Celebrating Ten Years of Promoting Healthy Lives and Well-being for All

Transcription

1 10th GENEVA CONFERENCE ON PERSON-CENTERED MEDICINE Celebrating Ten Years of Promoting Healthy Lives and Well-being for All Core Conference on May 8 10, 2017 Pre-Conference Workmeeting on May 7, 2017 Geneva University Hospital and World Health Organization CONFERENCE BOOKLET Organization Program Presenters Abstracts CPD Credits Form icpcmsecretariat@aol.com 1

2 Conference Organization Organizing Committee: James Appleyard (President, International College of Person Centered Medicine), Juan E. Mezzich (Secretary General, International College of Person Centered Medicine), George Christodoulou (Program Director for the 10 th Geneva Conference on Person-Centered Medicine), Michel Botbol (ICPCM Director for Meetings), Tesfamicael Ghebrehiwet (ICPCM Director for Education), Jo Groves (ICPCM Director for Membership), Ihsan Salloum (ICPCM Director for Research), Sandra Van Dulmen (ICPCM Director for Publications), Jon Snaedal (Advisor to the ICPCM Board), and Eugenio Villar (WHO Representative). Collaborating Organizations: The Tenth Geneva Conference on Person-centered Medicine is organized by the International College of Person-centered Medicine (ICPCM) in collaboration with the World Medical Association (WMA), the World Health Organization (WHO), the International Alliance of Patients' Organizations (IAPO), the International Council of Nurses (ICN), the International Federation of Social Workers (IFSW), the International Pharmaceutical Federation (FIP), the World Organization of Family Doctors (Wonca), the World Federation for Mental Health (WFMH), the Council for International Organizations of Medical Sciences (CIOMS), the Latin American Network of Person Centered Medicine (RLAMCP), the International College of Surgeon s (ICS), the International Federation of Gynecology and Obstetrics (FIGO), the International Federation of Ageing (IFA), the Medical Women s International Association (MWIA), the European Federation of Associations of Families of People with Mental Illness (EUFAMI), the World Federation for Medical Education (WFME), the International Association of Medical Colleges (IAOMC), the Paul Tournier Association, the World Association for Dynamic Psychiatry (WADP), the European Association for Communication in Health Care (EACH), L'Observatoire Francophone de Medecine de la Personne, the WHO Collaborating Center at Imperial College London, the International Francophone Psychiatric Federation (ALFAPSY), the French Psychiatric Association, the German Association for Dynamic Psychiatry, the International Federation of Medical Students Associations (IFMSA), the Zagreb University Medical School, San Fernando Medical School of San Marcos National University of Peru, the Peruvian University Cayetano Heredia, Francisco de Vitoria University, the Universite de Bretagne Occidentale, the Medical University of Plovdiv-Bulgaria, the Belgrade University Institute of Mental Health, and University of Buckingham Press, with the auspices of the Geneva University, and its Medical School and Hospital. Conference Participants are clinicians and scholars in medicine and other health fields as well as other interested individuals. ICPCM Continuing Professional Development (CME) Certificates will be ed upon request to all registered participants. The registration fee is 500 Euros for persons residing in World Bank Group A (High Income Countries) and 350 Euros for persons in other countries. Full time students and official representatives of patient and family organizations pay discounted half rates. Presentation Formats include a Key Note Lecture, Plenary Symposia, Parallel Symposia, and Brief Oral Presentations Conference Secretariat: ICPCM Secretariat at Int'l Center for Mental Health, Icahn School of Medicine at Mount Sinai, Fifth Ave & 100 St, Box 1093, New York NY 10029, USA. E: ICPCMsecretariat@aol.com. 2

3 10 th Geneva Conference Program PRE-CONFERENCE WORKMEETINGS ON PERSON-CENTERED MEDICINE SUNDAY MAY 7, 2017 Venue: Geneva University Hospital, Auxiliary Halls one floor under the Marcel Jenny Auditorium, 4 rue Gabrielle-Perret-Gentil CH-1211 Geneva 4, Switzerland. 9:00AM 4:00 PM Pre Conference Institutional Work Meetings Chairs: Jim Appleyard, Jon Snaedal Person Centered Integrative Diagnosis: J Mezzich, I Salloum (75 min) Person Centered Clinical Care: J. Appleyard, J Snaedal (75 min) [11:30 AM, Coffee Break] Person-centered Care Index: J Mezzich, L Kirisci, I Salloum (75 min) Person Centered Nursing Network: T. Ghebrehiwet et al (20 min) Person-centered Mental Health Network: M Abou-Saleh, M Botbol (20 min) [1:30 PM, Lunch Break] People Centered Public Health Network: W Van Lerberghe (20 min) Global Research Network: I Salloum (20 min) Regional Networks: A Perales, W Van Lerberghe, Y Pongsupap (20 min) Publications: Person Centered Medicine & Health: J Mezzich (20 min) [3:45 PM, Coffee Break] 4:00 5:00 PM IJPCM Editorial Board Meeting: J Mezzich, C Woodhead 5:00 6:30 PM ICPCM Board Meeting: J Appleyard et al CORE CONFERENCE FIRST DAY, MONDAY MAY 8, 2017 Geneva University Hospital Marcel Jenny Auditorium and Auxiliary Halls 8:00 8:30 AM Registration and check-in 8:30 9:00 AM Conference Opening (Marcel Jenny Auditorium) Welcoming words from officers of the ICPCM (Jim Appleyard, President), Geneva University (Denis Hochstrasser, Vice-Rector), World Medical Association (Ketan Desai, President), World Health Organization (E. Villar), and 10 GC Program Director (George Christodoulou) (Organizational Note: For most sessions, each presentation should last 10 minutes followed by 2 min clarifying Qs&As, plus ample time at the end for general discussion and conclusions) 9:00 10:30 AM Plenary Symposium 1: Reviewing Ten Years of Person Centered Medicine Promoting Healthy Lives and Well Being for All (Marcel Jenny Auditorium) Chairs: Jon Snaedal (Reykjavik), Wim Van Lerberghe (Brussels) Building health promotion: George Christodoulou (Athens) Constructing roads to euthymia and well-being: Robert Cloninger (St. Louis) Striving for health and well-being through the life course: James Appleyard (London) The collaborative building of Person Centered Medicine: Juan Mezzich (New York) WHO s contributions to people-centered healthy lives: Eugenio Villar (Geneva) 10:30 10:45 AM Coffee Break 10:45 12:15 PM Plenary Symposium 2: Sustainable Development Goals and Person Centered Medicine (Marcel Jenny Auditorium) 3

4 12:15 1:15PM Lunch (open) Chairs: Eugenio Villar (WHO), Robert Cloninger (St.Louis) Public health perspectives on the Sustainable Development Goals: Maria Neira (WHO, Geneva) Clinical Medicine and the SDGs: Jon Snaedal (Reykjavik) Primary Care and SDGs: Yongyuth Pongsupap (Bangkok) Health, culture and human rights: Werdie Van Staden (Pretoria, South Africa) 1:15 2:45 PM Parallel Session 1.A: The Person Centered Practice of Medical Specialties (Marcel Jenny Auditorium) Chairs: Lembit Rägo (CIOMS, Geneva), Helen Millar (Dundee, Scotland) Family Medicine: Ruth Wilson (Kingston, Canada) Pediatric Medicine: James Appleyard (London) Geriatric Medicine: Jon Snaedal (Reykjavik) Surgery: Ketan Desai (WMA, India) Psychiatry: Michel Botbol (Brest, France) 2:45 3:00 PM Coffee Break Parallel Session 1.B: The Person Centered Management of the Health Consequences of Disasters (Room E-1,2) Chairs: George Christodoulou (Athens), Dusica Lecic-Tosevski (Belgrade) General Framework: George Christodoulou (Athens) Natural Disasters: Shridhar Sharma (New Delhi) Human-made Disasters: Dusica Lecic-Tosevski (Belgrade) Economic Disasters: George Rachiotis (Larisa, Greece) Disasters and Social Determinants of Health: Aleksandra Kuzmanovic (WHO) 3:00 4:30 PM Parallel Session 2.A: The Person Centered Approach in Various Health Disciplines (Marcel Jenny Auditorium) Chairs: Tesfa Ghebrehiwet (Alberta, Canada), John Cox (Cheltenham, UK) Nursing: Howard Catton (ICN, Geneva) Psychology: Ilse Burbiel (WADP, Munich) Pharmacy: Olivier Bugnon (IPA, Lausanne) Pastoral Counseling: John Cox (Cheltenham, UK) Forensic Perspectives: Albrecht Goering (Munich) Parallel Session 2.B: Person Centered Care and the Health of Refugees, Immigrants, and Host Country Citizens (Room E-1,2) Chairs: George Christodoulou (Athens), Afzal Javed (Nuneaton, UK) Introduction: George Christodoulou (Athens) Ethics and Human Rights in Refugee Protection: Thomas Wenzel (Vienna) The situation in Syria: Mohammed Abou-Saleh (London) The situation in Turkey: Peykan Gokalp (Istanbul) European perspectives: Ann Helgesen (Halden, Norway) 4:45 6:30 PM General Assembly of the International College of Person Centered Medicine (Marcel Jenny Auditorium)(including Board elections and presentation for discussion of the 2017 Geneva Declaration) 7:00 10:00 PM Conference Dinner 4

5 CORE CONFERENCE SECOND DAY, TUESDAY MAY 9, 2017 Geneva University Hospital Marcel Jenny Auditorium and Auxiliary Halls 9:00 10:30 AM Plenary Symposium 3: People Centered and Integrated Health Systems (Marcel Jenny Auditorium) Chairs: Otmar Kloiber (WMA,Ferney-Voltaire,France), Ruth Wilson (Kingston, Canada) WHO Framework for Integrated People-centered Health Services: Ann-Lise Guisset (WHO, Geneva) Gender and age in integrated person-centered health systems: Gerardo Zamora (WHO, Geneva) Person-centered health systems for non-communicable diseases: Cherian Varghese (WHO, Geneva) Equitable, integrated and person-centered health systems: Robert Cloninger (St Louis) CIOMS Perspectives on Patient Safety and Health Systems: Herve Le Louet (Paris) Achieving person-centered care through universal health coverage: Salman Rawaf (London) 10:30 10:45 AM Coffee Break 10:45 12:15 PM Plenary Symposium 4: On the Person-Centered Psychiatry Book (M Jenny Aud) Chairs: Juan Mezzich (New York), Jon Snaedal (Reykjavik) Introduction and Person-centered Diagnosis: Juan Mezzich (New York) Principles of Person Centered Psychiatry: Robert Cloninger (St. Louis) Person-centered Care Approaches: Michel Botbol (Brest, France) Person-centered Care for Specific Conditions: Ihsan Salloum (Miami) Special Topics: George Christodoulou (Athens) Panelist Comments: V. Djordevic, J. Cox, L Kirisci, A. Javed, N. Sartorius, J. Appleyard 12:15 1:15 PM Lunch (open) 1:15 2:45 PM Parallel Session 3.A: The Person Centered Approach in Illness Prevention and Health Promotion (Marcel Jenny Auditorium) Chairs: Alberto Perales (Lima), Jim Appleyard (London) The person-centered approach in illness prevention: George Rachiotis (Athens) The person-centered approach in health promotion: Robert Cloninger (St Louis, USA) Illness prevention and health promotion in persons with comorbidities: H Millar (Dundee) People-centered illness prevention and health promotion: Faten Ben-Abdelaziz (WHO, Geneva) Parallel Session 3.B: Patients, Families and Communities and the Person Centered Approach (Room E-1,2) Chairs: Tesfa Ghebrehiwet (Alberta, Canada), Maria Ammon (Berlin) The health and health-care needs of the person: Werdie Van Staden (Pretoria, S Africa) The role of families in person-centered care: Ann Helgesen (Halden, Norway) The role of caregivers and community support in person-centered care: Spyros Zorbas (Athens) The role of patient associations in the person-centered care movement: Christine Janus (IADPO, Ottawa, Canada) 5

6 2:45 3:00 PM Coffee Break Advancing person-centered maternal and new born care in Bangladesh: T Mazumder, J Perkins, AE Rahman, J Sormani (Presenter), C Capello, C Santarelli. 3:00 4:30 PM Parallel Session 4.A: The Person Centered Approach in Health Education (Marcel Jenny Auditorium) Chairs: Mohammed Abou-Saleh (London), Ann Karin Helgesen (Halden, Norway) The making of a physician: Shridhar Sharma (New Delhi) Communication in health education: Veljko Djordjevic, Marijana Bras and (Zagreb) Inter-Professional Education: Tesfa Ghebrehiwet (Alberta, Canada) Context Based Learning: Yongyuth Pongsupap (Bangkok, Thailand) Embedding a person-centered approach in health workforce education: Giorgio Cometto (WHO, Geneva) 4:30 4:45 PM Break Parallel Session 4.B: Ethics and the Person Centered Approach (Room E-1,2) Chairs: Jim Appleyard (London), Ihsan Salloum (Miami) Principles of personified ethics: George Christodoulou (Athens) The Helsinki Declaration and Person Centered Medicine: Jon Snaedal (Reykjavik) Culture, ethics and person-centered care: Werdie Van Staden (Pretoria, South Africa) Ethics in person-centered university education: Alberto Perales (Lima) CIOMS perspectives on research ethics: Lembit Rägo (CIOMS, Geneva) Parallel Session 4.C: Interactive Workshop on Clinical Communication and Coaching (Room E-3) Chairs: Peykan Gokalp (Istanbul), Herve Granier (Montpellier) Empathy and communication: Michel Botbol (Brest, France) Value-based health coaching: Ayse Cinar (Dundee, UK) The role of communication in person-centered medicine. Insights from EACH: Sandra Rubinelli (Lucerne, Switzerland) Medical interviewing and communication: Marijana Bras, Veljko Djordjevic (Zagreb) 4:45 6:45 PM Parallel Session 5.A: Person-centered Health Care Research (Marcel Jenny Auditorium) Chairs: Ruth Wilson (Kingston, Canada), Norman Sartorious (Geneva) Research on conceptualizing person-centered medicine: Juan Mezzich (New York) Metrics research in person-centered medicine: Levent Kirisci (Pittsburgh) Global engagement for person-centered health research: Ihsan Salloum (Miami) Psychometric evaluation of the Arabic language Person-centred Climate Questionnaire Staff Version: Mohammed Aljuaid (London) Person-centric research on impact of disease: Christine Janus (IADPO, Ottawa) Towards sufficiency benchmarks for knowledge in screening and treatment decisions: Harald Schmidt (Philadelphia) The hierarchical taxonomy of psychopathology (HiTOP): dimensional alternative to traditional classification systems: Camilo Ruggero (Denton, Texas) The health paradigm: epistemological change: Giuseppe Brera (Milan) Parallel Session 5.B: Brief Oral Presentations on Person Centered Healthcare (Room E-1,2) Chairs: Hans-Rudolf Pfeifer (Zurich), George Rachiotis (Larisa, Greece) Quality circles with self-help groups: Ottomar Bahrs (Goettingen) It is the patients` legal right, but it`s seldom done Nurses experiences of giving information about the patients` legal rights and changes in medication: LV Fagerli (Halden, Norway) Patients experiences with person centered care in a new high-tech hospital: VA Groendahl (Halden, Norway) 6

7 7:30 PM Networking Dinner Person-centered care for asthma: Ian Sinha (Liverpool, UK) Orienting medical students towards person-centered care: Experience from India: Baridalyne Nongkynrih (New Delhi) Primary care nurses in a local Belgian setting: responding to healthcare needs of people with disabilities: Hannelore Storms (Diepenbeek, Belgium) Communication and Person Centered Medicine: Winn Sams (Columbus, NC, USA) Quality of care from the perspective of persons with dementia: AK Helgesen, VA Groendahl (Halden, Norway) Quality of care in university hospitals in Saudi Arabia: a systematic review: Mohammed Aljuaid (London) Parallel Session 5C: Interactive Workshop on Arts and Person Centered Care (Room E-3) Chairs: Michel Botbol (Brest, France), Hachem Tyal (Casablanca) Creativity as a necessity for personal development and health in Person Centered Care: Maria Ammon (Berlin) Art is not a therapy: Herve Granier (Montpellier) Art and Person Centered Medicine: Grenville Hancox (Canterbury, UK) CORE CONFERENCE THIRD DAY, WEDNESDAY MAY 10, 2017 WHO Headquarters, Main Building, 5 th Floor, Salle C 8:30 9:00 AM Paul Tournier Prize Session Chairs: Jim Appleyard (London), Frederic Von Orelli (Basel), Juan Mezzich (Neew York) Introduction to Paul Tournier and his legacy: Frederic Von Orelli ( 5 minutes) Laudatio for Professor Wim van Lerberghe: Jim Appleyard (5 minutes) Presentation of the Paul Tournier Prize Plaque: Alain Tournier (Geneva) Paul Tournier Prize Lecture: Wim van Lerberghe (Brussels)(20 minutes). 9:00 10:30 AM Plenary Symposium 5: Impact and Horizons of Person Centered Medicine Chairs: Jon Snaedal (Reykjavik), Eugenio Villar (WHO) The impact of Person Centered Medicine: Jim Appleyard Horizons of Person Centered Medicine: Juan Mezzich Panelist Comments: George Christodoulou, Michel Botbol, Robert Cloninger, Roy Kallivayalil, Ruth Wilson, Yongyuth Pongsupap, Alberto Perales, Werdie Van Staden, Wim Van Lerberghe 10:30-10:45 AM Coffee Break 10:45 11:45 AM Plenary Closing Session Chairs: Jim Appleyard (London), Juan Mezzich (New York), George Christodoulou (Athens) Conference highlights: Jim Appleyard 2017 Geneva Declaration: George Christodoulou Next Steps: Juan Mezzich 11:45 12:00M Break and Group Photograph 12:00 2:15PM WHO Collaborative Special Session on WHO Global Programs Chairs: Jim Appleyard (London), Eugenio Villar (WHO) Summary presentations of WHO programs on integrated people-centered health services (Ann- Lise Guisset), person-centered care for children, women and families (Gerardo Zamora), personcentered care for non-communicable diseases (Cherian Varghese), global mental health (Tarun Dua), global health work force (Giorgio Cometto), people-centered public health (Eugenio Villar). Contributions from the ICPCM and collaborating institutions. 7

8 TENTH GENEVA CONFERENCE ON PERSON-CENTERED MEDICINE GALLERY OF PRESENTERS Prof. Mohammed Abou-Saleh Professor of Psychiatry, St George s Medical School, University of London London, United Kingdom. mabousal@sgul.ac.uk Dr. Mohammed Aljuaid PhD student at Imperial College London London, United Kingdom. m.aljuaid14@imperial.ac.uk Prof. Maria Ammon Secretary General, World Association for Dynamic Paychiatry, Berlin, Germany. DAPBerlin@t-online.de Prof. James Appleyard President, International College of Person-centered Medicine Vice President, International Association of Medical Colleges Former President, World Medical Association, London, United Kingdom. Jimappleyard2510@aol.com Dr. Jennifer Austin Executive Director Operations International Alliance of Dermatology Patient Organizations (IADPO) Ottawa, Canada. jennifer.austin@globalskin.org Dr. Ottomar Bahrs Institute of Medical Psychology and Medical Sociology University of Göttingen, Göttingen, Germany obahrs@gwdg.de Prof. Michel Botbol Board Director, International College of Person-centered Medicine Chair, WPA Section on Psychoanalysis in Psychiatry Professor of Child and Adolescent Psychiatry, University of Western Brittany, Brest, France botbolmichel@orange.fr 8

9 Prof. Marijana Bras Centre for Palliative Medicine, Medical Ethics and Communication Skills, Zagreb University School of Medicine, Zagreb, Croatia. Prof. Giuseppe Brera Rector, Ambrosiana University Milan, Italy. Prof. Olivier Bugnon International Pharmaceutical Federation (FIP) Professor of Pharmaceutical Sciences, Lausanne University Lausanne, Switzerland. Prof. Ilse Burbiel German Academy of Psychoanalysis World Association for Dynamic Psychiatry Munich, Germany. Dr. Howard Catton The International Council of Nurses (ICN) ICN Nursing and Health Policy Consultant Geneva, Switzerland. Prof. George Christodoulou Honorary Fellow, World Psychiatric Association Past President, World Federation for Mental Health Emeritus Professor of Psychiatry, University of Athens Athens, Greece. Ayse Basak Cinar, DDS, MBA, THD, DSci Dundee University Dundee, Scotland, UK. 9

10 Prof. Robert Cloninger Professor of Psychiatry, Genetics and Psychology, Director, Center for the Science of Wellbeing Washington University School of Medicine, St. Louis, USA Dr. Giorgio Cometto Global Health Workforce Alliance Adviser to Executive Director Geneva, Switzerland. Prof. John Cox World Psychiatric Association Secretary General Emeritus Professor, Keele University Medical School Cheltenham, United Kingdom. Prof. Ketan Desai President, World Medical Association Gujarat, India. Prof. Veljko Djordjevic Head, Centre for Palliative Medicine, Medical Ethics and Communication Skills Zagreb University School of Medicine Zagreb, Croatia. Dr. Tarun Dua Program for Neurological Diseases and Neuroscience, Management of Mental and Brain Disorders Department of Mental Health and Substance Abuse World Health Organization Geneva, Switzerland. Prof. Liv Berit Fagerli Associate Professor of Nursing Science Østfold University College, Halden, Norway 10

