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Collier KM. What is medicine for? BMJ LEADER 2024; 8:55-58. [PMID: 37407067 DOI: 10.1136/leader-2022-000667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/13/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Kristin M Collier
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Arandjelović O. Disease: An ill-founded concept at odds with the principle of patient-centred medicine. J Eval Clin Pract 2024. [PMID: 38368599 DOI: 10.1111/jep.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Despite the at least decades long record of philosophical recognition and interest, the intricacy of the deceptively familiar appearing concepts of 'disease', 'disorder', 'disability', and so forth, has only recently begun showing itself with clarity in the popular discourse wherein its newly emerging prominence stems from the liberties and restrictions contingent upon it. Whether a person is deemed to be afflicted by a disease or a disorder governs their ability to access health care, be it free at the point of use or provided by an insurer; it also influences the treatment of individuals by the judicial system and employers; it even affects one's own perception of self. AIMS All existing philosophical definitions of disease struggle with coherency, causing much confusion and strife, and leading to inconsistencies in real-world practice. Hence, there is a real need for an alternative. MATERIALS AND METHODS In the present article I analyse the variety of contemporary views of disease, showing them all to be inadequate and lacking in firm philosophical foundations, and failing to meet the desideratum of patient-driven care. RESULTS Illuminated by the insights emanating from the said analysis, I introduce a novel approach with firm ethical foundations, which foundations are rooted in sentience, that is the subjective experience of sentient beings. DISCUSSION I argue that the notion of disease is at best superfluous, and likely even harmful in the provision of compassionate and patient-centred care. CONCLUSION Using a series of presently contentious cases illustrate the power of the proposed framework which is capable of providing actionable and humane solutions to problems that leave the current theories confounded.
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Armitage R. The WHO's definition of health: a baby to be retrieved from the bathwater? Br J Gen Pract 2023; 73:70-71. [PMID: 36702589 PMCID: PMC9888582 DOI: 10.3399/bjgp23x731841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Richard Armitage
- Richard is a GP and Public Health Specialty Registrar, and Honorary Assistant Professor at the University of Nottingham's Academic Unit of Population and Lifespan Sciences. @drricharmitage
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van Druten VP, Bartels EA, van de Mheen D, de Vries E, Kerckhoffs APM, Nahar-van Venrooij LMW. Concepts of health in different contexts: a scoping review. BMC Health Serv Res 2022; 22:389. [PMID: 35331223 PMCID: PMC8953139 DOI: 10.1186/s12913-022-07702-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/23/2022] [Indexed: 01/07/2023] Open
Abstract
The rationale of our study was that the World Health Organization's (WHO) definition of health from 1947 which includes "… complete physical, mental and social wellbeing…" does not fit the current societal viewpoints anymore. The WHO's definition of health implies that many people with chronic illnesses or disabilities would be considered unhealthy and complete wellbeing would be utopian and unfeasible for them. This is no longer uniformly accepted. Many alternative concepts of health have been discussed in the last decades such as 'positive health', which focusses on someone's capability rather than incapability,. However, the question remains whether a general health concept can guide all healthcare practices. More likely, health concepts need to be specified for professions or settings. The objective of our study was to create a structured overview of published concepts of health from different perspectives by conducting a scoping review using the PRISMA-ScR guideline. A literature search was conducted in Pubmed and Cinahl. Articles eligible for inclusion focussed on the discussion or the conceptualisation of health or health-related concepts in different contexts (such as the perspective of care workers' or patients') published since 2009 (the Dutch Health Council raised the discussion about moving towards a more dynamic perspective on health in that year). Seventy-five articles could be included for thematic analyses. The results showed that most articles described a concept of health consisting of multiple subthemes; no consensus was found on one overall concept of health. This implies that healthcare consumers act based on different health concepts when seeking care than care workers when providing care. Having different understandings of the concepts of health can lead to misunderstandings in practice. In conclusion, from every perspective, and even for every individual, health may mean something different. This finding stresses the importance that care workers' and healthcare consumers' meaning of 'health' has to be clear to all actors involved. Our review supports a more uniform tuning of healthcare between healthcare providers (the organisations), care workers (the professionals) and healthcare consumers (the patients), by creating more awareness of the differences among these actors, which can be a guide in their communication.
