An Evolutionary Perspective on Pain Communication

Pain serves as a signal to elicit care from others. In turn, displaying pain might be attractive because of the benefits it might bring. Additionally, displaying pain is easy, because helpers distinguish poorly between genuine pain and faked pain. Hence, helpers face the problem of distinguishing true sufferers from free riders, while sufferers face the problem of communicating need convincingly. This article will propose solutions to these adaptive problems. Based on theoretical arguments and on empirical insights from lie detection research, it will be argued that the credibility of pain signals cannot be found in features of the signal itself, but in its context. Namely, pain is obviously credible when the context features unforgeable cues, such as an open wound or the enlarged abdomen of a pregnant woman, but also external cues such as the ice water in cold pressor tasks. In absence of such cues, pain can become credible through costly consequences, such as refraining from rewarding behaviors for a significant period. However, these adaptive mechanisms for communicating need may not be shaped for modern circumstances such as experimental settings and therapeutic encounters

An Evolutionary Explanation of the Placebo Effect

Placebo research shows that the subjective quality of care and social support, as well as the patients’ expectations of treatment, influence therapeutic outcomes. However, this phenomenon, known as the placebo effect, does not usually cure the disease, but rather can provide symptomatic relief: It may soothe symptoms such as pain, swelling, or nausea that constitute part of an immune response. The function of this mechanism remains unclear. This article puts forward the Signaling Theory of Symptoms (STS) as a possible explanation. According to STS, discernible aspects of an immune response, such as pain, swelling, or nausea, not only serve a defensive and healing function but also a signaling function: symptoms signal the need for care and treatment to potential helpers. Once help and treatment are granted, the signaling function is fulfilled and the symptoms diminish. This mechanism may have been a significant advantage in preindustrial environments, when sufferers depended on extensive social support and personal treatment. Nowadays, from the point of view of modern materialist medicine, the mobilization of social support no longer seems so crucial, and thus the placebo effect has been assigned a somewhat mysterious quality

Being the Instrument of Change : Staff Experiences in Developing Trauma-informed Practice in a Norwegian Child Welfare Residential Care Unit

The overall aim of this project is to contribute to the development of interventions that benefit children and adolescents in residential care. Research shows that this is a particularly vulnerable population, typically with histories of detrimental care and traumatic experiences, and which is institutionalised as an additional burden. Many of them display severe emotional, interpersonal, and behavioural problems. Meeting their needs in a residential care setting is challenging, and there has been a general call for models of care that can encompass the complexity of their life histories and problems and the institutional context. Along with the growing understanding of the effects of developmental trauma, trauma-informed practice (TIP) has emerged as a theoretical framework guiding residential treatment and care. TIP was introduced in Norway around 2010 and has since become widespread, especially in child welfare settings. TIP is a theoretical framework or model, rather than a standardised or operationalised method, that must be operationalised within each concrete context. In Norway, TIP has mainly been based on the Three Pillars Model advanced by the Australian psychologist Howard Bath. The objective of this project was to gain information on how Bath’s TIP model was operationalised and experienced by staff at a child welfare institution for adolescents in Buskerud County, Norway. The institution was among the first in Norway to start operating in accordance with a TIP framework, starting with the implementation of Bath’s Three Pillars model in 2014. The regional resource centre on violence, traumatic stress, and suicide prevention in southern Norway (RVTS-south) facilitated the implementation process. The qualitative research project this thesis is based upon was initiated as part of this process. In the project, the following main research question was explored: how do staff in a residential care unit in Norway transform the TIP framework into practice, and how do they experience and reflect upon this practice? The project comprised three studies examining the research question from different angles with a qualitative phenomenological research methodology. Over the course of six years, a total of 27 individual in-depth interviews were conducted with 19 informants. Data were analysed in accordance with the principles of thematic analysis, thematic network analysis, and narrative inquiry. The findings of the three studies are presented in three separate papers. The focus of the first study (presented in Paper I) was how the TIP framework of Howard Bath was translated into concrete practices. Using thematic network analysis of data from interviews with all 19 informants, we identified three global themes: self-awareness, including self-reflection, other-regulation, and authenticity; intended actions, including building strength, building mentalisation skills, providing staff availability, setting safe limits, and collaborating with youth; and organisational and cultural practices, including having a commonly shared mindset, stability and routines, and cultural safety. We suggest that the described practices, in general, reflect shared ideas across TIP models and resonate with informants' training. However, some practices also seemed to be influenced by other, and perhaps partly conflicting perspectives. In particular, the results indicate confusion and the need for clarification regarding the roles of authenticity and boundary setting within TIP. The second study (presented in Paper II) focused on prerequisites for staff members’ capacity to maintain an emotionally regulated state when faced with disruptive emotional and behavioural expressions. Providing other-regulation through one’s own emotional state is considered a core element of TIP. Using thematic analysis of data from interviews with 15 of the informants, we found that informants experienced their self-regulation capacity as depending on critical self-reflection, self-acceptance, being part of a regulating work environment, and having a trustworthy theoretical model to be guided by. The findings point to the importance of organisational cultures and procedures that encourage critical self-reflection and self-acceptance, which promote self-compassion and shame-resilience, and where investments are made to ensure staff identification with the chosen model of care. The third study (presented in Paper III) explored informants’ experiences with situations and interactions that could potentially threaten their capacity to maintain an emotionally regulated state. Data from interviews with eight of the informants were analysed using narrative inquiry, with an interest in how informants made sense of their experiences. We identified three major narrative themes: Are we doing the right things?, My childhood issues surfaced, and Missing togetherness with trusted others. The themes reflect that situations and interactions were seen as particularly challenging due to their complexity and confusing character, their potential to trigger painful childhood memories, and their potential to evoke fear of disconnection from colleagues. Findings were discussed in terms of what strain working within a TIP framework may imply for staff members – a strain that we suggest should be acknowledged and addressed at an organisational and structural level. An overarching interpretation is that informants, in their ways of practicing TIP, experienced themselves as ‘the instruments of change’. They engaged in a reflexive self-scrutinising endeavour, where they tended to attribute successes and failures in interactions with residents to factors within themselves. Although informants were generally in favour of working in accordance with TIP principles, the results revealed that working this way comes at a cost and may be deeply personally and emotionally challenging. Findings of the project point to the importance of acknowledging these costs and of establishing cultural and organisational practices that enable staff to endure the strain they face as the 'instruments of change'. This may include a particular focus on the management of shame by working with self-compassion, for example, by applying standardised procedures developed for this purpose. To be able to face potentially dysregulating situations on a day-to-day basis, based on the project findings, the work environment should entail a culture of other-regulation, wherein cultural safety, transparency, and collegial support are emphasised. In addition, to be able to invest so much of themselves in their work, both personally and emotionally, staff would need an understanding of why they are doing it and confidence in the productivity of the approach. Additionally, based on project results, it is recommended that services practising or implementing TIP clarify to the greatest possible extent what TIP is and what it is not, including a clarification of what is unique or generic to the model. Clarifying the role of authenticity and boundary setting within TIP might be of particular importance.Doktorgradsavhandlin

