Barriers and Facilitators to Dental Care Services Utilization Among Children With Disabilities: A Systematic Review and Thematic Synthesis.

BACKGROUND: This systematic review investigates barriers and enablers to dental care utilization by disabled children. Given the high global prevalence of disabilities in children, coupled with poor oral hygiene and a 45% rate of dental caries in this group, developing inclusive oral health strategies is critical. The review aims to synthesize literature on factors affecting oral healthcare improvement for disabled children, identifying barriers, facilitators and knowledge gaps. METHODS: The review was conducted following the Joanna Briggs Institute's methods and reported according to PRISMA guidelines. A comprehensive search spanned multiple databases, considering perspectives from carers, parents, dentists and health professionals. The focus was on studies involving children up to age 17 with disabilities, as defined by WHO, using dental care services. Exclusions included non-qualitative studies, populations over 18 and nondisabled children. There were no restrictions on publication date or language. Thematic synthesis of the studies extracted themes related to barriers and enablers in oral healthcare for disabled children. RESULTS: Thematic synthesis identified five overarching themes: stigma, communication issues, professional development, oral health education and medical-dental collaboration. Facilitators included enhancing accessibility and availability of dental care through a holistic approach, improving dental care facility environments and ensuring skilled dental care providers. DISCUSSION: The review underscores the importance of interprofessional collaboration, improved parent/caregiver education and specialized dental facilities to support children with disabilities. It identifies key barriers and facilitators in dental care, including challenging stereotypes, improving communication between providers and parents, enhancing holistic training and addressing gaps in oral health education and integrated healthcare systems. CONCLUSION: Addressing the complex dynamics of dental care for disabled children is essential for developing inclusive and effective preventive and therapeutic strategies. This review highlights the need for tailored approaches and enhanced support systems to improve oral health outcomes in this vulnerable population. PATIENT AND PUBLIC CONTRIBUTION: The members of the family support department, Middle East and North Africa (MENA) Organization for Rare Disease and Disability who provided the disability voice and contributed to providing input to the review protocol.

Focal dystonia in musicians, a literature review.

BACKGROUND: Musician's focal dystonia (mFD) is a rare, neurological, task-specific disorder that mainly affects the upper extremity (especially the hands) and generally appears as a painless muscular incoordination that can mark the end of a musician's professional career. The present literature review intends to highlight the current understanding of musician's focal dystonia, its underlying neural mechanisms and the role of prevention and treatment in physiotherapy, psychotherapy and other fields as occupational therapy. PURPOSE: The aim of the present literature review was to gain an overview of mFD in the medical, psychological and physical therapy literature and investigate what strategies for diagnosis and rehabilitation are available today. STUDY DESIGN: The present article is a literature review, based on the search for full-text publications with the goal of comparing the main strategies for mFD rehabilitation and prevention presented in the literature. METHODS: This literature review compared many relevant papers and studies available in literature today for mFD epidemiology, neural mechanisms, treatment and prevention, to discuss what we know today and highlight the aspects that can still be enhanced in the future. RESULTS: According to our results, current literature gives a good understanding of mFD epidemiology, but further studies are needed to fully comprehend the neurological aspects and develop more rehabilitation strategies, especially in the psychological field. Our research also highlighted the need for a multidisciplinary approach that considers both physical and psychological aspects. CONCLUSIONS: Physical rehabilitation strategies are helpful but, considering the amount of psychological aspects involved in mFD, a holistic approach should be considered and developed in the future. Finally, prevention must have a primary role in mFD treatment, raising awareness around it and, possibly, avoiding its development.

Navigating the holistic conceptualizations of mental health issue in social work: a cross-cultural study of practitioner perspectives.

