Is there an association between Health Related Quality of Life, socio-demographic status and Fatigue in Patients with Chronic Hepatitis B?

BACKGROUND: Chronic hepatitis B (CHB) is a serious and prevalent disease which may negatively influence health related quality of life (HRQOL) and fatigue. The aim of the present study was to examine the relationship between demographic variables, HRQOL, and fatigue. METHODS: A cross-sectional study was conducted involving 418 Iranian patients with CHB (average age 44.1 years, majority males). Participants completed a multidimensional fatigue inventory, chronic liver disease questionnaire, Euro quality of life-five dimensions questionnaire, and demographic information. Bivariate analyses were conducted using the Spearman correlation and Mann-Whitney U test. Hierarchical logistic regression modeling identified independent predictors of fatigue. RESULTS: The most prevalent problems related to HRQOL were anxiety/depression and pain/discomfort. Except for reduced motivation other dimensions of fatigue were significantly higher among those with CHB compared to healthy controls (p<0.05). Age, sex, education, employment, disease stage and all HRQOL subscales were significantly related to fatigue level. The Nagelkerke R Square for the logistic regression model was 0.542. CONCLUSIONS: Poor HRQOL and fatigue are widespread among patients with CHB. Given these associations between demographic, psychological, and other HRQOL dimensions and fatigue, interventions that address these factors may help to reduce fatigue in patients with CHB.

Religious/spiritual characteristics of indian and indonesian physicians and their acceptance of spirituality in health care: a cross-cultural comparison.

Religious/spiritual (r/s) characteristics of physicians influence their attitude toward integrative medicine and spiritual care. Indonesia physicians collaborate with traditional, complementary, and alternative medicine (TCAM) professionals within modern healthcare system, while Indian physicians are not reported to do so. The aim of the study was to understand the r/s characteristics and their influence on Indian and Indonesian physicians' acceptance of TCAM/spirituality in modern healthcare system. An exploratory, pilot, cross-cultural, cross-sectional study, using Religion and Spirituality in Medicine, and Physician Perspectives (RSMPP) survey questionnaire, compared r/s characteristics and perspectives on integrative medicine of 169 physicians from two allopathic, Sweekar-Osmania University (Sweekar-OU), India, University of Airlanga (UNAIR), Indonesia, and a TCAM/Central Research Institute of Unani Medicine (CRIUM) institute from India. More physicians from UNAIR and CRIUM (89.1 %) described themselves as "very"/"moderately" religious, compared to 63.5 % Sweekar-OU (p = 0.0000). Greater number of (84.6 %) UNAIR physicians described themselves as "very" spiritual and also significantly high (p < 0.05) in intrinsic religiosity as compared to Sweekar-OU and TCAM physicians; 38.6 % of UNAIR and 32.6 % of CRIUM participants reported life-changing spiritual experiences in clinical settings as against 19.7 % of Sweekar-OU; 92.3 % of UNAIR, compared to CRIUM (78.3 %) and Sweekar-OU (62 %), felt comfortable attending to patients' spiritual needs, (p = 0.0001). Clinical comfort and not r/s characteristics of participants was the significant (p = 0.05) variable in full regression models, predictive of primary outcome criteria; "TCAM or r/s healing as complementary to allopathic treatment." In conclusion, mainstreaming TCAM into healthcare system may be an initial step toward both integrative medicine and also improving r/s care interventions by allopathic physicians.

Female sexual dysfunction in patients with spinal cord injury: a study from Iran.

OBJECTIVES: We assess the prevalence of sexual dysfunction in patients with spinal cord injury (SCI), compare sexual function and sexual distress between female patients with SCI and gender-matched healthy controls, and address risk factors associated with sexual dysfunction among Iranian female patients with SCI. SETTING: Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. METHODS: Eligible Iranian female patients with SCI were included in this cross-sectional study. They were asked to provide sociodemographic information, and complete the Female Sexual Function Index, Hospital Anxiety and Depression Scale and Female Sexual Distress Scale-Revised questionnaire. RESULTS: Of the 105 patients participated in this study, the average age was 41.0 (s.d.=10.1) years. Women with SCI reported significantly higher levels of sexual dysfunction compared with normal controls. Approximately, 88% of SCI patients reported at least one type of sexual dysfunction, whereas only 37% of healthy controls reported sexual dysfunction. Lack of vaginal lubrication was reported more frequent in SCI patients compared with controls. Women with SCI reported a significantly higher level of sexual distress compared with healthy women. Sexual dysfunction was observed to be significantly higher in older patients, those with less education, patients with complete lesions, those with sexual distress and patients who were anxious and depressed. CONCLUSION: Sexual dysfunction is highly prevalent among Iranian women with SCI. Sexual dysfunction is associated with age, education, symptoms of depression and anxiety and level of injury. Sexual counseling during the rehabilitation period may help to prevent sexual dysfunction following SCI.

