Does exposure to issues of spirituality predict medical students' attitudes toward spirituality in medicine?

In 1999, the authors surveyed 137 third-year medical students regarding exposures to and attitudes toward spiritual and religious issues in medicine. Path analysis showed that greater exposures predicted more positive attitudes toward these issues.

Prayer in the medical encounter.

A large percentage of the population report that they believe in God and pray regularly. Recent reviews suggest that prayer and religious commitment are positively associated with mental and physical health. These data, taken together, strongly imply that the health professional must find a way to recognize and work with patients' religious practices. There is already a reasonable amount of literature detailing the beliefs and desires of both patients and professionals in commencing upon this work. This paper provides a comprehensive review of that literature and concludes with a discussion of implications and future directions.

Anger, depression, and disability: a path analysis of relationships in a sample of chronic posttraumatic headache patients.

Anger and depression are common affective concomitants of chronic headache. Previous research suggests that the affective component of headache may contribute to the patient's perceptions of the degree to which the headache is disabling. The present study examined the relationship between anger expression, anger suppression, depression, and headache-related disability (interference with function) in a sample of chronic posttraumatic headache patients. A path analytic model indicated a direct relationship between depression and perceived disability. Anger suppression and anger expression each had a direct influence on depression, but their effects on disability were mediated through depression. The results partially replicate a previous path analytic study of the relationships among these variables in a chronic headache sample.

The influence of body size on linear measurements used to reflect cervical range of motion.

BACKGROUND AND PURPOSE: The purposes of the study were to demonstrate that linear measurements of cervical range of motion are confounded by differences in body size when comparisons are made between groups and to introduce an alternative measure of range of motion that adjusts for variation in body size. SUBJECTS: The sample consisted of 42 subjects (25 female, 17 male) with chronic posttraumatic headaches. METHODS: Using a tape measure, a physical therapist measured the distance between two anatomical landmarks with the subject's neck in the anatomical neutral position and with the subject's neck fully laterally flexed, rotated, and forward flexed. Range of motion was effected with two measurements: the distance between the landmarks at full flexion/rotation and the proportion of distance traversed between the landmarks. RESULTS: The end-of-range values were significantly correlated with body size. No significant correlations emerged between the proportion-of-distance values and body size. CONCLUSION AND DISCUSSION: Linear measurements of cervical motion are potentially confounded by body size when subjects of nonequivalent size are compared. Proportion-of-distance measurement is presented as a more valid alternative to end-of-range measurement.

Postconcussion symptoms and cognitive functioning in posttraumatic headache patients.

Forty-two patients with posttraumatic headache of at least three months duration following motor vehicle accident completed the Postconcussion Syndrome Checklist which assessed their experience of 10 commonly reported cognitive, emotional, and physical symptoms. The patients also completed the Beck Depression Inventory and a brief battery of neuropsychological tests. Results indicated that postconcussion symptoms remained quite prevalent among these subjects. More pronounced postconcussion symptomatology was associated with significantly greater impairment on 6 of 13 measures of neuropsychological functioning. Neither severity of subjects' postconcussion symptoms nor neuropsychological test performance were affected by litigation status. However, depressed subjects reported more severe cognitive and emotional symptoms than did nondepressed subjects. Additional information about postconcussion symptom prevalence and a description of the relationship between self-reported symptoms, cognitive functioning on neuropsychological tests, and depression is provided. The implications of these findings are discussed.

Evidence for construct validity of the TMJ scale in a sample of chronic post-traumatic headache patients.

The construct validity of the TMJ Scale was examined in a sample of chronic post-traumatic headache patients. Clinical indicators of temporomandibular (TM) dysfunction and measures of psychosocial distress were compared with relevant scales of the TMJ Scale. The clinical indicators were first subjected to principal components analysis. The resulting factor scores correlated significantly with selected physical domain scales of the TMJ Scale. The factor scores also significantly predicted the TMJ Global Scale in a regression analysis. Selected psychosocial domain scales of the TMJ Scale correlated strongly with measures of depression and anger and a clinical diagnosis of post-traumatic stress disorder. The results support the validity of the TMJ Scale and demonstrates its utility with post-traumatic headache patients.

Post-traumatic stress disorder in chronic post-traumatic headache patients.

