SELF-ADMINISTERED WRITTEN PROMPTS TO TEACH HOME ACCIDENT PREVENTION SKILLS TO ADULTS WITH BRAIN INJURIES

This study evaluated the use of written checklists and task analyses as self-administered prompts to teach home accident prevention skills to 4 adults with brain injuries. Subsequent to baseline, participants used written checklists that identified potential in-home hazards but did not prompt behaviors necessary for hazard remediation. Written individualized task analyses, incorporating specific behavioral steps for correcting hazards that participants had failed to remediate during the checklist phase, were used to prompt appropriate responding when necessary. These were subsequently faded to transfer stimulus control to the natural conditions. A multiple probe technique across participants and settings was used. Results indicated that the checklist alone was sufficient to increase appropriate responses to many of the potential hazards. Individualized task analyses, when needed, resulted in appropriate remediation of all potential hazards. Generalization to untrained potential hazards occurred to some degree for all participants. Follow-up results showed that most skills trained were maintained over a 1-month period.     

Effects of behaviour change interventions on physical activity in people with spinal cord injury: A systematic review and meta-analysis

ObjectivesThis review investigated the effectiveness of behaviour-change interventions to improve physical activity (PA) participation in individuals with a spinal cord injury. Additionally, the review sought to analyse the change in PA behaviour that might be expected by utilising behaviour change in PA interventions and what specific intervention characteristics, application of behaviour change theories, and behaviour change techniques are most efficacious.MethodsThe protocol was prospectively registered on PROSPERO: CRD42021252744, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed in this review. Eight databases were comprehensively searched using a well-defined strategy developed in collaboration with an academic liaison librarian. Randomised, non-randomised controlled, and non-controlled studies were included in this review; however, controlled and non-controlled studies were analysed separately. Studies were included if participants were older than 16 years and had an SCI of any cause, level or severity, regardless of the time since injury. The behaviour change technique taxonomy version 1 was used to code the intervention characteristics for behaviour modification. The combined effects across studies were pooled in a meta-analysis, and the risk of bias was assessed using the Cochrane Risk of Bias 2 tool.ResultsThe search retrieved 10,155 titles and abstracts. After duplicate removal and screening against the eligibility criteria, 23 studies were included. The overall effect estimate of the change in PA participation in the controlled trials post-intervention was medium (d = 0.50, 95% CI = 0.31–0.70) in favour of behaviour-targeted interventions. The mean difference in PA volume between pre- and post-intervention was an increase of 22 minutes per week (95% CI = 5.96–38.90). Interventions that provided practical support (d = 0.81, 95% CI = 0.46–1.16), which were individualised (d = 0.62, 95% CI = 0.34–0.90) and that utilised monitoring (d = 0.59, 95% CI = 0.34–0.83) had a greater effect on change to PA than those that were group-based and did not utilise those specific techniques.ConclusionsInterventions that target behaviour change to increase PA in people with SCI appear effective. Utilising behaviour change frameworks and specific behaviour change techniques augments PA uptake and levels, and interventions aimed at improving PA in people with SCI should incorporate a behaviour modification component. More research is needed on the isolated effect of intervention structure parameters and specific behaviour change techniques.     

Development and validation of the Moral Outcomes of Relationship Aggression Scale: A measure of moral distress following intimate partner violence perpetration

Research with military veterans has established that distress may arise in response to perpetrating violent behaviors that violate individuals' moral beliefs. To date, no studies have similarly examined morally-related cognitive and emotional responses specifically among intimate partner violence (IPV) perpetrators. However, research on moral cognitions and emotions in response to IPV perpetration may inform understanding of the behavior and potential mechanisms for intervention. In the current series of four studies, we used classical test theory to develop a measure of moral distress following IPV perpetration that focuses on thoughts about the actions (assimilated cognitions), thoughts about the self due to one's actions (accommodated cognitions), and emotions experienced due to one's actions (moral emotions). Items were developed and tested among two samples of undergraduate students, and psychometric properties of the final measure were confirmed among two community samples. The final measure consists of three subscales consisting of five items each. Results demonstrate support for internal consistency and test–retest reliability, convergent, discriminant, and incremental validity, and factor structure. This measure can be used in future research designed to examine how individuals respond to their IPV perpetration, and to study the implications this may have for long-term outcomes and behavioral change.     

