Recovery in anorexia nervosa: the struggle to develop a new identity.

This study aims to explore recovery in AN from the perspective of individuals who have experience of it and examine if there are implications for practice. A Grounded Theory methodology was used and semi structured interviews employed to collect the data. The sample consisted of 12 individuals who had experience of AN, either as currently ill or self-defined as recovered from AN. All interviews were recorded and transcribed and the constant comparison method employed to analyse the data. The findings show that recovery for the person involves the successful integration of the four major dimensions of recovery; deciding to recover, sustaining recovering, doing the necessary tasks and building a life without AN. Each of these dimensions represents a series of tasks, which the person must complete, to varying degrees, if they are to recover. The grounded theory that emerged makes explicit that recovery from AN is conditional on the individuals' decision to recover and to take an active part in making it happen. Integrating the four dimensions is a spiralling process where the change in one is dependant on and is influenced by change in the others. They have to improve their physical condition or no recovery is possible because of the effects of starvation. They must tackle the issues that contributed to the AN and take on new roles if they are to move away from the AN identity. They must reconnect with others, asking for and accepting their help because recovery is not achieved alone. If they invest the substantial physical and emotional energy needed to sustain their recovery then they are transformed. They explore and build a life separate from the AN through the integration of the four dimensions. As a result the limited identity of AN is replaced by a more complex identity where individuals are stronger, more connected with others and in control of their lives. This study supports greater attention to the role of self-development tasks and models of treatment that promote autonomy in the person

Recovery in anorexia nervosa : the struggle to develop a new identity

This study aims to explore recovery in AN from the perspective of individuals who have experience of it and examine if there are implications for practice. A Grounded Theory methodology was used and semi structured interviews employed to collect the data. The sample consisted of 12 individuals who had experience of AN, either as currently ill or self-defined as recovered from AN. All interviews were recorded and transcribed and the constant comparison method employed to analyse the data. The findings show that recovery for the person involves the successful integration of the four major dimensions of recovery; deciding to recover, sustaining recovering, doing the necessary tasks and building a life without AN. Each of these dimensions represents a series of tasks, which the person must complete, to varying degrees, if they are to recover. The grounded theory that emerged makes explicit that recovery from AN is conditional on the individuals' decision to recover and to take an active part in making it happen. Integrating the four dimensions is a spiralling process where the change in one is dependant on and is influenced by change in the others. They have to improve their physical condition or no recovery is possible because of the effects of starvation. They must tackle the issues that contributed to the AN and take on new roles if they are to move away from the AN identity. They must reconnect with others, asking for and accepting their help because recovery is not achieved alone. If they invest the substantial physical and emotional energy needed to sustain their recovery then they are transformed. They explore and build a life separate from the AN through the integration of the four dimensions. As a result the limited identity of AN is replaced by a more complex identity where individuals are stronger, more connected with others and in control of their lives. This study supports greater attention to the role of self-development tasks and models of treatment that promote autonomy in the person.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The alarms should no longer be ignored: survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19.

This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance. Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016-2017 and 2019-2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18-25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS. This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP

The clinical effectiveness and cost-effectiveness of a ‘stepping into day treatment’ approach versus inpatient treatment as usual for anorexia nervosa in adult specialist eating disorder services (DAISIES trial): a study protocol of a randomised controlled multi-centre open-label parallel group non-inferiority trial

