Review of Connections in the clinic: Relational narratives from team-based primary care.

Reviews the book, Connections in the Clinic: Relational Narratives from Team-Based Primary Care edited by Randall Reitz, Laura E. Sudano, and Mark P. Knudson (2021). This book is an edited collection of poems and stories reflecting the personal nature of the mission, vision, and practice of integrated primary care. This collection reflects the biopsychosocial model, which has been growing steadily in research and practice over the last few decades. These stories from the frontlines illustrate the increased awareness of the strong mind-body-interpersonal and team connections that are a critical part of a successful primary care system. This book is intended to be inspirational for anyone working in a primary care clinic. The editors describe the central purpose of the book is to find meaning in the relationships that are created in team-based primary care. This is a book where these stories are collected to expand our recognition and appreciation of the full diversity of patterns in our personal and work lives. The collection of stories is intended to inspire readers to actively practice their own reflections and learnings and encourages sharing them with others. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Using natural language processing to link patients' narratives to visual capabilities and sentiments.

SIGNIFICANCE: Analyzing narratives in patients' medical records using a framework that combines natural language processing (NLP) and machine learning may help uncover the underlying patterns of patients' visual capabilities and challenges that they are facing and could be useful in analyzing big data in optometric research. PURPOSE: The primary goal of this study was to demonstrate the feasibility of applying a framework that combines NLP and machine learning to analyze narratives in patients' medical records. To test and validate our framework, we applied it to analyze records of low vision patients and to address two questions: Was there association between patients' narratives related to activities of daily living and the quality of their vision? Was there association between patients' narratives related to activities of daily living and their sentiments toward certain "assistive items"? METHODS: Our dataset consisted of 616 records of low vision patients. From patients' complaint history, we selected multiple keywords that were related to common activities of daily living. Sentences related to each keyword were converted to numerical data using NLP techniques. Machine learning was then applied to classify the narratives related to each keyword into two categories, labeled based on different "factors of interest" (acuity, contrast sensitivity, and sentiments of patients toward certain "assistive items"). RESULTS: Using our proposed framework, when patients' narratives related to specific keywords were used as input, our model effectively predicted the categories of different factors of interest with promising performance. For example, we found strong associations between patients' narratives and their acuity or contrast sensitivity for certain activities of daily living (e.g., "drive" in association with acuity and contrast sensitivity). CONCLUSIONS: Despite our limited dataset, our results show that the proposed framework was able to extract the semantic patterns stored in medical narratives and to predict patients' sentiments and quality of vision.

Are Differences Evident in the Ways Boys and Girls Appraise and Interpret Their Traumatic Experiences? A Qualitative Analysis of Youth Trauma Narratives.

The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth (N = 16) ages 8-16 who had experienced multiple types (M = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth's trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth's appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.

Temporal organization of narrative recall is present but attenuated in adults with hippocampal amnesia.

Studies of the impact of brain injury on memory processes often focus on the quantity and episodic richness of those recollections. Here, we argue that the organization of one's recollections offers critical insights into the impact of brain injury on functional memory. It is well-established in studies of word list memory that free recall of unrelated words exhibits a clear temporal organization. This temporal contiguity effect refers to the fact that the order in which word lists are recalled reflects the original presentation order. Little is known, however, about the organization of recall for semantically rich materials, nor how recall organization is impacted by hippocampal damage and memory impairment. The present research is the first study, to our knowledge, of temporal organization in semantically rich narratives in three groups: (1) Adults with bilateral hippocampal damage and severe declarative memory impairment, (2) adults with bilateral ventromedial prefrontal cortex (vmPFC) damage and no memory impairment, and (3) demographically matched non-brain-injured comparison participants. We find that although the narrative recall of adults with bilateral hippocampal damage reflected the temporal order in which those narratives were experienced above chance levels, their temporal contiguity effect was significantly attenuated relative to comparison groups. In contrast, individuals with vmPFC damage did not differ from non-brain-injured comparison participants in temporal contiguity. This pattern of group differences yields insights into the cognitive and neural systems that support the use of temporal organization in recall. These data provide evidence that the retrieval of temporal context in narrative recall is hippocampal-dependent, whereas damage to the vmPFC does not impair the temporal organization of narrative recall. This evidence of limited but demonstrable organization of memory in participants with hippocampal damage and amnesia speaks to the power of narrative structures in supporting meaningfully organized recall despite memory impairment.

