Current Holistic-medicine News Results

Partnering with education and job and training programs for sustainable tobacco control among Baltimore african american young adults.

Prog Community Health Partnersh. 2009; 3(1): 9-17
Smith KC, Bone L, Clay EA, Owings K, Thames S, Stillman F

Background: Young adults are generally overlooked in tobacco control initiatives, even though they are critical to sustained success. African American young adults who are not in higher education or working are particularly vulnerable to harmful tobacco use, given high smoking rates and limited access to cessation services. Objectives: Guided by community-based participatory research (CBPR) principles, we sought to identify programand community-level strategies to reduce tobacco use among African American young adults in Baltimore. We describe the challenges and opportunities for integrating effective tobacco control into community-based education and job training programs for unemployed young adults. Methods: As part of a longstanding community-research partnership in Baltimore, we conducted fourteen semistructured key informant interviews with leaders from city government and education and job training programs for young adults. The research design, data collection, analysis, and dissemination all included dialogue between and active contribution by both research and community partners. Results: Interview data were structured into opportunities (mindset for change and desire for bonds with a trusted adult), challenges (culture of fatalism, tobacco as a stress reliever, and culture of tobacco use among young adults), and possible tobacco control solutions (tobacco education designed with and for program staff and participants and integration of tobacco issues into holistic program goals and policies). Conclusions: The emergent themes enhance our understanding of how tobacco is situated in the lives of unemployed young adults and the potential for building sustainable, community-based public health solutions.

What is adolescence?: Adolescents narrate their lives in Lima, Peru.

J Adolesc. 2010 Mar 5;
Bayer AM, Gilman RH, Tsui AO, Hindin MJ

This study explores the lives of Peruvian adolescents in a low-income human settlement outside of Lima. Twenty 12-17 year olds were asked to narrate their own life stories using the life history narrative research method. Holistic content analysis was coupled with a grounded-theory approach to explore these data. Intergenerational responsibility, family tensions, economic pressures, racism and violence emerged without prompting and dominated the narrators' life stories, underscoring the degree to which these adolescents lack access to the supportive individuals and structures that are key to positive adolescent development. The challenges faced by these and the other 5.8 million 10-19 year olds in Peru require increased attention to the role of families, peers and communities in ensuring that adolescents are able to maintain their well-being and achieve their future expectations.

How will area regeneration impact on health? Learning from the GoWell study.

Public Health. 2010 Mar 5;
Beck SA, Hanlon PW, Tannahill CE, Crawford FA, Ogilvie RM, Kearns AJ

OBJECTIVES: To establish the theoretical and perceived links between area regeneration and health in a Scottish context in order to inform a comprehensive evaluation of regeneration activity. The evaluation will include health outcomes. STUDY DESIGN: Mixed method combining and comparing key informant interviews with policy analysis. METHODS: Analysis of identified links between elements of regeneration activity and health was undertaken of published policies and strategies which described regeneration for Scotland and the city of Glasgow. Interviews with key informants explored their understanding of the inputs to regeneration, and the pathways between regeneration and better health outcomes. RESULTS: The policy analysis and interviews revealed a holistic approach to a complex problem. Both identified a need for action to improve housing, neighbourhoods and services, education, employment, community participation and social issues. Improved health was identified as an emergent property. Interviewees identified a need to augment the established structural components with a more person-centred approach, fostering confidence and higher aspirations, but were uncertain how to achieve this. The interviews revealed a lack of confidence that current practice would deliver all the components of the holistic model. CONCLUSIONS: A holistic model of regeneration appears to inform policy, but is proving difficult to deliver. Improved health and reduced health inequalities were not primary objectives but emergent properties. In light of this, the ability of regeneration to actively maximize positive health impacts, particularly if this requires focused planning or opportunity costs to other activities, is questioned.

Living with Type 1 diabetes: a by-person qualitative exploration.

