Espiritualidade, saúde e suas aplicações práticas: desenvolvimento do Programa de Saúde, Espiritualidade e Religiosidade: Aplicações práticas

This paper describes the development and reporting of ProSER - Spirituality and Religiousness Health Program’s experiences. ProSER was founded in 2008 to promote broader attention to spiritual and religious needs in health context, as well as to produce and disseminate knowledge at the health, spirituality and religiosity interface for academic centers and health institutions. This study aims to describe the trajectory and performance of ProSER in the areas of training, research and care. ProSER's work has promoted changes in health care mindset through its assistance modalities, as well as the dissemination of knowledge to other health professionals and academic centers, through scientific articles, classes and courses.presente trabalho descreve o desenvolvimento e relato de experiências do Programa de Saúde Espiritualidade e Religiosidade – ProSER. O ProSER foi implantado em 2008, com a finalidade de promover uma atenção mais ampla às necessidades espirituais e religiosas no contexto de saúde, bem como produzir e difundir conhecimento na interface saúde, espiritualidade e religiosidade para centros acadêmicos e instituições de saúde. Esse estudo tem como objetivo descrever a trajetória e atuação do ProSER nas áreas de ensino, pesquisa e assistência. A atuação do ProSER tem promovido mudanças nos cuidados em saúde, por meio de suas modalidades de assistência, além da disseminação de conhecimento para outros profissionais de saúde e centros acadêmicos, através de trabalhos científicos e cursos

Concepts of spirituality and measurement instruments: an overview

Objetivo: Investigar as definições de espiritualidade e os instrumentos de sua mensuração na área da saúde, identificando suas principais dimensões e propondo uma estrutura que operacionalize a compreensão desse conceito. Métodos: Foi realizado um levantamento etimológico sobre os termos espírito e spirit e duas revisões sistemáticas da literatura, uma que buscou as definições e outra, os instrumentos de mensuração de espiritualidade, publicados em periódicos científicos. As buscas foram realizadas na base de dados PubMed e nas referências bibliográficas dos artigos encontrados na base de dados, seguidas de seleção segundo os critérios de elegibilidade. Resultados: No levantamento etimológico foram encontrados 9 termos associados a espírito, agrupados por proximidade semântica. Na revisão sobre definições, de um total de 493 artigos encontrados, 166 foram incluídos na análise final, mostrando que existe um grande corpo de literatura científica propondo e analisando definições de espiritualidade. Nestes artigos, foram identificadas 24 dimensões da espiritualidade, sendo que as mais frequentes estão relacionadas à sensação de conexão e ao sentido da vida. A espiritualidade foi descrita como um aspecto humano e individual. Essas descobertas nos levaram a propor uma representação de estrutura conceitual que explicita as relações entre as dimensões ligadas ao conceito de espiritualidade. Na revisão sobre os instrumentos de mensuração, um total de 481 instrumentos foi encontrado, dos quais 81 foram incluídos na análise final, entre instrumentos voltados para a abordagem na prática clínica e na pesquisa. As dimensões de espiritualidade mais acessadas foram experiências, práticas e crenças, seguidas pelas dimensões de conexão com o divino e com outros/ comunidade. Conclusões: Há uma pluralidade de conceitos de espiritualidade que não refletem diretamente o que é avaliado pelos instrumentos, já que esses, em sua maioria, trazem a perspectiva ocidental e cristã; assim não foi encontrado um instrumento que avalie todas as dimensões de espiritualidade levantas. O olhar segmentado para esses instrumentos também permite avaliar uma possível necessidade de criar outras formas de mensuração, para abranger as dimensões ainda não abordadas. Espera-se que o presente trabalho auxilie um melhor entendimento da complexidade desse tema, onde avanços são desejáveis haja vista a relevância que tem adquirido para o cuidado integral em saúdeObjective: To investigate the definitions of spirituality and the instruments for its measurement in the health area, identifying its main dimensions and proposing a framework that operationalizes the understanding of this concept. Methods: An etymological survey was carried out on the terms espírito and spirit and two systematic literature reviews, one that sought definitions and the other, the instruments for measuring spirituality, published in scientific journals. Searches were performed in the PubMed database and in the bibliographic references of the articles found in the database, followed by selection according to the eligibility criteria. Results: In the etymological survey, 9 terms were found associated with spirit, grouped by semantic proximity. In the review of definitions, from a total of 493 articles found, 166 were included in the final analysis, showing that there is a large body of scientific literature proposing and analyzing definitions of spirituality. In these articles, 24 dimensions of spirituality were identified, the most frequent being related to the feeling of connection and the meaning of life. Spirituality was described as a human aspect and personal. These discoveries led us to propose a framework that explains the relationships between the dimensions linked to the concept of spirituality. In the review of measurement instruments, a total of 481 instruments were found, of which 81 were included in the final analysis, among instruments aimed at addressing clinical practice and research. The most accessed dimensions of spirituality were experiences, practices and beliefs, followed by the dimensions of connection with the divine and with others/community. Conclusions: There is a plurality of concepts of spirituality that do not directly reflect what is evaluated by the instruments, as these, for the most part, bring a Western and Christian perspective; thus, an instrument that assesses all the dimensions of spirituality raised was not found. The segmented look at these instruments also allows us to assess a possible need to create other forms of measurement, to cover dimensions that have not yet been addressed. It is hoped that the present work will help to better understand the complexity of this topic, where advances are desirable, given the relevance it has acquired for integral health car

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)