Ischemic Heart Disease in Nigeria: Exploring the Challenges, Current Status, and Impact of Lifestyle Interventions on Its Primary Healthcare System

The burden of ischemic heart disease in Nigeria calls for an evidence-based, innovative, and interdisciplinary approach towards decreasing health inequalities resulting from individual lifestyle and poor socioeconomic status in order to uphold the holistic health of individuals to achieve global sustainability and health equity. The poor diagnosis and management of ischemic heart disease in Nigeria contributes to the inadequate knowledge of its prognosis among individuals, which often results in a decreased ability to seek help and self-care. Hence, current policies aimed at altering lifestyle behaviour to minimize exposure to cardiovascular risk factors may be less suitable for Nigeria’s diverse culture. Mitigating the burden of ischemic heart disease through the equitable access to health services and respect for the autonomy and beliefs of individuals in view of achieving Universal Health Coverage (UHC) requires comprehensive measures to accommodate, as much as possible, every individual, notwithstanding their values and socioeconomic status.

The Nature of Enticement

<p>As the world’s population rapidly becomes significantly more urban than rural, the structures that enable urban adapted living can also become a barrier between humans and the living ecosystems they are a part of and have evolved within. It is becoming increasingly apparent that urbanisation in its current form, which tends to entail a disconnection with nature is having negative impacts on the minds and bodies of residents (such as excessive stress, headaches and fatigue). This thesis explores the theories of biophilia and how architects can respond to the adverse effects of urbanisation on humans by applying biophilic concepts to the built environment; this being biophilic design. The research investigates how to invite people into designed spaces that connect them with the immediate ecosystem, the outcomes that are felt on the mind and body. Specifically, biophilic principles and the articulation of the nature of a space is explored regarding their importance for reducing stress, encouraging relaxation and restoring cognitive functions, to potentially ignite a ripple effect that can change the way in which we live our daily lives in urban settings. Wellington, New Zealand has been identified as a global ‘biophilic city’ and is the chosen site for this design-led thesis, which tests how an area largely devoid of nature can be redesigned and used in a positive way to entice and draw people through space. The intention is to further enhance the connections made between the existing biophilic interventions and ultimately improve the holistic health of those who experience the urban setting. A set of biophilic criteria are developed and used in the design, with the outcome of this design exploration being a collaborative Ecologies Design Lab where professionals and students from different disciplines can come together for the collective goal of forwarding urban biophilic practice research. In addition to this, the intervention is designed to encourage the public to interact with the building, widening the scope of the building and targeted demographic. The investigation of aspects in biophilic design and how this can draw people through and beyond the immediate site to existing biophilically alive spots in other parts of the city is examined in correlation with other complementary theories such as narrative design, interior architecture principles, landscape architecture and founding architectural principles. The research aims to propose a journey throughout the city intent on initiating the healing process that occurs as people experience a connection with nature, either literally or metaphorically.</p>

The Nature of Enticement

<p>As the world’s population rapidly becomes significantly more urban than rural, the structures that enable urban adapted living can also become a barrier between humans and the living ecosystems they are a part of and have evolved within. It is becoming increasingly apparent that urbanisation in its current form, which tends to entail a disconnection with nature is having negative impacts on the minds and bodies of residents (such as excessive stress, headaches and fatigue). This thesis explores the theories of biophilia and how architects can respond to the adverse effects of urbanisation on humans by applying biophilic concepts to the built environment; this being biophilic design. The research investigates how to invite people into designed spaces that connect them with the immediate ecosystem, the outcomes that are felt on the mind and body. Specifically, biophilic principles and the articulation of the nature of a space is explored regarding their importance for reducing stress, encouraging relaxation and restoring cognitive functions, to potentially ignite a ripple effect that can change the way in which we live our daily lives in urban settings. Wellington, New Zealand has been identified as a global ‘biophilic city’ and is the chosen site for this design-led thesis, which tests how an area largely devoid of nature can be redesigned and used in a positive way to entice and draw people through space. The intention is to further enhance the connections made between the existing biophilic interventions and ultimately improve the holistic health of those who experience the urban setting. A set of biophilic criteria are developed and used in the design, with the outcome of this design exploration being a collaborative Ecologies Design Lab where professionals and students from different disciplines can come together for the collective goal of forwarding urban biophilic practice research. In addition to this, the intervention is designed to encourage the public to interact with the building, widening the scope of the building and targeted demographic. The investigation of aspects in biophilic design and how this can draw people through and beyond the immediate site to existing biophilically alive spots in other parts of the city is examined in correlation with other complementary theories such as narrative design, interior architecture principles, landscape architecture and founding architectural principles. The research aims to propose a journey throughout the city intent on initiating the healing process that occurs as people experience a connection with nature, either literally or metaphorically.</p>

