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• CBT effectively improves endometriosis symptoms in adults. • Evidence for CBT is lacking but is needed for adolescents with endometriosis. • We propose a biopsychosocial model using CBT to improve adolescent endometriosis symptoms. Recent advances and interest in nonpharmacological treatment approaches for various chronic pain conditions in adolescent patients have increased. Cognitive behavioral therapy (CBT) is widely regarded as the leading nonpharmacological treatment for chronic pain, encompassing gynecological conditions associated with chronic pelvic pain, such as endometriosis. Adolescents with endometriosis often present with different symptoms than adults and frequently report more comorbid psychiatric disorders than the general public. This review aims to (1) justify the application of CBT interventions in the context of adolescent patients with endometriosis; (2) integrate and analyze existing empirical evidence and reviews; (3) highlight the advantages, constraints, and future research directions in CBT for this demographic; and (4) introduce a novel biopsychosocial conceptual model. This model intricately considers the interplay of thoughts, emotions, behaviors, and physical symptoms specific to adolescents with endometriosis, providing a foundation for targeted CBT interventions. This holistic approach recognizes the multifaceted nature of their experience, paving the way for comprehensive and effective nonpharmacological therapeutic strategies. Given the nuanced and intricate nature of endometriosis in adolescents, there is a pressing need for innovative conceptual models and clinical trials of behavioral interventions explicitly designed for this demographic. [ABSTRACT FROM AUTHOR]

The objective of this scoping review was to examine resilience and resilient pain behaviors for those with CLBP in relation to resilience definitions, operationalization (e.g. trait or behavior), and application of theoretical frameworks. This scoping review examined resilience and resilient pain behaviors for those with CLBP in relation to resilience definitions, operationalization (e.g. trait or behavior), and application of theoretical frameworks. To gather data, we used five databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Ovid MEDLINE, PsycInfo, and Scopus. Authors used a systematic data charting spreadsheet (Microsoft Excel) to review and analyze the extracted data. A total of 26 articles, from 2011-2021, were included in the final analysis. A majority of articles were conducted in the United States (11) and cross-sectional secondary data analysis design (13). Resilience definitions varied across the studies. Three studies operationalized resilience as a trait and only one as a behavior. Most studies (20) did not include a theoretical framework. The majority cross-sectional design and heterogeneity of a resilience definition indicates resilience research is still emerging. The lack of operationalized resilience, specifically as a behavior, and the limited use of theoretical frameworks suggest advancements in resilience pain research are needed. This research has implications for nursing practice to support nurse's holistic perspective and the ability to incorporate resilience within nursing care. This research provides the initial steps to developing standard resilience definitions and frameworks to guide nursing practice. [ABSTRACT FROM AUTHOR]

TMD pain and dysfunction were observed in up to 66 % and 41 % of patients seeking orthodontic treatment. Evidence-based knowledge of TMD etiology, detection, and management is thus paramount in contemporary orthodontic practice. This analytical review aims to introduce the biopsychosocial model, scrutinize the psychosocial construct, propose psychosocial screening tools, and clarify the effectiveness of psychological interventions for TMDs. The biopsychosocial model specifies that TMDs are the consequence of dynamic interactions between biological, psychological, and social factors across time. As the frequency of moderate-to-severe psychological distress and somatization/somatic symptoms burden is high in individuals with TMDs, prospective orthodontic patients should be screened for TMDs/psychosocial impairments to circumvent treatment and medico-legal complications. Among the available screening tools, an amalgamation of the quintessential 5 TMD symptoms (5Ts) of the DC/TMD, Physical Symptom Scale-8 (PSS-8), and Patient Health Questionnaire-4 (PHQ-4) provides an efficient way of identifying TMD, somatic, and psychological symptoms synchronously. For prospective orthodontic patients with considerable TMD pain/dysfunction and distress, tailored multimodal and multidisciplinary treatments incorporating psychosocial interventions, including counseling/self-management, cognitive-behavioral therapy, and behavior modification, may be warranted. Complementary positive psychological interventions could also be valuable in TMD management and the paradigm shift from "reactive" to "proactive" TMD care. [ABSTRACT FROM AUTHOR]

• Fruit diseases cause significant quantitative and qualitative losses. • Nanotechnology emerged as an efficient tool for disease management. • Beneficial microbes also have an effective role in managing fruit diseases. Management of fruit diseases is a leading challenge at the cutting-edge innovations in agriculture having a direct impact on safety, sustainability and quality of food. The present review hunts through the innovative domains of nano-based and biocontrol and approaches for the disease management of fruits, exploring the mechanism of actions as well as the plausible impacts on agriculture. Various types of nano-materials, along with their mode of action, are analyzed comprehensively, highlighting their antimicrobial potential, genetic and physical disruption capacities, command over production of ethylene and maturity of harvest, intervention with cellular pathways, and part it plays in modulating the activities of enzymes and gaseous interchange. The biocontrol strategy concentrates on using naturally occurring agents to manage pathogenic organisms and to evaluate the mode of action of these bio-agents. It also focuses on parameters that influence the efficiency of these bio-agents as well as their effect on the quality of the fruits. The present in-depth review focuses on providing a comprehensive picture of both these novel strategies, emphasizing their potential as a sustainable substitute for conventional strategies of control, their efficiency, and their significance in disease management of fruits. Simultaneously, it provides important insight into the subsequent agricultural strategies in the future and the materialization of sustainable, eco-friendly, and efficient means of minimizing losses and maintenance of the quality of fruits. [ABSTRACT FROM AUTHOR]

Proximal humerus fracture (PHF) is a common upper extremity injury. PHF often causes prolonged disability and interferes with independent function. This study reviewed and summarized prognostic factors of recovery following PHF and classified them within the International Classification of Functioning, Disability and Health (ICF) with each domain sub-categorized by modifiability. Systematic review. We searched MEDLINE, CINAHL, EMBASE, and PsychINFO from the date of database inception to March 2019 and updated searches in December 2021. Studies included examining an association between prognostic factors and recovery with at least a 6-month follow-up. Two independent reviewers used the Quality in Prognosis Studies tool for methodological bias and levels of evidence. Designs showed wide variability in terms of characteristics of the included population, definition of recovery, assessment of prognostic factors, and outcome measures used. This prevented pooled estimates from being produced. Prognostic factors linked to ICF domains were possible. Twenty-three studies including 4323 participants aged ≥18 met inclusion criteria. The risk of bias was low (35%), moderate (30%), and high (35%) across the included studies. Moderate evidence showed a significant association between pre-fracture functional independence and post-fracture complications with recovery. Fracture type, structural deformity, medication use, age, and gender were prognostic factors with inconclusive evidence. We assigned a weak level of evidence to the remaining 20 factors due to limited data. Immediate rehabilitation, compliance to post-fracture rehabilitation exercise, task-oriented exercise, and pain self-efficacy (i.e., coping behavior) are modifiable and are tapped into the ICF contextual factors. An array of factors that fit within an ICF biopsychosocial framework have been investigated as potential mediators of outcomes after PHF. The evidence is incomplete conceptually and in terms of research design quality. Preoperative functional status is predictive of functional recovery emphasizing the importance of healthy aging. • Proximal humerus fracture (PHF) is a commonly injury causing prolonged disability. • Evidence for modifiable prognostic factors of recovery after PHF is lacking. • Preinjury functional status is predictive of recovery after PHF. • Biopsychosocial predictors should be considered in recovery plan after PHF. [ABSTRACT FROM AUTHOR]

