Self‐liking and self‐competence: relationship to symptoms of anorexia nervosa

Self‐esteem has been hypothesised to play a pivotal role in the development and treatment, and outcome of anorexia nervosa (AN). Though this relationship is typically investigated by considering self‐esteem as a unitary construct, research suggests that this comprises of two related but distinct components of self‐liking and self‐competence. This study investigates the association between self‐liking, self‐competence, and symptomatology of AN through the course of a defined treatment episode in 77 women. Self‐liking was significantly associated with laxative abuse. Self‐competence was significantly associated with elevated ineffectiveness, perfectionism and interpersonal distrust. Although self‐competence and eating disturbance severity significantly improved over the treatment episode, one in three participants reported a reduced self‐like or self‐competence. Changes in both self‐competence and self‐liking at the end of treatment was associated with changes in drive for thinness. Such findings have implications for treatment models concerned with improving self‐esteem. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Patient–provider perceptions of diabetes and its impact on self‐management: a comparison of African‐American and White patients

Aims To compare patient–provider differences in diabetes‐related perceptions between African‐American and White patients and to examine its association with self‐care behaviours. Methods One hundred and thirty patient–provider pairs were recruited from the greater Detroit area. Patients and providers completed a survey assessing perceptions about diabetes‐related concepts and demographic background. The Diabetes Semantic Differential Scale was used to measure diabetes‐related perceptions. Patients also reported the frequency of performing self‐care behaviours, including following a healthy eating plan, engaging in physical activity, blood glucose monitoring, and taking medication and/or insulin. Results There were a greater number of patient–provider differences in diabetes‐related perceptions for the African‐American patients (nine of 18 concepts) compared with the White patients (four of 18 concepts). Stepwise regression analyses found patients’ semantic differential scores to be significantly associated with five self‐care behaviours for African‐American patients and two self‐care behaviours for White patients. Providers’ semantic differential scores emerged as predictors of self‐care behaviours for African‐American patients, but not for White patients. Conclusions Our findings suggest that compared with White patients, African‐Americans differ in a greater number of diabetes‐related perceptions than their providers. Patients’ and providers’ perceptions of diabetes care concepts have a significant impact on a greater number of self‐care behaviours for African‐American patients than White patients.     

An evidence-based review and guidelines for patient self-testing and management of oral anticoagulation

There is a limited evidence base for self-testing and -management for oral anticoagulation management. Available data suggest that these are credible models for a significant minority of patients if underpinned by structured training and follow-up. The guidelines presented are necessarily consensual and outline procedures for patient selection, training, product procurement, product maintenance, quality assurance procedures, dosage adjustment and clinical supervision. The cost-effectiveness of these models remains to be elucidated within the UK. Further data on both health economic and clinical outcomes are required from UK based studies before widespread implementation of self-testing and management can be recommended on a wider scale.     

Can the application of control theory assist patient management in rheumatoid arthritis?

Supporting patient self‐management is an important part of the care of patients with rheumatoid arthritis (RA) but patients vary in their capacity and willingness to manage their illness and may feel overwhelmed by the challenge of controlling the impact on their life. This paper discusses the value and importance of control theory and how it might be applied to enhance patients' self‐management. Not only does it offer a means of identifying those who might have greatest difficulty in managing their illness, but it also points the way to effective interventions. Copyright © 2010 John Wiley & Sons, Ltd.     

Application of protection motivation theory in epidemic prevention in patients with respiratory diseases under the COVID‐19 pandemic: A cross‐sectional study

Objective

This study aimed to investigate the effects of nursing intervention based on protection motivation theory (PMT) on patients with respiratory diseases in the context of the Coronavirus Disease 2019 (COVID-19) pandemic.

Methods

A total of 74 patients with respiratory diseases who were hospitalized from June 2020 to February 2021 were enrolled and stratified into a control group (n = 37) and an experimental group (n = 37) according to a stratified random sampling method. The control group adopted a routine nursing intervention program of the respiratory department, whereas the experimental group received a PMT-based nursing intervention program on the basis of the control group. Chronic Disease Self-Management Study Measures (CDSMS) and Self-Efficacy for Managing Chronic Diseases 6-item Scale (SECD6) were used to evaluate the effect of PMT intervention before intervention, after 1 week, and after 4 weeks of intervention. The levels of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC and peak expiratory flow (PEF) were measured to evaluate pulmonary function.

Results

Before the intervention, there were no significant differences in the scores of CDSMS and SECD6 scales and liver function indexes between the two groups (p > 0.05). After 1 and 4 weeks of intervention, the scores of CDSMS and SECD6 scales of the experimental group were significantly higher than those of the control group (p < 0.0001). The indexes of pulmonary function of the experimental group were improved, but there was no significant difference compared with the control group (p > 0.05).

Conclusion

Nursing intervention based on PMT contributes to the improvement of self-management behaviors and self-efficacy, which is conducive to the prognoses of patients.     

Assessment of self-reported self-esteem in healthy and diabetic children and adolescents in Greece

Background: The aim of the present study was to evaluate any possible negative effect of diabetes on the self‐esteem of children and adolescents with diabetes. Methods: Self‐esteem was evaluated using the Culture‐Free Self‐Esteem Inventory (CFSEI‐2) in 144 patients with Type 1 diabetes mellitus (T1DM; 7–18 years of age) treated in a diabetes center and compared against that of 136 healthy children and adolescents. Results: Self‐esteem was correlated with age (P = 0.017), but not with diabetes (P = 0.886). The median CFSEI‐2 score for both healthy and diabetic children was 22. There was no significant correlation between self‐esteem and sex, body mass index (BMI), physical exercise, HbA1c or parental educational level. According to Spearman’s rank correlation coefficient (r_s), there was a significant association between age and self‐esteem (r_s = ?0.15). Conversely, although BMI (r_s = ?0.09) and treatment duration (r_s = ?0.107) had a slight negative effect on self‐esteem and the duration of physical exercise (r_s = 0.11) and parental education (r_s = 0.07) seemed to have a positive effect, the associations did not reach statistical significance. Conclusions: Self‐esteem in diabetic children is mainly affected by their age, level of physical activity and level of family support. These findings emphasize the need to discriminate between glycemic control and diabetic adjustment.     

The impact of cognitive impairment in dementia on self‐care domains in diabetes: A systematic search and narrative review

Self‐management is integral to effective chronic disease management. Cognitive impairments (CogImp) associated with dementia have not previously been reviewed in diabetes mellitus (DM) self‐care. The aims of this study are to know (1) whether CogImp associated with dementia impact self‐care and (2) whether specific CogImp affects key DM self‐care processes. A systematic literature search with a narrative review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. This review examined studies published from January, 2000 to February, 2016 describing the relationship between cognition and DM self‐care domains in community dwelling older adults with dementia/CogImp. Eight studies met inclusion criteria. Decrements in all self‐care domains were associated with CogImp. Problem solving was related to reduced disease knowledge (OR 0.87, 95% CI = 0.49‐1.55), resulting in poorer glycemic control. Decision‐making impairments manifested as difficulties in adjusting insulin doses, leading to more hospital admissions. People without CogImp were better able to find/utilize resources by adhering to recommended management (OR 1.03, 95% CI = 1.02‐1.05). A lack of interaction with health care providers was demonstrated through reduced receipt of important routine investigation including eye examinations (ARR = 0.85, 95% CI = 0.85‐0.86), HbA1c testing (ARR = 0.96, 95% CI = 0.96‐0.97), and LDL‐C testing (ARR = 0.91, 95% CI = 0.901‐0.914). People without CogImp had better clinic attendance (OR 2.17, 95% CI = 1.30‐3.70). Action taking deficits were apparent through less self‐testing of blood sugar levels (20.2% vs 24.4%, P = 0.1) resulting in poorer glycemic control, self‐care, and more frequent micro/macrovascular complications. Persons with diabetes and CogImp, particularly in domains of learning, memory and executive function, were significantly impaired in all self‐care tasks.     

Phobia of self-injecting and self-testing in insulin-treated diabetes patients: opportunities for screening.

AIMS: To define clinically relevant cut-off points for severe fear of self-injecting (FSI) and self-testing (FST) (phobia) in insulin-treated patients with diabetes, and to estimate the magnitude of these phobias in our research population. METHODS: FSI and FST were assessed in a cross-sectional survey using the Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ). A sample of 24 insulin-treated adult diabetic patients was selected from the high-scorers on FSI and/or FST (> or = 95th percentile). FSI and FST were re-assessed, after which patients participated in a behavioural avoidance test (BAT), thereby determining the current level of avoidance of either self-injecting or self-testing. FSI and FST scores were linked to the outcome of the BATs. Cut-off scores for severe FSI/FST were determined and extrapolated to the total study population (n = 1275). RESULTS: Seven patients participated in the self-injecting BAT: two patients refused to perform an extra injection. In the self-testing BAT (n = 17) four patients declined to perform the extra blood glucose self-test. Extrapolation of FSI and FST cut-off scores to the total research population showed that 0.2-1.3% of the population scored in the severe FSI range. In FST, 0.6-0.8% of the total study population obtained scores in the cut-off range. CONCLUSIONS: Severe FSI and FST, characterized by emotional distress and avoidance behaviour, seems to occur in a small group of insulin-treated patients with diabetes. The D-FISQ can be of use to health care professionals (physicians, nurse specialists) in quickly providing valuable information on levels of FSI and FST in diabetes patients.     

