Complementary religious and spiritual interventions in physical health and quality of life: A systematic review of randomized controlled clinical trials

<div><p>Objective</p><p>To examine whether religious and spiritual interventions (RSIs) can promote physical health and quality of life in individuals.</p><p>Methods</p><p>The following databases were used to conduct a systematic review: PubMed, Scopus, Web of Science, EMBASE, PsycINFO, Cochrane, and Scielo. Randomized controlled trials that evaluated RSIs regarding physical health outcomes and/or quality of life in English, Spanish or Portuguese were included. RSI protocols performed at a distance (i.e. intercessory prayer) or for psychiatric disorders were excluded. This study consisted of two phases: (a) reading titles and abstracts, and (b) assessing the full articles and their methodological quality using the Cochrane Back Review Group scale.</p><p>Results</p><p>In total, 7,070 articles were identified in the search, but 6884 were excluded in <i>phase</i> 1 because they were off topic or repeated in databases. Among the 186 articles included in <i>phase</i> 2, 140 were excluded because they did not fit the inclusion criteria and 16 did not have adequate randomization process. Thus, a final selection of 30 articles remained. The participants of the selected studies were classified in three groups: chronic patients (e.g., cancer, obesity, pain), healthy individuals and healthcare professionals. The outcomes assessed included quality of life, physical activity, pain, cardiac outcomes, promotion of health behaviors, clinical practice of healthcare professionals and satisfaction with protocols. The divergence concerning scales and protocols proposed did not allow a meta-analysis. RSIs as a psychotherapy approach were performed in 40% of the studies, and the control group was more likely to use an educational intervention (56.7%). The results revealed small effect sizes favoring RSIs in quality of life and pain outcomes and very small effects sizes in physical activity, promotion of health behaviors and clinical practice of health professionals compared with other complementary strategies. Other outcomes, such as cardiac measures and satisfaction with the protocols, revealed no evidence for RSIs. Regarding the quality of the selected articles according to the Cochrane Back Review Group Scale, the average score was 6.83 (SD = 9.08) on a scale of 11, demonstrating robustness in the studies.</p><p>Conclusion</p><p>Clinical trials on RSIs demonstrated that they had small benefits compared with other complementary health therapies by reducing pain and weight, improving quality of life and promoting health behaviors. The lack of clinical trials that included biological outcomes and the diversity of approaches indicate a need for more studies to understand the possible mechanisms of action of RSIs and their roles in health care.</p></div

Using traditional or flipped classrooms to teach “Geriatrics and Gerontology”? Investigating the impact of active learning on medical students’ competences

<p><b>Background:</b> The present study aims to investigate the effect of two educational strategies to teach geriatrics (flipped classroom-FL and traditional lectures-TR) in relation to a control group (no intervention) on students’ competences.</p> <p><b>Method:</b> An intervention study was conducted during the third year of medicine. Two different educational strategies (flipped classroom and traditional lectures) were incorporated into a theoretical–practical discipline of geriatrics. Students were evaluated about their attitudes towards older persons (Maxwell–Sullivan, UCLA geriatric attitudes), empathy (Maxwell–Sullivan), knowledge (Palmore and cognitive knowledge), skills (standardized patient assessment), and satisfaction with the activities.</p> <p><b>Results:</b> A total of 243 students were assessed. The FL group demonstrated greater gains in knowledge among students and improved attitude compared to the TR. We found no differences in the skills using a standardized patient. In addition, students exposed to FL felt more prepared to treat older people, believed they had more knowledge, were more satisfied, and evaluated the discipline’s format better in relation to the traditional group.</p> <p><b>Conclusions:</b> Strategies in teaching geriatrics can impact students’ knowledge, attitudes, and satisfaction with the course. We found that the way this teaching is delivered can influence students’ learning, since there were differences between active and traditional strategies.</p

Flowchart of study selection.

<p>Flowchart of study selection.</p

Characteristics of religious and spiritual interventions in weight and activity outcomes.

