Evaluating Outcome Domains Assessing Caregivers of Individuals with Mental Illness: A Review

In this article, we describe the properties and consider the outcome dimensions of a collection of self‐administered questionnaires that assess caregivers of offspring with mental illness. To this end, we searched the MEDLINE, Web of Science, and PsycINFO databases, as well as reference lists of studies published between 1980 and 2012. We reviewed 43 instruments, and found multiple outcome domains, associated with either objective burden or subjective burden, or both. A number of tools captured additional negative aspects of caregiving (e.g., strain, stress, and worrying) as well as positive aspects (e.g., personal growth, strength, support, rewards, and satisfaction), supplemented by measures assessing caregivers' perceptions and attitudes toward their offspring with SMI (e.g., insight, stigma, and efficacy). This current review of existing measures and their specific domains contributes to a more comprehensive understanding of the caregiving experience and allows both clinicians and researchers to select the most appropriate measurement tools for their purposes.     

The Effect of Communication Change on Long‐term Reductions in Child Exposure to Conflict: Impact of the Promoting Strong African American Families (ProSAAF) Program

African American couples (n = 331) with children, 89% of whom were married, were assigned to either (a) a culturally sensitive couple‐ and parenting‐enhancement program (ProSAAF) or (b) an information‐only control condition in which couples received self‐help materials. Husbands averaged 41 years of age and wives averaged 39 years. We found significant effects of program participation in the short term on couple communication, which was targeted by the intervention, as well as over the long term, on self‐reported arguing in front of children. Long‐term parenting outcomes were fully mediated by changes in communication for wives, but not for husbands. For husbands, positive change depended on amount of wife reported change. We conclude that wives' changes in communication from baseline to posttest may be more pivotal for the couples' long‐term experience of decreased arguing in front of children than are husbands' changes, with wives' changes leading to changes in both partners' reports of arguments in front of children.     

Looking for Solutions: Gender Differences in Relationship and Parenting Challenges Among Low‐Income,Young Parents

The need for parenting and relationship strengthening programs is important among low‐income minority parents where the burden of relational and parental stressors contributes to relationship dissolution. We examine these stressors among young parents. Data were collected from four focus groups (N = 35) with young parents. Data were audio‐recorded and transcribed. Inductive coding was used to generate themes and codes, and analysis was completed using NVivo. Relationship and parenting challenges, values, and areas of need were the three major themes that emerged. Women's relationship challenges were family interference and unbalanced parenting, and men reported feeling disrespected and having limited finances. Common relationship challenges for women and men were family interference and unbalanced parenting. Both genders valued trust, communication, and honesty in relationships. Areas of need for women and men included: improving communication and understanding the impact of negative relationships on current relationships. Parenting challenges for women were unbalanced parenting, child safety, and feeling unprepared to parent; men reported limited finances. Both genders valued quality time with child to instill family morals. Areas of need for women and men included learning child discipline techniques and increasing knowledge about child development. Finally, women and men have relationship and parenting similarities and differences. Young parents are interested in learning how to improve relationships and co‐parent to reduce relationship distress, which could reduce risk behaviors and improve child outcomes.     

Thinking and Working Relationally: Interviewing and Constructing Hypotheses to Create Compassionate Understanding

In the initial interviews of family therapy sessions, the therapist faces the challenge of obtaining and organizing the information that is most relevant toward understanding the essential concerns that families and couples bring to therapy. This article describes the process of clinical interviewing and case conceptualization used in training family therapists at the Ackerman Institute for the Family. This approach helps the therapist bring forward, and organize, specific information into relational hypotheses, or systemic‐relational conceptualizations, that allow both family members and the therapist to understand presenting problems within their relational contexts. While always provisional, relational hypotheses help anchor the therapist in a systemic‐relational frame and provide a conceptual through‐line to guide the ongoing work of the therapy. The process of interviewing and the construction of clear and complex conceptualizations of presenting problems are illustrated through case examples.     

Intersubjectivity and the creation of meaning in the analytic process

By means of a clinical illustration, the author describes how the intersubjective exchanges involved in an analytic process facilitate the representation of affects and memories which have been buried in the unconscious or indeed have never been available to consciousness. As a result of projective identificatory processes in the analytic relationship, in this example the analyst falls into a situation of helplessness which connects with his own traumatic experiences. Then he gets into a formal regression of the ego and responds with a so‐to‐speak hallucinatory reaction—an internal image which enables him to keep the analytic process on track and, later on, to construct an early traumatic experience of the analysand.     

The Philosophical Role of Illness

This article examines the philosophical role of illness. It briefly surveys the philosophical role accorded to illness in the history of philosophy and explains why illness merits such a role. It suggests that illness modifies, and thus sheds light on, normal experience, revealing its ordinary and therefore overlooked structure. Illness also provides an opportunity for reflection by performing a kind of suspension (epoché) of previously held beliefs, including tacit beliefs. The article argues that these characteristics warrant a philosophical role for illness. While the performance of most philosophical procedures is volitional and theoretical, however, illness is uninvited and threatening, throwing the ill person into anxiety and uncertainty. As such it can be viewed as a radical philosophical motivation that can profoundly alter our outlook. The article suggests that illness can change the ways in which we philosophise: it may shape philosophical methods and concerns and change one's sense of salience and conception of philosophy.     

P16、CyclinDl和CDK4在结直肠癌组织中表达及意义

细胞周期过程中癌基因的激活与抑癌基因的失活等是造成细胞恶性增殖、转化的重要因素。细胞周期G1／S期各调节因子的异常改变与细胞癌变关系尤为密切。P16、CyclinDl和CDK4均为重要的细胞周期调控蛋白,任何原因导致这些蛋白异常表达时,将引起细胞周期调节失控,导致肿瘤的发生和恶性演进。结直肠癌的发生发展同上述三者关系密切。本实验通过免疫组化方法进行检测结直肠癌组织中P16、CyclinDl和CDK4三者的表达及其与结直肠癌临床指标的关系,为揭示三者在结直肠癌发生发展中的作用提供一定的实验依据。