While further research is needed to help clarify the sources, additional correlates, and course of religious struggle, the findings in this study confirm the association between religious struggle and emotional distress in these three groups of medical patients. Clinicians should be attentive to signs of religious struggle. Where patient's responses indicate possible religious struggle, clinicians should consider referral to a trained, professional chaplain or pastoral counselor.

Recently, the use of self-expanding metal stents has become a well-established method of palliative treatment for stenotic malignant diseases in the middle and distal esophagus. However, published results on the use of self-expanding metal stents in cervical esophageal cancer are somewhat limited by a paucity of clinical details and experience. A new self-expanding esophageal metal stent with a short upper flange 0.7 cm in length was studied prospectively in order to assess its efficacy for palliative treatment. This report presents experience in three patients in whom this new stent was used in the treatment of cervical esophageal cancers. Stent placement was successful in all three patients, with no serious complications such as esophageal perforation, hemorrhage, or foreign-body sensation. All of the patients experienced rapid improvement in dysphagia and clinical symptoms. The newly designed self-expanding stent can be of value in the treatment of stenotic cervical esophageal cancer.

Objectives: To explore (a) how spiritual well-being, emotional wellbeing, life satisfaction, and functional status change during and after rehabilitation; (b) the relationships among these variables over time; and (c) associations with demographic and clinical characteristics. Study Design: Longitudinal assessment across 3 time points. Participants and Setting: 155 adults admitted to a freestanding rehabilitation hospital. Main Outcome Measures: Spiritual Weil-Being Scale, Life Satisfaction Questionnaire, Short-Form Health Survey, and the Functional Independence Measure™. Results: Emotional well-being increased during rehabilitation, whereas life satisfaction and spiritual well-being did not change; however, substantial subgroups of individuals experienced changes in life satisfaction and spiritual well-being over time. Measures of spiritual well-being, emotional well-being, and life satisfaction were moderately correlated within and across time points. Persons making smaller functional gains during inpatient rehabilitation were least likely to experience increased emotional well-being. Although African Americans as a group reported greater spiritual well-being than other racial-ethnic groups on admission, they were least likely to increase in emotional well-being over time. Persons with less than a high school education were more likely to experience significant declines in life satisfaction, whereas persons with more than a high school education were least likely to experience significant gains in spiritual well-being over time. Conclusions: Interventions designed to target spiritual well-

Background We examined the implementation of a behavioural activation (BA) model, via telemedicine, for perinatal populations during a confluence of significant global events in 2020. We conducted a rigorous qualitative study to identify relevant barriers and facilitators from the perspectives of both perinatal participants and treatment providers, We also present two case studies where BA was used and adapted to provide patient-centered care. Methods Within the ongoing SUMMIT non-inferiority randomized controlled trial in Canada and US, we interviewed a random selection of perinatal participants (n=23) and all treatment providers (n=28). A content analysis framework was developed to identify relevant barriers and facilitators and frequencies were calculated for each emergent theme within and across respondent groups. Results Key facilitators reported by participants receiving BA were that BA helped with support and social connection (73.9%), creative problem solving (26.1%) and attending to pandemic-related symptoms (21.7%). Key facilitators endorsed by providers to deliver BA were the use of telemedicine (35.7%) and loosening of government restrictions (21.4%). Both participant groups reported similar barriers to BA during the pandemic such as a lack of privacy and limited activities due to pandemic restrictions. However, providers were more likely to endorse pandemic-related life stressors as a barrier to treatment delivery compared to participants (64.3% vs. 34.8%). Both participant groups experienced explicit discussion of race and the racial justice movements during sessions as beneficial and reported harms of not doing so to the therapeutic alliance. Conclusions BA offers a person-centered model to facilitate social connection through creative problem-solving for women with perinatal depressive and anxiety symptoms within the context of the COVID-19 pandemic. Explicit discussion of race and racial injustice during sessions is an important and helpful aspect in psychological treatments.

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