Indian health care professionals' attitude towards spiritual healing and its role in alleviating stigma of psychiatric services.

Persons with mental illnesses in India and rest of developing world continue to consult religious/spiritual (R/S) healers or traditional, complementary and alternative medicine (TCAM) professionals prior to seeking psychiatric services that are devoid of spiritual components of care. We aim to understand TCAM and allopathic professionals' perspectives on patients' R/S needs within mental health services, cross-sectional study was conducted at five TCAM and two allopathic tertiary care hospitals in three different Indian states; 393 participants completed RSMPP, a self-administered, semi-structured survey questionnaire. Perspectives of TCAM and allopathic health professionals on role of spirituality in mental health care were compared. Substantial percentage, 43.7 % TCAM and 41.3 % allopathic, of participants believe that their patients approach R/S or TCAM practitioners for severe mental illness; 91.2 % of TCAM and 69.7 % of allopaths were satisfied with R/S healers (p = 0.0019). Furthermore, 91.1 % TCAM and 73.1 % allopaths (p = 0.000) believe that mental health stigma can be minimized by integrating with spiritual care services. Overall, 87 % of TCAM and 73 % of allopaths agreed to primary criterion variable: 'spiritual healing is beneficial and complementary to psychiatric care.' A quarter of allopaths (24.4 %) and 38 % of TCAM physicians reportedly cross-refer their grieving patients to religious/TCAM healer and psychiatrist/psychologist, respectively; on logistic regression, significant (p < 0.05) predictors were clinical interactions/references to r/s healers. Providing spiritual care within the setup of psychiatric institution will not only complement psychiatric care but also alleviate stigma against mental health services. Implications on developing spiritual care services like clinical chaplaincy are discussed.

Nursing home care: exploring the role of religiousness in the mental health, quality of life and stress of formal caregivers.

Despite the high number of studies on family caregivers, there is little research on the impact of religiosity on formal caregiving (paid providers). We examine the role of religiousness in the mental health, quality of life and stress of nurse aides (NA) who provide care for patients in a nursing home. NA in a Brazilian nursing home were invited to participate. Because of its coping function, we hypothesized that religiousness was related to better mental health and quality of life. Linear regression was used to test this hypothesis and control for confounders. Compared with the Brazilian general population, NA scored higher on measures of religious involvement. Intrinsic religiosity was associated with better mental health and quality of life. Organizational religiosity was associated with better social functioning, better general mental health and fewer anxiety symptoms. Non-organizational religiosity (prayer), however, was associated with negative outcomes, such as higher stress, poorer general health perceptions and more anxiety symptoms. Most NA indicated that they had prayed for and with their patients. In conclusion, paid caregivers (NA) have a strong sense of religiousness, which plays an important role in many ways, including the type of care they provide, their mental health and their quality of life.

Perspectives of Indian traditional and allopathic professionals on religion/spirituality and its role in medicine: basis for developing an integrative medicine program.

