The dominant view of women has changed radically during the last century. These changes have had an important impact on the way of life of women in general and, undoubtedly, on women as patients. So far, gender differences have received little attention when developing healthcare services. Stroke hits a great number of elderly women. Wyller et al. found that women seemed to be harder hit by stroke than men; they achieved lower scores in tests of motor, cognitive and ADL functions, (...) both in the acute phase and 1 year after stroke. It is reasonable to expect that differences in outcome among male and female sufferers may in part be explained by the fact that rehabilitation services are designed primarily to meet the needs of men. de Beauvoir's feminist theory maintains that one's body is fundamental in creating the person, which is a lifelong process. Traditionally, the female body has been exposed to alienation and oppression through life. This has led women to develop a life in immanence. This we feel can be of significance in connection with rehabilitation after a stroke, particularly for elderly women. In this article we will discuss how de Beauvoir's theory can throw new light on the experiences and rehabilitation of elderly women and point to ways of improving the process of rehabilitation. (shrink)

Embodied cognitive theories predict that linguistic conceptual representations are grounded and continually represented in real world, sensorimotor experiences. However, there is an on-going debate on whether this also holds for abstract concepts. Grammar is the archetype of abstract knowledge, and therefore constitutes a test case against embodied theories of language representation. Former studies have largely focussed on lexical-level embodied representations. In the present study we take the grounding-by-modality idea a step further by using reaction time (RT) data from the linguistic (...) processing of nominal classifiers in Chinese. We take advantage of an independent body of research, which shows that attention in hand space is biased. Specifically, objects near the hand consistently yield shorter RTs as a function of readiness for action on graspable objects within reaching space, and the same biased attention inhibits attentional disengagement. We predicted that this attention bias would equally apply to the graspable object classifier but not to the big object classifier. Chinese speakers (N = 22) judged grammatical congruency of classifier-noun combinations in two conditions: graspable object classifier and big object classifier. We found that RTs for the graspable object classifier were significantly faster in congruent combinations, and significantly slower in incongruent combinations, than the big object classifier. There was no main effect on grammatical violations, but rather an interaction effect of classifier type. Thus, we demonstrate here grammatical category- specific effects pertaining to the semantic content and by extension the visual and tactile modality of acquisition underlying the acquisition of these categories. We conclude that abstract grammatical categories are subjected to the same mechanisms as general cognitive and neurophysiological processes and may therefore be grounded. (shrink)

A search for the terms ‘acceptability judgment tasks’ & ‘language’ and ‘grammaticality judgment tasks’ & ‘language’ produces results which report findings that are based on the exact same elicitation technique. Although certain scholars have argued that acceptability and grammaticality are two separable notions that refer to different concepts, there are contexts in which the two terms are used interchangeably. The present work shows that these two notions and their scales do not coincide: there are sentences that are acceptable, even though (...) they are ungrammatical, and sentences that are unacceptable, despite being grammatical. First we adduce a number of examples for both cases, including grammatical illusions, violations of Identity Avoidance, and sentences that involve a level of processing complexity that overloads the cognitive parser and tricks it into (un)acceptability. We then discuss whether the acceptability of grammatically ill-formed sentences entails that we actually assign a meaning to them. Last, it is shown that there are n ways of unacceptability, and two ways of ungrammaticality, in the absolute and the relative sense. Since the use of the terms ‘acceptable’ and ‘grammatical’ is often found in experiments that constitute the core of the evidential base of linguistics, disentangling their various uses is likely to aid the field reach a better level of terminological clarity. (shrink)

