R|S Atlas: Identifying existing cohort study data resources to accelerate epidemiological research on the influence of religion and spirituality on human health.

OBJECTIVE: Many studies have documented significant associations between religion and spirituality (R/S) and health, but relatively few prospective analyses exist that can support causal inferences. To date, there has been no systematic analysis of R/S survey items collected in US cohort studies. We conducted a systematic content analysis of all surveys ever fielded in 20 diverse US cohort studies funded by the National Institutes of Health (NIH) to identify all R/S-related items collected from each cohort's baseline survey through 2014. DESIGN: An R|S Ontology was developed from our systematic content analysis to categorise all R/S survey items identified into key conceptual categories. A systematic literature review was completed for each R/S item to identify any cohort publications involving these items through 2018. RESULTS: Our content analysis identified 319 R/S survey items, reflecting 213 unique R/S constructs and 50 R|S Ontology categories. 193 of the 319 extant R/S survey items had been analysed in at least one published paper. Using these data, we created the R|S Atlas (https://atlas.mgh.harvard.edu/), a publicly available, online relational database that allows investigators to identify R/S survey items that have been collected by US cohorts, and to further refine searches by other key data available in cohorts that may be necessary for a given study (eg, race/ethnicity, availability of DNA or geocoded data). CONCLUSIONS: R|S Atlas not only allows researchers to identify available sources of R/S data in cohort studies but will also assist in identifying novel research questions that have yet to be explored within the context of US cohort studies.

"The Study on Stress, Spirituality, and Health (SSSH): Psychometric Evaluation and Initial Validation of the SSSH Baseline Spirituality Survey".

This paper describes the development and initial psychometric testing of the baseline Spirituality Survey (SS-1) from the Study on Stress, Spirituality, and Health (SSSH) which contained a mixture of items selected from validated existing scales and new items generated to measure important constructs not captured by existing instruments. The purpose was to establish the validity of new and existing measures in our racially/ethnically diverse sample. Psychometric properties of the SS-1 were evaluated using standard psychometric analyses in 4,634 SSSH participants. Predictive validity of SS-1 scales was assessed in relation to the physical and mental health component scores from the Short-Form 12 Health Survey (SF-12). Scales exhibited adequate to strong psychometric properties and demonstrated construct and predictive validity. Overall, the correlational findings provide solid evidence that the SS-1 scales are associated with a wide range of relevant R/S attitudes, mental health, and to a lesser degree physical health.

Religion and Spirituality among American Indian, South Asian, Black, Hispanic/Latina, and White Women in the Study on Stress, Spirituality, and Health.

Social scientists have increasingly recognized the lack of diversity in survey research on American religion, resulting in a dearth of data on religion and spirituality (R/S) in understudied racial and ethnic groups. At the same time, epidemiological studies have increasingly diversified their racial and ethnic representation, but have collected few R/S measures to date. With a particular focus on American Indian and South Asian women (in addition to Blacks, Hispanic/Latinas, and white women), this study introduces a new effort among religion and epidemiology researchers, the Study on Stress, Spirituality, and Health (SSSH). This multi-cohort study provides some of the first estimates of R/S beliefs and practices among American Indians and U.S. South Asians, and offers new insight into salient beliefs and practices of diverse racial/ethnic and religious communities.

Predicting baccalaureate nursing students' first-semester outcomes: HESI Admission Assessment.

As a means of promoting evidence-based admission selection decisions in a baccalaureate school of nursing, the faculty at a college of nursing in the southeastern part of the United States investigated the value of including preadmission exam scores as one criterion in the admission protocol. The purpose of this study was to evaluate the use of Elsevier's HESI Admission Assessment (A(2)) exam as a predictor of student success. Four A(2) exams were administered to baccalaureate nursing students: reading comprehension, vocabulary & general knowledge, math, and anatomy & physiology. The mean of reading comprehension scores and vocabulary & general knowledge scores constituted the students' English scores, and the mean of all 4 exam scores constituted the students' A(2) composite scores. A(2) scores were correlated with final course grades in the 3 first-semester nursing courses (N = 184). There was a significantly positive (P ≤ .01) relationship between A(2) scores and final course grades for the 3 first-semester nursing courses-as A(2) scores increased, so did final course grades. Faculty concluded that A(2) scores provided a valuable measure of students' ability to succeed within the nursing program and, as such, they enabled faculty to make evidence-based decisions regarding applicant selection.

[Cultural adaptation and validation of the Underwood's Daily Spiritual Experience Scale--Brazilian version]. / Adaptação cultural e validação da Underwood's Daily Spiritual Experience Scale - versão brasileira.

This study aimed to perform the cultural adaptation and analyzing the psychometric properties of the Brazilian version of the Underwood's Daily Spiritual Experience Scale (DSES). The adaptation followed the internationally recommended procedures and the adapted version maintained equivalence to the original after wording adjustments in five items. In the application to 179 medical-surgical patients it was found evidences of internal consistency (Cronbach's alpha=0.91), test-retest reliability (ICC=0.94) and convergent validity, correlating with the Intrinsic Religiosity subscale of the Duke Religious Index DUREL (r=0.56, p<0.001). Exploratory factor analysis extracted three principal components explaining 60.5% of the total variance. The DSES-Brazilian version shows evidences of reliability and validity among hospitalized patients. Further studies are needed to confirm its factor composition and to test its applicability in different populations.

Adaptação cultural e validação da Underwood's Daily Spiritual Experience Scale - versão brasileira / Cultural adaptation and validation of the Underwood's Daily Spiritual Experience Scale - Brazilian version / Adaptación cultural y validación de la Underwood's Daily Spiritual Experience Scale-versión brasileña

Este estudo objetivou adaptar culturalmente e analisar as propriedades psicométricas da versão brasileira da Underwood's Daily Spiritual Experience Scale (DSES). A adaptação seguiu as etapas internacionalmente recomendadas e a versão adaptada manteve equivalência com a original, após ajustes na redação de cinco itens. Na aplicação a 179 pacientes médico-cirúrgicos mostrou evidências de consistência interna (alfa de Cronbach=0,91), estabilidade temporal (ICC=0,94 no teste e reteste) e validade de construto convergente, na correlação com a subescala Religiosidade Intrínseca do instrumento DUREL (r=0,56; p<0,001). A análise fatorial exploratória extraiu três componentes, explicando 60,5% da variância do total. A versão brasileira da DSES apresenta evidências de confiabilidade e validade junto a pacientes hospitalizados. São necessários mais estudos para confirmar a sua composição fatorial e testar a sua aplicabilidade em diferentes populações.

This study aimed to perform the cultural adaptation and analyzing the psychometric properties of the Brazilian version of the Underwood's Daily Spiritual Experience Scale (DSES). The adaptation followed the internationally recommended procedures and the adapted version maintained equivalence to the original after wording adjustments in five items. In the application to 179 medical-surgical patients it was found evidences of internal consistency (Cronbach's alpha=0.91), test-retest reliability (ICC=0.94) and convergent validity, correlating with the Intrinsic Religiosity subscale of the Duke Religious Index DUREL (r=0.56, p<0.001). Exploratory factor analysis extracted three principal components explaining 60.5% of the total variance. The DSES-Brazilian version shows evidences of reliability and validity among hospitalized patients. Further studies are needed to confirm its factor composition and to test its applicability in different populations.

Este estudio objetivó adaptar culturalmente y analizar las propiedades psicométricas de la versión brasileña de la Underwood's Daily Spiritual Experience Scale (DSES). La adaptación cultural siguió los pasos metodológicos internacionalmente recomendados y la versión adaptada se ha mantenido equivalente con la original, después de ajustes en la redacción de cinco ítems. En la aplicación en 179 pacientes médico-quirúrgicos mostró una alta consistencia interna (alfa de Cronbach=0,91), estabilidad temporal (CCI=0,94 en el test-retest) y validez convergente, en la correlación con la subescala Religiosidad Intrínseca del instrumento DUREL (r=0,56; p<0,001). En el análisis factorial exploratorio se han obtenido tres componentes que explican el 60.4% de la varianza total. La DSES-versión brasileña muestra evidencias de fiabilidad y validez entre pacientes hospitalizados. Se necesitan más estudios para confirmar su composición factorial y testar su aplicabilidad en diferentes poblaciones.

Psychometric testing of the daily spiritual experiences scale among African Americans in the Jackson Heart Study.

This study provided the first examination of the psychometric properties of the 6-item Daily Spiritual Experiences Scale (DSES) in a large African American sample, the Jackson Heart Study (JHS). The JHS included measures of spiritual (DSES) and religious practices. Internal reliability, dimensionality, fit indices, and correlation were assessed. DSES scores reflected frequent daily spiritual experiences (12.84 ± 4.72) and reliability scores were high (α = 0.85; 95% CI 0.84-0.86). The DSES loaded on a single factor, with significant goodness-of-fit scores (RMSEA = 0.094, P < 0.01). Moderate significant correlations were noted among DSES items. Our findings confirm that the 6-item DSES had excellent psychometric properties in this sample.

Now bounded, now immeasurable: perspectives on time in disability, in suffering and at end of life.

Novels, films, poems and visual art can expand our view of time in ways that can be useful in dealing with disability, suffering and end of life. In particular, they can reveal more complex ways to view time. This can be effective both for the person suffering and for those who care for them. Our typical ways of viewing time include linear sequential clock time, which progresses in an evenly parsed, ordered, unidirectional way, and memory or narrative time-time as we remember it. These two ways of viewing time often do not agree. Since these can compete as the best predictors of outcomes in different circumstances, neither can make an exclusive claim to be "real time." A third view of time that has potential application is one that is multilayered, extending endlessly and evidencing expansiveness in each moment. Examples of the usefulness of this third, more complex view of time in asthma, pain, end of life and disability are presented. The arts can introduce this more complex view in a way that can help one fold it into life. All these ways of viewing time in combination can broaden the perspective clinicians have when co-creating with patients good decisions in difficult situations.

