What frailty can tell us about ageing well: towards an alternative paradigm to 'successful ageing'

This paper considers the concept of successful ageing by means of a dialogue with the concept of frailty. This dialogue reveals the limits and blindspots of both concepts as well as their apparent dichotomy and the importance of understanding both the objective and subjective experience of ageing. In particular, the dialogue highlights that both frailty and successful ageing are social constructs that derive their meaning from what society values (autonomy, youthful capacities). They cannot by themselves account for the fact that flourishing and frailty are often found together whilst conversely successful ageing may not bring satisfaction. I argue that the arts and humanities supply us with conceptual and methodological tools with which to revisit what it is to age well offering a holistic approach that combines sensitivity both to older people's lived experience and to the underpinning material conditions and embodied realities. For this purpose, and building on previous scholarship in cultural gerontology, I suggest the unique value of concepts and frameworks associated by Simone de Beauvoir. When brought into alignment with the tenets of cultural and narrative gerontology, these concepts facilitate a rich understanding of the nuances and paradoxes of flourishing in deep old age which can also aid in restorying both old age and the life course more generally. I illustrate this through two examples: a feminist self-help guide to ageing, which accepts both limitations and growth and a film that imagines the possibilities of authentic ageing even despite a context of poverty, patriarchy and Alzheimer's Disease.

Flemish equine veterinarians' perceptions on the use of and client communication about complementary and alternative veterinary medicine

BACKGROUND

Complementary and alternative veterinary medicine (CAVM) is increasingly popular in horses. As CAVM usage could have risks, client-veterinarian communication about CAVM is crucial.

OBJECTIVES

Evaluating equine veterinarians' attitude towards CAVM, their CAVM usage and veterinarian-client communication about CAVM.

STUDY DESIGN

Cross-sectional study.

METHOD

A telephone survey was conducted among equine veterinarians providing ambulatory care on a daily or weekly basis. The first section of the survey included questions about the veterinarians' attitude towards CAVM and their CAVM usage. The second section focused on veterinary-client communication about CAVM.

RESULTS

When herbs are included as CAVM modality, 83% of the participants applied CAVM. Nighty-eight percent had already communicated with horse owners about CAVM and 81% agreed to be open to talk about CAVM. However, 95% agreed that sometimes CAVM usage takes place without disclosure to the veterinarian. The majority of participants communicated about CAVM on a weekly (40%) or daily (22%) basis, most often in person during consultations (99%) or via phone (32%). The median percentage of conversations about CAVM initiated by the owner was 50% (range 50%-80%). When the veterinarian initiated the conversation, this was usually by mentioning it as a treatment option, mostly in addition to conventional treatments. Some participants directly asked about CAVM use in the information-gathering phase.

MAIN LIMITATIONS

A convenience sample was used due to lack of data on the number of equine veterinarians in Flanders. Potential favourability bias with higher participation of veterinarians interested in CAVM.

CONCLUSION

Equine veterinarians generally had a positive attitude towards CAVM use, although this depended on the specific modality. Veterinarian-client communication about CAVM occurs frequently in ambulatory care. An open dialogue with horse owners about CAVM is important to provide information about CAVM and thus enable them to make informed decisions concerning CAVM usage, together with their veterinarian.

Stress Factors for the Paediatric and Adult Palliative Care Multidisciplinary Team and Workplace Wellbeing Solutions

BACKGROUND

Palliative care is a challenging specialty, especially when it comes to caring for children with serious life-limiting conditions and supporting their families. Workers face significant challenges and experience major impacts on their wellbeing. We conducted a qualitative study to understand the sources of stress in the palliative care team, their work expectations, and how they can cope with the demands.

METHODS

We used an online questionnaire about the causes of stress, the impact of the COVID-19 pandemic and the ways in which support is needed in the workplace.

RESULTS

Of the 56 palliative care professionals who participated in the survey, 57.1% considered the main causes of stress to be high workload, difficult emotional burdens (55.4%) affecting their outlook on life (61.2%), the death of patients (46.4%), and communication with patients' families (26.8%). The COVID-19 pandemic increased stress levels for the majority of respondents (89.3%). The need for specialised training (53.6%), support groups, psychological counselling and adapted organisational policies was highlighted.

CONCLUSIONS

The study demonstrates the importance of understanding the needs of both paediatric and adult palliative care staff in order to provide optimal care and support their balance in this demanding area of the healthcare system.

Enhancing End-of-Life Care Through Yoga

This editorial explores the integration of yoga into end-of-life care, emphasizing its potential to enhance the quality of life, comfort, and dignity of patients. Rooted in over 5,000 years of history, yoga's holistic approach, encompassing physical, mental, and spiritual practices, aligns seamlessly with the goals of end-of-life care. We discuss the benefits of incorporating yoga's diverse practices, such as physical postures, breathing exercises, and meditation, particularly in palliative care settings. These practices offer significant improvements in physical health, psychological well-being, and spiritual fulfillment, especially pertinent for older adults and patients with serious illnesses like HIV and cancer. The philosophical underpinnings of yoga, emphasizing acceptance, harmony, and peace, provide a framework for a dignified and peaceful transition, resonating deeply with the concept of a 'good death'. However, challenges exist in integrating yoga into end-of-life care, including limited research, cultural and religious considerations, physical and emotional limitations of patients, and logistical constraints within healthcare settings. Ethical considerations are also paramount, focusing on patient-centered approaches, respect for individual beliefs, informed consent, and patient autonomy. The editorial concludes by underscoring the need for further research to evaluate the long-term effects of yoga in end-of-life care and to establish comprehensive ethical guidelines. The integration of yoga offers a multifaceted approach to address not only physical discomfort but also provide emotional and spiritual solace for terminally ill patients, thereby enhancing the overall quality of end-of-life care.

Plant responses to climate change, how global warming may impact on food security: a critical review

Global agricultural production must double by 2050 to meet the demands of an increasing world human population but this challenge is further exacerbated by climate change. Environmental stress, heat, and drought are key drivers in food security and strongly impacts on crop productivity. Moreover, global warming is threatening the survival of many species including those which we rely on for food production, forcing migration of cultivation areas with further impoverishing of the environment and of the genetic variability of crop species with fall out effects on food security. This review considers the relationship of climatic changes and their bearing on sustainability of natural and agricultural ecosystems, as well as the role of omics-technologies, genomics, proteomics, metabolomics, phenomics and ionomics. The use of resource saving technologies such as precision agriculture and new fertilization technologies are discussed with a focus on their use in breeding plants with higher tolerance and adaptability and as mitigation tools for global warming and climate changes. Nevertheless, plants are exposed to multiple stresses. This study lays the basis for the proposition of a novel research paradigm which is referred to a holistic approach and that went beyond the exclusive concept of crop yield, but that included sustainability, socio-economic impacts of production, commercialization, and agroecosystem management.

Psychometric properties of the client-centred rehabilitation questionnaire-is derived from a large and varied group of rehabilitation users

PURPOSE

The purpose of this study was to inspect and establish the factor structure of the Icelandic Client-Centred Rehabilitation Questionnaire [CCRQ-is] and investigate the service experiences of a large and varied sample of rehabilitation users.

MATERIALS AND METHODS

Altogether 499 rehabilitation users completed the questionnaire. Confirmatory and exploratory factor analysis was conducted for analysis of items. Mann-Whitney's U and Kruskal-Wallis test was used to compare subscale responses based on participants' characteristics.

