The purpose of this paper is to assess Profet’s (1992) and others’ hypothesis that nausea and vomiting in pregnancy (NVP) is adaptive. A number of studies have found an association between NVP and a decreased risk for early fetal loss (<20 weeks). It is assumed that the adaptive benefits of improved survivorship associated with NVP outweigh the minimal nutritional consequences. However, in populations that experience marginal levels of nutrition, NVP may have important nutritional consequences. To test these potential (...) consequences, a study on NVP, nutritional status, and pregnancy outcome was conducted among Turkana pastoralists, who experience seasonal and chronic nutritional stress. Interviews and anthropometric assessments were conducted on 68 pregnant Turkana women of Kenya during a 1993–1994 field season. The results from the case study suggest that women who experience NVP do encounter nutritional consequences in the later stages of pregnancy and are more likely to experience poor pregnancy outcomes. These results suggest that NVP may not be adaptive in all environmental settings, particularly among marginally nourished populations. (shrink)

Bowel necrosis is a commonly observed condition in elderly patients with longstanding diabetes. In such condition, intestinal resection is usually performed for the removal of the gangrenous part. Post-surgical dietary management after bowel resection poses several challenges for the health care team. The case presented in this study is that of an elderly diabetic male who developed acute renal failure as a result of neglect in post-surgical feeding after intestinal resection. After the intervention by a trained dietitian, a transitional diet (...) was planned and successfully executed, resulting in reversal of acute renal failure, dehydration, and post-surgical stress. Several complications including hepatic dysfunction and mouth ulcers were resolved through well-planned transitional diet. The patient was finally discharged in a stable health condition and was regularly followed up for any nutritional or medical issues. Neglects in nutritional care of patients can have severe implications including development of medical complications, resulting in increased length of hospital stay, augmenting the disease stress of the patient and family, and finally the preventable drainage of several human and monetary resources. Therefore, recognition of nutritional intervention as an important part of in-hospital health care may have social as well as economic impacts. (shrink)

The working poor are not a clearly defined group. There are still people who work full-time, but have incomes bordering on poverty level. They tend to remain in work despite their low wages simply to avoid becoming unemployed and risk social exclusion. However, working in low-income jobs for long periods creates stress and gives rise to further problems. Stress affects sleep patterns and leads to problems associated with food intake and nutrition, and thus to disorders of the gastrointestinal (...) system. Cardiovascular and neurological disorders may occur too. A lack of finances, and the stresses stemming from that are statistically significant and a strong predictor of a worse mental state. There is also a higher probability of psychosis occurring. All this affects the entire family, especially children. The inability to invest money and time in their development is another consequence. (shrink)

Tackling impaired bioenergetics in multiple sclerosis has been recently recognized as an innovative approach with therapeutic potential. Guanidinoacetic acid is an experimental nutrient that plays a significant role in high-energy phosphate metabolism. The preliminary trials suggest beneficial effects of supplemental GAA in MS, with GAA augments biomarkers of brain energy metabolism and improves patient-reported features of the disease. GAA can also impact other metabolic footprints of MS, including demyelination, oxidative stress, and GABA-glutamate imbalance. In this mini-review article, we summarize (...) studies evaluating GAA effectiveness in MS, explore mechanisms of GAA action, and discuss the challenges of using dietary GAA as an element of MS therapy. (shrink)

Developmental origins of health and disease and epigenetics have expanded understanding of how the environment affects the health of women before and during pregnancy—with lifelong health consequences for the fetus. This has translated to a narrow focus on women’s lifestyle during pregnancy, especially for women classified as obese. In this study, we show that psychosocial harms such as distress or shame felt by pregnant women are rarely countenanced in these endeavors. To demonstrate this, we examine published documents about a large (...) set of trials of lifestyle interventions united through an international consortium. Yet there is now a literature in which pregnant women with large bodies report feeling humiliated and a wider literature on the stigma of obesity. We argue that shame is produced and reproduced through the discursive and material knowledge-making scientific practices of DOHaD translation. Interventions that intensify the shame of large body size in pregnancy may be stressful, and neurophysiological stress pathways are well-known within DOHaD to have consequences for fetal development, so these interventions potentially undermine the very processes they set out to protect. A feminist response may protect women from shame and redirect attention to the social and structural determinants of health. (shrink)

Introduction. Healthcare workers (HCWs) should theoretically have the necessary education and environment to adopt a healthy lifestyle, and they supposedly also should have a higher participation rate in WHP programmes. HCWs are, for several reasons, considered to be a key group in health promotion, especially due to the fact that the healthcare system reaches a substantial number of people in need of lifestyle changes such as increased physical activity (PA) [5]. Furthermore, healthcare professionals are considered to be the most credible (...) source of health information [6]. HCWs' lifestyles can play an important role in increasing awareness among patients regarding lifestyle changes, because HCWs' own lifestyle habits and interests in lifestyle behaviour have been shown to positively influence their counselling practices and attitudes [6–7]. The international movement 'Health Promoting Hospitals and Health Services', which was initiated by the World Health Organization (WHO), highlights the importance of also focusing on the health and lifestyle of the employees. Methods. We conducted survey based on a standardized and adapted questionnaire that included socio-demographic data and points related to healthy lifestyle. We adhered to the latest recommendations on designing and reporting survey studies. Before conducting the study, the questionnaire was pretested among 5 experts and revised twice. The survey was conducted in Kazakh / Russian for respondents who speak two languages fluently at the choice of participants. The filling of the questionnaire took on average 45 minutes. We reported absolute numbers and percentages. Chi-square tests were used to compare responses between groups. Results were considered significant at a P value of < 0.05. Statistical analyses were performed using the application SAS OnDemand for academia (version 3.81, Carry, North Carolina, USA). Results. Our data revealed that nurses were more likely to adhere to healthy eating principles and to have a regular diet at home. GPs were more likely to consume fast food and add salt when food is not salted enough. Nurses were more likely to eat greens regularly. GPs had a stronger belief in the impact of diet on health. More nurses rated their diet as healthy. Media promotion significantly influenced GPs for changing diet towards healthier options. Eating patterns vary according to the risk of stress. Research shows that chronic stress influences the amount and types of consumed food, contributing to both overeating and malnutrition, and that stress hormones can lead to the development of obesity. GPs are more likely to have used tobacco products compared to nurses. GPs are more likely to smoke more than 10 cigarettes per day. GPs have a slightly higher belief in the necessity of a healthy lifestyle compared to nurses. GPs and nurses have different testing frequencies for Hepatitis B and C, with nurses testing more frequently. GPs are more likely to have sexual activity after drinking alcohol. Conclusion. It is known that a healthy lifestyle of doctors affects the attitude of patients and their motivation to change their lifestyle. Thus, the lifestyle patterns of health workers, as well as the understanding of the motivation of these patterns, are more likely to affect public health. (shrink)

