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The biopsychosocial model (BPSM) was proposed by George Engel in 1977 as an improvement to the biomedical model (BMM), to take account of psychological and social as well as biological factors relevant to health and disease. Since then the BPSM has had a mixed reputation, as the overarching framework for psychiatry, perhaps for medicine generally, while also being criticized for being theoretically and empirically vacuous. Over the past few decades, substantial evidence has accumulated supporting the BPSM but its theory remains less clear. The first part of this paper reviews recent well-known, general theories in the relevant sciences that can provide a theoretical framework of the model, constituting a revitalized BPSM capable of theorizing causal interactions within and between biological, psychological, and social domains. Fundamental concepts in this new framework include causation as regulation and dysfunction as dysregulation. Associated research paradigms are outlined in Part 2. Research in psychological therapies and social epidemiology are major examples of programs that have produced results anomalous for the BMM and consistent with the BPSM. Theorized models of causal mechanisms enrich empirical data and two biopsychosocial examples are models of chronic stress and pain perception. Clinical implications are reviewed in Part 3. The BPSM accommodates psychological and social as well as biological treatment effects evident in the clinical trials literature. Personal, interpersonal, and institutional aspects of clinical care are out of the scope of the BMM, assigned to the art of healthcare rather than the science, but can be accommodated and theorized in the BPSM.

Background In 2020, the long‐lasting effects of the Covid‐19 virus were not included in public messages of risks to public health. Long Covid emerged as a novel and enigmatic illness with a serious and life‐changing impact. Long Covid is poorly explained by objective medical tests, leading to widespread disbelief and stigma associated with the condition. The aim of this organic research is to explore the physical and epistemic challenges of living with Long Covid. Methods Unlike any previous pandemic in history, online Covid communities and ‘citizen science’ have played a leading role in advancing our understanding of Long Covid. As patient‐led research of this grassroots Covid community, a team approach to thematic analysis was undertaken of 66 patient stories submitted online to covid19‐recovery.org at the beginning of the Covid‐19 pandemic between April and September 2020. Results The overriding theme of the analysis highlights the complexities and challenges of living with Long Covid. Our distinct themes were identified: the life‐changing impact of the condition, the importance of validation and how, for many, seeking alternatives was felt to be their only option. Conclusions Long Covid does not easily fit into the dominant evidence‐based practice and the biomedical model of health, which rely on objective indicators of the disease process. Patient testimonies are vital to understanding and treating Long Covid, yet patients are frequently disbelieved, and their testimonies are not taken seriously leading to stigma and epistemic injustice, which introduces a lack of trust into the therapeutic relationship. Patient Contribution The research was undertaken in partnership with our consumer representative(s) and all findings and subsequent recommendations have been coproduced.

The mission ofthe National Institutes of Health (NIH) is to seek fundamental knowledge about the nature and behavior of living systems and to apply that knowledge to enhance health and reduce illness and disability. As new tools such as big data analytics, computational biology, and high throughput processes have emerged, the NIH has integrated these tools to fuel scientific advances. One tool that has become more commonly used is the theoretical framework of intersectionality, defined as how multiple marginalized or disadvantaged social statuses interact at the micro level of individuals' lived experience to reflect interlocking systems of privilege and oppression at the macro social structural level (e.g., racism, classism, colonialism, sexism, heterosexism, ableism).1,2 Intersectionality theory, long used in other disciplines, is a relative newcomer to health research. This theory can foster a greater understanding of human health by moving beyond the biomedical model and individual-level determinants to examine the health effects resulting from the intersection of structural power dynamics, such as systemic sexism and racism. In our roles in extramural research administration at NIH, we have seen a growth in research addressing intersectionality, as well as a lack of consensus about best practices for studying this complex construct. In this editorial, we share our views on important areas for research development that we believe will help to advance the science of intersectionality. These views were shaped in part by the numerous grant applications we have seen submitted to the NIH, where we have a first-hand opportunity to view the latest innovations and cutting-edge science, as well as gaps and limitations.