Parental Identity and Lived Experiences when Parenting a LGBTQIA+2 Child: A Critical Narrative Synthesis of Current Evidence.

PURPOSE: Most LGBTQIA + 2 studies focus on the core sexually and gender diverse population without exploring the peripheral familial perspectives. Current research needs to explore parental experiences of parenting a LGBTQIA+2 child, since parents undergo an identity change after their child's disclosure. This parental identity change may affect parental well-being and add to the existing stress of parenting a LGBTQIA + 2 child. METHODS: This paper uses the identity process theory (IPT) to review 18 studies on parental narratives to highlight the change in parental identity. Databases were searched for first-hand parenting experiences and shortlisted articles were qualitatively synthesized. FINDINGS: We identified six main themes: I) Parental identity change is triggered by a child's disclosure. II) Parental identity change drives parental emotions that evolve from initial anger, shock, fear, concern, grief, etc. to eventual acceptance of their child. III) Parental identity and emotions change, as for any life change process, across assimilation, accommodation, adjustment, and evaluation phases of the IPT. IV) Parental identity change is motivated by continuity, coherence, self-efficacy, belongingness, distinctiveness, meaning and self-esteem principles of the IPT. V) Parental identity influences parental micro-individual, meso-interactional and macro-societal interactions of the IPT framework. VI) Parental mental well-being may be affected across the assimilation, accommodation, adjustment phases of the IPT before eventual acceptance of the child in the evaluation phase. CONCLUSIONS: Parental lived experiences require a stronger consideration today within the wider, non-white, contexts. The effect of identity change on parental mental well-being and its intergenerational effect needs to be explored within the context of the IPT. Parental narratives will contribute towards creating appropriate counselling toolkits and interventions for health care providers and parents of LGBTQIA + 2 children.

Testing the efficacy of a narrative short film in educating the public about providing emotional support to individuals with fertility problems.

BACKGROUND: To educate the public on how best to support people with fertility problems, a narrative short film "Ten Things Not to Say to Someone Struggling with Infertility" was created, depicting the impact that helpful versus unhelpful dialogue has on someone with fertility problems. METHODS: Before and after watching the video, 419 participants from the public were presented with a hypothetical vignette describing a woman experiencing fertility problems and asked about the likelihood that they would endorse a series of helpful and unhelpful statements when communicating with the protagonist. Pre and post endorsement of helpful versus unhelpful statements were compared, as were self-perceived knowledge about the mental health aspects of fertility problems, confidence in providing emotional support to someone with fertility problems, and empathy for the protagonist. RESULTS: Participants endorsed fewer unhelpful statements after the video relative to before (M(SD) = 2.2(2.3) vs. 1.3(2.3), p < .001) and fewer participants endorsed at least one unhelpful statement (72% to 47%, p < .001). Self-perceived knowledge of fertility problems, confidence in providing support, and empathy increased at post-test (ps < .001; Cohen's d = .56-.83) indicating medium-large effects. CONCLUSIONS: A narrative short film appears to be an effective dissemination strategy for sensitizing the public to the emotional struggles of individuals experiencing fertility problems.

A longitudinal follow-up study of rescue and recovery narratives of Oklahoma City bombing responders nearly a quarter century later.

