Mishandling the Gift of Life: Noncompliance in Renal Transplant Patients1

Two studies investigating renal transplant patients compliance with their post-transplant medical regimen are presented. Compliance was operationalized as a multidimensional construct incorporating behaviors that represent adherence to the regimen. Study 1 examined the association of noncompliance with clinically significant outcomes and the medical and demographic predictors of noncompliance. Noncompliance was associated with rejection episodes, graft loss, and multiple transplants. The best predictors of noncompliance were medication side effects, age, education, and insurance coverage. Study 2 examined the psychosocial predictors of noncompliance. After age and side-effects complaints, self-efficacy and threat appraisal were the best predictors of compliance. The implications of these results for expectancy-value models of health behaviors (e.g., protection motivation theory; Rogers, 1983) and their ability to predict compliance in patients following long-term regimens are discussed.     

男性不育患者的心理社会因素的研究

男性不育是一个较为复杂的临床综合症。婚后同居2年以上,有正常性生活,未采取避孕措施,女方不怀孕,称为不育症。在中国10对夫妇中约1对发生不育,属于女方因素约为60％,单属于男方约40％,属于男女双方共同的约10％。欧美等国家不育症患病率约为15％—20％。不育是令人非常痛苦的事,它不仅严重影响患者的身心健康,而且还会带来一定的社会问题。因此,不育症的相关因素显得颇为重要。本文对30列男性不育患者和30例已育子女的健康男性进行心理社会方面的调查研究。     

Characterization of the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) in Lung Transplant Candidates

The SIPAT is a standardized measure for pre-transplant psychosocial evaluation. Previous SIPAT studies utilized a relatively small lung transplant sample and only included listed patients. This study characterized the SIPAT in 147 lung transplant candidates to better elucidate its utility. The average score corresponded to a minimally acceptable rating and nearly half of the patients had relative or absolute contraindications. Interstitial Lung Disease (ILD) patients scored more favorably than non-ILD patients (U?=?7.69, p?<?.05). The Total (β?=?? .05, SE?=?.018, p?<?.01), Social Support Subscale (β?=?? .133, SE?=?.058, p?<?.05), and Psychosocial Stability and Psychopathology Subscale (β?=?? .103, SE?=?.040, p?<?.05) significantly predicted listing status. The SIPAT has a unique profile in lung transplant candidates and demonstrated utility for guiding transplant decisions. Future research should examine which lung transplant outcomes are significantly associated with SIPAT scores.

     

Psychosocial Factors and Disease Progression in Cancer

ABSTRACT— Psychosocial factors such as stress, personality, and social support relate to differences in disease progression in cancer patients. Neuroendocrine substances associated with psychosocial factors may regulate immune responses to cancer, as well as regulate the activity of oncogenic (cancer-causing) viruses, DNA-repair processes, and the expression in tumor cells of genes that may affect the tumor's growth and metastasis. Biobehavioral oncology research seeks to understand how these psychosocial factors, and interventions designed to modify them, become neurohormonal changes that alter cell signaling and tumor growth, viral oncogenesis, and immune responses. We review the empirical basis for psychosocial factors and biobehavioral processes in cancer progression and suggest future research.     

Psychosocial Factors in Child Safety Restraint Use1

Within the past 3 years, a majority of states have passed laws requiring children riding in automobiles to be properly restrained in safety devices. Several studies indicate that such laws have only a modest effect on the number of children being properly protected. To determine factors associated with safety restraint use a telephone interview survey was conducted with 211 residents of a state that has had a child safety restraint law in effect for two years. Several hypotheses derived from the Health Belief Model were tested. The model was generally supported, but will require some revision to explain a routine and repetitive behavior such as safety seat use. While strong general resistance to government intervention in family behavior was found, this did not translate into resistance of safety seat laws.     

