Stigma and treatment of eating disorders in Ireland: healthcare professionals' knowledge and attitudes

Objectives: This study examines aspects of health professionals’ knowledge and attitudes about eating disorders (EDs) , which might impede the effective detection or treatment of EDs in Ireland. Methods: 1,916 health professionals were invited to participate in a web-based survey. Participants were randomly allocated to view one of five vignettes depicting a young person with symptoms consistent with Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Depression or Type 1 Diabetes. Study-specific questions examined participants’ responses to the vignettes and ED knowledge and experience

Eating disorder literacy and stigmatising attitudes towards anorexia, bulimia and binge eating disorder among adolescents

Little research has investigated adolescents’ understanding of eating disorders (EDs) or attitudes towards people affected by EDs. This impedes the development of targeted health promotion interventions. In the current study, 290 adolescents viewed a vignette depicting a target with either Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Depression or Type 1 Diabetes. Subsequent questionnaires assessed understanding of and attitudes towards the disorder described . Adolescents recognised the symptoms of depression significantly more frequently than any ED. Relative to depression and Type 1 diabetes, participants held targets with EDs more personally responsible for their illness and ascribed them more negative personality characteristics. The data revealed a particularly unfavourable view of Binge Eating Disorder, which was conceptualised as a failure of self-discipline rather than a medical condition. The results confirm previous findings that EDs are more stigmatised than other mental or physical health conditions and extend the findings to an adolescent cohort

Eating disorder services for young people in Ireland: perspectives of service providers, service users and the general adolescent population

Objectives: This paper illuminates how national eating disorder (ED) policy translates into day-to-day practice by exploring how ED services are experienced by those who deliver and use them. Methods: A mixed-methods approach was used, which combined qualitative and quantitative techniques. The paper collates data from three studies: (i) an interview study exploring the lived experiences of young people with EDs (n =8), their parents (n =5) and their healthcare professionals (n =3); (ii) a national survey of health professionals’ perspectives on existing ED services (n =171); (iii) a nationwide survey of secondary-school students’ eating concerns and patterns of help - seeking (n=290). Results: The qualitative interviews with young people and their parents revealed feelings of isolation and helplessness. Young people expressed interest in patient support groups, while parents desired greater support for the family unit. Parents were highly critical of available services, particularly in relation to access. These criticisms were echoed in the survey of healthcare professionals, who reported many barriers to delivering effective care. Clinicians were almost unanimous in calling for care pathways to be clarified via a standardised treatment protocol. The survey of adolescents indicated widespread reluctance to seek help regarding eating concerns: over one-third expressed concern about their own eating habits, but half of these had not divulged their concerns to anyone. Participants’ preferred pathways of help-seeking revolved around family and friends, and adolescents were unsure about routes of access to professional support. 3 Conclusions: The research demonstrates that many aspects of national ED policy have not been implemented in practice. The paper highlights specific gaps and suggests ways they can be redressed

Adolescents' and parents' views of Child and Adolescent Mental Health Services (CAMHS) in Ireland

Aim: To explore adolescents’ and parents’ experiences of CAMHS in relation to accessibility, approachability, and appropriateness. Methods: Using a descriptive qualitative design, a combination of focus group and single interviews were conducted with adolescents (n=15) and parents (n=32) from three mental health clinics. Data were transcribed verbatim and analysed using thematic analysis. Results: Accessing mental health services was a challenging experience due to knowledge deficit, lack of information and limited availability of specialist services. Participants desired more information, involvement in decision-making, single and shared consultations, flexible scheduling of appointments, continuity with clinicians, school support and parent support groups. Participants seem to be generally satisfied, however adolescents felt less involved in decision making than they would have liked. Frequent staff changes was problematic as it disrupted continuity of care and hindered the formation of a trusting relationship. Implications for practice: Parents and adolescents expressed similar views of the positive and negative aspects of mental health services. Their need for more information-sharing and involvement in decision-making underline the importance of collaborative practice. Clinician continuity contributed to trusting therapeutic relationships and was valued. These are key principles that with attention, could lead to quality service provision for adolescents and families

Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland

Objective: The ITRACK study explored the process and predictors of transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Republic of Ireland. Method: Following ethical approval, clinicians in each of Ireland's four Health Service Executive (HSE) areas were contacted, informed about the study and invited to participate. Clinicians identified all cases who had reached the transition boundary (i.e. upper age limit for that CAMHS team ) between January and December 2010. Data were collected on clinical and socio-demographic details and factors that informed the decision to refer or not refer to AMHS and case notes were scrutinised to ascertain the extent of information exchanged between services during transition

Cold Feedback in Cooling-Flow Galaxy Clusters

We put forward an alternative view to the Bondi-driven feedback between heating and cooling of the intra-cluster medium (ICM) in cooling flow galaxies and clusters. We adopt the popular view that the heating is due to an active galactic nucleus (AGN), i.e. a central black hole accreting mass and launching jets and/or winds. We propose that the feedback occurs with the entire cool inner region (5-30 kpc). A moderate cooling flow does exist here, and non-linear over-dense blobs of gas cool fast and are removed from the ICM before experiencing the next major AGN heating event. Some of these blobs may not accrete on the central black hole, but may form stars and cold molecular clouds. We discuss the conditions under which the dense blobs may cool to low temperatures and feed the black hole.Comment: 6 pages, no figures, to appear in the Proceedings of "Heating vs. Cooling in Galaxies and Clusters of Galaxies", August 2006, Garching (Germany

Shock-Like Dynamics of Inelastic Gases

We provide a simple physical picture which suggests that the asymptotic dynamics of inelastic gases in one dimension is independent of the degree of inelasticity. Statistical characteristics, including velocity fluctuations and the velocity distribution are identical to those of a perfectly inelastic sticky gas, which in turn is described by the inviscid Burgers equation. Asymptotic predictions of this continuum theory, including the t^{-2/3} temperature decay and the development of discontinuities in the velocity profile, are verified numerically for inelastic gases.Comment: 4 pages, 5 figures, revte

Coefficient of normal restitution of viscous particles and cooling rate of granular gases

We investigate the cooling rate of a gas of inelastically interacting particles. When we assume velocity dependent coefficients of restitution the material cools down slower than with constant restitution. This behavior might have large influence to clustering and structure formation processes.Comment: 3 figures, Phys. Rev. E (in press

Self-diffusion in granular gases

The coefficient of self-diffusion for a homogeneously cooling granular gas changes significantly if the impact-velocity dependence of the restitution coefficient $\epsilon$ is taken into account. For the case of a constant $\epsilon$ the particles spread logarithmically slow with time, whereas the velocity dependent coefficient yields a power law time-dependence. The impact of the difference in these time dependences on the properties of a freely cooling granular gas is discussed.Comment: 6 pages, no figure

Transitioning from child and adolescent mental health services with attention-deficit hyperactivity disorder in Ireland: case note review

Aim: In a context of international concern about early adult mental health service provision, this study identifies characteristics and service outcomes of young people with attention-deficit hyperactivity disorder (ADHD) reaching the child and adolescent mental health service (CAMHS) transition boundary in Ireland. Methods: The iTRACK study invited all 60 CAMHS teams in Ireland to participate; 8 teams retrospectively identified clinical case files for 62 eligible young people reaching the CAMHS transition boundary in all four Health Service Executive Regions. A secondary case note analysis identified characteristics, co-morbidities, referral and service outcomes for iTRACK cases with ADHD (n = 20). Results: Two-thirds of young people with ADHD were on psychotropic medication and half had mental health co-morbidities, yet none was directly transferred to public adult mental health services (AMHS) at the transition boundary. Nearly half were retained in CAMHS, for an average of over a year; most either disengaged from services (40%) and/or actively refused transfer to AMHS (35%) at or after the transition boundary. There was a perception by CAMHS clinicians that adult services did not accept ADHD cases or lacked relevant service/expertise. Conclusions: Despite high rates of medication use and comorbid mental health difficulties, there appears to be a complete absence of referral to publically available adult mental health services for ADHD youth transitioning from CAMHS in Ireland. More understanding of obstacles and optimum service configuration is essential to ensure that care is both available and accessible to young people with ADHD