Virtual mortality and near-death experience after a prolonged exposure in a shared virtual reality may lead to positive life-attitude changes

Perspectives on death among rural older adults in mainland China: A qualitative study

The study aimed to explore perspectives on death among rural older adults in mainland China. A semi-structured interview was conducted with 18 rural older adults from Guangzhou, China. Data were sorted and coded using NVivo 12.0 software, and analyzed through thematic analysis. Three themes were extracted, including attitudes toward death (lack of contemplating death, coexistence of death acceptance and death anxiety, avoidance of discussing death), end-of-life preferences (defining a good death, preference of place of death, not desiring to be over-rescued) and needs of death education (participation attitudes, content and form). Results suggested that rural older adults in mainland China lacked contemplating death, avoided discussing death, and experienced a certain degree of death anxiety. In the future, it's important to provide appropriate death-related interventions for them, guide them in actively contemplating death and expressing their perceptions and preferences, and ultimately improve their death competence and enhance quality of death.

Strategies for Implementing Palliative Care Services for Cancer Patients in Low- and Middle-Income Countries: A Systematic Review

Palliative care (PC) services are essential for cancer patients, particularly in low- and middle-income countries (LMICs), where cancer-related deaths are disproportionately high. Despite their significance, access to effective PC remains limited in many LMIC settings. This systematic review aims to identify strategies for implementing PC services for cancer patients in these regions, focusing on the challenges faced. A comprehensive search was conducted for peer-reviewed articles published between January 2004 and July 2024, utilizing the databases Web of Science, Scopus, PubMed, and Google Scholar. The Critical Appraisal Skills Program (CASP) assessment tool was employed to evaluate the quality of the studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for transparency. Out of approximately 966 818 articles retrieved, only 17 studies met the defined inclusion criteria. The findings highlighted effective strategies for delivering PC services in LMICs, including patient navigator-led programs, telemedicine, and home health care services. The review highlighted several interventions for PC services, including massage, Cancer and Living Meaningfully (CALM), and light therapies. However, it also identified significant challenges, such as the educational levels of caregivers, patient acceptance of PC services, logistical issues, medication side effects, and a preference for traditional healing practices. This systematic review highlights the critical need for effective PC services for cancer patients in LMICs, where cancer-related mortality rates remain alarmingly high. By synthesizing data from various studies, this analysis offers a comprehensive framework for developing successful palliative care initiatives in these regions. It emphasizes the importance of training caregivers of cancer patients to enhance their confidence in delivering palliative care services and counseling patients about the benefits of these services. Utilizing this information can help practitioners and policymakers improve palliative care services, ultimately enhancing the quality of life for cancer patients in LMICs.

Perceptions, beliefs, and anticipations regarding living wills among Master's degree nursing students in China: an exploratory qualitative study

BACKGROUND

Steeped in cultural heritage, the Chinese traditionally equate death with misfortune. This deeply rooted belief has led to a low rate of living will signings and poses challenges for implementing death education. Master's degree nursing students are instrumental in facilitating and promoting the adoption of living wills, leveraging their specialized knowledge in providing compassionate care. Despite existing research on living wills, there is a scarcity of qualitative studies that consolidate the perceptions, beliefs, and anticipations of Master's degree nursing students regarding living wills.

AIM

To scrutinize the perceptions, beliefs, and anticipations regarding living wills among Master's degree nursing students in China.

METHOD

This study followed Colizzi's phenomenological research method. An exploratory qualitative descriptive approach was employed, utilizing semi-structured face-to-face interviews. Thirteen participants participated in focus group interviews. The research question was: "What is your perception on living wills?".

RESULTS

Three main themes and eight subthemes were identified: Perceptions of living will (high attention, knowledge deficit, and lack of education), beliefs of living wills (high acceptance and positive clinical significance), and anticipations of the living will (high expectations of improved knowledge, factors influencing promotion, and suggestions for improvement).

CONCLUSION

The facilitation and progression of living wills is an intricate and drawn-out process, encountering obstacles at various stages. These insights are significant for policymakers and healthcare systems, emphasizing the necessity to cultivate a supportive environment for the establishment of living wills. As indispensable contributors to the clinical operations team, Master's degree nursing students are required to possess relevant perceptions and to foster a constructive belief system.

The Role of Virtual Reality in the Management of Irritable Bowel Syndrome

PURPOSE OF REVIEW

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction that significantly impacts health-related quality of life (HRQOL). This article explores the potential role of virtual reality (VR)-based cognitive behavioral therapy (CBT) in treating patients with IBS.

RECENT FINDINGS

While CBT is a proven, skills-based therapy approach that modifies behaviors and alters dysfunctional thinking patterns to influence the gut-brain axis and improve IBS symptoms, it is rarely prescribed given a paucity of CBT-trained clinicians. We developed a novel VR program that delivers a standardized CBT program over an 8-week period to help patients manage their symptoms. In initial qualitative validation testing, patients expressed positive perceptions about using VR CBT for IBS. Home-based, standardized VR CBT has the potential to be an effective and scalable treatment option for patients with IBS. While initial studies have shown proof-of-concept definitive randomized controlled trials are needed to demonstrate the efficacy of self-administered VR CBT in IBS.

Perspectives of telemedicine-based services among family caregivers of patients with end-of-life cancer: a qualitative study in mainland China

BACKGROUND

Despite being driven by a strong sense of duty and familial obligation, providing care for patients nearing the end of life poses challenges for family caregivers. Telemedicine has rapidly gained traction as a transformative approach to healthcare delivery, offering an array of benefits that could be particularly valuable in end-of-life care. However, research on the perspectives of telemedicine-based services among family caregivers of patients with end-of-life cancer is limited. Therefore, this study aims to explore the perspectives and preferences of telemedicine-based services among family caregivers of patients with end-of-life cancer and provide a framework for developing and executing a tailored telemedicine-based end-of-life care program that addresses the unique needs of family caregivers in mainland China.

METHOD

A descriptive phenomenological approach was used. Family caregivers were selected using purposive sampling at a tertiary cancer hospital. One-on-one semi-structured interviews were conducted with the participants from November to December 2022. Colaizz's method was used to analyze the interviews.

RESULTS

Fourteen participants participated in interviews. Three themes and ten subthemes were identified: motivation to receive telemedicine services (relief from the burden of home care; access to professional health care services), supportive care needs for telemedicine services (support for symptom management; negative emotional adjustment; death education; daily life care guidance), and functional expectations of telemedicine service platforms (ease of use; real-time online guidance and response; personalized automatic reminder; targeted matching push of health knowledge).

CONCLUSION

Family caregivers expressed interest in telemedicine-based services and identified various care needs before receiving telemedicine services. The findings of this study can help policymakers and healthcare providers develop more effective and culturally appropriate telemedicine-based service programs that can better support family caregivers of end-of-life cancer patients.

Exploring the knowledge, attitudes, behaviors and training needs of obstetric and gynecological nurses regarding COVID-19 during the peak period of the pandemic in middle-risk areas of China: A cross-sectional study

Background

COVID-19 has become a global pandemic, which necessitates that health workers be capable of protecting themselves and their patients. This article aimed to describe knowledge levels, attitudes, behaviors and training needs regarding COVID-19 among obstetric and gynecological nurses in medium-risk areas during the pandemic.

Method

A cross-sectional survey of obstetric and gynecological nurses in medium-risk areas was performed during the peak period of the pandemic in China. The main survey tool was the self-designed COVID-19 Knowledge, Attitude, Behavior and Training Needs Questionnaire. Pearson correlation analysis was conducted to analyze the relationships among knowledge, attitudes, behaviors and training needs.

Results

A total of 599 nurses were recruited, of whom 27.7% failed the knowledge part of the questionnaire. Positive correlations were found between knowledge and attitudes (r = 0.100, P = 0.015) and between attitudes and behaviors (r = 0.352, P = 0.000) regarding occupational protection against COVID-19. A total of 88.5% of nurses preferred online training to traditional training, and more than 70% believed that demonstration of and training in operations by their own department were effective ways to learn about how to protect themselves against COVID-19.

