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PubMed2004

Clinical holistic medicine: holistic adolescent medicine.

The holistic medical approach seems to be efficient and can also be used in adolescent medicine. Supporting the teenager to grow and develop is extremely important in order to prevent many of the problems they can carry into adulthood. The simple consciousness-based, holistic medicine--giving love, winning trust, giving holding, and getting permission to help the patient feel, understand, and let go of negative beliefs--is easy for the physician interested in this kind of practice and it requires little previous training for the physician to be able to care for his/her patient. A deeper insight into the principles of holistic treatment and a thorough understanding of our fellow human beings are making it work even better. Holistic medicine is not a miracle cure, but rather a means by which the empathic physician can support the patient in improving his/her future life in respect to quality of life, health, and functional capacity--through coaching the patient to work on him/herself in a hard and disciplined manner. When the patient is young, this work is so much easier. During our lifetime, we have several emotional traumas arranged in the subconscious mind with the smallest at the top, and it is normal for the person to work on a large number of traumatic events that have been processed to varying degrees. Some traumas have been acknowledged, some are still being explored by the person, and yet others are still preconscious, which can be seen for example in the form of muscle tension. Sometimes the young dysfunctional patient carries severe traumas of a violent or sexual nature, but the physician skilled in the holistic medical toolbox can help the patient on his/her way to an excellent quality of life, full self-expression, a love and sex life, and a realization of his/her talents--all that a young patient is typically dreaming about. Biomedicine is not necessary or even recommended when the physical or mental symptoms are caused by disturbances in the personal development that can be corrected with love and understanding. If possible, biomedicine must be avoided, even if this means suffering for the young person, who needs to confront the tough realities of life in order to grow into an able and sound adult.

Adolescent↗
PubMed2005

Retinal vessel diameters and risk of hypertension: the Rotterdam Study.

Generalized retinal arteriolar narrowing is an important sign of systemic hypertension, and a lower arteriolar:venular diameter ratio predicts the risk of hypertension. We investigated whether this association was based on arteriolar or venular diameters or both. This study was based on the prospective population-based Rotterdam Study (1990-1993) and included 1900 participants (> or =55 years of age) of whom 739 persons had normal blood pressure (systolic <120 mm Hg and diastolic <80 mm Hg) and 1161 prehypertension (systolic 120 to 139 mm Hg or diastolic 80 to 89 mm Hg). For each participant, retinal arteriolar and venular diameters were measured on digitized images of 1 eye. After a mean follow-up of 6.6 years, 808 persons developed hypertension, defined as either systolic blood pressure > or =140 mm Hg or diastolic blood pressure > or =90 mm Hg or use of antihypertensive medication. Adjusted for age, gender, follow-up time, body mass index, smoking, diabetes mellitus, total and high-density lipoprotein cholesterol, C-reactive protein, and intima-media thickness, arteriolar narrowing was associated with an increased risk of hypertension (odds ratio per SD: 1.38; 95% CI, 1.23 to 1.55); for venular narrowing this was less striking (OR: 1.17; 95% CI, 1.04 to 1.32). Each SD decrease in the arteriolar:venular diameter ratio significantly increased the risk of hypertension by 24%. To examine the effect of baseline blood pressure, we stratified persons into those with "normal blood pressure" or "prehypertension." Within these strata, arteriolar narrowing was still related to incident hypertension. These data show that both retinal arteriolar and venular narrowing may precede the development of systemic hypertension.

Aged↗
PubMed2004

Health promotion through self-care and community participation: elements of a proposed programme in the developing countries.

BACKGROUND: The concepts of health promotion, self-care and community participation emerged during 1970s, primarily out of concerns about the limitation of professional health system. Since then there have been rapid growth in these areas in the developed world, and there is evidence of effectiveness of such interventions. These areas are still in infancy in the developing countries. There is a window of opportunity for promoting self care and community participation for health promotion. DISCUSSION: A broad outline is proposed for designing a health promotion programme in developing countries, following key strategies of the Ottawa Charter for health promotion and principles of self care and community participation. Supportive policies may be framed. Self care clearinghouses may be set up at provincial level to co-ordinate the programme activities in consultation with district and national teams. Self care may be promoted in the schools and workplaces. For developing personal skills of individuals, self care information, generated through a participatory process, may be disseminated using a wide range of print and audio-visual tools and information technology based tools. One such potential tool may be a personally held self care manual and health record, to be designed jointly by the community and professionals. Its first part may contain basic self care information and the second part may contain outlines of different personally-held health records to be used to record important health and disease related events of an individual. Periodic monitoring and evaluation of the programme may be done. Studies from different parts of the world indicate the effectiveness and cost-effectiveness of self care interventions. The proposed outline has potential for health promotion and cost reduction of health services in the developing countries, and may be adapted in different situations. SUMMARY: Self care, community participation and health promotion are emerging but dominant areas in the developed countries. Elements of a programme for health promotion in the developing countries following key principles of self care and community participation are proposed. Demonstration programmes may be initiated to assess the feasibility and effectiveness of this programme before large scale implementation.

Community Health Workers↗
PubMed1991

Changes in human figure drawings during intensive treatment.

This article examines change in the human figure drawings (HFDs) of 32 seriously disturbed young adults during the course of intensive inpatient treatment. HFDs drawn at the time of admission were compared with HFDs obtained more than 1 year after intensive treatment began; both sets were scored on the Goodenough-Harris Scale (GH) and the Robins Balance-Tilt Scale (RBT). The findings indicate that the HFDs significantly improved over the course of treatment, but only for those patients judged introjective, not anaclitic. These findings are consistent with prior research on the same population that were based on analyses of clinical case records and Rorschach protocols (Blatt, Ford, Berman, Cook, & Meyer, 1988). Significant change in the HFDs over the course of treatment suggests that the HFDs provide a unique and independent dimension for assessing therapeutic change.

Adolescent↗
PubMed1985

On the place of siblings in psychoanalysis.

In summary, this paper is a beginning attempt to close a gap that has existed in the psychoanalytic literature. Scant attention has been paid to the significance of sibling relationships, which have largely been relegated to an ancillary position as the cause of rivalry and envy. It is the contention of this paper that sibling relationships are of far greater significance to ego development, to structural and defensive considerations, and to self and object representations. Further, efforts have been made to delineate some of the ways in which sibling relationships can foster or abet the emergence of pathology in patients. Through the presentation of case studies, it has been shown that siblings are significant objects of internalization and that sibling contacts deserve attention in the analysis of personality development, psychodynamics and in the psychoanalytic treatment process.

Adult↗
PubMed1990

Coping with PKU: results of narrative interviews with parents.

Eleven parents of 8-year-olds suffering from PKU were interviewed about their experiences with the disease. The narrative interview method was selected in order to expose the problems from the parents' angle without influence through expert prompting. On being notified of the diagnosis after birth, the parents were extremely shocked and went through emotional crises and adjustment problems during the first 12 months. The narcissistic hurt of not having a healthy child was compounded by problems with dietary technique. The behaviour and development of the children themselves were no particular problem. Handling the diet ranked highest among the problems raised by the parents. It turned out that all the parents did not always apply the diet strictly and deviated from it. The underlying reason was a compromise between an ideal attitude towards the diet with the accompanying experience of loss and guilt, and the goal of undisturbed personality development of the child. Discussion groups with therapeutic support are suggested as a way of relieving the burden on the parents.

Adaptation, Psychological↗
PubMedDate not supplied

Supervision and boundaries in a combined family practice and psychiatry residency training program: the National Capital Consortium experience.

OBJECTIVES: The combined discipline of family practice and psychiatry was created in 1995. There are no established guidelines for 1) teaching residents how to integrate these two specialties, 2) providing appropriate supervision, and 3) helping residents develop personal and professional boundaries. The authors share their approach and aim to stimulate dialogue and promote the establishment of standards for combined programs. METHOD: The authors review some of the difficulties encountered in supervising family practice-psychiatry residents and the rationale for their approach. RESULTS: Providing residents with clear boundaries of practice and supervision that initially separate the two specialties during training facilitates the development of specialty knowledge and skills as well as the capacity to form clear boundaries. CONCLUSION: Our experience suggests that only when residents learn the appropriate practice and boundaries of each specialty can they successfully integrate the two without boundary or role confusion.

Education↗
PubMed1977

[Psychiatric aspects of low back pain (author's transl)].

Chronic low back pain is more significant from the psychiatric point of view than the acute pain. As a persistent pain of organic origin it leads to typical psychopathological symptoms ("algogenic psychosyndrome"). The algogenic psychosyndrome must be differentiated diagnostically from neurotic developments and masked depressions. Psychosomatic low back pain is a warning of failure in the accomplishment of professional or family duties and chronic and chronic inhibited aggression. - An interdisciplinary study of the courses of 50 patients operated on for prolapse of the lumbar intervertebral disk showed that the psychopathological picture and the pain syndrome are usually determined by several factors. The majority of neurotic disordered personalities developed symptoms of new syndromes after the operation.

Adult↗
PubMed2005

Denying and preserving self: Batswana women's experiences of infertility.

This qualitative study was conducted to understand and theoretically explain infertility from the perspective of 40 infertile women and four members of the traditional health care system. Symbolic interaction and feminism were combined to under-gird the study. Through ongoing data collection and analysis, a theoretical framework of denying and preserving self was constructed. Preserving self or self-preservation means developing personal measures aimed at preventing o rreducing harm inflicted by others as a result of one's infertility. Contributory factors to denying of self include denial of status as a woman; denial of immortality; denial of experiences of pregnancy, labour and delivery; denial of economic and social security; and the belief that they are being chastised by God and the forefathers. In addition, the women develop strategies to deal with such denials by looking for deeper meaning, working it out, giving in to feelings, getting more involved, getting away, and doin gadoption. Implications of the study are discussed.

Adaptation, Psychological↗
PubMed2006

Innovative training for new surgical roles--the place of evaluation.

BACKGROUND: This paper describes the central role of 'external' evaluation, provided by an independent researcher, in developing an innovative curriculum for new professional roles with surgery. Workforce changes affecting the National Health Service provided an opportunity to develop 2 new roles and design training programmes to support them. The perioperative specialist practitioner (PSP) role was designed from scratch, while surgical care practitioner (SCP) training built on existing practice. Training programmes combined formal modules at Imperial College London (approximately 48 days over 10 months) with supervised clinical practice in each participant's base hospital. Programmes balanced factual knowledge, clinical and communication skills, professional issues and personal development and used a range of innovative techniques. EVALUATION METHODS: A qualitative approach based on a utilisation-focused model monitored the development and implementation of 4 pilot PSP and SCP training programmes. A total of 124 individual and 48 group interviews were conducted at intervals over 3 years, sampling course participants, the project team clinical supervisors and administrators. An independent researcher collected, analysed and presented data at key stages, feeding back findings to the project team as the programmes evolved. DISCUSSION: Effective training programmes for new roles can be developed, but the process is time-consuming and requires sensitivity. An independent evaluator offers great benefits, modulating the collaborative partnership between participants and project team. Positive responses (relating to content and teaching methods) from our study enabled us to refine a learner-centred programme. Negative responses often demanded immediate action to address important concerns, and evaluation provided early warning. External evaluation provides a vital perspective in the development of curricula supporting new roles.

Curriculum↗
PubMed1988

Dimensions of personality organization as predictors of teenage pregnancy risk.

Personality development as measured by Loevinger's Washington University Sentence Completion Test, The Friedman Developmental Level Scoring System for the Rorschach, The Urist Mutuality of Autonomy Scale, The Thematic Apperception Test, and indexes from a structured interview were able to discriminate between teenagers at high- and low-risk for pregnancy. In addition, these measures correlated significantly with each other and enabled a description and comparison of the personality characteristics of adolescents who are at risk for pregnancy and those who are not.

Adolescent↗
PubMed2006

Long-term effects of traumatic experience: Comparison study in the adolescent IDPs in Serbia.

The purpose of this study is to examine the long term psychological effects of war stress regarded as traumatic experience. The subjects are Serbian internally displaced people (IDP) of adolescent population from Kosovo. It is a very big concern whether the adolescents would overcome the social and psychological difficulties caused by the war stress in order to reconstruct the better society. The result came out that the long-term effects still exist in PTSD, depression and hopelessness, which affects self-esteem and the attitude in purpose in life that are important factors for personality development. This paper also examines the difference between IDPs with war stress and the adolescent sufferers of the big earthquake in Japan.

Adaptation, Psychological↗
PubMed1999

[Investigation of personal niche as basis of supportive psychotherapy].

According to the ecological theory of Willi 1996, people create and maintain their psychic wellbeing through constant shaping of their environment, i.e. setting up a personal niche. The personal niche in turn responds to, guides and challenges further personal development. This study explores what kind of solutions single patients with psychiatric invalidity can find in order to form their environment as a niche in which they may develop effectiveness and use it for their psychic regulation. 30 people were questioned with a semi-structured interview: they were patients of a psychiatric out-patient's clinic, living alone and psychiatrically invalidated (2/3 with schizophrenia of the residual type). The results were ranked after their increasing demands in a relational and in an activity inventory. The more relationship is based on mutuality expectations of others, personal disclosure and binding the more the subjects feel overstrained. The investigation of these inventories serve as a technical aid in supportive psychotherapy.

Adaptation, Psychological↗
PubMedDate not supplied

A pioneering experience in Brazil: the creation of a center for assistance and research for medical residents (NAPREME) at the Escola Paulista de Medicina, Federal University of São Paulo.

The decision to develop a treatment service for medical residents at Escola Paulista de Medicina was influenced by three main factors: the suicide of four young doctors (2 residents) at this institution between 1995 and 1996, a research study that investigated stress among medical residents and the experience of other countries in response to similar problems. NAPREME has the following objectives: to help to reduce stress among residents, stimulate professional and personal development, prevent professional dysfunction and emotional disorders, offer psychological treatment, assess the tutors of residency programmes and develop research programmes to better identify risk factors for emotional problems during the residency period. We hope that by doing this the overall quality of the residency programme will improve, both for the professionals and the patients.

Brazil↗
PubMed2002

Accessibility to the public environment as perceived by teenagers with functional limitations in a south Swedish town centre.

PURPOSE: Owing to physical inaccessibility persons with mobility restrictions and other functional limitations often face problems in public environments, leading to restrictions in activity and participation. To investigate general accessibility and perceived problems of accessibility to the public environment in a town centre, as well as visiting preferences to public facilities, among teenagers with functional limitations. METHODS: An interview questionnaire specific to a south Swedish town was constructed and used with 33 Swedish teenagers with functional limitations. RESULTS: To a varying degree, all 33 teenagers commented on accessibility problems, e.g. concerning uneven surface material outdoors, steps at entrances, heavy doors and restricted space indoors. The results also indicated that teenagers with functional limitations to a high extent want to visit the same environments as other teenagers, but that it is often impossible owing to accessibility problems. Furthermore, because of accessibility problems, many of the teenagers were dependent on personal assistance. CONCLUSION: Inaccessibility results in dependence, which might affect personal development negatively, and much effort are required in order to ensure activity and societal participation. Efficient priorities in public environment accessibility matters and discussions with the actors involved require valid and reliable data on local accessibility problems.

Adolescent↗
PubMed1997

Estimating the number of AIDS-defining opportunistic illness diagnoses from data collected under the 1993 AIDS surveillance definition.

Expansion of the surveillance definition for AIDS in the United States in 1993 caused a substantial distortion in the trend in AIDS incidence, mainly because CD4-positive (CD4+) T-lymphocyte criteria were added to the definition. To evaluate trends in the rate at which HIV-infected persons develop the opportunistic illnesses listed in the AIDS surveillance definition (AIDS-OIs), we developed a procedure for estimating the incidence of these diseases. This estimate is based primarily on the probability distributions of the time from a CD4+ count in given ranges to the diagnosis of the first AIDS-OI. Our estimates of AIDS-OI incidence change by <4% during most calendar quarters during 1991 through 1995 if we also include the estimated effects of unreported AIDS-OIs among persons with AIDS reported based on the CD4+ criteria. Our procedure eliminates the transient effect of adding the CD4+ criteria to the AIDS surveillance definition and permits us to evaluate trends in the incidence of AIDS-OIs.

AIDS-Related Opportunistic Infections↗
PubMed1986

D. H. Lawrence and self-psychology.

The work and life of D. H. Lawrence is examined as an example of Kohut's notion of the anticipatory function of art and as providing a rich source of material for examination of the respective importance in personality development of Oedipal conflict and the pre-Oedipal establishment of a sense of self. The importance of self-psychology as an expansion of psychoanalysis is noted and some of the ways Lawrence anticipated this development are described. It is also suggested that Lawrence provides convincing confirmation of a self-psychology view of creative drive, and a thesis is briefly expounded that in his major novels he was pursuing his own self-healing.

Creativity↗