Tangible Experiences of Grace: A Qualitative Investigation of Divine Grace in Roman Catholics.

According to Catholic theology, God offers a gift of love, known as divine grace, to all of humanity. This gift of divine grace is the gift of redemption and forgiveness of sins from God that is offered to everyone who decides to acknowledge and accept it. Grace is central to the lived experience of many Christians. This qualitative study examined how Catholics perceive and experience divine grace using interviews that assessed perceptions of divine grace in 29 practicing adult Catholics. A grounded theory analysis resulted in themes indicating that these Catholics view God's divine grace as a tangible gift that is undeserved though continuously offered. The participants' experience of God's grace is not just an abstract theological concept but an embodied aspect of religious life with which believers can interact in many powerful ways. Three characteristics of God's divine grace (i.e., salvific grace, cooperation through free will, primacy of conscience and the afterlife) and three mechanisms to experiencing God's grace (i.e., sacraments, prayer and meditation, saints) are presented.

Assessing the Relationships Among Forgiveness by God, God Images, and Death Anxiety.

Previous research suggests that people who feel forgiven by God may experience lower levels of death anxiety. The purpose of the current study is to contribute to this work by assessing whether the relationship between forgiveness by God and death anxiety varies according to how people view God. Three images of God are assessed: a pantheistic view of God, a theistic view of God, and a deistic view of God. Data from nationwide survey that was conducted in 2014 (N = 2,650) suggest that the relationship between forgiveness by God and death anxiety is strongest among people with a theistic view of God, significantly weaker among people with a pantheistic view of God, and not significant among individuals with a deistic view of God. The findings point to the importance of taking views of God into account when assessing the relationship between forgiveness by God and death anxiety.

Spiritual Struggles and Problem Drinking: Are Younger Adults at Greater Risk than Older Adults?

BACKGROUND: Although a good deal of research has assessed the positive effects that involvement in religion has on alcohol use, there is relatively little research on the negative aspects of religious life and alcohol problems. OBJECTIVES: This study has two objectives. The first is to see if spiritual struggles are associated with problem drinking. The second is to see if the relationship between spiritual struggles and problem drinking is stronger for younger than for older adults. METHODS: The data come from a recent nationwide survey of adults of all ages who reside in the United States (N = 2142).The study was conducted in 2014. Problem drinking is assessed with the CAGE questionnaire. RESULTS: The findings indicate that people who encounter more spiritual struggles are more likely to experience problem drinking. The relationship between spiritual struggles and problem drinking was stronger than the relationship between three other frequently used measures of religion and problem drinking (i.e., attendance at worship services, private prayer, and affiliation with Evangelical denominations). The results further reveal that spiritual struggles are associated with a greater risk of drinking problems among younger than among older individuals. Conclusions/Importance: Although many studies show that various facets of religion are associated with a lower risk of experiencing problems with alcohol the findings from the current study show that there are negative aspects of religious life that may be associated with a greater risk of having problems with alcohol.

Religious and Spiritual Salience, Well-Being, and Psychosocial Functioning Among Psychotherapy Clients: Moderator Effects for Humility.

A number of studies have examined the mediating factors in the relationship between religion and spirituality (R/S) and psychological health. Humility is a virtue that has been positively correlated with R/S variables, measures of well-being, and indicators of psychosocial functioning. In this study, we investigate dispositional humility as a potential moderator in the relationship between religious and spiritual salience and (1) well-being and (2) psychosocial functioning outcomes in a clinical sample. Results indicated that dispositional humility significantly moderated the relationships tested. Implications for future research and clinical practice are discussed.

The Mediating Role of Meaning in the Association between Stress and Health.