La dépersonnalisation est décrite comme banale et fréquente dans des registres aussi variés que l'hystérie, le trouble phobique et anxieux, les troubles dissociatifs, la dépression et la psychose. Tandis que très peu d'écrits en donnent une description clinique en rapport avec des atteintes plus spécifiquement somatiques comme la drépanocytose, le présent article donne une description dudit trouble chez trois jeunes adultes drépanocytaires homozygotes (SS) et tente d'en décrypter la psychopathologie et les processus inconscients responsables de son apparition dans un tel contexte. L'étude est exploratoire, descriptive et qualitative. La méthode appliquée est l'étude de cas. Les participants ont été sélectionnés en milieux hospitaliers dans la ville de Yaoundé au Cameroun. Les données ont été collectées à l'aide d'une grille d'entretien clinique de type semi-directif puis ont fait l'objet d'une analyse de contenu. Nous avons repéré chez ces participants des phénomènes de dépersonnalisation–déréalisation corrélés à des facteurs « contre-élaboratifs » – un sentiment trop présent de « mort imminente » – et une présence trop marquée des signes visibles de la maladie, elle-même liée à un environnement culturel marqué par la rareté de soins adaptés aux besoins biopsychosociaux des populations atteintes ; – et ainsi qu'à des registres psychopathologiques dont l'étiopathogénie s'aggrave à la faveur d'un vacillement identitaire et d'un infléchissement de la libido au moment d'entrer dans la vie adulte. Cette thèse remonte à Mayer Gross qui avait suggéré que la dépersonnalisation serait une réponse archaïque du cerveau à des situations de survie. Ces résultats suggèrent une compréhension de la dépersonnalisation comme une attitude défensive du jeune adulte homozygote face à une réalité jugée trop menaçante. Un mouvement régressif comme retour à une phase primaire du développement où il faisait bon vivre. Depersonalization is described as commonplace and frequent in such varied registers as hysteria, phobic and anxiety disorders, dissociative disorders, depression, and psychosis. However, very few papers give a clinical description in relation to more specifically somatic disorders such as sickle cell disease. This article describes the disorder in three young adults with homozygous sickle cell disease (SS) and attempts to decipher its psychopathology and the unconscious processes responsible for its appearance in this context. The study is exploratory, descriptive, and qualitative. The method applied is the case study. The participants were selected in hospitals in the city of Yaoundé in Cameroon. The data were collected using a clinical interview grid of the semi-directive type and then subjected to a content analysis. We identified depersonalization–derealization phenomena in these participants, correlated with "counter-elaborative" factors – an overly present feeling of "imminent death" – and an overly marked presence of visible signs of the disease. This is itself linked to a cultural environment marked by the scarcity of care adapted to the biopsychosocial needs of the affected populations, and to psychopathological registers whose etiopathogenesis is aggravated by a vacillation of identity and an inflection of the libido in the transition from adolescence to adulthood. This thesis is inspired by Mayer Gross who suggested that depersonalization is an archaic response of the brain to survival situations. These results suggest an understanding of depersonalization as a defensive attitude of the homozygous young adult faced with a reality judged as too threatening, regressive movement as a return to a primary phase of development where life was good. [ABSTRACT FROM AUTHOR]

This paper presents a new approach based on the combination of machine learning techniques, in particular, sentiment analysis using lexicons, and multivariate statistical methods to assess the evolution of social mood through the COVID-19 vaccination process in Spain. Analysing 41,669 Spanish tweets posted between 27 February 2020 and 31 December 2021, different sentiments were assessed using a list of Spanish words and their associations with eight basic emotions (anger, fear, anticipation, trust, surprise, sadness, joy and disgust) and three valences (neutral, negative and positive). How the different subjective emotions were distributed across the tweets was determined using several descriptive statistics; a trajectory plot representing the emotional valence vs narrative time was also included. The results achieved are highly illustrative of the social mood of citizens, registering the different emerging opinion clusters, gauging public states of mind via the collective valence, and detecting the prevalence of different emotions in the successive phases of the vaccination process. The present combination in formal models of objective and subjective information would therefore provide a more accurate vision of social reality, in this case regarding the COVID-19 vaccination process in Spain, which will enable a more effective resolution of problems. [ABSTRACT FROM AUTHOR]

Functional Neurological Disorder (FND) is considered a biopsychosocial disorder nowadays, with chronicity in >50% of cases. The INTERMED Self-Assessment Questionnaire (IMSA) assesses the various domains and indicates biopsychosocial complexity. FND patients were compared with a sample of psychosomatic (PSM) patients as well as post-stroke patients. The three samples (N = 287 altogether) were largely in inpatient and day clinic psychotherapeutic treatment or inpatient neurological rehabilitation. The IMSA covers all three biopsychosocial domains as well as health care utilisation in the time frame of the past, the present and the future. In addition, affective burden (GAD-7, PHQ-9), somatoform symptoms (PHQ-15), dissociation (FDS) and quality of life (SF-12) were evaluated. FND and PSM patients scored highly in the IMSA, with ≥70% regarded as complex, compared to 15% of post-stroke patients. Affective, somatoform and dissociation scores were high in FND and PSM patients. Mental and somatic quality of life were lower in these groups compared to post-stroke patients. FND patients showed high biopsychosocial strain, similar to a typical sample of inpatient and day clinic, i.e. severely affected, PSM patients, and they were more affected than post-stroke patients. These data emphasize that FND should be evaluated with a biopsychosocial perspective. The IMSA likely represents a valuable tool, which has to be assessed by further longitudinal studies. • Seventy per cent of patients with FND are biopsychosocially complex. • All domains of the biopsychosocial evaluation show high values in FND patients. • FND patients show lower values of quality of life than stroke patients. • Biopsychosocial evaluation should be used in the initial evaluation of FND. • Prospective longitudinal studies should include a biopsychosocial evaluation. [ABSTRACT FROM AUTHOR]

We examined the relation between psychological flow and cardiovascular markers of challenge. According to flow theory and the biopsychosocial model of challenge and threat (BPS-CT) optimal motivational states (flow, challenge) arise during activities where task demands meet personal resources. Participants (N = 154) played Tetris in either an underload, fit, or overload condition. Cardiovascular responses were measured during the task and a flow state scale was completed afterwards. Unexpectedly, it was in the underload condition where cardiovascular responses developed in the direction of challenge. Moreover, it was under this condition where relative challenge related positively to both task performance and self-reported flow. Similar results were found for cardiovascular markers of task engagement. In line with the BPS-CT, when only selecting clearly task-engaged participants a tendency towards challenge was found in the fit condition. We discuss why flow and challenge might have co-occurred in the underload condition, as well as the further theoretical and methodological implications of the study. We conclude that at least under some circumstances flow and challenge relate to each other but that future research should examine this relation further. • We integrate flow theory with the biopsychosocial model of challenge and threat. • We propose that flow is marked by a cardiovascular pattern of challenge. • We find evidence for this in a computer game context. • Flow also related to cardiovascular makers of task engagement. [ABSTRACT FROM AUTHOR]

Nachdem in Teil 1 des Beitrags im vorigen Heft ein deutlicher Bedarf für einen kohärenten, interprofessionellen und metakonzeptionellen Rahmen für die osteopathische Versorgung nachgewiesen wurde, wird im 2. Teil des Hypothesenpapiers die Integrale Theorie (IT) als ein ganzheitlicher, evidenzbasierter, multimodaler, selbstreflexiver klinischer Argumentationsprozess vorgeschlagen und aufgezeigt, wie die verschiedenen osteopathischen Versorgungsmodelle in das Vier-Quadranten-Modell der IT eingefügt werden können. Die Integrale Theorie findet beispielsweise im Rahmen der psychosomatischen Osteopathie ihre Anwendung, bei der auch die spirituelle Komponente des Seins beleuchtet wird, um Patient*innen innerhalb ihres gesamten Lebenskontexts zu behandeln. So können beim Menschen in jedem dieser – von der Befruchtung bis zum Tod reichenden – Entwicklungsschritte und Morphodynamiken mögliche schädliche oder belastende externe oder interne Einflüsse auftreten, die zu Befindensstörungen, Symptomen und zu somatisch-energetisch-psychischen Dysfunktionsmustern führen können. Having demonstrated a clear need for a coherent, interprofessional, and metaconceptual framework for osteopathic care in part 1 in the previous issue, part 2 of this hypothesis paper proposes Integral Theory (IT) as a holistic, evidence-based, multimodal, self-reflexive clinical reasoning process and shows how the different osteopathic models of care can be integrated into the 4-quadrant model of IT. This is used, for example, in the context of psychosomatic osteopathy, where the spiritual component of being is also taken into account in order to treat patients within their whole life context. Thus, in humans, in each of these developmental steps and morphodynamics – from conception to death – possibly harmful or stressful external or internal influences may occur, which can lead to disorders of well-being, symptoms and to somatic-energetic-psychic dysfunctional patterns. [ABSTRACT FROM AUTHOR]

Predicting suicide risk based on risk and protective factors is a critical and complex endeavor. In this study, we combined insights from comprehensive aetiological theories on suicide with the methodological strengths of machine learning techniques. Our primary objectives were twofold: a) to identify hazardous feature combinations that characterize a high risk of suicide, and b) to enhance our understanding of the potential interactions between risk and protective factors related to suicide. We established an interpretable decision tree model to classify young adults at high risk of suicide, utilizing fifty-five variables covering distal, developmental, proximal, and social context factors from a large-scale cross-sectional survey (N = 88,214). The results highlighted the significance of variables such as self-compassion and non-suicidal self-injury (NSSI), and the accumulation of depressive symptoms, medium-to-low self-compassion, and a history of NSSI as substantial indicators of heightened suicide risk. This study serves as a valuable reference for the clinical identification of individuals at risk of suicide. • We developed a decision tree model for classifying suicide risk based on cross-sectional data of 88,214 young adults. • Significant markers for a high suicide risk included low self-compassion, non-suicidal self-injury (NSSI), and depression. • The co-occurrence of low self-compassion, depression, and NSSI indicates a five-fold increased risk of suicide. [ABSTRACT FROM AUTHOR]

The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) is to review the available evidence and provide expert advice regarding the diagnosis and management of cyclic vomiting syndrome. This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. This expert commentary incorporates important as well as recently published studies in this field, and it reflects the experiences of the authors who are experts in treating patients with cyclic vomiting syndrome. [ABSTRACT FROM AUTHOR]

Certains spécialistes de l'autisme font de l'idiotisme l'origine historique du trouble. En résonance avec cette hypothèse, l'augmentation de la prévalence du trouble du spectre autistique est expliquée par différentes hypothèses, impliquant ou non une continuité historique. L'objectif de cet article est d'explorer la validité de ces hypothèses, en nous appuyant sur une comparaison historique des descriptions cliniques de l'idiotisme et de l'autisme. Afin d'établir cette correspondance sémiologique, nous relèverons les descriptions cliniques de l'époque de l'idiotisme et les comparerons à celles de l'autisme du DSM-5. Puis, nous regarderons les autres maladies pouvant être responsables d'un retard mental et associées potentiellement à l'idiotisme. La correspondance est frappante, notamment en ce qui concerne la communication, l'absence de contact visuel, les caractéristiques psychomotrices, l'attachement aux routines, les réactions extrêmes à la sensorialité et les compétences hors-normes. Cette correspondance pourrait bien être le fruit d'un biais d'interprétation. Aujourd'hui, certaines maladies responsables du retard mental ont disparu ou leur origine biologique a été identifiée. Il apparaît que la population atteinte d'idiotisme au 19ème siècle ne correspond pas à la population observée actuellement dans l'autisme. Il se pourrait que cette correspondance soit en partie vraie, mais elle semble biaisée par l'omission de certaines maladies sorties depuis du champ psychiatrique, du fait de la découverte de leur étiologie biologique. Some autism specialists locate idiocy as the historical origin of the disorder, implying that it would be a phenomenon present throughout the ages, but only correctly diagnosed today. In resonance with this hypothesis, the increase in the prevalence of Autism Spectrum Disorder is explained by different theories. It could be linked either to an improvement in the diagnostic approach and better identification of the disorder, or to a bio-psycho-social context favoring its appearance, or to an extension of the diagnostic criteria and a modification of the classifications. The purpose of this article is to explore the validity of these different hypotheses, drawing on a historical comparison of clinical descriptions of idiocy and autism. In order to establish this semiological correspondence, we will identify the clinical descriptions from the era of idiocy written by Edouard Séguin, "l'instituteur des idiots" (the schoolmaster of idiots), and will compare them with those of the autism in the DSM-5. Then, we will look at the historical process of other diseases that may be responsible for mental retardation and potentially associated with idiocy. The overlap between idiocy and autism is striking, especially with lack of communication skills, lack of eye contact, psychomotor characteristics, attachment to routines, extreme sensory reactions, and non-standard skills. This correspondence could demonstrate the continuity of the diagnostic entity over time between idiocy and autism, but could just as well be the result of a bias in interpretation. Some diseases responsible for mental retardation observed by the alienists of Séguin's time have been identified as having a biological and genetic origin. For some of them, treatments have been found and have led to their disappearance. It appears that the population identified with idiocy in the 19th century does not correspond to the population currently diagnosed with autism. This correspondence may be partly valid, but it seems mainly biased by the omission of some diseases that have been forgotten or removed from the psychiatric field, by the fact that their biological etiology has been identified. [ABSTRACT FROM AUTHOR]

Structural racism is a powerful determinant of health that drives health disparities, morbidity, and mortality across racialized and minoritized groups. This article discusses approaches for measuring structural racism and its resultant network of negative biopsychosocial consequences for health and well-being. We draw on prevailing theoretical models and approaches to characterize both the nature of structural racism and integrated methods for assessing its consequences across mental and physical health. This article will serve to guide researchers in health-related disciplines to accurately assess the biopsychosocial consequences of structural racism in key populations. • Structural racism creates poor health for racialized and minoritized communities. • Structural racism is multilevel and multidimensional. • Structural racism should be examined as a predictor of biopsychosocial health. • Biopsychosocial approaches are useful for identifying downstream health impacts. • Interdisciplinary research is needed in close partnership with communities. [ABSTRACT FROM AUTHOR]

Abdominal pain is the most distressing symptom of chronic pancreatitis (CP), and current treatments show limited benefit. Pain phenotypes may be more useful than diagnostic categories when planning treatments, and the presence or absence of constant pain in CP may be a useful prognostic indicator. This cross-sectional study examined dimensions of pain in CP, compared pain in CP with chronic primary pain (CPP), and assessed whether constant pain in CP is associated with poorer outcomes. Patients with CP (N = 91) and CPP (N = 127) completed the Comprehensive Pancreatitis Assessment Tool. Differences in clinical characteristics and pain dimensions were assessed between a) CP and CPP and b) CP patients with constant versus intermittent pain. Latent class regression analysis was performed (N = 192) to group participants based on pain dimensions and clinical characteristics. Compared to CPP, CP patients had higher quality of life (p < 0.001), lower pain severity (p < 0.001), and were more likely to use strong opioids (p < 0.001). Within CP, constant pain was associated with a stronger response to pain triggers (p < 0.05), greater pain spread (p < 0.01), greater pain severity, more features of central sensitization, greater pain catastrophising, and lower quality of life compared to intermittent pain (all p values ≤ 0.001). Latent class regression analysis identified three groups, that mapped onto the following patient groups 1) combined CPP and CP-constant, 2) majority CPP, and 3) majority CP-intermittent. Within CP, constant pain may represent a pain phenotype that corresponds with poorer outcomes. CP patients with constant pain show similarities to some patients with CPP, potentially indicating shared mechanisms. [ABSTRACT FROM AUTHOR]

We aimed to describe jaw function characteristics in patients with anterior disc displacement without reduction (ADDWoR) using the jaw function limitation scale (JFLS), and to investigate the effects of biopsychosocial risk factors on limited jaw function. In this cross-sectional study of 636 patients with ADDWoR (females, 568; males, 68), we used the JFLS to assess jaw function. Behavioral, psychological, sociodemographic, and biomedical data were collected. Multivariate logistic regression analysis was used to determine risk factors affecting limited jaw function. A receiver operating characteristic curve was used to evaluate the predictive effect of these risk factors. ADDWoR-associated limitations included restricted jaw mobility and mastication, which exceeded median global functional limitations scale scores, especially mouth opening to bite an apple and chewing tough food. Females had greater limitations in jaw mobility, verbal and emotional communication, and overall. Multivariate logistic regression analysis findings indicated that oral behaviors, anxiety, sex, pain intensity, and maximal mouth opening (MMO) were predictive of limited jaw function (area under the curve, 72 %). Patients with ADDWoR reported mastication and jaw mobility restrictions, with females having more pronounced limitations, and specific risk factors identified as significant predictors of jaw function limitations. Along with pain relief and improvement in MMO, appropriate psychological counseling and oral behavioral correction facilitates recovery of jaw function in such patients. • Patients with ADDWoR have restrictions in jaw mobility and mastication. • Jaw mobility, verbal and emotional communication, and global are more limited in women. • Oral behaviors, anxiety, sex, pain, and MMO predict jaw function limitations. • Psychological counseling and oral behavioral correction may also be required. [ABSTRACT FROM AUTHOR]

• There is a need for biopsychosocial integrative hypotheses concerning depression. • The schismogenesis construct could be part of a potential hypothesis. • Such hypothesis could explain a common mechanism of action for all validated antidepressant therapies. In recent decades, an important amount of biomedical and psychosocial data regarding major depression etiology and treatment has emerged. Despite this wealth of information, a global hypothesis seeking to integrate all available data into a unified explanatory model of depression is still missing. The biopsychosocial model is a precedent in this endeavor. This model proposes a systemic conceptual framework, suggesting that the dynamic interactions of biological, psychological, and social factors constantly condition individuals' health status. However, it has been criticized for its lack of practical utility when it comes to understanding the onset and potential reversion of depression. Gregory Bateson proposed a systemic, transdisciplinary construct that may be useful for addressing these criticalities: schismogenesis. While this concept has found increasing application across different areas such as politics, ecology, or even psychotherapy, to the best of our knowledge, its use as a biopsychosocial etiology hypothesis for depression remains unexplored. The schismogenesis hypothesis suggests that depression can be considered as a switching process mediated by positive feedback curves, leading to a functional dissociation due to insufficient inhibitory control. Nonetheless, this process can be either reversed spontaneously or through external help, resulting in a rebalancing of the system. [ABSTRACT FROM AUTHOR]

Physiotherapy in a specialized rehabilitation center (CER) has an important role in the care of Persons with Disabilities (PwD), it can be a fundamental part of adopting the biopsychosocial approach that is sought in these centers, provided that the organization of work is also aligned providing comprehensive care to PwD. to know facilitators and obstacles related to the organization of the physiotherapist's work in the Center specialized in rehabilitation and its relationship with the care practices provided to Persons with Disabilities. This is a qualitative and descriptive study, taking the case study as a guiding model, developed from ethnographic analysis resources. The study was developed with the association of three data collection strategies: document analysis, direct observation with conversational approaches and interviews with CER physiotherapists in the state of Paraíba-PB, data analysis was performed through the reconstruction of scenes, articulating the elements captured in the data production process. The study reveals that there are weaknesses in the organization of the work of physiotherapists in the CER in question, and that these have an impact on the way work is conducted and provided to people with disabilities, noting that improvements and adjustments are needed in the organization of work in issues such as: promoting strategies that bring the physiotherapist closer to practices such as welcoming, favoring moments between the physiotherapist and the multidisciplinary team for assessments in an integrated manner and articulation with other points of the care network for people with disabilities, stimulating and organizing strategies to strengthen and include shared care in the sector, and implement strategies such as team meetings and the execution of the Singular Therapeutic Project. Knowledge of the facilitators and obstacles in the organization of the physiotherapists' work allowed identifying the weaknesses present in the service, which distances these professionals from providing assistance from the perspective of the biopsychosocial approach to CER users, and verifying the aspects that contribute to the distance between work prescribed by the Rehabilitation Instruction, and how the work is performed at the study site. Understanding the organization of the work of physiotherapists in health services is still a scarce task in the field of research, so this work raises this debate in the field of physiotherapy. In addition, its results can become important elements for a better understanding of the management of the work of these professionals in the centers and perhaps produce changes in the organization and work process of physiotherapists in the CER. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia due to changes in the hormone insulin. The most common type is type 2(DM2), which has insulin resistance as one of its manifestations. Several metabolic changes affect these patients, including endothelial dysfunction and vascular and neurological disorders, as well as impact on quality of life, mental health, and sleep. Pharmacological therapy is one of the main interventions, associated with adaptations in the diet and physical activity routine. However, patients with DM2 do not adhere to treatment for various reasons and the disease continues its progression, burdening the entire health system and impacting the lives of this individual and his entire community. Photobiomodulation therapy (PBMT) appears as an alternative because it acts on energy metabolism, the side effects are negligible, and its non-invasive application can favor adherence. Several scientific studies have shown its effectiveness in glycemic control in an experimental model and the first studies with humans are beginning to emerge to consolidate this possibility. To verify the effects of PBMT by infrared LED on blood glucose levels and consequent impact on the biopsychosocial context of patients with DM2. Therefore, initial and final laboratory tests of fasting blood glucose, glycated hemoglobin, HOMA-IR index and application of quality of life and sleep questionnaires, perception of pain, sensitivity and mental health will be carried out. Randomized, double-blind controlled trial with sham group. Sample space of 36 volunteers diagnosed with DM2, distributed in: sham (irradiation with zero parameters), panel (irradiation by the Joovv Elite system of the whole body) and blanket (irradiation with a flexible blanket prototype applied to the abdomen and bilaterally to the quadriceps femoris, hamstrings, triceps surae, arm and forearm). The volunteers underwent initial and final assessments consisting of laboratory tests (fasting blood glucose, glycated hemoglobin and HOMA-IR index) and questionnaires (Diabetes Quality of Life-Brazil-8, Neuropathic Pain Questionnaire 4, painDETECT, Sleep Quality Index of Pittsburgh, Depression, Anxiety and Stress Scale). Participants will be irradiated (active or not) every other day within a 12-day period. As this is a study protocol, there are no results, conclusions, and implications to be presented. [ABSTRACT FROM AUTHOR]

Early intervention is highly recommended for infants who present some biological risk. Some principles of this intervention are well established, such as family-centered practice, parental involvement in-home therapy, and environmental enrichment. However, although participation is currently considered the main goal to be achieved in the intervention, few protocols assess this component, and even fewer use participation as a component of early intervention. Furthermore, it is essential to verify the effectiveness of remote protocols, considering that this modality of therapy delivery has been adopted more frequently in recent years. To verify the effectiveness of the remote STEP protocol (composed of stimulation of motor skills, participation, mother-child interaction, and environmental enrichment) in the participation of infants at biological risk at home in the first year of life. This is a randomized controlled clinical trial. The study included 46 infants with biological risk (prematurity, low birth weight, hospitalization, cardiopulmonary resuscitation) between 3 and 9 months, who were randomized into the STEP Group (n=24, mean age=6.3 months) and the Control Group (n=22, mean age=6.4 months). Assessments were blinded, and infants were assessed for their frequency and involvement in participation at home by Young Children's Participation and Environment Measure (YC-PEM) via telephone interview, before and after the intervention. The STEP group 79had goals established by the parents and the intervention consisted of specific motor training (based on the principles of motor learning, focus on repetition, variation, and increasing the complexity of the task); stimulation of participation (increased involvement of the infant in daily tasks, such as feeding and self-care, and playing with family members); guidance regarding mother-child interaction and environmental enrichment (promotion of an environment rich in stimuli, with greater possibilities for exploration). The control group had its goals defined by the therapist, and the intervention was based on motor stimulation, according to the infant's abilities. In both groups, the intervention was carried out by the parents at home, with instructions given by the therapist remotely, lasting 10 weeks (5 times a week, 30 minutes a day). Infants showed no differences in baseline measurements. A Mann-Whitney test was applied to verify the difference between the change of groups after the intervention, with a significance of 5%. The STEP group showed significantly higher improvement compared to the control group after the intervention, in the domain of frequency (p=0.005) and participation involvement (p=0.005). The STEP protocol proved to be promising to enhance the participation at home of infants at biological risk in the first year of life. This result reinforces the importance of stimulating participation in activities of daily living and interactions with the family. Early intervention protocols that stimulate not only motor domains but also involve a biopsychosocial approach, should be included in clinical practice. The results demonstrate how this model, which takes into account preferences and family involvement, encourages participation, and has a low investment cost, can improve functionality in the first year of life. [ABSTRACT FROM AUTHOR]

The misuse of the lower extremities during mobility activities can affect individuals with different health conditions and directly impact their daily routines. Thus, it is essential to assess the performance of individuals in these activities for an accurate diagnosis of the limitation. The Lower Extremity Motor Activity Log (LE-MAL) is an instrument developed to assess the use of the lower extremities in mobility activities. However, how the content of the LE-MAL items is related to the framework of the current biopsychosocial functioning model is unknown. To link the LE-MAL items with the International Classification of Functioning, Disability, and Health (ICF) and identify the contents of the LE-MAL items. Concepts within each item of the LE-MAL were linked to the best-matched ICF categories using established linking rules. Two independent researchers performed the initial linkage of the items, and the final consensus was reached after a meeting with the other researchers involved in the study. Ten concepts were identified. The two-level main concepts identified were d410 (changing basic body position), d450 (walking), d455 (moving around), and d460 (moving around in different locations). All items assess performance through information about need or dependence, personal and environmental factors, and appraisal. All items are covered in the Mobility domain (d4) of the Activity and Participation component. Moderate agreement was obtained between researchers. The LE-MAL fits into the mobility domain of ICF, and the items' general construct is the performance evaluation. The study highlighted the conceptual connection between the LEMAL and the ICF framework. The use of the functioning model proposed as a framework – the ICF, enables the use of the LE-MAL as a tool that supports clinical professionals' use of ICF coding in clinical settings. This allows the common language between professionals and the classification of patients with different conditions. Moreover, the LE-MAL was developed for people with gait dysfunction and might represent a comprehensive way to analyze the lower extremity use during mobility activities in different health conditions. [ABSTRACT FROM AUTHOR]

To explore the available knowledge on the application of biopsychosocial model (BPS) in patients with chronic low back pain (CLBP). Methods: A scoping review, including 32 papers that used a BPS to manage adult patients with CLBP, published in any language. Six different databases were searched. According to the description of the protocols, most of them use BPS for assessment of the patients. In this first stage the most often evaluated were pain and disability, kinesiophobia and quality of life, and work-related factors. The intervention most used associate psychological and physical domains using pain education or cognitive functional therapy and active exercise. Even though was not the most common, in the social domain occupational, behavioral and family interventions were observed. BPS is more often used as combination of physical and psychological aspects, being the social domain restricted to work-related factors. Patien'ts perception of their health status is little explored, and it is suggested that the International Classification of Functioning, Disability and Health be used. Practice Implication: Patient perception as well as social factors in addition to occupational ones should be included in the clinical approach of the patient with CLBP and should be further explored in research. • Patient's perspective on health status should be considered during treatment course. • Interventions using the model usually uses physical and psychological aspects. • The use of the International Classification of Functioning was not observed in the studies, despite the World Health Organization recommendation. • Social aspects are frequently not considered in assessments and interventions. [ABSTRACT FROM AUTHOR]

Positive airway pressure treatment (CPAP) is the gold standard for obstructive sleep apnea syndrome (OSAS). CPAP is highly effective, but its issue lays in poor adherence rates mainly caused by its invasive nature and related stigma. In accordance with a biopsychosocial model of CPAP adherence, psychosocial interventions have been implemented to alleviate low rates of adherence with promising results. The increase in the number of psychosocial interventions has highlighted the need to systematically evaluate their effectiveness. This review aims to identify psychosocial interventions used to increase CPAP adherence, to compile available data on their effectiveness, and the reasons why they are effective. Moreover, the review evaluates the impact of the interventions on sleep quality. Experimental and quasi-experimental studies testing psychosocial interventions (excluding educational only interventions) that aimed to increase CPAP adherence in adults with obstructive sleep apnea vs. no intervention or control group were included. A literature search in PsycINFO, MEDLINE, COCHRANE, EMBASE, CINAHL, and Web of Science was performed for studies published in English and French between 1980 and January 2020. Risk of bias and methodological quality were assessed using the Joanna Briggs Institute Critical Appraisal Tools. Fourteen studies were included involving 1923 participants, six trials tested a motivational intervention, three trials tested a cognitive behavioral intervention and five others tested one of the following: relaxation, exposition therapy, phone coaching, audiotape or stage-matched intervention. Thirteen studies reported a positive effect of the intervention on CPAP adherence, while one reported no effect. Psychosocial interventions for CPAP adherence appear effective at increasing sleep quality, but more studies are needed to test this hypothesis. Reasons for the effectiveness of the interventions were pooled into five categories: time related, the intervention's adaptability, the patient's characteristics, the intervention's nature and characteristics and the intervention's specifics and target. The current review raises a significant gap between the biomedical and psychosocial domains. In fact, even in a psychosocial intervention study, the interpretation of the results revolves around biomedical models and very little consideration is given to biopsychosocial models. Our findings demonstrate the importance of examining the relationship between psychosocial variables and CPAP adherence to better tailor interventions to increase CPAP adherence. [ABSTRACT FROM AUTHOR]

Although a range of risk factors have been identified for disordered eating and weight status, the breadth of risk factors have been rarely considered within a single, comprehensive model. The robustness of these findings across countries also remains an open question. The present study sampled 6272 participants aged 18–30 years from eight countries in an attempt to evaluate combined and unique predictors for these two conditions, and to explore possible cross-country differences in these models. Participants completed a range of demographic, biological, behavioral, psychological, and sociocultural measures to test a comprehensive model of the contributions of these predictors for disordered eating and weight-related constructs (binge eating, body mass index, compensatory behaviors, dietary restraint, drive for muscularity, and drive for leanness). Structural invariance testing within a multigroup path analysis framework revealed that a single model across the eight countries provided poor model fit. Freeing of 22% of parameters across countries provided excellent fit and a satisfactory compromise for country-invariant and country-variant parameters in the model. Overall, predictors accounted for between 15% and 60% of variance in the outcome measures, with lowest explained variance for the disordered eating outcomes. Significant unique contributions to prediction were observed for each of the five risk factor variable types and across the eight countries. Thus, the findings show strong support for this model as an explanatory framework of both disordered eating and weight status. • Tested a biopsychosocial model predicting weight, body image and disordered eating outcomes. • Most model parameters (78%) functioned equivalently across eight countries tested. • Significant demographic, biological, behavioral, psychological and sociocultural predictors were found. • Variance explained ranged from 15% to 60%, with lower explanatory power for disordered eating. [ABSTRACT FROM AUTHOR]

Objective: To evaluate patients' and partners' satisfaction with a prostate cancer survivorship program embedded in urologic-oncologic care. As a part of quality improvement activity, we developed a patient and partner-centered, biopsychosocial support program for men and partners coping with the urinary and sexual side-effects of surgical treatment for prostate cancer. The program became a part of usual care for all prostate cancer patients.Methods: Patients who saw both an advanced practice provider and a sex therapist between August 1, 2018 and July 31, 2019 were eligible. Surveys packets were sent to 146 patients with surveys included for partners (N = 292). We used descriptive statistics to characterize participant responses.Results: Responses were received from 88 patients and 70 partners (56% response rate for the group). Patients and partners reported very high or fairly high satisfaction with the rehabilitation activities of the program (86-97% and 90%-100%, respectively); 91% of patients and 84% of partners thought having pre-operative education and post-operative rehabilitation was a good or fairly good idea; 83% of patients and 79% of partners would very much or somewhat recommend the program to a friend who was considering surgical treatment for prostate cancer.Conclusion: Embedding a patient and partner-centered prostate cancer survivorship support program in oncologic care can positively impact patients' and partners' engagement in and satisfaction with post-operative rehabilitation. [ABSTRACT FROM AUTHOR]

Background: We aimed to identify randomized clinical trials (RCTs) which evaluated the efficacy of adjunctive psychosocial interventions to improve outcomes during the perinatal period for women with bipolar disorder (BD).Methods: We scanned the literature to identify RCTs evaluating the efficacy of adjunctive psychosocial therapies or interventions provided during the perinatal period to women with BD. We searched from 1946 to July 2020 using Embase, Ovid Medline, PsycINFO, and Scopus. We then searched for future, current, and recently completed RCTs described on www.ClinicalTrials.gov.Results: This scoping review (1946 - July 2020) revealed no published RCTs for this population. The findings expose an important gap in research and knowledge, as well as a health disparity.Conclusion: We heuristically tied a mechanistic stress reduction model to relevant findings. The initial hypotheses are informed by effective stress reducing psychosocial interventions for: a) people with BD outside the perinatal period and b) perinatal women with major depressive disorder (MDD may improve the health of perinatal women with BD). We hypothesize that the perinatal trajectory of health for women with BD will improve by adding psychosocial interventions or therapies to treatment as usual. We propose maternal stress reduction as a potential mediator/mechanism.Limitations: Findings reported are limited to the methods of a scoping review. Reproductive status tends to be a missing variable; we highlight the need for its inclusion. Interdisciplinary, collaborative research to improve the treatment outcome for perinatal women with BD is warranted and ripe for advancement. [ABSTRACT FROM AUTHOR]

Chronic disease self-management is the establishment and maintenance of behaviors needed to be an active participant in one's health care and experience the best health outcomes. Kidney disease self-management behaviors to slow disease progression include engaging in exercise or physical activity; adhering to a diet low in sodium, potassium, and phosphorus; monitoring laboratory parameters; managing complex medication regimens; coping with disease-related emotional distress; and communicating effectively with providers. Durable behavior change has been difficult to achieve in kidney disease, in part because of an incomplete understanding of the multilevel factors determining chronic disease self-management in this patient group. The biopsychosocial model of chronic illness care posits that an individual's health outcomes result from biological, psychological, social, and environmental factors as part of a multilevel systems hierarchy. Although this theoretical model has been used to comprehensively identify factors driving self-management in other chronic conditions, it has been applied infrequently to behavioral interventions in kidney disease. In this scoping review, we apply the biopsychosocial model of health to identify individual, interpersonal, and systems-level drivers of kidney disease self-management behaviors. We further highlight factors that may serve as novel, impactful targets of theory-based behavioral interventions to understand and sustain behavior change in kidney disease. [ABSTRACT FROM AUTHOR]

• Older Latino adults living in rural communities experience significant disparity in chronic pain care. • Low-cost, low-literacy pain management training based on biopsychosocial model can be delivered by health professionals without training in chronic pain treatment. • A culturally tailored chronic pain management program focusing on patient's functional needs is feasible and offers access to evidence-based pain care for low-income older adults in rural communities. This study explored if a self-management training program was feasible for a predominantly older rural Latino adults with chronic pain who had limited access to non-pharmacologically based pain treatment. Physical therapy doctoral students delivered the six-week low-literacy low-cost patient-centered program. The intervention was feasible to the participants (n=38) who showed improvement in a majority of the eight outcome measures at 6-week posttest and three measures at 18-week followup. The changes in pain severity, pain interference and pain-related physical functions reached minimally clinically important difference at follow-up. A randomized controlled trial with long-term follow-up is needed to test the program effectiveness in partnership with community health centers to increase access to pain management in rural communities. [ABSTRACT FROM AUTHOR]

Adolescence can be a particularly challenging period for individuals with a chronic illness. To help the specialized healthcare teams, an expert panel drafted a checklist of topics to be addressed throughout adolescence that are often not covered in subspecialty clinic visits such as peers, coping, adherence, understanding of illness, sexuality, etc., since these topics apply to youth with special healthcare needs. Each member of the specialized team can discuss one of the themes according to their role with the adolescent as a doctor, educator, nurse, dietician, etc. The coherence of the team enables a comprehensive approach and will facilitate the transition to adult medical care. [ABSTRACT FROM AUTHOR]

Mood dynamics during pregnancy are important in understanding a critical period of human development, and also as a model for biopsychosocial stress processes. Here, in four large samples of smartphone app respondents (differentiated by time period and number of responses), we modeled mood for each gestational day during the pregnancy period. We aimed to delineate patterns of changes in mood across pregnancy, as well as potential changes in measurement properties across the period. Results indicated that three prominent mood factors — positivity, distress, and irritability — could account for responses in this period, and that changes in measurement properties of mood items across pregnancy were small in magnitude. Mean irritability increased, and positivity decreased, in the first trimester before reversing in direction; there was also some evidence for previously reported U-shaped trends in mood, where negative mood is greatest early in pregnancy, decreases, and then increases again. Results help characterize mood processes at a detailed level during a critical period, and point to directions for future research to explicate causes and effects of mood changes during this time. [ABSTRACT FROM AUTHOR]

Objective: Does psychosocial intervention affect pregnancy outcomes in women and couples undergoing assisted reproductive technology (ART) treatment?.Design: A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) evaluating the efficacy of psychosocial intervention on pregnancy outcomes in women and couples undergoing ART treatment. The primary outcome was Pregnancy Rates. Secondary outcomes were Live Birth Rate (LBR) and Abortion Rate (AR).Materials and Methods: Databases searched were Pubmed, PsycINFO, Embase, CINAHL and The Cochrane Library. 1439 records were screened, 15 were eligible and included in the meta-analyses (N = 2434). Data was extracted using the Covidence software. Effect sizes were reported as relative risks with 95% confidence-intervals and p-values.Results: A positive association was found between psychosocial intervention and pregnancy rates (RR = 1.12 CI=(1.01;1.24), p = 0.033). Long-duration interventions and mind-body intervention types were found to be associated with increased pregnancy rates (RR 1.21, CI= (1.04;1.43), p = 0.017) and (RR = 1.25, CI= (1.00;1.55), p = 0.046) respectively. Q and I2tests suggested no to low heterogeneity. Funnel plots, Trim and Fill analyses and Fail-safe numbers were applied to adjust for possible publication bias.Conclusions: Our findings suggest a positive association between psychosocial interventions, particularly long-duration interventions, and pregnancy rate in infertile women and couples in ART treatment. The findings are in line with findings from other reviews and meta-analyses exploring the same topic. More good quality RCTs need to be performed to increase the quality of guidance for infertile women and couples. The effect of psychosocial interventions on LBR and AR remain to be examined. [ABSTRACT FROM AUTHOR]

In the past two decades, stress researchers have mainly studied the harmful consequences of stress on individuals' physical, psychological and performance outcomes. Hence, these adverse effects were broadly shared through the media, leading to the conventional thinking that stress is "mostly a bad thing to be avoided". Yet, stress is not always bad; in some contexts, high stress levels are normal and desirable. Besides the adaptative nature of these stress responses to environmental threats or challenges, they were also shown to facilitate personal initiative, productivity (Dienstbier, 1989; Epel, McEwen, & Ickovics, 1998; Fay & Sonnentag, 2002), and performance (Jamieson et al., 2010). What then determines whether stress responses help or harm individuals? A recent research field is interested in studying how the way individuals think of, perceive, or appraise stress influences stress-related outcomes. Stress mindsets are the meta-cognitive processes that shape how individuals interpret stress's overall meaning as debilitating (negative) or enhancing (positive). Interestingly, these stress mindsets are important moderators of whether stress responses end up being good or bad for individuals. When confronted with specific stressful situations such as academic tests, stress mindsets shape whether individuals appraise their stress responses as either a resource to face the situation or harmful and uncontrollable. Individuals who hold the mindset that stress-can-be-enhancing benefit the most from their stress responses, as shown, for instance, by increased performance on tests. Grounded in the mindset theory and the biopsychosocial model of challenge and threat (Jamieson et al., 2018), new interventions were developed to inform individuals that the broad nature of stress can be enhancing and even beneficial. These interventions are called « wise interventions » as they are very short and aim to manipulate the psychological processes by which people make sense of themselves, the world, or any situation they are facing (Walton & Wilson, 2018). Results from studies evaluating the effectiveness of these interventions showed that stress mindsets were indeed easily malleable. Furthermore, by optimizing stress mindsets, individuals benefited from several positive physiological, psychological, and performance outcomes (Crum et al., 2013, 2017; Yeager et al., 2022; Jamieson et al., 2013, 2016; Keech et al., 2018). However, while this promising field of research is growing, some questions remain. First, as this field is mainly based on college participants, more is needed to know about how stress mindsets vary between individuals and other population groups. Audrey-Ann Journault (University of Montreal, Canada) will present a study showing how stress mindsets vary across three age groups and gender in a large descriptive study. Second, the moderating effect of stress mindsets on various cognitive outcomes under stressful conditions remains to be examined. Felix Duplessis-Marcotte (University of Quebec in Montreal, Canada) will discuss recent evidence from an experimental study that a stress-can-be-enhancing mindset differentially affects decision-making under stressful conditions across sexes. Third, while stress mindsets are a belief system about what stress can be, they may not in themselves help people seek out and engage with difficult stressors. Thus, research has shown that it is also important to teach individuals 1) that they can grow and learn from difficult challenges as their abilities are malleable (i.e., to develop a growth mindset) and 2) that they can appraise their stress responses (e.g., increased heart rate) in these specific situations as additional tools to persevere through difficulties and attain valued goals. A new synergistic mindsets intervention integrating both ideas has shown promising psychological and physiological effects, but these were heterogeneous. Hence, this field of research now aims to explore psychological affordances, or in other words, what modulating factors explain that these interventions work in some contexts but not others? Cameron Hecht (University of Texas, United States) will discuss the effects of this synergistic mindsets intervention on peripheral resistance (i.e., a measure of vasoconstriction in the body's periphery) under a specific laboratory stressful condition (TSST), and on young adults' appraisals of this specific stressor as being whether challenging or threatening. He will also show that the consistency between the messages communicated by the classroom instructors and the intervention content is one contextual factor that can help maintain the intervention's effects over time and explain part of the heterogeneity in these effects. Finally, compared to the clear beneficial effects of the mindsets intervention on the autonomic system, its effects on the HPA axis (as measured by salivary cortisol) have been inconsistent and sometimes surprising. Karishma Singh (University of Rochester, United States) will discuss the recent promising results from an experimental study that further assessed the effects of the synergistic mindsets intervention in a school-based ecological context. Using a diary journaling design, this study captured the daily stressful situations that youth from minoritized and low-income backgrounds experienced throughout a week. She will present that the synergistic mindsets intervention decreased youth's daily cortisol levels while increasing their academic grades in difficult classes (e.g., mathematics and sciences) compared to a control condition. Understanding better individual differences in stress mindsets, their psychological and physiological implications, and the contexts in which stress mindsets interventions are best helpful will contribute to extending the research on stress. Most of all, this symposium also aims to create a place for collective reflections and discussions about the negative angle we chose and promote while studying stress and its potential repercussions for the lay public. [ABSTRACT FROM AUTHOR]

• In 2020, students' beliefs regarding chronic pain were more biopsychosocial. • In 2020, students' guideline adherence was higher except for work, it remained low. • 4th year students have stronger biopsychosocial beliefs than 2nd year students. • Students' beliefs regarding chronic pain differed significantly between institutions. • Actions are needed to improve students' attitudes and beliefs regarding chronic pain. In 2013, physical therapy students demonstrated low guideline-adherent recommendations regarding chronic low back pain (CLBP) for spinal pathology, activity, and work. To assess the differences in physical therapy students' attitudes, beliefs, and adherence to guideline recommendations regarding CLBP and knee osteoarthritis between 2013 and 2020. In 2013 and 2020, second and fourth-year physical therapy students were recruited from 6 Belgian and 2 Dutch institutions. Attitudes and beliefs regarding CLBP and knee OA were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and a questionnaire regarding therapeutic exercise and knee osteoarthritis. A clinical vignette was used to measure guideline-adherent recommendations regarding spinal pathology, activity, and work. In 2013, 927 second-year and 695 fourth-year students; in 2020, 695 second-year and 489 fourth-year students; were recruited to participate in the study. Compared to 2013, students had less biomedical and stronger biopsychosocial attitudes and beliefs regarding CLBP, more guideline-adherent recommendations for activity, and more biopsychosocial beliefs regarding the benefits of exercise for patients with knee osteoarthritis in both the second and fourth year. Only fourth-year students in 2020 scored significantly better on HC-PAIRS and guideline-adherent recommendation relating to spinal pathology. No differences were found regarding work recommendations. Between 2013 and 2020, physical therapy students made a positive shift towards a more biopsychosocial approach to CLBP and knee osteoarthritis management. Guideline-adherent recommendations for CLBP concerning activity improved, however, concerning work and spinal pathology, it remained low. [ABSTRACT FROM AUTHOR]

New Zealand is a peaceful nation, but ongoing political tensions and inequities between Māori (the indigenous peoples of New Zealand) and Pākehā (the majority group of Europeans) persist as a result of its colonial history. Identifying ways to redress the enduring legacy of colonialism are therefore of critical importance. Accordingly, this paper examines data from 7017 Māori, as well as 37,233 Pākehā, to examine the impact of regional-level Pākehā warmth towards Māori on Māori support for progressive collective action. Results reveal that Pākehā warmth towards Māori varies markedly across 257 regional wards (regional units created for New Zealand electoral purposes). Moreover, multilevel modelling demonstrates that Pākehā warmth towards Māori at the region-level correlates positively with Māori identity and political efficacy at the individual level which, in turn, both correlate positively with collective action support. Collectively, these results demonstrate the impact of the broader social climate on social change, while identifying a previously-unknown facilitator of collective action support (namely, a broader context of warmth towards structurally disadvantaged groups). [ABSTRACT FROM AUTHOR]

