Self-care Health Research Articles

Introducing peer worker roles into UK mental health service teams: a qualitative analysis of the organisational benefits and challenges

BackgroundThe provision of peer support as a component of mental health care, including the employment of Peer Workers (consumer-providers) by mental health service organisations, is increasingly common internationally. Peer support is strongly advocated as a strategy in a number of UK health and social care policies. Approaches to employing Peer Workers are proliferating. There is evidence to suggest that Peer Worker-based interventions reduce psychiatric inpatient admission and increase service user (consumer) empowerment. In this paper we seek to address a gap in the empirical literature in understanding the organisational challenges and benefits of introducing Peer Worker roles into mental health service teams.MethodsWe report the secondary analysis of qualitative interview data from service users, Peer Workers, non-peer staff and managers of three innovative interventions in a study about mental health self-care. Relevant data was extracted from interviews with 41 participants and subjected to analysis using Grounded Theory techniques. Organisational research literature on role adoption framed the analysis.ResultsPeer Workers were highly valued by mental health teams and service users. Non-peer team members and managers worked hard to introduce Peer Workers into teams. Our cases were projects in development and there was learning from the evolutionary process: in the absence of formal recruitment processes for Peer Workers, differences in expectations of the Peer Worker role can emerge at the selection stage; flexible working arrangements for Peer Workers can have the unintended effect of perpetuating hierarchies within teams; the maintenance of protective practice boundaries through supervision and training can militate against the emergence of a distinctive body of peer practice; lack of consensus around what constitutes peer practice can result in feelings for Peer Workers of inequality, disempowerment, uncertainty about identity and of being under-supported.ConclusionsThis research is indicative of potential benefits for mental health service teams of introducing Peer Worker roles. Analysis also suggests that if the emergence of a distinctive body of peer practice is not adequately considered and supported, as integral to the development of new Peer Worker roles, there is a risk that the potential impact of any emerging role will be constrained and diluted.

Study on the correlation between self-care ability and health behavior in gynecologic patients receiving chemotherapy

Objective To discuss the status of self-care ability and health behavior in gynecologic patients receiving chemotherapy,and analyze their correlation.Methods ESCA and HPL were used to investigate 90 cases of gynecologic patients receiving chemotherapy and analyze the correlation.Results The score of self-care ability was (112.17 ± 17.46),health behavior was (123.21 ± 20.23),and there was a positive correlation between the self-care ability and health behavior in gynecologic patients receiving chemotherapy (r =0.275-0.705,P ＜ 0.05).Conclusions Nurses should take effective nursing measures to improve self-care ability of gynecologic patients receiving chemotherapy,so as to promote them take health behaviors to reduce tumor recurrence and improve cancer survivors' quality of life. Key words: Genitalis tumor, female; Health behavior; Self-care ability ; Chemotherapy ; Correlation research

The effect of Orem self-care model and health education on the quality of life of patients with glaucoma surgery

Objective To explore the application effect of health education and Orem self-care model in improving the quality of life of patients with glaucoma surgery.Methods A total of 40 patients with glaucoma surgery were randomly divided into control group and observation group with 20 patients in each.Control group adopted routine nursing,the observation group receiced health education and the Orem care system.Quality of life indicators were used to survey two groups of patients with the quality of life after 1 week and half a year.Results Two groups of patients after 1 week when the quality of life of patients with no significant difference (P ＞ 0.05).But six months after discharge when the patient's quality of life study group was significantly higher (P ＜ 0.05).Conclusions Health education and the use of Orem self-care model can significantly improve the quality of life of patients with glaucoma surgery. Key words: Health education; Orem self-care model; Glaucoma surgery; Quality of life

Effect of intervention integrated nursing care to quality of life of coronary heart disease patients

Objective To discuss the effect of intervention integrated nursing care to quality of life (QOL)of coronary heart disease patients.Methods 100 patients with coronary hean disease were randomly divided into observation group and control group with 50 cases for each group.control group was only given heart routine nursing,on the basis of conventional nursing care,the observation group was given intervention integrated nursing care including psychological,diet,medication,the vital signs detection.life health guidance education.and so on,using the U.S.institute of medicine development of QOL scale for assessment,and the QOL was better with higher score,we compared the QOL hetween two groups.Results All the scores of observation group patients were significantly higher than those in the control group.showing significantly highPr statistical differenee (P＜0.05).Conclusion Coronary heart disease patients using implement of intervention integrated nursing care can improve their QOL and rlerraase the.recurrenre rate,reduce the numher of hospital stay.strengthen self-health care and lighten the social and familv burdPn.which is worth for spreading application. Key words: Coronary heart disease; Intervention integrated care; Quality of life(QOL)

