Disordered eating attitudes and behaviours in coeliac disease

This thesis examines the relationship between coeliac disease (CD) and disordered eating attitudes and behaviours. The literature review describes the development of a theoretical model of disordered eating in CD that will be evaluated throughout this thesis. Chapter Three reports the results of a study that found a high prevalence of disordered eating in CD. Chapter Four reports the results of a qualitative study; participants in this study discussed an increased concern around food that affected their eating patterns. Chapter Five describes the development and validation of the CD Food Attitudes and Behaviours Scale (CD-FAB), which was designed to assess the increased food concerns reported in CD. Chapter Six reports the results of an online survey that explored the correlates of this tool; participants with increased food concerns were more psychologically distressed and had an impaired quality of life. Chapter Seven reports the results of a laboratory study that explored the relationship between food concerns, food intake and cognitive processes related to eating. Overall, this thesis provides novel experimental and theoretical insights into the relationship between CD and disordered eating. The findings have implications for the management and treatment of people with CD

Development and Validation of the Coeliac Disease Food Attitudes and Behaviours Scale

Objectives. Previous studies on coeliac disease suggest that attitudes towards the gluten-free diet may contribute to the development of disordered eating. This study describes the development and validation of the Coeliac Disease Food Attitudes and Behaviours scale (CD-FAB) to measure these behaviours in coeliac disease. Research Methods and Procedures. Focus groups were used to develop 33 potential questionnaire items. These items were reviewed by service users and then distributed online to 157 adults with coeliac disease. Items were removed based on ceiling/floor effects, high interitem correlations (>0.7) and factor analysis. 11 items were retained. Exploratory factor analysis was then conducted. The psychometric properties of the final version of the CD-FAB were assessed via using an online platform. Results. The CD-FAB had 11 items distributed across one factor assessing attitudes and behaviours towards food. These factors explained 44.1% of the variance in responding. The CD-FAB and its subscales had high internal consistency (Cronbach’s alpha > 0.7) and psychometric validation indicated good convergent and discriminant validity. High scores on the CD-FAB are associated with psychological distress and an impaired quality of life. Conclusions. The CD-FAB is a reliable and valid measure of food attitudes and behaviours in coeliac disease. As a new disease-specific instrument, it may be a useful tool for evaluating food concerns in individuals with coeliac disease in a clinical setting and for further exploring the development of disordered eating patterns in coeliac disease. Further research is required to assess the full potential of the CD-FAB

Relations of distinct psychopathic personality traits with anxiety and fear : findings from offenders and non-offenders

Early descriptions of psychopathy emphasise fearlessness and a lack of nervousness or anxiety as key characteristics of the disorder. However, conflicting evidence suggests that anxiety may be positively correlated with some aspects of the psychopathy construct. This position may seem somewhat paradoxical when considered alongside impaired processing of fear related stimuli in psychopathic personality. The aim of the current paper was to examine the distinct relations of callous, egocentric, and antisocial psychopathic traits with measures of anxiety and social anxiety in samples of non-offenders (Study 1) and violent offenders (Study 2). In Study 2 we also used an emotion recognition task to examine fearful face recognition. In Studies 1 and 2 we showed distinct and opposite significant relationships of egocentric and antisocial psychopathic traits with trait anxiety. Thus, while trait anxiety was negatively predicted by egocentric traits, it was predicted in a positive direction by antisocial traits in both samples. In Study 2 we found that callous traits were predictive of greater impairments in fearful face recognition. These findings suggest that anxiety and fear are distinguishable constructs in relation to psychopathic personality traits, and are discussed in terms of potentially separable mechanisms for these two constructs

Emotional expression recognition and attribution bias among sexual and violent offenders:a signal detection analysis

