bluuebunny/crossref_metadata_2025 huggingface dataset:
Spanish Foreign Policy
Authors: Pacheco Pardo Ramón
Published: March 2020

Spain’s foreign policy since its transition to democracy has been marked by a high degree of continuity over the years and across governments. Foreign-policy-making structures have remained relatively unchanged at the domestic level, with the president and the Cabinet Office playing a dominant role as a result of the presidentialization of Spanish politics. Domestic structures are complemented by EU-level structures evermore relevant as foreign policy has become increasingly Europeanized. In terms of goals, successive Spanish governments have prioritized Europeanization itself, a strong presence in Latin America and the Mediterranean, and boosting economic opportunities for Spanish businesses. Regarding foreign-policy tools, Spain has long displayed a preference for multilateralism, diplomacy, and soft power over the use of military power. In other words, Spain has prioritized the use of the main tools available to middle powers.
Memory and Politics in Democratic Spain
Authors: Encarnación Omar G.
Published: March 2020

This chapter explains the persistence of Spain’s ‘politics of forgetting’, a phenomenon revealed by the wilful intent to disremember the political memory of the violence of the Spanish Civil War and the human rights abuses of General Franco’s authoritarian regime. Looking beyond the traumas of the Civil War, the limits on transitional justice and truth-telling on the Franco regime imposed by a transition to democracy anchored on intra-elite pacts, and the conciliatory and forward-looking political culture that consolidated in the new democracy, this analysis emphasizes a decidedly less obvious explanation: the political uses of forgetting. Special attention is paid to how the absence of a reckoning with the past, protected politicians from both the right and the left from embarrassing and inconvenient political histories; facilitated the reinvention of the major political parties as democratic institutions; and lessened societal fears about repeating past historical mistakes. The conclusion of the chapter explains how the success of the current democratic regime, shifting public opinion about the past occasioned by greater awareness about the dark policies and legacies of the Franco regime, and generational change among Spain’s political class have in recent years diminished the political uses of forgetting. This, in turn, has allowed for a more honest treatment of the past in Spain’s public policies.
Security and Defence Policy
Authors: Arteaga Félix
Published: March 2020

The focus of Spain’s security and defence policy evolved from the national to the international stage after the country’s transition to democracy, when Spain joined a number of multilateral security organizations and Spanish troops contributed to international post-Cold War missions. The enlargement of the concept of security incorporated new actors and dimensions into a defence policy that became one of ‘security and defence’ and later a policy of ‘national security’. The changes have transformed the scope of the security and defence policy and the dispositions of the armed forces, but their adaptation to the changing strategic context is conditioned by structural factors such as the strategic culture, military spending, and the defence sector’s industrial and technological base. These factors are essential to understanding change and continuity in the security and defence policy of Spain.
Spain and Latin America
Authors: Bianculli Andrea C.
Published: March 2020

The relationship between Spain and Latin America (LAC) goes back to the fifteenth century, yet it is after Spanish democratization in 1975 that this was defined as ‘a special relationship’. A fundamental component of Spain’s foreign policy and international strategy since then, in practice, however, it has experienced a constant tension between the idea of community and the pursuit of material interests. To understand Spain–LAC relations one must explore the changing interplay between ideas and interests, as well as the institutional frameworks, their context, and time. This chapter shows that accommodation and compromise between the idea of an Iberoamerican community, based on a shared history and common values, on the one hand, and material objectives, on the other, were easily reached during the 1980s and 1990s, assuring Spain’s leadership in LAC and in the European Union (EU). With the turn of the century, though, this strain became more pronounced as Spain’s agenda turned more strongly towards economic considerations and became imbued with a vertical logic, whereas the institutional frameworks put into place, and which were built on the notion of community, turned out to be insufficient to process the conflicting pressures. Spain–LAC dynamics seem to have moved from special relations to an increasing detachment.
Barth and Roman Catholicism
Authors: Johnson Keith L.
Published: March 2020

This chapter provides an interpretative lens for understanding Karl Barth’s dialogue with Roman Catholicism. The central argument is that Barth’s engagement with Roman Catholic theology changed over time, even as his core theological convictions remained constant. This argument is defended through an examination of Barth’s theological development, his debates with his Catholic contemporaries, and the dramatic changes in Roman Catholic theology during the twentieth century. A number of important specific issues are explored, including Barth’s criticism of the Roman Catholic analogia entis (analogy of being), Hans Urs von Balthasar’s interpretation of Barth’s theology, Barth’s reception history amongst Roman Catholic theologians, Barth’s visit to Rome after the Second Vatican Council, and the question of Barth’s interpretation of Roman Catholic primary texts.
Barth and Politics
Authors: Gorringe Timothy
Published: March 2020