BACKGROUND: Anorexia nervosa (AN) is a serious and disabling mental disorder with a high disease burden. In a proportion of cases, intensive hospital-based treatments, i.e. inpatient or day patient treatment, are required, with day patient treatment often being used as a 'step-down' treatment after a period of inpatient treatment. Demand for such treatment approaches has seen a sharp rise. Despite this, the relative merits of these approaches for patients, their families, and the NHS and wider society are relatively unknown. This paper describes the rationale for, and protocol of, a two-arm multi-centre open-label parallel group non-inferiority randomised controlled trial, evaluating the effectiveness and cost-effectiveness of these two intensive treatments for adults with severe AN: inpatient treatment as usual and a stepped care day patient approach (the combination of day patient treatment with the option of initial inpatient treatment for medical stabilisation). The main aim of this trial is to establish whether, in adults with severe AN, a stepped care day patient approach is non-inferior to inpatient treatment as usual in relation to improving body mass index (BMI) at 12 months post-randomisation. METHODS: 386 patients with a Diagnostic and Statistical Manual 5th edition diagnosis of severe AN or related disorder, with a BMI of ≤16 kg/m2 and in need of intensive treatment will be randomly allocated to either inpatient treatment as usual or a stepped care day patient approach. Patients in both groups will receive treatment until they reach a healthy weight or get as close to this point as possible. Assessments will be conducted at baseline (prior to randomisation), and at 6 and 12 months post-randomisation, with additional monthly symptom monitoring. The primary outcome will be BMI at the 12-month post-randomisation assessment. Other outcomes will include psychosocial adjustment; treatment motivation, expectations and experiences; cost-effectiveness; and carer burden. DISCUSSION: The results of this study will provide a rigorous evaluation of two intensive treatment approaches which will inform future national and international treatment guidelines and service provision

The Swarm Initial Field Model for the 2014 geomagnetic field

Data from the first year of ESA's Swarm constellation mission are used to derive the Swarm Initial Field Model (SIFM), a new model of the Earth's magnetic field and its time variation. In addition to the conventional magnetic field observations provided by each of the three Swarm satellites, explicit advantage is taken of the constellation aspect by including east-west magnetic intensity gradient information from the lower satellite pair. Along-track differences in magnetic intensity provide further information concerning the north-south gradient. The SIFM static field shows excellent agreement (up to at least degree 60) with recent field models derived from CHAMP data, providing an initial validation of the quality of the Swarm magnetic measurements. Use of gradient data improves the determination of both the static field and its secular variation, with the mean misfit for east-west intensity differences between the lower satellite pair being only 0.12 nT

The Role of Aesthetics in Intentions to Use Digital Health Interventions

Digital interventions are increasingly recognised as cost-effective treatment solutions for a number of health concerns, but adoption and use of these interventions can be low, affecting outcomes. This research sought to identify how individual aesthetic facets and perceived trust may influence perceptions toward and intentions to use an online health intervention by building on the Technology Acceptance Model, where perceived attractiveness, perceived usefulness, perceived ease of use and perceived enjoyment are thought to predict behavioural intentions towards a website. An online questionnaire study assessed perceptions of nine stimuli varying in four aesthetic facets (simplicity, diversity, colour & craftsmanship), utilising a quasi-experimental within-subjects design with a repetition among three different groups: individuals from the general population who were shown stimuli referring to general health (GP-H) (N = 257); individuals experiencing an eating disorder and shown stimuli referring to eating disorders (ED-ED) (N = 109); and individuals from the general population who were shown stimuli referring to eating disorders (GP-ED) (N = 235). Linear mixed models demonstrated that perceptions of simplicity and craftsmanship significantly influenced perceptions of usefulness, ease of use, enjoyment and trust, which in turn influenced behavioural intentions. This study demonstrates that developing the TAM model to add a further construct of perceived trust could be beneficial for digital health intervention developers. In this study, simplicity and craftsmanship were identified as the aesthetic facets with the greatest impact on user perceptions of digital health interventions. Author summary Digital health interventions are playing a growing role in health care for a wide range of health conditions. However, people do not always engage with these interventions as much as might be hoped for. In this study we looked at a specific factor that might influence the user’s first impressions of digital health interventions, and in turn how much they will use them; aesthetic design. By building on an existing model of user acceptance of digital technology, we explored the elements of aesthetic design that are most important in influencing positive judgements when different groups of people access different digital health interventions. We found that using designs that look simple and professional improved user’s judgements of how useful and trustworthy the intervention is, how easy and enjoyable it is to use, and how likely they would be to use it. This work is intended to help guide future developers to create digital health interventions that are both visually appealing and engaging to users