Psychol Health. 2009 Mar 2; 1-16
Watts S, O'Hara L, Trigg R

Type 1 diabetes is a chronic condition which places enormous demands on the individual diabetic. A strict care routine is necessitated, yet even the most controlled and disciplined diabetic is likely to experience associated health problems and automatically faces a reduced life expectancy. The current study explores the psychological repercussions of this situation via a small scale qualitative study which focuses on the very different viewpoints and experiences of four adults living with Type 1 diabetes. A new and original form of by-person (or by-case) qualitative analysis is employed in order to capture, in a rich and holistic fashion, each participant's current relationship with their condition, their experience of living and dealing with diabetes and the ways in which diabetes is integrated within their lives and identities. The findings have implications for, and are discussed in relation to, issues of control, regimen adherence, and what it means to be a 'good' or 'successful' diabetic. The conclusion is drawn that the satisfaction of personal goals and a focus on psychological as well as physical health may be very important if positive quality of life outcomes are to be attained in the context of Type 1 diabetes.

Socioeconomic gradients in health in international and historical context.

Ann N Y Acad Sci. 2010 Feb; 1186: 24-36
Dow WH, Rehkopf DH

This article places socioeconomic gradients in health into a broader international and historical context. The data we present supports the conclusion that current socioeconomic gradients in health within the United States are neither inevitable nor immutable. This literature reveals periods in the United States with substantially smaller gradients, and identifies many examples of other countries whose different social policy choices appear to have led to superior health levels and equity even with fewer aggregate resources. The article also sheds light on the potential importance of various hypothesized mechanisms in driving major shifts in U.S. population health patterns. While it is essential to carefully examine individual mechanisms contributing to health patterns, it is also illuminating to take a more holistic view of the set of factors changing in conjunction with major shifts in population health. In this article, we do so by focusing on the period of the 1980s, during which U.S. life expectancy gains slowed markedly relative to other developed countries, and U.S. health disparities substantially increased. A comparison with Canada suggests that exploring broad social policy differences, such as the weaker social safety net in the United States, may be a promising area for future investigation.

A decolonizing approach to health promotion in Canada: the case of the Urban Aboriginal Community Kitchen Garden Project.

Health Promot Int. 2010 Mar 2;
Mundel E, Chapman GE

Aboriginal people in Canada suffer ill-health at much higher rates compared with the rest of the population. A key challenge is the disjuncture between the dominant biomedical approach to health in Canada and the holistic and integrative understandings of and approaches to health in many Aboriginal cultures. More fundamentally, colonization is at the root of the health challenges faced by this population. Thus, effective approaches to health promotion with Aboriginal people will require decolonizing practices. In this paper, we look at one case study of a health promotion project, the Urban Aboriginal Community Kitchen Garden Project in Vancouver, Canada, which, guided by the teachings of the Medicine Wheel, aims to provide culturally appropriate health promotion. By drawing on Aboriginal approaches to healing, acknowledging the legacy of colonization and providing a context for cultural celebration, we suggest that the project can be seen as an example of what decolonizing health promotion could look like. Further, we suggest that a decolonizing approach to health promotion has the potential to address immediate needs while simultaneously beginning to address underlying causes of Aboriginal health inequities.

Complementary therapies: a challenge for nursing practice.

Nurs Stand. 2010 Jan 27-Feb 2; 24(21): 35-9
O'Regan P, Wills T, O'Leary A

There has been a vast increase in the use of complementary therapies in recent years. Nurses, who are at the forefront of healthcare delivery, require adequate knowledge of complementary therapies and the skills to provide appropriate advice and holistic care incorporating the individual's physical, psychological, social and emotional wellbeing and needs. This article explores the use and development of complementary therapies in health care. The role of, and the need for, an enhanced education approach to expand the current body of knowledge is discussed.

Meditation in medical practice: a review of the evidence and practice.

Prim Care. 2010 Mar; 37(1): 81-90
Fortney L, Taylor M

Meditation practice in the medical setting is proving to be an excellent adjunctive therapy for many illnesses and an essential and primary means of maintaining holistic health and wellness. Rather than being a fringe or marginal concept, meditation is now widely known and accepted as a beneficial mind-body practice by the general public and in the scientific community. Extensive research shows and continues to show the benefits of meditation practice for a wide range of medical conditions. Further efforts are required to operationalize and apply meditation practice in clinical and medical educational settings in ways that are practical, effective, and meaningful.

Involvement of hospital nurses in care decisions related to administration of artificial nutrition or hydration (ANH) in patients with dementia: A qualitative study.

Int J Nurs Stud. 2010 Feb 24;
Bryon E, Gastmans C, Dierckx de Casterlé B

BACKGROUND: Nurses that care for patients with advanced dementia are increasingly faced with consequences of disease progression, often requiring them to decide whether to artificially feed these patients. Clarifying how nurses can be better supported in complex care processes involving ethically sensitive decision-making requires that their practice be mapped out. OBJECTIVES: The aims of this study were to explore and describe how nurses are involved in the care that surrounds decisions concerning artificial nutrition or hydration in hospitalized patients with dementia. DESIGN: We used a qualitative interview design. Data collection and analysis were informed by the grounded theory approach. SETTING: Nine hospitals geographically spread throughout the five provinces of Flanders, Belgium. PARTICIPANTS: Twenty-one nurses were purposively selected for interview, with the aim of including nurses that reflected diverse personal characteristics and experiences with the subject matter. METHODS: Between April 2008 and June 2009, we conducted 21 interviews that were audiotaped and later transcribed. Data processing involved (1) simultaneous and systematic data collection and analysis, (2) constant forwards-backwards wave, (3) continuous dialogue with the data, and (4) interactive team processes. RESULTS: Nurses' involvement was characterized by a desire to provide 'good care', which was the basis for their motivation and aspiration during the care process. Early in the process, nurses developed a holistic picture of their patients, laying the foundation of their 'good care' view. During the actual decision-making, nurses fulfilled the roles of messengers and guiding communicators, as they attempted to realize their 'good care' view. Nurses judged the physicians' decisions in light of their care view. If a decision matched their view, they supported the decision. If not, they resisted it openly or covertly. Some nurses remained passively in the background, while others took action to override the decision. Nurses' involvement ended with the intensive aftercare of the patients and their family. CONCLUSIONS: Nurses are closely and continuously involved in the care that surrounds decisions concerning artificial nutrition or hydration in hospitalized patients with advanced dementia. During the care process, nurses play several and specific roles, giving their contribution a unique and variable character.

Comparison of case note review methods for evaluating quality and safety in health care.

Health Technol Assess. 2010 Feb; 14(10): 1-170
Hutchinson A, Coster J, Cooper K, McIntosh A, Walters S, Bath P, Pearson M, Young T, Rantell K, Campbell M, Ratcliffe J

OBJECTIVES: To determine which of two methods of case note review - holistic (implicit) and criterion-based (explicit) - provides the most useful and reliable information for quality and safety of care, and the level of agreement within and between groups of health-care professionals when they use the two methods to review the same record. To explore the process-outcome relationship between holistic and criterion-based quality-of-care measures and hospital-level outcome indicators. DATA SOURCES: Case notes of patients at randomly selected hospitals in England. REVIEW METHODS: In the first part of the study, retrospective multiple reviews of 684 case notes were undertaken at nine acute hospitals using both holistic and criterion-based review methods. Quality-of-care measures included evidence-based review criteria and a quality-of-care rating scale. Textual commentary on the quality of care was provided as a component of holistic review. Review teams comprised combinations of: doctors (n = 16), specialist nurses (n = 10) and clinically trained audit staff (n = 3) and non-clinical audit staff (n = 9). In the second part of the study, process (quality and safety) of care data were collected from the case notes of 1565 people with either chronic obstructive pulmonary disease (COPD) or heart failure in 20 hospitals. Doctors collected criterion-based data from case notes and used implicit review methods to derive textual comments on the quality of care provided and score the care overall. Data were analysed for intrarater consistency, inter-rater reliability between pairs of staff using intraclass correlation coefficients (ICCs) and completeness of criterion data capture, and comparisons were made within and between staff groups and between review methods. To explore the process-outcome relationship, a range of publicly available health-care indicator data were used as proxy outcomes in a multilevel analysis. RESULTS: Overall, 1473 holistic and 1389 criterion-based reviews were undertaken in the first part of the study. When same staff-type reviewer pairs/groups reviewed the same record, holistic scale score inter-rater reliability was moderate within each of the three staff groups [intraclass correlation coefficient (ICC) 0.46-0.52], and inter-rater reliability for criterion-based scores was moderate to good (ICC 0.61-0.88). When different staff-type pairs/groups reviewed the same record, agreement between the reviewer pairs/groups was weak to moderate for overall care (ICC 0.24-0.43). Comparison of holistic review score and criterion-based score of case notes reviewed by doctors and by non-clinical audit staff showed a reasonable level of agreement (p-values for difference 0.406 and 0.223, respectively), although results from all three staff types showed no overall level of agreement (p-value for difference 0.057). Detailed qualitative analysis of the textual data indicated that the three staff types tended to provide different forms of commentary on quality of care, although there was some overlap between some groups. In the process-outcome study there generally were high criterion-based scores for all hospitals, whereas there was more interhospital variation between the holistic review overall scale scores. Textual commentary on the quality of care verified the holistic scale scores. Differences among hospitals with regard to the relationship between mortality and quality of care were not statistically significant. CONCLUSIONS: Using the holistic approach, the three groups of staff appeared to interpret the recorded care differently when they each reviewed the same record. When the same clinical record was reviewed by doctors and non-clinical audit staff, there was no significant difference between the assessments of quality of care generated by the two groups. All three staff groups performed reasonably well when using criterion-based review, although the quality and type of information provided by doctors was of greater value. Therefore, when measuring quality of care from case notes, consideration needs to be given to the method of review, the type of staff undertaking the review, and the methods of analysis available to the review team. Review can be enhanced using a combination of both criterion-based and structured holistic methods with textual commentary, and variation in quality of care can best be identified from a combination of holistic scale scores and textual data review.

The role of occupational participation and environment among Icelandic women with breast cancer: a qualitative study.

Scand J Occup Ther. 2010 Feb 27;
Palmadottir G

Abstract Breast cancer diagnosis generally causes a disruption of occupational life. The purpose of this study was to explore the role of occupational participation and environment in the perception of health and well-being of Icelandic women with breast cancer. Eighteen women were interviewed using the main areas from the Occupational Performance History Interview as a guideline. An inductive analysis revealed seven categories that were organized under two main headings: occupational participation and environment. The categories were labelled "maintaining control and stability", "experiencing sense of self-worth", "enhancing self development", "access to information", "support and care", "refuge in community", and "rehabilitative opportunities". Through occupational participation the women were able to regain control of life and a sense of competence and development. Information, emotional support, safety, and stimulating environments were crucial in alleviating distress and facilitate satisfactory coping with the cancer experience. The results support that occupational participation in a safe and supportive environment has powerful restorative properties. Rehabilitative and supportive services should be based on a holistic perspective and emphasize the healthy aspects of a women's life. Furthermore, occupational therapists need to widen their approach when working with women with breast cancer and focus on their needs as occupational beings.

Bangladeshi Dental Students' Knowledge, Attitudes and Behaviour Regarding Tobacco Control and Oral Cancer.

J Cancer Educ. 2010 Feb 26;
Chowdhury MT, Pau A, Croucher R

Bangladesh's oral cancer incidence is high. Dentists can participate in tobacco control. The aim of this study is to explore tobacco use, tobacco control attitudes and oral cancer knowledge among Bangladeshi dental undergraduates. This cross-sectional study used the Global Health Professional Students Survey and the Humphris Oral Cancer Knowledge Scale. One hundred eighty six questionnaires were analysed, a 79% response rate. Tobacco use, oral cancer knowledge, attitudes towards tobacco control and the dentist's role in tobacco cessation varied significantly between colleges and by gender. Oral cancer knowledge and positive tobacco control attitudes did not influence tobacco use. There is a global problem in preparing dental students for a holistic, integrated approach to oral cancer prevention.

Creating opportunities for successful international student service-learning experiences.

Holist Nurs Pract. 2010 Mar-Apr; 24(2): 89-98
Wittmann-Price RA, Anselmi KK, Espinal F

Healthcare and educational expeditions to developing countries are a life-altering experience for both faculty and students. The benefits gained personally and professionally from foreign travel are invaluable. Providing healthcare to people in developing countries gives a new dimension to holistic care. Proper trip preparation with consideration of safety, legal liabilities, and educational goals is a necessity to ensure positive outcomes for patients, students, faculty, and the university or college. This article extracts lessons learned from an actual trip and dissects them from a safety, legal, and educational standpoint. The information presented is a "must read" for any faculty member considering embarking on a healthcare expedition with students to a developing country.

"Open your heart first of all": perspectives of holistic providers in costa rica about communication in the provision of health care.

