XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

▪ Abstract Well-being is a complex construct that concerns optimal experience and functioning. Current research on well-being has been derived from two general perspectives: the hedonic approach, which focuses on happiness and defines well-being in terms of pleasure attainment and pain avoidance; and the eudaimonic approach, which focuses on meaning and self-realization and defines well-being in terms of the degree to which a person is fully functioning. These two views have given rise to different research foci and a body of knowledge that is in some areas divergent and in others complementary. New methodological developments concerning multilevel modeling and construct comparisons are also allowing researchers to formulate new questions for the field. This review considers research from both perspectives concerning the nature of well-being, its antecedents, and its stability across time and culture.

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On Happiness and Human Potentials: A Review of Research on Hedonic and Eudaimonic Well-Being

Attachment--and loss.

Many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. Unfortunately, because much of psychology’s knowledge about how adults cope with loss or trauma has come from individuals who sought treatment or exhibited great distress, loss and trauma theorists have often viewed this type of resilience as either rare or pathological. The author challenges these assumptions by reviewing evidence that resilience represents a distinct trajectory from the process of recovery, that resilience in the face of loss or potential trauma is more common than is often believed, and that there are multiple and sometimes unexpected pathways to resilience. M ost people are exposed to at least one violent or life-threatening situation during the course of their lives (Ozer, Best, Lipsey, & Weiss, 2003). As people progress through the life cycle, they are also increasingly confronted with the deaths of close friends and relatives. Not everyone copes with these potentially disturbing events in the same way. Some people experience acute distress from which they are unable to recover. Others suffer less intensely and for a much shorter period of time. Some people seem to recover quickly but then begin to experience unexpected health problems or difficulties concentrating or enjoying life the way they used to. However, large numbers of people manage to endure the temporary upheaval of loss or potentially traumatic events remarkably well, with no apparent disruption in their ability to function at work or in close relationships, and seem to move on to new challenges with apparent ease. This article is devoted to the latter group and to the question of resilience in the face of loss or potentially traumatic events. The importance of protective psychological factors in the prevention of illness is now well established (Taylor, Kemeny, Reed, Bower, & Gruenewald, 2000). Moreover, developmental psychologists have shown that resilience is common among children growing up in disadvantaged conditions (e.g., Masten, 2001). Unfortunately, because most of the psychological knowledge base regarding the ways adults cope with loss or potential trauma has been derived from individuals who have experienced significant psychological problems or sought treatment, theorists working in this area have often underestimated and misunderstood resilience, viewing it either as a pathological state or as something seen only in rare and exceptionally healthy individuals. In this article, I challenge this view by reviewing evidence that resilience in the face of loss or potential trauma represents a distinct trajectory from that of recovery, that resilience is more common than often believed, and that there are multiple and sometimes unexpected pathways to resilience.

/pdf/loss-trauma-and-human-resilience-have-we-underestimated-the-2kd7sl9mfq.pdf

Loss, Trauma, and Human Resilience Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?

Erik Eriksen is a remarkable individual. He has no college degrees yet is Professor of Human Development at Harvard University. He came to psychology via art, which explains why the reader will find him painting contexts and backgrounds rather than stating dull facts and concepts. He has been a training psychoanalyst for many years as well as a perceptive observer of cultural and social settings and their effect on growing up. This is not just a book on childhood. It is a panorama of our society. Anxiety in young children, apathy in American Indians, confusion in veterans of war, and arrogance in young Nazis are scrutinized under the psychoanalytic magnifying glass. The material is well written and devoid of technical jargon. The theme of the volume is that it is human to have a long childhood which will leave a lifelong residue of emotional immaturity in man. Primitive groups and

Childhood and Society.

The relationship between adult attachment styles and emotional and cognitive reactions to stressful events.

