1
|
Fang S, Xu L, Liu J, Zhang X, Li M, Zhang T, Lu M. Self-rated health and health-related quality of life among cancer patients: the serial multiple mediation of anxiety and depression. BMC Psychol 2024; 12:415. [PMID: 39080782 PMCID: PMC11290125 DOI: 10.1186/s40359-024-01919-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) in cancer patients has attracted increasing attention, which may be associated with self-rated health (SRH), anxiety, and depression. However, limited studies have focused on the mediating role of anxiety and depression in the relationship between SRH and HRQOL among cancer patients. Therefore, this study aims to explore the serial multiple mediating effects of anxiety and depression between SRH and HRQOL in cancer patients. METHODS This cross-sectional study investigated a total of 565 hospitalized cancer patients in Anhui province in China from November 2020 to October 2021. SRH was assessed using a single-item measure, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) and HRQOL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). Socio-demographic and clinical characteristics were analyzed using descriptive statistics. The relationships between SRH, anxiety, depression, and HRQOL were evaluated by Pearson correlation analysis. The serial multiple mediation of anxiety and depression was assessed by SPSS PROCESS macro. RESULTS SRH, anxiety, depression and HRQOL were significantly correlated(P < 0.001). In comparison to the fair SRH, the good SRH exhibited a significantly positive direct effect (Effect = 0.2366, Bootstrap 95%CI: 0.0642 ~ 0.4090) and total effect on HRQOL (Effect = 0.4761, Bootstrap 95%CI: 0.2975 ~ 0.6546). Conversely, the poor SRH demonstrated a significantly negative total effect on HRQOL (Effect= -0.4321, Bootstrap 95%CI: -0.7544~ -0.1099). When considering the fair SRH as the reference group, the poor SRH displayed a negative indirect effect on HRQOL through the single mediation of anxiety (Effect= -0.1058, Bootstrap 95%CI: -0.2217~ -0.0107) and the serial mediation of anxiety and depression (Effect= -0.0528, Bootstrap 95%CI: -0.1233~ -0.0035). Conversely, the good SRH had a positive indirect impact on HRQOL through the single mediation of anxiety (Effect = 0.1153, Bootstrap 95%CI: 0.0583 ~ 0.1900) and depression (Effect = 0.0667, Bootstrap 95%CI: 0.0206 ~ 0.1234), as well as the serial mediation of anxiety and depression (Effect = 0.0575, Bootstrap 95%CI: 0.0192 ~ 0.1030). CONCLUSION SRH can improve HRQOL through the decrease of anxiety and depression in cancer patients. Focusing on SRH would be beneficial for their mental health and HRQOL in cancer patients.
Collapse
Affiliation(s)
- Shuowen Fang
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Lingfeng Xu
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Jingsong Liu
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Xinzhou Zhang
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Mimi Li
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China
| | - Tao Zhang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Manman Lu
- School of Health Service Management, Anhui Medical University, No.81, Meishan Road, Shushan District, Hefei, Anhui, 230032, China.
| |
Collapse
|
2
|
Taylor RM, Hughes L, Fern LA, Hogg J, Petrella A. Evaluation of the impact of redeployment during the COVID-19 pandemic: results from a multi-centre survey. J Res Nurs 2023; 28:401-415. [PMID: 38144964 PMCID: PMC10741270 DOI: 10.1177/17449871231206916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Background The COVID-19 pandemic brought unprecedented upheaval for healthcare systems globally. Rapid changes in the way nurses were asked to work brought about many challenges, especially with the requirement for nurses to move into intensive care and high dependency areas to deliver care for the increasing number of critically ill patients. Aim The purpose of this evaluation was to assess the impact of these changes on nurses who were redeployed during the first acute phase of the pandemic and explore factors associated with burnout. Methods A redeployment survey, containing 42 items in four domains (preparation for redeployment, safety and support, perceived competence, reflections and emotional impact) was administered online to nurses who had been redeployed in two hospitals in England, one urban and one rural. Bivariate correlations and a multiple linear regression model were conducted to explore associations between perceptions of leadership, training, communication and feeling valued with levels of emotional exhaustion. Results Valid responses were received from 240/618 (39%) nurses. The majority of respondents felt it was their duty to work where they were asked (79%), were prepared to work where needed (72%) and were consulted on changes to their working hours (55%). However, nurses were nervous about the new role (75%) and felt they had a lack of choice regarding redeployment (66%) and the way it was implemented (50%). Multiple regression analysis showed that lack of training (β = 0.18) and feeling undervalued (β = 0.48) was positively associated with emotional exhaustion, which accounted for 38% of the variance among redeployed nurses. Conclusions To mitigate the risk of nurses developing burnout as a result of redeployment, there is a need for training to upskill them so they feel competent in doing the changed role. Additionally, nursing leadership needs to support nurses feeling valued as individuals in their role.
