BackgroundRespect for confidentiality is important to safeguard the well-being of patients and ensure the confidence of society in the doctor-patient relationship. The aim of our study is to examine real situations in which there has been a breach of confidentiality, by means of direct observation in clinical practice.MethodsBy means of direct observation, our study examines real situations in which there has been a breach of confidentiality in a tertiary hospital. To observe and collect data on these situations, we recruited students (...) enrolled in the Medical Degree Program at the University of Cordoba. The observers recorded their entries on standardized templates during clinical internships in different departments: Internal Medicine; Gynecology and Obstetrics; Pediatrics; Emergency Medicine; General and Digestive Surgery; Maxillofacial Surgery; Plastic Surgery; Orthopedics and Traumatology; Digestive; Dermatology; Rheumatology; Mental Health; Nephrology; Pneumology; Neurology; and Ophthalmology.ResultsFollowing 7138 days and 33157 h of observation, we found an estimated Frequency Index of one breach per 62.5 h. As regards the typology of the observed breaches, the most frequent were related to the consultation and/or disclosure of clinical and/or personal data to medical personnel not involved in the patient’s clinical care, as well as people external to the hospital. As regards their severity, severe breaches were the most frequent, accounting for 46.7 % of all incidents. Most of the reported incidents were observed in public areas, such as corridors, elevators, the cafeteria, stairs, and locker rooms.ConclusionsIn addition to aspects related to hospital organization or infrastructure, we have shown that all healthcare personnel are involved in confidentiality breaches, especially physicians. While most are committed unintentionally, a non-negligible number are severe, repeated breaches, thus suggesting a certain carelessness, perhaps through ignorance about certain behaviors that can jeopardize patient confidentiality. (shrink)

The physician’s duty of confidentiality is based on the observance of the patient’s privacy and intimacy and on the importance of respecting both of these rights, thus creating a relationship of confidence and collaboration between doctor and patient. The main objective of this work consists of analyzing the aspects that are related to the confidentiality of patients’ data with respect to the training, conduct and opinions of doctors from different Clinical Management Units of a third-level hospital via a questionnaire. The (...) present study aimed to define the problem and determine whether the opinions of these professionals correspond to those observed in a previous work conducted at the same center. Of the 200 questionnaires that were collected, 62.5% were from consultants and the rest were from residents with an average of 14.4 ± 12.5 years in professional practice. The respondents noted habitual situations in which confidentiality was breached in the reference hospital. The section on their attitudes and behaviors towards situations related to confidentiality showed a slightly lower average score than that of their medical knowledge; significant differences in these scores were observed between the consultants and residents as well as between the extreme age groups and years of professional practice, thus more inadequate attitudes were consistently noted in younger doctors who had fewer years of experience. Finally, the respondents answered that the training of doctors in the aspects of healthcare law and ethics was the most important measure that the hospital could adopt regarding confidentiality practices. (shrink)

BackgroundMoral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes.MethodsA regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level (...) of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice.ResultsThe mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9).ConclusionsFemale, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals. (shrink)

In this article I discuss the history of Italian Jews from the Emancipation to the racial laws of 1938 and their present-day attitudes to Judaism and the State of Israel. My aim is to suggest how the policy of social integration enabled Italian Jews to construct a new identity without losing their ancestral heritage. The example of Italian Jewry is relevant to understanding the growing need in today‘s European Union—now comprising 27 countries with different languages, cultures, and values—of revising the (...) concept of national identity and of exploring ways of constructing a new European identity. (shrink)

The history of Italian Jews from 1861 to 1938 is often viewed as the period in which they totally assimilated into the Italian nation. This article, however, argues that rather than their assimilation it was a period of their integration into Italian society. Various approaches to this question are presented, including a review of the literature, with a view to reconsidering the relationship between Jewish culture and Italian culture, or rather non-Jewish culture. Italian Jewish history is shown not to be (...) separated from, but to be “internal” to Italian social, cultural, and political history—part of the dynamic process of change that occurred during this period not only in Italy but throughout Europe. (shrink)

Acting in the present in anticipation of the future is argued to be a behavioral correlate of mental time travel (MTT). Yet, it is important to consider how other future-directed behaviors figure into a theory of MTT and future thinking more broadly. Developmental science can help in this formulation.

Humans are able to transcend the present and mentally travel to another time, place, or perspective. Mentally projecting ourselves backwards (i.e., episodic memory) or forwards (i.e., episodic foresight) in time are crucial characteristics of the human memory system. Indeed, over the past few years, episodic memory has been argued to be involved both in our capacity to retrieve our personal past experiences and in our ability to imagine and foresee future scenarios. However, recent theory and findings suggest that semantic memory (...) also plays a significant role in imagining future scenarios. We draw on Tulving’s definition of episodic and semantic memory to provide a critical analysis of their role in episodic foresight tasks described in the developmental literature. We conclude by suggesting future directions of research that could further our understanding of how both episodic memory and semantic memory are intimately connected to episodic foresight. (shrink)

We applaud Millikan's psychologically plausible version of the causal theory of reference. Her proposal offers a significant clarification of the much-debated relation between concepts and beliefs, and suggests positive directions for future empirical studies of conceptual development. However, Millikan's revision of the causal theory may leave us with no generally satisfying account of concept individuation in the mind.

Gilead et al.'s theory presupposes that traversing temporal, spatial, social, and hypothetical distances are largely interchangeable acts of mental travel that co-occur in human ontogeny. Yet, this claim is at odds with recent developmental data suggesting that children's reasoning is differentially affected by the dimension which they must traverse, and that different representational abilities underlie travel across different dimensions.

While other theorists have turned to Arendt’s analysis of statelessness and superfluity to consider questions of immigration, “illegality,” and the status of noncitizens, this essay argues that Arendt’s account of labor and her nonconsequentialist account of action offer a richer optic for considering the undocumented in the United States. To explore this claim, this essay constructs an alternate account of the nationwide demonstrations for immigrant rights that occurred in 2006. Rather than defining “success” in terms of replicability or immediate legislative (...) results, the author’s analysis of the 2006 protests emphasizes the significance of noncitizens laying claim to the public realm. Considering Michael Warner’s concept of counterpublics, the author argues that the demonstrations can be best understood as a moment of initiation and an inaugural performance of the political. Rereading Arendt’s notion of animal laborans, the essay concludes by exploring the limitations of noncitizens invoking labor as a way to gain civic standing. (shrink)

In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one ‘normativist’ label (...) ceases to be appropriate for the whole range of positions. If values and norms are not explicit components of the concept of disease, but only intervene in other explanatory roles, then the concept of disease is no more value-laden than many other scientific concepts, or even any other scientific concept. We call the newly identified position “value-conscious naturalism” about disease, and point to some of its theoretical and practical advantages. (shrink)

BackgroundMany procedures currently require the use of bone grafts to replace or recover bone volume that has been resorbed. However, the patient’s opinion and preferences must be taken into account before implementing any treatment. Researchers have focused primarily on assessing the effectiveness of bone grafts rather than on patients' perceptions. Thus, the aim of this study was to explore patients' opinions regarding the different types of bone grafts used in dental treatments.MethodsOne hundred patients were randomly chosen participated in the study. (...) A standardized survey of 10 questions was used to investigate their opinions regarding the different types of bone grafts used in dental treatments. Descriptive statistics were calculated for the different variables, and absolute frequencies and percentages were used as summary measures. A value of p <0.05 was selected as the threshold for statistical significance.ResultsThe highest rate of refusal was observed for allografts and xenografts. The grafts with the lowest rates of refusal were autologous grafts and alloplastics. No significant differences were found between the various types of bone grafts in the sociodemographic variables or the refusal/acceptance variable. Similarly, no significant relations were observed between a specific religious affiliation and the acceptance/refusal rates of the various types of graft.ConclusionsAllografts and xenografts elicited the highest refusal rates among the surveyed patients, and autologous bone and alloplastics were the most accepted bone grafts. Moreover, no differences were found in the sociodemographic variables or religious affiliations in terms of the acceptance/refusal rates of the different bone grafts. (shrink)

With disparate rates of morbidity and mortality among minoritized communities, COVID-19 illuminated the need for equity-informed practices in public health. Pacia et al posit FQHCs as entities that addressed inequity when others failed. This commentary further situates how FQHCs address the public health crisis of institutional racism and related health inequities every day and presents a FQHC-led Ethics and Equity Framework and Workflow Checklist to guide ethical and equitable engagement with FQHCs.

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of mental disorder to better understand what necessary criteria actually (...) characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it. (shrink)

In this paper I review how the notion of gender is understood in psychiatry, specifically in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). First, I examine the contraposition between sex and gender, and argue that it is still retained by DSM-5, even though with some caveats. Second, I claim that, even if genderqueer people are not pathologized and gender pluralism is the background assumption, some diagnostic criteria still conceal a residue of gender dualism and (...) essentialism. Third, I consider gender dysphoria, which is characterized by an incongruence between one’s experienced or expressed gender and one’s assigned gender; since this condition pertains to distress and disability, not to the incongruence per se, it does not pathologize transgender people. Still, I contend that it should be removed from DSM-5 for theoretical reasons. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on addressing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome that (...) reflects adysfunctionand is usually associated with significantdistress or disability. More importantly, there is an explicit statement saying thatallmental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

The COVID-19 pandemic has made it especially visible that mortality data are a key component of epidemiological models, being a single indicator that provides information about various health aspects, such as disease prevalence and effectiveness of interventions, and thus enabling predictions on many fronts. In this paper we illustrate the interrelation between facts and values in death statistics, by analyzing the rules for death certification issued by the World Health Organization. We show how the notion of the underlying cause of (...) death can change in view of public health goals. This brings us to a general point about how non-epistemic factors, such as values and goals, are reflected in the choice of different measures in epidemiological models. We finally argue that this analysis is not only relevant from a theoretical point of view but also has important practical consequences. (shrink)

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of Autism Spectrum Disorder. This (...) opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

This book investigates the role of translation processes in the shaping and re-shaping of ideological discourse and their impact on the actors involved in the translation process, focusing on institutional texts and their influence on lifestyle issues both public and personal. The volume employs a unique approach in its focus on "lifestyle politics," examining texts produced by political actors, such as international organizations and national governments, and their translations. The book draws on an interdisciplinary perspective, integrating work from translation studies (...) and linguistics with political science and economics, and applies it to English and French versions of the same documents, calling attention to ideological differences across versions. In light of our increasingly globalized world, Caimotto and Raus demonstrate the ways in which globalized discourse undergoes processes of depoliticization and marketization which produce a trickle-down effect on individuals’ personal identities. This book will be of interest to students and scholars in translation studies, critical discourse analysis, and political science. -/- . (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on address- ing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome (...) that reflects a dysfunction and is usually associated with significant distress or disability. More importantly, there is an explicit statement saying that all mental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

Wines with geographical indication can be classified and represented by such features as designations of origin, producers, vintage years, alcoholic strength, and grape varieties; these features allow us to define wines in terms of a set of necessary and/or sufficient conditions. However, wines can also be identified by other characteristics, involving their look, smell, and taste; in this case, it is hard to define wines in terms of necessary and/or sufficient conditions, as wine concepts exhibit typicality effects. This is a (...) setback for the design of computer science ontologies aiming to represent wine concepts, since knowledge representation formalisms commonly adopted in this field do not allow for the representation of concepts in terms of typical traits. To solve this problem, we propose to adopt a hybrid approach in which ontology-oriented formalisms are combined with a geometric representation of knowledge based on conceptual spaces. As in conceptual spaces, concepts are identified in terms of a number of quality dimensions. In order to determine those relevant for wine representation, we use the terminology developed by the Italian Association of Sommeliers to describe wines. This will allow us to understand typicality effects about wines, determine prototypes and better exemplars, and measure the degree of similarity between different wines. (shrink)

1. In her latest book (Jefferson, 2022), “Are Mental Disorders Brain Disorders?”, Anneli Jefferson (AJ) argues that mental disorders can be considered brain disorders when they involve brain dysfun...