The continuation of non-physical abuse from childhood to adulthood in eating disorder patients: An interpretative phenomenological analysis.

BACKGROUND: The ED literature has focused on the physical forms of childhood abuse with respect to eating disorders, overlooking non-physical abuse even though eating disorder patients report the latter either as primary experiences or as a revival of their childhood experiences. Additionally, there is no literature exploring whether adult eating disorder patients who have experienced childhood non-physical abuse continue to experience abuse as adults, and if they do, how well-being is impacted or linked with eating pathology. OBJECTIVE: This study explored the lived experiences of eating disorders patients who have experienced non-physical childhood abuse in childhood and adulthood. PARTICIPANTS AND SETTINGS: Six adult female eating disorder outpatients each took part in a semi-structured interview. METHODS: This study used the Interpretative Phenomenological Analysis framework. RESULTS: Three master themes and eleven superordinate themes were drawn from the analysis, addressing the research question: continuation of non-physical abuse across a lifetime, developmental factors and non-physical abuse, and non-physical abuse and eating pathology. CONCLUSIONS: The participants' accounts indicate that childhood non-physical abuse is related to eating disorder onset, and abuse continuation in adulthood contributes to the disorder's maintenance. Moreover, the lifelong consequences of non-physical childhood abuse impact psychological factors, such as self-esteem, attachment and emotion regulation, affecting the individuals' adult lives and keeping participants inside a vicious cycle of trauma re-enactment. Low self-esteem is considered by the participants as the key factor for their disturbed relationship with food.

Treatment of Nocturnal Enuresis Using Miniaturised Smart Mechatronics With Artificial Intelligence.

Our study was designed to develop a customisable, wearable, and comfortable medical device - the text so-called "MyPAD" that monitors the fullness of the bladder, triggering an alarm indicating the need to void, in order to prevent badwetting - i.e., treating Nocturnal Enuresis (NE) at the text pre-void stage using miniaturised mechatronics with Artificial Intelligence (AI). The developed features include: multiple bespoke ultrasound (US) probes for sensing, a bespoke electronic device housing custom US electronics for signal processing, a bedside alarm box for processing the echoed pulses and generating alarms, and a phantom to mimic the human body. The validation of the system is conducted on the text tissue-mimicking phantom and volunteers using Bidirectional Long Short-Term Memory Recurrent Neural Networks (Bi-LSTM-RNN) and Reinforcement Learning (RL). A Se value of 99% and a Sp value of 99.5% with an overall accuracy rate of 99.3% are observed. The obtained results demonstrate successful empirical evidence for the viability of the device, both in monitoring bladder expansion to determine voiding need and in reinforcing the continuous learning and customisation of the device for bladder control through consecutive uses. Clinical impact: MyPAD will treat the NE better and efficiently against other techniques currently used (e.g., post-void alarms) and will i) replace those techniques quickly considering sufferers' condition while being treated by other approaches, and ii) enable children to gain control of incontinence over time and consistently have dry nights. Category: Early/Pre-Clinical Research.

Effects of family functioning on eating pathology and psychosocial quality of life: The mediating role of self-esteem.

OBJECTIVE: Family dysfunction and self-esteem play an important role in the development of eating disorders (EDs), but this role has not been sufficiently examined regarding eating pathology and psychosocial quality of life (QoL), which often remains unchanged even after ED symptoms reduce. The purpose of this study was to therefore assess the mediating role of self-esteem between family dysfunction and both eating pathology and psychosocial QoL in ED patients and controls. METHOD: One hundred and fifty four female adult ED patients and 154 female healthy adult controls were recruited from Athens, Greece, and self-reported measures were used to assess family dysfunction, eating pathology, self-esteem, and psychosocial QoL. Structural equation modelling (SEM) was employed to test the mediation hypotheses. RESULTS: For both the ED and control groups, family dysfunction levels did impact eating pathology, but only through self-esteem. Family dysfunction, self-esteem, and eating pathology had a direct effect on both groups' psychosocial QoL. CONCLUSION: Self-esteem's important role in EDs was confirmed in both groups, along with its sensitivity to family dysfunction. We propose a parsimonious yet comprehensive theoretical model of the role of family dysfunction and self-esteem in EDs which future studies should further investigate longitudinally and in other population groups.

