A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness.

The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).

A Time for Action on Health Inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All.

Global inequalities contribute to marked disparities in health and wellness of human populations. Many opportunities now exist to provide health care to all people in a person- and people-centered way that is effective, equitable, and sustainable. We review these opportunities and the scientific, historical, and philosophical considerations that form the basis for the International College of Person-centered Medicine's 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. Using consistent time-series data, we critically examine examples of universal healthcare systems in Chile, Spain, and Cuba. In a person-centered approach to public health, people are recognized to have intrinsic dignity and are treated with respect to encourage their developing health and happiness. A person-centered approach supports the freedom and the responsibility to develop one's life in ways that are personally meaningful and that are respectful of others and the environment in which we live together. Evidence suggests that health care organizations function well when they operate in a person-and people-centered way because that stimulates better coordination, cooperation, and social trust. Health care coverage must be integrated at several interconnected levels in order to be effective, efficient, and fair. To reduce the burden of disease, integration is needed between the people seeking and delivering care, within the social network of each person, across the trajectory of each person's life, among primary caregivers and specialists, and across multiple sectors of society. For integration to succeed across all these levels, it must foster common values and a shared vision of the future.

Background, Structure and Priorities of the 2013 Geneva Declaration on Person-centered Health Research.

Declarations are relevant tools to frame new areas in health care, to raise awareness and to facilitate knowledge-to-action. The International College on Person Centered Medicine (ICPCM) is seeking to extend the impact of the ICPCM Conference Series by producing a declaration on every main topic. The aim of this paper is to describe the development of the 2013 Geneva Declaration on Person-centered Health Research and to provide additional information on the research priority areas identified during this iterative process. There is a need for more PCM research and for the incorporation of the PCM approach into general health research. Main areas of research focus include: Conceptual, terminological, and ontological issues; research to enhance the empirical evidence of PCM main components such as PCM informed clinical communication; PCM-based diagnostic models; person-centered care and interventions; and people-centered care, research on training and curriculum development. Dissemination and implementation of PCM knowledge-base is integral to Person-centered Health Research and shall engage currently available scientific and translational dissemination tools such journals, events and eHealth.

Índice de calidad de vida: Validación en una muestra peruana / Quality of Life Index: Validation in a sample Peruvian

La publicación describe la metodología del cálculo del Índice de Calidad de Vida (ICV) versión española de Mezzich y colaboradores, estimar su confiabilidad y validez, obtención de normas para la población de Lima y análisis de variación de las puntuaciones según las variables demográficas

The dynamic origins of positive health and wellbeing.

The causes of wellbeing and illbeing interact with feedback dynamics resulting in the same set of traits giving rise to a variety of health outcomes (multi-finality) and different traits giving rise to the same health outcome (equi-finality). As a result, a full understanding of health and its disorders must be in terms of a complex adaptive system of causes, rather than in terms of categorical diagnoses or sets of symptoms. The three domains of person-centered integrative diagnosis (PID) are considered here as interacting components of a complex adaptive system comprised of health status (functioning/wellness versus disability/disorder), experience of health (self-awareness/fulfillment versus misunderstanding/suffering) and contributors to health (protective versus risk factors). The PID domains thereby allow healthcare and health promotion to be understood in terms of measurable components of a complex adaptive system. Three major concepts of health are examined in detail to identify their dynamic origins: Psychological Maturity, Flourishing and Resilience. In humanistic psychology, psychological maturity (i.e. healthy personality, mental wellbeing) involves the development of high self-directedness, high co-operativeness and high self-transcendence, but self-transcendence is nevertheless devalued in individualistic and materialistic cultures except when people must face adversity and ultimate situations like suffering or the threat of death. Psychological Maturity develops through two complementary processes often labeled as Flourishing and Resilience. Flourishing is the development of one's potential to live optimally, especially as the result of favorable circumstances, whereas Resilience is positive adaptation to life despite adverse circumstances. As a result of the complex feedback dynamics between the processes of flourishing and resilience, each person is a unique individual who has a variety of paths for achieving positive health and wellbeing open to him or her. Person-centered health promotion and care can thereby be approached as a creative life project that can be conducted with the assistance of healthcare workers who are both therapeutic allies and well-informed experts.

Developing an Institutional Informational Base and Bibliographical Clearinghouse.

Successful management and implementation of the diverse functions of the International Network of Person-Centered Medicine (INPCM) require a comprehensive and efficient informational base to advance quality of patient care though timely and rapid distribution of knowledge via publications, conferences, and education programs in concert with catalyzing research through systematic efficient data acquisition, storage, retrieval, and analysis. This study describes the structure and functions of the proposed INPCM's information system.

The Multicultural Quality of Life Index: presentation and validation.

RATIONALE AND OBJECTIVES: Quality of life has emerged as a crucial concept for the assessment of health and the planning of health care. Desirable features for the evaluation of quality of life include comprehensiveness, self-ratedness, cultural sensitivity, practicality and psychometric soundness. An attempt to meet these challenges led to the development of a brief multicultural quality of life instrument and to the appraisal of its applicability, reliability and validity. METHODS: The development of the proposed assessment instrument was based on a wide review of the literature and the engagement of a multicultural mental health scholarly team. Its validation was conducted on samples of psychiatric patients (n = 124) and hospital professionals (n = 53) in New York City. RESULTS: A new generic culture-informed and self-rate instrument, the Multicultural Quality of Life Index, has been developed. Its 10 items cover key aspects of the concept, from physical well-being to spiritual fulfilment. Concerning its applicability, mean time for completion was less than 3 minutes and 96% of raters found it easy to use. Test-retest reliability was high (r = 0.87). A Cronbach's α of 0.92 documented its internal consistency and a factor analysis revealed a strong structure. With regard to discriminant validity, a highly significant difference was found between the mean total scores of professionals (x = 8.41) and patients (x = 6.34) presumed to have different levels of quality of life. CONCLUSIONS: The Multicultural Quality of Life Index is a brief and culturally informed instrument that appears to be easy to complete, reliable, internally consistent and valid.

The Geneva Conferences and the emergence of the International Network for Person-centered Medicine.

The yearly Geneva Conferences on Person-centered Medicine started in May 2008 as a collaborative effort of global medical and health organizations and committed clinicians and scholars to place the whole person at the centre of medicine and health care. They were informed by the traditions of great ancient civilizations and recent developments in clinical care and public health. The process of the Geneva Conferences led to the development of the International Network for Person-centered Medicine as a non-for-profit institution aimed at organizing future editions of the Geneva Conference and building person-centred medicine as a paradigmatic repriorizing of the medical and health fields in collaboration inter alia with the World Medical Association, the World Health Organization and the World Organization of Family Doctors.

Outlining the bases of person-centred integrative diagnosis.

UNLABELLED: RATIONAL AND AIMS: As diagnosis is a critical first step for clinical care, it was early recognized that an appropriate diagnostic model was necessary as informational basis for person-centred clinical care. METHODS: The design of a person-centred integrative diagnosis model was based on literature reviews and work meetings in London, Paris, Geneva, Preston, UK and Uppsala, Sweden over the past 2 years. RESULTS AND CONCLUSION: The current person-centred integrative diagnosis model argues for a broader concept of diagnosis and covers both ill health and positive health through the following three levels: Health Status (from illness to recovery/wellness and from disabilities to adaptive functioning), Experience of Health (cultural factors and values concerning ill health and positive health) and Contributory Factors (including internal and external risk and protective factors). Each of these domains will be evaluated with standardized categories and dimensions as well as narratives. Specific attention is paid to evaluators (clinicians, patient, family and other carers) and the interactive evaluation process.

Person-centred integrative diagnosis: conceptual bases and structural model.

OBJECTIVES: To review the conceptual bases of Person-centred Integrative Diagnosis (PID) as a component and contributor to person-centred psychiatry and medicine and to outline its design and development. METHOD: An analysis was conducted of the historical roots of person-centred psychiatry and medicine, tracing them back to ancient Eastern and Western civilizations, to the vicissitudes of modern medicine, to recent clinical and conceptual developments, and to emerging efforts to reprioritize medicine from disease to patient to person in collaboration with the World Medical Association, the World Health Organization, the World Organization of Family Doctors, the World Federation for Mental Health, and numerous other global health entities, and with the coordinating support of the International Network for Person-centered Medicine. RESULTS: One of the prominent endeavours within the broad paradigmatic health development outlined above is the design of PID. This diagnostic model articulates science and humanism to obtain a diagnosis of the person (of the totality of the person's health, both ill and positive aspects), by the person (with clinicians extending themselves as full human beings), for the person (assisting the fulfillment of the person's health aspirations and life project), and with the person (in respectful and empowering relationship with the person who consults). This broader and deeper notion of diagnosis goes beyond the more restricted concepts of nosological and differential diagnoses. The proposed PID model is defined by 3 keys: broad informational domains, covering both ill health and positive health along 3 levels: health status, experience of health, and contributors to health; pluralistic descriptive procedures (categories, dimensions and narratives); and evaluative partnerships among clinicians, patients, and families. An unfolding research program is focused on the construction of a practical guide and its evaluation, followed by efforts to facilitate clinical implementation and training. CONCLUSIONS: PID is aimed at appraising overall health through pluralistic descriptions and evaluative partnerships, and leading through a research program to more effective, integrative, and person-centred health care.

Indian psychiatry: Research and international perspectives.

Indian psychiatry has many contributions to the world psychiatry to its credit. These include active participation in the international scientific organizations, research, and also creation of the manpower resources in many other countries. India has been an active partner in the research initiatives of the World Health Organization and the World Psychiatric Association. Research by the Indian psychiatrists played an important role in recognition of the entity of acute and transient psychotic disorders, some culture bound syndromes like Dhat syndrome and understanding the role of families in care of schizophrenia and course and outcome of schizophrenia.