What language does your heart speak? The influence of foreign language on moral judgements and emotions related to unrealistic and realistic moral dilemmas

Emotional attenuation in a second language is believed to be one of the main causes of the Moral Foreign Language effect (MFLe). However, evidence on the mediating role of emotion in the relationship between language and moral judgements is limited and mainly derives from unrealistic moral dilemmas. We conducted two studies to investigate (1) whether the MFLe is present in both unrealistic (Study 1) and realistic (Study 2) moral dilemmas, and (2) whether this effect can be attributed to reduced emotionality. In Study 1, the MFLe was found in the moral judgements made by Spanish-English bilinguals. However, the same pattern was not observed in Greek Cypriot-English bilinguals’ moral judgements, and this result was attributed to the prominent role of English in Cyprus. In Study 2, the MFLe extended to realistic moral dilemmas when the outcome of the action entailed the violation of a social norm. Study 1 and Study 2 also revealed that these bilinguals experienced a wide range of emotions in their L1 and L2, which did not differ significantly across languages. Mediation analyses further indicated that the MFLe was not mediated by emotional blunting, which made us consider alternative explanations for the MFLe

Thalassaemia and Aberrations of Growth and Puberty

Endocrine dysfunction in Thalassaemia major (TM) is a common and disturbing complication, which requires prompt recognition and treatment. The contribution of the underlying molecular defect in TM to the development of endocrinopathies is significant because the patients with the more severe genetic defects have a greater rate of iron loading through higher red cell consumption. TM patients frequently present delay of growth and puberty with reduction of final height. The pathogenesis of growth failure is multifactorial and is mainly due to chronic anemia and hypoxia, chronic liver disease, zinc and folic acid deficiency, iron overload, intensive use of chelating agents, emotional factors, and endocrinopathies (hypogonadism, delayed puberty, hypothyroidism) and GH-IGF-1 axis dysregulation. Although appropriate iron chelation therapy can improve growth and development, TM children and adolescents treated intensively with desferrioxamine remain short as well, showing body disproportion between the upper and lower body segment. Body disproportion is independent of pubertal or prepubertal period of greater height gain. Treatment with recombinant GH (rhGH) is recommended when GH deficiency is established, and even so, the therapeutic response is often non satisfactory. Growth acceleration is mostly promoted with sex steroids in children with associated pubertal delay. Sexual complications in TM, which include Delayed Puberty, Arrested Puberty and Hypogonadism, present the commonest endocrine complication. Iron deposition on gonadotroph cells of the pituitary leads to disruption of gonadotrophin production which is proven by the poor response of FSH and LH to GnRH stimulation. In the majority of patients gonadal function is normal as most women with Amenorrhea are capable of achieving pregnancy with hormonal treatment and similarly men with azoospermia become fathers. Secondary Hypogonadism appears later in life, and is manifested in women as Secondary Amenorrhea and in men as decline in sexual drive and azzoospermia. The damage to the hypothalamus and pituitary is progressive, even when intensive chelating therapy is given and the appearance of Hypogonadism in both sexes is often unavoidable. Close follow up and proper management is crucial for every patient with TM. Early recognition of growth disturbance and prevention of hypogonadism by early and judicious chelation therapy is mandatory for the improvement of their quality of life. Patients with TM can now live a better life due to modern advances in their medical care and our better understanding in the pathogenesis, manifestation and prevention of endocrine complications

Moral judgements in a foreign language: Expressing emotions and justifying decisions

