Mind, Body, and Spirit: Family Physicians’ Beliefs, Attitudes, and Practices Regarding the Integration of Patient Spirituality into Medical Care

This study used a qualitative approach to explore family physicians’ beliefs, attitudes, and practices regarding the integration of patient spirituality into clinical care. Participants included family medicine residents completing training in the Southwest USA. The qualitative approach drew upon phenomenology and elements of grounded-theory. In-depth interviews were conducted with each participant. Interviews were recorded, transcribed and coded using grounded-theory techniques. Four main themes regarding physicians’ attitudes, beliefs, and practices were apparent from the analyses; (1) nature of spiritual assessment in practice, (2) experience connecting spirituality and medicine, (3) personal barriers to clinical practice, and (4) reflected strengths of an integrated approach. There was an almost unanimous conviction among respondents that openness to discussing spirituality contributes to better health and physician–patient relationships and addressing spiritual issues requires sensitivity, patience, tolerance for ambiguity, dealing with time constraints, and sensitivity to ones “own spiritual place.” The residents’ voices in this study reflect an awareness of religious diversity, a sensitivity to the degree to which their beliefs differ from those of their patients, and a deep respect for the individual beliefs of their patients. Implications for practice and education are discussed.Michael M. Olson, Ph.D., is a member of the Department of Family Medicine, University of Texas Medical Branch in Galveston.M. Kay Sandor, Ph.D., R.N., is in the School of Nursing.Victor Sierpina, M.D., is in the Department of Family Medicine.Harold Vanderpool, Ph.D., Th.M., represents the Institute for Medical Humanities at the university and Patricia Dayao, M.A., is a graduate student there.Funding for this study provided in part by the John G. and Marie Stella Kenedy Foundation and the George Washington Institute for Spirituality and Health/John Templeton Foundation. Correspondence to Michael M. Olson, mmolson@utmb.edu.     

Subdirectly Irreducible Residuated Semilattices and Positive Universal Classes

CRS(fc) denotes the variety of commutative residuated semilattice-ordered monoids that satisfy (x ⋀ e)^k ≤ (x ⋀ e)^k+1. A structural characterization of the subdi-rectly irreducible members of CRS(k) is proved, and is then used to provide a constructive approach to the axiomatization of varieties generated by positive universal subclasses of CRS(k). Dedicated to the memory of Willem Johannes Blok     

Developing a Framework for Assessing Responsible Conduct of Research Education Programs

Education in the responsible conduct of research (RCR) in the United States has evolved over the past decade from targeting trainees to including educational efforts aimed at faculty and staff. In addition RCR education has become more focused as federal agencies have moved to recommend specific content and to mandate education in certain areas. RCR education has therefore become a research-compliance issue necessitating the development of policies and the commitment of resources to develop or expand systems for educating faculty and staff and for assuring compliance. These changes implied the need to develop a program evaluation model that could be applied to institutional RCR education programs, which were expected to differ from traditional academic credit-bearing courses targeting trainees. Information gleaned from the examination of corporate compliance models was analyzed in order to create a program evaluation module that could be used to document and assess educational programs focused on teaching RCR. A programmed series of questions for each of the nine RCR content areas identified by the United States Office of Research Integrity was created based on a performance-monitoring evaluation model. The questions focus on educational goals, resources provided to support the educational efforts, educational content, content delivery, educational outcomes, compliance requirements and feedback. Answers collected in response to the questions could be used to both document and continually improve the quality of RCR educational programs through on-going formative assessment and feedback.     

PROMPTING PATRON SAFETY BELT USE AT A RESTAURANT

A reversal (ABABAB) design was used to assess the effects of a verbal prompt on safety belt use of restaurant patrons. A verbal prompt delivered by employees at the exit door resulted in an average increase of 20% in safety belt use by drivers leaving the restaurant. A previous study provided this type of antecedent immediately before supermarket patrons entered their vehicles. This effort demonstrates the effects of a verbal prompt with greater latency between the prompt and target response.     

