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PubMed2002

Mental disorders as possible intrapsychic routes to remission. Part II: psychopathic personality disorder.

In this article an attempt is made, on the basis of a case report of a psychopathic swindler, to explain psychopathy as an intrapsychic mechanism which may lead to remission. In some cases psychopathic personality disorder can have the function of a route that should be completed within the possibilities and capacities of the patient in question. When this route is completed successfully the patient might be able to, and motivated for healthy emotional, moral and social development.

Antisocial Personality Disorder↗
PubMed2000

Gene 33/Mig-6, a transcriptionally inducible adapter protein that binds GTP-Cdc42 and activates SAPK/JNK. A potential marker transcript for chronic pathologic conditions, such as diabetic nephropathy. Possible role in the response to persistent stress.

Chronic stresses, including the mechanical strain caused by hypertension or excess pulmonary ventilation pressure, lead to important clinical consequences, including hypertrophy and acute respiratory distress syndrome. Pathologic hypertrophy contributes to decreased organ function and, ultimately, organ failure; and cardiac and diabetic renal hypertrophy are major causes of morbidity and morality in the developed world. Likewise, acute respiratory distress syndrome is a serious potential side effect of mechanical pulmonary ventilation. Whereas the deleterious effects of chronic stress are well established, the molecular mechanisms by which these stresses affect cell function are still poorly characterized. gene 33 (also called mitogen-inducible gene-6, mig-6) is an immediate early gene that is transcriptionally induced by a divergent array of extracellular stimuli. The physiologic function of Gene 33 is unknown. Here we show that gene 33 mRNA levels increase sharply in response to a set of commonly occurring chronic stress stimuli: mechanical strain, vasoactive peptides, and diabetic nephropathy. Induction of gene 33 requires the stress-activated protein kinases (SAPKs)/c-Jun NH(2)-terminal kinases. This expression pattern suggests that gene 33 is a potential marker for diabetic nephropathy and other pathologic responses to persistent sublethal stress. The structure of Gene 33 indicates an adapter protein capable of binding monomeric GTPases of the Rho subfamily. Consistent with this, Gene 33 interacts in vivo and, in a GTP-dependent manner, in vitro with Cdc42Hs; and transient expression of Gene 33 results in the selective activation of the SAPKs. These results imply a reciprocal, positive feedback relationship between Gene 33 expression and SAPK activation. Expression of Gene 33 at sufficient levels may enable a compensatory reprogramming of cellular function in response to chronic stress, which may have pathophysiological consequences.

3T3 Cells↗
PubMed1988

Medical ethics and the Islamic tradition.

After tracing the main features of the foundational ethical perspectives and their relationship to the rise of medical practice in early Islam, the paper focuses on the development of the moral concept of adab. This concept served as an important tool in defining and shaping an ethical tradition based on the integration of the Hippocratic tradition into Muslim medicine and its underlying moral values. The existence of plural therapeutic systems and their moral and theological sources are also noted and an attempt is made to show how all of these diverse modes co-existed through most of the pre-modern history of medicine among Muslims. The paper ends by outlining the impact the European colonial and cultural encounter with the World of Islam had, in creating a duality in medical practice, education and institutions, thus limiting sustained and meaningful discourse between modern medical science and the ethical values of Islam.

Cultural Diversity↗
PubMed1993

The priesthood of bioethics and the return of casuistry.

Several recent attempts to develop models of moral reasoning have attempted to use some form of casuistry as a way to resolve the moral controversies of clinical ethics. One of the best known models of casuistry is that of Jonsen and Toulmin who attempt to transpose a particular model of casuistry, that of Roman Catholic confessional practice, to contemporary moral disputes. This attempt is flawed in that it fails to understand both the history of the model it seeks to transpose and the morally pluralistic context of secular, postmodern society. The practice of casuistry which Jonsen and Toulmin wish to revive is a practice set in the context of a community with a shared set of moral values and structures of moral authority. Without a set of common moral values and rankings, and a moral authority to interpret cases the casuistry of the postmodern age will be pluralistic, that is, there will be many casuistries not just one.

Bioethics↗
PubMed1996

Whither career development in the NHS?

Observes that changes in the nature of employment and career development in the private sector have also affected the National Health Service in a similar way. Highlights how economic pressures have forced organizations to rationalize their workforces, and with this has come an end to the psychological contract which has existed between employers and employees. Outlines the nature of those changes, and their effect on individuals who need to take responsibility for their own career development. Suggests that there is now a need to develop a new moral contract between employers and employees. In return for job security, employers can offer a range of developmental opportunities to enable employees to become more employable when new employment is required.

Administrative Personnel↗
PubMed2005

Proto-professionalism: how professionalisation occurs across the continuum of medical education.

INTRODUCTION: Professionalism and its assessment across the medical education continuum have become prominent topics in recent years. We consider the nature of professionalism and how it emerges and relates to the work carried out by doctors and doctors-in-training. THESIS AND DISCUSSION: We suggest 6 domains in which evidence of professionalism can be expected: ethical practice; reflection/self-awareness; responsibility for actions; respect for patients; teamwork, and social responsibility. Furthermore, we propose that a defining characteristic is encapsulated by the Greek term phronesis, or practical wisdom. Phronesis is acquired only after a prolonged period of experience (and reflection on experience) occurring in concert with the professional's evolving knowledge and skills base. The prior period we have termed as one of 'proto-professionalism'. Influences on proto-professionalism are considered in terms of moral and psychosocial development and reflective judgement. CONCLUSION: Curricula that develop meta-skills will foster the acquisition and maintenance of professionalism. Adverse environmental conditions in the hidden curriculum may have powerful attritional effects.

Curriculum↗
PubMed1992

Community health and ethical theory: implications for holistic nursing.

A conceptual shift from Enlightenment philosophies to communitarian virtues is discussed. Epidemics and preventing disease spread are used as a basis for discussing the major bioethical concepts beneficence, justice, respect for autonomy, and Moskop's principle of restrictive measures. The addition of the concept of community and communitarian virtues to the ethical analysis is discussed. Holistic nurses are challenged to develop and employ morally sound rationale for ethical decisions.

Beneficence↗
PubMed2004

Engaging youth through photovoice.

The photovoice process aims to use photographic images taken by persons with little money, power, or status to enhance community needs assessments, empower participants, and induce change by informing policy makers of community assets and deficits. This article describes a youth photovoice project implemented in an after-school program that attempted to adapt the photovoice method to youth participants, test the effectiveness of the method with youth, and develop and refine a curriculum for replication. A process such as photovoice provides youth the opportunity to develop their personal and social identities and can be instrumental in building social competency. Youth should and need to be given the opportunity to build and confirm their abilities, to comment on their experiences and insights, and to develop a social morality for becoming a positive agent within their communities and society. For more examples of photos taken by the youth during this project, visit http://www.jhsph.edu/youthphotovoice.

Adolescent↗
PubMedDate not supplied

Child sexual abuse. 2: Techniques for helping adult survivors.

Nurses play a valuable role in helping victims of child sexual abuse. Through constant reassurance and skilled assistance the victims can realize that they can survive the abuse experience. The nurse wishing to work with this group of patients has an ethical and moral obligation to develop the necessary expertise and clinical competence to ensure that the intervention does not cause further harm and the development of maladaptive behaviour.

Adult↗
PubMed2005

Nanoscience and literature: bridging the two cultures.

The growth of nanoscience and nanotechnology as academic pursuits raises important questions about the nature of disciplinarity both within and beyond the sciences. These burgeoning fields also offer many opportunities for interdisciplinary and multidisciplinary collaboration among the sciences and various humanities fields. Literature-nanoscience collaborations, specifically, offer one way for workers in the humanities and sciences--the "two cultures" described by English scientist-writer C. P. Snow in the late 1950s--to cross the great divide that typically isolates them in order more fully to understand and address the potential social and moral consequences of developments in nanotechnology.

Journal Article↗
PubMed1999

Violence against caregivers in nursing homes. Expected, tolerated, and accepted.

Violence against caregivers is not a new phenomenon. Caregivers have experienced verbal and physical assaults from nursing home residents for many years. However, because much of the violence has been associated with demented or mentally ill residents, the word aggression was used in lieu of violence. This study found that the caregivers and nursing directors considered the assaults to be violence. The study suggests that such violence occurs frequently and is of concern to caregivers and nursing directors. The study also suggests that nursing homes may not have policies or procedures in place for preventing, monitoring, and controlling violence in their workplaces. In 1996, OSHA published violence prevention guidelines for health are facilities. These guidelines support OSHA's mandate that employees are entitled to a safe and healthy workplace (OSHA, 1996b). Although it is not possible to prevent all violence against caregivers in this unique setting, nursing home directors and administrators have a legal and moral responsibility to develop an action plan to minimize the violence and plan interventions for its effects. Violence against caregivers in nursing homes no longer can be thought of as expected, tolerated, and accepted. Quality of care and employee well-being depend on it.

Adult↗
PubMed1986

A challenge to examine the meaning of living and dying.

The case of Paul Brophy, decided by a four-to-three vote of the Supreme Judicial Court of Massachusetts, focused on the patient's right to terminate artificial nutrition and hydration. According to the majority opinion, artificial feeding is an "intrusive" procedure that one should be able to refuse without being accused of committing suicide. The court based its reasoning on the right to privacy and, in relation to that right, the state's interests in preserving life, protecting innocent third parties, preventing suicide, and maintaining the medical profession's ethical integrity. The majority could have been more persuasive, however, if it had considered Catholic moral tradition in developing its argument, especially the importance of judging a treatment's outcome and burden in relation to the individual patient's life. The Brophy opinion probably will leave many people dissatisfied because it fails to explore the values of the parties involved and the meaning of Catholic teaching. It should serve as a challenge, however, to the Catholic community to more fully articulate for a technologically oriented culture the meaning of living and dying.

Catholicism↗
PubMed1999

Influence of prolactin on the differentiation of mouse B-lymphoid precursors.

Development and activation of immune cells are submitted to hormonal influences, as illustrated by the roles of corticosteroids in thymus, pregnancy-related estrogens in B-cell development, or prolactin (PRL) on T-cell generation and function. We have analyzed the putative role of PRL in B lymphopoiesis and differentiation. We chose as an experimental model the interleukin (IL)-3 dependent BaF-3 pro-B cell line, which was transfected with the rat long form of the PRL receptor (PRL-R) and transferred from IL-3- to PRL-enriched media. When stimulated with PRL, the PRL-R transfectants underwent some changes characteristic of B-cell differentiation: (a) IL-2R alpha chain became positively controlled by PRL; (b) antiapoptotic Bcl-2 protein was induced by PRL in a dose-dependent manner; and (c) transcription of the pre-B cell receptor encoding the lambda5 gene was strongly up-regulated. We attempted to evaluate the differentiation-promoting activity of PRL in more physiological conditions, and the presence of PRL-R in bone marrow B-cell precursors was revealed. Furthermore, PRL promoted significant expansions of defined B-lineage cell populations in short-term bone marrow cell cultures. These findings suggest that PRL, in collaboration with other cytokines and hormonal influences, modulates B-cell development.

Animals↗
PubMed1999

Treatment of a transvestic fetishist with cognitive-behavioral therapy and supportive psychotherapy: case report.

Transvestic fetishism is a paraphilia marked by recurrent, intense sexually arousing fantasies, sexual urges, or behavior involving cross-dressing, in a heterosexual male. There are many explanations of the pathogenesis, but none are conclusive. Different treatments have been applied, but they generally remain obscure and disappointing. Transvestic fetishists rarely seek psychotherapy, because of their dynamic balance between perversion and intrapsychic disintegration. There are few studies, either qualitative or quantitative, associated with transvestic fetishism in Taiwan. This case report describes an adolescent transvestic fetishist who underwent a brief course of psychotherapy in the outpatient department of a psychiatric center in Taipei. After consultation for one year, he still maintained his deviant sexual behavior but also developed more severe moral anxiety. He was then referred for psychotherapy. Cognitive-behavioral and psychodynamic theories associated with transvestic fetishism were reviewed and applied in both understanding and treating this client. Some temporal effectiveness was achieved with combined cognitive-behavioral and dynamic-oriented supportive psychotherapy. After 18 sessions of psychotherapy over more than 4 months, the client was able to stop his perverse behavior and have fewer sexually arousing fantasies. The prognosis of transvestic fetishism is generally supposed to be pessimistic and have a high rate of recurrence. Some propose that adolescents have a better outcome after treatment. This case report reveals the possibility of change for a transvestic fetishist. However, the long-term effects of the brief course of psychotherapy require further evaluation in the future.

Adolescent↗
PubMed1989

Ethical questions in adolescent contraception.

Ethical problems often revolve around the conflicts of the models of beneficence and autonomy. Adolescents present a particular complication in their own struggle for autonomy. The physician is confronted with the further dilemma of sorting out the role of parents and the role of the adolescent patient in decision making. Furthermore, as adolescents develop their own moral code, they may lack consistency in their actions and opinions. The physician must examine the total context in arriving at a decision. The prescription of contraception is taken as an example of a common ethical dilemma.

Abortion, Induced↗
PubMed2000

The role of a county health department as a linking-pin organization in a network.

This is a case study of a local health department's role in the formation and operation of a network of health care providers. The local health department served as a linking-pin organization in the network and engaged in actions to legitimize itself and the network it formed. Legitimacy management requires the development of pragmatic, moral, and cognitive strategies that can be used for gaining, maintaining or repairing legitimacy. The results of this study indicate a unique government legitimacy management profile in which there is a predominant use of cognitive and pragmatic actions intended to gain legitimacy. The implications of this profile are discussed.

Community Health Planning↗
PubMed1988

Perinatal law and ethics rounds.

Advances in perinatal medicine have increased the complexity of the clinical decision-making process. Medical education curricula have paid little attention to exploring the ethical and legal aspects of these decisions. In response to this perceived need, we initiated a case-oriented teaching program in perinatal law and ethics. The goals of the program included the following: to develop skills in "moral diagnosis" and analysis (the ability to interpret and analyze clinical cases from a moral point of view); to understand the relevant laws; to appreciate the ethical and legal relationships between the pregnant woman, her fetus, and the professionals; and to encourage open and frank discussion of these important issues. The teaching rounds, led by a lawyer and ethicist, were held monthly, and included all professionals who care for pregnant women and their newborns. A patient was presented in lay language, stressing the ethical or legal issue raised by the case. Cases could be separated into five categories: questions concerning abortion, issues of maternal-fetal conflict, labor management in extreme prematurity or fetal abnormality, innovative therapy, and the psychological concerns of difficult decisions. Careful case analysis with an in-depth discussion of the ethical principles and legal precedents on which decisions are based appears to be an effective and useful educational exercise. This approach to perinatal teaching can prepare professionals to deal with exigent situations that may occur in practice.

Abortion, Induced↗