The role of attitudes and beliefs in differential health care utilisation among Chinese in Singapore

Abstract

One hundred and twenty-eight Chinese patients at two Western medical practices and two Chinese medical practices in Singapore completed a questionnaire regarding perceptions of illnesses. Health beliefs and attitudes towards different medical practitioners. Results indicate significant differences between those who consult only allopathic physicians (Western doctors) and those who consult both practitioners of traditional Chinese medicine (sinsehs) and Western doctors. Individuals consulting both Western doctors and sinsehs perceived a smaller proportion of “general” illness attributes (those found in both Western and Chinese medicine) to be relevant to specific diseases and showed greater endorsement of Chinese health beliefs than did individuals seeking help only from Western doctors. Also individuals consulting both types of practitioners expressed less satisfaction with the doctor's treatment than did those consulting only Western doctors and also rated sinsehs as more concerned with patient well-being and as listening more to their patients.     

Public Health Principlism: The Precautionary Principle and Beyond

What accounts for the continued lack of clarity over the legal procedures for the patenting of DNA sequences? The patenting system was built for a "bricks-and-mortar" world rather than an information economy. The fact that genes are both material molecules and informational systems helps explain the difficulty that the patent system is going to continue to have.     

Effects of optimism on recovery and mental health after a tornado outbreak

Objective: Dispositional optimism, a stable expectation that good things will happen, has been shown to improve health outcomes in a wide range of contexts, but very little research has explored the impact of optimism on post-disaster health and well-being.

Design: Data for this study come from the Centers for Disease Control and Prevention’s Public health systems and mental health community recovery (PHSMHCR) Survey. Participants included 3216 individuals living in counties affected by the April 2011 tornado outbreak in Mississippi and Alabama.

Main outcome measures: This study assesses the effect of dispositional optimism on post-disaster recovery and mental health.

Results: Dispositional optimism was found to have a positive effect on personal recovery and mental health after the disaster. Furthermore, it moderated the relationship between level of home damage and personal recovery as well as the relationship between home damage and post-traumatic stress disorder (PTSD), with stronger effects for those with increased levels of home damage.

Conclusions: The utility of screening for optimism is discussed, along with the potential for interventions to increase optimism as a means of mitigating adverse mental health effects and improving the recovery of individuals affected by disasters and other traumatic events.     

Complexity of online gender confirmation resources surpass patient literacy

Background: Increasing transgender health care coverage has resulted in easier access to gender confirmation surgery. Patients considering surgery consistently access medical information online to improve knowledge regarding surgical options, complications, recovery, and life after transitioning. As a result, national health institutes recommend that patient educational materials be written at a sixth-grade–reading level. The purpose of this study is to assess the complexity of online gender confirmation surgery information.

Methods: An Internet search was performed using the key phrase “transgender surgery”. Health care and non–health care websites were evaluated for pertinent articles regarding gender confirmation surgery. Readability analyses were conducted using Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. A two-tailed z test was used to compare means; significance was set at p ≤ 0.05.

Results: A total of 108 articles from 87 websites were analyzed. The average readability for all online gender confirmation-surgery information was at an 11th-grade reading level. Materials written by health care entities were written at a 12th-grade–reading level compared to non–health care articles, which were written at a 10th-grade level (p < 0.001). Male-to-female surgery materials were written at a 12th-grade level, significantly higher than the 11th-grade reading level of female-to-male surgery materials (p = 0.04).

Conclusion: Online information regarding gender confirmation surgery is written at a level that is too complex for patients to understand. Informational materials should be written at lower grade levels to improve patient education, informed consent, and outcomes.     

Equality in health care: Christian engagement with a secular obsession.

A frenetic search for equality lies at the center of much secular and even "Christian" bioethics. In a secular world, if one does not believe in God, if this life is one's whole existence, it would seem that one could not settle for less than equal approbation, especially equality before the risks of suffering and death, which medicine promises to ameliorate. Yet, the concern for equality in health care is puzzling. After a modest level of access to health care there is little difference in average life expectancy. Are concerns for equality in health care even vaguely Christian? The pursuit of Christian perfection has never been correctly equated with state-imposed egalitarianism. Furthermore, an all-encompassing, secular, egalitarian health care system may provide equal access to significantly immoral medical treatments. In contrast to secular thought, the call of Christianity is a call to holiness, not a call to an egalitarianism that superficially resonates with certain elements of Christian thought.     

An experimental test of the relationship between voice intonation and persuasion in the domain of health

Objective: In the process of behaviour change, intonation of speech is an important aspect that may influence persuasion when auditory messages are used. In two experiments, we tested to what extent different levels of intonation are related to persuasion and whether for some recipients the threat posed by the message information might become too strong to face.

Design: In Study 1, 130 respondents listened to a health message with either a low, moderate or high level of intonation. In Study 2 (N?=?143), the same manipulations of intonation were applied but half of the respondents were affirmed before they listened to the persuasive message. Intention to increase fruit and vegetable intake was used as a dependent variable.

Results: Both studies showed that high intonation led to a significant drop in intention among respondents who perceived their own health as good. After self-affirmation, persuasion was increased.

Conclusion: A high level of intonation seems to induce self-regulatory defences in people who do not see the necessity to change their health behaviour, whereas people with poor perceived health might perceive potential to change. The use of a normal level of intonation in auditory health messages is recommended.     

How WEIRD are positive psychology interventions? A bibliometric analysis of randomized controlled trials on the science of well-being

ABSTRACT

The past two decades have witnessed a rapid rise in well-being research, and a profusion of empirical studies on positive psychology interventions (PPIs). This bibliometric analysis quantifies the extent to which rigorous research on PPIs that employ randomized controlled trials (RCTs) reaches beyond Western Educated Industrialized Rich Democratic (WEIRD) populations. A search was conducted through databases including PubMed, PsycINFO, and Scopus for studies from 1998 to 2017. In total, we found 187 full-text articles that included 188 RCTs from 24 countries. We found that RCTs on the efficacy of PPIs are still predominately conducted in western countries, which accounted for 78.2% of the studies. All these countries are highly industrialized and democratic, and study populations are often highly educated and have a high income. However, there has been a strong and steady increase in publications from non-Western countries since 2012, indicating a trend towards globalization of positive psychology research.     

Brain Fag: A Case Study Showing the Diagnosis and Therapy in Nigeria

The co-occurrence of somatic complaints along with other forms of mental illness such as depression, anxiety and brain fag is well documented in mental health literature. In Africa, the notion that somatic complaints are a variant of depression is popular. However objective empirical efforts to prove this notion are inconclusive. The common co-occurrence of somatic complaints along with depression, anxiety and brain fag complaints in Nigeria may put clinicians in a dilemma in making diagnostic and therapeutic decisions for their clients. In this paper the authors applied the Harmony Restoration Therapy (HRT) in the management of somatic, depressive, anxiety and brain fag symptoms of a client. The HRT is a psychotherapeutic framework based on the Africa world view of health and illness where health is harmony and illness is disharmony in one’s world of relationships. The case was used to illustrate the co-morbidity of depression, anxiety, somatization and Brain Fag and tries to contribute to how Brain Fag can be treated.     

Alternative Methodologies in Research Literature Review: Links Between Clinical Work and MFT Effectiveness

Traditionally, "good outcome research" has referred to laboratory-based, controlled studies that report the efficacy of a given treatment on a specific population. Although useful and needed in the struggle to establish MFTs as accepted mental health service providers, this type of research does not address whether MFT is effective in "real world" settings. In order to highlight the clinical and professional relevance of existing effectiveness research, this article reviews 15 years of clinical research in three major family therapy journals. The results suggest that 1) MFT effectiveness is under-represented in major review articles, 2) clinicians can use a variety of methodologies to establish the effectiveness of their work, and 3) more research is needed that investigates how and why MFT works in "real world" settings. Implications for practice and future research are discussed.     

Hermeneutics in science and medicine: A thesis understated

Drew Leder's “Clinical Interpretation: The Hermeneutics of Medicine” [1] is an essay which understates its case and thereby opens itself to misinterpretation. This response to Leder argues for a more thorough-going hermeneutic for both medicine and science. At the conceptual as well as the practical level, modern medicine and its scientific foundations are hermeneutic enterprises. The purpose of this essay is to argue that we should not back away from this more radical thesis. Embracing it will result in less alienation of physicians from patients, and of physicians from the tasks of medicine.     

Dialetheism and the Impossibility of the World

This paper first offers a standard modal extension of dialetheic logics that respect the normal semantics for negation and conjunction, in an attempt to adequately model absolutism, the thesis that there are true contradictions at metaphysically possible worlds. It is shown, however, that the modal extension has unsavoury consequences for both absolutism and dialetheism. While the logic commits the absolutist to dialetheism, it commits the dialetheist to the impossibility of the actual world. A new modal logic AV is then proposed which avoids these unsavoury consequences by invalidating the interdefinability rules for the modal operators with the use of two valuation relations. However, while using AV carries no significant cost for the absolutist, the same isn't true for the dialetheist. Although using AV allows her to avoid the consequence that the actual world is an impossible world, it does so only on the condition that the dialetheist admits that she cannot give a dialetheic solution to all self-referential semantic paradoxes. Thus, unless there are any further available modal logics that don't commit her to the impossibility of the actual world, the dialetheist is faced with a dilemma. Either admit that the actual world is an impossible world, or admit that her research programme cannot give a comprehensive solution to the self-referential paradoxes.     