BACKGROUND: Most research examining first responders of terrorist incidents has been conducted in early post-disaster periods, utilized quantitative research methods, and focused on psychopathology such as post-traumatic stress. METHODS: Longitudinal follow-up assessments of 124 workers from 181 baseline volunteer rescue and recovery workers originally studied were completed nearly a quarter century after the terrorist bombing of the Murrah Federal Building in Oklahoma City. Open-ended qualitative interviews were used in the follow-up study. RESULTS: The rescue and recovery work, vividly described decades later, was gruesome. These workers' descriptions captured their mental toughness and their professional missions, as well as the emotional and mental health (MH) toll on their lives. CONCLUSIONS: The extreme nature of rescue and recovery work in the aftermath of terrorism suggests potential utility for MH interventions to address the psychological toll that can be expected of human beings under the most extraordinary circumstances.

Inquiring into conditions for engaging in narrative relations on a geriatric ward - how interpretation matters in everyday practices.

Drawing on data from ethnographic fieldwork and interprofessional focus group discussions, this study enquires into staff's everyday life on a geriatric ward to explore and understand conditions for engaging in narrative relations in in-patient geriatric care. Avoiding individualistic understandings of narrative practices, we applied a narrative-in-action methodology built on a relational understanding of narrativity, where individual narratives are not separated from social and cultural features. This helped us explore how individual interpretations of the conditions for everyday practices come together with broader social or cultural understandings to gain situated insights about how these are continuously related and reformed by one another in everyday situations of geriatric care. The findings offer insights into the opportunities to engage in narrative relations based on how healthcare staff on a geriatric ward interpret conditions for their practices, and how they act based on such interpretations. While some interpretations were associated with attitudes and activities encouraging narrative relations, others simultaneously thwarted narrative relations by enacting task-orientation, division, or a focus on measurable biomedical or function-related outcomes. Moreover, the findings suggest and discuss consequences of the tensions created as interpretations are enacted in everyday healthcare situations, thus questioning assumptions about conditions as something static and linear.

Sexual assault and the matrix of harm: Sexual assault survivors narrate their whole lives in more negative ways.

This paper uses data from the American Voices Project, an interview study based on a random population sample, to explore the relationship between assault experiences and how people narrate their lives. Using quantitative sentiment analysis, we find that survivors of assault express significantly greater negative sentiment when asked to tell their life stories. These negative sentiments are observable throughout the entire interview, including before questions of assault are asked. Survivors of assault narrate their experiences with more anger, disgust, fear, and sadness, and less anticipation, joy, and trust than those who do not report assault experiences. We provide evidence that the negative sentiment associated with sexual violence is greater than having lost a parent and less than having experienced a significant financial hardship within the last month. We contextualize these findings with a qualitative evaluation of the interview transcripts, further substantiating our finding. Overall, this paper suggests that sexual violence is part of what we have called, drawing inspiration from the work of Beth Richie, a "matrix of harm" that structures people's lives. While our finding is consistent with what we might expect given the negative life experiences and sequalae associated with sexual assault, it has important implications. Sentimental differences in narrating life experience are an important yet relatively understudied phenomenon, and experiences of assault are rarely asked about yet may be consequential to both quantitative and qualitative accounts of social processes.

"Nothing Is More Powerful than Words:" How Patient Experience Narratives Enable Improvement.

