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1.
Artigo em Inglês | MEDLINE | ID: mdl-31264800

RESUMO

AIM: Previous studies suggest that Mindfulness-Based Cognitive Therapy for Children (MBCT-C) is feasible and may improve anxiety and emotion regulation in youth with anxiety disorders at-risk for bipolar disorder. However, controlled studies are warranted to replicate and extend these findings. METHODS: In the current study, 24 youth with anxiety disorders who have at least one parent with bipolar disorder participated in a MBCT-C treatment period (n = 24; Mage = 13.6, 75% girls, 79% White) with a subset also participating in a prior psychoeducation waitlist control period (n = 19 Mage = 13.8, 68% girls, 84% White). Participants in both the waitlist and MBCT-C periods completed independently-rated symptom scales at each time point. Participants in the waitlist period received educational materials 12 weeks prior to the beginning of MBCT-C. RESULTS: There were significantly greater improvements in overall clinical severity in the MBCT-C period compared to the waitlist period, but not in clinician- and child-rated anxiety, emotion regulation or mindfulness. However, increases in mindfulness were associated with improvements in anxiety and emotion regulation in the MBCT-C period, but not the waitlist period. CONCLUSIONS: Findings suggest that MBCT-C may be effective for improving overall clinical severity in youth with anxiety disorders who are at-risk for bipolar disorder. However, waitlist controlled designs may inflate effect sizes so interpret with caution. Larger studies utilizing prospective randomized controlled designs are warranted.

2.
Med Acupunct ; 30(1): 21-24, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29410717

RESUMO

Objectives: Urinary incontinence (UI) is common in middle- and old-age. Previous studies have shown that multiple-point and multiple-frequency acupuncture are efficacious treatment modalities for UI. This study investigated the efficacy of single-point acupuncture for the treatment of UI in women. Materials and Methods: Twelve female subjects, ages 40-75, participated in the trial. Acupuncture at CV 2 was performed. Before needle insertion, each subject completed the Revised Urinary Incontinence Scale (RUIS). After treatment, subjects were contacted at 2 and 8 weeks to assess treatment effects using the RUIS questionnaire again. Results: Statistically significant improvements were seen with respect to symptoms of urgency, stress incontinence, impact of urine leakage, quantity of urine leakage, and the total score at 2 weeks postintervention. A statistically significant increase in impact of urine leakage was found at the 8-week follow-up, compared to the 2-week results. Conclusions: In this pilot trial, single-point acupuncture was associated with significant but short-term improvements in UI symptoms. Future trials should include a control group and an increased sample size for a more-rigorous examination of this potential adjunctive treatment for UI.

3.
Neurology ; 90(11): e963-e970, 2018 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-29444968

RESUMO

OBJECTIVE: To evaluate the effect of a stress-reduction intervention in participants with medication-resistant epilepsy. METHODS: Adults with medication-resistant focal epilepsy (n = 66) were recruited from 3 centers and randomized to 1 of 2 interventions: (1) progressive muscle relaxation (PMR) with diaphragmatic breathing, or (2) control focused-attention activity with extremity movements. Following an 8-week baseline period, participants began 12 weeks of double-blind treatment. Daily self-reported mood and stress ratings plus seizure counts were completed by participants using an electronic diary, and no medication adjustments were permitted. The primary outcome was percent reduction in seizure frequency per 28 days comparing baseline and treatment; secondary outcomes included stress reduction and stress-seizure interaction. RESULTS: In the 66 participants in the intention-to-treat analysis, seizure frequency was reduced from baseline in both treatment groups (PMR: 29%, p < 0.05; focused attention: 25%, p < 0.05). PMR and focused attention did not differ in seizure reduction (p = 0.38), although PMR was associated with stress reduction relative to focused attention (p < 0.05). Daily stress was not a predictor of seizures. CONCLUSIONS: Both PMR and the focused-attention groups showed reduced seizure frequency compared to baseline in participants with medication-resistant focal seizures, although the 2 treatments did not differ. PMR was more effective than focused attention in reducing self-reported stress. CLINICALTRIALSGOV IDENTIFIER: NCT01444183.

5.
Med Teach ; 39(2): 118-119, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28103729

RESUMO

The high prevalence of physician burnout is of great concern and may begin with observed declines in empathy and increases in stress and burnout in medical and health professions students. While underlying causes have been described, there is less certainty on how to create effective interventions in curricula and workplace. In October 2015, The Center for Innovation and Leadership in Education (CENTILE) at Georgetown University, together with MedStar Health, Georgetown's clinical partner, and six academic institutions sponsored a conference in Washington, DC. The goal was to discuss the current state of stress and burnout in the health professions, and to share best practices on strategies to promote resilience, empathy and well-being in students, residents, faculty and practitioners across health professions. In this issue of Medical Teacher, three articles address pertinent themes of the conference. Maslach and Leiter provide insights into burnout and strategies to alleviate it. Ekman and Krasner discuss various types of empathy and how neuroscience can be used to effectively cultivate empathy. In the third paper, Kreitzer and Klatt highlight three successful curricular interventions that foster self-awareness and boost resilience. Ultimately, effective strategies will be needed to address this issue at both the individual and organizational levels.


Assuntos
Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Empatia , Estresse Psicológico/epidemiologia , Estresse Psicológico/prevenção & controle , Esgotamento Profissional/psicologia , Congressos como Assunto , Humanos , Estresse Psicológico/psicologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-28057447

RESUMO

Among pediatricians, perceived knowledge of efficacy, tolerability, dosing, and side effects of antidepressants represent significant sources of variability in the use of these medications in youth with depressive and anxiety disorders. Importantly, the qualitative factors that relate to varying levels of comfort with antidepressants and willingness to prescribe are poorly understood. Using a mixed-methods approach, in-depth interviews were conducted with community-based and academic medical center-based pediatricians (N = 14). Interviews were audio recorded and iteratively coded; themes were then generated using inductive thematic analysis. The relationship between demographic factors, knowledge of antidepressants, dosing, and side effects, as well as prescribing likelihood scores for depressive disorders, anxiety disorders or co-morbid anxiety and depressive disorders, were evaluated using mixed models. Pediatricians reported antidepressants to be effective and well-tolerated. However, the likelihood of individual physicians initiating an antidepressant was significantly lower for anxiety disorders relative to depressive disorders with similar functional impairment. Pediatricians considered symptom severity/functional impairment, age and the availability of psychotherapy as they considered prescribing antidepressants to individual patients. Antidepressant choice was related to the physician׳s perceived knowledge and comfort with a particular antidepressant, financial factors, and the disorder-specific evidence base for that particular medication and consultation with mental health practitioners. Pediatricians noted similar efficacy and tolerability profiles for antidepressants in youth with depressive disorders and anxiety disorders, but tended to utilize "therapy first" approaches for anxiety disorders relative to depressive disorders. Parental and family factors that influenced prescribing of antidepressants by pediatricians included parental ambivalence, family-related dysfunction and impairment secondary to the child׳s psychopathology as well as the child׳s psychosocial milieu. Pediatricians consider patient- and family-specific challenges when choosing prescribing antidepressant medications and are, in general, less likely to prescribe antidepressants for youth with anxiety disorders compared to youth with depressive disorders. The lower likelihood of prescribing antidepressants for anxious youth is not related to perception of the efficacy or tolerability, but rather to a perception that anxiety disorders are less impairing and more appropriately managed with psychotherapy.


Assuntos
Antidepressivos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Atitude do Pessoal de Saúde , Transtorno Depressivo/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Antidepressivos/efeitos adversos , Competência Clínica , Tomada de Decisão Clínica , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pediatras/psicologia , Projetos Piloto , Estados Unidos
7.
Mindfulness (N Y) ; 8(6): 1522-1531, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29335671

RESUMO

Hospital employees may experience occupational stress and burnout, which negatively impact quality of life and job performance. Evidence-based interventions implemented within the hospital setting are needed to promote employees' well-being. We offered a 4-week Mindfulness-Based Cognitive Therapy group program for hospital employees, and used a mixed-methods practice-based research approach to explore feasibility, acceptability, and effects on stress and burnout. Participants were 65 hospital employees (Mage = 44.06; 85% white) who participated between September 2015 and January 2016. Participants completed validated measures of stress and burnout before and after the program, and answered open-ended satisfaction questions after the program. Groups consistently enrolled at least 10 participants, but attendance rates declined across sessions (76% at session 2 vs. 54% at session 4) due primarily to work-related scheduling conflicts. The program content was acceptable as evidenced by high perceived value (M = 9.18 out of 10), homework compliance (51% practicing at least 3 times/week), and qualitative requests for program expansion. There were large, statistically significant decreases in stress (ΔM = 2.1, p < .001, d = .85) and medium decreases in burnout (ΔM = .46, p = .01, d = .57), which were supported by qualitative themes of improved self-regulation and mindfulness skills, stress reduction, emotional well-being, and improved work productivity and patient care skills. Findings suggest that 4-week MBCT is acceptable and useful for hospital employees, though research is needed to identify alternate delivery methods or strategies to enhance session attendance.

8.
Teach Learn Med ; 28(2): 219-28, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27064724

RESUMO

PROBLEM: Medical students face rigorous and stressful work environments, resulting in high rates of psychological distress. However, there has been a dearth of empirical work aimed at modifying risk factors for psychopathology among this at-risk group. Distress tolerance, defined as the ability to withstand emotional distress, is one factor that may be important in promoting psychological well-being in medical students. Thus, the aim of the current mixed-methods study was (a) to describe changes in facets of distress tolerance (i.e., emotional tolerance, absorption, appraisal, regulation) for medical students who completed a mind-body skills training group, and a no-intervention control group of students; (b) to examine the relationship between changes in psychological variables and changes in distress tolerance; and (c) to report students' perceptions of the mind-body group, with an emphasis on how the group may have affected personal and professional functioning due to improvements in distress tolerance. INTERVENTION: The mind-body program was an 11-week, 2-hour skills training group that focused on introducing, practicing, and processing mind-body skills such as biofeedback, guided imagery, relaxation, several forms of meditation (e.g., mindfulness), breathing exercises, and autogenic training. CONTEXT: Participants were 52 first- and second-year medical students (62.7% female, Mage = 23.45, SD = 1.51) who participated in a mind-body group or a no-intervention control group and completed self-report measures before and after the 11-week period. OUTCOME: Students in the mind-body group showed a modest improvement in all distress tolerance subscales over time (ΔM = .42-.53, p = .01-.03, d = .44-.53), whereas the control group showed less consistent changes across most subscales (ΔM = .11-.42, p = .10-.65, d = .01-.42). Students in the mind-body group qualitatively reported an improved ability to tolerate affective distress. Overall, improvements in psychological symptoms were associated with improvements in distress tolerance in the mind-body group but not in the control group. LESSONS LEARNED: These preliminary findings provide support for the notion that improving distress tolerance through mind-body skills training might serve to protect medical students from becoming functionally impaired by psychological distress. Thus, implementing mind-body skills training into medical school education may help to improve the psychological well-being of medical students. Future studies utilizing more methodologically rigorous designs are warranted.


Assuntos
Adaptação Psicológica , Atenção Plena , Estresse Psicológico/prevenção & controle , Estudantes de Medicina/psicologia , Feminino , Humanos , Masculino , Projetos Piloto , Resultado do Tratamento , Adulto Jovem
9.
J Child Adolesc Psychopharmacol ; 26(4): 372-9, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26783833

RESUMO

OBJECTIVE: We sought to evaluate the neurophysiology of mindfulness-based cognitive therapy for children (MBCT-C) in youth with generalized, social, and/or separation anxiety disorder who were at risk for developing bipolar disorder. METHODS: Nine youth (mean age: 13 ± 2 years) with a generalized, social, and/or separation anxiety disorder and a parent with bipolar disorder completed functional magnetic resonance imaging (fMRI) while performing a continuous processing task with emotional and neutral distractors (CPT-END) prior to and following 12 weeks of MBCT-C. RESULTS: MBCT-C was associated with increases in activation of the bilateral insula, lentiform nucleus, and thalamus, as well as the left anterior cingulate while viewing emotional stimuli during the CPT-END, and decreases in anxiety were correlated with change in activation in the bilateral insula and anterior cingulate during the viewing of emotional stimuli (p < 0.05, uncorrected; p < 0.005 corrected; cluster size, 37 voxels). CONCLUSIONS: MBCT-C treatment in anxious youth with a familial history of bipolar disorder is associated with increased activation of brain structures that subserve interoception and the processing of internal stimuli-functions that are ostensibly improved by this treatment.


Assuntos
Transtornos de Ansiedade/terapia , Transtorno Bipolar/prevenção & controle , Terapia Cognitivo-Comportamental/métodos , Atenção Plena/métodos , Adolescente , Transtornos de Ansiedade/psicologia , Encéfalo/diagnóstico por imagem , Criança , Feminino , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Fatores de Risco , Resultado do Tratamento
10.
Early Interv Psychiatry ; 10(5): 426-34, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-25582800

RESUMO

AIM: Children and adolescents with bipolar parents have an elevated risk for anxiety disorders. However, antidepressant medications commonly used to treat symptoms of anxiety may accelerate the onset of mania in these already at-risk youth. Therefore, studies evaluating innovative non-pharmacologic treatments for anxiety in this population are urgently needed. METHODS: Subjects participated in 12 weekly sessions of mindfulness-based cognitive therapy for children (MBCT-C), a manualized group psychotherapeutic intervention utilizing cognitive behavioural principles and mindfulness exercises to increase regulation of attention and non-judgmental acceptance of present moment thoughts, emotions and experiences. Independent raters administered symptoms rating scales prior to each treatment session. Spearman correlations and paired-samples signed rank tests were used to examine outcomes. After-intervention surveys and session transcripts were reviewed to assess feasibility and acceptability of the intervention. RESULTS: Participants included 10 youth (meanage = 13.2; 80% girls; 40% biracial) with generalized, social and/or separation anxiety disorders, and a parent with bipolar disorder. Clinician-rated anxiety was significantly reduced after intervention (meanbefore = 11.1; meanafter = 4.3; P < 0.01), as well as youth-rated trait anxiety (P = 0.03). Parent-rated emotion regulation significantly increased from before to after intervention (P = 0.05). Increases in mindfulness were associated with decreases in anxiety (P = 0.03). Finally, children and parents/guardians reported high levels of feasibility, acceptability and usefulness of the intervention. CONCLUSION: Findings support the feasibility, acceptability and preliminary efficacy of MBCT-C for treating anxiety in youth at risk for bipolar disorder. Future controlled and larger studies are needed to confirm these preliminary findings.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Atenção Plena , Adolescente , Transtorno Bipolar/psicologia , Criança , Feminino , Humanos , Masculino , Pais/psicologia , Projetos Piloto , Psicoterapia de Grupo
11.
Glob Adv Health Med ; 4(4): 32-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26331102

RESUMO

BACKGROUND: Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting. OBJECTIVE: The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcomes among hospitalized infants. METHODS: We conducted a retrospective review of a clinical database from a level III NICU regularly delivering integrative care therapies. Paired-samples t-tests were used to examine associations between integrative care therapies and 4 pre-post outcome measures: therapist-rated pain and presentation (ranging from asleep to agitated) and neonates' heart rate and oxygen saturation. RESULTS: Of 186 patients (M age=68 days), 58% were male and 67% were Caucasian. Sixty-two percent received both massage and healing touch; the remainder received a single therapy. From pre-post therapy, statistically significant changes were observed in infants' heart rate (M pre=156 vs M post=140 per minute; P<.001), oxygen saturation (M pre=95.0% vs.M post=97.4%; P<.001), and therapist-reported pain (M pre=2.8 vs M post=0.2; P<.001) and presentation (M pre=3.2 vs. M post=1.0; P<.001). CONCLUSION: Observed improvements in pain-related outcomes suggest that massage and healing touch may be useful integrative therapies to consider as pain management options in the NICU.

