Giancarlo Lucchetti

Validation of the Duke Religion Index: DUREL (Portuguese version).

The purpose of the current study was to examine the psychometric properties of the Portuguese version of the Duke Religion Index (PDUREL) in a community setting. PDUREL was translated and adapted for administration to 383 individuals from a population-based study of low-income community-dwelling adults. The PDUREL intrinsic subscale and total scores demonstrated high internal consistency (alphas ranging from 0.733 for the total scale score to 0.758 for the intrinsic subscale). Correlations among the DUREL subscales were also examined for evidence of discriminant validity. Correlations were ranging from 0.36 to 0.46, indicating significant overlap between the scales without marked redundancy. PDUREL is a reliable and valid scale. The availability of a comprehensive, but brief measure of religiousness can help to study the role of religiousness in health by researchers from countries that speak the Portuguese language.

Religiousness affects mental health, pain and quality of life in older people in an outpatient rehabilitation setting.

OBJECTIVES To evaluate the relationship between religiousness and mental health, hospitalization, pain, disability and quality of life in older adults from an outpatient rehabilitation setting in Sao Paulo, Brazil. DESIGN Cross-sectional study. SUBJECTS/PATIENTS A total of 110 patients aged 60 years or older were interviewed during attendance at an outpatient rehabilitation service. METHODS Researchers administered a standardized questionnaire that assessed socio-demographic data, religiousness, self-reported quality of life, anxiety, physical activity limitation, depression, pain and cognition. Predictors were included in each model analysis, and a backward conditional method was used for variable selection using logistic regression (categorical outcomes) or linear regression (continuous outcomes). RESULTS Thirty-one patients (28.2%) fulfilled criteria for significant depressive symptoms, 27 (24.5%) for anxiety, and 10 (9.6%) for cognitive impairment. Pain was present in 89 (80.7%) patients. Limited depressive symptoms (as assessed by the Geriatric Depression Scale), and greater self-reported quality of life were related to greater self-reported religiousness, as were scores on the Mini-Mental State Examination (less cognitive impairment), and lower ratings of pain. CONCLUSION Religiousness is related to significantly less depressive symptoms, better quality of life, less cognitive impairment, and less perceived pain. Clinicians should consider taking a spiritual history and ensuring that spiritual needs are addressed among older patients in rehabilitation settings.

Clinical implications of spirituality to mental health: review of evidence and practical guidelines

OBJECTIVE Despite empirical evidence of a relationship between religiosity/spirituality (R/S) and mental health and recommendations by professional associations that these research findings be integrated into clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment. METHODS PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice. RESULTS The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH), which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility. CONCLUSIONS This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic.

Impact of Spirituality/Religiosity on Mortality: Comparison With Other Health Interventions

Scientists have been interested in the influence of religion on mortality for at least 130 years. Since this time, many debates have been held by researchers who believe or do not believe in this association. The objective of this study is to compare the impact of spirituality and religiosity (S/R) with other health interventions on mortality. The authors selected 25 well-known health interventions. Then, a search of online medical databases was performed. Meta-analyses between 1994 and 2009 involving mortality were chosen. The same was done for religiosity and spirituality. The combined hazard ratio was obtained directly by the systematic reviews and the mortality reductions by S/R and other health interventions were compared. Twenty-eight meta-analyses with mortality outcomes were selected (25 health interventions and three dealing with S/R). From these three meta-analyses, considering those with the most conservative results, persons with higher S/R had an 18% reduction in mortality. This result is stronger than 60.0% of the 25 systematic reviews analyzed (similar to consumption of fruits and vegetables for cardiovascular events and stronger than statin therapy). These results suggest that S/R plays a considerable role in mortality rate reductions, comparable to fruit and vegetable consumption and statin therapy.

Spirituality, Religion, and Health: Over the Last 15 Years of Field Research (1999–2013)

Objective: Although several studies have examined the contribution of specific countries, journals, and authors in different scientific disciplines, little is known about the contribution of different world countries, journals, and authors to scientific research in the field of “Spirituality, religion, and health” (S/R). The present study aims to analyze the last 15 years of research in the field of spirituality and religiousness (S/R) through a bibliometric analysis. Methods: Using the Pubmed database, we retrieved all articles related to S/R field for the period 1999–2013. We then estimated the total number of publications, number of articles published per year, articles published per country, journals with most publications in S/R field, most productive authors, and most used keywords. Results: We found a growth of publications in the last years, most from the United States and the United Kingdom and published in the English language. Noteworthy, some developing countries such as India, Brazil, Israel, and Iran are at higher positions in this list. The S/R articles were published in journals embracing all fields of research, including high impact journals. Conclusion: In the present study, we took a closer look at the field of “Spirituality, religion, and health,” showing that this field of research has been constantly growing and consolidating in the scientific community.

Spirituality in Medical Education: Global Reality?

