Biosocial Model Research Articles

Social medicine education towards structural transformation in Palestine

IntroductionSocial medicine, a field of study that uniquely centers the social and structural drivers of health in society, has been increasingly integrated into medical professional education over the last several decades. In Palestine, due to the fragmentation of Palestinian geographies, education, culture, and health, integrating a social medicine approach for allied health care students has remained elusive. We seek to introduce the theoretical underpinnings and practical implementation of an experiential Palestine social medicine course. Materials and methods30 Students from the Gaza Strip, West Bank, and the United States convened at the Institute of Community and Public Health at Birzeit University, Palestine, for a three-week experiential social medicine course. The course introduced critical social and structural frameworks and utilized a biosocial model for training and education that included reflective knowledge acquisition and praxis. Pre- and post-course evaluations provided feedback and insight into the knowledge, attitudes, and learning evolution of the student cohort. ResultsParticipant experiences highlighted the importance of the critical reflective nature of the course and importance of practice through praxis. Students identified the convening of Palestinians from different regions and the focus on Palestinian-centered perspectives as foundational for the course. Tensions highlighted included the challenges and distress in identifying tangible next steps in addressing the identified structural determinants of Palestinian health. ConclusionThe Palestine social medicine course provided a Palestinian narrative-centered course that focused on critical structural frameworks to identify and clarify the overarching connections of various, fractured Palestinian health experiences. This course provides a model, and first step, towards meaningful decolonial education, partnership, and praxis, while also providing further evidence of the power of mobilizing in health solidarity and the transformative power of the social medicine movement.

Fragmentation in One Health policy and practice responses to antimicrobial resistance and the salutary value of collaborative humility

This paper investigates One Health (OH) applied to antimicrobial resistance (AMR) to deepen and nuance its conceptual underpinnings and inform effective implementation. We consider how models of OH and AMR wedded to bioscience assumptions of life obscure biosocial complexity and reinforce the misleading assumption that scientific knowledge of AMR is generated outside social systems. With reference to in-depth interviews with medical practitioners, scientists and policy-makers working on AMR in Australia and the UK, we explore accounts of OH action on AMR. We show that the implementation of OH is subject to some fragmentation due to workforce organisation, funding arrangements and the absence of detailed guidance for translating OH into practice. Despite OH aspirations for transdisciplinary cooperation and innovation, human-centrism and somewhat incommensurable professional and scientific views on OH constrain trust in the policy approach and limit effective action. We discuss how, in some settings, OH action on AMR does resemble policy aspirations when emphasis is placed on collaborative humility, a finding that underlines OH’s biosocial character. We argue for the development of more robust biosocial models of OH to guide its application to AMR in real world settings.

Cumulative ecological risk and nonsuicidal self-injury in adolescents: The mediation of depression and the moderation of impulsiveness.

This study is based on the biosocial model of nonsuicidal self-injury (NSSI), to explore the effects of cumulative ecological risk on adolescents' NSSI, the mediating effect of depression between cumulative ecological risk and adolescents' NSSI, and the moderating role of impulsiveness in this mediating pathway. A total of 16 508 adolescents, with 7903 males (47.9%), participated in the study and completed the Cumulative Ecological Risk Questionnaire, the Short Form of the Center for Epidemiological Studies Depression Scale, the Impulsiveness assessment, and the Nonsuicidal Self-Injury Scale. (1) There was a significant positive correlation between cumulative ecological risk, depression, impulsiveness, and NSSI; (2) cumulative ecological risk significantly predicted adolescents' NSSI; (3) depression had a mediating effect between cumulative ecological risk and adolescents' NSSI; and (4) impulsiveness moderated both the effects of cumulative ecological risk on adolescents' depression and NSSI and the effects of depression on NSSI in adolescents. Impulsiveness and depression are risk factors for adolescent NSSI and play a crucial role between cumulative ecological risk and NSSI in adolescents.

Linehan's biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization.

Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan's biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan's model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan's biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan's model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.