Bacteria have evolved advanced strategies for surviving during nutritional stress, including expression of specialized enzyme systems that allow them to grow on unusual nutrient sources. Inorganic phosphate (Pi) is limiting in most ecosystems, hence organisms have developed a sophisticated, enzymatic machinery known as carbon‐phosphorus (C‐P) lyase, allowing them to extract phosphate from a wide range of phosphonate compounds. These are characterized by a stable covalent bond between carbon and phosphorus making them very hard to break down. Despite the (...) challenges involved in both synthesizing and catabolizing phosphonates, they are widespread in nature. The enzymes required for the bacterial C‐P lyase pathway have been identified and for the most part structurally characterized. Nevertheless, the mechanistic principles governing breakdown of phosphonate compounds remain enigmatic. In this review, an overview of the C‐P lyase pathway is provided and structural aspects of the involved enzyme complexes are discussed with a special emphasis on the role of ATP‐binding cassette (ABC) proteins. (shrink)

What is the biological function of daily mood variations? What is the relationship between mood and such factors as exercise, time of day, nutrition, stress, and illness? Drawing on his own wide-ranging research concerning subjective assessments of mood and on extensive research by others, Dr. Thayer presents a comprehensive theory of normal mood states, viewing them as subjective components of two biological arousal systems, one which people find energizing, and the other which people describe as producing tension. The author (...) explains these two mood effects in relation to a complex relationship between energy and tension. Relevant research is systematically reviewed, and moods are analyzed in relation to circadian rhythms, exercise, nutrition, sleep, stress, and cognition. Perceptual and motivational effects of mood are also discussed, as are measurement and research design issues. Unique in its depth and comprehensiveness, this book will be of interest not only to researchers in psychology, biology, and medicine, but its clear style of presentation and the practical activities suggested for mood regulation will make it interesting to general readers as well. (shrink)

Pregnancy is thought to be a metabolically very expensive endeavor, yet investigations have produced inconsistent results concerning the responsiveness of human birth weight to maternal nutritional stress or nutritional intervention. These findings have led some researchers to conclude that fetal growth is strongly buffered against fluctuations in maternal energy balance, making the fetus in effect a “nearly perfect parasite.” This buffering would appear to be a reasonable adaptive response given the high risk of morbidity and mortality associated (...) with low birth weight. However, a life-history approach leads to the prediction that maternal investment strategies in pregnancy should be geared toward maximizing lifetime reproductive success rather than simply the success of the current pregnancy, and by extension that maternal investment strategies should vary with reproductive value. The physiology of human pregnancy in fact appears to include a number of mechanisms that protect maternal energy resources from diversion to the fetus and preserve them for future reproductive events. These mechanisms include adjustment of blood flow to the uterus and perhaps minor adjustments in gestation length, although evidence for the latter is scant. Suggestions are made for ways of investigating these maternal options. (shrink)

On ‘Mismatch’ and ‘Metabolic Ghettos:’ The Conceptualization of Global Health Differences in Research on the Developmental Origins of Health and Disease. Epigenetic approaches to human health have received growing attention in the past two decades. They allow to view the development of human organisms as plastic, i.e. as open to influences from the social and material environment such as nutrition, stress, and trauma. This has lent new credence to approaches in biomedicine that aim to draw attention to the importance (...) of development for later life health. Some scholars in the social sciences and humanities have welcomed such approaches as a departure from gene‐centric perspectives and as an opportunity for highlighting the social and political determinants of health and illness. Others have warned that they might lead to new forms of biological reductionisms and determinisms. In this article, we explore how research on developmental plasticity addresses and articulates global health disparities, specifically in the context of postcolonial India. We discuss two prominent approaches from the field of Developmental Origins of Health and Disease (DOHaD) that build on epigenetic perspectives on health and illness and view different global rates of disease susceptibility as the result of developmental processes: first, the ‘mismatch paradigm’ by Peter Gluckman and Mark Hanson and second, the ‘metabolic ghetto’ concept by Jonathan Wells. We highlight how both approaches render historical and social factors meaningful for the development of global health disparities, but emphasize how they at the same time remain prone to determinisms and reductionisms reminiscent of a gene‐centric perspective. DOHaD actors themselves are critical of these tendencies, and in conclusion we explore novel opportunities for interdisciplinary collaborations enabled by this critical potential. (shrink)

This article reviews the effects of malnutrition on early brain development using data generated from animal experiments and human clinical studies. Three related processes, each with their own functional consequences, are implicated in the alteration of brain development. (1) Maternal undernutrition at the start of pregnancy results in reduced transfer of nutrients across the placenta, allowing the conservation of effort for future reproductive episodes. (2) Differential allocation to growing organs by the fetus in response to nutritional stress spares (...) the brain to a large though still limited degree, reflecting the organ’s relative contribution to survival and reproductive success. (3) Prenatal malnutrition disrupts developing neurotransmitter systems, which results in the expression of specific cognitive and affective traits. It is argued that the increasing size and therefore cost of the brain, in conjunction with increasing ecological instability and marginality, reinforced selection for maternally controlled growth suppression of offspring, reallocation of organ growth rates by offspring, and behavioral changes related to development of neurotransmitter systems. (shrink)

Zooarchaeological evidence has often been called on to help researchers determine prehistoric relative abundances of elk (Cervus elaphus) in the Greater Yellowstone ecosystem. Some interpret that evidence as indicating elk were abundant; others interpret it as indicating elk were rare. Wildlife biologist Charles Kay argues that prehistoric faunal remains recovered from archaeological sites support his contention that aboriginal hunters depleted elk populations throughout the Intermountain West, including the Yellowstone area. To support his contention Kay cites differences between modern and prehistoric (...) relative abundances of artiodactyls, age and sex demographics of ungulates in the prehistoric record indicating selective predation of prime-age females, and a high degree of fragmentation of artiodactyl bones indicating humans were under nutritional stress. Kay’s data on taxonomic abundances are time and space averaged and thus mask much variation in elk abundances. When these data are not lumped they suggest that elk were at some times, in some places, as abundant as they are today. Data on the age-sex demography of artiodactyl prey are ambiguous or contradict Kay’s predictions. Bone fragmentation data are variously nonexistent or ambiguous. The zooarchaeological implications of Kay’s aboriginal overkill hypothesis have not yet undergone rigorous testing. (shrink)

