Body image and self-disgust as self-appraisals influencing adjustment to limb amputation

This thesis explored the roles of body image and self-disgust, as self-appraisals, in their relationship to psychosocial adjustment and related factors in people with limb amputations. The thesis includes a systematic literature review of body image relating to psychosocial adjustment and a research paper examining the relationship of self-disgust to psychosocial adjustment following limb amputation. A critical appraisal of the research process and an ethics section are also included. Section one presents a quantitative systematic literature review of sixteen studies examining body image perception as a correlate or predictor of demographic, clinical and psychosocial factors related to adjustment following limb amputation. Body image concerns were found to be associated with poorer outcomes on several psychosocial factors, such as depression, anxiety, activity restriction and self-esteem, as well as prosthesis satisfaction. Findings are discussed in regard to theories of body image. Body image is proposed as an important consideration for clinical and prosthetic services, in working with people with limb amputations. In section two, an empirical study of quantitative, cross sectional methodology is presented, in which correlational and hierarchical regression analysis are used to examine the relationship of self-disgust to psychosocial adjustment and related factors; prosthesis use, prosthesis satisfaction, and body image. Self-disgust was found to correlate with each of the outcome measures and to significantly contribute to variance in psychosocial adjustment, prosthesis use, aesthetic prosthesis satisfaction and body image. Self-disgust emerged as an important consideration in understanding poor adjustment to amputation. Section three includes a critical appraisal of the research process, in which reflections are presented on the design of the study, the importance of researching difficult topics, such as selfdisgust, and potential areas for future research

Prosthesis use is associated with reduced physical self-disgust in limb amputees

Self-disgust is an emotion schema negatively affecting people’s body image and is triggered by bodily imperfections and deviations from the “normal” body envelope. In this study, we explore the idea that “normalising” the body in those with limb amputations via the prosthesis would be linked to reduced self-directed disgust. An international clinical community sample (N = 83) with mostly lower limb amputations completed measures about their demographics, prosthesis, adjustment, body image disturbance, psychological distress, and self-directed disgust in a survey design. Consistent with the “normalising” hypothesis, correlation and bootstrapped regression models revealed, first, that frequency of prosthesis use was significantly and negatively associated with physical self-disgust. Second, prosthesis use significantly mediated the exogenous effect of time since amputation on physical self-disgust. These results emphasise the psychological value of the prosthesis beyond its functional use, and stress its importance in normalising the body envelope in those with limb amputations, which may in turn promote psychological well-being

ESPEN Guideline: Clinical Nutrition in inflammatory bowel disease

Introduction: The ESPEN guideline presents a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD). Methodology: The guideline is based on extensive systematic review of the literature, but relies on expert opinion when objective data were lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required. Results: IBD is increasingly common and potential dietary factors in its aetiology are briefly reviewed. Malnutrition is highly prevalent in IBD – especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnu-trition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally if necessary) is strongly recommended. Routine provision of a special diet in IBD is not however supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative man-agement of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis, but is mod-erately well supported in Crohn's disease, especially in children where the adverse conse-quences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed. Conclusions: Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recom-mendations (grade A), 22 are strong recommendations (grade B) and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP)

Well-being and resilience in children with speech and language disorders

© 2018, American Speech-Language-Hearing Association. All rights reserved. Purpose: Children with speech and language disorders are at risk in relation to psychological and social well-being. The aim of this study was to understand the experiences of these children from their own perspectives focusing on risks to their well-being and protective indicators that may promote resilience. Method: Eleven 9- to 12-year-old children (4 boys and 7 girls) were recruited using purposeful sampling. One participant presented with a speech sound disorder, 1 presented with both a speech and language disorder, and 9 with language disorders. All were receiving additional educational supports. Narrative inquiry, a qualitative design, was employed. Data were generated in home and school settings using multiple semi-structured interviews with each child over a 6-month period. A total of 59 interviews were conducted. The data were analyzed to identify themes in relation to potential risk factors to well-being and protective strategies. Results: Potential risk factors in relation to well-being were communication impairment and disability, difficulties with relationships, and concern about academic achievement. Potential protective strategies were hope, agency, and positive relationships. Conclusion: This study highlights the importance of listening to children’s narratives so that those at risk in relation to well-being can be identified. Conceptualization of well-being and resilience within an ecological framework may enable identification of protective strategies at both individual and environmental levels that can be strengthened to mitigate negative experiences