Health Commun. 2009 Oct; 24(7): 631-46
Geist-Martin P, Bell KK

Research documents how the care the holistic providers offer represents the quality communication that patients often do not receive from their biomedical providers. However, research investigating the perspectives of holistic providers concerning the role they see themselves playing in the provision of health is limited. This research explores the perceptions of holistic providers in Costa Rica about their communication with their patients. The results reveal two practices of communication-authenticating and integrating as central to providers' communication with patients in the provision of holistic health care. Providers describe their communication as an exploration of an anatomy of pain/suffering, including investigating the location, timing, length, intensity, and overall rhythm of the patient's condition and sense making that leads them to seek the care of a holistic provider. Most holistic providers see their role as being careful or full of care and suggest that they have an obligation to open their heart first of all.

Cerebral localization in the eighteenth century--an overview.

J Hist Neurosci. 2009 Jul; 18(3): 248-53
Karenberg A

At the beginning of the eighteenth century, attempts to localize cerebral functions generated a wide range of different ideas. Ancient theories and their revisions stood next to new doctrines; anatomical, pathological, and surgical observations stood beside philosophical conjectures or conclusions from physiological experiments. Echoing Descartes and Willis, many scholars placed the sensorium commune in structures such as corpus callosum, cerebellum, or meninges. Since the explanatory power of these ideas was limited, a strictly holistic approach gained momentum around 1750. The key neurophysiological concept of the second half of the eighteenth century was Haller's doctrine of the equipotentiality of all cerebral structures including the cortex. However, shortly before 1800, one final effort to reconcile philosophy and science was made. The anatomist Samuel Thomas Soemmerring contended that ventricular fluid was the immediate organ of the soul. The refutation of this hypothesis and the rise of Gall's doctrine mark the end of the premodern era of cerebral localization. This paper reconstructs the era's principle arguments and contemporary experiments. It demonstrates that some current controversies regarding the mind-body problem are repetitions of eighteenth-century neuro-philosophical debates.

Interdisciplinary relationships between chaplains and social workers in health care settings.

J Health Care Chaplain. 2009 Jan; 16(1): 13-23
Harr C, Openshaw L, Moore B

As professional members of interdisciplinary teams in health care settings, chaplains and social workers must be prepared to interface with each other in a competent manner and to work cooperatively in caring for the needs of patients and their families. This article shares the results of a combined qualitative and quantitative research study (N = 403) that focused on determining chaplains' perceptions of their professional collaborative relationships with social workers. The findings indicate that chaplains have an overall positive perception of their interdisciplinary relationships with social workers. However, the results suggest areas that should be addressed in order to maintain and improve their functioning as colleagues who each play a critical role in providing holistic treatment.

Motivational Interviewing to promote self-awareness and engagement in rehabilitation following acquired brain injury: A conceptual review.

Neuropsychol Rehabil. 2010 Feb 18; 1-28
Medley AR, Powell T

The benefits of rehabilitation following acquired brain injury (ABI) are all too often disrupted by a lack of engagement in the process, variously attributed to cognitive, emotional and neurobehavioural sequelae, and prominently to impaired self-awareness of deficits. Motivational Interviewing (MI) has been widely applied to address treatment adherence in health settings, including a small but emerging evidence base in brain injury contexts. A conceptual review of the literature is offered, examining the interplay of neurological and psychosocial determinants of engagement difficulties after ABI, and discussing the possibilities and limitations of MI as a therapeutic strategy to enhance motivation. The theoretical bases of MI are outlined, focusing particularly on the transtheoretical stages of change model and self-determination theory. The converging evidence suggests that the guiding philosophy and principles of MI - characterised by non-confrontation, collaboration and self-efficacy - might help to foster readiness for participation in rehabilitation. A dynamic motivational model of engagement is presented, identifying MI's potential contribution in three key areas: firstly, to set the stage for therapeutic alliance and case formulation; secondly, to facilitate acceptance of deficits and realistic goal-setting; and thirdly, to promote constructive engagement in the range of clinical interventions that comprise a holistic neurorehabilitation programme.

Overcoming mixed messages on alcohol consumption: A teaching strategy.