Allopathic medical professionals in developed nations have started to collaborate with traditional, complementary, and alternative medicine (TCAM) to enquire on the role of religion/spirituality (r/s) in patient care. There is scant evidence of such movement in the Indian medical community. We aim to understand the perspectives of Indian TCAM and allopathic professionals on the influence of r/s in health. Using RSMPP (Religion, Spirituality and Medicine, Physician Perspectives) questionnaire, a cross-sectional survey was conducted at seven (five TCAM and two allopathic) pre-selected tertiary care medical institutes in India. Findings of TCAM and allopathic groups were compared. Majority in both groups (75% of TCAM and 84.6% of allopathic practitioners) believed that patients' spiritual focus increases with illness. Up to 58% of TCAM and allopathic respondents report patients receiving support from their religious communities; 87% of TCAM and 73% of allopaths believed spiritual healing to be beneficial and complementary to allopathic medical care. Only 11% of allopaths, as against 40% of TCAM, had reportedly received 'formal' training in r/s. Both TCAM (81.8%) and allopathic (63.7%) professionals agree that spirituality as an academic subject merits inclusion in health education programs (p = 0.0003). Inclusion of spirituality in the health care system is a need for Indian medical professionals as well as their patients, and it could form the basis for integrating TCAM and allopathic medical systems in India.

Primary care physicians' and psychiatrists' approaches to treating mild depression.

OBJECTIVE: To measure how primary care physicians (PCPs) and psychiatrists treat mild depression. METHOD: We surveyed a national sample of US PCPs and psychiatrists using a vignette of a 52-year-old man with depressive symptoms not meeting Major Depressive Episode criteria. Physicians were asked how likely they were to recommend an antidepressant counseling, combined medication, and counseling or to make a psychiatric referral. RESULTS: Response rate was 896/1427 PCPs and 312/487 for psychiatrists. Compared with PCPs, psychiatrists were more likely to recommend an antidepressant (70% vs. 56%), counseling (86% vs. 54%), or the combination of medication and counseling (61% vs. 30%). More psychiatrists (44%) than PCPs (15%) were 'very likely' to promote psychiatric referral. PCPs who frequently attended religious services were less likely (than infrequent attenders) to refer the patient to a psychiatrist (12% vs. 18%); and more likely to recommend increased involvement in meaningful relationships/activities (50% vs. 41%) and religious community (33% vs. 17%). CONCLUSION: Psychiatrists treat mild depression more aggressively than PCPs. Both are inclined to use antidepressants for patients with mild depression.

Religiosity is an important part of coping with grief in pregnancy after a traumatic second trimester loss.

Women (n = 15) who were pregnant after a traumatic late pregnancy loss (termination because of fetal death or serious anomalies) completed psychometric screening tests and scales, including the Perinatal Grief Scale (PGS), the Impact of Event Scale (IES), the Duke Depression Inventory (DDI), the Generalized Anxiety Disorder-7 (GAD), and the Hoge Scale for Intrinsic Religiosity (IR). Despite a mean elapsed time since the prior loss of 27 (range, 7-47) months, half (7/15, 47%) of the combined groups had high levels of grief on the PGS. Multiple positive scores on psychometric tests were frequent: Sixty percent (9/15) had high scores on the PGS Active Grief subscale or on the IES. Forty percent (6/15) had a high score on the DDI, and 17% (3/15) on the GAD. IR scores significantly and negatively correlated with scores on the Despair subscale of the PGS. The results from this pilot study suggest that high levels of grief and PTS symptoms are significant problems for pregnant women who have suffered late loss of a wanted pregnancy. Religiosity may play an important part in maternal coping during these stressful pregnancies.

Long-term Adjustment After Surviving Open Heart Surgery: The Effect of Using Prayer for Coping Replicated in a Prospective Design.

PURPOSE: despite the growing evidence for effects of religious factors on cardiac health in general populations, findings are not always consistent in sicker and older populations. We previously demonstrated that short-term negative outcomes (depression and anxiety) among older adults following open heart surgery are partially alleviated when patients employ prayer as part of their coping strategy. The present study examines multifaceted effects of religious factors on long-term postoperative adjustment, extending our previous findings concerning prayer and coping with cardiac disease. DESIGN AND METHODS: analyses capitalized on a preoperative survey and medical variables from the Society of Thoracic Surgeons' National Database of patients undergoing open heart surgery. The current participants completed a mailed survey 30 months after surgery. Two hierarchical regressions were performed to evaluate the extent to which religious factors predicted depression and anxiety, after controlling for key demographics, medical indices, and mental health. RESULTS: predicting lower levels of depression at the follow-up were preoperative use of prayer for coping, optimism, and hope. Predicting lower levels of anxiety at the follow-up were subjective religiousness, marital status, and hope. Predicting poorer adjustment were reverence in religious contexts, preoperative mental health symptoms, and medical comorbidity. Including optimism and hope in the model did not eliminate effects of religious factors. Several other religious factors had no long-term influences. MPLICATIONS: the influence of religious factors on the long-term postoperative adjustment is independent and complex, with mediating factors yet to be determined. Future research should investigate mechanisms underlying religion-health relations.