BACKGROUND: Stress is a common feature of life and has routinely been linked with negative health outcomes. However, meaning has been identified as a possible buffer against stress. PURPOSE: The purpose of the current study was to examine whether the relationship between stress and health was mediated by meaning in life. METHODS: Drawing from Wave 1 of the Landmark Spirituality and Health Study, a nationally representative sample of adults, participants (N = 1871) reported their level of stress in the past 12 months, current meaning in life, health (measured as minor symptoms, major conditions, and overall health), and provided a blood sample for biomarker of immune system functioning (i.e., presence of Epstein-Barr virus antibodies). RESULTS: Results revealed an indirect effects model in which stress was inversely associated with meaning. Higher meaning was related to better self-reported health (across minor, major, and overall health measures), which, in turn, was associated with better immune system functioning. CONCLUSIONS: These findings suggest that part of the negative effect of stress on health is accounted for by reduced meaning.

Volunteer Work, Religious Commitment, and Resting Pulse Rates.

Research indicates that greater involvement in volunteer activities is associated with better health. We aim to contribute to this literature in two ways. First, rather than rely on self-reports of health, measured resting pulse rates serve as the dependent variable. Second, an effort is made to see if religious commitment moderates the relationship between volunteering and resting pulse rates. Data that come from a recent nationwide survey (N = 2265) suggest that volunteer work is associated with lower resting pulse rates. The results also reveal that the relationship between engaging in volunteer work and resting pulse rates improves among study participants who are more deeply committed to religion.

Scar quantification by cardiovascular magnetic resonance as an independent predictor of long-term survival in patients with ischemic heart failure treated by coronary artery bypass graft surgery.

BACKGROUND: Scar burden by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is associated with functional recovery after coronary artery bypass surgery (CABG). There is limited data on long-term mortality after CABG based on left ventricular (LV) scar burden. METHODS: Patients who underwent LGE CMR between January 2003 and February 2010 within 1 month prior to CABG were included. A standard 16 segment model was used for scar quantification. A score of 1 for no scar, 2 for ≤ 50 % and 3 for > 50 % transmurality was assigned for each segment. LV scar score (LVSS) defined as the sum of segment scores divided by 16. All-cause mortality was ascertained by social security death index. RESULTS: One hundred ninety-six patients met the inclusion criteria. 185 CMR studies were available. History of prior MI was present in 64 % and prior CABG in 5.4 % of patients. Scar was present in 72 % of patients and median LVEF was 38 %. Over a median follow up of 8.3 years, there were 64 deaths (34.6 %). There was no statistically significant difference in mortality between Scar and No-scar groups (37 % versus 29 %). In the group with scar, a lower scar burden (defined either < 4 segments with scar or based on LVSS) was independently associated with increased survival. CONCLUSION: In patients undergoing surgical revascularization, scar burden is negatively associated with survival in patients with scar. However, there is no difference in survival based on presence or absence of scar alone. CMR prior to CABG adds additional prognostic information.

Health and Well-Being Among the Non-religious: Atheists, Agnostics, and No Preference Compared with Religious Group Members.

Although recent research suggests that the proportion of the US population identifying as non-religious has been rapidly expanding over the course of the last decade, relatively little research has examined the implications of this development for health and well-being. This study uses data from a large representative survey study of religion and health in the adult US population (N = 3010) to examine group differences among religious group members (N = 2401) and three categories of non-religious individuals: atheists (N = 83), agnostics (N = 189), and those stating no religious preference (N = 329). MANCOVA was used to analyze group differences on five outcome dimensions, incorporating 27 outcome variables. Religious non-affiliates did not differ overall from affiliates in terms of physical health outcomes (although atheists and agnostics did have better health on some individual measures including BMI, number of chronic conditions, and physical limitations), but had worse positive psychological functioning characteristics, social support relationships, and health behaviors. On dimensions related to psychological well-being, atheists and agnostics tended to have worse outcomes than either those with religious affiliation or those with no religious preference. If current trends in the religious composition of the population continue, these results have implications for its future healthcare needs.

Ascending aortic injuries following blunt trauma.

BACKGROUND: The diagnosis and the management of traumatic thoracic aortic injuries have undergone significant changes due to new technology and improved prehospital care. Most of the discussions have focused on descending aortic injuries. In this review, we discuss the recent management of ascending aortic injuries. METHODS: We found 5 cohort studies on traumatic aortic injuries and 11 case reports describing ascending aortic injuries between 1998 to the present through Medline research. RESULTS: Among case reports, 78.9% of cases were caused by motor vehicle accidents (MVA). 42.1% of patients underwent emergent open repair and the operative mortality was 12.5%. 36.8% underwent delayed repair. Associated injuries occurred in 84.2% of patients. Aortic valve injury was concurrent in 26.3% of patients. The incidence of ascending aortic injury ranged 1.9-20% in cohort studies. CONCLUSIONS: Traumatic injuries to the ascending aorta are relatively uncommon among survivors following blunt trauma. Aortography has been replaced by computed tomography and echocardiography as a diagnostic tool. Open repair, either emergent or delayed, remains the treatment of choice.

Patients with severe asymptomatic carotid artery stenosis do not have a higher risk of stroke and mortality after coronary artery bypass surgery.

BACKGROUND AND PURPOSE: Stroke development is a major concern in patients undergoing coronary artery bypass grafting (CABG). Whether asymptomatic severe carotid artery stenosis (CAS) contributes to the development of stroke and mortality in such patients remains uncertain. METHODS: A retrospective analysis of 878 consecutive patients with documented carotid duplex ultrasound who underwent isolated CABG in our institution from January 2003 to December 2009 was performed. Patients with severe CAS (n=117) were compared with those without severe CAS (n=761) to assess the rates of stroke and mortality during hospitalization for CABG. The 30-day mortality rate was also assessed. RESULTS: Patients with severe CAS were older and had a higher prevalence of peripheral arterial disease and heart failure. Patients with severe CAS had similar rates of in-hospital stroke (3.4% versus 3.6%; P=1.0) and mortality (3.4% versus 4.2%; P=1.0) compared with patients without severe CAS. The 30-day rate of mortality was also similar between the 2 cohorts (3.4% versus 2.9%; P=0.51). CONCLUSIONS: Severe CAS alone is not a risk factor for stroke or mortality in patients undergoing CABG. The decision to perform carotid imaging and subsequent revascularization in association with CABG must be individualized and based on clinical judgment.

Perioperative outcomes in reoperative cardiac surgery guided by cardiac multidetector computed tomographic angiography.

BACKGROUND: Preoperative evaluation with contrast-enhanced multidetector computed tomographic angiography (MDCTA) is considered an "appropriate" indication based on expert consensus. We aimed to evaluate how the presurgical evaluation with MDCTA impacts the outcomes after reoperative cardiac surgery (RCS). METHODS: We retrospectively studied 364 patients undergoing RCS between 2004 and 2008, including 137 referred for MDCTA. High-risk CT findings were defined as the presence of right ventricle or aorta <10 mm from the sternum or a bypass graft <10 mm from the sternum crossing the midline. The primary clinical end point was the composite of perioperative death, myocardial infarction (MI), stoke, and hemorrhage-related reoperation. Secondary end points included surgical procedural variables and the perioperative volume of bleeding and of red blood cell (RBC) transfusion. RESULTS: Baseline clinical characteristics were similar between the 2 groups. Individuals referred for MDCTA showed a trend toward a lower incidence of the composite primary end point (17.5% vs 24.2%, P = .13), primarily related to a significantly lower incidence of perioperative MI (0% vs 5.7%, P = .002). Multidetector computed tomographic angiography was also associated with shorter perfusion (90 vs 110 minutes, P = .002), cross clamp time (63 vs 75 minutes, P = .003), and total time in intensive care unit (103 vs 148 hours, P = .04), and a lower volume of postoperative RBC transfusion (627 vs 824 mL, P = .09). These differences remained significant after adjustment for the Society of Thoracic Surgeons score and the performing surgeon. CONCLUSION: The use of MDCTA before RCS was associated with shorter perfusion and cross clamp time, shorter intensive care unit stays, and less frequent perioperative MI.

Race as a moderator of the relationship between religiosity and political alignment.

