Development in Danish medical students' empathy: study protocol of a cross-sectional and longitudinal mixed-methods study.

BACKGROUND: Clinical empathy has been associated with positive outcomes for both physicians and patients such as: more accurate diagnosis and treatment, increased patient satisfaction and compliance, and lower levels of burnout and stress among physicians. International studies show mixed results regarding the development of empathy among future physicians associating medical education with decline, stability or increase in empathy levels. These mixed results are due to several study limitations. In Denmark, no investigation of Danish medical students' empathy trajectory has yet been conducted wherefore such a study is needed that optimizes the study design of earlier studies. METHODS: The aim of the study is to examine and analyze empathy levels and empathy changes among Danish medical students from the four medical faculties in Denmark, employing a cross-sectional and longitudinal mixed-methods design including a control group of non-medical students. By supplementing cross-sectional and longitudinal questionnaire studies with a focus group interview study it is the aim to identify and analyze factors (including educational) that are perceived by medical students to influence the development of empathy and its expression in clinical care. DISCUSSION: The results of the study will provide insight into the trajectory of medical students' empathy and in undergraduate and graduate students' experiences with and perceptions of empathy development. In addition, the study will provide evidence to support further research on how targeted educational programmes can best be designed to educate empathic and patient-centered physicians.

Religiousness and depressive symptoms in Europeans: findings from the Survey of Health, Ageing, and Retirement in Europe.

OBJECTIVE: Religiousness has been found to protect against depression based on studies conducted in the United States, though there are limited data in the European population. We sought to evaluate the associations between religiousness and six depressive symptoms in Europeans aged 50+ years. STUDY DESIGN: Longitudinal study. METHODS: Our sample consisted of participants (n = 23,864) in wave 1 (2004-05) of the Survey of Health, Ageing, and Retirement in Europe who were followed up in waves 2-6 (2006-07 to 2015). Analyses were conducted using multivariable logistic regression. RESULTS: Higher frequency of prayer was associated with lower odds of having no hopes for the future (odds ratio [OR] = 0.89, 95% confidence interval [CI]: 0.81-0.99) and of suicidal thoughts (OR = 0.84, 95% CI: 0.72-0.97). Attending religious service was associated with lower odds of having no hopes for the future (OR = 0.74, 95% CI: 0.67-0.83), of suicidal thoughts (OR = 0.69, 95% CI: 0.59-0.81), difficulty in concentration (OR = 0.80, 95% CI: 0.72-0.88), irritability (OR = 0.77, 95% CI: 0.71-0.85), fatigue (OR = 0.84, 95% CI: 0.78-0.91), and having no enjoyable activity (OR = 0.84, 95% CI: 0.76-0.94). Religious education was associated with lower odds of not having engaged in any enjoyable activities lately (OR = 0.86, 95% CI: 0.78-0.95). Restful religiousness was associated with lower odds of experiencing suicidal thoughts, of having been irritable recently, and of having experienced fatigue in the last month, compared with crisis religiousness. Crisis religiousness was associated with higher odds of having been irritable recently and of having experienced fatigue in the last month compared with non-religiousness. CONCLUSIONS: Our findings suggest that religiousness is associated with lower odds of depressive symptoms, particularly for those who attend religious service.

Spiritual, religious, and existential concerns of cancer survivors in a secular country with focus on age, gender, and emotional challenges.

PURPOSE: The purpose of this study was to examine the associations between self-reported spiritual/religious concerns and age, gender, and emotional challenges among cancer survivors who have completed a 5-day rehabilitation course at a rehabilitation center in Denmark (the former RehabiliteringsCenter Dallund (RC Dallund)). METHODS: The data stem from the so-called Dallund Scale which was adapted from the NCCN Distress Thermometer and comprised questions to identify problems and concerns of a physical, psychosocial, and spiritual/religious nature. Descriptive statistics were performed using means for continuous variables and frequencies for categorical variables. Odds ratios were calculated by logistic regression. RESULTS: In total, 6640 participants filled in the questionnaire. Among participants, 21% reported one or more spiritual/religious concerns, the most reported concerns related to existence and guilt. Having one or more spiritual/religious concerns was significantly associated with age (OR 0.88), female gender (OR 1.38), and by those reporting emotional problems such as being without hope (OR 2.51), depressed (OR 1.49), and/or anxious (OR 1.95). Among participants, 8% stated they needed help concerning spiritual/religious concerns. CONCLUSIONS: Cancer patients, living in a highly secular country, report a significant frequency of spiritual/religious and existential concerns. Such concerns are mostly reported by the young, female survivors and by those reporting emotional challenges. Spiritual/religious and existential concerns are often times tabooed in secular societies, despite being present in patients. Our results call for an increased systemic attention among health professionals to these concerns, and a particular focus on identifying and meeting the spiritual/religious and existential concerns of women, the young and those challenged by hopelessness, depression, and anxiety.