11 Tesfamicael Ghebrehiwet, MPH, Ph.D. Board Director, International College of Person-centered Medicine Former Consultant, Nursing and Health Policy, International Council of Nurses Alberta, Canada. Dr. Albrecht Goering Doctor of Law Barrister, Specialist in Criminal Law Munich, Germany Prof. Peykan Gökalp Maltepe University Turkish Neuropsychiatric Society Istanbul, Turkey. Dr. Herve Granier Executive Board International Francophone Psychiatric Federation (ALFAPSY), Montpellier, France Prof. Vigdis Grondahl, PhD Associate Professor of Nursing Science Ostfold University College Halden, Norway Dr. Ann-Lise Guisset, Services Organization and Clinical Interventions, Department of Service Delivery and Safety World Health Organization Geneva, Switzerland Dr. Mohamed Hachem Tyal International Francophone Psychiatric Federation (ALFAPSY), Clinic Villa des Lilas Casablanca, Morocco. 11

12 Prof. Ann Karin Helgesen, PhD Associate Professor of Nursing Science Ostfold University College Halden, Norway. Prof. Denis Hochstrasser Vice-Rector, University of Geneva. Geneva, Switzerland. Dr. Christine Janus CEO International Alliance of Dermatology Patient Organizations (IADPO) Ottawa, Canada. Dr. Afzal Javed Secretary for Sections, World Psychiatric Association The Medical Center Nuneaton, United Kingdom. Prof. Roy A. Kallivayalil Secretary General, World Psychiatric Association; President, World Association for Social Psychiatry; Professor and Head, Dept. Psychiatry, Pushpagiri Inst of Medical Sciences, Kerala, India. Prof. Levent Kirisci Statistical Editor, Int J of Person Centered Medicine School of Pharmacy, University of Pittsburgh Pittsburgh, Pennsylvania, USA levent@pitt.edu Dr. Otmar Kloiber Secretary General, World Medical Association Ferney-Voltaire, France otmar.kloiber@wma.net 12

13 Dr. Aleksandra Kuzmanovic Master of Arts in Standardization, Social Regulation and Sustainable Development, University of Geneva, Consultant, World Health Organization Geneva Switzerland Prof. Dusica Lecic-Tosevski Professor of Psychiatry, University of Belgrade Director, Institute of Mental Health Belgrade, Serbia. Prof. Hervé Le Louet President, Council for International Organizations of Medical Sciences Professor of Clinical Pharmacology, Paris University Paris, France. Prof. Tapas Mazumder BRAC University, Dhaka International Centre for Diarrheal Disease Research Dhaka, Bangladesh. Prof. Juan E. Mezzich Secretary General, International College of Person-centered Medicine President , World Psychiatric Association Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA. Dr. Helen Millar Consultant Psychiatrist, University of Dundee, Dundee, Scotland, UK. Prof. Baridalyne Nongkynrih Community Medicine All India Institute of Medical Sciences, New Delhi, India 13

14 Prof. Alberto Perales President, Latin American Network of Person Centered Medicine Past President, National Academy of Medicine of Peru Professor of Psychiatry and Director, Institute of Ethics in Health, San Marcos National University School of Medicine, Lima, Peru. Dr. Janet Perkins Association Enfants du Monde Grand-Saconnex, Geneva, Switzerland Dr. Hans-Rudolf Pfeifer Board Member, Paul Tournier Association Psychiatry & Psychotherapy FMH, Zurich, Switzerland Yongyuth Pongsupap, MD, MPH, PhD. Founding Fellow, International College of Person Centered Medicine Senior Expert, National Health Security Office, Bangkok, Thailand. Dr. George Rachiotis Assistant Professor, Epidemiology and Occupational Hygiene, University of Thessaly, Larissa, Thessaly, Greece. Prof. Lembit Rägo Secretary-General, Council for International Organizations of Medical Sciences Geneva, Switzerland Prof. Salman Rawaf Founding Fellow, International College of Person Centered Medicine Director, WHO Collaborating Center, Department of Primary Care and Public Health, Imperial College, London, United Kingdom. 14

15 Dr. Sara Rubinelli President-Elect, International Association for Communication in Healthcare Assistant Professor, Department of Health Sciences, University of Lucerne Lucerne, Switzerland Dr. Camilo Ruggero Psychologist University of Northern Texas Denton, Texas, USA. Prof. Ihsan M. Salloum Board Director, International College of Person Centered Medicine Chair, WPA Section on Classification and Diagnostic Assessment. Professor of Psychiatry and Behavioral Sciences, University of Miami, School of Medicine, Florida, USA Dr. Winn P. Sams Chiropractic Medicine, Columbus NC, USA Prof. Norman Sartorius President, Association for the Improvement of Mental Health Programs Former President, World Psychiatric Association Geneva, Switzerland. Dr. Harald Schmidt Assistant Professor of Medical Ethics and Health Policy Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA Prof. Shridhar Sharma Emeritus Professor, National Academy of Medical Sciences & Institute of Human Behaviour and Allied Sciences, Delhi New Delhi, India. 15

16 Dr. Ian Sinha Consultant Respiratory Pediatrician Alder Hey Children s Hospital, Liverpool, United Kingdom Ian.sinha@alderhey.nhs.uk Jessica Sormani Midwife, Association Enfants du Monde Geneva, Switzerland jessica.sormani@edm.ch Prof. Jon Snaedal Advisor to the Board, International College of Person-centered Medicine World Medical Association President Professor of Geriatric Medicine, University of Reykjavik Reykjavik, Iceland. jsn@mmedia.is Hannelore Storms, MSc, PhD Student Faculty of Medicine and Life Sciences Hasselt University Diepenbeek, Belgium Hannelore.storms@uhasselt.be Mr. Alain Tournier Secretary and Treasurer, Paul Tournier Association, Geneva, Switzerland H.R.pfeifer@bluewin.ch Prof. Wim Van Lerberghe MD, DTM&H, PhD Former Director, Department for Health Systems Policies and Workforce, World Health Organization Brussels, Belgium. vanlerberghew@gmail.com Prof. C. Werdie van Staden Nelson Mandela Professor of Psychiatry & Philosophy, University of Pretoria. Pretoria, South Africa. werdie.vanstaden@up.ac.za Dr. Cherian Varghese Coordinator, Management of Non Communicable Diseases World Health Organization Geneva, Switzerland varghesecc@who.int 16

17 Dr. Eugenio Villar Coordinator, Social Determinants of Health Team Department of Public Health, Environmental and Social Determinants of Health, World Health Organization Geneva, Switzerland Dr. Frédéric von Orelli Pain Specialist, Internal Medicine Pain Clinic Basel Basel, Switzerland Prof. Thomas Wenzel Professor of Psychiatry, Medical University of Vienna, Vienna, Austria. Prof. C. Ruth Wilson Vice-President for North America, World Organization of Family Doctors Departments of Family Medicine and Obstetrics, Queen s University Kingston, Ontario, Canada. ruth.wilson@dfm.queensu.ca Mr. Christopher Woodhead Managing Director University of Buckingham Press Buckingham, United Kingdom. christopher.woodhead@buckingham.ac.uk Dr. Gerardo Zamora Program Officer, Gender, Equity and Human Rights World Health Organization Geneva, Switzerland. zamorag@who.int Spyros Zorbas Economist and Mental Health Advocate Board Member, EUFAMI and World Federation for Mental Health Athens, Greece. szorbas@gmail.com Dr. Faten Ben-Abdelaziz Coordinator for Health Promotion, World Health Organization, Geneva, Switzerland. benabdelazizf@who.int 17

18 TENTH GENEVA CONFERENCE ON PERSON-CENTERED MEDICINE ABSTRACTS PRE CONFERENCE INSTITUTIONAL WORK MEETINGS PERSON CENTERED INTEGRATIVE DIAGNOSIS Juan E. Mezzich (New York), Ihsan M. Salloum (Miami), Camilo Ruggero (Denton, Texas) Diagnosis is a fundamental activity in medicine and health care, as it involves developing an adequate informational base to substantiate and guide clinical care. It is argued logically that for practicing well Person Centered Medicine) (a medicine that places the whole person in context as the focus and goal of clinical care), Person Centered Diagnosis is needed. A theoretical model for person centered diagnosis has been developed and published by the International College of Person Centered Medicine as Personcentered Integrative Diagnosis (PID)[1]. This theoretical model has been applied for the development of the Latin American Guide for Psychiatric Diagnosis (GLADP-VR), published by the Latin American Psychiatric Association (APAL)[2] for the use of health professionals in that continental region. At the 9th Geneva Conference on Person Centered Medicine, a consultational exploration was conducted towards the development of a practical guide for person-centered diagnosis in general medicine, which is expected to move forward. At the Work Meeting on Person-centered Integrative Diagnosis within the framework of the 10th Geneva Conference on Person Centered Medicine, the following activities are planned: Brief review of the work accomplished so far. Review of prospects for the improvement of the description and classification of psychiatric disorders, including the prospects for ICD-11 and the The Hierarchical Taxonomy Of Psychopathology (HiTOP) (to be briefly introduced by Camilo Ruggero). Review of prospects for the description and classification of diseases in general, including the Wonca classification for primary care and ICD-11 in general. Review of prospects for advances in the diagnosis of disabilities and quality of life, contributory factors for health, and experience and values for health. Review of prospects for the overall formulation and organizational development of Person-centered Integrative Diagnosis. References 1. Mezzich JE, Salloum IM, Cloninger CR, Salvador-Carulla L, Kirmayer L, Banzato CE, Wallcraft J, Botbol M: Person-centered Integrative Diagnosis: Conceptual Bases and Structural Model. Canadian Journal of Psychiatry 55: Asociación Psiquiátrica de América Latina (APAL): Guía Latinoamericana de Diagnostico Psiquiátrico, Versión Revisada (GLAP-VR). Sección de Diagnostico y Clasificación, Asociación Psiquiátrica de América Latina (APAL), Lima. 3. Kotov R et al (2017). The Hierarchical Taxonomy Of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, in press. PERSON-CENTERED CARE INDEX (PCI) Juan E. Mezzich (New York), Ihsan M. Salloum (Miami), Levent Kirisci (Pittsburgh) Complex new fields and perspectives, such as Person Centered Medicine, require pointed efforts to advance their conceptualization. Furthermore, the development of measures to assess progress in these fields and perspectives would offer the prospect of greater usefulness and impact. The pertinent literature showed few efforts on careful conceptualization and very few attempts at developing measures that were solid and widely applicable [1]. In response to this situation, a project towards the systematic conceptualization of Person Centered Medicine and the development of relevant measures was initiated in 2011 by the International College of Person Centered Medicine, with support from the World Health Organization. The systematic conceptualization component of this project was based on critical reviews of the literature and broad international consultations with an array of health professionals as well as patient and family representatives. This led to the design of a Person-centered Care Index (PCI) and efforts to assess its applicability, replicability and validity [2] There is a need of further work along the following lines: Systematic evaluation of the concept of Person Centered Medicine in different world regions and application settings. Validation of the applicability, reliability and validity of the PCI in different world regions and a wide range of healthcare settings, large clinical populations, and various groups of healthcare providers. Refinement s of the PCI towards optimizing its content, structure, and the efficiency of its application. References 1. Kirisci L, Hayes J, Mezzich JE: Evaluation of Person-centered Health Services. In: Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM (eds): Person Centered Psychiatry. Springer, Switzerland, Mezzich JE, Kirisci L, Salloum IM, Trivedi JK, Kar SK, Adams N, Wallcraft J: Systematic Conceptualization of Person Centered 18

19 Medicine and Development and Validation of a Person-centered Care Index. International Journal of Person Centered Medicine, 6: , ESTABLISHING AN ICPCM NURSING NETWORK ON PERSON CENTRED CARE Tesfamicael Ghebrehiwet (Alberta, Canada) Introduction Nursing has a historical interest and mandate in person centred care. In line with this mandate, this proposal aims to map out the issues and way forward in establishing a Nursing Network on Person Centred Care nested within the ICPCM. The overall aim of the Nursing Network is to mobilise resources and expertise towards refocusing nursing and health care on the patient, clinician, family members/carers, policy makers, managers and members of the community within the overall mission of the ICPCM. Objectives The ICPCM Nursing Network will be an evolving and growing forum and a resource that aims to: Provide opportunities for exchange of knowledge and evidence related to person centred care within ICPCM conferences and congresses and using the International Journal of Person Centred Medicine.. Serve as an expert resource to the ICPCM in matters related to nursing practice, education, research and management. Organise opportunistic meetings and conferences at ICPCM conferences and others. Disseminate person-entered care through, for example, advocacy, publications, and partnerships with other organisations. Promote ICPCM and others' work in person centred health care. Mapping of Activities and Deliverables The Network s short and long term activities and deliverables will include: Develop a Concept Note as a basis for discussion and feedback A short presentation at the 10th Geneva Pre-Conference on April 7 th Literature review on nursing contribution to person-centred care Disseminate the literature review in the International Journal of the ICPCM. Expertise of Initial Members of the Nursing Network The founding members of the Network represent a diverse group with nursing as a core field of expertise and wide professional and academic background that covers education, research, management and international nursing and health policy. The Group will serve as the nucleus that aims to involve more nurses as the Network evolves to represent a wider regional coverage. Outcome Indicators of Success The Nursing Network does not intend to duplicate the work done by others within ICPCM and its activities and outcome indicators will be within its specific mandate of nursing education, research and leadership. To this end, the extent of achievement of the objectives will form the key outcome indicator Founding members of the ICPCM Nursing Network 1. Tesfamicael Ghebrehiwet, ICPCM, Board member, former ICN Consultant. 2. Vigdis Abrahamsen Grøndahl, Associate Professor, Østfold University College, Norway 3. Liv Berit Fagerli, Associate Professor, Østfold University College, Norway 4. Liv-Solveig Tvete, assistant professor, Østfold University College, Norway 5. Ann Karin Helgesen, associate professor, Østfold University College, Norway PERSON- CENTRED MENTAL HEALTH NETWORK: BASES AND PROSPECTS Mohammed Abou-Saleh (London) and Michel Botbol (Brest, France) Person- Centred Mental Health Network is a proposed initiative to place the whole person at the centre of mental health care which has been comprehensively covered in the book Person Centered Psychiatry presenting an authoritative overview of this emerging field (Mezzich et al, 2016). This perspective, articulating science and humanism, arose within the World Psychiatric Association and aims to shift the focus of psychiatry from organ and disease to the whole person. The person is conceived of in a contextualized manner, in line with the words of Ortega y Gasset, I am I and my circumstance, and if I do not save it I do not save myself. It is part of a broader person-centered perspective in medicine and health that is being advanced by the International College of Person-Centered Medicine through the annual Geneva Conferences and world-wide PCM International Congresses. In addition to refining the above statement, this session will discuss prospective activities of the Network such as the following: Project on Clinical Empathy, including a concept paper, a research study, and an educational program. Academic paper on the potential of Syndemics (a conceptual framework for understanding health conditions influenced by social and environmental milieus) for Person-centered Mental Health. Pointed presence in major meetings of the ICPCM, the Latin American Network of Person Centered Medicine, the WPA, the European Psychiatric Association and others. 19

20 GLOBAL RESEARCH NETWORK Ihsan Salloum (Miami) The primary goal of this workshop is to promote the development of Person-centered Medicine Global Research Network (PCM-GRN) dedicated to foster the development of an international network with common interest focusing on the scientific and empirical evaluation of the different aspects related to person-centered medicine. Several aspects related to the establishment of the PCM-GRN will be discussed including its scope, feasibility, and potential pilot developmental projects. PUBLICATIONS IN PERSON CENTERED MEDICINE Juan E. Mezzich (New York) Under the umbrella of the International College of Person Centered Medicine, the following publication efforts have been launched. 1.An institutional website initiated in This effort includes presently a historical archive of its monthly newsletters. 2.The International Journal of Person Centered Medicine < which is a principal vehicle for research and scholarly peer-reviewed papers in our field. 3.A Person Centered Psychiatry volume recently published by Springer [1]. 4.A prospective volume on Person Centered Medicine requested by Springer. The following are initial considerations for the preparation of this volume: It would be a multi-editor and multi-author book, engaging some of the principal clinicians and scholars in Person Centered Medicine. Each chapter would be typically authored by two or more authors to enhance representativeness and authoritativeness in this new field. Tentative sections would include the following: Principles of Person Centered Medicine, such as the eight key concepts elucidated in a recent systematic conceptualization paper [2] Diagnosis in Person Centered Medicine, including content, structure, and processes. Clinical Care Approaches, such as prevention, treatment, rehabilitation, health promotion, education, and counseling. Person-centered Care for People Experiencing Major Disease Groups. Special Topics, such as services development, program evaluation, public health, public education, professional training, and research. References 1. Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM (eds): Person Centered Psychiatry. Springer, Switzerland, Mezzich JE, Kirisci L, Salloum IM, Trivedi JK, Kar SK, Adams N, Wallcraft J: Systematic Conceptualization of Person Centered Medicine and Development and Validation of a Person-centered Care Index. International Journal of Person Centered Medicine, 6: ,

21 CORE CONFERENCE SESSIONS Plenary Symposium 1: Reviewing Ten Years of Person Centered Medicine Promoting Healthy Lives and Well Being for All BUILDING HEALTH PROMOTION George Christodoulou (Athens, Greece) The ICPCM celebrates its 10 years of promotion of healthy lives and well-being for all. Although evaluation of the impact of the College' activities is difficult, yet the fact that the College has managed to be present constructively for ten years, edit a high-quality journal, organize yearly high-quality conferences, sensitize health professionals in the person-centered approach, highlight the necessity of multi-disciplinary collaboration, emphasize the importance of empathic attention to the needs of the recipient of our services (medicine for the person) and transmit information, dexterities and especially attitudes to colleagues in our professional environment is a remarkable set of achievements. Health Promotion is a different concept than Prevention. Its scope is advancement of Health whilst the scope of Prevention is avoidance of Illness. The emphasis of Prevention is on Health whilst the emphasis of Prevention is on Illness. Antonovski's concept of Salutogenesis is considered as the theoretical basis of Health Promotion and has links with the person centered perspective. Health Promotion is closely linked with measures that are not necessarily associated with the health sector, like social, political and economic actions that result in reduction of unemployment, improvement of schooling, reduction of discrimination and management of economic and other crises as well as the protection of social, civil, economic, political and cultural rights. On an individual basis, health promotion is linked with concepts and actions like positive health, empowerment, resilience, self-help, holism and recovery. Preservation of Peace is also seen as a target of mental health promotion (WHO, 2004) and in line with this the ICPCM has supported the Athens Anti-War Declaration (2016) ( that has been co-signed by more than 100 associations worldwide and is relevant to mental healthrelated issues of refugees but also citizens of the host countries. References Athens Anti-War Declaration (2016). Christodoulou G, Jenkins R, Tsipas V, Christodoulou N, Lecic- Tosevski D, Mezich J-E. (2011) Mental Health Promotion - A conceptual review and guidance. European Psychiatric Review 4, CONSTRUCTING ROADS TO EUTHYMIA AND WELL-BEING Robert Cloninger (St. Louis) Objectives: To review knowledge of the paths to well-being and euthymia prior to 2008 and what advances have been made in the subsequent decade Methods: Literature review of empirical evidence Findings: Prior to 2008, evidence-based treatments used by adults for medical conditions are highly diverse, including physical exercise, diet, sleep hygiene, deep breathing exercises, muscular relaxation, guided imagery, healing narratives, and meditation (Servan-Schreiber, 2005). Such alternative treatments produce results that are often indistinguishable from more conventional allopathic interventions, suggesting a common mechanism is being influenced by complementary pathways (Targ & Levine, 2002). Person-centered care involves a cooperative working alliance that promotes attitudes of hope, empathy, and respect (Rogers, 1995). Such shifts in outlook facilitate the development of increased selfawareness, which appears to be the common mechanism that consistently promotes health and well-being (Cloninger, 2004). Individual differences in a person s outlook on life strongly determine their capacity to work, love, and serve others with satisfaction and health. During the subsequent decade, the majority of physicians who do not practice person-centered care report burn-out that reduces their well-being and that of their patients (Shanafelt et al, 2012). Randomized controlled trials show that the character traits promoting well-being can be developed in physicians and their patients (Campanella et al, 2014). The roads to well-being all engage physical, mental, social, and spiritual aspects of a person by cultivating plasticity, self-transcendent values, and creative functioning (Cloninger & Cloninger, 2011). Conclusions: Substantial progress has been made in understanding the roads to well-being during the past decade. References (1) Cloninger CR and Cloninger K (2011). Person-centered therapeutics. IJPCM 1(1): (2) Campanella F et al (2014). Mindfulness-oriented meditation improves self-related character scales in healthy individuals. Comprehensive Psychiatry 55:

22 STRIVING FOR HEALTH AND WELL-BEING THROUGH THE LIFE COURSE James Appleyard (London) Objectives To develop an integrated approach to the Health and Wellbeing of a person related to the consequences of genetic, biological, social, cultural behavioral and economic determinants throughout the Life course Methods A review of the literature related to the evolution of the changes as the person develops with accumulative risk and protective factors especially during critical and sensitive periods, with an emphasis on an integrated continuum of early intervention and education rather than of disconnected and unrelated stages Findings Risk factors are embedded in a person's biological makeup, manifested in the disparities in a population's health, and maintained by social, cultural, and economic forces Research on differences even in the apparently healthy These differences result in varying levels of resilience that have profound implications for future health status and development in the face of risks and adversity Conclusions The well established links between events in the early part of the life course and their inherent bio psychosocial implications are related the maintenance of health and the onset of disorders and disease later in life They are therefore essential for planning a person and people centered approach to the heath care of the individual and the preventive strategies effective for each community and large populations References 1. Cloninger CR Salloum I M Mezzich J E 2012 The dynamic origins health disparities has demonstrated the effect of many of positive health and wellbeing International Journal of Person determinants interacting in various contexts at developmentally Centered medicine 2.(2) p 1-9 sensitive points. 2. Discussion Assessment of the health status of both individuals and populations need to understand the inherent bio-psychosocial potential and Appleyard J 2015 Person-Centered and Integrated Care across the Life-Cycle International Journal of Person Centered medicine 5 1 p15-20 THE COLLABORATIVE BUILDING OF PERSON CENTERED MEDICINE Juan Mezzich (New York) It can be said from personal and group reflection and insights that Person Centered Medicine is not only a concept, but also an experience, an attitude, and a process. The delineation of the itinerary and vicissitudes in the process of constructing Person Centered Medicine might contribute to the clarification and understanding of what is Person Centered Medicine as much as a philosophical analysis of its principles and arguments. Investigating early collaborative landmarks, historians Garrabe and Hoff have posited that the World Psychiatric Association (WPA) was born in 1950 from the articulation of science and humanism. Building on these roots and precedents, the WPA General Assembly established in 2005 an Institutional Program on Psychiatry for the Person. This person-centered psychiatry initiative expanded into general medicine through interactions and collaboration with other global institutions since Particularly fundamental here were the helpful attitude and guiding role of the World Medical Association. It had carefully prepared, published, and sequentially refined two major medical ethics documents: the Declaration of Geneva first published in 1948 as an updated oath for medical graduates and the other the Declaration of Helsinki, first published in 1964 and the most respected international guide for medical research ethics. Through several of its top leaders and its secretariat the WMA collaborated enthusiastically from the very inception of Person Centered Medicine in Medical specialty institutions involved at the global level from the beginning were the World Organization of Medical Doctors (Wonca), the World Federation of Neurology, and the International Federation of Gynaecology and Obstetrics as well as broad medical institutions such as the Council of International Organizations for Medical Science, the World Federation of Medical Education, and the International Federation of Medical Students Associations. Also collaborating from the start were other key health professional organizations such as the International Council of Nurses, the International Federation of Social Workers, and the International Federation of Pharmacists. This was also the case for the International Alliance of Patients Organizations and the European Federation of Associations of Families of People Experiencing Mental Illness. Further significant for its constituency was the early involvement of the World Federation for Mental Health, the membership of which includes psychiatrists, other general health and mental health professionals, patients, families and advocates. The World Health Organization has played in these developmental efforts a crucial collaborative role. This followed the World Health Assembly adopting in 2009 resolutions which for the first time included the promotion of people-centered care [2]. Recent World Health Assemblies adopted its Twelfth Global Program of Work , which emphasizes achieving universal health coverage through integrated and people-centered health systems, and the Global Framework for Integrated People-centered Health Services. The collaborative alliances highlighted above christallized through the Geneva Conferences of Person Centered Medicine, from which emerged the International Network, now International College, of Person Centered Medicine [2]. References 1. World Health Organization (2009). Resolution WHA Primary health care, including health system strengthening. In: Sixty-Second World Health As sembly, Geneva, May

23 Resolutions and decisions. Geneva, 2009 (WHA62/2009/REC/1), Page Mezzich JE, Snaedal J, van Weel C, Heath I (2009): The International Network for Person-centered Medicine: Background and First Steps. World Medical Journal 55: Plenary Symposium 2: Sustainable Development Goals and Person Centered Medicine PUBLIC HEALTH PERSPECTIVES ON THE SUSTAINABLE DEVELOPMENT GOALS Maria Neira (WHO, Geneva) The 2030 Agenda for Sustainable Development is a universal plan of action for people, planet and prosperity. All countries and stakeholders have committed to take bold and transformative steps to forge a sustainable and resilient path of development, ensuring that no one is left behind. Good health is a precondition for, and an outcome and indicator of, sustainable development. The health of individuals and populations is determined partly by the effectiveness of health systems, but is also influenced by, and contributes to, progress towards most social, economic and environmental goals. The Sustainable Development Goals (SDG) provide a new and exciting opportunity for the Global Health Community to strengthen its leadership role in global health. The successful achievement of the health-related Goals will depend on our ability to deepen existing relationships in the health sector, expanding work beyond health into and across other sectors to address social, economic and environmental determinants, embracing core values of equity, gender equality, human rights, environmental protection and shared prosperity. Leadership and stewardship for health and the Sustainable Development Goals would be critical. This scope of work extends across multiple SDGs, and supports the integrative and transformative approach set out to achieve the Goals CLINICAL MEDICINE AND SUSTAINABLE DEVELOPMENTAL GOALS Jon Snaedal (Reykjavik) Introduction. Amongst the 17 global goals of the SDG, only one seems to be directly clinical; goal three on Good Health and Well Being. Other targets are public health related like to increase access to clean water but others are clearly political such as to decrease poverty and to increase equality. Goal 3 includes 13 targets to be met in 2030 and for all targets, each country has committed to adhere to a minimum target by signing the resolution. Targets of Goal three of the SDG. Inspired by some success of the previous UN Millennium Developmental Goals for , the path is continued by specific targets, altogether 13. Some of those are specific such as to reduce maternal mortality to under 70/ but others are softer such as to strengthen prevention and treatment for substance abuse and harmful use of alcohol. Obviously, the main focus is on health problems of the developing world but since many of life style disorders are increasing in frequency in the developing world, some targets are more universal. Even though many of the goals can be reached by political and public health means, some must be directed to individuals as well such as to decrease substance abuse and to increase well being. PRIMARY CARE AND SDGs: PRIMARY CARE STRENGTHENING TOWARD AN INTEGRATED AND PEOPLE-CENTERED-HEALTH SYSTEM IN THAILAND Yongyuth Pongsupap, Patrick Martiny (Bangkok) Primary care strongly supports the third Sustainable Development Goal (SDG) which is to ensure healthy lives and promote wellbeing for all at all ages. Primary care potentially brings promotion and prevention, cure and care together in a safe, effective and socially productive way at the interface between the population and the health system. What needs to be done to achieve this potential is to put people first: to give balanced consideration to health and wellbeing as well as to population and health workers values and capacities. The features of health care are essential for ensuring improved health and social outcomes: along with effectiveness and safety, they are person-centeredness, comprehensiveness and integration, continuity, and a regular point of entry into the health system, so that an enduring relationship of trust is built between people and their health-care providers. What this implies for the organization of health care delivery is a switch from the focus on specialized care to generalist-ambulatory care, with responsibility given for a defined population and the ability to coordinate support from hospitals, specialized services and civil society organizations (1). In Thailand, health care system is now moving from a hospitaldominated towards people-centered - health system with primary care being the hub for integration of care. The strategy to support change includes the district health board as the main lever, primary care cluster as the key driver, information systems and financing mechanism as main tools, and context based learning (CBL) among the approaches for capacity building (2). Primary care strengthening within the local health system (district), setting up in this way an integrated and people-centered health system, can be a good example of a way forward to achieve the SDG. Reference 23

24 1. World Health Organization (2008). World Health Report, Geneva, Switzerland. 2. Pongsupap Y, Achananuparp S, Boonyapaisarncharoen T, Phanumaswiwat S, and Martiny P (2017). Context based learning (CBL) in Thailand for district health system integration and better people-centeredness. Prince Mahidol Award Conference, 1-3 February 2017, Bangkok, Thailand. HEALTH, CULTURE AND HUMAN RIGHTS Werdie Van Staden (Pretoria, South Africa) Objective: This presentation draws connections between Person- Centered Medicine (PCM) and the human rights underpinning the Sustainable Development Goals (SDG). Method: Conceptual means are used to make clear the connections, and examples are presented by which the kind of relations are demonstrated. Findings: Some of the human rights as articulated in the Universal Declaration of Human Rights by the United Nations in 1948, can serve as support for PCM. Examples relate to the recognition of being a legal person; dignity of the person; liberty and freedom; a standard of living adequate for health and well-being including food, clothing and housing; protection of privacy, honour, reputation, and a right to work; a cultural life of a community; and sharing in scientific advances. These human rights may be deployed as a rights-informed pursuit of PCM. This pursuit, however, should also account for its limitation as being partial in scope, for a mere pursuit of human rights in PCM may overshadow and even defy the values and interests of the person that are not a matter of rights. The focus on human rights in PCM may thus push the person into the background. Examples thereof in the pursuit of the SDG caution against too narrow a focus on human rights in the pursuits of PCM. Conclusion: PCM is supported by the pursuit of human rights as expressed in the SDG, but in PCM the person should remain more important than his or her rights. References: 1) United Nations General Assembly. The Universal Declaration of Human Rights Resolution 217 A of ) United Nations General Assembly. Transforming Our World: the 2030 Agenda for Sustainable Development Resolution 70/1 of Parallel Sessions 1: A: Symposium on The Person Centered Practice of Medical Specialties THE PERSON CENTERED PRACTICE OF FAMILY MEDICINE/OBSTETRICS AND GYNAECOLOGY: CHALLENGES IN PERSON-CENTERED REPRODUCTIVE CARE Ruth Wilson (Kingston, Canada) Family medicine has traditionally had at its core the relationship between the family physician and the patient, using continuity and comprehensiveness as key aspects of a therapeutic alliance. Person centered medicine challenges family physicians to organize and provide their services in an even more respectful and responsive manner. The case of the provision of obstetric services in remote indigenous communities is used to explore this question. Childbirth is a normal physiologic process, with the potential for poor outcomes for mother, newborn, and the family. Current policies in Canada require that pregnant women in remote indigenous communities leave their communities at 36 weeks gestation to await delivery. This policy has been likened to the forcible removal of children to residential schools, which is acknowledged to have led to decline of cultural cohesiveness in indigenous communities. The tension between respecting the autonomy of parturients versus the provision of safe maternity services challenges the provision of obstetric care, which in much of Canada is undertaken by family physicians Women s choices for the site of delivery will vary depending on their perception of the risk of travel and separation from family and community versus the perceived safety of medically supervised obstetric deliveries. Removing obstetrics services from a community leads to decreased access to prenatal care, emergency transfers in labour, and decreasing respect for the experience of women in childbirth by community members. Some women are willing to accept the risks of obstetric deliveries in sites which do not offer operative deliveries. These decisions have implications for the health workforce and the design of safe structures of care. References: Honouring the Truth, Reconciling for the Future: Summary of the Final Report of the Truth and Reconciliation Commission of Canada July 2015 Webber G, Wilson R. Childbirth in the north: a qualitative study in the Moose Factory zone. Can Fam Physician 1993;39: PERSON CENTERED PRACTICE OF PEDIATRIC MEDICINE James Appleyard (London) Objectives To describe essence of paediatric Medicine as the dynamic dialogue of care between a child, their family and the physician from the newborn, infancy, childhood and adolescence Methods Families with children seek help in a variety of settings - in primary care surveillance which include the prevention, of illness and the promotion of health and wellbeing and acute episodes of illness, accident and emergency departments, on ward rounds in hospital, in a hospital specialist clinic or in the multi professional environment of a child development centre etc. themes common to each of these situations will be described Findings

25 From a review of medical literature and personal experience the essential elements of the paediatric consultation involve building the doctor patient relationship based on the medical ethical framework.- listening and gathering information, understanding the child in the context of biomedical, psychosocial, developmental cultural and spiritual factors, recognising the child s and the family s worries, recording a profile of the child and the family, sharing information and reaching an agreement on the nature of any problem and the appropriate action plans usually in a multi professional setting. Conclusions Consultation skills are crucial to the practice of paediatric medicine and need to be acquired through, planning, rehearsal and analysis. The preparation of a summary profile of the child and their family is a helpful clinical aid. Learning by experience has a greater impact on communication behaviour than any other teaching/learning style. References 1. Crossley J1, Davies H Doctors' consultations with children and their parents: a model of competencies, outcomes and confounding influences. Med Educ (8): Deau X, Appleyard J (2015) Person Centered Medicine as an Ethical Imperative International Journal of Person centered medicine Vol 5, No 2 (2015) 5(2):60-63 THE PERSON CENTERED PRACTICE OF GERIATRIC MEDICINE Jon Snaedal (Reykjavik) Individual differences are more obvious in older age than earlier in life and this fact is one of the cornerstones of geriatric medicine. Individual difference is based on his/her life history in its broadest sense; social status, psychological factors, medical events and relationships with other human beings from childhood and through life. Geriatric medicine is therefore a person-centered discipline per se and thus stands in sharp contrast to the classical organ specific nature of most other medical specialties.1) The methods used in geriatric medicine are based on teamwork. The classical geriatric team is interdisciplinary in nature rather than multidisciplinary meaning that the team works closely together and comes to a mutual conclusion in each case rather than working in a loose contact where each professional is independent in his/her judgments. One aspect of geriatric medicine is to evaluate the strengths of each individual to the same extent as the weaknesses (i.e. medical illnesses). The person s strength is used to make plans for treatment and care taking into account the prognosis of the medical ailment. In this evaluation, the person s family and social attributes are taken into account when planning for future assistance. Persons with a dementing illness pose a special challenge2). In usual medical care, a person is guided from an illness to partial or total health but in dementia, the main role of health professionals is to help the person and the family on the rode of increased disability. In military terms, this could be called an organized retreat. 1) Wilberforce M, Challis D, Davies L et al. Person-centredness in the care of older adults: a systematic review of questionnaire-based scales and their measurement properties. BMC Geriatrics 2016;16:63 DOI: /s y 2) Kitwood TM. Dementia reconsidered: the person comes first. Buckingham: Open University Press; PERSON CENTERED MEDICINE IN UROLOGY PRACTICE Ketan Desai (New Delhi, India) Person Centric medicine plays a vital role in practice of urology. The diseases of male and female urinary tract and genital system are not discussed freely by the patients either in the society or family or even with the medical practioners who take their patients casually. The four vital factors for achieving holistic and people centric treatment of the patient plays a very important role in urology practice. Due to social taboos and personal hesitancy patient does not open up to his /her doctor till he/she is confident about the confidentiality of the disease and has full faith in his doctor. It is for the practioners in urology to give sympathetic listening, take careful history and explore the possibility of different factors contributing to the problem of the patient. Causual approach to the treatment without connecting to the patient is the frequent cause of treatment failure making patient miserable. Person centric urology care is essential to the managment of the diseases involving all stake holders for desired outcome. Reference Patient Centered Healthcare - World Health Organization, Western pacific Region, Eighth meeting 14 September 2007 WPR/RC58/SR /8 Desai etal, BJ Medical college, Ahmedabad, India PERSON CENTERED PRACTICE OF PSYCHIATRY Michel Botbol (Brest, France) More than other specialties Psychiatry and Mental Health are exposed to the negative effects of disorder centered approach. Because of the many competing theories about the very nature of the psychiatric disorders, mental health classifications have to neglect key aspects of the person s mental health status, such as subjectivity and psychodynamic dimensions, in order to mimic the paradigm on which are based the biomedical classifications in other medical disciplines. The first stake of psychodynamic psychiatry is to fight against this abusive reductionism that leaves us with half a science (Strauss) and a nosography not well adapted to clinical practice. To achieve this goal, Person Centered Psychiatry has to meet the three major conditions required by PCM to take into account the complexity of the person To consider the totality of the person (positive and ill health, the person and his/her context) using an integrative diagnostic reference and all the available tools to approach the various levels involved in the person s functioning (dimensions, categories, idiosyncratic narrative formulations) To see the diagnosis and the therapeutic choices as a joint process involving the person of the patient, the person of the clinician and the person of the carers d

26 To take into account the subjective aspects of this various levels and not only their objective ones An example will be given of how these basic principles can translate into practice Reference Mezzich J, Botbol M, Christodolou G, Cloninger R, Salloum I (2016) Person Centered Psychiatry, Springer, New York B. Symposium on The Person Centered Management of the Health Consequences of Disasters GENERAL FRAMEWORK George Christodoulou (Athens, Greece) Disasters have accompanied humanity since time immemorial and they will continue to do so. We can prevent some of them, mitigate the effects of some others and tolerate the rest. The mental health effects of disasters range from "normal" or even "beneficial" to psychopathological (either of general nature like exacerbation of the symptoms of a pre-existing condition or specific nature, like acute stress reaction or PTSD). The degree of mental health effects of disasters is greatly influenced by the meaning ascribed to the traumatic event and this meaning has a great influence on whether the individual responses will be dysfunctional or adaptive. This explains why human-made disasters have greater psychopathological impact than natural disasters. The effects of disasters are not limited to the directly traumatized persons but also involve indirectly traumatized ones like rescue workers, police, paramedics, by-passers, TV-watchers etc. Members of the families of the traumatized persons are also affected and may need professional support. The personal and social qualities that should be reinforced before, during and after a disaster are mainly resilience at a personal level and solidarity at a social level. Person-centered care is of great importance. Traumatized people carry with them a huge, delicate and complex personal history that shapes their response. The trauma has a different effect on each person. Timing is an important issue to deal with in the case of disasters. Issues of survival and safety deserve priority and mental health care can wait. However, at later stages mental health issues should be given the attention they deserve as many of the psychosocial consequences of disasters can lead to psychological invalidity. Economic catastrophes constitute a very important area with serious mental health consequences. For this reason we have decided to add a third category of disasters to the "classical" categories (natural and man-made) namely the Economic Disasters (Christodoulou et als, 2016). References Christodoulou GN, Mezzich J-E, Christodoulou NG, Lecic-Tosevski D (2016) Disasters: Mental Health Context and Responses, Cambridge Scholars Publishing, Newcastle Upon Tyne, UK. PERSON CENTERED RESPONSES TO NATURAL DISASTER Shridhar Sharma and Gautam Sharma (New Delhi) All disasters hurt people. They kill, injure, cause psychological and social trauma. Due to the geography and topography, India has faced serious large scale natural disasters like droughts, cyclones and earthquakes. The available statistics also show that the number of disasters per year is increasing but also the number of people affected and killed is also rising. The last century has added a new ecological dimension to the definition of a disaster. Coping and resilience have been among the key interests of researchers who have studied disaster affected communities. The ability to cope and recover from loss is determined by a host of factors in pre-disaster, within-disaster and post-disaster periods. Personal strength, religious belief and faith and external/community support appear to play key roles in coping after a massive disaster. In the present study using anecdotal evidences from 1984 Bhopal gas tragedy, 2004 Indian Ocean Tsunami in Andaman and Nicobar Islands and 2015 Nepal Earthquake we set out to investigate the strategies adopted by survivors to escape and cope with the disaster. Keywords: Natural Disaster, Person Centered Response Ref: Mezzich JE (2007) Psychiatry for the person, articulating medicine s science and humanism, World Psychiatry ECONOMIC DISASTERS: HEALTH AND MENTAL HEALTH CONSEQUENCES George Rachiotis (Larisa, Greece) and Nikos Christodoulou (Nottingham, UK) It is now well documented in the literature that financial crises are associated with a profound detrimental effect on society as a whole, including multiple facets of public health notably including mental health. For instance, multiple examples of financial crises, such as the 90s so called shock therapy in ex-soviet States and the current austerity measures imposed in Greece, have been associated with a range of detrimental effects, from increased substance misuse, to a dire link of unemployment and suicide, or increased social and income inequality leading to multiple negative health effects, including suicide. On the contrary, the mortality rate due to traffic accidents has decreased. In many cases (e.g. health behaviours) there is relative sparsity of evidence where in other cases (e.g. cardiovascular mortality) the evidence is controversial and mixed. Beyond their direct effects, financial crises also affect individuals indirectly, through burdening and disempowering health systems, exactly when they should be strengthened. Financial

27 crises are usually man-made disasters of political origin, and therefore countering the effects of financial crises on public health requires in essence a political response. This may include advocating for political measures to safeguard vulnerable individuals (e.g. homeless, deprived, unemployed), and health systems (especially the public sector), as well as adopting potentially more effective and cost-effective approaches towards public health, such as person-centred care and health promotion. References G. Rachiotis. The impact of economic crises on health: an overview. In Disasters: Mental Health Context and Responses; p , Cambridge Scholars Publishing, N. Christodoulou. Individual and systemic effects of economic crises and their associated measures. In Disasters: Mental Health Context and Responses; p , Cambridge Scholars Publishing, DISASTERS AND SOCIAL DETERMINANTS OF HEALTH Aleksandra Kuzmanovic (WHO) The number of conflicts in the world is decreasing, but they are getting more violent, affecting more people and lasting longer periods. Due to an increased globalized world, the effects of conflicts increasingly spread to other parts of the world outside the conflicts zones. The 2030 Sustainable Development agenda gives a new opportunity to reduce violence, insecurity and conflicts by focusing on broad development and building fair communities and societies; and strengthening the rule of law and promoting human rights through the achievement of the goal 16: Peace, justice and strong institutions. Since all the Sustainable Development Goals (SDGs) targets are integrated and indivisible, the achievement of Goal 16 requires progress in all the SDGs, especially those related to Poverty, Education, Health, Economic Growth and Inequality. Therefore, the main objective of this presentation is to provide an overview about the underlying determinants of health inequity as a result of conflict and the possible ways to address them in a comprehensive manner. The presentation will cover following structure: Social Determinants of Health (SDH) and Health Inequity Conflicts in the context of the Sustainable Development Goals (SDGs) Distribution of conflicts in the world Explaining the impact of conflicts using an SDH approach Suggestions for addressing the SDH in conflicts the way forward References used in presentation: (2016) The social determinants of health in Gaza World Health Organization (2015) The Armed Conflict Survey - The International Institute for Strategic Studies, Accessed at: (2015) Child health in Syria: recognising the lasting effects of warfare on health - Devakumar D, Birch M, Rubenstein LS, Osrin D, Sondorp E, Wells JC. Confl Health Nov 3;9:34. doi: /s ecollection Parallel Sessions 2: A. Symposium on The Person Centered Approach in Various Health Disciplines THE PERSON CENTRED APPROACH IN NURSING Howard Catton (ICN, Geneva) Person centeredness is at the heart of nursing philosophy and practice and reflected in the professions code of ethics and standards for conduct. Throughout the care continuum it is likely to be a nurse that a patient spends most time with and that influence goes beyond the individual but also deep into families and communities. However changing health needs and demands, patient expectations, technology, access to information and new and emerging models of care and nursing roles also mean that relationship is continually evolving. This presentation will consider how nurses and nursing are responding to these changes including the evidence demonstrating the relationship between nursing practice and both the outcomes and experience of care for patients. It will also reflect on where there are shared and mutual interests and benefits particularly in relation to engagement and involvement in change processes and developing new services. International Council of Nurses (2017). Nurses A Voice to Lead. Nurses Role in Achieving the Sustainable Development Goals ICN Policy Brief (2015) Nursing Leadership in Primary Health Care Brief2NsgLeadershipPHC.pdf PSYCHOLOGY IN PERSON-CENTERED CARE AND ILLUSTRATIVE RESOURCE-ORIENTED PSYCHOTHERAPY Ilse Burbiel (WADP, Munich) Psychodynamic psychotherapy implies a holistic view of human nature, thus it is per se a person-centered approach that is concerned with a comprehensive understanding of the complex conditions that determine the development of a patient`s personality in both health and illness. Whereas traditionally emphasis in treatment was on changing deficient and destructive developments, it is now the integration of the resources and the healthy potential of development in psychotherapeutic treatment.