<p>Characteristics of religious and spiritual interventions in weight and activity outcomes.</p

Flowchart of guidelines to create a religious/spiritual intervention.

<p>Flowchart of guidelines to create a religious/spiritual intervention.</p

Assessment of the methodological items evaluated on Cochrane classification.

<p>Assessment of the methodological items evaluated on Cochrane classification.</p

Effect of an educational intervention in “spirituality and health” on knowledge, attitudes, and skills of students in health-related areas: A controlled randomized trial

<p><b>Background:</b> To date there have been no randomized studies that assess whether “Spirituality and Health” (S/H) programs are, indeed, effective, or not. We sought to evaluate if an intervention in teaching S/H fosters competence changes in healthcare students.</p> <p><b>Methods:</b> A randomized controlled trial was carried out. Students were randomized into two groups: an Intervention Group (a theoretical-practical course in S/H) and a control group (waiting list). Students’ S/H knowledge, attitudes, and skills (through a simulated patient) were assessed.</p> <p><b>Results:</b> A total of 49 students were evaluated. Students in the intervention group received higher scores on knowledge tests, felt more comfortable and prepared to talk about religious/spiritual beliefs with patients, more readily recognized importance of hospital chaplains, and more frequently held the opinion that addressing spirituality is important. Furthermore, a breaking down of S/H barriers was identified. Students also demonstrated more ability in obtaining a patient’s spiritual history when compared to the control group.</p> <p><b>Conclusions:</b> There were some differences on knowledge, attitudes, and spiritual history skills between students who participated in the S/H teaching strategy and students who have not been exposed to the theme. These results might foster discussion for the development of new educational strategies about the subject.</p

Burnout among medical students during the first years of undergraduate school: Prevalence and associated factors

<div><p>Objective</p><p>To evaluate the prevalence and possible factors associated with the development of burnout among medical students in the first years of undergraduate school.</p><p>Method</p><p>A cross-sectional study was conducted at the Barretos School of Health Sciences, Dr. Paulo Prata. A total of 330 students in the first four years of medical undergraduate school were invited to participate in responding to the sociodemographic and Maslach Burnout Inventory-Student Survey (MBI-SS) questionnaires. The first-year group consisted of 150 students, followed by the second-, third-, and fourth-year groups, with 60 students each.</p><p>Results</p><p>Data from 265 students who answered at least the sociodemographic questionnaire and the MBI-SS were analyzed (response rate = 80.3%). One (n = 1, 0.3%) potential participant viewed the Informed Consent Form but did not agree to participate in the study. A total of 187 students (187/265, 70.6%) presented high levels of emotional exhaustion, 140 (140/265, 52.8%) had high cynicism, and 129 (129/265, 48.7%) had low academic efficacy. The two-dimensional criterion indicated that 119 (44.9%) students experienced burnout. Based on the three-dimensional criterion, 70 students (26.4%) presented with burnout. The year with the highest frequency of affected students for both criteria was the first year (p = 0.001). Personal attributes were able to explain 11% (ΔR = 0.11) of the variability of burnout under the two-dimensional criterion and 14.4% (R² = 0.144) under the three-dimensional criterion.</p><p>Conclusion</p><p>This study showed a high prevalence of burnout among medical students in a private school using active teaching methodologies. In the first years of graduation, students’ personal attributes (optimism and self-perception of health) and school attributes (motivation and routine of the exhaustive study) were associated with higher levels of burnout. These findings reinforce the need to establish preventive measures focused on the personal attributes of first-year students, providing better performance, motivation, optimism, and empathy in the subsequent stages of the course.</p></div

Prevalence of burnout syndrome among medical students according to the subscales of the <i>Maslach Burnout Inventory Student Survey</i> (MBI-SS) (n = 265).

<p>Prevalence of burnout syndrome among medical students according to the subscales of the <i>Maslach Burnout Inventory Student Survey</i> (MBI-SS) (n = 265).</p

Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

Background: Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings: In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation: Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation