Global synergistic actions to improve brain health for human development.

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.

O cuidado em saúde promovido pelas religiões afro-brasileiras / Health care promoted by afro-brazilian religions / El cuidado en salud promovido por las religiones afrobrasileñas

No decorrer da história, sempre foram infindáveis os casos em que os sujeitos recorriam a centros espíritas ou terreiros de religiões de matrizes africanas em decorrência de problemas como doenças, desempregos ou amores mal resolvidos, com o objetivo de saná-los. Por conta disso, este artigo visa apresentar os resultados da pesquisa relacionados ao objetivo de mapear os processos de cuidado em saúde ofertados em três terreiros de umbanda de uma cidade do litoral piauiense. Para isso, utilizamos o referencial da Análise Institucional "no papel". Os participantes foram três líderes de terreiros e os respectivos praticantes/consulentes dos seus estabelecimentos religiosos. Identificamos perspectivas de cuidado que se contrapunham às racionalidades biomédicas, positivistas e cartesianas, e faziam referência ao uso de plantas medicinais, ao recebimento de rezas e passes e à consulta oracular. A partir desses resultados, podemos perceber ser cada vez mais necessário, portanto, que os povos de terreiros protagonizem a construção, implementação e avaliação das políticas públicas que lhe sejam específicas.(AU)

In history, there have always been endless cases of people turning to spiritual centers or terreiros of religions of African matrices due to problems such as illnesses, unemployment, or unresolved love affairs. Therefore, this article aims to present the research results related to the objective of mapping the health care processes offered in three Umbanda terreiros of a city on the Piauí Coast. For this, we use the Institutional Analysis reference "on Paper." The participants were three leaders of terreiros and the respective practitioners/consultants of their religious establishments. We identified perspectives of care that contrasted with biomedical, positivist, and Cartesian rationalities and referred to the use of medicinal plants, the prescript of prayers and passes, and oracular consultation. From these results, we can see that it is increasingly necessary, therefore, that the peoples of the terreiros lead the construction, implementation, and evaluation of public policies that are specific to them.(AU)

A lo largo de la historia, siempre hubo casos en los cuales las personas buscan en los centros espíritas o terreros de religiones africanas la cura para sus problemas, como enfermedades, desempleo o amoríos mal resueltos. Por este motivo, este artículo pretende presentar los resultados de la investigación con el objetivo de mapear los procesos de cuidado en salud ofrecidos en tres terreros de umbanda de una ciudad del litoral de Piauí (Brasil). Para ello, se utiliza el referencial del Análisis Institucional "en el Papel". Los participantes fueron tres líderes de terreros y los respectivos practicantes / consultivos de los establecimientos religiosos que los mismos conducían. Se identificaron perspectivas de cuidado que se contraponían a las racionalidades biomédicas, positivistas y cartesianas, y hacían referencia al uso de plantas medicinales, al recibimiento de rezos y pases y a la consulta oracular. Los resultados permiten concluir que es cada vez más necesario que los pueblos de terreros sean agentes protagónicos de la construcción, implementación y evaluación de las políticas públicas destinadas específicamente para ellos.(AU)

Hospitalized Patients' Perspectives on Spiritual Assessment: A Mixed Methods Study.

BACKGROUND: Research shows that spirituality is important, but patients report that nurses rarely address spiritual issues, and research from the patient viewpoint is limited. AIM: The research objective was to gain knowledge about hospitalized patients' perspectives on spiritual assessment by nurses. METHOD: This is a mixed methods exploratory study reporting on quantitative/qualitative aspects of the patient perspective. Norwegian nurses in an acute care hospital distributed a 21-item spiritual assessment survey to patients they felt would not be burdened by completing it. Patients' demographic data were not identifiable, survey packets were returned anonymously via hospital mail by 157 hospitalized patients. Each survey item and several variables on the demographic sheet had space for comments. Quantitative analysis used SPSS 21, qualitative data were thematically analyzed. FINDINGS: Statistically significant correlations were found with all survey items. Hospitalized people reported high comfort with spiritual assessment by nurses. Qualitative findings revealed that patients had differing views on if, when, and how nurses should ask spiritual questions of them. CONCLUSIONS: It is important to identify patients' perspectives in order to provide patient-centered holistic care. Understanding patient views will enlighten nurses and may promote spiritual care and improve patient health outcomes.

Depression and suicidal ideation: association of physical, mental, social, and spiritual health status.

