Andrea Abraham

Landscape and well-being: a scoping study on the health-promoting impact of outdoor environments.

ObjectivesThe present literature review conceptualises landscape as a health resource that promotes physical, mental, and social well-being. Different health-promoting landscape characteristics are discussed.MethodsThis article is based on a scoping study which represents a special kind of qualitative literature review. Over 120 studies have been reviewed in a five-step-procedure, resulting in a heuristic device.ResultsA set of meaningful pathways that link landscape and health have been identified. Landscapes have the potential to promote mental well-being through attention restoration, stress reduction, and the evocation of positive emotions; physical well-being through the promotion of physical activity in daily life as well as leisure time and through walkable environments; and social well-being through social integration, social engagement and participation, and through social support and security.ConclusionThis scoping study allows us to systematically describe the potential of landscape as a resource for physical, mental and social well-being. A heuristic framework is presented that can be applied in future studies, facilitating systematic and focused research approaches and informing practical public health interventions.

Online Health Information Seeking in the Context of the Medical Consultation in Switzerland

A growing number of patients search for medical information on the Internet. Understanding how they use the Internet is important, as this might impact their health, patient—practitioner roles, and general health care provision. In this article, we illustrate the motives of online health information seeking in the context of the doctor—patient relationship in Switzerland. We conducted semistructured interviews with patients who searched for health information online before or after a medical consultation. Findings suggest that patients searched for health information online to achieve the goals of preparing for the consultation, complementing it, validating it, and/or challenging its outcome. The initial motivations for online health information seeking are identified in the needs for acknowledgment, reduction of uncertainty, and perspective. Searching health information online was also encouraged by personal and contextual factors, that is, a person’s sense of self-responsibility and the opportunity to use the Internet. Based on these results, we argue that online health information seeking is less concerned with what happens during the consultation than with what happens before or after it, in the sociocultural context.

Kulturelles Kapital, kollektive Lebensstile und die soziale Reproduktion gesundheitlicher Ungleichheit

Trotz intensiver Bemuhungen der empirischen Public Health Forschung und trotz wachsender Zahl statistischer Befunde zu einzelnen Zusammenhangen von sozialen Merkmalen und Gesundheit, sind eine Reihe grundlegender Fragen zur sozial ungleichen Verteilung von Gesundheit bis heute offen (Siegrist & Marmot 2004, Krieger 2003). Insbesondere fur die Fragen zur sozialen Produktion und Reproduktion der gesundheitlichen Ungleichheit fehlen bis heute hinreichende Erklarungsmodelle. Theoretische Ansatze werden gebraucht um Ungleichverteilungen von Gesundheit und Krankheit besser beschreiben zu konnen und darin die Bedeutung der sozialen Benachteiligung zu erklaren (Krieger 2003). Daruber hinaus sollten theoretische Zugange aber auch unser Verstandnis verbessern zur Frage, wie sich gesundheitliche Ungleichheit aktiv einpasst in die grundlegenden gesellschaftlichen Prozesse der sozialen Strukturierung und Differenzierung.

End-of-Life Decision Making for Parents of Extremely Preterm Infants

Objective To explore parental attitudes and values in the end‐of‐life decision‐making process of extremely preterm infants (gestational age < 28 weeks). Design Hermeneutically oriented qualitative research design with in‐depth interviews. Setting Level III NICU in Switzerland. Participants Purposive sample of seven couples, five mothers, and one father (20 parents). Methods Qualitative content analysis was used to categorize and interpret themes from parents’ narratives. Results Parents described factors that affected the decision‐making process in satisfactory or unsatisfactory ways. Transparent information, empathy, and honesty enhanced communication between parents and the health care team. Lack of transparent information and continuous support decreased satisfaction. The level of involvement in decisions differed by setting. Most parents made decisions regarding lung maturation and/or initiation of care in the delivery room. Parent participation in the NICU was experienced differently. Contrary to the hospitals ethical model, few parents recalled being involved in the decision‐making process. Some parents experienced a dissociative state of mind that hindered their involvement, whereas others felt actively involved. Conclusions Our results suggest the need for careful and continuous professional evaluation of parents’ wishes about involvement in the decision‐making process, along with descriptions of medical facts and treatment options. A lack of attentive listening and dialogue may cause paternalistic decision trajectories.

“You Can Only Give Warmth to Your Baby When It’s Too Late”: Parents’ Bonding With Their Extremely Preterm and Dying Child:

This study on end-of-life decisions in extremely preterm babies shows that the parents under study experience a multitude of stressors due to the immediate separation after birth, the alienating setting of the neonatal intensive care unit (NICU), the physical distance to the child, medical uncertainties, and upcoming decisions. Even though they are considered to be parents (assigned parenthood), they cannot act as primary caregivers. Instead, they depend on professional instructions for access and care. Embodied parenthood can be experienced only at the end-of-life, that is, during the dying trajectory and after the child’s death. Professionally supporting parents during this compressed process (from assigned and distant to embodied parenthood) contributes fundamentally to their perception of being a family and supports their mourning. This calls for the further establishment of palliative and bereavement care concepts in neonatology.