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1.
Transcult Psychiatry ; : 13634615211000555, 2021 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-33818199

RESUMO

Our present understanding of depression relies on a Western nosology that might not be generalizable across diverse cultures around the world. As a consequence, current clinical research and practice may not capture culturally salient features of depression. Expanded cross-cultural research that uses ethnographic methods and local instruments may yield information of clinical utility to enhance culturally sensitive research and practice. In this mixed methods study, we used ethno-semantic interview procedures based on the DSM-5's cultural formulation process to elicit a broad range of depression features reported by the Luo people of western Kenya. We identified how the Luo conceptualize depression, including idioms of depressive distress, moods associated with persistent negative affect, and other features including context, stressors and support systems. This information informed the co-development of a Luo Depression Questionnaire (LDQ-17). We used the LDQ-17 in a cross-sectional community survey (N = 116) to investigate its association with a standard Western instrument (Patient Health Questionnaire-9; PHQ-9). Factor analysis revealed a one-factor model for the PHQ-9 but not the LDQ-17 for which exploratory factor analysis suggested a three-factor model including cognitive, affective, and physical symptoms. Psychological, environmental/social, and even supernatural causes (i.e., ancestors, God and devil) of these symptoms were identified, as were support systems. Finally, visualizations through multidimensional scaling approaches showed some overlap between the LDQ-17 and the PHQ-9, but the local LDQ-17 identified salient features the Luo associated with depression that the PHQ-9 missed. Our findings illustrate how simple ethnographic procedures may guide the development of local instruments to complement current standardized instruments, potentially enhancing cultural relevance.

3.
N Engl J Med ; 382(9): 880, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-32101682
4.
Perspect Biol Med ; 63(3): 458-465, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33416619

RESUMO

The human sciences have witnessed a decades-long transition from an emphasis on theories centered on hermeneutics and the interpretation of meaning to a preoccupation with theories that privilege performance, action, and being/becoming. This essay develops out of the conceptual orientation of William James, which holds that all knowledge comes from experience, as well as the author's writings on what matters most to participants in local worlds. The essay shows how meaning and being/becoming are unified in moral life and understood as embodied and lived experiences of care and caregiving, and it draws upon the author's experience of being the primary family carer for his late wife, who died of early onset Alzheimer's disease, as well as his experience of self-isolation in the COVID-19 pandemic. The essay's intention is to advance theoretical questions raised in the author's 2019 book The Soul of Care: The Moral Education of a Husband and a Doctor.


Assuntos
Cuidadores , Isolamento de Pacientes , Doença de Alzheimer , Cuidadores/psicologia , Feminino , Humanos , Isolamento de Pacientes/psicologia , Racismo , Autocuidado , Apoio Social , Cônjuges
6.
Lancet ; 394(10199): 630-631, 2019 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-31448729
8.
Lancet Psychiatry ; 6(4): 350-356, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30704963

RESUMO

The large and increasing burden of mental and substance use disorders, its association with social disadvantage and decreased economic output, and the substantial treatment gaps across country-income levels, are propelling mental health into the global spotlight. The inclusion of targets related to mental health and wellbeing in the UN's Sustainable Development Goals, as well as several national and global initiatives that formed during the past 5 years, signal an increasing momentum toward providing appropriate financing for global mental health. Drawing on the organisational and financial architecture of two successful global health scale-up efforts (the fight against HIV/AIDS and the improvement of maternal and child health) and the organisational models that have emerged to finance these and other global health initiatives, we propose a multi-sectoral and multi-organisational Partnership for Global Mental Health to serve two main functions. First is the mobilisation of funds, including raising, pooling, disbursing, and allocating. Second is stewardship, including supporting countries to use funds effectively, evaluate results, and hold stakeholders accountable. Such a partnership would necessarily involve stakeholders from the mental health field, civil society, donors, development agencies, and country-level stakeholders, organised into hubs responsible for financing, scale-up, and accountability.


Assuntos
Saúde Global , Saúde Mental , Saúde Global/economia , Governo , Humanos , Agências Internacionais/economia , Saúde Mental/economia , Parcerias Público-Privadas/economia , Participação dos Interessados
10.
Dev World Bioeth ; 18(1): 26-36, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28922547

RESUMO

To investigate the phenomenon of patient-physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust (particularly physicians' distrust of patients and their relatives) leads to increased levels of fear and self-protection by doctors which exacerbate difficulties in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism-the primacy of patient welfare-as well as the traditional Chinese ideal of "medicine as the art of humanity". Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures.