Self care under the perception of the mental health nursing professionals

This qualitative research aimed at understanding the self care of the mental health nursing professionals. Ten nursing professionals of the mental health team of a psychiatric unit of a university hospital in the State of Rio Grande do Sul, Brazil, were interviewed from September to December 2010. The research data were collected through interviews and analyzed based on the referential phenomenology. The research result unveiled these categories: situations experienced in the encounter with the other and the possibilities of self-care in mental health. We conclude that self-care starts from the perception of the intersubjective encounter as a way to build relationships and human interactions which are more sensitive and open to dialogue with one another.

SMCa: Sistema de Monitoreo Móvil Cardiaco

Las enfermedades cardiovasculares siguen siendo una de las principales causas de muerte en el mundo. Son numerosas las campañas de prevención, especialmente las soportadas en una alimentación saludable, en un ambiente confortable y en frecuente actividad física, como lo recomienda la Organización Mundial de Salud en su informe de Marzo del 2013. Así, gran parte de la responsabilidad recae en el autocuidado. En Colombia, especialmente desde el año 2008 se ha informado de este problema de salud pública a través de diferentes medios de comunicación visual, escrita y multimedial. El grupo de investigación en telemedicina de la Universidad Militar Nueva Granada, viene desarrollando aplicaciones que promuevan el uso de las tecnologías de la información y comunicación en el autocuidado de la salud. En este trabajo se presenta una aplicación para dispositivos móviles sobre SO Android v.4 llamada SMCa que permite medir, registrar y comunicar los datos de frecuencia cardiaca de un usuario. Para validarlo, se seleccionan tres grupos cada uno de cinco voluntarios diferenciados por su índice de masa corporal (imc): el primer grupo normal con imc menor a 25, el segundo un grupo con sobrepeso con imc entre 25.1 y 30 y el tercero un grupo con obesidad con imc mayor a 30. El protocolo experimental fue dividido en estadios de una hora cada uno: un estadio fue desarrollado en un ambiente de gym, otro en aula de clase y el último en casa. Los resultados obtenidos permiten validar dos aspectos importantes del uso de la TIC en salud, el primero se refiere al soporte de resultados desde una base experimental científica dada por una alta correlación en los datos, obtenida durante las pruebas en gym de r=0.91 (p<0.05), en clase r=0.95 (p<0.05) y de r=0.92 (p<0.05); la segunda por nivel de aceptabilidad del sistema por los usuarios, causado por el buen confort y facilidad de uso de la aplicación.

Stress and Health Habits in College Students

Research has demonstrated that college students experience stress from sources such as poor self-care habits, educational demands, daily hassles, and perceived control over situations. The present study examined perceived stress, health habits, and daily hassles and uplifts among 135 college freshmen. We hypothesized that students with lower stress levels would be male, would have better self-care health habits, would experience fewer minor medical health issues, would have higher academic performance, and would experience fewer daily hassles and more daily uplifts than students who experienced high perceived stress. Strong support was obtained for the hypothesis that students with low perceived stress had better health habits. Students with low perceived stress also experienced significantly fewer hassles and more uplifts per month. There were no significant effects of perceived stress on grade point average or minor medical issues, and there were no significant gender differences in levels of stress. The results could help college freshmen adjust to challenges of college by helping them understand some of the effects of stress and benefits of reducing that stress.

Self-care in oral health in the third age: report of an elderly group

Self-care in oral health in the third age: report of an elderly group

Informing the development of services supporting self-care for severe, long term mental health conditions: a mixed method study of community based mental health initiatives in England.

BackgroundSupporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems.MethodsA mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together.ResultsParticipants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health.ConclusionsService delivery components – e.g. peer support groups, personal planning – advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings.

