Services for children with developmental co-ordination disorder: the experiences of parents

BACKGROUND

Parents provide valuable information on their experiences of engaging with therapy services for their children, which can inform the future development of these services. The aim of this study was to explore the views and experiences of parents who had accessed therapy services for their child with developmental co-ordination disorder (DCD).

METHODS

Seven focus groups were conducted incorporating 52 parents who had a child diagnosed with, or fitting the diagnostic criteria for DCD. Focus groups were audiotaped, transcribed and analysed thematically.

FINDINGS

Parents reported struggling to gain access to therapy services. When they gained access, they found the services beneficial for their child but continued to experience difficulties regarding the quality of service delivery.

CONCLUSIONS/IMPLICATIONS

The study suggests that parents thought some health-care professionals lacked knowledge and understanding of DCD, which they believed impacted upon early recognition and access to services. They perceived that therapy at an early age was vital for children's development, and indicated that a clearer path for accessing these services was necessary in addition to improved service quality. They called for an increase in awareness of DCD by all therapy service professionals to aid early recognition and improved treatment.

Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: another nail in the coffin of a problematic distinction

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n = 37) or regular SBEs but not OBEs (n = 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.

Women with bulimic eating disorders: When do they receive treatment for an eating problem?

Variables associated with the use of health services were examined in a prospective, community-based study of women with bulimic-type eating disorders who did (n = 33) or did not (n = 58) receive treatment for an eating problem during a 12-month follow-up period. Participants who received treatment for an eating problem differed from those who did not in several respects, including higher body weight, higher levels of eating disorder psychopathology, general psychological distress, and impairment in role functioning, deficits in specific aspects of coping style, greater awareness of an eating problem, and greater likelihood of prior treatment for a problem with weight. However, the variables most strongly associated with treatment seeking were greater perceived impairment in role functioning specifically associated with an eating problem and greater perceived inability to suppress emotional difficulties. These were the only variables that were significantly associated with treatment seeking in multivariable analysis. The findings suggest that individuals' recognition of the adverse effects of eating-disordered behavior on quality of life may need to be addressed in prevention and early intervention programs for eating disorders.

Self-report versus interview assessment of purging in a community sample of women

OBJECTIVE AND METHODS

Agreement between self-report and interview assessment of purging behaviours was examined in a community sample of women with a high level of eating disorder symptoms (n = 324) who completed both the Eating Disorder Examination (EDE) and Eating Disorder Examination Questionnaire (EDE-Q).

RESULTS

Of 46 individuals who reported any use of self-induced vomiting or laxative misuse on the questionnaire, 19 (41.7%) denied these behaviours when subsequently questioned in a face-to-face interview. These individuals had lower levels of eating disorder psychopathology, functional impairment and general psychological distress, than participants who reported purging on both the questionnaire and at interview (n = 27).

CONCLUSIONS

The assumption of interview superiority in the assessment of specific aspects of eating disorder psychopathology should not be uncritically accepted. Caution should be exercised in drawing conclusions concerning the level of agreement between self-report and interview assessment of purging based on research in clinical samples.

Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status

OBJECTIVE

To examine levels of eating disorder behaviours and cognitions of young women with obesity in the Australian Capital Territory, Australia and assess the impact upon psychological status.

DESIGN

General population cross-sectional survey.

SUBJECTS

A total of 4891 young women from the community aged 18-42 years, of which 630 were in the obese weight range.

MEASUREMENTS

Body mass index (BMI), eating disorder psychopathology (eating disorder examination questionnaire), and psychological distress (K-10).

RESULTS

Women with obesity had significantly higher levels of dietary restraint, eating concern, weight concern, shape concern, binge eating, misuse of diuretics, use of diet pills and fasting compared to other women in the community. These eating disorder cognitions and behaviours were associated with increased levels of psychological distress. In women with obesity, eating concern, weight concern, shape concern, dietary restraint and decreased age predicted psychological distress in a multivariate model. Among other women in the community, behaviours such as laxative misuse, 'hard' exercise and subjective bulimic episodes also contributed to the model predicting psychological distress.

CONCLUSION

As disordered eating psychopathology is high in young obese women and negatively impacts upon psychological status, obesity prevention and treatment should consider eating disorder psychopathology and mental health outcomes.

