Spirituality and the care of patients at the end-of-life: an essential component of care

Spirituality is an essential component of the care of patients with serious illness and those that are dying. Dame Cicely Saunders developed the hospice movement based on the biopsychosocialspiritual model of care, in which all four dimensions are important in the care of patients. Of all the models of care, hospice and palliative care recognize the importance of spiritual issues in the care of patients and their families. The National Consensus Project Guidelines for Quality Palliative Care, in the United States, provides specific recommendations about all domains of care including the spiritual domain, which is recognized as a critical component of care (The National Consensus Project for Quality Palliative Care www.nationalconsensusproject.org). Studies indicate that the majority of patients would like their spiritual issues addressed, yet find that their spiritual needs are not being met by the current system of care. Interestingly, spirituality is the one dimension that seems to get slightly less emphasis than the biopsychosocial dimensions of care. Some reasons may include the difficulty with definitions of spirituality for clinical and research purposes, the time constraints and financial burdens in the current healthcare system in the United States, and the lack of uniform training for all healthcare professionals. Yet, there are theoretical and ethical frameworks that support spiritual care as well as some educational models in spirituality and health that have been successful in medical education in the United States. Spirituality can be seen as the essential part of the humanity of all people. It is at its root, relational and thus forms the basis of the altruistic care healthcare professionals are committed to. Spirituality has to do with respecting the inherent value and dignity of all persons, regardless of their health status. It is the part of humans that seeks healing, particularly in the midst of suffering. Spiritual care models are based on an intrinsic aspect that calls for compassionate presence to patients as well as an extrinsic component where healthcare professionals address spiritual issues with patients and their loved ones. Currently in the healthcare system, evidence-base models are the criteria for practice recommendations. Yet, spirituality may not be amenable entirely to strict evidence-base criteria. As hospice and palliative care continues to develop as a field, healthcare professionals are challenged to think of ways to advocate for and include the spiritual dimension of care.     

Gender differences in predictors of late-life health insurance knowledge

For many older adults having access to affordable health care is a major concern. The present study's goal was to examine what factors were related to individuals' knowledge of late-life health insurance. A total of 131 women and 116 men (all aged 55-71) answered questions about private, Medicare, Medigap, and long-term care insurances. In addition, they answered demographic, personality, and health status questions. Results revealed that different factors are related to men's and women's knowledge of late-life health insurance options implying genderspecific educational interventions would be more effective than current educational interventions.     

Private Pensions — a Viable Alternative? Their Distributive Effects in a Comparative Perspective

Pension reforms have been on the political agenda of governments and international organizations like the OECD and the World Bank for some time. The strengthening of private elements in pension systems is often believed to intensify existing inequalities in the distribution of pensions among the population and to contribute to the marginalization of large groups of older people. This paper explores the distributive effects of private pensions on the basis of Luxembourg Income Study microdata for 12 industrialized welfare states. While confirming that private pensions indeed tend to produce specific inequalities, its results also emphasize the importance of policy factors in mitigating the distributive effects.     

CULTURAL STUDIES IN AUSTRIA

One of the two main lines of argumentation of this text turns around the idea of ‘intellectual practices’. This idea is used here to criticize the hegemony that both academic institutions and publishing industries have been exerting on representations of the idea of ‘the intellectual’. In ­addition, the idea of ‘intellectual practices’ is useful to make more visible the diversity of forms in which intellectual work informs current social practices, as well as to show that this work assumes forms not limited to writing practices. The other line of argumentation turns around the conceptual pair ‘culture and power’. This pair, explicitly or implicitly used by many intellectuals, allows the formerly mentioned reflection to be grounded in a relatively more limited universe of practices. Moreover, the reference to this pair highlights the importance of the particular set of practices that explicitly or implicitly relate to it. These practices may be characterized as simultaneously involving a cultural approach (focusing on socio-symbolic dimensions) of issues of power, and a political approach (focusing on relations of power) of the cultural (socio-symbolic) dimensions of social processes. Finally, this article also presents a critic of the idea of ‘Latin American cultural studies’, which fundamentally criticizes a de-contextualized and de-contextualizing application of certain representations of the idea of cultural studies in Latin America, as well as studies about Latin America from abroad. Such de-contextualization impoverishes the critical impulse of such an intellectual perspective, and at the same time diminishes the visibility of other significant practices in culture and power developed in Latin America.     

Consanguinity and Other Marriage Market Effects of a Wealth Shock in Bangladesh

This paper uses a wealth shock from the construction of a flood protection embankment in rural Bangladesh coupled with data on the universe of all 52,000 marriage decisions between 1982 and 1996 to examine changes in marital prospects for households protected by the embankment relative to unprotected households living on the other side of the river. We use difference-in-difference specifications to document that brides from protected households commanded larger dowries, married wealthier households, and became less likely to marry biological relatives. Financial liquidity-constrained households appear to use within-family marriage (in which one can promise ex-post payments) as a form of credit to meet up-front dowry demands, but the resultant wealth shock for households protected by the embankment relaxed this need to marry consanguineously. Our results shed light on the socioeconomic roots of consanguinity, which carries health risks for offspring but can also carry substantial benefits for the families involved.     

