Linkages between Soil Security and One Health: implications for the 2030 Sustainable Development Goals.

Soil provides multiple and diverse functions (e.g., the provision of food and the regulation of carbon), which underpin the health of animals, humans, the environment and the planet. However, the world's soils face existential challenges. To this end, the concept of Soil Security was developed, compelled to: "maintain and improve soils worldwide so that they can continue to provide food, fiber and fresh water, contribute to energy and climate sustainability and help to maintain biodiversity and the overall protection of ecosystem goods and services." In parallel, the concept of One Health likewise works across the human-animal-environment interface, highly relevant for the goals of Soil Security. In this review, we evaluated the roles which both the Soil Security and One Health concepts have served in the literature between 2012 and 2023 and explore the potential linkages between both concepts. We outline that both concepts are used in disparate fields, despite considerable overlap in aims and objectives. We highlight the Soil Health concept as a potential connector between Soil Security and One Health. Overall, we argue that both Soil Security and One Health are highly complementary fields of scientific inquiry with solid leverage for translation into policy and practice. However, there is a need to define One Health dimensions, as has been done for Soil Security. As such, we proffer five measurable dimensions for One Health, the "5Cs"-Capacity, Condition, Capital, Connectivity and Codification-to allow for an overall measure of One Health. Finally, we advocate for a biosphere-focused framework to collectively make progress toward the 2030 Sustainable Development Goals and other global existential challenges.

"I Am Forever Changed": A Phenomenological Study of the Existential Experiences of Parents of Children and Young People With Complex Care Needs.

AIM: To explore the existential lived experiences of parents of children and young people with complex care needs. DESIGN: An explorative qualitative design. METHODS: We conducted 16 in-depth interviews with parents of children and young people with complex care needs across Norway from February to May 2022. Data collection and analysis were guided by the theoretical framework of van Manen's phenomenology of practice approach. RESULTS: Four distinct but interwoven themes reflecting the comprehensive and holistic nature of parents' existential lived experiences emerged: lived body: "I am forever changed"; lived space: Seeking sanctuary; lived time: "Time doesn't seem to exist"; and lived self-other: Parents' changing relationships. CONCLUSIONS: Parents' ongoing efforts to manage fluctuations in their daily lives profoundly affect the existential aspects of their well-being, suggesting that respectful and attentive nurse-parent relationships can nurture existential growth. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: There is a crucial need for a genuine nursing presence characterised by an attitude of open sensitivity and attentive listening to parents' existential experiences. Nurses should embrace the opportunity to engage in respectful and attentive dialogues with parents. Acknowledging that the insights emerging from these conversations can improve integrated and personalised nursing services worldwide. IMPACT: Parents of children and young people with complex care needs often experience suboptimal healthcare. Additionally, access to quality healthcare services, particularly in rural areas, is limited, creating inefficiencies and coordination challenges. This study provides nurses, other health care professionals, researchers, and decision-makers with valuable perspectives on supporting parents' existential needs which may significantly impact their overall well-being and coping abilities, contributing to a more compassionate approach to family care. REPORTING METHOD: Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: Parents of children and young people with complex care needs provided valuable feedback on the findings and implications of this work.

What do health professionals think about implementing psilocybin-assisted therapy in palliative care for existential distress? A World Café qualitative study.