Karl Barth was keenly interested in politics throughout his life. This chapter suggests that the implications of this interest for his theology were fourfold. It contends (a) that Barth’s theology functioned as an ideology critique of all forms of nationalism, militarism, and capitalism; (b) that his later work anticipated Walter Wink in developing a critique of ‘the lordless powers’ which oppose the God of life; (c) that his understanding of creation as grace underwrites a response to the current transgression of planetary boundaries and suggests an ecological theology; and (d) that his theology of reconciliation be understood as a theology of human freedom-in-community.
Exegesis
Authors: Wood Donald
Published: March 2020

This chapter examines the role and character of scriptural exegesis in Barth’s theology. The interpretation and exposition of the biblical texts was not of merely incidental or sporadic interest to Barth. On the contrary, scriptural exegesis was a fundamental and pervasive feature of both his pastoral and his academic activity, which remains inexplicable apart from attention to its exegetical coordinates. Study of Barth’s exegesis involves attending to three topics: his conception of the nature and authority of scripture; his portrayal of the grounds, tasks, and ends of scriptural interpretation; and his concrete exegetical practices and proposals. Engaging a selection of Barth’s writings from his Safenwil pastorate through the first volume of the Church Dogmatics, this chapter outlines some major features of Barth’s doctrine of scripture and theology of scriptural interpretation, observes the capacity of his exegesis to provoke strong critical reaction, and identifies opportunities for further research.
The Spirit
Authors: Krötke Wolf
Published: March 2020

This chapter presents Barth’s understanding of the Holy Spirit as the Spirit of Jesus Christ. It demonstrates the way in which Barth’s pneumatology is anchored in his doctrine of the Trinity: the Holy Spirit is understood as the Spirit of the Father and of the Son, the One whose essence is love. But Barth can also speak of the Holy Spirit in such a way that it seems as if the Holy Spirit is identical to the work of the risen Jesus Christ and his ‘prophetic’ work. The reception of the pneumatology of Karl Barth thus confronts the task of relating these dimensions of Barth’s understanding of the Holy Spirit so that the Spirit’s distinct work is preserved. For Barth, this work consists in enabling human beings to respond in faith, with their human possibilities and their freedom, to God’s reconciliation in Jesus Christ. In this faith, the Holy Spirit incorporates human beings into the community of Jesus Christ—the community participates in the reconciling work of God in order to bear witness to God’s work to human beings, all of whom have been elected to ‘partnership’ with God. Barth also understood the ‘solidarity’ of the community with, and the advocacy of the community for, the non-believing world to be a nota ecclesiae (mark of the church). Further, to live from the Holy Spirit, according to Barth, is only possible in praying for the coming of the Holy Spirit.
Intellectual and Personal Biography I
Authors: Jehle Frank
Published: March 2020

This chapter presents the early years of the life of Karl Barth, considering first his family life, youth, and student days, and then his twelve years in the pastorate prior to being called to academic work. Particular consideration is given to primary sources such as letters, sermons, and lectures. Along the way, Barth’s close—but not uncritical—relationship to socialism is carefully analysed. At the centre of the chapter stands the way in which Barth as a young pastor found it necessary, under the shadow of the First World War, to give his theology a new foundation. With the phrase ‘God is God’ Barth rejected a concept of God constructed on the basis of human needs. He insisted instead that God and God’s movement towards human beings—and not human religion in itself—should be the central concern of theological reflection.
Election
Authors: Aragon Bruce Matthew J.
Published: March 2020

This chapter introduces and summarizes Barth’s doctrine of election. It begins with an overview of Barth’s criticism and rejection of classical Augustinian and Reformed versions of predestination. It then treats Barth’s Christological revision of the tradition by focusing on his conception of Jesus Christ as both the subject and the object of election. It shows how Barth’s doctrine of election is connected to his doctrine of God, highlighting how Barth’s understanding of ‘God as the one who loves in freedom’ serves as the key to understanding his doctrine of election. Finally, it suggests a new approach to the current debate over Barth’s doctrine of election by seeing it as a version of the classical intellectualist–voluntarist debate.
Creation
Authors: Clough David L.
Published: March 2020

Barth’s doctrine of creation is stated comprehensively in the four books and over two thousand pages of the third volume of Church Dogmatics, encompassing the relationship between creation and covenant (CD III/1), theological anthropology (CD III/2), themes in the relationship of creator to creature—providence, the lordship of God, nothingness, and the angels—(CD III/3), and the ethical topics which Barth treats under the doctrine of creation (CD III/4). This chapter reviews the breadth of his doctrine of creation, emphasizing in particular the Christocentric focus that Barth maintains, and notes key criticisms that have been raised in relation to the anthropocentric structure of his doctrine of creation, his identification of sexual differentiation as the image of God, and his account of evil as nothingness.
Sin and Evil
Authors: Thomas Günter
Published: March 2020

