Salutogenic mechanisms in nature-based work: fostering sense of coherence for employees with limited capability for work.

Having a job is important for the well-being and inclusion of people with limited capability for work (LCW) due to physical and/or mental disability. This study explores salutogenic mechanisms that contribute to work-related sense of coherence (Work-SoC) of employees with LCW, i.e. perceiving their work in nature as manageable, comprehensible and meaningful. Semi-structured interviews (26 in total) were conducted with employees with LCW, employee supervisors, job coaches and foresters, all working in nature management. Interviews were held at four worksites of a governmental organisation in the Netherlands that provides permanent jobs for people with LCW. Employees with LCW contributed to the design and analysis of the study as co-researchers. Thematic analysis was used and member checks were carried out on preliminary findings. We identified six salutogenic mechanisms that contribute to nature-based Work-SoC of employees with LCW: (i) having constructive working relationships, (ii) experiencing structure and clarity, (iii) receiving practical and emotional support, (iv) support in the creation of meaning, (v) experiencing and learning in practice and (vi) physical activity and (absence of) stimuli. Identified mechanisms can create a positive effect when leveraged, thereby boosting (new) salutogenic mechanisms. Our findings illustrate that nature-based work can provide resources that promote Work-SoC of employees with LCW through the identified mechanisms. However, employees with LCW, colleagues, supervisors and stakeholders must recognize, mobilize and use these resources to leverage identified mechanisms in order to facilitate health-promoting workplaces for people with LCW. This, in turn, can contribute to sustainable inclusion through enablement.

[Psychological stress and the need for stress management in veterinary studies]. / Psychische Belastung und die Notwendigkeit von Stressmanagement im Veterinärmedizinstudium.

INTRODUCTION: Veterinary students suffer from increased psychological stress compared to the general public and are increasingly affected by manifest mental illnesses such as depression and anxiety disorders, as well as an increased prevalence of suicidal thoughts. Additionally, veterinary students tend to ignore signs of mental distress and do not seek support for their mental health issues. This impaired mental health is also evident in fully trained veterinarians, who, among other things, have the highest suicide rates of all medical professions. In our survey, we examined a total of 428 veterinary students at the two veterinary faculties of the Universities of Zurich and Bern. The survey was carried out across all six years of the curriculum as a cross-sectional survey using standardized questionnaires on resilience, sense of coherence and depression. In all years, the students showed increased levels of depression compared to the general public, and the salutogenic parameters of resilience and sense of coherence were also reduced. The constellation with increased depression, reduced resilience and reduced sense of coherence was particularly accentuated in the second and third year. The increased affective stress on students presents itself as a consistent condition, which - if you look at studies on fully trained veterinarians - continues into their working life together with a reduced ability to cope. The low number of participants in the higher years of study and the high number of female study participants could limit the generalizability of the results. In addition, the data was collected in spring 2021 during the COVID-19 pandemic, which may have influenced the results. Active counteracting, for example by integrating the teaching of protective behavior such as mindful self-compassion and resource-oriented behavior such as mind-body techniques, therefore appears to be recommended in the veterinary training curriculum from the first semester onwards. Various measures to support students have been introduced since 2021, such as events on learning strategies, a mentoring system and seminars on mental health.

