Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient’s ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.     

Motor imagery in spinal cord injured people is modulated by somatotopic coding,perspective taking,and post‐lesional chronic pain

Motor imagery (MI) allows one to mentally represent an action without necessarily performing it. Importantly, however, MI is profoundly influenced by the ability to actually execute actions, as demonstrated by the impairment of this ability as a consequence of lesions in motor cortices, limb amputations, movement limiting chronic pain, and spinal cord injury. Understanding MI and its deficits in patients with motor limitations is fundamentally important as development of some brain–computer interfaces and daily life strategies for coping with motor disorders are based on this ability. We explored MI in a large sample of patients with spinal cord injury (SCI) using a comprehensive battery of questionnaires to assess the ability to imagine actions from a first‐person or a third‐person perspective and also imagine the proprioceptive components of actions. Moreover, we correlated MI skills with personality measures and clinical variables such as the level and completeness of the lesion and the presence of chronic pain. We found that the MI deficits (1) concerned the body parts affected by deafferentation and deefferentation, (2) were present in first‐ but not in third‐person perspectives, and (3) were more altered in the presence of chronic pain. MI is thus closely related to bodily perceptions and representations. Every attempt to devise tools and trainings aimed at improving autonomy needs to consider the cognitive changes due to the body–brain disconnection.     

植入前组织配型孕育“救星同胞”的伦理思考

应用植入前遗传学诊断技术在胚胎植入母体子宫前,对人类白细胞组织相容性抗原配型检测,选择与现存患儿相同HLA配型的胚胎进行受孕,孕育一个组织配型相同的脐带血干细胞供者。在某种意义上说,该项技术的应用是创造人来获得移植组织,由此引发系列伦理争议。讨论孕育"救星同胞"这一医学实践内在需要的伦理规范。     

Analysis of An Intervention to Reduce or Prevent Secondary Conditions for People with Spinal Cord Injuries

People with acute spinal cord injuries (SCI) are at risk for developing secondary conditions such as pressure sores, urinary tract infections, pain, weight gain and deconditioning, and depression. This study analyzed the effectiveness of an Internet assessment and feedback tool in determining secondary condition risk for this population based on individual responses to a knowledge and behavioral questionnaire. Seventy-one people with newly-diagnosed SCI who were treated at one of five Model Spinal Cord Injury Systems Centers were randomly assigned to either an experimental condition in which they received computerized feedback and one-on-one consultations based on their online questionnaire answers, or to a control condition in which they received no feedback until the study's completion. One year after the initial assessment, the online questionnaire was re-administered to all participants as a post-test. Three times between the pre- and post-test assessments researchers telephoned participants to administer phone surveys probing secondary condition development. Results indicate there were significant differences among race groups and between complete and incomplete injury status for pressure sore occurrence. This study represents a new era of interactive technology in health promotion that can serve as a basis for future research to decrease secondary condition risk for people with SCI.     

Relationships Between Locus of Control, Coping Strategies and Emotional Well-Being in Persons with Spinal Cord Lesion

Relations between locus of control, coping strategies and emotional well-being in persons with traumatically acquired spinal cord lesion (SCL) were examined. The sample included 132 community-residing adults. Structural equation modelling, including confirmatory factor analysis, was used. A model was hypothesized based on the transactional theory of stress and coping where coping strategies mediated the relation between locus of control and emotional well-being. The model showed acceptable fit to the data and was compared with five alternative models. The alternative models fitted the data less well or were difficult to interpret. In the preferred model, persons indicating internal control reported more coping strategies (Acceptance, Fighting spirit) related to increased well-being, whereas persons indicating external control reported a coping strategy (Social reliance) related to poorer well-being. The findings support the stress and coping framework in medical rehabilitation and illustrate why some persons need coping effectiveness training to enhance emotional adjustment.     

Exploring the relationship between umbilical blood cord donation and the impact of social distance on altruism and trust

Allogeneic umbilical cord blood (UCB) donation is a pro-social behaviour directed to strangers that has a certain cost for the donor. Although the promotion of such behaviour is an important goal for many countries' health systems, little is known about the reasons that would lead to it. With this study, we explored how the impact of social closeness on altruism and trust could be related to UCB donation in a sample of new-mothers (N = 167). Participants played hypothetical Dictator and Trust games with socially close (e.g., parents) or distant (e.g., strangers) others. They donated more money to parents and siblings compared to cousins, friends and strangers and they trusted more parents, siblings and friends than cousins and strangers. Interestingly, the lower the impact of social closeness on altruism (i.e., generosity towards socially distant others), the higher the intention and the actual probability of UCB donation. A mediation analysis has shown that the relationship between social closeness on altruism and UCB donation was mediated by objective intention to donate (i.e., having followed all the procedures needed). These findings show that other-oriented motivations towards distant others might have important practical implications in identifying the targets of interventions for the promotion of UCB donation.     

Self-appraised problem-solving skills and the prediction of secondary complications among persons with spinal cord injuries

Secondary complications following spinal cord injury (SCI) include decubitus ulcers and recurrent urinary tract infections. These conditions can significantly impair quality of life and prove life-threatening; it is also believed that these conditions are mediated by behavioral pathways. According to the social problem-solving model, persons who report effective problem-solving skills should be capable of adhering to long-term therapeutic regimens of self-care necessary to prevent these complications. We tested this assumption in the present study. Discriminant function analyses revealed self-appraised skills in approaching and defining problems contributed to the prediction of secondary complications among 53 persons with SCI. Results are discussed in light of the social problem-solving model, and the utility of problem-solving interventions in rehabilitation is explored.     

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.     

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.     

脐血干细胞移植中的伦理思考

现代干细胞移植技术飞速发展。脐血干细胞移植在伦理学上具有胚胎干细胞和骨髓干细胞移植治疗不可比拟的优势,但是其伦理学上的可接受性并不等于伦理问题的消失。在脐血干细胞移植研究过程中,应该遵循伦理道德观和科学理性的原则,健康发展,造福人类。