12.
J Asthma ; 52(9): 889-96, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26374696

RESUMO

OBJECTIVE: Asthma affects approximately seven million children/adolescents in the USA, with African-American children disproportionately affected. Breathing retraining techniques have been shown to improve asthma outcomes in adults, though research in youth is limited. The purpose of this pilot study was to test the feasibility and preliminary efficacy of a school-based randomized controlled trial of breathing retraining for asthma outcomes and anxiety symptoms in a sample of urban, African-American adolescents. METHODS: Adolescents were randomized into either the intervention group (20-min breathing retraining plus education) or control group (20-min standard education). Participants completed two study visits, one month apart. Asthma control, asthma quality of life and lung functioning (FEV1 and peak flow) were the primary outcomes, and state anxiety (pre-post the intervention) and trait anxiety (over the one-month period) were the secondary outcomes. RESULTS: Thirty-three African-American adolescents participated in the study, with a 90% retention rate between visit 1 and visit 2. Asthma control and asthma quality of life, significantly improved over time (p ≤ 0.01) with no differences between intervention and control groups. State anxiety significantly decreased (p ≤ 0.01) immediately post intervention at both time points with no differences between groups. There were no significant differences found in lung functioning or trait anxiety over the one-month time period. CONCLUSIONS: These preliminary results suggest that breathing retraining is a feasible, acceptable and potentially efficacious intervention (although no significant differences between groups were found) for improving asthma symptoms in urban adolescents with asthma in a school-based setting.


Assuntos
Afro-Americanos , Asma/reabilitação , Qualidade de Vida , Respiração , Adolescente , Ansiedade , Asma/psicologia , Relações Comunidade-Instituição , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto , Projetos Piloto , Testes de Função Respiratória , Autocuidado , Estados Unidos , Universidades , População Urbana
13.
Psychol Assess ; 26(1): 127-37, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24188147

RESUMO

The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp; Peterman, Fitchett, Brady, Hernandez, & Cella, 2002) has become a widely used measure of spirituality; however, there remain questions about its specific factor structure and the validity of scores from its separate scales. Specifically, it remains unclear whether the Meaning and Peace scales denote distinct factors. The present study addresses previous limitations by examining the extent to which the Meaning and Peace scales relate differentially to a variety of physical and mental health variables across 4 sets of data from adults with a number of chronic health conditions. Although a model with separate but correlated factors fit the data better, discriminant validity analyses indicated limited differences in the pattern of associations each scale showed with a wide array of commonly used health and quality-of-life measures. In total, the results suggest that people may distinguish between the concepts of Meaning and Peace, but the observed relations with health outcomes are primarily due to variance shared between the 2 factors. Additional research is needed to better understand the separate and joint role of Meaning and Peace in the quality of life of people with chronic illness.


Assuntos
Doença Crônica/psicologia , Senso de Coerência , Espiritualidade , Adulto , Idoso , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Psicometria , Inquéritos e Questionários
14.
J Relig Health ; 53(2): 604-13, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24173602

RESUMO

This qualitative study examined the preferences of urban adolescents with asthma for including religious/spiritual (R/S) inquiry in a variety of hypothetical clinical encounters. Twenty-one urban adolescents (M(age) = 15.6 years, 52 % female, 81 % African American) with asthma participated in a semi-structured interview. Interviews were transcribed and underwent a thematic analysis. R/S preferences were contextual rather than personal, driven by: (1) acuity of the hypothetical clinical context; (2) nature of the patient-provider relationship; and (3) level of R/S intervention/inquiry. Most adolescents welcomed prayer if near death, but did not see the relevance of R/S in a routine office visit.