Psychological Distress in Caregivers of Liver and Lung Transplant Candidates

Although organ transplantation represents a stressful experience for the entire family, surprisingly little research has focused on the adjustment of caregivers. The purpose of this study was to examine what caregivers report to be the greatest benefits and stressors pretransplant, the prevalence of psychological distress and caregiver strain in pretransplant caregivers as compared to normative populations, and the physical, psychological, and demographic variables that predict distress. Fifty-two caregivers of transplant candidates (28 liver and 24 lung) completed a series of questionnaires, including the Psychosocial Adjustment to Illness Scale (PAIS-SR), SF-36 Health Survey, Caregiver Strain Index (CSI), and qualitative questions about benefits and stressors. The most commonly reported benefit of being a caregiver could be categorized as Helping the Patient, and the most common stressors were associated with Uncertainty/Waiting/Fears. Compared to normative samples of caregivers of patients with Alzheimer's disease, caregivers of liver transplant candidates reported more caregiver strain; there were no differences for lung transplant caregivers. Caregiver social functioning was found to be the only significant predictor of caregiver distress, with those caregivers who report greater distress also reporting extreme and frequent interference with normal social activities. Implications of these findings for psychological interventions are discussed.     

活体肝移植供者心理社会方面问题的研究进展

活体肝移植供者心理社会方面问题的主要研究进展为：多数供者与受者之间有血缘关系,或者有亲密的情感联系;供者有利他主义动机;供者术后有短期健康相关生存质量下降,但术后1年之内可恢复正常。     

Psychosocial Factors Predicting SARS-Preventive Behaviors in Four Major SARS-Affected Regions

This multinational study examined intended and actual adoption of SARS-preventive behaviors in major SARS-affected regions: Guangdong (China), Hong Kong, Singapore, and Toronto (Canada). The theory of reasoned action (TRA) and the theory of planned behavior (TPB) were adopted as theoretical frameworks. A measure was constructed to assess attitude, subjective norm, perceived behavioral control (PBC), knowledge of SARS, and SARS-preventive behaviors. Seventy-five working adults were recruited from each region. They completed the new measure in an initial study, and reported their actual behaviors 2 weeks later. Results provided cross-cultural generalizability of the TRA by showing that attitude and subject norm predicted SARS-preventive behaviors for all the groups. PBC was a statistically significant predictor for all participants except those from Guangdong, indicating that the TPB is applicable only to people from Hong Kong, Singapore, and Toronto. Knowledge of SARS also was found to be an independent predictor.     

A Review of Psychosocial Factors in Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a disabling pain condition poorly understood by medical professionals. Because CRPS is particularly enigmatic, and has significant impact on patient function, researchers have examined psychological processes present among patients with this diagnosis. This systematic review examines psychosocial factors associated with CRPS, both predictors and sequelae. Our conclusions are that CRPS is associated with negative outcomes, both psychological (e.g., increased depression and anxiety) and psychosocial (e.g., reduced quality of life, impaired occupational function) in nature. However, research does not reveal support for specific personality or psychopathology predictors of the condition.     

Evaluating Psychosocial Factors and Psychological Reactions to Infertility Treatment

Abstract

This study presents preliminary findings evaluating the relationship between marital cohesion, pregnancy outcome, and gender and the level of stress and depression experienced by individuals pursuing infertility treatment. Women exhibited more stress and depression than men prior to treatment did, yet the level of change (pre-post) in depression and stress after treatment did not differ by gender. Pregnancy outcome helped predict post-treatment depression in women and men, and post-treatment stress for women. Clinical suggestions for preand post-cycle consultations are presented.     

循证医学对肝移植患者心理治疗应用

采用循证医学方法,通过计算机检索Pubmed和CNKI有关肝移植与心理学的文章,对肝移植患者术前和术后心理不同特点进行总结,制定心理干预措施。以便在临床工作中为患者进行合理的心理指导,从而提高肝移植患者健康水平和生活质量。     

Refraining Resistance and Noncompliance in Cognitive Therapy

Despite its general success, not everyone responds to cognitive therapy. Some clients have difficulty complying with assignments and others appear to be frankly resistant. This article considers strategies for dealing with passive noncompliance and active resistance within cognitive therapy. In general, it is argued that the process of therapy is usually facilitated by staying within the cognitive model—that is, by exploring and working through those beliefs and attitudes that underlie noncompliance and resistance in the same manner that other problematic beliefs and attitudes are approached. Also considered are strategies for dealing with unrealistic expectations regarding the pace of change, therapists' errors leading to noncompliance and resistance, and instances in which the therapeutic model is simply insufficient.     