BACKGROUND AND OBJECTIVES: Patient experience narratives (narratives) are an increasingly important element of both measurement approaches and improvement efforts in healthcare. Prior studies show that narratives are considered by both clinicians and staff to be an appealing, meaningful, and credible form of evidence on performance. They also suggest that making concrete use of narratives within organizational settings to improve care can be complex and challenging. Our qualitative study was designed to explore how middle managers working in a health system's outpatient clinics value and use written narratives in their day-to-day work. METHODS: We conducted qualitative interviews with 20 middle managers working in 8 outpatient clinics. Interviews were fully transcribed, loaded into MAX-QDA software, and coded using thematic analysis techniques. Code reports were extracted and reanalyzed for subthemes related to the objectives of this paper. RESULTS: Middle managers across sites described valuing narratives as a tool to: enable better patient experience assessment by augmenting data from patient experience scores; deepen understanding of and relationships with patients; provide insight about operational issues; identify areas for needed improvement and potential solutions; and facilitate strategic work. They reported using narratives for a range of activities related to their roles as supervisors, such as focusing attention on positive practices and needed improvements, promoting deeper group learning, motivating change, reinforcing sense of purpose for staff, recognizing staff strengths and training needs, and inspiring transformational thinking. Finally, interviewees reported numerous specific quality improvement projects (both short- and longer-term) that were informed by narratives-for example, by identifying an issue to be addressed or by suggesting a workable solution. Together, these interviews suggest a collective "narrative about narratives" woven by these organizational actors-a story which illustrates how narratives are highly relevant for how middle managers derive meaning from their work, put organizational values such as responsive service provision into practice, and enact their roles as supervisors. CONCLUSIONS: Our results add to the nascent literature a detailed description of how narratives can be used both as a tool for middle managers in their leadership and supervisory roles, and as a blueprint for improvement work within outpatient settings. They also illuminate why patient experience scores may improve when narrative data are collected and used. Finally, our results suggest that for middle managers, perhaps "nothing is more powerful than words" because narratives function as both an insight provider and a compelling tool that adds direction and meaning to workplace endeavors.

The empowered family: New narratives to rethink dengue prevention and control in Córdoba, Colombia. / La familia empoderada: Nuevas narrativas para repensar la prevención y control del dengue en Córdoba, Colombia.

Dengue is a disease that constitutes a public health problem difficult to control due to the multidimensionality of associated factors and the particularities of the territories. This article analyzes the notion of family empowerment related to the prevention and control of dengue in Córdoba, Colombia. From July to October 2023, using a qualitative approach, semi-structured interviews were conducted with 30 family groups located in the municipalities of San Andrés de Sotavento, San Bernardo del Viento, Pueblo Nuevo, and Montería, selected for being indigenous, Afro-descendant, or rural and urban populations in vulnerable conditions. The results show that families, beyond their particular arrangements in terms of structure and dynamics, are aware of their role in the prevention and control of diseases, identifying the capacities required to face dengue. However, they reproduce narratives of conceptual and power dominance that assign a greater commitment on the part of educational and health agents to promote alternatives that contribute to reducing the risks of dengue. The challenges that must be faced for effective family empowerment are discussed, so that prevention practices gain greater strength.

El dengue es una enfermedad que constituye un problema de salud pública difícil de controlar por la multidimensionalidad de factores asociados y las particularidades de los territorios. En este artículo se analiza la noción de empoderamiento familiar relacionada con la prevención y control del dengue en Córdoba, Colombia. De julio a octubre de 2023, a partir de un enfoque cualitativo se realizaron entrevistas semiestructuradas a 30 grupos familiares localizados en los municipios de San Andrés de Sotavento, San Bernardo del Viento, Pueblo Nuevo y Montería, seleccionados por ser territorios indígenas, afrodescendientes o con población rural y urbano en condiciones de vulnerabilidad. Los resultados muestran que las familias, más allá de sus arreglos particulares en términos de estructura y dinámica, son conscientes de su lugar en la prevención y control de enfermedades, identificando las capacidades requeridas para enfrentar el dengue. Sin embargo, reproducen narrativas de dominio conceptual y de poder que asignan un mayor compromiso por parte de los agentes educativos y de salud para el fomento de alternativas que contribuyan a disminuir los riesgos por dengue. Se discuten los desafíos que se deben enfrentar para un efectivo empoderamiento familiar, de modo que las prácticas de prevención cobren mayor vigor.

The power of animation: encouraging doctors to access support for psychological wellbeing.

