Mindfulness and Embodiment in Family Therapy: Overview, Nuances, and Clinical Applications in Poststructural Practices.

This paper discusses the inclusion of ideas from mindfulness, embodiment, and associated brain research in poststructural family therapies. Connecting research and practice across diverse fields is presented as enriching therapeutic work, increasing clinical effectiveness, and broadening options for families seeking our assistance. Ways of incorporating mindfulness and embodiment are described and offer distinctively novel practices not typically used in traditional forms of poststructural therapies. These innovative practices are illustrated by clinical work with a mother and her five-year- daughter who survived a dangerous health crisis and an extremely painful hospitalization. Therapeutic work with this family exemplifies how traumatic experiences are not always accessible through linguistic means alone. Working with interpersonal mind-body practices can uniquely contribute to relaxing the sympathetic nervous system and activating the social engagement branch of the parasympathetic nervous system. The inclusion of such practices can provide valuable opportunities to facilitate the emergence of preferred experiences of self for all family members.

Este artículo trata de la inclusión de las ideas de conciencia plena y personificación, y de la investigación neurológica asociada en las terapias familiares posestructurales. La conexión de la investigación y la práctica entre áreas diversas se presenta como un trabajo terapéutico enriquecedor que aumenta la eficacia clínica y amplía las opciones para las familias que buscan nuestra asistencia. Se describen las maneras de incorporar la conciencia plena y la personificación y se ofrecen prácticas distintivamente innovadoras que normalmente no se usan en las formas tradicionales de las terapias posestructurales. Estas prácticas innovadoras se ilustran mediante el trabajo clínico con una madre y su hija de cinco años que sobrevivieron a una emergencia de salud peligrosa y a una hospitalización sumamente dolorosa. El trabajo terapéutico con esta familia ejemplifica cómo no siempre es posible acceder a las experiencias traumáticas por medios lingüísticos solamente. El trabajo con prácticas interpersonales centradas en el cuerpo y la mente puede contribuir de manera única a relajar el sistema nervioso simpático y a activar la rama de la participación social del sistema nervioso parasimpático. La inclusión de dichas prácticas puede brindar oportunidades valiosas de facilitar el surgimiento de experiencias preferidas del yo para todos los miembros de la familia.

Changes in the pattern of sun exposure and sun protection in young children from tropical Australia.

BACKGROUND: Australia has one of the highest rates of skin cancer globally. Lifetime risk is associated with childhood sun exposure. OBJECTIVE: We sought to investigate whether skin cancer prevention programs have resulted in improvements in sun-exposure and sun-protection behavior among young children in tropical Australia. METHODS: Two cohorts of 12-to 35-month-old children from Townsville, Australia, were compared: cohort 1 was recruited from hospital birth records (1991) and cohort 2 was recruited via local child-care centers (1999-2002). Children's phenotypic characteristics were assessed. Parents completed questionnaires detailing children's demographic characteristics, and sun-exposure and sun-protective practices. RESULTS: Although 1-year-old children from cohort 2 spent more time in the sun than those from cohort 1 (median 2.2 vs 2.8 h/d; P = .002), a higher proportion almost always wore sunscreen and a swim-shirt year round. Although more 1-year-old children in cohort 2 had experienced a sunburn (35.5% vs 51.2%; P = .007), both cohort 2 age groups experienced fewer hours of sun exposure to the back of the trunk (P < .001), were less likely to have been sunburned on the back/shoulders (age 1 year 34.8% vs 10.1% and age 2 years 52% vs 10.1%; P < .001), and acquired fewer melanocytic nevi at these sites (P < .001). LIMITATIONS: There was potential for socially desirable responses (information bias). CONCLUSION: Although duration of sun exposure in early childhood did not decrease during an 8-year period, reported use of personal sun protection did. The observed increase in popularity of swim-shirts and sunscreen between cohorts coincided with the development of significantly fewer melanocytic nevi in these children.

Geographical variation of incidence of cutaneous melanoma in Queensland.