28 These are the patients already considerably confused and disturbed at a pre-verbal stage, i.e. at the earliest development of attachment and contact, affecting their relation of themselves and their environment, to other human beings, to nature as well as to mental and spiritual contents and values. As a result of this personality structure we observe the formation of a deficit in the unconscious core of personality combined with destructively and deficiently developed personality functions as well as a discontinuation of the whole process of differentiation, delimitation, regulation and integration, essential for the personality development. At Günter Ammon`s berlin School of Dynamic Psychiatry, the work with the healthy parts of identity is one of the central treatment paradigms using multifaceted verbal and more non-verbal psychotherapeutic treatment methods in single and grouptherapeutic settings. Starting with the clarification of the term healthy parts of the identity and its concept with its structural-dynamic, functionalprocess and energetic aspects. The speaker`s objective is to discuss some of the central prerequisites of resource oriented treatment and therapeutic interventions in the work with severely disturbed patients e.g. the therapeutic attitude, the shaping of the therapeutic relationship and structure of the therapeutic process; furthermore, the work with the destructive and deficient parts of the identity, and the development of the therapeutic process. The evolution of Pharmacy practice supports changes in the priorities of health systems. In its Centennial Declaration (2012), the International Federation of Pharmacy (FIP) expressed the commitment of pharmacists in this context : «Pharmacists and Pharmaceutical scientists accept responsibility and accountability for improving global health and patient health outcomes by closing gaps in the development, distribution, and responsible use of medicines. The responsible use of medicines means a concordance with the following person centered criteria : - appropriate choice based on what is proven by scientific and/or clinical evidence ; - only used when necessary ; - to be most effective and least likely to cause harm ; - with a timely access to and the availability of quality medicines ; - properly administred and monitored for effectiveness and safety ; - choice that makes the best use of limited healthcare resources; - choice, that also considers patient preferences ; PHARMACY IN PERSON CENTERED CARE Olivier Bugnon (IPA, Lausanne) - a multidisciplinary collaborative approach used that includes patients and those in addition to health professionals assisting in their care. The presentation of the day will illustrate two Swiss pilot experiments of collaborative Pharmacy services, developed and scientifically evaluated by my university team : 1. Reconciliation of the medication plans of polymedicated patients 2. Personalized support of medication adherence for chronic patients (SISCare programs) The two approaches are supported by the health authorities, the first at the cantonal level (Vaud) and the second at the federal level, in a political context that promotes primary care, interprofessionality and patient safety. References: 1. International Pharmaceutical Federation (FIP): 2. Mélanie Lelubre et al., Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland, BioMed Research International, vol. 2015, Article ID , 10 pages, doi: /2015/ PASTORAL COUNSELING IN PERSON CENTERED CARE John Cox (Cheltenham, UK) In this presentation, I will open a discussion about the role of chaplains as spiritual advisers and pastoral counsellors in contemporary health care. In addition, we will consider the values that underpin Person Centered Medicine and their partial bases on religious traditions as well as secular considerations. FORENSIC PERSPECTIVES: PERSON-CENTERED PROPOSALS FOR THE CRIMONAL JUSTICE SYSTEM Albrecht Göring (Munich) This presentation proposes improvements in the criminal justice system. It involves a substantial change in approach. In the last century, since the sixties, psychiatric patients have been unshackled from the chains of medieval safekeeping institutions. Now our perspective should focus on neglected people behind prison bars to achieve better outcomes. In this respect, it is obvious that delinquent people have to be protected from themselves as well as society has to protect itself. This protected space, however, should be filled with real interest in these human beings. I am confident that in this way at least eighty percent of these people could be reached successfully just as is the case in inpatient psychotherapy. This approach will give these people an alternative to constructively redesign themselves into/within the world, as they would be offered something better than delinquency. This presentation will demonstrate the mean necessary to reach a better goal.

29 B. Symposium on Person Centered Care and the Health of Refugees, Immigrants, and Host Country Citizens INTRODUCTION George Christodoulou (Athens) The influx of refugees and immigrants making their way across the Mediterranean to Europe in the last 2-3 years has been estimated as the biggest since the Second World War. In Syria, about 5 million people have been registered as refugees since the conflict started in The waves of refugees constitute extreme challenges for their own health and for the care systems of the hosting countries. Of special importance are the mental health problems as at least one in five of war refugees suffer from depression, PTSD and anxiety disorders. Depression is closely associated with poor post-migration socioeconomic status (Abou-Salleh and Christodoulou, 2016). The main gateway of refugees to Europe is Greece with its numerous islands. A Frontex report of November 2015 stated that refugees had entered the country since the start of that year. This influx has coincided with an ongoing and deteriorating financial crisis in Greece (Christodoulou et al. 2013) that makes occupational rehabilitation of the refugees and immigrants practically impossible (Christodoulou and Abou-Salleh, 2016). The refugee problem is creating distress and mental health problems not only to refugees themselves but also to the hosting populations. Change of attitude towards refugees is a worrying possibility that has become reality in some countries. Some important Declarations on the mental health of refugees and related issues have been prepared recently (mentioned by Christodoulou and Abou-Salleh, 2016). Among them the Athens Anti-War Declaration ( cosigned by more than 100 organizations is of particular importance as it calls for termination of war which is the actual cause of the recent forced immigration in Europe and elsewhere in the world. References Abou-Salleh M and Christodoulou GN (2016) Editorial, Mental Health of Refugees: Global perspectives. BJPsych International, 13, Christodoulou GN and Abou-Salleh M (2016) Special Paper, Greece and the Refugee Crisis: Mental Health context. BJPsych International, 13, Christodoulou NG and Christodoulou GN (2013) Financial crises: impact on mental health and suggested responses. Psychother. Psychosom. 82, Objectives: A substantial part of the global population is by now forced to leave their home countries and become refugees in often hostile host countries. Protection especially for vulnerable groups such as Unaccompanied Minors and Torture survivors is a key issue and precondition of any treatment program offered. International guidelines such as the UN Convention against Torture, the Istanbul Protocol, the EU reception directives but also Ethical professional guidelines provide for such protection. Method: The presentation will analyse the relevance of the above standards for REFUGEE PROTECTION AN INTERDISCIPLINARY CHALLENGE Thomas Wenzel, Onder Ozkalipci (Vienna) international monitoring, detention, abuse in transition, and protection against refoulement. but also the need to contribute tot he international awareness of patients and physicians that are at risk in countries of origin. Conclusions: Due to the special ethical and humanitarian challenges in the protection of vulnerable groups, further steps are required to support this important task in the face of an often adverse social discourse that questions basic human rights and ethical standards. mental health profesisonals. Discussion: The interface between 1. Wenzel T. Torture. Curr Opin Psychiatry. 2007;20(5): legal, human rights, cultural anthropology and medical aspects 2. Wenzel T, Frewer A, Mirzaei S. The DSM 5 and the Istanbul require close interdisciplinary collaboration between the respective Protocol: Diagnosis of psychological sequels of torture. Torture. professionals. Special critical situations include the asylum process, 2015;25(1): THE SITUATION IN SYRIA Mohammed Abou-Saleh (London) Objective and methods: The conflict in Syria, now in its sixth year, is almost unprecedented in the magnitude of humanitarian and public health catastrophe. The Objective of the presentation is to review the regional and global initiatives and actions to meet the mental health needs of Syrian refugees. The methods were to review the literature and outline the activities of governmental, professional and NGOs in responding to the escalating situation in Syria. Results and discussion: There have been numerous activities and extensive action by all concerned organizations in response to the Syrian crisis. However these activities are predominantly in countries hosting refugees and in Europe, are often poorly coordinated and fall short of meeting the needs of Syrian refugees for mental health and psychosocial support (MHPSS). Conclusion: The Syrian crisis has become a global humanitarian concern. Whilst the WHO, UNHCR, IOM, NGOs and professional organizations are taking initiatives to address the challenges of providing MHPPS for Syrian refugees, there needs to be more provision of MHPSS with integration into the national health strategies of hosting countries as well as planning for Building Back Better of integrated health services in post-conflict Syria. The Syrian catastrophe is a wake-up call for all humanity to unite against the forces of injustice and the degradation of all humans. Syria was the cradle of civilization and must not become its grave. Abou-Saleh M, George N Christodoulou G (2016) Mental Health of Refugees: Global Perspectives, British Journal pf Psychiatry- International.(November 2016; Vol 13, Issue 4:79-81.

30 WHO:BUILDING BACK BETTER Sustainable mental health care after emergencies (2013) r/en/ Movement of people on earth has always been a multi sided issue throughout history. Migration to the Americas and Europe were main waves of human mobility in the new era, starting from the 17th Century. Migration is considered as a factor mediating development, change and growth both economic and cultural. On the other hand, migration is also linked with crises, conflicts, trauma and related mental health problems. Main reasons for migrations and being a refugee are natural disasters, wars, including civil wars, political unrest, economic crisis, climate change, better living conditions, further education opportunities. After the Syrian conflict that began in 2011, nearly 12 million people have fled to neighboring countries as Lebanon, Turkey and Western Balkans. Gaziantep is the south eastern city where a large number of refugees were located in camps, while many others were scattered all over the country in various facilities or in their own resources.. MIGRATION AND MENTAL HEALTH: THE SITUATION IN TURKEY Peykan Gökalp (Istanbul) In 2015, the EU has set up humanitarian aid and resources for refugees and displaced persons mainly in Turkey, Greece and the Balkans. The EU Civil protection mechanism states that the mechanism does not address the causes of the refugee crisis, but extends aid for vulnerable population for their immediate needs in collaboration with the governments and the NGOs of the hosting country. In this presentation, the links between migration, displacement, mental health issues and resilience will be discussed in accordance with current situation and developments, mainly focusing on the situation in Turkey. References: Sirin SR, Rogers-Sirin L. 2015, The Educational and Mental Health Needs of Syrian Refugee Children. Washigton DC, Migration Policy Institute. Volkan VD. 2017, Immigrants and Refugees. Karnac Books,London EUROPEAN PERSPECTIVES: THE IMPORTANCE OF FINDING COMMON GROUND Ann Helgesen (Halden, Norway) Background: Along with the globalization and immigration from different parts of the world, many European countries including Norway, have become more complex and diverse. The health systems around Europe face several challenges when a growing population of older immigrants from countries in Asia, Africa and Eastern Europe needs treatment and care. Objective: The aim of the study was to obtain knowledge about how nurses experience interacting with elderly immigrant patients and their relatives in nursing homes. Methods: The study had an explorative/descriptive design, with a hermeneutic approach. The qualitative research interview was used as method for collecting data. All together six nurses at two nursing homes with the required experience were interviewed. Findings: Nurses experienced that they meet many challenges when interacting with elderly immigrants in nursing homes. The findings are systemized under four categories: Language problems constituted a barrier in trying to get to know the patient The relationship with the patient s family was of ultimate importance Encountering a foreign view on sickness and caring caused uncertainty Lack of awareness of own cultural influence Conclusions: The nurses faced complex challenges when meeting elderly immigrants in nursing homes. The challenges reflected that nurses and elderly immigrant patients and their families had different understandings of reality and they lack a base for common meaning. The study indicated that the degree of awareness of own cultural influence and how this can colour the interaction varied amongst nurses. References: 1. Thyli, Bente, Birgitta Hedelin, and Elsy Athlin. "Experiences of health and care when growing old in Norway-From the perspective of elderly immigrants with minority ethnic backgrounds." Clinical Nursing Studies 2.3 (2014): p Diaz, Esperanza, and Bernadette N. Kumar. "Differential utilization of primary health care services among older immigrants and Norwegians: a register-based comparative study in Norway." BMC health services research 14.1 (2014): 623. Plenary Symposium 3: Symposium on People Centered and Integrated Health Systems WHO GLOBAL FRAMEWORK ON INTEGRATED PEOPLE-CENTERED HEALTH SERVICES Ann-Lise Guisset (WHO, Geneva) Integrated people-centred health services (IPCHS) are a key feature of robust and resilient health services and are critical for progress towards universal health coverage (UHC) and the Sustainable Developmental Goals (SDGs). Why are they so vital? What does it mean in practice? How can we take action? This presentation explains more about IPCHS with numerous illustrations from countries experiences. In 2016 the World Health Assembly adopted the Framework on IPCHS, giving WHO the mandate to work with Member States to make their health services more integrated and people-centred. The Framework provides a new way of thinking about how health services are organized, managed and delivered and suggests five interwoven strategies for moving forward that necessitate local adaptation.

31 1. Engage and empower people and communities to take an active role in their health and health services. 2. Strengthen governance and accountability to build legitimacy, transparency and trust. 3. Reorient health services to ensure that care is provided in the most appropriate setting with the right balance between health promotion, prevention and in- and out-patient care 4. Strengthen the coordination of care across providers, organizations, care settings and beyond the health sector to include social services and others. 5. Create an enabling environment to facilitate transformational change through enhanced leadership and management, information systems, financial incentives and reorientation of the healthcare workforce. IPCHS can be achieved through a staged and prioritized approach to change management, focusing on priority strategies and activating key policy levers to prompt and sustain change. It is also critical to foster a culture of experimentation and to pilot change at demonstration sites at the local level. The local (e.g. district) level is the heart and soul of IPCHS. PERSON-CENTERED HEALTH SYSTEMS FOR NON-COMMUNICABLE DISEASES Cherian Varghese (WHO, Geneva) WHO Global action plan for the prevention and control of noncommunicable diseases provides a framework for addressing four major NCDs (cardiovascular disease, diabetes, cancer and chronic respiratory diseases) and their risk factors (tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity). Objective 4 of the global action plan calls for a strengthened health system directed towards addressing noncommunicable diseases to improve prevention, early detection, treatment and sustained management of people with or at high risk for NCDs. Policy options to improve efficiency, equity, coverage and quality of health services with a special focus on NCDs. Health systems in resource limited settings will have to adapt to the needs of chronic care and multimorbidity. NCD risk factors and NCDs often co-exist in the same person. Polypharmacy, duplication of laboratory procedures and recurrent hospitalizations can be reduced if multiple risk factors and multimorbidity is addressed through a person-centred approach. Unlike communicable diseases, NCD management goes for decades with regular interaction with the health services. During the course the person can develop multiple health issues which may be related to existing pathologies. A person-centered health system can address the multiple needs of people with NCDs. Multimorbidity and co-morbidity, socio-economic context of the person which can affect and modify the disease process, compliance to medication and other parameters are more amenable and can be delivered in a more equitable manner through a person-centered health system. Palliative care is another approach for addressing the needs of a person through a holistic support. This presentation will highlight some of these issues and also highlight technical packages that can be adapted to primary care as part of the person-centered health care. References 1. Global action plan for the prevention and control of Noncomunicable disease ng.pdf?ua=1 2. HEARTS- Technical package for cardiovascular disease management in primary health care 3. Planning and implementing palliative care services: a guide for programme managers. eng.pdf?ua=1 EQUITABLE, INTEGRATED AND PERSON-CENTERED HEALTH SYSTEMS Robert Cloninger (St Louis) Objective: To describe the opportunities and challenges of creating equitable, integrated, and person-centered health systems Method: review of the scientific, historical, and scientific foundations for 2014 Geneva Declaration on health inequities Findings: In a person-centered approach to public health, people are recognized to have intrinsic dignity and are treated with respect to encourage their developing health and happiness. A personcentered approach supports the freedom and the responsibility to develop one s life in ways that are personally meaningful and that are respectful of others and the environment in which we live together. Using consistent time-series data, examples of universal healthcare systems in Chile, Spain, and Cuba were critically examined and discussed. Evidence suggests that health care organizations function well when they operate in a person-and people-centered way because that stimulates better coordination, cooperation, and social trust. Conclusions: Health care coverage must be integrated at several interconnected levels in order to be effective, efficient, and fair. To reduce the burden of disease, integration is needed between the people seeking and delivering care, within the social network of each person, across the trajectory of each person s life, among primary caregivers and specialists, and across multiple sectors of society. For integration to succeed across all these levels, it must foster common values and a shared vision of the future. References: (1) Cloninger CR, Salvador-Carulla L, Kirmayer LJ, Schwartz MA, Appleyard J, Goodwin N, Groves J, Hermans MHM, Mezzich JE, van Staden CW, Rawaf S. A time for action on health inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered Integrative health care for all. International Journal of Person-Centered Medicine 2014; 4(2): (2) WHO. World Health Report: Research for Universal Health Coverage WHO; Geneva: 2013.

32 CIOMS PERSPECTIVES ON PATIENT SAFETY AND HEALTH SYSTEMS Herve Le Louet (Paris) The Council for International Organizations of Medical Sciences (CIOMS) is an international, non-governmental, non-profit organization established jointly by WHO and UNESCO in In 2009 CIOMS celebrated the 60thanniversary of its creation. Through its membership, CIOMS is representative of a substantial proportion of the biomedical scientific community. In 2013, the membership of CIOMS included 49 international, national and associate member organizations, representing many of the biomedical disciplines, national academies of sciences and medical research councils. The main objectives of CIOMS are: To facilitate and promote international activities in the field of biomedical sciences, especially when the participation of several international associations and national institutions is deemed necessary; To maintain collaborative relations with the United Nations and its specialized agencies, in particular with WHO and UNESCO; and To serve the scientific interests of the international biomedical community in general. To achieve its objectives, CIOMS has initiated and coordinates the following main long-term programmes: Bioethics Health Policy, Ethics and Human Values - An International Dialogue Drug Development and Use : A broad range of drug safety topics has been covered by CIOMS via working groups. There have also been joint working groups together with WHO covering drug development research and pharmacovigilance in resource-poor countries and vaccine pharmacovigilance. International Nomenclature of Diseases All these programs and activities are dedicated to the patient safety and well being Plenary Symposium 4: On the Person Centered Psychiatry Book INTRODUCTION AND PERSON-CENTERED DIAGNOSIS Juan Mezzich (New York) Person centered psychiatry and medicine may be traced back to how medicine was conceived and practiced in ancient civilizations and through the present time, including efforts to redress contemporary reductionist distortions in clinical medicine and public health. With a sense of paramount ethical commitment, many leaders in medicine have recognized the interdependency of science and humanism and reaffirmed a psychiatry and medicine of the person, for the person, by the person, and with the person. Recent systematic explorations of person centered care have identified as key concepts in addition to its ethical imperative: a holistic framework to understand health and illness, cultural awareness and responsiveness, a communicational and relationship focus at all levels, individualization of care, establishment of common ground among clinicians, patient and family to arrive at and formulate a joint diagnosis and shared care decisions, people-centered organization of integrated care, and person-centered health education and research. The implementation and fulfillment of person centered psychiatry and medicine requires a person centered diagnosis, one that is not restricted to identifying diseases or differentiating among them, but represents a diagnosis of full health, both ill- and positive-health. In response to this challenge, a Person-centered Integrative Diagnosis (PDI) model [1], has been developed under the auspices of the International College of Person Centered Medicine (ICPCM). The distinctive features of the PID model are the diagnosis of a person s whole health, its multilevel informational structure composed of health status, health contributors, and health experience and values, its encompassing a formulation and also a process engaging clinicians, patient and family, and the use of categories, dimensions and narratives as descriptive tools. Representing an illustration of the PID model, the GLADP-VR, a Latin American Guide of Psychiatric Diagnosis (using ICD categories and codes of illness) has been recently published by the Latin American Psychiatric Association. Other guides based on the PID model are in the works for psychiatric and general medical practical use. The purpose of this book is to present authoritatively the emerging field of Person Centered Psychiatry [2]. It is organized under the aegis of the International College of Person Centered Medicine and published by Springer Verlag, Switzerland. The World Psychiatric Association (WPA) and the World Federation for Mental Health are officially co-sponsoring it. Eighteen WPA Scientific Sections are engaged in its authorship. Its five editors and 83 chapter authors come from across the world and are among the most experienced scholars and clinicians in the new field. The volume includes forty chapters organized into the following five sections: Principles, Diagnosis and Assessment, Person-centered Care Approaches, Person-centered Care for Specific Mental Conditions, and Special Topics. This book emerges from a broad conceptual and collaborative process. Its authorship and structure reflects these features. References 1.Mezzich JE, Salloum IM, Cloninger CR, Salvador-Carulla L, Kirmayer L, Banzato CE, Wallcraft J, Botbol M: Person centered Integrative Diagnosis: Conceptual Bases and Structural Model. Canadian Journal of Psychiatry 55: , Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM (eds): Person Centered Psychiatry. Springer, Switzerland, 2016.

