The impact of testosterone replacement therapy on glycemic control,vascular function,and components of the metabolic syndrome in obese hypogonadal men with type 2 diabetes

Objective: This study set out to assess effects of testosterone replacement therapy (TRT) on parameters of metabolic syndrome and vascular function in obese hypogonadal males with type 2 diabetes mellitus (DM2).

Study design: Fifty-five obese hypogonadal diabetic males on oral hypoglycemic treatment were enrolled into this one-year, double-blind, randomized, placebo-controlled clinical study. Group T (n?=?28) was treated with testosterone undecanoate (1000?mg i.m. every 10?weeks) while group P (n?=?27) received placebo.

Methods: Anthropometrical and vascular measurements – flow-mediated dilatation (FMD) and intima media thickness (IMT) – biochemical and hormonal blood sample analyses were performed at the start of the study and after one year. Derived parameters (BMI, HOMA-IR, calculated free testosterone (cFT) and bioavailable testosterone (BT)) were calculated.

Results: TRT resulted in reduction of HOMA-IR by 4.64?±?4.25 (p?p?p?=?.005).

Conclusion: TRT normalized serum testosterone levels, improved glycemic control and endothelial function while exerting no ill effects on the study population.     

Wilderness adventure therapy effects on the mental health of youth participants

Adventure therapy offers a prevention, early intervention, and treatment modality for people with behavioural, psychological, and psychosocial issues. It can appeal to youth-at-risk who are often less responsive to traditional psychotherapeutic interventions. This study evaluated Wilderness Adventure Therapy (WAT) outcomes based on participants’ pre-program, post-program, and follow-up responses to self-report questionnaires. The sample consisted of 36 adolescent out-patients with mixed mental health issues who completed a 10-week, manualised WAT intervention. The overall short-term standardised mean effect size was small, positive, and statistically significant (0.26), with moderate, statistically significant improvements in psychological resilience and social self-esteem. Total short-term effects were within age-based adventure therapy meta-analytic benchmark 90% confidence intervals, except for the change in suicidality which was lower than the comparable benchmark. The short-term changes were retained at the three-month follow-up, except for family functioning (significant reduction) and suicidality (significant improvement). For participants in clinical ranges pre-program, there was a large, statistically significant reduction in depressive symptomology, and large to very large, statistically significant improvements in behavioural and emotional functioning. These changes were retained at the three-month follow-up. These findings indicate that WAT is as effective as traditional psychotherapy techniques for clinically symptomatic people. Future research utilising a comparison or wait-list control group, multiple sources of data, and a larger sample, could help to qualify and extend these findings.     

Dialogical Research in Supervision: Practical Guidelines from Experienced Supervisors in Family Therapy,Child Protection,and Specialty Mental Health Services

This two‐year qualitative participatory research project examines practical guidelines for supervision. Sixteen experienced supervisors across professional settings of family therapy, child protection, and specialty mental health services in the geographical regions of Northern Norway and Northern Sweden outline four main practical guidelines in supervision based on their supervisory practices: (1) elaborating an agreed‐upon contract; (2) exploring potential formats; (3) exploring contents; (4) acknowledging responsibility for process and dilemmas. Participants summarised how they generated mutual growth in supervisory relationships, while being respectful of the first‐person perspective of supervisees. The study challenges pre‐dominating guidelines about deficit‐ or developmental stage‐oriented supervision. It illustrates reflecting processes and a polyphonic orientation in supervision by welcoming diversity, wondering, and tolerance for the not‐yet‐decided among involved persons in a mutual exploration and calibration of relevant knowledge. It outlines a dialogical research for sharing, exploring, and questioning knowledge as beneficial for whom, told by whom, and evaluated by whom.     