Validating the biosocial model of borderline personality disorder: Findings from a longitudinal study.

This longitudinal study aimed to validate the biosocial theory of borderline personality disorder (BPD) by examining the transactional relationship between individual vulnerabilities and parental invalidation, and their links to BPD symptoms. We recruited a sample of 332 adolescents (mean age = 14.18 years; 58.3% female) residing in Singapore and administered self-report measures across three time-points (six months apart). Results from our path analytic model indicated that parental invalidation, impulsivity, and emotional vulnerability exhibited unique predictive associations with emotion dysregulation six months later. There was also a reciprocal prospective relationship between emotion regulation difficulties and BPD symptoms. Using random-intercepts cross-lagged panel models, we found partial evidence for a within-individual reciprocal relationship between parental invalidation and emotional vulnerability, and a unidirectional relationship of within-individual changes in impulsivity positively predicting changes in parental invalidation six months later. Overall, the study provided partial empirical support for the biosocial model in a Singaporean context.

Retrospective reports of perceived parental invalidation and borderline personality traits: The indirect effect of personality functioning.

This study examined the indirect effect via Criterion A (personality functioning) of the Alternative Model for Personality Disorders (AMPD) in the relationship between retrospective reports of perceived parental invalidation and borderline personality traits measured by Criterion B (pathological personality traits). A total of 3,019 college students completed self-report scales of the Chinese Invalidating Family Scale, Level of Personality Functioning Scale-Brief Form 2.0, and Personality Inventory for DSM-5. It was found that the indirect effect of personality functioning was significant for the association between levels of perceived overall-B = 0.52, 95% CI [0.47, 0.57], maternal-B = 0.83, [0.75, 0.91], and paternal-B = 0.97, [0.87, 1.08] invalidation, and BPD traits. The outcomes of the research suggested the critical role of personality functioning as a potential mediator in the pathological effect of perceived parental invalidation on the development of borderline personality disorder features. While the study is limited by the use of self-report measurement, retrospective responding, and cross-sectional design, significant implications on the biosocial model and AMPD were discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Pathology of Borderline Personality Disorder Symptomatology in a Nonclinical Sample: The Role of Mental Pain, Cognitive Emotion Regulation, Self-compassion, and Depression

Objectives: Patients with borderline personality disorder (BPD) often develop a certain depression that may be accompanied by “mental pain.” A negative self-concept, aversive chronic emotions, and pervasive helplessness characterize mental pain. This research aims to explore the pathology of BPD symptomatology in a nonclinical sample. Also, the role of mental pain, cognitive emotion regulation, self-compassion, and depression are assessed. Methods: Following a correlational study, 300 university students were selected via the multi-stage random cluster sampling method. The study data were collected by the personality assessment inventory-borderline features scale, Orbach and Mikulincer mental pain questionnaire, cognitive emotion regulation questionnaire, self-compassion scale (SCS-SF), and Beck depression inventory version 2. Results: Multiple regression analyses indicated that components of putting into perspective, rumination, loss of control, refocus on planning, catastrophizing, irreversibility, somatic, and isolation (ΔR2=0.507, P<0.001) significantly predicted BPD symptomatology. Discussion: The results support the biosocial model dimensions in an Iranian context. In addition, it shows a strong association between mental pain, cognitive emotion regulation, self-compassion, depression, and BPD symptoms.

Emotion regulation strategies in borderline personality disorder: a meta-analysis

