Perceptions of the body interior by children with asthma and children with no known chronic disease

The body interior in anorexia nervosa: from interoception to conceptual representation of body interior

Background

Body image disorders are well documented in anorexia nervosa (AN); however, knowledge of interoceptive awareness (IA) in this population remains poor. This descriptive study investigated whether and how the representation of the interior of the body may have an impact on IA.

Methods

The representations and knowledge of the body interior were evaluated with a drawing task in 34 women with AN and 34 healthy controls (HCs). A lexicometric analysis was performed on the vocabulary used to describe the drawn body parts in a structured interview. It was assumed that the conceptual representation of the body interior could be affected by or influence IA. Thus, the relationship between IA, measured with the heartbeat task and the ischemia-induction test, and the drawings was explored. Other scales, such as those of body shape, awareness or satisfaction, were used to assess affective representations of the body.

Results

The drawing, lexicometric and IA results were similar in the two groups. No correlations were found among IA, body representation scores and representation level of body interior. Only the representation of bones by the AN group was significantly different.

Discussion

Increased visual attention to the skeleton or greater awareness of bone health could explain the stronger representation of bones in the AN group. The psychophysical therapy received by some AN participants (73%) did not seem to have influenced IA. Our results do not support a relationship between IA and the representation of the body interior.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT03988218.

Imaging and imagining chronic obstructive pulmonary disease (COPD): Uruguayans draw their lungs

PURPOSE

This anthropological study investigated what people imagined chronic obstructive pulmonary disease to look like in their lungs, what may be influencing these images and how this imagery shapes embodiment.

METHOD

Employing graphic elicitation, in one of multiple ethnographic interviews, participants were asked to draw their lungs: "If we could look inside your chest now, what would we see?" Lung drawings and accompanying narratives and fieldnotes from 14 participants were analyzed for themes and patterns.

RESULTS

The theme of "imaging/imagining" emerged and three distinct patterns within this theme were identified: the microscope perspective, the X-ray perspective and the reduced pulmonary capacity perspective. These patterns demonstrate how embodiment can be shaped by an integration and reinterpretation of the medical images that form part of everyday clinic visits and pulmonary rehabilitation.

CONCLUSIONS

Medical technology and images impact patients' embodiment. Understanding this is important for rehabilitation practitioners who work in a challenging space created by potentially conflicting medical narratives: on the one hand, chronic obstructive pulmonary disease is incurable permanent damage, and on the other, improvement is possible through rehabilitation. Drawing could be integrated into pulmonary rehabilitation and may help identify perceptions of the body that could hinder the rehabilitation process. Implications for rehabilitation Drawings, when combined with interviews, can lead to a deeper and more complex understanding of patients' perspectives and embodiment. Rehabilitation practitioners should be concerned with how patients embody the medical technology and imagery they are exposed to as part of the educational component of pulmonary rehabilitation and healthcare generally. Asking patients to visualize their illness through drawing may help pulmonary rehabilitation practitioners identify perceptions of the body which could hinder the patient's ability to reap the full benefit of their treatment.

Thinking 'taller': sharing responsibility in the everyday lives of children with asthma

AIMS

To explore negotiation of responsibilities for asthma self-care between a group of preadolescent children aged 7-12 and their parents/carers and to explore the meaning of responsibility to these children and their adult carers.

BACKGROUND

Living with asthma requires the distribution of a range of responsibilities between children and their adult carers, highlighting tensions between protection and promotion of autonomy. Previous studies have identified diverse factors associated with transfer of responsibility but a better understanding is required of the meaning of responsibility in children's lives and how parents and children negotiate responsibilities.

DESIGN

The design was qualitative.

METHODS

Eighteen child participants aged 7-12 years and their parents/carers participated in open-ended, conversational-style interviews. The framework approach was used to analyse the data and interpretation of data drew upon both feminist epistemology and sociological understandings of children, health and the body which relocate subjective experience at the heart of scientific enquiry.

RESULTS

Children demonstrated responsibility by avoiding asthma exacerbators and limiting the effect of asthma on themselves and their parents but there were limitations on children's opportunities to exercise some responsibilities.

CONCLUSIONS

It is possible to consider responsibility as the exercise of agency by children rather than simply as compliance with adults' instructions and prescriptions.

RELEVANCE TO CLINICAL PRACTICE

Some parents would like more assistance from health professionals in managing the process of increasing independent self-care by children. It is important to maintenance of the health of children with long-term conditions that the distribution of responsibilities between adults and children both ensures children's safety and provides appropriate preparation for independence in adult life. Understanding the process by which parents and children negotiate distribution of responsibilities for long-term conditions could provide a basis for development of interventions to respond to parents' requests for more professional support for managing this process.

Illness perceptions about asthma are determinants of outcome

This article reviews an emerging area of research on patients with asthma: namely, illness perceptions and their relationships with various aspects of outcome. The article briefly introduces the Common Sense Model, outlining the relevance of how "lay" patients conceptualize symptoms, illness, and treatment. On the basis of a comprehensive literature search, nine empirical studies illustrating the relationships between illness perceptions and outcomes are discussed. It is concluded that further research should focus on assessing asthma-specific illness and treatment beliefs. Also, given the effects of intervention studies in illness perceptions in other patient categories, it is recommended that serious consideration be given to intervention studies focusing on eliciting and changing illness perceptions in asthma patients, especially in those whose self-management seems to be inadequate.

A STUDY OF THE SELF-CONCEPTS OF 9–14 YEAR-OLD CHILDREN WITH ACUTE AND CHRONIC DISEASES

This study identified the level of self-concept in children with acute and chronic illnesses and determined the factors that may influence their self-concepts. The study sample includes 154 children (77 children with chronic illness, 77 children with acute illness). The data were collected via the General Information Form and the Piers-Harris Self-Concept Scale for Children (Piers & Harris, 1969). The data were analyzed via MANOVA, ANOVA and the Duncan Test. The findings indicate that self-concept scores vary, depending on the age of the child (p < .01) and the age of the mother (p < .05). Furthermore, for children with chronic illnesses, the medical department (p < .05), diagnosis (p < .05), treatment period (p < .05), and length of hospitalization (p < .01) all affected self-concept scores.

Asthma education: the adolescent experience

Recent studies show that prevalence of asthma is higher among adolescents than children. Adolescents have poor asthma self-management skills resulting in a significant increase in the severity of asthma exacerbations and a reduction in their quality of life. Despite this, few self-management programs have been developed for adolescents. Adolescents experience developmental transitions that both hinder and facilitate asthma self-management. In this paper we discuss developmental transitions in cognition, knowledge, autonomy, identity development, and peer relations in terms of their influence on adolescents' management of asthma. Next, we describe the Asthma Self-Management for Adolescents (ASMA) program that incorporates developmental characteristics into an age-appropriate school-based asthma education program. Preliminary data is presented indicating that the program is successful in enrolling and engaging the interest of adolescents with persistent asthma.