Perceptions of Liver Transplant Candidates with or Without an Alcohol Use History

Cirrhosis secondary to alcohol use is a primary cause of liver disease and a medical condition for which liver transplantation is a viable treatment option. However, there remains considerable debate within both the lay and the medical communities regarding the distribution of a scarce medical resource to adults with alcoholism. This study examined college students' perceptions toward an adult, presented in a written vignette, for whom liver transplantation was medically indicated. The influence of gender (female and male) and alcohol use history (no alcohol history, alcoholism history with long-term abstinence, alcoholism history with current use) on these ratings was examined. Subjects rated the adult presented with no alcohol history more positively than they did the adults presented with a history of alcoholism. Also, the adult with no alcohol history was more likely to be offered transplantation and was given higher priority ratings for transplantation by subjects. While subjects' own alcohol use history and organ donor registration status were not associated with ratings, having a family member with an alcohol problem and personally knowing a transplant recipient were related to more favorable ratings toward the adult presented in the vignette. Implications of these findings as well as limitations of the study are discussed.     

正确认识心理因素在颞颌关节紊乱病中的作用

颞颌关节紊乱病(temporomandibular disorder,TMD)是口腔颌面部常见的疾病之一。TMD病因比较复杂,目前认为是多种因素作用的结果,主要为心理因素、牙合因素等。但是目前对于心理因素在TMD的发生、发展、治疗和转归方面,很多学者尚持有异议。运用系统论中的整体性原则、动态性原则、系统涨落理论、综合性原则和最佳化原则等阐明如何才能获得对心理因素在TMD中的作用的全面认识,并指出重视心理因素在TMD中的作用也是顺应医学模式转变,体现人文关怀的需要。     

心理社会因素在糖尿病发病及其干预中的作用

近年来,全球糖尿病患病率逐年上升,并成为继肿瘤、心脑血管疾病后第三大严重危害人类健康的疾病。本文从生物-心理-社会医学角度出发,通过查阅并汇总文献,论述了糖尿病对现代人生活质量的影响,并探究了影响糖尿病的各种心理社会因素,最后提出了三种防治糖尿病的心理干预措施。     

Selection of Movement Patterns During Functional Tasks in Humans

These experiments examine the role of vision and step height in the selection of a simple binary choice of movement pattern by human subjects. The subjects selected a heel strike movement pattern (HS) (as used during level surface locomotion) or a toe strike movement pattern (TS) (as used during stair descent). The functional task involved descending a step of adjustable height followed by level surface walking under vision and nonvision conditions. Triceps surae and tibialis anterior electromyographic (EMG) activity, ankle angle position, and vertical force were examined. As step height was increased, there was an indistinct threshold at which subjects switched from landing with a HS movement pattern to a TS movement pattern. The tibialis anterior and triceps surae precontact EMG bursts and subsequent ankle movement for HS and TS trials appear to be part of preprogrammed movement patterns, which are presumably of central origin. The particular mixture of voluntary, stereotypic, and reflex actions for any specified movement is based on the intent or functional outcome desired. The switching to the TS movement pattern as step height increased presumably results in the most efficient and stable movement.     

心理社会因素在糖尿病发病及其干预中的作用

近年来,全球糖尿病患病率逐年上升,并成为继肿瘤、心脑血管疾病后第三大严重危害人类健康的疾病.本文从生物一心理一社会医学角度出发,通过查阅并汇总文献,论述了糖尿病对现代人生活质量的影响,并探究了影响糖尿病的各种心理社会因素,最后提出了三种防治糖尿病的心理干预措施.