Holistic approaches, such as the Biopsychosocial model, have become mainstream frameworks for organizing mental health services in recent decades. However, little research has explored how frontline social workers embrace and synthesize the different dimensions within this holistic approach. This paper uses semi-structured interviews to investigate diverse conceptualizations of mental health issues among frontline social workers. Fourteen social workers from Hong Kong and twelve from Sydney were interviewed. Three prevalent positions were identified: prioritizing chemical imbalance, questioning the concept of illness, and refusing a fixed understanding of mental health issues. The analysis also reveals how these understandings influence frontline social work practice, uncovers broader socio-cultural influences through s cross-cultural lens, and highlights implications for social work education for navigating the inclusivity of holistic approaches.

Medication-free mental health treatment: a focus group study of milieu therapeutic settings.

BACKGROUND: Medication-free treatment within mental health care aims to offer therapeutic support as an alternative to psychotropic medication. Introducing milieu therapy for severely mentally ill persons in a medication-free unit requires significant changes to the traditional medication-based psychiatric setting. The present study examines how milieu therapists experience working with medication-free treatment for people with severe mental health challenges. The research question was "What may be required to succeed with medication-free treatment in milieu therapeutic settings?" METHODS: A qualitative study with four focus groups were conducted with 23 milieu therapists from three inpatient units in two mental health institutions. Thematic analysis was performed. RESULTS: One main theme was identified: medication-free treatment involves therapists and patients working together on holistic and personal health promotion. This common thread links the four themes: helping patients to make changes in their life; having time to focus on the individual patient; being a professional companion; and working together as a team with the patient. CONCLUSIONS: A holistic approach is necessary for medication-free treatment to succeed. This requires working together in multidisciplinary teams with a focus on the individual patient. Milieu therapists must engage and take more responsibility in the patient's process of health promotion. A change from a medical to a humanistic paradigm within mental health care is needed.

A Holistic Approach to Physical and Mental Health: Associations Between Chronic Disease and Psychiatric Conditions.

Prior studies suggest that patients with chronic conditions are more likely to develop psychiatric disorders compared to healthy individuals without any medical conditions. The objective of this study was to investigate the link between chronic conditions and psychiatric disorders. The authors hypothesize that patients with chronic conditions have a higher comorbidity of certain psychiatric disorders compared to healthy individuals. Patients from Rowan University School of Osteopathic Medicine (Rowan SOM) Family Medicine offices completed an anonymous survey about medical and psychiatric diagnoses (Appendix 1). Multivariate analysis was used to examine the relationships between patients' rank of control of their chronic medical and psychiatric conditions compared to the age of onset and total number of conditions. One-hundred thirteen study participants reported having at least one chronic condition and seventy-four reported having at least one psychiatric disorder listed on the survey. Among the participants comorbid with both medical and psychiatric conditions, patients' ranking of control of their chronic conditions positively correlated with their ranking of control of their psychiatric disorders (p = 0.009). Patients' ranking of control of their chronic conditions negatively correlated with the total number of psychiatric disorders (p = 0.002). The study did not generate significant evidence to support the original hypothesis. The results highlight a strong relationship between patients' perceived control of their physical health and mental health. The comorbidity of both chronic conditions and psychiatric disorders may present challenges for patients. Utilizing a holistic approach to patient care can help clinicians improve patient outcomes.

The Effects of Cardioprotective Antidiabetic Therapy on Microbiota in Patients with Type 2 Diabetes Mellitus-A Systematic Review.

As the pathophysiologic mechanisms of type 2 diabetes mellitus (T2DM) are discovered, there is a switch from glucocentric to a more comprehensive, patient-centered management. The holistic approach considers the interlink between T2DM and its complications, finding the best therapies for minimizing the cardiovascular (CV) or renal risk and benefitting from the treatment's pleiotropic effects. Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) fit best in the holistic approach because of their effects in reducing the risk of CV events and obtaining better metabolic control. Additionally, research on the SGLT-2i and GLP-1 RA modification of gut microbiota is accumulating. The microbiota plays a significant role in the relation between diet and CV disease because some intestinal bacteria lead to an increase in short-chain fatty acids (SCFA) and consequent positive effects. Thus, our review aims to describe the relation between antidiabetic non-insulin therapy (SGLT-2i and GLP-1 RA) with CV-proven benefits and the gut microbiota in patients with T2DM. We identified five randomized clinical trials including dapagliflozin, empagliflozin, liraglutide, and loxenatide, with different results. There were differences between empagliflozin and metformin regarding the effects on microbiota despite similar glucose control in both study groups. One study demonstrated that liraglutide induced gut microbiota alterations in patients with T2DM treated initially with metformin, but another failed to detect any differences when the same molecule was compared with sitagliptin. The established CV and renal protection that the SGLT-2i and GLP-1 RA exert could be partly due to their action on gut microbiota. The individual and cumulative effects of antidiabetic drugs on gut microbiota need further research.