Les approches pour lutter contre le fléau des maladies chroniques qui augmentent dans le monde entier se révèlent infructueuses et très coûteuses. Il est maintenant possible de corriger les chiffres alarmants et d’envisager une prévention efficace en adoptant le nouveau paradigme des Origines du Développement de la Santé et des Maladies (DOHaD), à condition d’intervenir très tôt en agissant sur le risque et non lorsque la maladie est déjà apparue. Ce concept est largement reconnu grâce à des études épidémiologiques et (...) des études animales. Les influences des facteurs environnementaux – nutrition, stress, psycho-affectifs, toxiques, bactériens et physiques – sur les processus épigénétiques représentent une révolution. En effet, les DMR modifications épigénétiques conservent la mémoire des impacts de facteurs environnementaux auxquels un individu est soumis tout au long de sa vie. Une période cruciale est le développement précoce, pré et postnatal, les 1000 jours ; cruciale parce que l’épigénome est particulièrement sensible aux effets de l’environnement, et aussi parce que l’individu construit son capital santé pour répondre plus ou moins bien aux aléas de la vie. En outre, l’existence de mécanismes non génétiques et non culturels capables de transférer la mémoire des expériences/expositions à des facteurs environnementaux parentaux et qui conditionnent la réactivité des générations suivantes à différents environnements au cours de leur vie suscite un intérêt grandissant. L’idée selon laquelle des marques épigénétiques non effacées lors des phases de reprogrammation est actuellement très en vogue, voire considérée à tort comme acquise malgré la rareté des exemples probants. Cependant, des questions fondamentales subsistent quant à la nature, aux rôles et à l’impact des marques et des mécanismes épigénétiques, des ARN non codants ou d’autres mécanismes et à leur persistance au cours des générations. Un modèle intégrant ces différents systèmes, leurs interactions avec l’environnement et les fenêtres de développement de la sensibilité selon le sexe du parent et de l’enfant reste à construire. Sur la base de la malléabilité des mécanismes épigénétiques sous-jacents, la réversibilité des marques environnementales ouvre de nouvelles perspectives. Cependant, comment les facteurs conférant une susceptibilité accrue ou une résilience vis-à-vis du développement des maladies agissent et influencent les mécanismes épigénétiques reste à élucider. Si la mémoire des expériences/expositions à des facteurs environnementaux est effectivement transmissible, le principal défi pour l’individu, et surtout pour les pouvoirs publics, est d’être en mesure d’éviter ceux qui posent des risques pour la descendance. Ces données peuvent déplacer le curseur des responsabilités en matière de soins de santé, de la sphère privée à la sphère socio-géographico-politique. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 623 Jaye Cee Whitehead, Kath Bassett, Leia Franchini, and Michael Iacolucci “The Proof Is in the Pudding”: How Mental Health Practitioners View the Power of “Sex Hormones” in the Process of Transition In the United States today, popular discourse touts the power of “sex hormones” and hormone receptors in the brain to chemically produce gender expressions (manifested in (...) physical sex traits, behaviors, and attitudes) and identities (a sense of self as feminine or masculine). These accounts range from common assumptions that Western ideals of femininity (such as empathy understanding, cooperative orientation, nurturing behavior) and masculinity (rational/spatial understanding, competitive orientation, violent behavior) are produced by corresponding sex hormones, to studies that reduce complex gender identities and macrosocial economic phenomena to presocial, binary, hormonal processes.1 For sociologists, accounts that reduce complex identities to internal hormonal reactions are problematic for two primary reasons: first, they are inaccurate because they fail to examine how hormonal reactions are embedded in a complex cultural process of meaning and interpretation; second, they operate as bioreductive ideologies that obscure the social power inherent to the process of gender identity construction. In what follows, we extend both of these insights by examining mental health 1. For an example of a hybrid popular-scientific account of the power of sex hormones to destabilize economic structures, see Jon Coates and Joe Herbert, “Endogenous Steroids and Financial Risk Taking on a London Trading Floor,” Proceedings of the National Academy of Sciences 105, no. 16 (April 2008): 6167–72. 624 Whitehead, Bassett, Franchini, and Iacolucci practitioners’ divergent interpretations of the power of sex hormones in the process of gender transition.2 In doing so, we examine the cultural power of sex hormones in crafting gender identities without reproducing reductionist interpretations of trans embodiment. Perhaps what is most perplexing about the way we speak of sex hormones is that we know it is inaccurate to describe these hormones as sexed; scientists have acknowledged since the 1930s that they are neither sex specific in their function, nor in terms of their location in male or female bodies.3 In her extensive historicization of sex hormones, Anne Fausto-Sterling concludes that it is more accurate to call androgen- and estrogen-based hormones, “steroid hormones” as they have functions that are not confined to corresponding sexed bodies. In fact she urges scientists to “break out of the sex hormone straightjacket” and to look at steroids as just one of a number of components that are important to the creation of sex and gender, including environment and experience.4 Scholars also point to an inextricable link between the chemical operation of hormones and the social process of constructing meaning, both at the level of social interaction and macrocultural constructions of sex categories and gender ideologies.5 While brain organization/activation theory attributes sex and gender differences to hormonal interactions within the developing brain, Fausto-Sterling questions the distinction between activation and organization by pointing out how “the brain can respond to hormonal stimuli with anatomical changes…hormonal systems, after all, respond exquisitely to experience, be it in the form of nutrition, stress, or sexual activity (to name but a few possibilities ).”6 Drawing from Elizabeth Grosz, Fausto-Sterling argues that the power of hormones is best understood according to the model of the 2. “Gender transition” is a controversial phrase, as it implies that transgendered individuals who receive hormone therapy are changing identities. We are only using it for lack of clear alternative phrasing, not because we believe body modifications change gender identities. 3. See Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (New York: Basic Books, 2000); Rebecca Jordan-Young, Brainstorm: The Flaws in the Science of Sex Differences (Cambridge, MA: Harvard University Press, 2010); and Nelly Oudshoorn, Beyond the Natural Body: An Archeology of Sex Hormones (New York: Routledge, 1994). 4. Fausto-Sterling, Sexing the Body, 193–94. 5. Fausto-Sterling, Sexing the Body. 6. Ibid., 232. Whitehead, Bassett, Franchini, and Iacolucci 625 Möbius strip, wherein internal components of the self are always connected to and continuous with outer components such as culture and environment.7 In other... (shrink)

The conditions animals experience during the early developmental stages of their lives can have critical ongoing effects on their future health, welfare, and proper development. In this paper we draw on evolutionary theory to improve our understanding of the processes of developmental programming, particularly Predictive Adaptive Responses (PAR) that serve to match offspring phenotype with predicted future environmental conditions. When these predictions fail, a mismatch occurs between offspring phenotype and the environment, which can have long-lasting health and welfare effects. Examples (...) include metabolic diseases resulting from maternal nutrition and behavioral changes from maternal stress. An understanding of these processes and their evolutionary origins will help in identifying and providing appropriate developmental conditions to optimize offspring welfare. This serves as an example of the benefits of using evolutionary thinking within veterinary science and we suggest that in the same way that evolutionary medicine has helped our understanding of human health, the implementation of evolutionary veterinary science (EvoVetSci) could be a useful way forward for research in animal health and welfare. (shrink)

In the care of patients with disorders of consciousness (DOC), some ethical difficulties stem from the challenges of accurate diagnosis and the uncertainty of prognosis. Current neuroimaging research on these disorders could eventually improve the accuracy of diagnoses and prognoses and therefore change the context of end-of-life decision making. However, the perspective of healthcare professionals on these disorders remains poorly understood and may constitute an obstacle to the integration of research. We conducted a qualitative study involving healthcare professionals from an (...) acute care university medical center. A short questionnaire captured demographic data as well as the experience of participants with DOC patients. A semi-structured interview was used to explore attitudes toward ethical issues identified in a previous literature review. Qualitative content analysis of interviews was conducted with the NVivo software. Accurate diagnosis among DOC is often regarded as a challenge, but this was generally not the case for our participants because most reported high confidence in DOC diagnoses. However, participants reported struggling with prognosis, especially because of its essential role for end-of-life decision making and communication with families. Variability of opinion between healthcare professionals was reported and identified by some as a minor issue while others stressed how families struggle with different medical opinions. End-of-life decision making encompassed a large proportion of ethical challenges in these patients, and the removal of artificial nutrition and hydration created significant discomfort in a minority of participants. The concept of futility was subject to wide-ranging understandings with both favorable and unfavorable opinions. Our data suggest that to ensure the incorporation of new evidence-based advances, attention should be directed to the real-world practices and challenges of accurate diagnosis and prognosis. Given pervasive challenges in end-of-life care, we recommend improved training of healthcare professionals in the care of patients with DOC, particularly in end-of life care, understanding the context of decision making, and determining how to optimally integrate new neuroscience research on the care of patients with DOC. (shrink)

The aim of this article is to introduce the concept of Cognitive Fitness (CF), identify its key ingredients underpinning both real-time task performance and career longevity in high-risk occupations, and to canvas a holistic framework for their assessment, training, and augmentation. CF as a capacity to deploy neurocognitive resources, knowledge and skills to meet the demands of operational task performance, is likely to be multi-faceted and differentially malleable. A taxonomy of CF constructs derived from Cognitive Readiness (CR) and Mental fitness (...) (MF) literature maps into phases of operational cycles from foundational to advanced, mission-ready and recovery. Foundational cognitive attributes, such as attention, executive control and co-action, were hypothesized to be trainable at the initial Cognitive Gym phase. More advanced training targets at the CR phase included stress and arousal regulation, adaptability, teamwork, situation awareness (including detection, sense-making and prediction) and decision making (de-biasing and confidence calibration). The mission-ready training phase is focused on tolerances (to sleep loss, monotony, pain, frustration, uncertainty) and resistance (to distraction, deception or manipulation). Operational Augmentation phase relies on support tools such as decision aids and fatigue countermeasures, while the Recovery phase employs reflexive (e.g., mindfulness), and restorative practices (e.g., nutrition and sleep hygiene). The periodization of cognitive training in this cycle is hypothesized to optimize both real-time cognitive performance and the resilience that enables life-long thriving. One of the most promising avenues of validating this hypothesis is by developing an expert consensus on the key CF ingredients and their relative importance in high-performance settings. (shrink)

Self-tracking-technologies can serve as a prominent example of how digital technologies put to test established practices, institutions, and structures of medicine and healthcare. While proponents emphasize the potentials, e.g., for individualized healthcare and new research data, opponents stress the risk that these technologies will reinforce gender-related inequalities. -/- While this has been made clear from—often intersectional—feminist perspectives since the introduction of such technologies, we aim to provide a queer-feminist perspective on self-tracking applications in healthcare by analyzing three concrete cases. (...) In this way, we want to show why such a perspective is helpful in assessing self-tracking technologies and how such a perspective might contribute to a queering of healthcare. -/- After a short introduction to self-tracking in healthcare and the corresponding risks of reproducing gender-related inequalities, we introduce queer bioethics as a methodology to examine structural discrimination and marginalization in bioethical research. We apply this framework in the analysis of three exemplary self-tracking applications from the areas of nutrition/fitness, reproductive health, and mental health. In the subsequent discussion of these results against the backdrop of already existing queer-sensitive technologies, we identify an equal access, a subversive design, an inclusive database, and a diversity-sensitive and discriminatory-critical definition of purposes as well as individualized usage possibilities as first possible starting points for a queering of self-tracking applications. Finally, we draw conclusions, how such a critical perspective on self-tracking applications might also contribute to a queering of the healthcare system at a structural level. (shrink)

This article critically examines the recent papal allocution on patients in a persistent vegetative state with regard to the appropriate conditions for considering “reformable statements.” In the first part of the article, the purpose and meaning of the allocution are assessed. O'Rourke concludes that given consideration of the individual patient's best interest, prolonging artificial nutrition and hydration is not, in every case, the best option. Although he stresses favorability for preservation of the life of the patient through artificial nutrition and (...) hydration, costs and benefits to the patient should be weighed. Ultimately, he argues in favor of leaving the decision to the patient, his caregivers, and others immediately involved in the case. (shrink)

Addiction: A Philosophical Approach CHAPTER ABSTRACTS “Introduction: Dismantling the Catchphrase” by Candice Shelby Shelby dismantles the catchphrase “disease of addiction.” The characterization of addiction as a disease permeates both research and treatment, but that understanding fails to get at the complexity involved in human addiction. Shelby introduces another way of thinking about addiction, one that implies that is properly understood neither as a disease nor merely as a choice, or set of choices. Addiction is a phenomenon emergent from a complex (...) dynamic system that is at once physical, psychological, social, and more. “A Philosophical Analysis of Addiction” by Candice Shelby Shelby brings much-needed clarity to the discourse surrounding the topic of addiction. Arguing that addiction can neither properly be understood as a disease nor as merely a set of choices, Shelby exposes the weaknesses of both approaches. She shows that addicted persons do not exhibit the elements characteristic of compulsion, nor does an account of addiction in terms of weakness of will, or irrational choosing, provide a satisfying explanation. Instead, by replacing traditional substance ontology with process ontology, and accepting the reality of emergent entities, a coherent account of persons, minds, and addiction can be provided. A fundamental philosophical shift is necessary to see that bodies, minds, values, and addictions are all part of the natural world. “Addiction at the Individual Level” by Candice Shelby Shelby discusses the most influential accounts of addiction as it is understood at the purely individual level. From hedonic theories to incentive sensitization, to habit theories of addiction, to behavioral theories and the ego depletion theory, Shelby considers a variety of approaches to understanding addiction in individuals, as framed in both psychological and in neuroscientific terms. She notes some important caveats that should be considered before accepting the research regarding addiction at the individual level, namely that the scanning studies that are so popularly used to characterize addiction in neurobiological terms are ambiguous, and rely on numerous assumptions that may be false, and that certainly mislead. Shelby provides much-needed critique of both disease and choices models as they characterize addiction at the individual level. “Addiction and the Local Environment” by Candice Shelby Shelby argues that human addiction cannot be understood without serious consideration of the individual’s local environment, her home and family. From the gestational environment to interactions with caregivers during post-natal development to the adult environment in which people become addicted, Shelby shows that no one becomes an addict in a vacuum. Stress is a major influence in the environment throughout life, and has serious consequences for addictive vulnerability. Genetic influences as well are important to addictive vulnerability, but genes always express in interaction with their environment. Social acceptance or rejection is another particularly important factor in the local environment with respect to both coming to be addicted and transitioning out of it. “The Relation Between Addiction and Culture” by Candice Shelby Shelby provides a groundbreaking analysis of the relation between addicts and the cultures that breed them. In this cultural critique, Shelby shows that addictions to certain substances have historically been both the solution to the problem of how to grow economies and control people, and a problem for economic productivity and controlling citizens. Not all cultures have even the concept of addiction, while others, such as the contemporary Western world, and the U.S. in particular, seem to foster it. Shelby shows that addiction is both a cultural construct and, from another way of thinking about it, the result of conditions created by particular cultures. Social inequities, alienation, driving capitalism, and in particular the power of pharmaceutical companies, all contribute to the spiraling endemic of addiction. “Addiction and Meaning” by Candice Shelby Shelby provides a unique argument that understanding how meanings work is essential to a complete analysis of addiction. Individuals experiencing addiction and those who care about and for them often utterly fail to communicate. This is because their respective systems of meanings come to be significantly different. Meanings are not, Shelby argues, best understood in the symbolic terms that characterized the theory of language in the 20th century, but are better apprehended as emotion-rich prototypes carved from repeated interaction with the world. Becoming addicted essentially changes one’s entire system of meanings. Requisite to transitioning out of addiction is a Gestalt-type shift in one’s system of meanings. This holistic way of understanding meanings also provides one level of explanation of what happens when an addict relapses. “The Phenomenology of Addiction and its Implications” by Candice Shelby One way of judging theories of addiction is by how well they capture the phenomenal descriptions that addicts give of their own experiences. Shelby considers variations on 5 basic patterns of addictive experience through the eyes of particular individuals who lived through addictive periods, and shows how even the most influential theories of addiction fail to capture all of them. She argues that an important implication of taking the details of individuals’ addictive stories seriously is that addiction must be understood as a personal phenomenon emergent from a particular complex dynamic system. As her theory of addiction would lead one to expect, no two addicts are the same, and no single-focus theory can explain why not. “Possibilities for Transitioning Out of Addiction” by Candice Shelby Shelby provides numerous strategies for transitioning out of addiction. Given that the vast majority of addiction treatment programs currently available are 12-step based and only successful about 5-8% of the time, it is essential that other approaches be undertaken. Shelby canvasses a variety of options for helping addicted individuals to make the transition out of their troubled pattern of thinking and behaving. From direct brain interventions to drugs to trauma therapy to exercise and nutrition to habit reformation to use of narrative and changing one’s social context as ways of redefining the self, Shelby shows that the possibilities for transitioning out of addiction are legion. Perhaps the best approach is to understand addiction treatment in terms of providing physical, psychological, and social tool kits. “Addiction Emerges from a Complex Dynamic System” by Candice Shelby Shelby considers whether there truly exists such a thing as “an addict” or “addictive thinking” in the universal sense. She concludes that within the context of disruptive substance use or repetitive engagement in certain activities, ordinary human cognitive biases and behavior patterns are categorized as addictive. Addiction, she argues, is best understood as an irreducible human reality, emergent from a sufficiently complex dynamic system (an organism with self-awareness, within a particular cultural milieu) that is both shaped by and contributes to the shaping of its environment. Attempts to simplify addiction into one or a few dimensions may create a solvable problem, but by doing so they fail to solve the real one. (shrink)

Mindfulness for the High Performance World provides a unique approach to mindfulness training, built upon the principles of Buddhist philosophy written in line with the Dalai Lama’s description of meditation and mindfulness as “Science of the Mind”. This unique volume explores mindfulness as a learnable skill in context with the underpinnings of the teachings of Eastern psychology. The authors, Norm, a physician, cancer researcher and triathlete and Karolynn, a psychotherapist, mindfulness meditation teacher and marathoner, live and work in a high- (...) class='Hi'>stress, high-expectation world. Their approach is rooted in an understanding that thoughts produce biochemical and physiological changes and provides a strategic framework to instruct an individual on how to categorize types of thoughts. After harnessing this ability, one is positioned to become both more aware of his or her thoughts as well as the specific patterns of sensations they produce, or Sentinel SitesSM. The awareness of what the mind is doing and the ability to interrupt a thought pattern and/or control the response almost instantly leads one to having a healthier life, improved relationships with others and better adaptability to one’s environment. Emphasizing the importance of physical activity and nutrition, the authors present a systematic approach for people who want to learn and incorporate mindfulness and transform how they live without having to divert their lives and careers. Offering itself as an accessible and skill-based introduction to the principles, practices, and benefits of mindfulness, Mindfulness for the High Performance World is a useful resource for students, athletes and professionals living and working in high-performance, high-stress environments and also for mindfulness practitioners seeking to deepen their skill level. (shrink)

We focus on alternative innovation pathways for addressing agricultural sustainability challenges in Odisha, India. The first pathway that we term as industrial, is focused on breeding new seed varieties in modern laboratories and test fields, ostensibly for climate resilience. It is driven by public scientific institutions and private corporations. The second pathway that we call agroecological, is grounded in saving and sharing of diverse local varieties, largely by Indigenous (Adivasi) smallholders and their allies in civil society. Using the pathways’ descriptions (...) as bases, we present perspectives of different professional groups who appraise how effectively each pathway addresses a range of sustainability issues. While all participants appraise the agroecological pathway to be clearly better performing for addressing agricultural biodiversity and cultural uses of rice, appraisals for issues of the economy, seed accessibility, stress tolerance, and nutrition diverged from each other. An overall picture in support of one pathway did not emerge. Embracing such ambiguities and uncertainties associated with appraisals, we argue for balancing political support between diverse pathways. Greater support for structurally marginalised agroecological pathways may be crucial to meet sustainability goals. This support can include the restitution of lands and other socio-ecological resources for marginalised pathways as well as guaranteeing autonomy of Adivasi (Indigenous) communities among whom the pathways thrive. (shrink)

This article critically examines the recent papal allocution on patients in a persistent vegetative state with regard to the appropriate conditions for considering “reformable statements.” In the first part of the article, the purpose and meaning of the allocution are assessed. O'Rourke concludes that given consideration of the individual patient's best interest, prolonging artificial nutrition and hydration is not, in every case, the best option. Although he stresses favorability for preservation of the life of the patient through artificial nutrition and (...) hydration, costs and benefits to the patient should be weighed. Ultimately, he argues in favor of leaving the decision to the patient, his caregivers, and others immediately involved in the case. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:What's in a Name?Steven R. Sabat (bio)Keywordslabeling, mild cognitive impairment, recall memory, selfhood, stereotype threatCorner and Bond (2006) raise a number of important conceptual issues related to the problems involved in defining mild cognitive impairment (MCI), differentiating it from normal aging, the definition of normal aging itself, and ethical issues surrounding the possible adverse effects of a diagnosis of MCI on the individuals thus described. It would (...) seem that portentous ramifications are involved and that clarifying the conceptual issues would be of great value, not only to researchers but also to the ever-growing population of elderly people. In what follows, I address some of these issues further.Problems of Definition and MeasurementOne of the problems that the authors discuss at the outset of their article concerns what methods are appropriate for detecting those with MCI: "Neuropsychological tests alone do not discriminate between normal aged-related memory loss and MCI or dementia and clinical judgment remains central to diagnosis" (Corner and Bond 2006, 5). Of course, to be able to discriminate between normal aged-related memory problems and MCI, we must first be able to define the former. What exactly is normal? As the authors correctly point out, the term has different meanings, one being normative (usual), another being nonpathologic. Is it normal (usual) for some sort of breakdown to occur in brain systems as a function of increased age? If so, is there a threshold age below which the very same physiologic breakdown is unusual? Would such a threshold age, if one existed, be the same for everyone, regardless of genotype and the cumulative interactive effects of nutrition, health, and stress-related factors over a period of decades? In effect, is some sort of memory impairment part of the natural (usual) process of aging for some people at particular ages rather than for others? And exactly what does it mean to be mildly impaired in the cognitive domain?Hogan and McKeith (2001) presented a working group's definition characterizing MCI such that people who complain about memory problems and who also provide objective evidence of such problems, yet who simultaneously display "normal general cognitive function and intact activities of daily living" (Hogan and McKeith 2001, 1131), should be identified and followed. Here again, however, we confront the problem of defining "normal general cognitive function" as well as "normal activities of daily living." Can one have normal general cognitive function without normal memory function? If so, what exactly constitutes [End Page 13] general cognitive function and on what conceptual or theoretical basis is such a definition valid? Furthermore, what sort of memory function are we talking about? Memory can be said to involve a number of stages: encoding, storage, and retrieval. Retrieval can be of the explicit type (conscious recall or recognition of specific information) with which people with Alzheimer's disease (AD) often reveal deficits or of the implicit type (a change in behavior as a result of previous experience of which the person may have no conscious recollection) as demonstrated in people with AD (Knopman and Nissen 1987). That is, people with AD can display deficits in explicit memory functions without similar deficits simultaneously in implicit memory functions.A partial answer to the question about memory loss in MCI may be found in the use of the Mini-Mental State Examination (MMSE; Folstein, Folstein, and McHugh 1975), originally intended to be used as a screening device, but employed more and more frequently as an outcome measure to assess cognitive decline as well as the efficacy of drug treatments. Although the examination purports to test orientation, registration, attention, calculation, recall, language (naming, repeating, reading, writing, three-stage command), and construction, a task analysis reveals that the test is not quite as "global" in the cognitive domain as it is purported to be. For example, ten of the maximum thirty points on the examination are earned for "orientation" in time and place. Yet, all of the questions in this section of the test require intact recall of the relevant information. For example, if a person is asked, "What day of the week is this?" and replies "I don't know," the... (shrink)

Judo is a multifactorial sport where many variables or key performance indicators such as force-velocity profile, bioenergetic capacity, technical and tactical skills, and cognitive and emotional competence play a role and influence the final result. While there have been many academic studies of these variables, usually in isolation, none have examined KPIs holistically or analyzed their impact on strategic performance. The main objective of the present study, therefore, is to apply a novel and easily replicable methodology to identify and prioritize (...) the main KPIs affecting performance in professional judo. Such a methodology was applied to the High-Performance Judo Centre of Valencia, using a multi-criteria decision aid technique: the analytic network process. The ANP is used to identify and quantify cause and effect relationships not only between KPIs but also between KPIs and performance objectives. Further, the ANP offers effective results when there is a lack of historical KPI data, because it is based on experts' opinions and judgments. A judo expert group comprising elite judo coaches and half-lightweight male judokas applied the methodology to discriminate between the characteristics required when aiming to reach high-level strategic objectives. The JEG, which consisted of five elite judokas, national and international champions, and three Olympic coaches—including a former European champion and silver medalist in a world championship—provided high added value to the study. The main findings were that the KPIs that made the most difference were mostly psychological, specifically motivation, stress, and team cohesion. Of these, motivation was by far the most important KPI for success in our case study, so judokas should make sure that they analyze it properly. Motivation is usually intrinsic to the competitor and should be maintained at a high level, not only during tournaments but also during daily training and lifestyle activities. Physical and other specific forms of training, as well as lifestyle KPIs, are very important for the elite competitor but are not sufficient to reach high-level objectives. The most important of these KPIs were Kumi-Kata, dual career, focus and concentration level, scouting, nutrition, and basic technique. Power and strength were the most important physical KPIs. In general, these are essential for meeting strategic objectives, but they do not make the crucial difference. This suggests that professional psychological support should be provided in daily training and that international team composition and internships should be fostered. (shrink)

Whether as New Year's resolutions, birthday wishes, or daily promises, most everyone vows at some point to make a major life change. But change is easier said than done, especially when it comes to better managing our wellness amidst the chaos of everyday living. Fortunately, wellness coach and award-winning writer Brett Blumenthal has devised a way to inspire and motivate her readers to live healthier and make positive changes in their lives. Although Blumenthal's method is not a quick fix, it (...) is a surprisingly simple one: make one small change per week, for fifty-two weeks, and at the end of a year, you'll be happier and healthier. After all, it is the small changes that are the most realistic, instead of trying to overhaul your lifestyle all at once. 52 Small Changes addresses all areas of wellbeing, including nutrition, exercise, stress management, mental wellness, and even the health of one's home environment. By guiding readers through these changes at an easy, manageable pace, Blumenthal provides an engaging roadmap to lasting results and "happier, healthier you."'. (shrink)

BackgroundAdvance directives imply the promise of determining future medical treatment in case of decisional incapacity. However, clinical practice increasingly indicates that standardized ADs often fail to support patients’ autonomy. To date, little data are available about the quality and impact of ADs on end-of-life decisions for incapacitated acute stroke patients.MethodsWe analyzed the ADs of patients with fatal stroke, focusing on: their availability and type, stated circumstances to which the AD should apply, and stated wishes regarding specific treatment options.ResultsBetween 2011 and (...) 2014, 143 patients died during their hospitalization on our stroke unit. Forty-two of them had a completed and signed, written AD, as reported by their family, but only 35 ADs were available. The circumstances in which the AD should apply were stated by 21/35 as a “terminal condition that will cause death within a relatively short time” or an ongoing “dying process.” A retrospective review found only 16 of 35 ADs described circumstances that, according to the medical file, could have been considered applicable by the treating physicians. A majority of patients objected to cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition, while almost all directed that treatment for alleviation of pain or discomfort should be provided at all times even if it could hasten death.ConclusionsThe prevalence of ADs among patients who die from acute stroke is still low. A major flaw of the ADs in our cohort was their attempt to determine single medical procedures without focusing on a precise description of applicable scenarios. Therefore, less than half of the ADs were considered applicable for severe acute stroke. These findings stress the need to foster educational programs for the general public about advance care planning to facilitate the processing of timely, comprehensive, and individualized end-of-life decision-making. (shrink)

This paper aims to fill the gap in literature concerning community gardens in post-communist countries by focusing on the situation in Prague, Czechia. It introduces Prague′s newly emerged community gardens and presents the results of a first representative survey of these gardens. Information was gathered about eleven of the sixteen larger community gardens and the data were collected by semi-structured interviews with the managers of the particular gardens. The paper compares the Czech community gardens as representatives of civic agriculture forms (...) in post-communist countries with their counterparts and stresses their similarities and differences. The results show that the new community gardens reflect much of what can be seen elsewhere in terms of spatial and organizational design, as well as reasons for starting them, motivations for participation and some of the challenges experienced. However, in contrast to many community gardens in the USA, Canada and UK that focus on food and nutrition provision, in Prague the community is more of a priority than food and the other mentioned benefits. The paper shows that different activities, events and functions make gardens important hubs of their communities and potential tools of further community involvement and social change. (shrink)

Dietary changes can alter the human microbiome with potential detrimental consequences for health. Given that environment, health, and evolution are interconnected, we ask: Could diet‐driven microbiome perturbations have consequences that extend beyond their immediate impact on human health? We address this question in the context of the urgent health challenges posed by global climate change. Drawing on recent studies, we propose that not only can diet‐driven microbiome changes lead to dysbiosis, they can also shape life‐history traits and fuel human evolution. (...) We posit that dietary shifts prompt mismatched microbiome‐host genetics configurations that modulate human longevity and reproductive success. These mismatches can also induce a heritable intra‐holobiont stress response, which encourages the holobiont to re‐establish equilibrium within the changed nutritional environment. Thus, while mismatches between climate change‐related genetic and epigenetic configurations within the holobiont increase the risk and severity of diseases, they may also affect life‐history traits and facilitate adaptive responses. These propositions form a framework that can help systematize and address climate‐related dietary challenges for policy and health interventions. (shrink)

In a recent judgment1 the Court of Protection was highly critical of health professionals for continuing to provide clinically-assisted nutrition and hydration in the face of disagreement about the patient’s best interests, without seeking to resolve the issue. This hearing had been set up specifically to consider whether GU’s dignity had been properly protected, and if not why not, given concerns raised by the Official Solicitor about what she considered to be “a complete abrogation of responsibility to consider properly or (...) at all, and to determine whether it was in GU’s best interests and therefore lawful to continue to give him an invasive medical treatment, CANH.” In April 2014, at 63 years old and living in Thailand, GU sustained severe injuries after suffering from an electrocution accident. He sustained a cardiorespiratory arrest with a significant delay before cardiopulmonary resuscitation was started and was unconscious and unresponsive. In September 2014 he was transferred to the UK. In August 2018, GU’s brother made a request for a best interests decision concerning the continuation of CANH. The family met to discuss this and all except GU’s son, agreed that continuing CANH was not in GU’s best interests. In view of the fact that there was not unanimity among the family, a decision was made that CANH should continue. Commenting on this decision, Mr Justice Hayden said ‘the apparent assumption that in the face of family disagreement ‘ therefore will continue to be cared for by nursing staff ” is a troubling non sequitur’ and stressed that ‘family dissent to a medical consensus should never stand in the way of an incapacitated patients’ best interests being properly identified’. He also made clear that the responsibility for ensuring that a best interests assessment is undertaken rests with the …. (shrink)

The tumor microenvironment (TME) plays a pivotal role in the behavior and development of solid tumors as well as shaping the immune response against them. As the tumor cells proliferate, the space they occupy and their physical interactions with the surrounding tissue increases. The growing tumor tissue becomes a complex dynamic structure, containing connective tissue, vascular structures, and extracellular matrix (ECM) that facilitates stimulation, oxygenation, and nutrition, necessary for its fast growth. Mechanical cues such as stiffness, solid stress, interstitial (...) fluid pressure (IFP), matrix density, and microarchitecture influence cellular functions and ultimately tumor progression and metastasis. In this fight, our body is equipped with T cells as its spearhead against tumors. However, the altered biochemical and mechanical environment of the tumor niche affects T cell efficacy and leads to their exhaustion. Understanding the mechanobiological properties of the TME and their effects on T cells is key for developing novel adoptive tumor immunotherapies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Aristotelian Explorations by G. E. R. LloydRosamond Kent SpragueG. E. R. Lloyd. Aristotelian Explorations. Cambridge: Cambridge University Press, 1996. Pp. ix + 242. Cloth, $49.95.Although the essays in this richly rewarding book were given as lectures and seminars in a variety of places over a period of eight years, they possess a unity of theme that welds them into a satisfying whole. Furthermore, by the judicious use of (...) postscripts and additional notes, the author keeps us abreast of current discussion. [End Page 126]Lloyd’s chief concern is to compare Aristotle’s theory (notably as expressed in the Posterior Analytics) with his practice (especially in the zoology). The topic may be, as he admits in his 1990 Boston Colloquium lecture, “The Theories and Practices of Demonstration,” a “hoary old chestnut,” but his response to it is not; as is evident from the very title of his paper, he adopts a pluralistic approach to Aristotle’s methodology. Lloyd’s minute and extensive knowledge of the texts, as when he studies passages in the Topics in which what is there called apodeixis does not meet the conditions laid down in Posterior Analytics, makes his view compelling. Again, a careful study of Parts of Animals I, 1 issues in the caveat that “we had better be careful when talking about demonstration in the physical treatises, to examine what mode or manner of demonstration is in question” (33); it could be the method of deduction of antecedents, for instance, where we start with what will be rather than what is. In general, it needs to be considered not just whether a particular theory of demonstration is applied, but whether it is applicable.In a chapter entitled “The Relationship of Psychology to Zoology,” Lloyd discusses Aristotle’s theory of matter, particularly “the problem of reconciling what is true of earth, water, air, and fire haplōs... and what is true of them as the constituent elements of living uniform parts” (64). This difficulty has its repercussions for his form/matter distinction: the difference between the two is best illustrated by artefacts (as, I might add, is evident to those who attempt to teach it), but the unity of the sonolon by the cases in which the soul is form and the matter a living body of which the soul is the actuality.In this connection Lloyd makes reference to Aristotle’s “top-down theory of life” as being one quite definitely held by him (64, 99). I think that this is only partially the case. A passage such as De Anima 415a25ff. in which not only animals but plants are said, through reproduction, to aim at the eternal and divine, suggests that a “bottom-up” theory of life is equally important in his psychology, especially in view of his pervasive desire to stress the final cause. I think that Lloyd’s own principle of plurality in relation to context could well be applied here. The overall structure of the De Anima illustrates Aristotle’s use of both methods: bottom-up from nutrition through sensation to thought, but top-down from sight to touch. It is, of course, true that the De Anima is not concerned to address the question of how life emerges from not-life, but its discussion of living things quite definitely begins at the bottom of the scala naturae, with plants. Again, at History of Animals 588b4ff. (a passage crucial to Lloyd’s consideration of borderline cases in his chapter entitled “Fuzzy Natures?”), we find that Nature proceeds from the inanimate to the animate, and that first after the inanimate come plants. It also strikes me as being of interest that, when Aristotle discusses the difficult topic of growth in Generation and Corruption 321b16ff., he does so at the level of flesh and not of hands, from the bottom up, that is.Of other topics on which Lloyd has things to say, that of spontaneous generation is of particular interest. Here he points out that spontaneously generated creatures are of regular kinds; they have determinate material causes. As to whether Aristotle’s recognition of such cases has driven him “into admitting a principle that offers a glaring... (shrink)

BackgroundFew studies have paid attention to ethical responsibility related to malnutrition in elder care. The aim was to illuminate whether politicians and civil servants reason about malnutrition in elder care in relation to ethical responsibility, and further about possible causes and how to address them.MethodEighteen elected politicians and appointed civil servants at the municipality and county council level from two counties in Sweden were interviewed. They worked at a planning, control and executive level, with responsibility for both the elder care (...) budget and quality of care. Qualitative method was used for the data analysis.ResultsTwo themes emerged from their reasoning about malnutrition related to ethical responsibility. The theme assumed role involves the subthemes quality of care and costs, competent staff and govern at a distance. Old and ill patients were mentioned as being at risk for malnutrition. Caregivers were expected to be knowledgeable and stated primary responsible for providing adequate nutritional care. Extended physician responsibility was requested owing to patients' illnesses. Little was reported on the local management's role or on their own follow-up routines. The theme moral perception includes the subthemes discomfort, trust and distrust. Feelings of discomfort concerned caregivers having to work in a hurried, task-oriented manner. Trust meant that they believed for the most part that caregivers had the competence to deal appropriately with nutritional care, but they felt distrust when nutritional problems reappeared on their agenda. No differences could be seen between the politicians and civil servants.ConclusionNew knowledge about malnutrition in elder care related to ethical responsibility was illuminated by persons holding top positions. Malnutrition was stressed as an important dimension of the elder care quality. Governing at a distance meant having trust in the staff, on the one hand, and discomfort and distrust when confronted with reports of malnutrition, on the other. Distrust was directed at caregivers, because despite the fact that education had been provided, problems reappeared. Discomfort was felt when confronted with examples of poor nutritional care and indicates that the participants experienced failure in their ethical responsibility because the quality of nutritional care was at risk. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) by Sarah RichardsonQuill KuklaQuill Kukla, review of Sarah Richardson's The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021)I had been eagerly anticipating the release of Sarah Richardson's meticulously researched The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) for several years, and I was not disappointed. A leading feminist scholar of the history and philosophy of (...) science, Richardson traces the scientific history of the idea that pregnant people's bodies control the future health, character, and well-being of their offspring. She also explores how this science is translated into social messaging and shaped by social ideology. Richardson delves into the details of the methodology, motivations, results, and communication of the science of maternal influences. She reveals a history of shaky results, contested methods, and socially loaded messaging, unified by a sustained interest in framing maternal bodies as sites of risk and responsibility for birth outcomes.A central narrative of the book is that the perceived location and mechanism through which pregnant bodies control fetal development keeps shifting around; over time, scientists have located this maternal influence in the uterine environment, the cytoplasm, the methylation of DNA, maternal nutrition, and even in the emotions, thoughts, and imagination of the mother, among other locations.1 Each time a version of the maternal influence hypothesis re-emerges, targeting a different bodily location and mechanism, it comes along with similar social messaging: pregnant people are distinctively responsible for the 'quality' of their children; their bodies are distinctive sites of risk, in need of social management; and their influence can be understood and controlled independent of the context in which they live. Given how many times this scientific hypothesis and its accompanying social messaging has died and been reborn, it is hard not to conclude, with Richardson, that background ideology compels us to keep searching for new stories that take this same form. The idea that pregnant people's bodies are understood as decontextualized and heightened sites of risk and responsibility for birth outcomes, in need of systematic discipline (both self-discipline and social discipline) in order to ensure their production of proper offspring, is one that has been explored [End Page e-1] in quite a bit of depth within feminist theory and reproductive ethics over the last thirty years. To name just a few, Barbara Duden's Disembodying Women: Perspectives on Pregnancy and the Unborn (1993), Deborah Lupton's "Risk and the Ontology of Pregnant Embodiment" (1999), Lisa Mitchell's Baby's First Picture: Ultrasound and the Politics of Fetal Subjects (2001), and my own Mass Hysteria: Medicine, Culture, and Mothers' Bodies (2005) are all works firmly within this tradition. What is new about Richardson's book is not the development and exploration of this cultural narrative and imaginary, but rather her rigorous and skillful analysis of the science that has grown out of and undergirded it. Richardson is a masterful writer, who makes scientific details comprehensible and fascinating. Her historical and epistemological analyses of exactly what shaped the science at each stage, what each scientific iteration did and didn't manage to show, and how these different scientific movements were translated into public messaging, is sharp and compelling. Richardson shows us the inner workings of how scientific programs build momentum; how scientists make methodological decisions; and how results feed into ongoing research programs. From this book, we also develop a rich sense of just how much uncertainty is baked into the science of human development, and how both scientific and public excitement about a given research program are mostly independent of the success and security of the science that comes out of it. The book traces 150 years of the history of the science of maternal influences, culminating in the current focus on epigenetics—which, like various past maternal influence theories, has ignited our broader social imagination. Epigenetics, roughly, is the study of molecular changes outside our DNA that control how genes express themselves. Environmental stimuli (such as stress) can cause changes in methylation, and thereby influence the expression of the genome: "Epigenetic markers that help determine whether a... (shrink)

This study elucidates the nursing of undernourished patients as experienced by eight registered clinical nurses and five nursing assistants by using content analysis. The participants' narratives describe the inner perspective of caring for undernourished patients, known in Sweden as `the thin ones'. Categories identified were: frustration in nursing, joy in nursing and that undernourishment is taboo. The taboo was narrated as feelings of guilt and shame. Frustration in nursing could be seen as feeling stressed, exposed, lonely, powerless, helpless, and being (...) torn between demands and needs. Joy in nursing was experienced when creating a trusting relationship, promoting pleasure in the meal situation and working with respect for each individual's life-style and context of life. Understanding staff members' views is important when implementing guidelines as well as in the teaching situation in order to identify where staff stand with regard to knowledge and attitudes. (shrink)

A large section of the population (70%) of Uttarakhand largely depends upon agricultural based activities for their livelihood. Rural community of the mountains has developed several indigenous and traditional methods of farming to conserve the crop diversity and rejoice agrodiversity with religious and cultural vehemence. Traditional food items are prepared during occasion, festivals, weddings, and other religious rituals from diversified agrodiversity are a mean to maintain agrodiversity in the agriculture system. Agrodiversity is an insurance against disease and extreme climatic fluctuations, (...) as a coping mechanism in times of scarcity, as a means to enhance overall productivity of farms, as a source of critical nutrition and medicine in the Himalayan region. The different traditional system of agriculture and indigenous method of maintaining soil fertility, socio-cultural and religious rituals has saved many crops that are under threatened category. But all these system and practices are ignored nauseatingly in hill agriculture policy, where more emphasis was given for plain areas. Less emphasis is being put on local systems that rely on existing natural, human, and social assets such as biodiversity, traditional knowledge, and social capital underpinning collective action to ensure food security. Of late, development planners have realized the importance of appropriate technologies and therefore have stressed the need for on-site training, and capacity building of user groups in rural areas of the region. Rural technology demonstration and training center have been supposed as a means disseminating technologies enabling improvement in the yield potential of farms, income generation from off-farm activities, and conservation and efficient use of natural resources. There is a strong need to bring desirable changes in the agricultural policy, research, and development in reference to mountainous regions. The present paper describe present scenario of agriculture, traditional, and socio-cultural practices of retaining soil fertility and agrodiversity, policy dimensions, and strategies for management of the Himalayan agroecosystems. (shrink)

Cultural identity of rural areas is discussed with some basic concepts such as culture, territory, contemporary globalization, and individuation processes. This case study of cultural identity in the Slovenian countryside focuses on its spiritual culture, of which several components are presented in detail: the language of rural areas, (handy)crafts, nutrition and food culture, co-operation and mutual help among rural residents at work and in leisure, and the art products of Slovenian farmers. In discussing the present status and the future of (...) rural cultural identity, the danger of idolizing (romanticizing) traditions for the sake of selling them to tourists is pointed out and the necessity of traditions being part of everyday life of rural residents stressed. As a part of work and leisure life of rural residents, traditions are constantly changing due to local as well as to international socio-economic processes, to inner and outer stimuli to keep existing traditions and to create new ones. (shrink)

Coping with a relative with a learning disability could be a stressful experience for family members. The present study is aimed at exploring the coping strategies adopted by families in trying to make meaning of their situation. A qualitative study design using focus group discussions was adopted. Ten FGD sessions were held with family members of persons with a learning disability. Findings revealed patterns of family coping to include problem-focused, emotion-focused, and spiritual/religious-focused. Also, coping responses to a learning disability varied (...) based on the level of information available to families about the condition of their relative. In some cases, interspousal relationship was strained due to stress. It was recommended that families of persons with a learning disability need social support and professional help from social workers to facilitate the adoption of more positive-oriented coping strategies by family members. (shrink)