This chapter reconstructs the context and argument of Karl Barth’s innovative account of human sin and evil. For a proper understanding of the shifts in Barth’s treatment of these core themes, some ‘default positions’ are briefly sketched. The chapter next describes the implications that attend a transference of the doctrine of sin from anthropology to Christology. This shift is not only epistemic, changing the basis on which sin is recognized and understood. It is also a significant conceptual move, with sin described as a specific posture towards the grace of God, manifest in Christ. The chapter also shows how Karl Barth resists the temptation to reduce the existence of evil to a manageable deficiency of creation, while avoiding any dramatization of the experience of evil. Barth construes evil (nothingness, das Nichtige) in light of God’s creation as an election, with nothingness being that which is rejected in the divine act of creation. Rejecting a personification of evil (i.e., the devil), Barth nonetheless emphasizes the agency of evil as that against which the sovereign God battles.
Christian Life
Authors: Mangina Joseph L.
Published: March 2020

Standing in a relation of both continuity and discontinuity with modernist Protestantism, Barth offers a vision of the Christian life that is radically Christocentric, eschatological, and morally engaged. The subject of the Christian life for Barth is the whole person, the embodied self not excluding emotions and affections. To be a Christian is to live a life marked by prayer, joy, and love of both God and neighbour. Like John the Baptist in Matthias Grünewald’s ‘Crucifixion’, the Christian is called to bear witness to the divine mercy in Jesus Christ. We see this vision played out in Barth’s doctrine of reconciliation, which shows how the stories of Christians unfold within God’s story. Barth’s late lectures on ethics, titled The Christian Life, portray Christian existence as invocation using the Lord’s Prayer as model. This ethic is marked by a ‘great passion’ that nevertheless takes shape in the midst of the quotidian and the secular.
Church
Authors: Nimmo Paul T.
Published: March 2020

This chapter exposits and analyses the central contours of Barth’s mature doctrine of the church, in which the church is innovatively characterized by a twofold ec-centricity—a double decentring of its life and work. In a first section, it considers Barth’s radical understanding of the being of the church in relation to Jesus Christ and the Spirit, and the way in which the church has its originating centre outwith itself, in its being from God. In a second section, it attends to the creative way in which Barth conceives of the church as a divine event, and thereby relativizes the church as human institution. In a third section, it focuses on the significance and content of the human activity of the church, and the provocative way in which Barth locates the ultimate purpose of the church outwith itself, in its being for the world. In a fourth section, the chapter explores in outline some of the critical responses to Barth’s groundbreaking doctrine of the church. Finally, by way of conclusion, the chapter considers the relationship of Barth’s ecclesiology to ecumenical conversation.
Eschatology
Authors: McDowell John C.
Published: March 2020

This chapter traces the key themes in Barth’s eschatological discourse through an exploration of his later dogmatic writings. It begins with the recognition that reading Barth’s eschatology faces a number of difficulties, and moves on to articulate his work on the doctrine by way of four themes: Jesus Christ as our hope; Jesus Christ as the gift of divine presence and human fulfilment; the shape and nature of the time between Easter and the consummation; and the eschatological ethics of the doctrine of reconciliation. It is maintained that eschatological assertions function in three main ways in Barth’s dogmatics. First, they depict the consummating telos of God’s work in Christ, anticipating God’s being all in all; second, they offer a hermeneutic lens that sheds light on other dogmatic claims; and third, they ground the crucial business that hope engages in as corresponding work.
Barth and the Racial Imaginary
Authors: Jennings Willie James
Published: March 2020

Karl Barth never wrote a treatise against racism or colonialism, but his theological vision offers important resources for addressing the racial imaginary. This is due in large measure to the shape of his educational experiences as a Swiss student—these were heavily influenced by the German educational system and its intellectual dynamics, which refined a masculinist vision of knowledge and power. Barth’s work formed in reaction to this dynamic. In effect, Barth offered an alternative (theological) subjectivity to counter the white male (hegemonic) subjectivity of Western modernity and theology. We could see this alternative construction of subjectivity as the unintended consequence of a theology that nevertheless often showed the sensibilities and intellectual reflexes of white masculine heterosexual hegemony.
Barth and Gender
Authors: Bodley-Dangelo Faye
Published: March 2020

At the heart of Barth’s theological anthropology and its accompanying special ethics is a human agent set in motion by the creative and redemptive work of Christ and directed towards its human fellows in a relationship of shared need and obligation. I mobilize the ethically oriented, critical, and reflective mechanisms in Barth’s depiction of this agent to contest his heterosexist framework for the relationship and difference between the sexes. I propose that Barth’s Christocentric account of human agency undermines his efforts to subordinate women to men, that it has critical mechanisms that can contest, decenter, and reconfigure his rigid gender binary, and that it resonates in productive and suggestive ways with Judith Butler’s gender theory.
Barth and Hermeneutics
Authors: Congdon David W.
Published: March 2020

