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ZUSAMMENFASSUNG Hintergrund In Krisenzeiten wie der Covid-19-Pandemie hat das individuelle Coping für jeden Tumorpatienten eine besondere Bedeutung zur Bewältigung ihrer spezifischen Belastungen. Material und Methode Wir haben in zwei Projekten Daten zu Mental Health für Patienten mit Kopf-Hals-Karzinomen erfasst: WHO-5, SpREUK, Distress-Thermometer zu Belastung. Vor der Pandemie inkludierten wir 113 Patienten, während des 1. Lockdowns 84 Patienten und während des 2. Lockdowns 86 Patienten. Ergebnisse Wir sehen während des 1. Lockdowns im Trend eine Abnahme der allgemeinen Krankheitslast gegenüber der Zeit vor Covid-19. Lebenszufriedenheit steigt, Copingstrategien wie Sinnsuche, Vertrauen und Reflexion der eigenen Situation werden aktiviert. Im zweiten Lockdown lassen diese Entwicklungen wieder nach, wobei insbesondere das per se nicht sehr große religiöse Vertrauen geschwunden zu sein scheint. Schlussfolgerung Tumorpatienten können Krisensituationen durch Coping besser überwinden. Spiritual Care kann gezielt diese Copingmuster unterstützen.

To provide spiritual care, an assessment and documentation of patients´ spiritual struggles and/or their spiritual needs is required to initiate appropriate support planning processes. For that purpose, the Spiritual Needs Questionnaire (SpNQ) was developed in 2009 as an easy to apply standardized measure. The tool has so far been translated into numerous languages and is widely used as a valid and reliable instrument to assess a wide range of spiritual needs of patients with chronic diseases, elderly, adolescents, and healthy persons. Its four main factors address Religious needs, Existential needs, Inner Peace needs, and Giving/Generativity needs. Here, the main findings are summarized and discussed.

A series of (NHC)Au(I)Cl monocarbene complexes and their gold(III) analogues (NHC)Au(III)Cl3 were prepared and investigated as antibacterial agents and inhibitors of bacterial TrxR. The complexes showed stronger antibacterial effects against the Gram-positive MRSA and E. faecium strains than against several Gram-negative bacteria. All complexes were efficient inhibitors of bacterial thioredoxin reductase, indicating that inhibition of this enzyme might be involved in their mechanism of action. The efficacy of gold(I) and gold(III) analogues was comparable in most of the assays. The cytotoxicity of the gold NHC compounds against cancer and human cells was overall weaker than the activity against the Gram-positive bacteria, suggesting that their optimization as antibacterials warrants further investigation.

This study addresses perceptions of spiritual dryness (a specific form of spiritual struggle) during the COVID-19 pandemic among Iranian Muslims (n = 362), and how these perceptions can be predicted. Spiritual dryness was perceived often to regularly by 27% and occasionally by 35%. Regression models revealed that the best predictors of spiritual dryness (SDS-7) were usage of mood-enhancing medications, loneliness/social isolation and praying as positive predictors, and being restricted in daily life concerns as negative predictor. The pandemic challenges mental stability of people worldwide and may also challenge trust in God. Reliable and humble support of people experiencing these phases is required.

Zusammenfassung Fragestellung Spiritual Care ist ein etablierter Bestandteil einer ganzheitlichen Betreuung in der Palliativmedizin. Stellen Religiosität und Spiritualität auch eine Ressource in früheren Phasen der Erkrankung von Kopf-Hals-Tumorpatienten (KHT) dar? Material und Methode An der prospektiven Studie nahmen 113 KHT-Patienten (27 Frauen, 84 Männer, 2 divers) teil. Der Fragebogen erfasste die momentane Belastungssituation (NRS), Spiritualität als Ressource (SpREUK-15), spirituelle Bedürfnisse (SpNQ-20), Krankheitsinterpretationen (IIQ) sowie die Lebenszufriedenheit der Patienten (BMLSS-10, BMLSS-Support, WHO-5). 39 Patienten befanden sich aktuell in Therapie, 74 in Langzeitbetreuung. Ergebnisse Nur 31/111 (28 %) Patienten empfinden sich als religiös und/oder spirituell, 72 % als weder religiös noch spirituell. 51/111 Teilnehmer erkennen in der Reflexion über ihre Erkrankung eine Teil-Ressource zur Bewältigung der Lebenssituation. An spirituellen Bedürfnissen beschreiben sie: religiöse 35/112, existenzielle 67/112, innerer Frieden 90/112, Generativität 84/112. Neben der eigenen Religiosität ist das Stadium der Erkrankung eine Einflussgröße auf spirituelle Bedürfnisse und Ressourcen. Patienten mit Kopf-Hals-Tumoren neigen zu depressiven Verstimmungen (WHO-5 ≤ 50 %) und sind mit ihrer Lebens- und Unterstützungssituation tendenziell unzufrieden. Schlussfolgerung 60–90 % der Kopf-Hals-Tumorpatienten haben spezifische spirituelle Bedürfnisse, die aber nicht immer erkannt werden. Moderne Konzepte integrativer Onkologie nehmen diese auf und stärken über diese Ressourcen die Lebensqualität und das Coping der Betroffenen.

Objective During the COVID-19 pandemic, tumor patients not only perceived fears and worries but were experiencing also positive changes as the perception of nature and silence, moments of wondering awe, and more intense relationships. We intended to analyze whether these perceptions may differ between patients from waves 1 and 2 of the pandemic. Methods Cross-sectional study at two time periods (May to June, sample 1) and September to November 2020 (sample 2) with standardized questionnaires (i.e. WHO-5, MLQ, PCQ-12). Results Patients from sample 1 (n = 292) and sample 2 (n = 221) did not differ with respect to gender, age, partner or tumor status. Most are still “irritated by statements about danger and course of the infection” (58%) and are “worrying to be infected and to have complicated course of disease” (55%). Neither their well-being nor meaning in life nor fears and worries were significantly different. In sample 2 patients, Worrying reflections and loneliness scored significantly lower, while their Perception of nature and silence was lower in trend only; more intense relationships are still relevant. Moments of wondering awe and religious trust were perceived less often during wave 2. Particularly religious patients scored stronger for Perception of nature and silence and Worrying reflections and loneliness. Conclusion Oncologists/psychologist have to know that patients’ situation has not changed within the time of pandemic and that they still require information, close support and encouragement to rely on their resources to cope. Perceived changes are reflecting coping strategies that could be trained to increase patients’ resilience during further pandemic waves.

In a cross-sectional survey among 626 Adventists, we investigated their perception of spiritual dryness, and its association with indicators of Acedia, well-being and emotional exhaustion. Women, younger persons and those without a specific duty within the church had significantly higher spiritual dryness scores. Spiritual dryness was predicted best by perceived Excessive Spiritual Demands (indicating spiritual exhaustion) and low perception of the sacred. Further predictors are Acedia’s Difficulties in Prayer Life, reduced well-being and emotional exhaustion. The underlying causes might be complex and thus to support persons experiencing these phases, a thorough differentiation of the underlying ‘spirits’ is required.

