as perceived by a group of university students, the most prominent potential contributing factor considered was the media, specifically social media. This finding could contribute to further research looking at the role of social media, not only its relationship in the potential development of a Psychiatric Illness, but possibly, too, its role in the educational and rehabilitation process. / MT2017

Bakgrund: Upp till 25 % av alla barn har någon gång under uppväxten någon typ av uppfödningsproblem.  Begreppet uppfödningsproblem brukar innefatta någon form av svårighet med att suga, tugga och svälja och delas ofta in i olika kategorier beroende på symtombild eller tänkt orsak. Symtomen eller den möjliga orsaken får sedan avgöra hur man väljer att behandla problemet. Spektrumet är stort vid uppfödningsproblem, alltifrån svårigheter som inte leder till några egentliga hälsorisker för barnet till allvarliga svårigheter som leder till undernäring och behov av alternativ nutrition.                                         Syfte: Beskriva gruppen barn med uppfödningsproblem vars föräldrar sökt hjälp hos Specialist Barnavårdscentral (SpecialBVC) och att jämföra föräldrarnas upplevelse av problemet före respektive efter avslutad kontakt med denna. Även att undersöka om medicinska och sociala faktorer hos barnet och föräldrar eller olika vårdprocessmått hade samband med föräldrars upplevelse av uppfödningsproblemets svårighetsgrad efter avslutad kontakt.                                                                                                                      Metod: Deskriptiv, komparativ longitudinell studie på redan insamlat material.         Resultat: Det fanns en skillnad i upplevelsen av uppfödningsproblemets svårighetsgrad hos föräldrar efter avslutad kontakt med SpecialBVC. Analysen visade en signifikant positiv förändring av föräldrarnas upplevelse av problemets svårighetsgrad vid jämförelse före respektive efter avslutad kontakt med SpecialBVC. I populationen för den deskriptiva analysen hade 13  % av mödrarna depression och 17  % annan psykisk ohälsa. Många familjer (32 %) hade ett sviktande nätverk. Förekomst av dessa faktorer hos föräldrar vid uppfödningsproblem hos barn stöds i annan forskning.                                            Slutsats: Föräldrarna upplevde att uppfödningsproblemets svårighetsgrad minskade både för barnet och för familjen efter kontakt med SpecialBVC. En förklaring kan vara SpecialBVCs arbetssätt. För att kunna förstå patienten rätt och därmed kunna hjälpa behöver enligt Joyce Travelbee (1971) en relation uppstå mellan patient och behandlare. SpecialBVCs arbetssätt att genom hembesök med noggrann anamnesupptagning, planering av behandling utifrån familjens resurser samt uppföljning på det sätt som passar familjen ligger väl i linje med Joyce Travelbees Interaktionsteori. / Background: Up to 25 % of all children have at some time during childhood some type of eating difficulties. The concept of eating difficulties usually include some form of difficulty with sucking, chewing and swallowing. Eating difficulties are often divided into different categories depending on symptoms or the supposed cause. The symptoms or the possible cause to, decides how to treat the child. The spectrum is wide for eating difficulties, ranging from difficulties that do not lead to any real health risk, to severe difficulties leading to malnutrition and the need for alternative nutrition.                                                 Purpose: To describe the group of children with food problems whose parents sought help from specialist Child health (SpecialBVC) and comparing the parent's perception of food problems before and after completion of contact with SpecialBVC. Also see if the medical and social factors in the child and parent, and various health care processes measures related with the parent's perception of the difficulty of the food problem after finishing the contact. Method: Descriptive, comparative longitudinal study on the already collected material. Results: There was a difference in the experience of the severity of the food problem of parents after completing contact with SpecialBVC. This difference was significant. The study population had a high percentage of maternal depression or other mental illnesses. Many families had a failing network. These factors among parents supports the already done research on breeding problems in children.                                                        Conclusion: Parents perception of the severity of the food problem for both the child and family decreased after contact with SpecialBVC. One explanation may be SpecialBVCs approach that can be transferred in Joycee Travelbees interaction theory. To properly understand the patient seeking care, and thus able to help must first be a relationship-interaction occur. The result is a mutual contact and understanding that health care is based on forward.