OBJECTIVES: Promising studies show that psilocybin-assisted therapy relieves existential distress in patients with serious illnesses, a difficult condition to treat with current treatment options. There is growing interest in this therapy in palliative care. Canada recently amended its laws to allow physicians to request psilocybin for end-of-life distress. However, barriers to access remain. Since implementing psilocybin-assisted therapy within palliative care depends on the attitudes of healthcare providers willing to recommend it, they should be actively engaged in the broader discussion about this treatment option. We aimed (1) to identify issues and concerns regarding the acceptability of this therapy among palliative care professionals and to discuss ways of remedying them and (2) to identify factors that may facilitate access. METHODS: A qualitative study design and World Café methodology were adopted to collect data. The event was held on April 24, 2023, with 16 palliative care professionals. The data was analyzed following an inductive approach. RESULTS: Although participants were interested in psilocybin-assisted therapy, several concerns and needs were identified. Educational and certified training needs, medical legalization of psilocybin, more research, refinement of therapy protocols, reflections on the type of professionals dispensing the therapy, the treatment venue, and eligibility criteria for treatment were discussed. SIGNIFICANCE OF RESULTS: Palliative care professionals consider psilocybin-assisted therapy a treatment of interest, but it generates several concerns. According to our results, the acceptability of the therapy and the expansion of its access seem interrelated. The development of guidelines will be essential to encourage wider therapy deployment.

Understanding non-pharmacological palliative care for people with serious COPD: the individual and organizational perspective.

TOPIC IMPORTANCE: This narrative review emphasizes the growing interest in palliative care for people with serious lung diseases, such as COPD. It reflects upon recent publications from the American Thoracic Society (ATS), the World Health Organization (WHO) and European Respiratory Society (ERS) with a focus on non-pharmacological palliative care for people with COPD, from both the healthcare professional and the organizational perspective. REVIEW FINDINGS: The concept of palliative care has changed over time and is now seen as applicable throughout the whole disease trajectory according to need, in conjunction with any disease-modifying therapies. Palliative care should pay attention to the needs of the person with COPD as well as the informal caregiver. Timely integration of palliative care with disease-modifying treatment requires assessment of needs at the individual level as well as organizational changes. High-quality communication, including advance care planning is a cornerstone of palliative care. SUMMARY: Therefore, services should be based on the understanding that palliative care is not just specific standardized actions and treatments, but a holistic approach that includes compassionate communication and treatment and care addressing the patient, informal and formal caregivers. Living with and dying from COPD is much more than objective measurements. It is the sum of relationships with others and the experience of living in the best possible harmony with one's own values and hopes despite having a serious illness.

Psychosocial Impact of Brain Tumors: A Cross-Sectional Study on Existential Anxiety in Saudi Arabian Patients.

Background Existential anxiety is a significant concern for patients with life-threatening illnesses like brain tumors. This study explores the prevalence and impact of existential anxiety among brain tumor patients in Saudi Arabia, examining relationships between demographic, clinical, and psychological variables and death anxiety. Methods A cross-sectional study was conducted with 120 brain tumor patients from inpatient and outpatient settings at King Abdulaziz University Hospital, King Fahad Hospital, and King Abdullah Medical Complex in Saudi Arabia. Data were collected using the Death Anxiety Scale (DAS), Spiritual Well-Being Scale (SWBS), Meaning in Life Questionnaire (MLQ), and the 12-item Short Form Survey (SF-12). Descriptive and inferential statistics analyzed the relationships between variables. Results Females exhibited significantly higher DAS scores (77.9 ± 14.2) compared to males (48.5 ± 19.4) (p < 0.001). Educational attainment was inversely related to DAS, with illiterate patients scoring highest (83 ± 13.5) and those with higher education scoring lowest (47.3 ± 18.2) (p < 0.001). Widowed patients had higher anxiety (68.5 ± 22.1) compared to married (51.4 ± 21.5) and single patients (50 ± 12) (p < 0.001). Monthly income showed an inverse relationship with DAS. Patients with chronic medical conditions reported lower DAS scores compared to those without (p = 0.004). The tumor stage significantly influenced DAS, with third-stage patients showing lower anxiety than those in the first and second stages (p < 0.001). Longer duration since diagnosis was associated with lower DAS scores (p = 0.03). Conclusion This study highlights the significant psychosocial impact of brain tumors on Saudi Arabian patients, emphasizing the need to address demographic factors in managing death anxiety. Findings indicate that chronic medical conditions and advanced tumor stages might be associated with lower anxiety, revealing potential resilience factors. The positive influence of spiritual well-being and meaning in life on quality of life underscores the importance of holistic care approaches. Integrating psychological and spiritual support tailored to individual patient demographics could enhance management strategies and improve patient outcomes. Future research should explore longitudinal changes in existential anxiety, the role of cultural factors, and the effectiveness of holistic interventions in reducing anxiety and improving quality of life.