Religious beliefs affect grieving after pregnancy loss.

Religious beliefs and practices may aid in coping with bereavement and grief after pregnancy loss. Data from 103 women enrolled in the original Lehigh Valley Perinatal Loss Project, and who were followed-up for at least 1 year, were evaluated for the impact of initial religious practices and beliefs on the course and severity of grief. Religious practices corresponding to standard scales of religiosity and agreement with specific beliefs were rated by the women on a Likert scale of 1-5. Neither agreement with statements corresponding to extrinsic and intrinsic religiosity or to positive religious coping, nor frequency of religious service attendance was predictive of follow-up scores on the Perinatal Grief Scale. Religious struggle, agreement with statements classified as negative religious coping, and continued attachment to the baby were all associated with more severe grief.

A prospective study of religion/spirituality and depressive symptoms among adolescent psychiatric patients.

OBJECTIVE: Previous research has uncovered relationships between religion/spirituality and depressive disorders. Proposed mechanisms through which religion may impact depression include decreased substance use and enhanced social support. Little investigation of these topics has occurred with adolescent psychiatric patients, among whom depression, substance use, and social dysfunction are common. METHOD: 145 subjects, aged 12-18, from two psychiatric outpatient clinics completed the Beck Depression Inventory-II (BDI-II), the Fetzer multidimensional survey of religion/spirituality, and inventories of substance abuse and perceived social support. Measures were completed again six months later. Longitudinal and cross-sectional relationships between depression and religion were examined, controlling for substance abuse and social support. RESULTS: Of thirteen religious/spiritual characteristics assessed, nine showed strong cross-sectional relationships to BDI-II score. When perceived social support and substance abuse were controlled for, forgiveness, negative religious support, loss of faith, and negative religious coping retained significant relationships to BDI-II. In longitudinal analyses, loss of faith predicted less improvement in depression scores over 6 months, controlling for depression at study entry. LIMITATIONS: Self-report data, clinical sample. CONCLUSIONS: Several aspects of religiousness/spirituality appear to relate cross-sectionally to depressive symptoms in adolescent psychiatric patients. Findings suggest that perceived social support and substance abuse account for some of these correlations but do not explain relationships to negative religious coping, loss of faith, or forgiveness. Endorsing a loss of faith may be a marker of poor prognosis among depressed youth.

Health behaviour, depression and religiosity in older patients admitted to intermediate care.

OBJECTIVE: To examine health behaviour, severity of depression, gender differences and religiosity in older patients admitted to intermediate care for further rehabilitation. DESIGN: Cross-sectional survey. PARTICIPANTS: A research physiotherapist interviewed 173 older patients (113 female), 60 and older consecutively admitted to intermediate care for rehabilitation, usually after acute care. MEASUREMENTS: Religiosity was measured using the Duke University Religion Index, depressive and anxiety symptoms using the Hospital Anxiety Depression Scale, and severity of depression measured by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended Activities of Daily Living Scale and quality of life measured by the SF-36 questionnaire. RESULTS: After controlling for other factors using multiple regression, religious attendance was associated with positive general health perception (t = 1.9, p = 0.05), and inversely associated with number of pack years smoked (t = -2.05, p = 0.04) and severity of illness (Charlson Index), [t = -2.05, p = 0.04]. Intrinsic religious activity was associated with older age (t = 3.06, p < 0.003), female gender (t = 2.52, p = 0. 01), living situation (t = -2.17, p < 0.03) and with less severe depression (t = -2.43, p = 0.01). CONCLUSION: In older patients with chronic diseases in intermediate care, religious attendance was associated with positive perceptions of health, less severe illness, and fewer pack years. Intrinsic religious activities were associated with less severe depression and lower likelihood of living alone.

[Prayers for patients with internal and cardiological diseases--an applicable therapeutic method?]. / Internistische und kardiologische Erkrankungen. Das Gebet als Therapeutikum?

Previous intercessory prayer studies showed symptom improvement and lower rates of complications in patients who were prayed for, whether it was a direct prayer or a distant intercessory prayer. The effect of intercessory prayer was not observed in cardiology patients during two new multicentre studies (MANTRA, STEP). The STEP study actually showed an unfavourable effect when the patient knew of distant prayers made on his/her behalf. Thus, prayer as an "applicable therapeutic method" could not be empirically verified. However, active prayer within the framework of a doctor-patient relationship can strengthen the patient's optimism and activate the body's healing resources.

Comparison of older depressed hospitalized patients with and without heart failure/pulmonary disease.

Test the hypothesis that depressed hospitalized patients with congestive heart failure (CHF) and/or chronic pulmonary disease (CPD) are no different from depressed patients with other medical disorders, and so can be treated similarly. Consenting patients aged 50 or over consecutively admitted to the medical services at Duke University Medical Center and three community hospitals were screened for depressive disorder using the Structured Clinical Interview for Depression (SCID-IV). Characteristics of patients reflecting vulnerability, stressors, and coping resources were assessed. CHF/CPD patients with major (n = 413) and minor (n = 587) depression were compared to depressed patients with other medical disorders (n = 63). Among those with major depression, patients with CHF/CPD differed from those with other medical disorders in having less severe depression and less severe cognitive impairment, but greater physical illness severity. Among those with minor depression, CHF/CPD patients tended to be older and, as with major depression, had less severe depression and more severe medical illness. These findings were largely confirmed when CHF and CPD patients were examined separately. Depressive disorders in CHF/CPD patients are similar to those in patients with other medical disorders. However, they may be associated with less severe depressive symptoms and more severe physical illness than depressed patients with other medical disorders. These findings help to identify the unique ways in which depressive disorder manifests itself in hospitalized patients with chronic heart and lung disease that may impact their management.

Religiosity and mental health in southern, community-dwelling older adults.

This study considers potential interaction effects of three measures of religiosity, organized (OR), non-organized (NOR), and intrinsic religiosity (IR), on depression and general mental health, controlling for socio-demographic characteristics and mobility. In-home interviews were conducted among a stratified random sample of Medicare beneficiaries from five central Alabama counties (the University of Alabama at Birmingham Study of Aging). Those who were high on all three dimensions of religiosity reported having fewer symptoms of depression and better mental health than did those who were low on all three dimensions of religiosity. Subjects who scored high on OR reported lower levels of depression (F (1,981) = 3.97, p<0.05). Neither IR nor NOR had salutary effects on the measure of depression nor on the general measure of mental health.The interpretation of the relationships of religiosity with the Geriatric Depression Scale (GDS) and the general mental health (Mental Component Score of the SF-12; MCS) measures was complicated by the presence of three way interactions (F (1,981) = 9.02, p<0.01 and F (1, 981) = 5.46, p<0.05, for GDS and MCS respectively). The presence of interaction effects between the different dimensions of religiosity and mental health affirms the importance of remaining sensitive to the multidimensional nature of religiousness and its relationships with measures of mental health.

A 10-year review of research on chaplains and community-based clergy in 3 primary oncology nursing journals: 1990-1999.

A manual examination of 3 primary oncology nursing journals was conducted to identify quantitative studies about chaplains and community-based clergy that were published between 1990 and 1999. This systematic review identified 7 studies involving chaplains and/or clergy dealing with a range of issues. Although the rate at which such studies were published in the oncology nursing literature was relatively low (1 in 123 studies), this rate far exceeds the rate found in a similar review of psychology journals (1 in 600 studies). The nature of the 7 studies and the issues they addressed are discussed and the authors make recommendations for future collaborative efforts.

Integrative noetic therapies as adjuncts to percutaneous intervention during unstable coronary syndromes: Monitoring and Actualization of Noetic Training (MANTRA) feasibility pilot.