Let Your Pharmacist Be Your Guide: Navigating Barriers to Pharmaceutical Access

At the end of this case, students will be able to: • Describe policy, organizational, and individual factors that contribute to barriers to accessing medications and pharmaceutical care • Identify resources to improve access to affordable medications for uninsured and underinsured patients • Recommend appropriate resources for obtaining affordable medicationshttps://digitalcommons.chapman.edu/pharmacy_books/1028/thumbnail.jp

Digging Deeper: Improving Health Communication with Patients

At the end of this activity, students will be able to: Identify five theories and models that can be used to facilitate the patient-provider health communication process Describe opportunities to optimize communication with patients in healthcare settings Apply health communication theories within patient care, providing specific approaches and language to utilizehttps://digitalcommons.chapman.edu/pharmacy_books/1026/thumbnail.jp

Experiences of Becoming Emotionally Dysregulated. A Qualitative Study of Staff in Youth Residential Care

Trauma informed care (TIC) emphasizes the importance of professionals maintaining an emotionally regulated state. We interviewed eight staff members in a residential care unit for children and adolescents where TIC had been implemented, about situations wherein they experienced difficulty regulating their own emotions. We identified three major narratives in informants’ descriptions: (1) “Are we doing the right things?”, (2) “My childhood issues surfaced”, and (3) “Missing togetherness with trusted others.” The narratives illustrate the emotional strain that can be evoked when working in residential child welfare settings, and within TIC frameworks, and point to potential challenges to resolve when implementing TIC in similar organizations.publishedVersio

31P solid-state NMR on skeletal muscle of wild and farmed Atlantic salmon

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Aging Societies and Intergenertional Conflict in Europe

Vor dem Hintergrund alternder Gesellschaften in Europa wird zunehmend vor einem Generationenkonflikt gewarnt. Doch haben Alte und Junge tatsächlich unterschiedliche Interessen und damit entgegen gesetzte Politikpräferenzen? Hierauf geben wir eine theoretische und eine empirische Antwort. Wir zeigen spieltheoretisch, dass Alte wie Junge ein Interesse an intergenerationaler Umverteilung haben sollten. Ein Konflikt bezüglich Transferzahlungen zwischen den Generationen ist erst zu erwarten, wenn die Gesellschaft altert. Unsere empirische Auswertung basiert auf Umfragedaten aus 27 EU-Mitgliedsländern im Jahr 2009 und zeigt einen schwachen Konflikt zwischen den Generationen. Die Zustimmung der Alten zu einer altenfreundlichen Ausgabenpolitik mit mehr Renten- und weniger Bildungsausgaben ist etwas stärker als die der Jungen. Allerdings finden wir keine Hinweise, dass der Konflikt zwischen Alten und Jungen mit einer Alterung der Gesellschaft stärker wird.The possibility of upcoming intergenerational conflict in an aging society is a recurrent topic in scholarly and public debate. However, do old and young people really have opposing political preferences? We give a theoretical as well as an empirical answer to this question. Game theoretical modelling leads us to the conclusion that both old andyoung people might be expected to favor intergenerational redistribution, but also that aging within society might heighten the possibility of generational conflict. Empirical analyses based on survey data from twenty-seven EU member states reveal a rather weak conflict status. We find a small intergenerational difference in regard to preferences forgovernmental spending on education and pensions. Old people as compared to young people have a slight preference for a policy favoring old people. We do not find evidence that aging intensifies intergenerational conflict. Our results suggest that intergenerational conflict could be mitigated by adopting an active policy on aging

Blick ins Neckartal mit Schloss Rosenstein

BLICK INS NECKARTAL MIT SCHLOSS ROSENSTEIN Blick ins Neckartal mit Schloss Rosenstein ( -