Causal Reasoning and Clinical Practice: Challenges from Molecular Biology

Not only has the philosophical debate on causation been gaining ground in the last few decades, but it has also increasingly addressed the sciences. The biomedical sciences are among the most prominent fields that have been considered, with a number of works tackling the understanding of the notion of cause, the assessment of genuinely causal relations and the use of causal knowledge in applied contexts. Far from denying the merits of the debate on causation and the major theories it comprises, this paper is meant as a stimulus for theorists of causation in the philosophy of biomedicine, with a focus on clinical matters. Without aiming at putting forward an original theory of causation and starting from the narration of two actual but paradigmatic cases at the joints between biomedical research and clinical practice, we want to point out that some pathological situations addressed by molecular medicine actually prove resistant to (at least) some of our major epistemological accounts of causal explanation. Given this scenario, which is very frequent in our hospitals, our analysis aims to provide a stimulus for the debate among theorists of causation in biomedicine interested in real cases in science in practice. We believe that this might in turn encourage some more general rethinking of the complex intertwinement of science, philosophy of science and ethics, as well as of the role of philosophy of science for clinical medicine itself.

     

Violence and Latin‐American preadolescents: A study of social brain function and cortisol levels

The present study investigated exposure to violence and its association with brain function and hair cortisol concentrations in Latin‐American preadolescents. Self‐reported victimization scores (JVQ‐R2), brain imaging (fMRI) indices for a social cognition task (the ‘eyes test’), and hair cortisol concentrations were investigated, for the first time, in this population. The eyes test is based on two conditions: attributing mental state or sex to pictures of pairs of eyes (Baron‐Cohen, Wheelwright, Hill, Raste, & Plumb, 2001). The results showed an association among higher victimization scores and (a) less activation of posterior temporoparietal right‐hemisphere areas, in the mental state condition only (including right temporal sulcus and fusiform gyrus); (b) higher functional connectivity indices for the Amygdala and Right Fusiform Gyrus (RFFG) pair of brain regions, also in the mental state condition only; (c) higher hair cortisol concentrations. The results suggest more exposure to violence is associated with significant differences in brain function and connectivity. A putative mechanism of less activation in posterior right‐hemisphere regions and of synchronized Amygdala: RFFG time series was identified in the mental state condition only. The results also suggest measurable effects of exposure to violence in hair cortisol concentrations, which contribute to the reliability of self‐reported scores by young adolescents. The findings are discussed in light of the effects of exposure to violence on brain function and on social‐cognitive development in the adolescent brain. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=qHcXq7Y9PBk     

Persistence of Traumatic Symptoms After Seven Years: Evidence from Young Individuals Exposed to the L’Aquila Earthquake

In this article, we investigated the presence of trauma-induced sequelae in a sample of 41 young individuals exposed to the L’Aquila earthquake who did not seek mental help in the aftermath of the disaster or in the ensuing months. We compared this group with 43 individuals, matched for age and education, who had not experienced an earthquake but had moved to and lived in L’Aquila after the earthquake and thus experienced the challenges of living in an earthquake-struck city. This study aimed to show that earthquake-exposed individuals scored significantly higher than nonexposed persons on certain scales of the Trauma Symptom Inventory (TSI) seven years after the event. Our results indicated that exposed individuals exhibited higher scores on the dissociation, intrusive experience, and defensive avoidance scales. Furthermore, a correlational analysis between specific conditions detected by the Earthquake Checklist L’Aquila (ECLA) and the TSI identified the influences of specific conditions, such as being trapped or injured under rubble during the earthquake, experiencing a persistent fear of aftershocks or a life-threatening feeling, and witnessing the death of a loved one. All of these experiences resulted in the persistence of trauma-related symptoms. Dissociative experiences during the trauma, cognitive and behavioral avoidance and reexperiencing were associated with negative effects and may hinder the natural process of recovery in trauma-exposed individuals. Knowledge of mid- and long-term psychological difficulties following a traumatic event may be useful for promoting interventions in mental health across exposed populations.     

Adolescent maternity: A risk factor in poverty situations?

This paper describes the psychosocial characteristics of adolescent mothers living in poverty in urban communities of Uruguay, whose children are now 0 to 5 years old. A sample of 965 mothers representative of the poor urban communities in the entire country was studied. One hundred thirty-six of these mothers were adolescents, 19 years old or younger. Six major areas were explored: socioeconomic status and social support, family characteristics, child-rearing practices, maternal and paternal availability, and characteristics of the child. In the group of children 2 to 5 years of age, psychomotor development was explored using the Test de Desarrollo Psicomotor (TEPSI). Psychosocial risk and child development were compared for adolescent and nonadolescent poor urban mothers. Children in both groups showed negative effects. It was not found that children of adolescent mothers did worse than those of nonadolescent mothers. Therefore, it was concluded that adolescent maternity is a complex phenomenon that cannot be viewed in isolation from the social environment in which it takes place. The results indicated that in poor communities the poverty-related risk factors may obscure the effect of the age-related ones.     

Structural differences in the production of written arguments

The purpose of this study is to analyse the structure of written argumentative texts produced by pupils in grades 3, 5, 7 and 11 in relation to three different tasks: Group A — subjects are assigned a topic question consisting of a single statement (open question); Group B — subjects are given a topic question consisting of both a statement and its opposite (opposite opinions); Group C — subjects are given an initial and a final sentence of a text, which they have to complete, and which refers to opposite opinions (oriented task). Six different types of text organization were evidenced on the basis of the argumentative moves presented in the texts, the linguistic indexes used to express the relationships between the moves, the presence or absence of counter-arguments and the type of argumentation or reasoning used. The organization of the texts range from a simple affirmation of a position (repitition of the proposition or its opposition without any support) to a use of data or reasons to support a position, to others still in which two positions are presented in the body of a unitary structure, developed in parallel and interconnected regularly. Our analysis found a well-defined tendency corresponding to the age levels in the types of texts produced by the subjects. The texts produced by the younger group, the pupils in elementary school, contained a fairly simple structural organization, characterized by very few argumentations or a lack of explicitness of the essential moves and a juxtaposing of arguments. The older subjects, in particular those attending secondary school, were able to produce texts which were more complex with regard to the presence and the organization of the argumentative moves, and more coherent and cohesive with respect to their articulation of opinions and use of adequate linguistic indices to analyze t topic. As regards the different types of tasks, when the subjects were presented explicitly with two opposite opinions (though in different terms), they developed both positions in their responses, contrary to the situation in which they produced one position when only one of two opinions was presented.