Environment and Physical Activity Dynamics: The Role of Residential Self-selection

OBJECTIVES: Within the socio-ecologic framework, diet and physical activity are influenced by individual, interpersonal, organizational, community, and public policy factors. A basic principle underlying this framework is that environments can influence an individual's behavior. However, in the vast majority of cross-sectional and even the few longitudinal studies of this relationship, the question of whether individuals select their area of residence based on physical activity-related amenities is ignored. In this paper, we address a critical methodological issue: self-selection of residential location, which is generally not accounted for, and can significantly compromise research on the relationship between environmental factors and physical activity behaviors. METHOD: We define and discuss the problem of residential self-selection in the study of neighborhood influences on health and health behavior, review methods used to control for residential self-selection in the literature, and present our strategy for addressing this potentially important source of bias. CONCLUSION: Existing research has built our understanding of residential self-selection bias, but important gaps remain. Our strategy uses data from a longitudinal cohort study linked to contemporaneous environmental measures to create a multi-equation model system to simultaneously estimate residential choice, environmental influences on physical activity, and downstream health outcomes such as obesity and clinical cardiovascular disease risk factor measures.     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

Workplace Mobbing: Family Dynamics and Therapeutic Considerations

Workplace mobbing is an underreported and understudied public health problem with significant health consequences on victims, intimate relationships, and families. Family and systemic dynamics influence the victim's response and recovery from in mobbing. Effective therapy with victims of mobbing, their significant others, and families requires familiarity with family and systemic dynamics. Various therapeutic considerations and interventions are described and illustrated in a case example.     

The Social Dynamics of Cigarette Smoking: A Family Systems Perspective

This paper uses family systems concepts and the Family FIRO model to show how cigarette smoking occurs in the context of the important relationships in a smoker's life. Specifically, smoking is viewed as a way a person is included in relationships, is in control in relationships, and perhaps is intimate in relationships. When smoking is well-established in the relationship, predictable interaction patterns surround it. When a person tries to quit or succeeds in quitting, these patterns change and may need to be replaced by nonsmoking alternatives. Partners may respond with support and willingness to create alternative patterns, or with undermining behavior stemming from a perceived threat to the established patterns. The model is offered for its heuristic value in guiding research and clinical experimentation. The paper also describes implications for family therapists as consultants to smoking-cessation programs.     

Family Dynamics and AIDS Phobia: A Case Study

The author introduces and defines AIDS phobia. He illustrates the hypochondria type of AIDS phobia from a combined individual, couple, and family treatment perspective. He describes the treatment process and outcome after an effective countertransference-based intervention, connects the individual manifestations of the index patient's illness to the family dynamics, and concludes with an analysis of the multigenerational contributions to the individual's psychopathology.     

Family Dynamics and Substance Abuse: A Preliminary Study

The authors discuss family patterns of interaction that are thought to contribute to the maintenance of substance abuse. Preliminary research findings pertaining to the interaction patterns are also presented. The data suggest that these families are often highly interdependent, that in about 50% of the cases they ideally desire some sort of triangulation between parents and offspring, and that in about 50% of the cases they have or are working toward a hierarchical reversal. Therefore, in addition to evaluating characteristics of the substance abuser, the authors recommend that counselors consider the nature of relationships within the client's family of origin.     

Assimilative and Accommodative Integration: The Basic Dialectics

Two basic styles in psychotherapy integration can be described, in which respectively the assimilative or the accommodative mode of proceeding preponderate. The first is chosen by those who wish to keep a firm grounding in any one theoretical system, into which they incorporate perspectives or practices from other schools, reinterpreted and reformulated in their own terms. The second is favored by those who prefer to practice eclectically, without worrying too much about the contradictions and incompatibilities among the different approaches. The latter therapists can remain at this purely eclectic level, or move on towards a proper integration. In this case the integration does not usually happen on the base of a preferred system, as in theoretical integration, but rather follows the line of the common factors approach. This integration mode has a prevalent accommodative character. It points to a basic structure that is common to the different methods, and becomes clearer the more the relation is freed of the constriction of theoretical models. An attempt is made to show the substantial complementarity and the dialectical relation that links the two fundamental modes of psychotherapy integration.     

高压氧医学与康复医学的协同发展

随着医学理论与实践的不断创新和发展,中国也正在努力寻求一种具有中国特色的现代医学发展模式.高压氧医学与康复医学都是新兴的边缘交叉性学科,具有广阔的发展潜能和空间;然而,两者在快速发展的同时也突显了一些问题,如:后续动力不足、发展方向不明确等.本文从哲学中联系与发展的角度出发,通过机制探讨及发展趋势的分析,试图寻找两者共同发展的结合点,为推动康复医学与高压氧医学在临床工作中的继续向前发展提供一种借鉴与参考.     

Family Dynamics and Drug Overdoses*

ABSTRACT: In a study of 40 patients who had taken an overdose, and with the relatives of 18 of these subjects, a pattern of family factors that appeared relevant to the choice of drugs was found. These family factors included: (a) a specific expectation that the person would use drugs; (b) an identification with another suicidal family member; (c) a high level of oral preoccupation and oral fixation; (d) trauma in the life history associated with food or orality; and (e) a direct participation of other family members in the suicidal act. The direct study of family interactions in evaluating suicidal potential is recommended for its unique diagnostic and therapeutic implications.     

