"I Do Not Believe We Should Disclose Everything to an Older Patient": Challenges and Ethical Concerns in Clinical Decision-Making in Old-Age Care in Ethiopia.

Clinical decision-making in old-age care is a complex and ethically sensitive process. Despite its importance, research addressing the challenges of clinical decision-making in old-age care within this cultural context is limited. This study aimed to explore the challenges and ethical concerns in clinical decision-making in old-age care in Ethiopia. This qualitative study employed an inductive approach with data collected via semi-structured interviews with 20 older patients and 26 health professionals recruited from healthcare facilities in Ethiopia. Data were analysed using reflexive thematic analysis. Our analysis identified three key themes. First, participants highlighted perceptions that older patients' religious beliefs interfere with the clinical decisions both older patients and health professionals make. Second, older patients often receive limited information from health professionals about their diagnosis and treatment. Third, families of older patients appear to strongly influence clinical decisions made by older patients or health professionals. This research enhances the understanding of clinical decision-making in old-age care within Ethiopia, a context where such research is scarce. As a result, this study contributes towards advancing the deliberation of ethical dilemmas that health professionals who work with older patients in Ethiopia might face. A key implication of the study is that there is a need for more ethics and cultural competence training for health professionals working with older patients in Ethiopia.

Nutrition, Chronic Care, Measurement Scales and COVID-19.

In the year of the Olympics (Paris, 2024), this issue of JORH explores nutrition and chronic care, offers a caution regarding the use of religiosity and spiritual measurement scales, and revisits the topic of COVID-19. While the latter has been rapidly declining in terms of its global impact, each of these areas of inquiry generate a great deal of research from which humanity still has much to learn.

What Explains Voting for DENK: Issues, Discrimination or In-group Favouritism?

Why do ethnic and religious minorities vote for DENK? DENK is the first pro-Turkey and pro-Islam party represented in Dutch parliament, led by Turkish- and Moroccan-origin politicians who openly profess to practicing Islam. Drawing on an original survey (N= 905) among Dutch voters in which we oversampled those with Turkish, Moroccan and Surinamese roots, we put three possible explanations to the test: issues, discrimination and in-group favouritism. Each subsample is religiously mixed and includes Muslims and/or Christians and voters who are not religious. While ethnic in-group favouritism, feelings of belonging in the Netherlands, experiences with discrimination and issues sometimes explain voting for DENK, Muslim in-group favouritism is the decisive factor. These findings contribute to understanding voting behaviour in increasingly religiously diverse European immigration societies.

Devil among us or inside us? Exploring the relationships of internalized racism and suicidal ideation among US Asian adults.

OBJECTIVES: Prior research shows that perceived racism was associated with higher risks of suicidal ideation among US Asians. Nevertheless, the relationship between internalized racism and the suicidal risks of US Asians has not been adequately researched. In addition, as an important social institution, religion has been left out of the studies of racism and suicide for US Asians. This study is aimed at filling in these gaps and contributing to a better understanding of internalized racism, religion, and the mental health of US Asians. DESIGN: This study surveyed 970 Asian or Asian American adults living in the United States. Survey participants were recruited using Qualtrics online panel samples between April and June 2024. Quotas were set for key demographic variables, such as sex and ethnicity, following the national census. RESULTS: The main results suggest that even after controlling important mental health measures such as anxiety and loneliness, higher internalized racism was still tied to higher risks of suicidal ideation. The effect of internalized racism was not only robust but also stronger than other mental health measures as well as perceived external racism. Finally, the deleterious internalized racism effect on suicidal ideation was stronger among US Asians, who attend religious services more often. CONCLUSION: Internalized racism exerts a fairly strong and robust effect on suicidal ideation among US Asians. This deleterious effect is also interactive with the religious characteristics of US Asians. Healthcare providers, community workers, and religious leaders may want to take internalized racism into consideration in their future service to the US Asian community.

The Spiritual Well-Being Scale in the Polish Catholic Setting: Construct, Structure, and Relationships with Psychological Well-Being.

The population of Poland could be of particular interest to researchers studying religion and spirituality. Catholicism has played a significant role in shaping the country's culture, history, and tradition and is considered a national religion. More recently, however, the processes of moving away from regular participation in religious services and loosening ties with the institution of the Catholic Church are marked (Polish Public Opinion Research Center, CBOS). The Polish Catholic setting may modify the associations between psychological variables that have been studied in their relationships with spirituality, which have been investigated in religious contexts differing from a Polish Catholic one. Given this context, we examined the internal structure of spiritual well-being in the sample of present-day Polish Catholics (Study 1) and how spiritual well-being is related to mental health (Study 2). The internal structure of the Spiritual Well-Being Scale was replicated in the Polish sample, but only positively worded items loaded on the Religious and Existential Well-Being subscales. Spiritual well-being was positively related to positive mood, satisfaction with life, and psychological well-being; it was negatively associated with negative mood, depression, and anxiety, thus remaining significantly related to psychological well-being among Polish Catholics.

Barriers and Facilitators Towards Deceased Organ Donation: A Qualitative Study Among Three Major Religious Groups in Chandigarh, and Chennai, India.

This study aimed to examine the barriers and facilitators of the public toward deceased organ donation in Chandigarh, and Chennai, India, from three major religious groups, Hinduism, Islamism, and Christianity. Twenty-five focus groups were conducted (n = 87) stratified by study region, religion, sex, and age. Data were analysed using framework analysis. The results revealed that individuals were primarily willing to donate their organs. However, their religious views regarding death, after-life beliefs, funeral ritual practices, and lack of knowledge regarding their religion's position toward deceased organ donation created tension and ambiguity in the decision-making. However, younger age groups (18-30 years) appeared more open and positive toward deceased organ donation. The conclusion demands a clear need for religious leaders and stakeholders to address their religion's stance, which creates tension and ambiguity in any uncertainties surrounding cultural and religious-based views among the Indian population.

Improving Outcomes for ICU Family Members: The Role of Spiritual Care.

Having a family member hospitalized in the intensive care unit (ICU) can be a stressful experience for family members, encompassing both psychological and spiritual distress. With over 5 million ICU admissions annually in the United States, it is imperative to enhance the experiences and coping mechanisms of ICU family members. In particularly challenging situations, some family members even face psychological effects known as post-intensive care syndrome-family, which includes anxiety, depression, and posttraumatic stress. The distress may be worsened when patients and families experience poor communication or medical care, which has been shown to be more common among minoritized populations including Black and Hispanic patients and families. Family members' emotional and spiritual distress also has an effect on the medical decisions they make for the patient. While research has delved into the impact of spiritual care for ICU family members, further investigation is still needed to determine the most effective approaches for delivering such care. This narrative review will describe a conceptual model aimed at guiding future research in this endeavor. The model proposes that chaplains provide emotional, spiritual, and information support to ICU family members. This affects both their ICU experience, decision making, and outcomes for the patient and family. This process is also affected by characteristics of the family such as race, ethnicity, and economic status. This model helps identify gaps in research, including the need for randomized trials of spiritual care that identify mechanisms underlying outcomes and demonstrate impact of spiritual care, and consider race, ethnicity, and other characteristics.

Religion, Wealth, and Health: Exploring the Economic Dimensions of Four Major Faiths.

Religions shape the economic attitudes of their congregations. Thus, in a country where a particular faith dominates the economic ideas of that faith will significantly influence its economic growth and the health and well-being of its population. Using an extensive bibliographic review, this article analyses the economic impact of four major religions (Christianity, Judaism, Islam, and Buddhism) and studies the channels through which religion exerts its economic influence. Three key economic markers are correlated with religion, and results show significant differences in economic outcomes based on religion. In-depth analysis of the literature suggests that these differences have their roots not only in the specific beliefs of a given religion but also how its institutional structures foster elements essential to economic success such as trust.

What Sexual Orientation Change Efforts Change: Evidence From a United States Sample of 72 Exposed Men.

BACKGROUND:  Voluntary non-coercive therapeutic interventions for adults are collectively known as sexual orientation change efforts (SOCE). Research on SOCE has reported global or average sexual orientation change, but not in more detail. This study addresses two questions: Does change consist primarily of reduced homosexual orientation or increased heterosexual orientation? Does change consist primarily of change in behavior or change in attraction?  Method: A convenience sample of 72 men who had completed SOCE was examined for the decrease in homosexual attraction, increase in heterosexual attraction, and corresponding changes in sexual behavior among those experiencing a homosexual-to-heterosexual shift. All measures were self-reported. RESULTS: Participants reported extremely high religiosity. A third (32%, N=23) reported a shift from general homosexual attraction (score of 4-6) to general heterosexual attraction (score of 0-2) on the Kinsey scale, which ranges from "exclusively heterosexual" (0) to "exclusively homosexual" (6). Among these, effect sizes (Cohen's d) for sexual fantasy and desire for romantic intimacy were larger for homosexual reduction (fantasy: -2.3, desire: -1.5) than for heterosexual increase (fantasy: +1.8, desire: + 1.0). Effect sizes for sexual behaviors, measured by kissing and sex relations, dropped the largest possible amount for homosexual behavior (kissing: -1.0, sex: -1.5, both statistically significant at p<0.004) while there was little to no increase in heterosexual behavior (kissing: +0.36, sex +0.38, both statistically non-significant at p>0.13). CONCLUSION: Change consisted primarily of reduced homosexual orientation and change in behavior was much stronger than change in attraction. SOCE supported conformity to strong religious norms against homosexual behavior, but not attractions, for this group of extremely religious men. Implications for understanding SOCE-related sexual orientation change are discussed.

Mood Disorder Public Stigma in Jewish Communities in the United States.

This study employed an experimental vignette design in Jewish communities in the United States (n = 243) to investigate whether public stigma toward target individuals with major depressive disorder or bipolar disorder presenting with either mania or depression was associated with their gender and symptomatology. The Mental Illness Stigma Scale (Day et al., in J Appl Soc Psychol 37(10):2191-2219, 2007) was used to measure the following dimensions of public stigma: (a) anxiety; (b) relationship disruption; (c) hygiene; (d) visibility; (e) treatability; (f) professional efficacy; and (g) recovery. The influence of characteristics of survey respondents on public stigma was also examined. In Jewish communities in the United States, mood disorder symptomatology was associated with the stigma dimensions of recovery, relationship disruption, and hygiene. Among respondents, younger and middle-aged males reported increased treatment efficacy stigma. Research implications include designing stigma reduction interventions tailored to specific diagnostic (e.g., bipolar disorder) and demographic (e.g., younger males) groups within the Jewish community.

Associations Between Every day and Medical Setting-Based Discrimination and Religious and Sociodemographic Characteristics of Muslim Americans: Findings from a National Survey.

We investigated the associations between sociodemographic factors, religiosity traits, and the perception of discrimination among Muslim Americans in both everyday life and medical settings. A self-administered web-based questionnaire, comprising validated measures of discrimination and religiosity, was completed by a convenience sample of English-speaking adult Muslim Americans, recruited through both in-person and online channels. Among the 1281 respondents, less than half were born in the USA (46%), and a significant portion displayed visible religious markers, such as wearing a hijab or having a beard (61%). Only 154 (12%) reported never experiencing everyday discrimination, while 358 (28%) reported not experiencing discrimination in medical settings. In a multivariable linear regression model, greater perceived everyday discrimination (ß = 1.053, p < 0.01) was positively associated with greater discrimination in medical settings. Participants more comfortable self-identifying as Muslim in hospital settings (ß = -0.395, p < 0.05) were less likely to perceive healthcare discrimination. Those visibly expressing their religiosity (ß = 0.779, p < 0.01) and those with greater intrinsic religiosity (ß = 0.231, p < 0.05) were more likely to encounter everyday discrimination. Conversely, older participants (ß = -0.015, p < 0.05), adult immigrants to the US (ß = -0.375, p < 0.05), those in better health (ß = -0.157, p < 0.05), and those more comfortable identifying as Muslim (ß = -0.305, p < 0.05) had lower perceptions of everyday discrimination. This study underscores the significance of the relationship between religiosity characteristics and experiences of both hospital and everyday discrimination for Muslim Americans.

Kin selection favors religious traditions: ancestor worship as a cultural descendant-leaving strategy.

Recent years have seen renewed interest in the role of religious systems as drivers of the evolution of cooperation in human societies. One suggestion is that a cultural tradition of ancestor worship might have evolved as a "descendant-leaving strategy" of ancestors by encouraging increased altruism particularly between distant kin. Specifically, Coe and others have suggested a mechanism of cultural transmission exploiting social learning biases, whereby ancestors have been able to establish parental manipulation of kin recognition and perceived relatedness as a traditional behavior, leading to increased altruism among co-descendants and thereby maximizing the ancestor's long-term inclusive fitness. Here, we develop a demographically explicit model in order to quantify the resulting increase in altruism and concomitant "ancestor-descendant conflict", and to determine the evolutionary feasibility of religiously motivated cultural norms that promote altruism among co-descendants. Our analysis reveals that such norms could indeed drive an overall increase in altruism with potential for ancestor-descendant conflict, particularly in low-dispersal settings. Moreover, we find that natural selection can favor traditions encouraging increased altruism towards co-descendants under a range of conditions, with the inclusive-fitness costs of enacting an inappropriately high level of altruism being offset by inclusive-fitness benefits derived from the cultural tradition facilitating kin recognition.

Is religion beneficial for mental health? A 9-year longitudinal study.

Background/Objective: This study aimed to investigate the within-person and between-person effects of religious variables on mental health and vice versa. Method: Using a large sample of adults residing in Germany from the GESIS Panel study (N = 8146), the random intercept cross-lagged panel model was used. Data on six dimensions of religion (i.e., membership in a religious community; attendance at a place of worship; frequency of prayers; importance of religion in life; and participation in a religious organization) and three indicators of mental health (i.e., depression symptoms, happiness, and life satisfaction) were collected. Results: The findings revealed that there is almost no evidence of lagged effects of religion on mental health and limited evidence regarding the role of mental health in influencing the dimensions of religion. Moreover, at the between-person level, there was some evidence of significant covariance between the trait-like components, indicating stable, trait-like differences between persons on religion and mental health. Conclusions: The beneficial effect of religion on mental health may have been exaggerated in previous research.

Pandemic preparedness: why humanities and social sciences matter.

Whilst many lessons were learned from the COVID-19 pandemic, ongoing reflection is needed to develop and maintain preparedness for future outbreaks. Within the field of infectious disease and public health there remain silos and hierarchies in interdisciplinary work, with the risk that humanities and social sciences remain on the epistemological peripheries. However, these disciplines offer insights, expertise and tools that contribute to understanding responses to disease and uptake of interventions for prevention and treatment. In this Perspective, using examples from our own cross-disciplinary research and engagement programme on vaccine hesitancy in South Africa and the United Kingdom (UK), we propose closer integration of expertise, research and methods from humanities and social sciences into pandemic preparedness.

Science and Islamic ethics: Navigating artificial womb technology through Quranic principles.

This paper explores the complex interplay between scientific innovation and religious ethics, with a specific focus on the ethical implications of Artificial Womb Technology (AWT) as interpreted through the lens of Quranic teachings on the essence of life. The objective is to meld the burgeoning field of reproductive technologies with the foundational principles of Islamic theology through an examination of Islamic jurisprudential rulings, contemporary bioethical discourse and innovations in reproductive technology. In addition to attention given to the compatibility of AWT with Islamic teachings concerning the sanctity of life, there is also a focus on the concept of motherhood and the preservation of family structure. This study undertakes an extensive exploration of both historical and contemporary interpretations of Islamic precepts, culminating in the establishment of an ethical framework. This framework is designed to harmonise religious doctrines with the exigencies of reproductive science by proposing normative guidelines for the ethical implementation of AWT and similar technologies. This paper makes a substantial contribution to academic discourse on science and religion by integrating advancements in reproductive health technology with moral principles intrinsic to the Islamic faith.

Impact of religion and spirituality on the incidence of depression and mental health among young adults in the Czech Republic.

Introduction: The issue of the impact of religion and spirituality on mental health is a phenomenon which has recently become increasingly more accentuated. Despite the attention given to the topic, many questions still remain as to whether and how religion and spirituality affect a person's mental wellbeing. In the text below, we have focused on examining the relationship between religion and spirituality and mental health among young adults in the Czech Republic. Research also explored the idea that forgiveness can be viewed as a component of religion or spirituality. Materials and methods: The research project was executed in close cooperation with STEM/MARK, a renowned data collection agency. The methodological framework was constructed with a dual focus: leveraging standardized questionnaires to ensure data reliability and comparability while also incorporating tailored questions that delve into the participants' socioeconomic status (SES) and background details. The study unfolded across four online sessions, a format chosen for its convenience and effectiveness in facilitating participant engagement while accommodating our respondents' diverse schedules. The total sample approached comprised of 270 young adults that expressed certain form of religiosity. Results: Forgiveness and the depth of one's personal religious or spiritual history emerged as the most influential factors. Forgiveness was significantly associated with an increase in self-blame (positively), and decrease in refocusing, planning (both negatively), and putting things into perspective (negatively) (Beta = 0.25, Beta = -0.06, and Beta = -0.16, respectively). In contrast, a deeper personal religious history was positively associated with self-blame, rumination, and refocusing (Beta = 0.22, Beta = 0.13, and Beta = 0.15, respectively). Conclusion: The finding that forgiveness may be a risk factor associated with regularly elevated depressive symptoms, stress, and maladaptive coping strategies such as self-blame and ruminating over problems, while negatively affecting physical, psychological, and environmental quality of life, clearly points to the need to examine the inner aspects of individual religions and spiritualities. These findings suggest that religious and spiritual beliefs may play a key role in how people experience and manage the emotional burdens and difficulties of life.

Impact of Religious Affiliation on Clinical Outcomes in Liver Transplant Patients.

While the impact of spirituality as it relates to quality of life post-liver transplant (LT) has been studied, there are limited data showing how religious affiliation impacts objective measures such as survival. The aim of the study is to investigate whether LT recipients who identified as having a religious affiliation had better clinical outcomes when compared to LT recipients who did not. Religious affiliation is obtained as part of general demographic information for patients within our institution (options of "choose not to disclose" and "no religious affiliation" are available). Subjects in this retrospective cohort study which conformed with the Declarations of Helsinki and Istanbul were separated into cohorts: LT recipients who self-reported religious affiliation and LT recipients who did not. All LT recipients between March 2007 and September 2018 who had available information regarding their reported religion were included. Excluded patients included those who received a multi-organ transplant, underwent re-transplantation, received a partial liver graft, and identified as agnostic. Outcomes included 30-day readmission, death, and the composite outcome of re-transplantation/death. In an unadjusted analysis of 378 patients, there were no statistically significant differences between the two groups for 30-day readmission (OR=1.15, P=0.71), death (HR=0.63, P=0.19), or re-transplantation/death (HR=0.90, P=0.75). In multivariable analysis, adjusting for age at transplant and hospital admittance status when called for transplant, results were similar. We found no statistically significant difference in the outcomes measured between patients with and without self-reported religious affiliation. Further studies into the role of participation in religious activity and the impact of engagement with a religious community should be conducted in the future.

Parental attitudes towards sexual orientation and gender diversity: challenging LGBT discrimination in Australian schools.

As Australia considers legislative reform regarding the rights of religious schools to discriminate against LGBT students and staff, claims are often made that religious parents or those enrolling children in religious schools do not affirm diversity of sexuality or gender. Using a national dataset of parents (n = 2418), attitudes towards sexual orientation, gender diversity, homophobia and transphobia were examined. Across all religiosities, school sectors and attitudinal statements, significant majorities of parents reported positive attitudes (62.7%-93.5%). Only small minorities expressly reported negative attitudes (1.6%-20.2%). Pairwise religiosity comparisons between parents with children only at a secular school, versus any religious school, revealed few differences. Amongst Catholic parents, those with children at Catholic schools and those with children only at secular schools, held similar attitudes towards LGBT issues and a majority held favourable attitudes, suggesting most Catholic parents who enrol their children in Catholic schools do so despite or in ignorance of Catholic doctrine. Findings suggest a significant majority of parents sending children to religious schools hold supportive attitudes towards diverse sexual orientations, gender diversity, and actions to address homophobia and transphobia. This empirical evidence contradicts religious schools' calls for the rights to discriminate against LGBT persons based on parental values and attitudes.

A Latent Profile Analysis of Religious Parents' Responses to Their Sexual and Gender Diverse Child.

Prior research indicates that religious parents can have negative, positive, or ambivalent responses to their child's sexual orientation and gender identity (SOGI). Yet, to our knowledge no research has quantitatively examined patterns of sexual and gender diverse (SGD) youth's perceptions of their religious parents' responses to their SOGI. Without examining variations in these patterns, we are unable to better understand the experiences of SGD youth with religious parents. In the current paper, we examined patterns of SGD youth's perceptions of their religious parents' SOGI-specific rejection, acceptance, and SOGI change efforts. We also examined if these patterns differed by SGD youth's individual and contextual factors. The analytic sample consisted of online responses from 5,686 SGD youth (Mage = 15.95). We found four distinct profiles: Positive Parental Response, Moderate Negative Parental Response, Low Parental Response, and High Negative Parental Response. The largest profile was the Positive Parental Response, suggesting that many SGD youth perceived positive responses from their religious parents. SGD youth with diverse gender identities and intersecting identities, such as race/ethnicity, were more vulnerable to religious parents' negative responses. Findings have implications for existing resources and programs aimed at strengthening SGD youth's relationship with their religious parents.

The Impact of Public Holidays on Insurgent Attacks: The Case of Thailand.

This paper analyzes Malay-Muslim insurgents' attacks in the three southern provinces of Thailand between the years of 2010-2021 and identifies the role of public holidays on the level of violence. The existing literature suggests terrorists consider holidays during attack planning. However, there is a lack of agreement on the effect direction. Some studies have found that holidays are a force for peace while others have found they can act as trigger for more violence. Applying environmental criminology to the timing of terrorist attacks, we argue that the type of the holiday matters. Therefore, we analyze public (secular), Islamic, and Buddhist holidays separately. We show that Islamic holidays witness increased violence while Buddhist and public holidays see reductions. We discuss that Islamic holidays increase the Malay-Muslim insurgents' motivation to attack by assigning to those dates a higher symbolic value. On the other hand, on Buddhist and public holidays, insurgents may hesitate to attack to avoid the adverse effects of losing public support and triggering a backlash. The results demonstrate the necessity to analyze the temporal dynamics of terrorist attacks.