ABSTRACT Objectives Many theoretical models pinpoint emotional dysregulation not only as a symptom of borderline personality disorder (BPD) but also as a component in the development and maintenance of the disorder. In this meta-analysis, results from studies that examined the association between emotion regulation strategies and BPD symptoms were systematically analysed. Design A quantitative meta-analysis approach was used to systematically assess previous research studies and conduct subgroup and meta-regression analysis to test for theoretical, methodological and demographic moderating variables. Results Emotion regulation strategies are significantly and largely associated with BPD symptoms. Negative associations were found between BPD symptoms and acceptance (r = −.558), mindfulness (r = −.581) and reappraisal (r = −.303) and positive associations were found between BPD symptoms and avoidance (r = .528), distraction (r = .336), rumination (r = .551) and suppression (r = .449). As heterogeneity was high, moderating variables (clinical status, type of reporting, comorbidity control, type of population, mean age, percentage of females) were also investigated. Conclusion The findings highlight the need for active involvement of emotion regulation in explaining BPD psychopathology, as well as promoting interventions focused on individual emotion regulation strategies. KEY POINTS What is already known about this topic: (1) The biosocial model of BPD and dialectical behaviour therapy focuses on emotion dysregulation as a core characteristic of BPD. (2) Emotional dysregulation is a core feature of BPD and is strongly involved in the appearance and maintenance of BPD pathology. (3) Emotional regulation difficulties in BPD are also well reflected in the diagnostic criteria according to DSM-5 (APA, 2013). What this topic adds: (1) In the present review, acceptance and mindfulness are considered different emotion regulation strategies. (2) Problem solving is not seen as an emotion regulation strategy because it refers to meta-cognitive processes of dealing with emotions and does not target direct attempts to regulate emotions. (3) Psychological treatments that target the reduction of BPD associated symptoms should continue to focus on emotional dysregulation as a core component of BPD psychopathology.

The relationship between parenting behavior and the personality of kindergarten children.

According to Cloninger's biosocial model of personality touching upon temperament and character, personality development is a lifelong adaptive process that begins in early childhood. Similarly, theories of parenting behavior and attachment predict that associations between personality and parenting behavior should be found in young children. The present study therefore had the goal to investigate, whether associations between parenting behavior and personality in terms of Cloninger's temperament and character dimensions previously found in adolescence and adults can already be observed in kindergarten children. This study assessed personality in a sample of 324 kindergarten children (169 girls/155 boys) aged 3-6 years (M age = 4.59, SD = 0.90). Parents rated their children's temperament and character using the JTCI 3-6 R questionnaire, which has been specifically developed to measure personality dimensions in three to six-year-olds according to Cloninger's model. Character traits (especially Self-Transcendence), which reach mature levels in adults, may not be reliably assessed in three-year-old children. Parenting behavior was documented using the DEAPQ-EL-GS self-report questionnaire measuring the parenting behavior dimensions Responsiveness and Demandingness. Correlation analyses revealed that responsive parenting behavior was positively related to the personality dimensions Reward Dependence, Self-Directedness, and Self-Transcendence. Demanding parenting behavior was positively related to the personality dimension Novelty Seeking, but negatively related to the personality dimensions Persistence, Self-Directedness and Cooperativeness. Although the cross-sectional design of our study prevents unequivocal conclusions about the causal direction of these associations, our results highlight possible differential consequences of responsive vs. demanding parenting behavior for personality development in children in line with theories of parenting behavior and attachment. Our results thus advance earlier work in adolescents and adults, by showing that parenting behavior influences the development of the child's personality according to Cloninger's biosocial model already in three to six-year-olds.

Maternal invalidation and child RSA reactivity to frustration interact to predict teacher-reported aggression among at-risk preschoolers.

Aggression is a transdiagnostic indicator of risk and represents one of the most common reasons children are referred for mental health treatment. Theory and research highlight the impact of maternal invalidation on child aggression and suggest that its influence may vary based on differences in child physiological reactivity. Moreover, the interaction between these risk factors may be particularly pronounced among children of mothers with emotion regulation (ER) difficulties. The current study examined the independent and interactive effects of maternal invalidation and child physiological reactivity to frustration on teacher-reported aggression in an at-risk sample of preschool children. Participants included 77 mothers (Mage = 33.17 years, s.d. = 4.83; 35% racial/ethnic minority) and their children (Mage = 42.48 months; s.d. = 3.78; 56% female; 47% racial/ethnic minority). Groups of mothers with and without clinician-rated ER difficulties reported on maternal invalidation, and child respiratory sinus arrhythmia (RSA) was assessed continuously during a frustration task as an indicator of physiological reactivity. Teachers or daycare providers reported on child aggression. Results demonstrated positive associations between maternal ER difficulties and both maternal invalidation and child RSA reactivity to frustration. As expected, the interaction between maternal invalidation and child RSA reactivity was significant, such that higher maternal invalidation and greater child RSA reactivity to frustration predicted more aggression in a daycare or preschool setting. Importantly, this effect was demonstrated while controlling for demographic covariates and baseline RSA. Findings are in line with diathesis-stress and biosocial models of risk and point to multiple targets for prevention and early intervention.