Eating Disorder Examination Questionnaire (EDE-Q): norms for young adult women

In order to establish norms for the Eating Disorder Examination Questionnaire (EDE-Q) among young adult women, the questionnaire was administered to a large general population sample of women aged 18-42 yr in the Australian Capital Territory (ACT) region of Australia. Normative data were derived for EDE-Q subscales and for the occurrence of specific eating disorder behaviours, for each of five age bands (18-22, 23-27, 28-32, 33-37, 38-42 yr). Mean scores (SDs) for the Restraint, Eating Concern, Weight Concern and Shape Concern subscales for the total sample (n = 5,255) were, respectively, 1.30 (1.40), 0.76 (1.06), 1.79 (1.51) and 2.23 (1.65). The mean global score was 1.52 (1.25). The regular occurrence of objective and subjective overeating episodes was reported by 10.6% and 12.7% of participants, respectively. The regular use of self-induced vomiting, laxative misuse, and use of diuretics, was reported by 1.4%, 1.0%, and 0.3%, of participants, respectively, while 2.2% of participants reported regularly using diet pills. "Extreme dietary restraint" and "excessive exercise" were reported by 3.4% and 4.9% of participants, respectively. Both attitudinal and behavioural features of eating disorder psychopathology tended to decrease with increasing age. These data will inform researchers intending to use the EDE-Q in epidemiological studies.

Group interpersonal psychotherapy for postnatal depression: a pilot study

We conducted a pilot study to assess the potential effectiveness of group interpersonal psychotherapy (IPT-G) as a treatment for postnatal depression (PND). The study was also established to test a treatment manual for IPT-G, assess the acceptability of this format for participants and test a recruitment strategy for a randomised controlled trial. 18 mothers diagnosed with PND participated in 2 individual session and 8 sessions of group IPT. A two-hour psychoeducational session was also held for the partners of the participants. Measures of depressive symptomatology and social adjustment were administered by an independent clinician at baseline, 4 weeks, 8 weeks and 3 months post treatment. Patient satisfaction with the treatment was also evaluated. Severity scores on the BDI, EPDS and the HDRS decreased from pre- to post-treatment. This was maintained at three months follow up. No overall improvement in the Social Adjustment Scale-Self Report was noted, although there was improvement in their relationship with their significant other. The results confirm previous work that IPT-G may improve symptom severity for women suffering from postnatal depression. Limitations included the use of antidepressant therapy by 67% of subjects and the lack of a control group. There is a need for further randomised controlled trials of IPT-G with larger sample sizes to establish its effectiveness as treatment for PND.

Understanding of blood pressure and behavioural risk factors amongst British adolescents

OBJECTIVES

To survey students aged 16-18 years in secondary education establishments in one school district in the south of England in order to: assess knowledge about the importance of blood pressure (BP) for health; investigate associations between knowledge and health-related behaviours; and explore home, school and health service influences on knowledge.

STUDY DESIGN

Observational.

METHODS

Self-reported data from a structured questionnaire administered to convenience samples of students in schools were analysed by Chi-squared tests and multiple linear regression. The questionnaire assessed knowledge about BP risks, symptoms, consequences and measurement, and collected information on BP-related instruction, health behaviours (smoking, exercise, alcohol and nutrition) and family background.

RESULTS

A cross-section of 569 students completed questionnaires, representing 19.6% of the total age cohort. Most students recognized the major behavioural risks and consequences of high BP, but 104 (18.3%) could not describe how BP is measured, and 401 (88.1%) had no idea what a normal BP reading should be. In multivariate analysis, BP knowledge was associated with previous academic attainment, having received advice or instruction about BP, and having BP measured in the last 2 years. Family experience was not significant. Many students reported unhealthy behaviours: current smoker (n = 87, 15.3%); less than three exercise sessions per week (n = 172, 30.2%); and two portions or less of fruit/vegetables per day (n = 223, 39.2%). BP knowledge was significantly associated with regular exercise but not with other health-promoting behaviours. One hundred and twenty-one (21.3%) students acknowledged having received instruction about BP, mainly from doctors/nurses (32%) and schools (28%).

CONCLUSION

Gaps in adolescents' knowledge about BP were identified. Greater awareness was associated with having received formal advice and instruction, so health services and schools could play an important part in improving BP knowledge among adolescents. More understanding of cumulative risks may encourage fuller engagement in health-promoting activities.

The management of squamous cell carcinoma of the neck. The Birmingham UK experience

AIMS

To review our treatment strategy and outcomes for metastatic squamous cell carcinoma of the neck.

METHODS

One hundred and six consecutive patients treated between 1992 and 1998 were analysed retrospectively. The following data were obtained. Demographic details, tumour site, clinical and pathological TMN staging, tumour grade and presence of extracapsular spread, treatment modality (surgery, radiotherapy and chemotherapy), type of neck dissection and complications, 2-year loco-regional control and 5-year overall survival.