Task Oriented Training For Stroke Rehabilitation: A Mini Review.

Stroke is the leading global cause of death and disability and the need for stroke rehabilitation services in increasing. The usual stroke rehabilitation protocol involves a combination of therapeutic exercises, occupational therapy, speech therapy and counselling sessions depending upon the severity of the deficit and associated co-morbidities. However, there is a need for better protocols and new therapies for improving outcomes after stroke rehabilitation. The term 'task-oriented training' (TOT) refers to guided rehabilitation training of patients' limb function using goal oriented tasks, which can be used to enhance neuroplasticity in brain after injury. Task oriented training could be modified with action selection and environmental enrichment to fulfill the limitations of stroke like, holistic approach, outcome/goal based intervention, proper dosage for desirable outcomes. This mini review provides an overview of the TOT and to identify gaps and challenges in stroke rehabilitation related to integrating TOT.

Towards a Holistic Model of Care for Moral Injury: An Australian and New Zealand Investigation into the Role of Police Chaplains in Supporting Police Members following exposure to Moral Transgression.

Police members can be exposed to morally transgressive events with potential for lasting psychosocial and spiritual harm. Through interviews with police members and police chaplains across Australia and New Zealand, this qualitative study explores the current role that police chaplains play in supporting members exposed to morally transgressive events. The availability of chaplains across police services and the close alignment between the support they offer, and the support sought by police, indicates they have an important role. However, a holistic approach should also consider organizational factors, the role of leaders, and access to evidence-based treatment in collaboration with mental health practitioners.

Holistic management of hepatocellular carcinoma: The hepatologist's comprehensive playbook.

Hepatocellular carcinoma (HCC) is a common complication in patients with chronic liver disease and leads to significant morbidity and mortality. Liver disease and liver cancer are preventable by mitigating and managing common risk factors, including chronic hepatitis B and C infection, alcohol use, diabetes, obesity and other components of the metabolic syndrome. The management of patients with HCC requires treatment of the malignancy and adequate control of the underlying liver disease, as preserving liver function is critical for successful cancer treatment and may have a relevant prognostic role independent of HCC management. Hepatologists are the ideal providers to guide the care of patients with HCC as they are trained to identify patients at risk, apply appropriate surveillance strategies, assess and improve residual liver function, evaluate candidacy for transplant, provide longitudinal care to optimize and preserve liver function during and after HCC treatment, survey for cancer recurrence and manage its risk factors, and prevent and treat decompensating events. We highlight the need for a team-based holistic approach to the patient with liver disease and HCC and identify necessary gaps in current care and knowledge.

[Precision medicine in oncology : where do we stand ?] / Médecine de précision en oncologie : où en sommes-nous ?

The «one size fits all¼ approach is seriously challenged by rapid progression of medical knowledge, especially in the field of individual genome expression. It is currently known that the anti-tumour effect of a given treatment and possible side effects at the level of healthy tissues, can at least partly be predicted and explained by individual variations of gene expression. However, most of us realize that these differences in response are also linked to a variety of other individual characteristics, such as for example the environment and socio-economic factors. Without any possible doubt, there are multiple problems (technical, administrative, financial, cultural and ethical) to be solved, before we witness the real irruption of precision medicine and its holistic individualized approach in our daily oncological practice. It has to start with an international effort, disregarding borders of individual countries, in order to obtain very large amounts of data (with a high degree of variability to avoid bias). This holistic approach, at both societal and individual levels, is the entrance door for a personalized approach in care, whether this is curative, predictive or preventive.

