Association between Spirituality and Adherence to Management in Outpatients with Heart Failure

Abstract Background: Spirituality may influence how patients cope with their illness. Objectives: We assessed whether spirituality may influence adherence to management of outpatients with heart failure. Methods: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence. Results: One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments. Conclusion: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

Density and sowing season of two Brachiaria species on the soybean culture

The aim of this study was to evaluate the growth and yield of soybean cultivar M-8766 in consortium with Brachiaria brizantha. BRS Piata and Brachiaria ruziziensis at different densities and sowing dates. The experimental design was randomized blocks with treatments arranged in a factorial 2 x 2 x 3 with four replications. Used as factors grass species (Brachiaria brizantha Piata and Brachiaria ruziziensis BRS) intercropped with soybean M-8766, sowing dates (12 and 24 days after soybean emergence) and three seeding rates (0, 5, 10 kg ha-1 of seed). At 71 days after soybean emergence were evaluated plant height, stem diameter, dry mass of leaves, stems and shoots, and 4 months after sowing determined the weight of 100 grains and soybean yield. The results showed that when seeded at a density of 10 kg ha-1 at 12 and 24 DAE soy, Brachiaria brizantha. BRS Piata caused reduction in yield in the order of 6.71% and 3.03% respectively, while the Brachiaria ruziziensis was one that caused a greater reduction in productivity in the order of 13.42 and 16.23%, respectively, of these values expression when considering the price of soybean sack. B. ruziziensis expressed less competitive with soybean. However, the large biomass production of this grass provides deployment system till the next harvest.

Facilitators of the transition process for the self-care of the person with stoma: subsidies for Nursing

OBJECTIVE To know the facilitating factors of the transition process from dependency to the self-care of people with a stoma. METHOD This is a descriptive study of qualitative approach, including 27 people with permanent stomas due to cancer. The data were collected through semi-structured interviews and submitted to content analysis based on the Transition Theory as theoretical reference. RESULTS The self-care facilitators related to the person were the positive significance of ostomy; the preparation for this experience already in the preoperative period; emotional stability; faith; religiousness; and a sense of normalcy acquired from a next image similar to the previous one. The facilitators related to the community were the following: receiving equipment for free from the government; support from family and the multidisciplinary team, especially the nurses; and having contact with other people with stomata. CONCLUSION The results allow that nurses develop strategies to help people with stomata to resume their self-care.

Chronic Disease in the Elderly: Spirituality and Coping

This is an exploratory study using a qualitative methodology which aimed to identify and understand the role of spirituality in the management of chronic disease in the elderly. The discourse analysis revealed the following central themes: multidimensional impact of chronic diseases, coping and expectations of the elderly. Regarding coping with chronic diseases, the individual coping, social support and religiosity/spirituality/faith were analyzed. The results showed the changes brought about the diagnosis of chronic disease and its implications for the adaptation to the new way of life. The management of these changes is complex and many factors influence positively and negatively in order to deal with the new condition. The results showed that spirituality/religiosity /faith interfere positively in addressing the barriers and difficulties of life, strengthening the resilience of the patient, thus improving their quality of life.

Religiousness and health-related quality of life of older adults

OBJECTIVE To examine whether religiousness mediates the relationship between sociodemographic factors, multimorbidity and health-related quality of life of older adults.METHODS This population-based cross-sectional study is part of the Survey on Health, Well-Being, and Aging (SABE). The sample was composed by 911 older adults from Sao Paulo, SP, Southeastern Brazil. Structural equation modeling was performed to assess the mediator effect of religiousness on the relationship between selected variables and health-related quality of life of older adults, with models for men and women. The independent variables were: age, education, family functioning and multimorbidity. The outcome variable was health-related quality of life of older adults, measured by SF-12 (physical and mental components). The mediator variables were organizational, non-organizational and intrinsic religiousness. Cronbach’s alpha values were: physical component = 0.85; mental component = 0.80; intrinsic religiousness = 0.89 and family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve) = 0.91.RESULTS Higher levels of organizational and intrinsic religiousness were associated with better physical and mental components. Higher education, better family functioning and fewer diseases contributed directly to improved performance in physical and mental components, regardless of religiousness. For women, organizational religiousness mediated the relationship between age and physical (β = 2.401, p < 0.01) and mental (β = 1.663, p < 0.01) components. For men, intrinsic religiousness mediated the relationship between education and mental component (β = 7.158, p < 0.01).CONCLUSIONS Organizational and intrinsic religiousness had a beneficial effect on the relationship between age, education and health-related quality of life of these older adults.

Family dynamics in face of Alzheimer's in one of its members

Abstract OBJECTIVE To understand the family dynamics when there is a member in the residence with Alzheimer's disease. METHOD A study of qualitative approach, using the creative sensitive method (CSM), and with participation of two families who had a member with Alzheimer's disease at home. RESULTS Three categories emerged: Effects of Alzheimer's disease and the family dynamics; Development process of Alzheimer's disease and Coping strategies in face of the disease. CONCLUSION It was possible to know the manifestations and consequences of Alzheimer's disease in the family, such as mutual help, the mobilization of resources to activate memories of the past, spirituality and faith. There was also understanding of the structure of family dynamics.

Kant, Nietzsche and the idealization of friendship into nihilism

Is friendship still possible under nihilistic conditions? Kant and Nietzsche are important stages in the history of the idealization of friendship, which leads inevitably to the problem of nihilism. Nietzsche himself claims on the one hand that only something like friendship can save us in our nihilistic condition, but on the other hand that precisely friendship has been unmasked and become impossible by these very conditions. It seems we are struck in the nihilistic paradox of not being allowed to believe in the possibility of what we cannot do without. Literary imagination since the 19th century seems to make us even more skeptical. Maybe Beckett provides an illustration of a way out that fits well to Nietzsche's claim that only "the most moderate, those who do not require any extreme articles of faith" will be able to cope with nihilism.