Psilocybin-Assisted Therapy for Brain Cancer Related Existential Distress: A Case-Report.

Introduction: Psilocybin-assisted therapy (PAT) has gained traction in palliative care as a treatment for existential distress in the last decade. Patients with brain cancer have been excluded from studies, yet they stand to benefit as much as other patients with cancer-related psychological distress. Case description: In this report, we discuss the case of a patient with end-of-life distress secondary to stage 4 astrocytoma that received PAT through Health Canada's Special Access Program. The patient had a positive response to PAT without adverse events. Discussion: Standard treatment for existential distress is often inefficacious and PAT is rarely available, especially for patients with brain cancer. We highlight the importance of making PAT more available as many patients with unresolved existential distress resort to medical assistance in dying without ever knowing of the existence of PAT. Conclusion: PAT was effective in partially alleviating the patient's existential distress. Access to PAT needs to be expanded urgently.

Searching for meaning and purpose in elite sport: A narrative review of sport psychology literature with theoretical insights from psychology.

Athletes' stories about their experiences in elite sport inevitably evoke the notion of meaning, a concept, which has appeared in many shapes and forms within sport psychology. Qualitative scholarship, for example, has generated a large literature base on the meaning of experience (i.e., implicit meaning) in elite sport. However, the experience of meaning(fulness) (i.e., existential meaning) has received less scholarly attention and has rarely been the explicit study object. To assist theorizing and the empirical investigation of meaning and purpose in elite sport in these early stages, we take stock of the emerging body of literature in sport psychology. The article has three parts: Firstly, we distinguish between implicit and existential meaning to delineate our study object. Secondly, we introduce psychological theory to show how existential meaning can be conceptualized (e.g., dimensions, sources, crisis of meaning). Thirdly, we analyzed 23 studies in a narrative review approach to understand how meaning (n = 17) and purpose (n = 6) in elite sport have been understood, and what we know about these concepts empirically. The current scholarship revealed itself heterogenous in terms of study designs, methodologies, theoretical frameworks, and conceptualizations of meaning and purpose. Findings are discussed in eight overarching themes (e.g., moments when meaning and purpose are questioned; as mechanism and indicator of growth following adversity) to map the reviewed literature comprehensibly and to provide a foundation for applied work. The article concludes by highlighting unresolved issues and proposing future directions for studying and applying existential meaning in elite sport.

Excruciating existential suffering and complicated grief: The essence of surviving the suicide of a son or daughter.

BACKGROUND: Suicide is the fourth most common cause of death for the 15-29 age group. Research on the impact of suicide on parents is scarce and, therefore, poorly understood. AIM: To explore parents' experiences who have lost a son or a daughter due to suicide and their experience of the services available to them. METHODS: This phenomenological study involved 1-2 interviews with ten parents aged 40-65, seven mothers and three fathers in all 13 interviews. The age range of their sons and daughters was 17-37 years when they died. RESULTS: For the parents, losing a son or a daughter to suicide is an overwhelming life experience characterised by Excruciating existential suffering and complicated grief where they are confronted with deep meaning-making and existential questions without answers since the person who can answer most of them is no longer alive. They, therefore, felt stuck in their grief for up to 4 years. The initial experience was an immense paralysing shock and sense of unreality. The subsequent period was a blur, and they were numb. Then, their psyche and bodies collapsed, and for a long time, they felt no grief processing was taking place. They sorely needed long-term professional trauma-informed support and felt that, in too many cases, they had to reach out for help themselves. They would have liked to see the healthcare system embrace them with more open arms, offer help and be met with information and individualised support. CONCLUSIONS: Standard operating procedures must be installed to support suicide-bereaved parents better. Long-term professional support and trauma-focused care are required following such major trauma, and providing such support could help to reduce their adverse health impacts. Nurses and other health professionals must be better educated on existential suffering in this context.

To Talk or not to Talk About Existential Questions - An Interview Study With Elderly Persons and Patients With Fatal Disease.

Background: Existential experiences often come to the fore in the case of a severe and/or life-threatening disease and in old age. This can evoke a variety of thoughts and emotions. The existential dimension is a concept that encompasses spiritual, religious and secular perspectives. Objective: The aim of this study was to gain a deeper understanding of how patients describe the existential dimension of life and whether and in what way the existential questions are raised in conversations and other forms of support within care. Methods: A qualitative design, with in-depth semi-structured interviews with patients admitted to an out-clinic oncology department at one hospital and participants living in a nursing home. The interviews were analysed using qualitative content analysis. Results: A total of 15 persons were interviewed. The respondents varied in age from 44 to 96. Two main themes emerged: What are existential questions? and Talk about existential questions. The existential questions refer to life as a whole and death as an end of life. It was summarized into three subcategories: The experience of the life, Existing within context and Spirituality and religion. About half of the participants thought it was important to talk about existential questions. They wanted to choose who to talk to, when and about what. Support was received from loved ones, professionals and experiences beyond conversations. Conclusions: The study provide new knowledge of how patients and elderly experience the existential dimension. The respondents emphasized a desire to be selective with whom they shared these questions and thoughts.

Psilocybin-assisted psychotherapy for existential distress: practical considerations for therapeutic application-a review.

Existential distress is commonly experienced by patients diagnosed with a life-threatening illness. This condition has been shown to adversely impact quality of life and is correlated with increased suicidal ideation and requests for hastened death. While palliative care teams are experienced in treating depression and anxiety, existential distress is a distinct clinical condition for which traditional medications and psychotherapy approaches demonstrate limited efficacy or duration of effect. Psychedelic drugs, including psilocybin and lysergic acid diethylamide (LSD), in conjunction with psychotherapy have been shown to produce rapid and sustained reductions in existential and psychiatric distress and may be a promising treatment for patients facing existential distress in palliative care settings. In this narrative review article, we describe the history of psychedelic medicine including early studies and the modern wave of research over the past 20 years, which includes high quality clinical trial data. This review outlines specific considerations for therapeutic application of psilocybin including pharmacokinetics, patient selection, dosing, protocol designs, and safeguards to reduce potential adverse effects to help guide future psychedelic practitioners. With growing public interest and evolving state level policy reforms allowing access to psychedelic treatments, it is critical for palliative care providers to gain familiarity with the current state of science and the potential of psilocybin assisted psychotherapy in the treatment of existential distress.

Understanding post-hospitalised patients' experiences of long-COVID - the PELCO study.

Despite significant advances in long COVID research, many aspects of the condition remain unknown. There is a persisting need for further research to improve the management of long COVID symptoms. This study aimed to explore the experiences and psychological needs of patients who were previously hospitalised with COVID-19, and who subsequently developed long COVID symptoms. Twelve patients with long COVID were interviewed between October 2021 and June 2022. Transcripts were analysed thematically. An overarching theme of 'Existential Crisis' was developed, incorporating three interconnecting sub-themes: 'Facing Psychological Threat', 'Seeking Legitimisation' and 'Forging a Path Through Uncertainty'. Findings suggest that the psychological impact of emergency hospitalisation for COVID-19 can be severe, particularly for those with ongoing long COVID symptoms, and that early psychological intervention should be available. Our findings also suggest the importance of further planning for future pandemics to ensure the presence of patient advocates during hospitalisation at points of critical decision-making.

Death Anxiety in Patients With Advanced Cancer and Their Family Caregivers.

