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Scarinci F, Patacchioli FR, Parravano M. Exploring the Biopsychosocial Pathways Shared by Obstructive Sleep Apnea (OSA) and Central Serous Chorioretinopathy (CSC): A Literature Overview. J Clin Med 2021; 10:jcm10071521. [PMID: 33917331 PMCID: PMC8038656 DOI: 10.3390/jcm10071521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/18/2021] [Accepted: 03/31/2021] [Indexed: 12/18/2022] Open
Abstract
This study addressed the following question: “Is it possible to highlight the link between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) through common biopsychosocial pathogenetic pathways?”. The study was conducted through electronic searches of the PubMed, Web of Science, and Scopus databases. All relevant selected human research studies published from January 2003 to December 2020 were included. The scientific literature search was performed through repeated use of the words “OSA” and/or “acute/chronic CSC” paired with “biomedical/biopsychosocial illness model”, “psychopathology”, “stress”, “personality characteristics”, “functional diseases”, “comorbidity”, and “quality of life” in different combinations. Our literature search identified 213 reports, of which 54 articles were ultimately reviewed in this paper. Taken together, the results indicate that there is a cross-link between OSA and CSC that can be classified among biopsychological disorders in which various major biological variables integrate with psychological-functional and sociological variables; many of these variables appear in both diseases. This concept can have important implications for improving patients’ quality of life, thus providing the necessary strategies to cope with challenging life events even through nonpharmacological approaches.
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Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care. BMC FAMILY PRACTICE 2020. [PMID: 32106823 DOI: 10.1186/s12875‐020‐01116‐x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pain-related fear-avoidance (FA) is a common problem affecting many patients with painful medical conditions. As there is great interest in the clinical importance of the relationship between FA and disability, several questionnaires have been developed to measure FA. The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument that addresses critical issues not previously considered in previous FA-related questionnaires. The original English version of the FACS demonstrated good reliability, internal consistency, and construct, criterion, and predictive validity. Two factors were determined: General Fear Avoidance and Types of Activities That are Avoided. The aim of this study was to to translate the FACS into European-style Spanish (FACS-Sp), and validate its psychometric properties. METHODS This two-stage psychometric study included 330 subjects with various chronic musculoskeletal pain disorders. An initial translation and cross-cultural adaptation of the FACS, from English to Spanish, was performed. Then, critical psychometric properties were analysed, including internal consistency by Cronbach's α coefficients, structural validity from the Maximum Likelihood Extraction (MLE), and convergent validity by Pearson correlation with the Central Sensitization Inventory (CSI). RESULTS This study reports for the first time the psychometric properties of the Spanish version of the FACS. Total scores ranged from 0 to 88 points, with a mean of 30.49 (±17.18). The FACS-Sp showed a high internal consistency for factor 1 (α = 0.902) and factor 2 (α = 0.88). Factor structure was two-dimensional and supported structural validity, accounting for 48.75% of the total variance. Convergent validity analysis found a significant Pearson correlation r = 0.414. CONCLUSION This study reports for the first time the psychometric properties of the Spanish version of the FACS-Sp. Psychometric properties supported the validation of FACS-Sp and ensured the conceptual equivalence with the original English version. In primary care and chronic pain rehabilitation, FA assessment is crucial for clinical decision-making and treatment guidance. The FACS-Sp offers a new measure of FA in Spanish speaking populations. Future research on the FACS-Sp should evaluate test-retest reliability, treatment responsiveness and psychometric comparisons with other translated versions.