Le concept du traitement «taille unique¼ est sérieusement remis en question par la progression accélérée des connaissances du rôle prédictif du génome individuel, tant en matière de la réponse tumorale à un traitement, qu'en ce qui concerne l'apparition d'effets secondaires au niveau des tissus sains. Cette réponse au traitement ne dépend pas simplement de l'expression de quelques gènes, ni d'ailleurs du génome individuel entier. Elle est également influencée par une multitude d'autres facteurs, ce qui requiert une approche holistique prenant en compte, par exemple, l'environnement et les facteurs socio-économiques. Il y a indubitablement des problèmes techniques, administratifs, financiers, culturels et éthiques (protection de la vie privée) à surmonter avant que cette médecine de précision ne soit largement disponible en pratique oncologique journalière. Il faut surtout une collaboration allant largement au-delà des frontières géographiques d'un pays, afin d'assurer une manne suffisante et très variable de données, pour éliminer autant que possible les différents biais. Cette approche holistique, tant au niveau sociétal qu'individuel, ouvre la porte à la personnalisation des soins oncologiques dans le domaine curatif, prédictif et préventif.

Holistic Approach in Patients With Presumed Lyme Borreliosis Leads to Less Than 10% of Confirmation and More Than 80% of Antibiotic Failures.

BACKGROUND: There is no precise idea whether patients with chronic symptoms attributed to Lyme borreliosis (LB) have LB or another disease. METHODS: We evaluated patients consulting for a presumed LB with a holistic approach including presumptive treatment. We included symptomatic patients consulting for presumed LB. They were classified as confirmed LB when they met four criteria, and possible LB if three with a positive clinical response to presumptive treatment. RESULTS: Amongst the 301 patients, 275 (91%) were exposed to tick bites, and 165 (54%) were bitten by a tick. At presentation, 151 patients (50.1%) had already been treated with a median of one (1-22) course of antimicrobials, during 34 (28-730) days. Median number of symptoms was three (1-12) with a median duration of 16 (1-68) months. Median number of signs was zero (0-2). ELISA was positive in 84/295 (28.4%) for IgM and 86/295 (29.1%) for IgG, and immunoblot was positive in 21/191 (10.9%) for IgM and 50/191 (26.1 %) for IgG. Presumptive treatment after presentation failed in 46/88 patients (52%). Diagnosis of LB was confirmed in 29 patients (9.6%), and possible in 9 (2.9%). Of the 243 patients with non-LB diagnosis, diseases were psychological, musculoskeletal, neurological or other origin in 76 (31.2%), 48 (19.7%), 37 (15.2%) and 82 (33.7%) patients respectively. Patients with other diseases were significantly younger, having more symptoms, longest duration of symptoms, less clinical signs and less frequent LB positive serologies. CONCLUSIONS: Overdiagnosis and overtreatment of LB is worsening. Health authorities should investigate this phenomenon.

Caring science research in the ambulance services: an integrative systematic review.

BACKGROUND: The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings. AIM: This integrative systematic review aims to describe caring science research content and scope in the ambulance services. DATA SOURCES: Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156. REVIEW METHODS: The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five-stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3-level scale, and data relevance was evaluated on a 2-level scale. RESULTS: After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision-making; Public environment and patient safety; Life-changing situations; and Ethics and values. CONCLUSION: Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional-patient relation, with special focus on value conflicts in emergency situations.

A comprehensive optimum integrated water resources management approach for multidisciplinary water resources management problems.