CONTEXT: Death anxiety is associated with fears of suffering and uncertainty at the end of life. It is also relevant to patients' family caregivers, who can experience fears about the patients' death and dying. OBJECTIVES: This study investigates the prevalence of death anxiety in advanced cancer patients and their family caregivers and its association with sociodemographic and medical characteristics. METHODS: We recruited patients with UICC stage IV solid tumors from in- and outpatient oncology and palliative care settings. We administered the Death and Dying Distress Scale to assess clinically significant death anxiety. We analyzed its association with sociodemographic and medical characteristics using simultaneous multiple linear regression analyses. RESULTS: Death anxiety was prevalent in 37% of patients (N = 481) and 75% of family caregivers (N = 140). Most frequent death anxiety concerns were "feeling distressed about the impact of one's own death on loved ones" (52% of patients) and "feeling distressed about running out of time with their loved one" (69% of family caregivers). Patients who experienced high death anxiety were more likely to be younger (standardized ß = -0.1; P=0.005) and have known about their diagnosis for less time (standardized ß = -0.1; P=0.046). Being female predicted higher death anxiety in patients (ß = 0.12; P=0.041) and family caregivers (ß = 0.32; P=0.002). CONCLUSION: The results indicate that death anxiety is a common, clinically significant problem in patients with advanced cancer and their family caregivers, emphasizing the need for targeted psychological support.

Existential Needs in Mental Health - Who Cares? A Mixed Methods Study in Norway.

Mental health care that is open to patients' existential needs requires well-trained professionals who work in teams and use an open conceptualization of spirituality, religion and other meaning-making domains. Using a mixed methods approach, this article explores how professionals (n = 262) in secular Norway perceive obstacles and opportunities in existential care. The results show correlations between age group, personal religiosity, terminology and perceived expertise. Commitment is high, but collaboration with chaplains and team training are neglected.

"It doesn't Always Have to Be an Expert": Professionals' Perceptions of Practical Aspects of the Existential Dimension of Care for People Approaching Death.

'Existential' can be seen as a broad term for issues surrounding people's experiences and way of thinking about life. This study examined availability of existential care and found that many different staff categories performed existential care. Existential care is associated with conversations and experienced as both easy and difficult; several factors were cited, e.g. insufficient time, stress and the difficulty of addressing existential questions for oneself. Respondents reported need for education, guidance and reflection around existential issues and care. Existential care is described as a natural part of patient care that all professional categories have a responsibility to offer.

E-consultation as existential media: Exploring doctor-patient 'digital thrownness' in Danish general practice.

In this article we use an existential media framework to explore the asynchronous, written and digital form of GP-patient communication that takes place through e-consultations in a Danish general practice context. This approach acknowledges e-consultation as more than a tool for information delivery and frames GP and patient not as skilful media users but as dependent co-existers: Both thrown into and trying to navigate the digital healthcare ecology. Through a thematic analysis of 38 semi-structured qualitative interviews with patients and GPs we carve out three themes unpacking the existential dimensions of e-consultation: 1. Patient and GP are placed in a Culture of non-stop connectivity and we show the ambivalences arising herein fostering both relief, reassurance and new insecurities. 2. Ethical challenges of responsible co-existence points to dilemmas of boundary setting and caring for self and co-exister in the digital encounter. 3. We-experiences illustrates the potential of e-consultation to signal GP presence, even when the GP is silent. We also discuss the existential ethics of care emerging from the contemporary digital healthcare ecology and call for empirically grounded studies of the existential dimensions tied to encounters in contemporary digital care infrastructures.

Strategies of coping with existential concerns in educationally active older adults.