Artikkelen undersøker hvordan NIPT ble vedtatt implementert i det norske fosterdiagnostiske systemet gjennom en fagligpolitisk prosess mellom 2012 og 2017. Prosessen innebar at Nasjonalt kunnskapssenter for helsetjenesten, Helsedirektoratet, Bioteknologirådet og Helse- og Omsorgsdepartementet ga sine vurderinger av testen og sine råd omkring en eventuell innføring. Artikkelen viser at det i denne prosessen foregikk en forsiktig tilnærming eller sammensmelting mellom de tradisjonelt helt ulike måtene å forstå og å ramme inn fosterdiagnostikk på i Norge, dvs. i en ‘autonomi/ behandlingsramme’ og en (...) ‘sorteringsramme’. Artikkelen argumenterer videre for at denne tilnærmingen eller konvergensen var mulig fordi prosessen ble holdt innenfor de fagligpolitiske byråkratiene, og de ulike etatene var innstilt på å ‘samarbeide’ om å inkludere både kunnskap og verdier fra begge rammene i sine tilrådninger. Politikk for fosterdiagnostikk er imidlertid et svært politisk betent område i Norge, og denne konvergensen var et skjørt byggverk. Den sprakk da også opp i løpet av tre uker i mai 2020, da Fremskrittspartiet plutselig inngikk et ‘bioteknologiforlik’ med Arbeiderpartiet og SV etter at de hadde gått ut av Solbergregjeringen. Dermed endte spørsmålet om implementeringen av NIPT i Stortinget, hvor konvergensen i den fagpolitiske prosessen ble erstattet av de tradisjonelle frontene, og de gamle innrammingene igjen ble ‘satt i arbeid’. Artikkelen diskuterer avslutningsvis kort de bortimot uløselige dilemmaene disse innrammingene både representerer og produserer. Nøkkelord: NIPT, fosterdiagnostikk, humanmedisinsk bioteknologi, regulering English Title: Fetal diagnostics between medicine and ethics: Implementation of Prenatal Invasive Testing in a turbulent policy area: The article examines how the decision to implement Prenatal Invasive Testing in the Norwegian Fetal Diagnostic System was reached through a professional policy process between 2012 and 2017. The process involved the Norwegian Research Centre for Health Services, the Norwegian Directorate of Health, the Norwegian Biotechnology Advisory Board and the Ministry of Health and Care Services, which provided their individual assessments and advice regarding the potential implementation of the test. The article finds that a careful convergence took place between traditionally opposing ways to understand and frame fetal diagnostics in Norway – either as a ‘treatment frame’ or a ‘sorting frame’. The article further argues that this convergence was possible because the process was kept within these bureaucracies, and that the different agencies were willing to collaborate to include knowledge and values from both frames in their recommendations. However, policy for fetal diagnostics is a very turbulent political area in Norway, and this convergence was a fragile construction. During three weeks in May 2020, the convergence collapsed when the Norwegian Progress Party suddenly entered a “biotechnology settlement” with the Labour Party and the Socialist Left Party after exiting the conservative Government coalition. Hence, the question of implementing NIPT ended up in the Norwegian Parliament, where the convergence from the professional policy process was replaced by the traditional fronts, and the old framings were again set in motion. Lastly, the article briefly discusses the almost unsolvable dilemmas these framings both produce and represent. Keywords: NIPT, non-invasive prenatal testing, fetal diagnostics, medical biotechnology, regulation. (shrink)

Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (N = 15) were interviewed twice, using semi-structured in-depth interviews, analyzed by and the responses subject to interpretative-phenomenological analysis. Persons with firsthand experience of avoidant personality disorder were included in the research process. Results: The superordinate theme emerging from the interviews, “searching for courage to be” encompassed three main themes: “seeking trust, strength, and freedom,” “being managed,” and “discovering (...) the possibility for change and development.” The main theme, “being managed,” included the subthemes: “getting a diagnosis,” “receiving medication,” and “attending therapy.” Conclusion: Although this may not be specific to avoidant personality disorder, Ttheese findings highlight the importance, importance of being met intersubjectively as a person with intentionality and agency, even when one does not feel like one.as an agentive intentional being, even when one does not feel like one, of being met intersubjectively by a therapist. The importance of establishing an emotional bond and emergent trust for open therapeutic communication, collaboration, learning, and becoming able to build courage to begin to approach that which one fears, is emphasized. (shrink)

Objectives Prompt Mental Health Care (PMHC) is the Norwegian version of the England’s Improving Access to Psychological Therapies (IAPT). Both programs have been associated with substantial symptom reductions from pre- to post-treatment. The present study extends these findings by investigating symptom levels at 12 months post-treatment, as well as treatment outcome in relation to low- vs. high-intensity treatment forms. Design and Outcome Measures A prospective cohort design was used. All participants ( n = 1530) were asked to complete the Patient (...) Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 questionnaire (GAD-7) at baseline, before each session during treatment, at final treatment, and at 12 months post-treatment. Cohen’s d was used as effect size measure. Sensitivity analyses were conducted to examine the impact of the high missing data rates at post-treatment (≈44%) and 12 months post-treatment (≈58%). Results A large symptom reduction was seen from baseline to 12 months post-treatment for both PHQ ( d = −0.98) and GAD ( d = −0.94). Improvements observed at post-treatment were largely maintained at 12 months post-treatment (PHQ (Δ d = 0.10) and GAD (Δ d = 0.09). Recovery rates decreased only slightly from 49.5% at post-treatment to 45.0% at follow-up. Both low- and high-intensity treatment forms were associated with substantial and lasting symptoms reductions (−1.26 ≤ d ≤ −0.73). Sensitivity analyses did not substantially alter the main results. Conclusion The findings suggest long-lasting effects of the PMHC program and encourage the use of low-intensity treatment forms in PMHC like settings. (shrink)