PURPOSE: The aim of this study was to determine if multidimensional (physical, mental, social, spiritual) health status could predict the presence of depressive symptoms and suicidal ideation in the general population. METHODS: We administered a population-based, cross-sectional survey to 1200 participants from the general Korean population. The survey included the 5 Health Status Questionnaire (5HSQ) for self-rated health status, Patient Health Questionnaire-9 (PHQ-9) for depression, and a question from the PHQ-9 for suicidal ideation. Multiple logistic regression was performed to estimate the association of significant socio-demographic factors and self-rated health status with depression and suicidal ideation. RESULTS: Physical health status was associated with depression in both men and women (men: adjusted odds ratio [aOR], 4.69; 95% confidence interval [CI] 2.44-9.00; women: aOR, 2.05; 95% CI 1.13-3.72) while spiritual health status only affected men (aOR, 5.50; 95% CI 2.59-11.65) and mental health status only women (aOR, 3.92; 95% CI 2.03-7.54). Social health status was associated with suicidal ideation in men (aOR, 4.87; 95% CI 2.74-19.99) while mental health status was associated with suicidal ideation in women (aOR, 4.31; 95% CI 1.90-9.76). CONCLUSION: Physical, mental, social, and spiritual self-rated health statuses were all found to be associated with an individual's predisposition to depression and suicidal ideation with notable differences between men and women.

O potencial consolador das cartas psicografadas na saúde emocional de enlutados / The consoling potential of psychographed letters in the emotional health of bereaved people

Resumo A pesquisa objetivou conhecer o estado emocional de pessoas em luto complicado que receberem cartas escritas por médiuns, cuja emissão foi atribuída a seus entes falecidos. Trata-se de estudo qualitativo com abordagem quantitativa, realizado com 48 voluntários em três cenários, sendo um virtual e dois presenciais. Estes responderam a formulários estruturados compostos por nove perguntas que definiram o perfil dos participantes; e a 17 perguntas sobre o luto, elaboradas conforme critérios do Diagnostic and Statistical Manual of Mental Disorder (DSM-5), que verificou os sentimentos antes e depois da comunicação mediúnica. Concluímos que as mensagens contribuíram para melhorar a saúde emocional das pessoas provenientes dos cenários presenciais, interferindo positivamente na qualidade de vida, validando o conceito de "Cartas Consoladoras".

Abstract The research aimed to know the emotional state of people in complicated mourning who receive letters written by mediums, whose emission was attributed to their deceased ones. This is a qualitative study with a quantitative approach, carried out with 48 volunteers in three scenarios - one virtual and two in person. These responded to structured forms composed of nine questions that defined the profile of the participants; and 17 questions about grief, elaborated according to the criteria of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), which verified feelings before and after mediumistic communication. We conclude that the messages contributed to improve the emotional health of people from face-to-face settings, positively interfering in the quality of life, validating the concept of "Consoling Letters".

BeWell: quality assurance health promotion pilot.

PURPOSE: The purpose of this paper is to determine the experience participating in a health promotion program for refugee and asylum seekers and torture survivors in a safety net clinical setting. DESIGN/METHODOLOGY/APPROACH: Refugee and asylum seeker torture survivors participated in a seven-week health promotion program at a safety-net clinic. Participants interviewed before, during and after the program was designed to improve and maintain health promotion program quality. FINDINGS: Six major themes emerged: social networks; tools/techniques/skills; wellness planning; spiritualism; health maintenance; and social/group interaction. Preliminary results suggest that this multi-pronged approach is feasible and acceptable to foreign-born torture survivors. RESEARCH LIMITATIONS/IMPLICATIONS: Torture impacts many facets of one's life. A program which addresses health from a multidisciplinary perspective has promise to facilitate healing. PRACTICAL IMPLICATIONS: The impact of torture and human rights violations significantly affects many facets of peoples' lives including emotional, social, physical and spiritual dimensions. Therefore a program which utilizes a multidisciplinary integrated bio-psychosocial and spiritual approach has the potential to simultaneously address many domains facilitating healing. ORIGINALITY/VALUE: BeWell, a bio-psychosocio-spiritual health promotion strategy aimed at improving health service quality and increasing patient satisfaction to support positive health outcomes by implementing in-classroom/person modules for patients, to the authors' knowledge is unique in its efforts to encompass multiple domains simultaneously and fully integrate an approach to wellbeing.

Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy.

In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples' ability to enact moral agency in making such decisions.

Perception of Candomble Practitioners About Herbal Medicine and Health Promotion in Ceará, Brazil.