OBJECTIVE: The study investigated geographical differences and time trends of incidence rate and body site distribution of cutaneous melanoma in Queensland. DESIGN: Analysis of data recorded by Queensland Cancer Registry. PATIENTS: Analysis included 34 021 patients with invasive and 10 710 patients with in situ melanoma diagnosed between 1982 and 2002. MAIN OUTCOME MEASURES: Age-standardised incidence rates (world standard population) per 100 000 inhabitants of cutaneous melanoma and annual percentage change (APC). RESULTS: Yearly age-standardised incidence rates of invasive melanoma averaged over the 21 years of observation were highest in the south-eastern part of the state, notably in the statistical division Moreton for men (54.2) and in Fitzroy for women (51.4). Inland divisions had on average lower rates than coastal areas. For both men and women, age-standardised incidence rates of invasive and of in situ melanoma increased between 1982 and 2002 for Queensland as a whole and for almost all its statistical divisions. For invasive cancer, the increase was strongest for Moreton (APC men: 5.4%; women: 4.5%; P < 0.001, respectively). APCs were higher for in situ melanoma compared with invasive melanoma for all statistical divisions and both genders. In both genders, the increase in invasive rates was most pronounced for the trunk (APC men: 3.2%, P = 0.040; women: 2.3%; P = 0.306). CONCLUSIONS: The south-eastern corner of Queensland endured the main burden of melanoma. Behavioural and lifestyle choices might create the observed differences between statistical divisions. The increase in trunk melanomas is discussed with respect to aetiology.

Sun exposure and the incidence of melanocytic nevi in young Australian children.

The number of melanocytic nevi (MN) is an important risk factor for cutaneous melanoma. The present study further investigated the relationship between sun exposure, the incidence of MN, and the prevalence of large acquired MN (>or=5 mm). A cohort of 479 preschool children born in Townsville, Australia was examined for MN in 1991 and a year later. Sun exposure was assessed by questionnaire. The erythemally effective dose of solar UV radiation was estimated from questionnaire data combined with local UV biometry. Almost all (97.7%) children had acquired new MN (median, 12), with a median incidence rate of 11.0 per year (interquartile range, 7.0-16.5). Total number of hours of sun exposure during follow-up (P = 0.034) and tendency to burn (P = 0.028) were independent risk factors for MN incidence. Sunburn experience during follow-up failed to reach significance when adjusted for tendency to burn. Lifetime number of sunburns (P < 0.001) and the severity of sunburns experienced during follow-up (P < 0.001) were significantly related to the presence of large acquired MN at follow-up. Reducing the total number of hours of sun exposure is particularly relevant in sun-sensitive children and may restrain the development of MN, whereas avoiding sunburn in young children might prevent large MN, subsequently reducing the risk of melanoma.

Betel quid not containing tobacco and oral leukoplakia: a report on a cross-sectional study in Papua New Guinea and a meta-analysis of current evidence.

Leukoplakia is an asymptomatic, potentially malignant change in the oral mucosa. Previous studies have reported that smoking and betel quid chewing are associated with increased risk of leukoplakia; few studies have reported on these associations in populations where betel quid does not contain tobacco. We conducted a case-control study nested in a cross-sectional study in Papua New Guinea and a systematic review of studies that included chewers of betel quid without tobacco. Our study recruited 1,670 adults. We recorded betel quid chewing and smoking. The prevalence of leukoplakia was 11.7%. In the nested case-control study of 197 cases and 1,282 controls, current betel chewing was associated with increased risk of leukoplakia with an adjusted odds ratio for current chewers of 3.8 (95% CI 1.7, 8.4) and in the heaviest chewers of 4.1 (95% CI 1.8, 9.1) compared to non-chewers. Current smoking was associated with an increased risk of leukoplakia with an adjusted odds ratio for current smokers of 6.4 (95% CI 4.1, 9.9) and amongst heaviest smokers of 9.8 (95% CI 5.9, 16.4) compared to non-smokers. The systematic review identified 5 studies examining risk of leukoplakia associated with betel quid chewing in populations where betel quid did not contain tobacco and that controlled for smoking. In studies that adjusted for smoking, the combined random effect odds ratio was 7.9 (95% CI 4.3, 14.6) in betel quid chewers. The results of this study and systematic review of similar studies provide evidence of the role of betel quid not containing tobacco and leukoplakia.