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Cuesta-Vargas AI, Neblett R, Gatchel RJ, Roldán-Jiménez C. Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care. BMC FAMILY PRACTICE 2020; 21:44. [PMID: 32106823 PMCID: PMC7047382 DOI: 10.1186/s12875-020-01116-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pain-related fear-avoidance (FA) is a common problem affecting many patients with painful medical conditions. As there is great interest in the clinical importance of the relationship between FA and disability, several questionnaires have been developed to measure FA. The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument that addresses critical issues not previously considered in previous FA-related questionnaires. The original English version of the FACS demonstrated good reliability, internal consistency, and construct, criterion, and predictive validity. Two factors were determined: General Fear Avoidance and Types of Activities That are Avoided. The aim of this study was to to translate the FACS into European-style Spanish (FACS-Sp), and validate its psychometric properties. METHODS This two-stage psychometric study included 330 subjects with various chronic musculoskeletal pain disorders. An initial translation and cross-cultural adaptation of the FACS, from English to Spanish, was performed. Then, critical psychometric properties were analysed, including internal consistency by Cronbach's α coefficients, structural validity from the Maximum Likelihood Extraction (MLE), and convergent validity by Pearson correlation with the Central Sensitization Inventory (CSI). RESULTS This study reports for the first time the psychometric properties of the Spanish version of the FACS. Total scores ranged from 0 to 88 points, with a mean of 30.49 (±17.18). The FACS-Sp showed a high internal consistency for factor 1 (α = 0.902) and factor 2 (α = 0.88). Factor structure was two-dimensional and supported structural validity, accounting for 48.75% of the total variance. Convergent validity analysis found a significant Pearson correlation r = 0.414. CONCLUSION This study reports for the first time the psychometric properties of the Spanish version of the FACS-Sp. Psychometric properties supported the validation of FACS-Sp and ensured the conceptual equivalence with the original English version. In primary care and chronic pain rehabilitation, FA assessment is crucial for clinical decision-making and treatment guidance. The FACS-Sp offers a new measure of FA in Spanish speaking populations. Future research on the FACS-Sp should evaluate test-retest reliability, treatment responsiveness and psychometric comparisons with other translated versions.
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Affiliation(s)
- Antonio I. Cuesta-Vargas
- Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, Cátedra de Fisioterapia, Universidad de Málaga, Andalucía Tech, Av/ Arquitecto Peñalosa, 3 (Teatinos Campus Expansión), Malaga, 29071 Spain
- School of Clinical Science, Faculty of Health at the Queensland University of Technology, Brisbane, Australia
- Instituto Investigación de Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Robert J. Gatchel
- Department of Psychology, Center of Excellence for the Study of Health & Chronic Illnesses, College of Science, The University of Texas at Arlington, Arlington, TX USA
| | - Cristina Roldán-Jiménez
- Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, Cátedra de Fisioterapia, Universidad de Málaga, Andalucía Tech, Av/ Arquitecto Peñalosa, 3 (Teatinos Campus Expansión), Malaga, 29071 Spain
- Instituto Investigación de Biomédica de Málaga (IBIMA), Málaga, Spain
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Levula A, Harré M, Wilson A. The Association Between Social Network Factors with Depression and Anxiety at Different Life Stages. Community Ment Health J 2018; 54:842-854. [PMID: 29127564 DOI: 10.1007/s10597-017-0195-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 11/04/2017] [Indexed: 10/25/2022]
Abstract
This study examines whether social network factors influence individual's depression and anxiety outcomes at different life stages. Data was drawn from the Household, Income and Labour Dynamics in Australia survey. Hierarchical regression modelling was applied to examine the effects within and across different life stages. The depression and anxiety measures were taken from the Kessler Psychological Distress Scale (K10) and the social network factors were taken from the self-completion questionnaire. With the exception of social trust in seniors, the social network factors were significant predictors of depression and anxiety. This has practical implications for the design of social policy initiatives.