Candomble, a Brazilian religion of African origin that worships Orishas, promotes "healing" assistance during its worship rituals using therapy with plants and beliefs. From its ancestry tradition, the respect and beware with nature are expressed. Therefore, the aim of this study is to investigate the perception of ethnoecology and health promotion among Candomble practitioners from a Candomble temple in the state of Ceará, Brazil. The ethnography was designed to allow greater immersion into the current mystique. This immersion results in the breaking of existing prejudices and admiration for their worldview. Thus, it can be observed that people seek Candomble to get rid of "bad" health difficulties, such as insomnia, depression, eyesight problems among others, which are commonly treated with herbal preparations, baths, and teas, using plants native to the region; however, their indications are not always in accordance with scientific evidence. In parallel with biomedicine, their hospitable and healthcare practices are considered by most as the equivalent to traditional healthcare actions, but greater recognition of biomedicine is necessary. Based on this perspective, the use of native plants in Candomble is examples of memory, hospitality, and humanization for the community wellness.

Spiritual distress of military veterans at the end of life.

OBJECTIVE: Although combat experiences can have a profound impact on individuals' spirituality, there is a dearth of research in this area. Our recent study indicates that one unique spiritual need of veterans who are at the end of life is to resolve distress caused by combat-related events that conflict with their personal beliefs. This study sought to gain an understanding of chaplains' perspectives on this type of spiritual need, as well as the spiritual care that chaplains provide to help veterans ease this distress. METHOD: We individually interviewed five chaplains who have provided spiritual care to veterans at the end of life in a Veterans Administration hospital. The interviews were recorded, transcribed, and analyzed based on "grounded theory." RESULTS: Chaplains reported that they frequently encounter veterans at the end of life who are still suffering from thoughts or images of events that occurred during their military career. Although some veterans are hesitant to discuss their experiences, chaplains reported that they have had some success with helping the veterans to open up. Additionally, chaplains reported using both religious (e.g., confessing sins) and nonreligious approaches (e.g., recording military experience) to help veterans to heal. SIGNIFICANCE OF RESULTS: Our pilot study provides some insight into the spiritual distress that many military veterans may be experiencing, as well as methods that a chaplain can employ to help these veterans. Further studies are needed to confirm our findings and to examine the value of integrating the chaplain service into mental health care for veterans.

Impact of patients' religious and spiritual beliefs in pharmacy: from the perspective of the pharmacist.

BACKGROUND: Socio-cultural perspectives including religious and spiritual beliefs affect medicine use and adherence. Increasingly communities that pharmacists serve are diverse and pharmacists need to counsel medicine use issues with ethical and cultural sensitivity as well as pharmaceutical competence. There is very little research in this social aspect of pharmacy practice, and certainly none conducted in Australia, an increasingly multicultural, diverse population. OBJECTIVES: The purpose of this study was to explore, from a pharmacy practitioner's viewpoint, the frequency and nature of cases where patients' articulated religious/spiritual belief affect medicine use; and pharmacist perspectives on handling these issues. METHODS: Qualitative method employing semi-structured interviews with pharmacy practitioners, constructed around an interview guide. Pharmacist participants were recruited purposively from areas of linguistic diversity in Sydney, New South Wales, Australia. Verbatim transcription and thematic analyses were performed on the data. RESULTS: Thematic analyses of 21 semi-structured interviews depicted that scenarios where religious and spiritual belief and medication use intersect were frequently encountered by pharmacists. Patient concerns with excipients of animal origin and medication use while observing religious fasts were the main issues reported. Participants displayed scientific competence; however, aspects of ethical sensitivity in handling such issues could be improved. This novel study highlights the urgent need for more research, training and resource development for practitioners serving patients in multi-faith areas.

Nurse and physician barriers to spiritual care provision at the end of life.

