The architecture and spatial organization of the living human body as revealed by intratissular endoscopy - An osteopathic perspective.

This article presents an overview of research conducted by Dr Jean-Claude Guimberteau into the architecture and spatial organization of living matter and the relationship between the cells and the extracellular matrix. His research is discussed in the context of previous and current research into fascial anatomy. Andrew Taylor Still, the founder of Osteopathy, did not have access to modern research and yet his observations are proving to be surprisingly accurate in the light of recent findings. This article sets out to highlight the relevance of his insights from a purely anatomical perspective, and to draw parallels with a new way of thinking about the architecture of the living human body that is slowly emerging. Dr Guimberteau's research shows that a force applied to the surface of the skin is transmitted deep into living tissue via a continuous bodywide multifibrillar network. It also confirms the concept of the body as a dynamic functional unit, as proposed by A.T. Still. Still also proposed that structure and function are interrelated at all levels within the living human body. There is a growing body of research to support this. Intratissular endoscopy has highlighted the importance of the quality of the mobility and adaptability of the network of collagen and elastin fibers that structures the ECM in healthy living tissue. Factors such as abnormal stiffness of collagen fibers in the ECM are thought to have adverse effects on local tissue health.

Group health coaching: strengths, challenges, and next steps.

There is great need for cost effective approaches to increase patient engagement and improve health and well-being. Health and wellness coaching has recently demonstrated great promise, but the majority of studies to date have focused on individual coaching (ie, one coach with one client). Newer initiatives are bringing a group coaching model from corporate leadership development and educational settings into the healthcare arena. A group approach potentially increases cost-effective access to a larger number of clients and brings the possible additional benefit of group support. This article highlights some of the group coaching approaches currently being conducted across the United States. The group coaching interventions included in this overview are offered by a variety of academic and private sector institutions, use both telephonic and in-person coaching, and are facilitated by professionally trained health and wellness coaches as well as trained peer coaches. Strengths and challenges experienced in these efforts are summarized, as are recommendations to address those challenges. A working definition of "Group Health and Wellness Coaching" is proposed, and important next steps for research and for the training of group coaches are presented.

Existe una gran necesidad de planteamientos económicamente rentables que incrementen el compromiso de los pacientes, y mejoren su salud y su bienestar. La formación de salud y bienestar ha demostrado recientemente ser muy prometedora, pero la mayoría de los estudios realizados hasta la fecha se han centrado en la formación individual (es decir, de un entrenador con un cliente). Existen iniciativas más recientes, procedentes del área de desarrollo del liderazgo empresarial y de entornos académicos, para trasladar modelos de formación en grupo al ámbito de la atención sanitaria. El abordaje en grupo podría proporcionar un acceso rentable a un mayor número de clientes, además de contar con la posible ventaja adicional del apoyo del grupo. En este artículo destacamos algunos de los planteamientos de formación en grupo que se están llevando a cabo en Estados Unidos. Las intervenciones de formación en grupo que incluimos en este resumen provienen de diversas instituciones académicas y privadas, utilizan la formación telefónica y presencial, y cuentan con el apoyo de monitores de salud y bienestar con formación profesional, así como de colegas entrenadores cualificados. Resumiremos los puntos fuertes y los retos a los que se enfrentan estas iniciativas, y se ofrecerán recomendaciones para abordar dichos desafíos. Se propondrá una definición operativa de "formación de grupos de salud y bienestar" y se mostrarán los próximos pasos importantes que deben seguir la investigación y la formación de monitores de grupos.

Predictors of clinical outcome in a national hospitalised cohort across both waves of the influenza A/H1N1 pandemic 2009-2010 in the UK.

BACKGROUND: Although generally mild, the 2009-2010 influenza A/H1N1 pandemic caused two major surges in hospital admissions in the UK. The characteristics of patients admitted during successive waves are described. METHODS: Data were systematically obtained on 1520 patients admitted to 75 UK hospitals between May 2009 and January 2010. Multivariable analyses identified factors predictive of severe outcome. RESULTS: Patients aged 5-54 years were over-represented compared with winter seasonal admissions for acute respiratory infection, as were non-white ethnic groups (first wave only). In the second wave patients were less likely to be school age than in the first wave, but their condition was more likely to be severe on presentation to hospital and they were more likely to have delayed admission. Overall, 45% had comorbid conditions, 16.5% required high dependency (level 2) or critical (level 3) care and 5.3% died. As in 1918-1919, the likelihood of severe outcome by age followed a W-shaped distribution. Pre-admission antiviral drug use decreased from 13.3% to 10% between the first and second waves (p=0.048), while antibiotic prescribing increased from 13.6% to 21.6% (p<0.001). Independent predictors of severe outcome were age 55-64 years, chronic lung disease (non-asthma, non-chronic obstructive pulmonary disease), neurological disease, recorded obesity, delayed admission (≥5 days after illness onset), pneumonia, C-reactive protein ≥100 mg/litre, and the need for supplemental oxygen or intravenous fluid replacement on admission. CONCLUSIONS: There were demographic, ethnic and clinical differences between patients admitted with pandemic H1N1 infection and those hospitalised during seasonal influenza activity. Despite national policies favouring use of antiviral drugs, few patients received these before admission and many were given antibiotics.

Nosocomial pandemic (H1N1) 2009, United Kingdom, 2009-2010.

To determine clinical characteristics of patients hospitalized in the United Kingdom with pandemic (H1N1) 2009, we studied 1,520 patients in 75 National Health Service hospitals. We characterized patients who acquired influenza nosocomially during the pandemic (H1N1) 2009 outbreak. Of 30 patients, 12 (80%) of 15 adults and 14 (93%) of 15 children had serious underlying illnesses. Only 12 (57%) of 21 patients who received antiviral therapy did so within 48 hours after symptom onset, but 53% needed escalated care or mechanical ventilation; 8 (27%) of 30 died. Despite national guidelines and standardized infection control procedures, nosocomial transmission remains a problem when influenza is prevalent. Health care workers should be routinely offered influenza vaccine, and vaccination should be prioritized for all patients at high risk. Staff should remain alert to the possibility of influenza in patients with complex clinical problems and be ready to institute antiviral therapy while awaiting diagnosis during influenza outbreaks.

Validation of the telephone and in-person interview versions of the 7-day PAR.

PURPOSE: To validate the 7-d Physical Activity Recall (PAR) telephone interview version and its activity intensity categories. METHODS: Seventy-four adults (47 women, 27 men), ranging in age (18-67) and activity levels, were interviewed by phone and in-person using the same PAR protocol. Each participant wore a TriTrac-R3D accelerometer for 10 d. Validity was assessed by comparing the phone and in-person PAR interviews with the TriTrac-R3D data. RESULTS: Sixty-nine adults (44 women, 25 men) were used for all statistical analyses. Intraclass correlations between the two PAR interviews for total minutes per week of activity were r = 0.96, and r = 0.94 for moderate, r = 0.97 for hard, and r = 0.97 for very hard intensity activities. Pearson product moment correlations between the phone PAR and TriTrac-R3D for total minutes per week of physical activity were r = 0.43, and r = 0.31 for moderate, r = 0.39 for hard, and r = 0.78 for very hard intensity activities. Pearson correlations between the in-person PAR and TriTrac-R3D for total minutes per week of physical activity were r = 0.41, and r = 0.33 for moderate, r = 0.43 for hard, and r = 0.74 for very hard intensity activities. Participants overestimated the amount of physical activity in both interviews as compared with the TriTrac-R3D. CONCLUSION: The phone and in-person versions of the PAR are equivalent measures for self-reported physical activity. Regardless of age, body mass index, or physical activity level both interview methods had similar estimates for total minutes per week of moderate, hard, and very hard activity. Correlations between each interview method and the TriTrac-R3D were lower for moderate and hard activities as compared with very hard activities.