RESULTS

Ninety-two patients had advanced disease (stages 3 and 4) and of these, 57% had palpable neck metastases. One hundred and six patients underwent a total of 132 neck dissections. Seventy-three patients had post-operative radiotherapy to both sides of the neck and a total of 31 patients took part in the UKHAN 1 trial. Seventy percent of patients achieved 2-year loco-regional control and 63% survived 5-years.

CONCLUSION

Metastatic squamous cell carcinoma of the neck can successfully be treated with an aggressive surgical approach and post-operative radiotherapy when indicated. Excellent 2-year loco-regional control and 5-year survival rates are possible.

Assessing quality of life in eating disorder patients

OBJECTIVE

To examine quality of life among subgroups of eating disorder patients.

METHOD

Self-report questionnaires which included two quality of life measures were completed by 87 individuals referred for treatment to the Australian Capital Territory Eating Disorders Day Program. Health-related quality of life, as measured by the Medical Outcomes Study 12-item Short Form Mental Component Summary scale, and subjective quality of life, as measured by subscales of the World Health Organization Brief Quality of Life Assessment Scale (WHOQOL-BREF), were compared among individuals who received the diagnosis of anorexia nervosa purging subtype (n = 15), anorexia nervosa restricting subtype (n = 19), bulimia nervosa (n = 40) and binge eating disorder (n = 10), and among a general population sample of young adult women employed as a control group (n = 495).

RESULTS

Eating disorder patients, when considered together, showed marked impairment in both health-related and subjective quality of life relative to normal control subjects. However, in both domains, restricting anorexia nervosa patients reported significantly better quality of life than other patient groups, after controlling for levels of general psychological distress. Scores on the Social Relationships subscale of the WHOQOL-BREF among individuals in this subgroup were similar to those of normal control subjects.

CONCLUSIONS

Reliance on any one instrument is likely to be misleading in assessing the quality of life of eating disorder patients. Careful consideration needs to be given to the assessment of restricting anorexia nervosa patients in particular.

Mode of delivery, but not questionnaire length, affected response in an epidemiological study of eating-disordered behavior

BACKGROUND AND OBJECTIVES

The effects of questionnaire length and mode of delivery on response rates were examined in an epidemiological study of eating-disordered behavior.

METHODS

Short (8 pages) and long (14 pages) questionnaires were posted or hand-delivered to a community sample of 802 women. Nonrespondents who received the first questionnaire by hand delivery received a reminder letter and replacement questionnaire by post; those who received the initial questionnaire by post were further randomized to receive the first reminder by hand delivery or by post, in short or long form. A second reminder letter and questionnaire (in short or long form) were posted to all remaining nonrespondents.

RESULTS

The overall response rate was 52.9%. This is a conservative estimate of true response, because in a substantial proportion of cases (12.2%) individuals were no longer resident at the listed address. There was a significant effect of mode of delivery on response, favoring hand delivery, at both the initial mailout and first reminder. There was no effect of questionnaire length on response to the initial mailout, although overall response was significantly higher for the longer form. It was estimated that an overall response of 58.0% would have been achieved had first reminders been hand-delivered to all nonrespondents who received the initial mailout by post.

CONCLUSIONS

Delivery of questionnaires by hand may be an effective way to increase response rates in epidemiological research, but little is to be gained by reducing questionnaire length.

Sexually transmitted infections in women who have sex with women

OBJECTIVES

To describe the prevalence of sexually transmitted infection (STIs) in a sample of women who have sex with women (WSW) and to identify risk factors for the acquisition of STI.

METHOD

Cross sectional survey. Questionnaire for demographic, sexual history, and sexual practice data linked with the results of genitourinary examination. 708 new patients attending two sexual health clinics for lesbians and bisexual women in London were surveyed.

RESULTS

A majority of WSW reported sexual histories with men (82%). Bacterial vaginosis and candida species were commonly diagnosed (31.4% and 18.4% respectively). Genital warts, genital herpes, and trichomoniasis were infrequently diagnosed (1.6%, 1.1%, and 1.3% respectively). Chlamydia, pelvic inflammatory disease, and gonorrhoea infections were rare (0.6%, 0.3%, and 0.3% respectively) and diagnosed only in women who had histories of sex with men.

CONCLUSIONS

Although we have demonstrated a low prevalence of STI, WSW may have sexual histories with men as well as women or histories of injecting drug use, and are therefore vulnerable to sexually transmitted or blood borne infections. Diagnosis of trichomoniasis, genital herpes, and genital warts in three women who had no history of sex with men implies that sexual transmission between women is possible.