CONTEXT: Spiritual care (SC) from medical practitioners is infrequent at the end of life (EOL) despite national standards. OBJECTIVES: The study aimed to describe nurses' and physicians' desire to provide SC to terminally ill patients and assess 11 potential SC barriers. METHODS: This was a survey-based, multisite study conducted from October 2008 through January 2009. All eligible oncology nurses and physicians at four Boston academic centers were approached for study participation; 339 nurses and physicians participated (response rate=63%). RESULTS: Most nurses and physicians desire to provide SC within the setting of terminal illness (74% vs. 60%, respectively; P=0.002); however, 40% of nurses/physicians provide SC less often than they desire. The most highly endorsed barriers were "lack of private space" for nurses and "lack of time" for physicians, but neither was associated with actual SC provision. Barriers that predicted less frequent SC for all medical professionals included inadequate training (nurses: odds ratio [OR]=0.28, 95% confidence interval [CI]=0.12-0.73, P=0.01; physicians: OR=0.49, 95% CI=0.25-0.95, P=0.04), "not my professional role" (nurses: OR=0.21, 95% CI=0.07-0.61, P=0.004; physicians: OR=0.35, 95% CI=0.17-0.72, P=0.004), and "power inequity with patient" (nurses: OR=0.33, 95% CI=0.12-0.87, P=0.03; physicians: OR=0.41, 95% CI=0.21-0.78, P=0.007). A minority of nurses and physicians (21% and 49%, P=0.003, respectively) did not desire SC training. Those less likely to desire SC training reported lower self-ratings of spirituality (nurses: OR=5.00, 95% CI=1.82-12.50, P=0.002; physicians: OR=3.33, 95% CI=1.82-5.88, P<0.001) and male gender (physicians: OR=3.03, 95% CI=1.67-5.56, P<0.001). CONCLUSION: SC training is suggested to be critical to the provision of SC in accordance with national care quality standards.

We fall down: the African American experience of coping with the homicide of a loved one.

Rates of homicide among African Americans are much higher than those of other racial or ethnic groups. Research has demonstrated that homicide can be psychologically debilitating for surviving family members. Yet, exploring the experiences of homicide victims' surviving loved ones has received little attention. This study examined the coping strategies of African American survivors of homicide. Qualitative interviews were conducted with 8 African American family members (ages 18-82) of homicide victims. Survivors were recruited from the Massachusetts Office of Victim Services and from homicide survivor support, school, and community groups throughout the New England area. Interviews were conducted using open-ended questions derived from coping, support network, grief, and bereavement literatures. Results indicate that the primary coping strategies utilized by African American survivors of homicide victims are spiritual coping and meaning making, maintaining a connection to the deceased, collective coping and caring for others, and concealment. Implications for research and practice are discussed.

The peripatetic cultural psychiatrist: reflections on a forty-five year longitudinal study of a South India village.

This article presents one woman's odyssey, which began with a career in linguistics and later incorporated cultural psychiatry. While engaged in fieldwork as a linguist, studying the syntactic structure of Havyaka Kannada and dialectal accommodation among the castes in a South India village, I developed language skills and rapport with the village residents. Then I transferred my community-wide rapport to research on depression as a cultural psychiatrist. The articles I wrote on depression and its relationship to socialized passivity and endorsed assertiveness in progressive generations of South Indian women, illustrate the impact of change on mental health. The cultural background from my community-based longitudinal study of more than forty-five years has contributed to my understanding disorders in Indian patients living in a globalized world.

[Equivocal quintessence. Spiritual alchemy and counterfeit money in 16th-century Spain]. / Equívoca quintaesencia. Alquimia espiritual y moneda falsa en la España del siglo XVI.

One of the main obsessions of the early modern era was that of determining the notions of true and false, in order to apply them to various fields of knowledge and thus establish the divide between the lawful and unlawful. This trend was to have a particular impact on the fields of religion and science, where it became necessary to distinguish not only between true and false spirits, relics or miracles, but also between genuine and fake astrologers and alchemists. Situated in the middle ground between idealism and materialism, alchemy was prime territory for such tensions, as was demonstrated by a trial held in 1593 at the Jeronymite monastery of Santa Enracia in Saragossa, whose prior accused a friar of making "silver out of smoke and jewels from goblins".

Spiritual health, clinical practice stress, depressive tendency and health-promoting behaviours among nursing students.

AIM: This paper is a report of an exploration of the association of spiritual health with clinical practice stress, depressive tendency and health-promoting behaviours among nursing students. BACKGROUND: Several studies in western countries have demonstrated an association between spirituality and health. Spirituality-related research in eastern countries, however, is still in its infancy. METHODS: A cross-sectional design was adopted and structured questionnaires were used for data collection. We adopted the Probability Proportional to Size cluster sampling method to recruit nursing students in senior grades. Data were collected in 2005 using the Spiritual Health Scale, Perceived Clinical Practice Stress Scale, Beck Depression Inventory-II and Health Promotion Behaviours Scale. RESULTS: A total of 1276 nursing students with an average age of 20.1 years (sd = 1.6 years) participated in the study. Spiritual health was negatively associated with clinical practice stress (r = -0.211, P < 0.001) and depressive tendency (r = -0.324, P < 0.001) and positively associated with health-promoting behaviours (r = 0.611, P < 0.001). Using hierarchical regression analysis to control for demographic factors, spiritual health was found to be an important predictive factor for clinical practice stress, depressive tendency and health-promoting behaviours. CONCLUSION: These results are consistent with research findings from western countries. Educators should develop strategies to address nursing students' spiritual health. This may help nursing students to manage their stress, to reduce depressive symptoms and to enhance health-promoting behaviours.