A structural equation model in adults with type 1 and 2 diabetes: exploring the interplay of psychological states and diabetes outcomes, and the mediating effect of resilience.

AIMS: Type 1 and 2 diabetes mellitus (T1DM and T2DM) can lead to emotional distress and cognitive impairments, often caused by psychological factors such as low mood or anxiety; yet, few studies have explored the theoretical mechanisms underlying these relationships and within one study. This study explored the relationships between psychological states (anxiety/worry, fatigue) and diabetes outcomes (diabetes distress, cognitive dysfunction), and whether resilience mediated the association between these in T1DM and T2DM. METHODS: A sample of 307 UK adults with a clinical diagnosis of diabetes (T1DM = 129; T2DM = 178) completed a cross-sectional online survey, composed of six questionnaires. Associations between variables were investigated using Pearson's correlations and Structural Equation Modelling (SEM). RESULTS: Psychological states were significantly correlated with diabetes outcomes, and resilience was significantly related to both psychological states and diabetes outcomes. The SEM model achieved an acceptable model fit with a significant mediating effect of resilience between psychological states (anxiety/worry, fatigue) and diabetes outcomes (diabetes distress, cognitive dysfunction), with no significant differences between diabetes type. CONCLUSIONS: We propose a new theoretical model of T1DM and T2DM that could be used to provide guidance for those designing interventions. These findings help to understand the complex nature of diabetes management, suggesting resilience could be a key factor in managing psychological states and diabetes outcomes.

Diabetes and eating disorders: an exploration of 'Diabulimia'.

BACKGROUND: 'Diabulimia' is the term given to the deliberate administration of insufficient insulin for the purpose of weight loss. Although Diabulimia can be life-threatening and prevalence rates in diabetes are high, there is a lack of research for how to effectively support people with the condition. This exploratory study aimed to provide much-needed information to healthcare professionals and guide the focus for future research. METHODS: Forty-five individuals with Type 1 diabetes mellitus (T1DM) and a history of insulin misuse completed an online questionnaire. This included an assessment of their eating disorder psychopathology with the Eating Disorder Examination Questionnaire (EDE-Q) and 16 open-ended questions exploring their experience of Diabulimia. The responses to the open-ended questions were analysed using thematic analysis. RESULTS: The average global EDE-Q score was 3.96 (1.21), which is consistent with eating disorder populations. Common themes identified were concerns about weight, difficulty coping with diabetes, past trauma, and the importance of relationships. Experiences with health professionals were overwhelmingly negative. Most participants had experienced serious medical intervention due to Diabulimia and were fully aware of the consequences of insulin restriction. CONCLUSIONS: Overall, individuals believed that a greater awareness of Diabulimia and more training for healthcare professionals is needed. While education on insulin misuse may be a necessary first step in treatment, psychological support is crucial. To deliver effective treatment, clinicians should be aware of the specific issues facing those with Diabulimia. The current study identified themes that clinicians may find useful to consider.

Intelligent autonomous treatment of bedwetting using non-invasive wearable advanced mechatronics systems and MEMS sensors : Intelligent autonomous bladder monitoring to treat NE.

Post-void alarm systems to monitor bedwetting in nocturnal enuresis (NE) have been deemed unsatisfactory. The aim of this study is to develop a safe, comfortable and non-invasive pre-void wearable alarm and associated technologies using advanced mechatronics. Each stage of development includes patient and public involvement and engagement (PPI). The early stages of the development involved children with and without NE (and parents) who were tested at a hospital under the supervision of physicians, radiologists, psychologists, and nurses. The readings of the wearable device were simultaneously compared with B-mode images and measurements, acquired from a conventional ultrasound device, and were found to correlate highly. The results showed that determining imminent voiding need is viable using non-invasive sensors. Following on from "proof of concept," a bespoke advanced mechatronics device has been developed. The device houses custom electronics, an ultrasound system, intelligent software, a user-friendly smartphone application, bedside alarm box, and a dedicated undergarment, along with a self-adhesive gel pad-designed to keep the MEMS sensors aligned with the abdomen. Testing of the device with phantoms and volunteers has been successful in determining bladder volume and associated voiding need. Five miniaturised, and therefore more ergonomic, versions of the device are being developed, with an enabled connection to the cloud platform for location independent control and monitoring. Thereafter, the enhanced device will be tested with children with NE at their homes for 14 weeks, to gain feedback relating to wearability and data collection involving the cloud platform. Graphical Abstract Design of the MyPAD advanced mechatronics system.