A Bio-Social Model during the First 1000 Days Optimizes Healthcare for Children with Developmental Disabilities.

Most children with developmental disabilities (DD) live in resource-limited countries (LMIC) or high-income country medical deserts (HICMD). A social contract between healthcare providers and families advocates for accurate diagnoses and effective interventions to treat diseases and toxic stressors. This bio-social model emphasizes reproductive health of women with trimester-specific maternal and pediatric healthcare interactions. Lifelong neuronal connectivity is more likely established across 80% of brain circuitries during the first 1000 days. Maladaptive gene-environment (G x E) interactions begin before conception later presenting as maternal-placental-fetal (MPF) triad, neonatal, or childhood neurologic disorders. Synergy between obstetrical and pediatric healthcare providers can reduce neurologic morbidities. Partnerships between healthcare providers and families should begin during the first 1000 days to address diseases more effectively to moderate maternal and childhood adverse effects. This bio-social model lowers the incidence and lessens the severity of sequalae such as DD. Access to genetic-metabolomic, neurophysiologic and neuroimaging evaluations enhances clinical decision-making for more effective interventions before full expression of neurologic dysfunction. Diagnostic accuracy facilitates developmental interventions for effective preschool planning. A description of a mother-child pair in a HIC emphasizes the time-sensitive importance for early interventions that influenced brain health throughout childhood. Partnership by her parents with healthcare providers and educators provided effective healthcare and lessened adverse effects. Effective educational interventions were later offered through her high school graduation. Healthcare disparities in LMIC and HICMD require that this bio-social model of care begin before the first 1000 days to effectively treat the most vulnerable women and children. Prioritizing family planning followed by prenatal, neonatal and child healthcare improves wellness and brain health. Familiarity with educational neuroscience for teachers applies neurologic diagnoses for effective individual educational plans. Integrating diversity and inclusion into medical and educational services cross socioeconomic, ethnic, racial, and cultural barriers with life-course benefits. Families require knowledge to recognize risks for their children and motivation to sustain relationships with providers and educators for optimal outcomes. The WHO sustainable development goals promote brain health before conception through the first 1000 days. Improved education, employment, and social engagement for all persons will have intergenerational and transgenerational benefits for communities and nations.

Parental invalidation and its associations with borderline personality disorder symptoms: A multivariate meta-analysis.

Childhood invalidation has been postulated to be implicated in the development of borderline personality disorder (BPD), according to the biosocial model. Despite its significance, most systematic reviews and meta-analyses have focused on examining the associations between extreme forms of invalidation, such as sexual abuse, and BPD. Nonetheless, individuals could experience mild-to-severe levels of parental invalidation, with or without abuse. This study examined the relationship between parental invalidation as an overall construct and BPD symptoms, synthesized across 21 studies (total N = 7,198). As most reviewed studies utilized retrospective self-report measures, the effect sizes derived pertained largely to the association between reported childhood parental invalidation and BPD symptoms. We conducted a multivariate meta-analysis to account for the dependence of multiple effect sizes obtained from a single study and to maintain precision in obtained effect sizes. Maternal, paternal, and overall parental invalidation were positively associated with BPD symptoms, with small-to-moderate effect sizes of .26, .23, and .25, respectively. The mean effect size of maternal invalidation was greater than that of paternal invalidation. We also investigated if the parental invalidation-BPD associations were moderated by child gender, age, and culture (degree of individualism). Only overall parental invalidation and BPD symptoms association was moderated by child's gender, with larger effect sizes found for samples with a greater proportion of males. Age and culture did not moderate the parental invalidation-BPD association. Risk of publication bias was low. Our findings provide support for the invalidating childhood environment component of the biosocial model. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Early Parkinson's Disease Phenotypes Tailored by Personality, Behavior, and Motor Symptoms.

