Teleonics of health and healthcare: Focus on health promotion

Teleonics is an approach to the study of living systems. The latter can be regarded as synergistic collections of processes through which the systems interact with their internal and external environments. Teleonics can serve as a framework for positioning issues of health into the wider context of the fabric of life. There are essentially three webs of processes that are of relevance for a discussion of healthcare, viz, the normal web of the living fabric (Biomatrix), the “web of disease” (Pathomatrix) and the web of Healthcare. The latter interacts with the first two through the processes of Health Promotion, Disease Prevention and Disease Management. The end result of these interactions is an entirely new web of great complexity that incorporates the processes of all three webs intertwined with each other. This complexity presents a considerable challenge to all those involved in healthcare and can only be untangled with the aid of a process‐based methodology, such as teleonics.     

Mature adults' attitudes to mental health service utilisation

This qualitative study examined mature adults' attitudes to mental health services, in order to improve service utilisation among members of this group. Twenty individual and 12 focus group interviews were conducted with 111 West Australians aged ≥40 years living in urban and regional areas. The findings indicate that mature individuals may be receptive to information that assists them in differentiating the symptoms of ageing and mental illness and empowers them to make appropriate help‐seeking decisions. Perceived stigma and an aversion to medication were identified as barriers preventing individuals from acknowledging and addressing mental illness. A model of mature adults' intentions to utilise mental health services is proposed.     

A Critical Review of the Forms and Value of Religious Coping Among Informal Caregivers

A review of the literature revealed high rates of religiousness and religious coping among informal caregivers (i.e., unpaid family and friends) and some associations with better mental and spiritual health and caregiving experience. However, the information necessary to practically and empirically apply this knowledge to improve the lives of caregivers was noticeably absent. To this end five key issues were identified: (a) Measurement, (b) Process, (c) Effectiveness, (d) Moderators, and (e) Mediators. A greater understanding of the specific types of religious coping strategies used, how their use changes over time, for whom and what outcomes they are most effective, and what influences and explains their effectiveness, will better equip healthcare workers to promote the functioning and well being of caregivers.     

Challenges of patient‐led mental health services to psychoanalytic clinicians

This paper considers implications to psychoanalytic psychotherapy of the British Government's decision to implement a patient choice agenda for state‐funded mental health services in England and Wales. It places the patient choice agenda in the context of consumerist society and argues that the complex nature of psychoanalytic psychotherapy leaves it more vulnerable than other psychological therapy modalities to compete in the current reality of ‘consumer’‐led public mental health, which, in turn reflects a profoundly changed social context from that to which psychoanalysis traces its roots. Unless psychoanalytic clinicians recognize and find ways to adjust to this context they will jeopardize the survival of psychoanalytic psychotherapy in an increasingly market‐orientated model of mental healthcare provision in the public sector, eager to promote more ‘consumer friendly’ psychological therapy models.     

医者叙事素养量表的编制及信度效度检验

医者叙事素养将成为评价医疗人才实力的重要指标。然而,目前国内仍缺少以中国叙事医学理论与实践为基础的相关量表。研究以全国三十几家叙事医学基地的实践经验为基础制定量表,展开条目和探索性因子分析、内部一致性检验和验证性因子分析。最终形成的中国医者叙事素养量表由两个分量表组成,其中叙事认知能力量表分为生命健康叙事意识和职业叙事思维2个维度;叙事行为能力量表分为生命健康、家庭连接、职业发展、同行交流、医患互动5个维度,均具良好信效度,可为中国叙事医学研究、教育和实践提供科学有效的评估工具。

     

Religious support and psychosocial well-being among a religious Jewish population

The three subscales of the Religious Support Scale assess perceived support from a person’s religious community, religious leaders, and God. This three-factor structure was replicated in the current study with a sample of 277 religious Jewish persons residing in Israel. Hierarchical canonical analysis showed that, even after controlling for general social support, Religious Leader and God Support were related to lower emotional distress, Religious Leader and Religious Community Support contributed to a higher level of life satisfaction, and Religious Community and God Support contributed to the prediction of perceived health. Findings are discussed in terms of religious support’s generalizability as a psychosocial resource for persons of various faiths.     