This study examines the association between adult attachment style and the way people reacted to the Iraqi missile attack on Israel during the Gulf War. One hundred forty Israeli students were interviewed 2 weeks after the war and classified according to their attachment style (secure, avoidant, or ambivalent) and residence area (dangerous vs. less dangerous). Ambivalent people reported more distress than secure people. Avoidant persons reported higher levels of somatization, hostility, and trauma-related avoidance than secure persons. These results characterized Ss living in dangerous areas. In addition, secure people used relatively more support-seeking strategies in coping with the trauma, ambivalent people used more emotion-focused strategies, and avoidant people used more distancing strategies. Findings are discussed in terms of attachment working models.

https://psycnet.apa.org/journals/psp/64/5/817.pdf

Attachment styles, coping strategies, and posttraumatic psychological distress: the impact of the Gulf War in Israel.

Five studies examined the contribution of attachment style to mortality salience effects. In Study 1, mortality salience led to more severe judgments of transgressions only among anxious-ambivalent and avoidant persons but not among secure persons. In addition, whereas anxious-ambivalent persons showed immediate and delayed increases in severity judgments, avoidant persons showed this response only after a delay period. In Study 2, anxious-ambivalent persons showed immediate and delayed increases in death-thought accessibility after death reminders. Avoidant and secure persons showed this effect only after a delay period. Study 3 revealed that worldview defense in response to mortality salience reduced death-thought accessibility only among avoidant persons. Studies 4-5 revealed that mortality salience led to an increase in the sense of symbolic immortality as well as in the desire of intimacy only among secure persons, but not among avoidant and anxious-ambivalent persons.

Exploring individual differences in reactions to mortality salience: does attachment style regulate terror management mechanisms?

The current study assesses the impact of attachment style on the ways young adults react to the stress of 4-month combat training. Ninety-two Israeli recruits completed an attachment scale at the beginning of the training. Their appraisal of the training their ways of coping with it, and peer evaluations of their leadership ability were assessed 4 months later. Compared with secure persons, ambivalent persons reported more emotion-focused coping, appraised the training in more threatening terms, appraised themselves as less capable of coping with the training, and were evaluated by their peers as less fitting for military leadership. Avoidant persons reported more distancing coping and less support seeking and appraised the training in more threatening terms. They did not differ from secure persons in the appraisal of their ability to cope with the training or in the nominations they received for leadership positions. Results are discussed in the framework of attachment theory.

Appraisal of and Coping with a Real-Life Stressful Situation: The Contribution of Attachment Styles

The relation between attachment styles and fear of personal death was assessed. We classified a sample of Israeli undergraduate students into secure, ambivalent, and avoidant attachment groups and assessed the extent of, and the meaning attached to, overt fear of personal death as well as the extent of fear at a low level of awareness. Ambivalent subjects exhibited stronger overt fear of death than did secure and avoidant subjects, and both ambivalent and avoidant subjects showed stronger fear of death at a low level of awareness than secure subjects. Ambivalent subjects were also more likely to fear the loss of their social identity in death, and avoidant subjects were more likely to fear the unknown nature of their death. Results are discussed in terms of the effects of attachment styles on affect regulation. According to Bowiby's (1973) attachment theory, "when an individual is confident that an attachment figure will be available to him whenever he desires it, that person will be much less prone to either intense or chronic fear than will an individual who for any reason has no such confidence" (p. 202). Whereas most attachment research has focused on the fear of separation from a loved person, no attention has been paid to the fear of the ultimate separation: personal death. The purpose of the present study was to examine the relation between attachment styles and fear of personal death.

Victor Florian

Papers

The relationship between adult attachment styles and emotional and cognitive reactions to stressful events.

Attachment styles, coping strategies, and posttraumatic psychological distress: the impact of the Gulf War in Israel.

Exploring individual differences in reactions to mortality salience: does attachment style regulate terror management mechanisms?

Appraisal of and Coping with a Real-Life Stressful Situation: The Contribution of Attachment Styles

Attachment styles and fear of personal death: A case study of affect regulation.