An adjusted version of Kohlberg's moral theory: discussion of its validity for research in nursing ethics

Critics of Kohlberg's moral theory today focus on the content of his theory and more specifically on its justice-orientated moral concept. This has led to the well-known 'justice-care debate'. The purpose of this article is to critically examine the validity of Kohlberg's moral theory for research in nursing ethics from a caring perspective (referring to the content) as well as from a cognitive-structural perspective (referring to the basic assumptions of the model). The analysis points to the usefulness and value of the cognitive-structural model to empirically study nurses' ethical behaviour; the content of Kohlberg's model, however, needs to be adapted by adding a caring perspective as well as some personal and situational variables. An adjusted version of Kohlberg's model is proposed and discussed.     

Cognitive behaviour therapy approach to disputing automatic thoughts: a two-stage model

Research shows that clients with automatic thoughts (dysfunctional thinking) often do not think of alternative explanations in relation to negative events. Furthermore, these automatic thoughts are characterized by a broad global, self-evaluative and ambiguous nature that could make disputing (or changing the ways they think) the most difficult part of the therapeutic process. This paper proposes a two-stage practise-based disputing model, guided by research, that aims to 'bring' an automatic thought to a specific, objective, quantifiable and concrete level at which not only is the particular aspect(s) of the automatic thought that causes emotional disturbances finely focused, but the disputing is also likely to be effective and manageable. Furthermore, it will also generate alternative explanations that are helpful in reducing emotional disturbances and in facilitating problem solving approach. In this paper, the authors use a case example to discuss the rationale that underpins the conceptualization of the model and to illustrate the process in which the strategies of the model are effectively used.     

Development and reproducibility of a tool to assess school food-purchasing practices and lifestyle habits of Australian primary school-aged children

Objective: To describe the development and reproducibility of a self‐report instrument, for use with children in years 4–6, to identify sources of food eaten during the day, and type and frequency of food purchases at school. Design: Tool development stages included formulation of content and format, expert review, piloting and a test–retest study. Subjects/setting: The pilot study included school students (n = 20) in years 4 and 5 (seven girls, mean age 9.7 ± 0.7 years) attending an Australian public primary school. The test–retest study was performed in a large metropolitan public primary school (n = 245 children, 52% female, mean age 10.7 ± 0.91 years) including children from years 4 (n = 88), 5 (n = 84) and 6 (n = 73). Statistical analysis: A Kappa statistic was used to assess level of agreement between the two time periods separated by 1 week. The results were analysed using SAS version 8.2 with each question compared at time 1 and 2. Results: The mean kappa was 0.529 using pairings from 17 questions. Values ranged from 0.18 to 0.71 (CI 0.46–0.60). Conclusions and applications: The School Eating Habits and Lifestyle Survey has been developed and pilot‐tested in primary school‐aged children and shown to have moderate stability over time. The results show that each phase of development, particularly those spent in consultation and testing, led to progressive improvement of this instrument. This process improved the quality of information produced and gave insights to self‐report of dietary intake and behaviours among children.     

The Fetal Patient: Coordinated Care for Families

Complete and accurate knowledge is critical to parent decision making for families with complex and/or life-threatening fetal conditions. Comprehensive fetal centers are available to provide multidisciplinary specialized assessment, evaluation, diagnosis, and nondirectional counseling. Interventional option may include fetoscopic procedures, open fetal surgery, and ex utero intrapartum treatment. The nurse coordinator serves as the family and health care provider liaison for arrangement of services and communication of the plan of care.     

Composite indicators of dental health: functioning teeth and the number of sound-equivalent teeth (T-Health)

Abstract –This study investigated whether two new composite dental indicators -"the number of functioning teeth" and "the number of sound-equivalent teeth" are more efficient than the conventional DM FT index in revealing the social and behavioural factors which are significantly related to oral health status. The arbitrary set of weights given to the T-Health indicator was also evaluated. The number of functioning teeth was defined as the aggregate of filled (otherwise sound) and sound teeth. The T-Health was defined as a weighted average of sound teeth, filled (otherwise sound) teeth and teeth with some decay, the weights intended in principle to represent the relative amounts of sound tissue in these three categories of teeth. An arbitrary set of weights was used: 4, 2, and 1 for sound, filled, and decayed teeth, respectively. 164 families (father, mother and at least one 13-yr-old child) from Belo Horizonte, Brazil, were randomly selected from 13-yr-old children from private and state schools. The parents'ages ranged from 35 to 44 yr. Socio-economic status, area of residence, level of education, family income, sugar consumption, toothbrushing frequency and type of dental attendance were the social and behavioural oral health risk-factors considered in this study. The results indicated that the two new dental indicators are more sensitive to the influence of social and behavioural factors, such as those investigated here, than is the traditional DM FT index. A different set of weights (4, I, and I for sound, filled, and decayed) was suggested for the construction of the T-Health.     