Patient Engagement in Medical Device Design: Refining the Essential Attributes of a Wearable, Pre-Void, Ultrasound Alarm for Nocturnal Enuresis.

BACKGROUND: To date, no pre-void wearable alarm exists to treat nocturnal enuresis (NE)-night-time bedwetting, and children with NE and their families are disappointed in relation to the post-void moisture alarms and medicine currently available. Development of a safe, comfortable and non-invasive wearable pre-void alarm and associated technology, using advanced mechatronics, is underway (the MyPAD device). Each stage of development includes patient and public involvement (PPI), particularly with respect to human factors, in collaboration with physicians, radiologists, psychologists, nurses, engineers and designers. OBJECTIVES: The aim of this study was to help us understand the families' experience of the condition of enuresis, and to provide opinion relating to existing NE alarms, designed to detect moisture, and most importantly, the initial design of the MyPAD wearable technology. METHODS: A PPI workshop in the form of a focus group, made up of children with enuresis and their parents, was conducted during the early stage of the MyPAD product development. The key research questions (RQs) were: (RQ1) What were the families' experiences of using existing post-void enuresis alarms? (RQ2) What do families like about the MyPAD prototype? and (RQ3) What do families not like about the MyPAD prototype? A nurse specialised in terms of NE treatment, including post-void alarms, from the Lancashire Teaching Hospitals NHS Foundation Trust, and two MyPAD design engineers were also present, to explain the MyPAD design concept. Braun and Clarke's six-phase approach to thematic analysis was implemented, which included familiarisation with the data, initial descriptive coding, identifying themes, reviewing themes, defining and labelling themes and producing a report. RESULTS: Four common themes were identified from the focus group discussions: the importance of sleep; children do not want to feel different; parents feel frustrated and concerned; resilience and perseverance. These themes applied across the research questions; for example, sleep disruption was highlighted as an issue with existing post-void alarms and as an important requirement for the design of MyPAD. The evaluation of the early version of the MyPAD device has prompted the consideration of changes to some existing facets of the device, including providing multiple alarm types, more options for the design of the garment that houses the device, and the need for clear, age-appropriate and informative instructions relating to how the device should be used, in order to maximise its performance/efficiency and acceptance. CONCLUSIONS: The qualitative data derived from the focus group discussion was incredibly valuable as it enabled the research and design team to experience the perspectives of the families in terms of the challenges and conflicts of managing the condition and the limited utility of existing post-void alarms. This has improved our understanding of the social and environmental challenges that will need to be considered during the design process.

A comparison of finger 2D:4D by self-report direct measurement and experimenter measurement from photocopy: methodological issues.

The ratio of 2nd and 4th digit length (2D:4D) is sexually dimorphic and may be a correlate of prenatal sex steroids. 2D:4D is often calculated from measurements of photocopies of fingers. However, 2D:4D from photocopies is lower than 2D:4D from direct measurements of the fingers. A new and promising source of 2D:4D measures is self-reports from Internet studies. This necessitates self-report of direct finger measurements and such measurements may be unreliable. In the present study, we compared 2D:4D from self-reported finger lengths measured directly from the fingers (S-R 2D:4D) and experimenter-measured finger lengths from photocopies of the fingers (photo 2D:4D). There were 329 participants (77 men, 252 women) recruited from a first-year undergraduate psychology pool. Compared to photo 2D:4D, (1) S-R 2D:4D tended to include some extreme values; (2) S-R 2D:4D was higher; (3) S-R 2D:4D showed weak similarities which increased when extreme values of S-R 2D:4D were removed; (4) photo 2D:4D and S-R 2D:4D showed lower values for males compared to females but the dimorphism was significant for the former but not for the latter. We conclude that, insofar as S-R 2D:4D has similarities to 2D:4D from Internet studies, the 2D:4D from Internet studies will show extreme values which should be removed, mean 2D:4D will be higher than from photocopy studies, and the sexual dimorphism will be weaker than in photo 2D:4D. We suggest that large samples are necessary in Internet studies of 2D:4D because measurement error will reduce effect sizes.