Large language models (LLMs) have the intrinsic potential to acquire medical knowledge. Several studies assessing LLMs on medical examinations have been published. However, there is no reported evidence on tests related to robot-assisted surgery. The aims of this study were to perform the first systematic review of LLMs on medical examinations and to establish whether ChatGPT, GPT-4, and Bard can pass the Fundamentals of Robotic Surgery (FRS) didactic test. A literature search was performed on PubMed, Web of Science, Scopus, and arXiv following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. A total of 45 studies were analyzed. GPT-4 passed several national qualifying examinations with questions in English, Chinese, and Japanese using zero-shot and few-shot learning. Med-PaLM 2 obtained similar scores on the United States Medical Licensing Examination with more refined prompt engineering techniques. Five different 2023 releases of ChatGPT, one of GPT-4, and one of Bard were tested on FRS. Seven attempts were performed with each release. The pass score was 79.5%. ChatGPT achieved a mean score of 64.6%, 65.6%, 75.0%, 78.9%, and 72.7% respectively from the first to the fifth tested release on FRS vs 91.5% of GPT-4 and 79.5% of Bard. GPT-4 outperformed ChatGPT and Bard in all corresponding attempts with a statistically significant difference for ChatGPT (p < 0.001), but not Bard (p = 0.002). Our findings agree with other studies included in this systematic review. We highlighted the potential and challenges of LLMs to transform the education of healthcare professionals in the different stages of learning, by assisting teachers in the preparation of teaching contents, and trainees in the acquisition of knowledge, up to becoming an assessment framework of leaners.

Background A population-based approach to healthcare goes beyond the traditional biomedical model and addresses the importance of cross-sectoral collaboration in promoting health of communities. By establishing partnerships across primary care (PC) and public health (PH) sectors in particular, healthcare organizations can address local health needs of populations and improve health outcomes. The purpose of this study was to map a series of interventions from the empirical literature that facilitate PC-PH collaboration and develop a resource for healthcare organizations to self-evaluate their clinical practices and identify opportunities for collaboration with PH. Methods A scoping review was designed and studies from relevant peer-reviewed literature and reports between 1990 and 2017 were included if they met the following criteria: empirical study methodology (quantitative, qualitative, or mixed methods), based in US, Canada, Western Europe, Australia or New Zealand, describing an intervention involving PC-PH collaboration, and reporting on structures, processes, outcomes or markers of a PC-PH collaboration intervention. Results Out of 2962 reviewed articles, 45 studies with interventions leading to collaboration were classified into the following four synergy groups developed by Lasker’s Committee on Medicine and Public Health: Coordinating healthcare services ( n  = 13); Applying a population perspective to clinical practice ( n  = 21); Identifying and addressing community health problems ( n  = 19), and Strengthening health promotion and health protection ( n  = 21). Furthermore, select empirical examples of interventions and their key features were highlighted to illustrate various approaches to implementing collaboration interventions in the field. Conclusions The findings of our review can be utilized by a range of organizations in healthcare settings across the included countries. Furthermore, we developed a self-evaluation tool that can serve as a resource for clinical practices to identify opportunities for cross-sectoral collaboration and develop a range of interventions to address unmet health needs in communities; however, the generalizability of the findings depends on the evaluations conducted in individual studies in our review. From a health equity perspective, our findings also highlight interventions from the empirical literature that address inequities in care by targeting underserved, high-risk populations groups. Further research is needed to develop outcome measures for successful collaboration and determine which interventions are sustainable in the long term.