Psychosocial stress and symptoms of menopause: a comparative study of menopause clinic patients and non-patients

In much of the literature to date, the definition of climacteric symptoms has been based largely upon women who present for medical treatment of symptoms. It is already well recognised that patients (of all ages and both sexes) presenting for medical treatment tend to report themselves as suffering from more life stresses and from more neurotic symptoms than people in the general population. Life stress and adequacy of coping may thus be important factors in the incidence of symptomatology at the climacteric, as at any other time of life. This study therefore investigated the proposal that post-menopausal women who present for treatment at menopause clinics suffer from more life stresses and more neurotic symptoms than post-menopausal women in the general pupolation.

It was found that patients did indeed suffer from more psychosocial stress, measured in terms of life events, clinical depression and anxiety scales and a rating scale based on a clinician's judgements of ongoing psychosocial stress, vulnerability and adequacy of coping. Patients also suffered from significantly more symptoms than non-patients, not only psychological, but also hypothalamic and metabolic symptoms. However, the incidence of hot flushes and vaginal atrophy was the same in both groups. The stress/coping rating was the measure which correlated most highly with the psychological symptoms reported by subjects as symptoms of menopause. Life events and clinical stress measures were more consistently related in the non-patient group, indicating possible intervening variables (such as hormone imbalance) in this relationship in the patient group.     

The osmotic behaviour of toad skin epithelium (Bufo viridis)

The effect of saline adaptation on the intracellular Na, K, Cl, P concentrations and dry weight content of the toad skin epithelium (Bufo viridis) was studied using the technique of electron microprobe analysis. The measurements were performed on isolated abdominal skins either directly after dissection or after additional incubation in Ussing-type chambers.Adaptations of the toads to increasing NaCl concentrations for 7 days resulted in increased blood plasma osmolarity and a parallel increase in the cellular electrolyte, P and dry weight concentrations of the epithelium, the K increase representing the most significant fraction of the intracellular osmolarity increase. No evidence was obtained to show that the nucleus and cytoplasm reacted differently from each other and all living epithelial cell types basically showed the same response.Incubation of the isolated skins under control conditions showed a drastic inhibition of the transepithelial Na transport after adaptation to high salinities. In spite of the large variations in the transport rate almost identical intracellular electrolyte concentrations were observed. In tap water adapted toads the average cellular concentrations were 8.8 mmole/kg wet weight for Na, 109.6 for K, 41.5 for Cl, and 135.3 for P, respectively. Incubation of the skin with Ringer's solution of different osmolarities demonstrated that the epithelial cells are in osmotic equilibrium with the inner bathing solution. The results are consistent with the view that the osmotic adaptation is mainly accomplished by the movement of water.This work was supported by grants from the Deutsche Forschungsgemeinschaft and the Stiftung Volkswagenwerk     

骨骼肌介电行为的理论模型仿真

在 10 0 Hz～ 10 0 MHz范围内 ,应用椭圆壳介电理论模型 ,经过模拟仿真蛙骨骼肌细胞的介电行为 ,确定了蛙骨骼肌细胞的椭圆壳模型各相参数。为将来对骨骼肌疲劳、肌营养不良和肌肉萎缩等病症的模型分析奠定理论基础。     

早期干预对高危儿智能发育影响的研究

目的探讨定期随访高危儿,进行早期发育评价及干预,对高危儿智能发育的影响。方法将82例高危儿随机分成干预组42例和常规组40例,干预组接受早期干预,两组患儿定期随访,以中国婴幼儿发育量表（CDCC）和《Ge-sell发育诊断量表》进行智能发育评估。结果3、6、9月龄时干预组患儿智力发育指数（MD I）和运动发育指数（PD I）均显著高于常规组;1岁时Gesell智能检查,干预组除大运动能区与常规组有显著性差异外（P〈0.05）,其他四大能区均存在非常显著性差异（P〈0.01）。结论早期干预可促进高危儿的智能发育,改善其预后。