The biopsychosocial model is a modern humanistic and holistic view of the human being in health sciences. Currently, many researchers think the biopsychosocial model should be expanded to include the spiritual dimension as well. However, “spiritual” is an open and fluid concept, and it can refer to many different things. This paper intends to explore the spiritual dimension in all its meanings: the spirituality-and-health relationship; spiritual–religious coping; the spirituality of the physician affecting his/her practice; spiritual support for inpatients; spiritual complementary therapies; and spiritual anomalous phenomena. In order to ascertain whether physicians would be willing to embrace them all in practice, each phrase from the Physician’s Pledge on the Declaration of Geneva (World Medical Association) was “translated” in this paper to its spiritual equivalent. Medical practice involves a continuous process of revisions of applied concepts, but a true paradigm shift will occur only when the human spiritual dimension is fully understood and incorporated into health care. Then, one will be able to cut stereotypes and use the term “biopsychosocial–spiritual model” correctly. A sincere and profound application of this new view of the human being would bring remarkable transformations to the concepts of health, disease, treatments, and cure.

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It has been proposed that the multiple-platform method (MP) for desynchronized sleep (DS) deprivation eliminates the stress induced by social isolation and by the restriction of locomotion in the singleplatform (SP) method. MP, however, induces a higher increase in plasma corticosterone and ACTH levels than SP. Since deprivation is of heuristic value to identify the functional role of this state of sleep, the objective of the present study was to determine the behavioral differences exhibited by rats during sleep deprivation induced by these two methods. All behavioral patterns exhibited by a group of 7 albino male Wistar rats submitted to 4 days of sleep deprivation by the MP method (15 platforms, spaced 150 mm apart) and by 7 other rats submitted to sleep deprivation by the SP method were recorded in order to elaborate an ethogram. The behavioral patterns were quantitated in 10 replications by naive observers using other groups of 7 rats each submitted to the same deprivation schedule. Each quantification session lasted 35 min and the behavioral patterns presented by each rat over a period of 5 min were counted. The results obtained were: a) rats submitted to the MP method changed platforms at a mean rate of 2.62 ± 1.17 platforms h -1 animal -1 ; b) the number of episodes of noninteractive waking patterns for the MP animals was significantly higher than that for SP animals (1077 vs 768); c) additional episodes of waking patterns (26.9 ± 18.9 episodes/session) were promoted by social interaction in MP animals; d) the cumulative number of sleep episodes observed in the MP test (311) was significantly lower (chisquare test, 1 d.f., P<0.05) than that observed in the SP test (534); e) rats submitted to the MP test did not show the well-known increase in ambulatory activity observed after the end of the SP test; f) comparison of 6 MP and 6 SP rats showed a significantly shorter latency to the onset of DS in MP rats (7.8 ± 4.3 and 29.0 ± 25.0 min, respectively; Student t-test, P<0.05). We conclude that the social interaction occurring in the MP test generates additional stress since it increases the time of forced wakefulness and reduces the time of rest promoted by synchronized sleep.

SUMMARY The term meditation can be used in many different ways, according to the technique to which it refers. Transcendental Meditation (MT) is one of these techniques. TM could serve as a model for research on spiritual meditation, unlike the meditation techniques based on secular knowledge. The purpose of the present study is to conduct a bibliographic review to organize scientific evidence on the effects of TM on neurophysiology, neurochemistry, and cognitive and behavioral aspects of its practitioners. To conduct this critical narrative review of the literature, we searched for scientific papers on the PubMed database of the National Center for Biotechnology Information. The keywords used in the search were Transcendental Meditation, Neuroscience of meditation e Meditation and behavior. We selected 21 papers that analyzed different aspects that could be altered through meditation practice. We concluded that TM has positive and significant documentable neurochemical, neurophysiological, and cognitive-behavioral effects. Among the main effects are the reduction of anxiety and stress (due to the reduction of cortisol and norepinephrine levels), increase of the feeling of pleasure and well-being (due to the increase of the synthesis and release of dopamine and serotonin), and influence on memory recall and possible consolidation. Further studies are needed using creative and innovative methodological designs that analyze different neural circuitry and verify the clinical impact on practitioners.

ImplIcatIons for publIc health of the relIgIosIty-longevIty relatIon rev assoC med bras 2017; 63(10):837-841 837 POINT OF VIEWImplications for public health of the religiosity-longevity relation A growing body of scientific studies has demonstrated a consistently positive association between religious-spiritual (R/S) involvement and beneficial effects on physical health, culminating with increased longevity. This protective effect on the mortality risk is not only statistically significant but also clinically relevant. The mechanisms involved in this association include psycho-neuro-endocrineimmune pathways, greater adherence to healthy behaviors and diverse social factors. Public health strategies could better explore this association. This can be done on an individual (health professionals adopting simple measures) or institutional scale (health institutions joining religious organizations). Some evidence suggests that the benefits of R/S to health and longevity would be more present in populations from more religious regions. In this sense, the Americas (Latin and North) are privileged places for the exploration of this association, compared to regions where there is certain indifference about R/S practices. Exploring this interface can improve the supply and usage of health care, especially for marginalized populations. To achieve this, health professionals, religious leaders and policy makers need to work together.