As an international network of historians and social scientists who study approaches to the management of drugs across time and place, we have noticed the effort to redefine addiction as a chronic, relapsing brain disease (CRBD). The CRBD model is promoted as a route to destigmatize addiction and to empower individuals to access treatment that works within that model's terms.1 CRBD usefully recognizes that brain-based neural adaptations place individual brains in chronic states of readiness to relapse. But brains are housed inside of people. Substance use is biological, social, and political; our concepts and approaches to complex questions surrounding substance use must be, too.2,3 By overlooking the sociopolitical dynamics and inequalities bound up with substance use, the CRBD model can paradoxically further marginalize people who use drugs by positing them as neurobiologically incapable of agency or choice. We are concerned that the CRBD model paints drug users as individuals whose exclusion from social, economic, and political participation is justified by their biological flaws and damaged brains.This view of people who use drugs has resulted in special emphasis on medications developed to limit propensity to relapse and to manage the neurophysiological elements of problem substance use. Although medications can be empowering to people with problem substance use and can enhance social, economic, and political participation, they do not always or necessarily do so. The social and political contexts within which a biomedical model such as the CRBD model is implemented matter, but the model is not designed to address such contexts or questions of justice. In this editorial, we explore prospects of doing better by comparing US policies with a brief historical survey of Western European countries that have adopted medications for problem substance use while remaining skeptical of or agnostic toward the CRBD model. These examples show that the CRBD model is not the only or best way to fight stigma and provide treatment. Policies in these countries provide support and push back against stigma in a range of ways, the most effective of which incorporate aspects of harm reduction. We can learn from these successes and continuing challenges as we work to achieve effective policies in the United States.We believe that a historical and socially rooted analysis offers an especially powerful lens to reassess the CRBD model's value and implications.4,5 Our goal is not to show that the model is wrong but that it is wrongheaded- incomplete in ways that carry risks as well as benefits.

Policy Points The meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity. Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies, intersectoral collaborations that include diverse communities, organizational and cultural change in medical education, and implementation of high‐quality primary care. The 2023 report by the National Academies of Sciences, Engineering, and Medicine on achieving whole health offers recommendations for action.

This editorial considers how healthcare systems should approach the problems associated with ongoing, persistent symptoms and limitations on a person’s ability to undertake activities. It starts from the premise, established in the first editorial, that the current reliance on the biomedical model of health and illness is no longer ‘fit for purpose’, and is one major cause of current difficulties within the health service. Among other problems, it may lead to the marginalisation of rehabilitation services, especially when resources are limited. This editorial describes and then highlights the implications of the holistic, biopsychosocial model of illness. It also outlines the rehabilitation process, demonstrating its similarity to the process used by medical services, with the primary difference being the centre of attention: disease for medical service, disability for rehabilitation services. The model of rehabilitation emphasises: the importance of being patient-centred and goal-directed in rehabilitation; the need for liaison by the team and learning by the patient; and that the patient needs to be encouraged and enabled to practice wanted activities.

Current medical models assume that all illness is secondary to disease. Revision is needed to explain illnesses without disease and improve organisation of health care

Men's participation in antenatal care (ANC) in sub-Saharan Africa (SSA) is shaped by diverse conceptions and experiences of fatherhood. However, most discussions rely on biomedical models that typically view men's participation narrowly as a strategy to increase ANC uptake in mainstream health facilities, often marginalizing culturally specific forms of participation. We aimed to consolidate the existing literature on the complex nuances of how attitudes, knowledge, variations in involvement, and decision-making dynamics influence men's participation in ANC in rural SSA. Following the scoping review methodology developed by Arksey and O'Malley, we searched ten databases (African Index Medicus, Africa Journals Online, CINAHL, Cochrane Library, EMBASE, MEDLINE/PubMed, PsycINFO, Sociology Collection, Social Sciences Abstract, Social Sciences Citation Index) for peer-reviewed articles published between January 1st, 2000, and October 31st, 2024. We included only studies that systematically analyzed primary or secondary data to examine fatherhood and men's participation in ANC in a rural setting in SSA. We applied no language restrictions. We identified 7665 articles, full-text reviewed 797 articles, and included 77 articles that reported 58 qualitative, 6 quantitative, and 13 mixed-methods studies conducted in 15 SSA countries. We identified nine themes under three categories addressing our review's objective: 1) three themes described men's attitudes and knowledge around participating in ANC; 2) four themes depicted variations in men's participation in ANC throughout pregnancy; and 3) two themes described how men's participation in ANC was shaped by largely collaborative communal decision-making structures in rural SSA. While heterogeneous, the existing body of evidence highlights contextually-valid and socioculturally meaningful nuances that reflect the lived realities of fatherhood and men's participation in ANC across rural SSA. Policymakers and practitioners should leverage these nuances as strengths, and further research should employ Afrocentric approaches to better understand these issues.