A Moral Framework for Multicultural Education in Healthcare

The goal of this paper is two-fold. First, I begin by reviewing several of themajor points of emphasis among health educatorsas they begin to incorporate multiculturalissues into healthcare education. I thenconsider the role of moral relativism, which iscurrently being endorsed by some healtheducators, as the foundation for resolvingcross-cultural conflicts in healthcare. Iargue that moral relativism is ultimatelyinconsistent with the stated goals inmulticultural curricular proposals and fails toprovide an effective framework for consideringmoral conflicts in cross-cultural settings. Instead, I propose that those methods seekingto establish a common morality, built uponmutually shared values, offer the mostpromising means of resolving cross-culturalconflicts. This leads to my second goal, tocompare recent work in moral pragmatism withwhat is now widely known in bioethics as moral``principlism.' I argue that while proponentsof principlism and pragmatism each seek toestablish a common foundation for moraldeliberation, they fail to appreciatesignificant similarities between theirrespective approaches. Instead of offeringtwo completely unique and independent methodsof moral deliberation, I suggest thatprinciplism and pragmatism embrace commonthemes that point us in a positive direction,providing an effective framework useful forconsidering cross-cultural conflicts inhealthcare.     

Impact of psychiatric illness upon asthma patients’ health care utilization and illness control. Are all psychiatric comorbidities created equal?

The impact of psychiatric illnesses upon asthma patients' functioning is not well understood. This study examined the impact of psychiatric comorbidity upon illness management in asthma patients using empirically-derived psychiatric comorbidity groups. Participants were a clinic sample of Greek-speaking asthma patients (N = 212) assessed using the Patient Health Questionnaire (PHQ) Somatoform, Depression, Panic Disorder (PD), Other Anxiety Disorder, Eating Disorder (ED) and Alcohol sub-scales. The associations between sub-scales were examined using multiway frequency analysis. The following groups were derived: Somatoform disorder and/or Any Depressive disorder (n = 63), Somatoform disorder and/or Other Anxiety disorder (n = 51), Somatoform disorder and/or Any ED (n = 60), and Any Anxiety group including PD and/or Other Anxiety disorder (n = 24). Across all groups, psychiatric illness was associated with significantly worse asthma control (p < .01). Participants in Any Anxiety group, OR = 4.61, 95% CI [1.90, 11.15], Somatoform and/or Any Depressive disorder, OR = 2.06, 95% CI [1.04, 4.09] and Somatoform and/or Other Anxiety disorder, OR = 2.75, 95% CI [1.35, 5.60] were at higher risk for asthma-related Emergency Room (ER) visits compared to controls. However only Somatoform and/or Any Depressive disorder, OR = 3.67, 95% CI [1.60, 8.72], Somatoform and/or Other Anxiety disorder, OR = 5.50, 95% CI [2.34, 12.74], and Somatoform and/or Any ED, OR = 4.98, 95% CI [2.14, 11.60] group membership were risk factors for asthma-related hospitalizations. Results suggest that while comorbid psychiatric disorders generally negatively impact asthma illness management, different psychiatric comorbidities appear to have disparate effects upon illness management outcomes.     

Nigerian Clergy and healthcare professionals’ perceptions of health-seeking behaviours among Nigerian immigrants in the UK

The diversity in patient populations due to immigration in the UK has implications for adequate understanding of a patients’ culture by the clinician as well as patient–clinician cultural matching for enhanced service use and outcome. This qualitative study investigated how Nigerian clergy and health professionals perceived health-seeking behaviours among Nigerians in the UK, while considering the impact of their own beliefs and values as care providers. Six participants were interviewed (clergy, n?=?2; health professionals, n?=?4). Data were analysed using Interpretative Phenomenological Analysis. Results showed that the clergy and health professionals themselves use religious/cultural cure and formal healthcare methods, and believed Nigerian immigrants as predominantly using religious/cultural methods which can affect healthcare utilisation, although differences between the professionals were reported. The potentials for integrating other cure methods into the formal healthcare services were considered, while highlighting the challenges that may arise from such collaborative effort.