Gender‐specific or Common Classroom Norms? Examining the Contextual Moderators of the Risk for Victimization

We tested whether gender‐specific vs. common classroom norms were more powerful moderators of the association between a risk factor (rejection) and peer victimization among girls and boys. The participants were 1220 elementary schoolchildren from grades 4–6 (with 10–13 years of age). We compared different multilevel models including combined vs. separate regressions for boys and girls, as well as the effects of norms of the whole class, same‐sex classmates, and cross‐sex classmates. Among girls, the association between rejection and victimization was strongest in classes where bullying behavior was common, and anti‐bullying attitudes were rare among girls. Among boys, the strength of the slope of victimization on rejection could not be explained by either common or gender‐specific classroom norms, but boys' level of bullying behavior was related to overall classroom level of victimization. The findings suggest that contextual factors may contribute to victimization especially among high‐risk girls. The importance of exploring multiple levels of influence on children's social development is discussed.     

A Novel Approach to Chemical Mixture Risk Assessment—Linking Data from Population‐Based Epidemiology and Experimental Animal Tests

Humans are continuously exposed to chemicals with suspected or proven endocrine disrupting chemicals (EDCs). Risk management of EDCs presents a major unmet challenge because the available data for adverse health effects are generated by examining one compound at a time, whereas real‐life exposures are to mixtures of chemicals. In this work, we integrate epidemiological and experimental evidence toward a whole mixture strategy for risk assessment. To illustrate, we conduct the following four steps in a case study: (1) identification of single EDCs (“bad actors”)—measured in prenatal blood/urine in the SELMA study—that are associated with a shorter anogenital distance (AGD) in baby boys; (2) definition and construction of a “typical” mixture consisting of the “bad actors” identified in Step 1; (3) experimentally testing this mixture in an in vivo animal model to estimate a dose–response relationship and determine a point of departure (i.e., reference dose [RfD]) associated with an adverse health outcome; and (4) use a statistical measure of “sufficient similarity” to compare the experimental RfD (from Step 3) to the exposure measured in the human population and generate a “similar mixture risk indicator” (SMRI). The objective of this exercise is to generate a proof of concept for the systematic integration of epidemiological and experimental evidence with mixture risk assessment strategies. Using a whole mixture approach, we could find a higher rate of pregnant women under risk (13%) when comparing with the data from more traditional models of additivity (3%), or a compound‐by‐compound strategy (1.6%).     

A Screening,Brief Intervention,and Referral to Treatment Collaborative: Impact for Social Work Students

Screening brief intervention, and referral to treatment (SBIRT) is a clinical intervention empirically linked to reductions in substance usage. However, less is known on how to effectively train social work students on SBIRT. This study examines the impact of a SBIRT training administered to BSW and MSW students (N=228) at the University of Oklahoma. Based on exposure to the training, our evaluation measured changes on students’ objective knowledge of how to perform SBIRT and in attitudes toward practicing with substance users. Results indicated exposure to the training was associated with robust gains across variables and across classes. Such results suggest that the proffered SBIRT training is an effective means to educate social work students on substance abuse practice.     

DISSECTING THE MONTY HALL ANOMALY

We assess competing explanations of irrational behavior in the Monty Hall problem by creating new variants of the problem. Some variants employ a feature that automates the merging of probabilities, thus rendering transparent the probabilistic advantage of the rational choice. That feature also enables systematic variation in informational asymmetry, and in ordering of actions. Data from 77 subjects, each of whom makes 30 binary decisions, indicate that automated merging raises the fraction of rational choices from around 40% to over 80%. Other features examined have much less impact, indicating the importance of a Bayesian updating failure. (JEL C91, D02, D81, D83)     

When Evolution Works Against the Future: Disgust's Contributions to the Acceptance of New Food Technologies

New food technologies have a high potential to transform the current resource‐consuming food system to a more efficient and sustainable one, but public acceptance of new food technologies is rather low. Such an avoidance might be maintained by a deeply preserved risk avoidance system called disgust. In an online survey, participants (N = 313) received information about a variety of new food technology applications (i.e., genetically modified meat/fish, edible nanotechnology coating film, nanotechnology food box, artificial meat/milk, and a synthetic food additive). Every new food technology application was rated according to the respondent's willingness to eat (WTE) it (i.e., acceptance), risk, benefit, and disgust perceptions. Furthermore, food disgust sensitivity was measured using the Food Disgust Scale. Overall, the WTE both gene‐technology applications and meat coated with an edible nanotechnology film were low and disgust responses toward all three applications were high. In full mediation models, food disgust sensitivity predicted the disgust response toward each new food technology application, which in turn influenced WTE them. Effects of disgust responses on the WTE a synthetic food additive were highest for and lowest for the edible nanotechnology coating film compared to the other technologies. Results indicate that direct disgust responses influence acceptance and risk and benefit perceptions of new food technologies. Beyond the discussion of this study, implications for future research and strategies to increase acceptance of new food technologies are discussed.