Recontextualising moral injury among military veterans: An integrative theoretical review

Moral injury was originally conceived as a socially-inflicted wound of betrayal experienced by military veterans (Shay, 1994). However, moral injury has since been redefined by psychological researchers as an individualised, predominantly perpetration-driven, and psychopathological phenomenon (e.g., Currier et al., 2015; Jinkerson, 2016). However, social scientific researchers (e.g., Hodgson & Carey, 2017; Molendijk, 2019; Wiinikka-Lydon, 2017) have contested mainstream psychology's medicalisation and decontextualisation of moral injury. This theoretical review integrates insights from across these discourses, and brings them into dialogue with ideas from moral psychology, evolutionary science, and community psychology. The aim of this cross-disciplinary review is to promote a more holistic understanding of moral injury that does justice to its individual and social dimensions. Drawing on these different theoretical strands, this paper proposes that moral injury can be best understood as a psychological wound to basic human needs for social belonging and cohesion. The implications of this integrative understanding of moral injury for applied psychologists and other societal actors are explored. While the relevance of moral injury to civilian populations such as health and social care professionals is clear (e.g., Dombo et al., 2013; French et al., 2021), this paper focuses on military veterans, whose experiences originally prompted the coinage of the term. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.     

The adverse influence of narcissistic injury and perfectionism on college students’ institutional attachment

This study examined the relationship of narcissistic vulnerability, shame-proneness, and perfectionism to college student adjustment. Using a sample of 200 college students, narcissistic injury, socially prescribed perfectionism, other-oriented perfectionism, and self-oriented perfectionism predicted college adjustment as defined as institutional attachment in a canonical correlation analysis. In addition, narcissistic injury, shame-proneness, and socially prescribed perfectionism were found to correlate positively with each other.     

Social Problem-Solving Abilities and Health Behaviors Among Persons with Recent-Onset Spinal Cord Injury

Although many persons with spinal cord injuries (SCI) are at risk for preventable complications, very little research has examined the health behaviors of these individuals. In this study, we examined self-reported health behaviors of persons with recent-onset SCI. We also studied the association between health behaviors and social problem-solving abilities. The results indicated that positive problem-solving characteristics were associated with more adaptive wellness and accident prevention behaviors. A negative orientation toward problem solving and avoidant and impulsive/careless styles was associated with increased traffic and substance risk taking. Implications are discussed in terms of health education, research, and prevention programs.     

“医药分业”改革的经济学分析

目前,我国药品监督管理机构正在推行“渐进式的医药分业”政策,目标是将药品价格总体下降26%～30%,将每年469亿元～547亿元的药品毛利化作医疗服务收费标准的调整幅度,以后医疗服务收费标准按物价指数逐年调整。但在现有条件下执行这一政策,表面上医疗机构是直接的利益受损者,但事实上广大的药品消费者或支付者将为之埋单而成为利益受损者,药品生产者和流通渠道才是这一政策的真正受益者,政府也将面临提高医疗服务收费标准或增加医疗机构补偿的两难抉择。     

临床肝移植的几点思考

近几年临床肝移植发展极为迅速,也因此产生了许多热点问题,本文对我国目前临床肝移植中存在的几个热点问题加以阐述,同时运用系统和辩证的观点进行分析,针对这些问题提出了自己的观点。     

Metamemory following childhood brain injury: A consequence of executive impairment

In this study, we investigated the influence of children’s level of executive functioning on two types of metamemory knowledge following a traumatic brain injury (TBI). For this purpose, 22 children (aged 7 to 14 years) who had sustained a moderate to severe TBI and 44 typically developing children were recruited. The children with TBI were divided into two groups according to the severity of their executive impairment. Injury severity was determined by the Glasgow Coma Scale (GCS) score on admission or by the duration of unconsciousness. All children were then tested on both their knowledge of general memory functioning and their level of memory self-awareness, respectively assessed using the total number of correct responses on an adapted version of a metamemory interview and a self-other discrepancy score on a questionnaire evaluating everyday memory abilities. Data analyses revealed that participants with TBI who suffered impaired executive functions demonstrated less general metamemory knowledge, and underestimated the frequency of their memory problems, compared with children with TBI who had preserved executive functions and with control participants. Considering the well-established effect of metamemory knowledge on people’s spontaneous implementation of strategies, the interest and the importance of these findings on both theoretical and clinical grounds are discussed.     

When Self-Blame Is Rational and Appropriate: The Limited Utility of Socratic Questioning in the Context of Moral Injury: Commentary on Wachen et al. (2016)

In this commentary, we argue that a generally sound therapeutic technique—Socratic questioning—is ill-suited to address a common variant of combat-related emotional and psychological distress. Specifically, moral injury is a term used to describe a syndrome of shame, self-handicapping, anger, and demoralization that occurs when deeply held beliefs and expectations about moral and ethical conduct are transgressed. Importantly, moral injury can and often does result from instances of intentional perpetration. We contend that challenging the accuracy of self-blame in such cases is conceptually problematic and potentially harmful. Such an approach is based on a questionable premise—i.e., that self-blame and resulting guilt are inherently illogical or inaccurate. Though this is often the case, it is not invariably so. We briefly describe an alternate approach—Adaptive Disclosure—that allows for accurate and legitimate self-blame when warranted but also promotes the possibilities of self-forgiveness, compassion, and moral reparation.