Source: Masters Abstracts International, Volume: 45-04, page: 1953. Adviser: Deanna M. Hoelscher. Includes bibliographical references

Thesis advisor: Susan Kelly-Weeder / Refeeding Hypophosphatemia (RH) is the most common complication of nutritional restoration during medical hospitalization for individuals with anorexia nervosa (AN). Characterized by a drop in serum phosphorus levels, consequences of RH can be seen throughout the body and are potentially life threatening. Despite the seriousness of this outcome, little is known about which individuals with AN are at greatest risk of developing RH and best practices for prevention. The purpose of this retrospective cohort study was to examine demographic, feeding, and biochemical factors found in hospitalized adolescent and young adults (AYA) diagnosed with AN that may contribute to the development of RH. Individuals diagnosed with AN who were admitted to Boston Children’s Hospital between the years of 2010-2016 were considered for inclusion. Three hundred charts were analyzed using logistic regression to determine factors associated with RH and multivariate regression to determine factors associated with serum phosphorus nadir. In the final logistic regression model, receiving nasogastric tube feeding (p=0.54), age at admission (p=.022), weight gain during hospitalization (p=.003), serum potassium level (p=.001), and serum magnesium level (p=.024) significantly contributed to the model. Odds of RH were 3 times higher in those who received NG feeding, 1.2 times higher for each year of increasing age, 1.5 times higher for each kilogram of weight gain, 9.2 times higher for each unit reduction in potassium, and 13.7 times higher for each unit reduction in magnesium. With regards to phosphorus nadir, 1-unit increase in magnesium resulted in 1.2 increase in phosphorus, and each unit of admit BMI increased phosphorus by .060. The results indicate that NG feeding, age, weight gain, electrolyte abnormalities, and admit BMI are potential indicators of development of RH in AYA hospitalized with AN. This study will inform clinicians of risk factors associated with RH, and may guide further investigation into the clinical management of AYA diagnosed with AN. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Bakgrund Ätstörningar är en växande sjukdom i dagens samhälle och den mest utsatta gruppen är unga kvinnor mellan 15 och 25 års ålder. Ätstörningar är en global sjukdom men som framförallt ses i västvärlden där det smala idealet länge betraktats som det vackra och det framgångsrika och kan vara en stor riskfaktor för insjuknandet. Sjukdomens uppkomst kan bero på biologiska, psykologiska och/eller sociokulturella faktorer. För att kunna skapa ett fördelaktigt möte mellan hälso- och sjukvårdspersonal och individen med ätstörning är det viktigt att se personen bakom sjukdomen samt att relationen innehåller kunskap, tillit, trygghet och hopp. Syfte Syftet var att belysa vad patienten upplever främjar tillfrisknandet från en ätstörning i mötet med hälso- och sjukvårdspersonalen. Metod Metoden som användes var en icke-systematisk litteraturöversikt. Sökandet efter vetenskapliga artiklar utfördes på databaserna Cinahl, PubMed och PsycINFO. 16 artiklar med övergripande kvalitativ metod, men även mixad och kvantitativ metod, inkluderades i resultatet. Resultat Det framkom sex huvudkategorier som patienterna med ätstörning upplevde vara viktiga i en vårdrelation för att kunna främja ett tillfrisknande: Behovet av att överlämna kontrollen till vårdpersonalen, Vikten av att känna tillit i mötet, Modergestaltens betydelse, Hälso- och sjukvårdspersonalens kunskap och erfarenhet, Se personen bakom ätstörningen samt Hoppets betydelse. Slutsats Hälso- och sjukvårdspersonalen bör ha en fördomslös inställning i vårdandet av en patient med ätstörning. Det är viktigt att vårdpersonalen har kunskap och är bekant med sjukdomen samt att lyckas förmedla tillit, hopp och trygghet i relationen för att främja behandlingen. Patienten med ätstörning vill separeras från sin ätstörning och bli sedd som personen bakom ätstörningen. Det är ytterst viktigt att som vårdpersonal och sjuksköterska kunna skilja på sjukdom och person för att kunna skapa en patientnära relation och vara en hjälpande hand i att främja hälsa. / Background Eating disorders are an increasing problem in the current society. Although it is considered a global disease, it is most common in the western world, and the highest prevalence is seen among young females aged 15-25. The ideal of being slim is considered equivalent to beauty and success and can easily be a risk factor of becoming ill. The onset of eating disorders could be connected to biological, psychological and/or sociocultural factors. In order to create a positive encounter between the ill person and the healthcare professionals, it is important to see the person behind the disease as well as to create a relationship with knowledge, trust, comfort and hope. Aim The aim was to illuminate the patient experience of what promotes recovery from an eating disorder when meeting healthcare professionals. Method The method used was a literature review. Databases Cinahl, PubMed and PsycINFO was used to find relevant scientific articles. 16 articles with mainly qualitative design, but also quantitative design and mixed methods, were chosen for the result. Results Six main categories constitute what patients with an eating disorder found was important in the interrelationship to promote recovery: The need of surrendering control, The importance of feeling trust in the relationship, The meaning of a maternal figure, Health care professionals’ knowledge and experience, To see the person behind the disease and The meaning of hope. Conclusions Health care professionals should carry a non-prejudiced attitude while caring for a patient suffering from an eating disorder. To be able to support recovery it is shown to be important for caregivers to possess knowledge about eating disorders and to convey trust, hope and the feeling of being safe in the relationship. The patient with an eating disorder wish to be distinguished from the eating disorder and for caregivers to see the person behind the disease. It is of great importance for health care professionals, including nurses, being able to distinguish the person from the eating disorder in order to establish a trusting relationship and promoting health.