Betel quid not containing tobacco and oral cancer: a report on a case-control study in Papua New Guinea and a meta-analysis of current evidence.

Smoking and betel quid chewing are associated with increased risk of oral cancer but few studies have reported on associations in populations where betel quid does not contain tobacco. We conducted a case-control study in Papua New Guinea and a systematic review. Our case-control study recruited 143 cases with oral cancer and 477 controls. We collected information on smoking and betel quid chewing. Current smoking was associated with an increased risk of oral cancer with an adjusted odds ratio (OR) for daily smokers of 2.63 (95% confidence intervals (95% CI) 1.32, 5.22) and amongst heaviest smokers of 4.63 (95% CI 2.07, 10.36) compared to never-smokers. Betel chewing was associated with increased risk of oral cancer with an adjusted OR for current chewers of 2.03 (95% CI 1.01, 4.09) and in the heaviest chewers of 2.47 (95% CI 1.13, 5.40) compared to nonchewers. The OR in those who both smoked tobacco and chewed betel quid was 4.85 (95% 1.10, 22.25), relative to those who neither smoked nor chewed. The systematic review identified 10 previous studies that examined risk of oral cancer associated with betel quid chewing that controlled for smoking in populations where betel quid did not contain tobacco. In studies that reported results for non-smokers the combined OR was 2.14 (95% CI 1.06, 4.32) in betel quid chewers and in studies that adjusted for smoking the combined OR was 3.50 (95% CI 2.16, 5.65) in betel quid chewers. Preventive efforts should discourage betel quid chewing as well as smoking.

The North Queensland "Sun-Safe Clothing" study: design and baseline results of a randomized trial to determine the effectiveness of sun-protective clothing in preventing melanocytic nevi.

In 1999, the authors began recruitment for a randomized controlled intervention trial aimed at preventing melanocytic nevi (moles) by minimizing sun exposure through the use of sun-protective clothing. The study involves 652 Caucasian children (75.6% response) aged 0-35 months from 25 child-care centers (n = 13 intervention and n = 12 control) living in the high-solar-irradiance environment of Townsville, Queensland, Australia. Children attending intervention centers wear investigator-provided garments made from fabrics with ultraviolet protection factors rated very good to excellent. Control centers continue to offer usual care. Three-year follow-up of all children will be completed in 2005. The main outcome measure is the number of new melanocytic nevi. At baseline, the two groups were similar with respect to nevi, phenotype, age, demographic characteristics, sun-protection habits, and history of sun exposure, except that more children from control versus intervention centers (2% and 0%, respectively; p = 0.006) had experienced painful sunburn with blistering. Higher melanocytic nevus counts were associated with more time spent outdoors and a history of sunburn, while sunscreen use, particularly during the mild winter months, appeared to have a protective effect. These findings further substantiate the hypothesis that nevus development in young children is related to sun exposure.

Cuisine: the concept and its health and nutrition implications--global.

Cuisine, broadly food culture, has evolved greatly in the past ten thousand years, following the domestication of plants and animals which greatly increased the food supply and led to villages, cities and civilizations. Major factors in the evolution of cuisines have been the existing biota, soils, fuel for cooking and climates, followed by new technologies, exploration and trade. These provide the context of the world's amazing variety of cuisines, but not the understanding of why cuisines developed as they have, in particular why China has the world's greatest cuisine. There is evidence that the diet of older women in Zhejiang province meets the recent WHO guidelines for the prevention of chronic disease, consistent with reported longevity in the province. But current changes with the industrialization and globalization of cuisines are associated with increases in chronic diseases, and point to much greater increases in the future.

Cuisine: the concept and its health and nutrition implications--a Hangzhou perspective.