A Randomized Controlled Trial of a Positive Family Holistic Health Intervention for Probationers in Hong Kong: A Mixed-Method Study

Introduction: Probationers, offenders with less serious and non-violent offences, and under statutory supervision, have low levels of self-esteem and physical health, and high level of family conflict, and poorer quality of family relationships. This study examined the effectiveness of the existing probation service and the additional use of a positive family holistic health intervention to enhance physical, psychological, and family well-being in probationers and relationships with probation officers.Methods: Probationers under the care of the Hong Kong Social Welfare Department were randomized into a care-as-usual control group (CAU), a brief intervention group (BI) receiving two 1-h individual sessions [of a brief theory-based positive family holistic health intervention integrating Zero-time Exercise (simple and easy-to-do lifestyle-integrated physical activity) and positive psychology themes of “Praise and Gratitude” in the existing probation service], or a combined intervention group (CI) receiving BI and a 1-day group activity with family members. The outcomes were physical activity, fitness performance, self-esteem, happiness, anxiety and depression symptoms, life satisfaction, quality of life, family communication and well-being, and relationships with probation officers. Self-administered questionnaires and simple fitness tests were used at baseline, 1-month and 3-month follow-up. Linear mixed model analysis was used to compare difference in the changes of outcome variables among groups, adjusted of sex, age, and baseline values. Focus group interviews were conducted. Thematic content analysis was used.Results: 318 probationers (51% male) were randomized into CAU (n = 105), BI (n = 108), or CI (n = 105) group. CAU showed enhanced physical activity, fitness performance and psychological health, and family communication with small effect sizes (Cohen’s d: 0.19–0.41). BI and CI showed further improved physical activity, family communication and family well-being (Cohen’s d: 0.37–0.70). Additionally, CI reported greater improvements in the relationships with probation officers than CAU with a small effect size (Cohen’s d: 0.43). CI also reported greater increases in physical activity and family communication than BI with small to moderate effect sizes (Cohen’s d: 0.38–0.58). Qualitative feedbacks corroborated the quantitative findings.Conclusion: Our trial provided the first evidence of the effectiveness of probation service and the additional use of an innovative, relatively low-cost, theory-based brief positive family holistic health intervention. This intervention may offer a new model for enhancing probation service.Trial Registration: The research protocol was registered at the National Institutes of Health (identifier: NCT02770898).

Interventions Adopting Body-Mind-Spirit Model to Improve the Holistic Health of Older Adults: A Systematic Review

This systematic review aims to summarize 5 key information from non-pharmaceutical intervention studies which adopt Body-Mind-Spirit (BMS) model for older adults: (1) definition of BMS, (2) types and formats of the interventions, (3) background and BMS training of the interventionists, (4) activities included in the interventions, and (5) effect of these interventions on the holistic health of older adults. We conducted a systematic search of 9 databases (ProQuest, Web of Science, PsycINFO, PubMed, Cochrane, Wanfang, AIRITI, CADAL, CNKI) for studies published in English or Chinese through May 31, 2021. Inclusion criteria were: (1) Must be empirical studies; (2) Participants must be aged 55 and above; and (3) Must adopt the BMS model or contain BMS in full-text. We found 15 studies (7 RCTs, 1 cluster randomized trial, 3 mixed-method studies, and 4 qualitative studies). Ten studies (66.67%) adopted Chan’s BMS model. Thirteen studies (86.67%) adopted in-person group interventions. Only five studies (33.33%) provided BMS training to the interventionists. Six articles (40%) categorized the activities as body-, mind- or spirituality-related. Ten studies (66.67%) reported effectiveness in all 3 dimensions of BMS. Of the 7 RCTs, 5 were rated as medium-quality, and 2 were rated as low-quality according to the Cochrane’s Risk of Bias tool. Most interventions based on the BMS model claimed to be effective in improving the holistic health of older adults. In order to improve the internal validity, future RCT studies should be more prudent about the randomization process and adhere to the BMS model when designing the interventions.