Endurance running and digit ratio (2D:4D): implications for fetal testosterone effects on running speed and vascular health.

There is anatomical and physiological evidence that endurance running (ER), i.e., running one or more kilometers using aerobic metabolism, originated early in the evolution of Homo, and the consequences of early selection for ER may be important in modern Homo. Here we examine ER performance in competitive ER. ER is sex dependent such that men tend to run faster than women, and the influence of sex on ER suggests that it may be modified by testosterone (T). It is shown that a putative proxy for prenatal T, the ratio of the length of the 2nd and 4th digits (2D:4D), is correlated with ER. Thus performance in training for ER was associated with high prenatal T, as measured by low 2D:4D, in both men and women. In cross-country races from 1 to 4 miles, 2D:4D explained about 25% of the variance in both male and female ER. Therefore, speed in ER was dependent on a proxy for prenatal T. 2D:4D correlates with performance in sport and exercises, which test a mix of strength and fitness, but the associations are in general quite weak with 2D:4D accounting for less than 10% of the variance in performance. Our finding that 2D:4D explains about 25% of the variance in ER suggests that prenatal T is important in determining efficiency in aerobic exercise. Early populations of Homo may have been strongly selected for ER and high prenatal T. The implications of this for patterns of predisposition to cardiovascular disease in modern Homo are discussed.

Photocopies yield lower digit ratios (2D:4D) than direct finger measurements.

The ratio between 2nd and 4th digit length (2D:4D) may be a negative correlate of prenatal testosterone. This possibility has led to a number of studies of 2D:4D and its relationship with sexual orientation and other sex-dependent traits. At first, 2D:4D ratio was calculated from measurements made directly on the fingers but recently a number of studies have used measurements from photocopies of the hands. Here, we compared finger lengths (2D, 3D, 4D, and 5D) and ratios obtained from these two measurement techniques. Our sample consisted of 30 homosexual men and 50 men and 70 women who were not selected for their sexual orientation. We found evidence that (1)2D:4D from photocopies tended to be lower than that from direct measurements, (2) there were differences in finger lengths such that 2D from photocopies tended to be shorter or equal in length to direct measurements, while 4D from photocopies tended to be longer or equal in length to direct measurements, (3) the sex differences in 2D:4D tended to be stronger for photocopy measurements, and (4) the pattern for length differences across 2D to 5D appeared to be different for homosexual men compared to men and women recruited without regard to sexual orientation. We conclude that there are differences in digit ratios obtained from photocopies and direct measurements, and these differences arise from length differences recorded from the different protocols. Therefore, 2D:4D ratios obtained from photocopies and direct measurements should not be combined within one study nor should they be used together in comparative studies. We suggest that finger length differences between the two techniques could result from the shapes of fat-pads at the tips of the fingers and these may be dependent on sex and sexual orientation.

Differential effects of active and passive stress on food intake in restrained and unrestrained eaters.

This study examined the effects of active (AC) and passive coping (PC) stress tasks on food intake in female restrained (n = 20) and unrestrained eaters (n = 20) Participants completed a reaction time task (AC), a cold-pressor test (PC), and a relaxation control condition separated by 1-week intervals. Food intake was assessed after each task. Self-reported anxiety, heart rate and blood pressure (BP) were measured before and after each task. Restraint was measured using the Dutch Eating Behaviour Questionnaire. Significant increases in BP were evident in the AC task only. Stress tasks produced significant increases in self-rated anxiety. Restrained eaters consumed more than unrestrained following the reaction time task, while the opposite was observed following relaxation. The findings of this study show that disinhibited eating of restrained eaters can be triggered by the distracting effects of a cognitively demanding task and may be independent of anxiety experienced.