In Adventists (n = 603) 45% were less effective and 55% more effective in coping with phases of spiritual dryness, particularly those with leading roles in the church. Strategies such as devotion/trust in God, private prayer/meditation/scripture reading, openness, talks with close others, and self-care were most often utilized. Their ability to cope was predicted best by low Acedia, Living from the Faith, low emotional exhaustion, well-being and having a duty in the church (R2 = .24). When these phases were overcome, several perceived spiritual depth and were able to help others all the more. Helpful strategies should be made available to support persons struggling with spiritual dryness.

Zusammenfassung Hintergrund Ebenso wie die World Psychiatric Association (WPA) und andere nationale psychiatrische Fachgesellschaften hat auch die Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) ein Positionspapier zu Religiosität und Spiritualität (R/Sp) in Psychiatrie und Psychotherapie veröffentlicht, in dem sie Patientenzentrierung und spirituelle Kompetenz (SpK) der psychiatrischen Berufe fordert. Es ist bekannt, dass Kompetenzmangel das wichtigste Hindernis für die Implementierung von Spiritual Care (SpC) in die klinische Praxis darstellt. Fragestellung Ziel der vorliegenden Studie ist die praxisnahe Untersuchung der SpK in Psychiatrie und Psychotherapie. Wie schätzen psychiatrisch Tätige die SpK ihrer eigenen Berufsgruppe ein und welche Variablen beeinflussen dieses Urteil? Material und Methoden Insgesamt 391 psychiatrische Pflegekräfte, 75 Psychiater, 119 Therapeuten verschiedener Professionen und 62 andere (n = 647) aus Krankenhäusern in Deutschland und Österreich füllten den SpC Competency Questionnaire (SCCQ) aus. Ergebnisse Pflegekräfte, ältere und spirituell erfahrenere Personen schätzen die SpK der eigenen Berufsgruppe vergleichsweise höher ein und meinen seltener, diesbezüglich nicht zuständig zu sein. Pflegende nennen häufiger als andere Berufsgruppen das Fehlen geeigneter Räumlichkeiten als Hindernis für die Implementierung von SpC. Höhere Einschätzung der SpK der eigenen Berufsgruppe geht mit höheren Werten in den SCCQ-Faktoren „Selbsterfahrung und proaktive Öffnung“, „Team-Spirit“, „Wahrnehmungs‑/Dokumentationskompetenz“ einher. Diskussion Die Zuständigkeit der Gesundheitsberufe für SpC in Psychiatrie und Psychotherapie wird unter den deutschsprachigen psychiatrischen Berufsgruppen noch kontrovers diskutiert. Dies hängt mit mangelnder Kompetenz in diesem Feld zusammen.

Zusammenfassung Hintergrund Die Dauer des Aufenthalts von Patienten auf Palliativstationen (PCU) nimmt ab und damit vermutlich auch die Möglichkeit, eine tiefergreifende Unterstützung im Sinne von Spiritual Care bereitzustellen. Ziel unseres Projektes war es daher, die spirituellen Bedürfnisse der Patienten zu Beginn und am Ende ihres PCU-Aufenthalts zu analysieren. Methoden Zunächst Analyse von 118 Patienten (hauptsächlich mit Tumorerkrankung) und anschließend Prä-Post-Vergleich (gepaarter t-Test) der Daten von 62 bzw. 58 Patienten hinsichtlich ihrer spirituellen Bedürfnisse (SpNQ-20), des spirituellen Wohlbefindens (FACIT-Sp), Lebenszufriedenheit (BMLSS), Zufriedenheit mit der Team-Unterstützung (BMLSS) und dem wahrgenommenen Gesundheitszustand (VAS) mit standardisierten Fragebögen in zwei PCUs. Ergebnisse Von den spirituellen Bedürfnissen der Patienten waren die Bedürfnisse nach Innerem Frieden und die Bedürfnisse nach Geben/Generativität am stärksten ausgeprägt, die religiösen Bedürfnisse und existenziellen Bedürfnisse waren geringer ausgeprägt. Hinsichtlich ihres spirituellen Wohlbefindens war diese am größten für die Dimension Sinn/Bedeutung, gefolgt von Frieden und Glauben. Die meisten blieben 2–3 Wochen in der palliativmedizinischen Behandlung auf der PCU. Innerhalb dieses Zeitraums änderten sich weder ihre spirituellen Bedürfnisse noch ihr spirituelles Wohlbefinden oder ihre Lebenszufriedenheit signifikant, während sich ihr wahrgenommener Gesundheitszustand leicht verbesserte. Die Zufriedenheit mit der Teamunterstützung war sehr hoch. Schlussfolgerungen Der Zeitrahmen für eine tiefgreifende Unterstützung der spirituellen Betreuung ist eher begrenzt. Obwohl – oder gerade weil – sich die meisten in Bezug auf ihre spirituellen Bedürfnisse unterstützt fühlten, änderten sich weder ihre Bedürfnisse noch ihr Wohlbefinden signifikant. Die individuelle Entwicklung der spirituellen Bedürfnisse und des spirituellen Wohlbefindens können sehr unterschiedlich sein; daher muss sich das Krankenhauspersonal bewusst sein, dass während des Aufenthaltes auch eine Verstärkung der spirituellen Bedürfnisse und eine Verschlechterung des spirituellen Wohlbefindens auftreten können, was entweder auf eine stärkere Bewusstwerdung oder auf eine Zunahme von Angst und Belastung hinweisen kann.

Religious persons may experience phases of spiritual dryness, ranging from spiritual insecurity to a spiritual crisis. The authors analyzed the underlying causes of spiritual dryness in religious brothers and sisters who had lived for several decades in monastic structures. They performed qualitative interviews with 16 brothers and 14 sisters and asked for triggers of phases of spiritual dryness. In the content analysis of the 30 narratives, the identified categories were inductively structured and condensed to five main topics: (1) Loss of Relationship with God, (2) Loss of Orientation, (3) Loss of Depth, (4) Difficulties with the Religious Community, and (5) Intrinsic Factors: Overload, Uncertainty, Depression. These five main topics can be further categorized as extrinsic (God is not responding, others cause difficulties) and intrinsic (loss of orientation and depth, uncertainty, and depressive state) causes. A thorough discernment of the underlying ‘spirits’ (the triggers) is important to help and support individuals during these phases. It seems that no single (theological) interpretation of the causes is correct but that different interpretations might be true for the very diverse persons experiencing these phases of darkness, dryness, desolation, or loss of faith.

