Socializing the public: invoking Hannah Arendt’s critique of modernity to evaluate reproductive technologies

The article examines the writings of one of the most influential political philosophers, Hannah Arendt, and specifically focuses on her views regarding the distinction between the private and the public and the transformation of the public to the social by modernity. Arendt’s theory of human activity and critique of modernity are explored to critically evaluate the social contributions and implications of reproductive technologies especially where the use of such technologies is most dominant within Western societies. Focusing on empirical studies on new reproductive technologies in Israel, it is argued, powerfully demonstrates Arendt’s theory, and broadens the perspectives through which society should evaluate these new technologies towards a more reflective understanding of its current laws and policies and their affect on women more generally.     

Relieving one’s relatives from the burdens of care

It has been proposed that an old and ill person may have a ‘duty to die’, i.e. to refuse life-saving treatment or to end her own life, when she is dependent on the care of intimates and the burdens of care are becoming too heavy for them. In this paper I argue for three contentions: (1) You cannot have a strict duty to die, correlating to a claim-right of your relatives, because if they reach the point at which the burdens of care are larger than you can reasonably expect them to take, the natural conclusion is that their duty ends. (2) They may be prepared, however, to go on caring for you beyond that point. In that case your responsibility for their wellbeing may require you to refuse this care, even if this results in a situation for you in which death will be preferable to continued life. (3) If this is the correct understanding of your responsibilities, the objection that in the context of family life the burdens of care attached to one family member’s valued existence can never be ‘too heavy’, fails. It postulates unlimited concern on one side and a total lack of concern on the other.     

A critique of the US Surgeon General’s conclusions regarding e-cigarette use among youth and young adults in the United States of America

Background

In December 2016, the Surgeon General published a report that concluded e-cigarette use among youth and young adults is becoming a major public health concern in the United States of America.

Methods

Re-analysis of key data sources on nicotine toxicity and prevalence of youth use of e-cigarettes cited in the Surgeon General report as the basis for its conclusions.

Results

Multiple years of nationally representative surveys indicate the majority of e-cigarette use among US youth is either infrequent or experimental, and negligible among never-smoking youth. The majority of the very small proportion of US youth who use e-cigarettes on a regular basis, consume nicotine-free products. The sharpest declines in US youth smoking rates have occurred as e-cigarettes have become increasingly available. Most of the evidence presented in the Surgeon General’s discussion of nicotine harm is not applicable to e-cigarette use, because it relies almost exclusively on exposure to nicotine in the cigarette smoke and not to nicotine present in e-cigarette aerosol emissions. Moreover, the referenced literature describes effects in adults, not youth, and in animal models that have little relevance to real-world e-cigarette use by youth. The Surgeon General’s report is an excellent reference document for the adverse outcomes due to nicotine in combination with several other toxicants present in tobacco smoke, but fails to address the risks of nicotine decoupled from tobacco smoke constituents. The report exaggerates the toxicity of propylene glycol (PG) and vegetable glycerin (VG) by focusing on experimental conditions that do not reflect use in the real-world and provides little discussion of emerging evidence that e-cigarettes may significantly reduce harm to smokers who have completely switched.

Conclusions

The U.S. Surgeon General’s claim that e-cigarette use among U.S. youth and young adults is an emerging public health concern does not appear to be supported by the best available evidence on the health risks of nicotine use and population survey data on prevalence of frequent e-cigarette use. Nonetheless, patterns of e-cigarettes use in youth must be constantly monitored for early detection of significant changes. The next US Surgeon General should consider the possibility that future generations of young Americans will be less likely to start smoking tobacco because of, not in spite of, the availability of e-cigarettes.

     

Estimating the effectiveness of a hospital’s interventions in India: impact of the choice of disability weights

ObjectiveTo calculate the effect of using two different sets of disability weights for estimates of disability-adjusted life-years (DALYs) averted by interventions delivered in one hospital in India.MethodsDALYs averted by surgical and non-surgical interventions were estimated for 3445 patients who were admitted to a 106-bed private hospital in a semi-urban area of northern India in 2012–2013. Disability weights were taken from global burden of disease (GBD) studies. We used the GBD 1990 disability weights and then repeated all of our calculations using the corresponding GBD 2010 weights. DALYs averted were estimated for surgical and non-surgical interventions using disability weight, risk of death and/or disability, and effectiveness of treatment.FindingsThe disability weights assigned in the GBD 1990 study to the sequelae of conditions such as cataract, cancer and injuries were substantially different to those assigned in the GBD 2010 study. These differences in weights led to large differences in estimates of DALYs averted. For all surgical interventions delivered to this patient cohort, 11 517 DALYs were averted if we used the GDB 1990 weights and 9401 DALYs were averted if we used the GDB 2010 disability weights. For non-surgical interventions 5168 DALYs were averted using the GDB 1990 disability weights and 5537 DALYS were averted using the GDB 2010 disability weights.ConclusionEstimates of the effectiveness of hospital interventions depend upon the disability weighting used. Researchers and resource allocators need to be very cautious when comparing results from studies that have used different sets of disability weights.     

The effect of preschool on children’s school readiness

The purpose of this study was to examine the effect of preschool on children’s school readiness in connection with their intellectual abilities, language competence and parents’ education. The sample included 219 children from 68 to 83 months old attending the first year of primary school, differentiated by whether or not they had attended preschool before starting school. Children’s intellectual ability was determined using Raven’s Coloured Progressive Matrices, language competence using the Lestvice splo?nega govornega razvoja–LJ (Scales of General Language Development) and school readiness with the Preizkus pripravljenosti za ?olo (Test of School Readiness). The results indicate that children’s intellectual ability and language competence have high predictive value for the school readiness because they explain 51% of the variance in children’s scores on the Preizkus pripravljenosti za ?olo. Preschool enrollment has a positive effect on school readiness for children whose parents have a low level of education, but not for those whose parents are highly educated. The results obtained indicate that enrollment in preschool is able to compensate for deficiencies in children’s development if the parents have a lower level of education. Preschool is not an important factor in school readiness for children whose parents are highly educated. These parents probably already offer their children quality stimulation in the family environment that preschool activities do not surpass.     

The challenges of parent–teacher collaboration in the light of hospital school pedagogy

This article provides viewpoints to the development of hospital school pedagogy by analysing challenges of collaboration and encounters between a hospital school teacher and students’ parents. The teacher’s pedagogical work necessitates the ability to work with quite a heterogeneous student group and their parents, and with teachers from students’ own schools. The article is based on experience as a special education teacher at a hospital school and a researcher’s diary of the everyday encounters in the teacher’s work. The observation period formed the data of this study. Findings are presented as the process of collaboration negotiation between the hospital school teacher and the students’ parents. Based on the data and findings, collaboration with students’ own teachers had a significant role. The findings lean on case examples from a hospital school teacher’s everyday work. The research helps to understand the nature of a hospital school teacher’s work and develop hospital school pedagogy.     

‘Therapeutic landscapes’ and the importance of nostalgia,solastalgia, salvage and abandonment for psychiatric hospital design

We examine emotional reactions to changes to medical spaces of care, linked with past experiences. In this paper we draw on findings from a qualitative study of the transfer of psychiatric inpatient care from an old to a newly built facility. We show how the meanings attributed to ‘therapeutic landscapes’ from one׳s past can evoke emotions and memories, manifesting in ideas about nostalgia, solastalgia, salvage and abandonment, which can impinge on one׳s present therapeutic experience. We reflect on how consideration of these ideas might contribute to better future design of psychiatric inpatient facilities and the wellbeing of those using them.     

