Spirituality in medicine: what is to be done?

Role of Spiritual Sentiments in Improving the Compliance of Water Intake in Patients with Urolithiasis

The aim of this study was to compare the compliance for water intake and rate of recurrence between spiritually motivated and non-motivated patients of renal tract stone disease. It is a multi centric prospective cohort study, conducted in Department of Urology, Institute of Kidney Diseases and Peshawar Medical College, from January 10, 2009 to December 2012. A total of 180 patients with comparable demographic, IQ, EQ and BMI after achieving complete stone clearance were divided into two equal groups. Both groups were instructed to increase the water intake timetable according to AUA guidelines. Group 'A' comprising of 90 patients who were identified as spiritually motivated patients based on questioner of FICA 12 is also instructed that increasing the water intake is mentioned in contemporary Islamic medicine. No spiritual instruction was given to Group B. The instructed guidelines and practice for amount and timing of water intake were recalled from participants at the end of 6 and 12 months. The data were recorded on structured proforma and was analyzed using SPSS version 17. The mean age of the patient in Group A was 37.5 years (18-70 years), while in Group B it was 34 years (18-65 years). Urolithiasis affected predominantly male gender in both groups. Sixty-five patients (72.2 %) in Group A have significant compliance (p < 0.001) for water intake over Group B (46 %). The spiritually motivated Group A has significantly reduced rate of recurrence of stones in 23 patients versus 37 in Group B. The spiritually motivated patients had significantly better compliance for water intake and reduced rate of recurrence versus non-motivated individuals in urolithiasis.

ESPIRITUALIDADE E SAÚDE: UMA EXPERIÊNCIA NA GRADUAÇÃO EM MEDICINA E ENFERMAGEM

Resumo Pesquisas demonstram que, ainda hoje, a espiritualidade representa um aspecto importante na vida humana. As conquistas do modelo biomecânico de ensino e prática da medicina não conseguiram ofuscar o papel que a espiritualidade ocupa no processo saúde-doença. Seguindo uma tendência que ocorre em escolas médicas de todo o mundo, os autores introduziram, na Universidade Federal de São Paulo, a disciplina eletiva – Espiritualidade e Medicina – dirigida a estudantes de medicina e enfermagem com o objetivo de promover o reconhecimento da dimensão espiritual do paciente e, consequentemente, um atendimento mais humanizado. Após quatro anos de curso, procedeu-se a um estudo qualitativo para determinar o perfil dos estudantes que escolheram a disciplina eletiva, sua percepção em relação ao tema espiritualidade e saúde e a importância atribuída ao curso no que concerne à sua formação pessoal, profissional e humanística. Os textos produzidos pelos alunos durante o curso constituíram a principal fonte de dados. A interpretação dos dados foi realizada por meio de um enfoque da fenomenologia hermenêutica e evidenciou os seguintes temas: busca de sentido da vida; independência entre concepções acerca de Deus e espiritualidade e a importância atribuída à disciplina; espiritualidade e humanização; e espiritualidade, cuidado de si e autoconhecimento.

The relationship between self-reported health status and spirituality among adult patients attending general outpatient clinic of tertiary hospital in ibadan

BACKGROUND

Spirituality is an important aspect of health that is not always addressed in modern day medical practice. This is related to lack of clarity about the nature of the concept, however its role in researches and health service provision is being revisited because of the evergreen importance.

OBJECTIVE

To determine the relationship between spirituality and selfreported health status of adult patients attending general outpatient clinic of University College Hospital, Ibadan, Nigeria.

METHODS

A cross-sectional descriptive study wherein interviewer administered questionnaire was applied on randomly selected 422 eligible and consenting adult patients attending general outpatient clinic of University College Hospital between 1st November, 2010 and 31st January, 2011. Their Spirituality and Heath status were assessed using spirituality scale and self reported health questionnaire respectively.

RESULT

Of all the respondents, 270(64.0%) were females while 152(36.0%) were males with a ratio of 1.8:1, and mean age of 42.8±15.9. The overall mean spirituality score was 125.7 ± 12.1, the maximum obtainable score was 138. A total of 63(15.0%) respondents rated their health as excellent, 114 (27.0%) rated theirs as very good while 150 (35.5%) respondents considered theirs as good. Respondents who rated their health as good had significantly higher mean scores when compared with those who rated theirs as poor or fair (mean difference = 3.347, 95% C I = 0.552 to -6.142 p=0.019).

CONCLUSION

The study revealed that perceived spiritual wellbeing is positively related to the patient's sense of general wellbeing. Therefore, there is need to give attention to patient's spiritual wellbeing during medical encounter in the hospital.

Initial evidence of religious practice and belief in depressed african american cancer patients

Objective:

This study examined spiritual coping (beliefs and practices) of depressed African American cancer patients through a comparison with depressed White cancer patients and non-depressed African American cancer patients.

Methods:

Using mixed methods, 74 breast (n=41) and prostate (n=33) cancer survivors including 34 depressed and 23 nondepressed African Americans and 17 depressed Whites were interviewed. The interviews were audiotaped and transcribed. Qualitative data analysis identified themes that were coded. The codes were entered into SPSS software. The Fisher’s exact test was performed to examine group differences in self-reported spiritual coping.

Results:

Significantly more depressed African Americans questioned God when learning of a cancer diagnosis than the non-depressed African Americans (p=.03), but they did not differ from the depressed Whites in this regard (p=.70). Significantly more depressed African Americans reported having faith in God (p=.04), reading the bible (p=.02), and conversing with God (p=.01) than did the depressed Whites. They also reported praying alone (p=.01) more frequently than the depressed Whites who, on the other hand, reported praying with others (non-family members) together for one’s own health more frequently (p=.04).

Conclusions:

Depression is associated with a deepening need for spirituality and it affects religious beliefs and practices more in African American than White cancer patients. Given its important role in the lives of African American cancer patients, spirituality may be utilized as a reasonable, culturally-based approach to better assess and treat depression in these patients.

Negotiating religious beliefs in a medical setting

This manuscript studies in detail, following a discourse analytical approach, medical consultations in which a patient's religious belief does not allow blood transfusion to be administered. The patient is a young Jehovah's Witness suffering myeloid leukaemia who is being treated in a Catholic cancer hospital where the practice of blood transfusion forms part of the standard protocol to treat the disease. The consultations under analysis take place in a Chilean cancer clinic where mainly the oncologist and a Jehovah's Witness Representative (JWR) present discuss and negotiate expert information on the substitute methods to be used. The exchange dynamics of the consultations differ from the usual visits where the medical knowledge and expertise is primarily in the hands of the medical practitioner. In these encounters, the JWR shares vital information with the oncologist providing the basis of the treatment to be used. This shifting of the balance of power-which could have been a cause of tension in the visit and a contributing factor in the disruption of communication-has instead brought light to the encounter where the negotiated treatment has been achieved with relative ease. The patient's future is in the hands of the oncologist and the JWR, and their successful negotiation of treatment has made it possible to cater for the particular needs of a JW patient. Sharing different medical practices has not been an obstacle, but an opportunity to find out ways to deliver equity access and well-informed practices to a non-conventional patient.

Antioxidant activity of ethanolic extract of inflorescence of Ormenis Africana in vitro and in cell cultures

Background

The antioxidant potency of the hydroethanolic extract of Ormenis Africana (HEOA), Asteraceae was evaluated with regards to total polyphenol, flavonoid and anthocyanins content. Antioxidant activity has been assessed chemically and biologically. First, the free radical scavenging ability of HEOA was evaluated using two commonly in vitro tests: ABTS and DPPH radicals. Then, the protection effect of this extract against oxidative stress was conducted in HeLa cells treated with Fe²⁺ or H₂O_2. Oxidative stress was evaluated by measuring the lipid peroxidation levels (TBARs and DC) and the antioxidant enzymes activities (catalase and Superoxide dismutase). Cytotoxic effect of HEOA was prealably determined against HeLa cell line by MTT assay.

Results

HEOA contain considerable levels of antioxidant compound as evidenced by high amount of polyphenols (312.07 mg GAE/g dray matter), flavonoids (73.72 ± 1.98 mg QE/g dray matterl) and anthocyanins (0.28 ± 0.09 mg Cy-3-glu E/g dray matter). DPPH and ABTS assays showed a high antioxidant activity (IC₅₀ = 24 μg/ml; TEAC = 2.137 mM) which was comparable to BHT.