INTRODUCTION: Les étudiants en médecine vétérinaire souffrent d'un stress psychologique plus important que le grand public et sont de plus en plus touchés par des maladies paychiques manifestes telles que la dépression et les troubles anxieux, ainsi que par une prévalence accrue de pensées suicidaires. En outre, les étudiants en médecine vétérinaire ont tendance à ignorer les signes de détresse mentale et ne cherchent pas de soutien pour leurs problèmes de santé mentale. Cette détérioration de la santé mentale est également évidente chez les vétérinaires formés, qui, entre autres, présentent les taux de suicide les plus élevés de toutes les professions médicales. Dans notre enquête, nous avons examiné un total de 428 étudiants vétérinaires des deux facultés vétérinaires des universités de Zurich et de Berne. L'enquête a été menée sur les six années du cursus sous forme d'enquête transversale à l'aide de questionnaires standardisés sur la résilience, le sentiment de cohérence et la dépression. Pour toutes les années, les étudiants ont montré des niveaux de dépression plus élevés que le grand public, et les paramètres salutogènes de la résilience et du sentiment de cohérence ont également été réduits. La constellation avec une dépression accrue, une résilience réduite et un sentiment de cohérence réduit était particulièrement accentuée en deuxième et troisième année. Le stress affectif accru des étudiants se présente comme un état constant qui, si on examine les études sur les vétérinaires ayant reçu une formation complète, se poursuit dans leur vie professionnelle, accompagné d'une capacité réduite à faire face. Le faible nombre de participants dans les années d'études supérieures et le nombre élevé de participantes à l'étude pourraient limiter la généralisation des résultats. En outre, les données ont été collectées au printemps 2021, pendant la pandémie de COVID-19, ce qui a pu influencer les résultats. La lutte active, par exemple en intégrant l'enseignement d'un comportement protecteur tel que l'autocompassion consciente et d'un comportement orienté vers les ressources tel que les techniques corps-esprit, semble donc être recommandée dans le programme de formation vétérinaire dès le premier semestre. Diverses mesures de soutien aux étudiants ont été introduites depuis 2021, telles que des événements sur les stratégies d'apprentissage, un système de mentorat et des séminaires sur la santé mentale.

Functioning Management and Recovery, a psychoeducational intervention for psychiatric residential facilities: a multicenter follow-up study.

AIM: Functional Management and Recovery is a standardized Psychoeducational Intervention, derived from "Integro", an effective salutogenic-psychoeducational intervention for people in recovery journey, designed to improve recovery and functioning of individuals with psychotic disorders in Psychiatric Residential Facilities (PRFs). The aim of this study is to evaluate the primary and secondary outcomes of this intervention elaborated specifically for PRFs where evidence based structured interventions seem rare and desirable. METHODS: 66 individuals with psychotic disorders were recruited in 9 PRFs dislocated in the North, Center and South Italy and 63 underwent a multicenter follow-up study with a two time-point evaluation (t0, pre-treatment and t1, 6 months; ). At each time point, social functioning was assessed as primary outcome by the Personal and Social Performance scale (PSP); furthermore, psychopathological status was assessed by Brief Psychiatric Rating Scale (BPRS), Recovery by Recovery Assessment Scale (RAS), Cognitive Functioning by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Stress management by Stress-Scale, Cognitive Flexibility by Modified Five-Point Test (M-FPT), Emotional Intelligence by Emotional Intelligence Index (EI-I), the PRF Atmosphere and the Opinion of users about the PFR by an ad hoc questionnaire. The Abilities Knowledge, the Utility and Pleasantness of sessions were measured by an ad hoc list of items. RESULTS: 63 individuals out of 66, 52 (82,5%) affected by schizophrenia and 11 (17,5%) by bipolar I disorder with psychotic symptoms according to DSM-5-TR completed the study. At the end of the study, 43 (68,3%) were male, 57 (90.5%) were single, 5 (7.9%) engaged, 1 (1.6%) married; 45 (71.4%) unemployed. The total scores of PSP, RAS, BPRS, BANS, Stress management, Abilities Knowledge, Utility and Pleasantness of sessions showed a statistically significant improvement at t1 vs. t0. Two sub-scales out of 5 of M-FPT showed a statistically significant improvement. The Emotional Intelligence, the Unit Atmosphere and the Opinion of Users about PFR improved without statistical significance. Six months after the end of the follow-up study 22 individuals of the sample were dismissed with a very high turnover. CONCLUSIONS: After a six-month follow-up (a short period of time), these results showed improvement in functioning, the primary outcome, as well as in the following secondary outcome variables: RAS, BPRS, BANS, Stress management, Abilities Knowledge, two sub-scales out of 5 of M-FPT, Utility and Pleasantness of sessions. Overall, a remarkable impact of psychoeducational structured intervention on the key Recovery variables is observed. Further studies are needed to address extent and duration of these improvements.

