Temporal associations between meaning in life, ultimate meaning struggles, and mental health outcomes in a spiritually integrated inpatient program

BACKGROUND

Meaning in life is a benchmark indicator of flourishing that can likely mitigate the severity of depression symptoms among persons seeking mental healthcare. However, patients contending with serious mental health difficulties often experience a painful void or absence of ultimate meaning in their lives that might hinder recovery. This two-wave longitudinal study examined temporal associations between perceived presence of meaning in life, struggles with ultimate meaning, flourishing, and depression symptoms among adults in a spiritually integrated inpatient treatment program.

METHODS

Of the 242 patients assessed at intake, 90% (N = 218; 40% Cisgender male; 57% Cisgender female; 3.0% nonbinary) completed validated measures of these meaning-related factors and mental health outcomes at discharge.

RESULTS

Cross-sectional analyses revealed perceptions of meaning in life and ultimate meaning struggles were inversely linked with one another along with being associated with indices of positive and negative mental health in varying ways at the start and end of treatment. Drawing upon a two-wave cross-lagged panel design, longitudinal structural equation modeling analyses supported a Primary Meaning Model whereby having a subjective sense of meaning in life at intake was prospectively linked with lower levels of ultimate meaning struggles and greater flourishing at discharge. However, baseline levels of mental health outcomes were not predictive of the meaning-related factors in this sample.

CONCLUSION

Findings highlight the utility of assessing patients' perceived meaning in life and ultimate meaning struggles in spiritually integrated programs and for clinicians to be prepared to possibly address these meaning-related concerns in the treatment process.

"God Loves All Equally and Infinitely": A Mixed Methods Analysis of LGBTQ+ Ally Development Within Religious/Spiritual Contexts

Within the United States, conservative theological perspectives have exerted influential sociocultural influences toward LGBTQ+ communities, with profound implications toward ally development. Ally development can present its challenges, especially for those in non-affirming religious and/or spiritual (R/S) contexts. We employed a mixed methods approach, utilizing both Enhanced Critical Incident Technique and chi-square tests of independence, focusing on the self-identified incidents that influenced the internal negotiation process of 315 LGBTQ+ allies within R/S contexts. Participants described critical R/S incidents that impacted their ally development, and these incidents fell into four main categories: (1) the influence of religious organizations, leaderships, and congregants, (2) the impact of meaningful relationships, (3) the experience of spiritual or divine shifting events, and (4) meaning making. Additionally, participants identified wish list items represented by four main themes: (1) fostering ally development, (2) taking action, (3) nothing should have changed, and (4) wishing for support broadly. Chi-square tests of independence revealed that R/S incidences were related to specific wish list items.

A scoping review of Islamic pilgrimage to Mecca: Mapping the health concerns and proposed solutions

OBJECTIVES

To map the current evidence about the health concerns and the potential solutions related to the Islamic pilgrimage to Mecca.

DESIGN

A scoping review was applied. Papers published in English between 2012 and 2023 were included but non-human research and sources without any related data were excluded. Data charting and extraction were used to map the current evidence.

RESULTS

The total of 36 papers were included with the total number of pilgrims of 17,075,887. The majority of studies were published in the Asia Pacific region (36.11%) as original articles (88.89%). The health concerns were grouped into five main aspects. There were 7603 deaths recorded or about 44 incidences of deaths per 100,000 pilgrims during the pilgrimage. There were recorded 11,018; 6178; 3393; and 17,810 cases for communicable diseases; non-communicable diseases; injuries and trauma; and health services (i.e., cardiac catheterization) and vaccination, respectively.

CONCLUSION

Relating to the five health concerns, this study identified the top seven issues in each category (i.e., hypertension, influenza vaccination), except for the death record. Moreover, there were three solutions (for general health, non- and communicable-diseases) presented. Stakeholders could use this evidence to improve healthcare quality particularly related to the annual Islamic pilgrimage to Mecca.

Religion, Psychological Strain, and Suicidality in China: A Preliminary Study

BACKGROUND

There is a lack of religiosity studies in China especially in relation to mental health and suicidality. In this research, we focus our studies on medical workers of which some studies reported to have higher stress, and to pilot our studies in this adult age-group.

DATA AND METHODOLOGY

Data were obtained by a questionnaire survey in a large public hospital in a big metropolitan city of China. The final sample consisted of 1012 respondents with 237 (23.4%) being male and 775 (76.6%) being female. The respondents were of three groups: (1) Believers (n = 34; 3.5%); (2) Non-Believers or Atheists (n = 547; 55.8%); and (3) Agnostics or Fence-Sitters (n = 400; 40.8%). Suicidality was measured by the NCS-Suicidality Scale, and standard measures were employed for other major variables.

FINDINGS

In line with other recent studies in China, the religion rate among the urban adults remained low (3.5%). However, about 40.8% of the respondents chose "don't know" and could be fence-sitters on the issue of religious belief. Many of them are involved in various folk beliefs which may not be considered as religious. The religious believers were at higher risk of suicidality and depression than the atheists and the fence-sitters. However, the fence-sitters were higher than the believers and atheists on psychological strains, and they were higher on depression compared to the atheists.

CONCLUSION

The religious believers and religious fence-sitters have higher psychopathologic risks and suicidal risk than the atheist group. Religion as of low prevalence in Chinese societies is a social value deviant from the norm and its practitioners are likely to be marginalized or stigmatized. The Strain Theory of Suicide is used for detailed explanations.

Religion, Psychedelics, Risky Behavior, and Violence

Research has found that psychedelic use is associated with positive behavioral changes, however research has yet to explore the relationship between socio-cultural conditions on this relationship. This paper intends to fill this gap by testing the effects of religious participation and beliefs on the relationship between psychedelic use and behaviors. This study examines the relationship between Lifetime Classic Psychedelic Use (LCPU), different aspects of religion (such as salience and attendance), and the likelihood of committing a violent assault. The analysis uses pooled data from the National Survey of Drug Use and Health (NSDUH) from 2015 to 2019, with a sample size of 282,768. Binary logistic regression models conducted in Stata 17 reveal that LCPU and religion (salience and influence) are independently associated with reduced violence. Additionally, two-way interactions indicate that the association between risky behavior and violence is smaller among individuals with high levels of religious salience. Furthermore, a three-way interaction suggests that the association between risky behavior and violence is smaller for those who have used psychedelics, with the largest effect observed among individuals with high religious salience. These results show that religious factors can influence the relationship between psychedelic use and behaviors, with both attendance and salience operating simultaneously.

Do religious and cultural considerations militate against body donation? An overview and a Christian perspective

The development of anatomy as a scientific undertaking appears to have left little room for religious and cultural input into the conduct of anatomical investigations. This has been brought to the fore by questionnaires regarding the willingness or otherwise of individuals to donate their bodies for dissection, with higher levels of willingness from those without religious affiliations. This has led to the assumption that there is inherent opposition to body donation by those with a religious stance, although there has been little exploration of this. This is increasingly important with growing awareness that anatomy is an international discipline, leading to increasing attention to the religious and cultural contexts within which it is practiced. There is a diversity of responses toward body donation within different countries, as well as by those influenced by Islam, Hinduism, and Buddhism. Additionally, there are diverse cultural attitudes within Confucianism in Asia, Zulu in Africa, and Māori in New Zealand. Even those within the Christian church are influenced by a variety of values, some of which are in tension, with emphasis on the sacredness of life and the significance of burial being negative toward body donation, with informed consent and altruism pointing in a positive direction. The challenge for anatomists is to understand those within their communities, seek to appreciate their perspectives, and also make known the potential of body donation and dissection for enhancing medical practice and improving the education of future health workers.

Negative religious coping versus spiritual struggles: Moderator or main effect?

OBJECTIVE

While previous research indicates that negative religious coping relates with distress, it is unclear if this represents generalized spiritual struggles or a specific vulnerability activated by negative events. Moreover, past research treats coping as a stable phenomenon, although it likely fluctuates. This research simultaneously tested both models longitudinally and examined the relationship between coping and distress.

METHODS

The current study is a secondary analysis of longitudinal data collected online over 3 years from 397 participants. Life events, negative religious coping, and depressive symptoms were assessed on six occasions, and linear mixed-effect models were used to analyze data.

RESULTS

Negative religious coping was largely stable with increases at times of stress. Participants with higher mean negative coping reported more depressive symptoms regardless of life circumstances (i.e., main effect), likely reflecting generalized spiritual struggles. In addition, those with higher mean coping or with particularly high levels at a given time reported even higher levels of symptoms when they experienced more negative life events (i.e., moderation effect).

CONCLUSION

Results suggest that previous research merges two distinct phenomena-spiritual struggles and negative coping. This has important theoretical and research implications and suggests that integrating spirituality and religion into treatment can be warranted.

Queer in the Latter Days: An Integrated Model of Sexual and Religious Identity Development Among Former Mormon Sexual Minority Adults

Sexual minority individuals often have complicated relationships with conservative religion, including conflicts between their sexual and religious identities. Sexual minority members of the Church of Jesus Christ of Latter-Day Saints (CJCLDS) experience unique struggles, given the policies and doctrine of the CJCLDS and its commitment to heteronormative family structures and gender roles. A better understanding of the identity development trajectory for sexual minority individuals formerly involved in the church can deepens our understanding of sexual identity development in constrained contexts and help promote successful identity integration within this subpopulation. Transcripts from semi-structured interviews with thirty-four sexual minority individuals who identified as former members of the CJCLDS were analyzed using an inductive thematic approach, followed by a deductive theory-building process in which Cass's Homosexual Identity Formation Model and Genia's Religious Identity Development Model were overlaid on themes. We present a model that captures the trajectory of sexual and religious identity development that captures the experiences of sexual minority adults within the constraints of the CJCLDS, a non-affirming religious denomination.

Donor memorialization practices at religious institutions in the United States

Many institutions worldwide honor the gift of human body donors through memorial services, ceremonies, and various other means, such as guided reflection or art activities. Memorial services can vary when it comes to the name, who is involved in the planning, and who may attend. Within the United States, the role of religion in the planning and delivery of these ceremonies at religious institutions has yet to be actively explored. This study aimed to collect information about human body donor memorialization practices at religious institutions in the United States to help guide further suggestions for enhancing inclusivity in these practices. This study utilized a voluntary survey that was distributed to anatomy educators and human body donor programs to complete if they were from a religious institution that utilized human body donors. Based on the data collected in this study (n = 39), most religious institutions have some form of donor memorialization practices, which may or may not include a formal memorial service. In these practices described by survey participants, religion was commonly represented using an interfaith approach, in which campus ministry often assisted in planning and facilitating the memorialization. Those with masses/services refer to them by different names, and most occur in a religious-specific place on campus. In conclusion, among survey participants at religious institutions that utilize and memorialize human body donors, most take an inclusive interfaith approach to their memorialization practices, as this can be more representative of the body donors and students who learn from them.

A Qualitative Study of the Meaning of Food and Religious Identity

OBJECTIVE

To identify common themes of the meaning of food among people who identify with a specific religious tradition, particularly focusing on potential applications for nutrition education and professional practice at multiple levels of the Social-Ecological Model.

DESIGN

Virtual and in-person focus groups were used to collect qualitative data.

SETTING

A midsized city in eastern Washington State.

PARTICIPANTS

Nine focus groups (n = 35), each representing a distinct religious congregation.

PHENOMENON OF INTEREST

Meaning of food in the context of religion.

ANALYSIS

Qualitative, reflexive thematic analysis using web-based software to organize data.

RESULTS

Four key themes were identified that applied to both of the overarching focus group topic areas (general and religious): (1) food fosters connection, (2) food influences health, (3) relationships with food are complicated, and (4) food choices reflect values. Subthemes were specific to topic areas. In religious contexts, the meaning of food was more likely understood at a community level in addition to individual and relational levels of the Social-Ecological Model.

CONCLUSIONS AND IMPLICATIONS

Acknowledgment and consideration of the religious identities of patients and clients may provide greater opportunities for community connection, which may have potential implications for community-level nutrition interventions.

Conscientious objection - a cross-sectional, vignette-based, mixed methods exploration of Australian pharmacists' perspectives

Background: Conscientious objection (CO) in healthcare is a controversial topic. Some perceive CO as freedom of conscience, others believe their professional duty-of-care overrides personal-perspectives. There is a paucity of literature pertaining to pharmacists' perspectives on CO. Aim: To explore Australian pharmacists' decision-making in complex scenarios around CO and reasons for their choices. Method: A cross-sectional, qualitative questionnaire of pharmacists' perspectives on CO. Vignette-based questions were about scenarios related to medical termination, emergency contraception, IVF surrogacy for a same-sex couple and Voluntary Assisted Dying (VAD) Results: Approximately half of participants (n = 223) believed pharmacists have the right to CO and most agreed to supply prescriptions across all vignettes. However, those who chose not to supply (n = 20.9%), believed it justifiable, even at the risk of patients failing to access treatment. Strong self-reported religiosity had a statistically significant relationship with decisions not to supply for 3 of 4 vignettes. Three emergent themes included: ethical considerations, the role of the pharmacist and training and guidance. Conclusion: This exploratory study revealed perspectives of Australian pharmacists about a lack of guidance around CO in pharmacy. Findings highlighted the need for future research to investigate and develop further training and professional frameworks articulating steps to guide pharmacists around CO.

The social relations of prayer in healthcare: Adding to nursing's equity-oriented professional practice and disciplinary knowledge

Although spiritual practices such as prayer are engaged by many to support well-being and coping, little research has addressed nurses and prayer, whether for themselves or facilitating patients' use of prayer. We conducted a qualitative study to explore how prayer (as a proxy for spirituality and religion) is manifest-whether embraced, tolerated, or resisted-in healthcare, and how institutional and social contexts shape how prayer is understood and enacted. This paper analyzes interviews with 21 nurses in Vancouver and London as a subset of the larger study. Findings show that nurses' kindness can buffer the loneliness and exclusion of ill health and in this way support the "spirit" of those in their care. Spiritual support for patients rarely incorporated prayer, in part because of ambiguities about permission and professional boundaries. Nurses' engagement with prayer and spiritual support could become a politicized site of religious accommodation, where imposition, religious illiteracy, and racism could derail person-centered care and consequently enact social exclusion. Spiritual support (including prayer) sustained nurses themselves. We propose that nursing's equity-oriented knowledge encompass spirituality and religion as sites of exclusion and inclusion. Nurses must be supported to move past religious illiteracy to provide culturally and spiritually sensitive care with clarity about professional boundaries and collaborative models of spiritual care.

Spiritual Fitness, Spiritual Readiness, and Depressive Symptoms in Reserve Officers' Training Corps Cadets

CONTEXT

Over the past decade, the United States military has taken an interest in addressing soldiers' spiritual fitness and readiness to help improve their mental health and resiliency. Similar efforts have not been applied within the Reserve Officers' Training Corps (ROTC) population despite the mental health challenges these college students experience.

OBJECTIVE

To examine spiritual readiness, spiritual fitness, and depressive symptoms in ROTC cadets.

DESIGN

Cross-sectional study.

SETTING

Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

We recruited ROTC cadets from 1 large southeastern university (n = 91 of 315, 28.9% response rate). The ROTC cadets (age = 21 ± 3 years; men = 68, 74.7%; women = 22, 24.2%; missing = 1, 1.1%) were mainly classified as juniors (n = 30, 33.0%) and in Army ROTC (ROTC branch: Army = 69, Air Force = 20, Navy = 2).

MAIN OUTCOME MEASURE(S)

The survey contained 3 validated instruments used to assess spiritual fitness (the Spiritual Fitness Inventory [SFI]), spiritual readiness (Spiritual Wellbeing Scale [SWBS]), and mental health via depressive symptoms (Patient Health Questionnaire [PHQ-9]). Results were analyzed using descriptive statistics and nonparametric Mann-Whitney U tests to compare belief in God or gods with the dependent measures. A Pearson correlation was calculated to assess the relationship between the SWBS score and PHQ-9 data.

RESULTS

In total, 85.7% (n = 78/91) of ROTC cadets stated that they believed in God or gods. Overall, the cadets were considered to have average spiritual fitness (mean = 75.04 ± 14.89) and moderate spiritual well-being (mean = 90.46 ± 18.09). The average PHQ-9 score was 4.22 ± 5.25. Individuals who believed in God or gods had higher spiritual readiness (believer = 94.44 ± 16.10, nonbeliever = 67.00 ± 9.35; P ≤ .01). No statistically significant differences were noted for symptoms of depression (believer = 3.38 ± 4.90, nonbeliever = 6.60 ± 6.90; P = .143) or spiritual fitness (believer = 76.12 ± 14.78, nonbeliever = 64.40 ± 12.68; P = .054) in ROTC cadets based on belief status.

CONCLUSIONS

Overall, the ROTC cadets had moderate to average spiritual fitness and readiness, with typical depressive symptoms scores. Spiritual readiness was different for those who believed in God or gods, and existential well-being was significantly correlated with depressive symptoms.

Teenage pregnancy in Tambogrande, Peru: causes, consequences and cycles of violence and disadvantage

Teenage pregnancy carries adverse consequences for health and well-being. In this article, we investigate the perceived causes, consequences and cycles of violence and disadvantage associated with teenage pregnancy in Tambogrande, Peru using an applied anthropological approach. Data were drawn from a larger project investigating the relationship between water insecurity and gender-based violence in Indonesia and Peru. The analysis presented here is derived from 49 semi-structured interviews and 5 focus groups with local community members and stakeholders in Peru. Study participants highlighted two main factors contributing to teenage pregnancy in Tambogrande: machismo and religious deterrents to contraceptive use. Participants described how these factors overlapped, resulting in gendered power imbalances that increased the risk of violence, decreased educational opportunities, and reduced the economic independence of women. However, study participants stated that educational interventions targeting machismo could reduce teenage pregnancy and break the associated cycle of disadvantage. Future research will further investigate local social and gender norms to inform the design of a rights-based educational intervention, targeting upstream factors associated with teenage pregnancy in this area.

Asian Hate, religion, and perceived changes in physical health: exploring the flip side of minority stress during the COVID-19 pandemic

OBJECTIVES

Prior research suggests that racism is associated with adverse mental health outcomes for Asians in the United States. Relatively less research has been conducted to examine the effects of racism on physical health, particularly the changes in physical health among Asians and Asian Americans. This study aims to fill in this gap in prior research.

DESIGN

Survey was conducted via Qualtrics in March 2023. A panel sample of 356 Asian and Asian American adults from across the US was collected. Ordinary Least Squares Regression was employed to examine the interrelationships among racism, religion, and perceived changes in physical health during the COVID-19 pandemic.

RESULTS

Contrary to conventional wisdom, more frequent experience with blatant racism was associated with a perceived improvement in physical health after controlling for subtle racism, anxiety, acculturation, and various sociodemographic variables. Interestingly, this robust relationship was more significant among Asians who attended religious services more frequently. Additional three-way interactions revealed that the interaction between blatant racism and religious service attendance on perceived changes in physical health was more significant for US-born Asians and Asians of Indian or Japanese ethnicity.

CONCLUSION

Racism exerts a significant influence on physical health outcomes among Asians and Asian Americans. However, this relationship was contingent upon the specific aspect of racism and intersected with religiosity, acculturation, and ethnic identity.

Identifying and Addressing the Spiritual Needs of Older Adults in Care Facilities: Administrators of Chinese Nursing Homes Relate Their Perspectives

Addressing the spiritual needs of older adults is a central component of holistic service provision. Using a qualitative description design, this study identified: (1) common spiritual needs among Chinese nursing home residents, including the needs of residents with dementia, (2) the process staff use to identify these needs when residents are unable to verbalize them, and (3) the strategies staff implement to meet the identified needs. Semi-structured interviews were conducted with 21 nursing home administrators. Analysis produced five themes, including the need for older adults to express their faith, receive love and care, have contact with their children, interact with others, and participate in activities. For residents with dementia who are unable to verbalize their concerns, staff used two primary strategies to identify spiritual needs: careful observation and communication with family members. To address the identified spiritual needs, multiple strategies were offered including arranging clergy visits and personalizing care.

Religion and the everyday citizenship of people with dementia in Nigeria: A qualitative study

Background

Research on the lived experience of dementia is burgeoning across the social and health sciences. Yet, very little is still known about the experience of dementia for many tribes and ethnoreligious groups, as most studies are conducted in Western countries.

Objective

The aim is to advance the understanding of the role of faith and prayer in the lives of people with dementia in Nigeria through a lens of everyday citizenship.

Method

Interviews were conducted with 17 older people with dementia in a low-income, Yoruba-speaking community in Southwestern Nigeria. After transcription, the data were analysed thematically.

Results

The major theme identified in participants' accounts was that prayer served as a space for active and agentic participation. This theme was further elaborated upon through four subthemes: (1) agency in routine and daily prayer, (2) cognitive (re)framing through prayer, (3) prayer as a vehicle for active social interaction and support, and (4) prayer as work and transaction.

Conclusion

Participants described religious practices as important to their acceptance of the situations, their feelings of hope in everyday lives, and their connection and contributions to the community. Analysis also shows the centrality of relationality in the everyday experiences of people with dementia.

Contribution

This article contributes to advancing the understanding of the socially orientated everyday experience of dementia. It contributes to a small body of literature on the social aspect and everyday experiences of living with dementia in Africa and stands out as the first of its kind study in Nigeria.

Inspired anatomy education: Might God be relevant?

Anatomy education is essential for developing healthcare professionals, and discussion continues about factors that impact and improve the anatomy learning environment. Neglected in this discussion is a consideration of the diverse religious assumptions and beliefs that college students bring to anatomy learning. Surveys of religion among United States college students indicate that many identify as religious and Christian. This viewpoint commentary summarizes main elements of Christian theology and anthropology, discusses the holistic and positive view of the body presented in Christian scripture, and outlines how these Christian beliefs inform and impact student preparation for anatomy education and human body dissection, address ethical issues in body donation, and support professionalism for future career practice.

Traditional health practitioners' understanding of spirit possession in Gauteng province, South Africa

Background

Traditional health practitioners (THPs) understand spirit possession as a cultural or religious spirit occupying a person, while the mental healthcare providers understand it as a mental illness. The different understanding is based on manifestations that mimic that of mental illness, such as seeing and hearing things that others cannot see or hear. Spirit possession holds different meanings in different cultures and religions that could be either beneficial or detrimental. Furthermore, spirit possession is understood as a channel of communication between the living and the dead or God or a supernatural phenomenon in which a spirit owns a person.

Aim

This study explored and interpreted THPs' understanding of spirit possession in Gauteng province, South Africa.

Method

Hermeneutic phenomenology study explored and interpreted the THPs' understanding of spirit possession in Gauteng province. In-depth individual interviews were conducted with 12 THPs who were selected through snowball sampling techniques. Data analysis followed Heidegger's and Gadamer's philosophies and Van Manen's six steps of the analytic approach.

Results

The findings revealed that THPs understood spirit possession as spiritual illness, ancestral calling and demonic spirit or witchcraft.

Conclusion

Traditional health practitioners' understanding of spirit possession could promote mental health and prevent mental illness by providing support to a spirit-possessed person and referral to mental healthcare services.

Contribution

This study contributed that not all manifestations presented by persons with spirit possession are actual and clear-cut mental illness, but could be unwritten cultural and/ or religious illnesses that needs cultural and religious services also.

Religion and sociodemographic characteristics at baseline of the Brazilian Longitudinal Study of Adult Health study

OBJECTIVE

The aim of this study was to investigate whether sex, age, race, income, education, and marital status are associated with having a religion in a sample of Brazilian men and women.

METHODS

Data were obtained from 15,098 participants of the Brazilian Longitudinal Study of Adult Health, a longitudinal study that ultimately aims to investigate long-term outcomes of chronic diseases. The sociodemographic characteristics and data on religion status were self-reported during interviews conducted by trained personnel. All study procedures followed standard and validated protocols.

RESULTS

There was a strong association between being a woman and having a religion (adjusted OR=2.12, 95%CI 1.95-2.31) when compared to men. Regarding age, those with 45-54 years were more likely to have a religion (adjusted OR=1.14, 95%CI 1.03-1.27). Blacks and Browns were more religious (adjusted OR=1.31, 95%CI 1.15-1.49, and OR=1.22, 95%CI 1.10-1.34, respectively) compared to Whites. Those with high income and education were less likely to state having a religion (adjusted OR=0.78, 95%CI 0.70-0.87, and adjusted OR=0.50, 95%CI 0.43-0.59, respectively). Those who did not have a stable conjugal union were found to be less religious (adjusted OR=0.82, 95%CI 0.75-0.89). Stratifying the analysis according to income showed that higher education was inversely associated with religion on both strata: lower and higher annual earnings.

CONCLUSION

This study suggests that education is one of the most important socioeconomic characteristics to consider when studying religion. Race, sex, income, and marital status are also important factors; however, there was not a clear association between religion and age.

The Reasonable Content of Conscience in Public Bioethics

Bioethicists aim to provide moral guidance in policy, research, and clinical contexts using methods of moral analysis (e.g., principlism, casuistry, and narrative ethics) that aim to satisfy the constraints of public reason. Among other objections, some critics have argued that public reason lacks the moral content needed to resolve bioethical controversies because discursive reason simply cannot justify any substantive moral claims in a pluralistic society. In this paper, the authors defend public reason from this criticism by showing that it contains sufficient content to address one of the perennial controversies in bioethics-the permissibility and limits of clinician conscientious objection. They develop a "reasonability view" grounded in public reason and apply it to some recent examples of conscientious objection.

Perceived Health Risks, Health Behaviors, and BMI Among Diverse Adults in Israel

INTRODUCTION

Obesity is associated with an increased relative risk of COVID-19-related mortality. The interplay of culture and religion in the overweight/obesity context has been minimally examined. The purpose of this study was to examine the association between preventive health behaviors, sociodemographic factors, and obesity among religiously diverse adults in Israel.

METHODS

Using a quantitative cross-sectional design, an online survey was distributed to diverse adults in Israel during the pandemic using social media, email, and snowball methods.

RESULTS

Participants included 635 adults: 69.1% Jewish, 26.5% Muslim, and 4.4% "other." Jewish adults scored lower than others on perceived personal risk (p < .001), infection spread risk (p < .001), and preventive behaviors engagement (p < .005). Higher body mass index (BMI) predicted higher personal risk and higher likelihood of preventive behaviors engagement (p < .001).

DISCUSSION

Results demonstrate the association between religion, health risk perceptions, and COVID-19-related health behaviors. Nurses should consider the influence of culture and religion on health practices and recommend relevant lifestyle modifications to reduce COVID-19 risks.

The voice of a group of teachers in full-service schools in South Africa

Background

Full-service schools (FSSs) were introduced into the South African school system as part of the movement towards inclusive education.

Objectives

The authors of this article embarked on a study to obtain the opinions and feelings of a group of teachers about FSSs and inclusive education. Thus, the 'voice' of these teachers could be heard.

Method

The research followed a qualitative approach using group discussions and classroom observations. Triangulation was used to verify information.

Results

The data revealed that the teacher participants had definite opinions and feelings about inclusive education in FSSs and their classroom experiences also came to light. The themes arising from the research are the teachers' opinions about teaching in FSSs, support from the school and the school management, discipline in the schools, teaching methods, language issues, religion and parent involvement.

Conclusion

It is clear that the specific needs of teachers whose schools were transformed into FSSs will have to be attended to. The teachers are the ones who have to apply inclusive education in their classrooms, and it is essential that teachers' teaching and personal needs in full-service classrooms are addressed.

Contribution

The article contributes to a better understanding of the teachers' important role in FSSs and the problems experienced by the teachers. This aligns with the ethos of inclusive education and human rights included in the scope of the journal.

Faith and facts: Exploring the intersection of religion and science among anatomy educators

The intersection of religion and science often elicits polarizing views among scientists, though approximately half of American scientists identify as religious. Mounting evidence also supports the role of spirituality in comprehensive patient care. The purpose of this study was to explore the religiosity of faculty who teach in the anatomical sciences at U.S. colleges and universities. Surveys were administered to anatomists through two professional societies. Two-thirds (64.9%, 74/114) of respondents identified as religious, 26.3% (30/114) as atheist, and 8.8% (10/114) as agnostic. Most respondents (64.9%, 74/114) disagreed with the statement, "There is no place for religion and science to intersect." Approximately one in three respondents expressed concern that sharing/disclosing their religious beliefs would negatively affect the perceptions of colleagues (32.5%, 37/114) and students (28.9%, 33/114) toward them. Faculty at faith-based institutions were more open to disclosing their beliefs (p = 0.045), and highly religious individuals were more concerned (p = 0.001). Fewer than one-fifth of respondents 17.5% (20/114) personally experienced mistreatment or discrimination within academic settings due to their religious beliefs. Most respondents held politically liberal-leaning views (71.0%, 76/107). Highly religious individuals were more likely to be politically conservative (p < 0.001). Overall, this study demonstrates that the number of anatomists who identify as religious may be higher than that of other biological disciplines and that mistreatment due to religious views remains a challenge for some in the profession. Continued dialogue regarding the role of religion in professional identity expression may be an important step in mitigating religion-focused mistreatment and discrimination in academic settings.

Public Reason Requirements in Bioethical Discourse

This paper analyzes the use of public reason requirements in bioethical discourse and discusses when such requirements are warranted. By a "public reason requirement," I mean a requirement that those involved in a particular discourse or debate only use reasons that can properly be described as public reasons. The first part of the paper outlines the concept of public reasons as developed by John Rawls and others and discusses some of the general criticisms of the concept and its importance. The second part then distinguishes between two types of public reason requirements in bioethics. One type is what I will call the orthodox public reason requirement since it hews closely to the original Rawlsian conception. The second is what I will call the expansive public reason requirement, which departs quite radically from the Rawlsian conception and applies the requirement not to policy discourse or policymaking, but to the actions of individuals. Both types of requirements will be analyzed, and some problems in applying public reason requirements in bioethics will be identified. It will be argued that the expansive public reason requirement is misguided. The concluding part argues that requirements of civic civility and what Rawls terms an "inclusive view" of public reason should be important in bioethical discourse.

Art, Media, and Fashion: Negotiating Queerness and Catholicism Through Depictions of Saint Sebastian, From the 15th Century to the Present

Queerness and Catholicism have historically been at odds with one another. The Church's condemnation of queer individuals was pervasive globally for centuries, yet one way queerness and Catholicism converge is via Saint Sebastian depictions. The purpose of this research is to examine how and why Sebastian, a Catholic saint, has come to serve as an icon for the queer community as well as how dress has been used in depicting shifting representations of the Saint from the 15th to 21st centuries. Drawing upon the historic method, we critically analyze the meanings present in imagery of Saint Sebastian. Through our study of portrayals of the Saint, several key themes have emerged. Several of these contemporary artworks incorporated written language that reifies sainthood and associated suffering. Furthermore, many artworks' overall composition surrounding Saint Sebastian reinforced sainthood through contextual visual elements. Ambivalence in depictions of Saint Sebastian's fleshy body was apparent, with an emphasis on depicting Sebastian within the context of his executions. A gap in time periods and differing artwork styles was observed, with many of our examples being either from the Renaissance or post 1960s. Finally, many of the contemporary artworks surveyed included overt signifiers of queerness, with minimal references to subtle queerness.

Discrimination on Grounds of Sexual Orientation and Gender Identity: The Limits of Human Rights in Africa

The right to sexual orientation and gender identity (SOGI) are integral to and manifest in LGBTIQ rights including homosexuality and same-sex marriage. International law promotes these rights and prohibits discrimination on these grounds. Many western countries endorse these rights and prohibitions in parliamentary legislation or judicial fiat. In comparison with all other jurisdictions worldwide, and within the African sub-region, only South Africa specifically prohibits unfair direct or indirect discrimination based on "sexual orientation" in its national constitution. This paper explores African approach to SOGI and LGBTIQ rights including homosexuality and same-sex marriage. It argues that despite the threat of homocapitalism, prevalent Afrocentrism and religions reject these form of "new rights" for being immoral, ungodly, unnatural and un-African, thereby underlining the limits of human rights in the sub-region.

Arranged cohabitation among Chinese Muslims

While modern family-related ideas and behaviors have become more widely accepted in contemporary China, Chinese Muslim minorities continue to hold on to traditional religious practices. Surprisingly, data from our survey conducted in Gansu province in China's northwestern borderlands reveal that Muslims of the Hui and Dongxiang ethnicities reported much higher rates of cohabitation experience than the secular majority Han. Based on follow-up qualitative interviews, we found the answer to lie in the interplay between the highly interventionist Chinese state and the robust cultural resilience of local Islamic communities. While the state maintains a high minimum legal age of marriage, the early marriage norm remains strong in Chinese Muslim communities, where religion constitutes an alternative and often more powerful source of legitimacy-at least in the private sphere of life. Using the 2000 census data, we further show that women in almost all 10 Muslim ethnic groups have higher percentages of underage births and premarital births than Han women, both nationally and in the northwest where most Chinese Muslims live. As the once-outlawed behavior of cohabitation became more socially acceptable during the reform and opening-up era, young Muslim Chinese often found themselves in "arranged cohabitations" as de facto marriages formed at younger-than-legal ages. In doing so, Chinese Muslim communities have reinvented the meaning of cohabitation. Rather than liberal intimate relationship based on individual autonomy, cohabitation has served as a coping strategy by which Islamic patriarchs circumvent the Chinese state's aggressive regulations aimed at "modernizing" the Muslim family.

Corrigendum: Perceptions and experiences of community-based healthcare professionals in the state of Qatar having do not attempt resuscitation discussions during the COVID-19 pandemic

[This corrects the article DOI: 10.3389/fmed.2023.1232954.].