While Karl Barth avoided the question of hermeneutics and theological method, preferring to focus on the actual exegesis of Scripture, his work is thoroughly—albeit often implicitly—hermeneutical. His hermeneutics, however, is always determined by the subject matter. Over against historical critics who advocated a posture of feigned neutrality, Barth argued that the interpretation of a text requires a participation in its subject matter. Barth’s hermeneutics thus changed over the course of his career as his understanding of the subject matter changed. The eschatological subject matter of his early theology led to a hermeneutic of simultaneity. The historical subject matter of his later, Christocentric theology led to a hermeneutic of description. This chapter argues for an apocalyptic subject matter that unifies the eschatological and the historical and generates a bifocal hermeneutic.
Barth and Preaching
Authors: Hancock Angela Dienhart
Published: March 2020

Some interpretations of Barth’s theology emphasize the constraints it places on the practice of preaching. This chapter argues that, granting Barth’s affirmation of certain homiletical limits, the implications of Barth’s theology for the task of proclamation are best understood under the category of freedom. The first half of the chapter provides an overview of Barth’s homiletical theology, including its Trinitarian backdrop, the Christological aspects of his doctrines of the ‘Word of God’ and of ‘reconciliation’, and the implications of these commitments for Barth’s homiletical approach. The second half explores three issues related to the preacher’s task: the use of language, the role of cognate disciplines in homiletical theory (particularly rhetoric), and the use of ‘secular’ material in sermons. In each case, the chapter demonstrates the way in which, for Barth, the freedom of the preacher is not freedom from all constraint but a freedom for cooperation in the mission of the eloquent and radiant God.
Barth and Environmental Theology
Authors: Jenkins Willis
Published: March 2020

This chapter explains the critical reception of Karl Barth by scholars of ecotheology and the challenges that his theology presents to environmental thought. Then, working along lines of critical reconsideration in environmental thought, it develops lines of possibility for reconsidering the environmental legacy of Barth. It argues that Barth silences nature and that his searing critique of modernity unwittingly reproduces its fundamental ecological illusion, the sundering of humanity from nature. Yet the silencing of nature is the first moment in a dialectic that anticipates a recovery of creation in which one may listen to other creatures. With an ecological imagination informing Barth’s logic, his system could constructively be developed to support an unusual stewardship ethic.
Barth and Culture
Authors: DeCou Jessica
Published: March 2020

Due to a widespread perception that he was a theologian of division, Karl Barth is not generally counted amongst the twentieth century’s great theologians of culture. Although this reputation derives largely from an unfair caricature, it also grows out of Barth’s very real scepticism concerning the possibility of a theology of culture that could avoid the deification of human achievements. Those who delve deeply into Barth’s understanding of culture, however, find in his writings a rich resource in his eschatological appreciation of secular culture. This chapter examines his writings on culture between 1926 and 1932, including his lectures on ethics and Church Dogmatics I/1, as well as his later essays on Mozart (1956) and relevant portions of Church Dogmatics IV/3, noting how these texts can be positively interpreted and can fund a contemporary theology of culture.
Intellectual and Personal Biography III
Authors: Drewes Hans-Anton
Published: March 2020

This chapter outlines Barth’s life and work following his enforced return from Germany to his native city of Basel in 1935 on account of his participation in the German church struggle. It considers Barth’s activity through the years of the Second World War and the ensuing conflict between East and West up to Barth’s retirement in 1962, and Barth’s last reveille in the publication of Church Dogmatics IV/4 (Fragment) in 1967. It also considers some of the academic and ecclesial relationships, which were hugely significant for Barth in his later years.
Barth, Religion, and the Religions
Authors: Ralston Joshua
Published: March 2020

Barth is often depicted by theologians of religion as representing an exclusivist position on both salvation and the knowledge of God. This chapter troubles these claims through a reading of Barth’s discussion of religion in the second edition of his commentary on Romans and his critique of religion in §17 of Church Dogmatics. Building on Barth’s commitment to the primacy of revelation and particularity in §17, the chapter then critically challenges how Barth extends his critique of religion to non-Christian religions, which are often characterized by sweeping generalizations and dismissals. Barth thus fails to come to grips with the challenge that other religious traditions present to Christianity—not as religions, but as alternative claims to revelation. As such, theological engagement with other religions after Barth should not be based on a return to the category of religion, but on a deeper engagement with the primacy of revelation and particularism—both those of Christianity as well as those of others.
Barth and Contemporary Protestant Theology
Authors: van der Kooi Cornelis
Published: March 2020

The appropriation of Barth’s theology in contemporary Protestant theology is related to the culture and conditions of its reception. While the direct influence of Barth may broadly have decreased in recent years, some of his major insights and decisions have found wide acceptance in Protestant theology. The importance of Christology for the doctrine of God is recognizable in many strands of contemporary Protestant thought; equally, the ethical dimensions of Barth’s theology have drawn much attention to this domain of the theological enterprise. Barth’s emphasis on God’s action in favour of God’s creatures and of the human being—the creature called to creative and free response to God—also features heavily in current Protestant reception of his work.
Barth and Patristic Theology
Authors: Greggs Tom
Published: March 2020