Cuisine is an activity that meets human physical and psychological needs. With the development of civilization, cuisine is an important component of culture and includes the dietary profession. However, each nation or each area has its own characteristic cuisine. There are eight major styles of Chinese cuisine, Hangzhou style is an important part of Zhe style. It was divided into two branches named 'Lake branch' and 'Town branch'. An ideal Chinese dish should satisfy in terms of colour, aroma, taste, shape, texture and sustenance. But nowadays, people pay more attention to other aspects of dishes than sustenance. It is estimated that food and beverages will cost up to 570 billion RMB (about 69 billion US dollars) in China this year. The incidence of chronic diseases also increases year after year. There are 40 million diabetic and 70 million obese persons in China. Hence it is important to make efforts to promote in-depth knowledge of cooking and nutrition.

Nutrition-related disease and death in Zhejiang Province?

In Zhejiang province economic development and changes in nutrition appear to have increased both life expectancy and nutrition-related chronic disease morbidity. Life expectancy is longer in urban populations than in rural and in both urban and rural females. From 1997 to 2002 urban females had an average life expectancy of 81.4 years. In 2002 the estimated incidence of ischaemic heart disease was higher in rural males and females whereas diabetes mellitus was higher in urban males and females. From 1990 to 2002 lung cancer had large increases in all groups, cancers of the oesophagus and stomach increased in rural males and females, and cancer of the large intestine increased 40 per cent in urban males. In 2002 deaths from cerebrovascular disease were much higher in rural males and females. Apart from differences in lifestyle factors between urban and rural, access to medical resources may also be relevant to the differences within the province in chronic disease rates and in life expectancy.

Do people in rural and remote Queensland delay using health services to manage the episodes of incapacity?

The research project described in the present paper aimed to explore the types of self-reported management which families in relatively 'high', 'moderate' and 'low' medically resourced areas use for episodes of incapacity and the length of time from an initial symptom to the management behaviours. A telephone survey was conducted in rural and remote Queensland, Australia, to explore one or more types of management for the most recent incapacity episode of family members. A respondent indicated at least one type of management for any one episode. These included using a home remedy, self-treatment and an ambulatory doctor's visit. Data were analysed descriptively and analytically. Log transformations were used for all outcomes prior to using bivariate analyses which incorporated the correlation between observations to compare the time from initial symptom to management between groups. Among 394 households contacted, 270 provided information about 697 household members, 269 (38.5%) of whom had had at least one episode of incapacity in the previous 12 months. Among people in each of the three resourced areas, there was a significant difference in the length of time taken to visit accident and emergency (A&E) units. Men visited the units and consulted books earlier than women. Although age was not quite significantly related to the use of A&E units (P = 0.06), data suggested that people 35 years or older tended to take a longer time to use the services than the younger age groups. After taking into account that the members of the same household might take the same time from initial symptoms to management, people who were incapacitated and lived in areas with different levels of medical resources and gender were likely to be different in the time taken to use services at the A&E units.

The Eastern Australian Childhood Nevus Study: site differences in density and size of melanocytic nevi in relation to latitude and phenotype.

It has been postulated that site-specific variation in melanocytic nevus density and size is explained by differential response to sunlight. We observed the density and size of nevi at different body sites in relation to age, phenotype, latitude, and other measures of ultraviolet exposure. A standard protocol was used to assess nevi, phenotype, and sun exposure in 1123 Australian schoolchildren at 3 contrasting latitudes. Associations with phenotype (red hair, skin reflectance, sun sensitivity, and tanning) varied by body site. In Queensland, gender differences in nevus density on the back and lower limbs, unrelated to sun exposure, were similar to gender differences for melanoma. Small nevi (2-4 mm) were most dense on the arms, whereas large nevi (> or =5 mm) were most dense on the posterior trunk where they were related to age, decreasing latitude, male sex, and freckling. Our findings support the hypothesis of site-specific differences in nevus proliferative potential.

Health beliefs, perceived self-efficacy, and breast self-examination among Thai migrants in Brisbane.