Religiosity, especially religious fundamentalism, is often assumed to have an inherent connection with conservative politics. This article proposes that the relationship varies by race in the United States. In Study 1, race moderated the relationships between religiosity indicators and political alignment in a nationally representative sample. In Study 2, the effect replicated in a student sample with more reliable measures. Among both Black and Latino Americans, the relationship between religiosity and conservative politics is far weaker than it is among White Americans, and it is sometimes altogether absent. In Study 3, a tradition-focused view of religion was found to more strongly mediate the link between religiosity and political attitudes among Whites than it did among Blacks and Latinos. It is argued that the relationship between religiosity and political alignment is best understood as a product of cultural-historical conditions associated with group memberships.

The psychological study of religion and spirituality in a disaster context: A systematic review.

OBJECTIVE: The purpose of this systematic review is to synthesize the existing empirical psychology of religion/spirituality (R/S) and disaster research and offer a prospectus for future research. METHOD: Searches were conducted in PsycINFO, PsycARTICLES, Medline databases, and through personal communication with study authors covering a period from 1975 (from the earliest identified study meeting our criteria) to 2015. Studies that took an empirical approach to studying the impact of disasters on R/S phenomena, as well as the relationship between R/S phenomena, cognition, behavior, and well-being in disaster contexts were included. RESULTS: A total of 51 articles met the inclusion criteria. We organized the empirical findings under five main categories, which emerged from sorting studies by their primary R/S focus: (a) general religiousness, (b) God representations, (c) religious appraisals, (d) R/S meaning making, and (e) religious coping. On the whole, R/S appears to generally lead to positive outcomes among disaster survivors. Results suggest positive benefits of R/S comes more from how one engages faith and access to resources via R/S communities. CONCLUSIONS: This review revealed several emerging patterns regarding what is known as well as existing gaps in the literature, including the need for more rigorous methodological designs and ongoing systematic programs of study. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Early readmission of low-risk patients after coronary surgery.

BACKGROUND: Early readmission after coronary artery bypass grafting (CABG) is an expensive adverse outcome. Although the perioperative experience of high-risk CABG patients has been studied extensively, little attention has been paid to low-risk CABG patients. The primary goal of this study was to identify the preoperative characteristics and to define risk predictors of readmission and preventive factors for readmission in low-risk isolated-CABG patients. METHODS: We identified 2157 patients who underwent CABG between January 2000 and December 2005 at Washington Hospital Center, Washington, DC, and defined as low risk patients who had a Parsonnet bedside risk score lower than the 25th percentile. Patients who were rehospitalized within 30 days after surgery were compared with those who were not rehospitalized during this period. RESULTS: The overall readmission rate for this study cohort was 6.3%. Compared with non-readmitted patients, early-readmitted patients were more likely to have diabetes mellitus (27.94% versus 20.88%, P = .05) and less likely to have hypertension (42.65% versus 51.36%, P = .05). Blood product transfusion (P < .01), postoperative length of intensive care unit stay (P = .01), and length of hospital stay (P = .05) were all significantly increased in the readmitted patients. The use of beta-blockers (P = .03) and angiotensin-converting enzyme inhibitors (P = .04) was significantly lower at discharge in this group of patients; however, multivariate regression analysis demonstrated diabetes (odds ratio, 1.59; 95% confidence interval, 1.08-2.42) to be the only independent predictor of early readmission. CONCLUSIONS: For low-risk CABG patients, diabetes mellitus is the risk predictor of early readmission. Early discharge was not associated with early readmission.

Assessing the role of race/ethnicity in the relationships among spiritual struggles, health, and well-being.

A growing body of research suggests that greater exposure to spiritual struggles is associated with more physical and mental health problems. Spiritual struggles involve difficulties that a person may encounter with his or her faith, which may include having a troubled relationship with God, encountering difficulties with religious others, or being unable to find a sense of meaning in life. However, little is known about the way in which spiritual struggles may differ across racial/ethnic groups. The purpose of this study was to assess variations in spiritual struggles, health, and well-being among Whites, Blacks, and Hispanics. We examined two ways in which race/ethnic variations may arise. First, the differential-exposure perspective suggests that some groups may experience more spiritual struggles than others. Findings from a recent nationwide survey suggest that Blacks experience more spiritual struggles than either Whites or Hispanics. Second, the differential-impact perspective suggests that the relationship between spiritual struggles, health, and well-being varies across racial/ethnic groups. Findings from the current study suggest that when spiritual struggles arise, Blacks experience fewer symptoms of physical illness, less anxiety, and they tend to be happier than Whites or Hispanics. The theoretical implication of these findings is discussed. (PsycINFO Database Record

Effect of clopidogrel premedication in off-pump cardiac surgery: are we forfeiting the benefits of reduced hemorrhagic sequelae?

BACKGROUND: Premedication with clopidogrel has reduced thrombotic complications after percutaneous coronary revascularization procedures. However, because of the enhanced and irreversible platelet inhibition by clopidogrel, patients requiring surgical revascularization have a higher risk of bleeding complications and transfusion requirements. A principal benefit of surgical coronary revascularization without cardiopulmonary bypass is its lower hemorrhagic sequelae. The purpose of this study was to evaluate the effect of preoperative clopidogrel administration in the incidence of hemostatic reexploration, blood product transfusion rates, morbidity, and mortality in patients undergoing off-pump coronary artery bypass graft surgery using a large patient sample and a risk-adjusted approach. METHODS AND RESULTS: Two hundred eighty-one patients (17.9%) did and 1291 (82.1%) did not receive clopidogrel before their surgery, for a total of 1572 patients undergoing isolated off-pump coronary artery bypass graft surgery between January 2000 and June 2002. Risk-adjusted logistic regression analyses and a matched pair analyses by propensity scores were used to assess the association between clopidogrel administration and reoperation as a result of bleeding, intraoperative and postoperative blood transfusions received, and the need for multiple transfusions. Hemorrhage-related preoperative risk factors identified in the literature and those found significant in a univariate model were used. The clopidogrel group had a higher likelihood of hemostatic reoperations (odds ratio [OR], 5.1; 95% confidence interval [CI], 2.47 to 10.47; P<0.01) and an increased need in overall packed red blood cell (OR, 2.6; 95% CI, 1.94 to 3.60; P<0.01), multiple unit (OR, 1.6; 95% CI, 1.07 to 2.48; P=0.02), and platelet (OR, 2.5; 95% CI, 1.77 to 3.66; P<0.01) transfusions. Surgical outcomes and operative mortality (1.4% versus 1.4%; P=1.00) were not statistically different. CONCLUSIONS: Clopidogrel administration in the cardiology suite increases the risk for hemostatic reoperation and the requirements for blood product transfusions during and after off-pump coronary artery bypass graft surgery.

Assessing the Relationship Between Religious Involvement and Health Behaviors.

A growing body of research suggests that people who are more deeply involved in religion may be more likely to adopt beneficial health behaviors. However, religion is a complex phenomenon, and as a result, religion may affect health behaviors in a number of ways. The purpose of the current study was to see whether a sacred view of the body (i.e., belief that the body is the temple of God) is associated with better health behavior. It was proposed that the relationship between a sacred body view and health behavior will emerge only among study participants who have a stronger sense of religiously oriented control (i.e., stronger God-mediated control beliefs). Five positive health behaviors were evaluated: more frequent strenuous exercise, more frequent moderate exercise, more frequent consumption of fruits and vegetables, higher quality sleep, and the adoption of healthy lifestyles. Data from a recent nationwide sample reveal that a sacred body view is associated with each health behavior, but only among study participants who have a strong religiously oriented sense of control.

Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer.

BACKGROUND: Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clinical trials. Prior studies have not addressed whether prayer itself or knowledge/certainty that prayer is being provided may influence outcome. We evaluated whether (1) receiving intercessory prayer or (2) being certain of receiving intercessory prayer was associated with uncomplicated recovery after coronary artery bypass graft (CABG) surgery. METHODS: Patients at 6 US hospitals were randomly assigned to 1 of 3 groups: 604 received intercessory prayer after being informed that they may or may not receive prayer; 597 did not receive intercessory prayer also after being informed that they may or may not receive prayer; and 601 received intercessory prayer after being informed they would receive prayer. Intercessory prayer was provided for 14 days, starting the night before CABG. The primary outcome was presence of any complication within 30 days of CABG. Secondary outcomes were any major event and mortality. RESULTS: In the 2 groups uncertain about receiving intercessory prayer, complications occurred in 52% (315/604) of patients who received intercessory prayer versus 51% (304/597) of those who did not (relative risk 1.02, 95% CI 0.92-1.15). Complications occurred in 59% (352/601) of patients certain of receiving intercessory prayer compared with the 52% (315/604) of those uncertain of receiving intercessory prayer (relative risk 1.14, 95% CI 1.02-1.28). Major events and 30-day mortality were similar across the 3 groups. CONCLUSIONS: Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.

Heparin-Induced Thrombocytopenia in Contemporary Cardiac Surgical Practice and Experience With a Protocol for Early Identification.

This analysis was designed to (1) examine the impact of heparin-induced thrombocytopenia (HIT) on contemporary cardiac surgical practice and (2) describe the results of a protocol designed for early identification of the presence of the immune mechanisms involved. Consecutive patients who underwent cardiac surgery were screened postoperatively for thrombocytopenia. Patients with thrombocytopenia were tested for antiplatelet factor 4 (PF4)/heparin antibodies by ELISA and clinical evidence of thrombosis sought. Demographics, co-morbidities, operative details, and outcomes were abstracted from the departmental registry. Of 14,415 consecutive patients undergoing cardiac surgery, 1,849 patients (13%) had thrombocytopenia. Of them, 277 patients (15%) had PF4/heparin antibodies and 76 patients (4%) had both antibodies and clinical thrombosis. Antibodies were more frequent: (1) in women (p = 0.01), (2) in patients with an increased body mass index (p <0.01), and (3) in patients with clinical heart failure before surgery (p <0.01). Thirty-day mortality was greatest among the 76 patients with the triad of thrombocytopenia, antibodies, and clinical thrombosis (30%). Of the 1,849 patients with thrombocytopenia, the presence of PF4/heparin antibodies was an independent predictor of 30-day mortality (odds ratio 2.09, 95% CI 1.46 to 2.49; p <0.001). HIT remains an infrequent but very serious complication of heparin therapy in contemporary cardiac surgical practice. The possibility that the presence of HIT antibodies in patients with thrombocytopenia independently increases operative mortality deserves further study.

Chronologic distribution of stroke after minimally invasive versus conventional coronary artery bypass.

OBJECTIVES: We sought to investigate whether the chronologic distribution of the onset of stroke occurring after coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass (off-pump CABG) is different from the conventional on-pump approach (CABG with cardiopulmonary bypass). BACKGROUND: Off-pump CABG has been associated with a lower stroke rate, compared with conventional on-pump CABG. However, it is unknown whether the chronologic distribution of the onset of stroke is different between the two approaches. METHODS: We evaluated the chronologic distribution of postoperative stroke in patients undergoing CABG from June 1996 to August 2001 (n = 10,573). Preoperative risk factors for stroke were identified using the Northern New England preoperative estimate of stroke risk. Multivariate logistic regression analysis was used to determine the independent predictors of early stroke and to delineate the association between the surgical approach and the chronologic distribution of the onset of stroke. RESULTS: Stroke occurred in 217 patients (2%, n = 10,573). A total of 44 (20%) and 173 (80%) of these patients had stroke after off-pump CABG and on-pump CABG, respectively. The median time for the onset of stroke was two days (range 0 to 11 days) after on-pump CABG versus four days (range 0 to 14 days) after off-pump CABG (p < 0.01). On-pump CABG was associated with a higher risk of early stroke (odds ratio 5.3, 95% confidence interval 2.6 to 10.9; p < 0.01) compared with off-pump CABG. CONCLUSIONS: Compared with off-pump CABG, on-pump CABG is associated with an earlier onset of postoperative stroke during the recovery phase, suggesting different mechanisms in the pathogenesis of stroke between the two surgical approaches.