We aim to evaluate studies dealing with the incorporation of spirituality in medical education and to list the most scientific productive countries in this field. A bibliographical review was carried out. The final sample comprised 38 articles, which were divided into sub-topics for a clearer description. From these articles, 31 (81.5%) were provided by US medical schools, 3 (7.8%) by Canadian medical schools and 4 (10.5%) from other countries. The studies in this review indicate a predominance of studies related to health/medicine and spirituality in US and Canadian medical schools. New studies outside North America are needed in order to address what is being taught, whether courses are evaluated and what is the student and faculty opinions regarding this educational topic in multiple cultures.

Coping Strategies in Chronic Pain

Patients with chronic pain need strategies to manage their pain and its impact, also known as coping. Coping is not restricted to one dimension of functioning; it involves virtually every dimension of human functioning: cognitive, affective, behavioral, and physiological. We review the literature on coping strategies for chronic pain, including concept and types of coping (eg, religious, social, psychological), as well as coping-with-pain questionnaires, studies available, other topics of interest, interventions to enhance coping with pain, and future directions in this field.

Spirituality and health in the curricula of medical schools in Brazil

BackgroundAccording to recent surveys, 59% of British medical schools and 90% of US medical schools have courses or content on spirituality and health (S/H). There is little research, however, on the teaching of S/H in medical schools in other countries, such as those in Latin America, Asia, Australia and Africa. The present study seeks to investigate the current status of teaching on S/H in Brazilian medical schools.MethodsAll medical schools in Brazil (private and public) were selected for evaluation, were contacted by email and phone, and were administered a questionnaire. The questionnaire, sent by e-mail, asked medical school directors/deans about any S/H courses that were taught, details about those courses, S/H lectures or seminars, importance of teaching this subject for medical school directors, and medical schools characteristics.ResultsA total of 86 out of 180 (47.7%) medical schools responded. Results indicated that 10.4% of Brazilian Medical Schools have a dedicated S/H courses and 40.5% have courses or content on spirituality and health. Only two medical schools have S/H courses that involve hands-on training and three schools have S/H courses that teach how to conduct a spiritual history. The majority of medical directors (54%) believe that S/H is important to teach in their schools.ConclusionFew Brazilian medical schools have courses dealing specifically with S/H and less than half provide some form of teaching on the subject. Unfortunately, there is no standard curriculum on S/H. Nevertheless, the majority of medical directors believe this issue is an important subject that should be taught.

Taking Spiritual History in Clinical Practice: A Systematic Review of Instruments

BACKGROUND To facilitate the addressing of spirituality in clinical practice, several authors have created instruments for obtaining a spiritual history. However, in only a few studies have authors compared these instruments. The aim of this study was to compare the most commonly used instruments for taking a spiritual history in a clinical setting. METHODS A systematic review of spiritual history assessment was conducted in five stages: identification of instruments used in the literature (databases searching); relevant articles from title and initial abstract review; exclusion and Inclusion criteria; full text retrieval and final analysis of each instrument. RESULTS A total of 2,641 articles were retrieved and after the analysis, 25 instruments were included. The authors independently evaluated each instrument on 16 different aspects. The instruments with the greatest scores in the final analysis were FICA, SPIRITual History, FAITH, HOPE, and the Royal College of Psychiatrists. Concerning all 25 instruments, 20 of 25 inquire about the influence of spirituality on a persons life and 17 address religious coping. Nevertheless, only four inquire about medical practices not allowed, six deal with terminal events, nine have mnemonics to facilitate their use, and five were validated. CONCLUSIONS FICA, SPIRITual History, FAITH, HOPE, and Royal College of Psychiatrists scored higher in our analysis. The use of each instrument must be individualized, according to the professional reality, time available, patient profile, and settings.

Fatores associados à polifarmácia em idosos institucionalizados

INTRODUCTION: Polypharmacy is an important issue in the elderly care. The ones under institutionalization have higher risks, due to their comorbidities, frailty and dependency. This study aims to evaluate the factors associated with polypharmacy in institutionalized elderly. METHODS: A retrospective, crosssectional study was carried out. All medical charts of patients aged 60 years old or more in a huge public nursing home were evaluated. A protocol containing socio-demographic data, number and types of diseases, number of drugs, types of drugs, functional status and time of institutionalization were analyzed. Through statistical analysis, these factors were linked or not to polypharmacy. RESULTS: The final sample comprised 209 patients, 73.2% women, average age of 75.9 years and with an institutionalized time of 95.3 months. The most prevalent diseases were: arterial hypertension - 67.9%, dementia - 36.8% and stroke or head trauma sequelae - 33.9%. In this study, the associated factors related to polypharmacy in nursing home residents were: lack of cognitive deficit, (OR=3,61 - IC: 1,96-6,65), use of cardiovascular drugs (OR=0,22 - IC: 0,11-0,44), use of gastrointestinal and metabolic drugs(OR=0,38 - IC: 0,21-0,67), five or more diagnosis (OR=1,90 - IC: 1,08-3,33), institutionalized time between 12 and 23 months (OR:0,32 - IC: 0,11- 0,91) and greater dependency in Katz scale (OR: 1,90 - IC:1,07-3,22). There were no relationship with age, sex, psychiatric drugs and diagnosis of stroke or head trauma sequelae. CONCLUSION: It follows that institutionalized elderly have different aspects as compared to outpatients or community, with major factors related to functionality and time of institutionalization than to age and sex.