Quality of life, sense of coherence and experiences with three different treatments in patients with psychological distress in primary care: a mixed-methods study

Study Circles as a Possible Arena to Support Self-Care-A Swedish Pilot Study

Today, issues related to people's mental health and well-being have been described as a challenge for society, globally as well as in Sweden. This calls for new approaches to mental health promotion. The aim was to evaluate the adequacy of its content and structure, describing experiences of study circles as a means of supporting participants' self-care and self-compassion. The overall design is a descriptive QUAL + quan design, where the quantitative and qualitative results are integrated. Five participants participated in a focus group interview, of whom four completed questionnaires. One individual interview was conducted with the study circle leader. Study circles can be an arena for mental health promotion, as learning and sharing of experience contributes to a sense of coherence, as well as self-compassion and a genuine concern for one's own and others' well-being, but are not considered an alternative to psychiatric care for those in need of professional services. Study circles can be a possible means to support self-care and thereby promote mental health in the general population and are a valuable contribution to public health. However, in addition to modifications of the content, further research is needed on the qualifications for study circle leaders, as well as the dissemination of study circles.

Association Between Vocal Symptoms, Communication, Work Environment, and Sense of Coherence in Hospital Health Professionals

OBJECTIVE

This study aimed to associate the presence of vocal symptoms with sociodemographic and occupational data, work environment self-perception, oral communication wearing a face mask, and the sense of coherence (SOC).

METHOD

This cross-sectional analytical observational study included 66 health professionals from a Brazilian hospital. They answered an online questionnaire on sociodemographic aspects, self-perception of the physical work environment, and oral communication at work. The Voice Symptom Scale (VoiSS) and Sense of Coherence Scale (SOC-13) were also applied. The significance level was set at 5% for the statistical analysis.

RESULTS

The self-perception of vocal symptoms was 62%. Professionals who considered the noise in their work environment unsatisfactory had more vocal symptoms (P = 0.005), especially in the limitation (P = 0.013) and physical (P = 0.028) domains of the VoiSS. Professionals with higher self-perceived vocal symptoms also reported incoordination between breathing, speech, and articulation (P = 0.041) and self-perceived difficulty being heard with a protective mask (P = 0.033). Professionals with a higher self-perceived score in the limitation domain of the VoiSS also had a higher self-perceived effort to speak with a mask (P = 0.035) and a higher self-perception that other people find it difficult to hear them with a face mask (P = 0.050). There was a weak negative correlation between VoiSS and SOC (P < 0.05) and between its domains (P < 0.05).

CONCLUSION

Self-perception of voice symptoms is high among health professionals in a Brazilian public hospital. The presence of these symptoms is related to the perception of a noisy work environment and communication difficulties due to the use of a face mask. The lower the ability to cope with stressful situations, the larger the presence of voice symptoms among health professionals.

Relationships Between Sense of Coherence, Self-perception of Voice and Work Environment Among Teachers

OBJECTIVE

to analyze the relationship between sense of coherence and sociodemographic data, remote physical work environment, and self-perception of symptoms, vocal handicap and vocal fatigue in teachers.

METHODS

Seventy eight teachers pertaining to the municipal education network of a Brazilian capital city participated in the study, during the period of social isolation by COVID-19. An online questionnaire was applied with sociodemographic and physical remote work environment questions, the Sense of Coherence Scale (SOC-13), the Brazilian Dysphonia Screening Tool (Br-DST), the Vocal Fatigue Index (VFI), and the Vocal Handicap Index (VHI-10). Descriptive analysis, bivariate and multivariate Logistic regression models were performed to check the proportion of teachers with high and low SOC among the different categories of independent variables. Student's t test and Mann Whitney test were used to compare SOC, IDV, and VFI scores between the groups, and Hedge's g test was used to access the effect size. The total scores of SOC, VHI and VFI were correlated using Pearson's Correlation Coefficient. All tests adopted a 5% significance level.

RESULTS

Male teachers and those over 45 years old were, respectively, 6.79 (95%CI = 1.16-39.58) and 5.27 (95%CI = 1.40-19.76) times more likely to present a high SOC. The variables associated with a lower chance of presenting high SOC were vocal restriction (OR = 0.21; 95%CI = 0.06-0.79) and voice-related physical discomfort (OR = 0.13; 95%CI = 0.02-0.78). Regarding the remote work environment, in bivariate analysis, teachers who were dissatisfied with air quality (OR = 0.08; 95%CI = 0.01-0.65), temperature (OR = 0.11; 95%CI = 0.01-0.92), and noise (OR = 0.25; 95%CI = 0.61-0.99) were less likely to have high SOC. Higher values of SOC are associated with lower self-perception of vocal fatigue and voice handicap (P < 0,001).

CONCLUSION

The way individuals face stressful situations interferes with the self-perception of their voice and their work environment. The relationship between the sense of coherence and voice perception is relevant to favor programs to promote vocal health and stress management in teachers.