Uterus transplantation: what the world's religions have to say

Uterus transplantation (UTx) has evolved from a purely experimental procedure to a clinical treatment option available outside the clinical trial context, offering women with absolute uterine-factor infertility an opportunity to experience pregnancy. As UTx becomes better established and more widely known and performed, it is likely to be sought out by geographically and culturally diverse patients, particularly those whose religious beliefs impose barriers to other paths to achieve parenthood, such as gestational surrogacy and adoption. Many religions do not currently have official positions on UTx, meaning that clinicians involved in screening candidates can expect questions about how the UTx process aligns with various religious beliefs. This article provides a broad background on the current positions major world religions have taken on UTx (or its components) and the alternative paths to parenthood of gestational surrogacy and adoption. It is intended to help clinicians communicate the information necessary for individuals interested in uterus donation or transplantation to determine-in consultation with their spiritual advisors or religious authorities when needed-how these options align with religious beliefs or teachings.

Divine struggles and whole person functioning: a 9-year longitudinal study of middle-aged U.S. adults

OBJECTIVE

This longitudinal study examined the associations of divine struggles with 25 psychological distress, psychological well-being, social well-being, prosociality, physical health, and health behavior outcomes assessed approximately nine years later.

METHODS

We used three waves of data from the National Survey of Midlife Development in the United States (N = 4041): M1 (1995-1996), M2 (2004-2006), and M3 (2013-2014). Following the analytic template for outcome-wide longitudinal designs, our primary analysis employed a series of regression models to estimate the associations between a continuous measure of divine struggles assessed at M2 with each outcome assessed at M3. All models adjusted for a rich set of covariates, including prior values of all outcomes.

RESULTS

There was modest evidence suggesting that divine struggles were associated with worse subsequent functioning on one or more outcomes for each domain except health behaviors (effect sizes were generally very small).

CONCLUSIONS

Divine struggles have the potential to degrade long-term functioning across multiple domains of life. Practitioners should attend to and address divine struggles in their clinical work.

Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial

BACKGROUND

Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being.

OBJECTIVE

This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants.

METHODS

This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores.

RESULTS

Participants reported (54/72, 75% responded with "very likely" or "likely" to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use.

CONCLUSIONS

This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted.

Life Course Religious Attendance and Cognitive Health at Midlife: Exploring Gendered Contingencies

A growing body of literature suggests that religious attendance might mitigate processes of cognitive decline associated with aging. However, few studies have made adequate linkages with the life course perspective. We draw from over 35 years of prospective panel data from the National Longitudinal Study of Youth (1979-2015) to assess the associations of cumulative exposures to religious attendance over the life course (childhood and midlife) for self-rated cognitive health and working memory (as assessed by the Serial 7s task). Our results suggest that midlife adults who attended religious services consistently between childhood and adulthood had higher self-rated cognitive health and better working memory. Women were also found to receive stronger benefits to self-rated cognitive health from consistent religious practice between childhood and adulthood. This pattern of findings allows for greater reflection into the neural enrichment and neural depletion arguments proposed to explain the religion/cognitive health link in previous research.

Parents' Anticipated Discussions About Death With Young Children

Guided by family communication patterns theory and terror management theory this mixed-methods investigation explored how parents (N = 112) of young children (ages 3-6) described the way they would discuss death when it comes up in conversations. Responses were coded inductively, resulting in four themes: explanations that death is inevitable, explanations that death is in the distance, the use of religion to frame discussions of death, and finally, discussing afterlife connections to deceased family members. Logistic regression analyses were used to evaluate whether parents' conformity or conversation orientations were associated with the frequency with which parents discussed death with their child and the content of parent vignette responses. Quantitative analysis revealed parents' conversation orientations were associated with the frequency with which they discussed death with their child and conformity orientations were associated with parents' use of religion and discussing afterlife connections to deceased family members in their responses.

Flourishing, religion, and burnout among caregivers working in pediatric palliative care

INTRODUCTION

Providers working with children who are dying are especially prone to burnout. Encouraging models of human flourishing may mitigate burnout and improve quality of care. However, models of job satisfaction and human flourishing have not been well-described. This project explores factors that promote human flourishing among caregivers working with children in pediatric palliative care in South Africa.

METHODS

A convenience sample of caregivers working in pediatric palliative care were invited to complete an anonymous, confidential survey comprised of validated instruments. The survey also included open-ended questions to explore opinions and attitudes about satisfaction, struggles, and coping.

RESULTS

Twenty-nine people from a variety of occupations and work environments completed the survey. The prevalence of burnout was 3/29 (10%). Life satisfaction was associated with private religious activities (P = .38, P < .05), and carrying religion into all aspects of life (P = .44, P < .05). Burnout was not associated with life satisfaction. Qualitative analysis of the open-ended questions revealed the following themes as factors contributing to their joy in work: being able to make a difference, finding meaning and purpose, having a relationship with the children and their families, and with the multi-disciplinary team. The greatest challenges in their work were identified as the lack of resources, challenges within their team, and emotional demands.

CONCLUSIONS

Despite job stress and working with terminally ill children, several factors were associated with flourishing. These findings are particularly relevant to enhance caregiving in the resource-challenged setting of pediatric palliative care in South Africa.

"Sense for Gambling" Among Jewish Ultra-Orthodox Men With Gambling Disorder

Making sense of the social world is an intricate process heavily influenced by cultural elements. Gambling is a prevalent leisure-time activity characterized by risk-taking conduct. While some individuals who engage in it do so without experiencing any harm, others will develop gambling problems. Judaism tends to perceive gambling negatively since it contradicts fundamental Jewish principles. The current study focuses on the Jewish Ultra-Orthodox community in Israel which is characterized as a cultural enclave with minimal interaction with the secular world. Hence, it provides a unique and novel socio-cultural context to inquire how individuals with gambling disorder (GD) from this community make sense of gambling. Following constructivist grounded theory guidelines, 22 Ultra-Orthodox men with GD were interviewed using a purposeful sampling design. Sixteen Rabbis were also interviewed, illuminating the socio-cultural context of Halachic regulations and norms regarding gambling in this community. An abductive analysis of the data, interwoven with Bourdieu's concept of habitus, yielded an overarching theme that we dub as "sense for gambling," encompassing matrices of Ultra-Orthodox external (e.g., a conservative cultural structure with numerous prohibitions and life marked by poverty) and internal (e.g., feelings of loneliness, dissatisfaction, and deviance) dispositions imprinted onto the body, creating diverse embodied reactions (emotional and sensory) to gambling, and leading to developing GD. We recommend placing the body, as the locus of internalized dispositions, at the core of examination when researching pathways to GD. We propose that this intricate interplay between external and internal dispositions shapes the decision-making regarding gambling, thus mitigating individual responsibility for GD.