The COVID-19 pandemic has exacerbated already high rates of poor psychological wellbeing in doctors. Many doctors perceive a stigma associated with acknowledging psychological wellbeing concerns, resulting in a reluctance to seek support for those concerns. The aim of this study was to develop a theoretically-informed and evidence-based composite narrative animation (CNA) to encourage doctors to access support for psychological wellbeing, and to evaluate the acceptability of the CNA.A composite narrative was developed from an evidence-base of interviews with 27 GP participants across Scotland (May-July 2020). The Behaviour Change Wheel was used to identify behaviour change techniques (BCTs) to be embedded within the CNA. The narrative was turned into a script in collaboration with an animation company. A brief animation 'Jane the GP' was developed reflecting specific BCTs.Scottish doctors (n = 83) were asked for their views on acceptability of the CNA concept, and subsequently asked to provide views on the acceptability of the CNA after viewing it. Participants thought the concept of a CNA was novel but may not appeal to all. After viewing the CNA, the widespread view was that it portrayed an authentic experience, could reduce stigma around seeking support for psychological wellbeing, and highlighted formal routes to access such support.CNAs are a novel and acceptable intervention method for encouraging doctors to access support for psychological wellbeing. The use of a theory driven intervention development framework to create the CNA facilitates the link between theory and practice.

Compassionate Othering: the construction of refugee patients in medical students' narratives - a qualitative study using story completion.

BACKGROUND: Refugees remain a marginalized population and are exposed to a variety of discriminatory processes, among them Othering which categorizes people as belonging or not-belonging according to certain ascribed characteristics. We explored how the narrative construction of refugee patients by medical students constitutes a form of Othering. METHODS: Using story completion, 124 5th year medical students at the Martin- Luther- University Halle-Wittenberg in October 2019 wrote a fictional story in response to a story stem situated in a medical practice. In a comparative approach, one patient presenting with abdominal pain lacks further characterization (version A) and the other is a refugee (version B). The stories were coded using qualitative content analysis by Mayring with a focus on content and narrative strategies (plot structure and perspective). RESULTS: We identified four themes: characters, medical condition, access to care and provision of substandard care. The stories were predominantly framed with a medical or an interaction-based plot structure and written from a process-oriented perspective. The themes in version B, supported by their use of narrative strategies, were largely contextualized within the patients' history of migration. An empathic depiction of patient B and the students' compassion for the patients facing substandard care were key motifs as well. CONCLUSION: The perception of the version B patients predominantly as refugees establishes their construction as an Other. The students' compassion acts as a representation of societal inequalities and remains an inept response without the tools to counter underlying discriminatory structures. Based on a discourse of deservingness, compassion alone therefore perpetuates Othering and highlights the need for structural competency training in medical school.

La Rana or El Rana: Dual Language Learners' Grammatical Variability in Narrative Retells.

PURPOSE: This longitudinal study investigated the trajectory of Spanish article accuracy in Spanish-English dual language learners (DLLs) from preschool to first grade, addressing the need for longitudinal data on the variability of Spanish grammatical skills in DLLs in English immersion classrooms. METHOD: Language sample analysis was conducted on 336 Spanish and English narrative retells elicited from 31 Spanish-English DLLs (range: 45-85 months). Growth curve models captured within- and between-individual change in article accuracy from the beginning of preschool to the end of first grade. RESULTS: As a group, DLLs did not exhibit significant positive or negative growth in Spanish article accuracy over time. On average, article accuracy remained stable at 76% from preschool throughout first grade. Participants exhibited significant variability in article accuracy that was partly explained by changes in Spanish proficiency. Spanish article accuracy was lower for DLLs with lower Spanish proficiency indexed by measures from the Spanish language samples, while English proficiency indexed by the English language samples did not affect Spanish article accuracy. CONCLUSIONS: These findings suggest that expectations for Spanish grammatical performance in DLLs need to be adjusted to account for the possible impact of not receiving Spanish support in English immersion school settings. DLLs in these instructional programs do not exhibit article accuracy at a level expected for monolingual Spanish speakers. Significant individual differences in both individual status and growth rates of Spanish article accuracy highlight the broad variability in Spanish language skills of DLLs in the United States.

