Kelly R. Morton

Traumatic experiences, major life stressors, and self-reporting a physician-given fibromyalgia diagnosis.

The contribution of stress to the pathophysiology of fibromyalgia has been the subject of considerable debate. The primary purpose of the present study was to evaluate the relationship between traumatic and major life stressors and a fibromyalgia diagnosis in a large group of older women and men. Data were from the federally funded Biopsychosocial Religion and Health Study, and subjects were 10,424 of the 10,988 survey respondents-two-thirds women and one-third men-providing responses to a fibromyalgia question. Average age was 61.0+/-13.5 years. A physician-given fibromyalgia diagnosis in a subjects lifetime was reported by 3.7% of the sample, 4.8% of the women and 1.3% of the men. In two multivariable logistic regression models (all respondents and women only, controlling for age, sex, race/ethnicity, and education), two traumatic experience types (sexual and physical assault/abuse) were associated with a fibromyalgia diagnosis. Two other trauma types (life-threatening and emotional abuse/neglect) and major life stress experiences were not. The highest odds ratios in both models were those for sexual assault/abuse followed by physical assault/abuse. The relationship between age and fibromyalgia was curvilinear in both models (odds ratios rising until approximately age 63 and declining thereafter). In the all-subjects model, being a woman increased the odds of a fibromyalgia diagnosis, and in both models, fibromyalgia was associated with being White (versus non-White) and lower education. We recommend that researchers investigate the relationship between stress and fibromyalgia in concert with genetic and biomarker studies.

Cohort profile: The biopsychosocial religion and health study (BRHS).

How did the study come about? In The Secrets of Long Life in the National Geographic Buettner explored longevity among three communities in Sardinia Italy, Okinawa Japan, and Loma Linda California. Loma Linda is largely a community of 7th-day Adventists. In 1969 initial research found that among individuals surviving past age 35 Adventist women in California lived 3.7 years longer than their counterparts and Adventist men 6.2 years longer. In a later, larger California sample the differences were even stronger—4.4 years for women and 7.3 years for men. Exercise, vegetarian diet, not smoking, eating nuts and social support have been found to predict longevity in Adventists. Yet even when these and several psychological variables are controlled church attendance still predicts greater longevity. Interest has been increasing regarding the association of both mental and physical health with religion or spirituality. There have been a number of literature reviews that have concluded that the associations of religion and health are largely positive. In fact, Hall concluded religious attendance was more cost-effective in increasing longevity than statin-type medications. While some have questioned the quality of these research conclusions and others have pointed out that the benefits or costs of religion may vary depending on the indicator of religious involvement, there is general agreement regarding the need for more and better research on the subject. Nonetheless, Hummer and his colleagues concluded there was consistent evidence that religious attendance was associated with lower mortality risk in cross-sectional and prospective studies. They also concluded there was a need for more diverse measures of religious involvement, comparison among specific subpopulations, and a better understanding of the pathways by which religion might influence health (p. 1226). It was with this goal in mind that this Biopsychosocial Religion and Health Study was developed.

Evaluation of an ethics consultation service: Patient and family perspective

PURPOSE The purpose of this study was to determine whether patients and their families found ethics consultations to be helpful and whether they were satisfied with the treatment decisions that were made in those cases where ethics consultation was requested. METHODS Interviews were conducted with each patient (or surrogate) concerning whom an ethics consultation had been provided during a 1-year period at Loma Linda University Medical Center, excepting those who met exclusion criteria. The interview was done by telephone a few weeks after hospital discharge. It included multiple choice and open-ended questions. A content analysis was done on the solicited and spontaneous comments. RESULTS Eighty-six ethics consultations were provided and interviews were completed for 56 of them (65%). Fifty-seven percent of interviewees found the ethics consultation to have been helpful, and only 4% found them to have been detrimental. Interviewees were more likely to have found the consultation helpful when they perceived that it had resulted in a significant change in treatment, and were less likely to have found it helpful when the patients were more seriously ill. In addition, 77% were satisfied with the treatment decisions made, and 11% showed some degree of dissatisfaction. CONCLUSIONS Patients and families found ethics consultation provided by clinical ethicists at Loma Linda University Medical Center to be helpful in a majority of instances, and rarely found them detrimental. Based on an analysis of their comments, we believe ethics consultations were perceived as helpful in 7 ways: increased clinical clarity, increased moral or legal clarity, motivation to do what they believe is right, facilitation of the process of decision-making, implementation of a decision, interpretation of technical language, and consolation and support.

