A cross-cultural study of somatic countertransference: a brief overview

Whilst countertransference is commonly experienced as feelings, thoughts, images, symbols and dreams endured by the therapist in relation to their client, somatic countertransference is positioned as embodied, physical manifestations in the therapist’s body. Common examples include headaches, nausea, aches, pains, sleepiness, sexual arousal, dizziness and trembling felt by the psychotherapist in session. Current interest in somatic countertransference spans the spectrum from the psychoanalytic, post-Jungian, dance movement and humanistic modalities to empirical studies originating from the trauma research field. Although the clinical literature emphasizes the therapeutic relevance and richness of somatic countertransference for understanding unconscious communications occurring in the session, trauma research advocates greater self-awareness and management of somatic countertransference to prevent therapist burnout. This article will outline the rationale and research process for proposing the first cross-cultural study of somatic countertransference. This study is suggested as a means to extend our understanding of, and ability to work with, somatic countertransference. Preliminary results from an initial study of Chinese psychotherapists will be discussed.

Prevalence of visual impairment and uncorrected refractive error - report from a Canadian urban population-based study

The prevalence of visual impairment due to uncorrected refractive error has not been previously studied in Canada. A population-based study was conducted in Brantford, Ontario. The target population included all people 40 years of age and older. Study participants were selected using a randomized sampling strategy based on postal codes. Presenting distance and near visual acuities were measured with habitual spectacle correction, if any, in place. Best corrected visual acuities were determined for all participants who had a presenting distance visual acuity of less than 20/25. Population weighted prevalence of distance visual impairment (visual acuity <20/40 in the better eye) was 2.7% (n = 768, 95% confidence interval (CI) 1.8–4.0%) with 71.8% correctable by refraction. Population weighted prevalence of near visual impairment (visual acuity <20/40 with both eyes) was 2.2% (95% CI 1.4–3.6) with 69.1% correctable by refraction. Multivariable adjusted analysis showed that the odds of having distance visual impairment was independently associated with increased age (odds ratio, OR, 3.56, 95% CI 1.22–10.35; ≥65 years compared to those 39–64 years), and time since last eye examination (OR 4.93, 95% CI 1.19–20.32; ≥5 years compared to ≤2 years). The same factors appear to be associated with increased prevalence of near visual impairment but were not statistically significant. The majority of visual impairment found in Brantford was due to uncorrected refractive error. Factors that increased the prevalence of visual impairment were the same for distance and near visual acuity measurements.

Effects of bone-specific physical activity, gender and maturity on tibial cross-sectional bone material distribution; a cross-sectional pQCT comparison of children and young adults aged 5-29 years

Growth is the opportune time to modify bone accrual. While bone adaptation is known to be dependent on local loading and consequent deformations (strain) of bone, little is known about the effects of sex, and bone-specific physical activity on location-specific cross-sectional bone geometry during growth. To provide more insight we examined bone traits at different locations around tibial cross sections, and along the tibia between individuals who vary in terms of physical activity exposure, sex, and pubertal status. Data from 304 individuals aged 5-29 years (172 male, 132 female) were examined. Peripheral quantitative computed tomography (pQCT) was applied at 4%, 14%, 38%, and 66% of tibial length. Maturity was established by estimating age at peak height velocity (APHV). Loading history was quantified with the bone-specific physical activity questionnaire (BPAQ). Comparisons, adjusted for height, weight and age were made between sex, maturity, and BPAQ tertile groups. Few to no differences were observed between sexes or BPAQ tertiles prior to APHV, whereas marked sexual dimorphism and differences between BPAQ tertiles were observed after APHV. Cross-sectional location-specific differences between BPAQ tertiles were not evident prior to APHV, whereas clear location-specificity was observed after APHV. In conclusion, the skeletal benefits of physical activity are location-specific in the tibia. The present results indicate that the peri- or post-pubertal period is likely a more favourable window of opportunity for enhancing cross-sectional bone geometry than pre puberty. Increased loading during the peri-pubertal period may enhance the bone of both sexes.

A cross-cultural study investigating body features associated with male adolescents' body dissatisfaction in Australia, China, and Malaysia

This study investigated how dissatisfaction with particular aspects of the body was associated with overall body dissatisfaction among male adolescents in Western and Asian cultures. One hundred and six Malaysian Malays, 55 Malaysian Chinese, 195 Chinese from China, and 45 non-Asian Australians aged 12 to 19 years completed a questionnaire assessing dissatisfaction with their overall body and dissatisfaction with varying aspects of their body. Dissatisfaction with the face, height, and hair was positively correlated with overall body dissatisfaction among Malaysian Malays after body mass index, age and dissatisfaction with body areas typically included in measures (weight/shape, upper, middle, and lower body, and muscles) had been controlled for. Dissatisfaction with the face was positively correlated with overall body dissatisfaction among Malaysian Chinese. These findings demonstrate the differences in body focus for males from different cultures and the importance of using assessment measures that address all possible areas of body focus.