Research with violent offenders has consistently shown impaired recognition of other’s facial expressions of emotion. However, the extent to which similar problems can be observed among sexual offenders remains unknown. Using a computerized task, we presented sexual and violent offenders, and non-offenders, with male and female expressions of anger, disgust, fear, happiness, sadness, and surprise, morphed with neutral expressions at varying levels of intensity (10%, 55%, and 90% expressive). Based on signal detection theory, we used hit rates and false alarms to calculate the sensitivity index d-prime (d’) and criterion (c) for each emotional expression. Overall, sexual offenders showed reduced sensitivity to emotional expressions across intensity, sex, and type of expression, compared with non-offenders, while both sexual and violent offenders showed particular reduced sensitivity to fearful expressions. We also observed specific effects for high (90%) intensity female faces, with sexual offenders showing reduced sensitivity to anger compared with non-offenders and violent offenders, and reduced sensitivity to disgust compared with non-offenders. Furthermore, both sexual and violent offenders showed impaired sensitivity to high intensity female fearful expressions compared with non-offenders. Violent offenders also showed a higher criterion for classifying moderate and high intensity male expressions as fearful, indicative of a more conservative response style, compared with angry, happy, or sad. These results suggest that both types of offender show problems in emotion recognition, and may have implications for understanding the inhibition of violent and sexually violent behaviors

Children and Young People's Health Partnership (CYPHP) Evelina London model of care: protocol for an opportunistic cluster randomised controlled trial (cRCT) to assess child health outcomes, healthcare quality and health service use.

INTRODUCTION: Children and young people (CYP) in many high-income settings have poor healthcare outcomes, especially those with long-term conditions (LTCs). Emergency and outpatient hospital service use is increasing unsustainably. To address these problems, the Children and Young People's Health Partnership (CYPHP) has developed and is evaluating an integrated model of care as part of a health systems strengthening programme across two boroughs of London, UK that are characterised by mixed ethnic populations and varying levels of deprivation. The CYPHP Evelina London model of care comprises proactive case-finding and triage, specialist clinics and transformative education and training for professionals working with CYP. Services are delivered by multidisciplinary health teams with an emphasis on increased coordination across primary, community and hospital settings and integration of physical and mental healthcare that accounts for the CYP's social context. METHODS AND ANALYSIS: The phased roll out of the CYPHP Evelina London model allows an opportunistic population-based evaluation using a cluster randomised controlled trial design. Seventy general practices across two London boroughs, grouped into 23 clusters, were randomised to provide either the CYPHP model of care (n=11) or enhanced usual care (n=12).The evaluation will measure the impact of the CYPHP Evelina London model of care on child and parent health and well-being, healthcare quality and health service use up to 2 years postimplementation. A population-level evaluation will use routinely collected pseudonymised healthcare data to conduct a service-use analysis for all CYP registered with a participating general practice (n=~90 000) with the rate of non-elective admissions as the primary outcome. We will seek consent from a subset of this population, with specific conditions (target n=2138) to assess the impact on patient-reported outcomes using the Paediatric Quality of Life Inventory (PedsQL) and Warwick-Edinburgh Mental Well-Being Scale (WEBWMS) as, respectively, the child- and parent-related primary outcomes. ETHICS AND DISSEMINATION: Ethics approval obtained from South West-Cornwall & Plymouth Research Ethics Committee. Results will be submitted for publication in peer-reviewed journals. Findings will be generalisable to community-based models of care, especially in urban settings. Our process evaluation will identify barriers and enablers of implementation and delivery of care salient to the context and condition. TRIAL REGISTRATION NUMBER: NCT03461848; Pre-results

Experiences of healthcare for mothers of children with ongoing illness, living in deprived neighbourhoods health and place

While the association between socioeconomic deprivation and children's poor health is clear, the complex pathways linking socioeconomic deprivation with access to care and health inequalities are less well understood. This analysis sought to understand the root cause of these inequalities by exploring how mothers living in deprived neighborhoods support their sick children, and their experiences with primary care.Interview transcripts from eight mothers, living in socioeconomically deprived neighborhoods, were analyzed using interpretative phenomenological analysis.Participants described their experiences in three distinct themes. Each theme highlights the importance of the mother's agency, voice, and power in supporting their child's health, and the crucial role played by the health system in addressing, maintaining, or reinforcing health inequalities. Participants used several strategies to address these health inequalities, which included fighting against the health system, using past experiences to explain health needs, and support from friends and family.Although the health system is an essential resource to support families, encounters with primary care may fail to address health inequalities and may therefore exacerbate existing health inequalities for families living in deprived neighborhoods, irrespective of health system financing and ability to pay.•Associations between socioeconomic deprivation and children's poor health are clear.•Complex pathways linking deprivation and poor health are poorly understood.•Mother's worked hard to address their children's health needs.•Health encounters may fail to address or exacerbate existing health inequalities