A holistic Integrated Water Resources Management (IWRM) model can be difficult to implement and the associated high-dimension optimization problems' complexity often forces the decision makers to downscale such problems. These challenges however have motivated this research to develop a comprehensive Optimum IWRM approach (OP-IWRM) using a many-objective optimization algorithm to solve complex and large-scale problems. The approach employs the social, economic, and environmental objectives; ground and surface water resources; and water infrastructure for river basin management to: (1) improve the relevant revenues, (2) enhance community welfare, and (3) pave the road for the decision makers to set better investment policy. The results demonstrate comprehensive improvement of all considered targets. The decision makers may reconsider implementing complex integrated water resources management of large-scale regions. The OP-IWRM may extend for country-scale approach as a pathway towards a national sustainable development plan. The large-scale Diyala river basin, Iraq, was adopted to evaluate the approach using seventeen objectives and more than 1500 decision variables.

[Development through encounter-Kurt Goldstein's contributions to psychotherapy]. / Entwicklung durch Begegnung ­ Kurt Goldsteins Beiträge zur Psychotherapie.

The life and works of neurologist and psychiatrist Kurt Goldstein (1878-1965) were almost forgotten for decades but have aroused increasing interest in recent years. Studies on Goldstein generally focus on his groundbreaking contributions to a holistic neurology, neuropsychology and neurorehabilitation; however, his contributions to the development of psychotherapy have received less attention. The present article reviews Goldstein's substantial input to the development of psychotherapy, and especially of humanistic psychotherapies. It is further shown how these contributions are rooted in Goldstein's observations on brain-damaged World War I veterans. From these observations Goldstein derived a holistic view of the organism as a system that embodies and constantly re-establishes an identity, thereby also defining the meaning of anxiety for human existence and drawing conclusions for the therapeutic relationship. It can therefore be argued that brain research impinged on the development of psychotherapy at an early stage, even though its research paradigm differed profoundly from that of present day reductionism.

Holistic management of malignant wounds in palliative patients.

Malignant wounds are a complication of cancer, and usually occur in those individuals with advanced disease. When healing ceases to be the goal, treatment is centred around symptom control and improving quality of life. Caring for individuals with malignant wounds presents challenges for patients, their families and nurses alike. This article discusses the holistic management of malignant wounds, with an emphasis on the control of both physical and psychosocial symptoms of wound management, as well as the impact that this may have on all those involved. Common physical symptoms of malignant wounds include malodour, bleeding, pain, exudate and pruritis. Psychosocial symptoms may result in social isolation and depression. All these symptoms have a huge impact, not only on patients and their families, but also on healthcare professionals both during and after care. Managing these symptoms requires a multidisciplinary approach to facilitate the best possible outcomes for patients and their caregivers.

Defining interdisciplinary competencies for audiological rehabilitation: findings from a modified Delphi study.

OBJECTIVES: The aim of this study is to derive a consensus on an interdisciplinary competency framework regarding a holistic approach for audiological rehabilitation (AR), which includes disciplines from medicine, engineering, social sciences and humanities. DESIGN: We employed a modified Delphi method. In the first round survey, experts were asked to rate an initial list of 28 generic interdisciplinary competencies and to propose specific knowledge areas for AR. In the second round, experts were asked to reconsider their answers in light of the group answers of the first round. STUDY SAMPLE: An international panel of 27 experts from different disciplines in AR completed the first round. Twenty-two of them completed the second round. RESULTS: We developed a competency framework consisting of 21 generic interdisciplinary competencies grouped in five domains and nine specific competencies (knowledge areas) in three clusters. Suggestions for the implementation of the generic competencies in interdisciplinary programmes were identified. CONCLUSIONS: This study reveals insights into the interdisciplinary competencies that are unique for AR. The framework will be useful for educators in developing interdisciplinary programmes as well as for professionals in considering their lifelong training needs in AR.

[Psoriasis in 2016 : Co-morbidities and therapeutic update]. / Psoriasis en 2016 : Co-morbidités et nouveautés thérapeutiques.

Recognition of psoriasis as a chronic systemic inflammatory condition rather than just a skin disease is now widely accepted in the medical community. Association with joint involvement and depressive symptoms has been established for many years and several studies demonstrated an increased risk for comorbidities. These include the metabolic syndrome, obesity, hypertension, diabetes, dyslipidemia, non-alcoholic fatty liver disease, inflammatory bowel disease, and an increased incidence of cardiovascular events among those patients.

La reconnaissance du psoriasis comme un état inflammatoire systémique chronique plutôt qu'une simple maladie de la peau est actuellement largement admise dans la communauté médicale. A côté de l'atteinte articulaire et des symptômes dépressifs connus de longue date, de nombreuses études établissent un risque accru de comorbidités. Celles-ci incluent le syndrome métabolique, l'obésité, l'hypertension artérielle, le diabète, les dyslipidémies, la stéatose hépatique non alcoolique, les maladies inflammatoires du tube digestif et une survenue plus importante chez ces patients de maladies cardiovasculaires.

[Dehumanizacja wspólczesnej medycyny: przyczyny i przeciwdzialanie].

A discussion of causes of dehumanisation in contemporary medicine and possible methods of preventing this situation. The causes can be divided into external, associated with the influence of the environment of civilisation, and internal, which constitute a form of aunwanted side effects" of the rapid progress of civilisation. The latter include reductionist thinking and axiological neutrality typical of natural sciences, increased import_ance of technology, and excessive specialisation combined with poor coordination of diagnostic work-up and treatment or the lack of such coordination. Possible preventive measures include a change in the model of medical education, consisting for instance in the inclusion of humanistic elements and a more holistic view of the patient, as well as a change in the health care model so that the diagnostic work-up and treatment would be coordinated mainly by the primary health care doctor.

Combining Sustainable Land Management Technologies to Combat Land Degradation and Improve Rural Livelihoods in Semi-arid Lands in Kenya.

Drylands occupy more than 80% of Kenya's total land mass and contribute immensely to the national economy and society through agriculture, livestock production, tourism, and wild product harvesting. Dryland ecosystems are areas of high climate variability making them vulnerable to the threats of land degradation. Consequently, agropastoralists inhabiting these ecosystems develop mechanisms and technologies to cope with the impacts of climate variability. This study is aimed to; (1) determine what agropastoralists inhabiting a semi-arid ecosystem in Kenya attribute to be the causes and indicators of land degradation, (2) document sustainable land management (SLM) technologies being undertaken to combat land degradation, and (3) identify the factors that influence the choice of these SLM technologies. Vegetation change from preferred indigenous forage grass species to woody vegetation was cited as the main indicator of land degradation. Land degradation was attributed to recurrent droughts and low amounts of rainfall, overgrazing, and unsustainable harvesting of trees for fuelwood production. However, despite the challenges posed by climate variability and recurrent droughts, the local community is engaging in simple SLM technologies including grass reseeding, rainwater harvesting and soil conservation, and dryland agroforestry as a holistic approach combating land degradation and improving their rural livelihoods. The choice of these SLM technologies was mainly driven by their additional benefits to combating land degradation. In conclusion, promoting such simple SLM technologies can help reverse the land degradation trend, improve agricultural production, food security including access to food, and subsequently improve livelihoods of communities inhabiting dryland ecosystems.

[Geriatric multimorbidity--one of the key problem of contemporary medicine]. / Geriatrická multimorbidita--jeden z klícových problému soucasné medicíny.

In the elderly population there are common permanent decrease of functional capacity, gradual emergence of various diseases leading to the wider multimorbidity and increased problems in the social sphere, which can develop frailty and social dependency. The paper analyzes the complex issue of geriatric multimorbidity and emphasizes its pitfalls, the need of an interdisciplinary approach and thinking of doctors, including the risks of modern pharmacotherapy. The aim of geriatric medicine is to optimize residual functions despite the decline in total functional capacity with increasing multimorbidity. The authors want to direct the attention of the professional community to the permanently growing numbers of the elderly and to emphasize the need of awareness of the problem so that they could understand and cope with this absolutely new reality.