33 PRINCIPLES OF PERSON CENTERED PSYCHIATRY Robert Cloninger (St. Louis) The core feature of Person-centered Psychiatry (PCP) is its focus on the person as a self-aware human being endowed with intrinsic dignity. Recognition of the dignity of every person has many implications that have been more or less clearly articulated and implemented since antiquity in both Western (Hippocrates) and Eastern (China, India) traditions. PCP has been describe as psychiatry "for the person, with the person, by the person, and of the person. Several key concepts of PCP are ethical commitment to recognize the freedom and duties of each person, to understand both positive health and ill-health in an integrative and holistic approach, to recognize the uniqueness of each person, to develop cultural awareness and respect for diversity as adaptations to distinct conditions, to value communication and relationships with stakeholders at all levels, to foster common values and a shared vision of the future in a cooperative working alliance, and to integrate care across several interrelated levels. PCP is a biopsychosocial approach that recognizes the inseparability of physical, mental, and social/spiritual aspects of health. Its integrative diagnostic approach considers both well-being and illbeing in relation to assessments of health status, contributing factors that influence health status, and also the subjective experience of health. Treatment is formulated in terms of understanding what each person values, what resources and obstacles need to be considered, and encourages and empowers a person to visualize and create a life narrative in which they can reduce their suffering and find satisfaction, health, and fulfillment. References (1) Mezzich JE, Snaedal J, van Weel C, Botbol M, Salloum I. Introduction to person-centred medicine: from concepts to practice. J Eval Clin Practice 2011; 17: (2) Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM (editors). Person-Centered Psychiatry. Springer, Switzerland, PERSON-CENTERED CARE APPROACHES Michel Botbol (Brest, France) Person centred cares applies in cares the principles of Person centred medicine and particularly the integration of the patient s subjective dimension and values, the joint elaboration of these cares by the professionals the patient and his carers. These shared principles are applied in various types of cares as Psychopharmacotherapy, Psychotherapy, Sociotherapy, Psychosial Rehabilitation. This perspective is also crucial in team work, Prevention and mental health promotion. In this intervention, we will briefly describe each of this fields highlighting how they are affected by the person-centred perspective. PERSON-CENTERED CARE FOR SPECIFIC CONDITIONS Ihsan Salloum (Miami) The aim of this presentation is to present survey the applicability of Person-centered Care for specific major psychiatric disorders. This Section include chapters on Person-centered Care perspectives on dementia, substance use disorders, bipolar disorder, depression and anxiety disorders, eating disorders, sexual disorders, trauma, personality disorders, child and adolescent psychiatry and on psychiatric and general medical comorbidity. SPECIAL TOPICS IN PSYCHIATRY George Christodoulou (Athens) The special topics in Person-centered Psychiatry comprise a group of great importance, indeed "special". Spirituality is a rather neglected albeit important issue, in view of the fact that 84% of the world population are "religiously affiliated". Religion has a by and large positive effect on mental health but there are negative aspects as well (e.g. Scientology, Jehovah's Witness). Similarly, Palliative Care has not received the attention it deserves. The health professional-patient relationship in palliative care should include four dimensions, namely emotional attunement, cognitive attunement, personal experience and ethical attunement. Increasing the patient's sense of dignity is a crucial element in palliative care. Person-oriented Forensic Psychiatry is an area in which application of the person-centered principles is sometimes difficult. Intricate situations arise and often one segment of the professional's work relates to the work of witness expert and another to clinical care in a personified doctor-patient relationship. Care should be taken not to confuse these roles. People-centered Organization of Psychiatric Services should aim at the provision of services to the people without discrimination and should aim at reducing the unacceptable treatment gap which sometimes reaches 90% of the population and is more pronounced in low and middle income countries. The issue of Evaluation of Person-centered Health Services is of extreme importance and relates to the evaluation of the contribution of the person-centered movement during its 10 years of existence. Assessment tools should incorporate not only economic growth but also human welfare. Development of a reliable Person-centered Care Index is an important aim. Person-centered Psychiatric Education is a prerequisite for personcentered psychiatric practice. Speaking TO the students should be replaced by speaking WITH the students in person-centered psychiatric education (interactional process). Person-centered Psychiatric and Mental Health research has been given priority by the ICPCM in a series of documents and especially in the 2013 Geneva Declaration. Conceptual, terminological and ontological issues are major areas of development. In addition to scientific training in research, the emotional maturity of students as persons (and researchers) should be given priority. Reference

34 Mezzich JE, Botbol M, Christodoulou GN, Cloninger RC, Salloum IM. Person Centered Psychiatry, Springer, Switzerland, Parallel Sessions 3: A: The Person Centered Approach in Illness Prevention and Health Promotion THE PERSON-CENTERED APPROACH IN ILLNESS PREVENTION George Rachiotis (Larissa, Greece) Disease prevention is a key aspect of public health policy. Typically, there are three forms of prevention: primary, secondary and tertiary. Nevertheless, the level of allocation of resources to these forms of prevention remains a challenge for policy makers. It is well known that the amount of resources allocated to primary and secondary prevention is very limited in comparison to curative /tertiary services. In the context of people -centered public health approach it is suggested that individuals exist with their particular circumstances. In this context the study of social determinants of primary and secondary prevention is a vital prerequisite for the implementation of a humanistic and holistic public health approach. There is enough evidence that the impact of socioeconomic context, (e.g. deprivation, ethnicity or geography) on vaccination programs is considerable. This is also the case for other subtypes of primary prevention like health promotion. It is well known that lower Socio Economic Status (SES) has a negative impact on the uptake of health promotion campaigns. By analogy participation in secondary prevention activities (screening) is strongly associated with the socio-economic framework of the individual. Screening coverage programs for breast, cervical and colorectal cancer were found to be influenced by socio-economic factors. Qualitative studies could shed light on the person-centered attitudes towards screening. Last, threshold limit values for occupational hazards which represent an important tool for primary prevention is an illustrating example of the complex interplay between socioeconomic circumstances and the ideal goal of person-centered public health. References Miles A and Mezzich JE. Advancing the global communication of scholarship and research for personalized healthcare: The International Journal of Person Centered Medicine, 2011,1:1-5. Sorensen G, Stoddard A, Ockene JK, Hunt MK, Yongstrom R. Worker participation in an integrated health promotion health protection program: results from the Well Works project. Health Educ Q., , 1. THE PERSON-CENTERED APPROACH TO HEALTH PROMOTION Robert Cloninger (St Louis, USA) Effective health promotion engages people in a way that allows them to express their own goals and values. Health promotion has only weak and inconsistent effects (correlations of about 0.15) when it relies only on instruction about facts regarding a healthy lifestyle, or focuses on reduction of disease rather than the cultivation of well-being. The most consistent and strong predictor of both subjective well-being and objective health status in longitudinal studies is a creative personality profile characterized by being highly self-directed, cooperative, and self-transcendent. There is a synergy among these personality traits that enhances all aspects of the health and happiness of people. In addition to benefits mediated by choice of diet, physical activity, and health care utilization, the effect of a creative personality on health include improved subjective well-being, resilience despite stress or adversity, greater heart rate variability, and longevity. Health, happiness, and meaning can be cultivated by a complex adaptive process that enhances healthy functioning, plasticity and selftranscendent values by means of increasing self-awareness through systematic evalluation of personality, lifestyle, and their relationship to health to motivate each person to identify valued changes they want to make in a way that is creative and selfactualizing. Achievement of these goals then is facilitated by experience-dependent learning through exercises for body awareness, mental awareness, and social awareness including methods of stress reduction, reflection, and meditation. Health promotion is likely to have only weak and consistent benefits unless it is person-centered. References: (1) Cloninger CR, Cloninger KM (2013). People create health: Effective health promotion is a creative process. International Journal of Person-centered Medicine, 2013; 3(2): (2) Cloninger CR (2013). Person-centered health promotion in chronic disease. International Journal of Person-centered Medicine, 2013; 3(1):5-12. PREVENTION AND EARLY INTERVENTION: INTEGRATED PERSON CENTERED CARE FOR COMORBIDITY IN THE MENTALLY ILL Helen Millar (Dundee, Scotland) Objectives and Methods The objective of this presentation is to highlight the current and growing epidemic of physical comorbidity in the mentally ill and risk factors leading to a reduced life expectancy in this population. A literature review including recent guidelines and consensus statements in the field has informed the presentation including examples of good practice, monitoring systems and risk assessment instruments. This up to date evidence will be reviewed with the key developments supporting proactive and preventative strategies and interventions to tackle co-morbidity in this population. Findings

35 Excessive deaths due to co-morbidities especially cardiovascular disease continue to contribute to the significant reduction in life expectancy in people with mental health problems. Important risk factors have already been identified including life style choices such as smoking, alcohol and substance misuse and a lack of exercise leading to excessive obesity and diabetes in this population. Certain prescribed medications exacerbate the problem with an increased risk of weight gain, dyslipidaemia and diabetes. Strategies encompassing prevention and early intervention with lifestyle and pharmacological management are required to improve quality of life and life expectancy. Discussion and Conclusions Discussion will include current early intervention approaches with a focus on screening, engagement with appropriate lifestyle interventions along with medication review. Contemporary models of care for co-morbidity emphasize the importance of managing physical well being from the onset of treatment of people with mental health problems in order to ensure better outcomes, improved overall wellbeing and a longer life expectancy. The approach encompasses a person centered model of care aiming at safe and effective practice, through thorough assessment, risk management and good communication and coordination across primary and secondary care. References 1. Cooper S J et al. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. Journal of Psychopharmacology 2016: Naylor C et al. Bringing together physical and mental health. A new frontier for integrated care: Kings Fund: Ideas that change health care March PEOPLE CENTERED CARE AND HEALTH PROMOTION Faten Ben-Abdelaziz (WHO, Geneva) People centered health care is an approach to care that consciously adopts individuals, cares, families and communities perspectives as participants in, and beneficiaries of trusted health systems that respond to their needs and preferences in humane and holistic ways. Indeed it is an essential component of health promotion as it requires that people have sufficient literacy to support their decisions and participate in their own care The advocacy around re-thinking how health care should be designed was already endorsed in the action areas of the Ottawa Charter on health promotion, more than thirty years ago through two main action areas re-orientation of health care service and community empowerment. However, limited progresses have been shown mainly because of a lack of governments investment on health workforce to acquire the required capacities and skills around a culture of patient-centeredness as compared to investing on new technology. This approach requires changing the way health care is provided to include information on client socioeconomic conditions and the quality of communication/interaction between client and health care providers. There is sufficient evidence supporting the fact that when health care is responsive to the clients needs and conditions, it improves not health outcomes, wellbeing but also responsiveness of heath treatments, particularly of vulnerable population groups. Thus, supporting People centered health care generates great results on investment. Policy makers need to look beyond such areas as health technology to shape a coordinated and focused national policy based on the existing resources allocated, structures in place, the systems for delivering health care services and products, resources for enhancing health literacy that consider the social determinants of health. The agenda 2030 on the Sustainable Development Goals offers a great opportunity for more advocacy and gaining commitment to reorient health care services. The presentation seeks to demonstrate how health promotion approaches and tools, as set in the Shanghai Declaration to promote health within the SDGs agenda, constitute valuable tools that would support policy makers engagement towards improved people centered health care services. B: Symposium on Patients, Families and Communities and the Person Centered Approach SURPASSING ATTRIBUTES AND CIRCUMSTANCES OF THE PERSON IN A PERSON-CENTERED APPROACH Werdie Van Staden (Pretoria, South Africa) Objective: This presentation distinguishes within Person-Centered Medicine (PCM) between serving the person vis-a-vis his or her attributes. It explains the practical relevance of this distinction when true to the ethos of PCM. Method: Conceptual means are used to make clear the distinction, and examples are presented by which its practical relevance is demonstrated. Findings: Various attributes of the person feature strongly in PCM including his or her family, community, circumstances, health, well-being, illness, healthcare needs, autonomy, rights, dignity, culture, etc. PCM also incorporates the unequivocally important emotional, bodily, and even molecular attributes of the person. The clinical attention to these attributes is crucial in serving the person. Notwithstanding, attending to merely the attributes of the person rather than the person him/herself would defy the holistic ethos of PCM. The person, moreover, may even disappear behind attendance to his or her attributes and circumstances. Instead, if true to the holistic ethos of PCM, clinical attention to the attributes and circumstances of the person should be positioned as secondary to attending principally to the person per se through a reciprocal relationship with the practitioner. Conclusion: The holistic ethos of PCM requires that the person per se is more important than his or her attributes and circumstances. The clinical attention to his or her attributes and circumstances, crucial as these are notwithstanding,

36 should come second to attention to the person through reciprocal relationship. References: 1) Mezzich JE, Botbol M, Christodouluo GN, Cloninger CR, Salloum IS. Introduction to Person Centered Psychiatry. In Mezzich JE, Botbol M, Christodouluo GN, Cloninger CR, Salloum IS (eds), Person Centered Psychiatry. Switzerland: Springer; pp.1-18, ) Christodoulou GN, Van Staden CW, Mezzich JE. Ethics in person-centered psychiatry. In Mezzich JE, Botbol M, Christodouluo GN, Cloninger CR, Salloum IS (eds), Person Centered Psychiatry. Switzerland: Springer; pp.35-46, THE ROLE OF FAMILIES IN PERSON-CENTERED CARE Ann Helgesen (Halden, Norway) Background: Patient participation in healthcare is an ideology, a legal right and an ethical value in most western countries. Patient participation is an important element in person centered care. Studies that explore the phenomenon in one of the most rapidly growing areas in healthcare, elderly care in general and dementia care in particular, are scarce. Studies exploring the experience of families of persons with dementia as to their role in the patient participation process are limited. Objective: The aim of this study was to explore the role of families in the patient participation process for persons with dementia living in special care units in Norwegian nursing homes, with focus on everyday life. Methods: Data collection was carried out by 24 interviews with twelve close relatives. Simultaneously, data analysis was performed with open, axial and selective coding. Findings: The families role in the patient participation process was experienced as transitions between different roles to secure the patient s wellbeing, which was understood as the patient s comfort. and dignity. This was the ultimate goal for their participation. The categories being a visitor, being a spokesperson, being a guardian and being a link to the outside world described the different roles. Conclusions: Family members are persons who have valuable roles in the patient participation process. More attention should be paid to initiating better cooperation between the personnel and the families, as this may have a positive impact both on the patient and the families wellbeing. References: 1. Edvardsson D, Winblad B & Sandman P (2008) Person-centred care of people with severe Alzheimer's disease: Current status and ways forward. The Lancet Neurology 7, Davies S & Nolan M (2006) Making it better : Self-perceived roles of family caregivers of older people living in care homes: A qualitative study. International Journal of Nursing Studies 43, THE ROLE OF CAREGIVERS AND COMMUNITY SUPPORT IN PERSON-CENTERED CARE Spyros Zorbas (Athens) Six organizations from five EU countries are part of a European partnership with long experience in mental health care, deinstitutionalization and social inclusion actions for people with severe mental disease and are interested in sharing community based policies, educational methodologies and praxis on housing at EU level. The partnership originates from the European Mental Health Action Plan for , linked with the inclusion policies at their national level. During the 2017, in project HERO, four focus groups for mental health users, families and professionals were held. Mr. Zorbas will share some interesting opinions from the participants of those focus groups. PATIENT ORGANIZATIONS AS PARTNERS IN THE PERSON-CENTRED HEALTHCARE MOVEMENT Christine Janus (IADPO, Ottawa, Canada) 1. Patient organizations (POs) can bring the voice of patient/family/person and their lived experience of the disease and of their care and treatment issues, to decision making, and policymaking bodies a. Their objectives are aligned with those of the person-centered medicine ( PCM) movement b. They are your boots on the ground Nothing about us, without us 2. Why partner? POs leaders can be: a. sources of information and insight ( especially for in-depth psycho-social impacts on the patient and their families) which often will differ from what they may tell physicians/researchers /policy makers. They feel safe speaking to people who walk the same path. b. a way to reach people grappling with conditions or diseases c. easier to engage than individual patients d. better at understanding the big picture issues, given their access to many patient stories e. representatives of the broader patient perspective beyond the individual patient voice f. uniquely validate the person-centric message to late adopters 3. What are some challenges to bringing patient representatives to the table a. PO leaders don t generally speak the same language as policy & decision makers. They usually come with diverse skills and knowledge. i. Can we provide appropriate training to allow them to participate effectively? ii. Can we treat them like equals who bring valuable information? ( requires a paradigm shift in some medical policy environments?) b. Shortage of resources can mean that patient leaders lack validated data and are therefore less credible where data is the currency of accepted input.

37 i. Is providing direct funding to organizations so that their staff are well equipped an answer? (e.g. Sweden) ii. Bring PO leaders into early research design for increased patient participation and the creation of patient-validated data to be used by them and the PCM movement win/win iii. Support patient-initiated research (like GRIDD) by officially recognizing the invaluable contribution brought forward by research for the people, by the people. c. Patient organizations often depend upon pharma for funding, and thus their messages may be deemed to be contaminated. i. POs would welcome other sources of funding. ii. Most have clearly delineated codes of conduct which firmly keep pharma reps out of their policy and decision-making. Consider IAPO and IADPO codes of conduct as examples adopted by their members. 4. How does the PCM movement involve POs? a. Locally, invite them to sit on think tanks, on boards etc b. Invite their participation in this conference and in any local PCM events or boards c. Provide them with information about the movement and stand back they will run with it. d. Mentor, educate and support PO leaders and their constituents e. Suggestions/examples from the audience? ADVANCING PERSON-CENTERED MATERNAL AND NEW BORN CARE IN BANGLADESH T Mazumder, J Perkins, AE Rahman, J Sormani (Presenter), C Capello, C Santarelli. Introduction: In Bangladesh, women and newborns continue to face elevated risks around the time of pregnancy birth and postpartum. Applying a person-centered approach to MNH services is a priority in such contexts to increase use of services and improve the health of women and newborns. In 2009, the NGO Enfants du Monde, in collaboration with the local NGO PARI Development Trust, began supporting Ministry of Health at local level to implement birth preparedness and complication readiness (BPCR) in Netrokona district as an intervention to empower women, families and communities to improve health and increase access to skilled care. Objective: To assess the contribution of the BPCR intervention in advancing person-centered MNH care in Netrokona, Bangladesh Methods: The intervention was evaluated in 2016 using qualitative and quantitative methods. We conducted 16 in-depth interviews, one focus group discussion and three group discussions with different stakeholders. In addition, a household survey was conducted with 737 women with a recent birth history and their husbands (comparison 295, intervention 442). Findings: The BPCR intervention was co-designed though a consultative process with national technical experts, local health managers, frontline health workers and the community, ensuring the reflection of local preferences and context. Training of health care providers in counselling allowed them to apply effective counselling skills (e.g. open dialogue, respect, responsiveness to individual needs) to BPCR counselling during antenatal care visits (ANC). The intervention contributed to empowering pregnant women to plan to prepare for birth and emergencies independently. Discussion on BPCR in households and courtyard meetings provoked and sustained families and communities engagement in MNH. There was remarkable increase across all indicators related to BPCR between baseline and endline: BPCR among women increased from 28% to 72.2% and male involvement increased significantly. Regarding use of health services, ANC4+ increased from 5.4% to 28.5%, while little change was observed in facility birth and postnatal care. Conclusion: The BPCR intervention was successful in advancing personcentered MNH care by empowering women and increasing the engagement of men, families and communities in MNH care. Moreover, BPCR in conjunction with the counselling training increased responsiveness of health care providers to women and families and their particular needs. Further research is needed to understand how this reorientation contributes to use of services and health outcomes Parallel Sessions 4: A. Symposium on The Person Centered Approach in Health Education THE MAKING OF A PHYSICIAN Shridhar Sharma (New Delhi) The subject of "The Making of a Physician" is important, because of the current changing health care environment, where practice of medicine is being increasingly influenced-by growth in science, technology, high cost, rising expectation of the people and other powerful market forces emerging from globalization process, which have put medical practice at cross roads. The essence of medicine lies in the therapeutic relationship between the doctor and the patient and our attitude to our patients. Traditionally physicians were not greedy but his basic needs of living were looked after by the society. He was not only respected but was held in high esteem and which was next to God. The relief of suffering is one of the main objectives of medicine. It is the person in totality that we are interested in both in health and disease. In reality, the relief of suffering and the cure of a person must be seen as twin obligations of the profession, and true dedication to the cure of the sick. The cure of disease is influenced by our scientific knowledge and growth of science while the relief of suffering is guided by our compassion to the patient and sharing of patients suffering and feelings. There is an old saying "who is not a good man shall not make a good Physician", Bieganski W (1908) "one cannot help the patient without understanding the man" "Aleksandrowicz J (1985). References: Aleksandrowicz J. (1985) Studia meaticzne a etos zawodu lekarza A.M. KRAKOW. Bieganski W. (1908) Logica medycyny wyd E. Wende, WARSZAWA