Maternal experiences of women who had received salutary childbirth education: A descriptive qualitative study.

BACKGROUND: Childbirth education, underpinned by Salutogenesis, presents a paradigm shift in maternal care. There was no present information about the maternal experiences of women who had received Salutary childbirth education. OBJECTIVE: The present study aimed to deeply explore women's pregnancy, birth and postnatal experiences who attended the 'Salutary Childbirth Education Program' and shed light on the mechanisms of Salutogenesis on maternal health promotion. METHODS: A descriptive qualitative study was conducted with 15 mothers. The study was conducted during April-October 2023. Data were obtained through semi-structured, in-depth individual longitudinal interviews to cover all maternal periods. A thematic analysis was performed. RESULTS: Women stated that they 'acquired normality oriented perspective' which provides 'attribution of positive meanings to the period' and 'freedom from their risk focus concerns'. Women experienced the naturality of the process and were in the flow. They described that they became 'aware of their internal resources', and gained 'skills for the construction of resources' and 'ability to manage the period'. The 'emotional strength' and 'Investment ability for themselves' in addition to obtained autonomy provided them a feeling of strength to actively engage in their experience. PRACTICE IMPLICATIONS: This study explores the experiences of women who participated in the Salutary Childbirth Education Program and describes the mechanisms of the program's components on their experiences. By doing so, it aims to enhance understanding of how healthcare professionals can present effective childbirth education through the use of the Salutogenesis Model. PATIENT OR PUBLIC CONTRIBUTION: The authors would like to acknowledge and thank the women who attended the education program and were willing to interview.

Effect of the health and wellness Kneipp concept on health promotion and reduction of sick days for kindergarten children: a cluster randomized controlled trial protocol.

Background: The holistic health and wellness Kneipp concept, has a long tradition in Europe with demonstrated health benefits. Based on the five elements of the Kneipp concept, kindergartens in and around Germany are used to certify "Kneipp Kindergartens" that practice regular Kneipp applications and activities: cold water applications, exercise, nutrition, herbs and mind-body interventions. Little is known about the potential health benefits for children, however. This study protocol describes our study design and intervention of the Kita Kneipp Study to investigate the effect of the Kneipp concept on kindergarten children aged 2-6 years. Methods and design: The Kita Kneipp Study, registered with the German Clinical Trial Register (DRKS-ID: DRKS00029275), is a confirmatory, mixed-method, two-armed, waitlist, clinical, cluster randomized controlled trial (RCT). Kindergartens in Berlin, Germany that would like to implement the Kneipp concept into their facility will be recruited and randomized to the intervention or control group. Changes in the number of kindergarten sick days will be the primary outcome measure. Kindergarten attendance and reason for absence including illness will be collected on a weekly basis at two time points for 6 weeks from the parents and kindergarten directors: baseline and 1 year after baseline. Secondary outcomes will measure cold symptoms through the Common Cold Questionnaire (CCQ) and National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) Scales describing gastroenterological-based symptoms Kindergarten educator sick days will be aggregately reported for the same time period. Kneipp concept activities will be recorded on a weekly basis over the one-year intervention period. To understand the experience of Kneipp concept implementation and possible changes in the kindergarten, expert interviews will be conducted with intervention kindergarten educators and focused ethnographies will be planned to observe and analyze the intervention activities. Discussion: This mixed method study design has potential to help identify if the Kneipp concept can be used for salutogenic purposes among young children and provide insights and experience of the implementation and practicing a holistic health and wellness concept in a kindergarten setting.

Investigation of the relationship between the sense of coherence and the level of depression in mothers of children with autism.

INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental disorder originating from early childhood. Although there are studies investigating the sense of coherence in caregivers of children with ASD, there is not a previous study in our country. In this study, we aimed to examine the relationship between the sense of coherence and depression levels in mothers of children with ASD. METHOD: Seventy-five mothers of children followed up in rehabilitation centers with the diagnosis of ASD were included in this study. Beck Depression Inventory (BDI) and Sense of Coherence Scale-13 (SOC-13) were administered to mothers. Participants were divided into two groups: a depressive group and a control group according to the BDI cut-off score. SOC-13 total score and sub-scores were compared between these groups. RESULTS: According to the BDI cut-off score, 45 participants (60%) were included in the depressive group. Total SOC-13 score and sub-scores were found to be statistically significantly lower in the depressive group compared with the control group. CONCLUSION: Our study is the first study in our country to examine the relationship between the sense of coherence and depression in mothers of children with ASD. The results showed that there was a significant negative correlation between depression scores and sense of coherence. It is predicted that psychological interventions that will improve the sense of coherence of mothers with children with ASD may play an important role in the treatment of depression, thus leading to an increase in the quality of care provided by parents.

The influence of nationwide COVID-19 lockdown on the functional impairment and long-term survival of dependent people for carrying out basic activities of daily living in a neighborhood of the city of Madrid, Spain: Orcasitas Cohort Longitudinal Study.

Background: Prolonged confinement can lead to personal deterioration at various levels. We studied this phenomenon during the nationwide COVID-19 lockdown in a functionally dependent population of the Orcasitas neighborhood of Madrid, Spain, by measuring their ability to perform basic activities of daily living and their mortality rate. Methods: A total of 127 patients were included in the Orcasitas cohort. Of this cohort, 78.7% were female, 21.3% were male, and their mean age was 86 years. All participants had a Barthel index of ≤ 60. Changes from pre- to post-confinement and 3 years afterward were analyzed, and the effect of these changes on survival was assessed (2020-2023). Results: The post-confinement functional assessment showed significant improvement in independence over pre-confinement for both the Barthel score (t = -5.823; p < 0.001) and the classification level (z = -2.988; p < 0.003). This improvement progressively disappeared in the following 3 years, and 40.9% of the patients in this cohort died during this period. These outcomes were associated with the Barthel index (z = -3.646; p < 0.001) and the level of dependence (hazard ratio 2.227; CI 1.514-3.276). Higher mortality was observed among men (HR 1.745; CI 1.045-2.915) and those with severe dependence (HR 2.169; CI 1.469-3.201). Setting the cutoff point of the Barthel index at 40 provided the best detection of the risk of death associated with dependence. Conclusions: Home confinement and the risk of death due to the COVID-19 pandemic awakened a form of resilience in the face of adversity among the population of functionally dependent adults. The Barthel index is a good predictor of medium- and long-term mortality and is a useful method for detecting populations at risk in health planning. A cutoff score of 40 is useful for this purpose. To a certain extent, the non-institutionalized dependent population is an invisible population. Future studies should analyze the causes of the high mortality observed.

Validation and Refinement of the Sense of Coherence Scale for a French Population: Observational Study.

BACKGROUND: Salutogenesis focuses on understanding the factors that contribute to positive health outcomes. At the core of the model lies the sense of coherence (SOC), which plays a crucial role in promoting well-being and resilience. OBJECTIVE: Using the validscale Stata command, we aimed to assess the psychometric properties of the French version of the 3-dimension 13-item SOC questionnaire (SOC-13), encompassing the comprehensibility, manageability, and meaningfulness dimensions. We also aimed to determine if a refined scale, assessed through this method, exhibits superior psychometric properties compared to the SOC-13. METHODS: A sample of 880 consecutive primary care patients recruited from 35 French practices were asked to complete the SOC-13. We tested for internal consistency and scalability using the Cronbach α and Loevinger H coefficients, respectively, and we tested for construct validity using confirmatory factor analysis and goodness-of-fit indices (root mean square error of approximation [RMSEA] and comparative fit index [CFI]). RESULTS: Of the 880 eligible patients, 804 (91.4%) agreed to participate (n=527, 65.6% women; median age 51 years). Cronbach α and Loevinger H coefficients for the SOC-13 were all <0.70 and <0.30, respectively, indicating poor internal consistency and poor scalability (0.64 and 0.29 for comprehensibility, 0.56 and 0.26 for manageability, and 0.46 and 0.17 for meaningfulness, respectively). The RMSEA and CFI were >0.06 (0.09) and <0.90 (0.83), respectively, indicating a poor fit. By contrast, the psychometric properties of a unidimensional 8-item version of the SOC questionnaire (SOC-8) were excellent (Cronbach α=0.82, Loevinger H=0.38, RMSEA=0.05, and CFI=0.97). CONCLUSIONS: The psychometric properties of the 3-dimension SOC-13 were poor, unlike the unidimensional SOC-8. A questionnaire built only with these 8 items could be a good candidate to measure the SOC. However, further validation studies are needed before recommending its use in research.