Mindful of the Intersession Break in Family Therapy: The Time to Think Experiment

The Time to Think Experiment researches the experience of clinicians, consumers, and families of an intersession break, which has been used historically in various models of family therapy training. This qualitative pilot study explores the experiences of 21 clinicians, 19 consumers, and six family members using this break for reflection, across the domains of family and couple therapy, individual therapy, group work, and supervision in a mental health service covering the whole age range. Using a phenomenological design, the analysis included narrative, thematic, content, and comparative techniques. The paper considers the impact of privileging reflection in the therapy process, in a climate where models, work cultures, and general lifestyles may not encourage it. Using the intersession break to create space to ‘be’ in the therapy process is one way to integrate mindful and family therapy practice. The emerging themes of an intersession break to promote a richer and deeper therapy experience, and the apparent shift of responsibility for change from clinicians to consumers is discussed.     

Separations: A Personal Account of Bowen Family Systems Theory

This paper is a personal account of my own family of origin research. It explores the impact of separations from parents, nuclear family, and extended family through a Bowen family systems theory perspective using concepts pertaining to Bowen theory such as chronic anxiety, differentiation of self, multigenerational family process, and the emotional system. An outline of the process of doing research in ‘vivo’ with my mother as well as conversations with my supervisor are included. Theoretical differences between individual and system models are discussed. A Bowen theoretical approach to the anxiety of separations is investigated. The efficacy of engaging in family of origin work and the effects of thinking systems is examined in light of how it assisted me to view family members, family system disturbances, and clients’ emotional systems more objectively.     

Development and Evaluation of a Web-Based Clinician Training Program for a Family-Focused Depression Preventive Intervention

This study evaluated the acceptability, feasibility, and satisfaction associated with a newly developed online clinician training program for the Family Talk preventive intervention, both alone and together with a redesigned, shortened, face-to-face component. Fifty-eight predominately in-home therapy clinicians participated in the study. Results indicated that clinician participants found the online training to be enjoyable and comprehensive, and they reported that the most beneficial training package involved the combination of web-based and in-person training. This combined training could efficiently cover necessary didactic material online while also delivering important clinical skill practice and in-person discussion. Exceptions, limitations, and important future research questions are discussed.     

A qualitative case study of a Korean former addict’s existential self‐interpretation and identity transformation

This study explored the case of a former addict, focusing on his existential self‐interpretation and identity transformation process. This study began from the question of whether philosophical processes related to existential self‐interpretation could lead to the formation of the concept of bottoming out and of identity transformation. To answer this question, the study analyzed the case of a male in his mid‐forties who was addicted to drugs for approximately 30 years and has only recently maintained abstinence. The study used the phenomenological approach to determine the meaning drugs held for him in each stage, and what drug‐related identity he had in each stage. Further, this study identified the integrative implications of these meanings in terms of existential self‐interpretation and identity transformation. The four different identities the man identified for the four stages of his life were juvenile delinquent, gang member, half‐gangster, and breadwinner, and the associated meanings drugs had for him during each period were “glue,” “filthy,” “leeches,” and “abstinence,” respectively. Finally, this study elucidated the integration of these meanings through the hermeneutic circle, identified the social welfare implications of the findings, and developed educational recommendations.     

Responding to Adolescent Violence in the Home – A Community Mental Health Approach

Family violence perpetrated by adults is increasingly understood as a health issue, and we argue that this pertains even more strongly to violence by adolescents. The co-dependence of the parent–child bond, lack of maturity in the adolescent, and often related issues of disability or mental illness make these young people both complex and also vulnerable. This research paper reviews the current literature relating to adolescent violence in the home, identifies known best practice, and evaluates the importance of taking a family-focused, therapeutic approach to adolescent family violence, in place of a punitive one. It describes the use of a co-design workshop to unpack gaps in service provision and develop a potential family focused model of care to address the needs both of young people who use violence, and their families. The findings indicate that an inclusive family approach is a key element in addressing adolescent violence in the home across a spectrum of behaviours and mental health care needs. The use of a coordinated, family-inclusive response through mental health care services is recommended to address the complexity of this issue, as well as to provide support both to adolescents and to their families and carers.