An investigation of intra-individual variability in children with fetal alcohol spectrum disorder (FASD)

Intra-individual variability (IIV) is defined as systematic within-person variation in performance either across test sessions (e.g., test/retest performance on the same task) or in one session (e.g., variations in performance on multiple trials of a single task). Higher levels of IIV have been noted as a characteristic of neurodevelopmental disorders such as attention deficit/hyperactivity disorder? (ADHD), but IIV is yet to be investigated in fetal alcohol spectrum disorder (FASD). FASD is a term used to describe a range of conditions resulting from prenatal exposure to alcohol. As part of a comprehensive neuropsychological battery, four study groups (1. fetal alcohol syndrome/partial fetal alcohol syndrome; 2. static encephalopathy/alcohol exposed; 3. neurobehavioral disorder/alcohol exposed as diagnosed using the University of Washington FASD 4-Digit Code; 4. typically-developing (TD) age-matched children with no prenatal alcohol exposure) were administered measures of motor response and inhibitory control, attention, and adaptive behavior. The results indicate increased levels of IIV in those with FASD compared to the TD controls. It was found that IIV uniquely contributes to predicting adaptive behavior above and beyond attention, while attention partially mediates the relationship between IIV and adaptive behavior. This is the first study to the authors’ knowledge to show the presence of increased IIV in children with FASD. It additionally provides evidence that IIV measures some inherent variability in performance independent of poor attention in children with FASD.     

Early risk pathways to physical versus relational peer aggression: The interplay of externalizing behavior and corporal punishment varies by child sex

Children who aggress against their peers may use physical or relational forms, yet little research has looked at early childhood risk factors and characteristics that uniquely predict high levels of relational versus physical aggression in preadolescence. Accordingly, the main aim of our study was to link early corporal punishment and externalizing behavior to children's physical and relational peer aggression during preadolescence and to examine how these pathways differed by sex. Participants were 193, 3‐year‐old boys (39%) and girls who were reassessed following the transition to kindergarten (5.5 years) and preadolescence (10.5 years). A series of autoregressive, cross‐lagged path analyses were conducted to examine the relationships between child externalizing problems and corporal punishment at ages 3 and 5.5 years, and their association with physical and relational aggression at age 10.5. Multiple group analysis was used to determine whether pathways differed by sex. Three developmental pathways were identified: (i) direct associations between stable childhood externalizing problems and later physical aggression; (ii) a direct pathway from early corporal punishment to preadolescent relational and physical peer aggression; and (iii) an indirect pathway from early corporal punishment to later physical aggression via continuing externalizing problems in middle childhood. Child sex moderated the nature of these pathways, as well as the direction of association between risk and outcome variables. These data advance our understanding of the etiology of distinct forms of peer aggression and highlight the potential for more efficacious prevention and intervention efforts in the early childhood years.

     

Postpartum exuberance: Not all women in a highly positive emotional state in the postpartum period are denying depression and distress

The question addressed in this study was whether or not mothers who scored low on self-report depression scales—so-called “deniers”—were denying their symptoms and suffering from an illusion of mental health. The findings did not support the interpretation that low-scoring mothers were denying other symptoms. Rather, low-scoring mothers: 1) experienced a wide range of emotions and similar levels of positive emotions compared to mid-symptom mothers; 2) changed their reported levels of depressive symptoms over the course of the study; 3) reported a variety of symptoms at levels similar to those of mothers in the mid symptom range; and 4) were affected negatively by having a diagnosis of depression, in a manner similar to mothers in the mid and high symptom groups. Furthermore, low symptom mothers consistently reported the most positive profiles of maternal adaptation with higher levels of maternal self-esteem and a high ratio of self-reported positive to negative affect. Thus, they appeared to be experiencing a heretofore underdescribed highly positive normal postpartum state that we have labeled “postpartum exuberance.” Postpartum exuberance, as well as a compromise of affective functioning associated with any lifetime diagnosis of depression regardless of the mothers' current level of depressive symptoms, highlights the complexity of emotional reactivity during the postpartum period. © 1997 Michigan Association for Infant Mental Health