Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients.

Depression adversely predicts prognosis in individuals with symptomatic heart failure. In some clinical populations, spiritual wellness is considered to be a protective factor against depressive symptoms. This study examined associations among depressive symptoms, spiritual wellbeing, sleep, fatigue, functional capacity, and inflammatory biomarkers in 132 men and women with asymptomatic stage B heart failure (age 66.5 years ± 10.5). Approximately 32 % of the patients scored ≥10 on the Beck Depression Inventory, indicating potentially clinically relevant depressive symptoms. Multiple regression analysis predicting fewer depressive symptoms included the following significant variables: a lower inflammatory score comprised of disease-relevant biomarkers (p < 0.02), less fatigue (p < 0.001), better sleep (p < 0.04), and more spiritual wellbeing (p < 0.01) (overall model F = 26.6, p < 0.001, adjusted R square = 0.629). Further analyses indicated that the meaning (p < 0.01) and peace (p < 0.01) subscales, but not the faith (p = 0.332) subscale, of spiritual wellbeing were independently associated with fewer depressive symptoms. Interventions aimed at increasing spiritual wellbeing in patients lives, and specifically meaning and peace, may be a potential treatment target for depressive symptoms asymptomatic heart failure.

Beliefs about asthma and complementary and alternative medicine in low-income inner-city African-American adults.

BACKGROUND: The gap in asthma prevalence, morbidity, and mortality is increasing in low-income racial/ethnic minority groups as compared with Caucasians. In order to address these disparities,alternative beliefs and behaviors need to be identified. OBJECTIVE: To identify causal models of asthma and the context of conventional prescription versus complementary and alternative medicine(CAM) use in low-income African-American (AA) adults with severe asthma. DESIGN: Qualitative analysis of 28 in-depth interviews. PARTICIPANTS: Twenty-six women and 2 men, aged 21 to 48, who self-identified as being AA, low-income, and an inner-city resident. APPROACH: Transcripts of semi-structured in-depth qualitative interviews were inductively analyzed using the constant comparison approach. RESULTS: Sixty-four percent of participants held biologically correct causal models of asthma although 100% reported the use of at least 1 CAM for asthma. Biologically based therapies, humoral balance, and prayer were the most popular CAM. While most subjects trusted prescription asthma medicine, there was a preference for integration of CAM with conventional asthma treatment. Complementary and alternative medicine was considered natural, effective, and potentially curative. Sixty-three percent of participants reported non adherence to conventional therapies in the 2 weeks before the research interview. Neither CAM nor nonmedical causal models altered most individuals(93%) willingness to use prescription medication. Three possibly dangerous CAM were identified. CONCLUSIONS: Clinicians should be aware of patient-generated causal models of asthma and use of CAM in this population. Discussing patients' desire for an integrated approach to asthma management and involving social networks are 2 strategies that may enhance patient provider partnerships and treatment fidelity.

Sleep paralysis as spiritual experience.

This article presents an overview of the sleep paralysis experience from both a cultural and a historical perspective. The robust, complex phenomenological pattern that represents the subjective experience of sleep paralysis is documented and illustrated. Examples are given showing that, for a majority of subjects, sleep paralysis is taken to be a kind of spiritual experience. This is, in part, because of the very common perception of a non-physical 'threatening presence' that is part of the event. Examples from various cultures, including mainstream contemporary America which has no widely known tradition about sleep paralysis, are used to show that the complex pattern and spiritual interpretation are not dependent on cultural models or prior learning. This is dramatically contrary to conventional explanations of apparently 'direct' spiritual experiences, explanations that are summed up as the 'Cultural Source Hypothesis.' This aspect of sleep paralysis was not recognized through most of the twentieth century. The article examines the way that conventional modern views of spiritual experience, combined with medical ideas that labeled 'direct' spiritual experiences as psychopathological, and mainstream religious views of such experiences as heretical if not pathological, suppressed the report and discussion of these experiences in modern society. These views have resulted in confusion in the scientific literature on sleep paralysis with regard to its prevalence and core features. The article also places sleep paralysis in the context of other 'direct' spiritual experiences and offers an 'Experiential Theory' of cross-culturally distributed spiritual experiences.

Barriers to the Entry of Biofield Healing Into "Mainstream" Healthcare.

In this article, we describe barriers to the entry of biofield healing into mainstream contemporary science and clinical practice. We focus on obstacles that arise from the social nature of the scientific enterprise, an aspect of science highlighted by the influential work of Thomas Kuhn (1922-1996), one of the most important- and controversial-philosophers of science in the 20th century. Kuhn analyzed science and its revolutionary changes in terms of the dynamics within scientific communities. Kuhn's approach helps us understand unconventional medical theories and practices such as biofield healing. For many years, these were called "complementary and alternative medicine" (CAM). However, because most people use nonmainstream approaches in conjunction with conventional treatments, the National Institutes of Health and many practitioners now prefer "Complementary and Integrative Medicine" (CIM) where integrative implies "bringing conventional and complementary approaches together in a coordinated way."(1) Biofield healing fits the integrative model well, provides a novel approach to therapeutic intervention, and is developing in a manner that can integrate with current medical science in simple ways. Yet, it still remains outside the conventional framework because of its conceptual bases, which contrast sharply with conventional assumptions regarding the nature of reality.

Humanities education at Pennsylvania State University College of Medicine, Hershey, Pennsylvania.

The Department of Humanities at Pennsylvania State University's (Penn State) College of Medicine, created at the founding of the College in 1967, was the first of its kind at any medical school. This article begins by describing how the department has developed over the years, and then discusses its present configuration, including kinds of faculty appointments, information about how it is funded, specific courses that comprise the department's four-year curriculum, and activities it sponsors. That a College of Medicine would make the teaching and practice of humanistic medicine a major and explicit commitment attracted the notice of Drs. Lawrence and Jane Kienle, who made possible the Doctors Kienle Center for Humanistic Medicine. The Humanities Department is closely allied with the Doctors Kienle Center, which integrates the College and the Medical Center by supporting a variety of projects, research, and awards that further the teaching and practice of humanistic medicine. Faculty in the department are encouraged to demonstrate excellence in scholarship and in teaching, but are also expected to become engaged in the life of the Medical Center, especially in furthering humanistic patient care. As such, the Humanities Department plays a major role in furthering the mission of the Pennsylvania State University's College of Medicine.

Ethnic minority use of complementary and alternative medicine (CAM): a national probability survey of CAM utilizers.

CONTEXT: US research results suggest that some sociodemographic characteristics predict use of complementary and alternative medicine (CAM). Specifically, use of CAM has been positively associated with persons from higher socioeconomic status groups and negatively associated with African-Americans. OBJECTIVE: To investigate the sociodemographic characteristics of CAM utilizers in a national probability sample, one containing an over-sampling of ethnic minorities. DESIGN: We tested the hypothesis that CAM use is prevalent among many different ethnic groups in the US. by analyzing a subset of data from The 1995 National Comparative Survey of Minority Health Care of The Commonwealth Fund, a national probability sample of 3,789 persons with an over-sampling of ethnic minorities. The survey was conducted by telephone in 6 languages. We analyzed use of CAM (defined by 5 items: herbal medicine, acupuncture, chiropractic, traditional healer, home remedy) within the last year. RESULTS: Use of 1 or more CAM modalities did not differ by ethnicity. Overall, 43.1% of the respondents reported using 1 or more CAM modality. Predictors of CAM use were female gender, being uninsured, and having a high school education or above. CONCLUSION: Use of CAM is equally prevalent among white, African-American/black, Latino, Asian, and Native American populations in the US, but characteristics of utilizers vary considerably by specific CAM modality.