Introduction: Although Muslims constitute nearly one fourth of the global population, many non-Muslims are not familiar with Islam. To address this unique need from such a specific cultural context, the present study aimed to examine the spiritual needs and influencing factors of Indonesian Muslims with cancer. Method: A cross-sectional research design with 122 cancer patients was conducted by using the Bahasa-version Spiritual Needs Questionnaire. Results: The degree of spiritual needs was generally high. Religious needs were the strongest aspect, and “praying five times a day” was the highest scoring item. Gender ( p = .04), age ( p = .01), and duration of being diagnosed with cancer ( p = .01) were associated with spiritual needs. Female gender ( p = .005) and older age ( p < .001) were predictors of spiritual needs. Discussion: As expected to provide cultural-congruent spiritual interventions, nurses could meet Muslim patients’ need to pray five times a day during hospitalization, thus help them manage and endure the illness.

Zusammenfassung Hintergrund Spirituelle Bedürfnisse (spB) sind von einer religiösen Gebundenheit prinzipiell unabhängige wichtige Elemente des menschlichen Wesens. Sie können in Belastungssituationen, die z. B. durch das akute Auftreten einer Erkrankung ausgelöst werden, eine Ressource zur Bewältigung der Situation sein. Notaufnahmen sind Bereiche des Krankenhauses mit hoher medizinischer Leistungsdichte, was für Notfallpatienten eine besondere Unsicherheit hervorruft. Die vorliegende Studie untersucht erstmals das Vorliegen spiritueller Bedürfnisse eines Kollektivs von Patienten eines Notfallzentrums. Methoden Insgesamt 383 von 479 kontaktierten Patienten füllten die deutschsprachige Version des Spiritual Needs Questionnaire (SpNQ-20) aus und stimmten der Erhebung demographischer und klinischer Daten zu. Die Auswertung umfasste deskriptive Statistiken, Korrelationsanalysen, univariate sowie multiple Varianzanalysen. Ergebnisse Bedürfnisse nach innerem Frieden und generative Bedürfnisse (etwas weitergeben, etwas für andere tun) waren stärker ausgeprägt als religiöse (rB) und existenzielle (eB) Bedürfnisse. Es fanden sich keine Zusammenhänge zwischen spB einerseits und Grund der Konsultation, Schweregrad und Anzahl der Komorbiditäten andererseits. Das Alter spielte keine ausschlaggebende Rolle; vielmehr waren die vorhandenen Bedürfnisse, insbesondere die rB, bei Frauen signifikant stärker ausgeprägt als bei Männern. Schlussfolgerung Auch in einer Notfallsituation sind Menschen bereit, ihre spirituellen Bedürfnisse zu äußern. Die frühzeitige Erhebung in einer Notaufnahme erfasst auch nichtmedizinische wichtige Aspekte des kranken Menschen und erlaubt die Berücksichtigung der erfassten Bedürfnisse. Ob das auf den weiteren Behandlungsverlauf und das Wohlbefinden der Patienten einen Einfluss hat, müssen weitere Studien klären.

Purpose: We aimed at updating the evidence found in controlled studies addressing general and event-free survival of cancer patients treated with the fermented mistletoe extract Iscador. Methods: The databases Embase, PubMed, CAMbase, Scopus, AMED and Cochrane were searched for clinical studies on cancer patients treated with Iscador. Quality of studies and risk of bias were evaluated according to the Cochrane guidelines and the Newcastle Ottawa Scale. Outcome data were expressed as hazard ratios (HR) and the respective 95% confidence intervals (CI). Meta-analysis was carried out using a random-effects model. Results: Eighty-two controlled studies met the inclusion criteria, of which 32 with 55 strata provided data for extracting HR and CI. The overall HR was 0.59 (95% CI: [0.53; 0.65], p < 0.0001) in favour of Iscador treatment. Heterogeneity of study results was moderate (I2 = 50.9%; p < 0.0001, τ2 = 0.053). Meta-regression did not reveal significant effects of sample size or study design. However, significant differences were found between cancer entities (p < 0.01), with most pronounced effects in cervical (HR = 0.43) and less pronounced effects in lung cancer (HR = 0.84). Conclusions: We found almost identical effects on cancer survival based on a broader database of higher quality. However, none of the studies was blinded and, therefore, there might be risk of performance bias. Implications for cancer survivors are as follows: findings indicate that adjuvant treatment of cancer patients with Iscador can be associated with a better survival.

Excessive use of screen media is a global public health issue and especially extensive screen exposure during very early childhood. This review was conducted in order to update previous reviews on the effectiveness of interventions to reduce screen time. An electronic literature search was carried out in MEDLINE, COCHRANE LIBRARY and CINAHL for articles indexed from June 2011 until October 2019. The search identified 933 publications of which 11 publications were included in this review. There are studies showing interventions with a positive influence on reduction of screen time and the participants’ awareness and behavior concerning the use of screen media, as well as studies without such effects. No intervention was identified to be superior. This warrants further investigation of potentially effective combinations of intervention components and long-term follow-up.

The celibacy of Roman Catholic priests, in contrast to a single lifestyle, implies an existential choice for spiritual reasons as a conscious motivation. Nevertheless, several of them struggle with celibacy life style and some experience phases of spiritual dryness. So far it is unclear which role priestly celibacy may play in this context. We therefore intended to investigate whether and how celibacy on the one hand and supportive relations to other persons and feelings of loneliness on the other hand are connected to the experience of spiritual dryness among priests. As part of the German Pastoral Ministry Study, we analyzed data sets of 2531 priests. The results at first hand confirmed a correlation of spiritual dryness with a low commitment to celibacy and loneliness. Regression analyses revealed problems with sexuality and loneliness as an inability to be alone are relevant indicators of spiritual dryness. Our results point to two important concomitant mental conditions in a considerable number of cases: to continuous psychosexual problems and immaturities on one hand and to a basic incapacity to be alone, pointing to a serious structural deficit in the psychic life of some of our participants. Our study finally is a call to address these problems adequately, first of all for the mental health and spiritual truth of these persons, secondly also in the interest of all of those who priests are called to minister.

Zusammenfassung Über die spirituellen Bedürfnisse von Müttern mit Kindern mit Down-Syndrom ist noch wenig bekannt. Ziel war es daher, ihre spirituellen Bedürfnisse und ihr Belastungserleben zu identifizieren und in Beziehung miteinander zu setzen. Dazu wurde eine anonyme Querschnittserhebung mit standardisierten Instrumenten unter 203 Müttern von Kindern mit Down-Syndrom in Deutschland durchgeführt. Es zeigte sich, dass bei nur moderat ausgeprägter Lebenszufriedenheit in der Gruppe viele das Gefühl haben, unter Druck zu stehen und im Alltag beeinträchtigt zu sein. Das Bedürfnis nach innerem Frieden und Generativität hatte für sie eine große Bedeutung, religiöse und existenzielle Bedürfnisse jedoch weniger. Empfundene Hoffnungslosigkeit und Trauer korrelierten stark mit existenziellen Bedürfnissen, das Gefühl unter Druck zu stehen und emotionale Müdigkeit stark mit dem Bedürfnis nach innerem Frieden. Religiöse Bedürfnisse korrelierten stark mit dem Gefühl, Stärke im Glauben an Gott zu haben. Da sich hier abzeichnet, dass ein Belastungserleben von eigentlich „zufriedenen“ Müttern mit der Ausprägung spiritueller Bedürfnisse assoziiert ist, ist eine weitergehende Unterstützung angezeigt.

Zusammenfassung Autismus-Spektrum-Störungen (ASS) sind Störungen der neuronalen Entwicklung, die mit andauernden Defiziten in der sozialen Kommunikation und Interaktion sowie restriktiven, repetitiven Verhaltensweisen, Interessen oder Aktivitäten einhergehen. Diese Symptome können bei Betroffenen zu klinisch bedeutsamem Leiden führen, sodass sie sich psychotherapeutische Hilfe suchen. Ein wichtiger Bestandteil von Psychotherapie ist die Aktivierung von Ressourcen, wie z. B. Spiritualität und Religiosität. Ziel der vorliegenden Arbeit war zu untersuchen, inwiefern spirituelle und religiöse Praktiken und Bedürfnisse bei Personen mit ASS im Alltag eine Rolle spielen, und inwieweit diese mit ihrer Lebenszufriedenheit assoziiert sind. Hierzu wurden 201 Personen mit ASS (Durchschnittsalter 37,4 ± 12,4 Jahre) gebeten, mehrere Fragenmodule eines Online-Surveys auszufüllen. Die Ergebnisse konnten zeigen, dass säkulare spirituelle Praktiken sowie entsprechende Bedürfnisse für den Alltag von Personen mit ASS von Relevanz sind, während dezidiert religiöse Formen der Praxis oder religiöse Bedürfnisse eher gering sind. Die Ergebnisse der durchgeführten multiplen linearen Regressionsanalyse konnten außerdem zeigen, dass ein signifikanter positiver Zusammenhang zwischen dem Empfinden von Ehrfurcht und Dankbarkeit und Lebenszufriedenheit bei Personen mit ASS besteht. Gleichzeitig zeigte sich ein signifikanter negativer Zusammenhang zwischen existenzialistischen Bedürfnissen und Lebenszufriedenheit. Die Ergebnisse legen somit eine Berücksichtigung dieser von Spiritualität und Religiosität für die psychotherapeutische Behandlung von Personen mit ASS nahe.

Objectives Art therapy (ArT) such as mindfulness-oriented painting therapy is increasingly used in psychosomatic, oncological integrative and rehabilitative medicine. Though it remains unknown how ArT works, we hypothesize that an engaged participation with painting (‘Inner-Correspondence’) contributes to improved symptom scores. In the context of a comprehensive cohort study for breast cancer survivors with cancer-related fatigue, we developed a patient-reported outcome measure to assess ‘Inner Correspondence’ with painting therapy and conducted a first validation study. Design A 24-item questionnaire on ‘Inner Correspondence’ (ICPTh) was administered after ten weeks of intervention and at six month followup together with concurrent scales (Inner Correspondence and Peaceful Harmony, Cancer Fatigue Scale, Hospital Anxiety and Depression Scale, Internal Coherence Scale). Statistical assessment included reliability- and factor analyses. Results A total of n = 68 BC (mean age, 58.2 years, SD = 8.7) participated in the preliminary validation study. Exploratory factor analysis revealed a robust 22-item scale with an unambiguous four-factor solution explaining 78% of total variance and the following subsales: 1) therapy congruence and relaxation (11 items), 2) inner development and mood (6 items), 3) artistic skill (3 items) and 4) task congruence (2 items). The 22-item ICPTh yielded high reliability (Cronbach’s alpha = .966, item-total correlation = .497 – .883, test-retest reliability = .888). Conclusions We present a reliable instrument to measure ‘Inner Correspondence’ with painting therapy. Due to the small sample size and sample selection further validation studies are indicated.

Parkinson disease (PD) is a neurodegenerative disorder with increasing impairments in disease progression. The aim of the pilot study was to investigate the influence of Tango argentino on the quality of life of people with PD compared to Tai Chi. Design, Setting, Interventions: In the two-arm, randomized controlled pilot study, patients with PD received a 10-week Tango argentino or Tai Chi intervention (once per week, 60 min each).The outcome parameters were assessed at three time points (after the 1st course, after the 5th course, and after the 10th course) using standardized instruments, i.e., Parkinson's Disease Questionnaire-39 (PDQ-39), Brief Multidimensional Life Satisfaction Scale (BMLSS), Inner Congruence with Practices (ICPH).Overall, 14 patients and their partners received Tango argentino (9 male, 5 female; mean age: 69 ± 8 years) and 15 received Tai Chi (3 male, 12 female; mean age: 69 ± 11 years). Four patients in each group were lost during the trial. No improvements were found in both groups for all outcomes. Patients in the tango group reported better emotional well-being (p = 0.039) after 10 weeks of intervention compared to the Tai Chi group.Further studies are needed taking into account findings from this study to improve recruitment and attrition of patients during the trial and to justify the potential implementation of Tango argentino into clinical care.Hintergrund: Parkinson ist eine neurodegenerative Erkrankung mit zunehmenden Beeinträchtigungen im Krankheitsverlauf. Ziel der Pilotstudie ist die Untersu­chung des Einflusses von Tango und Tai-Chi auf die Le­bensqualität von Erkrankten mit Parkinson. Design, Setting, Intervention: In der zweiarmigen, randomisiert-kontrollierten Pilotstudie erhielten Betroffene mit Parkinson sowie ihre Partner eine 10-wöchige Tango Argentino- oder Tai-Chi-Intervention (1 Mal wöchentlich, 60 Minuten). Hauptzielparameter: Die Hauptzielparameter wurden mittels standardisierter Fragebogeninstrumente zu drei Zeitpunkten erfasst (nach dem 1. Kurs, nach dem 5. Kurs und nach dem 10. Kurs): Parkinson’s Disease Questionnaire-39 (PDQ-39), Brief Multidimensional Life Satisfaction Scale (BMLSS), Inner Congruence with Practices (ICPH) Skala. Ergebnisse: Insgesamt erhielten 14 Patien­ten und ihre Partner Tango Argentino (9 Männer, 5 Frauen; Durchschnittsalter: 69 ± 8 Jahre) und 15 erhielten Ta-Chi (3 Männer, 12 Frauen; Durchschnittsalter: 69 ± 11 Jahre). Vier Patienten in jeder Gruppe erschienen nicht mehr zum Kurs. In beiden Gruppen wurden bei den Zielvariablen ­keine Verbesserungen gefunden. Patienten in der Tango-Gruppe berichteten nach 10 Wochen über ein etwas besseres emotionales Wohlbefinden (p = 0,039) als in der Tai-Chi-Gruppe. Zusammenfassung: Weitere Studien, die die Ergebnisse dieser Studie berücksichtigen sollten, um die Rekrutierung und den Verbleib von Patienten während der Studie zu verbessern und die mögliche Implementie­rung von Tango Argentino in die klinische Versorgung zu begründen, sind notwendig.