The prevalence of post-traumatic stress disorder (PTSD) was examined in a sample of chronic post-traumatic headache patients. All subjects had been injured in a motor vehicle accident and had developed headache or experienced marked exacerbation of an existing headache condition as a result. Nearly 30% of the sample was diagnosed with PTSD. Depression and suppressed anger were significantly higher in subjects with PTSD compared to the rest of the sample. Those with PTSD were more likely to have a history of headache prior to the accident than subjects without PTSD. Comparisons between the PTSD and non-PTSD groups on other headache and demographic variables were non-significant. The importance of evaluating post-traumatic headache patients for the presence of PTSD is discussed.

Migraine as a sequela to chronic low back pain.

The occurrence of headache as a sequela of low back pain was examined in a sample of chronic pain patients. All patients had low back pain without history of head, neck, or upper back injury or headache onset simultaneous with the low back pain. Consistent with prior research, headache was found to be a common concomitant of back pain. In many patients, headache was found to have begun or exacerbated markedly after onset of low back pain. Prevalence of migraine in female patients was significantly higher than the population prevalence for females in the United States; this was not true for male patients. Potential mechanisms for explaining the high prevalence of migraine following low back pain are discussed, including increased muscle tension, psychosocial factors, and analgesic overuse.

The effect of prayer on physical health: Experimental evidence.

There has been enough published scientific work on the direct effects of prayer upon physical health in the past thirty years to merit review. While experimental evidence has yet to reveal large direct effects of prayer on physical health, the effects which have been found are notable and encourage further study. In this article the authors review the major studies, discuss problems in their interpretation, and suggest considerations for future experimental study of prayer.

Personal and family stress in individuals with diabetes and vision loss.

The intrapersonal distress and the impact of diabetes and vision impairment on marital functioning were assessed. Significant degrees of intrapersonal distress were demonstrated by the Beck Depression Inventory, Rosenberg Self-Esteem Scale, and Rand Mental Health Index. Family functioning as assessed by the Family Assessment Device was significantly compromised. Vision impairment was a major stressor in the spousal relationship. Of 18 subjects who had been involved in a committed relationship at the onset of vision impairment, 9 had separated. Separation occurred at a mean of 1.6 years after the vision impairment. Totally blind individuals were at greater risk for separation than those who were legally, but not totally, blind. Psychological intervention was a limited benefit. Studies are necessary to identify the appropriate timing for further interventions.

The relationship of anger, depression, and perceived disability among headache patients.

Depression is a common concomitant of headache. Conflict with regard to anger or the expression of anger has also been discussed in terms of its relationships to headache. The direction of the relationship between headaches and depression and/or anger is not clear from available research literature. Thus, the present study proposed to examine the interrelationships among measures of anger expression, depression and self-reported disability in a sample of chronic headache patients. It was predicted that there would be significant correlations between depression and perceived disability, and anger held in and perceived disability. Finally, it was predicted that anger held in would be shown to impact perceived disability by way of its relationship to depression. Path analysis was employed to investigate the relationships among the variables. Results showed a significant and positive relationship between depression and perceived disability, which supported the first hypothesis. Anger expression was not significantly related to perceived disability. Therefore, the second hypothesis was not supported. Anger-in, however, was strongly and positively related to depression. Although the causal direction of the relationships cannot be stated with certainty, the suppression of anger appears to be a moderating variable that amplifies the experience of depression among chronic headache patients.

Psychotherapy with religious professionals: an aspect of the interface of psychology and religion.

Antipathy between psychology and religion is waning. The present paper describes one way in which an interaction of religion and psychology has developed in our own practice, the treatment of religious professionals. We discuss clinical issues which characterize this type of intervention and which may affect success.

Prevalence of temporomandibular symptoms in a large United States metropolitan area.

The prevalence of five symptoms of temporomandibular disorder and associated symptoms of pain, headache, and stress was estimated in a random telephone survey of a large United States metropolitan area. The prevalences for nocturnal bruxing, joint noise with use, soreness on waking, soreness with use, and diurnal clenching were roughly equivalent (ranging from 8% to 12%) and were within the range of prevalences reported in previous studies. Overall, 149 of the 500 respondents reported one or more of the five symptoms. Symptoms were not more prevalent among women than men, but were more prevalent among younger respondents. Soreness on waking and daytime clenching were the only symptoms significantly associated with report of pain. Pain was more commonly reported by respondents with multiple (four or five) symptoms. The results are compared with those of previous random surveys, and limitations to generalization of the present findings are discussed.

Stable factors in chronic pain.

