Instruments Measuring Spirituality in Clinical Research: A Systematic Review

ABSTRACT: INTRODUCTION: Numerous instruments have been developed to assess spirituality and measure its association with health outcomes. This study's aims were to identify instruments used in clinical research that measure spirituality; to propose a classification of these instruments; and to identify those instruments that could provide information on the need for spiritual intervention. METHODS: A systematic literature search in MEDLINE, CINHAL, PsycINFO, ATLA, and EMBASE databases, using the terms "spirituality" and "adult$," and limited to journal articles was performed to identify clinical studies that used a spiritual assessment instrument. For each instrument identified, measured constructs, intended goals, and data on psychometric properties were retrieved. A conceptual and a functional classification of instruments were developed. RESULTS: Thirty-five instruments were retrieved and classified into measures of general spirituality (N = 22), spiritual well-being (N = 5), spiritual coping (N = 4), and spiritual needs (N = 4) according to the conceptual classification. Instruments most frequently used in clinical research were the FACIT-Sp and the Spiritual Well-Being Scale. Data on psychometric properties were mostly limited to content validity and inter-item reliability. According to the functional classification, 16 instruments were identified that included at least one item measuring a current spiritual state, but only three of those appeared suitable to address the need for spiritual intervention. CONCLUSIONS: Instruments identified in this systematic review assess multiple dimensions of spirituality, and the proposed classifications should help clinical researchers interested in investigating the complex relationship between spirituality and health. Findings underscore the scarcity of instruments specifically designed to measure a patient's current spiritual state. Moreover, the relatively limited data available on psychometric properties of these instruments highlight the need for additional research to determine whether they are suitable in identifying the need for spiritual intervention

Simple rules for an efficient use of geographic information systems in molecular ecology

Geographic Information Systems (GIS) are becoming increasingly popular in the context of molecular ecology and conservation biology thanks to their display options efficiency, flexibility and management of geodata. Indeed, spatial data for wildlife and livestock species is becoming a trend with many researchers publishing genomic data that is specifically suitable for landscape studies. GIS uniquely reveal the possibility to overlay genetic information with environmental data and, as such, allow us to locate and analyze genetic boundaries of various plant and animal species or to study gene-environment associations (GEA). This means that, using GIS, we can potentially identify the genetic bases of species adaptation to particular geographic conditions or to climate change. However, many biologists are not familiar with the use of GIS and underlying concepts and thus experience difficulties in finding relevant information and instructions on how to use them. In this paper, we illustrate the power of free and open source GIS approaches and provide essential information for their successful application in molecular ecology. First, we introduce key concepts related to GIS that are too often overlooked in the literature, for example coordinate systems, GPS accuracy and scale. We then provide an overview of the most employed open-source GIS-related software, file formats and refer to major environmental databases. We also reconsider sampling strategies as high costs of Next Generation Sequencing (NGS) data currently diminish the number of samples that can be sequenced per location. Thereafter, we detail methods of data exploration and spatial statistics suited for the analysis of large genetic datasets. Finally, we provide suggestions to properly edit maps and to make them as comprehensive as possible, either manually or trough programming languages

The spiritual distress assessment tool: an instrument to assess spiritual distress in hospitalised elderly persons

BACKGROUND: Although spirituality is usually considered a positive resource for coping with illness, spiritual distress may have a negative influence on health outcomes. Tools are needed to identify spiritual distress in clinical practice and subsequently address identified needs. This study describes the first steps in the development of a clinically acceptable instrument to assess spiritual distress in hospitalized elderly patients. METHODS: A three-step process was used to develop the Spiritual Distress Assessment Tool (SDAT): 1) Conceptualisation by a multidisciplinary group of a model (Spiritual Needs Model) to define the different dimensions characterizing a patient's spirituality and their corresponding needs; 2) Operationalisation of the Spiritual Needs Model within geriatric hospital care leading to a set of questions (SDAT) investigating needs related to each of the defined dimensions; 3) Qualitative assessment of the instrument's acceptability and face validity in hospital chaplains. RESULTS: Four dimensions of spirituality (Meaning, Transcendence, Values, and Psychosocial Identity) and their corresponding needs were defined. A formalised assessment procedure to both identify and subsequently score unmet spiritual needs and spiritual distress was developed. Face validity and acceptability in clinical practice were confirmed by chaplains involved in the focus groups. CONCLUSIONS: The SDAT appears to be a clinically acceptable instrument to assess spiritual distress in elderly hospitalised persons. Studies are ongoing to investigate the psychometric properties of the instrument and to assess its potential to serve as a basis for integrating the spiritual dimension in the patient's plan of care

Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factor

Background and aims: Falls efficacy has been shown to predict functional decline, but whether it is independently associated with frailty is still unclear. This study investigated the cross-sectional association between falls efficacy and the frailty pheno-type in high-functioning older persons. Methods: Subjects (n=861) were a sub-sample of community-dwelling persons aged 65 to 70 years enrolled in the "Lc65+” cohort, who had gait assessment. Data included demographics, functional, cognitive, affective and health status, as well as measures of physical performance. Falls efficacy was measured with the Falls Efficacy Scale-International (FES-I) and frailty with Fried's criteria. Participants were categorized into robust (no frailty criterion) and vulnerable (1 or more criteria). Low falls efficacy was defined as a FES-I score in the lowest quartile. Results: Overall, 23.9% of participants were vulnerable. Compared with robust participants, they were more likely to report low falls efficacy (43.3% vs 19.1%, p<0.001) and had poorer health and functional and mental status. They had slower gait speed (1.07±0.18 vs 1.15±0.15 m/s, p<0.001) and increased gait speed variability (coefficient of variation 4.10±4.03 vs 3.33±1.45%, p<0.001), although only 6 participants (0.7%) fulfilled Fried's slow walking criterion. In multivariate analysis, low falls efficacy remained associated with being vulnerable (adjusted OR 1.80, 95%, CI 1.19-2.74, p=0.006), independent of comorbidity, functional status, falls history and gait performance. Conclusion: In high-functioning older persons, low falls efficacy was associated with vulnerability, even after controlling for gait performance and falls history. Whether low falls efficacy is a potential target on the pathway leading to frailty should be further examined prospectivel

Impact of the urbanization process on connectivity and genetic diversity - a spatially explicit simulation approach

Urbanization leads to fragmentation, degradation or loss of natural environments and reduces connectivity between remaining habitat patches. This affects dispersal and establishment of species and their genes and might have adverse effects on biodiversity in urban areas. Here we assess functional connectivity between green spaces for one plant (Plantago major) and one insect (Pieris rapae) model species in the Geneva urban area. We also estimate the impact of future urbanization projects planned until 2030 in Geneva (constructions and road projects) on the connectivity network. We show that the connectivity between small green spaces in the urban centres and larger ones in peripheral areas is fragile and unstable. Potential barriers to dispersal for the study species are mainly buildings, roads, but also large areas of forests, crops and vineyards. Furthermore and based on spatially explicit simulations of gene flow, we test how the distribution of genetic variation among populations along rural-urban gradients is affected by urban landscape elements. We compare these results to empirically observed population responses of the butterfly species P. rapae in the region of Marseille, France. For different dispersal scenarios and taking into account the effect of future intensification of urbanization, results show a decrease in genetic diversity in areas characterized by medium to high urban densities. In order to conserve and promote genetically stable and diverse populations, it is therefore important to maintain or increase landscape connectivity, especially between green spaces in dense urban centres and those in more natural peripheral areas

Spatial Areas of Genotype Probability of Cattle Genomic Variants Involved in the Resistance to East Coast Fever: A Tool to Predict Future Disease-Vulnerable Geographical Regions

East Coast Fever (ECF) is a livestock disease caused by Theileria parva, a protozoan transmitted by the vector tick Rhipicephalus appendiculatus. This disease causes high mortality in cattle populations of Central and Eastern Africa, especially in exotic breeds. Here, we highlight genomic regions likely involved into tolerance/resistance mechanisms against ECF, and we introduce the estimation of their Spatial Area of Genotype Probability (SPAG) to delimit areas where the concerned genotypes are predicted to be present. During the NEXTGEN project, 803 Ugandan cattle were geo-referenced and genotyped (54K SNPs), while 532 tick occurrences were retrieved from a published database. To get a proxy of the parasite selective pressure, we used WorldClim bioclimatic variables to model vector ecological niche. Landscape genomics models were then used to detect cattle genotypes associated with vector probability of presence, and to estimate their SPAGs. Finally, climate change scenarios for 2070 were considered to compare the predicted shift in the vector niche with the estimated current SPAG. The analysis revealed two main areas of presence of possibly resistance-related genotypes, one South and one East of Lake Victoria. Climate change will probably shift tick niche southwards in the Eastern regions of Lake Victoria, inducing a critical area that currently does not show the candidate genotypes, but where disease will likely spread in the future. The combined use of SPAGs and niche maps could therefore facilitate the identification of regions of concern and to direct future targeted breeding schemes

Effect of climate change on the spatial distribution of genomic variants involved in the resistance to East Coast Fever in Ugandan cattle