Assuntos
Assistência à Saúde/ética , Ética Médica , Relações Médico-Paciente/ética , Profissionalismo/ética , Confiança , China , Confidencialidade/ética , Características Culturais , Humanos , Preconceito , Pesquisa Qualitativa , Classe Social
12.
Dev World Bioeth ; 18(1): 56-64, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28922581

RESUMO

Trust is indispensable not only for interpersonal relationships and social life, but for good quality healthcare. As manifested in the increasing violence and tension in patient-physician relationships, China has been experiencing a widespread and profound crisis of patient-physician trust. And globally, the crisis of trust is an issue that every society, either developing or developed, has to face in one way or another. Yet, in spite of some pioneering works, the subject of patient-physician trust and mistrust - a crucial matter in healthcare especially because there are numerous ethical implications - has largely been marginalized in bioethics as a global discourse. Drawing lessons as well as inspirations from China, this paper demonstrates the necessity of a trust-oriented bioethics and presents some key theoretical, methodological and philosophical elements of such a bioethics. A trust-oriented bioethics moves beyond the current dominant bioethical paradigms through putting the subject of trust and mistrust in the central agenda of the field, learning from the social sciences, and reviving indigenous moral resources. In order for global bioethics to claim its relevance to the things that truly matter in social life and healthcare, trust should be as vital as such central norms like autonomy and justice and can serve as a potent theoretical framework.


Assuntos
Confidencialidade/ética , Assistência à Saúde/ética , Ética Médica , Relações Médico-Paciente/ética , Classe Social , Confiança , China , Diversidade Cultural , Humanos , Preconceito
13.
Acad Med ; 92(10): 1406, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28952997
15.
Lancet ; 387(10038): 2596-7, 2016 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-27358988

Assuntos
Luto , Memória , Emoções , Humanos
17.
Springerplus ; 5: 384, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27065092

RESUMO

Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders. We conducted separate focus groups with patients, clinicians, and administrators from the psychiatry department at one community hospital and compared responses to hospital policies. Stakeholders defined cultural competence through group-based or person-centered traits despite policies recommended person-centered approaches. Administrators and clinicians named clinician techniques for psycho-education whereas patients named these techniques for enlistment in treatment planning as equals. All groups named patient cultural views and institutional challenges as barriers to care, but only patients and administrators additionally named clinician biases as possible barriers. We discuss these discrepant perceptions and possible solutions to improve research, practice, and policy on cultural competence in mental health.

18.
BMJ Open ; 5(10): e008221, 2015 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-26443652

RESUMO

OBJECTIVE: To better understand the origins, manifestations and current policy responses to patient-physician mistrust in China. DESIGN: Qualitative study using in-depth interviews focused on personal experiences of patient-physician mistrust and trust. SETTING: Guangdong Province, China. PARTICIPANTS: One hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient-physician relationships. RESULTS: One of the most prominent forces driving patient-physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient-physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient-physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient-physician trust. CONCLUSIONS: The blind pursuit of financial profits at a systems level has eroded patient-physician trust in China. Restructuring incentives, reforming medical education and promoting caregiving are pathways towards restoring trust. Assessing and valuing the quality of caregiving is essential for transitioning away from entrenched profit-focused models. Moral, in addition to regulatory and legal, responses are urgently needed to restore trust.


Assuntos
Relações Médico-Paciente , Médicos/legislação & jurisprudência , Preconceito , Pesquisa Qualitativa , Violência/estatística & dados numéricos , China , Feminino , Reforma dos Serviços de Saúde , Humanos , Masculino
19.
Lancet Psychiatry ; 2(9): 844-50, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26236004

RESUMO

The UN Convention on the Rights of Persons with Disabilities (CRPD) is a major milestone in safeguarding the rights of persons with disabilities. However, the General Comment on Article 12 of the CRPD threatens to undermine critical rights for persons with mental disabilities, including the enjoyment of the highest attainable standard of health, access to justice, the right to liberty, and the right to life. Stigma and discrimination might also increase. Much hinges on the Committee on the Rights of Persons with Disabilities' view that all persons have legal capacity at all times irrespective of mental status, and hence involuntary admission and treatment, substitute decision-making, and diversion from the criminal justice system are deemed indefensible. The General Comment requires urgent consideration with the full participation of practitioners and a broad range of user and family groups.


Assuntos
Tomada de Decisões , Pessoas com Deficiência/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Saúde Mental/legislação & jurisprudência , Direitos Humanos , Humanos , Nações Unidas
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