Aim: Previous evidence suggests that language influences bilinguals’ moral judgements. One explanation for this phenomenon is that using a second language (L2) attenuates emotional arousal, thus leading to more rational decisions. This study examined whether bilinguals’ moral arguments and emotional vocabulary are influenced by the language – first language (L1) or L2 – in which a moral dilemma is presented. / Methodology and data analysis: A mixed-methods design was employed. We analysed the emotional vocabulary used by 204 Spanish-English bilinguals when making moral judgements and expressing their emotions in response to a highly emotional moral dilemma, as well as the type of arguments they employed to justify their moral decisions in L1 and L2. / Findings: The participants were more emotional in their L1, as reflected in the arguments they used to justify their decisions. This finding was supported by a significantly lower number of emotional words in their L2. Moreover, the effect of language on moral judgements was mediated by the participants’ emotions. / Originality: This study is the first to qualitatively examine the types of arguments underlying bilinguals’ moral decision-making in their L1 and in their L2. Moreover, the analysis of verbal emotional expressions in relation to moral decisions adds to the findings of previous research that was based almost exclusively on forced-choice measures and further supports the hypothesis that the reduction of emotional arousal in an L2 modulates individuals’ moral judgements. / Implications: The results have implications for L2 teaching and pedagogy. The L2 curriculum should include instruction in emotional vocabulary and should engage learners in discussions that require argumentation and critical thinking about strong emotional content. This may assist bilinguals not only to express their internal affective states more efficiently, but also to experience the intensity of L2 emotionally charged words in a similar way as they do in their L1

The role of language and emotional intelligence in judgments of real-life social and moral transgressions among Greek, Hungarian, and British users of English

Previous research suggests that people are more prone to commit moral transgressions when they face moral dilemmas in a second language (LX) as opposed to their first language(s) (L1). This study investigated the influence of language, emotional intelligence, and the degree of severity of real moral transgressions on bilinguals' judgments of offense seriousness, the intensity of the emotions they experienced, and the punishments they proposed for the perpetrators. To this end, 256 British L1 users, 209 Greek–English bilinguals, and 187 Hungarian–English bilinguals watched four videos presenting moral transgressions of mild and extreme severity. Data were analyzed by means of robust linear mixed‐effects models and moderated mediation analyses. For the extreme severity videos, the results revealed strong correlations between offensiveness, emotionality ratings, and proposed punishments for the perpetrators. However, the Greek and the Hungarian participants who watched the videos in their LX English reported lower offensiveness and emotionality ratings and less harsh punishments for the perpetrators than they did in their L1 (Greek and Hungarian, respectively). Furthermore, the role of language in the proposed punishments for the perpetrators was mediated by emotional intensity, but only for the extreme severity stimuli. The results also suggest that higher levels of emotional intelligence are linked with tougher judgments of offense seriousness and stronger emotions when watching real moral transgressions. These findings highlight that the moral foreign language effect does not only exist in the hypothetical moral realm but affects perceptions of offensiveness and emotionality and decisions for the future of perpetrators in real‐life situations

Prevalence of vertebral fractures in children with suspected osteoporosis

Objectives: To explore the prevalence and anatomic distribution of vertebral fractures in disease groups investigated for primary and secondary osteoporosis, using vertebral fracture assessment (VFA). Study design: VFA was performed independently by 2 nonradiologists, in 165 children (77 males, 88 females) as part of their investigation for osteoporosis. Vertebral bodies from T6 to L4 were assessed for vertebral fractures using the Genant scoring system. The common readings for the presence of vertebral fractures were used for evaluating the prevalence and anatomic distribution of vertebral fractures. Results: The median age of the subjects was 13.4 years (range, 3.6, 18). Of the 165 children, 24 (15%) were being investigated for primary bone disease, and the remainder had a range of chronic diseases known to affect bone health. Vertebral fractures were identified in 38 (23%) children. The distribution of the vertebral fractures was bimodal, with vertebral fractures peaks centered at T9 and L4. Conditions associated with increased odds for vertebral fractures were inflammatory bowel disease (OR, 3.3; 95% CI, 1.4, 8.0; P = .018) and osteogenesis imperfecta (OR, 2.3; 95% CI, 1.04, 5.8; P = .022). Among children with vertebral fractures, those with Duchenne muscular dystrophy (P = .015) and osteogenesis imperfecta (P = .023) demonstrated higher number of vertebral fractures than the other disease groups. Conclusions: VFA identified the presence of vertebral fractures, in a bimodal distribution, in both primary bone disease and chronic disease groups. VFA is a practical screening tool for identification of vertebral fractures in children and adolescents at risk of fragility fractures