The word globalization has already made it into our lexicon, though the term itself has appeared relatively recently. It is believed that it was first introduced into scientific circulation by the American economist R. Robertson in 1985. Under this concept began to bring various processes of the exit of social life in all its dimensions beyond individual countries and regions. The interpretation of this term in dictionaries, encyclopedias, as well as in individual studies often depends on the specificity of the (...) field of knowledge in which it is considered. However, it can be stated that globalization is a universal phenomenon and its consideration requires a multidisciplinary approach. In this article, we are only attempting to consider globalization processes and their impact on marital relations in the modern Muslim world. (shrink)

Pre-Implantation Genetic Diagnosis represents the first fusion of genomics and assisted reproduction and the first reproductive technology that allows prospective parents to screen and select the genetic characteristics of their potential offspring. However, for some, the idea that we can intervene in the mechanisms of human existence at such a fundamental level can be, at a minimum, worrying and, at most, repugnant. Religious doctrines particularly are likely to collide with the rapidly advancing capability for science to make such interventions. This (...) paper focuses on opinions and arguments of selected religious scholars regarding ethical issues pertaining to PGD. In-depth interviews were conducted with religious scholars from three different religious organizations in the Klang Valley, Malaysia. Findings showed that Christian scholars are very sceptical of the long-term use of PGD because of its possible effect on the value of humanity and the parent-children relationship. This differs from Islamic scholars, who view PGD as God-given knowledge in medical science to further help humans understand medical genetics. For Buddhist scholars, PGD is considered to be new medical technology that can be used to save lives, avoid suffering, and bring happiness to those who need it. Our results suggest that it is important to include the opinions and views of religious scholars when it comes to new medical technologies such as PGD, as their opinions will have a significant impact on people from various faiths, particularly in a multi-religious country like Malaysia where society places high value on marital relationships and on the traditional concepts of family. (shrink)

Dionysius Lardner rose to prominence in the 1830s as a popular scientific writer, lecturer and British literary figure. He became popular by promoting the ideals of scientific self-education, technological progress, and the practical applicability of science. His rapid fall from public favour after 1840 partly resulted from his involvement in a marital scandal; prior to that scandal, however, his character had provoked satire, and his caution and even pessimism about some technological prospects had offended the confident hopes of the audiences (...) of that time, confident hopes which Lardner had helped to create. (shrink)

: The objective of this research is to prove the effect of age, gender, marital status, educational level, tenure, emotional intelligence, job stressor, social support and organizational climate to burnout of the sales persons. Multiple regression is to analyzed data from 105 sales persons of a property business. The result shows that all variable had significant effect to burnout, and to three aspects of burnout (emotional exhaustion, cynicism and low professional efficacy). Emotional intelligence has the most significant effect to burnout, (...) emotional exhaustion and low professional efficacy. (shrink)

The objective of the study was to investigate the relationship between childhood IQ of parents and characteristics of their adult offspring. It was a prospective family cohort study linked to a mental ability survey of the parents and set in Renfrew and Paisley in Scotland. Participants were 1921-born men and women who took part in the Scottish Mental Survey in 1932 and the Renfrew/Paisley study in the 1970s, and whose offspring took part in the Midspan Family study in 1996. There (...) were 286 offspring from 179 families. Parental IQ was related to some, but not all characteristics of offspring. Greater parental IQ was associated with taller offspring. Parental IQ was inversely related to number of cigarettes smoked by offspring. Higher parental IQ was associated with better education, offspring social class and offspring deprivation category. There were no significant relationships between parental IQ and offspring systolic blood pressure, diastolic blood pressure, cholesterol, glucose, lung function, weight, body mass index, waist hip ratio, housing, alcohol consumption, marital status, car use and exercise. Structural equation modelling showed parental IQ associated with offspring education directly and mediated via parental social class. Offspring education was associated with offspring smoking and social class. The smoking finding may have implications for targeting of health education. (shrink)