Exploring Self‐Neglect in Older Adults: Preliminary Findings of the Self‐Neglect Severity Scale and Next Steps

Despite the public health implications of self‐neglect, no tool exists for characterizing this condition. Self‐neglecters often have no caregivers or surrogates to interview regarding the neglect and are often too cognitively impaired to provide valid self‐reports. In response to this need, researchers from the Consortium for Research in Elder Self‐neglect of Texas (CREST) collaborated with other experts in the field of elder self‐neglect to design the Self‐neglect Severity Scale (SSS). The SSS assesses three domains of self‐neglect (hygiene, functioning, and environment) and relies on observational ratings assigned by trained observers. After pilot testing and revision, the SSS was field tested in the homes of subjects who had been reported to and substantiated by Texas Adult Protective Services (APS) as self‐neglecting and compared with results of subjects recruited from a local geriatric clinic who were reported to APS but had no history of self‐neglect. The first field test demonstrated that the SSS could distinguish elderly self‐neglecters from community dwellers who do not self‐neglect. The SSS exhibited adequate scale reliability (Cronbach alpha) and correlation with case status. Interrater reliability also appeared adequate, although sensitivity and specificity fell below the conventional acceptable range. Future methods are proposed for refining the SSS to improve its use as the benchmark for identifying elder self‐neglect.     

Self‐esteem and cognitive development in the era of the childhood obesity epidemic

Consequences of obesity for mental health and cognitive development are not established to the same degree as those for chronic diseases. This study aims to document the interrelationships between body weight, self‐esteem and school performance in childhood. Height and weight measurements and self‐report of self‐esteem, diet quality and physical activity of 4945 grade 5 students were linked with standardized literacy test results. Structural equation models were applied to confirm hypothesized relationships between body weight, self‐esteem and school performance, and revealed that body weight affected self‐esteem negatively and that school performance affected self‐esteem positively. Body weight did not affect school performance, and self‐esteem did affect neither body weight nor school performance. Subsequent multi‐level logistic regression showed that obese students, relative to normal weight students, were more likely (1.44; 95% CI: 1.12–1.84), and students with good school performance, relative to those performing poor, were less likely (0.39; 95% CI: 0.26–0.58), to have low self‐esteem. Diet quality and active living had positive effects on both school performance and self‐esteem. The study findings further establish obesity as a risk factor for low self‐esteem and add to the rationale to promote healthy eating and active living among children and youth as this will prevent chronic diseases and improve mental health and cognitive development.     

Self‐care versus self‐harm: piercing,tattooing, and self‐injuring in eating disorders

Eating disordered patients seem to have a love–hate relationship with their bodies. Why do some decorate their bodies by means of tattooing and piercing, while others deliberately injure themselves and make parts of their body unattractive? We have explored this question in 101 eating‐disordered patients by means of self‐reporting questionnaires about the presence and characteristics of tattooing, piercing and self‐injuring as well as the underlying motives. Furthermore, we studied the co‐occurrence of impulsive behaviours as well as personality traits. In our patient sample, 11.9 per cent had one or more tattoos, 25.7 per cent a piercing and 64.9 per cent showed some form of self‐injurious behaviour (SIB). Tattooing and piercing are clearly driven by esthetical reasons, whereas SIB can have various explanations. All three behaviours were significantly more often linked to substance (ab)use. With respect to personality traits, piercing was positively linked to extraversion (positive affectivity) and openness, and negatively to conscientiousness. SIB, on the contrary, was positively linked to neuroticism (negative affectivity) and conscientiousness, and negatively to extraversion and openness. Tattooing did not show significant correlations with particular personality traits (probably due to the small number of tattooed patients). In summary, piercing and tattooing seem to reflect more self‐care, and might protect some patients against more self‐harm. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.