Space perception,movement, and insight: attuning to the space of everyday life after major weight loss

Physiotherapists are well placed to help people adjust and engage meaningfully with the world following major weight loss. Recent research indicates that the body size a patient has lived with for years can continue to affect movement and perception even after largescale weight loss. This article explores this discrepancy in depth from the perspective of phenomenology and space perception and through the concepts of body image, body schema, and affordances. It draws on an empirical example in which a nautical engineer described his lived experience of returning to work following bariatric surgery and the discrepancies he experienced while adjusting to his new situation, particularly when moving his smaller body around the ship’s engine room, previously inaccessible to him. Analysis of this empirical example suggests that transitions in weight and size following bariatric surgery are both highly explicit in awareness (i.e., body image) and outside awareness (i.e., body schema). Major weight loss can open up new affordances and possibilities of being in the world, but only after adjustments in body image and body schema. The article suggests ways in which such insights can contribute to physiotherapists’ clinical development and practice when working with patients undergoing major weight loss.     

Identity development, coping, and adjustment in emerging adults with a chronic illness: the sample case of type 1 diabetes

PURPOSE: The present study focused on identity development in emerging adults (aged 18-30 years) with type 1 diabetes. The three study aims were to examine the following: (1) whether identity development was affected by having diabetes, as compared with development in a nondiabetic sample; (2) how identity development was related to depressive symptoms, coping with diabetes, and diabetes-related problems in the diabetic sample; and (3) whether the pathways from identity development to problems with diabetes and depressive symptoms were mediated through coping strategies in the diabetic sample. METHODS: A total of 194 emerging adults with type 1 diabetes and 344 nondiabetic emerging adults participated. RESULTS: First, using analyses of variance, some mean identity differences between the diabetic and comparison samples were found, with emerging adults with diabetes scoring lower on proactive identity exploration. Using cluster analysis, we found that the same identity types or statuses emerged in both the diabetic and nondiabetic samples. Second, in emerging adults with diabetes, these identity statuses were differentially related to diabetes-related problems, depressive symptoms, and illness coping, with the identity statuses representing a strong sense of identity being accompanied by less diabetes-related problems and depressive symptoms and more adequate coping strategies. Third, using structural equation modeling, the pathways from a strong sense of identity to diabetes-related problems and depressive symptoms were mediated through adaptive and maladaptive coping. CONCLUSIONS: Clinicians should be sensitive to the normative task of identity development in emerging adults with diabetes because identity development can function as a resource in coping with and adjusting to diabetes.     

Detection and evaluation of endocrine-disruption activity in water samples from Portuguese rivers

Water samples (n = 183) from Portuguese rivers were tested for the presence of endocrine disruptors using the recombinant yeast assay (RYA) combined with chemical identification of compounds having endocrine-disruption properties by liquid chromatography coupled to mass spectrometry. Ten selected locations were sampled monthly for a period of 20 months, from April 2001 to December 2002. More than 90% of samples showed either no detectable or low levels of estrogenicity (<0.1 ng/L of estradiol equivalents). The remaining samples (17 in total, 9.3%) showed estrogenicity values ranging from 0.1 to 1.7 ng/L of estradiol equivalents; only two samples showed values greater than 1 ng/L of estradiol equivalents. Most highly estrogenic samples (13 of 17 samples) originated in five sampling sites clustered in two zones near Porto and Lisbon. Chemical analysis detected alkylphenolic compounds (octyl- and nonylphenol plus nonylphenol ethoxylates) in all samples, albeit at concentrations less than 1 microg/L for each compound in 80% of samples. Total analyte concentration exceeded 10 microg/L in only 10 samples, with all but one of those originating from only two sampling sites. In these two locations, a good correlation was observed between the concentrations of octylphenol, nonylphenol, and to a lesser extent, bisphenol A in the samples and their estrogenicity values as calculated by RYA. We conclude that estrogenic activity can be explained by alkylphenol contamination in only these sites; for the remainder, we propose that pesticides and urban waste may be the main factors responsible for estrogenic contamination.     

Reference values for the five electrophoretic serum protein fractions in Caucasian children by capillary zone electrophoresis.

We report age-related reference intervals for capillary zone electrophoresis for children between 1 and 14 years of age.     

Attitudes of Dutch, German and Swiss nursing staff towards physical restraint use in nursing home residents, a cross-sectional study

Objective

To investigate the attitudes of nursing staff towards restraint measures and restraint use in nursing home residents, and to investigate if these attitudes are influenced by country of residence and individual characteristics of nursing staff.

Methods

A questionnaire on attitudes regarding restraints (subscales: reasons, consequences, and appropriateness of restraint use) and opinions regarding the restrictiveness of restraint measures and discomfort in using them was distributed to a convenience sample of nursing staff in The Netherlands (n = 166), Germany (n = 258), and Switzerland (n = 184).