A retrospective analysis of longitudinal changes in bone mineral content in cystic fibrosis

Background: We aimed to describe the longitudinal changes in bone mineral content and influencing factors, in children with cystic fibrosis (CF). Methods: One hundred children (50 females) had dual X-ray absorptiometry (DXA) performed. Of these, 48 and 24 children had two to three scans, respectively over 10 years of follow-up. DXA data were expressed as lumbar spine bone mineral content standard deviation score (LSBMCSDS) adjusted for age, gender, ethnicity and bone area. Markers of disease, anthropometry and bone biochemistry were collected retrospectively. Results: Baseline LSBMCSDS was >0.5 SDS in 13% children, between −0.5; 0.5 SDS, in 50% and ≤−0.5 in the remainder. Seventy-eight percent of the children who had baseline LSBMCSDS >−0.5, and 35% of the children with poor baseline (LSBMCSDS<−0.5), showed decreasing values in subsequent assessments. However, mean LS BMC SDS did not show a significant decline in subsequent assessments (−0.51; −0.64; −0.56; p=0.178). Lower forced expiratory volume in 1 s percent (FEV1%) low body mass index standard deviation scores (BMI SDS) and vitamin D were associated with reduction in BMC. Conclusions: Bone mineral content as assessed by DXA is sub-optimal and decreases with time in most children with CF and this study has highlighted parameters that can be addressed to improve bone health

Gonadectomy in conditions affecting sex development: a registry-based cohort study

Objectives: To determine trends in clinical practice for individuals with DSD requiring gonadectomy. Design: Retrospective cohort study. Methods: Information regarding age at gonadectomy according to diagnosis; reported sex; time of presentation to specialist centre; and location of centre from cases reported to the International DSD Registry and who were over 16 years old in January 2019. Results: Data regarding gonadectomy were available in 668 (88%) individuals from 44 centres. Of these, 248 (37%) (median age (range) 24 (17, 75) years) were male and 420 (63%) (median age (range) 26 (16, 86) years) were female. Gonadectomy was reported from 36 centres in 351/668 cases (53%). Females were more likely to undergo gonadectomy (n = 311, P < 0.0001). The indication for gonadectomy was reported in 268 (76%). The most common indication was mitigation of tumour risk in 172 (64%). Variations in the practice of gonadectomy were observed; of the 351 cases from 36 centres, 17 (5%) at 9 centres had undergone gonadectomy before their first presentation to the specialist centre. Median age at gonadectomy of cases from high-income countries and low-/middle-income countries (LMIC) was 13.0 years (0.1, 68) years and 16.5 years (1, 28), respectively (P < 0.0001) with the likelihood of long-term retention of gonads being higher in LMIC countries. Conclusions: The likelihood of gonadectomy depends on the underlying diagnosis, sex of rearing and the geographical setting. Clinical benchmarks, which can be studied across all forms of DSD will allow a better understanding of the variation in the practice of gonadectomy

Understanding the needs of professionals who provide psychosocial care for children and adults with disorders of sex development

Objective: Disorders in sex development (DSD) can be treated well medically, but families will encounter many psychosocial challenges. Promoting counselling to facilitate acceptance and coping is important yet equality of access is unknown. This study investigated the modalities of psychosocial care provided in centres of DSD care. Methods: An international survey conducted among 93 providers of psychosocial care, identified through clinical networks, registries and professional forums. Results: Forty-six respondents from 22 different countries filled out the survey (49%). Most respondents (78%) were based in hospital-based expert teams. Referrals came from paediatric endocrinologists (76%), gynaecologists (39%) and paediatric urologists (37%). Psychological counselling was most frequently given to parents (74%), followed by children (39%), adolescents (37%) and adults (11%) and was most frequently focused on coping and acceptance of DSD (54%), education (52%), the atypical body (39%) and genital (41%), decisions on genital surgery (33%), complications with sexual intercourse (29%), disclosure (28%) and acceptance of infertility (11%). Respondents most frequently observed DSD related confusion about gender (54%), acceptance of cross gender behaviour (50%), anxiety (43%) and sadness and depression (38%). Conclusions: Most psychosocial care is provided to parents. It is assumed that parental support is important as acceptance is conditional to become affectionate caretakers. Although it may be more difficult for youngsters to communicate about their condition and treatment, providing opportunity to bring up issues that are important for them, is imperative. Clinicians and parents should be aware that parental and patients’ interests may not correspond completely. Psychosocial management should also include transition and adult care