38 COMMUNICATION IN HEALTH EDUCATION Veljko Djordjevic and Marijana Bras (Zagreb) Education in medicine must be interdisciplinary and directed toward the person rather than the symptom, diagnosis, or disease. Medical education is a critical component of person-centered health care, which is developed from the ground up and requires a revised approach to teaching of clinical skills (among them, communication skills). As health care in general is a very complex and dynamic system, reflecting social changes, in recent decades great attention has been paid to the quality of communication in medicine and health care. Therefore, communication is probably one of the most important issue in health education and training. We would like to present our 10-year experience in teaching communication skills in School of Medicine University of Zagreb. Croatia. According to our experience, is is very important to have longitudinal education of communication skills throughout the undergraduate and postgraduate curriculum. Also, teaching methods for communication skills are mostly related to experiential learning (role play, simulated patients, real patients), with emphasis on feedback. We have great experience with the patients as a teachers model. Also, when we talk about different forms of communication in medicine, we must never forget the importance of communication through art. The First International Congress of the ICPCM was held in Zagreb, Croatia on November 7-10, The main theme was the Whole Person in Health Education and Training. During the Zagreb Congress, two documents were formulated and adopted: the Zagreb Declaration on Person-Centered Health Professional Education and the Zagreb Statement on the Appraisal and Prospects for Person-Centered Medicine in Croatia. In our presentation, we will give our opinion about the impact of those declarations in Croatian health education system. Bras M, Djordjevic V. Person-centered health education and training. Croatian Medical Journal, 2014 Feb; 55(1): Đorđević V, Braš M, Milunović V, Brajković L, Stevanović R. The founding of the Centre for Palliative Medicine, Medical Ethics and Communication Skills: a new step toward the development of patient oriented medicine in Croatia. Croat Med J. 2011;52:87 8 INTER-PROFESSIONAL EDUCATION Tesfa Ghebrehiwet (Alberta, Canada) Background: Most health profession educational institutions devote little or no time and resources to IPE and team functioning. Yet, one of the promising solutions to today s health system challenges can be found in IPE (WHO, 2010). Aims: The presentation will highlight the importance of IPE in team approach in health care. Methods: A WHO environmental scan of interprofessional education practices in 42 countries showed generally low implementation of IPE (WHO, 2010). Results: Health professionals tend to adopt solo practice leading to fragmented care and poor health outcomes (Institute of Medicine, 2011). Discussion: The focus on hospital-based education that is segregated into professional silos does not prepare health professionals for team work (Frenk et al. 2010). Investments in the training of health professionals must be made in terms of IPE. Conclusion The time is now for a paradigm shift in educational programmes of health professionals to include IPE in order to prepare them for team approach in their practice. Reference [1] Frenk, J. et al. (2010).Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet, 376: [2] Institute of Medicine (2011). The Future of Nursing Leadership, Advancing Health. Washington, D.C., National Academy Press. [3] World Health Organization: Health Professions Network Nursing and Midwifery Office within the Department of Human Resources for Health (2010). Framework for Action on Interprofessional Education & Collaborative Practice. WHO HRH/HPN/10.3. Geneva: World Health Organization. CONTEXT BASED LEARNING WITHIN AND FOR DISTRICT HEALTH SYSTEM IN THAILAND Yongyuth Pongsupap, Surakiat Achananuparp, Tawekiat Boonyapaisarncharoen, Somchai Phanumaswiwat, and Patrick Martiny (Bangkok, Thailand) Introduction: Health staff in Thailand requires complementary learning for reinforcement of patient centeredness and integration of care. Context based learning (CBL) has been introduced from 2007 onwards targeting mainly health centre staff first, then also physicians and health system managers. CBL is participatory interactive learning through action (PILA) and relies on several learning activities (on-the-job and inter-service holistic practice, follow-up of selected families, implementation of health driving projects, etc.). Learning follows identification of gaps between expected capabilities and existing performance of individuals, teams, and health systems. Aim: CBL is transformative learning. It aims at transforming individuals emotional style. It is a cognitive transformation starting from what is already known. It produces change agents, able to reflect on their working environment and to modify it. Methods: CBL intended to be first a small-scale implementation research with some action-research features. Field actors were supported by senior experts and academics who produced several working papers and operational guidelines, underscoring each time concepts and hypotheses at stake. Developmental evaluations were carried out. CBL progressively became a large-scale implementation of packages of several actions. Results: CBL has led to social change bringing closer all health care system actors, including community members, not-health sector professionals and academics. The CBL concept has been defined and is now referred to nationwide. CBL has indirect results related to networking (district matrix extended teams, communities

39 of practice, cooperation with academics), organizational development (functional unit teams family care team, district health board, etc.) and health policy making. Conclusion: CBL is reinforcing primary care, patient centeredness, family medicine and district health system in Thailand. It is a learning system which bridges health professionals from all levels of care, health and not-health professionals, professionals and communities, health care and educational systems. It is in line with new management approaches which empower field actors. It is both large scale implementation and research. References: 1. Davidson RJ (2012). The emotional life of your brain. London: Hodder & Stoughton. 2. Panich V. Transformative Learning. Bangkok: S.R. Printings and Mass Products, Pongsupap Y et al. District Health Management Learning: A big leap forward to people-centred district health system in Thailand. The Journal of Public Health and Development, 2016; 14 (3): EMBEDDING A PERSON-CENTRED APPROACH IN HEALTH WORKFORCE EDUCATION Giorgio Cometto (WHO, Geneva) This presentation will articulate the global health workforce agenda as articulated in relevant WHO global strategies and normative frameworks, focusing most specifically on aspects relating to education of health workers, and specific approaches and strategies to enhance a person-centred approach to care. Person-centred delivery models require an appropriate and sustainable skills mix in order to meet population health needs equitably. Health systems should align market forces and population expectations with primary health care needs, universal access to health care and people-centred care, avoiding overmedicalization and unnecessary interventions. There is a need to modify and correct the configuration and supply of specialists and generalists, advanced practitioners, the nursing and midwifery workforce, and other mid-level and community-based cadres. This renewed focus should also ensure an adequate and genderbalanced pool of eligible high-school graduates, reflective of the population s underlying demographic characteristics and distribution, to enter health training programmes to improve health workforce distribution and enhance a person-centred approach. Priority should also focus on orienting admission policies and curricula to link HRH planning and education (including an adequate and gender-balanced pipeline of qualified trainees from rural and remote areas), and encourage inter-professional education and collaborative practice. Radical improvements in the quality of the workforce are possible if the higher education and health sector collaborate on a transformative education agenda grounded in competency-based learning. This approach should equip health workers with skills to work collaboratively in inter-professional teams, with knowledge to intervene effectively on social determinants of health and nurturing a public service ethic and social accountability attitudes requisite to deliver respectful care that responds to local needs and population expectations. References: 1. WHO. (2016). Global strategy on human resources for health: workforce Geneva, Switzerland. Retrieved from 2. WHO Global Strategy on People-Centred and Integrated Health Services interim report. Geneva: World Health Organization; 2015 (WHO/HIS/SDS/2015.6; B. Symposium on Ethics and the Person Centered Approach PRINCIPLES OF ETHICS AND PERSON-CENTERED CARE George Christodoulou (Athens) Principles of Ethics are more important than codes, rules and guidelines because it is on the principles that the latter are based. It should be pointed out, however, that the principles a) should be considered in conjunction and b) they are not static, they are not universal and they are not diachronic. They change from place to place and from time to time as they are subject to ever-changing sociocultural influences. The dictum of Heraclitos "τα πάντα ρει" (everything changes") is relevant here. The most important theories on which the ethics principles are based are the following: Virtue Ethics Casuistry Deontological Theory Utilitarianism Principlism Ethics of Care (Green and Bloch, 2006) These theories will be examined under the person-centered approach and it will be pointed out that moral decisions in Medicine are always filtered through the individual practitioner. It is not enough to have ethical principles, rules and guidelines. The implementing practitioner's attitude must also be ethical and person-centered. In the hands of an unethical practitioner the implementation of an ethical code can be distorted to produce an unethical result. References Christodoulou GN (2006) Ethics and Behavioral Disciplines, in Festschrift for Prof. S. Scarpalezos, Beta Publishers, Athens Green S and Bloch S. (2006) An Anthology of Psychiatric Ethics, Oxford, UK

40 THE HELSINKI DECLARATION AND PERSON CENTERED MEDICINE Jon Snaedal (Reykjavik) When the World Medical Association (WMA) was founded in 1947, medical ethical issues were very prominent. The first WMA policy was an updated version of the old Hippocratic oath; the WMA Declaration of Geneva1) intended for use as an oath when a medical student was entering the profession of a physician. The declaration is very person oriented in itself reflecting the duties of the physician towards the patient exemplified by this statement: The health of my patient will be my first consideration, Subsequently, the International Code of Ethics2) was adopted one year later with an in depth observation of the duties of the physician towards his/her patient. This declaration is also inherently person centered. The most influential policy of the WMA is however the Helsinki Declaration on Ethical Principles for Medical Research involving Human Subjects3). In this policy the person, being it a patient or a healthy individual, is the primary subject. The scene for this is set in early in the document such as in par. 3: It is the duty of the physician to promote and safeguard the health, well-being and rights of patients, including those who are involved in medical research. The policy addresses risks and burdens, vulnerable individuals and privacy and confidentiality, all extremely important aspects of research involving human subjects. The policy is thus inherently person centred but is however lacking the full holistic aspect of a person as generally considered in Person Centred Medicine. There is therefore a need for a specific policy for the WMA to guide physicians in holistic person centeredness. 1) 2) 3) CULTURE, ETHICS AND PERSON-CENTERED HEALTHCARE Werdie Van Staden (Pretoria, South Africa) Objective: This presentation provides for an ethical approach to cultural aspects in person-centered healthcare. Method: Conceptual means are used to make clear the scope of the concept of culture in a person-centered approach (PCA). The ethical importance of accounting for culture in its full scope is demonstrated through examples. Findings: A person-centered approach informed by value theory uncovers the natural tendency to have cultural blind-spots. Two kinds of blind-spots are apparent: a) having a blind-spot for one s own culture and ascribing culture merely to someone else, whether in theory or clinical practice; and b) not recognizing the scope of culture in theory and practice. Regarding the former, we spot cultural values relatively easy when they are different and even in conflict, whereas cultural values are less apparent when shared. Regarding the scope of the concept of culture, a PCA recognizes culture in the various practices of people rather than taking culture designating merely a group of particular locality. Conclusion: A remedy for the natural tendency to have blind-spots for culture is sensitivity and sophistication that accounts for both cultural uniformity and diversity in theoretical discourse and in clinical practice. References: 1) Rashed MA, Du Plessis RR, Van Staden CW. Culture and Mental Health. In: Psychology: Themes & Variations, South African Edition. W Weiten, J Hassim (Eds.). Cengage: Boston ) Van Staden CW, Fulford KWM. The indaba in African values-based practice: respecting diversity of values without ethical relativism or individual liberalism. In Oxford Handbook of Psychiatric Ethics. JZ Sadler, CW van Staden, KWM Fulford (Eds). Oxford: Oxford University Press ETHICS IN PERSON CENTERED UNIVERSITY EDUCATION Alberto Perales (Lima) BACKGROUND. Talking about ethics in university education is talking about moral attitudes and behaviours that students should acquire in order to fully comply with their professional role. The university has attempted to achieve those goals by teaching ethics, although its effectiveness is questioned (1). To improve the quality of the ethics teaching requires an adequate theory of the man s moral and health development since not all students enter the university in optimal conditions and many show mental health problems that will affect their education in a negative manner. PURPOSE. To examine the university teaching of Ethics in Latin America and to propose new study approaches and programmatic management considering the student as a Person. METHODOLOGY. A selective review of the literature from descriptive, prescriptive and analytical perspectives. RESULTS. The effectiveness of the ethics curriculum teaching as a means for the moral education of the university student is unsatisfactory. International studies (2,3) and another carried out in a public Peruvian university, (student population: 24,500; sample: 1784) (4) point out diverse moral misconducts and mental health pathologies in university students, that prevail significantly over those reported in the general population. DISCUSION AND PROPOSALS. Such circumstances pose the university a dilemma: Is it its pedagogical mission and purpose simply to teach ethics or should the university commit to help the students in their development as whole persons? To opt for the second statement, urgent need in Peru and probably in Latin America, requires to develop new strategies to evaluate and promote students moral, health and life quality, in order to help them achieve their full development as a person and upright professional. REFERENCES: 1. Cárdenas Max. La educación ética en las escuelas de medicina peruanas: un estudio de sílabus. Tesis de Magister. Universidad Nacional Mayor de San Marcos Lima. Peru. 2. Mendoza J. Medicina centrada en la persona. Perspectiva desde Colombia. Primeras Jornadas Latinoamericanas de Medicina Centrada en la Persona. Diciembre 17-18, Lima-Peru. 3. Hafeez K, Khan MLZ, Jawaid M, Haroon S. Academic misconduct among students in medical colleges of Karachi,

41 Pakistan. Pak J Med Sei 2013;29(3): Perales A. Conducta suicida en estudiantes de pre-grado de a Universidad Nacional Mayor de San Marcos. Reporte Final, Lima, Perú Council for International Organizations of Medical Sciences (CIOMS) released in November 2016 a new version of its ethical guidelines on biomedical research involving humans (International Ethical Guidelines for Health-Related Research Involving Humans. CIOMS, Geneva 2016: available from ). The new guidelines respond to various changes in research environment involving humans including: an increased emphasis on the importance of translational research, a need to clarify what counts as fair research in low-resource settings, more attention on community engagement in research, the awareness that exclusion of potentially vulnerable groups in many cases has resulted in a poor evidence base, and the increase of big data research. The new guidelines have increased the emphasis on the need for scientific and social value of research (Guideline 1), take a global approach to fair research with study populations in low-resource settings (Guideline 2), emphasize the importance of community engagement from the start to the implementation of research (Guideline 7), emphasize that potentially vulnerable groups must be included unless a good scientific reason justifies their exclusion CIOMS PERSPECTIVES ON RESEARCH ETHICS Lembit Rägo (CIOMS, Geneva) and how special protections apply to specific characteristics of study populations (Guideline 14), and provide guidance on biobanking and health-related data in research (Guideline 11 and 12). The changes in the new CIOMS Guidelines represent an international consensus effort to provide well-reasoned answers to emerging challenges. The presentation is elucidating the consultation process of the new guidelines together with an analysis of the new CIOMS guidelines in the context of personalized medicine. References 1. Van Delden JJM, Van der Graaf R. Revised CIOMS International Ethical Guidelines for Health-Related Research Involving Humans. JAMA, Published Online: December 6, doi: /jama Ehni HJ, Wiesing U. Research ethics for a globalised world: the revised CIOMS international guidelines. Indian J Med Ethics, 2017 Mar 7: 1-4. C. Interactive Workshop on Clinical Communication and Coaching EMPATHY AND NARRATIVES TO INTEGRATE SUBJECTIVITY IN PERSON-CENTERED MEDICINE Michel Botbol (Brest, France) More than other specialties Psychiatry and Mental Health are exposed to the negative effects of disorder centered approach. Because of the many competing theories about the very nature of the psychiatric disorders, mental health classifications have to neglect key aspects of the person s mental health status, such as subjectivity and psychodynamic dimensions, in order to mimic the paradigm on which are based the biomedical classifications in other medical disciplines. The first stake of psychodynamic psychiatry is to fight against this abusive reductionism that leaves us with half a science (Strauss) and a nosography not well adapted to clinical practice. To achieve this goal, psychiatrist have to be aware that observing is important but not enough to have access to the person s subjective feelings and that listening is crucial but not sufficient to access to the person s unconscious or repressed subjective feelings or representations. A method has to be found to access this hidden dimension. It is one of the main operational goal of Psychoanalysis In Psychiatry and of Person Centered Medicine Movement, to find a non metaphysic way of dealing with subjectivity (including spiritual aspects) we consider a corner stone for person-centeredness in medicine and other humanistic activities Starting with a naturalistic question: How do we do it naturally in clinical settings?, this paper will show how narrative empathy (involving the subjectivity of the professional, the patient and his carers), is the only tool to access the patient s subjectivity in most clinical situations, given that professional are properly trained to use their own subjectivity in this task References: Botbol M, Banzato C and Salvador-Carulla L: Categories, Dimensions and Narratives for Person-centered Diagnostic Assessment. International Journal for Person-Centered Medicine, 2 (2), pp Charon, R. (2006). Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press. Kleinman, A. (1989). Illness narratives: suffering, healing and the human condition. New York: Basic Books. Ricœur P (1983) Temps et récit [Time and narrative]. Paris, Le Seuil. Roberts, G.A. (2000). Narrative and severe mental illness: what place do stories have in an evidence-based world? Advances in Psychiatric Treatment 6, VALUE-BASED HEALTH COACHING: AN INTERNATIONAL AWARD WINNING NEW PERSON-CENTRED Ayse Basak Cinar (Dundee, Scotland) Objective: Value-based Health Coaching (VHC), a new personcentred approach (PCA), focuses on patient empowerment for better chronic disease management, especially diabetes type2 (DM2); that is in line with the core concept of WHO-2020 Goals and UN-Sustainable Development Goals. The present study aims to evaluate the effectiveness of VHC compared with Health Education (HE) on DM2 management using clinical and subjective measures among DM2 patients in Turkey (TR) and Denmark (DK). Methods: This prospective study (6-months initiation-maintenance, 6-months follow-up) randomly selected DM2 patients in TR (n=186)

42 and DK (n=116)) and allocated them to HC and HE groups. Selected outcomes were HbA1c, periodontal treatment loss (PAL), lean body mass (LBM), depression, tooth-brushing, self-efficacy and physical activity. Findings: At baseline, no statistically significant differences were found between HC and HE groups. Post-intervention, there was a reduction of HbA1c in HC groups (TR:0.8%; DK:0.4%,p<0.01) but not in the HE groups. Reduction in PAL was higher among coaching groups (p<0.01). Significant positive change at LBM among HC-DK (p<0.05) and significant loss at LBM among both HE groups were observed (p<0.05). HC group patients who brushed twice daily were more likely to be physically active than once a day or less toothbrushers, (p<0.05). Factor analysis revealed pathways of interaction between oral health, psycho-behavioural factors and DM2. Conclusion: VHC compared to HE seems to have a higher impact on improvement of health and psycho-behavioural factors among DM2 patients. VHC as a PCA can be integrated to holistic health promotion initiatives for DM2 management including oral health. References: 1. Cinar AB, Schou L. New Patient Centered Approach to Unlock the Individual`s Potential to Adopt Healthy Lifestyles: Health Coaching. Journal of Person Centered Medicine; 5 (4): World Health Organization. People-centred and integrated health services: an overview of evidence. Interim Report. Geneva, Switzerland, THE ROLE OF COMMUNICATION IN PERSON-CENTERED MEDICINE. INSIGHTS FROM EACH: INTERNATIONAL ASSOCIATION FOR COMMUNICATION IN HEALTHCARE Sara Rubinelli (EACH, Lucerne, Italy) Objectives. This presentation focuses, first, on the role and value of communication in person-centered medicine and, second, on how EACH: International Association for Communication in Healthcare works to promote healthcare communication that is effective, patient-centred and evidence-based. Methods. The content of this presentation is based on evidence from health communication, that is presented and discussed in light of the projects fostered by EACH and its committees. Findings. Shared decision-making as the gold standard for personcentered healthcare requires sophisticated communication skills of health professionals. The skills have now been clearly conceptualized and specific training techniques have been validated. The empowerment of patients, as partners of shared decision-making, is a main topic for patient education. It argues for the value of instruments to enrich patients health literacy from a comprehensive perspective, as well as for instruments (such as decision-making aids) to enhance patient participation. These findings are discussed in light of EACH s efforts to promote the development of healthcare communication research and education as a major initiative to improve the health outcomes of the general public. Discussions and conclusion. EACH has been developed with the appropriate infrastructure to influence the practice of health communication worldwide. Yet, knowledge translation (from research findings to practice) remains a main challenge in the field. EACH is currently working on how to disseminate knowledge about effective communication between patients, relatives and health professionals, extolling best practices and improvements in education to comply with the changing needs of health delivery. References: Brown J, Noble L, Papageorgiou A, Kidd J. Clinical communication in medicine. Wiley-Blackwell, Silverman J, Kurtz S, Draper J. Skills for communicating with patients. Taylor & Francis Group, MEDICAL INTERVIEWING AND COMMUNICATION Marijana Bras and Veljko Djordjevic (Zagreb) Communication is an integral part of any relationship with patients and their families, and represents the key to the success of the medical team. Medical interview is an extremely important factor in establishing relationship between health professionals and patients. Builds a relationship, opens the discussion, gathers information, understands the patient s perspective, shares information, reaches agreement and provides closure are essential elements of the medical interview. Interpersonal communication, which takes into account differences in life world and personal circumstances as well as the patient's individual level of comprehension, coping skills, informational needs and emotional needs, increases the chance of being heard and of reaching desired health outcomes. Communication skills training is now internationally accepted as an essential component of medical education. Just a personal experience or talent is not enough for optimal physician-patient communication. There are those who are more or less talented, more skilled or less skilled in communication. What is encouraging is that their skills can be improved by learning to become a better communicator in medicine. Only education can help us to reduce mistakes. Everything is in the relationship. Homo homini remedium! Kurtz SM, Silverman JD, Benson J and Draper J. Marrying Content and Process in Clinical Method Teaching: Enhancing the Calgary- Cambridge Guides. Academic Medicine. 2003; 78(8): Van Dulmen S. The value tailored communication for personcentered outcomes. Journal of Evaluation in Clinical Practice. 2011; 17(2): Parallel Sessions 5: A. Symposium on Person-centered Health Care Research RESEARCH ON CONCEPTUALIZING PERSON-CENTERED MEDICINE Juan Mezzich (New York)

43 Almost from the beginning of its institutional journey, Person Centered Medicine (PCM) has been defined as an approach that places the person in context (not organs or disease) at the center and as the goal of medicine and health care [1]. Conceptualization in terms of fundamental activities, has included a formulation of PCM as a medicine of the person (of the totality of the person's health, including its ill and positive aspects), for the person (promoting the fulfillment of the person s life project), by the person (with clinicians extending themselves as full human beings with high ethical aspirations) and with the person (working respectfully, in collaboration and in an empowering manner with persons presenting for care). Attempts at understanding have also looked at the dynamics of PCM. It has been posited, for example, that PCM is dedicated to the promotion of health as a state of physical, mental, socio-cultural and spiritual wellbeing as well as to the reduction of disease, and founded on mutual respect for the dignity and responsibility of each individual person. A fundamental activity in PCM emerging largely from interactions with the World Health Organization has been the articulation of person-centered clinical medicine and peoplecentered public health. These two concerns are now often considered as two sides of the same medal. Along similar lines, significant value for the conceptual delineation of PCM has been derived from the unfolding of longitudinal development processes. Interdisciplinary work and perspectives centered around the whole person have been also valuable contributors to PCM conceptual maturation. The identification of key concepts underlying PCM, has prominently emphasized its ethical base. This indicating that ethics is fundamental for all medical activities, including clinical care, education and research. It has also been argued by two recent presidents of the World Medical Association that PCM represents an ethical imperative for the medical profession. The ascertainment of a comprehensive set of key indicators has been a substantial ongoing concern of PCM. Systematic work in this direction has involved critical reviews of the literature as well as broad international consultations. This led to the design of a Person-centered Care Index (PCI) and efforts to assess its applicability, replicability and validity [2]. There is a need for further work on the systematic evaluation of the concept of Person Centered Medicine in different world regions and application settings. Coupled with empirical data-based research, philosophical efforts at conceptualization are needed. Ongoing work along these lines proposes that PCM articulates science and humanism towards a medicine informed by evidence, experience and values to enhance health restauration and health promotion of the whole person in context. References 1.Mezzich JE, Snaedal J, van Weel C, Heath I (2010): Toward Person-centered Medicine: From disease to patient to person. Mount Sinai Journal of Medicine 77: Mezzich JE, Kirisci L, Salloum IM, Trivedi JK, Kar SK, Adams N, Wallcraft J (2016): Systematic Conceptualization of Person Centered Medicine and Development and Validation of a Personcentered Care Index. International Journal of Person Centered Medicine, 6: METRICS RESEARCH IN PERSON-CENTERED MEDICINE: ITEM RESPONSE THEORY ANALYSIS OF DSM 4 OPIOID USE DISORDER ABUSE AND DEPENDENCE SYMPTOMS IN MEN AND WOMEN Levent Kirisci (Pittsburgh) Background: According to National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) conducted in in USA, prevalences of 12-month and lifetime nonmedical prescription opioid use were 4.1% and 11.3% and 12- month and lifetime rates of DSM-5 and DSM-IV nonmedical prescription opioid use disorder diagnosis were 0.9% and 2.1%, and 0.8 and 2.9%, respectively (Saha et al., 2016). Objective: This study examines the construct of diagnostic criteria of DSM-IV opioid use disorder abuse and dependence symptoms in males and females: how well each criterion performs, how much information each contributes to a diagnosis, and whether age is a factor in endorsing symptoms. Method: Item response theory (IRT) analyses were performed in 539 adult males and 306 adult females. Results: IRT analyses indicated that symptoms of opioid use disorder formed a unidimensional continuum in males and females. Abuse and dependence symptoms on average more severe in males than females. Contribution of statistical information to overall diagnosis by each symptom was significant. Endorsement of each symptom by younger adults and older adults showed significant differences in males and females. Conclusion: IRT methodology used to quantify the continuous latent trait of opioid use disorder diagnosis in males and females. Psychometric characteristics of abuse and dependence symptoms were examined. This may be helpful for person-centered medicine approach to effectively address intensity of treatment. References Saha, TD, Kerridge, BT, Goldstein, RB, Chou, SP, Zhang, H, Jung, J, et al. (2016). Nonmedical prescription opioid use and DSM-5 nonmedical prescription opioid use disorder in the United States. Journal of Clinical Psychiatry, 77(6), Kirisci L., Tarter, R., Reynolds, M., and Vanyukov, M.(2016). Item response theory analysis to assess dimensionality of substance use disorder abuse and dependence symptoms. International Journal of Person Centered Medicine, 6(4) GLOBAL ENGAGEMENT FOR PERSON-CENTERED HEALTH RESEARCH Ihsan Salloum (Miami) Person Centered Medicine (PCM) articulates science and humanism for a bio-psychosocio-cultural understanding of health. Fundamental ethical principles including respect for the dignity, autonomy and responsibilities of each person seeking care as a

44 unit in the overall social fabric of community and people health. Person-centered health is based on systematic attention to the biological, psychological and social aspects of both ill health and positive aspects of health within a partnership process among patients, families and health professionals. This includes interest, value and rights of patients and all persons involved. PCM is a holistic, multidisciplinary and relational perspective aimed at promoting the highest level of health for individuals and people by placing the whole person in context at the center and as the goal of clinical practice and public health. As such, PCM represents a higher level of complexity attempting to capture and account of the dynamic and multilevel relationship and interactions among its different component and relate them to the individual and the person at the center of care. The primary goal of Global Research Network is engage health care stakeholders in the promotion and application of research to increase our understanding, knowledge, utility and applicability of person-centered medicine and care at the individual and population levels. PSYCHOMETRIC EVALUATION OF THE ARABIC LANGUAGE PERSON-CENTRED CLIMATE QUESTIONNAIRE STAFF VERSION Mohammed Aljuaid (London) Aim: To evaluate the psychometric properties of the Arabic language Person-Centred Climate Questionnaire Staff version (PCQ-S). Background: In today s era, there is more emphasis on the need for a person-centred approach to care rather than a disease-centred approach. Person-centred care is about respecting the needs of others and organising care processes around their needs. Healthcare professionals should focus on both the person with the disease rather than the disease within the person. There are limited tools that measure the extent to which care is being delivered in a person-centred manner community), were 0.96, 0.97 and 0.95 respectively. Internal consistency was also high and measures of validity were very good. Conclusion: The Arabic version of the PSQ-S questionnaire provides a preliminary valid and reliable way to measure the degree of perceived person-centeredness in Arabic healthcare settings. The tool can be used for comparing levels of person-centeredness between wards, units, public and private hospitals. Also, the questionnaire can be used as a tool to measure the extent of person-centeredness in healthcare settings in Arab countries. References: Method: The validated version of the PCQ-S was translated into Arabic and distributed to a sample of Saudi healthcare professionals in teaching and non-teaching hospitals in Saudi Arabia (n = 152). Statistical estimates of validity and reliability were used for psychometric evaluation. Results: The results showed that the Arabic version of the PSQ-S questionnaire items had high reliability as Cronbach s alpha was very satisfactory for the total scale (0.98). The Cronbach s Alpha values for the three sub-scales (safety, everydayness and 1. Edvardsson, D., Sandman, P. O., & Rasmussen, B. (2009). Construction and psychometric evaluation of the Swedish language Person centred Climate Questionnaire staff version. Journal of nursing management, 17(7), Bergland, Å., Kirkevold, M., & Edvardsson, D. (2012). Psychometric properties of the Norwegian Person centred Climate Questionnaire from a nursing home context. Scandinavian journal of caring sciences, 26(4), PERSON-CENTRIC RESEARCH ON IMPACT OF DISEASE Christine Janus (IADPO, Ottawa) Two challenges: 1. Dermatological diseases are largely considered to be of low impact on the people afflicted with them. In a great many cases, this is simply false. 2. Patient organizations are usually ill equipped to provide burden of disease information in a way that can effectively impact decisions. Policy-makers governmental, HTA and global - making decisions about access to timely and respectful treatment and care struggle to use the largely qualitative information gathered by patient leaders in their largely quantitative decision-making rubric. The unique opportunity at this moment in time There is a growing movement worldwide to include the patient voice in healthcare policy decision-making as well as an increased focus on person/patient-centered healthcare. If people living with the disease can bring information to the table in the language used by decision-makers (i.e. data), then their perspective on the lived experience of the condition can inform healthcare decisions. IADPO s response: Global Research on the Impact of Dermatological Diseases (GRIDD) Our only agenda is to capture the voice of the people and their experience living with the condition in their own skin and to bring those perspectives to the attention of those making decisions on our behalves. Nothing about us, without us How GRIDD differs from existing research: o Two key stages involve patients and family members in the creation of the questions (unique), compile questions and send them back out to people living with the diseases to collect their burden of disease perspective Why it matters/conclusion: Person-centred healthcare policy should be informed by information collected directly from the people living and grappling with the disease themselves (incl. Family members). Putting the person at the center of the research design ensures that the data collected will reflect the perspectives of the people affected. Once this person-centric research data is added to the existing data, we have a better understanding of what it means to be a person living with a given condition. GRIDD sets the stage for other (overlooked) disease areas to use the same model and bring the patient/person-centric voice into

45 decision-making about access to care and treatment, and funding for residency places, research and much more. TOWARDS SUFFICIENCY BENCHMARKS FOR KNOWLEDGE IN SCREENING AND TREATMENT DECISIONS Harald Schmidt (Philadelphia) Evidence-based decision aids (DAs) have practical and ethical importance in supporting informed choices when it comes to preference-sensitive decisions. DAs have increased considerably in number over the past 10 years. The Cochrane review of randomized controlled trials (RCTs) of screening and treatment DAs included 17 RCTs in its 1999 version, 35 in 2003, 55 in 2009, 86 in 2001 and 115 in 2014; 15 new studies will be included in the 2017 update. The good news, and usual focus, is that DAs significantly increase knowledge (across all DAs by 13%) and risk perception (almost 2-fold). The underexplored--and ethically more challenging--finding relates to the peek into absolute levels of knowledge that the data enables. The mean score ([0]=no knowledge; [100]=perfect knowledge) is 57 in routine care, and 70 using DAs. 296/1,000 patients have accurate risk perception in routine care, and 542/1,000 using DAs. These data vary considerably by condition. Counter trends in policy and practice, I argue that (1) it is not acceptable to withhold effective DAs from patients in most circumstances. (2) I explore procedural and substantive ways for determining what should count as sufficiently informed in practice. (3) Regarding further DA research, an important critique argues that it is impermissible to study DAs against routine care if we have strong reasons to believe the DA will improve knowledge: I describe safeguards rendering such research acceptable in-principle, and urge their routine implementation. Stacey, Dawn, France Légaré, Nananda F. Col, Carol L. Bennett, Michael J. Barry, Karen B. Eden, Margaret Holmes Rovner et al. "Decision aids for people facing health treatment or screening decisions." The Cochrane Library(2014). Schmidt, Harald. "The ethics of incentivizing mammography screening." Jama 314, no. 10 (2015): THE HIERARCHICAL TAXONOMY OF PSYCHOPATHOLOGY (HITOP): DIMENSIONAL ALTERNATIVE TO TRADITIONAL CLASSIFICATION SYSTEMS Camilo Ruggero (Denton, Texas) Traditional taxonomies suffer from several major shortcomings, likely because these systems went beyond evidence available on the structure of psychopathology and were shaped by a variety of other considerations. The Hierarchical Taxonomy Of Psychopathology (HiTOP) system has emerged as a research effort to address these problems by constructing psychopathological syndromes and their components/subtypes based on observed covariation of symptoms (thus addressing heterogeneity problems), combining co-occurring syndromes into spectra (mapping out comorbidity), and characterizing these phenomena dimensionally (reducing diagnostic instability). This system is being developed by HiTOP consortium, and this talk will describe findings and ongoing work of the consortium, namely, (1) proposed data-driven organization of psychopathology, (2) validity and utility of major aspects of this system, (3) its implementation in clinical settings, and (4) measurement options for utilizing the system. The new system is a work in progress, but it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures. Kotov, R., Krueger, R.F., Watson, D. & (alphabetically) Achenbach, T.M., Althoff, R.R., Bagby, M.,Brown, T.A., Carpenter, W.T., Caspi, A. Clark, L.A., Eaton, N.R., Forbes, M.K., Forbush, K.T., Goldberg, D., Hasin, D., Hyman, S.E., Ivanova, M.Y., Lynam, D.R., Markon, K., Miller, J.D., Moffitt, T.E., Morey, L.C., Mullins-Sweatt, S.N., Ormel, J., Patrick, C.J., Regier, D.A., Rescorla, L., Ruggero, C.J., Samuel, D.B., Sellbom, M., Simms, L.J., Skodol, A.E., Slade, T., South, S.C., Tackett, J.L., Waldman, I.D., Widiger, T.A., Wright, A.G.C., Zimmerman, M. (2017). The Hierarchical Taxonomy Of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, online version available ahead of print. Andrews, G., Goldberg, D. P., Krueger, R. F., Carpenter, W. T., Hyman, S. E., Sachdev, P. S., & Pine, D. S. (2009). Exploring the feasibility of a meta-structure for DSM-V and ICD-11: Could it improve utility and validity?. Psychological Medicine, 39, B. Brief Oral Presentations on Person Centered Healthcare QUALITY CIRCLES WITH SELF-HELP GROUPS Bahrs O, Krüger N, Müller J, Röslen M Quality circles (QuiG ) are an established method for a bottom-up quality development. A quality circle consists of 8-12 people who want to develop the quality of their health-related work with reference to their own experiences, supported by a moderator. Up to now, the focus was on improving the quality of care provided by experts. Our project is different. We invited members of self-help groups to develop knowledge and coping skills concerning risks, resources and potentials for improved treatment of their illness and good consequences for the quality of life. In order to contribute from the patient s side to their own health promotion, they were asked for biography based case-presentations within the group and joint reflections of their illness history from the perspective of their life history. In members of self-help groups (6 women, 2 men) agreed to participate in our project. They were between 40 and 80 years old and organized in very different groups (heart diseases, COPD, MS, mourning parents, highly sensitive persons). They chose the topic

46 "coping with stressful situations" for their 1 ½ years of work. Each participant held a case presentation and in the group discussion resources were underlined and adjustments for further improvements suggested. At the last meeting the group work was evaluated by all participants. In our presentation, we will describe the group work and give an overall impression of the project. The group atmosphere was extraordinary good, the high attendance continuity noteworthy. The learning processes are examined in detail in the doctoral theses of Ms. Krüger and Mrs. Müller. It should be emphasized that almost all participants wanted to continue the group work and are interested in a follow-up project that specifically addresses the work of group leaders of self-help groups. Further participatory research is needed. References: 1. Bahrs O (Hrsg.): Qualitätszirkel in der Gesundheitsförderung und Prävention - Handbuch für Moderatorinnen und Moderatoren; BzgA, Köln Röslen M, Bahrs O (2013): Qualitätszirkel Hypertonie; Druck im Leben Druck in den Gefäßen? ; Auf dem Weg vom interprofessionellen Qualitätszirkel QuiG zum Patientenzirkel mit Expertenbeteiligung; Der Mensch Zeitschrift für Salutogenese und anthropologische Medizin; 46, ISSN 1862, S IT IS THE PATIENTS` LEGAL RIGHT, BUT IT`S SELDOM DONE NURSES EXPERIENCES OF GIVING INFORMATION ABOUT THE PATIENTS` LEGAL RIGHTS AND CHANGES IN MEDICATION Liv Berit Fagerli, Vigdis Abrahamsen Grøndahl, Ann Karin Helgesen (Halden, Norway) Objectives: Health personnel are judical obligated to give information to patients and patients have the right to receive information concerning themselves (1, 2). A recent dissertation shows that registered nurses (RN) in nursing homes paid little attention to judicial issues (3). In our study, person-centered care was operationalized into the interventions: give information about the patients` legal rights, and about changes in medication. The aim of this study was to acquire knowledge about how RNs experienced giving this information. Methods: The intervention was systematical conducted for 12 months in one nursing home (41 residents). The RNs should give information about legal rights two times during each patient`s stay and consecutively when the patient`s medication changed. Standardized care plans were developed for use. A focus group interview with RNs and individual interviews with two head-nurses 2. Ministry of Health and Care Services, Act relating to patients' rights were conducted when the project period ended. Data was Act , analyzed by conventional content analysis. Prelinimary findings: The RNs often considered the patients unable to receive the information because of cognitive failure or that they were not interested. The standardized care plans were not used. To give information was not systematical implemented in daily work. Some disagreement occurred whether it was RNs` responsibility to inform about changes in medication or not. Discussion: The study suggests that RNs lack knowledge about cognitive failure, legal rights and their obligation to give information. Conclusions: It is a need for educating RNs in how to communicate with persons with cognitive failure in order to fulfill person centered care in nursing homes. References: 1. Ministry of Health and Care Services, The Health Personnel Act, Act of 2 July 1999 No. 64, 64-relating-to-hea/id107079/ 3. Helgesen, A. K. (2013). Patient participation in everyday life in special care units for persons with dementia. DISSERTATION, Karlstad University Studies, 2013:43, Nursing Science Faculty of Health PATIENTS EXPERIENCES WITH PERSON CENTERED CARE IN A NEW HIGH-TECH HOSPITAL Vigdis Abrahamsen Groendahl and Ann Karin Helgesen ( Halden, Norway) Objectives: Previous studies show that hospital environment and healthcare personnel s behaviour (1,2) predict patients perceptions of care quality. The aim of the study was to explore differences in perceived care quality from patients perspective in relation to person-centered care from an old to a new high-tech hospital in Norway. Methods: A cross-sectional design was used. Using the questionnaire Quality from Patients Perspective, data were collected in September 2015 (old hospital) and in September 2016 (high-tech hospital), with respectively 253 and 346 respondents. Comparative statistics were used to test for differences between care quality perceptions from old to new high-tech hospital (p<.05). Findings: The respondents rated two out of four quality dimensions (the care organisation s socio-cultural approach (SCA) and physical-technical conditions (FTC)), significantly more highly in the new high-tech hospital. Examples on item level, significantly higher scores were given to My care was determined by my own requests and needs rather than the staff s procedures (SCA), and I had access to the apparatus and equipment that was necessary for my medical care, I had a comfortable bed and I received food and drink that I like from FTC. The quality dimensions comprising the personnel, that is the caregivers medical-technical competence and their identity-oriented approach, showed no significant differences between old and new high-tech hospital. Discussion: Results indicate that a new and high-tech environment does not influence healthcare personnel to be more personcentered in their care, but that they interact and cope with the new technology. Conclusions: Person-centered care need to be highlighted when the environment is technical advanced. References 1. Shen H-C., Chiu H-T., Lee P-H., Hu Y-C. & Chang W-Y. (2011). Hospital environment, nurse-physician relationships and quality of care: Questionnaire survey. Journal of Advanced Nursing, 67(2),

