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[Fault, sacrifice and traumatic neurosis. Apropos of a case].

The present case is one of a patient suffering from traumatic neurosis, on whom psychotherapeutic work has been possible. The traumatic experience, which dates back to the Franco-Algerian War, could have gradually started making sense in the context of its onset and of the state in which the relationship between the patient and his father remained at the time. Something along the lines of an irrevocable mistake, irrevocable since logically referred to as a serious moral mistake on the part of the father towards his son, renders humanely comprehensible his upkeep of his atrocity as represented by the repetition of the revival symptoms.

Adult↗

Premarital sexuality: a five-year follow-up study of attitudes and behavior by dating stage.

This paper presents the results of a survey on premarital sex conducted in 1988. The study focused on what respondents considered proper sexual behavior, what they reported they did, and what they thought others were doing at five stages of dating. Respondents were asked about cohabitation, the effect of AIDS on their premarital attitudes and behavior, and their views regarding the morality of premarital sex. When compared to the results of a similar study conducted in 1983, the data provided some evidence of change in premarital sexual attitudes and behavior. Female respondents in the 1988 sample showed lower levels of sexual intercourse at all five dating stages than did their counterparts in the 1983 study. However, males in the 1988 sample reported higher levels of sexual intercourse for the first four stages of dating than did males in the 1983 survey. In general, both males and females in the 1988 sample reported changing their attitudes and behavior regarding premarital sex in the direction of greater conservatism since hearing about AIDS. Attitudinal change was more widespread than actual behavioral change.

Acquired Immunodeficiency Syndrome↗

[Educational objectives in medical school: curriculum].

The author discuss in this paper the different options for a curricular reform in medical education presenting the difficulties to implement a curriculum with a broad abrangence. He consider the different possibilities for a curricular structure and evaluated the advantages and disadvantages of each (discipline-centered, body-system-based, problem-oriented and clinical presentation curriculum). He argue that most of the critical determinants of physician identity operate not within the formal curriculum but in a more subtle, less officially recognized hidden curriculum. He finish discussing that a significant component of medical training involves the development of a medical morality.

Curriculum↗

The influence of moral reasoning on behavioral choices.

This study examined the ways in which exposure to moral reasoning statements affected the subsequent behavioral choices of 144 seventh-, eighth-, and ninth-grade boys at different stages of moral judgment. The subjects were divided among 4 experimental conditions, each of which attempted to isolate and relate behavioral choice and reasoning in specific ways. The presentation of reasoning had different effects on the behavioral choices of subjects at 2 different stages. The findings were considered in terms of their implications for developmental change as well as for a developmental analysis of the relationship between moral reasoning and moral behavior.

Adolescent↗

[The development of third molars in the children of Croatia].

The objective of this research was to investigate the prevalence of third molars in children in Istria aged 7 to 18. There are 2350 panoramic radiographs of children in Istria that have been analysed and then divided into 7 age groups. In each of these groups there was the same number of boys and girls. It can be expected that over 50% of examinees have third morals at ages between 10-11. The development of third morals starts earlier in the mandible, and it is statistically significant that there are more third morals in the mandible before the age of 12 than in the maxilla (p < 0.01). Furthermore, it is statistically significant that nine year old girls have more third morals than boys, but twelve year old boys more than girls. The differences in the prevalence of third morals between the jaw sides were statistically significant only for mandibles of twelve year old girls. Hypodontia of third morals has been found in 4.5% of boys and 5.8% of girls aged 14 to 18.

Adolescent↗

The dual biological identity of human beings and the naturalization of morality.

The last two centuries have been the centuries of the discovery of the cell evolution: in the XIX century of the germinal cells and in the XX century of two groups of somatic cells, namely those of the brain-mind and of the immune systems. Since most cells do not behave in this way, the evolutionary character of the brain-mind and of the immune systems renders human beings formed by t wo different groups of somatic cells, one with a deterministic and another with an indeterministic (say Darwinian) behavior. An inherent consequence is that of the generation, during ontogenesis, of a dual biological identity. The concept of the dual biological identity may be used to explain the Kantian concept of the two metaphysical worlds, namely of the causal necessity and of the free will (Azzone, 2001). Two concepts, namely those of complex adaptive systems (CAS) and of emergence (Holland, 2002), are useful tools for understanding the mechanisms of adaptation and of evolution. The concept of complex adaptive systems indicates that living organisms contain series of stratified components, denoted as building blocks, forming stratified layers of increasing complexity. The concept of emergence implies the use of repeating patterns and of building blocks for the generation of structures of increasing levels of complexity, structures capable of exchanging communications both in the top-down and in the bottom-up direction. Against the concept of emergence it has been argued that nothing can produce something which is really new and endowed of causal efficacy. The defence of the concept of emergence is based on two arguments. The first is the interpretation of the variation-selection mechanism as a process of generation of information and of optimization of free energy dissipation in accord with the second principle of thermodynamics. The second is the objective evidence of the cosmological evolution from the Big Bang to the human mind and its products. Darwin has defended the concept of the continuity of evolution. However evolution should be considered as continuous when there is no increase of information and as discontinuous when there is generation of new information. Examples of such generation of information are the acquisition of the innate structures for language and the transition from absence to presence of morality. There are several discontinuity thresholds during both phylogenesis and ontogenesis. Morality is a relational property dependent on the interactions of human beings with the environment. Piaget and Kohlberg have shown that the generation of morality during childhood occurs through several stages and is accompanied by reorganization of the child mental organization. The children respect the conventions in the first stage and gradually generate their autonomous morality. The transition from absence to presence of morality, a major adaptive process, then, not only has occurred during phylogenesis but it occurs again in every human being during ontogenesis. The religious faith does not provide a logical justification of the moral rules (Ayala, 1987) but rather a psychological and anthropological justification of two fundamental needs of human beings: that of rendering Nature an understandable entity, and that of increasing the cooperation among members of the human societies. The positive effects of the altruistic genes in the animal societies are in accord with the positive effects of morality for the survival and development of the human societies.

Adaptation, Biological↗

Role of prepancreatic (pro)insulin and the insulin receptor in prevention of embryonic apoptosis.

The characterization of (pro)insulin as an early embryonic growth factor requires demonstration of its expression and cellular effects in vivo. By in situ hybridization, we found widespread preproinsulin transcripts in the chick embryo throughout gastrulation and neurulation, before the beginning of preproinsulin-like growth factor I expression and pancreatic organogenesis. To analyze the prepancreatic (pro)insulin effect on apoptotic cell death, we treated embryos with antisense oligodeoxynucleotides in ovo and in vitro. The specific effect of two preproinsulin messenger RNA (mRNA) antisense oligodeoxynucleotides was confirmed by the decrease in a biosynthetically labeled protein immunoprecipitated with antiinsulin Igs. Insulin receptor mRNA antisense oligodeoxynucleotide applied in ovo increased by 2.7-fold the level of apoptosis in the 1.5-day embryo (neurulation) compared with that in its random sequence control. In a whole embryo culture, apoptosis increased by 25-35% with the addition of preproinsulin or insulin receptor mRNAs antisense oligodeoxynucleotides, respectively, whereas it decreased by 64% after 10 h in the presence of 10(-8) M chicken insulin. Exogenous insulin also rescued the death induced by preproinsulin antisense oligonucleotides. These findings provide evidence for an autocrine/paracrine role ofpreproinsulin gene products acting through the insulin receptor in the control of cell survival/death during early embryonic development.

Animals↗

Nursing ethics in a developing country.

Nursing is a true profession, distinguished by its philosophy of care, its full-time commitment to human wellbeing, its particular blend of knowledge and skills and its valuable service to the community (Curtin & Flaherty, 1982:92). Ethics is vital to nursing. Being a professional implies ethical behaviour and knowledge of what it means to be ethical (Pera & Van Tonder, 1996:v). Ethics is the foundation of committed service to humankind. When nurses practice is an ethical manner they should adhere to ethical principles like autonomy, beneficence, justice, veracity, fidelity, confidentiality and privacy. From this conceptual framework two questions can be asked, namely: Does the behaviour of nurses in health services in South Africa comply with the principles of ethics? How can ethical behaviour be facilitated in nurses in South Africa? The first question was answered by doing a critical analysis of thirty-two case studies of recent ethical phenomena in health services. The ethical principles will be used as criteria for this analysis. Some of the ethical case studies will be presented in this paper to indicate the problems in relation to autonomy, beneficence, justice, veracity and fidelity. It will be demonstrated that from deontological ethical theories nurses are not doing their duty as advocates for the vulnerable patient and from utilitarianism the poor and uneducated patients are being exploited. To empower patients in developing countries it is of vital importance for nurses to behave in an ethical manner. From a literature study a program for rational interaction for moral sensitivity (Rossouw, 1995) and virtue-based ethics in Nursing Education is identified to facilitate moral behaviour amongst nurses in developing countries.

Attitude of Health Personnel↗

Lies and truth: a study of the development of the concept.

This study examined the developmental questions of when children begin to use the terms lie and truth, how they understand them, and when their understanding approaches that of adults. 150 subjects in 5 groups (nursery schoolers, preschoolers, first graders, fifth graders, and adults) were presented a series of 8 short puppet plays that systematically varied the presence of absence of the 3 prototype elements: factuality of a statement, the speaker's belief in the factuality or falsity of the statement, and the speaker's intent to deceive the listeners. The interactions of age, factuality, and belief most fully accounted for the use of the terms lie and truth. Persons at different ages differentially weighed the prototypic elements. Responses of fifth graders were transitional between those of the younger children and adults. The results are interpreted as supporting the development of definitional prototypes for these moral concepts.

Adolescent↗

Toward a procedure for integrating moral issues in health technology assessment.

OBJECTIVES: Although ethics has been on the agenda in health technology assessment (HTA) since its inception, the integration of moral issues is still not standard and is performed in a vast variety of ways. Therefore, there is a need for a procedure for integrating moral issues in HTA. METHODS: Literature review of existing approaches together with application of various theories in moral philosophy and axiology. RESULTS: The article develops a set of questions that addresses a wide range of moral issues related to the assessment and implementation of health technology. The issues include general moral issues and moral issues related to stakeholders, methodology, characteristics of technology, and to the HTA process itself. The questions form a kind of checklist for use in HTAs. CONCLUSIONS: The presented approach for integrating moral issues in HTA has a broad theoretical foundation and has shown to be useful in practice. Integrating ethical issues in HTAs can be of great importance with respect to the dissemination of HTA results and in efficient health policy making.

Bioethics↗

On being poor and feeling poor: low socioeconomic status and the moral self.

Persons of low socioeconomic status generally experience worse health and shorter lives than their better off counterparts. They also suffer a greater incidence of adverse psychosocial characteristics, such as low self-esteem, self-efficacy, and self-mastery and increased cynicism and hostility. These population data suggest another category of harm to persons: diminished moral agency. Chronic socioeconomic deprivation can create environments that undermine the development of self and capacities constitutive to moral agency--i.e., the capacity for self-determination and crafting a life of one's own. The harm affects not only the choices a person makes, but the chooser herself. This moral harm is particularly salient in modern Western societies, especially in the United States, where success and failure is attributed to the individual, with little notice of the larger social and political realities that inform an individual's circumstances and choices.

Aged↗