Assuntos
Comportamento do Adolescente/psicologia , Asma/psicologia , Relações Médico-Paciente , Religião e Medicina , Espiritualidade , População Urbana/estatística & dados numéricos , Adolescente , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Meio-Oeste dos Estados Unidos , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Religião , Religião e Psicologia , Inquéritos e Questionários
15.
J Altern Complement Med ; 20(2): 98-102, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24175871

RESUMO

BACKGROUND: Complementary or integrative care therapies are promising adjunctive approaches to pain management for pediatric inpatients that are currently underused and understudied. The purpose of this study was to examine the potential benefits of integrative care therapies delivered to hospitalized children and adolescents at a large Midwestern academic pediatric medical center over a 1-year period. METHODS: A retrospective chart review of an inpatient clinical database maintained by integrative care therapists over a 1-year period was used for the current study. Pre/post pain and relaxation scores associated with the delivery of inpatient integrative care therapies (primarily massage therapy and healing touch) were examined. RESULTS: Five-hundred nineteen hospitalized children and adolescents were treated by integrative care therapists for primarily pain or anxiety needs. Patients had a mean age of 10.2 years (standard deviation, 7.0), 224 were female (43%), 383 were white (74%), and most (393 [77%]) received massage therapy. Mean pain and relaxation scores decreased significantly from pre- to post-therapy across all demographic and clinical subgroups (p≤.001). CONCLUSIONS: Although integrative care therapies are increasingly requested and offered in children's hospitals, provision of these approaches is driven primarily by consumer demand rather than evidence-informed practice. Future controlled studies should examine the incremental effects of integrative care therapies as an adjunct to conventional treatment, assess how these therapies work mechanistically, and determine whether they improve outcomes, such as pain and cost, for hospitalized children and adolescents.


Assuntos
Adolescente Hospitalizado/estatística & dados numéricos , Criança Hospitalizada/estatística & dados numéricos , Terapias Complementares/métodos , Medicina Integrativa/métodos , Manejo da Dor/estatística & dados numéricos , Adolescente , Adolescente Hospitalizado/psicologia , Ansiedade/terapia , Criança , Criança Hospitalizada/psicologia , Feminino , Humanos , Masculino , Manejo da Dor/métodos , Estudos Retrospectivos
16.
Curr Psychiatry Rep ; 15(9): 391, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23943471

RESUMO

Integrative medicine (IntM) is a growing medical trend combining conventional medical approaches with evidence-based complementary therapies to promote well-being. Over half of individuals with depression use some form of IntM for symptom management. The purpose of the current study was to critically review the scientific evidence for IntM techniques in treating adult unipolar depression. We examined randomized controlled trials, systematic reviews, and meta-analyses published in the last one to three years using PsychINFO, PubMed, and Cochrane Library databases. The strongest evidence currently exists for mindfulness-based interventions and St. John's Wort (SJW) as monotherapies, and there is relatively strong evidence to support the use of omega-3 fatty acids and exercise as adjunct therapies. However, there remains an overall lack of methodologically rigorous research to support the efficacy of many other IntM techniques. Providers should be aware that many patients use IntM techniques for depression treatment and inquire regularly about such use.


Assuntos
Terapias Complementares , Transtorno Depressivo/terapia , Medicina Integrativa/métodos , Medicina Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Health Care Chaplain ; 19(2): 66-78, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23593948

RESUMO

A limited number of studies address parental faith and its relationship to their children's health. Using cystic fibrosis as a disease exemplar in which religion/spirituality have been shown to play a role and parental health behaviors (adherence to their child's daily recommended home treatments) are important, this study explored whether parents with different levels of adherence would describe use of faith differently. Twenty-five interviews were completed and analyzed using grounded theory methodology. Some parents described no relationship between faith and treatment adherence. However, of those who did, higher-adherence parents believed God empowered them to care for their child and they used prayer to change themselves, while lower-adherence parents described trusting God to care for their child and used prayer to change God. Clinical implications for chaplains' differential engagement with parents are presented.


Assuntos
Fibrose Cística/terapia , Pais/psicologia , Cooperação do Paciente/estatística & dados numéricos , Religião e Medicina , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Teoria Psicológica , Pesquisa Qualitativa , Adulto Jovem
18.
J Health Care Chaplain ; 19(1): 22-32, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23551048

RESUMO

Complementary and alternative medicine (CAM) use, including spiritual modalities, is common in pediatric chronic diseases. However, few users discuss CAM treatments with their child's physician. Semi-structured interviews of 25 parents of children who have cystic fibrosis (CF) were completed. Primary themes were identified by thematic analyses. Most parents (19/25) used at least one CAM modality with their child. Only two reported discussing CAM use with their child's pulmonologist. Most reported prayer as helpful (81%) and multi-faceted, including individual and group prayer; using aromatherapy or scented candles as an adjunct for relaxation; and the child's sleeping with a blessed prayer. Parents ascribed sacred significance to natural oral supplements. CAM use is relevant to the majority of participating parents of children under age 13 with CF. Chaplains can play a significant role by reframing prayer's integration into chronic disease care, co-creating rituals with pediatric patients, and mediating conversations between parents and providers.


Assuntos
Terapias Complementares/estatística & dados numéricos , Fibrose Cística/terapia , Pais/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Cura pela Fé , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Religiosa , Relações Profissional-Família , Pesquisa Qualitativa , Adulto Jovem
19.
J Health Care Chaplain ; 18(3-4): 110-20, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23094612

RESUMO

Chronic illness is a significant stressor; the majority of Americans cope utilizing spirituality. Numerous studies demonstrate links between spiritual coping and health outcomes. The purpose of this study was to determine whether persons diagnosed with cystic fibrosis (CF) as adults use spirituality to cope and influence disease management. Semi-structured interviews were completed and analyzed using grounded theory. Data saturation was reached following twelve interviews (83% female); representing 100% participation of those approached and 48% of eligible adults. Persons with late-life CF diagnoses used spirituality to make meaning, understanding themselves in a collaborative partnership with their pulmonologist and God. Supporting themes were: (a) God's intervention depended on treatment adherence and (b) spiritual meaning was constructed through positively reframing their experience. The constructed meaning differed from that of adult parents of children with CF. Late-life diagnosed adults focused on personal responsibility for health. Clinical and research implications for chaplains are presented.


Assuntos
Adaptação Psicológica , Fibrose Cística/psicologia , Motivação , Cooperação do Paciente/psicologia , Espiritualidade , Adulto , Fibrose Cística/diagnóstico , Fibrose Cística/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Teoria Psicológica , Pesquisa Qualitativa , Religião e Psicologia
20.
J Asthma ; 49(4): 409-15, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22715868

RESUMO

Objective. Many adolescents with asthma use complementary and alternative medicine (CAM) for asthma symptom management. The purpose of this study was to investigate cross-sectional and longitudinal differences in psychosocial health outcomes between high and low CAM users among urban adolescents with asthma. Methods. Adolescents (Time 1: N = 151, Time 2: N = 131) completed self-report measures regarding the use of 10 CAM modalities, mental health, and health-related quality of life (HRQoL) following two clinic visits 1 year apart as part of a larger observational study. Multivariable regression analyses using backward elimination examined relationships between CAM use at Time 1 and outcomes at Time 1 and Time 2, controlling for key covariates and, in longitudinal analyses, Time 1 functioning. Results. Participants (M(age) = 15.8, SD = 1.85) were primarily African-American (n = 129 [85%]) and female (n = 91 [60%]) adolescents with asthma. High and low CAM users differed significantly in terms of several psychosocial health outcomes, both cross-sectionally and longitudinally. In cross-sectional multivariable analyses, greater frequency of praying was associated with better psychosocial HRQoL (R(2) = 0.22). No longitudinal relationships remained significant in multivariable analyses. Conclusions. Specific CAM techniques are differentially associated with psychosocial outcomes, indicating the importance of examining CAM modalities individually. Greater frequency of praying was cross-sectionally associated with better psychosocial HRQoL. When controlling for key covariates, CAM use was not associated with psychosocial outcomes over time. Further research should examine the effects of CAM use in controlled research settings.


Assuntos
Asma/psicologia , Asma/terapia , Terapias Complementares/métodos , Saúde Mental , População Urbana , Adolescente , Afro-Americanos , Antiasmáticos/uso terapêutico , Asma/etnologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Qualidade de Vida , Religião , Índice de Gravidade de Doença , Fatores Socioeconômicos
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