The experience of the use of applied containerized biomedical software tools in cloud environment is summarized. The reproducibility of scientific computing in relation with modern technologies of scientific calculations is discussed. The main approaches to biomedical data preprocessing and integration in the framework of the intelligent analytical system are described. At the conditions of pandemic, the success of health care system depends significantly on the regular implementation of effective research tools and population monitoring. The earlier the risks of disease can (...) be identified, the more effective process of preventive measures or treatments can be. This publication is about the creation of a prototype for such a tool within the project «Development of methods, algorithms and intelligent analytical system for processing and analysis of heterogeneous clinical and biomedical data to improve the diagnosis of complex diseases», implementted by the V.M. Glushkov Institute of Cybernetics, National Academy of Sciences of Ukraine, together with the United Institute of Informatics Problems, National Academy of Sciences of Belarus. The insurers, entering the market, can insure mostly low risks by facilitating more frequent changes of insurers by consumers and mixing the overall health insurance market. Socio-demographic variables can be risk adjusters. Since age and gender have a relatively small explanatory power, other socio-demographic variables were studied – marital status, retirement status, disability status, educational level, income level. Because insurers have an interest in beneficial diagnoses for their policyholders, they are also interested in the ability to interpret relevant information – upcoding: insurers can encourage their policyholders to consult with doctors more often to select as many diagnoses as possible. Many countries and health care systems use diagnostic information to determine the reimbursement to a service provider, revealing the necessary data. For processing and analysis of these data, software implementations of construction for classifiers, allocation of informative features, processing of heterogeneous medical and biological variables for carrying out scientific research in the field of clinical medicine are developed. The experience of the use of applied containerized biomedical software tools in cloud environment is summarized. The reproducibility of scientific computing in relation with modern technologies of scientific calculations is discussed. Particularly, attention is paid to containerization of biomedical applications, this permits to get reproducibility of the conditions in which the calculations took place, technologies of software pipelining of calculations, that allows to organize flow calculations, and technologies for parameterization of software environment, that allows to reproduce, if necessary, an identical computing environment. The main approaches to biomedical data preprocessing and integration in the framework of the intelligent analytical system are described. The experience of using the developed linear classifier, gained during its testing on artificial and real data, allows us to conclude about several advantages provided by the containerized form of the created application: it permits to provide access to real data located in cloud environment; it is possible to perform calculations to solve research problems on cloud resources both with the help of developed tools and with the help of cloud services; such a form of research organization makes numerical experiments reproducible, i.e. any other researcher can compare the results of their developments on specific data that have already been studied by others, in order to verify the conclusions and technical feasibility of new results; there exists a universal opportunity to use the developed tools on technical devices of various classes from a personal computer to powerful cluster. (shrink)

During the eighteenth century, the discovery of sexual reproduction in insect species prompted the demise of spontaneous generation and new developments in natural history, theology, and political economy. The sexual lives of insects prompted debates on whether insects were governed by desire, free will, and even marital tendency. Fuelled by the democratisation of microscopy, early modern entomology took a new turn and breadth: the study of insects and of their sexual lives provided unexpected new insights into human sexuality, reproduction, and (...) Malthusian fears of overpopulation. This article surveys the intellectual culture of entomology and natural history during the crucial decades when entomologists worked to quantify the reproductive capacities of insect species. Assessing the influences these entomological works had within political economy and theology, we argue that the sexual lives of insects − once analysed and delineated − influenced familiar ideological features of the intellectual landscape of the late Enlightenment, particularly in the theological philosophies of northern Europe and in the political economy of population in Britain. (shrink)

This study examines the effects of demographic characteristics on ethical perceptions. While earlier research has produced conflicting results regarding the predictive power of these variables, significant and definite insights were obtained with proper controls. The following predictors of ethical attitudes are examined: age, gender, marital status, education, dependent children status, region of the country and years in business, while controlling for job status. A nation-wide random sample of employees was used in obtaining a response rate of fifty-three percent (total n (...) of 423). Indices of aspects of business ethical attitudes were constructed using factor analysis. Linear multiple regression analysis indicated the significant predictive variables. Age was found to be a most-significant predictor. Older workers had stricter interpretations of ethical standards. Gender and region predicted attitudes about job-discrimination practices only, with women and persons from the Midwest most strongly opposed to the practice. All the other variables proved to be unreliable ethics predictors. (shrink)

Most research on mate choice in modern societies is based on data that may or may not reflect actual mating behavior (e.g., stated preferences, personal advertisements). In the present study, real-life matings were reported by a large representative sample of men and women (N = 1,133). These data were used to test an evolutionary model in which mate choice is hypothesized to depend on resources potentially contributed to reproduction by each sex. Consistent with the model, it was found that (a) (...) men (but not women) of higher social status acquire more mating partners, suggesting that male status is an important criterion in female choice; (b) women’s (but not men’s) number of partners decreases linearly with age, suggesting that female reproductive potential is an important criterion in male choice; and (c) women (but not men) display a significant relationship between marital dissolution and promiscuity, suggesting that female sexual exclusivity is an important criterion in male choice. These results are discussed in relation to understanding mate choice mechanisms from behavioral data. (shrink)