Bible Overclaiming and Intimate Partner Violence

Religion has had a mixed impact on society, with some followers engaging in violent behavior. It remains unclear why some followers perpetrate violence and others are peaceful. We argue that religious overclaiming is one facet of religion to be considered when trying to understand the relationship between religion and violence. Across two studies (N = 551), we tested the hypothesis that a higher tendency to overclaim knowledge of the Christian Bible would be associated with higher perpetration of intimate partner violence (IPV). We also tested the hypotheses that men who overclaim would be most likely to engage in the perpetration of IPV, and that higher religiosity would attenuate the effects of religious overclaiming. In both studies, participants completed a measure of religious overclaiming, reported on their perpetration of IPV, and reported their religiosity. Our findings across both studies indicated that Bible overclaiming was associated with greater perpetration of IPV. Further, Study 1 found that those high in Bible overclaiming (especially men) engaged in the most perpetration of IPV. However, this gender-based finding did not replicate in Study 2. Both studies found that religiosity was unassociated with the perpetration of IPV. Our results provide evidence that Bible overclaiming is related to the perpetration of IPV. Specifically, individuals who claim to know religious concepts that do not exist are associated with a higher risk for IPV.

The relationship between the strength of religious faith and spirituality in relation to post-traumatic growth among nurses caring for COVID-19 patients in eastern Poland: a cross-sectional study

Introduction

The COVID-19 pandemic had forced intensive care unit (ICU) nurses to adapt to extreme conditions in a short period of time. This resulted in them experiencing extremely stressful situations. The aim of this study was to assess the relationship between post-traumatic growth (PTG) and religiosity and spirituality (R/S) among nurses caring for COVID-19 patients in intensive care during the pandemic.

Materials and methods

120 nurses working in Lublin, eastern Poland, participated in the cross-sectional study. The questionnaire was made up of three standardised tools: The Post-Traumatic Growth Inventory, The Santa Clara Strength of Religious Faith Questionnaire, The Spiritual Attitude and Involvement List.

Results

In terms of spirituality, the study group of nurses achieved the highest score in the Connectedness with Nature subscale (4.37 ± 1.07), while the strength of religious beliefs had a positive correlation with post-traumatic growth only in the Spiritual changes subscale (r = 0.422, p < 0.001). The following dimensions of spirituality were significantly correlated with post-traumatic growth in the multi-factor model that included religiosity and spirituality: Transcendent experiences, Spiritual activities, Meaningfulness, Acceptance, and Trust. We saw that increase in the assessment of the Transcendent experiences, Meaningfulness and Trust subscales significantly mirrors increase in post-traumatic growth, while increase in the assessment of the Spiritual activities and Acceptance subscales significantly mirrors decrease in post-traumatic growth. The above variables explained up to 44% of the dependent variable.

Conclusion

Both religiosity and spirituality were significantly associated with post-traumatic growth in the group of ICU nurses, but spirituality appears to have played a larger role. Our findings support the value and significance of the development of spiritual and religious identity as a means of enhancing positive psychological changes in the face of traumatic events.

Deconstructing spiritual care: Discursive underpinnings within palliative care research

Religion and spirituality are integral to the philosophy of palliative care, shaping its approach to spiritual care. This article aims to examine the discourses within palliative care research to illuminate prevailing assumptions regarding spiritual care. Eighteen original articles were analyzed to examine how spiritual care is understood within palliative care. The analysis, informed by Foucault, aimed to identify recurring discourses. The finding reveals that, in palliative care research, spirituality is viewed as enigmatic yet inherently human and natural, assuming that every individual has a spiritual dimension. The analysis points to healthcare professionals being expected to hold certain qualities to put spiritual care into practice. The analysis also reveals that in the analyzed articles, the concept of spiritual care is rooted in a Christian context, with the belief that all individuals possess inherent spirituality or religiosity, a concept often associated with Christian theology. The included articles often utilize theological terms and emphasize a monotheistic viewpoint. Spirituality is articulated as a complex, distinct concept, challenging clear definitions and professional responsibilities. Further, a moral formation of healthcare professionals is described, interpelling and ascribing qualities that healthcare professionals need to provide spiritual care.

When and why patients and families reject chaplains: challenges, strategies and solutions

Hospital chaplains perform important activities, but critical questions arise about the challenges they may face in working with patients, and how these professionals respond. Thirty-three telephone interviews of approximately 1 hour and were conducted with 21 board-certified chaplains. When asked about their biggest challenges and most rewarding interactions, several chaplains described rejections by patients or families. Patients and families at times rejected chaplains, and did so for six broad types of reasons - not wanting to discuss the disease due to conflicted feelings, including anger or frustration at the patient, the cosmos or God; or wanting to minimize it; wanting a chaplain of their own faith; or of a particular gender or other characteristic; being atheist or wary of religion; or misunderstanding what chaplains do. Patients at times also disagreed with family members about whether to reject a chaplain. Chaplains responded variously: feeling transitory hurt (which generally decreases with experience); respecting patients' autonomy and leaving; exploring reasons for rejection; and revisiting later and often then making helpful connections. These data have important implications for future practice, education and research regarding chaplains and other providers - suggesting, for example, how patients' families and the public might benefit from increased understanding about the field.

The mediating role of religion and loneliness on the association between reminiscence functions and depression: a call to advance older adults' mental health

BACKGROUND

Current literature lacks evidence about the relationship between reminiscence functions and depression and the mediating role of clinical constructs such as loneliness and religion. The study aimed to examine the mediating effects of loneliness and religion on the association between reminiscence functions and depression in a sample of older Jordanian adults.

METHODS

An anonymous online cross-sectional survey was employed to collect data from 365 older Jordanian adults. Convenience and snowball sampling methods were used to recruit participants through social media.

RESULTS

In the depression model, Bitterness Revival and Intimacy Maintenance factors, educational level, and Intrinsic Religiosity were statistically significant predictors of depression. Bitterness Revival and Intimacy Maintenance factors, work sector, and Intrinsic Religiosity were statistically significant predictors of loneliness. Loneliness has a negative, partial mediating effect on Intimacy Maintenance and depression.

CONCLUSION

Depression caused by significant losses in the Arab Jordanian environment might be mitigated by Intimacy Maintenance by reducing feelings of loneliness. Understanding how Intimacy Maintenance correlates with depression through loneliness could help psychiatric nurses develop psychosocial interventions that reduce depression among older adults.

Holistic care in healthy aging: Caring for the wholly and holy human

Health care should address the holistic gap between health outcomes, spirituality, religion, and humanistic care to optimize patient care. Treating the whole person encompasses both physical and metaphysical elements. Patients want health care professionals to recognize their spiritual and religious preferences, because these matter in their approach to illness, coping, and long-term outcomes.

Associations of religious and existential variables with psychosocial factors and biomarkers of cardiovascular risk in bereavement

Bereavement increases in prevalence as people age and is associated with multiple psychological and health risks, including cardiovascular risk. Religious and existential variables may play an important role in the health impacts of bereavement. Theorized pathways linking religious and existential variables with health have suggested these associations are due to intermediary psychosocial variables, but have not been tested in bereavement. This research empirically tested these pathways in a bereaved population. In N = 73 adults within 1 year of bereavement (mean age = 64.36), this study examined associations between (1) religious and existential characteristics (religious and spiritual struggles, intrinsic religiosity, and existential quest) and intermediary psychosocial variables (depression, loneliness, and difficulties in emotion regulation), and between (2) intermediary psychosocial variables and bereavement-relevant health outcomes (self-reported health, change in health since last year, grief severity, and cardiovascular biomarkers). Cardiovascular biomarkers (heart rate, heart rate variability, and blood pressure) were collected before, during, and after a laboratory grief recall emotion elicitation. Anticipated associations between self-reported religious and existential characteristics and intermediary variables, and between intermediary variables and self-reported bereavement-relevant outcomes, were consistently observed. However, associations between intermediary variables and cardiovascular biomarkers were largely unobserved. This study examined the role of religious and existential variables in whole-person health after bereavement and is among the first to include biomarkers of cardiovascular risk. Results suggest that although religious and existential variables are associated with important bereavement-related outcomes, these associations may be "skin-deep," and extensions to cardiovascular functioning should be re-examined.

An Overview of Ethical Issues Raised by Medicolegal Challenges to Death by Neurologic Criteria in the United Kingdom and a Comparison to Management of These Challenges in the USA

Although medicolegal challenges to the use of neurologic criteria to declare death in the USA have been well-described, the management of court cases in the United Kingdom about objections to the use of neurologic criteria to declare death has not been explored in the bioethics or medical literature. This article (1) reviews conceptual, medical and legal differences between death by neurologic criteria (DNC) in the United Kingdom and the rest of the world to contextualize medicolegal challenges to DNC; (2) summarizes highly publicized legal cases related to DNC in the United Kingdom, including the nuanced 2022 case of Archie Battersbee, who was transiently considered dead by neurologic criteria, but ultimately determined to be in a vegetative state/unresponsive-wakeful state; and (3) provides an overview of ethical issues raised by medicolegal challenges to DNC in the United Kingdom and a comparison to the management of these challenges in the USA.

Religious delusions in Dutch older adults in treatment for psychosis: a follow-up study

OBJECTIVE

The course over time of religious delusions (RDs) in late-life schizophrenia and psychotic depression may be relevant to know how long certain aspects of RDs may affect treatment. The present study examines (1) the 1-year follow-up of RDs and other prevalent delusions, (2) the association between RDs and the clinical course of psychotic depression and schizophrenia compared to those without RDs, and (3) associations of RDs and other prevalent delusions with "indicators of complexity" (e.g., suicidality, refusing medication).

DESIGN

Prospective study (half year and 1-year follow-up combined).

SETTING

Outpatients and inpatients in Geriatric Psychiatry Institution of Yulius, South-Holland, the Netherlands.

PARTICIPANTS

One hundred and thirty seven older adult patients, mean age 76.3 (s.d. 8.1).

INTERVENTION

Natural follow-up study.

MEASUREMENTS

Diagnostic interview measures included Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1), positive psychosis items of the Community Assessment of Psychic Experiences-42 (CAPE), and the 20-item measures from the Centre for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

Although RDs in older adults decline in the clinical course of psychotic depression, the course is unfavorable compared to psychotic depression without RDs with regard to depressive symptom severity as measured by CES-D. No significant differences were noted in relation to clinical course of positive psychotic symptoms for both psychotic depression and schizophrenia. In schizophrenia, RDs persist more frequently compared to the most prevalent delusions. No significant difference was observed between patients with RDs compared to patients without RDs regarding indicators of clinical complexity.

CONCLUSIONS

RDs predicting a less favorable course over time in psychotic depression. In schizophrenia, RDs appears to be relatively pervasive.

The Association Between Economic Status and Religious Identity With Oral Health Disparities and Inequalities Around the World

INTRODUCTION

The inequalities in oral health remain one of the current issues in the global public health agenda. The number of studies investigating health disparity by religious identity is limited and there is currently no such report relating to oral health. Similarly, there is compelling evidence for oral health disparities between socioeconomic statuses, education levels, and ethnic groups. This ecological study aimed to explore the disparity in oral health-related outcomes between Muslim and non-Muslim countries and country income status.

METHODS

Publicly available data related to oral health measures, country income status, and membership in the Organization of Islamic countries were used. Five oral health-related measures were examined: caries experience (decayed, missing, and filled teeth (DMFT)), percentage of the population with no periodontal disease, and disability-adjusted life years (DALY) attributed to oral conditions, and mouth and oropharynx cancer. One-way analysis of variance (ANOVA) and Kruskal-Wallis tests were used to compare the oral health parameters by country income status and simple linear regression was used to compare the parameters between the non-member countries (n-MC) and member countries (MC). For the significant parameters, adjusted coefficients were obtained using multiple linear regression.

RESULTS

From 170 countries included, 53 (31%) were MC and 117 (69%) were n-MC. Analysis showed that the mean DMFT in adults aged 35-44 years was significantly higher in the n-MC compared to MC after adjusting for country income status (p<0.05) but the latter was the stronger explanatory predictor of the outcome. The strength of the effect of country membership classification (standardized coefficient β: DMFT35-44-year-old = -0.16) was smaller than country income status (β = -0.60) in the multiple regression.

CONCLUSION

There is significant but weak evidence from the available data to support the claim that economic status and religion contribute to oral health disparity.

Two Islamophobias? Racism and religion as distinct but mutually supportive dimensions of anti-Muslim prejudice

Debates about Islamophobia have been blighted by the question of whether the prejudice can be defined as a form of racism or as hostility to religion (or a combination of the two). This paper sheds light on this debate by presenting the findings of a new nationally representative survey, focused on the UK, that contrasts perceptions of Muslims not only with perceptions of other ethnic and religious minorities but also with perceptions of Islam as a religious tradition. We find that prejudice against Muslims is higher than for any other group examined other than Travellers. We also find contrasting demographic drivers of prejudice towards Muslims and towards Islam. Across most prejudice measures we analyse, intolerant views are generally significantly associated with being male, voting Conservative and being older, although not with Anglican identity. We find, however, that class effects vary depending on the question's focus. Anti-immigration sentiment - including support for a 'Muslim ban' - is significantly correlated with being working-class. However, prejudice towards Islam as a body of teachings (tested using a question measuring perceptions of religious literalism) is significantly correlated with being middle-class, as is negative sentiment towards Travellers. Using these findings, the paper makes an argument for supplementing recent scholarship on the associations between racism and Islamophobia with analyses focusing on misperceptions of belief.

The Metaverse, Religious Practice and Wellbeing: A Narrative Review

The metaverse is touted as the next phase in the evolution of the Internet. This emerging digital ecosystem is widely conceptualized as a persistent matrix of interconnected multiuser, massively scaled online environments optimally experienced through immersive digital technologies such as virtual reality (VR). Much of the prognostication about the social implications of the metaverse center on secular activities. For example, retail, entertainment (gaming/concerts), and social networking. Little attention has been given to how the metaverse might impact religion. This narrative review explores contemporary research into online religious practice and the use of immersive digital technologies for religious purposes. This focus informs a discussion about how the metaverse, an online and immersive technology, might impact religion/religious practices. For billions worldwide, religion is an essential aspect of social identity and a cornerstone of psychological wellbeing. The emergence of the metaverse may represent a new way of connecting with an ancient source of human flourishing.