RESULTS

Four factors explained 53,2% of the variance: Respect and attentiveness, Interaction with significant others, Responsiveness to needs and preferences and Education and enablement. Subscales showed internal consistency from 0.72-0.91 and 0.92 for the whole instrument. The subscale Respect and attentiveness represented user centred rehabilitation the most and Interaction with significant others the least. Significant differences in relation to health conditions and age were obtained on all four subscales and differences by gender on one subscale.

CONCLUSIONS

Our results suggest the CCRQ-is is a reliable tool that can be used with rehabilitation users with a broad range of characteristics within the Icelandic context. The extent to which the intersection of age, gender and health issues influence users' perception of services needs to be further scrutinized.

Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

What Factors Discriminate Young Soccer Players Perceived as Promising and Less Promising by Their Coaches?

Purpose: This study aimed to verify whether there are differences in physical, technical, and tactical assessment outcomes derived from field-based tests and small-sided games (SSG) in addition to anthropometric and maturational characteristics between players classified as promising and less promising as per the coaches' perception. Method: A total of 53 male U-15 youth soccer players (age: 14.8 ± 0.2 years, weight: 61.7 ± 6.9 kg, height: 171.8 ± 6.7 cm) and three experienced coaches from three distinct sports clubs were enrolled in this study. Based on the coaches' perception, players were split into three group levels for both short- and long-term success ranking: (i) promising (PL; top 5 players; n = 15), (ii) intermediate (IL; n = 23) and (iii) less promising (LPL; 5 bottom players; n = 15). The following measures were determined: anthropometry, maturity offset, vertical jump, and aerobic-anaerobic running performance, soccer- specific skills tests, GPS-based running metrics, technical and tactical actions during SSG, and minutes played throughout the season. Results: There were no differences between groups for anthropometrical, maturational, and physical outcomes. PL players in both rankings covered more distances at sprinting and presented more offensive technical and tactical actions during SSG than their LPL peers. PL and IL presented more minutes played in competitive seasons than LPL of short-term ranking. Conclusion: The biggest differences between the players ranked by their coaches were apparent only during a representative game task, emphasizing the importance of SSG as a tool to assess the players' technical-tactical awareness. In addition to the SSG, the coach's eye plays a key role during the talent identification and selection process.

A holistic approach in epidemics

This paper explores the concept of a holistic approach in preventing and responding to epidemics. Epidemics are defined as the occurrence of an illness or health-related event exceeding normal expectations within a specific community or region. Holism emphasizes viewing systems as a whole rather than a collection of parts. In the context of epidemics, a holistic approach considers not only medical interventions but also social, economic, psychological and environmental factors that influence disease transmission and management. The impact of climate change on epidemic response, the understanding of the significance of animal health and agriculture, the consideration of art, culture and societal factors, the exploration of the use of technology and innovation, the addressing of limitations in resources and the provision of enhanced support for the mental and emotional well-being of individuals and affected communities, are parts of this holistic approach. By integrating them, innovative practices as well as cross-sectoral and interdisciplinary techniques can be employed. Such an approach has the potential to enhance epidemic prevention and response strategies, ultimately contributing to positive public health outcomes.

Coaching to strengthen critical success factors in integrative care for chronic fatigue patients: the Patient Needs-Resources Model

Theoretical and empirical studies discover that an integrative approach is particularly important in chronic disorders and multiple long-term conditions, such as chronic fatigue. Chronic fatigue syndrome (CFS) is a classic example of a potentially severe, multisystemic illness with a wide diversity of symptoms and the corresponding diagnostic complexity. The prevalence of CFS-like syndromes expanded in the context of the COVID-19 pandemic, increasing the disorder and treatment burden. Thus, this article aimed to draw attention to the possibilities to strengthen the integrative approach to diagnosing and treating chronic disorders and multiple long-term conditions. The main critical success factors identified for integrative approaches were: a holistic approach, that provides a more comprehensive diagnostic and personalized treatment strategy, a multidisciplinary team, and patient engagement. The strengths and weaknesses of these factors were explored and coaching was identified as a potential unifying and reinforcing element. Coaching has a wide spectrum of manifestations clearly representing a holistic approach, that has been successfully used in multidisciplinary team building. Moreover, coaching exposes support addressing the patient engagement issues identified by the Patient Needs-Resources Model (PN-R Model) such as low levels of self-efficacy, optimism, and subjective well-being. Coaching may assist patients to identify and prioritize their goals, becoming aware of their personal resources, developing strategies for managing symptoms, and building skills to increase their self-efficacy and active engagement in the treatment process. Therefore, the authors emphasize coaching as a perspective element of optimization of patient care, that requires additional theoretical and long-term empirical research.

Holistic Approach of a Leukemic Child Suffering from Oral Mucositis with Coinfections: A Case Report

Oral mucositis (OM) is a life-threatening side effect of chemo-radiotherapy. OM can provide a portal of entry for many microorganisms as coinfections which potentially generate other oral lesions. This case report describes a holistic approach to obtaining the successful treatment of OM with necrotizing ulcerative stomatitis (NUS) and oral candidiasis as coinfections in pediatric acute lymphoblastic leukemia (ALL). A 2-year-8-month-old boy was referred from the Pediatrics Department at Dr. Hasan Sadikin General Hospital with the chief complaint of canker sore and eating difficulty for the past two weeks. He had undergone the twelfth cycle of the last chemotherapy using methotrexate regimen. Extraoral examination revealed anemic conjunctiva, icteric sclera, and dry lips. Well-defined irregular multiple ulcers covered by yellowish to grayish pseudomembranous were found on the upper and lower labial mucosa, right and left buccal mucosa, tongue, palate, and gingiva. Potassium hydroxide (KOH) examination showed fungi in the oral lesions smear. The established diagnosis was OM with NUS and oral candidiasis as coinfections. Debridement was done using chlorine dioxide-zinc and 0.2% chlorhexidine gluconate. We collaborated with the pediatrician who prescribed ceftazidime, meropenem, and fluconazole, and also with parents. The holistic approach is beneficial and important in improving quality of life and supporting the successful treatment of OM with coinfections.

Sour Cherry Pomace Valorization as a Bakery Fruit Filling: Chemical Composition, Bioactivity, Quality and Sensory Properties

Sour cherry pomace filling (SCPF) and commercial sour cherry filling (CSCF) produced on a semi-industrial scale were tested and compared in terms of food safety, chemical composition, bioactivity, quality, sensory properties and thermal stability. Both samples were safe for human consumption, thermally stable and there was a lack of syneresis. SCPF had a significantly higher fiber concentration (3.79 g/100 g) due to higher skin fraction and is considered a "source of fibers". The higher skin fraction in SCPF also resulted in a higher mineral quantity (Fe-3.83 mg/kg fw) in comparison to CSCF (Fe-2.87 mg/kg fw). Anthocyanins concentration was lower in SCPF (7.58 mg CGE/100 g fw), suggesting that a significant amount of anthocyanins was removed from SC skin during juice extraction. However, there was a lack of statistical differences in antioxidant activity between the two fillings. CSCF was more spreadable, not as firm and less sticky, with lower storage and loss modulus values than SCPF. However, both fillings exhibited acceptable rheological and textural behaviour for fruit fillings. According to the consumer pastry test, 28 participants preferred each pastry; thus, there was a lack of preference toward any of the tested samples. SCP could be used as a raw material for the bakery fruit fillings industry, which leads to the valorization of food industry by-products.

Surveying dog owners' use and understanding of, and communication with veterinarians about, complementary and alternative veterinary medicine

BACKGROUND

Complementary and alternative veterinary medicine (CAVM) seems to be gaining acceptance by pet owners. Client-veterinarian communication about CAVM is important to explore client perceptions and facilitate open exchange of ideas between owners and veterinarians.