Background: Attitudes of nurses towards death and related concepts influence end-of-life care. Determining nurses’ views and attitudes towards these concepts and the factors that affect them are necessary to ensure quality end-of-life care. Objectives: The purpose of this study was to determine nurses’ views and attitudes about death, dying patient, euthanasia and the relationships between nurses’ characteristics. Methods: Participants consist of the nurses who volunteered to take part in this descriptive study from 25 hospitals (n = 340) which has a (...) paediatric or adult intensive care unit and located within the boundaries of Ankara, Turkey. ‘Nurse Information Form’ and ‘Attitude Scale about Euthanasia, Death and Dying Patients (DAS)’ were used as data collection tool. Ethical consideration: Written permissions were received from the ‘Noninterventional Clinical Researches Ethics Board’ of authors’ university and education councils of each hospital. Informed consent was obtained from participants. Findings: It is found that there are statistically significant difference among the factors of marital status, having a child, years of experience, bereavement experience, affected by working with dying patient, definition of euthanasia, views about patients who are appropriate for euthanasia, views about patients who desire to die and feeling need for counselling on these concepts according to the mean total score of nurses’ attitudes about euthanasia, death and dying patient (p < 0.05). Conclusion: The results indicate that nurses are negatively affected to face the concepts of death, euthanasia and work with dying patient. This is reflected in their attitude. In order to gain positive attitude towards death, dying patient and euthanasia, the implementation of training and consulting services to nurses at appropriate intervals during both education and professional life are required. (shrink)

Background Advance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a “Next Step” to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with (...) differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings. Methods We conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018–2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group. Results Analysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans. Conclusion Greater attention must be paid to ACP and veterans’ prior knowledge of ACP to consistently encourage annual review and status updates. (shrink)

Background Mental health nurses advocate for patients through a person-centered approach because they care for people experiencing mental distress who tend to be limited to exercising their human rights and autonomy through interpersonal relationships. Therefore, it is necessary to provide high-quality person-centered care for these patients by identifying the influencing factors. Aim This study aims to identify the factors affecting mental health nurses in performing person-centered care for patients. Research design This study had a cross-sectional, descriptive-correlational survey design. Participants and (...) method Nurses ( N = 166) working at psychiatric wards in Korea completed an online questionnaire on moral sensitivity, attitudes toward people with mental illness, and person-centered care. The t-test and stepwise multiple regression analysis were used. Ethical considerations Ethical approval for the study was obtained from the relevant ethics committee. Findings Moral sensitivity was a significant factor correlating with the provision and perception of person-centered care. Attitudes toward patients had no effect on person-centered care. The predictor variables for the provision of person-centered care (R2 = 0.247) were moral sensitivity (β = 0.33), having a professional qualification (β = 0.19), marital status (β = 0.18), and closed ward (β = −0.15). The predictor variables for the perception of person-centered (R2 = 0.150) care were closed ward (β = −0.25), moral sensitivity (β = 0.23), and marital status (β = 0.18). Discussion and conclusion Mental health nurses can strengthen person-centered care by improving moral sensitivity related to the ethical aspect of nursing and professional competence to address the complex needs of patients. Person-centered care needs to be applied more carefully in closed wards where human rights issues may arise. Through these efforts, the dignity of patients can be protected. (shrink)

The subject of the study is motherhood. The work is based on N.S. Rozov's model of the sphere of socio-historical existence. The biotechnosphere is about reproductive health and the possibility (not the possibility) of a woman becoming a mother. The psychosphere represents aspects of the mother's activity, motives and values, acceptance and rejection of motherhood, the choice of the form of motherhood. Culture and reproductive culture in the experience of motherhood is a direction that arouses interest and reflection (culture sphere). (...) The problems of reproductive status and marital gender, reproductive behavior in the context of the problems of motherhood (sociosphere) remain open for research. Modern realities lead to the need to rethink the experience and understanding of motherhood at all levels of socio-historical existence. The main conclusions are: the biotechnosphere includes a woman's reproductive ability to become a mother, physical health, the ability to bear, give birth and raise a child. The psychosphere includes aspects of the mother's activity (motivational and activity sphere and subject interaction, motivation for the birth of a child), the mother's personality (satisfaction with motherhood and readiness for motherhood; mother-child relations, the problems of family relations. The role of a man in a woman's life and vice versa and the birth of a child is an area of possible research. And the question remains open for research – parenthood and gender in modern conditions. A model of the spheres of socio-historical existence of the phenomenon of motherhood is presented. (shrink)