Nurse Educ Pract. 2010 Feb 22;
Willsher KA

The aim of this discussion paper is to outline the teaching of nursing students using a health promotion approach to guide young people on issues involving alcohol consumption. Health promotion uses a holistic approach involving the individual, attempts to understand complexities of human behaviour and attempts to address environmental and social issues which impact upon health. There are several models of health promotion but the health assessment tool chosen was HEEADSSS which focuses upon assessment of the Home environment, Education and Employment, eating disorders, peer related activities, Drugs, Sexuality, Suicide/depression and Safety from injury or violence . Society's approach to alcohol consumption is considered ambiguous therefore it is essential to teach health promotion. Research based on demographic and epidemiological information and anecdotal media reports indicates a high incidence of binge drinking among young people on the Eyre Peninsula. The plan was to develop and provide developmentally appropriate health promotion using the Australian National Health and Medical Research Council Recommendations on alcohol consumption and the Australian Nursing and Midwifery Council Competencies for the Registered Nurse.

Singing for children and adults with bronchiectasis.

Cochrane Database Syst Rev. 2010; 2: CD007729
Irons JY, Kenny DT, Chang AB

BACKGROUND: Bronchiectasis is a common respiratory disease, especially in developing countries. Its cause varies from chronic infection to rare immune deficiencies. Bronchiectasis can be present with other respiratory diseases, such as chronic obstructive pulmonary disease (COPD). People with bronchiectasis may suffer from chronic cough, fatigue, shortness of breath, chest pain and coughing up blood. Their lung function may decline with time. These can also have a negative impact on their quality of life. Thus, a holistic management is needed to provide treatment and support. Therapies which include breathing manoeuvres, such as singing, may have health benefits for respiratory function and psychological well being. OBJECTIVES: To evaluate the effects of a singing intervention as a therapy on the quality of life, morbidity, respiratory muscle strength and pulmonary function of children and adults with bronchiectasis. SEARCH STRATEGY: We searched the Cochrane Airways Group (CAG) trials register, the Cochrane Central Register of Controlled Trials, major allied complementary databases, and clinical trials registers. Professional organisations and individuals were also contacted. CAG performed searches in February, and additional searches were carried out in June 2009. SELECTION CRITERIA: Randomised controlled trials in which singing (as an intervention) is compared with either a sham intervention or no singing in patients with bronchiectasis. DATA COLLECTION AND ANALYSIS: Two authors independently reviewed the titles, abstracts and citations to assess potential relevance for full review. No eligible trials were identified and thus no data were available for analysis. MAIN RESULTS: No meta-analysis could be performed. AUTHORS' CONCLUSIONS: In the absence of data, we cannot draw any conclusion to support or refute the adoption of singing as an intervention for people with bronchiectasis. Given the simplicity of the potentially beneficial intervention, future randomised controlled trials are required to evaluate singing therapy for people with bronchiectasis.

Contribution of Regional White Matter Integrity to Visuospatial Construction Accuracy, Organizational Strategy, and Memory for a Complex Figure in Abstinent Alcoholics.

Brain Imaging Behav. 2009 Dec 1; 3(4): 379-390
Rosenbloom MJ, Sassoon SA, Pfefferbaum A, Sullivan EV

Visuospatial construction ability as used in drawing complex figures is commonly impaired in chronic alcoholics, but memory for such information can be enhanced by use of a holistic drawing strategy during encoding. We administered the Rey-Osterrieth Complex Figure Test (ROCFT) to 41 alcoholic and 38 control men and women and assessed the contribution of diffusion tensor imaging (DTI) measures of integrity of selected white matter tracts to ROCFT copy accuracy, copy strategy, and recall accuracy. Although alcoholics copied the figure less accurately than controls, a more holistic strategy at copy was associated with better recall in both groups. Greater radial diffusivity, reflecting compromised myelin integrity, in occipital forceps and external capsule was associated with poorer copy accuracy in both groups. Lower FA, reflecting compromised fiber microstructure in the inferior cingulate bundle, which links frontal and medial temporal episodic memory systems, was associated with piecemeal copy strategy and poorer immediate recall in the alcoholics. The correlations were generally modest and should be considered exploratory. To the extent that the inferior cingulate was relatively spared in alcoholics, it may have provided an alternative pathway to the compromised frontal system for successful copy strategy and, by extension, aided recall.