The Efficacy of Story Champs for Improving Oral Language in Third-Grade Spanish-English Bilingual Students With Developmental Language Disorder.

PURPOSE: We investigated the efficacy of Story Champs for improving oral language in third-grade Spanish-English bilingual children with developmental language disorder (DLD). METHOD: We implemented a concurrent multiple-baseline across-participants single-case design with four bilingual Spanish-English third-grade students with DLD. Treatment was carried out over 12 sessions with approximately two sessions per week. Maintenance sessions were conducted 1, 2, and 4 weeks postintervention. Participants were explicitly taught story grammar elements, causal and temporal connections, and modifiers within story retells and personal narratives. Dependent variables were story grammar, grammatical complexity, modifiers and listening comprehension within story retells, and story grammar and grammatical complexity within personal narratives. Outcome measures were assessed at the end of every baseline, intervention, and maintenance session using the Narrative Language Measures-Listening (NLM-L). RESULTS: Visual analyses for outcome measures suggested slight increases in scores on the NLM-L during intervention accompanied by marked variability. Within-case analyses of story retell performance suggested an intervention effect on story grammar for two participants and on grammatical complexity and modifier use for one participant. For personal narratives, within-case analyses of personal narrative performance suggested an intervention effect on story grammar for one participant. CONCLUSIONS: Overall, Story Champs demonstrated efficacy for improving story grammar use in story retells for three out of four participants. It did not show efficacy for improving grammatical complexity, modifier use, or listening comprehension within story retells, nor did it show efficacy for improving story grammar and grammatical complexity within personal narratives. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26053033.

Perspectives on vulnerability from the narratives of older migrants.

BACKGROUND: Older migrants are considered a vulnerable population group in many ways. Marginalization and social exclusion lead to unequal opportunities for social participation. AIM: In order to break down barriers for older migrants, the perspectives of people with migration biographies should be given greater consideration. MATERIAL AND METHODS: To this end, the results of an explorative intersectional ethical analysis of care narratives of older migrants are discussed in the light of aging studies research. The focus is on the ethical analysis of five guided interviews with older migrants between 65 and 80 years old, who have migrated from different countries in southeastern Europe. RESULTS AND DISCUSSION: In contrast to the prevalent expert perspective, the narratives of the older migrants interviewed revealed not only resistance to vulnerabilization but also multiple negotiations of autonomy and dependency. By making ambivalent narrative and action strategies visible and linking them to narratives of intergenerational care relationships, the significance of care-ethical interpretations of vulnerability and characterization of vulnerability as "a universal, inevitable, and anthropological feature of humanity resulting from the embodied, finite, and socially contingent structure of human existence" [4] can be demonstrated.

Evaluation of a knowledge-attitude-practice model based narrative life education program for community-dwelling older adults: a mixed-methods feasibility study.

BACKGROUND: The global aging population presents challenges that are particularly acute in China. Older Chinese adults' attitudes towards death significantly impact their quality of life. Death education is crucial for promoting positive perspectives on life and death. Narrative education offers a promising approach to facilitating death education. Integrating the Knowledge-Attitude-Practice (KAP) model into death education will enhance the feasibility and acceptability of death education programs. METHODS: This mixed-methods feasibility study included a quasi-experimental trial and semi-structured interviews. Older adults in the intervention group (N = 27) received a 6-week KAP-based narrative life education program in addition to standard community health education; participants in the control group (N = 20) received only the normal community health education. In both groups, attitudes toward death and the meaning of life were assessed at baseline and immediately after the intervention. A post-intervention semi-structured interview and satisfaction survey were also conducted for the intervention group. RESULTS: Forty out of 47 older adults completed the program for an 85.1% retention rate. All of the older adults in the experiment were very satisfied and satisfied with the life education program, and no adverse events were reported. Compared to the control group, participants in the intervention group had a significant decrease in the fear of death (P = 0.028), and substantial improvement in their value of life (P = 0.031), goal of life (P = 0.035), freedom of life (P = 0.003), and the total score for purpose in life (P = 0.017). The qualitative results yielded four themes: profound recognition of life and death, contradiction between thoughts and action, conflict between one's acceptance and others' avoidance, and evaluation of the life education program. CONCLUSIONS: The KAP-based narrative life education program is feasible and acceptable for older Chinese community-dwelling adults. It is also potentially effective in improving attitudes toward death attitudes and the meaning of life in this cohort. TRIAL REGISTRATION: This study was retrospectively registered at China Clinical Trial Registry as ChiCTR2300069551 on 2023-03-20. URL of registration: https://www.chictr.org.cn/showproj.html?proj=183176 .

Narratives in exposomics: A reversed heuristic determinism?

Since the completion of the Human Genome Project (HGP), biomedical sciences have moved away from a gene-centred view and towards a multi-factorial one in which environment, broadly speaking, plays a central role in the determination of human health and disease. Environmental exposures have been shown to be highly prevalent in disease causation. They are considered as complementary to genetic factors in the etiology of diseases, hence the introduction of the concept of the "exposome" as encompassing the totality of human environmental exposures, from conception onwards (Wild in Cancer Epidemiol Biomark Prev 14:1847-1850, 2005), and the launch of the Human Exposome Project (HEP) which aims to complement the HGP. At first sight, and seen as complementary to the genome, the exposome could thus appear as contributing to the rise of novel postgenomic deterministic narratives which place the environment at their core. Is this really the case? If so, what sort of determinism is at work in exposomics research? Is it a case of environmental determinism, and if so, in what sense? Or is it a new sort of deterministic view? In this paper, we first show that causal narratives in exposomics are still very similar to gene-centred deterministic narratives. They correspond to a form of Laplacian determinism and, above all, to what Claude Bernard called the "determinism of a phenomenon". Second, we introduce the notion of "reversed heuristic determinism" to characterize the specific deterministic narratives present in exposomics. Indeed, the accepted sorts of external environmental exposures conceived as being at the origins of diseases are determined, methodologically speaking, by their identifiable internal and biological markers. We conclude by highlighting the most relevant implications of the presence of this heuristic determinism in exposomics research.

Exploring moral competence regression: a narrative approach in medical ethics education for medical students.

BACKGROUND: Studies from different countries report a stagnation or regression of moral competence in medical students between the first and the last year of their studies, and the value of various educational interventions remains uncertain. METHODS: We used Moral Competence Test (MCT) to measure C-scores of moral competence to determine the change in the MCT C-scores between the first- and the fifth-year medical students from two medical schools in the Czech Republic in the academic year 2022/2023 and to analyze factors associated with the C-scores (observational study). In addition, for the first-year students, we compared the results of the MCT before and after an intervention in medical ethics curriculum (interventional study). We used a cross-sectional and descriptive design for the observational study. Students completed the MCT, consisting of two moral dilemmas (Worker´s Dilemma and Doctor´s Dilemma), the results measured by the C-score, which represents moral competence. RESULTS: In total, 685 students participated in the observational study. Objective 1: based on the analysis of the C-score, we observed a decrease in moral competence between the first and the fifth-year medical students (p < .001). Objective 2: we did not observe a statistically significant effect of gender (p = .278), or self-rated religiosity (p = .163). Objective 3: in the interventional study, 440 students participated in the pretest and 422 students participated in the posttest. The test of statistical significance found no improvement in students' moral competence after the intervention (p = .253). CONCLUSION: Medical students show a regression in moral competence during medical education; it was lower in medical students in their fifth year, compared to the first-year medical students without the effect of gender, or self-rated religiosity. Although educational intervention consisting of multiple tools of medical ethics teaching (PBL, CBL, KMDD and StorED) did not lead to increase in moral competence, the longitudinal effect of such intervention remains to be seen.