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Medical ethics, moral philosophy and moral tradition.

Medical ethics is commonly assumed to be a form of 'applied moral philosophy' in which practical moral judgments are deduced from moral theories. This account of the relationship between moral theory and moral judgment is inadequate in several reports. The deductivist approach often results in inadequate attention being given to social, historical and developmental contexts. It also fails to explain some common phenomena in practical moral reasoning. In contrast to the emphasis in deductivism, a case-centered or casuistic practical ethics insists on immersion in the particularities of cases and on interpretation of details in light of moral maxims and other mid-level forms of moral reasoning. Two features of casuistics that ought to be distinguished but frequently are not, are: (1) the emphasis on immersion and interpretation, and (2) a claim about the relation between moral judgment and moral theory as sources of moral knowledge. Once we consider case-centered moral judgments as sources of moral knowledge, we must also begin to look critically but open-mindedly to moral traditions which, upon examination, appear to be more dynamic and to have more reformist potential than is commonly assumed.

Cultural Diversity

[A preliminary study of the factors which lead to patient readmission in psychiatric hospitals].

The readmission of patients to psychiatric hospitals is preoccupying. This occurrence led us to this study which has as objective the identification of the determinant factors of the readmission; the nurse's opinion of what can be done to attenuate and the source of knowledge on the topic. The date collection was carried out with twenty three nurses of three countries: Peru (7), Brazil (9) and Colombia (7). The following factors were evidenced: social-economical, lack of orientation of family members and patient and institutional policy. Activities mentioned were actions directed toward working with families and patients, team work and community work. The sources of information most frequently mentioned were daily practice, reading and events. Some differences were evidenced among the three countries.

Brazil

Health problems and sexual activity of selected inner city, middle school students.

Physical examinations were performed and health and sexual histories were taken on 496 12-14-year-old, inner city, middle school students participating in extracurricular activities. Health problems were identified in 9.5% of students. Twenty-one percent of a subgroup of 276 students reported sexual activity; males were three times as likely as females to report intercourse. More than one-half of a smaller subgroup named their parents as their primary source of information on sex. The value of the screening exam is discussed, and suggestions are offered on the content of preventive health and sex education curricula for this age group.

Adolescent

Appropriate sex education for black teens.

This article is based on a year-long study of 207 low-income black youths. The major purpose of the research was twofold: (1) to study black teens' perceptions of family relationships in an effort to identify family member(s) who had the most potential for encouraging greater contraceptive responsibility and influencing teens' decisions about being or becoming sexually active, and (2) to study dating and sexual behavior, attitudes toward contraception, and sources of information, in an effort to identify more specific sex education needs of black teens and provide a basis for delineating pertinent characteristics of an effective sex education curriculum.

Adolescent

Study of immunisation: knowledge, attitude and practice.

A study was conducted to find out the knowledge, attitude and practice of preventive health care among the industrial workers by interviewing the workers of Durgapur Steel Plant, Durgapur and their family members who attended the health unit. The study revealed that 7.98% of the industrial workers were not aware of preventive aspects of health care. Most of this group were illiterate, rural in origin with family income less than Rs 1000 per month. Female child and the third and fourth child were more neglected. Main source of knowledge about preventive health care is mass media. Trade unions did not play any role in health education. There is seasonal variations in number of immunisation and drop out. Most common reason for drop out was negligency on the part of the parent and the parents remaining out of station. About 1% of the workers believed in other than scientific system of medicine.

Child

A profile of Australian women practicing breast self-examination.

Breast self-examination (BSE) and medical breast examination practices were studied in a group of 1,103 women without diagnosed breast cancer, randomly sampled to conform in age and social status with breast cancer cases from the population of Brisbane, Australia between 1981 and 1985. Relationships between these practices and sociodemographic factors, breast cancer risk indicators, health related behaviors and source of knowledge about BSE were analyzed. Overall, 63% of women reported performing BSE. BSE was practiced frequently (monthly or more). BSE frequency was only weakly associated with breast cancer risk indicators. It was more strongly linked with age, the 20-44 year group being more likely to examine their breasts occasionally and the women 65 years and over being less likely to examine their breasts. Married women were the most likely to practice BSE frequently and widowed or single women most likely never to practice. Women who underwent cervical smear testing were more likely to perform BSE than those who did not have smear tests. Women who learned BSE from their doctors as opposed to other sources practiced BSE more frequently and were more likely to practice BSE exactly as taught.

Adult

Review of management of incidents involving exposure to blood in a London teaching hospital, 1989-91.

OBJECTIVE: To review management of incidents involving exposure to blood reported to an occupational health unit. DESIGN: Analysis of all reported incidents from January 1989 to June 1991. SETTING: London teaching hospital. SUBJECTS: 447 health care workers and students. MAIN OUTCOME MEASURES: Immunisation against hepatitis B virus before exposure, proportion of known source patients tested for hepatitis B surface antigen and HIV antibodies, and reasons for not testing known source patients. RESULTS: 447 incidents were reported: 337 sharps injuries and 110 other exposures. 310 staff reporting incidents (205 (82%) nurses) were already immune to hepatitis B virus, nearly always because of immunisation. 345 source patients were identified, 77 of whom had already been tested for hepatitis B surface antigen (28 positive results) and 58 for HIV antibodies (18 positive results). Of those not previously tested, 145 of 266 were subsequently tested for hepatitis B surface antigen (two positive) and 149 of 287 for HIV antibodies (none positive). The main reasons for not testing source patients were that the incident was not considered a risk, that the patient had gone home, and that the clinical team were unwilling to ask the patient. Specific hepatitis B immunoglobulin was given to 18 staff who were not immune and was avoided in 11 cases by a negative result for the patient. Prophylactic zidovudine was discussed but not given to any staff member. CONCLUSIONS: Management of exposure to blood is improved by widespread immunisation against hepatitis B virus and by knowledge of source patients' hepatitis B virus and HIV status.

Blood

Update on pregnancy, condom use, and prevalence of selected sexually transmitted diseases in adolescents.

Adolescent pregnancy and its consequences continue as major sources of morbidity in the United States. A teenager who becomes a parent is at a significant disadvantage in becoming a contributing adult, both psychosocially and economically. The physician who cares for adolescents has the responsibility of helping parenting teens to find needed support so that they will be able to overcome this significant hurdle. Attention from public agencies has focused on increasing condom use as one approach to adolescent pregnancy prevention. The major advantage of using condoms is that they also prevent transmission of sexually transmitted diseases. Of note is that level of knowledge about condoms is not related to their use, and engaging in high-risk behaviors is related to a decreased likelihood of condom use. With rates of condom use estimated at less than 50%, rates of sexually transmitted disease remain high, as reported in recent surveys.

Adolescent

High school students' attitudes towards and use of contraceptives.

A questionnaire survey was conducted in an urban coeducational secondary school in the North Island region. Of the 162 adolescents sampled in this study, 39 percent reported coital experience. Of these coitally experienced students, contraception was always used by only 42%. The pill and the condom were reported as the most used contraceptives. Females were found to be significantly better contraceptive users than males. Although many students report preferring their parents as a source of contraceptive information, the majority of both males and females relied upon school sex education classes as their main source of their contraceptive education. Students ability to discuss contraceptive matters with parents was found to have no effect upon coital activity. These results indicate that society must come to terms with the fact that many adolescent New Zealanders are sexually active and run a high risk of having unplanned, unwanted pregnancies.

Adolescent

The relation of family and partner support to the adjustment of adolescent mothers.

The influence of teenage mothers' perceptions of family and partner social support on their postpartum adjustment was examined in this study. A structured interview with teenage mothers was conducted prenatally and a follow-up assessment was done when their children were 8 months of age. Both partner and family support were related to greater satisfaction with life, but each was associated in a different way with parenting and concerns about daily living. The results indicate the importance of distinguishing between specific sources of social support and different aspects of adjustment to teen parenthood.

Adolescent

Alcohol knowledge and experience in children aged 9 and 11.

An interview study of New Zealand children initially aged 9 (n = 743) and at the second interview aged 11 (n = 795) investigated the children's knowledge and experience of alcohol. The majority had tried alcohol and, by age 11, over 40% had at least a sip or drink in a typical month. There were indications of a shift towards a more adult drinking pattern in that more children at age 11 drank from their own glass but no increase in the proportion of those with experience of drinking from age 9 to 11. For the majority of children the context of use at both age 9 and age 11 was a parental one. Most children described the effects of drinking alcohol and the characteristics of drunkenness in somewhat negative terms. Television was nominated as a source of knowledge in this area by 37% of the children at age 9 and 47% of the children at age 11.

Alcohol Drinking

Knowledge about menstruation and practices of nursing students affiliated to University of Alexandria.