Conclusion

The higher the level of knowledge about the disease was, the more positive the attitude toward occupational protection, and consequently, the more actively protective behaviors were adopted. Training affected nurses' knowledge of COVID-19 occupational protection and promoted positive attitudes, which further facilitated the effective prevention and control of the disease. Online training with demonstrations are recommended for COVID-19 training of nurses.

Psychedelic unselfing: self-transcendence and change of values in psychedelic experiences

Psychedelic experiences have been shown to both facilitate (re)connection to one's values and change values, including enhancing aesthetic appreciation, promoting pro-environmental attitudes, and encouraging prosocial behavior. This article presents an empirically informed framework of philosophical psychology to understand how self-transcendence relates to psychedelic value changes. Most of the observed psychedelic value changes are toward the self-transcendent values of Schwartz's value theory. As psychedelics also reliably cause various self-transcendent experiences (STEs), a parsimonious hypothesis is that STEs change values toward self-transcendent values. I argue that STEs indeed can lead to value changes, and discuss the morally relevant process of self-transcendence through Iris Murdoch's concept of "unselfing". I argue that overt egocentric concerns easily bias one's valuations. Unselfing reduces egocentric attributions of salience and enhances non-egocentric attention to the world, widening one's perspective and shifting evaluation toward self-transcendent modes. Values are inherently tied to various evaluative contexts, and unselfing can attune the individual to evaluative contexts and accompanying values beyond the self. Understood this way, psychedelics can provide temporarily enhanced access to self-transcendent values and function as sources of aspiration and value change. However, contextual factors can complicate whether STEs lead to long-term changes in values. The framework is supported by various research strands establishing empirical and conceptual connections between long-term differences in egocentricity, STEs, and self-transcendent values. Furthermore, the link between unselfing and value changes is supported by phenomenological and theoretical analysis of psychedelic experiences, as well as empirical findings on their long-term effects. This article furthers understanding of psychedelic value changes and contributes to discussions on whether value changes are justified, whether they result from cultural context, and whether psychedelics could function as tools of moral neuroenhancement.

Metaverse-based virtual reality experience and endurance performance in sports economy: Mediating role of mental health and performance anxiety

Metaverse sports arena is gaining popularity globally that empowers virtual reality sporting experience through digital avatars. The main objective of the current study is to explore the impact of the Metaverse-based virtual reality sporting experience on the endurance performance of young Chinese athletes, with the mediating role of their mental health condition and performance anxiety. The study's participants mainly included Chinese athletes, especially the sample group is an accurate depiction of young athletes using a convenience sampling approach. SEM-AMOS statistical software was used for the analysis and validation of the proposed relationships. The study findings statistically validate that mental health and performance anxiety fully mediate the direct associations between virtual reality sporting experiences and the endurance performance of young Chinese athletes. Interestingly, the mental health condition of the young Chinese athletes imposes a greater impact on their endurance performance, in contrast to the adverse effects of their performance anxiety. The outcomes of the present research guide young athletes on the opportunities to enhance their virtual reality sporting abilities and boost their endurance performance. Policymakers can also build systems to dissolve physical and geographical barriers, reduce performance anxiety, and sustain mental health in virtual reality sporting events through the metaverse.

Comparison of psychedelic and near-death or other non-ordinary experiences in changing attitudes about death and dying

Both psychedelic drug experiences and near-death experiences can occasion changes in perspectives on death and dying, but there have been few direct comparisons of these phenomena. This study directly compared psychedelic occasioned and non-drug experiences which altered individuals’ beliefs about death. Individuals who reported an experience that altered their beliefs about death occasioned by either a psychedelic drug or a near-death or other non-ordinary experience completed an online survey. Circumstances of the experience, mystical and near-death subjective features, changes in attitudes about death, and other persisting effects were evaluated. The study sample (n = 3192) included five groups: non-drug near-death or other non-ordinary experiences (n = 933), and drug experiences occasioned by lysergic acid diethylamide (LSD) (n = 904), psilocybin (n = 766), ayahuasca (n = 282), or N,N-dimethyltryptamine (DMT) (n = 307). Analyses of differences in experiences were adjusted statistically for demographic differences between groups. Compared to the psychedelic groups, the non-drug group was more likely to report being unconscious, clinically dead, and that their life was in imminent danger. The groups were remarkably similar in the reported changes in death attitudes attributed to the experience, including a reduced fear of death and high ratings of positive persisting effects and personal meaning, spiritual significance, and psychological insight. Although both psychedelic and non-drug participants showed robust increases on standardized measures of mystical and near-death experiences, these measures were significantly greater in the psychedelic participants. Non-drug participants were more likely to rate their experiences as the single most meaningful of their lives. Comparing across psychedelic substances, ayahuasca and DMT groups tended report stronger and more positive enduring consequences of the experience than the psilocybin and LSD groups, which were largely indistinguishable. These data provide a detailed characterization and comparison of psychedelic occasioned and non-drug experiences that changed attitudes about death and suggest the importance of future prospective psychedelic administration studies.

Higher Residence Attachment and Religiosity Are Associated With Less Depressive Symptoms After Terror Event Exposure

Introduction: We examined how community type, residence attachment, and religiosity contribute to resilience to depressive symptoms, psychosomatic complaints, residential stress, and avoidance behavior among students exposed to terror.

Methods: Undergraduate students from Ariel University (N = 1,413; 62.7% females; M_age = 26.5; SD = 6.03) completed a self-report questionnaire on socio-demographics, terror exposure, place attachment, and depressive/psychosomatic symptoms. Participants were divided into three residential groups: “Ariel,” “Small settlement communities in Judea and Samaria” or “Other places in Israel.”

Results: Participants from small settlement communities in Judea and Samaria showed significantly fewer depressive symptoms and greater adjustment– less avoidance, psychosomatic symptoms, and residential stress– compared to those living in Ariel or other places in Israel, despite significantly higher exposure to terror.

Conclusion: Greater religiosity and residence attachment may protect against depressive symptom development following terror exposure. Secular, temporary residents living in highly terror-exposed areas should be targeted for community strengthening interventions.

Life-and-Death Attitude and Its Formation Process and End-of-Life Care Expectations Among the Elderly Under Traditional Chinese Culture: A Qualitative Study

Introduction

With the global aging process intensified, the demand for end-of-life care has surged, especially in China. However, its development is restricted. Understanding the life and death attitude among the elderly and its formation process, and clarifying their needs, are so important to promote social popularization of end-of-life care.

Methodology

This qualitative study included 20 elderly residents in Nan and Shuangbei Communities, Chongqing City, People’s Republic of China. Data were collected through semistructured in-depth individual interviews and processed by thematic analysis method.

Results

Three themes and eight subthemes were identified: Characteristics of formation process (passive thinking, closed and single), life-and-death attitude (cherish and enjoy life, quality of life priority, let death take its course) and expectations of end-of-life care (preferences, basic needs, good death).

Discussion

Life-and-death attitude and end-of-life care expectations of the elderly support the development and delivery of end-of-life care. Furthermore, the individual-family-hospital linkage discussion channel needs to be further explored.

Near-Death Experience as a Probe to Explore (Disconnected) Consciousness

Forty-five years ago, the first evidence of near-death experience (NDE) during comatose state was provided, setting the stage for a new paradigm for studying the neural basis of consciousness in unresponsive states. At present, the state of consciousness associated with NDEs remains an open question. In the common view, consciousness is said to disappear in a coma with the brain shutting down, but this is an oversimplification. We argue that a novel framework distinguishing awareness, wakefulness, and connectedness is needed to comprehend the phenomenon. Classical NDEs correspond to internal awareness experienced in unresponsive conditions, thereby corresponding to an episode of disconnected consciousness. Our proposal suggests new directions for NDE research, and more broadly, consciousness science.