BACKGROUND: Nutrition, diet, and fitness are among the most searched health topics by internet users. Besides that, health-related internet users are diverse in their motivations and individual characteristics. However, little is known about the individual characteristics associated with the usage of nutrition, weight loss, and fitness websites. OBJECTIVE: The aim of this study was to examine the individual factors associated with the usage of nutrition, weight loss, and fitness websites. METHODS: An invitation to an online survey was published on 65 websites and discussion forums. In total, we employed data from 623 participants (aged 13 to 39 years, mean 24.11 [SD 5.26]). The measures included frequency of usage of nutrition, weight loss and fitness websites, excessive exercise, eating disorder symptomatology, internalization of the beauty ideal, weight status, and perceived online social support. Participants' data were used as predictors in a base linear regression model. RESULTS: The final model had an acceptable fit (χ210 =14.1; P=.17; root mean square error of approximation=0.03; comparative fit index=0.99; Tucker-Lewis index=0.99). Positive associations were found between usage of (1) nutrition websites and being female, higher levels of excessive exercise, and perceived online social support; (2) weight loss websites and excessive exercise, internalization, being female, eating disorder symptomatology, and being overweight or obese; and (3) fitness websites and levels of excessive exercise, internalization, and frequency of internet use. CONCLUSIONS: The results highlighted the importance of individual differences in the usage of health-related websites. / Revisón por pares

Submitted by Rafael Santana (rafael.silvasantana@ufpe.br) on 2017-04-26T19:17:14Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação versão digital.pdf: 1969857 bytes, checksum: d2019e39778015fb2fdd0636c18abe59 (MD5) / Made available in DSpace on 2017-04-26T19:17:14Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação versão digital.pdf: 1969857 bytes, checksum: d2019e39778015fb2fdd0636c18abe59 (MD5) Previous issue date: 2016-07-27 / Objetivo: Avaliar a associação entre alterações do alinhamento de cabeça e tronco durante o posicionamento para a alimentação e a presença de dificuldade alimentar, vômitos e infecções respiratórias em pré-escolares com paralisia cerebral. Métodos: Foram incluídas 70 crianças com paralisia cerebral de dois a sete anos, com grau de função motora grossa de III a V, acompanhadas em dois serviços de referência para dificuldades alimentares e reabilitação, entre abril de 2015 a fevereiro de 2016. Foi aplicado formulário, registrando características sociodemográficas, a ocorrência de regurgitação durante a dieta, a percepção do cuidador do quanto de dificuldade a criança apresenta para comer, o tempo gasto na alimentação, o estresse do cuidador e da criança durante a refeição, a presença de vômitos e infecção respiratória nos últimos seis meses e o tipo de reabilitação realizada pela criança (fonoterapia, fisioterapia e terapia ocupacional). O alinhamento da cabeça e do tronco foi avaliado por três fisioterapeutas separadamente pela análise de vídeos, captados na vista anterior e lateral da criança durante o momento da refeição. Para essa análise, se observou os planos de movimento frontal e sagital, de modo que a cabeça e o tronco foram considerados alinhados quando o pavilhão auricular e a linha média axilar coincidiram com a linha mediana hipotética que passa pelo centro do corpo. Realizou-se Kappa para cálculo da concordância entre as três avaliações dos vídeos. As variáveis categóricas foram expressas em percentual e suas associações analisadas pelos testes do Qui-quadrado ou Exato de Fisher. Considerou-se p ≤ 0,05 como significante. Resultados: Das 70 crianças, 62 (88,8%) tinham grau de função motora IV e V. Observou-se que o alinhamento da cabeça e do tronco durante a dieta nos planos frontal e sagital esteve associado ao uso de mobiliário adaptado e a realização de fonoterapia no plano frontal (p=0,01) e no sagital (p=0,05), estando esse alinhamento também associado à redução na regurgitação. As crianças com comprometimento motor IV e V apresentaram uma maior frequência de desalinhamento da cabeça e tronco no plano sagital (88%) quando comparadas as de grau III (12%), contudo sem significado estatístico (p=0,63). O desalinhamento da cabeça e do tronco no plano sagital esteve associado ao aumento do tempo de dieta (50%). A hiperextensão da cabeça esteve associada a menor ocorrência de vômitos e de infecção respiratória. Houve tendência a uma maior dificuldade de alimentação referida pelo cuidador (69%) entre as crianças com extensão da cabeça e regurgitação de alimento (52,4%) entre os participantes com extensão da cabeça e do tronco. Conclusão: Em crianças com paralisia cerebral grave, o uso de mobiliário adaptado e o acompanhamento em fonoterapia promovem o alinhamento da cabeça e do tronco durante a alimentação. Contudo, a hiperextensão da cabeça parece ser um mecanismo de proteção contra os vômitos e aspiração de alimentos para vias aéreas superiores. / Objective: To evaluate the association between changes in the head and trunk alignment during positioning for food and the presence of feeding difficulties, vomiting and respiratory infections in preschool children with cerebral palsy (CP). Methods: The study included 70 children with cerebral palsy from two to seven years, with a degree of motor function III to V, followed in two reference centers for food and rehabilitation difficulties, from April 2015 to February 2016. It was applied form, recording sociodemographic characteristics, the occurrence of regurgitation during the diet, the perception of the caregiver how much difficulty the child has to eat, time spent on food, the stress of the caregiver and child during the meal, the presence of vomiting and respiratory infection in the last six months and the kind of rehabilitation carried out by the child (speech therapy, physiotherapy and occupational therapy). The alignment of the head and the trunk was evaluated by three physiotherapists separately by video analysis, obtained in the previous and side view of the child during the time of the meal. For this analysis, there was the frontal and sagittal planes of movement, so that the head and trunk were considered aligned when the ear and axillary midline coincided with the hypothetical median line through the center of the body. Held Kappa to calculate the correlation between the three assessments of the videos. Categorical variables were expressed as percentage and the associations analyzed by chi-square test or Fisher's exact. It was considered p ≤ 0.05 as significant. Results: Of the 70 children, 62 (88,8%) had degree of motor function IV and V. It was observed that the alignment of the head and trunk during the diet in the frontal and sagittal planes was associated with the use of adapted furniture and speech therapy in the frontal plane (p=0,01) and the sagittal plane (p=0,05), this alignment being also associated with a reduction in regurgitation. The children with IV and V motor impairment showed a higher frequency of misalignment of the head and trunk in the sagittal plane (88%) when compared to grade III (12%), but without statistical significance (p=0,63). The misalignment of the head and the trunk in the sagittal plane was associated with increased diet (50%). The hyperextension of the head was associated with lower incidence of vomiting and respiratory infection. There was a trend towards greater feeding difficulties reported by the caregiver (69%) among children with head extension and food regurgitation (52,4%) among participants with head and trunk extension. Conclusion: In children with severe cerebral palsy, the use of adapted furniture and the monitoring in speech therapy promote alignment of the head and trunk during feeding. However, the hyperextension of the head appears to be a protective mechanism against vomiting and aspiration of food to the upper airways.

