Religion, Spirituality, and Health Service Use by Older Hospitalized Patients

Background: Religious and spiritual beliefs and practices are common among medical inpatients, and may impact length of hospital stay (LOS) and other health services (HSU) during hospitalization. Methods: 812 consecutively admitted patients age 50 or over to Duke University Medical Center were assessed. Measures of religiousness and spirituality included religious TV/radio (RTV), self-rated religiousness (SRR), observer-rated spirituality (ORS), and daily spiritual experiences (DSE). The primary outcome was LOS. Results: RTV and SRR predicted longer LOS, whereas ORS and DSE predicted shorter LOS (p 0.05). Effects of RTV onLOS were stronger among women, but explained by worse health status. The effects of DSE on LOS were stronger among non-whites. Among those reporting high DSE, diagnostic tests and total procedures also tended to be less common. Conclusions: Religious activities, attitudes, and spiritual experiences are weak predictors of LOS and HSU during hospitalization. Whether the prediction is positive or negative depends on the religious or spiritual characteristic.     

The treatment of adolescents and their families in cultural transition: Issues and recommendations

Increasing numbers of immigrant families with adolescent children are seeking therapy because of intergenerational conflicts specific to the adolescent separation-individuation phase of the life cycle and transitional problems related to immigration and cultural transition. Three types of adolescent immigrants are identified and discussed: Immigrants (subtypes Reluctants and Optimists), Immigrant-Americans, and Americans. Therapists' issues which can negatively affect therapy with such adolescents and families are also discussed. Effective therapy with immigrant families requires that family therapists become more culturally sensitive, therapeutically flexible, and accepting of family values to which they may be diametrically opposed. Recommendations for therapy are offered.Dr. Baptiste is himself an immigrant. The experiences and observations discussed here are culled from his work with immigrant families and children over the past 19 years in the District of Columbia, Massachusetts, Indiana, and New Mexico.Portions of this article will appear in a chapter Psychotherapy with adolescent immigrants and their families in cultural transition in B. Settles and D. Hanks (Eds.),Families on the move: Emigration, immigration, migration and mobility. Sage Publications, 1990, and are used here with permission.     

Desire for euthanasia or physician-assisted suicide in palliative cancer care.

OBJECTIVE: To investigate the attitudes of terminally ill individuals toward the legalization of euthanasia or physician-assisted suicide (PAS) and to identify those who would personally desire such a death. DESIGN: In the Canadian National Palliative Care Survey, semistructured interviews were administered to 379 patients who were receiving palliative care for cancer. Patients who expressed a desire for physician-hastened death were followed prospectively. MAIN OUTCOME MEASURES: Attitudes toward the legalization of euthanasia or PAS were determined, as was the personal interest in receiving a hastened death. Demographic and clinical characteristics were also recorded, including a 22-item structured interview of symptoms and concerns. RESULTS: There were 238 participants (62.8%) who believed that euthanasia and/or PAS should be legalized, and 151 (39.8%) who would consider making a future request for a physician-hastened death. However, only 22 (5.8%) reported that, if legally permissible, they would initiate such a request right away, in their current situations. This desire for hastened death was associated with lower religiosity (p=.010), reduced functional status (p=.024), a diagnosis of major depression (p<.001), and greater distress on 12 of 22 individual symptoms and concerns (p<.025). In follow-up interviews with 17 participants, 2 (11.8%) showed instability in their expressed desire. CONCLUSION: Among patients receiving palliative care for cancer, the desire to receive euthanasia or PAS is associated with religious beliefs; functional status; and physical, social, and psychological symptoms and concerns. Although this desire is sometimes transitory, once firmly established, it can be enduring.     

Prevention education and substance abuse treatment

Relapse prevention is influenced by a number of variables including stress and negative mood states, motivation and commitment to abstinence, social support, physiological factors, withdrawal symptoms, and a repertoire of cognitive and behavioral strategies utilized in responding to the relapse process. Diverse theoretical approaches have emphasized conditioning models as well as information processing, cognitive and affective components of treatment, cognitive and behavioral coping responses, and a variety of other procedures. Outcome studies related to treatment have failed to consistently support the effectiveness of several of these components. To overcomes this, the authors advocate a single subject design in the study of these approaches. This article emphasizes the role of relapse prevention, and training and education in facilitating long-term abstinence, particularly with those intervention methods that are based on social learning theory and cognitive-behavioral models.     

The degree of similarity of differentiation of self between partners in married and dating couples: Preliminary evidence

Bowen's differentiation of self construct is examined through a test in two studies of the hypothesis that people select partners at similar levels of differentiation of self. One study used a sample of married couples and the other a sample of dating and engaged couples. The studies used different instruments for determining differentiation of self. Three data analysis procedures—correlations, t-tests, and the degree of similarity procedure—provided conflicting evidence for the similarity hypothesis. Results are discussed as they pertain to statistical analysis issues using related individuals and to Bowen family systems theory and the use of this theory in clinical practice.     

Untangling the Links between Narcissism and Self‐esteem: A Theoretical and Empirical Review

The links among narcissism, explicit (deliberate, controllable) self‐esteem, and implicit (automatic, uncontrollable) self‐esteem are unclear despite numerous attempts to illuminate these links. Some investigations suggest that narcissism reflects high explicit self‐esteem that masks low implicit self‐esteem, but other investigations fail to replicate this pattern. Here, we place the ‘mask’ model of narcissism in historical context and review the existing empirical evidence for this model. We then discuss three possible issues that might shed light on the inconsistent findings that have emerged from tests of the mask model. These issues include the unreliability of implicit attitude measures, narcissism's different associations with agentic versus communal self‐views, and distinctions between grandiose and vulnerable narcissism subtypes. We also summarize several alternatives to the mask model of narcissism. Throughout, we offer suggestions for improving the study of narcissism and self‐esteem and point to directions for future research on this topic.     

Tracking the mind during reading via eye movements: comments on Kliegl, Nuthmann, and Engbert (2006)

R. Kliegl, A. Nuthmann, and R. Engbert reported an impressive set of data analyses dealing with the influence of the prior, present, and next word on the duration of the current eye fixation during reading. They argued that outcomes of their regression analyses indicate that lexical processing is distributed across a number of words during reading. The authors of this comment question their conclusions and address 4 different issues: (a) whether there is evidence for distributed lexical processing, (b) whether so-called parafoveal-on-foveal effects are widespread, (c) the role of correlational analyses in reading research, and (d) problems in their analyses because they use only cases in which words are fixated exactly once.