East Coast Fever (ECF) is a major livestock disease caused by Theileria parva Theiler, 1904, an emo-parasite protozoan transmitted by the tick Rhipicephalus appendiculatus Neumann, 1901. This disease provokes high mortality in cattle populations of East and Central Africa, especially in exotic breeds and crossbreds (Olwoch et al., 2008). Here, we use landscape genomics (Joost et al., 2007) to highlight genomic regions likely involved into tolerance/resistance mechanisms against ECF, and we introduce Spatial Areas of Genotype Probability (SPAG) to delimit territories where favourable allelic variants are predicted to be present. Between 2010 and 2012, the NEXTGEN project (nextgen.epfl.ch) carried out the geo-referencing and genotyping (54K SNPs) of 803 Ugandan cattle, among which 496 were tested for T. parva presence. Moreover, 532 additional R. appendiculatus occurrences were obtained from a published database (Cumming, 1998). Current and future values of 19 bioclimatic variables were also retrieved from the WorldClim database (www.worldclim.org/). In order to evaluate the selective pressure of the parasite, we used MAXENT (Phillips et al., 2006; Muscarella et al., 2014) and a mixed logistic regression (Bates et al., 2014) to model and map the ecological niches of both T. parva and R. appendiculatus. Then, we used a correlative approach (Stucki et al., 2014) to detect molecular markers positively associated with the resulting probabilities of presence and built the corresponding SPAG. Finally, we considered bioclimatic predictors representing two different climate change scenarios for 2070 - one moderate and one severe - to forecast the simultaneous shift of both SPAG and vector/pathogen niches. While suitable ecological conditions for T. parva are predicted to remain constant, the best environment for the vector is predicted around Lake Victoria. However, when considering future conditions, parasite occurrence is expected to decrease because of the contraction of suitable environments for the tick in both scenarios. Landscape genomics’ analyses revealed several markers significantly associated with a high probability of presence of the tick and of the parasite. Among them, we found the marker ARS-BFGL-NGS-113888, whose heterozygous genotype AG showed a positive association. Interestingly, this marker is located close to the gene IRAK-M, an essential component of the Toll-like receptors involved in the immune response against pathogens (Kobayashi et al., 2002). If the implication of this gene into resistance mechanisms against ECF is confirmed, the corresponding SPAG (Figure 1) represents either areas where the variant of interest shows a high probability to exist now, or areas where ecological characteristics are the most favorable to induce its presence under future climatic conditions. Beyond the results presented here, the combined use of SPAG and niche maps could help identifying critical geographical regions that do not present the favourable genetic variant in the present, but where a parasite is likely to expand its range in the future. This may represent a valuable tool to support the identification of current resistant populations and to direct future targeted crossbreeding schemes

Biodiversity dynamics and the effect of urban environment on the distribution of genetic variation in the Geneva cross-border area

Population growth, urbanization and agriculture lead to degradation and loss of natural environment. This has an adverse effect on the diversity of habitats, species and genes and might cause decline in the quality of life of the resident population. In this context and in the densely populated Geneva cross-border area, we study biodiversity dynamics and the effect of the environment on the distribution of genetic variation (URBANGENE project). We use genetic information of three model species (a plant, an insect and an amphibian) in combination with environmental and landscape data to evaluate their potential to disperse and adapt to urban environments. Based on a representative population survey, we further investigate how urban residents perceive their quality of life with a local biodiversity perspective, compared with health data measured in the same areas. Using genome-wide SNP data, we assessed genome-environment associations for Plantago major, a synanthropic plant, in order to obtain information on its ability to disperse among habitats and to adapt to the urban environment. Butterfly (Pieris rapae) and amphibian model species (Bufo bufo) will be sampled in 2015. As regards the amphibians, we developed a WebGIS participatory platform, making it possible for Geneva residents to indicate the geographic location of amphibian habitats on an interactive map, and to transmit information on the species they observed in this area. The integration of results from this interdisciplinary project should allow for a more sustainable urban development and a better conservation and management of biodiversity in urban areas

Relationship between land cover type and Body Mass Index in Geneva

Past studies conducted in urban areas analyzed the impact of the presence of green spaces on public health, and highlighted in particular the psychological benefits of interacting with nature. To investigate a supposed relationship between overweight and dense built environment, we focused on the State of Geneva, Switzerland, and calculated the correlation between Body Mass Index (BMI) in a representative sample of 6663 adults and the percentage of natural areas at the locations where these individuals were living. To this end, we used populationbased health data from the “Bus Sante” study (Geneva University Hospitals) and multi-scale land cover maps obtained by means of satellite images and LiDAR data classification. We found little correlation between BMI (as a proxy for health) and land cover data and were not able to verify the working hypothesis at local and regional scales. However, an important phenomenon highlighted here is the difference in the results obtained between the city center and the whole State