Religiousness and Diseases in Europe: Findings from SHARE.

Recent research in religiousness and health suggests that epidemiological forces can have opposed effects. Here we examine two forms of religiousness and their association with disease. We performed a cross-sectional study of 23,864 people aged 50+ included in wave 1 (2004-2005) of the Survey of Health, Ageing and Retirement in Europe and a longitudinal study including people from wave 1, who were followed up during 11 years. Results suggested that taking part in a religious organization was associated with lower odds of heart attack (OR 0.74, 95% CI 0.60, 0.90), stroke (OR 0.68, 95% CI 0.50, 0.95), and diabetes (OR 0.72, 95% CI 0.58, 0.90) and longitudinally associated with lower odds of cancer (OR 0.78, 95% CI 0.60, 1.00). Conversely, praying was longitudinally associated with higher odds of heart attack (OR 1.27, 95% CI 1.10, 1.48) and high cholesterol (OR 1.12, 95% CI 1.00, 1.26). The most religious people had lower odds of stroke, diabetes, and cancer than other respondents, and in the longitudinal model, people who only prayed had higher odds of heart attack than non-religious people. Our findings lend support to the hypothesis that restful religiousness (praying, taking part in a religious organization, and being religiously educated) was associated with lower odds of some diseases, whereas little evidence was present that crisis religiousness (praying only) was associated with higher odds of disease.

Religiousness and lifestyle among Europeans in SHARE.

OBJECTIVES: Religiousness is associated with longevity and better physical health, which may be due to lifestyle choices. Here, we examine associations between religiousness and health, explained by lifestyle. STUDY DESIGN: This is a longitudinal study. METHODS: Data came from 23,864 people aged 50 and above included in the Survey of Health, Ageing and Retirement in Europe in 2004-2005 and followed up during 11 years. RESULTS: Praying and taking part in a religious organization were associated with lower odds of smoking [odds ratio (OR) = 0.82, 95% confidence interval (CI): 0.73, 0.92 and 0.61, 95% CI: 0.53, 0.70], alcohol consumption (OR = 0.71, 95% CI: 0.64, 0.78 and OR = 0.76, 95% CI: 0.67, 0.85), physical inactivity (OR = 0.88, 95% CI: 0.79, 0.98 and OR = 0.54, 95% CI: 0.48, 0.61), and doing no vigorous physical activity (OR = 0.92, 95% CI: 0.85, 0.98 and OR = 0.63, 95% CI: 0.58, 0.68). Furthermore, religious organizational involvement lowered the odds of sleep problems (OR = 0.83, 95% CI: 0.76, 0.91), whereas being religiously educated lowered the odds of high body weight (OR = 0.87, 95% CI: 0.79, 0.96). The more religious (people who prayed, took part in a religious organization and were religiously educated) had lower odds of smoking, alcohol consumption, physical inactivity, and sleep problems than other respondents, and compared with people who only prayed, they had lower odds of smoking, physical inactivity, and sleep problems. People who only prayed had lower odds of alcohol consumption but higher odds of sleep problems than the non-religious. CONCLUSIONS: This study confirms that the positive relations between religiousness and health to an important degree can be explained by lifestyle.

Faith Moves Mountains-Mountains Move Faith: Two Opposite Epidemiological Forces in Research on Religion and Health.

Research suggests opposite epidemiological forces in religion and health: (1). Faith seems to move mountains in the sense that religion is associated with positive health outcomes. (2). Mountains of bad health seem to move faith. We reflected on these forces in a population of 3000 young Danish twins in which all religiosity measures were associated with severe disease. We believe the reason for this novel finding is that the sample presents as a particularly secular population-based study and that the second epidemiological force has gained the upper hand in this sample. We suggest that all cross-sectional research on religion and health should be interpreted in light of such opposite epidemiological forces potentially diluting each other.