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Affiliation(s)
- V P van Druten
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital Jeroen Bosch Ziekenhuis, PO Box 90153, Henri Dunantstraat 1, 's Hertogenbosch, 5223 GZ, the Netherlands. .,Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands.
| | - E A Bartels
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands.,TiSEM Department of Management, Tilburg University, Tilburg, the Netherlands
| | - D van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands
| | - E de Vries
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital Jeroen Bosch Ziekenhuis, PO Box 90153, Henri Dunantstraat 1, 's Hertogenbosch, 5223 GZ, the Netherlands.,Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands
| | - A P M Kerckhoffs
- Department of Nephrology, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands.,Department of Geriatric Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - L M W Nahar-van Venrooij
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital Jeroen Bosch Ziekenhuis, PO Box 90153, Henri Dunantstraat 1, 's Hertogenbosch, 5223 GZ, the Netherlands
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Geronikolou SA, Takan I, Pavlopoulou A, Mantzourani M, Chrousos GP. Thrombocytopenia in COVID‑19 and vaccine‑induced thrombotic thrombocytopenia. Int J Mol Med 2022; 49:35. [PMID: 35059730 PMCID: PMC8815408 DOI: 10.3892/ijmm.2022.5090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022] Open
Abstract
The highly heterogeneous symptomatology and unpredictable progress of COVID-19 triggered unprecedented intensive biomedical research and a number of clinical research projects. Although the pathophysiology of the disease is being progressively clarified, its complexity remains vast. Moreover, some extremely infrequent cases of thrombotic thrombocytopenia following vaccination against SARS-CoV-2 infection have been observed. The present study aimed to map the signaling pathways of thrombocytopenia implicated in COVID-19, as well as in vaccine-induced thrombotic thrombocytopenia (VITT). The biomedical literature database, MEDLINE/PubMed, was thoroughly searched using artificial intelligence techniques for the semantic relations among the top 50 similar words (>0.9) implicated in COVID-19-mediated human infection or VITT. Additionally, STRING, a database of primary and predicted associations among genes and proteins (collected from diverse resources, such as documented pathway knowledge, high-throughput experimental studies, cross-species extrapolated information, automated text mining results, computationally predicted interactions, etc.), was employed, with the confidence threshold set at 0.7. In addition, two interactomes were constructed: i) A network including 119 and 56 nodes relevant to COVID-19 and thrombocytopenia, respectively; and ii) a second network containing 60 nodes relevant to VITT. Although thrombocytopenia is a dominant morbidity in both entities, three nodes were observed that corresponded to genes (AURKA, CD46 and CD19) expressed only in VITT, whilst ADAM10, CDC20, SHC1 and STXBP2 are silenced in VITT, but are commonly expressed in both COVID-19 and thrombocytopenia. The calculated average node degree was immense (11.9 in COVID-19 and 6.43 in VITT), illustrating the complexity of COVID-19 and VITT pathologies and confirming the importance of cytokines, as well as of pathways activated following hypoxic events. In addition, PYCARD, NLP3 and P2RX7 are key potential therapeutic targets for all three morbid entities, meriting further research. This interactome was based on wild-type genes, revealing the predisposition of the body to hypoxia-induced thrombosis, leading to the acute COVID-19 phenotype, the 'long-COVID syndrome', and/or VITT. Thus, common nodes appear to be key players in illness prevention, progression and treatment.