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Affiliation(s)
- Andrew Levula
- Complex Systems Research Group, Faculty of Engineering and Information Technology, The University of Sydney, Sydney, Australia.
| | - Michael Harré
- Complex Systems Research Group, Faculty of Engineering and Information Technology, The University of Sydney, Sydney, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, Australia
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Morin C, Desrosiers J, Gaboury I. Enablers and barriers to the development of interprofessional collaboration between physicians and osteopaths: A mixed methods study. J Interprof Care 2018; 32:463-472. [PMID: 29461138 DOI: 10.1080/13561820.2018.1435515] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Osteopathy is a complementary and alternative medicine (CAM) that is growing in popularity. Increasing numbers of parents are seeking pediatric osteopathic care in addition to conventional medical care. Information about the development of interprofessional collaboration (IPC) between these practitioners is scarce. This explanatory sequential mixed methods study aimed to explore enablers of and barriers to the development of IPC between physicians and osteopaths involved with pediatric patients in primary care in Quebec, Canada. Postal questionnaires about collaborative practices were first sent to all physicians and osteopaths working with pediatric patients in Quebec. Semi-structured individual interviews were then conducted with a subset of 10 physicians and 11 osteopaths. A total of 274 physicians (14%) and 297 osteopaths (42%) completed the survey. Forty-five percent (n = 122) of physicians reported that they referred at least one pediatric patient per month to an osteopath. Thirty-six percent (n = 96) of physicians and 41% (n = 122) of osteopaths indicated having professional relationships. Personal consultation, professional relationship, perceived utility of osteopathy and community practice were positively associated with osteopathic referrals. According to participants, the strongest enabler of the development of collaboration was positive clinical results reported by parents. Additional enablers included the osteopath having previous health professionals training such as physiotherapist, pediatric experience, mutual respect for professional boundaries and complementarity, perceived safety of osteopathy, and parents' requests for collaboration. Barriers were the absence of a common language, the organizational and legal context, uncertainty regarding one another's roles, lack of interprofessional interactions, and limited scientific evidence. These results related to enablers of and barriers to collaboration between physicians and osteopaths and the illustration of their dynamic interaction could be used to guide efforts to promote productive collaboration and safe patient-oriented care.
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Affiliation(s)
- Chantal Morin
- a Department of Family Medicine and Emergency Medicine and School of Rehabilitation, Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , Québec , Canada
| | - Johanne Desrosiers
- b School of Rehabilitation, Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , Québec , Canada
| | - Isabelle Gaboury
- c Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences , Université de Sherbrooke , Sherbrooke , Québec , Canada
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Miciak M, Mayan M, Brown C, Joyce AS, Gross DP. A framework for establishing connections in physiotherapy practice. Physiother Theory Pract 2018; 35:40-56. [PMID: 29432058 DOI: 10.1080/09593985.2018.1434707] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The therapeutic relationship between practitioner and patient is embedded in the clinical interaction. Research using self-report tools has illustrated that positively evaluated therapeutic relationships can have favorable impacts on patient satisfaction with services and clinical outcomes. However, little is known about how physiotherapists develop the connections, or positive attachments, that help establish the therapeutic relationship. This study aimed to identify the various ways that physiotherapists establish meaningful connections with their patients. Interpretive description, a qualitative methodology, was used to structure the inductive and iterative design. Eleven physiotherapists and 7 patients from private practice clinics participated in semi-structured interviews to describe their experiences of the therapeutic relationship. Textual data were analyzed using qualitative content analysis and constant comparison. The iterative data generation and analysis process resulted in a framework composed of three "ways" (i.e. categories) of establishing connections: (1) acknowledging the individual, (2) giving-of-self, and (3) using the body as a pivot point. Findings were supported by various rigor strategies including peer debrief and external audit. This framework demonstrates that establishing connections is a multi-faceted endeavor with personal and professional characteristics. The findings provide practical knowledge that can be used to guide clinicians, educators, and researchers in addressing the therapeutic relationship.