Previous studies described a parkinsonian personality characterized as rigid, introverted, and cautious; however, little is known about personality traits in de novo Parkinson's disease (PD) patients and their relationships with motor and neuropsychiatric symptoms. To investigate personality in de novo PD and explore its relationship with PD symptoms. Using Cloninger's biosocial model, we assessed personality in 193 de novo PD patients. Motor and non-motor symptoms were measured using several validated scales. Cluster analysis was conducted to investigate the interrelationship of personality traits, motor, and non-motor symptoms. PD patients showed low novelty seeking, high harm avoidance, and normal reward dependence and persistence scores. Harm avoidance was positively correlated with the severity of depression, anxiety, and apathy (rs = [0.435, 0.676], p < 0.001) and negatively correlated with quality of life (rs = -0.492, p < 0.001). Novelty seeking, reward dependence, and persistence were negatively correlated with apathy (rs = [-0.274, -0.375], p < 0.001). Classification of patients according to personality and PD symptoms revealed 3 distinct clusters: i) neuropsychiatric phenotype (with high harm avoidance and low novelty seeking, hypodopaminergic neuropsychiatric symptoms and higher impulsivity), ii) motor phenotype (with low novelty seeking and higher motor severity), iii) benign phenotype (with low harm avoidance and high novelty seeking, reward dependence, and persistence traits clustered with lower symptoms severity and low impulsivity). Personality in early PD patients allows us to recognize 3 patients' phenotypes. Identification of such subgroups may help to better understand their natural history. Their longitudinal follow-up will allow confirming whether some personality features might influence disease evolution and treatment.

Fear of COVID-19 mediates the relationship between negative emotional reactivity and emotional eating.

Recent studies have highlighted high levels of emotional eating during the coronavirus (COVID‐19) pandemic, but have not satisfactorily explained these changing eating patterns. Here, we tested one potential explanatory model broadly based on a biosocial model of emotional eating. Specifically, we examined the extent to which negative emotional reactivity was associated with emotional eating, as well as the mediating role of fear of COVID‐19. A total of 474 women from Romania were asked to complete measures of emotional eating, negative emotional reactivity, and fear of COVID‐19. Mediation analysis showed that higher negative emotional reactivity was significantly and directly associated with greater emotional eating. This direct relationship was also mediated by fear of COVID‐19. These results highlight one possible route through which the ongoing COVID‐19 pandemic may have resulted in elevated rates of emotional eating, though further research is needed.

THE USE OF INDICATORS OF THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING TO ASSESS THE CONDITION OF PATIENTS WITH HYPERTENSION WITH COMPLICATED HYPERTENSIVE CRISES

The International Classification of Functioning, Disability and Health (ICF) is gaining a special role. Using a set of clear definitions of functions, structure, activities and participation and environmental factors, the attending (family) doctor and rehabilitation doctor will be able to objectively assess the abilities and limitations of daily life and activities, consistently determining the factors influencing human functioning.&#x0D; The aim of the study: to assess the functionality, activity and participation of patients with arterial hypertension (AH) stage III, 2-3 degrees, severe risk according to the criteria of the ICF.&#x0D; Materials and methods: examined 53 patients with hypertension, 15 of whom had hypertensive crisis it was complicated by STEMI myocardial infarction (MI) with a rehabilitation diagnosis according to ICF s4100.378, b4200.8, 20 patients with hypertensive crisis complicated by ischemic stroke (rehabilitation diagnosis according to ICF - s110.878, b4200.8) and 18 patients with atrial fibrillation due to hypertensive crisis and a diagnosis of ICF - s4100.878, b4101.8.&#x0D; To assess the structural changes of the heart echocardiography. To assess activity and participation for all patients included in the study were offered and performed the Tinetti test (1986) with a separate assessment of balance and gait, using the Rivermead mobility index, a 6-minute walk test, and a modified Borg load perception scale. All obtained indicators were statistically processed.&#x0D; Results. Studies of myocardial structure show that its the largest mass was in patients with AH and atrial fibrillation and slightly lower, although insignificantly, in patients who developed a MI on the background of hypertensive crisis and significantly (p&lt;0.05) less in the subjects, where hypertensive crisis was complicated by ischemic stroke. At the same time MMLV of all the patients significantly (p1,2,3&lt;0,05) exceeded the similar indicator at healthy. The same nature of changes is characteristic of IMMLV in patients examined by us.&#x0D; The Tinnetti test for balance was the lowest (6.7±0.6 points) in patients with AH and hypertensive crisis complicated by ischemic stroke and 1.8 and 1.98 times higher (p1.3 &lt;0.05) in patients with AH in whom the hypertensive crisis was complicated by MI and atrial fibrillation. The overall mobility of the subjects also depended on the nature of the complications of the hypertensive crisis and was most severely impaired in patients with ischemic stroke (6.3±0.5 points) and decreased 1.4 times (p&lt;0.05) compared with patients with MI and 1.7 times in cases of complications of hypertensive crisis with cardiac arrhythmia.&#x0D; While performing the test with a 6-minute walk, it was found that patients with AH complicated by ischemic stroke, walked 133.3 m (p&lt;0.01) shorter distance than those examined with AH complicated by MI. The Borg scale in patients with AH and hypertensive crisis, complicated by MI and ischemic stroke was almost the same and slightly exceeded its average degree. In cases of development after a hypertensive crisis of cardiac arrhythmias (atrial fibrillation), the Borg scale showed a slight fatigue.&#x0D; Thus, apart the biological model that takes into account the localization of the pathological process and its complications, a biosocial model is very important, which includes activity, participation, adaptation to everyday life and the environment, which has diverse changes and must be evaluated for rehabilitation planning in such patients.

Examining the intergenerational transmission of parental invalidation: Extension of the biosocial model.

This study examined the intergenerational transmission of parental invalidation and whether parental difficulties in emotion regulation mediated the association between past experiences of invalidation and current invalidating parenting practices. We also aimed to investigate whether gender might influence the transmission of parental invalidation. We recruited a community sample of 293 dual-parent families (adolescent and their parents) based in Singapore. Parents and adolescents each completed measures of childhood invalidation, whereas parents additionally reported on their difficulties in emotion regulation. Results based on path analyses demonstrated that past parental invalidation experienced by fathers positively predicted current perceived invalidation by their children. The association between mothers' childhood invalidation and current invalidating practices was fully mediated by mothers' difficulties with emotion regulation. Further analyses revealed that parents' current invalidating behaviors were not predicted by their past experiences of paternal or maternal invalidation. These findings point to the importance of considering the family invalidating environment as a whole when examining the influence of past experienced parental invalidation on emotion regulation and invalidating behaviors of second-generation parents. Our study provides empirical support for the intergenerational transmission of parental invalidation and highlights the need to address childhood experiences of parental invalidation in parenting programs.

Enhancing Flexibility: A Biosocial Model for Resilience to Adversity in Youth With Autism

Flexibility is often associated with resilience from adversity. Youth with autism spectrum disorder (ASD) are at risk of stress and trauma yet have inherent difficulties with flexibility, including rigid behaviors, routines, “insistence on sameness,” and lack of social reciprocity. This review highlights literature of physiological and psychological processes related to inflexibility in ASD and proposes a heuristic model to understand mechanisms of resilience in the aftermath of adversity. This article presents the Biosocial Model for Resilience, which posits that interventions that target changes in central, autonomic, and endocrine dysregulation may in turn enhance processes of psychological flexibility (i.e., executive cognitive, emotional, and interpersonal regulation) that increase the likelihood of resilient adjustment in response to stressful experiences. This model of resilience is optimistic in positing that, in addition to critical programs on the prevention of social adversity, future research on flexibility can inform intervention programs that target this specific mechanism to minimize harmful aftereffects in youngsters with ASD.