47 2. Grøndahl V.A., Karlsson I., Hall-Lord M-L., Appelgren J. & Wilde- Larsson B. (2011). Quality of care from patients perspective: impact of the combination of person-related and external objective care conditions. Journal of Clinical Nursing, 20, PERSON CENTERED HEALTHCARE IN CHILDHOOD ASTHMA Ian Sinha (Liverpool, UK) Background: Asthma, the commonest chronic condition of childhood, causes significant morbidity, restriction of activities, and impairment of quality of life. Current models of healthcare are disjointed and disempowering to children and families. Objectives: We aimed to develop a person-centered model of healthcare to empower children and adolescents with asthma. Methods: Using literature review, we identified problems with clinical research evidence that hinders shared decision making. We highlight discrepancies in outcomes that are measured in clinical trials, and those of relevance to children and families. Proposed Model: Using scoping exercises and consultation with children and families we propose a programme ( SCORE ) that involves setting goals, committing to completion of the programme, optimization of medicines, reinforcement of positive health behaviours using peer groups, and enabling of activities using nonhealthcare community partners. ORIENTING MEDICAL STUDENTS TOWARDS PERSON-CENTERED CARE: EXPERIENCE FROM INDIA Baridalyne N, Kusuma YS, Sanjeev Gupta (New Delhi) Person-centered care for management of health conditions should be part of contemporary medical education (1). Objective: To orient medical students towards patient- centered care while focusing on social and biomedical factors of disease1. Methods: Clinico-psycho-social case review (CPSCR) is a teaching method for 3 rd semester students in Community Medicine at All India Institute of Medical Sciences, New Delhi for more than 35 years (2). Each student is allotted a patient as an index case. Keeping the person in focus, the student identifies socio-cultural and psychological factors of disease through home visits. The student then constructs a case study, designs a Web of Causation and identifies interventions. A team of doctors, health-workers and social-workers, together with students, provide sustainable interventions, ranging from medical care to social interventions (government social schemes, financial assistance). Individual assessment of students is done through a structured format. Findings: 3151 students have been registered in the institute since inception and each student undergoes this exercise. Feedback by students in the last 3 years showed 93 % (203/218) felt it is a unique and useful exercise. Involvement of health team ensures continuity and sustained intervention. Conclusion: Orientation of medical students to person-centred medicine is feasible in undergraduate medical education and should be promoted to improve health care delivery. References 1 Barr J, Ogden K, Rooney K. Committing to patient-centred medical education. Clin Teach Dec;11(7): Nongkynrih B, Anand K, Kusuma YS, Rai SK, Misra P, Goswami K. Linking undergraduate medical education to primary health care. Indian J Public Health Jan-Mar;52(1): PRIMARY CARE NURSES IN A LOCAL BELGIAN SETTING: RESPONDING TO HEALTHCARE NEEDS OF PEOPLE WITH DISABILITIES Hannelore Storms and Neree Claes (Diepenbeek, Belgium) Objective In Belgium, 16.2% of people with a disability (PD) use home care services delivered by primary healthcare providers [1]. In this research, nursing care needs of PD are explored based on primary care nurses (PCN) experiences. Methods A questionnaire was distributed electronically (September- December 2015) to 1547 PCN in Belgian region Limburg. Openended questions regarding (1) mental and behavioural problems, (2) medication policy, (3) swallowing problems, (4) monitoring of nutritional status and (5) any other needs arising in the care for PD were analyzed using qualitative data analysis techniques. Findings Comments of 588 PCN (response rate: 38%) were generated, mentioning: impact of PD s and informal caregivers behaviour on PCN s working environment, particularly regarding medication policy, swallowing problems and nutritional status monitoring; PCN s collaboration with PD and their informal caregivers in relation to respectively PD s limited ability to communicate with PCN and informal caregivers behaving in a counteracting way, not following through PCN s advice; PCN acting as a liaison towards other healthcare professionals or services in the interest of PD s. Overall, PCN mentioned tasks in all facets of PD s lives. Conclusions PCN help with different tasks related to daily living. This beyond standard - care enhances the likelihood of PD to keep on living in their homes for a longer period of time. PCN seem to play a crucial role in activating other healthcare professionals to meet the healthcare needs of PD. Findings can be used to align pre-qualification training and education of (future) PCN with the (unmet) needs of PD [2]. [1] Europe. European comparative data on Health of People with disabilities Task 6: Comparative data and indicators ANED [2] Bollard M, Lahiff J, Parkes N. Involving people with learning disabilities in nurse education: towards an inclusive approach. Nurse Educ Today. 2012; 32: PMid:

48 COMMUNICATION AND PERSON CENTERED MEDICINE Winn Sams (Columbus, NC, USA) While a person centered approach is an ideal vision, there are issues in its implementation, specifically communication between a patient and their doctor, hospital or health entity. This discussion will highlight areas of resistance from personal experience, so much so, that I started a communication tool named Least Invasive First (LIF), where responsibility for health information and directives are put back in the hands of the patient to monitor, share and update. Information was gathered from conversations/interactions with doctors/hospital/surgical staff on specific health directives, in addition to introducing LIF to the public, patient centered/ patient empowerment/doctor groups and hospitals. There is a HUGE range of interpretation of what person centered care means. The public is not aware of its existence nor know they have rights. A great majority of hospitals that claim to be person centered (patient rights stated on site and or magnet qualified) lack evidence of implementation. Patient empowerment personnel and top administration have little to no interest in tools (LIF) to empower better communication. Enthusiasm and support for tools like LIF, were found in people who have daily hands on experience, like nurses and office staff. Person centered doctors feel limited and frustrated by upper administration doctrines that don't align. Some hospitals/groups/agencies don't want to add to the patient's overwhelm, out of pocket costs or feel like what they do/offer is enough. To have a person centered approach, we have to bring back the spotlight to the uniqueness and power of the person. Many current healthcare systems encourage everything but that, with a focus on the doctor knowing what's best and healing is found in an outside form of a pill, surgery or procedure. If we want to implement a dynamic approach in healthcare, we need to have physical tools to support and anchor the intent. Education is needed on both sides, patient and doctor/hospital/health entity/medical colleges to introduce a more person centered approach. Tools like LIF, are needed to help patients be responsible for their health information/directives, provide communication for a more inclusive experience and enable the doctor to fashion an accurate plan of care, leading to better patient evaluations and reduced costs for everyone. References: 1. Miles, A., Ph.D, & Mezzich, J., MD. (March 29, 2011). Advancing the global communication of scholarship and research for personalized healthcare. The International Journal of Person Centered Medicine. Retrieved March 19, 2017, from s/int_j_pers_cent_med volume_1 complete.pdf 2. Prainsack, B. (2016, October 14). Person-Centred and Participatory Medicine. Retrieved March 22, 2017, from 3. Tondora, J., Psy.D, Miller, R., Ph.D, & Davidson, L., Ph.D. (n.d.). The Top Ten Concerns About Patient-Centered Care in Mental Health. Retrieved March 19, 2017, from TheTopTenConcernsaboutPerson- CenteredCarePlanninginMentalHealthSystems QUALITY OF CARE FROM THE PERSPECTIVE OF PERSONS WITH DEMENTIA AK Helgesen, VA Groendahl (Halden, Norway) Background A total of 47.5 million people have dementia worldwide, and there are 7.7 million new cases every year. The total is anticipated to reach 90.3 million in Despite the fact that dementia care is one of the most rapidly growing areas in healthcare, relatively little is known about the experiences of persons with dementia in relation to quality of care. Objective: The aim of this study was twofold: first, to adapt the Quality from the Patient s Perspective instrument (QPP) for use by persons with dementia and second, to describe perceptions of care quality among persons with dementia in special care units in nursing homes. Methods: A cross-sectional design was used. The study was conducted in special care units (SCU) in three nursing homes comprising 61 persons with dementia. Structured interviews using an adapted version of QPP labeled Quality from the Patient s Perspective (QPP-DC) were conducted. Findings: The main result is that it was possible to assess how persons with dementia living in nursing homes evaluate their care when using the QPP-DC. High ratings were noted on items designed to measure if one gets enough food, were a comfortable bed and if the relatives are treated respectfully. Low quality of care ratings are endorsed by more than 40% of the respondents on items measuring help and support when feeling uneasy, and help and support when feeling lonely. Conclusions: QPP-DC provides a meaningful tool for care quality improvements in SCUs by detecting areas of importance concerning healthcare for persons with dementia. Efforts must be made to provide a more person-centered approach in order to help and support the persons with dementia when feeling uneasy and lonely. References: 1. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: A systematic review and metaanalysis. Alzheimers Dement. 2013; 9: Wilde-Larsson B, Larsson G. Development of a short form of the Quality from the patient s perspective (QPP) questionnaire. Journal of Clinical Nursing. 2002; 11: QUALITY OF CARE IN UNIVERSITY HOSPITALS IN SAUDI ARABIA: A SYSTEMATIC REVIEW Mohammed Aljuaid (London) Objectives: To identify the key issues, problems, barriers and challenges particularly in relation to the health services and the quality of care in university hospitals in the Kingdom of Saudi Arabia (KSA), and to provide recommendations for improvements. Methods: A systematic search was sourced from five electronic databases between January 2004 and January We included studies conducted in the university hospitals in KSA that focusing on the quality of care in university. There independent reviewers verified that the studies met the inclusion criteria, assessed the

49 quality of the studies and extracted their relevant characteristics. All studies were assessed using the Institute of Medicine (IOM) indicators of high quality of care. Results: Of the 1430 references identified in initial search, eight studies were identified and met the inclusion criteria. The included studies clearly highlight a need to improve the quality of health care delivery, specifically in areas of patient safety, clinical effectiveness and patient-centredness at university hospitals in KSA. Problems with quality of care could be due to failures of leadership, a requirement for better management and a need to establish a culture of safety alongside leadership reform in university hospitals. Lack of instructions given to patients and language communication were key factors impeding optimum patient-centred care. Decisionmakers in KSA university hospitals should consider programmes and assessment tools to reveal problems and issues related to language as a barrier to quality of care. Conclusion: This review exemplifies the need for further improvement in the quality of healt hcare in university hospitals in KSA. Many of the problems identified in this review could be addressed by establishing a Council of University Hospitals (COUH) in KSA, which could monitor healthcare services and push for improvements in efficiency of care provision. References: 1. Almasabi M. An Overview of Health System in Saudi Arabia. Research Journal of Medical Sciences [P]. 2013;7(3): WHO. Country cooperation strategy for WHO and Saudi Arabia Geneva: World Health Organisation, C. Interactive Workshop on Arts and Person Centered Care CREATIVITY AS A NECESSITY FOR A PERSON S DEVELOPMENT AND HEALTH IN PERSON CENTERED CARE Maria Ammon (Berlin, Germany) Creativity has been and still is an important topic in psychoanalysis, psychotherapy and psychiatry. First recent publications on the understanding of creativity and the role of creativity in psychoanalytic psychotherapeutic treatment is reviewed. The concept of creativity in Dynamic Psychiatry and its importance in the therapeutic treatment are described. Here a human being has to be understood from a person centered point of view as a multi- dimensional holistic being with creative potentialities. Finally the author stresses the necessity of working with the creative dimensions of the patients in psychiatry and psychotherapy first for stabilization and second for a further development of the potentialities of the patient s personality. Maria Ammon: Dynamic Psychiatry an Integrative Psychiatric- Psychotherapeutic Concept Dynamische Psychiatrie/Dynamic Psychiatry Pages , Volume 30, issue 1997 Dynamische Psychiatrie, ein integratives theoretisches und praktisches multidisziplinäres Behandlungsprinzip, Dynamische Psychiatrie, , 2014 Pinel Verlag für humanistische Psychiatrie und Philosophie GmbH ART IS NOT A THERAPY Herve Granier (Montpellier, France) Art is not a therapy, artists know this well and tell us, especially those whose mental suffering and distress hinder and prevent creativity. However, the artistic creative process allows the subject not to care for himself but rather to construct himself, to struggle with his destructiveness and to access, at large, some new and more acceptable representatives of his symptom. It is the still mysterious work of sublimation. But the subject always hosts a psychical duality, he has difficulties talking about his mental suffering because he knows that his suffering involve the other in his responsibility as well as himself. The meeting with a psychoanalyst or a psychotherapist is then essential. The creativity of psychoanalysis in psychiatry is not just the use of art as a medium but rather the creativity of the therapist in his own way to reappropriate the patient s story and reconstruct it with him. The sublimation finds its intellectual meaning and its psychotherapeutic effects in the pleasure taken in a long term work, to forget the past and invent the future. Paul Tournier Prize Session INTRODUCTION TO PAUL TOURNIER AND HIS LEGACY Frederic Von Orelli (Basel, Switzerland) Paul Tournier (PT) was born 1898 in Geneva and lost his father after 2 months and his mother at 6 years. He grew up in an uncle s house and studied medicine in Geneva. He opened a general medical practice in 1925, transforming it in 1937 into a counselling practice, from which he drew his first book Médecine de la Personne (1940; Healing of Persons ) He observed the rapid progress in medicine and surgery leading to an analytic and technical medicine, conceiving the ill human being as a mechanism needing repair, and ignoring psychological and spiritual aspects of the person.

50 For PT, Personne meant the whole human being in relationship with another Personne. For the physician, Médecine de la Personne encompasses appropriate technical medicine, but carries a wider and more creative responsibility through a personal relationship with the patient, in whom he is interested as another person, who has potential for growth and development even in the context of illness. As Martin Buber showed, it is to enter not only into an I it relationship but into an I thou relationship, accompanying the patient as he deals with illness or impairment, helping him to accept and integrate his evolving condition into his life. PT was a deeply believing Christian, his faith an integral part of his counselling, books and lectures. PT wrote 25 books translated into 30 languages, reaching over 2 million readers, and led conference tours all over the world. He created the International Association of Medicine of the Person in 1947; these annual meetings of physicians and other care professionals in Europe continue today. He helped shape the conceptualisation of the doctor-patient relationship in the later 20th century, especially among Christian physicians. References: Paul Tournier Association: Médecine de la Personne International Group: LAUDATIO FOR PROFESSOR WIM VAN LERBERGHE Jim Appleyard (London) Professor Wim Van Lerberghe has had an outstanding career in Public Health within the WHO, leading to ten years of service in the Dept. of Health Systems Policies first as a Coordinator and then as Director During this period, he joined the Second Geneva Conference of the International Network of Person Centered Medicine and brought the WHO into the early discussions with the Person Centered Medicine movement inspired by the work of Paul Tournier. Professor Van Lerberghe s early experience as a District Medical Officer in Mozambique and Research Fellow, Public Health Unit of the Institute for Tropical Medicine, Kasongo, Zaire and Antwerp, Belgium proved to be a sound foundation for his subsequent career. While in Zaire he undertook a large follow up nutritional study in Kasonga, measuring the weight, height, and arm circumferences in under-five children. The results showed that local health centers, concerned with everyday health problems of the population, can have a strong positive influence upon the general health situation of a rural population. This study importantly revealed that the factors identified by Paul Tourneir were applicable in the wider context of primary care and public health. Person- and people-centeredness were found to be two sides of the same coin. A vertical targeted and reductionist approach to solving the problems of needy local communities proved ineffective, costly and unsustainable These insights were brought together into the seminal WHO Health Report 2008, Primary Health Care: Now more than Ever. Primary Health Care (PHV) needs to be the foundation of a country s health system by putting the people at the center of health care. What people consider desirable ways of living as individuals and what they expect for their societies i.e. what people value constitute important parameters for governing the health sector. PHC has remained the benchmark for most countries discourse on health precisely because the PHC movement tried to provide rational, evidence-based and anticipatory responses to health needs and to these social expectations. This theme has resonated throughout our subsequent Geneva Conferences and discussions with the WHO ever since. Prof Van Lerberghe collaborated with Dr. Yongyuth Pongsupap in a paper People-centered Medicine in Thailand and WHO's renewal of primary health care in the Journal of Evaluation in Clinical Practice, and published a follow up article in 2012 on articulating Personcentered Medicine and People-centered Public Health in the International Journal of Person Centered Medicine In all, Prof. Van Lerberghe has published over 200 scientific articles and books. He was Editor in Chief of WHO s key publications: World Health Report 2005 (Maternal, Newborn and Child Health) and World Health Report 2008 (Primary Health Care). He has produced reports dealing with health systems development in various countries in Africa, the Middle East and Asia, based on over 200 short term support missions for governments and development agencies and participated in numerous scientific projects and developments. More recently, in 2013, Wim was appointed Professor of International Health, at the Instituto de Higiene e Medecina Tropical, Universidade Nova de Lisboa, Portugal; which included teaching responsibilities for MPH and PhD programmes together with health systems research and the integration of the Institute s research activities on the quality of maternal health and midwifery care. He has assisted the Moroccan government in drafting its white paper on Healthcare Reform In , he was appointed Head, Health Sector Reform Programme, Greece and seconded to the Regional Office for Europe, World Health Organization to lead the EU-funded technical assistance programme designing and implementing its health reform We are delighted that Wim has agreed to give our first Paul Tourneir Prize Lecture. This award highlights his dedication to humanity, incredible capacity for hard work, and inspirational leadership in the field of person- and people-centered health care. Selected References 1. Mezzich Juan E, Andrew Miles, Jon Snaedal, Chris van Weel, Michel Botbol, Ihsan Salloum, Wim Van Lerberghe. 2012: Articulating Person-centered Medicine and People-centered Public Health. The International Journal of Person Centered Medicine Vol 2 Issue 1 pp Yongyuth Pongsupap and Wim Van Lerberghe. People-centered medicine and WHO's renewal of primary health care. Journal of Evaluation in clinical practice, 17, 2, , April 2011.

51 3. Van Lerberghe W, Evans T, Rasanathan K, Mechbal A, WHO. (2008) World Health Report Primary health Care: Now more than Ever. WHO. The World Health Organization, Geneva. 4. Pongsupap Y and Van Lerberghe W. (2006) Is motivation enough? Responsiveness, patient-centeredness, medicalization and cost in family practice and conventional care settings in Thailand. Human Resources for Health, 4:19 5. Manuel A, Matthews Z and Van Lerberghe W. (2005) Make every mother and child count. Findings of the World Health Report UN Chronicle, 3, W. Van Lerberghe for Kasongo Project Team The Kasongo project. World Health Forum 4: Plenary Symposium 5: Impact and Horizons of Person Centered Medicine Objectives To assess the historical and current impact of person centered medicine within the provision of healthcare Methods The evolution of the international college of person centered medicine over the last 10 years through the Geneva Conferences with their associated Declarations the publications by the International Journal of Person Centered Medicine and other relevant research will be reviewed Findings Person centered medicine (PCM) has provided one of the most influential discussions as a counter weight to the current primarily fiscal management directed medicine and care which is episodic, inflexible and fragmented and fails to see beyond a disease focus and fails to engage comprehensively with the psychological, social spiritual and cultural dimensions of health and wellbeing Discussion While the underlying raison d etre of medical care has always been focused on the patient as a person, there is often a reluctance to accept the need for the term person centered medicine even though evidence based medicine has become embedded in medical terminology. While there is diversity in many clinical models and measures that aim to recognize and respect personhood there THE IMPACT OF PERSON CENTERED MEDICINE Jim Appleyard is a commonality that allows each approach to learn from each other. The working definitions within the International College s Declarations are a helpful basis for further interdisciplinary discussion as well as their successful application into the wide range of health care systems and clinical practice Conclusions PCM recognizes each person in the context of their own social relationships, should be respected, listened to and informed and are an end in themselves, not just the means to an organizational end. The trust within the partnership between a physician and their patient is the ethical foundation which recognizes that optimal health an wellbeing can only be achieved through a sharing of knowledge and decision making within an integrated symbiotic relationship References 1. Mezzich J E Appleyard W.J. Botbol M et al Ethics in Person centered Medicine Conceptual Place and Ongoing developments The Journal of Person-centered Medicine 2013; 3 (4) Harding E, Wait S and Scrutton J 2016 The State of Play in Person centered care. The Health Foundation Health Policy Partnership London UK HORIZONS OF PERSON CENTERED MEDICINE Juan Mezzich (New York) It can bed posited that since its inception as a programmatic movement, Person Centered Medicine (PCM) has been a theory[1], a practice and a journey [2]. What the future may have in store for PCM? As popular wisdom has it, prediction is very difficult, particularly about the future. And, in the words of the poet Antonio Machado, Caminante, no hay camino, camino se hace al andar ( Walker, there is no path, path is made as you walk ). So, based on our imperfect vision, what promising horizons can we pry into?. I submit the following lines to your consideration and comments, with the hope that our collective vision and group commitment may guide us well. After all, as Margaret Mead observed, there is nothing that a group of committed people cannot achieve, in fact that is the only thing that has ever worked. Cultivation of humanism as the essence of medicine at clinical and community levels. Engagement of the scientific method as an essential tool and creative openness to other approaches for fuller understanding and helpful action. Integration of evidence, experience and values to inform medicine and health care. Consideration of PCM as a key professional strategy as well as a guide for the thoughtful delineation and effective pursuit of our life projects and those of persons presenting for care. Attention to the broad picture from the need for people-centered integrated equitable services to the fundamental focus of proper governance towards the promotion of all citizens well-being. References 1.Mezzich JE, Salloum IM: Person Centered Medicine: Core and Diversity. International Journal of Person Centered Medicine 5: , Mezzich JE, Appleyard J, Botbol M, Ghebrehiwet T, Groves J, Salloum IM, Van Dulmen S: International journey and the development of Person Centered Medicine. International Journal of Person Centered Medicine 4: , 2014.

52 International College of Person Centered Medicine (ICPCM) Continuing Professional Development Program (CPDP) Attendance Report Form Title of event: 10 th Geneva Conference on Celebrating Ten Years of Promoting Healthy Lives and Well-being for All Organised by: ICPCM Dates: 8-10 May, 2017 Please use this form to mark your attendance at ICPCM-CPDP approved sessions and add up at the end the number of credits earned. One credit is equivalent to 60 minutes of approved learning experience. After the event, complete and sign this form, scan it and it to On the basis of this information, the Secretariat will you a CPDP Certificate. Dates Session Periods Session Titles Session times and credits earned :45-10:15 Plenary Symposium 1 90 minutes, :45-12:15 Plenary Symposium 2 90 minutes, :15-2:45 Parallel session 1(A) 90 minutes 1.50 Parallel session 1(B) 90 minutes :00-4:30 Parallel session 2 (A) 90 minutes 1.50 Parallel session 2 (B) 90 minutes 1.50 Check-off attendance :00-10:30 Plenary symposium 3 90 minutes :45-12:15 Plenary symposium 4 90 minutes :15-2:45 Parallel session 3 (A) 90 minutes 1.50 Parallel session 3 (B) 90 minutes :00-4:30 Parallel session 4 (A) 90 minutes 1.50 Parallel session 4 (B) 90 minutes :45-6:45 Parallel session 5 (A) 120 minutes 2.00 Parallel session 5 (B) 120 minutes :00-10:30 Plenary session 5 90 minutes :00-2:30 WHO Special Session 150 minutes 2.50 Total Credits Earned ( ) : Name: Signature: