Daniela Rodrigues Recchia

Iyengar-Yoga Compared to Exercise as a Therapeutic Intervention during (Neo)adjuvant Therapy in Women with Stage I–III Breast Cancer: Health-Related Quality of Life, Mindfulness, Spirituality, Life Satisfaction, and Cancer-Related Fatigue

This study aims to test the effects of yoga on health-related quality of life, life satisfaction, cancer-related fatigue, mindfulness, and spirituality compared to conventional therapeutic exercises during (neo)adjuvant cytotoxic and endocrine therapy in women with breast cancer. In a randomized controlled trial 92 women with breast cancer undergoing oncological treatment were randomly enrolled for a yoga intervention (YI) (n = 45) or for a physical exercise intervention (PEI) (n = 47). Measurements were obtained before (t 0) and after the intervention (t 1) as well as 3 months after finishing intervention (t 2) using standardized questionnaires. Life satisfaction and fatigue improved under PEI (p < 0.05) but not under YI (t 0 to t 2). Regarding quality of life (EORTC QLQ-C30) a direct effect (t 0 to t 1; p < 0.001) of YI was found on role and emotional functioning, while under PEI only emotional functioning improved. Significant improvements (p < 0.001) were observed at both t 1 and t 2 also for symptom scales in both groups: dyspnea, appetite loss, constipation, and diarrhea. There was no significant difference between therapies for none of the analyzed variables neither for t 1 nor for t 2. During chemotherapy, yoga was not seen as more helpful than conventional therapeutic exercises. This does not argue against its use in the recovery phase.

Work stress associated cool down reactions among nurses and hospital physicians and their relation to burnout symptoms

BackgroundHospital staff experience high level of work stress and they have to find strategies to adapt and react to it. When they perceive emotional exhaustion and job dissatisfaction in response to constant work stress, one reaction might be emotional withdrawal. This emotional distancing can be seen as an adaptive strategy to keep ‘functionality’ in the job. Both, perception of emotional exhaustion and emotional distancing as a strategy, can be operationalized as ‘Cool Down’. We assume that work stress associated variables are positively associated with Cool Down reactions, while internal and external resources are negatively associated and might function as a buffer against emotional distancing. Moreover, we assume that the perception of stress and work burden might be different between nurses and physicians and women and men, but not their cool down reactions as a strategy.MethodsAnonymous cross-sectional survey with standardized instruments among 1384 health care professionals (66% nurses, 34% hospital physicians). Analyses of variance, correlation and also stepwise regression analyses were performed to analyze the influence of demands and resources on Cool Down reactions.ResultsAs measured with the Cool Down Index (CDI), frequency and strength of Cool Down reactions did not significantly differ between women and men, while women and men differ significantly for their burnout symptoms, stress perception and perceived work burden. With respect to profession, Cool Down and stress perception were not significantly different, but burnout and work burden. For nurses, “Emotional Exhaustion” was the best CDI predictor (51% explained variance), while in physicians it was “Depersonalization” (44% explained variance). Among putative resources which might buffer against Cool Down reactions, only team satisfaction and situational awareness had some influence, but not self-efficacy expectation.ConclusionThe perceptions of emotional exhaustion and distancing of nurses and physicians (and women and men) seems to be different, but not their adaptive Cool Down reactions. Data would support the notion that a structural approach of support would require first to control and eliminate work stressors, and second a multifaceted approach to strengthen and support hospital staff’s resources and resilience.

Ausdrucksformen der Spiritualität bei Schülern und jungen Erwachsenen

Zusammenfassung Bei 2.468 Schülern (18 ± 2 Jahre) sollten Ausdrucksformen der Spiritualität (ASP) mit Hilfe des ASP-Fragebogens erhoben werden. Im Vordergrund stand die Frage, welche Themenbereiche für sie von Bedeutung sind und welche Zusammenhänge mit sozialem Verhalten und Engagement bestehen. Betrachtet man die Ausprägung der ASP-Faktoren, so zeigte der Faktor Bewusster Umgang / Mitgefühl hohe Zustimmungs-Scores, Suche nach Weisheit / Einsicht und Transzendenz-Überzeugung eher moderate Scores, während die Zustimmungs-Scores für Religiöse Überzeugungen eher gering waren. Da zu vermuten ist, dass bestimmte spirituelle Haltungen und Einstellungen auch gesellschaftlich relevante Auswirkungen haben, wurden korrelative Zusammenhänge mit ethischem Verhalten sowie Engagement für andere untersucht. Hierbei zeigte sich, dass alle ASP-Faktoren, aber insbesondere die Religiöse Orientierung, moderat mit einer nach ethischen Normen ausgerichteten Lebensweise assoziiert sind. Das ehrenamtliche Engagement für andere war moderat nur mit Religiöser Orientierung und Bewusstem Umgang / Mitgefühl, das per se keine dezidiert religiöse Konnotation hat und somit auch für a-religiöse Personen bedeutsam ist, assoziiert.