Physiologic markers of chronic stress in premenopausal, middle-aged women.

OBJECTIVE: The purpose of this study was to identify physiological markers of chronic stress in middle-aged women that can be assessed simply and are thus feasible for introduction into large-scale, epidemiologic studies of aging. METHODS: Subjects were 40 nonsmoking, premenopausal women between the ages of 42 and 52 years, 20 of whom were chronically stressed because of undergoing a divorce or separation and 20 of whom were nonstressed because of being in stable marriages. Stressed and nonstressed women were matched for age, ethnicity, and education. Hypotheses focused on morning and evening salivary cortisol, overnight urinary catecholamines, cortisol, and testosterone, and platelet catecholamines. RESULTS: Relative to the nonstressed control subjects, the stressed women had elevated evening (9 PM) salivary cortisols, a finding that was observed on both days (mixed effects model: effect = 0.44; se = 0.14, p =.003). Support for the importance of the HPA axis was provided by the observation that the stressed women had less suppression of salivary cortisol in response to low-dose dexamethasone. Contrary to our hypothesis that stressed women would have lower overnight urinary testosterone, they had higher testosterone on day 2 (stressed = 0.76 ng/mg, nonstressed = 0.55 ng/mg; p =.04). Post hoc repeated measures analysis revealed a significant group effect over all time periods of observation (F = 5.48, p =.03, df = 1,18). Stressed women had a nonsignificant trend toward elevated platelet catecholamines. No association was found for overnight urinary catecholamines or cortisol. CONCLUSIONS: Promising markers of marital upheaval in middle-aged women are evening salivary cortisol and urinary testosterone from a first morning void. Replication of these findings with the same and different chronic stressors and with women of older ages is needed. The low cost and minimal burden of these potential markers makes it feasible to introduce them into large-scale epidemiologic studies of health in aging women.

The daily spiritual experience scale: development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data.

Spirituality and religiousness are gaining increasing attention as health research variables. However, the particular aspects examined vary from study to study, ranging from church attendance to religious coping to meaning in life. This frequently results in a lack of clarity regarding what is being measured, the meaning of the relationships between health variables and spirituality, and implications for action. This article describes the Daily Spiritual Experience Scale (DSES) and its development, reliability, exploratory factor analyses, and preliminary construct validity. Normative data from random samples and preliminary relationships of health-related data with the DSES also are included. Detailed data for the 16-item DSES are provided from two studies; a third study provided data on a subset of 6 items, and afourth study was done on the interrater reliability of the item subset. A 6-item version was used in the General Social Survey because of the need to shorten the measure for the survey. A rationale for the conceptual underpinnings and item selection is provided, as are suggested pathways for linkages to health and well-being. This scale addresses reported ordinary experiences of spirituality such as awe, joy that lifts one out of the mundane, and a sense of deep inner peace. Studies using the DSES may identify ways in which this element of life may influence emotion, cognition and behavior, and health or ways in which this element may be treated as an outcome in itself a particular component of well-being. The DSES evidenced good reliability across several studies with internal consistency estimates in the .90s. Preliminary evidence showed that daily spiritual experience is related to decreased total alcohol intake, improved quality of life, and positive psychosocial status.

Correlates of self-perceptions of spirituality in American adults.

To advance knowledge in the study of spirituality and physical health, we examined sociodemographic, behavioral, and attitudinal correlates of self-perceptions of spirituality. Participants were a nationally representative sample of 1,422 adult respondents to the 1998 General Social Survey. They were asked, among other things, to rate themselves on the depth of their spirituality and the depth of their religiousness. Results indicated that, after adjustment for religiousness, self-perceptions of spirituality were positively correlated with being female (r = .07, p < .01), having a higher education (r = .12, p < .001), and having no religion (r = .10, p < .001) and inversely correlated with age (r = -.06, p < .05) and being Catholic (r = -.08, p < .01). After adjustment for these sociodemographic factors, self-perceptions of spirituality were associated with high levels of religious or spiritual activities (range in correlations = .12-.38, all p < .001), low cynical mistrust, and low political conservatism (both r = -.08, p < .01). The population was divided into 4 groups based on their self-perceptions of degree of spirituality and degree of religiousness. The spiritual and religious group had a higherfrequency of attending services, praying, meditating, reading the Bible, and daily spiritual experience than any of the other 3 groups (all differences p < .05) and had less distress and less mistrust than the religious-only group (p < .05 for both). However, they were also more intolerant than either of the nonreligious groups (p < .05 for both) and similar on intolerance to the religious-only group. We conclude that sociodemographicfactors could confound any observed association between spirituality and health and should be controlled. Moreover, individuals who perceive themselves to be both spiritual and religious may be at particularly low risk for morbidity and mortality based on their good psychological status and ongoing restorative activities.