Beyond Pathology- Exploring Salutogenesis as a Novel Approach to Eye Inflammatory Disease Prevention and Management: A Perspective.

The aim of this perspective is to promote the theory of salutogenesis as a novel approach to addressing ophthalmologic inflammatory conditions, illustrating several concepts in which it is based upon and how they can be applied to medical practice. This theory can better contextualize why patients with similar demographics and exposures are not uniform in their clinical presentations. Stressors in daily life can contribute to a state of ill-health and there are various factors that help alleviate their negative impact. These alleviating factors are significantly impaired in people with poor vision, one of the most common presentations of ophthalmologic conditions. Salutogenic principles can guide the treatment of eye conditions to be more respectful of patient autonomy amidst shifting expectations of the doctor-patient relationship. Being able to take ownership of their health and feeling that their cultural beliefs were considered improves compliance and subsequently gives more optimal outcomes. Population-level policy interventions could also utilize salutogenic principles to identify previously overlooked domains that can be addressed. We identified several papers about salutogenesis in an ophthalmological context and acknowledged the relatively few studies on this topic at present and offer directions in which we can explore further in subsequent studies.

The Childbearing sense of coherence scale (CSOC-scale): development and validation.

BACKGROUND: the salutogenic theory is essential to explain an individual's ability to maintain health during the perinatal period. While previous studies mainly focused on the perspectives from a family-level orientation and a global orientation, the purpose of the present study was to develop and validate a scale, the childbearing sense of coherence scale (CSOC-scale) from the individual's perceptions of the stresses, resources, and meaningfulness of childbearing. METHODS: A total of 3 separate studies contributed to the development of the CSOC-scale between July 2022 and February 2023. In study 1, the initial item pool based on the conceptual framework of the childbearing sense of coherence and the salutogenic theory was developed. Delphi expert consultation was conducted to revise and improve items. Studies 2 and 3 were cross-sectional studies. In study 2, item analysis and explore factor analysis (EFA) (N = 351 for women, N = 256 for men) were used to screen items. In study 3, confirmatory factor analysis (CFA) and reliability analysis (N = 366 for women, N = 308 for men) were used to test the fit indices and reliability of the final scale. RESULTS: final analysis suggested the CSOC-scale includes three factors, consisting of 13 items. Confirmatory factor analysis demonstrated good model fit (χ2 = 157.448, df = 62, χ2/ df = 2.539, RMSEA = 0.065, CFI = 0.974, TLI = 0.968, SRMR = 0.029 for women; χ2 = 181.363, df = 62, χ2/ df = 2.925, RMSEA = 0.079, CFI = 0.968, TLI = 0.960, SRMR = 0.033 for men) and high factor loadings (from 0.751 to 0.929 for women; from 0.746 to 0.947 for men). Internal consistency (Cronbach's α ranging from 0.895 to 0.933 for women and 0.881 to 0.945 for men in three dimensions; Cronbach's α was 0.919 for women and 0.821 for men in the entire instrument) and split-half reliability (Spearman-Brown coefficients ranging from 0.876 to 0.921 for women and 0.841 to 0.937 for men in three dimensions; Spearman-Brown coefficient was 0.744 for women and 0.785 for men in the entire instrument) were excellent. CONCLUSIONS: the CSOC-scale has robust psychometric properties. It is reliable and valid in evaluating the childbearing sense of coherence in women and men during pregnancy. Utilisation of this scale can help healthcare professionals understand the health maintenance competencies of couples during the transition of parenthood and provide health promotion services from a salutogenic perspective.