The role of language and emotional intelligence in judgments of real-life social and moral transgressions among Greek, Hungarian, and British users of English

Previous research suggests that people are more prone to commit moral transgres-sions when they face moral dilemmas in a second language (LX) as opposed to theirfirst language(s) (L1). This study investigated the influence of language, emotionalintelligence, and the degree of severity of real moral transgressions on bilinguals'judgments of offense seriousness, the intensity of the emotions they experienced,and the punishments they proposed for the perpetrators. To this end, 256 British L1users, 209 Greek–English bilinguals, and 187 Hungarian–English bilinguals watchedfour videos presenting moral transgressions of mild and extreme severity. Data wereanalyzed by means of robust linear mixed-effects models and moderated mediationanalyses. For the extreme severity videos, the results revealed strong correlationsbetween offensiveness, emotionality ratings, and proposed punishments for the per-petrators. However, the Greek and the Hungarian participants who watched thevideos in their LX English reported lower offensiveness and emotionality ratings andless harsh punishments for the perpetrators than they did in their L1 (Greek andHungarian, respectively). Furthermore, the role of language in the proposed punish-ments for the perpetrators was mediated by emotional intensity, but only for theextreme severity stimuli. The results also suggest that higher levels of emotionalintelligence are linked with tougher judgments of offense seriousness and strongeremotions when watching real moral transgressions. These findings highlight that themoral foreign language effect does not only exist in the hypothetical moral realm butaffects perceptions of offensiveness and emotionality and decisions for the future ofperpetrators in real-life situations

The measurement of urinary gonadotropins for assessment and management of pubertal disorder

OBJECTIVE: Measurement of urinary LH (uLH) and FSH (uFSH) may facilitate non-invasive pubertal assessment but there is a need for further validation by studying children and adolescents with disorders of puberty. DESIGN: 65 cases (Male: 25) with a median age of 12 years (2.9-18.1) supplied at least one non-timed urine sample for uLH and uFSH measurement by immunoassay and corrected for creatinine excretion. 25 cases were receiving GnRH-agonist (GnRH-a) at the time of sample collection. In 41 cases, urine samples were collected prior to a LH RH test and in 12 cases matched serum samples for basal LH (sLH) and FSH (sFSH) were also available. RESULTS: There was a significant correlation between sLH and uLH: uCr (r=0.82; p-value &lt;0.001) and sFSH and uFSH: uCr (r=0.93; p-value &lt;0.001). Based on receiver operator characteristics analysis, a uLH : uCr value of 0.05 IU/mmol as a cut-off would detect a LH peak &gt;5U I/L with a sensitivity of 86% and a specificity of 72% with a positive predictive value of 93%. In pubertal boys (6) and girls (22) with a sLH peak &gt;5UI/L, median uLH: uCr was 0.27 IU/mmol (0.27-0.28) and 0.17 IU/mmol (0.09-0.43), respectively. The median uFSH: uCr was 0.51 IU/mmol (0.41-0.60) for boys and 1.1 IU/mmol (0.21-2.44) for girls. In the 25 cases on GnRH-a, the median uLH : uCr for boys and girls was 0.02 IU/mmol (0.01-0.02) and 0.02 IU/mmol (0.004-0.07), respectively, and the median uFSH: uCr was 0.07 IU/mmol (0.05-0.09) and 0.27 IU/mmol (0.09-0.54), respectively. CONCLUSION: Urinary gonadotrophins reflect serum gonadotrophin concentration and may represent a reliable non-invasive method of assessing pubertal progress