International study of objectively measured physical activity and sedentary time with body mass index and obesity: IPEN adult study

BACKGROUND: Physical activity (PA) has been consistently implicated in the etiology of obesity, whereas recent evidence on the importance of sedentary time remains inconsistent. Understanding of dose-response associations of PA and sedentary time with overweight and obesity in adults can be improved with large-scale studies using objective measures of PA and sedentary time. The purpose of this study was to examine the strength, direction and shape of dose-response associations of accelerometer-based PA and sedentary time with body mass index (BMI) and weight status in 10 countries, and the moderating effects of study site and gender. METHODS: Data from the International Physical activity and the Environment Network (IPEN) Adult study were used. IPEN Adult is an observational multi-country cross-sectional study, and 12 sites in 10 countries are included. Participants wore an accelerometer for seven consecutive days, completed a socio-demographic questionnaire and reported height and weight. In total, 5712 adults (18-65 years) were included in the analyses. Generalized additive mixed models, conducted in R, were used to estimate the strength and shape of the associations. RESULTS: A curvilinear relationship of accelerometer-based moderate-to-vigorous PA and total counts per minute with BMI and the probability of being overweight/obese was identified. The associations were negative, but weakened at higher levels of moderate-to-vigorous PA (>50 min per day) and higher counts per minute. No associations between sedentary time and weight outcomes were found. Complex site- and gender-specific findings were revealed for BMI, but not for weight status. CONCLUSIONS: On the basis of these results, the current Institute of Medicine recommendation of 60 min per day of moderate-to-vigorous PA to prevent weight gain in normal-weight adults was supported. No relationship between sedentary time and the weight outcomes was present, calling for further examination. If moderator findings are confirmed, the relationship between PA and BMI may be country- and gender-dependent, which could have important implications for country-specific health guidelines. © 2015 Macmillan Publishers Limited All rights reserved.

A cross-national study of calculus

The results from a cross-national study comparing calculus performance of students at East China Normal University (ECNU) in Shanghai and students at the University of Michigan before and after their first university calculus course are presented. Overall, ECNU significantly outperformed Michigan on both the pre- and post-tests, but the Michigan students showed a larger gain and normalized gain, and hence narrowed the gap. ECNU's superior performance was especially striking on the subset of problems requiring only a pre-calculus background. On those, Michigan's post-test scores were below ECNU's pre-test scores and, indeed, ECNU's higher performance on both the overall pre-test and overall post-test is attributable to its success on these problems.

Australian adult smokers' responses to plain packaging with larger graphic health warnings 1 year after implementation: results from a national cross-sectional tracking survey

Abstract
Background We assessed whether the Australian plain packs with larger graphic health warnings (GHWs) achieved three specific objectives of reducing the appeal of tobacco, increasing health warning effectiveness and reducing the ability of packaging to mislead about smoking harms.
Methods We compared responses from continuous cross-sectional telephone surveys of n=2176 cigarette smokers during pre-plain packaging (April–September 2012, pre-PP) with n=759 surveyed in the transition period (October–November 2012) and n=4240 during the first year of implementation (December 2012–November 2013, PP year 1), using multivariate logistic regression analyses.
Results From pre-PP to PP year 1, more smokers disliked their pack (p<0.001), perceived lower pack appeal (p<0.001), lower cigarette quality (p<0.001), lower satisfaction (p<0.001) and lower value (p<0.001) and disagreed brands differed in prestige (p=0.003). There was no change in perceived differences in taste of different brands. More smokers noticed GHWs (p<0.001), attributed much motivation to quit to GHWs (p<0.001), avoided specific GHWs when purchasing (p<0.001), and covered packs (p<0.001), with no change in perceived exaggeration of harms. PP year 1 saw an increased proportion believing that brands do not differ in harmfulness (p=0.004), but no change in the belief that variants do not differ in strength or the perceived harmfulness of cigarettes compared with a year ago. Interactions signified greater change for four outcomes assessing aspects of appeal among young adults and two appeal outcomes among mid-aged adults.
Conclusions The specific objectives of plain packaging were achieved and generally sustained among adult smokers up to 12 months after implementation.

