This new ALS-specific quality of life instrument is a practical tool for the assessment of overall quality of life in individuals with ALS and appears to be valid and useful across large samples. Validation studies of a shortened version are now under way.

This article presents an overview of the sleep paralysis experience from both a cultural and a historical perspective. The robust, complex phenomenological pattern that represents the subjective experience of sleep paralysis is documented and illustrated. Examples are given showing that, for a majority of subjects, sleep paralysis is taken to be a kind of spiritual experience. This is, in part, because of the very common perception of a non-physical 'threatening presence' that is part of the event. Examples from various cultures, including mainstream contemporary America which has no widely known tradition about sleep paralysis, are used to show that the complex pattern and spiritual interpretation are not dependent on cultural models or prior learning. This is dramatically contrary to conventional explanations of apparently 'direct' spiritual experiences, explanations that are summed up as the 'Cultural Source Hypothesis.' This aspect of sleep paralysis was not recognized through most of the twentieth century. The article examines the way that conventional modern views of spiritual experience, combined with medical ideas that labeled 'direct' spiritual experiences as psychopathological, and mainstream religious views of such experiences as heretical if not pathological, suppressed the report and discussion of these experiences in modern society. These views have resulted in confusion in the scientific literature on sleep paralysis with regard to its prevalence and core features. The article also places sleep paralysis in the context of other 'direct' spiritual experiences and offers an 'Experiential Theory' of cross-culturally distributed spiritual experiences.

BACKGROUND: The gap in asthma prevalence, morbidity, and mortality is increasing in low‐income racial/ethnic minority groups as compared with Caucasians. In order to address these disparities, alternative beliefs and behaviors need to be identified. OBJECTIVE: To identify causal models of asthma and the context of conventional prescription versus complementary and alternative medicine (CAM) use in low‐income African‐American (AA) adults with severe asthma. DESIGN: Qualitative analysis of 28 in‐depth interviews. PARTICIPANTS: Twenty‐six women and 2 men, aged 21 to 48, who self‐identified as being AA, low‐income, and an inner‐city resident. APPROACH: Transcripts of semi‐structured in‐depth qualitative interviews were inductively analyzed using the constant comparison approach. RESULTS: Sixty‐four percent of participants held biologically correct causal models of asthma although 100% reported the use of at least 1 CAM for asthma. Biologically based therapies, humoral balance, and prayer were the most popular CAM. While most subjects trusted prescription asthma medicine, there was a preference for integration of CAM with conventional asthma treatment. Complementary and alternative medicine was considered natural, effective, and potentially curative. Sixty‐three percent of participants reported nonadherence to conventional therapies in the 2 weeks before the research interview. Neither CAM nor nonmedical causal models altered most individuals (93%) willingness to use prescription medication. Three possibly dangerous CAM were identified. CONCLUSIONS: Clinicians should be aware of patient‐generated causal models of asthma and use of CAM in this population. Discussing patients' desire for an integrated approach to asthma management and involving social networks are 2 strategies that may enhance patient‐provider partnerships and treatment fidelity.

Medical practices that reside outside the mainstream medical structures have existed for centuries, often waxing and waning in prominence and use for various reasons. Recently, there has been a resurgence in interest and use of such practices in the USA generally referred to under the label of ‘complementary and alternative medicine' (CAM). In this article we summarize some of the highlight events that punctuated this resurgence over the last 20 years. As in the past, social forces affecting these trends circulate around power, resources, and scope of practice. However, a prominent feature of this dynamic is a discussion about the role of science and ‘evidence-based medicine' in addressing pluralistic healthcare-related practices. In the early years of this period, attempts to formulate the place of CAM practices as they relate to epistemology, nonconventional assumptions about health and healing, and the complexity of understanding ‘whole systems' were discussed and often examined. Less attention is being paid to those core assumptions in more recent times. The focus now seems to be on how CAM practices can be judiciously and effectively ‘integrated' into mainstream medicine. Examples of how this dynamic is evolving are described.