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Affiliation(s)
- Maxi Miciak
- a Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , AB , Canada
| | - Maria Mayan
- b Faculty of Extension , University of Alberta , Edmonton , AB , Canada
| | - Cary Brown
- c Department of Occupational Therapy , University of Alberta , Edmonton , AB , Canada
| | - Anthony S Joyce
- d Department of Psychiatry , University of Alberta , Edmonton , AB , Canada
| | - Douglas P Gross
- e Department of Physical Therapy , University of Alberta , Edmonton , AB , Canada
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Kusnanto H, Agustian D, Hilmanto D. Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. J Family Med Prim Care 2018; 7:497-500. [PMID: 30112296 PMCID: PMC6069638 DOI: 10.4103/jfmpc.jfmpc_145_17] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Biopsychosocial model is a useful worldview for primary care or family doctors. However, it is often considered as impractical or too complicated. The objective of this study is to review the implementation of the biopsychosocial model in clinical practice, and its contributions to clinical outcomes. Hermeneutic circle literature review was conducted to provide experiential learning in an attempt to understand biopscyhosocial model, first developed by George Engel. Literature search started with review articles in Medline and Scopus as search engines. Citations from previous articles, editorials, and research articles were identified and interpreted in the context of the knowledge derived from all identified relevant articles. The progress of biopsychosocial model has been slow, and primary care doctors do not implement biopsychosocial medicine in their practice, while biomedical thinking and approach are still the dominant model. Biopsychosocial research addressed chronic illnesses and functional disorders as conditions in need for biopsychosocial model implementation. As payment scheme, clinical guidelines and clinical performance indicators are biomedically oriented, there is no incentive for primary care doctors to adopt biopsychosocial model in their practice. Workload and lack of competence in primary care may hinder the implementation of biopsychosocial model. Biopsychosocial model helps primary care doctors to understand interactions among biological and psychosocial components of illnesses to improve the dyadic relationship between clinicians and their patients and multidisciplinary approaches in patient care. Biopsychosocial model potentially improves clinical outcomes for chronic diseases and functional illnesses seen in primary care.
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Affiliation(s)
- Hari Kusnanto
- Department of Family Medicine and Community Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Dwi Agustian
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Dany Hilmanto
- Department of Pediatrics, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
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Morin C, Desrosiers J, Gaboury I. Descriptive study of interprofessional collaboration between physicians and osteopaths for the pediatric population in Quebec, Canada. BMC Health Serv Res 2017; 17:726. [PMID: 29137632 PMCID: PMC5686955 DOI: 10.1186/s12913-017-2717-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/09/2017] [Indexed: 11/10/2022] Open
Abstract
Background Osteopathy is an increasingly popular healthcare approach that uses a wide variety of therapeutic manual techniques to address pain and somatic dysfunction. In Quebec, Canada, osteopathy is the complementary medicine most often recommended by family physicians. However, factors fostering the development of interprofessional collaboration (IPC) between physicians and osteopaths are unknown. This study aimed to describe the current situation in terms of IPC among practitioners working with pediatric patients. Methods A self-administered questionnaire was sent to osteopaths, family physicians, and pediatricians involved with pediatric patients in the province of Quebec. The postal questionnaire captured general knowledge about osteopathy and its practice parameters and role, sources of information, communication aspects including having a professional relationship and referrals, and influence of the upcoming government regulation. Quantitative data from the questionnaires were analyzed using descriptive statistics. Logistic regression model for factors associated with osteopathic referrals and multiple linear regression analyses for the number of correct answers about general osteopathic practice parameters were performed. Results A total of 274 physicians (155 family physicians (response rate 13%) and 119 pediatricians (17%)) and 297 osteopaths (42%) completed the survey. According to physicians, osteopathy was most appropriate for musculoskeletal pain (241; 91%) and plagiocephaly (235; 88%). Osteopathic referral was positively associated with having a professional relationship (odds ratio [OR] 4.10 (95% confidence interval [CI] 2.12; 7.95), p < 0.001), personal consultation (OR 2.58 (95% CI 1.35; 4.93), p = 0.004), community-based practice (OR 1.89 (95% CI 1.03; 3.47), p = 0.040), and belief in the active role of osteopathy for pediatric conditions (OR 1.22 (95% CI 1.01; 1.47), p = 0.042). The majority of physicians (72%) and osteopaths (62%) considered the upcoming government regulation of osteopathy a positive factor for collaboration. Conclusion Some collaboration already exists among these practitioners, including mutual referrals, but optimizing this collaboration still poses some challenges.