Background: During the COVID-19 pandemic, people reported about fears, depressive states, and phases of loneliness. However, there have also been positively experienced changes in terms of awareness of nature, reflection of life, more intensive relationships, meaningful digital media usage to connect with others, and interest in spirituality. We were interested in the dynamics of these indicators directly after the first lockdown, the summer months and during the second wave of the pandemic with its second lockdown, and how they relate to the perceived restrictions, fears, and worries.Method: Survey with standardized questionnaires, i.e., Perceived Changes Questionnaire, WHO-Five Well-being Index, Brief Multidimensional Life Satisfaction Scale, Awe/Gratitude scale. Participants were categorized as cohort 1 (June 2020; n = 1,333), cohort 2 (July to September 2020, n = 823), and cohort three (October 2020 to January 2021, n = 625).Results: Participants perceived changes in specific attitudes and behaviors, which have impacted their well-being and life satisfaction. Compared to their experiences directly after the first wave of the pandemic (cohort 1), well-being (Hedge's g = 0.83) and life satisfaction (g = 0.63) decreased during the second wave (cohort 3) and participants' stressors increased (g = −0.94). At the same time, positive perceptions such as Nature/Silence/Contemplation (g = 0.67), Spirituality (g = 0.62), Relationships (g = 0.55), and Digital media usage declined (g = 0.31), but not Reflections on life (g = −0.03). In cohort 3, the proportion of persons relying on their faith as a strong hold was declining also in nominally religious persons. Awe/Gratitude was among the best predictors of perceived positive changes, indicating a resource which is nevertheless declining during the second wave of the pandemic (g = 0.60).Conclusions: Several perceptions, attitudes, and behaviors have changed, particularly during the second wave of the pandemic, which had a strong influence on psychological health. Although Awe/Gratitude was confirmed as the best predictor of perceived positive changes, this resource may not buffer against the negative outcomes of the pandemic but helps to recognize the still positive aspects in life. There is a need for new and not yet defined public health communities that could focus on persons which are affected in their physical, mental, social, and spiritual health and well-being due to the pandemic.

Background: While the COVID-19 pandemic has affected the lives of almost all people worldwide, many people observed also positive changes in their attitudes and behaviors. This can be seen in the context of posttraumatic growth. These perceived changes refer to five main categories: Nature/Silence/Contemplation, Spirituality, Relationships, Reflection on life, and Digital media usage. A previous study with persons recruited in June 2020 directly after the lockdown in Germany showed that the best predictors of these perceived changes related to the Corona pandemic were the ability to mindfully stop and pause in distinct situations, to be “spellbound at the moment” and to become “quiet and devout,” indicating moments of wondering awe, with subsequent feelings of gratitude. Now, we intended to analyze (1) by whom and how strongly awe/gratitude was experienced during the COVID-19 pandemic, and (2) how these feelings relate to perceived changes and experienced burden, and (3) whether or not feelings of awe/gratitude contribute to participants' well-being or may buffer perceived burden in terms of a resilience factor.Methods: Online survey with standardized questionnaires [i.e., WHO-Five Well-being Index (WHO5), Life satisfaction (BMLSS), Awe/Gratitude scale (GrAw-7), and Perceived Changes Questionnaire (PCQ)] among 2,573 participants (68% women; mean age 48.7 ± 14.2 years, 74% with a Christian affiliation) from Germany recruited between June and November 2020.Results: Awe/Gratitude scored significantly higher particularly among women (Cohen's d = 0.40), older persons (d = 0.88), persons who rely on their faith as a “stronghold in difficult times” (d = 0.99), those with higher well-being (d = 0.70), and lower perceptions of loneliness (d = 0.49). With respect to perceived changes during the pandemic, more intense feelings of Awe/Gratitude were particularly related to Nature/Silence/Contemplation (r = 0.41), Spirituality (r = 0.41), and Relationships (r = 0.33). Regression analyses revealed that the best predictors of Awe/Gratitude (R2 = 0.40) were the frequency of meditation, female gender, life satisfaction and well-being, faith as a stronghold, and perceived burden and also life reflection, while Nature/Silence/Contemplation and Relationships had a further, but weaker, impact on Awe/Gratitude as a dependent variable. Awe/Gratitude was moderately associated with well-being (r = 0.32) and would predict 9% of participants' well-being variance. The best predictors of participants' well-being were multidimensional life satisfaction and low perceived burden (related to the pandemic), and further Awe/Gratitude and Nature/Silence/Contemplation; these would explain 47% of variance in well-being scores. However, Awe/Gratitude cannot be regarded as a buffer of the negative aspects of the COVID-19 pandemic, as it is only marginally (though negatively) related to perceived burden (r = −0.15). Mediation analysis showed that Awe/Gratitude mediates 42% of the link between well-being as a predictor on Nature/Silence/Contemplation as an outcome and has a direct effect of β = 0.15 (p < 0.001) and an indirect effect of β = 0.11 (p < 0.001). Further, Awe/Gratitude mediates 38% (p < 0.001) of the link between Nature/Silence/Contemplation as a predictor on well-being as the outcome; the direct effect is β = 0.18 (p < 0.001), and the indirect effect is β = 0.11 (p < 0.001).Conclusions: The general ability to experience Awe/Gratitude particularly during the COVID-19 pandemic may sensitize to perceive the world around (including nature and concrete persons) more intensely, probably in terms of, or similar to, posttraumatic growth. As this awareness toward specific moments and situations that deeply “touch” a person was higher in persons with more intense meditation or prayer practice, one may assume that these practices may facilitate these perceptions in terms of a training. However, the experience of Awe/Gratitude does not necessarily buffer against adverse events in life and cannot prevent perceived burden due to the corona pandemic, but it facilitates to, nevertheless, perceive positive aspects of life even within difficult times. As Awe/Gratitude is further mediating the effects of Nature/Silence/Contemplation on well-being, intervention programs could help to train these perceptions, as these self-transcendent feelings are also related to prosocial behaviors with respectful treatment of others and commitment to persons in needs, and well-being.

Objective: The purpose of formative examinations is that students and lecturers receive an early feedback regarding the success of learning behavior and teaching methods. These also serve as practice for later summative exams. The aim of this paper is to investigate to what extent the result of the formative MEQ* at the end of the first semester at Witten/Herdecke University (UW/H) in the study program human medicine can be used as a predictor for the summative MEQ-1 at the end of the second semester which is part of the equivalence examination replacing the state examination. Methodology: The predictive value of the score achieved in the MEQ* on the MEQ-1 score, as well as the potential influence of the variables gender, age, high school graduation grade (German Abiturnote), professional background, and self-efficacy expectancy, was determined for students of human medicine. Results: Data from two cohorts of UW/H with a total of 88 students were included. Scores on the formative MEQ* correlate with those on the summative MEQ-1 in both cohorts. In regression analyses, only the score on the MEQ* proves to be a significant predictor of performance on the MEQ-1 (40.5% variance explanation). Particularly significant predictors are the scores in the subjects anatomy and clinical reasoning. Vocational training or pre-study only appear to contribute to higher scores in the MEQ* after the first semester, but have no further significance in predicting scores in the MEQ-1. Conclusion: The MEQ* was confirmed to be a good predictor of the MEQ-1. Thus, it serves as a formative exam to inform students about their current state of knowledge with regard to the summative exam MEQ-1, so that they can adequately adapt their learning strategies in the course of the second semester., Zielsetzung: Damit Studierende und Dozierende frühzeitig ein Feedback bezüglich des Erfolgs von Lernverhalten und Lehrmethoden bekommen, werden formative Prüfungen geschrieben. Diese dienen auch als Übung für spätere summative Prüfungen. Ziel dieser Arbeit ist die Untersuchung, in wie weit das Ergebnis des formativen MEQ* am Ende des 1. Semesters an der Universität Witten/Herdecke (UW/H) im Studiengang Humanmedizin als Prädiktor für den summativen MEQ-1 am Ende des 2. Semesters, der Teil der Staatsexamens ersetzenden Äquivalenzprüfung ist, dienen kann. Methodik: Der prädiktive Wert der Punktzahl aus dem MEQ* auf die Punktzahl des MEQ-1 sowie der mögliche Einfluss der Variablen Geschlecht, Alter, Abiturnote, berufliches Vorwissen und Selbstwirksamkeitserwartung wurde für die Studierenden der Humanmedizin ermittelt. Ergebnisse: Einbezogen wurden Daten von zwei Jahrgängen der UW/H mit insgesamt 88 Studierenden. Die Punktzahlen im formativen MEQ* korrelieren für beide Jahrgänge mit denen des summativen MEQ-1. In Regressionsanalysen erweist sich lediglich die Punktzahl im MEQ* als signifikanter Prädiktor der Leistung im MEQ-1 (40.5% Varianzerklärung). Besonders bedeutsame Prädiktoren sind die Ergebnisse in den Fächern Anatomie und Klinisches Denken. Eine Berufsausbildung oder ein Vorstudium scheinen nur zu höheren Punktzahlen im MEQ* nach dem ersten Semester beizutragen, haben aber für die Prädiktion der Punktzahl im MEQ-1 keine weitere Bedeutung. Schlussfolgerung: Der MEQ* konnte als guter Prädiktor für den MEQ-1 bestätigt werden. Somit kommt dieser seiner Funktion als formative Prüfung nach, die Studierenden über ihren aktuellen Wissensstand im Hinblick auf die summative Prüfung MEQ-1 zu informieren, damit diese ihre Lernstrategien im Verlauf des 2. Semesters adäquat anpassen können.

The amount of research concerned with the values of health professionals (HPs) is steadily growing. Around the world HPs face similar challenges when patients express their existential and spiritual views. How HPs engage these views, and the degree of embedment into consultations, differ across cultures. Today, more than ever before, researchers in this field need to share experiences and build new knowledge upon local findings. To meet this demand, we founded the international collaboration "Network for Research on Spirituality and Health" ( https://NERSH.org ). One of the central projects of our network has been to build a large international data pool of health professionals' attitudes toward religiosity and spirituality. Today the data pool hosts answers from more than 6,000 health professionals from 17 separate surveys derived from 12 countries. Data were gathered by either the questionnaire "Religion and Spirituality in Medicine, Perspectives of Physicians" (RSMPP) or its successor 'NERSH Questionnaire'. In this article we describe the methodology behind the construction of the data pool. We also present an overview of five available scales related to HP religiosity and spirituality, including a description of scale reliability and dimensionality.

Cystic fibrosis (CF) is an inborn and incurable progressive disease that mainly affects the lungs. Patients’ life expectancy is reduced and disease burden increases over time. Recent studies suggest that spiritual issues are relevant to persons with CF and may be helpful for coping with the disease. However, which spiritual needs they have, is unclear. This chapter discusses findings of a multicenter study in Germany. Important spiritual needs in persons with CF were Attention and Positive Affirmation, Inner Peace and Religious Needs in some persons. Intensity of spiritual needs may be related to disease severity. Addressing spiritual needs should be part of holistic medical care in patients with CF.

Dementia is a clinical and social condition that has become a concern for many countries. Functional and cognitive decline, dependence on self-care, loss of verbal communication capacity and reduced interaction with the environment can appear in moderate or advanced stages. Evidence-based studies suggest that with people with dementia professionals and caregivers should invest in holistic care that promotes comfort and preserves the person’s dignity. Sensory interventions fulfill this objective. The aim of this chapter is to summarize the results of a study that assessed spiritual needs in a sample of people with dementia in Portugal, using for data collection the Portuguese version of SpNQ. People can seek spirituality as a way of dealing with dementia, minimizing suffering, dealing with deficits or even maintaining hope. Spirituality can be relevant to promote comfort in people with dementia but also be seen as a therapeutic intervention, like other sensory interventions that contribute to delaying cognitive decline, maintaining interaction with the environment and, at certain times, recovering even if momentarily.

Several studies underline that patients with chronic diseases have unmet spiritual needs that are not adequately addressed by health care professionals. An exception is palliative care, where the subject area of spirituality should be considered. In a sample of 118 patients at the start of their palliative care unit stay and 58 patients with pre-post data, we found (1) that the spiritual needs of palliatively treated cancer patients are similarly to those with more early stages of their disease and (2) that within the limited period of two to three weeks at the palliative care units, no significant changes in both, patients’ spiritual needs and their spiritual well-being were observed. Patients’ perceived satisfaction with the support of the hospital team was very high. The use of the SpNQ as an assessment instrument transformed spiritual care from a more or less random possibility to a structured, regular offer. It increased the team’s awareness of patients’ spiritual needs and provided a good framework and stimulus for patients to make personalized, specific remarks and requests. The use of the SpNQ may help to integrate spiritual care in routine bedside clinical care as part of holistic patient care.

Existential or spiritual concerns are especially important for older people and those faced with their fragility and mortality. In most cases, the elderly have to deal with their worries and needs alone, as several perceive low interest in their concerns. This chapter describes which spiritual needs were of relevance for the elderly living in retirement homes, assisted living homes or nursing homes, and what may trigger these. Findings from studies among the elderly from Germany, Poland and Italy are discussed. There were similarities in specific unmet spiritual needs, and significant differences that refer particularly to Religious needs and Existential needs. The underlying causes are probably multifactorial and involve cultural and religious differences, on the one hand, and negative mood states, feelings of loneliness and perceived daily life affections (and thus low self-care abilities and independence), on the other hands. The loss of connectedness and involvement were identified as crucial, and thus support concepts could start with these topics. These should be suited to facilitating the elderly’s social participation and inclusion, on the one hand, and their independence and generative giving abilities, on the other hand, which would help to maintain feelings of meaningfulness and psychosocial and spiritual well-being.

