Medical and psychological predictors of prescription opioids dependence during chronic pain treatment

Introduction

Due to the increasing rates of prescription opioids (PO) dependence, there is a need for designing evaluations that detect, before initiating treatment, those patients with a greater probability of developing PO dependence.

Burnout and occupational stress in the medical residents of Oncology,Haematology and Radiotherapy: a prevalence and predictors study in Portugal

Burnout is a professional syndrome associated with stress caused by overwork. Our aim was to calculate the prevalence of burnout and stress on medical residents of Oncology, Haematology and Radiotherapy in Portugal, as well as to determine predictors of burnout and stress. An anonymous questionnaire was applied (n = 118). Statistical analysis consisted of a descriptive and inferential analysis. The prevalence of burnout and stress was calculated to be 45.2 and 50%, respectively. The dimensions that generated higher levels of stress were ‘dealing with patients’ and ‘overwork’. Burnout was directly related with stress dimension ‘overwork’. The prevalence of burnout in Portuguese oncological residents is high as in other European countries and in the U.S. Therefore, interventional strategies can be designed.     

Psychological Change in Everyday Life: An Exploratory Study

The innovative moments model was used in a pilot study that aimed to explore the change processes involved in everyday change outside psychotherapy. According to this model, the emergence and development of innovative moments (IMs) as exceptions to a problematic pattern are closely associated with psychological change. A longitudinal design covering 4 months of interviews was implemented with 13 adults who were coping with significant personal problems without clinical psychopathological complaints. Semistructured interviews were used to explore participants' personal accounts of their problems, and change was assessed using a scaling task at the end of the study. A total of 114 interviews were analyzed using the innovative moments coding system. A general linear model showed that higher levels of change were associated with higher proportions of complex IMs over time. Moreover, lower levels of change were associated with an increase in elementary IMs. These results support the idea that successful psychological change in everyday life shares similarities with the change pattern found in psychotherapy using the innovative moments model.     

Making Space for a Dialogical Notion of Religious Subjects: A Critical Discussion From the Perspective of Postsecularity and Religious Change in the West

In this article I address some topical themes from the ongoing discussion on contemporary religious change in the West and how it poses conceptual challenges to the study of religion. The academic discussion on religious change is vast and my observations are, of course, by necessity limited to my particular interest and argument in this article. On the one hand, I draw on some of the literature that has evolved within and around the concept of postsecularity and, on the other, on more general literature on contemporary religious change. Based on some selected observations, I underline the need to critically rethink how we conceptualize both religion and religious subjects. In my view, current research fosters a greater attentiveness of complexity with regard to religion, but simultaneously it requires us to take seriously a dialogical notion of religious subjects that provides a conceptual account of a subject constituted by being located within and emerging through ongoing social process. This dialogical notion provides a better tool for how current social and cultural reconfigurations of religion are simultaneously played out as a diversity of identities that challenge received categories, such as the religious and the secular.     

The ethics of separating conjoined twins: two arguments against

I argue that the separation of conjoined twins in infancy or early childhood is unethical (rare exceptions aside). Cases may be divided into three types: both twins suffer from lethal abnormalities, only one twin has a lethal abnormality, or neither twin does. In the first kind of case, there is no reason to separate, since both twins will die regardless of treatment. In the third kind of case, I argue that separation at an early age is unethical because the twins are likely to achieve an irreplaceably good quality of life—the ss="EmphasisTypeItalic ">goods of conjoinment—that separation takes away. Evaluation of this possibility requires maturation past early childhood. Regarding the second type, I point out that with conceivable but unrecorded exceptions, these cases will consistently involve sacrifice separation. I present an argument that sacrifice separation is unethical, but in some cases a moral dilemma may exist in which separation and refraining from separation are both unethical. Perhaps in such cases a decision can be made on non-moral grounds; however, the possibility of such a decision serves not to mitigate but to underscore the fact that the separation is unethical. My conclusion, which applies to all three types of cases, is that it is unethical to separate conjoined twins before their developing personalities give some reliable indication as to whether they desire separation and whether they will achieve those goods of conjoinment.     

Contractualism,Person-Affecting Wrongness and the Non-identity Problem

A number of theorists have argued that Scanlon's contractualist theory both "gets around" and "solves" the non-identity problem. They argue that it gets around the problem because hypothetical deliberation on general moral principles excludes the considerations that lead to the problem. They argue that it solves the problem because violating a contractualist moral principle in one's treatment of another wrongs that particular other, grounding a person-affecting moral claim. In this paper, I agree with the first claim but note that all it shows is that the act is impersonally wrong. I then dispute the second claim. On Scanlon's contractualist view, one wrongs a particular other if one treats the other in a way that is unjustifiable to that other on reasons she could not reasonably reject. We should think of person-affecting wronging in terms of the reasons had by the actual agent and the actual person affected by the agent's action. In non-identity cases, interpersonal justifiability is therefore shaped both by the reason to reject the treatment provided by the bad suffered and the reason to affirm the treatment provided by the goods had as a result of existing. I argue it would be reasonable for the actual person to find the treatment justifiable, and so I conclude that Scanlon's contractualist metaethics does not provide a narrow person-affecting solution to the non-identity problem on its own terms. I conclude that the two claims represent a tension within Scanlon's contractualist theory itself.     

Violence,research, and non-identity in the psychiatric clinic

Violence in psychiatric clinics has been a consistent problem since the birth of modern psychiatry. In this paper, I examine current efforts to understand and reduce both violence and coercive responses to violence in psychiatry, arguing that these efforts are destined to fall short. By and large, scholarship on psychiatric violence reduction has focused on identifying discrete factors that are statistically associated with violence, such as patient demographics and clinical qualities, in an effort to quantify risk and predict violent acts before they happen. Using the work of Horkheimer and Adorno, I characterize the theoretical orientation of such efforts as ss="EmphasisTypeItalic ">identity thinking. I then argue that these approaches lead to epistemic imperceptiveness and a subtle form of conceptual restraint on patients. I suggest a reorientation in psychiatric research, away from identity thinking and toward a more productive and just approach to the problem of violence in psychiatric clinics.     

Narrative,Self-Realization,and the Shape of a Life

Velleman, MacIntyre, and others have argued for the compositional view that lives can be other than equally good for the person who lives them even though they contain all and only the same moments, and that this is explained by their narrative structure. I argue instead for explanation by self-realization, partly by interpreting Siegfried Sassoon’s exemplary life-narrative. I decide between the two explanations by distinguishing the various features of the radial concept of narrative, and showing, for each, either that self-realization is just as good an account, or that we should prefer the self-realization account, of the composition it is supposed to explain. I conclude that, if the shape of a life matters, it matters because some shapes are self-realizations, not because they are narratives.     

The joy of Desire: Understanding Levinas’s Desire of the Other as gift

In this paper, I argue that if we understand Levinas’s Desire of the Other as gift, we can understand it as joyful—that is, as celebratory. After presenting Levinas’s conception of Desire, I consider his claim, found in ss="EmphasisTypeItalic ">Otherwise than Being, that the self is a hostage to the Other, and I contend that, paradoxical as it may seem, being a hostage to the Other is actually liberating. Then, drawing on insights Richard Kearney offers in ss="EmphasisTypeItalic ">Reimagining the Sacred, I argue for understanding Desire as a gift that is the condition of possibility for joy. If I offer hospitality to the Other, I thereby accept the gift that makes joy possible, and this joy is not egoistic but is the proper response to the gift. Finally, I ask whether Desire can be joyful in practice, given that the pure gift is an originary condition and never a historical one, and I conclude that imperfect joy remains possible. Moreover, this imperfect joy is better than any solitary enjoyment I might experience in the total absence of the Other.