Attitudes and Behaviors Related to Franciscan-Inspired Spirituality and Their Associations with Compassion and Altruism in Franciscan Brothers and Sisters

In Christian tradition there are many different ‘schools’ of spirituality which address an ‘inner transformation’ referring to an individual experience of the Sacred. The focus of this study was to examine the ‘core’ component of Franciscan spirituality (life according to the Gospel) and the ‘transformative’ components (living with and for others in need and respectful commitment to the creation) in a group of brothers and sisters of the Franciscan family. In particular, the reflection on how this spirituality is connected with the perception of the divine in daily life, with feelings of awe and subsequent gratitude on the one hand and compassion and altruistic behavior on the other, was an essential aspect of the present work. Data from a cross-sectional study with standardized instruments among 388 Franciscan brothers and sisters (mean age 61 ± 25 years) showed that “Living from the Faith” and “Seeking God in Silence and Prayer” scored highest, followed by “Commitment to the Creation” and interpersonal factors such as “Peaceful Attitude/Respectful Treatment” and “Commitment to the Disadvantaged”. In all cases, women achieved significantly higher scores than men (with values of F between 5.3 and 23.5, p 5.0, p < 0.0001). With regard to the prosocial ‘outcomes’ (e.g., Compassion and Altruism), stepwise regression analyses showed that Compassion was best predicted by “Peaceful Attitude/Respectful Treatment” and Gratitude/Awe (both explain 27% of variance), and Altruism was best predicted by “Commitment to the Disadvantaged” and Gratitude/Awe (both explain 21% of variance). Mediator analyses with the standardized z-factor values showed that Gratitude/Awe is also a significant mediator of the effects of the Perception of the Divine (as a further significant predictor of prosocial behaviors) on Compassion (beta = 0.05 ± 0.02, p < 0.01) and Altruism (beta = 0.03 ± 0.02, p = 0.04). Surprisingly, “Commitment to the Disadvantaged” was only weakly linked to “Living from the Faith”. It could be shown that “Living from the Faith” was much more connected to Compassion as an intention rather than to Altruism as an action. “Living from the Faith”, as the fundamental aspect of Franciscan spirituality, mediated the effect of the Perception of the Divine on Compassion (beta = 0.08 ± 0.03, p < 0.01) and Altruism (beta = 0.06 ± 0.03, p = 0.04), as well as mediating the effect of Gratitude/Awe on Compassion (beta = 0.07 ± 0.02, p < 0.01) and Altruism (beta = 0.06 ± 0.02, p < 0.01). However, there are significant differences between more contemplative and charitably engaged Franciscans; “Living from the Faith” scored highest in contemplative brothers and sisters within the different branches of Franciscan orders when compared to more charitably engaged persons, while their “Commitment to the Disadvantaged” was significantly lower. These differences could also be ascribed to the different charisms and missions of the Franciscan branches.

Complementary and alternative therapies in dentistry and characteristics of dentists who recommend them

OBJECTIVES The aims of this study were to analyse whether dentists offer or recommend complementary and alternative medicine (CAM) remedies in their clinical routine, and how effective these are rated by proponents and opponents. A second aim of this study was to give a profile of the dentists endorsing CAM. DESIGN A prospective, explorative, anonymised cross-sectional survey was spread among practicing dentists in Germany via congresses, dental periodicals and online (n=250, 55% male, 45% female; mean age 49.1±11.4years). RESULTS Of a set of 31 predefined CAM modalities, the dentists integrated plant extracts from Arnica montana (64%), chamomile (64%), clove (63%), Salvia officinalis (54%), but also relaxation therapies (62%), homeopathy (57%), osteopathic medicine (50%) and dietetics (50%). The effectiveness of specific treatments was rated significantly higher (p<0.0001) by CAM proponents than opponents. However also CAM opponents classified some CAM remedies as highly effective, namely ear acupuncture, osteopathic medicine and clove. For ear acupuncture these scores did not significantly differ between both groups. With respect to the characteristic of the proponents, the majority of CAM endorsing dentists were women. The mean age (50.4±0.9 vs 47.0±0.9years) and number of years of professional experience (24.2±1.0 vs 20.0±1.0years) were significantly higher for CAM proponents than the means for opponents (p<0.0001 respectively). CAM proponents worked significantly less (p<0.0001) and their perceived workload was significantly lower (p=0.008). Their self-efficacy expectation (SEE) and work engagement (Utrecht work engagement, UWE) were significantly higher (p≤0.01 and p<0.0001) compared to dentists who abandoned these treatment options. The logistic regression model showed (exploratively) an increased association from CAM proponents with the UWES subscale dedication, with years of experience, and that men are less likely to be CAM proponents than women. CONCLUSION Various CAM treatments are recommended by German dentists and requested by their patients, but the scientific evidence for these treatments are often low or at least unclear. CAM proponents are often female, have higher SE and work engagement.

Surprise, p-value, s-value and a diagnostic procedure to detect not informative experiments

In this paper, examples of diverse measures of significance are studied in the frame of Neyman-Pearson hypothesis tests. A diagnostic procedure is proposed, to detect non informative experiments where the p-value procedure might fail to measure the significance of the outcome of an experiment.