The Dynamic Model of Health Assets: a model development.

AIM: Epidemiological research on resistance and resilience can build on models of health developed in health promotion. Nevertheless, these models need to be adjusted to approaches currently employed in epidemiology; namely, included concepts should be easy to operationalize, and links between them should be simple enough to enable statistical modeling. In addition, these models should include both individual and environmental assets. The objective of this study is to consolidate the current knowledge on health assets, adjust them to epidemiological research needs, and propose a new model of health assets for epidemiological studies on health. DESIGN: The conceptual paper was conducted according to the guidelines for the model development. METHODS: The development of the new model was made from the perspective of salutogenesis - the branch of health promotion studying the origins of health. The analysis of literature on health promotion, public health, and positive psychology was conducted to find the links connecting individual and environmental assets. RESULTS: The newly developed Dynamic Model of Health Assets circularly links individual characteristics, actions, environments, and support. Each preceding component of the model contributes to the following one; each component also independently contributes to resistance and resilience. The new model may guide large-scale epidemiological research on resistance and resilience. The model's components are easy to operationalize; the model allows for constructing multilevel models and accounting for the dynamic nature of the relationships between components. It is also generic enough to be adjusted to studying contributors to resistance and resilience to different specific diseases. CONCLUSION: The new model can guide epidemiological studies on resistance and resilience.

How to remain in working life with hearing loss - health factors for a sustainable work situation.

BACKGROUND: Persons with hearing loss (HL) are a vulnerable group in working life. Studies have shown that they are more likely than the general population to be in part-time work, to be unemployed, receive disability pension, and to be on sick leave. Many workers with HL also experience unhealthy work conditions, such as jobs where they experience high demands combined with low control as well as safety concerns and social isolation. There is a lack of studies that focus on factors that promote a healthy, sustainable work situation for the target group. OBJECTIVE: To investigate health factors that contribute to a sustainable work situation for employees with HL. METHODS: The current study was a comparative, observational study with a cross-sectional design including a clinical population of adults with HL. Comparisons were made between workers with HL "in work" and workers with HL on "HL-related sick leave". RESULTS: Seven health factors were identified. Those "in work" experienced a healthier work environment as well as lower levels of mental strain, hearing-related work characteristics and content, cognitively demanding work content, hearing-related symptoms, energy-demanding activities, and bodily aches and pain than those on "HL-related sick leave". CONCLUSION: The results demonstrate a clear pattern regarding health factors for a sustainable working life. The type of job was not related to whether an individual was on sick leave or working. Rather, the work climate and the content of the work mattered.

Unleashing the potential of Health Promotion in primary care-a scoping literature review.

The purpose of this study is to gain a better understanding of the role and extent of health promotion lifestyle interventions targeting adults in primary care, and especially those who are considered overall healthy, i.e. to study the outcomes of research applying salutogenesis. We performed a literature review, with three specific aims. First, to identify studies that have targeted the healthy population in intervention within the primary health care field with health promotion activities. Second, to describe these interventions in terms of which health problems they have targeted and what the interventions have entailed. Third, to assess what these programs have resulted in, in terms of health outcomes. This scoping review of 42 studies, that applied salutogenesis in primary care interventions shows that health promotion targeting healthy individuals is relevant and effective. The PRISMA-ScR guidelines for reporting on scoping review were used. Most interventions were successful in reducing disease-related risks including CVD, CVD mortality, all-cause mortality, but even more importantly success in behavioural change, sustained at follow-up. Additionally, this review shows that health promotion lifestyle interventions can improve mental health, even when having different aims.