Bakgrund   Ätstörningar påverkar ungefär nio procent av världens befolkning. De definieras som allvarliga och tvångsmässiga beteenden med potentiellt livsfarliga konsekvenser. Sexuella-och könsminoriteter är sårbara och marginaliserade grupper med hög risk för att lida av psykisk ohälsa. Deras upplevelser och erfarenheter som marginaliserade samhällsgrupper påverkar deras interaktion med vården. Syfte Att beskriva prevalensen och lidandet av ätstörningar hos sexuella-och könsminoriteter. Metod Studien är en icke-systematisk litteraturstudie. För att söka ut de 17 originalartiklar som inkluderades i studien användes tre separata databaser och manuell sökning. Alla artiklar har kvalitetsgranskats enligt Sophiahemmets Högskolas bedömningsunderlag. Därefter lästes materialet igenom och en integrerad dataanalys användes för att analysera det syntetiserade resultatet. Resultat Sexuella-och könsminoriteter påvisade en högre risk för att lida av ätstörningar än ciskönade heterosexuella individer. Helt homosexuella deltagare hade ofta en officiell ätstörningsdiagnos medan bisexuella deltagare rapporterade höga resultat på bedömningar om ätstörningar. Ätstörningar och ätstörningsbeteende var ofta förekommande hos könsminoriteter med motiveringen att framhäva eller förtrycka könskaraktärer. Deltagare rapporterade upplevt lidande på grund av en bristande kunskap eller möjlighet till vård. Slutsats Det finns ett behov av ett empatiskt förhållningssätt gentemot målgrupperna samt utbildning i att förstå minoritetsperspektivet för att minska lidandet bland sexuella-och könsminoriteter som lider av ätstörningar. Minoritetsstress måste tas i beaktning när man hanterar minoriteter då de löper hög risk för fysiska och psykiska sjukdomar. Resultaten illustrerade skillnader mellan grupperna vilket lyfte fram vikten av att se individen holistiskt. Genom att arbeta för att förstå minoritetsperspektivet kan vårdgivare bidra till globala mål samt lindra lidande för individen. / Background Feeding and eating disorders affect about nine percent of the human population. They are defined as serious and compulsory behaviours with potentially life-threatening consequences. Sexual and gender minorities are vulnerable and marginalised groups who are at risk of suffering psychological illnesses. Their experiences as marginalised groups of society affect their interaction with the healthcare system.  Aim To describe the prevalence and suffering of feeding and eating disorders amongst sexual and gender minorities. Method The study is a non-systematic literature review. Three separate databases along with manual search were used to find the 17 primary articles included in the study. All articles have been reviewed as per Sophiahemmet University’s assessment instruments. Thereafter, the source material was examined, and an integrated analysis was used to analyse the synthesised results.  Results Sexual and gender minorities exhibited a high risk for suffering feeding and eating disorders than cisgendered heterosexual individuals. Completely homosexual participants were more likely to have an official feeding and eating disorder diagnosis whilst bisexual participants reported high scores on feeding and eating disorder questionnaires. Feeding and eating disorders and disturbed eating behaviours were frequent amongst gender minorities with the motivation of accentuating or repressing sex characteristics. Participants reported further suffering due to lack of knowledge or care amongst healthcare providers.  Conclusions There is a need for an empathic attitude and education in understanding the minority perspective to reduce the suffering amongst sexual and gender minorities suffering feeding and eating disorders. Minority stress needs to be taken into consideration when dealing with minorities as they are at high risk of physical and mental illnesses. The results illustrated various differences between the subgroups which highlighted the importance of viewing the individual holistically. By working to understand the minority perspective, healthcare providers can contribute to global goals as well as alleviate suffering for the individual.

Restrictive eating behaviors occur across ages, but little is known about symptoms of avoidant/restrictive food intake disorder (ARFID), especially in adults. This study sought to examine the prevalence of symptoms of ARFID in the adult population, providing a psychometric evaluation of the Eating Disorders in Youth-Questionnaire (EDY-Q) and population norms.

Objective Restrictive eating behaviors occur across ages, but little is known about symptoms of avoidant/restrictive food intake disorder (ARFID), especially in adults. This study sought to examine the prevalence of symptoms of ARFID in the adult population, providing a psychometric evaluation of the Eating Disorders in Youth-Questionnaire (EDY-Q) and population norms. Method In a representative survey of the German population, N = 2,424 adults (1,297 women, 1,127 men; age 49.5 ± 17.5 years) were assessed with the EDY-Q and measures of eating disorder and general psychopathology for divergent validation. Results The point prevalence of self-reported symptoms of ARFID amounted to 0.8% (20/2,424), with 0.8% of women (10/1,297) and 0.9% of men (10/1,127) being affected. Adults with symptoms of ARFID were significantly more likely to have underweight or normal weight, were more likely to report restrictive behaviors and lower levels of eating disorder psychopathology and binge eating than noneating-disordered controls and adults with symptoms of an eating disorder, but did not significantly differ in levels of compensatory behaviors, or depression and anxiety. The EDY-Q revealed favorable item statistics, heterogeneity, and satisfactory construct validity, including factorial, discriminant, and divergent validity. Weight-status specific norms were provided. Discussion Both women and men from the population reported symptoms of ARFID with an anthropometric and psychopathological profile similar to that seen in youth with symptoms of ARFID, however, with lower prevalence estimates, and distinctive from that in other eating disorders. Interview-based assessment of this symptomatology is required to confirm the prevalence of ARFID diagnosis.