Personal illness narratives: using reflective writing to teach empathy.

Reflective writing is one established method for teaching medical students empathetic interactions with patients. Most such exercises rely on students' reflecting upon clinical experiences. To effectively elicit, interpret, and translate the patient's story, however, a reflective practitioner must also be self-aware, personally and professionally. Race, gender, and other embodied sources of identity of practitioners and patients have been shown to influence the nature of clinical communication. Yet, although medical practice is dedicated to examining, diagnosing, and treating bodies, the relationship of physicians to their own physicality is vexed. Medical training creates a dichotomy whereby patients are identified by their bodies while physicians' bodies are secondary to physicians' minds. As a result, little opportunity is afforded to physicians to deal with personal illness experiences, be they their own or those of loved ones. This article describes a reflective writing exercise conducted in a second-year medical student humanities seminar. The "personal illness narrative" exercise created a medium for students to elicit, interpret, and translate their personal illness experiences while witnessing their colleagues' stories. Qualitative analysis of students' evaluation comments indicated that the exercise, although emotionally challenging, was well received and highly recommended for other students and residents. The reflective writing exercise may be incorporated into medical curricula aimed at increasing trainees' empathy. Affording students and residents an opportunity to describe and share their illness experiences may counteract the traditional distancing of physicians' minds from their bodies and lead to more empathic and self-aware practice.     

Personal social networks of people with Down syndrome

Studies in the neurotypical population have demonstrated that personal social networks can mitigate cognitive decline and the development of Alzheimer disease. To assess whether these benefits can also be extended to people with Down syndrome (DS), we studied whether and how personal networks can be measured in this population. We adapted a personal networks instrument previously created, validated, and implemented for the neurotypical population. We created two versions of the survey: one for participants with DS, ages 25 and older, and another for their study partners, who spent a minimum of 10 h/wk in a caregiver role. Participants with DS gave concordant data to those of study partners. Their personal networks included a median network size of 7.50, density 0.80, constraint 46.00, and effective size 3.07. Personal networks were composed of 50% kin, 80% who live within 15 miles, and 80% who eat a healthy diet. In this proof-of-principle study, we demonstrated that the personal networks of people with DS can be quantitatively analyzed, with no statistical difference between self-report and parent-proxy report. Future research efforts can now evaluate interventions to enhance personal networks for preventing Alzheimer disease in this population.     

Using expert patients' narratives as an educational resource

In this article, we examine the topic of patient participation in health care and report on how we have drawn on the concept of patient expertise to produce a new kind of information booklet for chronic arthritis patients. The booklet is patient-generated and contains the illness narratives of patients with three kinds of arthritis. The booklet draws upon the knowledge of patients who feel they are flourishing despite their condition. By communicating information through the powerful medium of narrative it is hoped the booklet will be a useful educational and supportive resource for other patients with a similar condition. We would encourage health professionals to acknowledge patient expertise and to consider the expertise of certain patients as a valuable educational resource both for themselves and for other patients.     

Evaluating community participation as prevention: life narratives of youth

Community‐based prevention programs strive to foster the composition of positive life stories, in part, by promoting active participation in community settings. This article used life narratives of youth to explore the experience of community participation and showed how such participation influenced their lives. Youth aged 18–19 years who participated in Better Beginning, Better Futures (n=62), a community‐based prevention program, when they were aged 4–8 years, recounted stories of their lives that showed significantly higher levels of participation in community programs and greater personal impacts of that involvement compared with youth who were not involved in Better Beginnings (n=34). Qualitative analysis of a subsample of these youth (n=34) revealed individual and community characteristics that were instrumental in fostering positive outcomes of community participation. The findings indicated both the utility of using a narrative approach to evaluate community‐based prevention programs and the value of community participation for children and youth. © 2010 Wiley Periodicals, Inc.     

Personal coaching as a positive intervention

Personal coaching is a relatively new and unlicensed profession aimed at helping functioning individuals set and achieve goals, overcome obstacles, and maintain motivation. Coaching is increasingly merging with psychology as evidenced by new journals, academic programs, and research symposia. Although coaching has traditionally been used with non‐clinical populations, it can be highly relevant to psychotherapy. Clinicians who develop a hybrid psychotherapy‐coaching practice might be better protected from occupational stress and burnout. In addition, a number of coaching interventions and assessments might translate well to therapy and help clinicians innovate their practice. The synergy between personal coaching and psychotherapy are illustrated with a case example. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65: 1–10, 2009.     

Small rodents in the forest ecosystem as infectious disease reservoirs

Due to numerousness of populations and width of ecologic valence, small rodents are important parts of almost any forest ecosystem. The represent an important animal group, which connects primary makers with higher trophic levels. They transmit various infectious diseases dangerous for the health of people and domestic and wild animals (trichinosis, leptospirosis, tick encephalitis, Lyme disease, hemorrhagic fever with renal syndrome, etc.). The following species of small rodents live in forest ecosystems of Croatia: Chletrionomys glareolus Schreib., Arvicola terrestris L, M. subterraneus de Sel., M. arvalis Pall., M. agrestis L, M. multiplex Fat., Apodemus agrarius Pall., A. sylvaticus L. and A. flavicollis Melch. Small rodents transmit causative agents of diseases in active (excretion products) of passive (ectoparasites and endoparasites) ways. Their multiplication potential is quite high. Transmission of certain disease sometimes takes place extremely fast due to the high number of rodents, their high movability and distribution, and the fact that they easily get in touch with men and domestic and wild animals. The number of population of each species is directly influenced by abiotic and biotic factors and changes during one year and in a several year period. In a year when the influence of ecologic factors is favorable, it is presumed that the number of these rodents will significantly increase, by which the danger of their damaging effect also increases. The following factors influence the increase of a small rodent population: number and physiologic condition of the population, meteorologic conditions, habitat, food sources, natural enemies, and diseases. The occurrence of an epidemic is closely connected to the number and infectivity of causative agents. Regular control of the number of rodent population and their infectivity can help in planning preventive epidemiologic and sanitary measures to preclude the occurrence of epidemics and individual cases of disease among animals and humans who come in contact with forest (forest workers, holiday makers, hikers, soldiers, tourists, etc.).     

Machado Joseph disease maps to the same region of chromosome 14 as the spinocerebellar ataxia type 3 locus.

Machado Joseph disease (MJD) is an autosomal dominantly inherited neuro-degenerative disorder primarily affecting the motor system. It can be divided into three phenotypes based on the variable combination of a range of clinical symptoms including pyramidal and extra-pyramidal features, cerebellar deficits, and distal muscle atrophy. MJD is thought to be caused by mutation of a single gene which has recently been mapped, using genetic linkage analysis, to a 29 cM region on chromosome 14q24.3-q32 in five Japanese families. A second disorder, spinocerebellar ataxia type 3 (SCA3), which has clinical symptoms similar to MJD, has also been linked to the same region of chromosome 14q in two French families. In order to narrow down the region of chromosome 14 which contains the MJD locus and to determine if this region overlaps with the predisposing locus for SCA3, we have performed genetic linkage analysis in seven MJD families, six of Portuguese/Azorean origin and one of Brazilian origin, using nine microsatellite markers mapped to 14q24.3-q32. Our results localise the MJD locus in these families to an 11 cM interval flanked by the markers D14S68 and AFM343vf1. In addition we show that this 11 cM interval maps within the 15 cM interval containing the SCA3 locus, suggesting that these diseases are allelic.     

Obesity as disease and as social problem

This text is part of a broader line of study that aims to analyze how and why certain eating habits and bodily practices have become social problems, as is the case with fatness. We will show that the ideas that support the definition of obesity as a chronic and avoidable disease are leading experts and health authorities, and other social workers, to know and to think about its evolution in terms of "global" illness (epidemic) and to consider cultural factors as their main cause (obesogenic environment). Paradoxically, the international and national preventive measures taken are focused on changing individual behavior and, in particular, eating habits. The concepts about the regulation of excess weight and food provide interesting information about a particular understanding of lifestyles and culture and they take into account the current promotion of health patterns.     

Cancer narratives and the cancer support group

We conceptualize the experience of cancer as requiring 'biographical work' and examine the nature of this work in the context of peer support groups. Interviews with participants and leaders of support groups were used to theorize the importance of support to cancer patients with varying stages and length of disease. Patient interviews led us to describe the process of joining, belonging, and identifying with, support groups as an important process within patients' ongoing biographical work and encompassing a search for a 'separate social space'. We discuss the implications for understanding the stigmatizing nature of cancer and the 'civic life' these groups support.     

Life on the receiving end: A qualitative analysis of health providers' illness narratives.

PURPOSE: Clinical empathy is integral to forging therapeutic patient-physician relationships. Illness narratives are a potentially rich source of insight into what it feels like to be a patient or patient's family member. The authors performed a qualitative analysis of illness narratives to develop an explicit framework for understanding what it feels like to be a health care recipient and to explore how providers' behaviors influence that experience. METHOD: The authors used consensual qualitative research, a methodology based on principles of grounded theory, to analyze 24 illness narratives found in that number of essays from the Annals of Internal Medicine's "On Being a Patient" series published between January 1, 1999, and December 31, 2003. Trustworthiness was demonstrated via essayists' feedback on the analysis. RESULTS: Patients and their families faced formidable physical and psychosocial challenges. Providers' behaviors influenced the illness experience in profoundly positive and negative ways, independent of the technical quality of care. Consistent with previous studies of patient-physician relationships, providers' advocacy for patients and expressions of compassion were prominent determinants of patients' satisfaction. The experience of simultaneously being a health care provider and consumer was an additional source of stress for essayists, but it positively influenced their subsequent practice. CONCLUSIONS: Illness narratives vividly illustrate fundamental aspects of the illness experience and are a potentially rich resource for cultivating empathy. The authors' analysis provides a framework for enhancing trainees' and practitioners' ability to understand and meet patients' and families' psychosocial needs. The experiences of health care recipients with medical backgrounds are uniquely challenging and beneficial.     

Personal dynamic conflict as a predictor of expressed marital happiness

Ninety-three married couples completed the Motivation Analysis Test (MAT) (Cattell, Horn, Swency, & Radcliffe, 1964) and the Marriage Role Questionnaire (MRQ) (Tharp, 1963). Husbands' and wives' scores on the conflict measures of the MAT were analyzed in relation to the MRQ Personal conflict scores significantly differentiated men high in expressed marital happiness from those low in expressed happiness; no such differentiation was found among women. Paradoxically, it was high personal conflict that predicted greater avowed happiness. Possible reasons for this finding are discussed.     

Technical bioenergetics and ecosystem biotechnology.

The present work explores some possible practical uses of bioenergetic processes (fermentation, respiration and photosynthesis) in the microbial cell for the purpose of renewable fuel production. These considerations are based on ecosystem biotechnology which include the following main points: 1. Creation of closed energy-transducing ecosystems under laboratory conditions. 2. Production of renewable energy carriers with the help of microbial communities (e.g., mixed cultures of microorganism). 3. Investigation of the role of the individual microoganism in the population or community.