The sense of coherence scale: psychometric properties in a representative sample of the Czech adult population.

BACKGROUND: Sense of coherence (SOC) is a personal resource that reflects the extent to which one perceives the world as comprehensible, manageable, and meaningful. Decades of empirical research consistently show that SOC is an important protective resource for health and well-being. Despite the extensive use of the 13-item measure of SOC, there remains uncertainty regarding its factorial structure. Additionally, a valid and reliable Czech version of the scale is lacking. Therefore, the present study aims to examine the psychometric properties of the SOC-13 scale in a representative sample of Czech adults. METHODS: An online survey was completed by 498 Czech adults (18-86 years old) between November 2021 and December 2021. We used confirmatory factor analysis to examine the factorial structure of the scale. Further, we examined the variations in SOC based on age and gender, and we tested the criterion validity of the scale using the short form of the Mental Health Continuum (MHC) scale and the Generalized Anxiety Disorder (GAD) scale as mental health outcomes. RESULTS: SOC-13 showed an acceptable one- and three-factor fit only with specified residual covariance between items 2 and 3. We tested alternative short versions by systematically removing poorly performing items. The fit significantly improved for all shorter versions with SOC-9 having the best psychometric properties with a clear one-factorialstructure. We found that SOC increases with age and males score higher than females. SOC showed a moderately strong positive correlation with MHC, and a moderately strong negative correlation with GAD. These findings were similar for all tested versions supporting the criterion validity of the SOC scale. CONCLUSION: Our findings suggest that shortened versions of the SOC-13 scale have better psychometric properties than the original 13-item version in the Czech adult population. Particularly, SOC-9 emerges as a viable alternative, showing comparable reliability and validity as the 13-item version and a clear one-factorial structure in our sample.

Validation of the Internal Coherence Scale (ICS) in Healthy Geriatric Individuals and Patients Suffering from Diabetes Mellitus Type 2 and Cancer.

BACKGROUND: With increased life expectancy, the coexistence of functional impairment and multimorbidity can negatively impact life quality and coherence in geriatric individuals. The self-report 10-item Internal Coherence (ICS) measures how individuals cope with and make sense of disease-specific life challenges. The aim of this study was to validate the ICS in a sample of geriatric individuals. METHODS AND PROCEDURE: In a cross-sectional study, geriatric individuals with and without chronic diseases were recruited. A factor analysis with principal component extraction (PCA) and a structural equation model (SEM) was conducted to assess the ICS factor structure in a geriatric sample. To measure convergent validity, the following scales were used: Short Health Survey (SF-12), Karnofsky Performance Index (KPI), Trait autonomic regulation (Trait aR), Sense of Coherence Scale (SOC), and Geriatric Depression Scale (GDS). RESULTS: A sample of n = 104 (70-96 years of age) patients with Diabetes Mellitus Type 2 (n = 22), cancer diseases (n = 31) and healthy controls (n = 51) completed the ICS. PCA and SEM yielded the original two-factor solution: 1. Inner resilience and coherence and 2. Thermo coherence. Overall internal consistency for this cohort was satisfying (Cronbach's α with rα = 0.72), and test-retest reliability was moderate (rrt = 0.53). ICS scores were significantly correlated to all convergent criteria ranging between r = 0.22 * and 0.49 ** (p < 0.05 *; p < 0.01 **). CONCLUSION: Study results suggest that the ICS appears to be a reliable and valid tool to measure internal coherence in a geriatric cohort (70-96 years). However, moderate test-retest reliability prompts the consideration of potential age-effects that may bias the reliability for this specific cohort.

Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System.