METHODS

This study includes an online, cross-sectional survey of dog owners to evaluate CAVM use and client-veterinarian communication about CAVM. Based on the extended theory of planned behaviour, factors influencing the intention to use CAVM were evaluated.

RESULTS

Past CAVM use was reported by 45.3% clients based on 1000 valid surveys. The attitude towards CAVM was generally positive. Perceived knowledge about CAVM positively predicted perceived behavioural control and attitude towards CAVM. Both were the strongest predictors of future CAVM use. Around 45.7% of clients had already talked to their veterinarian about CAVM. This conversation was mainly initiated by the owner (66.3%). Owners expected the veterinarian to have knowledge about CAVM (91.5%) and offer referral (71.5%).

LIMITATIONS

The limitation is difficulty in classifying and defining CAVM modalities.

CONCLUSIONS

Owners' perceived behavioural control and attitude towards CAVM predict CAVM use. Failure to engage in a conversation about CAVM hampers clients to partner with veterinarians to discuss the treatment approach and maximise patient outcome. The veterinarian plays an essential role in providing objective accurate information about CAVM.

Reasons for Engaging in Complementary and Alternative Medicine Among Highly Educated Women With Multiple Sclerosis

BACKGROUND

Previous research has shown that users of complementary and alternative medicine (CAM) among persons with multiple sclerosis are more likely to be women and to have a higher level of education compared with nonusers. This qualitative study was performed to explore the motivations linked to CAM use among highly educated women with multiple sclerosis.

METHODS

The study was based on a phenomenological approach, and 8 semistructured, in-depth qualitative interviews were performed. Data were transcribed verbatim and analyzed through meaning condensation and identification of recurring themes.

RESULTS

Regarding the informants' motivations for CAM use, 3 main themes emerged: (1) Self-reliance is essential in disease management, (2) conventional health care lacks a holistic approach, and (3) personal experience is the primary guide.

CONCLUSIONS

The interviewees wanted approaches to health care that supported their desire to actively participate in the management of their disease. They were critical of the conventional health care system, and they emphasized the importance of letting their own personal experiences, as well as those of others, guide their decisions.

The Effects of Cardioprotective Antidiabetic Therapy on Microbiota in Patients with Type 2 Diabetes Mellitus-A Systematic Review

As the pathophysiologic mechanisms of type 2 diabetes mellitus (T2DM) are discovered, there is a switch from glucocentric to a more comprehensive, patient-centered management. The holistic approach considers the interlink between T2DM and its complications, finding the best therapies for minimizing the cardiovascular (CV) or renal risk and benefitting from the treatment's pleiotropic effects. Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) fit best in the holistic approach because of their effects in reducing the risk of CV events and obtaining better metabolic control. Additionally, research on the SGLT-2i and GLP-1 RA modification of gut microbiota is accumulating. The microbiota plays a significant role in the relation between diet and CV disease because some intestinal bacteria lead to an increase in short-chain fatty acids (SCFA) and consequent positive effects. Thus, our review aims to describe the relation between antidiabetic non-insulin therapy (SGLT-2i and GLP-1 RA) with CV-proven benefits and the gut microbiota in patients with T2DM. We identified five randomized clinical trials including dapagliflozin, empagliflozin, liraglutide, and loxenatide, with different results. There were differences between empagliflozin and metformin regarding the effects on microbiota despite similar glucose control in both study groups. One study demonstrated that liraglutide induced gut microbiota alterations in patients with T2DM treated initially with metformin, but another failed to detect any differences when the same molecule was compared with sitagliptin. The established CV and renal protection that the SGLT-2i and GLP-1 RA exert could be partly due to their action on gut microbiota. The individual and cumulative effects of antidiabetic drugs on gut microbiota need further research.

A Model for Clinical Coder Satisfaction in Saudi Arabia Based on a Holistic Approach: Clinical, Professional and Organizational Dimensions

The quality of clinical coding influences not only hospital revenue but also the quality and efficiency of healthcare services. Assessing the coders' satisfaction is essential to optimizing the quality of clinical coding. This mixed-method study used a qualitative approach to propose the study model while testing the model through a quantitative approach. The relevant variables of the satisfaction model were assessed through a survey targeting clinical coders across the country on a timely basis. Fourteen experts participated in establishing the model with three dimensions: professional, organizational, and clinical. Each dimension has its relevant variables. One hundred eighty-four clinical coders participated in phase two. 34.5% were male, 61% held a diploma, 38% had a bachelor's and above, and 49.7% worked in hospitals having fully electronic health records. We found that organizational and clinical dimensions strongly correlate with coders' satisfaction. Noticeably, the most influencing variables were the availability of coding policies and the computer-assisted coding (CAC) system. The results show that the model explains the satisfaction of the clinical coders, and organizational and clinical-related variables are crucial. Although gender-based differences exist, training (regardless of the training mode), coding policies, and the CAC system substantially influence coders' satisfaction. A significant stream of the literature supports these findings. However, attempting a holistic approach to assess coders' satisfaction and affecting coding quality is the added value of this study. Optimizing clinical coding practice requires organization-wide initiatives and policies to regulate coding practices and standards to promote the quality and timeliness of clinical documentation. Training is indispensable not only for clinical coders, but physicians also need to understand the rationale and value of clinical coding. Better utilization of the outcomes of the coding process and adopting the CAC system are significant drivers to enhance coders' satisfaction.

360° Diagnostic Tool to Personalize Lifestyle Advice in Primary Care for People With Type 2 Diabetes: Development and Usability Study

BACKGROUND

Various multifaceted factors need to be addressed to improve the health and quality of life of people with type 2 diabetes (T2D). Therefore, we developed a web-based decision support tool that comprises a more holistic diagnosis (including 4 domains: body, thinking and feeling, behavior, and environment) and personalized advice. This 360° diagnostic tool enables people with T2D and health care professionals at the general practice to obtain an overview of the most important T2D-related issues and, subsequently, determine the most suitable intervention for the person with T2D.

OBJECTIVE

This study aimed to describe the systematic and iterative development and evaluation of the web-based 360° diagnostic tool.

METHODS

We defined the requirements for the web-based 360° diagnostic tool based on previously developed tools, a literature review, and inputs from a multidisciplinary team of experts. As part of the conceptualization, we defined 3 requirements: diagnostics; feedback; and advice, consultation, and follow-up. Next, we developed and designed the content for each of these requirements. We evaluated the diagnostic part of the tool (ie, measurement instruments and visualization) with a qualitative design, in a usability study with a think-aloud strategy and interview questions, among 8 people with T2D at a Dutch general practice.

RESULTS

For each of the 4 domains, specific parameters and underlying elements were selected, and measurement instruments (including clinical data and questionnaires) were chosen. Cutoff values were defined to identify high-, middle-, and low-ranking scores, and decision rules were developed and implemented using R scripts and algorithms. A traffic light color visual design was created (profile wheel) to provide an overview of the scores per domain. We mapped the interventions that could be added to the tool and developed a protocol designed as a card deck with motivational interview steps. Furthermore, the usability study showed that people with T2D perceived the tool as easy to use, useful, easy to understand, and insightful.

CONCLUSIONS

Preliminary evaluation of the 360° diagnostic tool by experts, health care professionals, and people with T2D showed that the tool was considered relevant, clear, and practical. The iterative process provided insights into the areas of improvement, which were implemented. The strengths, shortcomings, future use, and challenges are also discussed.

Comprehensive Medication Management Services with a Holistic Point of View, a Scoping Review

Implementing Comprehensive Medication Management (CMM) services uncovered the importance of the totality of the patient's perspective in this process. The holistic approach takes into account the physical, mental and emotional well-being of individuals, as well as their socioeconomic circumstances. The aim of this study was to characterize the scientific evidence associated with CMM services that included this holistic approach. A scoping review was conducted based on Arksey and O'Malley's method. Searches were performed in Google Scholar for papers published between 2010 and 2020 in English, Spanish and Portuguese. Study design, health contexts, sample of patients, results obtained, barriers and facilitators, and the integration of a holistic approach were determined. Two hundred and eighteen papers were evaluated, most of which focused on the implementation of this service through prospective observational studies. A minority of studies reported on a holistic approach, a smaller number examined the effect of social determinants of health, the patient's medication experiences and the pharmacotherapy outcomes from the patient's perspective. Despite the progress achieved, most of the referents do not yet reflect a broader view of the patient's life situation and its relationship to pharmacotherapy and the ways in which the pharmacist implements holistic elements to solve or prevent drug-related problems.

Treating the musician rather than the symptom: The holistic tools employed by current practices to attend to the non-motor problems of musicians with task-specific focal dystonia

Musicians Focal Dystonia (MFD) is a task-specific movement disorder affecting highly skilled musicians. The pathophysiology is poorly understood, and the available treatments are unable to fully and reliably rehabilitate the affected skill. Recently, the exclusively neurological nature of the condition has been questioned, and additional psychological, behavioral, and psychosocial contributing factors were identified. However, very little is known about how these factors influence the recovery process, and how, if at all, they are addressed in ongoing practices. For this study, 14 practitioners with substantial experience in working with musicians with MFD were interviewed about the elements in their approach which are directed at the cognition, emotions, attitudes, and behaviors of their patients and clients. A wide variety of tools were reported in three areas: (1) creating a supportive learning environment and addressing anxiety and perfectionism, (2) using body-oriented methods to optimize the playing behaviors and (3) consciously channeling the focus of attention to guide the physical retraining exercises and establishing new habits. The study also revealed that in-depth knowledge of the instrumental technique is profitable to retrain the impaired motor patterns. Therefore, the importance of including music educators in developing new therapeutic approaches will also be highlighted.

Holistic management of hepatocellular carcinoma: The hepatologist's comprehensive playbook

Hepatocellular carcinoma (HCC) is a common complication in patients with chronic liver disease and leads to significant morbidity and mortality. Liver disease and liver cancer are preventable by mitigating and managing common risk factors, including chronic hepatitis B and C infection, alcohol use, diabetes, obesity and other components of the metabolic syndrome. The management of patients with HCC requires treatment of the malignancy and adequate control of the underlying liver disease, as preserving liver function is critical for successful cancer treatment and may have a relevant prognostic role independent of HCC management. Hepatologists are the ideal providers to guide the care of patients with HCC as they are trained to identify patients at risk, apply appropriate surveillance strategies, assess and improve residual liver function, evaluate candidacy for transplant, provide longitudinal care to optimize and preserve liver function during and after HCC treatment, survey for cancer recurrence and manage its risk factors, and prevent and treat decompensating events. We highlight the need for a team-based holistic approach to the patient with liver disease and HCC and identify necessary gaps in current care and knowledge.

The Psychosocial Impacts of Intimate Partner Violence against Women in LMIC Contexts: Toward a Holistic Approach

Work on the mental health impacts of intimate partner violence in low-and middle-income countries has focused primarily on clinical disorders such as post-traumatic stress disorder, depression, and substance abuse. This paper analyzes how non-clinical, psychosocial impacts from everyday stressors, particularly economic hardships and concern over one's children, cause extensive suffering and damage women survivors' well-being, influencing the development and expression of clinical disorders. Using a social ecological framework, the paper analyzes how psychosocial impacts arise at multiple levels, including societal levels where social norms often devalue women and privilege men, and how the stressor accumulation increases the harm caused by intimate partner violence (IPV) against women (IPVAW). Drawing on survivors' narratives and studies from diverse low and middle income country (LMIC) settings, including armed conflict and natural disaster settings, the paper underscores the importance of understanding both clinical impacts and the non-clinical, psychosocial impacts, which interact with and complement one another. Recognizing the interplay also between IPVAW and other forms of violence against girls and women, the paper calls for a more comprehensive approach to understanding and addressing the impacts of IPVAW. Recognizing the enormous variety within and across countries that are considered to be LMIC settings, the paper cautions against universalized approaches to understanding the effects of IPVAW and helping to support survivors.

A conservation organisation's approach to COVID-19: Lessons learned from Madagascar

Blue Ventures (BV) works holistically with communities in Madagascar, developing transformative approaches to catalyse and sustain locally led marine conservation. In response to the coronavirus disease 2019 (COVID-19) pandemic, BV's priority was to safeguard the immediate wellbeing and livelihoods of as many communities as possible, recognising that livelihoods are integral to broader well-being. This article describes in detail BV's health response and the perceptions of BV's Madagascar team regarding the successes and challenges of this effort. As a result of the combined efforts of BV teams across Madagascar and in the United Kingdom, the existing healthcare services at BV's sites were maintained, and messages about recognising and dealing with COVID-19 and the importance of vaccination were conveyed to communities that might otherwise not have received comprehensive information. Data were also collected on suspected cases in areas where testing was not available, and outbreaks of suspected COVID-19 cases were managed. Because BV's teams are embedded within the communities where they work, they maintain strong relationships with communities and conveyed important messages around reducing the spread of COVID-19, not only via activities in response to the pandemic but also through activities for other programmes such as fisheries and livelihoods. Blue Ventures' holistic approach ensured that the organisation had a multidimensional understanding of the impacts of the pandemic on communities, facilitating the development of more relevant messaging that considered both safety and the need for continued income-generating activities. Staff felt that an effective public health response was facilitated by strong in-country partnerships and BV's long-standing presence in communities.

CONTRIBUTION

The challenges in responding to the pandemic and in implementing and maintaining effective behaviour change are discussed. Although not an objective study of the effectiveness of the response or a comparison with other approaches, the lessons learned from this process are shared in the hope that they may inform responses to future shocks in low-income countries.

Effects of physical stress in alpine skiing on psychological, physiological, and biomechanical parameters: An individual approach

Alpine skiing is an attractive winter sport that often includes mental and physical demands. Since skiing is often done for several hours, fatigue processes occur that might lead to action errors associated with a higher risk of accidents and injuries. The aim of this study was to investigate the timing of changes in subjective, physiological, and biomechanical parameters during a physically demanding, standardized, non-competitive alpine skiing session. A group of 22 experienced male skiers carried out 10 runs, each lasting between 150 and 180 s, at a turn rate of 80 turns per minute with their best skiing technique. Immediately after the run, skiers reported ratings of fatigue, and other affective states. During skiing, breathing pattern and biomechanical data of the ski turns as radial force, turn duration, edge angle symmetry, and a composed motion quality score were recorded. Analyses of variances on skiers showing signs of fatigue (n =16) revealed that only the subjective data changed significantly over time: fatigue and worry increased, vitality and calm decreased. Subsequently, individual change points analyses were computed to localize abrupt distribution or statistical changes in time series data. For some skiers, abrupt changes at certain runs in physiological and/or biomechanical parameters were observed in addition to subjective data. The results show general effects in subjective data, and individual fatigue-related patterns concerning the onset of changes in subjective, physiological, and biomechanical parameters. Individuality of response to fatigue should be considered when studying indicators of fatigue data. Based on the general effects in subjective data, it is concluded that focusing on self-regulation and self-awareness may play a key role, as subjective variables have been shown generally sensitive to the physical stress in alpine skiing. In the future, customized algorithms that indicate the onset of fatigue could be developed to improve alpine skiers' self-awareness and self-regulation, potentially leading to fewer action errors.

A Study of Environmental Factors in Low Vision Rehabilitation

Healthcare has the past decades shifted from a narrow medical perspective to a more holistic, biopsychosocial perspective. Disability understood as a contextual condition constituted by the relation of the individual to their social and physical context. The disability model of the International Classification of Functions (ICF) contextualizes activity, participation, body functions and structure by including environmental and personal factors. However, illustrated by the consideration of the environmental factors as a neutral dimension, the dynamic interrelation of the individual parts of the system is rather unchartered. In 2017–2019, a lighting assessment was developed and tested on 60 participants in low vision rehabilitation. An action research project accompanied the pilot study from 2018. Ethnographic participatory observations of the low vision consultants in 15 consultations, semi-structured interviews, and a document analysis of the project material of the pilot project has been analyzed using the theoretical framework of science and technology studies. Mapping the physical environment showed a range of factors from spatial organization to luminaires and light bulbs. Moreover, in relation to specific activities, relevant factors were identified and assessed, and in the intervention adjusted to relevant personal and social factors. Identifying overlapping personal, environmental, and professional spheres illustrates the complexity of practicing rehabilitation in people's everyday lives. Acknowledging and coordinating different versions of lighting enabled low vision consultants to work across these spheres relationally. ICF was embedded in the practice of low vision consultants as a frame of reference, however, implementing this framework occurred through an assemblage of tools from different fields. The focus on lighting as an active element in low vision rehabilitation demonstrated a way to work across the personal and environmental to reduce the gap that caused disability. In everyday life, the physical environment was pivotal in the person–environment relationship and in enabling or disabling the individual. However, the physical environment was also key to the rehabilitation process, facilitating the individual's learning and change processes and reconfiguring their understanding and use of the environment. Consequently, the physical environment was not a neutral background to the other factors but rather enabling the rehabilitation and recovery processes.

Holistic Integration of Omics Tools for Precision Nutrition in Health and Disease

The combination of multiple omics approaches has emerged as an innovative holistic scope to provide a more comprehensive view of the molecular and physiological events underlying human diseases (including obesity, dyslipidemias, fatty liver, insulin resistance, and inflammation), as well as for elucidating unique and specific metabolic phenotypes. These omics technologies include genomics (polymorphisms and other structural genetic variants), epigenomics (DNA methylation, histone modifications, long non-coding RNA, telomere length), metagenomics (gut microbiota composition, enterotypes), transcriptomics (RNA expression patterns), proteomics (protein quantities), and metabolomics (metabolite profiles), as well as interactions with dietary/nutritional factors. Although more evidence is still necessary, it is expected that the incorporation of integrative omics could be useful not only for risk prediction and early diagnosis but also for guiding tailored dietary treatments and prognosis schemes. Some challenges include ethical and regulatory issues, the lack of robust and reproducible results due to methodological aspects, the high cost of omics methodologies, and high-dimensional data analyses and interpretation. In this review, we provide examples of system biology studies using multi-omics methodologies to unravel novel insights into the mechanisms and pathways connecting the genotype to clinically relevant traits and therapy outcomes for precision nutrition applications in health and disease.

A structured approach to effective mentoring of women health researchers in Africa

Objectives

To formatively evaluate the HIGHER Women consortium's Mentor Protégée Program (MPP) and derive lessons for successful African women scientist mentorship.

Design

Desk review of program documents and cross-sectional surveys of mentors and protégées.

Setting

All 10 regions of Cameroon.

Participants

Women working in health research participating in the MPP.

Interventions

Building health research skills and providing support for women to cope within the African psycho-social environment using a holistic approach.

Main outcome measures

Formed mentor-protégés duos applying the MPP with measurable accomplishments.

Results

The consortium counted 121 members with 103 protégées and 18 mentors. Of 103 protégées, 35 responded to the 2018 survey, while 77 responded to the 2022 survey. Mentioned benefits of the program included an increase in scientific peer-reviewed journal publications and presentations at national and international conferences. In the 2022 survey, a Pearson correlation showed an r of 0.41, which, although not statistically significant (p = .592), suggests a positive correlation between the increased number of peer-reviewed articles and increased number of years as HIGHER Women protégées.

Conclusions

Mentorship programs can help over time to bridge the gender gaps within Africa as well as the gaps between African-led research and the rest of the world while making a meaningful contribution to enhancing the quality, diversity, and productivity of researchers. A mentoring program such as the HIGHER Women MPP can be improved by leveraging local and international partners to foster the mentoring program's sustainability, scalability, and expanded reach.

Funding

World Health Organization's Special Programme for Research and Training in Tropical Diseases (WHO/TDR) and Canada's International Development Research Centre (IDRC Canada).

[Responsible and supportive teams of free nurses, an experiment promoting holistic patient care]

The Responsible and supportive teams of free nurses initiative is based on the Dutch Buurtzorg experience. It consists in allowing a patient-centered, holistic, team-based and coordinated nursing practice in the home, thanks in particular to a time-based pricing system that is different from the nomenclature of nursing acts currently in force.

Enhancing medical-imaging artificial intelligence through holistic use of time-tested key imaging and clinical parameters: Future insights

Much of the published literature in Radiology-related Artificial Intelligence (AI) focuses on single tasks, such as identifying the presence or absence or severity of specific lesions. Progress comparable to that achieved for general-purpose computer vision has been hampered by the unavailability of large and diverse radiology datasets containing different types of lesions with possibly multiple kinds of abnormalities in the same image. Also, since a diagnosis is rarely achieved through an image alone, radiology AI must be able to employ diverse strategies that consider all available evidence, not just imaging information. Using key imaging and clinical signs will help improve their accuracy and utility tremendously. Employing strategies that consider all available evidence will be a formidable task; we believe that the combination of human and computer intelligence will be superior to either one alone. Further, unless an AI application is explainable, radiologists will not trust it to be either reliable or bias-free; we discuss some approaches aimed at providing better explanations, as well as regulatory concerns regarding explainability (“transparency”). Finally, we look at federated learning, which allows pooling data from multiple locales while maintaining data privacy to create more generalizable and reliable models, and quantum computing, still prototypical but potentially revolutionary in its computing impact.

A Holistic Approach to Physical and Mental Health: Associations Between Chronic Disease and Psychiatric Conditions

Prior studies suggest that patients with chronic conditions are more likely to develop psychiatric disorders compared to healthy individuals without any medical conditions. The objective of this study was to investigate the link between chronic conditions and psychiatric disorders. The authors hypothesize that patients with chronic conditions have a higher comorbidity of certain psychiatric disorders compared to healthy individuals. Patients from Rowan University School of Osteopathic Medicine (Rowan SOM) Family Medicine offices completed an anonymous survey about medical and psychiatric diagnoses (Appendix 1). Multivariate analysis was used to examine the relationships between patients' rank of control of their chronic medical and psychiatric conditions compared to the age of onset and total number of conditions. One-hundred thirteen study participants reported having at least one chronic condition and seventy-four reported having at least one psychiatric disorder listed on the survey. Among the participants comorbid with both medical and psychiatric conditions, patients' ranking of control of their chronic conditions positively correlated with their ranking of control of their psychiatric disorders (p = 0.009). Patients' ranking of control of their chronic conditions negatively correlated with the total number of psychiatric disorders (p = 0.002). The study did not generate significant evidence to support the original hypothesis. The results highlight a strong relationship between patients' perceived control of their physical health and mental health. The comorbidity of both chronic conditions and psychiatric disorders may present challenges for patients. Utilizing a holistic approach to patient care can help clinicians improve patient outcomes.

Social workers' perspectives on barriers and facilitators in responding to intimate partner violence in primary health care in Spain

OBJECTIVE

To identify the barriers and facilitators of managing intimate partner violence (IPV) cases, from the perspective of primary health care (PHC) social workers.

METHOD

Qualitative study through interviews with 14 social workers working in PHC centres in Spain. A thematic analysis approach was applied to identify barriers and facilitators according to the Tanahashi model.

RESULTS

The barriers identified by social workers in providing effective coverage to women suffering from IPV included insufficient practical training, a lack of knowledge from women on social workers' roles, a lack of teamwork, and excess IPV case referrals from other professionals to social workers. The identified facilitators were the existence of electronic protocols and good practices including therapeutic support groups and holistic intervention approaches.

CONCLUSIONS

An excess of referrals to social workers of identified IPV cases following consultation by other members of the PHC team, alongside the lack of interdisciplinary teamwork, does not enable a comprehensive and holistic approach to this problem. Compulsory, practical, and interdisciplinary training in IPV for all PHC professionals and students must be a priority for health agencies and universities in order to facilitate a comprehensive and quality approach for all women suffering from IPV.

Varroa destructor from the Laboratory to the Field: Control, Biocontrol and IPM Perspectives-A Review

Varroa destructor is a real challenger for beekeepers and scientists: fragile out of the hive, tenacious inside a bee colony. From all the research done on the topic, we have learned that a better understanding of this organism in its relationship with the bee but also for itself is necessary. Its biology relies mostly on semiochemicals for reproduction, nutrition, or orientation. Many treatments have been developed over the years based on hard or soft acaricides or even on biocontrol techniques. To date, no real sustainable solution exists to reduce the pressure of the mite without creating resistances or harming honeybees. Consequently, the development of alternative disruptive tools against the parasitic life cycle remains open. It requires the combination of both laboratory and field results through a holistic approach based on health biomarkers. Here, we advocate for a more integrative vision of V. destructor research, where in vitro and field studies are more systematically compared and compiled. Therefore, after a brief state-of-the-art about the mite's life cycle, we discuss what has been done and what can be done from the laboratory to the field against V. destructor through an integrative approach.

A Microbiome-Driven Approach to Combating Depression During the COVID-19 Pandemic

The significant stressors brought about and exacerbated by COVID-19 are associated with startling surges in mental health illnesses, specifically those related to depressive disorders. Given the huge impact of depression on society, and an incomplete understanding of impactful therapeutics, we have examined the current literature surrounding the microbiome and gut-brain axis to advance a potential complementary approach to address depression and depressive disorders that have increased during the COVID-19 pandemic. While we understand that the impact of the human gut microbiome on emotional health is a newly emerging field and more research needs to be conducted, the current evidence is extremely promising and suggests at least part of the answer to understanding depression in more depth may lie within the microbiome. As a result of these findings, we propose that a microbiome-based holistic approach, which involves carefully annotating the microbiome and potential modification through diet, probiotics, and lifestyle changes, may address depression. This paper's primary purpose is to shed light on the link between the gut microbiome and depression, including the gut-brain axis and propose a holistic approach to microbiome modification, with the ultimate goal of assisting individuals to manage their battle with depression through diet, probiotics, and lifestyle changes, in addition to offering a semblance of hope during these challenging times.

Horse owners' attitudes towards and motivators for using complementary and alternative veterinary medicine

BACKGROUND

Complementary and alternative veterinary medicine (CAVM) is becoming increasingly popular in horses.

METHODS

Online, cross-sectional survey in 1532 horse owners. Attitude towards CAVM, subjective norms, perceived behavioural control and intention for future CAVM use were measured based on the theory of planned behaviour. Structural equation modelling was performed to characterize factors influencing intention to use CAVM.

RESULTS

Past use of CAVM, predominantly manual therapies and herbal supplements, was reported by 72.5% of all participants. Frequently reported indications were improving horse's well-being, illness which did not resolve after conventional treatment and chronic illness. The attitude towards CAVM was positive with a median (interquartile range) score of 6 of 7 (4.75-7.00). Predictors for past CAVM use were higher owner age, alternative medicine self-use and higher education (non-university). The strongest predictor of future CAVM usage was perceived behavioural control and perceived CAVM efficacy, as well as positive attitude towards and perceived knowledge about CAVM. The veterinarian was reported as a source of information about CAVM by 86.4% of all participants.

CONCLUSIONS

Horse owners showed a high intention to use CAVM with the owners' perceived behavioural control and perceived CAVM efficacy as the strongest predictor. Veterinarian-client communication is important to inform horse owners correctly.

Pudendal Neuralgia: The Need for a Holistic Approach-Lessons From a Case Report

Pudendal neuralgia is a form of chronic pelvic pain, although the validity of this diagnosis has not been firmly established. It is characterized by unilateral pain in the pudendal nerve dermatome, mostly while sitting. In this case report, a 76-year-old female patient presented to her general practitioner with a 10-year history of unilateral buttock pain, which had been diagnosed as pudendal neuralgia. She tried various treatments and visited numerous specialists, but there was little improvement overall. Some medications seemed to have a positive effect, but pain ultimately persisted until psychological factors were appropriately addressed. Management of pudendal neuralgia follows general chronic neuralgia principles, from medication over nerve block to definitive surgery. However, this case serves as a prime example of how the psychosocial approach is equally important. Given that psychological factors can make pain persist, it is imperative to properly address them. As pudendal neuralgia is uncommonly encountered in primary care, specific attention must be paid to psychological factors, which become significantly more important in long-standing chronic pelvic pain.

Holistic Approach in the Management of Skeletal Deformity in a Case of Homocystinuria

INTRODUCTION

Homocystinuria has a wide range of clinical presentations ranging from near normal intelligence and appearance with just lens dislocation and minimal skeletal deformities to severe mental retardation with gross skeletal deformities. In this background, we describe one such case with skeletal deformity managed comprehensively.

CASE REPORT

A 17-year-old boy presented with complaints of deformity of the left lower limb since childhood more evident for the past 5 years along with a history of blurring of vision. On examination the pubis-heal length > crown-pubis length along with genu valgum of left lower-limb with 16 cm intermalleolar distance. He also had a superolateral subluxation of the lens in both eyes. Valgus angle was 16° on the left leg compared to 6° on the right. The diagnosis of homocystinuria was confirmed by biochemical investigations. The left side genu valgum was addressed with medial closing wedge osteotomy and fixed with distal femur locking compression plating. Lens subluxation was treated with posterior chamber intra-ocular lens surgery. He was also given medical treatment and on regular monitoring of his homocysteine levels. The patient had good functional outcome at 2-year follow-up.

CONCLUSION

Homocystinuria is a rare disease that needs early identification and effective management to avoid complications. Skeletal complications are common and include genu valgum, pes cavus, chest wall deformities, and skeletal deformities such as kyphosis and scoliosis. Skeletal deformities can be avoided when identified early and associated osteoporosis which is managed effectively. A holistic approach is needed in the management of such patients with inter-departmental coordination to bring quality to the life of patients with homocystinuria.

Alternative Medicines on the Farm: A Study of Dairy Farmers' Experiences in France

Despite being of debatable efficacy, alternative medicines are in regular use on both organic and conventional dairy farms as part of a strategy for limiting the on-farm use of antibiotics. The study presented here examined French dairy farmers' understanding of and experiences with these medicines, focusing on homeopathy, aromatherapy and phytotherapy. Adopting an interdisciplinary approach combining animal science and sociology, we considered how dairy farmers' use of alternative medicines fits into a holistic approach to herd health management, on the one hand, and into farmers' networks of professional relationships, on the other. Our findings show that farmers are interested in alternative medicines for reasons that are at once technical, ethical, and economic. In the absence of local veterinarians specializing in homeopathy and aromatherapy, farmers enroll in short-term training courses to learn how to use these medicines. Alternative medicines are not a substitute for conventional medicine for these farmers; rather, they constitute one part of a holistic approach to herd health that combines preventive measures with a variety of curative treatments, and which is grounded in close attention to the animals' state of health. Farmers make use of guidelines for observing livestock that are central to the veterinary alternative medicine approach. Interestingly, women farmers appear to play an important role in introducing these practices into the management of the farm operation. Finally, farmers' interest in alternative medicines is indicative of their broader expectations for advice and support in moving toward the integrated management of livestock health, a key element of the agroecological transition. Recognizing these expectations offers useful insights for rethinking the role of veterinarians in dairy farming.

Unlocking the Mystery of the Therapeutic Effects of Chinese Medicine on Cancer

Over the past decade, the rise of cancer immunotherapy has coincided with a remarkable breakthrough in cancer therapy, which attracted increased interests in public. The scientific community clearly showed that the emergence of immunotherapy is an inevitable outcome of a holistic approach for cancer treatment. It is well established that traditional Chinese medicine (TCM) utilizes the principle of homeostasis and balance to adjust the healthy status of body. TCM treatment toward cancer has a long history, and the diagnosis and treatment of tumors were discussed in the ancient and classical literatures of Chinese medicine, such as the Yellow Emperor’s Inner Canon. Precious heritage has laid the foundation for the innovation and development of cancer treatment with TCM. The modern study indicated that TCM facilitates the treatment of cancer and enhances the survival rate and life expectancy of patients. However, the pharmacological mechanisms underlying these effects are not yet completely understood. In addition, physicians cannot always explain why the TCM treatment is effective and the mechanism of action cannot be explained in scientific terms. Here, we attempted to provide insights into the development of TCM in the treatment and interpret how TCM practitioners treat cancer through six general principles of TCM by using modern scientific language and terms based on newly discovered evidence.

Where Did All the Sport Go? Negative Impact of COVID-19 Lockdown on Life-Spheres and Mental Health of Spanish Young Athletes

During the 2020, the pandemic caused by the massive spread of the SARS-CoV-2 coronavirus (COVID-19) resulted in a global crisis. In Spain, the COVID-19 pandemic caused a lockdown for almost 100 days and forced the sudden stop of sport practices and competitions. This interruption had a negative impact on high-level athletes’ mental health. However, its impact on young athletes, who are intrinsically developing a high-demanding dual career, remains unclear. Therefore, this study aimed at (1) describing and characterizing the general impact that COVID-19 lockdown had on Spanish young athletes’ life-spheres and mental health, and (2) identifying different profiles of athletes regarding life-conditions and sport-related variables. A sample of 544 young athletes (M = 15.9; SD = 1.51) participated in this study. Measures included life-conditions and sport-related information along with the Holistic Monitoring Questionnaire (HMQ) and the General Health Questionnaire (GHQ-12). After the screening and description of the data, profiles were defined using a two-level cluster analysis using HMQ and GHQ-12 subscales. We explored differences in demographic and sports information between profiles using MANOVA and subsequent ANOVA. Results suggest a general negative impact of COVID-19 on young athletes’ life-spheres and mental health, but with three different clusters regarding the degree of such impact. Cluster 1 grouped the 54.78% of the sample and exhibited a low negative impact of COVID-19 lockdown on life-spheres and few mental health issues. Cluster 2 grouped a 29.96% of the participants who reported a medium negative impact on life-spheres and moderate mental health issues. Cluster 3 represented 15.26% of the sample including participants who showed a high negative impact of the COVID-19 lockdown with high mental health issues. The paradigmatic participant in this third group would be a female student-athlete from a medium or low socioeconomic status with high academic demands and poor or inexistent training conditions during lockdown. Current findings emphasize the need to pay attention to young athletes’ mental health and suggest possible influencing contextual variables. We suggest some applied recommendations aimed at helping clubs and sports institutions to mitigate the negative effects of such difficult circumstances on athletes’ mental health.

A Focus on Two Electrokinetics Issues

This review article intends to communicate the new understanding and viewpoints on two fundamental electrokinetics topics that have only become available recently. The first is on the holistic approach to the Poisson–Boltzmann equation that can account for the effects arising from the interaction between the mobile ions in the Debye layer and the surface charge. The second is on the physical picture of the inner electro-hydrodynamic flow field of an electrophoretic particle and its drag coefficient. For the first issue, the traditional Poisson–Boltzmann equation focuses only on the mobile ions in the Debye layer; effects such as charge regulation and the isoelectronic point arising from the interaction between the mobile ions in the Debye layer and the surface charge are left to supplemental measures. However, a holistic treatment is entirely possible in which the whole electrical double layer—the Debye layer and the surface charge—is treated consistently from the beginning. While the derived form of the Poisson–Boltzmann equation remains unchanged, the zeta potential boundary condition becomes a calculated quantity that can reflect the various effects due to the interaction between the surface charges and the mobile ions in the liquid. The second issue, regarding the drag coefficient of a spherical electrophoretic particle, has existed ever since the breakthrough by Smoluchowski a century ago that linked the zeta potential of the particle to its mobility. Due to the highly nonlinear mathematics involved in the electro-hydrodynamics inside the Debye layer, there has been a lack of an exact solution for the electrophoretic flow field. Recent numerical simulation results show that the flow field comprises an inner region and an outer region, separated by a rather sharp interface. As the inner flow field is carried along by the particle, the measured drag is that at the inner/outer interface rather than at the solid/liquid interface. This identification and its associated physical picture of the inner flow field resolves a long-standing puzzle regarding the electrophoretic drag coefficient.

Occupational therapists' competencies utilised in Danish job centres

BACKGROUND

Twenty-nine out of 94 Danish job centres employ occupational therapists (OTs) and numbers are increasing. Occupational therapy (OT) vocational rehabilitations are diverse, and a more specific description of OT practice within this field is lacking.

AIMS

To explore how OTs employed at Danish job centres describe their own competencies and what they perceive that their colleagues from other professions request from them.

MATERIAL AND METHODS

Firstly, working diaries were obtained from 16 OTs working in job centres and analysed using content analysis. Secondly, semi-structured interviews were performed and analysed using systematic text condensation.

RESULTS

The 16 OTs described four areas of competencies to their profession's practice within job centres; client-centeredness; a holistic approach; work ability assessments and ergonomics and adaptation. The OTs perceived that their colleagues requested their work ability assessment skills and their competencies as health professionals.

CONCLUSION

The OTs had a client-centered and holistic focus on the citizens' whole life situation and used their health professional education and knowledge of ergonomics and adaptation to strengthen their work ability assessments.

SIGNIFICANCE

The OTs perceived that they had competencies that supplemented the competencies of the interdisciplinary team. The results therefore support the inclusion of OTs within job centres.

Holistic Approach in Patients With Presumed Lyme Borreliosis Leads to Less Than 10% of Confirmation and More Than 80% of Antibiotic Failures

BACKGROUND

There is no precise idea whether patients with chronic symptoms attributed to Lyme borreliosis (LB) have LB or another disease.

METHODS

We evaluated patients consulting for a presumed LB with a holistic approach including presumptive treatment. We included symptomatic patients consulting for presumed LB. They were classified as confirmed LB when they met four criteria, and possible LB if three with a positive clinical response to presumptive treatment.