Failure to exploit learned spatial value information during visual search

ABSTRACT

In recent years there has been rapid proliferation of studies demonstrating how reward learning guides visual search. However, most of these studies have focused on feature-based reward, and there has been scant evidence supporting the learning of space-based reward. We raise the possibility that the visual search apparatus is impenetrable to spatial value contingencies, even when such contingencies are learned and represented online in a separate knowledge domain. In three experiments, we interleaved a visual choice task with a visual search task in which one display quadrant produced greater monetary rewards than the remaining quadrants. We found that participants consistently exploited this spatial value contingency during the choice task but not during the search task – even when these tasks were interleaved within the same trials and when rewards were contingent on response speed. These results suggest that the expression of spatial value information is task specific and that the visual search apparatus could be impenetrable to spatial reward information. Such findings are consistent with an evolutionary framework in which the search apparatus has little to gain from spatial value information in most real world situations.     

“Melancholic? Naturally!”: Impulses for Cultural Transformation from Queer-Ecological Worldmaking,Activism, and Art in a Western Context

Abstract

Although ecological grief is a common psychic response to socioecological losses, there are no shared spaces to engage with it in Western cultures—a symptom of the problematic way they conceive Nature as external and subordinate to humans. Seeking subversive impulses for paradigmatic transformation, this research centers queer-identifying eco-activists and -artists, and their practices of queer-ecological worldmaking. Arts-based research and interviews reveal the potential of melancholic grieving to create an understanding of interdependencies with the more-than-human world, as well as communities for healing. Impulses toward a joint liberation entail the extension of empathy and agency to the more-than-human world.     

Information search activity: An overview

IntroductionThis article exposes a brief history of information search models, from general and behavioural models to cognitive ones and presents recent theoretical advances in this research field.Literature findingsSince the beginning of 1990s, many theoretical models have tried to describe and predict the human behaviours involved in the information search tasks, and specifically when this activity is performed in computer systems. Some of these models elaborated by psychologists have attempted to infer the cognitive processes involved.DiscussionInformation search can be considered as a complex cognitive activity that involves various individual (cognitive, affective), contextual and social factors.ConclusionWe also suggest research issues to be developed in order to increase our knowledge in this area and we plead for further research on specific concepts depending on future and/or recent areas of interest.     

Understanding spirit possession in the Philippines: a social representations approach

ABSTRACT

Where there are diverse professionals and curers dealing with possession, differences in representations exist. This study uses social representations theory as a frame to examine both the representational overlaps and differences in possession among various Filipino health professionals and the lay distinctly socialised in Western biomedical and psychological lenses and in local religious and traditional folk beliefs. Themes were extracted from 12 individual interviews. Results showed five representational themes, namely: possession as sinakluban, as a vulnerability, as a disease, as kulam, and as being chosen. Findings were discussed in relation to the interface among religion, indigenous beliefs, psychopathological frame, and the Western biomedical model.     

Thinking through enactive agency: sense-making,bio-semiosis and the ontologies of organismic worlds

According to enactivism all living systems, from single cell organisms to human beings, are ontologically endowed with some form of teleological and sense-making agency. Furthermore, enactivists maintain that: (i) there is no fixed pregiven world and as a consequence (ii) all organisms “bring forth” their own unique “worlds” through processes of sense-making. The first half of the paper takes these two ontological claims as its central focus and aims to clarify and make explicit the arguments and motivations underlying them. Our analysis here highlights three distinct but connected problems for enactivism: (i) these arguments do not and cannot guarantee that there is no pregiven world, instead, they (ii) end up generating a contradiction whereby a pregiven world seems to in fact be tacitly presupposed by virtue of (iii) a reliance on a tacit epistemic perspectivalism which is also inherently representationalist and as a consequence makes it difficult to satisfactorily account for the ontological plurality of worlds. Taking these considerations on board, the second half of the paper then aims to develop a more robust ontologically grounded enactivism. Drawing from biosemiotic enactivism, science and technology studies and anthropology, the paper aims to present an account which both rejects a pregiven world and coherently accounts for how organisms bring forth ontologically multiple worlds.     

Access to Health Care for Transgendered Persons: Results of a Needs Assessment in Boston

SUMMARY

The transgender community is a population group that has experienced an increase in visibility, with only a small, concomitant increase in understanding. This study reports on four focus groups, in which 34 transgendered individuals discussed their experiences and interactions with the health care system.

The specific aims of the study were as follows:

• Identify the health needs of transgender and transsexual (TG/TS) individuals;

• Hear the experiences and perceptions of TG/TS individuals who are using the current health care system;

• Identify any barriers to obtaining services, support and/or resources;

• Assess the extent to which health care providers and systems are able to offer sensitive, high quality and user friendly services that meet TG/TS consumers' needs; and

• Identify ways that health care services can be enhanced to better meet the needs of the target population.

What the study found was a system that was anything but high quality in meeting the needs of TG/TS individuals. Ignorance, insensitivity and discrimination appear to be the norm. Specifically, the focus groups found the following:

• Transgendered and transsexual persons frequently encounter providers who will not treat them and blatantly say so. There is a need for education and a change in anti-discrimination law needed to change this.

• The lack of provider training on transgender issues creates insensitivity to simple issues of respect for trans people. One example is the unwillingness to address TG/TS people by the pronoun preferred by the patient/client.

• Many providers lack the knowledge to adequately treat many of the routine health care needs of TG/TS individuals when such treatment relates to issues of hormone use, gynecological care, HIV prevention counseling, or other concerns related to gender or sexuality.

• Providers frequently refer to trans issues in unrelated health care situations such as setting a broken bone, filling a cavity or treating a cold. Greater familiarity with the health care needs of the trans population would reduce such incidents.

• Mental health and substance abuse treatment providers need additional training in order to work cooperatively with TG/TS clients to identify when gender issues are or are not relevant to specific mental health or substance abuse treatment episodes. Sometimes gender issues are central to mental health or substance abuse treatment, sometimes they are peripheral and sometimes they are unrelated.

• Discrimination in health insurance is the rule, not the exception. There is a need for education to encourage policy changes on the part of insurers and public policy changes on the part of legislators and regulators.

     

Health promotion from the perspective of social cognitive theory

Abstract

This article examines health promotion and disease prevention from the perspective of social cognitive theory. The areas of overlap with some of the most widely applied psychosocial models of health are identified. The models of health promotion and disease prevention have undergone several generational changes. We have shifted from trying to scare people into health, to rewarding them into health, to equipping them with self-regulatory skills to manage their health habits, to shoring up their habit changes with dependable social supports. These transformations have evolved a multifaceted approach that addresses the reciprocal interplay between self-regulatory and environmental determinants of health behavior. Social cognitive theory addresses the socio structural determinants of health as well as the personal determinants. A comprehensive approach to health promotion requires changing the practices of social systems that have widespread detrimental effects on health rather than solely changing the habits of individuals. Further progress in this field requires building new structures for health promotion, new systems for risk reduction and greater emphasis on health policy initiatives. People's beliefs in their collective efficacy to accomplish social change, therefore, play a key role in the policy and public health approach to health promotion and disease prevention.     

Physical activity to address multimorbidity among survivors of sexual violence: A comprehensive narrative review

BackgroundSexual Violence (SV) is highly prevalent and experienced by women and men throughout the United States and world. Survivors of SV often experience poor mental and physical health, and poor health-related quality of life. Studies have explored the associations between SV survivorship and maladaptive health behaviors, but few have examined SV and health promoting activities such as exercise.PurposeThe aim of this narrative review is to describe available peer-reviewed literature regarding SV and physical activity and provide recommendations for future research. Specifically, this review aimed to identify information relevant for promoting and designing exercise interventions that can integrate into clinical treatments for adult survivors of SV.MethodsA search of electronic databases identified 18 articles on SV and exercise behavior.ResultsFour of these studies were exercise interventions, 10 were observational studies, and 4 were qualitative interviews. Results broadly indicate that levels of physical activity among survivors of SV is unclear. Findings from trials indicate exercise may have a positive impact on mental health in survivors of SV. Qualitative interviews found survivors often enjoyed exercising and identified several health benefits, suggesting exercise interventions may be feasible and acceptable in this population. Interviews also identified valuable information about survivors' experiences with exercise.ConclusionsResearch in this area would benefit from: representative samples of adults among populations at high risk for victimization, more consistent and in-depth reporting of SV history and exercise levels, consistent and trauma-informed outcome measurements, and more diverse study designs and interventions. Increased exploration of exercise in this population is warranted given the well-established evidence base indicating the health promoting qualities of exercise for mental and physical health among trauma affected populations.