DIVINE PURPOSE AND EVOLUTIONARY PROCESSES

When Darwin's theory of natural selection threatened to put Paley's Designer out of a job, one response was to reemploy God as the author of the evolutionary process itself. This idea requires an account of how God might be understood to act in biological history. I approach this question in two stages: first, by considering God's action as creator of the world as a whole, and second, by exploring the idea of particular divine action in the course of evolution. As creator ex nihilo God acts directly in every event as its sustaining ground. Because God structures the world as a lawful order of natural causes, God also acts indirectly by means of creatures. More controversially, God might act directly within the world to affect the course of events; this action need not take the form of a miraculous intervention, if the natural order includes the right sort of indeterministic chance. In each of these ways God's purposes can shape evolutionary processes.     

Psychology,health and health care

This article traces the development of the World Health Organization's emphasis on psychological and behavioural factors in health and notes its encouragement of recognition of these factors by member states. The article further outlines the reasons for this increasing recognition and stresses the important role of psychological and behavioural factors in the maintenance of health and prevention of illness.     

Social cognitions measured in 4 to 6 year olds are predictive of objectively measured physical activity

Objective: This study tested whether social cognitions from the reasoned action approach (RAA) can be reliably measured in a sample of primary school children (aged 4–6 years) and whether these RAA measures are predictive of physical activity.

Design: Longitudinal observational study with repeated measures over six months.

Measures: RAA variables were measured using a novel choice paradigm between physically active and sedentary pastimes. Relative reinforcing value, covariates (sex, age, deprivation and BMI) and physical activity by accelerometry (primary outcome) were also measured.

Results: RAA cognitions could be measured with acceptable retest reliability and discriminant validity and social norms regarding parents and teachers (but not friends) were correlated with physical activity and change in physical activity when relative reinforcing value and other covariates were controlled for.

Conclusions: RAA cognitions can be reliably measured in primary school children aged 4–6 and RRA measures appear useful in understanding children’s activity choices and may potentially inform future interventions.     

Controlled trial of a minimal-intervention exercise program for middle-aged working women

Abstract

Despite potential for major benefits, middle-aged women have low levels of aerobic exercise. A 12-week minimal-intervention exercise program was evaluated with female university employees aged 40 to 61. Following pre-testing, participants were randomly assigned to exercise or wait-list control. Testing was repeated at 12, 24 and 48 weeks. Exercisers improved significantly in aerobic fitness at 12 and 24 weeks, both groups decreased resting arterial pnssurc and body composition measures, and improved in exercise knowledge. Effects, however, were not well maintained at 48 weeks. These results are comparable to those obtained fmm intensive interventions and, while modest, suggest that a threshold has been reached for the modification of physiological control systems which are important for reducing cardiovascular disease risk. Middle-aged women face major social and practical baniers to regular exercise, and the minimal-intervention approach allows for a combination of flexibility and structure which seems appropriate for this group.     

Enhancement on the faceted growth and the coarsening of the MnBi primary phase during the directional solidification under a high magnetic field

The effect of a high magnetic field on the morphology of the MnBi primary phase during the directional solidification has been investigated experimentally and the results show that an application of a high magnetic field has enhanced the faceted growth and the coarsening of the MnBi primary phase. This may be attributed to the effect of a high magnetic field on the diffusion of the solute Mn and the growth anisotropy of the MnBi crystal.     

Extended problem solving treatment for depression

Introduction: Effective brief psychological approaches for depression that can be delivered by a variety of health professionals with minimal training increase access to treatment by patients. Problem Solving Treatment (PST) was developed for primary care and was modified for this study (EPST) to better meet the needs of mental health patients. Method: A total of 92 therapists from different professional backgrounds completed EPST workshops and treated 92 patients with major depression with interval clinical and treatment process assessments. Results: EPST achieved a significant reduction in depressive symptom scores, life problem scores, and there were few treatment non‐completers. Treatment outcome was predicted by process and therapist variables. Discussion: EPST is an effective and easy to teach treatment that can be delivered by a variety of practitioners and suitable for busy primary mental health care settings.     

Robert Burns in the counsellor's chair: A socio-cultural analysis of the Burns myth

To illustrate how difficult endings are, this paper first cites an Italian therapist's experience of the use of time with university students in Naples and then associates to contrasting examples in the novel, art, music and the cinema. It uses a dialogue about ending in the film Brief Encounter as a possible paradigm for what is needed in brief therapy. It then refers to the work of James Mann on different experiences of time which underlie the resistance to brief work. How can brief therapy contain the paradox between finite and infinite time? Incorporating another model of therapeutic intervention with the use of Milton Erickson's attitude to time and the unconscious, the paper then moves on to a clinical example, where treatment consisted of an assessment and five sessions. Here the practice of not interpreting the transference is challenged, along with an exploration of the concept of transference to the organization and the use of pre-treatment ‘maternal reverie’ associations. Using the combination of informal trance-like states with a clear focus on the ‘here and now’, the process of the therapeutic relationship is then worked with in the case material.     

Transgender Primary Medical Care

SUMMARY

Transgender medical care involves addressing general medical conditions and those related specifically to transgender issues. This article summarizes existing research in transgender medicine and provides guidance for family physicians and nurses in adapting standard primary care protocols relating to health maintenance, acute illness, and chronic disease management to address trans-specific clinical oncerns. Trans-specific issues in physical examination, health history, interpretation of laboratory tests, vaccination, screening, and treatment are explored, and the role of the primary care provider in caring for patients undergoing hormonal or surgical change is discussed.     

Identification and Follow-Up by Primary Care Doctors of Children with PTSD After Terrorist Attacks

Abstract

Many children and adolescents were among the victims of the suicide bomb attacks in Israel since March, 2000. While the number with emotional and behavioral symptoms was expected to be high, very few children who developed terrorism-related posttraumatic stress disorder (PTSD) were actually referred to mental health professionals for assessment or treatment. Prolonged exposure to terrorism lowers even further the number of children who remain in treatment. This article discusses reasons and presents a training program for primary care providers (pediatricians, family doctors) in identifying PTSD in child victims, and for mobilizing them to carry out long-term follow-up of these children.