R.D. Laing and theology: the influence of Christian existentialism on "The Divided Self".

The radical psychiatrist R.D. Laing's first book, "The Divided Self" (1960), is informed by the work of Christian thinkers on scriptural interpretation -- an intellectual genealogy apparent in Laing's comparison of Karl Jaspers's symptomatology with the theological tradition of "form criticism." Rudolf Bultmann's theology, which was being enthusiastically promoted in 1950s Scotland, is particularly influential upon Laing. It furnishes him with the notion that schizophrenic speech expresses existential truths as if they were statements about the physical and organic world. It also provides him with a model of the schizoid position as a form of modern-day Stoicism. Such theological recontextualization of "The Divided Self" illuminates continuities in Laing's own work, and also indicates his relationship to a wider British context, such as the work of the "clinical theologian" Frank Lake.

Adherence to depression treatment in older adults: a narrative review.

Depression in older adults has been detected, diagnosed and treated more frequently in recent years. However, substantial gaps in effective treatment remain. Adherence to depression treatment can be viewed as the 'next frontier' in the treatment of late-life depression. Using the Theory of Reasoned Action, a model of health behaviours, this paper conceptualizes and reviews the current evidence for key patient-level factors associated with depression treatment adherence among older adults. We categorize these factors according to how their impact on adherence might be affected by specialized treatment approaches or interventions as: (i) modifiable; (ii) potentially modifiable; and (iii) non-modifiable. Based on current evidence, modifiable factors associated with depression treatment adherence include patient attitudes, beliefs and social norms. Patient attitudes include perceptions of the effectiveness of depression treatment, preferences for the type of depression treatment and concepts regarding the aetiology of depression (e.g. resistance to viewing depression as a medical illness). There is also evidence from the literature that spiritual and religious beliefs may be important determinants of adherence to depression care. Social norms such as the impact of caregiver agreement with treatment recommendations and stigma may also affect adherence to depression treatment. Other factors may be less modifiable per se, but they may have an impact on adherence that is potentially modifiable by specialized interventions. Based upon a review of the current literature, potentially modifiable factors associated with adherence to depression treatment include co-morbid anxiety, substance use, cognitive status, polypharmacy and medical co-morbidity, social support and the cost of treatment. Finally, non-modifiable factors include patient gender and race. Importantly, non-modifiable factors may interact with modifiable factors to affect health behavioural intent (e.g. race and spiritual beliefs). Thus, adherence to depression treatment in older adults is associated with multiple factors. Strategies to improve patient adherence need to be multidimensional, including consideration of age-related cognitive and co-morbidity factors, environmental and social factors, functional status and belief systems. Evidence-based interventions involving greater patient, caregiver, provider and public health education should be developed to decrease stigma, negative attitudes and other modifiable barriers to detection, diagnosis, treatment and adherence to depression treatment. These interventions should also be tailored to the individual as well as to the treatment setting. While important progress has been made in increasing detection of depression in older adults, greater focus now needs to be placed on treatment engagement and continuation of improvements in quality of life, reducing suffering and achieving better outcomes.

Inca of the blood, Inca of the soul: embodiment, emotion, and racialization in the Peruvian mystical tourist industry.

In the context of the globalizing New Age movement and of the "turismo mistico" (mystical tourism) industry emanating from Peru, white and mestizo New Age practitioners and tourists fashion ideologies emphasizing the spiritual energy which supposedly resides in Quechua bodies, even as they freely appropriate Quechua cosmology and ritual for a hybridized New Age Andean spirituality. This case shows how racialized structural inequalities are expressed and experienced by tourists and New Age movement leaders through particular, essentialist representations of the body and through a common repertoire of emotional responses to inequality, commodification, and privilege. The paper provides an ethnographic account of how racialization may be perpetuated, negotiated, and resisted through religious systems, particularly through the work of constructing ideologies and experiences of the body and of emotional subjectivity.