In emergency rooms, the efforts of the hospital staff are necessarily patient-centered, while the concerns of relatives who accompany the patients are not in the primary focus. Consequently, relatives may wait for the patients and their needs to be addressed, or they may accompany the patients waiting, while their own fear and worries and their own needs go unnoticed. To assess how relatives rate their own spiritual needs and whether their needs differ from the patients´ needs, a cross-sectional survey was initiated enrolling 97 relatives from patients at a hospital´s emergency room. Surprisingly, the spiritual needs of relatives are not significantly different from patients´ needs. One explanation could be that both are in a similar phase of early insecurity about the implications of patients´ symptoms and illness. During the later course of being ill, relatives´ needs could change, depending on the implications of disease. However, the spiritual needs investigated herein are not disease-specific and may be experienced by all persons suffering from significant stressors, either due to disease, insecurity, hopelessness, etc.

Zusammenfassung Fragestellung Die COVID-19-Pandemie hat Auswirkungen auf die Versorgung von Tumorpatienten. Wie erleben Patienten mit Kopf-Hals-Tumoren (KHT) diese Situation und welche Coping-Strategien ergeben sich? Material und Methode Wir befragten in Studie 1 während des Lockdowns (15.04.–15.05.2020) 433 Tumorpatienten nach ihren Eindrücken/Belastungen (online, standardisiert, anonym). In Studie 2 wurden 292 Patienten nach dem Lockdown (06.05.–10.06.2020) zu ihren wahrgenommenen Veränderungen, Perspektivwechseln und Coping-Strategien mit standardisierten Tools (WHO-5, MLQ-10, GrAw-7) befragt. Für beide Studien analysierten wir die KHT. Ergebnisse An Studie 1 nahmen 91 Patienten mit KHT teil, in Studie 2 wurden 84 Patienten mit KHT aufgenommen. Studie 1 zeigte im Lockdown einen hohen Druck auf die Mehrheit der Patienten mit KHT (53,8 %). Es waren Ängste bezüglich der eigenen Krankheit (39,6 %), aber auch erwartete physische (24,7 %) und psychische Folgen (21,3 %) der Pandemie. Die soziale Isolation (Besuchsverbot) wurde als ein Hauptproblem (58,5 %) beschrieben. Studie 2 bestätigte diese Belastungen auch nach dem Lockdown. Intensivere Beziehungen in der Familie (60/100 Punkten) sowie eine Zuwendung zu Natur und Stille (58/100 Punkten) wurden als entlastend beschrieben. Eine hohe Inaktivität (MLQ-10) sowie ein vermindertes Wohlbefinden (WHO-5) und eine reduzierte Achtsamkeit (GrAw-7) waren Charakteristiken der KHT, die Ansatzpunkte für eine Stärkung der Resilienz sein können. Schlussfolgerung Patienten mit KHT haben einen hohen mentalen und psychischen Druck durch die Pandemie. Ihr Blickwinkel ergänzt unsere bisherige Sicht und kann zu einer verbesserten Gesamtversorgung dieser Patienten beitragen.

Fragestellung/Zielsetzung: Bereits im Medizinstudium besteht für Studierende eine höhere Gefährdung hinsichtlich Depression und Burnout [ref:1]. Doch für eine gute Qualität in der Krankenversorgung ist sowohl die physische wie auch psychische Gesundheit der Ärzte*innen[zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

BackgroundDuring the COVID-19 pandemic, the Working Group “Prevention and Integrative Oncology” (PRIO) in the German Cancer Society has initiated flash interviews and surveys. One of these stated increasing rates of fears and mental stress of tumor patients. Now we aimed to analyze whether tumor patients did perceive changes in their attitudes and behaviors related to their relationships, awareness of nature and quietness, interest in spiritual issues, or feelings of worries and isolation. A further point of interest was how these perceived changes could be predicted, either by meaning in life, spirituality as a resource to cope, perceived fears and worries, or particularly by their wellbeing.Materials and MethodsOnline survey with standardized questionnaires (i.e., WHO-Five Well-being Index (WHO5), Meaning in Life Questionnaire (MLQ), Spiritual and Religious Attitudes to cope with illness (SpREUK-15), Gratitude/Awe scale (GrAw-7)) among 292 tumor patients (72% men; mean age 66.7 ± 10.8 years; 25% < 60 years, 33% 60-70 years, 41% > 70 years) from Germany between May 6 to June 10, 2020.ResultsPatients´ wellbeing (WHO5) scores were in the lower range (14.7 ± 6.0); 35% scored < 13, indicating depressive states. Wellbeing was significantly higher in older persons and lower in younger ones (F=11.1, p

Gold complexes have a long tradition in medicine and for many examples antirheumatic, anticancer or anti‐infective effects have been confirmed. Herein, we evaluated the lead compound Auranofin and five selected gold organometallics as inhibitors of two relevant drug targets of severe acute respiratory syndrome coronaviruses (SARS‐CoV). The gold metallodrugs were effective inhibitors of the interaction of the SARS‐CoV‐2 spike protein with the angiotensin converting enzyme 2 (ACE2) host receptor and might thus interfere with the viral entry process. The gold metallodrugs were also efficient inhibitors of the papain‐like protease (PLpro) of SARS‐CoV‐1 and SARS‐CoV‐2, which is a key enzyme in the viral replication. Regarding PLpro from SARS‐CoV‐2, the here reported inhibitors are among the very first experimentally confirmed examples with activity against this target enzyme. Importantly, the activity of the complexes against both PLpro enzymes correlated with the ability of the inhibitors to remove zinc ions from the labile zinc center of the enzyme. Taken together, the results of this pilot study suggest further evaluation of gold complexes as SARS‐CoV antiviral drugs., Going for gold! Gold complexes show inhibitory effects on selected SARS‐CoV‐2 protein targets. The strong inhibition of PLpro correlates with the ability of the complexes to remove zinc from the enzyme.

Psychological stress may have harmful physiological effects and result in deteriorating health. Acute psychological stress acts also on cardiac autonomic regulation and may lead to nonstationarities in the interbeat interval series. We address the requirement of stationary RR interval series to calculate frequency domain parameters of heart rate variability (HRV) and use binary symbolic dynamics derived from RR interval differences to overcome this obstacle. 24 healthy subjects (12 female, 20–35 years) completed the following procedure: waiting period, Trier Social Stress Test to induce acute psychological stress, recovery period. An electrocardiogram was recorded throughout the procedure and HRV parameters were calculated for nine 5-min periods. Nonstationarities in RR interval series were present in all periods. During acute stress the average RR interval and SDNN decreased compared to rest before and after the stress test. Neither low frequency oscillations (LF), high frequency oscillations (HF) nor LF/HF could unambiguously reflect changes during acute stress in comparison to rest. Pattern categories derived from binary symbolic dynamics clearly identified acute stress and accompanying alterations of cardiac autonomic regulation. Methods based on RR interval differences like binary symbolic dynamics should be preferred to overcome issues related to nonstationarities.