RESULTS

Amongst the 301 patients, 275 (91%) were exposed to tick bites, and 165 (54%) were bitten by a tick. At presentation, 151 patients (50.1%) had already been treated with a median of one (1-22) course of antimicrobials, during 34 (28-730) days. Median number of symptoms was three (1-12) with a median duration of 16 (1-68) months. Median number of signs was zero (0-2). ELISA was positive in 84/295 (28.4%) for IgM and 86/295 (29.1%) for IgG, and immunoblot was positive in 21/191 (10.9%) for IgM and 50/191 (26.1 %) for IgG. Presumptive treatment after presentation failed in 46/88 patients (52%). Diagnosis of LB was confirmed in 29 patients (9.6%), and possible in 9 (2.9%). Of the 243 patients with non-LB diagnosis, diseases were psychological, musculoskeletal, neurological or other origin in 76 (31.2%), 48 (19.7%), 37 (15.2%) and 82 (33.7%) patients respectively. Patients with other diseases were significantly younger, having more symptoms, longest duration of symptoms, less clinical signs and less frequent LB positive serologies.

CONCLUSIONS

Overdiagnosis and overtreatment of LB is worsening. Health authorities should investigate this phenomenon.

Sex Differences in Swimming Disciplines-Can Women Outperform Men in Swimming?

In recent years, the interest of female dominance in long-distance swimming has grown where several newspaper articles have been published speculating about female performance and dominance—especially in open-water ultra-distance swimming. The aim of this narrative review is to review the scientific literature regarding the difference between the sexes for all swimming strokes (i.e., butterfly, backstroke, breaststroke, freestyle and individual medley), different distances (i.e., from sprint to ultra-distances), extreme conditions (i.e., cold water), different ages and swimming integrated in multi-sports disciplines, such as triathlon, in various age groups and over calendar years. The influence of various physiological, psychological, anthropometrical and biomechanical aspects to potentially explain the female dominance was also discussed. The data bases Scopus and PUBMED were searched by April 2020 for the terms ’sex–difference–swimming’. Long-distance open-water swimmers and pool swimmers of different ages and performance levels were mainly investigated. In open-water long-distance swimming events of the ’Triple Crown of Open Water Swimming’ with the ’Catalina Channel Swim’, the ’English Channel Swim’ and the ’Manhattan Island Marathon Swim’, women were about 0.06 km/h faster than men. In master swimmers (i.e., age groups 25–29 to 90–94 years) competing in the FINA (Fédération Internationale de Natation) World Championships in pool swimming in freestyle, backstroke, butterfly, breaststroke, individual medley and in 3000-m open-water swimming, women master swimmers appeared able to achieve similar performances as men in the oldest age groups (i.e., older than 75–80 years). In boys and girls aged 5–18 years—and listed in the all-time top 100 U.S. freestyle swimming performances from 50 m to 1500 m—the five fastest girls were faster than the five fastest boys until the age of ~10 years. After the age of 10 years, and until the age of 17 years, however, boys were increasingly faster than girls. Therefore, women tended to decrease the existing sex differences in specific age groups (i.e., younger than 10 years and older than 75–80 years) and swimming strokes in pool-swimming or even to overperform men in long-distance open-water swimming (distance of ~30 km), especially under extreme weather conditions (water colder than ~20 °C). Two main variables may explain why women can swim faster than men in open-water swimming events: (i) the long distance of around 30 km, (ii) and water colder than ~20 °C. Future studies may investigate more detailed (e.g., anthropometry) the very young (<10 years) and very old (>75–80 years) age groups in swimming

Losing Legs to Losing Everything: How Neglecting Holistic Health Devastated a Lower-limb Amputee

Holistic care means addressing the patient as a person; providing high-quality care by focusing on individual needs. Our goal is to implement a survey that quantifies the patients’ physical, mental, and spiritual health to enable improvements in client-centered therapy in lower-limb amputees. For this, we worked with a 43-year-old Hispanic male with a medical history of insulin-dependent diabetes complicated by sequential lower limb amputations. The second amputation cost him his job and left him homeless. The patient was hospitalized after developing severe depression, to the point that he had command auditory hallucinations to kill himself. He was discharged back into the community after a three-week hospitalization. However, he was readmitted to the hospital a week later due to a resurgence of suicidal ideation. Our team engaged the patient using the “Holistic Health and Wellness Survey” of Raymond W. Smith, which we used to assess and address various domains of his mental, spiritual, and physical health. We were able to create obtainable goals for the patient for each category on which he scored low in the health and wellness survey. The patient’s overall health and attitude improved substantially through his client-centered therapy, which addressed his quantified health needs; and he began to take an active role in developing short- and long-term goals that he found attainable as he adjusted to life as a double-amputee.

This case illustrates the potential for improving client-centered therapy in lower-limb amputees. We believe that providers may benefit from implementing this health and wellness survey to better assess how to provide client-centered care for their patients.

On the complementarity of holistic and analytic approaches to performance assessment scoring

BACKGROUND

A holistic approach to performance assessment recognizes the theoretical complexity of multifaceted critical thinking (CT), a key objective of higher education. However, issues related to reliability, interpretation, and use arise with this approach.

AIMS AND METHOD

Therefore, we take an analytic approach to scoring students' written responses on a performance assessment. We focus on the complementarity of holistic and analytic approaches and on whether theoretically developed analytical scoring rubrics can produce sub-scores that may measure the 'whole' performance in a holistic assessment.

SAMPLE

We use data from the Wind Turbines performance assessment, developed in the iPAL project this study where 55 students at a German university participated.

RESULTS

The (sub)scores generated from the scoring scheme empirically reproduced the theoretically assumed structure of CT, with valid and reliable scores in a three-dimensional model. The proposed interpretation of CT as assessed with a performance assessment and measured by the rating scheme was supported preliminarily.

CONCLUSION

Our results support the complementarity of holistic and analytic approaches to assessing CT. When combined, they provide interpretable scores for a complex, multifaceted construct useful in diagnostic contexts.

Caring science research in the ambulance services: an integrative systematic review

BACKGROUND

The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings.

AIM

This integrative systematic review aims to describe caring science research content and scope in the ambulance services.

DATA SOURCES

Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156.

REVIEW METHODS

The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five-stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3-level scale, and data relevance was evaluated on a 2-level scale.

RESULTS

After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision-making; Public environment and patient safety; Life-changing situations; and Ethics and values.

CONCLUSION

Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional-patient relation, with special focus on value conflicts in emergency situations.

Healthy Indoor Environments: The Need for a Holistic Approach

Indoor environments have a large impact on health and well-being, so it is important to understand what makes them healthy and sustainable. There is substantial knowledge on individual factors and their effects, though understanding how factors interact and what role occupants play in these interactions (both causative and receptive) is lacking. We aimed to: (i) explore interactions between factors and potential risks if these are not considered from holistic perspective; and (ii) identify components needed to advance research on indoor environments. The paper is based on collaboration between researchers from disciplines covering technical, behavioural, and medical perspectives. Outcomes were identified through literature reviews, discussions and workshops with invited experts and representatives from various stakeholder groups. Four themes emerged and were discussed with an emphasis on occupant health: (a) the bio-psycho-social aspects of health; (b) interaction between occupants, buildings and indoor environment; (c) climate change and its impact on indoor environment quality, thermal comfort and health; and (d) energy efficiency measures and indoor environment. To advance the relevant research, the indoor environment must be considered a dynamic and complex system with multiple interactions. This calls for a transdisciplinary and holistic approach and effective collaboration with various stakeholders.