Flourishing, religion, and burnout among caregivers working in pediatric palliative care.

INTRODUCTION: Providers working with children who are dying are especially prone to burnout. Encouraging models of human flourishing may mitigate burnout and improve quality of care. However, models of job satisfaction and human flourishing have not been well-described. This project explores factors that promote human flourishing among caregivers working with children in pediatric palliative care in South Africa. METHODS: A convenience sample of caregivers working in pediatric palliative care were invited to complete an anonymous, confidential survey comprised of validated instruments. The survey also included open-ended questions to explore opinions and attitudes about satisfaction, struggles, and coping. RESULTS: Twenty-nine people from a variety of occupations and work environments completed the survey. The prevalence of burnout was 3/29 (10%). Life satisfaction was associated with private religious activities (P = .38, P < .05), and carrying religion into all aspects of life (P = .44, P < .05). Burnout was not associated with life satisfaction. Qualitative analysis of the open-ended questions revealed the following themes as factors contributing to their joy in work: being able to make a difference, finding meaning and purpose, having a relationship with the children and their families, and with the multi-disciplinary team. The greatest challenges in their work were identified as the lack of resources, challenges within their team, and emotional demands. CONCLUSIONS: Despite job stress and working with terminally ill children, several factors were associated with flourishing. These findings are particularly relevant to enhance caregiving in the resource-challenged setting of pediatric palliative care in South Africa.

Religion, spirituality and improved glycemic control among people with type 2 diabetes: A systematic review.

OBJECTIVE: This systematic review investigates the association between measures of religiosity or spirituality (R/S) and glycemic control in patients with type 2 diabetes. METHODS: A systematic literature review was conducted for all English language articles published between 1966 and August 2022 in six relevant databases: PubMed, PSYCHinfo, CINAHL, ATLA, Scopus, Sociological Abstracts, and the Cochrane Central Register of Controlled Clinical Trials. Search terms for religious variables included, "religion", "religiosity", "spirituality", "religious attendance". Search terms for diabetes outcomes included, "diabetes", "hemoglobin A1c", "blood glucose", "glycemic control." The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS: A total of 758 studies examining correlations between R/S and glycemic control were screened from relevant databases. Forty studies were evaluated for eligibility and inclusion. Eight studies were selected and analyzed. Three studies showed positive associations, two studies showed positive and neutral associations, two studies showed positive and negative associations, and one study showed a neutral association. Limitations included small sample sizes and heterogeneity of study designs. CONCLUSION: Involvement in religious and spiritual practices may be associated with improved glycemic control in patients with type 2 diabetes. Specific mechanisms for associations may be partially explained by more effective self-management practices, increased positive social contacts, and regular community support. Further research is needed to clarify these associations.

Rates of Body Mass Index Increase in Children During the COVID-19 Pandemic.

Pediatric obesity is a significant public health concern, and the COVID-19 pandemic altered many of its risk factors. Understanding this impact can help pediatricians and public health officials prioritize initiatives and identify high-risk subgroups. We performed a retrospective longitudinal cohort study of 596 children and adolescents in a primary care clinic to determine changes in weight gain during the pandemic. A significant rise in normalized BMI was found during the prepandemic period across all age groups and initial BMI classification groups. This rate of change increased during the pandemic for those with pre-existing overweight or obesity status who were ≥10 years of age. Children with regular clinic visits in the prepandemic study period, but without a clinic visit during the pandemic, had significantly higher baseline normalized BMI and were older. These changes in the rate of weight gain during the COVID-19 pandemic period raise the possibility that pandemic influences may have exacerbated the rate of weight gain in children and adolescents with pre-existing obese or overweight range BMI. The difference in composition of the cohort without a pandemic time-period visit highlights the need for future studies in this area, especially those focused on adolescents.

We Need More Continuity Training.

We need to increase the continuity ambulatory component in medicine, pediatrics, and med-peds program requirements. I believe our curriculum has tilted too far towards inpatient training. We are grooming a generation of hospitalists and hospital-based practitioners at the expense of our outpatient training. Increasing continuity ambulatory training offers an important opportunity for autonomy, direct patient care and vocational formation.

Spirituality of the Traumatized Child: A Call for Increased Faith Community Participation in the Trauma-Healing Process for Children.

One-third of all children worldwide experience trauma. This includes domestic violence, serious illness, physical or mental abuse, and death of a parent, among other traumatic experiences. Children who experience trauma are more likely to experience other mental health disorders and often reject the religious and spiritual institutions of their upbringing. While cognitive-based therapy and other traditional psychological methods are crucial to the care of these children, incorporating their spirituality can be a helpful adjunct for their healing. Further, religious communities can play a critical role in reintroducing healthy forms of relationship building and community attentiveness, while providing a safe environment for coping.

The Effect of COVID-19 Pandemic Restrictions on Lead Screening in a Primary Care Clinic.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has disrupted outpatient pediatrics, postponing well-child care to address immediate patient safety concerns. Screening for lead toxicity is a critical component of this care. Children may be at increased risk for lead exposure at home because of social restrictions. We present data on how COVID-19 restrictions have impacted lead screening in a primary care practice. METHOD: Lead testing data on 658 children in a primary care practice were analyzed to determine the effect of COVID-19 restrictions on lead screening rates, levels, and deficiencies. RESULTS: Lead screening significantly decreased during peak restrictions, leading to increased screening deficiencies. Despite this decrease, screening lead levels increased during peak restrictions. DISCUSSION: These data show how COVID-19 restrictions have disrupted routine care and highlight the importance of continued lead screening in at-risk populations. The electronic medical record can be leveraged to identify deficiencies to be targeted by quality improvement initiatives.

Training to Conduct Research on Religion, Spirituality and Health: A Commentary.

Scientific research on religion, spirituality and health is fundamental, or our health care systems will become spuriously tokenistic rather than being truly holistic. Likewise, training in scientific research with respect to the interconnection between religion/spirituality and health, is also essential so as to ensure the future inclusion and development of religion and spirituality across the disciplines of medicine, nursing, psychology, social work, pastoral/spiritual care, and other allied health disciplines. This paper describes research training programs now available to obtain the skills and knowledge to develop, fund, manage, and publish research in this area, and disseminate it to clinicians and the general public. First, a model research program is described, and then, three examples of training programs at Duke, Emory, and Yale University are presented. Such training programs seek to develop the next generation of researchers who will dedicate their lives and careers to conducting research on religion and health, teaching it to students, and integrating the findings into clinical practice both in the USA and around the world. Scholarships are now available for health professionals to obtain such training, particularly for academic scholars early in their careers (e.g., graduate students, junior faculty) and for more senior researchers wishing to conduct studies in this area. Nearly 80% of the world's population have religious or spiritual beliefs that influence their health and well-being in one way or another. Learning to carry out and publish systematic research will help fill the many gaps in knowledge concerning how religion affects health and health affects religion.

Are we Athens or Florence? COVID-19 in historical context.

We have been here before. In 430 BCE, a plague struck Athens, killing as much as 25% of the population. In 1347 CE, the bubonic plague afflicted western Europe for 4 years, killing as much as 50% of the population. The plague of Athens led to a collapse of their religion, cultural norms and democracy. In contrast, the bubonic plague led eventually to the Renaissance, a growth of art, science and humanism. As we contend with the COVID-19 global pandemic, will we become Athens or Florence?

Association of Burnout with Emotional Coping Strategies, Friendship, and Institutional Support Among Internal Medicine Physicians.

Physician burnout influences physician mental health, staff stress, safety events, and patient outcomes. The association of burnout with compassion satisfaction, secondary stress, emotional coping strategies and many psychosocial variables, such as institutional support, friendship, and spirituality, have not been well studied. A convenience sample of internal medicine physicians was emailed a survey using validated instruments to explore these associations. The response rate was 337/1021 (33%), with a burnout prevalence of 175/337 (52%). Grit, acceptance, active coping, positive reframing, and strategy planning were associated with lower burnout domains and greater compassion satisfaction. Certain emotional coping strategies such as denial, disengagement, self-blame, substance abuse, and venting were associated with greater burnout and lower compassion satisfaction. Greater institutional support was associated with lower burnout (r = - .35, p < .001), secondary stress (r = - .14, p < .05), and compassion satisfaction (r = .28, p < .0001). Friendship was associated with lower burnout (r = - .25, p < .0001) and greater compassion satisfaction (r = .28, p < .0001). This study suggests that amelioration of burnout requires both intrinsic strategies that emphasize physician coping skills as well as extrinsic strategies that address institutional support.

Mortality, Health, and Substance Abuse by Religious Attendance Among HIV Infected Patients from the Veterans Aging Cohort Study.

Religion and spirituality have been associated with higher survival and improved biological markers among people living with HIV/AIDS (PLWH). Prior results have largely been among small cohort studies. We examined the association using a larger sample and longitudinal data from the Veterans Aging Cohort Study (VACS) years 2002-2012 (n = 3,685). Attending services at least monthly was associated with higher social support (80% vs 75%, p = 0.002), less unhealthy alcohol use (35% vs 39%, p = 0.006), less marijuana use in the past year (23% vs 32%, p < 0.001), less overall drug use within the past year (27% vs 31%, p = 0.01), and lower depression (20% vs 24%, p = 0.004). Attending services monthly was associated with a reduced mortality risk adjusting for age, race, gender, education, MSM, HCV, VL, CD4, and adherence to ARV (adjusted HazardRatio [aHR] = 0.89, 0.80-0.99). However, after controlling for smoking status, this association of mortality and religious attendance became non-significant (aHR = 0.93, 0.84-1.04).

RESUMEN: La religión y la espiritualidad se han asociado con una mayor supervivencia y mejores marcadores biológicos entre las personas que viven con VIH / SIDA (PLWH). Los resultados anteriores han sido en gran parte entre estudios de cohortes pequeñas. Examinamos la asociación utilizando una muestra más grande y datos longitudinales del Estudio de cohorte de envejecimiento de veteranos (VACS) años 2002­2012 (n = 3,685). Asistir a los servicios al menos mensualmente se asoció con un mayor apoyo social (80% frente a 75%, p = 0.002), menos consumo de alcohol no saludable (35% frente a 39%, p = 0.006), menos consumo de marihuana en el último año (23% vs 32%, p < 0.001), menos consumo total de drogas en el último año (27% vs 31%, p = 0.01) y depresión más baja (20% vs 24%, p = 0.004). La asistencia mensual a los servicios se asoció con una reducción del riesgo de mortalidad ajustada por edad, raza, sexo, educación, HSH, VHC, VL, CD4 y adherencia al ARV (HazardRatio ajustado [aHR] = 0.89, 0.80­0.99). Sin embargo, después de controlar el tabaquismo, esta asociación de mortalidad y asistencia religiosa se volvió no significativa (aHR = 0.93, 0.84­1.04).

The day the residents left: lessons learnt from COVID-19 for ambulatory clinics.

As the COVID-19 pandemic began, the residents from our ambulatory clinics were pulled to cover the increasing numbers of hospitalised patients. To provide care for our 40 000 patients, without resident support, we needed to develop quickly a new culture of communication and innovation. We accomplished this by regular, transparent meetings with senior leadership and key stakeholders who were empowered to make rapid decisions. We then convened regular meetings with clinic leadership and frontline providers to receive feedback and implement new practices. These rapid meeting cycles allowed for a nimble response to a changing landscape. We optimised our video-conferencing and telehealth services, reached out to our most vulnerable patients and engaged other providers and medical students who were not engaged in patient care due to social isolation practices. We discuss the implications of these innovations on our future practice.