All secondary school nursing students enrolled in the Main University Hospital during the scholastic year 1987-1988 were studied for knowledge and practices related to menstruation. Over 85% of the students were acquainted with age of menarche, length of the menstrual cycle, and duration of menstrual bleeding. Only 71.54% gave correct answers about age of menstrual cessation. Students' practices revealed that one quarter of the sample avoid bathing during their bleeding period. About two thirds of the students stated that they use 3-8 sanitary pads per day. First year students significantly used less pads than those at higher grades. Menstrual pains and fear of bleeding were the causes of absenteeism from school among 37.62% of the sample. The higher the grade the more likely that the student carries out her normal daily activities without any difficulties. The main source of knowledge on the topic was the mother. The nursing school education was not mentioned except by minority of students in relation to menstrual hygiene.

Adolescent

Sexual socialization during early adolescence: the menarche.

It has been shown that during adolescence most information about sexual matters, generally colored with misconceptions, comes from the peer group, since cultural inhibitions often prevent discussion with parents or other adults. In addition, there is abundant evidence from anthropological data of diffuse negative beliefs across cultures concerning menstruation. In order to explore the early socialization of beliefs and attitudes toward menarche, 258 adolescents, aged 11 to 14 years, male and female pre- and postmenarcheal, from southern Italy, were interviewed by way of an open questionnaire method. The results showed a consistent lack of accurate information by a high percentage of subjects, both male and female; negative beliefs were held only by girls, pre- and postmenarcheal, while boys were more likely to ignore the subject. Half of the postmenarcheal girls expressed a negative evaluation of their first experiences with menstruation, generally due to lack of advance information. As to sources of information, importance of the peer group was confirmed, especially for boys; the influence of the mother and the cultural environment accounted for the positive acceptance of menarche. Fathers appeared to be uninvolved in the transmission of information about menstruation to either boys or girls.

Adolescent

Ghana social mobilization analysis.

In order to increase communication channels for child survival and development, the government and UNICEF Ghana undertook a "social mobilization analysis." This analysis included three studies that aimed to identify individuals and existing organizations with the potential to serve as health communicators and to determine the type of assistance that they needed to maximize their effectiveness in this role. The first study surveyed governmental institutions, trade unions, revolutionary organizations, traditional leaders, and others and found a largely untapped reservoir of capacities to promote child health, with varying levels of current involvement. The primary need identified was for information and training materials. The second study focused on the mass media and revealed a low coverage of maternal and child health topics and the need for better cooperation between journalists and health professionals. The third study assessed sources of health information for parents and found several sources, such as religious organizations, women's groups, and school teachers that could be mobilized to promote child health. Recommendations are made for the use of the findings.

Attitude to Health

[Contraception in Austria].

952 sexual active women between 15 and 44 years were investigated for their contraceptive behaviour. In 42% the pill was the first choice followed by the condom in 16%. 18% of all sexual active women in this age group did not use any contraceptives. Therefore the rate of unplanned pregnancies was very high: 34% reported about such unplanned pregnancies in their history. The main sources for informations in contraception are the gynecologist and the partner, but not the parents or the newspapers. Nearly half of all women did not know how the pill really works and quite a lot has still the opinion that there are really harmful side effects of oral contraceptives.

Adolescent

Environmentally mediated disorders of the respiratory tract.

Although much of the evidence in environmental lung disease remains equivocal, some environmental exposures are known to be clinically relevant. Ambient air pollution remains of concern as a source of morbidity, particularly for susceptible populations such as persons with asthma, chronic obstructive pulmonary disease, or cardiac disease and the elderly. The adverse effects of several components of indoor air pollution have been established. Environmental tobacco smoke contributes to lower-respiratory illness in infants; office workers exposed to thermophilic actinomycetes contaminating ventilation systems have developed hypersensitivity pneumonitis; and in the home, components of house dust and fungus spores may provoke asthma via immediate hypersensitivity. The evidence is less compelling for a link between other exposures and disorders of the respiratory tract. For example, formaldehyde may be responsible for provoking vague respiratory symptoms and even nasal cancers; however, the associations are unproved. Likewise, the relation between low-level exposure to asbestos and the development of lung cancer, although a concern, is not conclusively established. The clinician should be aware of practical measures for patients who inquire about air cleaning. Often, relatively simple solutions are effective. A knowledge of sources and exposures as well as an understanding of the principles of inhalation lung injury should prove useful in directing patient care.

Air Pollutants