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Affiliation(s)
- Styliani A Geronikolou
- Clinical, Translational and Experimental Surgery Research Centre, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece
| | - Işil Takan
- Izmir Biomedicine and Genome Center (IBG), 35340 Izmir, Turkey
| | | | - Marina Mantzourani
- First Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece
| | - George P Chrousos
- Clinical, Translational and Experimental Surgery Research Centre, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece
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Whitaker RC, Dearth-Wesley T, Herman AN, Nagel KE, Smith HG, Weil HFC. Association of Childhood Family Connection With Flourishing in Young Adulthood Among Those With Type 1 Diabetes. JAMA Netw Open 2020; 3:e200427. [PMID: 32134463 PMCID: PMC7059021 DOI: 10.1001/jamanetworkopen.2020.0427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Higher levels of childhood family connection have been associated with measures of adult flourishing or eudaimonic well-being, such as purpose, self-acceptance, positive relationships, and growth. However, this association has not been examined among those with childhood-onset chronic disease. OBJECTIVES To investigate whether higher levels of childhood family connection were associated with greater flourishing in young adulthood among those with type 1 diabetes and, secondarily, whether this association was present across levels of adverse childhood experiences and childhood social position. DESIGN, SETTING, AND PARTICIPANTS In 2017, the cross-sectional Type 1 Flourish survey was administered to all 743 young adults, aged 18 to 29 years, with type 1 diabetes who had received outpatient care in 2016 at a diabetes specialty clinic in New York, New York. Eligible participants completed the survey online or during clinic visits. Data analyses were conducted in September and October 2019. EXPOSURES The main exposure was childhood family connection (sample-defined tertiles), based on scores from a 7-item scale assessing parental attention, affection, and communication during childhood. Adverse childhood experiences, childhood social position, and other sociodemographic characteristics were also reported. Recent hemoglobin A1c levels were abstracted from medical records. MAIN OUTCOMES AND MEASURES Flourishing score calculated from the 42-item Psychological Well-being Scale developed by Ryff. RESULTS The survey was completed by 423 of 743 patients (56.9%), and the analysis included 415 participants (98.1%) with complete data on family connection and flourishing. The mean (SD) age of the sample was 25.0 (3.2) years, with 246 (59.3%) female respondents and 288 (69.6%) non-Hispanic white respondents. The mean (SD) flourishing score was 221.8 (37.7). After adjusting for age, sex, race/ethnicity, education, income, age at type 1 diabetes diagnosis, and hemoglobin A1c level, mean flourishing scores increased from the lowest (201.0; 95% CI, 195.0-207.0) to medium (225.2; 95% CI, 219.4-231.0) to highest (240.4; 95% CI, 234.4-246.4) tertiles of family connection; compared with those in the lowest tertile of family connection, the flourishing scores were 1.04 (95% CI, 0.81-1.27) SD units higher among those in the highest tertile and 0.64 (95% CI, 0.42-0.86) SD units higher among those in the middle tertile. This association was also present across levels of childhood adversity. In the subgroup of respondents with 2 or more adverse childhood experiences, those in the highest tertile of family connection had adjusted flourishing scores 0.76 (95% CI, 0.14-1.38) SD units higher than those in the lowest tertile. In the subgroup with low childhood social position, those in the highest tertile of family connection had flourishing scores 1.08 (95% CI, 0.63-1.52) SD units higher than those in the lowest tertile. CONCLUSIONS AND RELEVANCE In this cross-sectional study of young adults with type 1 diabetes, higher levels of childhood family connection were associated with greater flourishing in young adulthood across levels of childhood adversity. Beyond disease management, clinician support of family connection may help children with type 1 diabetes flourish in adulthood.
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Affiliation(s)
- Robert C. Whitaker
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
- Vagelos College of Physicians and Surgeons, Department of Pediatrics, Columbia University, New York, New York
- College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Tracy Dearth-Wesley
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
- College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Allison N. Herman
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
- College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Kathryn E. Nagel
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- now with School of Medicine, Yale University, New Haven, Connecticut
| | - Hannah G. Smith
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Bassett Research Institute, Bassett Medical Center, Cooperstown, New York
- now with College of Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Henry F. C. Weil
- Columbia-Bassett Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Columbia-Bassett Program, Bassett Medical Center, Cooperstown, New York
- Vagelos College of Physicians and Surgeons, Department of Medicine, Columbia University, New York, New York
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Loughlin M, Fuller J, Bluhm R, Buetow S, Borgerson K. Theory, experience and practice. J Eval Clin Pract 2016; 22:459-65. [PMID: 27431729 DOI: 10.1111/jep.12586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 01/06/2023]
Abstract
Despite its potential hazards, the activity of questioning theoretical frameworks and proposing solutions is necessary if progress is even to be possible. Intellectual history has by no means ended, so we cannot expect to have all the answers, and from time to time the activity of critical questioning will be frustrating. But intellectual progress requires us to continue the process of asking fundamental questions. The alternative to thinking in this way is indeed unthinkable.
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Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
| | | | - Robyn Bluhm
- Department of Philosophy, Lyman Briggs College, Michigan State University, East Lansing, USA
| | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
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Clinical decision making in dementia: mapping the minefields. Br J Gen Pract 2015. [DOI: 10.3399/bjgp15x685981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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