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61.
Birgitte Lerbæk Rikke Jørgensen Jørgen Aagaard Julie Nordgaard Niels Buus 《Archives of Psychiatric Nursing》2019,33(2):174-181
Background
Life expectancy of people with severe mental illness (SMI) is greatly shortened compared to the general population, and despite extensive research, this issue is unsolved. Although it is widely recognised that people with SMI need support from health care services to manage health related issues, profound health inequalities exist within provision of health care. The aim of this study was to examine how mental health care professionals accounted for their actions and responsibilities related to managing physical health issues among people with SMI.Methods
Three focus groups were conducted with 22 mental health care professionals, employed at three mental health care locations. Participants' situated accounts were subjected to discourse analysis.Results
Participants accounted for actions and responsibilities in three typical ways; 1) by positioning people with SMI as difficult to motivate and actively resisting intervention, 2) by positioning people with SMI as so impaired that intervention was futile, and 3) by arguing they are undertreated for physical conditions and might have physical illnesses that staff are not aware of because of prominent mental illness. These discursive strategies seemed to legitimise situations where participants described not responding to physical health issues, and to downplay potential trouble in situations where participants described not succeeding in facilitating lifestyle changes or promoting compliance to treatment of physical conditions.Discussion and conclusion
Mental health care professionals need to increase their awareness of latent discriminating attitudes towards people with SMI. Such attitudes are suggested to reinforce barriers for people with SMI receiving physical health care. 相似文献62.
Kristine Lund Jenny Hultqvist Ulrika Bejerholm Elisabeth Argentzell Mona Eklund 《Scandinavian journal of occupational therapy》2020,27(6):462-473
AbstractBackground: There exist few recovery and occupation-based interventions for mental health service users. Balancing Everyday Life (BEL) is a new occupation-based lifestyle intervention that was created to fill this need.Aim: To gain group leaders’ and participants’ perspectives of the BEL intervention content and format, including factors that helped, hindered, and could be improved.Methods: A constructivist grounded theory method guided data collection and analysis. Interviews took place with 12 BEL group leaders and 19 BEL participants from out-patient psychiatry settings and community-based day centers in Sweden.Results: BEL’s structure and content were appreciated, yet flexibility was desired to adapt to participant needs. BEL could act as a bridge, helping participants connect with others, and to a more engaged and balanced everyday life. Facilitating factors included a person-focused (versus illness-focused) approach, physical and emotional environments, and connection. Barriers included room resources. More sessions were desired for the intervention.Conclusion: Group leaders and participants experienced BEL as a useful tool to instigate meaningful change and connection in the participants’ lives. The combination of a positive person-focused approach and group support was appreciated. These results could inform future research, evaluation, and development of occupation-focused lifestyle interventions for mental health service users. 相似文献
63.
ABSTRACT This study, using data collected as part of an ongoing programme evaluation, investigates whether participation in Saving Groups (SGs)—a community-owned microfinance intervention focused on poor households – is associated with maternal health service utilisation, and whether this association is mediated by women’s agency – as measured by self-efficacy and decision-making autonomy. We compared maternal health service utilisation among SG members (n=105) and non-members (n=100) in rural Mozambique. We estimated prevalence ratios for SG membership and women’s agency using Poisson regression while controlling for confounding factors. We also estimated mediation effects for women's agency. The results showed that SG membership is associated with four or more antenatal care (ANC) visits, skilled birth attendant (SBA) use, and postnatal care within 48?h of delivery. Self-efficacy mediated the relationship between SG membership and ANC vists and SBAuse, but not postnatal care; whereas women’s decision-making autonomy mediated the relationship with SBA use and postnatal care, but not ANC visits. This study suggests that the impact of SG membership on use of maternal health services goes beyond improvements in household income and may operate through women’s agency by giving women the ability to realize their preference for quality health care. 相似文献
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Jaume Morera-Balaguer José Martín Botella-Rico Mari Carmen Martínez-González Francesc Medina-Mirapeix Óscar Rodríguez-Nogueira 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(6):484-492
Background
Over recent years there has been a paradigm shift towards a patient-centred biopsychosocial care model in physical therapy. This new paradigm features a growing interest in understanding the contextual factors that influence the patient's experience of disease, pain and recovery. This includes generalized consensus regarding the importance of establishing a therapeutic relationship that is centred on the patient.Objective
To explore physical therapists’ perceptions and experiences regarding barriers and facilitators of therapeutic patient-centred relationships in outpatient rehabilitation settings.Methods
This is a qualitative study with four focus groups including twenty-one physical therapists. Two researchers conducted the focus groups, using a topic guide with predetermined questions. The focus group discussions were audiotaped and videotaped, transcribed verbatim and analysed thematically using a modified grounded theory approach.Results
Physical therapists perceived that the therapeutic patient-centred relationship not only depends on the personal qualities of the professional, but also on the patient's attitudes and the characteristics of the context, including the organization and team coordination.Conclusions
Although being more linked towards the patients’ contextual factors and needs than towards the practice of the profession, a therapeutic relationship is worth considering by physical therapists. Furthermore this study highlights the need for physical therapists and administrators to rethink the situation and propose strategies for improvement. 相似文献67.
Glenda M. Davison Heather L. Hendrickse Tandi E. Matsha 《Transfusion and apheresis science》2018,57(1):58-62
Introduction
Evidence suggests that red cell antigens may act as receptors for viruses and bacteria and therefore could be associated with HIV infection. Previous studies have been controversial and therefore the aim of this exploratory study was to analyse the expression of immunogenic red cell antigens in HIV-seropositive individuals and to compare the results to negative donors from South Africa.Methods
The expression of ABO, Rh, Kell and Duffy antigens from 119 HIV-seropositive patients was compared to 317 HIV-seronegative blood donors. Nucleic acid amplification testing and PCR were used to determine the HIV status and the ID-Gel Card Technology was used to determine the blood group antigen profile.Results
There was no significant difference in the expression of A, B, AB, Duffy or Kel antigens between the two groups but significantly lower numbers of HIV+ individuals were O Rh Negative (p?=?,0.0001). Analysis of those with a Duffy null phenotype revealed a significantly higher incidence of blood type A RH1-Positive, Dce/R0r and B RH1-Positive, DcEe/R2r within the HIV-seropositive group (p?=?<?0.05). None of the HIV-seropositive individuals were O RH1-Negative, dce/rr.Conclusion
In conclusion these initial findings have demonstrated a decreased incidence of blood type O Rh1-negative in HIV?+?individuals which suggests that red blood cell antigens may play an important role in susceptibility to HIV infection. The relationship between red cell antigens and HIV infection however remains complex and therefore larger studies are required to confirm these results. 相似文献68.
Common clinical studies assess the quality of prognostic factors, such as gene expression signatures, clinical variables or environmental factors, and cluster patients into various risk groups. Typical examples include cancer clinical trials where patients are clustered into high or low risk groups. Whenever applied to survival data analysis, such groups are intended to represent patients with similar survival odds and to select the most appropriate therapy accordingly. The relevance of such risk groups, and of the related prognostic factors, is typically assessed through the computation of a hazard ratio. We first stress three limitations of assessing risk groups through the hazard ratio: (1) it may promote the definition of arbitrarily unbalanced risk groups; (2) an apparently optimal group hazard ratio can be largely inconsistent with the p‐value commonly associated to it; and (3) some marginal changes between risk group proportions may lead to highly different hazard ratio values. Those issues could lead to inappropriate comparisons between various prognostic factors. Next, we propose the balanced hazard ratio to solve those issues. This new performance metric keeps an intuitive interpretation and is as simple to compute. We also show how the balanced hazard ratio leads to a natural cut‐off choice to define risk groups from continuous risk scores. The proposed methodology is validated through controlled experiments for which a prescribed cut‐off value is defined by design. Further results are also reported on several cancer prognosis studies, and the proposed methodology could be applied more generally to assess the quality of any prognostic markers. Copyright © 2015 John Wiley & Sons, Ltd. 相似文献
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巴林特小组是培训医生从精神动力学的视角关注和思考医患关系的一种训练方法。小组在组长的带领下,聚焦于案例报告者面临的医患关系困扰展开病例讨论,所有组员为案例报告者提供安全的、支持性的氛围,并阐述自己对于事件本身的深刻理解,提出建设性的问题和评论。案例报告者通过组员提供的不同视角和观点,发现自己的盲点,从中获益。除讨论形式外,组长也可以根据小组现场呈现出的医患关系和心理学动力做出"雕塑",即案例报告者和组员共同用身体语言、个体之间的位置关系代表现实中的医患关系,将隐形的人际关系可视化,一般会带来更直接的问题解决和更震撼的内心体验。巴林特小组有助于医护人员解决自己的心理问题、提高医患沟通技巧、在医护人员之间建立起有效的互动和支持,尤其在改善医患关系方面具有突出成效。因此,可以作为继续医学教育的新形式、新内容在我国医疗卫生领域推广应用。 相似文献