Defining Features of Moral Sensitivity and Moral Motivation: Pathways to Moral Reasoning in Medical Students.

Kohlbergs theory of moral development explores the roles of cognition and emotion but focuses primarily on cognition. Contemporary post‐formal theories lead to the conclusion that skills resulting from cognitive‐affective integration facilitate consistency between moral judgement and moral behaviour. Rests four‐component model of moral development delineates these skills specifically. The components, moral motivation, moral sensitivity, moral reasoning and moral character, operate as multidimensional processes that facilitate moral development and subsequently promote moral behaviour. The relationships between these components have been relatively unexplored, thereby missing the opportunity to unpack the processes underlying moral growth and development. In this study, moral motivation (spirituality), moral sensitivity (post‐formal skills) and moral reasoning are operationalized to examine the mediational effects of moral sensitivity of medical students. In the complex moral environment of medical students opportunities arise to question values and develop cognitive‐affective skills, among them spirituality and post‐formal thinking which are linked to increases in post‐conventional moral reasoning. The models tested indicate that moral sensitivity mediates the relationship between moral motivation and moral reasoning.

Patient Motivations for Using Complementary and Alternative Medicine

Although use of complementary and alternative medicine (CAM) is widespread, the underlying reasons patients choose CAM are not clearly understood. Several explanatory models have been suggested, including desire for personal control, compatibility with holistic beliefs, and dissatisfaction with conventional care. Methods: The relationship between CAM use and health functional status, desire for personal control over health, holistic beliefs, spirituality, and patient satisfaction were assessed in a mailed survey of 230 family practice outpatients using validated, multi-item measures. Patients with osteoarthritis, depression, or both were compared to healthy patients. Results: Holistic health beliefs, higher spirituality scores, and lower health functional status were predictive of more CAM use. Personal control over health and satisfaction with physicians were not. Conclusion: Patients use CAM when it is consistent with their worldview and conventional care is not relieving their symptoms.

Pathways from religion to health: Mediation by psychosocial and lifestyle mechanisms.

Religiosity, often measured as attendance at religious services, is linked to better physical health and longevity though the mechanisms linking the two are debated. Potential explanations include a healthier lifestyle, increased social support from congregational members, and/or more positive emotions. Thus far, these mechanisms have not been tested simultaneously in a single model though they likely operate synergistically. We test this model predicting all-cause mortality in Seventh-day Adventists (SDAs), a denomination that explicitly promotes a healthy lifestyle. This allows the more explicit health behaviors linked to the religious doctrine (e.g., healthy diet) to be compared with other mechanisms not specific to religious doctrine (e.g., social support and positive emotions). Finally, this study examines both church activity (including worship attendance and church responsibilities) and religious engagement (coping, importance, and intrinsic beliefs). Religious engagement is more inner-process focused (vs. activity-based) and less likely to be confounded with age and its associated functional status limitations, although it should be noted that age is controlled in the present study. The findings suggest that religious engagement and church activity operate through the mediators of health behavior, emotion, and social support to decrease mortality risk. All links between religious engagement and mortality are positive but indirect through positive religious support, emotionality, and lifestyle mediators. However, church activity has a direct positive effect on mortality as well as indirect effects through religious support, emotionality, and lifestyle mediators (diet and exercise). The models were invariant by gender and for both Blacks and Whites.