Results

In general, nursing staff held rather neutral opinions regarding the use of physical restraints, but assessed the use of restraints as an appropriate measure in their clinical practice. Gender and age were not related to attitudes of nursing staff, but we did find some differences in attitudes between nursing staff from the different countries. Dutch nursing staff were most positive regarding the reasons of restraint use (p < 0.01), but were less positive than German and Swiss nursing staff regarding the appropriateness of restraint use (p < 0.01). Swiss nursing staff were less positive than German nursing staff regarding the appropriateness of restraint use (p < 0.01). Nursing staff with longer clinical experience showed a more negative attitude towards restraint use than nursing staff with less experience (p < 0.05) and charge nurses had the least positive attitude towards restraint use (p < 0.05).Opinions regarding restraint measures differed between the three countries. The use of bilateral bedrails was considered as a moderate restrictive measure; the use of belts was rated as the most restrictive measure and nursing staff expressed pronounced discomfort on the use of these measures.

Conclusions

Nursing staff from three European countries have different attitudes and opinions regarding the use of physical restraints. The results underline the importance of more tailored, culturally sensitive interventions to reduce physical restraints in nursing homes.     

Weight loss surgery as a tool for changing lifestyle?

This article critically explores the tension between perceptions of weight loss surgery as a last resort and as a tool. This tension stems from patients’ doubt and insecurity whether expectations for a healthy life will come through. Thus, even after surgery, traditional weight loss methods, including diets and exercise, are considered paramount. Drawing on a series of interviews with Norwegian women, we argue that the commercialization of weight loss surgeries as well as the moral stigmas attached to such operations serve to perpetuate this tension. More specifically, the women were advised to leave their old habits behind, and embrace a healthier and more active lifestyle. In such a climate, we argue that undergoing surgery without subsequently embodying dietary and exercise norms is hardly an option. On the contrary, these become a moral obligation that modern women need to relate to—and perhaps negotiate—in order to repudiate stigmas attached to weight loss surgeries as a quick fix for those incapable of losing weight in the “proper” manner.     

“Then I Can Become Very Ill”: Women's Experiences of Living With Irreversible Changes in Their Viscera

Over the past 5 years, interest in weight-loss surgery has increased in tandem with the growing obesity epidemic in both Western and developing countries. In particular, scholars have documented the health promoting aspects of weight-loss surgery. Nevertheless, few researchers have explored the side effects, most prominently “dumping,” that frequently accompany weight-loss surgery. Building on the one previous qualitative study of dumping, I focused my research for this article on the challenges associated with limiting food intake. Based on interviews with 22 Norwegian women, all of whom had undergone the gastric-bypass procedure, I concluded that the women who had a history of struggling with overeating found adjusting their food intake after the surgery particularly challenging. Appropriate personalized support for individuals struggling to establish new eating habits after the surgery requires a thorough understanding of the challenges associated with adjusting food intake. In this context, the findings of this article should be of interest to an international audience.     

Dilemmas in the process of weight reduction: Exploring how women experience training as a means of losing weight

Patients diagnosed with obesity are usually offered group-based behavior interventions which include dietary advice and exercise programs. In particular, high-intensity training—combining weight lifting with aerobic exercising—has been proven effective for losing weight. Moreover, recent studies have shown that persons participating in high-intensity training are more likely to maintain their weight loss compared to persons with lower levels of physical activity. However, most of the research in the field has made use of quantitative methods focusing on the measurable effect of such interventions. Therefore, the aim of this study was to show how the training is experienced from a first-person perspective, namely the patients themselves. Our hope was to shed some new light on the process of weight loss that concerns more than the measurable “impacts” of the training. A qualitative approach was used based on interviews with five women selected from a primary healthcare clinic in Norway. Our results show that experiences of training are connected to the participants'' general experience of being overweight. Both relationships to other people and earlier experiences are important for how the training is carried out and perceived. Five themes were identified supporting this line of argument: (1) the gaze of others; (2) a common ground; (3) dependence of close-follow up; (4) bodily discomfort as painful; and (5) aiming for results—an ambivalent experience. The results highlight the importance of finding the proper context and support for each patient''s needs.     

BLT-1, a specific inhibitor of the HDL receptor SR-BI, induces a copper-dependent phenotype during zebrafish development

Block lipid transport-1 (BLT-1) is a small chemical widely used to inhibit the transfer of lipids between high-density lipoproteins (HDL) and cells mediated by scavenger receptor B, type 1 (SR-BI). This study demonstrated that BLT-1 induced in zebrafish (Danio rerio) embryos a copper-dependent phenotype with a twisted notochord, brain ventricle enlargement, and absence of melanisation, phenocopying neocuproine-treated, or calamity mutants. This finding supports an unexpected link between copper availability and SR-BI activity. The copper-chelating activity of BLT-1, revealed by its dramatic effect during embryo development, should be considered in any evaluation of the pharmacological effect of this thiosemicarbazone derivative on SR-BI activity and the potential therapeutic value of this molecule.