Diffusion of person-centred care within 27 European countries – interviews with managers, officials, and researchers at the micro, meso, and macro levels

Purpose

This study aimed to describe facilitators and barriers in terms of regulation and financing of healthcare due to the implementation and use of person-centred care (PCC).

Design/methodology/approach

A qualitative design was adopted, using interviews at three different levels: micro = hospital ward, meso = hospital management, and macro = national board/research. Inclusion criteria were staff working in healthcare as first line managers, hospital managers, and officials/researchers on national healthcare systems, such as Bismarck, Beveridge, and mixed/out-of-pocket models, to obtain a European perspective.

Findings

Countries, such as Great Britain and Scandinavia (Beveridge tax-based health systems), were inclined to implement and use person-centred care. The relative freedom of a market (Bismarck/mixed models) did not seem to nurture demand for PCC. In countries with an autocratic culture, that is, a high-power distance, such as Mediterranean countries, PCC was regarded as foreign and not applicable. Another reason for difficulties with PCC was the tendency for corruption to hinder equity and promote inertia in the healthcare system.

Research limitations/implications

The sample of two to three participants divided into the micro, meso, and macro level for each included country was problematic to find due to contacts at national level, a bureaucratic way of working. Some information got caught in the system, and why data collection was inefficient and ran out of time. Therefore, a variation in participants at different levels (micro, meso, and macro) in different countries occurred. In addition, only 27 out of the 49 European countries were included, therefore, conclusions regarding healthcare system are limited.

Practical implications

Support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.

Originality/value

Fragmented health systems divided by separate policy documents or managerial roadmaps hindered local or regional policies and made it difficult to implement innovation as PCC. Therefore, support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.

The effect of salutogenic approach-based interviews on sense of coherence and resilience in people with schizophrenia: A randomized controlled trial

PURPOSE

The aim of this study was to determine the effect of interviews based on a salutogenic approach on the sense of coherence and resilience in schizophrenic patients.

DESIGN AND METHODS

A pretest-posttest randomized controlled experimental trial was conducted with 49 patients.

FINDINGS

The posttest and follow-up mean scores of the subscales and the overall scale of sense of coherence and resilience differed in favor of the intervention group (p < 0.01). In the intra-group comparison, the pretest, posttest, and 1-month follow-up all the subscales and the total mean scores of the sense of coherence and resilience differed in the intervention group (p < 0.001).

PRACTICAL IMPLICATIONS

The salutogenic approach-based interview is an effective intervention to increase the sense of coherence and resilience.

Demographics, Socioeconomic Status, Social Distancing, Psychosocial Factors and Psychological Well-Being among Undergraduate Students during the COVID-19 Pandemic

The COVID-19 pandemic impacted on academic routine because of the social distancing measures. This study examined the relationships of sociodemographic characteristics, social distancing aspects and psychosocial factors on psychosocial well-being among undergraduate students during the social distancing period due to COVID-19. A web-based survey was conducted of undergraduate students at a public university in Brazil (n = 620). Demographics, socioeconomic status (SES), social distancing factors, negative affectivity (DASS-21), sense of coherence (SOC-13), social support and psychosocial well-being (GHQ-12) were measured. The direct and indirect links between was variables was tested using structural equation modelling. The estimated model showed that greater social support, higher sense of coherence and lower negative affectivity were directly associated with better psychological well-being. Female gender, higher SES, not working during the social distancing period and availability of online modules were indirectly associated with psychological well-being through psychosocial factors. Working during the social distancing period and availability of online modules mediated the link of age, gender, SES with psychological well-being. Our findings suggest the need to provide psychological support, online teaching and financial aid to undergraduate students during the social distancing period due to COVID-19 pandemic to improve their psychological well-being.

Non-specific effects of acupuncture and sham acupuncture in clinical trials from the patient's perspective: a systematic review of qualitative evidence

BACKGROUND

Previous clinical trials have demonstrated that both acupuncture and sham acupuncture exert significant, non-specific effects on treatment outcomes when compared to no-treatment controls. A recently developed framework (mechanisms in orthodox and complementary and alternative medicine-MOCAM) suggests that the non-specific effects of acupuncture originate from multiple domains (e.g. patient characteristics, acupuncturist skill/technique, the patient-acupuncturist relationship, and the acupuncture environment). However, it remains to be determined precisely how these domains influence the non-specific effects of treatment among patients receiving acupuncture and sham acupuncture in clinical trials. Therefore, we conducted a systematic review to synthesize existing qualitative evidence on how trial participants randomized to acupuncture and sham acupuncture groups experience non-specific effects, regardless of the types of medical condition investigated.

METHODS

This systematic review included primary qualitative studies embedded in randomized controlled trials designed to investigate acupuncture or sham acupuncture interventions. Eligible studies published in English were derived from a search of five international databases. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) tool. Using a framework synthesis approach, the identified MOCAM framework was adapted based on the synthesis of the available qualitative evidence.