Collapse
Affiliation(s)
- Rachel M Taylor
- Director of the Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, UK
| | - Luke Hughes
- Research Facilitator, Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, UK
| | - Lorna A Fern
- Senior Research Fellow, Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, UK
| | - Julie Hogg
- Chief Nurse, Corporate Nursing, University Hospitals of Leicester NHS Trust, Leicestershire, UK
| | - Anika Petrella
- Research Associate, Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, UK
| |
Collapse
|
3
|
Petrella AR, Sabiston CM, O’Rourke RH, Santa Mina D, Hamilton RJ, Matthew AG. Process Evaluation of a Sport-Based Supportive Care Intervention for Testicular Cancer Survivors: A Mixed Methods Study. Cancers (Basel) 2022; 14:cancers14112800. [PMID: 35681779 PMCID: PMC9179291 DOI: 10.3390/cancers14112800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Testicular cancer survivors report unmet supportive care needs that are associated with poorer physical and mental health, yet engagement in traditional supportive care is low. The Ball’s in Your Court intervention was designed to engage testicular cancer survivors in supportive care by leveraging a community-based sport and exercise model. Age-appropriate, gender-sensitized, and disease specific elements were reflected in the intervention design, setting, content, and delivery. The intervention included five weekly health promotion sessions among a group of testicular cancer survivors. The purpose of this study was to explore the intervention’s (i) feasibility and acceptability, (ii) effects on testicular cancer survivors’ perceived health, and (iii) gain feedback for intervention refinement. A total of 10 testicular cancer survivors participated in the pilot and completed questionnaires on demographics, cancer history, perceived health, and physical activity behavior at baseline (pre-intervention) and perceived health and satisfaction with intervention components (post-intervention). Open-ended feedback surveys were collected after each weekly session and researcher field notes were recorded by three members of the study team. One month following the intervention, a focus group was conducted with intervention participants. All participants were satisfied with the intervention. Content analysis of the qualitative data supported intervention acceptability. Visual analysis conducted at the individual level indicated that perceived health either remained stable or improved from pre- to post-intervention. The Ball’s in Your Court intervention provides a feasible and acceptable approach for the delivery of supportive care aimed at improving testicular cancer survivors’ health and wellness. Recommendations for intervention refinement were provided and require future examination.
Collapse
Affiliation(s)
- Anika R. Petrella
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Catherine M. Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (R.H.O.); (D.S.M.)
- Correspondence:
| | - Roxy H. O’Rourke
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (R.H.O.); (D.S.M.)
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (R.H.O.); (D.S.M.)
| | - Robert J. Hamilton
- The Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (R.J.H.); (A.G.M.)
| | - Andrew G. Matthew
- The Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (R.J.H.); (A.G.M.)
| |
Collapse
|
4
|
Picard M. Why Do We Care More About Disease than Health? PHENOMICS (CHAM, SWITZERLAND) 2022; 2:145-155. [PMID: 36939781 PMCID: PMC9590501 DOI: 10.1007/s43657-021-00037-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 04/30/2023]
Abstract
Modern Western biomedical research and clinical practice are primarily focused on disease. This disease-centric approach has yielded an impressive amount of knowledge around what goes wrong in illness. However, in comparison, researchers and physicians know little about health. What is health? How do we quantify it? And how do we improve it? We currently do not have good answers to these questions. Our lack of fundamental knowledge about health is partly driven by three main factors: (i) a lack of understanding of the dynamic processes that cause variations in health/disease states over time, (ii) an excessive focus on genes, and (iii) a pervasive psychological bias towards additive solutions. Here I briefly discuss potential reasons why scientists and funders have generally adopted a gene- and disease-centric framework, how medicine has ended up practicing "diseasecare" rather than healthcare, and present cursory evidence that points towards an alternative energetic view of health. Understanding the basis of human health with a similar degree of precision that has been deployed towards mapping disease processes could bring us to a point where we can actively support and promote human health across the lifespan, before disease shows up on a scan or in bloodwork.
Collapse
Affiliation(s)
- Martin Picard
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Irving Medical Center, New York, NY 10032 USA
- Department of Neurology, Merritt Center, Columbia Translational Neuroscience Initiative, Columbia University Irving Medical Center, New York, NY 10032 USA
- New York State Psychiatric Institute, New York, NY 10032 USA
| |
Collapse
|
5
|
Petrella AR, Hughes L, Fern LA, Monaghan L, Hannon B, Waters A, Taylor RM. Healthcare staff well-being and use of support services during COVID-19: a UK perspective. Gen Psychiatr 2021; 34:e100458. [PMID: 34222795 PMCID: PMC8228653 DOI: 10.1136/gpsych-2020-100458] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has drastically increased demands on healthcare workers (HCWs) leaving them vulnerable to acute psychological distress, burnout and post-traumatic stress. In response, supportive services in a central London hospital mobilised mental health support specifically for HCWs. AIMS This rapid evaluation assessed HCW psychological welfare during the acute phase of the COVID-19 pandemic and their use of supportive services made available. METHODS During the acute phase of COVID-19 (April to May 2020) all staff working for the hospital were invited to complete an online survey assessing well-being (self-rated health, moral distress exposure, symptoms of burnout and psychological distress) and use of available supportive services (awareness of, use and perceived helpfulness). Associations among personal characteristics and psychological well-being were explored using correlations and linear regression. RESULTS A total of 1127 staff participated in the rapid evaluation. On average, psychological distress was high (mean (SD): 22 (7.57)) regardless of role, with 84% of this sample scoring above the general population mean (14.5). Nearly half of the sample reported feeling emotionally drained and a profile emerged displaying higher levels of psychological distress and burnout in those who were younger and exposed to morally distressing situations, with this group also exhibiting greater support service use. Greater levels of burnout were associated with increased psychological distress when controlling for personal factors. During this acute phase of the pandemic, majority of staff used at least one service and rated it as helpful. CONCLUSION HCWs experienced high levels of psychological distress requiring continued support as the COVID-19 pandemic evolved. Although HCWs were aware of supportive services, uptake varied. In order to mitigate the risk of burnout and post-traumatic stress, long-term, effective strategies that facilitate staff accessing support are urgently required.
Collapse
Affiliation(s)
- Anika R Petrella
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Luke Hughes
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lisa Monaghan
- Staff Psychological and Welfare Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Benjamin Hannon
- Staff Psychological and Welfare Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Adam Waters
- Staff Psychological and Welfare Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel M Taylor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Self-Rated Health: When and How to Use It in Studies Among Older People? INTERNATIONAL HANDBOOK OF HEALTH EXPECTANCIES 2020. [DOI: 10.1007/978-3-030-37668-0_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
7
|
Elran-Barak R, Barak A, Lomranz J, Benyamini Y. Proactive Aging Among Holocaust Survivors: Striving for the Best Possible Life. J Gerontol B Psychol Sci Soc Sci 2019; 73:1446-1456. [PMID: 27744368 DOI: 10.1093/geronb/gbw136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 09/22/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives To investigate methods that older Holocaust survivors and their age peers use in order to maintain the best possible life and to examine associations between these methods and subjective well-being. Method Participants were 481 older Israelis (mean age 77.4 ± 6.7 years): Holocaust survivors (n = 164), postwar immigrants (n = 183), and prewar immigrants (n = 134). Measures included sociodemographics and indicators of health and well-being. Respondents were asked to answer an open-ended question: "What are the methods you use to maintain the best possible life?". Answers were coded into eight categories. Results Holocaust survivors were significantly less likely to mention methods coded as "Enjoyment" (32.3%) relative to postwar (43.7%) and prewar (46.2%) immigrants and significantly more likely to mention methods coded as "Maintaining good health" (39.0%) relative to postwar (27.9%) and prewar (21.6%) immigrants. Controlling for sociodemographics and health status, Holocaust survivors still differed from their peers. Discussion Aging Holocaust survivors tended to focus on more essential/fundamental needs (e.g., health), whereas their peers tended to focus on a wider range of needs (e.g., enjoyment) in their effort to maintain the best possible life. Our findings may add to the proactivity model of successful aging by suggesting that aging individuals in Israel use both proactive (e.g., health) and cognitive (e.g., accepting the present) adaptation methods, regardless of their reported history during the war.
Collapse
Affiliation(s)
| | - Adi Barak
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Jacob Lomranz
- The School of Social and Community Sciences, Ruppin Academic Center, Emek Hefer, Israel
- School of Psychological Sciences
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Israel
| |
Collapse
|
8
|
Han LKM, Verhoeven JE, Tyrka AR, Penninx BWJH, Wolkowitz OM, Månsson KNT, Lindqvist D, Boks MP, Révész D, Mellon SH, Picard M. Accelerating research on biological aging and mental health: Current challenges and future directions. Psychoneuroendocrinology 2019; 106:293-311. [PMID: 31154264 PMCID: PMC6589133 DOI: 10.1016/j.psyneuen.2019.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/22/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022]
Abstract
Aging is associated with complex biological changes that can be accelerated, slowed, or even temporarily reversed by biological and non-biological factors. This article focuses on the link between biological aging, psychological stressors, and mental illness. Rather than comprehensively reviewing this rapidly expanding field, we highlight challenges in this area of research and propose potential strategies to accelerate progress in this field. This effort requires the interaction of scientists across disciplines - including biology, psychiatry, psychology, and epidemiology; and across levels of analysis that emphasize different outcome measures - functional capacity, physiological, cellular, and molecular. Dialogues across disciplines and levels of analysis naturally lead to new opportunities for discovery but also to stimulating challenges. Some important challenges consist of 1) establishing the best objective and predictive biological age indicators or combinations of indicators, 2) identifying the basis for inter-individual differences in the rate of biological aging, and 3) examining to what extent interventions can delay, halt or temporarily reverse aging trajectories. Discovering how psychological states influence biological aging, and vice versa, has the potential to create novel and exciting opportunities for healthcare and possibly yield insights into the fundamental mechanisms that drive human aging.
Collapse
Affiliation(s)
- Laura K M Han
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Oldenaller 1, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Josine E Verhoeven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Oldenaller 1, the Netherlands
| | - Audrey R Tyrka
- Butler Hospital and the Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brenda W J H Penninx
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Oldenaller 1, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Owen M Wolkowitz
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Kristoffer N T Månsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Daniel Lindqvist
- Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA; Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Marco P Boks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, the Netherlands
| | - Dóra Révész
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Synthia H Mellon
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Martin Picard
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA; Department of Neurology, H. Houston Merritt Center, Columbia Translational Neuroscience Initiative, Columbia University Medical Center, New York, NY, USA; Columbia Aging Center, Columbia University, New York, NY, USA.
| |
Collapse
|
9
|
Marcum JA. Multimorbidity, P4 medicine and holism. J Eval Clin Pract 2017; 23:213-215. [PMID: 27357479 DOI: 10.1111/jep.12588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 05/17/2016] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Multimorbidity is a serious challenge to providing patients with quality health care. Sturmberg et al. propose a P4 or whole-person medical model based on a holistic approach to deliver such care. The aim of this commentary is to examine critically their P4 model and holistic approach. METHODS The P4 model and holistic approach of Sturmberg et al. are analysed conceptually in terms of an effective strategy or sequence for framing P4 medicine and with respect to different philosophical notions of holism for grounding it. RESULTS Instead of a P4 medicine strategy or sequence that emphasizes the predictive and preventive aspects of health care from a biomedical perspective, as Sturmberg et al. do, a more effective strategy or sequence for framing P4 medicine to deliver quality health care is to accentuate the personalized and participatory aspects from a humanistic perspective. The basis of this proposed strategy for P4 medicine is not a technoscientific holism that emphasizes mechanisms to define the whole utilizing bottom-up causation, as Sturmberg et al. ground their biomedical P4 model, but rather a phenomenological holism that also incorporates the person's illness experience and top-down causation. CONCLUSIONS The proposal of Sturmberg et al. to treat patient multimorbidity through P4 medicine and a holistic approach is certainly a move in the right direction. However, to achieve their goal requires an alternative strategy for P4 medicine and a more robust notion of holism.
Collapse
|
10
|
Sturmberg JP, Bennett JM, Picard M, Seely AJE. The trajectory of life. Decreasing physiological network complexity through changing fractal patterns. Front Physiol 2015; 6:169. [PMID: 26082722 PMCID: PMC4451341 DOI: 10.3389/fphys.2015.00169] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 05/19/2015] [Indexed: 12/15/2022] Open
Abstract
In this position paper, we submit a synthesis of theoretical models based on physiology, non-equilibrium thermodynamics, and non-linear time-series analysis. Based on an understanding of the human organism as a system of interconnected complex adaptive systems, we seek to examine the relationship between health, complexity, variability, and entropy production, as it might be useful to help understand aging, and improve care for patients. We observe the trajectory of life is characterized by the growth, plateauing and subsequent loss of adaptive function of organ systems, associated with loss of functioning and coordination of systems. Understanding development and aging requires the examination of interdependence among these organ systems. Increasing evidence suggests network interconnectedness and complexity can be captured/measured/associated with the degree and complexity of healthy biologic rhythm variability (e.g., heart and respiratory rate variability). We review physiological mechanisms linking the omics, arousal/stress systems, immune function, and mitochondrial bioenergetics; highlighting their interdependence in normal physiological function and aging. We argue that aging, known to be characterized by a loss of variability, is manifested at multiple scales, within functional units at the small scale, and reflected by diagnostic features at the larger scale. While still controversial and under investigation, it appears conceivable that the integrity of whole body complexity may be, at least partially, reflected in the degree and variability of intrinsic biologic rhythms, which we believe are related to overall system complexity that may be a defining feature of health and it's loss through aging. Harnessing this information for the development of therapeutic and preventative strategies may hold an opportunity to significantly improve the health of our patients across the trajectory of life.
Collapse
Affiliation(s)
- Joachim P Sturmberg
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle Wamberal, NSW, Australia
| | - Jeanette M Bennett
- Department of Psychology, The University of North Carolina at Charlotte Charlotte, NC, USA
| | - Martin Picard
- Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania Philadelphia, PA, USA
| | - Andrew J E Seely
- Thoracic Surgery and Critical Care Medicine, University of Ottawa and Associate Scientist, Ottawa Hospital Research Institute Ottawa, ON, Canada
| |
Collapse
|
11
|
Martin CM, Félix-Bortolotti M. Person-centred health care: a critical assessment of current and emerging research approaches. J Eval Clin Pract 2014; 20:1056-64. [PMID: 25492282 DOI: 10.1111/jep.12283] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 12/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Person-centred health care is prominent in international health care reforms. A shift to understanding and improving personal care at the point of delivery has generated debates about the nature of the person-centred research agenda. This paper purviews research paradigms that influence current person-centred research approaches and traditions that influence knowledge foundations in the field. It presents a synthesis of the emergent approaches and methodologies and highlights gaps between static academic research and the increasing accessibility of evaluation, informatics and big data from health information systems. FINDINGS Paradigms in health services research range from theoretical to atheoretical, including positivist, interpretive, postmodern and pragmatic. Interpretivist (subjective) and positivist (objectivist) paradigms have been historically polarized. Yet, integrative and pragmatic approaches have emerged. Nevertheless, there is a tendency to reductionism, and to reduce personal experiences to metrics in the positivist paradigm. Integrating personalized information into clinical systems is increasingly driven by the pervasive health information technology, which raises many issues about the asymmetry and uncertainty in the flow of information to support personal health journeys. The flux and uncertainty of knowledge between and within paradigmatic or pragmatic approaches highlights the uncertainty and the 'unorder and disorder' in what is known and what it means. Transdisciplinary, complex adaptive systems theory with multi-ontology sense making provides an overarching framework for making sense of the complex dynamics in research progress. CONCLUSION A major challenge to current research paradigms is focus on the individualizing of care and enhancing experiences of persons in health settings. There is an urgent need for person-centred research to address this complex process. A transdisciplinary and complex systems approach provides a sense-making framework.
Collapse
Affiliation(s)
- Carmel M Martin
- Public Health and Primary Care, Trinity College Dublin, Dublin, Co Dublin, Ireland
| | | |
Collapse
|
12
|
de Mendonça Freire L, Dalamaria T, de Aquino Cunha M, de Souza OF. Self-Rated Health in University Students from Rio Branco in the Western Brazilian Amazon. Health (London) 2014. [DOI: 10.4236/health.2014.616260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|