'Hearts on their sleeves': the use of systemic biofeedback in school settings

This article describes how a biofeedback device is used to 'externalize' internal physiological states. Heart rate monitors, emitting audible signals when a specific threshold is reached, are fitted to children and members of the family. This can help all those present to make connections between problematic behaviours and internal states of emotional/physical arousal. Devices may be worn for up to twenty-four hours and computer graph printouts of fluctuating heart rates can assist in contextualizing problematic interactions, particularly if other family members are also fitted with heart rate monitors. In this way biofeedback becomes 'systemic' as people are alerted to the interconnectedness of each others' states. Participants are not only helped to identify stressors leading to heightened states of emotional arousal and resulting 'out-of-control' behaviours, but also to find ways of employing (self-)calming strategies. This article outlines the application of systemic biofeedback in school settings with children at risk of exclusion. With the help of these biofeedback devices pupils begin to manage themselves in situations which would previously have resulted in stressed, angry or violent behaviours.     

Emotions as ecosystemic adaptations

Despite Gregory Bateson's interest in emotion and culture, the potential for understanding emotion systemically and culturally was lost very early in the mainstream development of family therapy, partly as a reaction to the dominant psychiatric‐psychoanalytic paradigm of North America at the time. In those pioneering years, to take emotion seriously was to risk appearing stuck in a one‐person psychology. In an interesting paradox, it is relational psychoanalysts and parent–infant researchers such as Beatrice Beebe and Frank Lachmann who have recently turned to systems theory to give a fuller account of emotions and emotional regulation in self and relationships. The author draws on their ideas together with the work of Peter Fonagy, Patricia Crittenden, Jessica Benjamin, Britt Krause and others to sketch briefly an ecosystemic theory of emotional expression. This sketch is used to give contextual meaning to two contrasting clinical topics in relation to anger: self‐harm and conduct ‘disorder’.     

大肠癌常见诊疗误区解析

大肠癌是最常见的恶性肿瘤之一。尽管近年诊疗水平不断提高,但在临床诊疗工作中,仍存在一些误区。本文主要针对肠镜检查的必要性、肝转移是否能手术治疗、术后辅助化疗的适应证、靶向药物的适应证以及K-RAS基因检测的必要性等5方面进行分析。逐步规范大肠癌的诊断和治疗,提高大肠癌综合治疗水平。     

对骨折治疗“优化选择”与“合理选择”的理解和思考

从合理化角度回顾了当前几种重要的骨折治疗理论体系的发展与演变,认为骨折治疗的最优原则是一种理想状态,现实中没有绝对最优只有相对合理。只有建立以患者为中心的思维体系,加强医疗逻辑思维能力,用多维思考的方式寻找矛盾的合理平衡点,始终坚守医学伦理道德底线,才能真正做到为每一位骨折患者进行最合理的治疗。     

干细胞技术与肝硬化:共性与个性的新实践

干细胞横向分化(transdifferentiation)的能力,在肝脏再生过程中发挥作用,随着对干细胞的深入研究,干细胞技术为终末期肝病的治疗提供了新思路。本文对干细胞加以分类并综述了各种干细胞研究进展,对干细胞在肝脏疾病细胞治疗上的应用及前景作了总结和展望。     

从雌激素替代治疗的历史看临床决策的影响因素

20世纪40年代,动物实验提供的致癌效应证据限制了雌激素替代治疗的应用。20世纪60年代,价值观因素极大地推动了雌激素替代治疗,以至于关于致癌效应的证据被忽视。20世纪70年代,人群研究提供的致癌效应证据使得雌激素替代治疗的应用不断减少。20世纪80年代,致癌效应的消除和观察性流行病学研究提供的心脏保护证据,将雌激素替代治疗的应用推向了顶峰。20世纪末,大规模随机对照试验提供的有害效应证据推动了雌激素替代治疗应用的大幅下降。雌激素替代治疗一波三折的历史体现了证据、价值观在不同时期对临床决策的不同影响,说明只有遵循循证医学的实践模式,基于现有最佳的科学证据,并结合医生的临床经验与患者的价值观,才可能做出科学、有效的临床治疗决策。     