The present study investigated the efficacy of the REACH Forgiveness psychoeducation program for the first time in Indian college students and examined theoretically-based predictors of program response based on the model of relational spirituality and forgiveness. This was an intervention experiment that spanned 5 weeks and included three measurement occasions (weeks 1, 3, 5) and two separate deliveries of the forgiveness intervention (weeks 2 and 4). Participants were N = 124 students at Karnatak University in Darwha, India (100 Hindu; 18 Muslim, 5 Christian, and 1 Jain). This was a manualized, secular intervention led by a trained facilitator in a group, psychoeducational format. Measures included forgiveness and unforgiveness as well as assessments of positive and negative affective states and spirituality. Participants who received immediate forgiveness training showed significant and large positive changes in forgiveness and unforgiveness, as well as, more positive affect and increased self-esteem in contrast to wait-list comparisons. Perceiving one's offender as having a similar spirituality to oneself was a consistent predictor of response to the REACH Forgiveness program. Specifically, perceiving the offender as having a similar spirituality was related to less growth of unforgiveness and more growth in empathy, positive affect, and emotional forgiveness as a result of the psychoeducational program. The REACH Forgiveness psychoeducational approach is efficacious in an Indian college student sample, and some relational spirituality variables are important predictors of response to the program. Future studies should consider the role of Indian culture in promoting forgiveness and possibly tailor the intervention to suit the significant proportions of Hindus and Muslims in India.

Research to date has shown that health professionals often practice according to personal values, including values based on faith, and that these values impact medicine in multiple ways. While some influence of personal values are inevitable, awareness of values is important so as to sustain beneficial practice without conflicting with the values of the patient. Detecting when own personal values, whether based on a theistic or atheistic worldview, are at work, is a daily challenge in clinical practice. Simultaneously ethical guidelines of tone-setting medical associations like American Medical Association, the British General Medical Council and Australian Medical Association have been updated to encompass physicians' right to practice medicine in accord with deeply held beliefs. Framed by this context, we discuss the concept of value-neutrality and value-based medical practice of physicians from both a cultural and ethical perspective, and reach the conclusion that the concept of a completely value-neutral physician, free from influence of personal values and filtering out value-laden information when talking to patients, is simply an unrealistic ideal in light of existing evidence. Still we have no reason to suspect that personal values, whether religious, spiritual, atheistic or agnostic, should hinder physicians from delivering professional and patient-centered care.

BACKGROUND: Spirituality is part of the basic needs of all humans, yet often undervalued by health professionals. Less is known about the spiritual needs of mothers of preterm or sick new born children.AIM: Identify unmet psychosocial and spiritual needs of these mothers, and to relate these needs to their perceived stress and impairments of life concerns.METHODS: Anonymous cross-sectional survey with standardized instruments (e.g., Spiritual Needs Questionnaire) among 125 mothers of two paediatric departments in Germany.FINDINGS: Mothers felt supported by their partner and hospital staff, and hospital staff assured 82% of them that they must not worry about their child's prognosis. They nevertheless did have specific unmet spiritual needs. Religious Needs and Existentialistic Needs scored lowest, while Giving/Generativity Needs were of moderate and Inner Peace Needs of strongest relevance. With respect to the expected diagnosis and prognosis of their child, there were no significant differences for their secular spiritual needs scores, but significant differences for Religious Needs which scored highest in mothers with children having an unclear prognosis (F=8.6; p=.004). Particularly Inner Peace Needs correlated with their stress perception (r=.34), impairments of life concerns (r=.25) and grief (r=.23).DISCUSSION: Mothers of sick born/premature children felt supported by the hospital team and their partner, but nevertheless experienced stress and daily life impairments, and particularly have unmet Inner Peace Needs.CONCLUSIONS: Addressing mothers' specific needs may help support them in their struggle with their difficult situation avoiding fears and insecurity and thus facilitating positive bonding to their child.

Phases of spiritual dryness may affect a person’s life orientation and sense of meaning, particularly of persons who work professionally for the sake of others and who rely on God as their main life orientation. This study investigated spiritual dryness in religiously motivated laypersons who are prosocially active volunteers. In particular, the study investigated which indicators of spirituality are related to spiritual dryness and also whether compassion and altruism are related to spiritual dryness. Data from 102 persons working for UNITALSI, an Italian volunteer organization, were collected using standardized questionnaires. Among these strongly religious laypersons, 12% reported that they experienced times of spiritual dryness (as measured with the Spiritual Dryness Scale) fairly often. Spiritual dryness was best predicted by low satisfaction with family life and by future prospects (which together explain 31% of the variance), followed by a low perception of the transcendent (an additional 8%) and high altruism (an additional 4% of explained variance). Most of those who found ways to deal with these feelings were inspired to help others more and perceived greater spiritual serenity and depth afterwards. It was found recently that for Catholic priests and non-ordained pastoral workers, the perception of the transcendent was the best (negative) predictor of spiritual dryness, but among Catholic laypersons investigated in this study, reduced life satisfaction was the best (negative) predictor. The data underline that laypersons who work voluntarily for others require spiritual guidance and support because spiritual dryness as a phase of spiritual crisis may impair their life satisfaction and may conflict with their voluntary engagement.

The aims of this study were to analyse whether dentists offer or recommend complementary and alternative medicine (CAM) remedies in their clinical routine, and how effective these are rated by proponents and opponents. A second aim of this study was to give a profile of the dentists endorsing CAM.A prospective, explorative, anonymised cross-sectional survey was spread among practicing dentists in Germany via congresses, dental periodicals and online (n=250, 55% male, 45% female; mean age 49.1±11.4years).Of a set of 31 predefined CAM modalities, the dentists integrated plant extracts from Arnica montana (64%), chamomile (64%), clove (63%), Salvia officinalis (54%), but also relaxation therapies (62%), homeopathy (57%), osteopathic medicine (50%) and dietetics (50%). The effectiveness of specific treatments was rated significantly higher (p0.0001) by CAM proponents than opponents. However also CAM opponents classified some CAM remedies as highly effective, namely ear acupuncture, osteopathic medicine and clove. For ear acupuncture these scores did not significantly differ between both groups. With respect to the characteristic of the proponents, the majority of CAM endorsing dentists were women. The mean age (50.4±0.9 vs 47.0±0.9years) and number of years of professional experience (24.2±1.0 vs 20.0±1.0years) were significantly higher for CAM proponents than the means for opponents (p0.0001 respectively). CAM proponents worked significantly less (p0.0001) and their perceived workload was significantly lower (p=0.008). Their self-efficacy expectation (SEE) and work engagement (Utrecht work engagement, UWE) were significantly higher (p≤0.01 and p0.0001) compared to dentists who abandoned these treatment options. The logistic regression model showed (exploratively) an increased association from CAM proponents with the UWES subscale dedication, with years of experience, and that men are less likely to be CAM proponents than women.Various CAM treatments are recommended by German dentists and requested by their patients, but the scientific evidence for these treatments are often low or at least unclear. CAM proponents are often female, have higher SE and work engagement.