In an effort to identify components of the chronic pain experience, a sample of 444 chronic pain patients who had completed a battery of self-report measures was divided into two groups. The data from each group were analyzed using principal components analysis. Four factors emerged for one group of patients, which accounted for 57.6% of the variance and represented the dimensions of psychological distress, pain-related disability, pain description, and pain history. In the other group, five factors emerged that accounted for 64.2% of the variance. These factors represented psychological distress, disability, pain intensity, pain sensation, and pain history. The similarity of these factors across groups suggests that they represent stable dimensions of the patient's pain experience. Research implications and methodological considerations are discussed.

Prevalence of very severe headache in a large US metropolitan area.

Reliable data regarding prevalence of headache, in general, and migraine, in particular, remain elusive. Methodological inconsistencies and inadequacies are largely responsible. The present study uses a random sampling technique to assess the prevalence of very severe headache. Estimates of headache prevalence were obtained for two time periods: indeterminate/lifetime and the past three months. The resulting prevalence estimates were 20.4 and 15.2%, respectively, for women, and 11.2 and 8.8%, respectively, for men. The estimates are compared with those of previous studies. The present study is compared with these previous studies and suggestions are offered for future research. Aspects of the treatment experience of respondents with poorly controlled headache are also addressed.

A review of studies evaluating biofeedback and relaxation training in the management of pediatric headache.

Headache is one of the most common types of recurrent pain among children. Response to pharmacological treatment has been inconsistent, and there is caution about prolonged pharmacotherapy for headache in children. Behavioral therapies for the management of chronic headache have emerged as a significant option over the last decade. Initial studies summarized in two previous reviews of behavioral therapy for pediatric headache were favorable, but few controlled studies had been done. In the last five years, more studies, the majority with controlled comparisons, have been published. The present review summarizes and interprets the evidence from these studies. Behavioral treatment appears to be a potent alternative for the management of chronic headache in children.

A model clinical program for patients with diabetes and vision impairment.

A program was developed to improve independence, self-esteem, and glycemic control in patients with diabetes and blindness. Twenty-nine individuals with both insulin-dependent and noninsulin-dependent diabetes mellitus entered 12-week programs that included education focusing on diabetes self-management skills for the visually impaired, monitored exercise sessions, and group support. Glycated hemoglobin values fell from 13.0% +/- 0.6% (SEM) to 11.4% +/- 0.5% (P = .001). Exercise tolerance in a 12-minute walk test improved from 0.48 +/- 0.04 to 0.64 +/- 0.05 miles (P = .001). Marked improvements occurred in psychosocial indices, demonstrated through changes in the Rand Mental Health Index from 155 +/- 6 to 174 +/- 5 (P = .0001), the Rosenberg Self-Esteem Scale from 22 +/- 1 to 19 +/- 1 (P = .001), the Zung Depression Scale from 0.50 +/- 0.02 to 0.44 +/- 0.02 (P = .001), and the Diabetes Self-Reliance Test from 60 +/- 3 to 74 +/- 2 (P = .0001).

The Stress-Arousal Checklist as a measure of situational stress versus simple arousal.

The Stress-Arousal Checklist was developed as a self-report measure both of arousal and of the favorable or unfavorable appraisal of that arousal. Previous studies with the checklist showed differential sensitivity of the two subscales to experimental manipulations. In the present study, the convergent and discriminant validity were further explored by comparing scores with those on the State-Trait Anxiety Inventory-State. The results supported the validity of the two-factor structure.

Psychosocial profiles in patients with visual impairment due to diabetic retinopathy.

The psychological impact of vision loss due to diabetic retinopathy is compounded by the loss of diabetes self-management skills. The appropriate role and timing for rehabilitative intervention has not been determined. Twenty-nine individuals with diabetes mellitus, 16 with stable visual impairment and 13 with fluctuating and transitional visual impairment, underwent psychological assessment before and after entering into a specially designed rehabilitation program. Low levels of performance were rehabilitation program. Low levels of performance were demonstrated by the Rosenberg Self-Esteem Scale and the Diabetes Self-Reliance Test in both groups. The Minnesota Multiphasic Personality Inventory, the Zung Self-Rating Depression Scale, and the Rand Mental Health Index suggested that subjects with stable vision impairment were moderately compensated relative to the transitional group, although the former group may have been totally blind. Both groups demonstrated significant improvements in psychological profiles after the program. It is suggested that a rehabilitation program may be of clinical benefit early in the course of vision loss associated with diabetic retinopathy.