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The clinical implications of the results are discussed.Family accommodation (FA) is significant in a range of disorders, yet it has never been explored in body dysmorphic disorder (BDD). Interviews were conducted with five young people with BDD, five parents, and five clinicians to explore the types, impact, and purpose of FA in BDD. Every participant reported significant FA of BDD, and the types reported were broadly similar to those found in other disorders. Reassurance giving/seeking and engagement in rituals were the two most common forms of FA reported with funding products being the third. Unsurprisingly, the driver for FA was to reduce the young person's distress and risk. Every participant commented on the negative impact FA had, including the financial burden, social implications, emotional well-being of family members, relationships, and conflict within the family, yet all young people also thought there were positive aspects to FA. Findings are discussed in the context of the limitations of this study.The authors discuss the psychoanalytic treatment of Little Hans, drawing on the perspective offered by Laplanche's concept of "enigmatic messages," which they believe can contribute to a better understanding of this case history. Adavivint They conclude that Little Hans's positive Oedipus complex conceals his negative Oedipus complex in which he represents his parents' oedipal problems in a distorted fashion. link2 They demonstrate the way his parents project aspects of these problems into Hans's psyche, where his subsequent identifications with them lead to substitutive formations. They trace the course of Little Hans's horse phobia and examine his search for substitutive formations that have to align with his parents' defenses if they are to succeed in securing his safety and their affection.Etty (Esther) Hillesum was a young Jewish Dutch woman who kept a diary throughout the entire period of the Holocaust, until she met her own death in Auschwitz. The diary, written in the hellish environment of the Nazi occupation of Holland, provides us with an opportunity to explore the transformational power manifested in the mutual witnessing that takes place between the writer and the reader. The author reviews three aspects of the writer's testimony, each one of which embodies a unique reparative function testifying about the events, testifying as evidence, and testifying to the reader.The author explores the notion of representation and trauma, taking into account their negative manifestation in the mind, as memories without representation. In the face of massive trauma, the mind deploys dissociative mechanisms, so the experience remains unrepresented. Psychoanalytic technique has to expand its scope in order to meet-create these unrepresented forms. Alongside our classic technique, the analyst needs to work in a particular way-one that involves a regressive state to preverbal, or even prerepresentational areas within the analyst, allowing him or her to gain access to the traumatic zones. The integration of the trauma into the systems of representations depends on the possibility of the analyst to submit to a process of regression so as to offer a substrate on which hitherto unformed experience may assume form and become represented.The potential for psychological transformation is fundamental to psychoanalytic theory and therapy and to Jewish belief and practice. While Freud's rejection of religious experience as a manifestation of personal and cultural pathology had a long-reaching effect in the history of psychoanalysis, the theoretical extensions and advances of some of his followers have made it possible to view religious experience through a different lens. The author explores the convergence of Jewish ideas about the process of repentance (teshuvah) and the integration of psychic polarities conceptualized in the psychoanalytic literature, namely, love and hate in the shift from the paranoid-schizoid to the depressive position (Klein) and separation and reunion in the establishment of the self and the development of sublimation (Loewald).

To estimate the pooled prevalence of, and factors associated with, the presence of patellar tendon abnormalities observed on imaging in people without symptoms.

Systematic review with stratified meta-analysis and meta-regression.

We searched Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science from 1980 to August 2020.

We included studies that reported the prevalence of asymptomatic patellar tendon abnormalities on imaging. We excluded studies of participants with current tendon pain, a history of tendon pain, or other systemic conditions.

Stratification and meta-regression of studies based on study-level descriptive statistics (mean age, body mass index, proportion of female participants, physical activity participation, imaging modality) were performed using a random-effects model to account for between-study heterogeneity. Risk of bias was assessed using the modified Newcastle-Ottawa scale.

Meta-analysis of 64 studies (7125 limbs from 4616 participants) found significant between-stuhe patellar tendon. J Orthop Sports Phys Ther 2021;51(5)216-231. Epub 28 Mar 2021. doi10.2519/jospt.2021.10054.

To determine the reliability of common clinical tests for tibialis posterior tendinopathy (TPT) and to investigate their relationship with grayscale ultrasound findings in individuals who have medial foot/ankle pain.

Prospective cohort.

Fifty-two individuals reporting medial foot/ankle pain were clinically examined by 2 physical therapists using 4 clinical tests for TPT pain on tendon palpation, swelling around the tendon, pain/weakness with tibialis posterior contraction, and pain during or inability to perform a single-leg heel raise (SLHR). Individuals also underwent an ultrasound examination by a sonographer. Physical therapists and the sonographer were blind to each other's findings. Positive ultrasound examination included at least 1 of the following grayscale changes hypoechogenicity, fibrillar disruption, or thickening of the tendon. For reliability between the 2 physical therapists, we calculated kappa coefficients and 95% confidence intervals (CIs). To assess relationships between clinical andnnect between clinical findings and ultrasound grayscale changes in the tibialis posterior tendon in individuals with TPT. J Orthop Sports Phys Ther 2021;51(5)253-260. Epub 28 Mar 2021. doi10.2519/jospt.2021.9707.Opioid-induced hyperalgesia (OIH) occurs when opioids paradoxically enhance the pain they are prescribed to ameliorate. To address a lack of perioperative awareness, we present an educational review of clinically relevant aspects of the disorder. Although the mechanisms of OIH are thought to primarily involve medullary descending pathways, it is likely multifactorial with several relevant therapeutic targets. We provide a suggested clinical definition and directions for clinical differentiation of OIH from other diagnoses, as this may be confusing but is germane to appropriate management. Finally, we discuss prevention including patient education and analgesic management choices. As prevention may serve as the best treatment, patient risk factors, opioid mitigation, and both pharmacologic and non-pharmacologic strategies are discussed.

To estimate the prevalence of, and factors associated with, Achilles tendon abnormalities observed on imaging in asymptomatic individuals.

Systematic review with stratified meta-analysis and meta-regression.

Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science were searched from 1980 to August 2020.

We included studies that reported the prevalence of Achilles tendon abnormalities, observed with any imaging modality, in an asymptomatic population. We excluded studies if participant mean age was younger than 12 years or if participants had current/previous lower-limb tendon injuries/symptoms or other systemic conditions.

Random-effects proportion meta-analysis was used to estimate prevalence. We used meta-regression for continuous variables (mean age and body mass index [BMI], sample size, proportion of female participants) and stratified categorical variables (imaging modality and participation in physical activity) to explain between-study heterogeneity.

We included 91 studies (10 156 her prevalence of abnormalities was associated with older age (40 years old or older), higher BMI, and participation in physical activity. A large proportion of heterogeneity remains unaccounted for, likely due to variations in abnormality definitions and study design. J Orthop Sports Phys Ther 2021;51(5)232-252. Epub 28 Mar 2021. doi10.2519/jospt.2021.9970.This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman's risk of developing cardiovascular disease (CVD) risk factors and of developing subsequent CVD (including fatal and nonfatal coronary heart disease, stroke, peripheral vascular disease, and heart failure). This statement highlights the importance of recognizing APOs when CVD risk is evaluated in women, although their value in reclassifying risk may not be established. A history of APOs is a prompt for more vigorous primordial prevention of CVD risk factors and primary prevention of CVD. Adopting a heart-healthy diet and increasing physical activity among women with APOs, starting in the postpartum setting and continuing across the life span, are important lifestyle interventions to decrease CVD risk. Lactation and breastfeeding may lower a woman's later cardiometabolic risk. link3 Black and Asian women experience a higher proportion APOs, with more severe clinical presentation and worse outcomes, than White women. More studies on APOs and CVD in non-White women are needed to better understand and address these health disparities. Future studies of aspirin, statins, and metformin may better inform our recommendations for pharmacotherapy in primary CVD prevention among women who have had an APO. Several opportunities exist for health care systems to improve transitions of care for women with APOs and to implement strategies to reduce their long-term CVD risk. One proposed strategy includes incorporation of the concept of a fourth trimester into clinical recommendations and health care policy.Using a longitudinal cluster-randomized controlled design, we examined whether the effects of Competencies for Adolescents with a Healthy Sexuality (COMPAS), an evidence-based sexual health promotion intervention, differ by adolescents' sexual experience. Participants were 699 students aged 14-16, 45.9% were sexually experienced, and assessed in the baseline, posttest, and 12- and 24-month follow-ups. All were recruited from 10 schools that were randomly assigned to the COMPAS program and waiting-list groups (WLG). Using an intent-to-treat analyses, longitudinal changes in psychosocial and behavioral outcomes were explored using generalized estimating equations. Compared to the WLG, COMPAS had a positive impact on six of the seven psychological and behavioral outcomes. Non-sexually experienced reported more favorable HIV-related attitudes, higher condom use intention, lower number of sexual partners, and higher condom use than those sexually experienced. Findings support the importance of implementing sex education actions before adolescents get involved in their first intimate relationships in order to achieve greater impact.