ABSTRACT
We have previously proposed a list of determinants (causes) of modern lifestyle-related chronic disorders, which provides a structure for the emerging discipline of lifestyle medicine. This consists of lifestyle factors with a common immune biomarker (metaflammation) that interact in a systems fashion linked with chronic disease outcomes. We considered this to be a work in progress and later added 3 psychosocial determinants into the causal mix: meaninglessness, alienation, and loss of culture and identity (MAL). Here, we propose adverse childhood experiences (ACEs) as deeper, or even more distal, disease drivers that may act directly or indirectly through MAL to influence later chronic disease. The links with metaflammation and the need for recognition of these embedded scars in the management of lifestyle-related health problems is discussed.
ABSTRACT
We have previously identified a number of "determinants" of chronic disease, using the acronym NASTIE ODOURS. These have been given the collective term "anthropogens," in this journal and other publications, to help direct the management of modern chronic ailments to a monocausal focus, akin to that afforded infectious diseases by the "germ theory." We suggested the acronym NASTIE ODOURS as a starting point for a taxonomy of lifestyle medicine determinants. In the current article, we add 3, less quantifiable, but currently increasingly more important psychosocial experiences to these: Lack of Meaning, Alienation, and Loss of culture, changing the previous acronym to NASTIE MAL ODOURS. As with other determinants, all have accumulating evidence of an underlying low-grade, systemic, inflammatory physiological base ("metaflammation"), but with the need for further research to solidify these findings.
Subject(s)
Cultural Competency , Health Services, Indigenous , Native Hawaiian or Other Pacific Islander/ethnology , Obesity , Weight Reduction Programs/methods , Humans , Melanesia/ethnology , Obesity/economics , Obesity/ethnology , Obesity/therapy , Overweight/economics , Overweight/ethnology , Overweight/therapyABSTRACT
BACKGROUND: In 2013, the Australasian Society of Lifestyle Medicine (ASLM) introduced shared medical appointments (SMAs) for managing chronic disease in clinical practice. The popularity of SMAs has increased with the shift towards a Health Care Homes model. Programmed shared medical appointments (PSMAs) are an extension of the standard SMA model, designed to help manage more complex and specific chronic disease issues. OBJECTIVE: The objective of this article is to describe the process of PSMAs and consider their use in primary care. DISCUSSION: PSMAs combine sequential medical consultations with peer support and interaction in a semi-structured group education arrangement. SMAs and PSMAs are ideally suited to the Health Care Homes model of clinical care currently proposed by the federal Department of Health. Proof of concept is currently being tested for PSMAs. Conditions suitable for future trials include overweight and obesity, diabetes (including pre-diabetes), cardiovascular diseases, chronic kidney disease, chronic obstructive pulmonary disease or emphysema, chronic pain or arthritis, mild anxiety or depression, perisurgical management and cancer survival.
Subject(s)
Appointments and Schedules , Chronic Disease/therapy , Primary Health Care/methods , Body Weight Maintenance , Disease Management , Humans , Interdisciplinary Placement , Patient Acceptance of Health Care/psychology , Primary Health Care/organization & administrationABSTRACT
BACKGROUND: Aboriginal and Torres Strait Islander health is generally the worst of any population group in Australia. Inaccessibility to health services is one possible cause of this. Shared medical appointments (SMAs) appear to be a culturally competent and appropriate way of improving access to, and the quality of, primary healthcare services for Aboriginal and Torres Strait Islander peoples. OBJECTIVE: The objective of this article is to assess the acceptability and appropriateness of SMAs as an adjunct process in primary care for Aboriginal and Torres Strait Islander men. METHODS: As part of a broader study on SMAs, three SMA sessions were delivered at an Aboriginal men's health centre in northern New South Wales. One-day training sessions in SMA facilitation were also provided to two groups of 12-14 Aboriginal health workers (AHWs). Mixed methods were used to assess patient and provider satisfaction, subjective outcomes, and operational procedures in the SMA groups, as well as interest in the SMA process by AHWs. RESULTS: Satisfaction with SMAs among Aboriginal men was unanimously positive, with the numbers in the group increasing over time. Patients most enjoyed the 'yarn up' nature of SMAs with peer support, which reduced the 'scary' and culturally 'unnatural' nature of one-on-one consultations with a general practitioner (GP). AHWs who were trained to a level to conduct SMAs saw this as an effective way of improving cultural competence in, and accessibility of, their various Aboriginal health services. DISCUSSION: The results, though not generalisable, suggest that SMAs may offer a culturally safe and appropriate tool to enhance Aboriginal and Torres Strait Islander peoples' access to primary care.
