Incorporating cross-cultural issues in psychotherapy: a relational framework

The purpose of this context statement is to trace my professional journey into the field of cross-cultural psychotherapy over a 20 year period. The personal factors that led me to this particular journey and the way they influenced my professional interests and choices are outlined. Although the context statement is based largely on the two text publications (1994 and 2010), it is important to mention that the latter text contains an updated version of most of my publications with the aim of providing a comprehensive cross-cultural text ‘under one roof’. I summarise the existential/phenomenological theoretical underpinnings discussed in the first text. The second text also has a philosophical underpinning but is largely based on a psychoanalytically informed theoretical base. In later sections, I indicate aspects which I have drawn upon from my publications and training, and how my thinking has evolved towards a relational framework. Furthermore, I identify the most significant professionals from around the world, which have facilitated my professional development, have inspired my career path and those I have collaborated with (teaching, publications and clinical work). During the two decades my learning comes from different and complementary sources: clinical work with children and adults, as well as both support and therapeutic groups. This substantial clinical experience took place through private practice, via different Hospitals, Voluntary and Charity organisations, and years of teaching and supervising child and adult counsellors, psychotherapists and psychologists and through an international network. Additionally, I describe the varied roles I have held on professional committees, including editorial reviewer, internal and external university examiner nationally and internationally, as well as psychological report writing for legal/insurance purposes. All have made a significant contribution to my learning

Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study

Research Question: Previous cross-sectional studies have shown an association between sudomotor dysfunction and diabetic foot ulceration (DFU). The aim of this prospective multicenter study was to determine the role of dryness of foot skin and of established neurological modalities in the prediction of risk for foot ulceration in a cohort of individuals with diabetes mellitus (DM). Design: The study was conducted from 2012 to 2017. A total of 308 subjects with DM without history of DFU or critical limb ischemia completed the study. Diabetic neuropathy was assessed using the neuropathy symptom score (NSS) and neuropathy disability score (NDS). In a subset of participants, vibration perception threshold (VPT) was evaluated. Dryness of foot skin was assessed by the visual indicator plaster method (IPM). The diagnostic performance of the above neurological modalities for prediction of DFU was tested by receiver operating characteristic curve (ROC) analysis. Results: During the 6-year follow-up, 55 patients (annual ulceration incidence 2.97%) developed DFU. Multivariate Cox-regression analysis after controlling for the effect of age, gender, and DM duration demonstrated that the risk (hazard ratio, 95% confidence intervals) of DFU increased significantly with either abnormal IPM (3.319, 1.460–7.545, p = 0.004) or high (≥6) NDS (2.782, 1.546–5.007, p = 0.001) or high (≥25 volts) VPT (2.587, 1.277–5.242, p = 0.008). ROC analysis showed that all neurological modalities could discriminate participants who developed DFU (p < 0.001). IPM testing showed high sensitivity (0.86) and low specificity (0.49), while high vs. low NDS and VPT showed low sensitivity (0.40 and 0.39, respectively) and high specificity (0.87 and 0.89, respectively) for identification of patients at risk for DFU. Conclusion: Dryness of foot skin assessed by the IPM predicts the development of DFU. IPM testing has high sensitivity, whereas high NDS and VPT have high specificity in identifying subjects at risk for DFU. The IPM can be included in the screening methods for identification of the foot at risk. © Copyright © 2020 Panagoulias, Eleftheriadou, Papanas, Manes, Kamenov, Tesic, Bousboulas, Tentolouris, Jude and Tentolouris