Use of illicit tobacco following introduction of standardised packaging of tobacco products in Australia: results from a national cross-sectional survey

ABSTRACT
Objectives: To assess whether following standardisation of tobacco packaging in Australia, smokers were, as predicted by the tobacco industry, more likely to use illicit tobacco.
Methods: National cross-sectional telephone surveys conducted continuously from April 2012 (6 months before implementation of plain packaging (PP)) to March 2014 (15 months after) using responses from current cigarette smokers (n=8679). Changes between pre-PP, the transition to PP and PP phase were examined using logistic regression models.
Results: Among those whose factory-made cigarettes were purchased in Australia, compared with pre-PP, there were no significant increases in the PP phase in use of: ‘cheap whites’ (<0.1%; OR=0.24, 95% CI 0.04 to 1.56, p=0.134); international brands purchased for 20% or more below the recommended retail price (0.2%; OR=3.49, 95% CI 0.66 to 18.35, p=0.140); or packs purchased from informal sellers (<0.1%; OR=0.24, 95% CI 0.04 to 1.47, p=0.124). The prevalence of any use of unbranded illicit tobacco remained at about 3% (adjusted OR=0.79, 95% CI 0.58 to 1.08, p=0.141).
Conclusions: While unable to quantify the total extent of use of illicit manufactured cigarettes, in this large national survey we found no evidence in Australia of increased use of two categories of manufactured cigarettes likely to be contraband, no increase in purchase from informal sellers and no increased use of unbranded illicit ‘chop-chop’ tobacco.

International study of perceived neighbourhood environmental attributes and Body Mass Index: IPEN Adult study in 12 countries

BACKGROUND: Ecological models of health behaviour are an important conceptual framework to address the multiple correlates of obesity. Several single-country studies previously examined the relationship between the built environment and obesity in adults, but results are very diverse. An important reason for these mixed results is the limited variability in built environments in these single-country studies. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and BMI/weight status in a multi-country study including 12 environmentally and culturally diverse countries. METHODS: A multi-site cross-sectional study was conducted in 17 cities (study sites) across 12 countries (Australia, Belgium, Brazil, China, Colombia, Czech Republic, Denmark, Mexico, New Zealand, Spain, the UK and USA). Participants (n = 14222, 18-66 years) self-reported perceived neighbourhood environmental attributes. Height and weight were self-reported in eight countries, and measured in person in four countries. RESULTS: Three environmental attributes were associated with BMI or weight status in pooled data from 12 countries. Safety from traffic was the most robust correlate, suggesting that creating safe routes for walking/cycling by reducing the speed and volume of traffic might have a positive impact upon weight status/BMI across various geographical locations. Close proximity to several local destinations was associated with BMI across all countries, suggesting compact neighbourhoods with more places to walk related to lower BMI. Safety from crime showed a curvilinear relationship with BMI, with especially poor crime safety being related to higher BMI. CONCLUSIONS: Environmental interventions involving these three attributes appear to have international relevance and focusing on these might have implications for tackling overweight/obesity.

Negative appraisals of insulin therapy are common among adults with Type 2 diabetes using insulin: results from diabetes MILES - Australia cross-sectional survey

AIM: To identify insulin therapy appraisals among adults with Type 2 diabetes using insulin and how negative appraisals relate to clinical, self-care and psychosocial outcomes. METHODS: Diabetes MILES - Australia 2011 was a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 273 adults with Type 2 diabetes using insulin (46% women; mean ± sd age: 59 ± 9 years; diabetes duration: 12 ± 7 years; years using insulin: 4 ± 4). They completed validated measures of insulin therapy appraisals (ITAS), depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and diabetes-specific self-efficacy (DES-SF). RESULTS: Insulin was perceived to be very important, and its benefits (e.g. improves health) were endorsed by most (82%). Fifty-one per cent believed that taking insulin means their diabetes has become worse; 51% that insulin causes weight gain; 39% that they have 'failed to manage' their diabetes. Those with the greatest and least 'ITAS negative' scores did not differ by diabetes duration or years using insulin, or by average number of insulin injections or blood glucose checks per day. Those with more negative insulin appraisals were significantly younger (Mean Diff. = 5 years, P < 0.001), less satisfied with recent blood glucose levels (P < 0.001, d = 0.63), had reduced diabetes-specific self-efficacy (P < 0.001, d = 0.7), and were more likely to report depressive symptoms, anxiety or diabetes distress (all P < 0.001, d = 0.65-1.1). CONCLUSIONS: Negative insulin therapy appraisals are common among adults with Type 2 diabetes using insulin, and are associated with lower general and diabetes-specific emotional well-being, reduced diabetes-specific self-efficacy and satisfaction with blood glucose.