Indigenous Midwives and the Biomedical System among the Karamojong of Uganda: Introducing the Partnership Paradigm.

Certainly there can be no argument against every woman being attended at birth by a skilled birth attendant. Currently, as elsewhere, the Ugandan government favors a biomedical model of care to achieve this aim, even though the logistical realities in certain regions mitigate against its realisation. This article addresses the Indigenous midwives of the Karamojong tribe in Northeastern Uganda and their biosocial model of birth, and describes the need British midwife Sally Graham, who lived and worked with the Karamojong for many years, identified to facilitate “mutual accommodation” between biomedical staff and these midwives, who previously were reluctant to refer women to the hospital that serves their catchment area due to maltreatment by the biomedical practitioners there. This polarisation of service does not meet that society’s needs. We do not argue for the provision of a unilateral, top-down educational service, but rather for one that collaborates between the biosocial model of the Karamojong and the biomedical model supported by government legislation. We show that such a partnership is practical, safer, and harnesses the best and most economical and effective use of resources. In this article, we demonstrate the roles of the Indigenous midwives/traditional birth attendants (TBAs) and show that not only is marriage of the two systems both possible and desirable, but is also essential for meeting the needs of Karamojong women. The TBA is frequently all the skilled assistance available to these women, particularly during the rainy season when roads are impassable in rural South Karamoja. Without this skilled help, the incidence of maternal and infant mortality would undoubtedly increase. Ongoing training and supervision of the TBA/Indigenous midwife in best practices will ensure better care. We offer a way forward via the Partnership Paradigm (PP) that lead author Sally Graham designed in conjunction with the Indigenous midwives and biomedical staff with whom she worked, the development and characteristics of which this article describes.

Onset of substance use: Deviant peer, sex, and sympathetic nervous system predictors.

We evaluated whether the association between deviant peer affiliation and onset of substance use is conditional upon sex and sympathetic nervous system (SNS) reactivity as measured by pre-ejection period (PEP). Community-sampled adolescents (N = 251; M = 15.78 years; 53% female; 66% White, 34% Black) participated in three waves. PEP reactivity was collected during a mirror star-tracer stress task. Alcohol, marijuana, tobacco, or any substance use, as well as binge drinking and sexual activity involving substance use were outcomes predicted by affiliation with deviant peers and two- and three-way interactions with sex and PEP reactivity. Probability of substance use increased over time, but this was amplified for adolescents with greater deviant peer affiliation in conjunction with blunted PEP reactivity. The same pattern of results was also found for prediction of binge drinking and sexual activity involving substance use. Findings are discussed in the context of biosocial models of adolescent substance use and health risk behaviors.

Concussion killjoys: CTE, violence and the brain’s becoming

CTE, or chronic traumatic encephalopathy, is caused by repetitive head trauma and detected by a distinctive stain for a protein called ‘tau’ in autopsied brain tissue. While the number of diagnosed patients is only in the hundreds, the cultural footprint of the disease in North America is huge, both because those diagnosed are often celebrity-athletes and because millions of children, adolescents and young men and women play collision sports like football and hockey. We argue that the widespread attention to CTE provides a useful wedge to crack open another, heretofore neglected public health concern: repetitive acts of violence in and around hypermasculine sports create subjects whose brains—and characters—are materially shaped by that violence. Brains change materially when delivering blows as well as receiving them, when participating in degrading hazing rituals as victim or assailant, when belittled or assaulted by a coach, when approaching an upcoming game riddled with fear. We adopt a biosocial model of the brain’s becoming to intervene in a linear discourse around CTE that medicalizes and oversimplifies violence, a story that prematurely dissects one slice of the problem from a noxious whole.