Exploring This Issue: Whole-Person, Whole-Systems Health and Healing.

This issue of Global Advances in Health and Medicine (GAHMJ) presents a diversity of topics relevant to whole-person, whole-systems health and healing.

In one of this issue's original articles, Hathaway et al performed a retrospective analysis of the University of Cincinnati's neonatal integrative therapy services.[1] Hospitalized infants in the neonatal intensive care unit were treated with gentle massage and/or healing touch, with improvement in pain ratings and physiological stress measures such as heart rate. This real-world analysis adds to a growing evidence base for the benefits of implementing infant massage into healthcare settings.[2]

Tai chi's effectiveness for improving balance and decreasing falls in frail elderly is well documented.[3] Increasingly, cognitive impairment is seen as a contributing factor to fall vulnerability. Walsh et al performed a hybrid observational and randomized controlled trial (RCT) exploring tai chi's effect on cognitive function.[4] Cognitive measures were overall better for seasoned tai chi practitioners compared to age- and gender-matched tai chi–naïve, healthy non-sedentary adults. However, a subsequent RCT for the tai chi–naïve individuals did not show any improvement in cognitive function after 6 months of tai chi training compared to a waitlist control.

In a small, single-arm pilot study of healthy Dutch volunteers and chronic pain patients, Soer et al provided participants with 3 sessions of the Heart Coherence Technique using a computerized biofeedback program.[5] Although measures of heart coherence increased with favorable reports of subjective improvement in awareness, emotion, and self-regulation, scores did not strongly correlate with standardized measures of mindfulness.

Occupational health investigators from Harvard University, Cambridge, Massachusetts, report the results of an online cross-sectional national nutritional survey of US firefighters.[6] Not surprisingly, fire-fighters have a prevalence of overweight and obesity similar to the rest of the US population. Among different nutritional approaches to try, firefighters ranked a Mediterranean diet as most desirable. The investigators intend to use the data collected in this study to plan a future nutritional intervention. Group meals during long work shifts are commonplace among career firefighters and can enhance cohesion and mutual support. A shift in communal meals from the typical high–saturated fat, high-carbohydrate meals to a healthier diet of whole grains, lean protein, fruits, and vegetables will hopefully facilitate better eating habits in this population.

Decision-making between patient and provider occurs on a continuum ranging from highly autonomous patients taking strong leadership in the direction of their care to the provider making decisions without seeking input from the patient. A process of shared decision-making between patient, family members, and care providers is an important aspect of whole-person healthcare. Using the decision to have cardiac catheterization as a lens to examine this, Mitchell et al found that US Veterans Affairs patients who felt they had no control over healthcare decisions had significantly lower rates of cardiac catheterization.[7] Strategies are needed at the health-system level to better enable patients to have input on the health-care they desire. Similarly, the education and work environments for providers must be transformed so that eliciting patients' preferences, values, and goals of care become the standard of care.

In every issue of GAHMJ, we feature a case report. Drs Shubov and Taw of the UCLA Center for East-West Medicine describe a successful integrative approach utilizing traditional Chinese medicine (acupuncture and Tui Na massage) for a patient with very challenging disorders to treat, namely, constipation related to a history of spinal cord injury from cauda equine syndrome as well as dyspepsia.[8]

GAHMJ continues to benefit from the insight of several outstanding columnists. In this issue, John Weeks' regular column highlights the well-established, but less well-appreciated, fact that clinical care can and does influence only 10% to 15% of health and disease outcomes.[9] Factors outside the sphere of influence of the clinician (ie, social determinants of health such as socioeconomic status) account for the vast majority of outcomes. However, our medical education systems are poorly equipped to train professionals to tackle the factors that influence so much of health and disease. Weeks advocates for a transformation of our health systems: No longer can we afford to “tinker around the edges.”

In Marilyn DeLuca's column on global policy perspectives, she encourages us to “think young.” Youths aged 12 to 24 years make up 28% of the global population.[10] However, in many ways they are marginalized, which can carry a high cost to society. Youths often lack representation in governing bodies, are vulnerable to exploitation, have unique health risks, and are relatively understudied in population research and therefore “uncounted.” Dr DeLuca makes an eloquent case for why we need to “think young.”

The regular column “Scanning the Global Literature” highlights important and novel papers on testing different targeting strategies to leverage social networks for public health interventions, the role of massage therapists in urban Canadian hospitals, impact of mindfulness meditation on sleep quality, self-care strategies for psychological distress among young adults in Catalonia, changes in molecular measures of cancer risk after only very brief changes in diet, and lastly, reduction in proinflammatory markers in breast cancer survivors after tai chi practice. As always, GAHMJ's editors offer their commentary on these topics.

Also in this issue, the Global Landscape column offers updates and news from 5 different organizations and associations related to whole-person, whole-systems health and healing: the Academic Consortium for Integrative Medicine and Health, the Academic Consortium for Complementary and Alternative Health Care, the Academy of Integrative Health and Medicine, the American Public Health Association, and the Integrative Health Policy Consortium.

Rounding out the July issue is another regular feature, “Images of Healing.” Katherine Gergen Barnett's poem, A Game of Cards, reminds us of the mutual healing power of the relationship between clinician and patient, even as death nears. Lastly, take a few moments to gaze at and reflect on Craig Blacklock's photograph, Sunrise, Chatterton Falls, Quetico Provincial Park. For me, it triggers a sense of awe of the beauty of the world in which we live.

Thank you for your continued support of and enthusiasm about the journal and the GAHMJ website (www.gahmj.com). Your inquiries, submissions, comments, and suggestions as we build the Global Advances in Health and Medicine community are always welcome.