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Affiliation(s)
- Chantal Morin
- Department of Family Medicine and Emergency Medicine and School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
| | - Johanne Desrosiers
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine and School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Abstract
This editorial considers how healthcare systems should approach the problems associated with ongoing, persistent symptoms and limitations on a person's ability to undertake activities. It starts from the premise, established in the first editorial, that the current reliance on the biomedical model of health and illness is no longer 'fit for purpose', and is one major cause of current difficulties within the health service. Among other problems, it may lead to the marginalisation of rehabilitation services, especially when resources are limited. This editorial describes and then highlights the implications of the holistic, biopsychosocial model of illness. It also outlines the rehabilitation process, demonstrating its similarity to the process used by medical services, with the primary difference being the centre of attention: disease for medical service, disability for rehabilitation services. The model of rehabilitation emphasises: the importance of being patient-centred and goal-directed in rehabilitation; the need for liaison by the team and learning by the patient; and that the patient needs to be encouraged and enabled to practice wanted activities.
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Primary reasons for osteopathic consultation: a prospective survey in Quebec. PLoS One 2014; 9:e106259. [PMID: 25184204 PMCID: PMC4153609 DOI: 10.1371/journal.pone.0106259] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 07/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Osteopathy is an increasingly popular health care modality to address pain and function in the musculoskeletal system, organs and the head region, as well as functional somatic syndromes. Although osteopathy is recommended principally in guidelines for management of back pain, osteopaths' scope of practice is wide, albeit poorly defined. In order to understand better the practice of osteopathy, this study aimed to investigate the most common reasons for osteopathic consultations in clinical settings in Quebec. METHODS A prospective survey of members of the Registre des ostéopathes du Québec was conducted to examine demographics in osteopathic practices, as well as patients' primary reasons for consultations over a two-week period. The questionnaire was devised following a literature review and refined and verified with two stages of expert input. RESULTS 277 osteopaths (60[corrected]% response rate) responded to the survey notice. 14,002 patients' primary reasons for consultations were reported in completed questionnaires and returned by practicing osteopaths. Musculoskeletal pain located in the spine, thorax, pelvis and limbs was the most common reason for consultations (61.9%), with females consulting most commonly for cervical pain and males for lumbar pain. Perinatal and paediatric (11.8%), head (9.1%), visceral (5.0%) and general concerns (4.8%) were the other most common reasons for consultations. Preventive care represented the remaining 0.3%. INTERPRETATION The nature of primary reasons for osteopathic consultations, coupled with documented satisfaction of patients with this approach, suggest a future for multidisciplinary collaborative health care including osteopathy. Results of this survey may contribute to informing physicians and others pending regulation of Quebec osteopaths, and also provide direction for future clinical research and guidelines development.
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Soler JK, Okkes I. Reasons for encounter and symptom diagnoses: a superior description of patients' problems in contrast to medically unexplained symptoms (MUS). Fam Pract 2012; 29:272-82. [PMID: 22308181 DOI: 10.1093/fampra/cmr101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This is a review of the literature on the role of symptoms in family practice, with a focus on the diagnostic approach in family medicine (FM). We found two, contrasting, approaches to reducing symptoms presented by patients in primary care, especially those which do not immediately allow the definition of a disease-label diagnosis. Years of research into 'medically unexplained symptoms' (MUS) has failed to support an international body of knowledge and cannot convincingly support the philosophy on which the reduction itself is based. This review supports the approach of researching reasons for encounter as they present to the family doctor, without artificial mind-body metaphors. The medical model is shown to be an incomplete reduction of FM, and the concept of MUS fails to improve this situation. A new model based on a substantial paradigm shift is needed. That model should be the biopsychosocial model, reflected in the philosophical concepts of the International Classification of Primary Care and the value of the patient's 'reason for encounter'. There is more to life than medicine may diagnose, and FM should strive to move closer to the lives of our patients than the medical model alone could allow.
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Affiliation(s)
- Jean Karl Soler
- Faculty of Life and Health Sciences, University of Ulster, Coleraine, Northern Ireland.
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Miciak M, Gross DP, Joyce A. A review of the psychotherapeutic ‘common factors’ model and its application in physical therapy: the need to consider general effects in physical therapy practice. Scand J Caring Sci 2011; 26:394-403. [DOI: 10.1111/j.1471-6712.2011.00923.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A cross-sectional survey of participation of asthmatic children in physical activity. World J Pediatr 2010; 6:238-43. [PMID: 20706822 DOI: 10.1007/s12519-010-0222-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Physical exercise has been proven to be beneficial to children with asthma, but the traditional view in China is that asthmatic children should not take part in sports. This study was undertaken to investigate the current status of children with asthma taking part in exercise in China. METHODS One hundred and twenty-three asthmatic children (7-14 years old) who had visited our asthma control center between February 2009 and June 2009 were enrolled in this cross-sectional study. Each child had a pulmonary function test and his/her health-related quality of life was assessed. The children also finished a questionnaire about their physical activity. As a control group, 109 nonasthmatic children from a primary school were surveyed about their level of activity. RESULTS Asthmatic children took part in less exercise than their healthy peers, and 62.6% (77/123) of the children with asthma never reached the criteria of exercise prescription for patients with asthma advised by the American College of Sports Medicine. The asthmatic children were divided into two groups based on the level of activity; compared with the group with a higher physical activity level, more children in the group with lower activity believed that exercise could make asthma worse, more parents and teachers restricted the children's exercise, and fewer doctors approved them participating in exercise. All of the parameters of basic lung function were higher in the group with higher activity level. Moreover, the children with a higher exercise level had a higher score on all parts of the pediatric asthma quality-of-life questionnaire. About 78.5% (96/123) of children ever experienced coughing, chest distress, dyspnea, or gasping during exercise, but 49.6% (61/123) had these symptoms occasionally. CONCLUSIONS Our study reveals that children with asthma do not have enough exercise in China. The concept that children, parents, teachers and doctors have about exercise for patients with asthma is urgent to be updated. We need to prescribe appropriate exercise for children with asthma.
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Hartog CS. Elements of effective communication--rediscoveries from homeopathy. PATIENT EDUCATION AND COUNSELING 2009; 77:172-178. [PMID: 19372024 DOI: 10.1016/j.pec.2009.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 02/21/2009] [Accepted: 03/04/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Patients are increasingly attracted to homeopathy despite the unproven effectiveness of homeopathic remedies. Clinical benefit of homeopathy may be due to communication. This review aims to identify and assess effective communication patterns in homeopathy. METHODS Narrative review and synthesis of published communication patterns, patient narratives and the author's professional experience as a homeopathic practitioner. RESULTS In the biomedical model, where the focus is on disease, communication is physician-centered with early redirection of patients' concerns, and associated with reduced compliance, increasing risk of malpractice claims and low professional fulfillment. The biopsychosocial and the developing integrative medicine models are based on biomedicine but aim to include the whole person. Patient-centeredness is a behavior that elicits, respects and incorporates patients' wishes, allows active patient participation and is related to improved outcomes. The homeopathic model is based on holism and comprehension of the totality of the patient and uses patient-centered communication with a high degree of physician co-operation, empathy, hopefulness, enablement and narrative competence, all of which can improve outcomes. CONCLUSION Both biopsychosocial and homeopathic models rely on patient-centered communication. Regardless of conceptual differences, they overlap in their common respect for the totality and individuality of the patient. The study of the homeopathic model shows that respect for the whole person is a basic requirement to entrench patient-centeredness more firmly in medicine. PRACTICE IMPLICATIONS Medical education should include values such as individual coping strategies, the benefits of a sound and healthy life-style and the necessity of hope and enablement. Health care should be redesigned to honor physicians who practice these values.
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Affiliation(s)
- Christiane S Hartog
- Department of Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University, Jena, Germany.
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