Introduction to the Special Issue of Articles from the 2007 National Survey of Children’s Health

Families of children affected by birth defects suffer from a significant psychological burden across the lifespan, but there have been few studies on this topic in China. Our goal was to assess depression among mothers of children with birth defects (MCBD) and to explore factors influencing depression among MCBD in China. A total of 154 mothers of affected children aged 0–3 years old (MCBD) and 321 mothers of healthy children (MHC) in the same age range took part in the study. The Center for Epidemiologic Studies Depression Scale was used to assess maternal depression, and logistic regression models were used to explore the factors influencing depression among MCBD. MCBD were more depressed than MHC and birth defects were associated with maternal depression after demographic variables were controlled. Poverty was the most important predictor of depression among MCBD. Appropriate interventions for depressed mothers are essential and should focus on poor families.     

Who’s afraid of EBM? Medical professionalism from the perspective of evidence-based medicine

Evidence-based medicine (EBM) and medical professionalism are two prominent notions in current medical debates. However, proponents of professionalism fear a restriction in doctors’ freedom to make their best decisions for individual patients caused by the influence of EBM and highly standardised decision procedures. The challenge which EBM allegedly poses to physicians’ discretion forms the starting point for an analysis of the relationship between professionalism, as an inherent value system of medical practice, and EBM, as an approach to optimise the decision-making for individual patients. The analysis starts with a brief conceptual clarification of the ambiguous term “professionalism”. It then focuses on three key aspects of medical professionalism which may come into conflict with the basic tenets of EBM. The potential tensions between (a) professional autonomy and clinical practice guidelines, (b) individualised care and standardisation, and (c) esoteric authority and public accountability are analysed and a suggestion for reconcilement regarding each point is made. The article closes with a summary on how a better reflection on medical professionalism may help towards a fuller understanding of EBM and vice versa.     

‘It’s more funner than doing work’: children’s perspectives on using tablet computers in the early years of school

There is a clamour of voices around the contemporary issue of tablet computers in early years education. A growing body of research presents the potential of tablet computers to transform education, provide unprecedented learning opportunities and positive outcomes for young children and offer rich opportunities for independent learning and collaborative interaction. However, this is tempered with disquiet from a number of sources which posit that digital devices are diminishing children’s play and are an affront to childhood. Many of these polemic debates come from adult perspectives yet children are the key users in the dizzying advancement of technology and their views are a crucial element in understanding the conceptualisation of tablet devices as pedagogical tools. This paper takes a children’s rights approach in acknowledging that children have the right to have their voices heard and their experiences understood. Therefore, this paper seeks to add further insights to the debates on digital technology in early years education by presenting the views of one of the central players within this debate – young children.     

The Agroecological Farmer’s Pathways from Agriculture to Nutrition: A Practice-Based Case from Ecuador’s Highlands

Agroecology is increasingly recognized as a sustainable production strategy that is appropriate for the rural poor. Meanwhile, agricultural initiatives have received much attention for their role in improving farmer nutrition, and three key pathways between agriculture and nutrition include consumption of own production, income and women’s empowerment. In this study based in Ecuador’s Imbabura province, we used qualitative methods to explore the practices of agroecological farmers with respect to these three key pathways. Results demonstrate the heterogeneity of lived experiences through which agroecology increases agricultural diversity and builds social and human capital to improve nutrition. We further identify barter as an under-explored means to nutrition outcomes, and we discuss the role of the complex rationales that mediate farmers’ performance on agriculture-for-nutrition pathways. Finally, our results illustrate agroecology’s potential to spread nutrition-promoting practices through endogenous farmers’ networks.     

Do reciprocal relationships between academic workload and self-regulated learning predict medical freshmen’s achievement? A longitudinal study on the educational transition from secondary school to medical school

One of the most important factors that makes the transition from secondary school to medical school challenging is the inability to put in the study time that a medical school curriculum demands. The implementation of regulated learning is essential for students to cope with medical course environment and succeed. This study aimed to investigate the reciprocal relationships between self-regulated learning skills (SRLS) and academic workload (AW) across secondary school to medical school transition. Freshmen enrolled in medical school (N?=?102) completed questionnaires at the beginning and at the end of their academic year, assessing AW (measured as study time hours and perceived workload), SRLS (planning and strategies for learning assessment, motivation and action to learning and self-directedness) and academic achievement. An exploratory factor analysis (EFA) and a longitudinal path analysis were performed. According to the EFA, study time and perceived workload revealed two factors of AW: students who had a high perceived workload also demonstrated increased study time (tandem AW); and those who had a low perceived workload also demonstrated increased study time (inverse AW). Only a longitudinal relationship between SRLS and AW was found in the path analysis: prior self-directedness was related to later tandem AW. Moreover, success during the first year of medical school is dependent on exposure to motivation, self-directedness and high study time without overload during secondary school and medical school, and prior academic achievement. By better understanding these relationships, teachers can create conditions that support academic success during the first year medical school.     

A View from Cheyenne Mountain: Generation III’s Perspective of Keystone III

In October 2000 the family of family medicine convened the Keystone III conference at Cheyenne Mountain Resort. Keystone III participants included members of Generation I (entered practice before 1970), Generation II (entered 1970–1990), and Generation III (entered after 1990). They represented a wide range of family physicians, from medical students to founders of the discipline, and from small-town solo practice to academic medicine. During the conference, the three generations worked together and separately thinking about the past, present, and future of family medicine, our roles in it, and how the understanding of a family physician and our discipline had and would continue to evolve. After the conference, the 10 Generation III members wrote the article published here, reflecting on our experiences as new physicians and physicians in training, and the similarities and differences between our experiences and those of physicians in Generations I and II. Key similarities included commitment to whole-person care, to a wide scope of practice, to community health, and to ongoing engagement with our discipline. Key differences included our understanding of availability, the need for work-life balance, the role of technology in the physician-patient relationship, and the perceptions of the relationship between medicine and a range of outside forces such as insurance and government. This article, presented with only minor edits, thus reflects accurately our perceptions in late 2000. The accompanying editorial reflects our current perspective.     

Sex-differential effects of diphtheria-tetanus-pertussis vaccine for the outcome of paediatric admissions? A hospital based observational study from Guinea-Bissau

BackgroundIn spite of protection against the targeted infections, a large volume of observational data indicates that diphtheria-tetanus-pertussis (DTP) vaccine may have a negative impact on overall childhood mortality in low-income countries, especially in girls.MethodsIn an observational study using data from Bandim Health Project’s continuous registration of all admissions to the paediatric ward at the National Hospital Simão Mendes in Bissau, we investigated whether DTP was associated with higher female than male in-hospital mortality (female/male case fatality ratio (F/M CFR)) and whether the CFR comparing DTP-vaccinated and DTP-unvaccinated children differed by sex. We included children aged 6 weeks to 8 months (274 days) admitted to the paediatric ward with a vaccination card seen during admission.ResultsFrom May 2001 to January 2008, 4230 children aged 6 weeks to 8 months were admitted and 3450 (82%; 1997 boys, 1453 girls) presented a vaccination card. The proportion presenting a vaccination card and DTP coverage did not differ by sex. During admission, 16% (200/1250) of the girls and 13% (220/1694) of the boys who had received DTP died. The F/M CFR among the 2944 DTP-vaccinated children was 1.23 (1.03–1.46); while it was 0.95 (0.66–1.38) among the 506 children who had not received DTP. DTP-vaccinated children were older and had better socioeconomic status. Adjusted for age, BCG-vaccination, residence, and maternal education the CFR comparing DTP-vaccinated boys with DTP-unvaccinated boys was 0.84 (0.63–1.11), while the CFR comparing DTP-vaccinated girls with DTP-unvaccinated girls was 1.28 (0.90–1.83) (p = .07 for same effect in boys and girls).ConclusionAmong DTP-vaccinated children, female in-hospital mortality was higher than male in-hospital mortality and DTP-vaccination tended to be associated with higher mortality in girls. The data are consistent with DTP having negative effects on mortality for girls. Further studies are necessary to design the optimal vaccination programme for both sexes.