Doctor-patient care relationship in genetic cardiomyopathies: An exploratory study on clinical consultations.

BACKGROUND: The present study aims to explore the setting of consultation and communication between physicians and patients affected by genetic cardiomyopathies, investigating how the two parts of the therapeutic relationship participate and share information. METHODS AND RESULTS: 45 adult patients affected by various cardiomyopathies took part in a prospective case study while attending consultations at a cardiologic outpatient clinic constituting an Italian referral centre for cardiomyopathies. A researcher observed the consultations, which were audio-recorded and transcribed. Transcripts were coded and an analysis of setting, type of communication implemented and participation of doctors and patients in terms of word-count and type of questions/answers was carried out. Overall word-count was significantly higher for physicians than for patients (t(44) = 9,506; p<0.001). Doctors were prone to ask closed questions (t(44) = -11,90; p<0.001) while patients preferred open answers (t(44) = 5.58; p<0.001), enriched with subjective issues related to their illness experience. Partial correlation highlights a significant positive relation between doctors' closed question and patients' open answers (r = .838; p<0.001). CONCLUSIONS: Findings emphasize patients' need for adequate time and space to share their subjective illness experience with the physician, within an approach informed by the insights and recommendations of Narrative Medicine. These findings are instrumental to improving the specific clinical setting for individuals with genetic cardiomyopathies.

Jerome Seymour Bruner: an Anticipator Scientist for an Anticipation Theory.

In this paper the Author intends to present the work of Jerome Bruner from the particular angle of the concept of anticipation. After having duly traced the biographical and scientific profile of the scientist, the Author shows how anticipation is a red thread that joints early youthful works up to those written in the last period of his life. The concept of anticipation then introduces that of expectation of a norm and that violation of the norm and how the person should consider them appropriately to produce new knowledge. Therefore Jerome Bruner was an anticipatory in his theories but also the anticipation was the pivotal concept in these theories, as they propose an idea of ​​ person capable of surprise in front of the incongruities of reality.

Beyond the Anomaly: Where Piaget and Bruner Meet.

The aim of this work is to focus on a basic concept in Brunerian narrative theory, that of violation of canonicity, showing how it relates to other basic concepts of cognitive theories such as anomaly, expectation and relationship between constancy and variability. To reach this aim, we will firstly discuss the Piagetian theory, in particular regarding the way in which the child deals with new and interesting events moved from the need to face and produce "spectacles interessantes" by means of experiencing the violation of canonicity. We will also briefly consider some results of neurosciences studies pointing out that the constancy-variability issue is at the base of human development. Secondly, we will show the convergence between Piagetian theory and Brunerian theory of narration, producing some examples of how violation of canonicity can occur in children and adults.

Facing the Language-Memory Problem in the Study of Autobiographical Memory.

This paper discusses the problem of the role of language in autobiographical memory, that is barely considered in studies on autobiographical memories and narratives. As a matter of fact, most of the current studies on autobiographical memory confounded memory and narrative together. The present paper focuses on two main issues. Firstly, it debates how narratives contribute to the construction of autobiographical memories through self-other communication. Secondly, it reflects on how language and communication should be manipulated in studies about autobiographical memory. This paper is made of three sections: the first section discusses the role of language, particularly in the form of narrative, as a social tool by which autobiographical memories can be organised in a life story; the second section examines previous methods of investigation used in the study of autobiographical memories; finally, the third section proposes different methodological alternatives to overcome the problems emerging from our analysis of literature.

Why Narrating Changes Memory: A Contribution to an Integrative Model of Memory and Narrative Processes.

This paper aims to reflect on the relation between autobiographical memory (ME) and autobiographical narrative (NA), examining studies on the effects of narrating on the narrator and showing how studying these relations can make more comprehensible both memory's and narrating's way of working. Studies that address explicitly on ME and NA are scarce and touch this issue indirectly. Authors consider different trends of studies of ME and NA: congruency vs incongruency hypotheses on retrieving, the way of organizing memories according to gist or verbatim format and their role in organizing positive and negative emotional experiences, the social roots of ME and NA, the rules of conversation based on narrating. Analysis of investigations leads the Authors to point out three basic results of their research. Firstly, NA transforms ME because it narrativizes memories according to a narrative format. This means that memories, when are narrated, are transformed in stories (verbal language) and socialised. Secondly, the narrativization process is determined by the act of telling something within a communicative situation. Thus, relational situation of narrating act, by modifying the story, modifies also memories. The Authors propose the RE.NA.ME model (RElation, NArration, MEmory) to understand and study ME and NA. Finally, this study claims that ME and NA refer to two different types of processes having a wide area of overlapping. This is due to common social, developmental and cultural roots that make NA to include part of ME (narrative of memory) and ME to include part of NA (memory of personal events that have been narrated).

Empathy and autobiographical memory: are they linked?

Autobiographical memory and empathy have been linked with social interaction variables as well as gender in independent bodies of literature. However a scarcity of research exists on the direct link between autobiographical memory and empathy. Exploring this link, in particular for memory of friendships and empathy, was the authors' main aim. A total of 107 Italian undergraduates participated. A memory fluency task was used to assess accessibility of memories spanning their entire life (preschool through university) and an empathy scale (Italian version of the Interpersonal Reactivity Index) was employed to measure the participants' level and dimensions of empathy. For men, empathy scores were related to how many memories they could recall. Specifically, men with higher scores on the fantasy and empathic concern scales and those with lower scores on the personal distress scales recalled more memories of friends. However, affective quality of their memories was unrelated to empathy. In contrast, for women there was no relationship between number of memories and empathy, but the emotional tone of their memories was related to empathy: those with higher scores on the personal distress scale had proportionately fewer affectively positive memories. Results are discussed in terms of gender differences in both empathy and parental socialization patterns.

Medical error and systems of signaling: conceptual and linguistic definition.

In recent years the issue of patient safety has been the subject of detailed investigations, particularly as a result of the increasing attention from the patients and the public on the problem of medical error. The purpose of this work is firstly to define the classification of medical errors, which are distinguished between two perspectives: those that are personal, and those that are caused by the system. Furthermore we will briefly review some of the main methods used by healthcare organizations to identify and analyze errors. During this discussion it has been determined that, in order to constitute a practical, coordinated and shared action to counteract the error, it is necessary to promote an analysis that considers all elements (human, technological and organizational) that contribute to the occurrence of a critical event. Therefore, it is essential to create a culture of constructive confrontation that encourages an open and non-punitive debate about the causes that led to error. In conclusion we have thus underlined that in health it is essential to affirm a system discussion that considers the error as a learning source, and as a result of the interaction between the individual and the organization. In this way, one should encourage a non-guilt bearing discussion on evident errors and on those which are not immediately identifiable, in order to create the conditions that recognize and corrects the error even before it produces negative consequences.

Medical successes and couples' psychological problems in assisted reproduction treatment: a narrative based medicine approach.

OBJECTIVE: 1) To explore the psychological processes that develop in women and men during their first pregnancy obtained with assisted reproduction treatment; 2) to individuate the main plot that women and men use to recount their transition to parenthood. METHODS: A face-to-face semi-structured autobiographical interview was administered. The interview was aimed to investigate the story of pregnancy. Interviews were transcribed verbatim and analyzed in order to merge principal themes. PARTICIPANTS: 15 Italian couples waiting for the first child after a conception with assisted reproductive technologies. RESULTS: Medically assisted pregnancy constitutes an extremely stressful, highly medicalised experience, that the couple, however, narrated according to a basic plot consisting in four phases: doubt, final sentence, victory, monitoring. CONCLUSIONS: Results suggest that physicians can benefit from knowing the phases that infertile couples experience during pregnancy because these can serve as a framework to use in monitoring their transition to parenthood and in planning psychological support and health interventions for them.

Parental influences on memories of parents and friends.

The authors evaluated the role parent-child relationship quality has on two types of memories, those of parents and those of friends. Participants were 198 Italian university students who recalled memories during 4 separate timed memory-fluency tasks about their preschool, elementary school, middle school, high school and university years. Half were instructed to recall memories involving parents and the remainder memories involving friends. Moreover, parent-child relationships were assessed by the Network of Relationships Inventory (NRI; W. Furman & D. Buhrmester, 1985) and Adolescents' Report of Parental Monitoring (D. M. Capaldi & G. R. Patterson, 1989). Results showed that men with positive parent-son relationships had more memories of parents and more affectively positive memories of friends, supporting a consistency model positing similarity between parent-child relationships and memories of friends. Women with positive parental relationship quality had more affectively positive memories of parents but for friends, positive relationship quality only predicted positive memories when young. At older ages, especially middle school-aged children, negative parent-daughter relationships predicted more positive memories of friends, supporting a compensatory model. The gender of parent also mattered, with fathers having a more influential role on affect for memories of friends.

Autobiography as tool to improve lifestyle, well being, and self-narrative in patients with mental disorders.

The aims of the present study were to explore how the autobiographical process can lead to a transformation in psychiatric patients' lifestyle, well-being, and self-narrative. Nine participants, aged between 20 and 42 years and affected by axis I psychiatric disorders (DSM IV) were selected to participate in an autobiographical laboratory. Eight to 10 meetings took place, each lasting about an hour, during which autobiographical accounts were collected. At the beginning and end of the autobiographical laboratory, the medical staff completed the Social Functioning Scale to evaluate each patient across 6 dimensions: social engagement, interpersonal ability, prosocial activities, recreation, independence-competence, and independence-performance. The Language Inquiry and Word Count (Pennebaker and Francis, 1996) was used to analyze patients' autobiographical accounts. A comparison between the first and second compilation of the Social Functioning Scale showed significant positive changes across the 6 social dimensions. The analysis of language in the narratives collected in the first and seventh meeting showed how inpatients passed from a narrative that was more centered on the memory of the past to a narrative that was more similar to a conversation and enriched with "insight" terms and the use of verbs in the conjunctive form. The authors interpret these outcomes as being consistent with the improvement that was observed in inpatients' social functioning.

A distant mirror: memories of parents and friends across childhood and adolescence.

Memories that were easily accessible (i.e., quickly retrieved in a memory-fluency task) of Italian university students were assessed. They were from four periods of life: preschool, elementary school, middle school, and high school/university. Half of the participants were instructed to recall only memories involving parents, and the other half memories involving friends. Across age at the time of remembered events, only memories of friends increased in frequency. For parental memories (but not friend memories), the proportion with negative affect increased over age, especially for males. There were also differences related to whether memories were episodic or generic. It was concluded that memories of different periods of childhood and adolescence can serve as a reflective mirror for developmental changes in parent-child and friendship relationships.

Autobiography as a tool for self-construction: a study of patients with mental disorders.

The aim of the present study was to explore how the autobiographical process can lead to a transformation in the quality of psychiatric patients' self-narrative. Fifteen participants, with ages ranging from 25 to 40 years and affected by axis I psychiatric disorders (DSM IV), were selected to participate. A 10-question interview referring to 10 autobiographical cruxes was used to collect autobiographical data; the interview was readministered 2 weeks later. A coding system (the N.O.I.S.) was used to analyze each participant's 2 autobiographical productions. Results from the second interviews showed significant and positive transformations in the quality of patients' autobiographical representation.

Parental influences on earliest memories.

Recently, independent lines of research have indirectly supported the notion that social variables, especially parent-child relationships, have a significant impact on adults' memories of their early life. In order to directly assess this Italian students were asked to recall as many memories involving parents as they could from before the age of 6 in a 3-minute timed recall task (i.e., memory fluency). They also filled out assessments about parental involvement in their lives as well as the quality of their relationships with their mothers and fathers. We found that, for males, the more involved the parents and the warmer the relationships between sons and both their mothers and their fathers, the more early memories, the more positive early memories, and the more episodic memories men recalled. For women, the warmer the relationship with their mothers, the earlier their earliest memory. Results are discussed in terms of gendered parent-child interactions as well as McAdam's emergent life-story theory.

Everyday life reasoning, possible worlds and cultural processes.

Discussing Faiciuc's paper, I first tackle the problem of fallacies in deductive reasoning showing how, in a possible world theory, non correct forms of reasoning can be useful strategies for discovery, providing these strategies remain at a hypothesis level. Secondly, everyday reasoning and its specificity in comparison to logical-normative one are analyzed. This topic stresses the notion of interpretation and, in this context, the role of the community and of cultural canons shared by the subject. From this point of view, reasoning does not occur, only, in the brain of a person but in everyday exchanges occurring between individuals and the history of their community.

Definitions of bullying: a comparison of terms used, and age and gender differences, in a fourteen-country international comparison.

The study of school bullying has recently assumed an international dimension, but is faced with difficulties in finding terms in different languages to correspond to the English word bullying. To investigate the meanings given to various terms, a set of 25 stick-figure cartoons was devised, covering a range of social situations between peers. These cartoons were shown to samples of 8- and 14-year-old pupils (N = 1,245; n = 604 at 8 years, n = 641 at 14 years) in schools in 14 different countries, who judged whether various native terms cognate to bullying, applied to them. Terms from 10 Indo-European languages and three Asian languages were sampled. Multidimensional scaling showed that 8-year-olds primarily discriminated nonaggressive and aggressive cartoon situations; however, 14-year-olds discriminated fighting from physical bullying, and also discriminated verbal bullying and social exclusion. Gender differences were less appreciable than age differences. Based on the 14-year-old data, profiles of 67 words were then constructed across the five major cartoon clusters. The main types of terms used fell into six groups: bullying (of all kinds), verbal plus physical bullying, solely verbal bullying, social exclusion, solely physical aggression, and mainly physical aggression. The findings are discussed in relation to developmental trends in how children understand bullying, the inferences that can be made from cross-national studies, and the design of such studies.