Objective To compare the perspectives of medical students in the preclinical and clinical phases of medical training on the issue of rationing scarce medical resources in times of crisis. Methods Questionnaire-based cross-sectional study. Results A total of 201 participants took part in the study, with 100 participants in the preclinical phase group, and 101 in the clinical phase group. A multivariable analysis found that just 14.9% (n = 34) of the clinical phase students were willing to give a short-supplied blood (...) unit to the first-arrived patient to the emergency department when more patients are expected compared to 63.9% in the preclinical group (n = 62) ( p < 0.001, OR = 0.75 95% CI: 0.029−0.192). Seventy-four percent (n = 74) of the clinical phase students were found to be willing to remove a patient from a respirator to allocate it to an ill child compared to 35.7% (n = 35) in the preclinical phase group ( p < 0.001, OR = 4.168 95% CI: 1.931−8.998). Of the clinical phase group, 46.6% (n = 41) were willing to allocate a short supplied flu medicine to a patient with poor prognosis compared to 57.7% (n = 56) in the preclinical phase group ( p = 0.04, OR = 0.457 95% CI: 0.216−0.966). Conclusion Clinical exposure during training may affect the way medical students make ethical decisions, independent of age, sex, as well as marital and parental status. (shrink)

The assessment of the fear of being laughed at in Poland: Translation and first evaluation of the Polish GELOPH The main aim of the paper was to translate and, for the first time, evaluate the Polish GELOPH. This is a 15-item questionnaire for the subjective assessment of gelotophobia, the fear of being laughed at. Gelotophobia is seen as an individual differences phenomenon at a sub-clinical level. The psychometric properties of the Polish version were tested in two independently collected samples with (...) a total N of 506 participants. The Polish GELOPH yielded good psychometric properties in terms of high reliability in both samples. The fear of being laughed at existed widely independently from the participants' age, sex, or marital status. The Polish GELOPH can be seen as a reliable instrument for the subjective assessment of gelotophobia for research and practical applications. (shrink)

BackgroundThe increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.MethodsWe examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations (...) of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.ResultsElevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.ConclusionContrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes. (shrink)

Le crime de viol conjugal, très récemment incriminé par le droit français, n’existe pas sous l’Ancien Régime. La sexualité conjugale est définie par le droit canon et séculier comme un sacrement dont la validité repose sur le principe de l’échange d’un consentement libre. La consommation nuptiale vient confirmer ce consentement initial et ratifie le mariage mais elle impose également aux époux le devoir conjugal. Ainsi, le consentement sexuel inaugural prévaut pour l’ensemble de la vie maritale, empêchant en théorie toute évocation (...) de viol conjugal. L’absence d’incrimination spécifique des violences sexuelles entre époux n’empêche pourtant pas leur poursuite judiciaire par des voies détournées. Par la mobilisation d’un corpus d’affaires matrimoniales variées entre 1600 et 1750 (requêtes de séparation d’habitation, de nullité de mariage pour impuissance sexuelle ou de mariage forcé), cette enquête permet d’accéder à de rares témoignages et expériences féminines de ces violences, de mieux comprendre ce qui était considéré comme violent dans la sexualité conjugale et de réfléchir à ce que ces comportements et leur répression disent de l’ordre de genre patriarcal. (shrink)

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)

Background: Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection. Aim: The aim of this study was to gain a deeper understanding of how (...) the ethics rounds were experienced and why the intervention in the form of ethics rounds did not succeed in improving the ethical climate for the staff. Research design: An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews. Participants and research context: A total of 11 healthcare personnel, working in two different psychiatry outpatient clinics and with experience of participating in ethics rounds, were interviewed. Ethical considerations: The study was based on informed consent and was approved by one of the Swedish Regional Ethical Review Boards. Findings: The participants were generally positive about the ethics rounds. They had experienced changes by participating in the ethics rounds in the form of being able to see things from different perspectives as well as by gaining insight into ethical issues. However, these changes had not affected daily work. Discussion: A crucial question is whether or not increased reflection ability among the participants is a good enough outcome of ethics rounds and whether this result could have been measured in patient-related outcomes. Ethics rounds might foster cooperation among the staff and this, in turn, could influence patient care. Conclusion: By listening to others during ethics rounds, a person can learn to see things from a new angle. Participation in ethics rounds can also lead to better insight concerning ethical issues. (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants report (...) positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according to the Vancouver Protocol. (...) Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress. (shrink)

Few qualitative studies explore the phenomenon of positive ethical climate and what actions are perceived as promoting it. Therefore, the aim of this study was to explore and describe actions that acute care ward nurses perceive as promoting a positive ethical climate. The critical incident technique was used. Interviews were conducted with 20 nurses at wards where the ethical climate was considered positive, according to a previous study. Meeting the needs of patients and next of kin in a considerate way, (...) as well as receiving and giving support and information within the work group, promoted a positive ethical climate. Likewise, working as a team with a standard for behaviour within the work group promoted a positive ethical climate. Future research should investigate other conditions that might also promote a positive ethical climate. (shrink)

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

For some time we have seen a shift away from direct marketing, a core feature and dominant exchange form in the alternative food world, towards a greater role for intermediation. Yet, we still need to better understand to what extent and in what ways new mediated Alternative Food Networks represent an evolution of or departure from core tenets of alternative food systems. This paper focuses on AFNs with new intermediaries that connect small-scale producers with urban end-consumers. Based on original research (...) in Frankfurt, Berlin, and Calgary, we analyze three different types of mediated AFNs: one driven by consumers, one by an external intermediary, and one by producers. Our cases include non-capitalist, capitalist, and alternative capitalist economic practices as identified by Gibson-Graham. Conceptually, we base our analysis on the three-pillar-model of alternative agri-food systems, which we further refine. Besides comparing our cases with each other, for heuristic purposes we also compare them with an ideal-type model that adheres to core tenets of alterity in all three pillars. Our empirical analysis shows that intermediary organizations can bring important benefits and that mediated AFNs are in principle able to hold true to the core tenets of alternative agri-food systems. However, it is very important to develop models of democratic control and ownership as well as economic arrangements in which created value is fairly shared. Only then can the potentials of new mediated models be realized while the pitfalls of the conventional systems they seek to replace be avoided. (shrink)

The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician—nurse collaboration, lack of (...) confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed. (shrink)

In the debate around ecological democracy, a pivotal point of contention has long been the question why democracy should actually be expected, as some claim, to deliver (more) ecological outcomes. This point is empirical as well as conceptual: it is difficult to conceive why voters would support any policies that – as is often (perceived to be) the case with environmental legislation – would leave them worse off; whilst democracy conceptually must remain open to all outcomes rather than being tied (...) to any particular agenda ex ante. Yet both empirically and conceptually, the nature and extent of this key puzzle has always hinged on the particular definitions used. This paper reconsiders the link between democracy and ecological sustainability from a cultural angle: I argue that conceiving of both sustainability and democratisation as essentially cultural transformations resolves the puzzle and thus makes a renewed case for ecological democracy. Only as cultural processes – the creation of new meanings of sustainable prosperity in people's everyday lives, and a culturally rather than institutionally based form of democratisation – can these transformations be deep-seated rather than superficial, and thus self-perpetuating rather than merely enforced. (shrink)

Deliberative democracy’s roots in critical theory are often invoked in relation to deliberative norms; yet critical theory also stands for an ambition to provoke tangible change in the real world of political practice. From this perspective, this paper reconsiders what deliberative democracy ought to look like as a critical theory, which has not just theoretical and practical, but also methodological implications. Against conceptions of activism as pushing through one’s pregiven convictions, recent debates in critical theory highlight the necessity for critical (...) activism to be emancipatory in way that is enabling rather than imposing, and inclusive rather than ‘enlightened’. As such deliberative democracy must be at once a critical theory of democracy and a democratic critical theory: committing itself to being an innately inclusive, itself reflexive and self-reflexive project rather than a substantive theory to be implemented. (shrink)

Introduction: We discuss Carol Gilligan's original concept of mature care in the light of the altruistic approach to caring and good clinical judgment. Discussion: In particular, we highlight how the concept of mature care can capture important challenges in today's nursing. Further, we illuminate how mature care might differ normatively from an altruistic approach to caring and the traditional prudential virtues in nursing. We also discuss similarities between mature care and virtue ethics. Conclusion: For nursing and nurses' identity, in today's (...) health care system that is increasingly pressured to ‘produce' health, we believe it is important to both developing further theories on mature care and having normative discussions about care. (shrink)

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as `fragile' phenomena that can easily `tip over' towards (...) their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses. (shrink)

Informed consent represents a cornerstone of the endeavours to make health care research ethically acceptable. Based on experience of qualitative research on power dynamics in nursing care in acute psychiatry, we show that the requirement for informed consent may be practised in formalistic ways that legitimize the researcher's activities without taking the patient's changing perception of the situation sufficiently into account. The presentation of three patient case studies illustrates a diversity of issues that the researcher must consider in each situation. (...) We argue for the necessity of researchers to base their judgement on a complex set of competencies. Consciousness of research ethics must be combined with knowledge of the challenges involved in research methodology in qualitative research and familiarity with the therapeutic arena in which the research is being conducted. The article shows that the alternative solution is not simple but must emphasize the researcher's ability to doubt and be based on an awareness of the researcher's fallibility. (shrink)