BACKGROUND: Women in Thailand have a relatively low risk of developing breast cancer; however, death rates from breast cancer are increasing. Rates in many migrant groups are also known to be on the increase. Little is known about breast cancer screening, particularly breast self-examination (BSE), among Thai migrant women in other countries. In Australia, non-English-speaking-background migrants are known to be low users of preventive health services. AIMS: To investigate, using the health belief model (HBM) and self-efficacy as a theoretical framework, the use of BSE in a recent migrant group, Thai women in Australia, and to identify sociodemographic variables that influence the women's regular use of BSE. METHODS: In 1998, a cross-sectional study was conducted among 145 Thai women in Brisbane recruited through a snowball-sampling method, which used personal contacts and key persons within the Thai community. The study was approved by the University Human Ethics Review Committee. Data were collected through designed closed-ended questions. RESULTS: Only 25% of the women performed BSE regularly. HBM indices were strongly associated with BSE. Beliefs in high personal susceptibility to breast cancer strongly increased the likelihood of BSE. After adjusting for potential confounding factors, cues or triggers to undertake BSE and self-efficacy, or the ability to do BSE were found to be important determinants of regular BSE. Study limitations, including data collection methods, are discussed. CONCLUSION: A low percentage of women practised BSE regularly. The HBM is a useful framework for identifying factors influencing the use of BSE. Strategies that increase the confidence of women to undertake preventive health behaviour or increase self-efficacy are likely to increase their regular screening for breast cancer.

Management of episodes of incapacity by families in rural and remote Queensland.

People in rural and remote areas have relatively poor health, so limited availability of and accessibility to doctors are major health issues. This cross-sectional study was conducted in rural and remote areas of Central Queensland. Using telephone interviews, the study described the use of formal and informal health services by families in response to episodes of incapacity. An episode of incapacity was defined as inability to conduct ordinary activities for at least half a day due to new or continued illness. Of the 394 households contacted, 270 (68.5%) provided information about 698 household members, of whom 269 (38.5%) reported at least one episode of incapacity in the previous 12 months. The respondents could report more than one type of management of an illness episode. The management of the most recent episode in each member included 68% visiting doctors and 8.2% using services at an accident and emergency unit. Persons living in "least" medically resourced areas were more likely than persons in relatively "high" and "moderate" areas to consult doctors, but were also more likely to first consult books and delay their visits. They also consulted by telephone three times more frequently. Only 7% consulted other health practitioners including nurses and chemists, suggesting that these health practitioners were not used by families in rural and remote areas during episodes of incapacity. Increasing the availability and accessibility of medical care resources in rural and remote areas, using alternative delivery methods such as telemedicine, may meet the health needs of rural populations.

How good are parents at assessing melanocytic nevi on their children? A study comparing parental counts, dermatologist counts, and counts obtained from photographs.

The objective of this study was to evaluate agreement among counts of melanocytic nevi made by parents, counts made by a dermatologist, and counts made by assessment of photographs. In 1990, 421 schoolchildren aged 6-15 years from Townsville, Queensland, Australia (latitude 19.16 degrees S), participated in the Eastern Australian Childhood Nevus Study. In an agreement study, parents were asked to mark on an anatomic diagram any melanocytic nevi greater than or equal to 2 mm in diameter and greater than or equal to 5 mm in diameter they observed on their child's back prior to the child's examination by a dermatologist; 324 parents responded (a 77% response rate). Standardized slide photographs of each child's back were taken, and melanocytic nevi were counted by an experienced non-medical-examiner upon projection. Agreement was assessed graphically and with the concordance correlation coefficient (r(c)). Parental counts of melanocytic nevi were similar to counts made by the dermatologist (n = 77; for nevi >or=2 mm, r(c) = 0.51; for nevi >or=5 mm, r(c) = 0.78) and counts obtained from the photographs (n = 324; for nevi >or=2 mm, r(c) = 0.68; for nevi >or=5 mm, r(c) = 0.68). Few parents reported false-positive lesions. Parents tended to underestimate the number of melanocytic nevi greater than or equal to 2 mm in diameter (mean difference from dermatologist: -3.2, standard deviation 6.8; mean difference from photographs: -1.1, standard deviation 5.1), particularly when the density of melanocytic nevi was high. Agreement between dermatologist counts and photograph counts was high (for nevi >or=2 mm, r(c) = 0.80; for nevi >or=5 mm, r(c) = 0.87). The authors conclude that parents are capable of counting melanocytic nevi on their children's skin with some validity. In epidemiologic studies of children, counts of melanocytic nevi obtained from standardized photographs have the potential to replace counts made by physicians.