Framework for assessing the performance of the Ghanaian health system: study protocol

Background Assessing the performance of health systems through quantitative and qualitative methods is recognized as an effective approach to strengthening national health systems. However, while many high-income countries have institutionalized health system performance assessment (HSPA) as an integral component of their respective health systems, few studies on HSPA have been documented in low- and middle-income countries, including Ghana. This study aims at providing a comprehensive framework for periodic assessment of the performance of the entire health system in Ghana. Methods The study will have four work packages. First, a structured review will be conducted to identify both international and national HSPA frameworks that could be applied to the Ghanaian context. Second, based on the structured review, an assessment framework tailored to the Ghanaian health system context will be developed. Third, the draft framework will be presented and discussed with experts and stakeholders for its appropriateness, feasibility and acceptability. Finally, the framework will be piloted to assess its effectiveness and suitability for full-scale implementation. Discussion Currently, Ghana does not have a full-fledged HSPA tool that provides a holistic health sector-wide approach to assessing health system performance. Thus, developing this HSPA framework for the country will provide a tool for periodic and comprehensive assessment of the performance of the health system, which can be compared with that of other countries. Such a comparison will offer the opportunity for mutual learning and for exploring new options for formulating more effective national health policies. As this is expected to be the first attempt to develop a comprehensive HSPA framework in Ghana, this study will provide a basis for future discussions on how to further develop and implement HSPA programmes in the country.

The Illusion of Separateness, a Philosophical Study of Nursing and Naturopathic Practice: Healing Connections Between People

<p>This thesis describes the journey of a practicing Independent Nurse Practitioner and Naturopath towards the understanding of the illusion of separateness and what this could mean in terms of health and healing generally and specifically through the stories of five clients. The study reveals through these stories how the practice developed over time in relation to this idea. As a result of personal experience, clinical practice and my quest for knowledge I have come to a consideration that what stops or blocks us realizing that we all have an innate potential for self-healing is the illusion of separateness; that is, believing we are beings separate from each other and separate from the rest of nature. The thesis is presented as a narrative and begins with an account of the events in the practitioner's life that lead to the specific study of natural therapies and the development of a cohesive practice using holistic health practices from a nursing perspective. The text essentially describes the process of establishing a private practice combining two disciplines of Nursing and Naturopathy in New Zealand. The study reveals how a nurse and naturopath's practice is based on the premise that it is crucial to recognise that the personal life and professional life of the nurse inform and influence each other and are always part of the process of care in such a practice. Three healing modalities that are central to the practice are described in detail. The description is informed by theory and research from nursing, the social sciences and the natural sciences. The study reveals the practical value of postmodern nurse theorists, Jean Watson and Margaret Newman to this practice. This study also briefly discusses the concepts from quantum theory, evolutionary theory and psychoneuroirnmunology that are used in the practice. The thesis reveals one nurse's journey of practice development using contemplation and reflection that records an important aspect that has already benefited clients and the community where the practice occurs.</p>

The Illusion of Separateness, a Philosophical Study of Nursing and Naturopathic Practice: Healing Connections Between People

<p>This thesis describes the journey of a practicing Independent Nurse Practitioner and Naturopath towards the understanding of the illusion of separateness and what this could mean in terms of health and healing generally and specifically through the stories of five clients. The study reveals through these stories how the practice developed over time in relation to this idea. As a result of personal experience, clinical practice and my quest for knowledge I have come to a consideration that what stops or blocks us realizing that we all have an innate potential for self-healing is the illusion of separateness; that is, believing we are beings separate from each other and separate from the rest of nature. The thesis is presented as a narrative and begins with an account of the events in the practitioner's life that lead to the specific study of natural therapies and the development of a cohesive practice using holistic health practices from a nursing perspective. The text essentially describes the process of establishing a private practice combining two disciplines of Nursing and Naturopathy in New Zealand. The study reveals how a nurse and naturopath's practice is based on the premise that it is crucial to recognise that the personal life and professional life of the nurse inform and influence each other and are always part of the process of care in such a practice. Three healing modalities that are central to the practice are described in detail. The description is informed by theory and research from nursing, the social sciences and the natural sciences. The study reveals the practical value of postmodern nurse theorists, Jean Watson and Margaret Newman to this practice. This study also briefly discusses the concepts from quantum theory, evolutionary theory and psychoneuroirnmunology that are used in the practice. The thesis reveals one nurse's journey of practice development using contemplation and reflection that records an important aspect that has already benefited clients and the community where the practice occurs.</p>