Im Gegensatz zum drei Jahre jüngeren Schelling, dem er sein Leben lang verbunden blieb, wird Steffens nach seinem Tod nahezu vergessen; in der landläufigen Überlieferung hat er als der Überbringer der Romantik nach Dänemark überlebt. Erst mit Beginn des 21. Jahrhunderts wird er als Naturforscher, als Philosoph und Universitätsreformer wiederentdeckt, nicht zuletzt auch im Diskurs-Zusammenhang um das Anthropozän. Steffens-Forscherinnen und Forscher aus Norwegen, Dänemark und Deutschland setzen sich mit dem romantischen Denken der Zeit, mit den Aspekten der nationalen Wiedergeburt in (...) Kultur, Politik und Wissenschaft auseinander, mit Naturgeschichte und Kunst: Marit Bergner, Marie-Theres Federhofer, Bernd Henningsen, Lore Hühn, Daniel Fulda, Norman Kasper, Jesper Lundsfryd Rasmussen, Jessika Piechocki, Anna Lena Sandberg und Elisabeth Décultot. (shrink)

_In this lively and groundbreaking book, arts educator Marit Dewhurst examines why art is an effective way to engage students in thinking about the role they might play in addressing social injustice._ Based on interviews and observations of sixteen high schoolers participating in an activist arts class at a New York City museum, Dewhurst identifies three learning processes common to the act of creating art that have an impact on social justice: connecting, questioning, and translating. Noting that “one of (...) the challenges of social justice art education has been the difficulty of naming effective strategies that can be used across multiple contexts,” Dewhurst outlines core strategies for an “activist arts pedagogy” and offers concrete suggestions for educators seeking to incorporate activist art projects inside or outside formal school settings. _Social Justice Art _seeks to give common language to educators and others who are looking to expand and refine their practices in an emerging field, whether they work in art education, social justice programming, or youth development. (shrink)

__Teachers Bridging Difference_ describes how educators can move out of their comfort zones and practice connecting with others across differences to become culturally responsive teachers. _Based on a course developed for preservice teachers, the book illustrates how educators can draw on the visual arts as a resource to explore their own identities and those of their students, and how to increase their understanding of the ways our lives intersect across sociocultural differences. Drawing on scholarship from multiple disciplines and from her (...) own experience, Marit Dewhurst identifies four stances designed to help educators connect with students in today’s multicultural classrooms. To practice these stances, the book introduces eight arts-based activities that can be used by educators in multiple contexts. Ranging from community maps and conversation portraits to scenario comics and reflection zines, the activities are designed to be accessible to even those with little arts experience and can be executed with a wide variety of materials and media. Unique and timely, _Teachers Bridging Difference _is an arts-based tool kit for teachers interested in exploring issues of identity and difference as a foundation for creating a more just and equal society. (shrink)

The idea behind this article is to discuss the importance and to develop the concept of reciprocity in asymmetric professional relationships. As an empirical starting point for an examination of the possible forms of reciprocity between patients and nurses in psychiatry, we chose two qualitative in-depth interviews with two different patients. The manners in which these two patients relate to medical personnel—one is dependent, the other is independent—show that this presents challenges to nurses. The theoretical context is provided by the (...) notion of mature care as it has been developed by feminist-oriented ethics of care, in contrast to the notion of altruistic care. In relation to the concept of mature care, we discuss how nursing can be perceived in demanding relationships with patients in psychiatry. Reciprocity implies that, in principle, the interests of the nurses also matter in a nurse-patient relationship. We show that reciprocity—in practice—is complicated and challenging in a number of different ways. Mature care—with its systematic inclusion of relationships and reciprocity—provides an alternative understanding of what takes place between patients and nurses compared with an altruistic notion of care. As such, mature care can be regarded as an useful paradigm for nurse-patient relationships in psychiatry. (shrink)

In this article we explore a notion of relationship which exists between humans. This notion of relationship takes as a point of departure that differences in human relations and interaction have to be safeguarded. Starting with the Irigarayan notion of ‘two’ as a gendered difference, opposed to an understanding of humans as one and same (gender), we elaborate an understanding of otherness which opens a space where both self and other are welcomed. This relational space cannot be appropriated by either (...) one for it to exist. We continue by drawing from Harry G. Frankfurt's discussion of care in order to understand human (inter)actions in this space. Through an elaboration of how love as a special form of care represents a motivational drive, a way in which a person's will is formed, we try to show how this attentiveness towards the other is possible. Our point of departure is two statements by female head teachers that prompted these theoretical inquiries into other possibilities for interpreting human (inter)action in leadership in education. (shrink)