Are we truly special and unique? A replication of Goldenberg et al. (2001)

According to the mortality salience hypothesis of terror management theory, reminders of our future death increase the necessity to validate our cultural worldview and to enhance our self-esteem. In Experiment 2 of the study 'I am not an animal: Mortality salience, disgust, and the denial of human creatureliness', Goldenberg et al. (Goldenberg et al. 2001 J. Exp. Psychol. Gen. 130, 427-435. (doi:10.1037/0096-3445.130.3.427)) observed that participants primed with questions about their death provided more positive evaluations to an essay describing humans as distinct from animals than control participants presented with questions regarding another aversive situation. In a replication of this experiment conducted with 128 volunteers, we did not observe evidence for a mortality salience effect.

Technological Competence Is a Pre-condition for Effective Implementation of Virtual Reality Head Mounted Displays in Human Neuroscience: A Technological Review and Meta-Analysis

Immersive virtual reality (VR) emerges as a promising research and clinical tool. However, several studies suggest that VR induced adverse symptoms and effects (VRISE) may undermine the health and safety standards, and the reliability of the scientific results. In the current literature review, the technical reasons for the adverse symptomatology are investigated to provide suggestions and technological knowledge for the implementation of VR head-mounted display (HMD) systems in cognitive neuroscience. The technological systematic literature indicated features pertinent to display, sound, motion tracking, navigation, ergonomic interactions, user experience, and computer hardware that should be considered by the researchers. Subsequently, a meta-analysis of 44 neuroscientific or neuropsychological studies involving VR HMD systems was performed. The meta-analysis of the VR studies demonstrated that new generation HMDs induced significantly less VRISE and marginally fewer dropouts. Importantly, the commercial versions of the new generation HMDs with ergonomic interactions had zero incidents of adverse symptomatology and dropouts. HMDs equivalent to or greater than the commercial versions of contemporary HMDs accompanied with ergonomic interactions are suitable for implementation in cognitive neuroscience. In conclusion, researchers' technological competency, along with meticulous methods and reports pertinent to software, hardware, and VRISE, are paramount to ensure the health and safety standards and the reliability of neuroscientific results.

Neurophenomenology of near-death experience memory in hypnotic recall: a within-subject EEG study

The neurobiological basis of near-death experiences (NDEs) is unknown, but a few studies attempted to investigate it by reproducing in laboratory settings phenomenological experiences that seem to closely resemble NDEs. So far, no study has induced NDE-like features via hypnotic modulation while simultaneously measuring changes in brain activity using high-density EEG. Five volunteers who previously had experienced a pleasant NDE were invited to re-experience the NDE memory and another pleasant autobiographical memory (dating to the same time period), in normal consciousness and with hypnosis. We compared the hypnosis-induced subjective experience with the one of the genuine experience memory. Continuous high-density EEG was recorded throughout. At a phenomenological level, we succeeded in recreating NDE-like features without any adverse effects. Absorption and dissociation levels were reported as higher during all hypnosis conditions as compared to normal consciousness conditions, suggesting that our hypnosis-based protocol increased the felt subjective experience in the recall of both memories. The recall of a NDE phenomenology was related to an increase of alpha activity in frontal and posterior regions. This study provides a proof-of-concept methodology for studying the phenomenon, enabling to prospectively explore the NDE-like features and associated EEG changes in controlled settings.

Semiology and Mechanisms of Near-Death Experiences

PURPOSE OF REVIEW

Near-death experiences (NDEs) are conscious perceptual experiences, including self-related emotional, spiritual, and mystical experiences, occurring in close encounters with death or in non-life-threatening situations. The origin of NDEs remains unknown. Here, we review recent advances in the understanding of NDE semiology and pathophysiology.

RECENT FINDINGS

Recent prospective studies confirm that NDEs reflect a spectrum of highly distinctive memories which are associated with negative or positive emotions and can be influenced by the nature of the causal event, but the temporal sequence with which these images unfold is variable. Some drugs, notably ketamine, may lead to experiences that are similar or even identical to NDEs. New models extend previous neural network theories and include aspects of evolutionary and quantum theories. Although the factual existence of NDEs is no longer doubted and the semiology well-described, a pathophysiological model that includes all aspects of NDEs is still lacking.