Vulnerability and the Psychosocial Aspects of Tooth Loss in Old Age: A Southern Brazilian Study

Extensive tooth loss and edentulism can have a negative impact on the general health and quality of life of older adults. The extent to which psychological and social factors affect an individual's decision to undergo tooth extraction and mouth clearance (extraction of all teeth), and the theoretical relationships between social structure, social life and oral health can be unraveled through qualitative research. This study aimed to explore the social and psychological factors involved in tooth extraction and mouth clearance within a historical perspective among rural Southern Brazilian older adults. It is based on qualitative data gathered via a series of eight focus groups among 41 older adults. Underlying the focus group discussions of different levels of health risks and resources for prevention of disease was the concept of vulnerability. Participants' responses illustrated that tooth loss and mouth clearance were related to a lack of public dental health policies and programs, were influenced by social norms (including values pertaining to gender), and were associated with a low level of oral health knowledge. The social and program-dependent contexts of vulnerability were shown to have played a major role in the development of norms and values towards tooth extraction and mouth clearance. Vulnerability must be reduced in order to prevent disease particularly among rural populations. The influence of fatalistic beliefs about the inevitable loss of teeth with age may negatively influence the acceptance of dental treatment and predilection for oral health self-care.

Experiencia de transferencia tecnológica de la Consejería Telefónica para Cuidados Crónicos de Salud, a equipos de Atención Primaria

The technology transfer process requires training future users in specific knowledge and skills, as well as performing administrative adjustments for an effective incorporation of innovation into the structure of the system and into the professional care. Pontificia Universidad Catolica de Chile's School of Nursing developed a model of Technological Support for Health Self-Care, which includes the use of telephone counseling to help people who suffer from chronic diseases manage their condition and look after themselves by teaching them techniques which alleviate their disease. Here, we present an experience that was carried out to transfer this technology to professionals related to the Cardiovascular Health Program in Chilean Public Primary Healthcare Centers located in a low-income district of Chile's capital city, Santiago, so that the technology could be applied to patients with type 2 diabetes who had joined such program. This process was conducted in two stages: 1. Making of a theoretical-practical workshop to support health decision-making and motivational strategies for health behavior change (workshops and demonstrations); and 2. Field demonstration, and monitoring with supervision and meetings at local level. The professionals who participated in the technology transfer program succeeded in developing the skills expected in the Telephone Counseling Tool to Support Self-Management of People suffering from DM2. Finally, to enable telephone counseling in clinical practice, healthcare centers restructured their system of service provisions, incorporating such counseling into their professional duties.

Experiencia de transferencia tecnológica de la Consejería Telefónica para Cuidados Crónicos de Salud, a equipos de Atención Primaria.

The technology transfer process requires training future users in specific knowledge and skills, as well as performing administrative adjustments for an effective incorporation of innovation into the structure of the system and into the professional care. Pontificia Universidad Católica de Chile's School of Nursing developed a model of Technological Support for Health Self-Care, which includes the use of telephone counseling to help people who suffer from chronic diseases manage their condition and look after themselves by teaching them techniques which alleviate their disease. Here, we present an experience that was carried out to transfer this technology to professionals related to the Cardiovascular Health Program in Chilean Public Primary Healthcare Centers located in a low-income district of Chile's capital city, Santiago, so that the technology could be applied to patients with type 2 diabetes who had joined such program. This process was conducted in two stages: 1. Making of a theoretical-practical workshop to support health decision-making and motivational strategies for health behavior change (workshops and demonstrations); and 2. Field demonstration, and monitoring with supervision and meetings at local level. The professionals who participated in the technology transfer program succeeded in developing the skills expected in the Telephone Counseling Tool to Support Self-Management of People suffering from DM2. Finally, to enable telephone counseling in clinical practice, healthcare centers restructured their system of service provisions, incorporating such counseling into their professional duties.

Impacto de una intervención educativa PREVENIMSS en el estilo de vida en hombres de 20 a 59 años