The evolution of complementary and alternative medicine (CAM) in the USA over the last 20 years.

Medical practices that reside outside the mainstream medical structures have existed for centuries, often waxing and waning in prominence and use for various reasons. Recently, there has been a resurgence in interest and use of such practices in the USA generally referred to under the label of 'complementary and alternative medicine' (CAM). In this article we summarize some of the highlight events that punctuated this resurgence over the last 20 years. As in the past, social forces affecting these trends circulate around power, resources, and scope of practice. However, a prominent feature of this dynamic is a discussion about the role of science and 'evidence-based medicine' in addressing pluralistic healthcare-related practices. In the early years of this period, attempts to formulate the place of CAM practices as they relate to epistemology, nonconventional assumptions about health and healing, and the complexity of understanding 'whole systems' were discussed and often examined. Less attention is being paid to those core assumptions in more recent times. The focus now seems to be on how CAM practices can be judiciously and effectively 'integrated' into mainstream medicine. Examples of how this dynamic is evolving are described.

Spirituality and the International Classification of Functioning, Disability and Health: content comparison of questionnaires measuring mindfulness based on the International Classification of Functioning.

PURPOSE: To identify and compare the concepts contained in questionnaires measuring mindfulness using the International Classification of Functioning (ICF) as external reference. METHOD: Questionnaires which are published in peer-reviewed journals and listed in Pubmed or PsycInfo were included. The questionnaires were analysed and, using a content-analytical approach, the respective items were categorised and linked to the ICF. RESULTS: Ten questionnaires were included. Ninety-four per cent (N = 341) of the concepts could be linked to 37 different ICF categories. One hundred and seventy-one (50.1%) concepts were linked to ICF categories of the component Body Function, 74 (21.7%) to categories of the component Activity and Participation and none to categories of the component Environmental Factors. In total, 28.2% of the linked concepts belonged to Personal factors, which are not yet classified in the ICF. The questionnaires exhibited considerable differences regarding content density (i.e. the average number of concepts per item) and content diversity (i.e. the number of ICF categories per concept). CONCLUSIONS: The ICF provides an useful external reference to identify and compare the concepts contained in mindfulness questionnaires. Also, mindfulness questionnaire concepts suggest potentially useful factors for classification within the ICF.

Cardiorespiratory events detected by home memory monitoring and one-year neurodevelopmental outcome.

OBJECTIVE: To determine if infants with cardiorespiratory events detected by home memory monitoring during early infancy have decreased neurodevelopmental performance. STUDY DESIGN: Infants (n = 256) enrolled in the Collaborative Home Infant Monitoring Evaluation also completed the Bayley Scales of Infant Development II at 92 weeks' postconceptional age. Infants were classified as having 0, 1 to 4, or 5+ cardiorespiratory events. Events were defined as apnea >or=20 seconds or heart rate <60 to 80 bpm or <50 to 60 bpm, for >or=5 to 15 seconds, depending on age. RESULTS: For term infants, having 0, 1 to 4, and 5+ cardiorespiratory events was associated with unadjusted mean Mental Developmental Index (MDI) values (+/-SD) of 103.6 (10.6), 104.2 (10.7), and 97.7 (10.9), respectively, and mean Psychomotor Developmental Index (PDI) values of 109.5 (16.6), 105.8 (16.5), and 100.2 (17.4). For preterm infants, having 0, 1 to 4, and 5+ cardiorespiratory events was associated with unadjusted mean MDI values of 100.4 (10.3), 96.8 (11.5), and 95.8 (10.6), respectively, and mean PDI values of 91.7 (19.2), 93.8 (15.5), and 94.4 (17.7). The adjusted difference in mean MDI scores with 5+ events compared with 0 events was 5.6 points lower in term infants ( P = .03) and 4.9 points lower in preterm infants ( P = .04). CONCLUSIONS: Having 5+ conventional events is associated with lower adjusted mean differences in MDI in term and preterm infants.