The Role of Aesthetics in Intentions to Use Digital Health Interventions

Digital interventions are increasingly recognised as cost-effective treatment solutions for a number of health concerns, but adoption and use of these interventions can be low, affecting outcomes. This research sought to identify how individual aesthetic facets and perceived trust may influence perceptions toward and intentions to use an online health intervention by building on the Technology Acceptance Model, where perceived attractiveness, perceived usefulness, perceived ease of use and perceived enjoyment are thought to predict behavioural intentions towards a website. An online questionnaire study assessed perceptions of nine stimuli varying in four aesthetic facets (simplicity, diversity, colour & craftsmanship), utilising a quasi-experimental within-subjects design with a repetition among three different groups: individuals from the general population who were shown stimuli referring to general health (GP-H) (N = 257); individuals experiencing an eating disorder and shown stimuli referring to eating disorders (ED-ED) (N = 109); and individuals from the general population who were shown stimuli referring to eating disorders (GP-ED) (N = 235). Linear mixed models demonstrated that perceptions of simplicity and craftsmanship significantly influenced perceptions of usefulness, ease of use, enjoyment and trust, which in turn influenced behavioural intentions. This study demonstrates that developing the TAM model to add a further construct of perceived trust could be beneficial for digital health intervention developers. In this study, simplicity and craftsmanship were identified as the aesthetic facets with the greatest impact on user perceptions of digital health interventions

Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM)

Background: Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Lifestyle intervention can prevent progression to type 2 diabetes in high risk populations. We designed a randomised controlled trial (RCT) to evaluate the effectiveness of an established lifestyle intervention compared to standard care for delaying diabetes onset in European women with recent GDM. Recruitment into the RCT was more challenging than anticipated with only 89 of 410 (22%) women agreeing to participate. This paper identifies factors that could enhance participation of the target population in future interventions. Methods: We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined, and secondly that it would be possible to predict participation on the bases of those risk factors. To test our hypothesis, we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3-5 years following GDM, reducing the sample to 43 participants and 73 decliners. We considered established diabetes risk factors: smoking, daily fruit and vegetable intake, participation in exercise, family history of diabetes, glucose values and BMI scores on post-partum re-screens, use of insulin during pregnancy, and age at delivery. We also analysed narrative data from 156 decliners to further understand barriers to and facilitators of participation. Results: Two factors differentiated participants and decliners: age at delivery (with women older than 34 years being more likely to participate) and insulin use during pregnancy (with women requiring the use of insulin in pregnancy less likely to participate). Binary logistic regression confirmed that insulin use negatively affected the odds of participation. The most significant barriers to participation included the accessibility, affordability and practicality of the intervention. Conclusions: Women with recent GDM face multiple barriers to lifestyle change. Intervention designers should consider: (i) the practicalities of participation for this population, (ii) research designs that capitalise on motivational differences between participants, (iii) alleviating concerns about long-term diabetes management. We hope this work will support future researchers in developing interventions that are more relevant, effective and successful in recruiting the desired population

Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial

Introduction: Internet-delivered psychological interventions among people with chronic pain have the potential to overcome environmental and economic barriers to the provision of evidence-based psychological treatment in the Irish health service context. While the use of internet-delivered cognitive-behavioural therapy programmes has been consistently shown to have small-to-moderate effects in the management of chronic pain, there is a paucity in the research regarding the effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) programme among people with chronic pain. The current study will compare the clinical-effectiveness and cost-effectiveness of an online ACT intervention with a waitlist control condition in terms of the management of pain-related functional interference among people with chronic pain.Methods and analysis: Participants with nonmalignant pain that persists for at least 3 months will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. The control group will be a waiting list group and will be offered the ACT intervention after the 3-month follow-up period. Participants will be assessed preintervention, postintervention and at a 3-month follow-up. The primary outcome will be pain-related functional interference. Secondary outcomes will include: pain intensity, depression, global impression of change, acceptance of chronic pain and quality of life. A qualitative evaluation of the perspectives of the participants regarding the ACT intervention will be completed after the trial.Ethics and dissemination: The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee (12/05/05). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals

The alarms should no longer be ignored: A Survey of the Demand, Capacity and Provision of Adult Community Eating Disorder Services in England and Scotland before COVID-19

Aims/Methods: This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) to NHSE commissioning guidance. Results: Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016/17 and 2019/20 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% were aged 18–25, 54%>25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for co-morbidities, offer assertive outreach, or provide seamless transitions. For patient volume, ACEDS workforce budget was 15% compared to the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for ACEDS. Clinical Implications: This study highlights the severe pressure in ACEDS, which has increased since the pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance for adults, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP