Holistic care in healthy aging: Caring for the wholly and holy human

Health care should address the holistic gap between health outcomes, spirituality, religion, and humanistic care to optimize patient care. Treating the whole person encompasses both physical and metaphysical elements. Patients want health care professionals to recognize their spiritual and religious preferences, because these matter in their approach to illness, coping, and long-term outcomes.     

Pocahontas Goes to the Clinic: Popular Culture as Lingua Franca in a Cultural Borderland

Urban hospitals constitute an example of what is arguably the most visible site in anthropology these days—the border zone. Negotiating health care requires trafficking in tricky spaces where patients and their families must pay vigilant attention about when to submit, when to resist, and how to collaborate. Drawing from ethnographic research carried out over the past nine years among African American families who have children with severe illnesses and disabilities, I examine how children's popular culture operates in the fraught borderland that constitutes the urban clinic. Global icons like a Disneyfied Pocahantas can function as a lingua franca, offering a language of publicly available symbols on which families, health professionals, and children can draw to create a shared imaginative space across race and class divides and across the sometimes even more radical divide between sufferer and healer.     

Structural violence and compassionate compatriots: immigrant health care in South Florida

Abstract

Based on more than twenty in-depth interviews with health care professionals in Miami-Dade County clinics and hospitals, this study explores immigrant access to health care. We focus on some of the debates that took place during the 2009–10 process of US health care reform, which uncovered a pervasive public fear that immigrants illegitimately access health care. This study found the opposite: immigrants in South Florida often avoid primary health care even when offered freely and legally. This is because of bewilderment about bureaucratic requirements, fear of deportation and bills, and cultural folkways. We present the former two barriers as forms of structural and symbolic violence. We conclude by describing South Florida's compassionate compatriots, as a means by which immigrants can be guided through the health care system.     

What do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study

Context Medically unexplained physical symptoms (MUPS) are frequently encountered in family medicine, and lead to disability, discomfort, medicalisation, iatrogenesis and economic costs. They cause professionals to feel insecure and frustrated and patients to feel dissatisfied and misunderstood. Doctors seek answers for rather than with the patient.Objectives This study aimed to explore patients'' explanations of the medically unexplained physical symptoms that they were experiencing by eliciting their own explanations for their complaints, their associated fears, their expectations of the consultation, changes in their ideas of causality, and the therapeutic approach that they considered would be useful.Methodology A qualitative analysis was under-taken of interviews with 15 patients with MUPS in a family medicine unit, 6 months after diagnosis.Results Experience is crucial in construction of the meaning of symptoms and illness behaviour. Many patients identify psychosocial causes under-lying their suffering. These patients received more medication and fewer requests for diagnostic examinations than they had expected. Normalisation is a common behaviour in the clinical approach. Normalisation without explanation can be effective if an effective therapeutic relationship exists that may dispense with the need for words. Listening is the procedure most valued by patients. Diagnostic tests may denote interest in patients'' problems. The clinician''s flexibility should allow adaptation to the patient''s phases of acceptance of the significance of their physical, emotional and social problems.Conclusion Patients with MUPS have explanations and fears associated with their complaints. The patient comes to the consultation not because of the symptom, but because of what he or she thinks about the symptom. The therapeutic relationship, therapeutic listening, and flexibility should be the basis for approaching patients with MUPS. Patients do not always expect medication, although it is what they most often receive. Diagnostic tests, although used sparingly, can be a way to maintain and build a relationship. Drugs and tests can be a ritual statement of clinical interest in the patient and their symptoms.     

围医患沟通理论的研究现状与进展

近些年来,医患关系呈日趋紧张之势,医疗纠纷数目不断攀升,各大医院纷纷强调医患沟通的重要性,各大医学院校也反复重申医患沟通的必要性,但往往注重沟通过程本身,忽视沟通前的准备以及沟通效果的评价。文章通过分析国内外医患沟通研究的趋势和现状,提出“围医患沟通”的理论实施与评价,进一步保障医疗安全,构建和谐医患关系。     

The other side of trust in health care: prescribing drugs with the potential for abuse

Defining a nonpaternalistic yet achievable form of trust in medicine in an era of simultaneous patient empowerment and institutional control has been and remains an important task of bioethics. The 'crisis of trust' in medicine has been viewed mainly as the problem of getting patients to trust their health care providers, especially physicians. However, since paradigmatic cases of trust are mutual, bioethicists must pay more attention to physician trust in patients. A physician's view of the reasonableness of trust in a particular patient is affected not just by his or her relationship with that patient, but also by what is going on institutionally, professionally, legally and politically with regard to a given treatment or intervention. Since general moral principles are insufficient in determining the moral value and reasonableness of trust in particular instances, I discuss in detail the role of trust and distrust in the specific case of treating patients with medications implicated in drug abuse. I conclude that it is important to become aware, first, of the clinical significance of physician trust and distrust in patients, and second, of the many factors which inform both of these moral attitudes. These two claims together suggest that a central, but overlooked, virtue of medical practice is reflective, context-responsive trust in patients.     

Laypeople's Health Concerns and Health Beliefs in Regard to Risk Perception of Mobile Communication

The consensus scientific view is that there is an absence of convincing scientific evidence for health risks of exposures to electromagnetic fields (EMF) at levels below those recommended in international guidelines. Nevertheless, some citizens are worried about EMF emitted by mobile communication and its consequences for health. The present study explored, by means of a mail survey, health concerns and the prevalence of health beliefs related to EMF in the general population. A random sample (n = 765, response rate 41%) of the German-speaking population in Switzerland was asked to assess various health beliefs. Results suggest that health concerns are widespread but lower than health concerns in regard to other hazards. About two-thirds of the respondents believed that some people suffer from electromagnetic hypersensitivity (EHS). Health beliefs items were analyzed using the Mokken scale. This scale was related to respondents' health concerns and showed that health beliefs differed in regard to sociodemographic variables. For example, analyses showed that females, younger respondents, and respondents who believed that some people are affected by EHS endorsed significantly more health beliefs than males, older respondents, and non-EHS respondents. Results indicate that it is important for policy-makers to develop a clear understanding of the possible effects of health beliefs on health concerns and risk perception. These findings may provide guidance for the further development of information materials and strategies.     

Risk Communication and the Precautionary Principle

The perception of risks for environment and health deriving from globalization processes and an uncontrolled use of modern technologies is growing everywhere. The greater the capacity of controlling living conditions, the larger is the possibility of misusing this power. In environmental and occupational health research we tend to reduce the complexity of the observed phenomena in order to facilitate conclusions. In social and political sciences complexity is an essential element of the context, which needs to be continuously considered. The Precautionary Principle is a tool for facing complexity and uncertainty in health risk management. This paper is aimed at demonstrating that this is not only a problem of technical risk assessment. Great attention should also be paid to improve risk communication. Communication between the stakeholders (experts, decision makers, political and social leaders, media, groups of interest and people involved) is possibly the best condition to be successful in health risk management. Nevertheless, this process usually runs up against severe obstacles. These are not only caused by existing conflicts of interest. Differences in values, languages, perceptions, resources to have access to information, and to express one's own point of view are other key aspects.     

21世纪医患关系的伦理学评判

随着医疗技术的迅猛发展,医疗水平不断提高,为人们带来福音的同时,使得医患关系的矛盾尤为凸显。21世纪的医患矛盾已经不仅仅是医生和患者之间的矛盾与冲突,而是两大社会群体之间的问题。在法律还无法规范的前提下,医学伦理学的评判标准可以为新时期医患关系提出更根本的指引与解释。     

提高规范化培训住院医师在CCU沟通能力的探讨

摘要：随着生物医学模式向生物．心理．社会医学模式的转变,构建和谐的医患关系成为当今医学发展和进步的时代新要求,构建和谐的医患关系,有效的医患沟通是获得良好医疗效果的基本保证,本文总结了目前参加规范化培训的住院医师在心脏科重症监护室培训轮转期间医患沟通中存在的问题,分析了沟通障碍的主要影响因素,包括住院医师对医患关系的沟通认识不够充分,沟通技巧不够,工作负担增加,患方经济负担增加,治疗效果心理预期增加,医患双方认知差异增加,失信增加,健康和维权意识增加等都影响了医患关系的和谐构建;心脏重症监护室是心血管系统中常见病,多发病发展到终末期或急重期间的治疗场所,特点是病情急,危,重,死亡率高,结合其医患关系的实际特点,提出了提高住院医师沟通能力的可行性措施,主要包括：沟通的内容务必真实可信,形式力求形象,换位思考,注重诚信待人,加强非语言沟通,注重沟通分寸,尊重患者或家属的知情同意权,加强心脏监护室的细节规范化管理等。     

Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level

Physical disorders are, compared to the general population, more prevalentin people with severe mental illness (SMI). Although this excess morbidityand mortality is largely due to modifiable lifestyle risk factors, the screeningand assessment of physical health aspects remains poor, even in developedcountries. Moreover, specific patient, provider, treatment and system factorsact as barriers to the recognition and to the management of physical diseasesin people with SMI. Psychiatrists can play a pivotal role in the improvementof the physical health of these patients by expanding their task from clinicalpsychiatric care to the monitoring and treatment of crucial physical parameters.At a system level, actions are not easy to realize, especially for developingcountries. However, at an individual level, even simple and very basic monitoringand treatment actions, undertaken by the treating clinician, can already improvethe problem of suboptimal medical care in this population. Adhering to monitoringand treatment guidelines will result in a substantial enhancement of physicalhealth outcomes. Furthermore, psychiatrists can help educate and motivatepeople with SMI to address their suboptimal lifestyle, including smoking,unhealthy diet and lack of exercise. The adoption of the recommendations presentedin this paper across health care systems throughout the world will contributeto a significant improvement in the medical and related psychiatric healthoutcomes of patients with SMI.     

Perceptions of oral health among older Cambodians and their caregivers: A qualitative study

Objective

Older adults (those above the age of 60) are an emerging demographic in Cambodia, and very little is understood about their oral health experiences, needs, perceptions and behaviours. The aim of this study was to explore the oral health experiences, practices and perceptions of a convenience sample of a small but diverse group of older adults in Cambodia.

Method

A cross‐sectional qualitative study in which focus group interviews were conducted by 5 trained senior Cambodian dental students. A convenience sample of 56 older adults and caregivers was recruited across urban, semi‐urban and rural locations. Focus group conversations were recorded, transcribed and analysed thematically.

Results

The themes that emerged were around low expectations for both general health and oral health. A communal responsibility for health was expressed, and both money and transport were identified as key barriers to accessing care. Participants recognised that they had oral health problems, and acknowledged the impact of poor oral function on health and nutrition.

Conclusion

This study is an important first step in better understanding the oral health experiences and perceptions of older people in Cambodia. Participants described the impacts of poor oral health as being important, even when compared with other general health conditions.     

Barriers to provision of dental care in long-term care facilities: the confrontation with ageing and death

Objective: The aim of the study was to reveal barriers to providing dental care for residents in long‐term care (LTC) facilities. Design: Participants were selected randomly from the dentist register in Berlin and Saxony, Germany. The sample consisted of 60 self‐employed and 60 employed dentists, a further 60 dentists worked in their own dental practice but also part‐time in an LTC facility. In semi‐structured interviews a questionnaire with 36 statements concerning working conditions, administration and cost, insecurity concerning treatment decisions as well as confrontation with ageing and death was employed. Subsequently, the study participants were asked to rank the four dimensions concerning their impact on the decision against providing dental care in an LTC facility. Results: The random sample was representative in age and gender for the dental register in Berlin and Saxony. Fifty‐six per cent of the participants (63% of the men and 51% of the women; 52% of the self‐employed, 60% of the employed and 56% of the consultant dentists) indicated unfavourable working conditions as biggest obstacle in providing dental care in an LTC‐facility. Thirty‐two per cent of participants rated administration and cost, 7% the insecurity in treatment decisions as major hindrance. Only 5% of the participants rated the confrontation with age and death as substantial barrier. There were no age and gender differences. Dentists in Berlin seemed more concerned about administration and cost of a consultancy activity and less secure in their therapy decisions than the colleagues from Saxony (p < 0.001). Dentists who work partly in LTC facilities were the least concerned about the confrontation with ageing and death (not significant), employed dentist showed the least secure in their treatment decisions (p > 0.001). Conclusion: It can be concluded that the awareness of infra‐structural and financial aspects in providing dental care in LTC facilities should be raised with health politicians and that these aspects should be considered when inaugurating or re‐structuring the consultancy services to LTC facilities. Further it would be desirable to establish more postgraduate training programmes to increase clinical and ethical competence in the area of gerodontology.     

英国健康服务整合进展及对中国的启示

通过万方、知网、PUMED和谷歌学术搜索,查阅获取近年来有关英国健康服务整合的文献和政策文件,分析了健康服务整合的内涵,归纳总结了英国健康服务整合实践的政策历程,目前的整合实践模式,并归纳分析了英国健康服务整合的应对策略,最后结合中国实际,提出对健康和社会保健相关职能部门进行整合,对中央和地方的责权利进行合理划分,从而落实健康服务的整合供给,通过信息化和多媒体,建立以患者为中心的健康保健提供的激励约束机制,建立现代化的健康和社会保健服务的人才保障机制。     

Breaking down the Species Boundaries: Selective Pressures behind Interspecific Communication in Vertebrates

Studying heterospecific communication provides an opportunity to examine the dynamics of cross‐species social behaviour. It allows us to ask questions about the extent to which the transfer of information is adaptive or accidental and provides an empirically tractable context for manipulating relationships. To date, most studies of heterospecific communication have focussed on receivers. However, the selective pressures on signallers can be as important in determining the dynamics of interspecific communication. Here, we propose a simple framework for thinking about cross‐species information transfer, which (i) considers whether information exchange is either accidental or adaptive and (ii) whether it is unidirectional or bidirectional. To clearly classify interactions, it is necessary to quantify all of the payoffs of interspecific communication to both signallers and receivers. This requires accurate characterisation of the currency influenced by cross‐species communication (e.g. weight gain, foraging success, survival). However, quantifying the payoffs may be difficult, because each side may be benefiting via different currencies. To date, studies on heterospecific communication have focussed on only one dimension of a niche (usually antipredator or foraging signals). However, because niches are multidimensional, investigations should incorporate multiple aspects of a species’ niche, to get a better perspective on why we see certain patterns of information use between species.