Family Dynamics and Attitudes Toward Marriage

To examine our hypothesis that family experiences would be associated with attitudes toward marriage, we administered the Family Environment Scale (FES; Moos & Moos, 1986) and a Marriage Attitudes Questionnaire (MAQ; adapted from Long, 1987) to 40 unmarried college students. Correlational analyses indicated that for the conflict subscale of the FES, only two of the six marital expectation questions approached significance. However, family expressiveness (another subscale of the FES) was significantly correlated with three of the marital expectation questions and approached significance with a fourth question. These results indicated that higher expressiveness in the family was significantly related to positive attitudes toward marriage. We concluded that family dynamics need to be studied from multiple perspectives to identify factors that influence marital expectations.     

Dialectics and the Transcendence of Dialectics: Adorno's Relation to Schelling

The influence of the thought of the great German Idealist philosopher G.W.F Hegel on the thought of Theodor Adorno, the leading thinker of the first generation of the Frankfurt School, is unmistakeable, and has been the subject of much commentary. Much less discussed, however, is the influence of Hegel's prominent contemporary, F.W.J. Schelling. This article investigates the influence of Schelling on Adorno, and the sometimes striking parallels between fundamental motifs in the work of both thinkers. It argues that Adorno's critique of Hegelian (and indeed of his own, negative) dialectics, his conception of the relation between nature and spirit, and his philosophy of history (amongst other aspects of this thought) owe a considerable debt to Schelling. Furthermore, when adequately explicated, Schelling's position on a range of problems which confronted German Idealist philosophy often prove intrinsically preferable to those of Hegel.     

Microtransitions and the Dynamics of Family Functioning

This paper presents a qualitative observational study aimed at exploring microtransitions in the relational dynamics of family functioning when the children are adolescents. Three concurrent levels were considered central for family functioning in this period: the acknowledgment of emerging competences, the redefinition of the power structure, and the regulation of interpersonal distances. Twenty-eight non-clinical Italian families with at least one adolescent child were interviewed and video-recorded in their homes. A stance-taking process analysis was carried out on the family interactive sequences arising in the course of the interviews. This analysis was based on the stances taken by all family members in relation to their reciprocal evaluations, positions, and alignments, which allowed us to point out the interlocking of competences, power and distances. Out of all the possible theoretical combinations of these three dimensions, we identified four forms of interaction. In two forms, the emerging changes were not incorporated in the families’ interactive repertoires by either reconfirming family stability or resisting family changes. In these ways of interacting competences, power, and distances were not reorganized. In the other two forms, instead, family microtransitions were observable in the extent to which family members either explored family changes or legitimated family reorganizations. In these processes, they could redefine and readdress their ways of interacting.     

The MMPI-2: A Contemporary Normative Study of Midwestern Family Medicine Outpatients

For more than 60 years it has been known that profiles from the Minnesota Multiphasic Personality Inventory (MMPI), obtained from medical patients, are elevated when scores are plotted using general population norms. These elevations have been most apparent on the neurotic triad (NTd), the first 3 clinical scales on the MMPI profile. More than 45 years have passed since a nonreferred, normative sample of MMPIs was established from 50,000 consecutive medical outpatients. We present comparable but contemporary normative data for the revised MMPI (MMPI-2) based on a nonreferred sample of 1,243 family medicine outpatients (590 women; 653 men). As true for the original MMPI, contemporary medical outpatients have profiles that are significantly different, clinically and statistically, from the general population norms for the MMPI-2. This is particularly evident in elevations on the NTd. New normative tables of uniform medical T (UMT) scores were developed following the procedures used to create the uniform T scores for the MMPI-2. Measures of internal consistency are reported; test-retest reliability was established over a mean of 3.7 weeks, and results characterizing the stability of the validity and clinical scales are presented.     

Family Research Study at Eagleville Hospital and Rehabilitation Center

The Eagleville Hospital and Rehabilitation Center Family Study Program is described, presenting an overview of the Family Research Study and the problem areas inherent in coordinating research with a new treatment program; an analysis of the sample of drug abusers, their families, and their course in family treatment is discussed. The Community School Program is included as a demonstration of the potential for effective primary prevention. Areas of promise for future development are reviewed as they provide direction for further clinical and research work with the family and drug abuse.     

Intergenerational Suicide and Family Dynamics: A Hermeneutic Phenomenological Case Study

A phenomenological case study of a family in which the father committed suicide following incarceration and an adult daughter also committed suicide years later is described. This study used an embedded design to triangulate multiple sources of data (family documents and interviews with survivors) within the study of a single family. Four themes emerged to describe the relational dynamics between the father and adult daughter: (a) Mirroring, (b) Caretaking, (c) Death, and (d) Suicide. Four themes emerged from interviews with survivors about their coping process: (a) Ongoing Grief process, (b) Media Exploitation, (c) Separation and Transformation, and (d) Forgiveness. Results are discussed in terms of prevention and family processes in coping with suicide.