Parental and school effects on students' occupational exploration: A longitudinal and multilevel analysis

The study examines school and parental influences on adolescents' occupational exploration. Analyses of data from 859 6th, 8th, and 10th graders attending high- and lower-track high schools in the German federal state of Thuringia suggested more extensive exploration among students closer to the school-to-work transition. Besides cross-sectional effects of parenting and achievement orientation at school, acceptance and openness students experienced in class predicted increases of their exploratory behaviors. Multilevel analyses showed, however, that school effects operated on the level of subjective perceptions (individual level), but not on the level of intersubjective reality (classroom level). Implications for attempts to foster and facilitate exploration are discussed.     

Commitment profiles: The configural effect of the forms and foci of commitment on work outcomes

This study is based upon the conceptual linking of the multidimensional and multi-focal nature of work-related commitment. The main aims of our study were to create, through K-means cluster analysis, commitment profiles based on the three components of organizational and occupational commitment, and to examine their joint effect on key work outcomes. One hundred and fifty seven working adults completed questionnaires measuring the three components of organizational and occupational commitment, and work outcomes. Our findings show (a) the incremental validity of occupational commitment in the prediction of work-related variables, (b) the compatibility of occupational and organizational commitment as reflected in the four form-oriented commitment profiles that emerged (highly committed, affective–normative dominant, continuance dominant, and non-committed), and (c) the positive effect of the highly committed profile (dually foci-committed employees with high AC, CC, and NC) on focal and discretionary behaviors. On a practical level, our results can foster the practice of management concerning control of withdrawal behaviors and development of desirable discretionary behaviors.     

Provoked vestibulodynia: Psychological predictors of topical and cognitive-behavioral treatment outcome

Psychological factors have been found to impact the pain experience and associated sexual impairment of women suffering from provoked vestibulodynia (PV). Despite a lack of randomized treatment outcome studies, particularly concerning psychological predictors of outcome, recent studies have shown that topical applications and cognitive-behavioral therapy (CBT) are among the most popular first-line interventions for PV. The present study aimed to determine the extent to which baseline fear-avoidance variables and pain self-efficacy were differentially associated with topical application and CBT outcomes at six-month follow-up. Data were obtained from 97 women who completed a randomized trial comparing these two treatments. Regression analyses revealed that for topical treatment, higher levels of baseline avoidance predicted worse pain and sexual functioning outcomes, whereas higher levels of pain self-efficacy predicted better outcomes. For CBT, higher levels of baseline fear of pain and catastrophizing contributed to higher pain intensity at follow-up, whereas higher levels of pain self-efficacy were associated with less pain. Psychological factors did not predict sexual functioning outcomes for CBT. Consistent with biopsychosocial models of pain and sexual dysfunction, results indicate that psychological factors contribute to pain and sexual impairment following treatment for PV. Specifically, findings suggest that fear-avoidance variables and pain self-efficacy are significant predictors of topical and CBT treatment outcomes in women with PV.     

Changes in personality in pre‐ and post‐dialectical behaviour therapy borderline personality disorder groups: A question of self‐control

Dialectical behaviour therapy (DBT) is an evidence‐based therapy for people with borderline personality disorder (BPD). Past research has identified behavioural changes indicating improved functioning for people who undergo DBT. To date, however, there has been little research investigating the underlying mechanism of change. The present study utilised a between‐subjects design and self‐report questionnaires of Self‐Control and the five factor model of personality and drew participants from a metropolitan DBT program. We found that pre‐treatment participants were significantly lower on Self‐Control, Agreeableness and Conscientiousness when compared to both the post‐treatment assessment and the norms for each questionnaire. Neuroticism was significantly higher both before and after treatment when compared to the norms. These findings suggest that Self‐Control may play a role in both the presentation of this disorder and the effect of DBT. High levels of Neuroticism lend weight to the Linehan biosocial model of BPD development.