This chapter examines Barth’s approach to patristic theology as well as his engagement with key doctrines and councils of the patristic era. It is clear in relation to Barth’s use of, and engagement with, the patristic fathers that the Bible is always sovereign over the church and its teachings; even so, the patristic witness is thought to proffer an authoritative reading of Scripture. This chapter, therefore, explores Barth’s approach to the patristic fathers in relation to the ‘Scripture principle’ and Barth’s Protestant, modern, and critical heritage. Having outlined Barth’s orientation, the chapter considers Barth’s approach to the major councils and definitions of the early church. It pays particular attention to the Niceno-Constantinopolitan Creed in relation to the divinity of Christ and the Symbol of Chalcedonian in relation to the hypostatic union.
Barth and Mediaeval Theology
Authors: Eitel Adam
Published: March 2020

Mediaeval works of theology are frequently cited throughout Karl Barth’s Church Dogmatics. Yet, with the exception of Anselm of Canterbury’s Proslogion, Barth shows little interest in engaging mediaeval works first-hand in his teaching or writing. This lifelong tendency to hold mediaeval theology at a distance springs from Barth’s critical judgement—first expressed in lectures in 1922 at the University of Göttingen—that the theology of the mediaeval era is by and large a ‘theology of glory’. Although Barth came to view Anselm as an important exception to this judgement by the time of Fides quaerens intellectum (1930), the question of whether he might have found further value in other mediaeval theologians deserves consideration.
Barth and Reformation Theology
Authors: Zachman Randall C.
Published: March 2020

Karl Barth seeks to restore the Gospel to the centre of Protestant theology by orienting dogmatic theology to the witness of the prophetic and apostolic authors of Scripture and to the theology of the sixteenth-century Protestant Reformation. Barth especially endorses Luther’s claim that the proclamation of the living and free Word of God in Jesus Christ lies at the heart of the commission laid on the church, and that the task of theology is to test the truth of that proclamation. However, Barth becomes increasingly critical of Luther and Calvin when they distinguish God revealed in Jesus Christ from God in Godself and when they distinguish a Word of God in Scripture—be it a Word of the Creator or the Word as Law—that is distinct from the one Word of God, Jesus Christ. Barth also disagrees with Luther and Calvin regarding the sacraments, insisting at the end of his career that Jesus Christ is the one and only sacrament of God.
Barth and Protestant Orthodoxy
Authors: te Velde Rudi A.
Published: March 2020

For many years, Karl Barth and Protestant Orthodoxy have been almost separate fields of study. On the basis of recent scholarship, however, it is now possible to judge the adequacy of Barth’s reception of the older Protestant theology with greater nuance than ever before. His intensive engagement with scholastic Protestant sources was one of the main factors that helped him to break free of his earlier ‘liberal’ and ‘dialectical’ leanings, and contributed to the consciously ecclesial character of his mature dogmatics. Throughout Church Dogmatics, Barth incorporated extensive discussions of Protestant scholastic notions and arguments in his doctrinal expositions, even as he gave them his own dialectical and actualistic twist. Despite certain hermeneutical and historical shortcomings, Barth’s discussions of Protestant scholasticism stand as a fascinating example of a creative, critical, and constructive reception of the Protestant Orthodox tradition.
(Un)Making Christianity
Authors: O'Toole Rachel Sarah
Published: March 2020

This chapter argues that although colonial authorities and church officials in the Iberian Americas limited Afro-Latin American participation in Catholic religious practices, men and women of the African Diaspora shaped colonial Latin American Catholicism. The Iberian Crowns, as well as early modern colonial clerics, profited from the transatlantic slave trade and the labor of enslaved Africans and their descendants. As a major financial and political institution of the early modern world, the Catholic Church participated in and developed the idea that black people could be sold and purchased because of their racial identity. Furthermore, early modern clerics, as well as the Spanish Crown, engaged in a Foucauldian governmentality of incorporation and control that included Afro-Latin Americans, enslaved and free, as Catholic subjects. Nevertheless, men and women of the African Diaspora in colonial Latin America employed Church structures to organize their communities. Africans and their descendants placed the worship of black saints at the center of colonial municipal celebrations and called on Iberian ecclesiastical courts to defend their families against the definitions of property by slaveholders. As a result, Afro-Latin Americans played a central role in the formation and development of Latin American Catholicism.
Alternative Christianities
Authors: Lawson Ronald , Xydias Kenneth , Cragun Ryan T.
Published: March 2020