In this paper we synthesize an expansive body of literature examining the multifaceted influence of chiropractic care on processes within and modulators of the neuroendocrine-immune (NEI) system, for the purpose of generating an inductive hypothesis regarding the potential impacts of chiropractic care on integrated physiology. Taking a broad, interdisciplinary, and integrative view of two decades of research-documented outcomes of chiropractic care, inclusive of reports ranging from systematic and meta-analysis and randomized and observational trials to case and cohort studies, this review encapsulates a rigorous analysis of research and suggests the appropriateness of a more integrative perspective on the impact of chiropractic care on systemic physiology. A novel perspective on the salutogenic, health-promoting effects of chiropractic adjustment is presented, focused on the improvement of physical indicators of well-being and adaptability such as blood pressure, heart rate variability, and sleep, potential benefits that may be facilitated through multiple neurologically mediated pathways. Our findings support the biological plausibility of complex benefits from chiropractic intervention that is not limited to simple neuromusculoskeletal outcomes and open new avenues for future research, specifically the exploration and mapping of the precise neural pathways and networks influenced by chiropractic adjustment.

Perspectives on community-based system change for people living with persistent pain: insights from developing the "Rethinking Pain service".

In this perspective article we advocate community-based system change for people living with persistent pain. Our view is that greater use of the voluntary and community sector, in partnership with the clinical sector, creates the conditions for a "whole person" approach to pain management, leading to greater personalised care for adults living with long-term pain whilst having the potential to ease some of the pressures on General Practitioners and other clinical services. We advocate pain care that is socially connected, meaningful within socio-cultural contexts and aligned with the principles of salutogenesis. We provide an example of a UK National Health Service (NHS) commissioned pain service called "Rethinking Pain" that operationalises this perspective. Led by the voluntary and community sector, Rethinking Pain works in partnership with the clinical sector to provide a central holistic pathway of care for people experiencing persistent pain. This is the first time that this model of care has been commissioned for persistent pain in this area of England. The Rethinking Pain service is underpinned by core values to work with people to manage their pain holistically. The Rethinking Pain team proactively engage with people in the community, actively approaching and engaging those who experience the biggest health inequalities. In this article we provide an overview of the context of pain services in the UK, the rationale and supporting evidence for community-based system change, and the context, pathway, values, goals, and aspirations of the Rethinking Pain service.

Occupational experiences and their importance for young peoples' mental health.

BACKGROUND: Young peoples' mental health challenges have increased in recent years to become an urgent public health issue. Research is required to gain a better understanding of how occupations influence young peoples' everyday lives and support their mental health. AIM: How do young people experience engaging in various occupations in their daily lives, and how do these experiences shape their mental health? METHOD: Semi-structured interviews were conducted with 12 Norwegian young people aged 13-16 years. Verbatim transcriptions of the interviews were analysed using thematic analysis. RESULTS: Four core themes emerged: 'doing' for balance and stability; self-discovery through doing; intentional doing to recharge and feel free; and reflecting on the consequences of doing social media. CONCLUSIONS: Young peoples' occupational experiences shape their mental health in several ways: they serve as coping strategies, as a means to experience joy and accomplishment, and as a source of routines and opportunities for relaxation. We suggest that health-promoting initiatives for young people would strongly benefit from the inclusion of an occupational perspective.

Psychobiographical reflections on Viktor von Weizsäcker within the cultural framework of salutogenesis and medical anthropology.

This article explores the life of Viktor von Weizsäcker (VvW, 1886-1957), a German medical doctor, philosopher and founder of the Heidelberg School of Anthropological Medicine, from a psychobiographical and salutogenic perspective. The authors use salutogenesis and sense of coherence (SOC), and take crucial cultural, historical, and socio-structural frameworks into account to explore the life during the 19th and 20th Centuries in Germany. They present the exploration of a strong SOC in the life of VvW and show how SOC is created within the tight family bonds of the family clan, which has produced many extraordinary theologists, philosophers, scientists and politicians over six generations. In a complex, interconnected and holistic way, SOC is evident in von VvW's individual life, and is also shown to be a family resource. This article contributes to psychobiography in three ways: it develops the salutogenetic perspective in psychobiography, explores the life of VvW within a specific sociocultural context, and investigates the life from a salutogenetic and socio-cultural perspective. Finally, conclusions are drawn, and recommendations for theory and practice are given.