In biological system, HEOA exhibited a 50% cytotoxic concentration evaluated as 16.52 μg/ml. Incubation of HeLa cell line with no cytotoxic concentrations resulted in a remarkable protection from oxidative stress induced by Fe²⁺ or H₂O₂ which was evidenced by a decrease of MDA and CD levels as well as a diminution of antioxidant enzymes activities (Catalase and SOD) as compared to cells treated with Fe²⁺ or H₂O₂ alone.

Conclusion

The hydroethanolic extract of O. Africana could thus be considered as a source of potential antioxidants. The results of this study will promote the reasonable usage of this plant in food and pharmacy industries as well as in alternative medicine and natural therapy.

Antimutagenic effects of ethanolic extracts from selected Palestinian medicinal plants

AIM OF THE STUDY

Eryngium creticum, Nigella sativa, and Teucrium polium have been traditionally used for the treatment of inflammations, liver disorders, and arthritis. Various studies on these plants revealed anti-inflammatory, hepatoprotective and antimutagenic activities. Previous results of our research group, however, indicate that aqueous extracts prepared as for the traditional use (tea) have neither cytoprotective nor antimutagenic activity. Instead, there is evidence for a mutagenic potential. Since the described antimutagenic activity may not be present in effective amounts in the aqueous extracts this study focuses on ethanolic extracts.

MATERIALS AND METHODS

Ethanolic extracts of the three plant species were prepared and tested against N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), a directly acting mutagen. Since it cannot be excluded that the active constituents of the plant extracts require biotransformation or induce metabolic enzymes, causing antimutagenic or detoxifying effects, primary cultures of rat hepatocytes were used for this study. Plant ethanolic extracts were applied along with MNNG in three protocols: pre-treatment, combined treatment and post-treatment.

RESULTS AND CONCLUSIONS

The results of this investigation clearly indicate an inhibitory effect of the plant extracts on MNNG mutagenicity, while the extracts had no effect on cytotoxicity indicators such as necrosis and apoptosis. The effects obtained can be attributed to a direct antimutagenic activity and an increased recovery at the chromosomal level. In order to identify the responsible compounds extracts will in a next step have to be fractionated, tested and chemically analyzed.

Is prayer CAM?

BACKGROUND

Alternative medicine researchers and policy makers have classified prayer as a mind-body intervention, and thus, a modality of complementary and alternative medicine (CAM). As such, numerous epidemiological surveys of CAM utilization-which have included prayer-depict increasing CAM use, particularly in specific racial and ethnic groups.

OBJECTIVES

This paper discusses the implications of conflating prayer and CAM, especially regarding the definitions of both concepts and the resulting statistics of CAM utilization.

The importance of spirituality in medicine and its application to clinical practice

Recent international and Australian surveys have shown that there is a need to incorporate the spiritual and religious dimension of patients into their management. By keeping patients' beliefs, spiritual/religious needs and supports separate from their care, we are potentially ignoring an important element that may be at the core of patients' coping and support systems and may be integral to their wellbeing and recovery. A consensus panel of the American College of Physicians has suggested four simple questions that physicians could ask patients when taking a spiritual history. Doctors and clinicians should not "prescribe" religious beliefs or activities or impose their religious or spiritual beliefs on patients. The task of in-depth religious counselling of patients is best done by trained clergy. In considering the spiritual dimension of the patient, the clinician is sending an important message that he or she is concerned with the whole person. This enhances the patient-physician relationship and is likely to increase the therapeutic impact of interventions. Doctors, health care professionals and mental health clinicians should be required to learn about the ways in which religion and culture can influence patients' needs and recovery.

Spirituality, religion and psychiatry: its application to clinical practice

OBJECTIVE

Based on evidence obtained from recent Australian psychiatric patient surveys, a need to include the spiritual and religious dimension of patients in their psychiatric care has been identified. This paper aims to review the evidence for this need and to suggest the parameters in which this dimension might be applied.

METHODS

The phenomenology of spirituality and its relevance to psychiatry is considered, the concept of the psychiatrist and the clinician as a healer visited, and the evidence for the need for spirituality and religiosity for patients examined.

RESULTS

Patients' spiritual needs should be addressed at different levels. Using previous data and experience, the authors suggest what psychiatrists might and might not do, in order that these issues are attended to in an ethical and sensitive manner.

CONCLUSIONS

In considering the spiritual dimension of the patient, the psychiatrist is able to send an important message that he or she is concerned with the whole person, a message that enhances the patient-physician relationship. This, in turn, is likely to increase the therapeutic impact of psychiatrists' interventions.