Pediatric living donor liver transplantation (LDLT) is the only way to save children with end-stage liver disease. The donor for liver transplantation (LT) may have a complicated psychosocial condition. This review aims to identify the domains of the donor psychosocial questions that should be addressed and summarize the aspects and tools future psychosocial assessments should include. We searched the PubMed, Medline, Cochrane Library, Embase, Web of Science, and Google Scholar databases for the terms pediatric, liver transplantation, donor, and psychosocial. We used the Joanna Briggs Institute Critical Appraisal Tool to appraise reporting quality. Two researchers independently selected the papers and performed data extraction and quality appraisal. The articles included in this review contain 26 quantitative studies and 2 qualitative studies. The study quality was moderate to high. Donors have ambivalence, anxiety, the need for family and social support, the need for adequate information, distress, and low self-esteem during the preoperative period. In the postoperative period they have poor psychological condition, panic disorder, conversion disorder and substance use/abuse disorder, abnormal family functioning, better psychosocial outcome, or among others. The assessment methods consisted of the questionnaire survey and semi-structured interview. Among the 28 studies, 17 different psychosocial domains were mentioned. The most frequently referred to was family and social support. The contents of the psychosocial assessment must include anxiety or depression, family and social support, ambivalence, information, and positive psychosocial characteristics. Assessment methods should use the questionnaire survey and semi-structured interview. According to this review, future research can develop a specific psychosocial assessment tool for pediatric LT donors. • This study explores the psychosocial status of donors in pediatric living donor liver transplantation. • We assessed anxiety, level of support, ambivalence, information, and positive characteristics. • We provide evidence for the next step in developing a psychosocial assessment tool. [ABSTRACT FROM AUTHOR]

Objective: To explore the views of primary care teams about the provision of self-management support to patients with common health problems.Methods: Semi-structured interviews were conducted with twenty-one members of the primary care team from thirteen general practices. Interviews were transcribed verbatim, and analysed using the 'Framework' approach.Results: Three categories and six sub-categories illustrating different self-management support activities across common health problems were identified from the analysis of interviews, and contributed to one major theme and one cross-cutting theme. Referral and signposting were frequently used to facilitate patient engagement with external services and resources. Practitioners faced some challenges in balancing medical management and psychosocial support and motivating patients to engage with self-management.Conclusions: Primary care teams described providing a wide range of self-management support activities, but the pattern of use varied for different types of health problem. These patterns may have been influenced, in part, by general practices focusing upon achieving financially incentivised quality improvement goals.Practice Implications: To improve self-management support, practitioners need a digital repository of services/resources, motivational interviewing skills, an understanding of the optimum duration and pattern of consultations, and incentivised targets that match a biopsychosocial model of care. [ABSTRACT FROM AUTHOR]

Background: Existing genetic information can be leveraged to identify patients with susceptibilities to conditions that might impact their perioperative care, but clinicians generally have limited exposure and are not trained to contextualise this information. We identified patients with genetic susceptibilities to anaesthetic complications using a perioperative biorepository and characterised the concordance with existing diagnoses.Methods: Adult patients undergoing surgery within Michigan Medicine from 2012 to 2017 were consented for genotyping. Genotypes were integrated with the electronic health record (EHR). We retrospectively characterised frequencies of variants associated with butyrylcholinesterase deficiency, factor V Leiden, and malignant hyperthermia, three pharmacogenetic factors with perioperative implications. We calculated the percentage homozygous and heterozygous for each that had been diagnosed previously and searched for EHR findings consistent with a predisposition.Results: Analysis of genetic data revealed that 25 out of 40 769 (0.1%) patients were homozygous and 1918 (4.7%) were heterozygous for mutations associated with butyrylcholinesterase deficiency. Of the homozygous individuals, 14 (56%) carried a pre-existing diagnosis. For factor V Leiden, 29 (0.1%) were homozygous and 2153 (5.3%) heterozygous. Of the homozygous individuals, three (10%) were diagnosed by EHR-derived phenotype and six (21%) by clinician review. Malignant hyperthermia was assessed in a subset of patients. We detected two patients with associated mutations. Neither carried clinical diagnoses.Conclusions: We identified patients with genetic susceptibility to perioperative complications using an open source script designed for clinician use. We validated this application in a retrospective analysis for three conditions with well-characterised inheritance, and showed that not all genetic susceptibilities were documented in the EHR. [ABSTRACT FROM AUTHOR]

• The concept of cerebral palsy (CP) has evolved over 2 centuries, with neuroscientific and social developmental theories, and was revolutionized by the International Classification of Functioning, Disability and Health framework. • Early brain injury (EBI) stands as a seminal turning point of the individual's story. • Post-EBI development is a new dimension of the developmental pathway in which the individual with EBI develops within his/her own environment. Cerebral palsy (CP), an umbrella term for a developmental motor disorder caused by early brain injury (EBI)/interference, remains debated. In this essay, we present a narrative, beginning with the original anatomical-clinical description of the so-called paralysie congéniale (congenial paralysis) by the French psychiatrist Jean-Baptiste Cazauvieilh. We then discuss how the concept has evolved over the last 2 centuries. We aim to illustrate these ideas with the biopsychosocial model of health, especially in light of the current neuroscientific and sociological knowledge of human development. We endeavour to integrate 3 connected but distinct entities: (1) the EBI as a seminal turning point of the individual's story; (2) the clinical findings we call CP, when motor impairment and activity limitation related to post-EBI (or other early non-progressive brain interference) appears, and; (3) a post-EBI developmental condition that encompasses the overall consequences of an EBI. This framework should guide individual, familial and collective care discussions and research strategies beyond the scope of CP. [ABSTRACT FROM AUTHOR]

The relationship between biopsychosocial factors and patient-reported function is less clear in pediatric than in adult hand surgery patients. Our primary hypothesis was that pain interference (PI) and peer relationships (PR) would demonstrate association with upper extremity function. Secondarily, we hypothesized that the magnitude of this effect would increase with age. Patients aged 5 to 17 years presenting to a tertiary academic clinic between October 2017 and January 2019 were included. The parent/guardian was administered the following instruments after indicating they, rather than the patient, were answering the questions on a tablet computer: Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Parent Proxy (PP) Computer Adaptive Test (CAT) v2.0, PROMIS PI PP CAT v2.0, and the PROMIS PR PP CAT v2.0. Ceiling/floor effects and Spearman correlations were calculated. Multivariable Tobit modeling was performed to determine whether biopsychosocial factors and upper extremity function were associated. Multivariable regression coefficients were compared between age cohorts using a separate multivariable model to evaluate the interaction between age and other predictors. Of 139 included participants, the mean age was 11.7 ± 3.7 years and 50% were female. For patients 11 years of age or younger, UE was weakly correlated with PI (coefficient, –0.34; 95% confidence interval, –0.56 to –0.08) and was not correlated with PR. For patients older than 11 years, UE had moderate correlation with PI (coefficient, –0.60; 95% confidence interval, –0.72 to –0.45) and was not correlated with PR. Multivariable analysis demonstrated a significant negative association between PI and UE, with a significantly larger magnitude of effect for patients older than 11 years of age. The biopsychosocial model applies to pediatric hand surgery patients. The association between greater pain interference and worse patient-reported upper extremity function, as assessed using parent proxy instruments, was significantly stronger for patients older than 11 years than those 11 years old or younger. This study suggests that the biopsychosocial model applies to pediatric hand patients. [ABSTRACT FROM AUTHOR]

Avoidant/restrictive food intake disorder (ARFID), which was introduced in DSM-5, may be one of the most functionally impairing eating disorders, yet little is known regarding risk factors, prevalence, or efficacious treatment models for the disorder. With no empirically supported treatment for ARFID, it is important to investigate the clinical utility of innovative therapeutic approaches. Here we describe a novel parent-facilitated behavioral treatment for youth with ARFID (PBT-ARFID) that is grounded in learning theory, as well as components of well-established family-based treatment (FBT) for eating disorders. We propose a two-factor theory of avoidance learning within a biopsychosocial model to explain behavior in ARFID and utilize counterconditioning as a core intervention to reverse paired, classically conditioned association between food and aversive state (i.e., disgust and/or anxiety). This report details a step-by-step comprehensive treatment approach for ARFID that can be adapted to a broad range of youth and their families, along with a case study illustrating application of the model. This pilot case provides preliminary evidence that the PBT-ARFID model incorporating counterconditioning may be a powerful treatment for youth with ARFID. More case and pilot studies are needed to justify formally investigating its efficacy in a randomized controlled trial. • This novel treatment PBT-ARFID is based on a biopsychosocial learning model • Treatment involves components of empirically supported FBT for eating disorders augmented with anxiety interventions such as food hierarchies and exposures • Counterconditioning is utilized to specifically target anxiety and disgust • It is adaptable to a broad range of ages, developmental levels, contexts, and clinical presentations • Research is needed to formally investigate the efficacy of this counterconditioning PBT-ARFID model [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is a common reason people seek osteopathic care. The biopsychosocial (BPS) model is a clinical model encompassing complex contextual aspects that contribute to a person's pain experience. This study aimed to understand osteopaths' experiences of the practical application of the BPS model to patients with LBP, and to describe any challenges in operationalisation. We conducted a qualitative study and interviewed purposively-sampled osteopaths who self-identified as applying a BPS approach to managing LBP. A constructivist approach consistent with elements of grounded theory was used to analyse these data. The following themes were constructed to describe participants' experiences of applying the BPS model; 1) collaboration 2) deriving meaning from narrative 3) coaching 4) empowerment 5) reframing 'pain' and 6) desensitising. Two further themes represent challenges; 7) deficiencies of undergraduate BPS training and clinical integration and 8) osteopathic identity and scope of practice. Two central concepts were established; A) the BPS model is used as an interactive frame; and B) challenges of integration and uncertainty exist and have the potential to lead to unintentional fragmentation of the model. Participants viewed the BPS model as essential in navigating a person's experience of pain; identifying emergent factors contributing to the cause or maintenance of the person's condition and informing management of these factors. However, the integration of the BPS model into clinical practice remains fraught with obstacles including the dualist nature of beliefs about pain, inadequacies of undergraduate training and uncertainty about remit. • Participants provide pragmatic strategies to operationalise the biopsychosocial model. • Operationalisation requires critical knowledge of the emergent nature of pain. • Challenges and uncertainty lead to unintentional fragmentation of the model. • Application of the biopsychosocial model expands traditional osteopathic practice. • Undergraduate training, to clinically integrate the biopsychosocial, must improve. [ABSTRACT FROM AUTHOR]

Pediatric asthma in inner cities is often severe and children living in these urban locations with socioeconomic disadvantage experience greater asthma morbidity. There are many interconnected risk factors that individually, and in combination, enhance asthma morbidity. These include biologic factors innate to the child, such as genetics and allergen susceptibility, as well as factors related to the family and neighborhood context. The biopsychosocial model can be used to frame these risk factors and develop interventions specific to the inner city. Successful inner city asthma interventions exist and key characteristics include multi-tiered components that operate within the community to coordinate disease management resources between patients, families and health care systems. [ABSTRACT FROM AUTHOR]

• Participants reported high rates of mental health challenges. • There is a lack of specialized services available in York Region, Ontario (a large suburban and semi-rural setting). • Youth experienced stressors, such as family rejection, stigma, and discrimination. • There is a need for specialized services in suburban and semi-rural settings. 2SLGBTQ+ youth disproportionately represent the homeless youth population in North America and are at much greater risk than their heterosexual and cisgender counterparts to experience homelessness. There is limited research on suburban and rural homelessness. This study reports on a mixed-methods study guided by the Social Ecological Model to understand the mental health and service needs among 2SLGBTQ+ youth experiencing homelessness across York Region, a suburban and semi-rural region in Ontario, Canada. In-depth one-on-one interviews and surveys were utilized to explore mental health and experiences of homelessness. This study found that youth participants reported an array of mental health difficulties and challenges including depression, suicidality, and substance use. Additionally, the study found that participants experienced family rejection, stigma, discrimination, inadequate services and hidden homelessness, which contributed to their poor mental health. This study reinforces the call for more population-based services and increased mental health support for 2SLGBTQ+ youth experiencing homelessness in suburban and rural settings. [ABSTRACT FROM AUTHOR]

The aetiology behind chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains unknown, which makes treatment challenging, while the diagnostic uncertainty related to CP/CPPS creates confusion and frustration for both patients and clinicians. As CP/CPSS may be persuaded by nociplastic pain mechanism and is associated with psychosocial and lifestyle factors, interventions should address biopsychosocial factors in combination with the treatment of the biomechanical impairments. This is a case study of a 71-year-old man diagnosed with CP/CPPS who was referred to the osteopathic clinic by his urologist. His main complaint was a constant dull aching pain in the urethra and right groin that had started almost 10 years previously. The patient was treated six times over a time period of 5 months using a multimodal osteopathic approach. The osteopathic intervention significantly decreased the numeric pain rating scale score, improved quality of life and reduced pain and dysfunction as measured with the National Institutes of Health chronic prostatitis symptom index. As CP/CPPS may be a nociplastic pain syndrome, and a multimodal osteopathic approach may therefore be needed that includes treatment of the biomechanical impairments with osteopathic manipulative treatment while also addressing various biopsychosocial factors via education, dietary modifications, advice about physical activity, breathing exercises, sleep and stress management. Application of the biopsychosocial model in addition to a biomedical osteopathic model seems to be a beneficial intervention strategy to improve quality of life, pain and dysfunction in a patient with CP/CPPS. • Chronic prostatitis/chronic pelvic pain (CP/CPPS) remains challenging to diagnose and treat. • CP/CPPS may be nociplastic driven and is related to psychosocial/lifestyle factors. • Biopsychosocial (BPS) factors are important in the osteopathic management in CP/CPPS. • Assessment and management of the associated BPS-factors is challenging in CP/CPPS. • A multimodal osteopathic intervention may influence QoL, pain and dysfunction in CP/CPPS. [ABSTRACT FROM AUTHOR]

Chronic low back pain (CLBP) is one of the leading causes of disability worldwide and its related healthcare costs are constantly increasing. Imaging studies have limited clinical utility in managing this condition and their overuse can lead to negative effects on patients. Clinicians' and patients' misconceptions seem to be one of the main drivers of such unnecessary use. However, there is a lack of research investigating osteopaths' views on imaging. This study explored Italian osteopaths' attitudes and beliefs towards imaging and its utilisation in the clinical evaluation and management of CLBP patients. A qualitative study, using elements of constructivist grounded theory, was conducted by means of semi-structured interviews. A purposive sampling approach was used to recruit 14 osteopaths practising in Italy with clinical and educational experiences. Data were collected until real saturation, transcribed verbatim and coded by using qualitative thematic analysis identifying categories, concepts and themes. Two main themes were identified with seven subcategories. The overarching themes were 1) Clinical relevance and utility; 2) Interacting with the patient through a biopsychosocial perspective. The findings highlight that imaging plays a marginal role in the interviewed osteopaths' clinical practice, except for ruling out red flags or contraindications for treatment. Participants have shown awareness about the potential negative effects of imaging in CLBP patients. They underlined the need to reassure and educate patients to minimise the psycho-behavioural impact of diagnostic investigations on patients' condition and also to provide a clinical value of their use, especially in relation to the complex and multidimensional nature of CLBP. [ABSTRACT FROM AUTHOR]

To analyze the internal consistency, reliability and measurement error of assessment measures for body structure and function (postural balance, muscle strength, cardiorespiratory function and physical fitness), activity (walking and mobility) and participation (quality of life and social reintegration) outcomes for use on pre-frail and frail older adults. Searches were performed in six databases (Medline, Embase, ScienceDirect, Web of Science, The Cochrane Library and Lilacs) and reproducibility studies were included. Cronbach's alpha and the classification proposed by Terwee et al. (2007) were used for the interpretation of internal consistency. The intraclass correlation coefficient (ICC) and the Munro classification were used for the determination of reliability. The standard error of measurement (SEM), minimal detectable change (MDC) as well as percentages of error (SEM%) and change (MDC%) were calculated. Methodological quality of the studies was appraised using Boxes 4, 6 and 7 of the COSMIN Risk of Bias checklist. Six studies were included in the present systematic review, with a total of 835 (82.4 years; 582 women and 253 men) pre-frail and frail older adults analyzed. Seven measures were identified for the assessment of body structure and function, activity and participation outcomes (Hierarchical Assessment of Balance and Mobility, Self-Assessment of Physical Fitness, Sarcopenia Quality of Life, Reintegration to Normal Living Index, Two-Minute Walking test, Six-Minute Walking test and Ten-Meter Walking test). The following measurement properties were identified: internal consistency = 0.84 (mean Cronbach's alpha); reliability = 0.87 (mean ICC); SEM range = 0.06 to 10.10; MDC range = 0.13 to 28.10; SEM% range = 5.2 % to 9.5 %; and MDC% range = 10.7 % to 28.5 %. The present systematic review found adequate internal consistency, high reliability and an acceptable measurement error for assessment measures of body structure and function, activity and participation outcomes for use on pre-frail and frail older adults. • Assessment measures of ICF components are reproducible. • These measures identify biopsychosocial changes in frail older adults. • The measures identified should be used for the assessment of these older adults. • The reliability of other measures should be investigated in frailty. • The ICF is an important tool for use in scientific research and clinical practice. [ABSTRACT FROM AUTHOR]