This chapter provides a clear but concise history of three of the more prominent proselytizing religious groups in Latin America: Mormons, Seventh-day Adventists, and Jehovah’s Witnesses. All three were founded in the United States in the nineteenth century, but for varying reasons began a global expansion that included efforts in Latin America. The different motivations behind their global expansion are detailed in the chapter. The groups have different dates of origin, and different dates at which their international expansion into Latin America began. The chapter discusses these dates and the reasons why the groups entered Latin America when and where they did. Once full-fledged proselytizing efforts began, the three groups adjusted their messages and approaches in different ways, reflecting the broader approaches employed by them as well as their different theologies. As a result, rates of growth for these groups have differed, as have retention rates. The chapter provides current membership data for each country in Latin America, illustrating differences in retention rates and proselytizing practices. The chapter explains why Mormon membership numbers are particularly overstated, why Seventh-day Adventist numbers are relatively accurate, but also slightly overstated, and why Jehovah’s Witnesses numbers are understated. Finally, it examines growth rates over time to better understand the likely future of these groups in Latin America.
Bishops, Priests, and CELAM
Authors: Helgen Erika
Published: March 2020

This chapter examines the evolution of the role and image of Latin American priests and bishops during the second half of the twentieth century. This period saw the emergence of new forms of clerical and episcopal organization, such as CELAM (the Latin American Episcopal Conference, or Consejo Episcopal Latinoamericano), as well as new ideas regarding clerical training, pastoral care, and hierarchical obedience. Such developments not only shaped the way in which priests and bishops approached social and political issues, but also transformed how the clergy thought about fundamental ecclesiological questions regarding the nature and mission of the Catholic Church.
Catholicism, Revolution, and Counter-Revolution in Twentieth-Century Latin America
Authors: Andes Stephen J. C.
Published: March 2020

Revolution divided Roman Catholics during the twentieth century in Latin America. Although Catholic activists formed ranks on all sides of Latin America’s social conflict, revolutionary anticlericalism, land reform, and state education became important wedge issues that kept the Catholic Church hierarchy on the side of counterrevolution. This chapter surveys Latin America’s “Big Three” social revolutions, beginning with Mexico (1910–1940), Cuba at mid-century, and Nicaragua in the late 1970s and 1980s. Catholic political and social allegiances, as well as the similarities across the century provide the focus of much of the chapter. The chapter argues that Latin America’s Cold War added ideological pungency and superpower conflicts to the region’s already festering mix of social exclusion, poverty, and oligarchical hegemony. Some attention is given to the emergence of the liberationist perspective. The result of Latin America’s revolutionary century can be seen in a shift within the moderate group of Catholic leadership, both lay and clerical, toward a more empathetic view of the poor. The development of Liberation Theology, endeavouring to answer endemic issues of poverty and economic inequality, helped focus the Church’s mission in the region after the Second Vatican Council. The chapter ends with a final parting note regarding the election of Pope Francis and how Latin America’s first pope was formed within the region’s revolutionary twentieth century.
Sleep and intrusive memories immediately after a traumatic event in emergency department patients
Authors: Porcheret Kate , Iyadurai Lalitha , Bonsall Michael B , Goodwin Guy M , Beer Sally A , Darwent Melanie , Holmes Emily A
Published: March 2020

Study objectives

Intrusive memories of psychological trauma are a core clinical feature of posttraumatic stress disorder (PTSD), and in the early period post-trauma may be a potential target for early intervention. Disrupted sleep in the weeks post-trauma is associated with later PTSD. The impact of sleep and intrusive memories immediately post-trauma, and their relation to later PTSD, is unknown. This study assessed the relationship between sleep duration on the first night following a real-life traumatic event and intrusive memories in the subsequent week, and how these might relate to PTSD symptoms at 2 months.

Methods

Patients (n = 87) recruited in the emergency department completed a sleep and intrusive memory diary from the day of their trauma and for the subsequent week, with optional actigraphy. PTSD, anxiety, and depression symptoms were assessed at 1 week and 2 months.

Results

A U-shaped relationship was observed between sleep duration on the first night and intrusive memories over the subsequent week: sleeping “too little” or “too much” was associated with more intrusive memories. Individuals who met Clinician-Administered PTSD Scale (CAPS) criteria for PTSD at 2 months had three times more intrusive memories in the first week immediately post-trauma than those who did not (M = 28.20 vs 9.96). Post hoc analysis showed that the absence of intrusive memories in the first week post-trauma was only observed in those who did not meet CAPS criteria for PTSD at 2 months.

Conclusions

Monitoring intrusive memories and sleep in the first week post-trauma, using a simple diary, may help identify individuals more vulnerable to later psychopathology.
Professionalism: The Wrong Tool to Solve the Right Problem?
Authors: Frye Victoria , Camacho-Rivera Marlene , Salas-Ramirez Kaliris , Albritton Tashuna , Deen Darwin , Sohler Nancy , Barrick Samantha , Nunes Joäo
Published: March 2020

Medical schools and other higher education institutions across the United States are grappling with how to respond to racism on and off campus. Institutions and their faculty, administrators, and staff have examined their policies and practices, missions, curricula, and the representation of racial and ethnic minority groups among faculty, staff, and students. In addition, student-led groups, such as White Coats for Black Lives, have emerged to critically evaluate medical school curricula and advocate for change. Another approach to addressing racism has been a focus on the role of professionalism, which has been variably defined as values, traits, behaviors, morality, humanism, a role, an identity, and even a social contract.