<span style="font-family: Garamond; font-size: x-small;"><p><strong><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Objetivo: </span></strong><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">evaluar el impacto de una intervención educativa del programa PREVENIMSS en el estilo de vida y nivel de conocimientos sobre el autocuidado de la salud en hombres de 20 a 59 años. <strong>Material y métodos: </strong>investigación cuasi-experimental. Se incluyeron 15 hombres de 20 a 59 años que firmaron consentimiento informado. Se diseñó una estrategia educativa previa identificación del estilo de aprendizaje que incluyó: 24 sesiones, dos días por semana durante tres meses. El nivel de conocimientos de la guía PREVENIMSS se evaluó mediante un instrumento elaborado y validado exprofeso. El estilo de vida se valoró mediante el instrumento Perfil de Estilo de Vida Promotor de Salud II (PEPS II). Los datos se analizaron con t de Student para muestras relacionadas, se consideró significancia estadística p< de 0.05. <strong>Resultados:</strong> el estilo de aprendizaje fue reflexivo; y el nivel de conocimiento significativo en todos los dominios, el mayor conocimiento se presentó en salud sexual y reproductiva. En el estilo de vida se observaron cambios significativos en todos los dominios: responsabilidad en salud 19.86 ± 1.27 a 25.53 ± 0.87; actividad física 14.53 ± 0.95 a 20.66 ± 0.65; nutrición 20.20 ± 1.26 a 25.33 ± 0.80, desarrollo espiritual 24.93 ± 1.25 a 27.93 ± 0.90, relaciones interpersonales de 22.86 ± 1.39 a 27.20 ± 0.90 y manejo de estrés 16.73 ± 0.95 a 21.46 ± 0.73. <strong>Conclusiones: </strong>una educación en salud, basada en </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-fareast-language: EN-US; mso-ansi-language: ES; mso-bidi-language: AR-SA;">el estilo de aprendizaje de los educandos, modifica el estilo de vida.</span></p></span>

An oral health literacy intervention for Indigenous adults in a rural setting in Australia.

BackgroundIndigenous Australians suffer substantially poorer oral health than their non-Indigenous counterparts and new approaches are needed to address these disparities. Previous work in Port Augusta, South Australia, a regional town with a large Indigenous community, revealed associations between low oral health literacy scores and self-reported oral health outcomes. This study aims to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care and oral health- related self-efficacy.Methods/designThis is a randomised controlled trial (RCT) that utilises a delayed intervention design. Participants are Indigenous adults, aged 18 years and older, who plan to reside in Port Augusta or a nearby community for the next two years. The intervention group will receive the intervention from the outset of the study while the control group will be offered the intervention 12 months following their enrolment in the study. The intervention consists of a series of five culturally sensitive, oral health education workshops delivered over a 12 month period by Indigenous project officers. Workshops consist of presentations, hands-on activities, interactive displays, group discussions and role plays. The themes addressed in the workshops are underpinned by oral health literacy concepts, and incorporate oral health-related self-efficacy, oral health-related fatalism, oral health knowledge, access to dental care and rights and entitlements as a patient. Data will be collected through a self-report questionnaire at baseline, at 12 months and at 24 months. The primary outcome measure is oral health literacy. Secondary outcome measures include oral health knowledge, oral health self-care, use of dental services, oral health-related self-efficacy and oral health-related fatalism.DiscussionThis study uses a functional, context-specific oral health literacy intervention to improve oral health literacy-related outcomes amongst rural-dwelling Indigenous adults. Outcomes of this study will have implications for policy and planning by providing evidence for the effectiveness of such interventions as well as provide a model for working with Indigenous communities.

Abstract 95: Formative Evaluation of the New Standardized Disease Management Protocol for Heart Failure: CHF QUERI

Formative Evaluation of the New Standardized Disease Management Protocol for Heart Failure: CHF QUERI Objectives: The U.S. Department of Veterans Affairs (VA) has been a leader in the use of telemedicine to monitor patients’ health status and self-care using Disease Management Protocols (DMPs) with 35,406 veterans enrolled in home-telehealth in fiscal year 2008. Such protocols have the potential to improve detection of disease exacerbation and to reduce duplication in healthcare resource use. Current technologies include in-home devices from four vendors at all VA facilities that ask the patient several daily questions regarding symptoms and vital signs. Based on the VA Office of Care Coordination’s strong desire for standardizing the type and number of questions asked of the heart failure patients, the VA Chronic Heart Failure (CHF) QUERI developed a standardized DMP for heart failure. After beta-testing it is being implemented by all 4 vendors at all VA facilities. We conducted a formative evaluation of this newly implemented DMP focusing on the frequency and type of patient and provider complaints regarding the new DMP. Method: A structured qualitative process was used to gather the data at 2 VA facilities. Using interview guides in-person semi-structured interviews were conducted with heart failure patients (n=41) currently enrolled in home-monitoring using the new DMP for heart failure. Simultaneously, data were also gathered from providers (telehealth coordinators, n=8) using the new DMP. All data were transcribed. A reflective exploration method was adopted to analyze the qualitative data. Quantitative data analyses relied on descriptive statistics. Results: Patients using the new DMP provided very positive feedback. Half of the patients reported being satisfied with the DMP. On most days 46% (n=19) patients spent 4-5 minutes responding to all questions and 85% responded at least 5 times a week to the questions asked by the device. Almost 100% of them found the questions and answer choices asked by the device easy to understand. These patients also found the questions helpful and relevant for their health condition and based on device 90% knew who to contact if their health condition worsened. Among the providers majority (75%) said the questions were good for screening and based on the questions patients knew who to contact if their health condition were to worsen. Most of them (84%) said their patients didn’t report having problems understanding the questions and choosing appropriate answers. They also said at least 75% of the patients responded to questions at least 5 times a week. Conclusions: These positive results from the formative evaluation of the new DMP for heart failure demonstrate that is a good standardized DMP which will yield good results to track the health of the heart failure patients. Implications: Formative evaluation is an essential component in the implementation of new protocols to relevance, feasibility and sustainability of program use.

Abstract 58: Health Literacy Influences Knowledge Attainment but not Self-Care or Self-Efficacy Longitudinally in Heart Failure Patients

Introduction: Inadequate health literacy may be a barrier during traditional clinic-based heart failure (HF) education. The influence of health literacy on gains over time in knowledge, self-efficacy and self-care is unknown. The purpose of this study was to examine health literacy, knowledge, self-efficacy, and self-care longitudinally in HF. Hypotheses: Patient health literacy level will be associated with differential gains in knowledge, self-efficacy, and self-care after completion of traditional clinic-based education. Methods: First-time patients at 3 HF clinics (N=51, age: 64.7±13.04 years) completed assessments of health literacy (Short-Form Test of Functional Health Literacy in Adults), knowledge (HF Knowledge Questionnaire), and self-care/self-efficacy (Self-Care of HF Index v.6) prior to HF education (baseline), 2 months (education completion), and 4 months post-baseline. Repeated measures Analysis of Variance was used to analyze longitudinal associations, and post-hoc tests with Bonferroni-adjusted alpha-levels were used for comparison. Results: Higher health literacy was associated with greater HF knowledge at 2 and 4 months (p<0.001), but there were no associations between health literacy and self-care or self-efficacy. In post-hoc analyses (Figure 1), patients with inadequate health literacy had less knowledge than those with marginal (p=0.024) or adequate (p<0.001) health literacy at 2 months. At 4 months, patients with inadequate health literacy continued to have less knowledge compared to adequate (p<0.001). Conclusions: Health literacy level is associated with attaining and retaining HF knowledge; however, it is not associated with self-care confidence or adherence. Tailoring HF education to health literacy level may aid in grasping concepts taught. It is unknown if a better grasp of concepts would enhance self-care adherence and promote improved health. Future research is needed to more fully understand the consequences of inadequate health literacy on self-care.

Mental health and patterns of work-related coping behaviour in a German sample of student teachers: a cross-sectional study

The aim of this cross-sectional study was to evaluate the mental health of student teachers, to analyse the extent to which they feel prepared for their profession by the university curriculum and to investigate patterns of coping with occupational stress. A sample of 481 German student teachers was investigated using two standardised instruments: GHQ-12 (General Health Questionnaire) and AVEM (Arbeitsbezogenes Verhaltens- und Erlebensmuster), an occupational stress and coping questionnaire describing four patterns of work-related coping behaviour. In addition, we asked how well the student teachers felt that the curriculum prepared them for their profession. Forty-four per cent of the student teachers report impaired mental health in the second teacher training period, indicated by a GHQ value equal to or over the cut-off of four. The AVEM responses revealed more than 40% showing risk patterns (A or B) compared to only 26.3% displaying a healthy coping style (G), while 32.8% demonstrate an unambitious style (S). These GHQ values are inversely correlated with the extent to which student teachers feel prepared for their work by the university curriculum. Our data indicate a problematic stress level for student teachers in the second training phase (high exposure to health risks and unfavourable coping styles). Since teaching is clearly an extremely demanding job, it is vital that teacher training systems contribute towards protecting the health of teachers by focusing on fostering healthy personal attitudes and equipping young teachers with coping styles and skills that will better prepare them for the challenges facing them in their daily work. Self-care health management should also be part of the teacher training curriculum.

The Association between Major Depression, Health Behaviors, and Quality of Life in Adults with Stroke

The study aims to examine the association between major depression, healthcare behaviors, and quality of life indices among adults with stroke. Data from 5869 participants with stroke in the 2006 Behavioral Risk Factor Surveillance Survey were examined. Multiple logistic regression was used to assess the independent association between depression status, self-care and preventive health behaviors, and quality of life indices, after accounting for relevant covariates. In multivariate models, individuals with major depression were less likely to engage in physical activity (odds ratio 0·41; 95% confidence interval 0·29, 0·56) than those without major depression. Women with major depression were also less likely to have received a mammogram in the past two-years (odds ratio 0·61; 95% confidence interval 0·40, 0·96 for women ≥ age 40 and odds ratio 0·58; 95% confidence interval 0·36, 0·72 for women ≥ age 50) and a pap smear in the past three-years (odds ratio 0·40; 95% CI 0·22, 0·72). In comparisons of quality of life, individuals with major depression were less likely to perceive their health as excellent/very good/good (odds ratio 0·36; 95% confidence interval 0·25, 0·53), to report being satisfied with life (odds ratio 0·13; 95% confidence interval 0·08, 0·20), and to report receiving needed social support (odds ratio 0·42; 95% confidence interval 0·28, 0·63). Individuals who were depressed were also more likely to report one or more poor physical and poor mental health days in the past 30 days (odds ratio 4·56; 95% confidence interval 3·08, 6·76 and odds ratio 10·97; 95% confidence interval 7·75, 15·52, respectively). In adults with stroke, major depression is associated with decreased engagement in stroke-specific and gender-specific self-care and preventive health behaviors, as well as a broad range of quality of life indices.

Forgiveness and health among people in outpatient physical therapy

Purpose: Forgiveness is associated with a variety of health-related outcomes; however much of this work has been in the context of forgiveness of others, direct associations and otherwise healthy samples. This study examined associations involving multiple dimensions of forgiveness, including indirect effects through health behavior, among outpatients receiving physical therapy. Methods: Participants from southern Appalachia (n = 141) completed cross-sectional self-report measures of forgiveness, lifetime religiousness, health behavior, health status and pain. Mediation analysis was employed to examine the direct and indirect relationships between forgiveness and health. Results: Forgiveness of self was associated with: (i) overall health status, physical health status and current pain in an indirect-only fashion and (ii) mental health status and chronic pain in a direct-only fashion. Feeling forgiven by God was associated with health-related social functioning in a direct-only fashion. Forgiveness of others was not associated with the health-related outcomes. Conclusions: Forgiveness of self appears to be the most important to health, yet the most difficult to achieve. Religious culture may influence whether feeling forgiven by God is also important. Forgiveness-based intervention may be useful in the context of rehabilitation, in general, and physical therapy, in particular.Implications for RehabilitationForgiveness may be particularly helpful for people seeking physical therapy and its effect may be direct and/or operate through association with better health behavior or self-care.Direct associations were observed for forgiveness of self with mental health status and chronic pain and for feeling forgiven by God with health-related social functioning.Forgiveness of self was indirectly associated with overall health status, physical health status and current pain through its association with health behavior.Clinicians may be able to facilitate the benefits of forgiveness through explicit forgiveness-based interventions.

Tendencias de la mortalidad por cáncer de mama en México, 1980-2009

Breast cancer has become an important health risk for women worldwide.The important growth of breast cancer-related deaths within those caused by malign tumors throughout the globe went past the 460 000 in 2008,becoming the deadliest disease worldwide. Demographic changes and lifestyles have modified the population exposure to risk factors of maladies such as cancer, and since 1980 breast cancer mortality has remained on an upward tendency, surpassing cervical cancer in 2006. After analyzing mortality rates along 30 years in Mexican women 25 or more years old, differences by state and age-groups are apparent. Although this cause of death has been associated with a highest regional development, some changes are taking place,since the number of deaths is also growing among women of less-developed regions in the country,as showed in this work. Mexico faces an evident challenge regarding breast cancer. Our country requires to join efforts and implement programs aimed at teaching self-care of health among the population,promoting healthier lifestyles, and reshaping our diagnostic infrastructure to achieve earlier detection and provide proper treatment.