OBJECTIVES: Old age is the stage of life when people are the most vulnerable to existential experience. These concerns intensify in late adulthood when individuals become increasingly prone to reflection and inclined to evaluate their lives. The study aimed to explore how older people who are active learners dealt with their existential concerns. METHOD: The study was based on the qualitative approach and grounded theory. The data collection methods were narrative interviews and semi-structured interviews. Eighteen interviews were conducted. The narrators were students of Universities of the Third Age. RESULTS: An in-depth analysis of the collected empirical material revealed three themes that helped us understand how study participants differentiated their ways of dealing with self-perception of aging, effectiveness, and performing developmental tasks. This also allowed us to distinguish three main strategies educationally active older adults used to cope with existential concerns: repression, escape, and engagement. CONCLUSION: The study's results indicate that confrontation or avoidance of existential problems can be perceived as a factor contributing to developing an older person's identity in two different ways. On the one hand, the readiness to face existential concerns leads to maturity in old age, a high level of social adaptation, supporting others, and, at the same time, focusing on oneself while ignoring existential concerns, which may contribute to held age identities that are younger than actual age.

Life-Suspending Technologies, Cryonics, and Catastrophic Risks.

I defend the claim that life-suspending technologies can constitute a catastrophic and existential security factor for risks structurally similar to those related to climate change. The gist of the argument is that, under certain conditions, life-suspending technologies such as cryonics can provide self-interested actors with incentives to efficiently tackle such risks-in particular, they provide reasons to overcome certain manifestations of generational egoism, a risk factor of several catastrophic and existential risks. Provided we have reasons to decrease catastrophic and existential risks such as climate change, we also have a (defeasible) reason for investing in developing and making life-suspending technologies (more) widespread.

Relational vulnerability in motherhood-an existential perspective on pain and exhaustion among women.

Introduction: Stress-related ill-health like pain and exhaustion are demanding public health problems in Europe. In Sweden, women are particularly at risk to develop stress-related ill-health during a period in life that coincides with child-rearing years. When entering motherhood, Swedish women's sick leave substantially increases. Yet, motherhood is rarely acknowledged in clinical encounters concerning pain and exhaustion although women suffer from these ailments more often than men. To incorporate motherhood as an existential dimension of health in the care of women living with pain and exhaustion might alleviate women's suffering. But knowledge on women's experiences of motherhood and health is scarce. Therefore, the aim of the study is to reach a deeper understanding of how women suffering from long-lasting pain and exhaustion experience their health in relation to motherhood. Methods: Ricoeur's interpretation theory has been applied to analyze 27 phenomenological interviews with 14 mothers suffering from long-lasting pain and exhaustion. Results: These women's experiences shed light on how closely motherhood is interwoven with the experience of their health and suffering: The women's suffering seems to be rooted in a relational vulnerability that has been uncovered during motherhood. Further, the women suffer from a burden of difficult life experiences and inner conflicts. Reconciliation with life is possible when women find an existential shelter, which offers ways to relate to their suffering making the own suffering more bearable.

The Spiritual Dimension of Parents' Experiences Caring for a Seriously Ill Child: An Interview Study.

BACKGROUND: Parents of children with life-threatening conditions may have to balance their personal, family, and professional lives in the anticipation of child loss and the demands of providing medical care for their child. The challenges these parents are confronted with may lead to specific care needs. In this paper we explore the spiritual dimension of caring for a child with a life-threatening condition from the parents perspective. METHODS: We held an exploratory qualitative study with in-depth interviews with parents of children (0-21) with life-threatening conditions. Interviews were transcribed and subsequently thematically analyzed. RESULTS: Twenty-four parents of 21 children participated in the interviews. The spiritual dimension is an important, although not always visible, aspect of the experience of parents dealing with their child's illness. The main domains with regard to spirituality were: 1) identity; 2) parenthood; 3) connectedness; 4) loss or adjustment of goals; 5) agency; 6) navigating beliefs and uncertainties; and 7) decision-making. Parents also reflected on their spiritual care needs. CONCLUSION: The spiritual dimension plays a central role in the experiences of parents who care for children with life-threatening conditions, but they receive little support in this dimension, and care needs often go unnoticed. If we want to provide high-quality pediatric palliative care including adequate spiritual support for parents, we should focus on the wide range of their spiritual experiences, and provide support that focuses both on loss of meaning as well as on where parents find growth, joy or meaning.