BACKGROUND: Patients undergoing percutaneous coronary intervention (PCI) for unstable coronary syndromes have substantial emotional and spiritual distress that may promote procedural complications. Noetic (nonpharmacologic) therapies may reduce anxiety, pain and distress, enhance the efficacy of pharmacologic agents, or affect short- and long-term procedural outcomes. METHODS: The Monitoring and Actualization of Noetic Training (MANTRA) pilot study examined the feasibility of applying 4 noetic therapies-stress relaxation, imagery, touch therapy, and prayer-to patients in the setting of acute coronary interventions. Eligible patients had acute coronary syndromes and invasive angiography or PCI. Patients were randomized across 5 treatment groups: the 4 noetic and standard therapies. Questionnaires completed before PCI reflected patients' religious beliefs and anxiety. Index hospitalization end points included post-PCI ischemia, death, myocardial infarction, heart failure, and urgent revascularization. Mortality was followed up for 6 months after hospitalization. RESULTS: Of eligible patients, 88% gave informed consent. Of 150 patients enrolled, 120 were assigned to noetic therapy; 118 (98%) completed their therapeutic assignments. All clinical end points were available for 100% of patients. Results were not statistically significant for any outcomes comparisons. There was a 25% to 30% absolute reduction in adverse periprocedural outcomes in patients treated with any noetic therapy compared with standard therapy. The lowest absolute complication rates were observed in patients assigned to off-site prayer. All mortality by 6-month follow-up was in the noetic therapies group. In patients with questionnaire scores indicating a high level of spiritual belief, a high level of personal spiritual activity, a low level of community-based religious involvement, or a high level of anxiety, noetic therapies appeared to show greater reduction in absolute in-hospital complication rates compared with standard therapy. CONCLUSIONS: Acceptance of noetic adjuncts to invasive therapy for acute coronary syndromes was excellent, and logistics were feasible. No outcomes differences were significant; however, index hospitalization data consistently suggested a therapeutic benefit with noetic therapy. Of all noetic therapies, off-site intercessory prayer had the lowest short- and long-term absolute complication rates. Definitive demonstration of treatment effects of this magnitude would be feasible in a patient population about 4 times that of this pilot study. Absolute mortality differences make safety considerations a mandatory feature of future clinical trials in this area.

Religion and medicine II: religion, mental health, and related behaviors.

In this second in a series of articles on religion and medicine, I focus on the relationship between religion and mental health. This discussion is based on a comprehensive and systematic review of a century of research examining religion's relationship to mental health, social support, substance abuse, and other behaviors affecting mental or social functioning. This review includes over 630 separate data-based reports that focus on religion and well-being, hope and optimism, meaning and purpose, depression, suicide, anxiety, psychosis, social support and marital stability, alcohol and drug abuse, cigarette smoking, extra-marital sexual behaviors, and delinquency. Reasons for the associations found are discussed and conclusions drawn in light of the findings.

Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study.

BACKGROUND: Although church attendance has been associated with a reduced risk of mortality, no study has examined the impact of religious struggle with an illness on mortality. OBJECTIVE: To investigate longitudinally the relationship between religious struggle with an illness and mortality. METHODS: A longitudinal cohort study from 1996 to 1997 was conducted to assess positive religious coping and religious struggle, and demographic, physical health, and mental health measures at baseline as control variables. Mortality during the 2-year period was the main outcome measure. Participants were 596 patients aged 55 years or older on the medical inpatient services of Duke University Medical Center or the Durham Veterans Affairs Medical Center, Durham, NC. RESULTS: After controlling for the demographic, physical health, and mental health variables, higher religious struggle scores at baseline were predictive of greater risk of mortality (risk ratio [RR] for death, 1.06; 95% confidence interval [CI], 1.01-1.11; chi(2) = 5.89; P =.02). Two spiritual discontent items and 1 demonic reappraisal item from the religious coping measure were predictive of increased risk for mortality: "Wondered whether God had abandoned me" (RR for death, 1.28; 95% CI, 1.07-1.50; chi(2) = 5.22; P =.02), "Questioned God's love for me" (RR for death, 1.22; 95% CI, 1.02-1.43; chi(2) = 3.69; P =.05), and "Decided the devil made this happen" (RR for death, 1.19; 95% CI, 1.05-1.33; chi(2) = 5.84; P =.02). CONCLUSIONS: Certain forms of religiousness may increase the risk of death. Elderly ill men and women who experience a religious struggle with their illness appear to be at increased risk of death, even after controlling for baseline health, mental health status, and demographic factors.