The challenges of epidemiologic translation: communicating with physicians, policymakers, and the public.

Translational epidemiology refers to the practical application of population-health research findings to efforts addressing health disparities and other public health issues. A principal focus of epidemiologic translation is on the communication of results to constituencies who can best make use of this information to effect positive health-related change. Indeed, it is contended that findings from epidemiologic research are of greatest use only if adequately communicated to health professionals, legislators and policymakers, and the public. This paper details the challenges faced by efforts to communicate findings to the these constituencies, especially three types of miscommunication that can derail efforts at translation. These include perceived misinformation, perceived disinformation, and perceived censorship. Epidemiologists are ethically obliged to avoid these types of miscommunication, and, accordingly, are advised to place greater emphasis on messaging and media outreach to physicians, government officials, medical educators, and the general public.

Human Flourishing and Population Health: Meaning, Measurement, and Implications.

Human flourishing has recently emerged as a construct of interest in clinical and population-health studies. Its origins as a focus of research are rooted in philosophical writing dating to Aristotle's concept of eudaimonia, in the work of contemporary psychologists, and in studies by epidemiologists, physicians, and social and behavioral scientists who have investigated religious influences on physical and mental health since the 1980s. Inasmuch as human flourishing has been characterized as multidimensional or multifaceted, with hypothetically broad antecedents and significant outcomes, it may be an especially valuable construct for researchers. For one, it would seem to tap something deeper and more meaningful than the superficial single-item measures that often characterize such studies. This article surveys the rich history of the concept of human flourishing in its multiple meanings and contexts across disciplines, proposes a conceptual model for assessing the construct, and lays out an agenda for clinical and population-health research.

Religious features of curanderismo training and practice.

The purpose of this study is to investigate religious features of curanderismo, specifically the role of ostensibly Roman Catholic beliefs and practices in the training and work of curandero/as. The integration of religious beliefs and practices within the rituals of curanderismo and how this potential clash of worldviews negatively and positively impacts clients and practitioners are examined. Interviews were conducted with practicing curandero/as and clients who had sought their services. Factors observed to have potential to facilitate healing include psychological reassurance gained through incorporating familiar religious beliefs and paraphernalia and the therapeutic healing property of features of curanderismo practice, such as herbs used in many remedies. Negative effects may result from feelings of distrust, fear, and embarrassment engendered by seeking care from a curandero/a. Future research targeting the complexities of the relationship between Roman Catholicism and curanderismo might focus specifically on how negotiating this conflict of worldviews may affect health.

Engaging the faith community for public health advocacy: an agenda for the Surgeon General.

This article proposes an agenda for the Surgeon General of the United States that is consonant with the traditional public health approach of "upstream" and "midstream" intervention addressing social and institutional determinants of health. Accordingly, this features a prominent role for expanded partnerships between the faith-based and public health sectors. Such an agenda would revise the current status quo for the Surgeon General, whose celebrated bully pulpit is currently focused more on encouraging "downstream" compliance with federal guidelines related to lifestyle behavior modification. A new faith-based agenda, by contrast, could more effectively advocate for core features of the traditional public health ethic, including primary prevention, the multiple determinants of population health, communitarianism and social justice, and a global perspective, supported by the historic prophetic role of the faith traditions.

Jewish ethical themes that should inform the national healthcare discussion: a prolegomenon.

Despite the passage of H.R. 3590 in the 111th Congress, the national healthcare debate in the United States continues, with repeal or modification of the Patient Protection and Affordable Care Act under ongoing consideration. Reference is often made to morality or ethics, but typically in general terms only. This paper elucidates themes from one system of moral theology, namely Jewish healthcare ethics, that would valuably inform this debate. Themes include "covenant," "holiness," "justice," "mercy," "for the sake of peace," "to save a life," "peoplehood," "repair of the world," "repentance," and "jubilee." Policy-related, economic, political, and moral challenges to acting on these principles are discussed.

Prevalence and sociodemographic correlates of spiritual healer use: findings from the National Survey of American Life.

OBJECTIVES: This study investigates sociodemographic and health-related correlates of use of a spiritual healer for medical help. A large national, multiracial-multiethnic data source permits a more comprehensive investigation than was possible in previous studies. It also enables a closer focus on socioeconomic disadvantage and health need as determinants of utilization. DESIGN AND SETTING: Respondents are from the National Survey of American Life: Coping with Stress in the 21st Century (NSAL), a nationally representative multi-stage area-probability survey of U.S. adult African Americans, Caribbean Blacks, and non-Hispanic Whites conducted from 2001 to 2003. The sample contains 6082 adults aged 18 and over. MAIN OUTCOME MEASURES: NSAL respondents were surveyed about lifetime use of alternative providers for medical care or advice. Response categories included two types of spiritual healers: faith healers and psychics. These outcomes were logistically regressed, separately, onto 10 sociodemographic or health-related indicators: race/ethnicity, age, gender, marital status, education, household income, region, medical care use, insurance coverage, and self-rated health. RESULTS: Lifetime utilization of a faith healer is more prevalent among respondents in good health and less prevalent among Caribbean Blacks and never married persons. Users of a psychic healer are more likely to be educated, residents of the Northeast or West, and previously married, and less likely to report excellent health. CONCLUSIONS: Use a spiritual healer is not due, on average, to poor education, marginal racial/ethnic or socioeconomic status, dire health straits, or lack of other healthcare options. To some extent, the opposite appears to be true. Use of a spiritual healer is not associated with fewer social and personal resources or limitations in health or healthcare.

Religion, health and medicine in African Americans: implications for physicians.

Recent years have seen a burgeoning of research and writing on the connections between religion and health. The very best of this work comes from epidemiologic studies of African Americans. This paper summarizes results of these investigations, including findings identifying effects of religious participation on both physical and mental health outcomes. Evidence mostly supports a protective religious effect on morbidity and mortality and on depressive symptoms and overall psychological distress among African Americans. This paper also carefully discusses what the results of these studies mean and do not mean, an important consideration due to frequent misinterpretations of findings on this topic. Because important distinctions between epidemiologic and clinical studies tend to get glossed over, reports of religion-health associations oftentimes draw erroneous conclusions that foster unrealistic expectations about the role of faith and spirituality in health and healing. Finally, implications are discussed for clinical practice, medical education and public health.

The transcendent experience: conceptual, theoretical, and epidemiologic perspectives.

This paper provides a conceptual, theoretical, and empirical overview of the concept of the transcendent experience. The principal goal is to formalize a scientific field around the study of dimensions, determinants, and health outcomes of transcendence. This is accomplished through posing several fundamental questions and then answering them as concisely as possible in light of current theory and existing empirical research. These include the following: "What is the transcendent experience?" "Can the transcendent experience be studied?" "What do we (and don't we) know about the transcendent experience?" "How is the transcendent experience triggered?" "How is the transcendent experience sustained?" "Are there physiological models of the transcendent experience?" "Are there health effects of the transcendent experience?" and, "How should we study the health effects of the transcendent experience?" Finally, an agenda is proposed for research on the role of the transcendent experience in health, emphasizing development of an epidemiology of the transcendent experience.