In this article, the authors consider the potential role that professionalism might play in responding to racism in medical education and at medical schools. They identify 3 concerns central to this idea. The first concern is differing definitions of what the problem being addressed really is. Is it isolated racist acts or institutional racism that is a reflection of white supremacy? The second concern is the notion that professionalism may be used as a tool of social control to maintain the interests of the social groups that dominate medicine. The third concern is that an overly simplistic application of professionalism, regardless of how the problem of racism is defined, may result in trainees practicing professionalism that is performative rather than internally motivated. The authors conclude that professionalism may complement a more systematic and holistic approach to addressing racism and white supremacy in medical education, but it is an insufficient stand-alone tool to address this core problem.
The Harvard Medical School Pathways Curriculum: Reimagining Developmentally Appropriate Medical Education for Contemporary Learners
Authors: Schwartzstein Richard M. , Dienstag Jules L. , King Randall W. , Chang Bernard S. , Flanagan John G. , Besche Henrike C. , Hoenig Melanie P. , Miloslavsky Eli M. , Atkins K. Meredith , Puig Alberto , Cockrill Barbara A. , Wittels Kathleen A. , Dalrymple John L. , Gooding Holly , Hirsh David A. , Alexander Erik K. , Fazio Sara B. , Hundert Edward M. ,   for the Pathways Writing Group
Published: March 2020

As the U.S. health care system changes and technology alters how doctors work and learn, medical schools and their faculty are compelled to modify their curricula and teaching methods. In this article, educational leaders and key faculty describe how the Pathways curriculum was conceived, designed, and implemented at Harvard Medical School. Faculty were committed to the principle that educators should focus on how students learn and their ability to apply what they learn in the evaluation and care of patients. Using the best evidence from the cognitive sciences about adult learning, they made major changes in the pedagogical approach employed in the classroom and clinic. The curriculum was built upon 4 foundational principles: to enhance critical thinking and provide developmentally appropriate content; to ensure both horizontal integration between courses and vertical integration between phases of the curriculum; to engage learners, foster curiosity, and reinforce the importance of student ownership and responsibility for their learning; and to support students’ transformation to a professional dedicated to the care of their patients and to their obligations for lifelong, self-directed learning.

The practice of medicine is rapidly evolving and will undoubtedly change in multiple ways over the career of a physician. By emphasizing personal responsibility, professionalism, and thinking skills over content transfer, the authors believe this curriculum will prepare students not only for the first day of practice but also for an uncertain future in the biological sciences, health and disease, and the nation’s health care system, which they will encounter in the decades to come.
Problematic Child Mealtime Behavior and Caregiver Mobile Phone Use
Authors: Milkovich Libby Matile , Sherman Ashley , Dreyer Gillette Meredith , Sweeney Brooke , Nyp Sarah , Black Benjamin
Published: March 2020

Objective:

To evaluate the associations of caregiver mobile phone problematic use and child problematic mealtime behaviors (PMBs) to improve understanding of the possible implications of caregiver mobile phone problematic use.

Methods:

Surveys were administered to caregivers of children aged 3 to 8 years. The survey included demographics, a validated measure for caregiver mobile phone problematic use (Mobile Phone Problematic Use Scale-10 [MPPUS-10]), and a validated measure for the perception of child PMB (Meals in our Household [MIOH]). The bivariate associations between child and caregiver characteristics, mobile phone problematic use, and PMBs of children were analyzed. Partial correlations examined these relations while controlling for significant (p ≤ 0.05) covariates.

Results:

Eighty-four caregivers (mean age 32.6 years, 63% white, 21% ≤ high school completion) participated. The correlation of MIOH problematic behavior total with MPPUS-10 was significant (r = 0.33, p ≤ 0.01). Significantly correlated caregiver variables with MPPUS-10 included age (r = −0.25, p = 0.02) and female sex (p = 0.01). No significant caregiver variables were noted for PMB. Child’s age was significantly correlated with PMB (r = −0.27, p = 0.01). MPPUS-10 and PMB correlation remained significant when controlling for significant covariates.

Conclusion:

A positive correlation existed between MPPUS-10 and PMB. Understanding the potential association between caregiver mobile phone problematic use and child PMB strengthens the pediatricians' ability to counsel about the implications of caregiver mobile phone problematic use when discussing child PMB.
Predictors of Aspirin Nonadherence in Adults With Prior Myocardial Infarction
Authors: Bhasin Varun , Mehta Aayushi , Skopicki Hal A. , Parikh Puja B.
Published: March 2020

Background:

Medication nonadherence is an alarming public health concern due to its effect on both individual treatment success and overall health care costs. This study sought to identify the predictors of aspirin nonadherence in adults with prior myocardial infarction (MI).