RESULTS

A total of 20 studies of high methodological quality were included. Our proposed model indicated that the effects of acupuncture may be increased by maintaining a professional status, applying a holistic treatment approach, practicing empathy, and providing patients with an appropriate explanation of the theory behind acupuncture and sham acupuncture. From the patient's perspective, the efficacy of treatment can be increased by following the lifestyle modification advice provided by acupuncturists, maintaining a positive attitude toward treatment efficacy, actively engaging with acupuncturists during consultation, and making behavioral changes based on experience gained during the trial.

CONCLUSION

The results of this study may provide a basis for improving and standardizing key components of non-specific effects in acupuncture treatment, and for improving the isolation of specific effects in future clinical trials involving acupuncture and sham acupuncture.

Patient-reported outcome measures as a new application in the Swedish Renal Registry: health-related quality of life through RAND-36

Background

Although patient-reported outcome measures (PROMs) are gaining increased interest in developing health care quality and are a useful tool in person-centered care, their use in routine care is still limited. The aim of this study is to describe the implementation and initial results of PROMs via the Swedish Renal Registry (SRR) on a national level.

Methods

After testing and piloting the electronic PROM application, nationwide measures were carried out in 2017 for completing the RAND-36 questionnaire online or by paper in a wide range of chronic kidney disease (CKD) patients (Stages 3–5, dialysis and transplantation) through the SRR. Cross-sectional results during the first year were analyzed by descriptive statistics and stratified by treatment modality.

Results

A total of 1378 patients from 26 of 68 renal units (39%) completed the questionnaire. The response rate for all participating hemodialysis units was 38.9%. The CKD patients had an impaired health profile compared with a Swedish general population, especially regarding physical functions and assessed general health (GH). Transplanted patients had the highest scores, whereas patients on dialysis treatment had the lowest scores. The youngest age group assessed their physical function higher and experienced fewer physical limitations and less bodily pain than the other age groups but assessed their GH and vitality (VT) relatively low. The oldest age group demonstrated the lowest health profile but rated their mental health higher than the other age groups. The older the patient, the smaller the difference compared with persons of the same age in the general population.

Conclusions

Nationwide, routine collection of PROMs is feasible in Sweden. However, greater emphasis is needed on motivating clinical staff to embrace the tool and its possibilities in executing person-centered care. CKD patients demonstrate impaired health-related quality of life, especially regarding limitations related to physical problems, GH and VT/energy/fatigue.

The Relationship between Constitution of Traditional Chinese Medicine in the First Trimester and Pregnancy Symptoms: A Longitudinal Observational Study

Objective. We report on the distribution of traditional Chinese medicine (TCM) constitution in the first trimester and on the association between TCM constitution and maternal symptoms related to pregnancy. Methods. Participants were followed up until delivery to observe primary measures (gestational hypertension and gestational diabetes mellitus) and secondary measures (signs of miscarriage, miscarriage, nausea and vomiting, and sleepiness and defecation during pregnancy). Descriptive analysis, t-tests, chi-square tests, and logistic regression analysis were used in this study. Results. 61.8% of the participants had unbalanced constitutions. We did not find a significant association between the TCM constitution and gestational hypertension, gestational diabetes, miscarriage, signs of miscarriage, and defecation during pregnancy. And we found that women with unbalanced constitutions in early pregnancy had a greater likelihood of severe nausea and vomiting and poor sleep during pregnancy in the logistic regression analysis. Conclusions. These results have implications for female health care providers and policy makers. Identification of TCM constitution may be helpful for understanding nausea and vomiting and poor sleepiness during pregnancy, especially in the condition that can not be explained by modern medical science, and be helpful for making program to improve these uncomfortable symptoms.

Understanding persons with psychological distress in primary health care

The purpose of this study was to gain more knowledge and a deeper understanding of experiences of persons living with psychological distress who seek help in primary care. Psychological distress is a state of emotional suffering associated with stressors and demands that are difficult to cope with in daily life. The lack of effective care for and difficulty in identifying psychological distress is frustrating for patients and health professionals alike. The aim was therefore to gain more knowledge about the experience of living with psychological distress. Twelve persons (nine women and three men) aged 23-51 years were interviewed. Analyses were based on a phenomenological hermeneutic method and indicated that psychological distress may be seen as an imbalance (incongruence) between the self and the ideal self, which slowly breaks down a person's self-esteem. This imbalance was described in three dimensions: Struggling to cope with everyday life, Feeling inferior to others and Losing one's grip on life. It seems to be associated with a gradual depletion of existential capacities and lead to dissatisfaction, suffering, poor self-esteem and lack of control. As psychological distress may be a forerunner to mental, physical and emotional exhaustion, there is a need to initiate preventive or early interventions to avoid mental, physical and emotional chaos in such patients. Patients' with psychological distress need to be involved in a person-centred salutogenic dialogue with health professionals to become aware of and strengthen their own capacities to regain health and well-being.