Methods:

The 2017 Centers for Disease Control’s Behavioral Risk Factor Surveillance Survey, a nationally representative, cross-sectional survey, was utilized to identify a cohort of community-dwelling adults (age ≥ 18 years) with prior MI (n = 2173). The primary outcome of interest was presence of self-reported aspirin nonadherence.

Results:

Among 2173 participants with prior MI studied, a total of 550 participants (25.3%) reported aspirin nonadherence, whereas 1623 participants (74.7%) reported adherence to aspirin. Adults with aspirin nonadherence were younger and more likely to be female, Black, and of Hispanic ethnicity. They also had lower annual income and were less likely to have health insurance or own a home. Participants with aspirin nonadherence had less frequent medical checkups and lower rates of multiple comorbidities including diabetes mellitus, hypertension, hyperlipidemia, and obesity. In multivariable analysis, independent predictors of aspirin nonadherence included female sex [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.14–1.83], Black race (OR, 1.64; 95% CI, 1.19–2.26), Hispanic ethnicity (OR, 2.27; 95% CI, 1.60–3.21), current employment (OR, 1.74; 95% CI, 1.28–2.36), and absence of homeowner status (OR, 0.71; 95% CI, 0.55–0.93).

Conclusions:

In this observational contemporary study of adults with prior MI, predictors of aspirin nonadherence included female sex, Black race, Hispanic ethnicity, currently employed status, and absence of homeowner status.
Ventricular Arrhythmias in Patients with Spontaneous Coronary Artery Dissection
Authors: Daoulah Amin , Al-Faifi Salem M. , Alsheikh-Ali Alawi A. , Hersi Ahmad S. , Lotfi Amir
Published: March 2020

Background:

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome in young women, with a wide clinical spectrum of severity. Ventricular arrhythmia (VA) can occur and worsen prognosis. The current study compared in-hospital and follow-up adverse cardiovascular events in patients with and without VA at presentation.

Methods:

Eighty-three cases of SCAD were collected retrospectively from 4 Gulf countries (KSA, UAE, Kuwait, and Bahrain) during the period from January 2011 to December 2017. We divided the patients into 2 groups: those with and without VA at presentation. VA was defined as ventricular tachycardia and/or ventricular fibrillation. In-hospital (recurrent VA, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) events were compared among the 2 groups.

Results:

The median age of patients in the study was 44 (37–55) years. Forty-two (51%) were women. VA occurred in 10 (12%) patients in the first 24-hour of hospitalization, and 5 (50%) of those patients had recurrent in-hospital VA. Among those with recurrent VA, 1 died during hospitalization and 1 died within the first year following hospital discharge.

Conclusions:

In-hospital adverse cardiovascular events were significantly more frequent for patients with SCAD who presented with VA. However, follow-up events were not statistically significant between those with and without VA at presentation.
Approach to Evaluating and Managing Adult Attention-Deficit/Hyperactivity Disorder in Primary Care
Authors: Huang Hsiang , Huang Heather , Spottswood Margaret , Ghaemi Nassir
Published: March 2020

Requests for the evaluation of potential adult attention-deficit/hyperactivity disorder (ADHD) is on the rise across primary care clinics. Many health care providers, however, may feel ill equipped to diagnose and manage adults presenting with inattention and impulsivity. The diagnosis of ADHD is often complicated by medical and psychiatric conditions that can contribute to inattention symptoms. In this article, the authors provide a pragmatic clinical approach for evaluating and managing adult ADHD in the primary care setting.
Pseudoprogression of Metastatic Melanoma to the Orbit With Pembrolizumab
Authors: Garcia Giancarlo A. , Topping Katie L. , Mruthyunjaya Prithvi , Kossler Andrea L.
Published: March 2020

The management of metastatic melanoma to the orbit may involve a variety of therapeutic modalities including external-beam radiation, chemotherapy, and varying degrees of surgical resection or debulking. Pembrolizumab is an immunotherapeutic agent that has demonstrated efficacy in the treatment of metastatic melanoma. The authors present a case of metastatic melanoma to the orbit demonstrating profound pseudoprogression within hours of beginning pembrolizumab therapy, with associated mass effect and vision loss. Systemic corticosteroids, orbital external-beam radiation therapy, and a brief interruption in pembrolizumab halted expansion of the orbital lesion and vision loss. This case illustrates that rapid increase in orbital melanoma size, due to acute inflammatory response, may occur after initiation of systemic pembrolizumab therapy. Clinicians should be aware of this pseudoprogression mechanism as a potential cause of vision compromise in metastatic orbital melanoma. Prompt recognition and treatment may be needed to prevent permanent vision loss.