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PubMed2005

Self-concept: comparison between school-aged children with congenital heart disease and normal school-aged children.

AIMS AND OBJECTIVES: The aim of this study was to evaluate and compare the self-concept of school-aged children with congenital heart disease to those of normal school-aged children. The primary objective was to analyse results of the Self-Concept Scale questionnaire administered to children with congenital heart disease aged 9-12 years. Sixty-four children with congenital heart disease (study group), and 71 without congenital heart disease (control group), completed the questionnaire. BACKGROUND: Little attention has focused on school-aged children with congenital heart disease who are in the important stages of developing self-concept. RESULTS: The mean score on the Physical self-concept of the Self-Concept Scale was significantly lower for the study group than the control group (P < 0.05). No significant differences were observed between children with congenital heart disease and normal children in terms of family self-concept, school self-concept, appearance self-concept, emotional self-concept and general self-concept for the Self-Concept Scale. CONCLUSIONS: Nurses should use the study findings to encourage positive self-concept development and improve their patient education about physical activity before the child is discharged. Thus, children with congenital heart disease could leave the hospital with a clear understanding of their body and condition, and how it affects daily life. RELEVANCE TO CLINICAL PRACTICE: The results of this study may provide more holistic views on self-concept for clinical nurses working with children who have congenital heart disease and their families and for school nurses working with elementary school children.

Child↗
PubMed2005

Concept analysis: examining the state of the science.

As methods for analyzing concepts have proliferated in nursing, a critical methodological issue has arisen. Analytic techniques for examining conceptual meaning have incorporated varied strategies for advancing the concept under the rubric of concept analysis, concept development, and theory building. The authors argue that this evolution has created methodological confusion. Following a discussion of a conceptualization of concepts and concept-theory-truth linkages, methods of concept analysis are critiqued in terms of the purpose and the nature of the findings produced by analyses using both traditional and emergent methods. The authors argue that concept analysis is a process of strategic examination of the scientific literature that results in an integrated perspective of the state of the science, or what is known about the concept. In contrast, concept advancement refers to techniques that emphasize the synthesis of new or deeper knowledge that is relevant to the discipline. The authors conclude that disentangling concept analysis from techniques for concept advancement is critical to enhancing the utility of concept-based research in nursing.

Concept Formation↗
PubMedDate not supplied

[Theoretical and empirical studies on the structure of self concepts of the elderly].

It has been demonstrated that theoretical and empirical investigations on the structure of self-concepts open possibilities for the differential description of self-concepts. Centrality, a characteristic of structure, is the focus of this investigation and is defined via correlations: centrality is characterized by the degree of association (determined by intercorrelations) of one of the self-concepts with each of the other self-concepts. Correlational studies on 10 differentiated self-concepts, determined by the Frankfurt Self-Concept Scales FSKN, have been drawn on the analysis of the structure of self-concepts. Data of 141 elderly people (56 to 95 years old) have been compared with the results for different status groups: 100 students, 70 trainees, 202 adults. The results have supplied the following hypotheses: The 10 differentiated self-concepts are significantly intercorrelated. Several differentiated self-concepts show a different centrality in the self-structure. Self-concepts in the region of performance and self-esteem also have a central position in elderly people's self-structure. However, the aspect of performance which is represented by the self-concept of certainty on behaviour and decision seems to be less central for elderly people than for younger subjects. According to the data the self-concept of autonomy in respect to significant others is distinguished by special centrality among the differentiated psychosocial self-concepts of both elderly persons and students.

Achievement↗
PubMedDate not supplied

Concept maps as an assessment tool in a nursing course.

A concept map can be thought of as a scheme representing visual knowledge in the form of a hierarchical graphic network composed of nodes and links. In the complex health environment, it is very important for nursing educators to cultivate in nursing students thinking and judgment skills. Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts by organizing and analyzing information. Concept maps can be successfully used to teach conceptual thinking, thus increasing students' competence in critical thinking in the modern paradigm. The purpose of this study was to implement concept mapping as a learning strategy in a nursing course and to evaluate students' learning progress through the construction of concept maps based on scenarios. Forty-three students, who had enrolled in a 2-year nursing program and took Nursing I in the fall semester of 2002, were invited to participate in this study, which was approved by the institutional research committee. Written informed consent was obtained from all the students. The class met for 4 hours, once a week, for 16 weeks. Participants were divided into seven groups, and during the course, they were required to complete six concept maps, five of which dealt with physical functions, including activity and rest, fluids and electrolytes, neuroendocrines, sensory-perception, and sexuality. The last map dealt with role functions. All the first drafts of the concept maps received low scores, but the third and following drafts made by all the teams showed improvement. The results of this study indicated that the students developed their concept maps from a linear sequence of concepts at the beginning into a highly integrated web of concepts in the final draft. In this study, despite complaints about the heavy workload and time consumption, the students acquired problem-solving and critical-thinking skills by organizing complex patient data, analyzing concept relationships, and identifying interventions.

Attitude of Health Personnel↗
PubMed2003

The structure of the self-concept and its relation to psychological adjustment.

Research on the relation between the structure of the self-concept and psychological adjustment has produced seemingly inconsistent findings. Some research suggests that greater pluralism in self-concept structure enhances adjustment, whereas other research suggests that greater unity in the structure enhances adjustment. Four studies examined the relations among measures of self-concept structure and their relations with adjustment. The measures of self-concept structure included two that we viewed as reflecting self-concept pluralism (self-complexity and self-concept compartmentalization) and four that we viewed as reflecting self-concept unity (self-concept differentiation, self-concept clarity, self-discrepancies, and the average correlation among participants' self-aspects). The measures of self-concept pluralism were unrelated to one another, were unrelated to the measures of self-concept unity, and were unrelated to the measures of adjustment. The measures of self-concept unity were moderately related to one another and were moderately related to the measures of adjustment.

Adaptation, Psychological↗
PubMed1996

Isolated and interrelated concepts.

A continuum between purely isolated and purely interrelated concepts is described. Along this continuum, a concept is interrelated to the extent that it is influenced by other concepts. Methods for manipulating and identifying a concept's degree of interrelatedness are introduced. Relatively isolated concepts can be empirically identified by a relatively large use of nondiagnostic features, and by better categorization performance for a concept's prototype than for a caricature of the concept. Relatively interrelated concepts can be identified by minimal use of nondiagnostic features, and by better categorization performance for a caricature than for a prototype. A concept is likely to be relatively isolated when subjects are instructed to create images for their concepts rather than find discriminating features, when concepts are given unrelated labels, and when the categories that are displayed alternate rarely between trials. The entire set of manipulations and measurements supports a graded distinction between isolated and interrelated concepts. The distinction is applied to current models of category learning, and a connectionist framework for interpreting the empirical results is presented.

Adult↗
PubMed1995

Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning.

OBJECTIVE: Our purpose was to ascertain the effects of timing of conception on the risk of spontaneous abortion. STUDY DESIGN: To assess these effects, women who conceived while using natural family planning were identified in five centers worldwide between 1987 and 1993. Timing of conception was determined from 868 natural family planning charts that recorded day of intercourse and indices of ovulation (cervical mucus peak obtained according to the ovulation method and/or basal body temperature). Conceptions on days - 1 or 0 with respect to the natural family planning estimated day of ovulation were considered to be "optimally timed," and all other conceptions were considered as "non-optimally timed." The rate of spontaneous abortions per 100 pregnancies was examined in relation to timing of conception, ages, reproductive history, and other covariates with bivariate and multivariate statistical methods. RESULTS: There were 88 spontaneous abortions among 868 pregnancies (10.1%). The spontaneous abortion rate was similar for 361 optimally timed conceptions (9.1%) and 507 non-optimally timed conceptions (10.9%). However, among 171 women who had experienced a spontaneous abortion in a prior pregnancy, the rate of spontaneous abortion in the index pregnancy was significantly higher with non-optimally timed conceptions (22.6%) as compared with optimally timed conceptions (7.3%). This association was not observed among 697 women with no history of pregnancy loss. The adjusted relative risk of spontaneous abortion among women with non-optimally timed conceptions and a history of pregnancy loss was 2.35 (95% confidence intervals 1.42 to 3.89). The excess risk of spontaneous abortion was observed with both preovulatory and postovulatory conceptions. CONCLUSIONS: Overall, there is no excess risk of spontaneous abortion among the pregnancies conceived during natural family planning use. However, among women with a history of pregnancy loss, there is an increased risk of spontaneous abortion associated with preovulatory or postovulatory delayed conceptions.

Abortion, Spontaneous↗
PubMedDate not supplied

Adequacy of evolving national standardized terminologies for interdisciplinary coded concepts in an automated clinical pathway.

PURPOSE: The purpose of this analysis was to determine the adequacy of evolving national standardized terminologies with regard to coded data elements (concepts) in an automated clinical pathway designed to drive adherence with the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for Evaluation and Management of Chronic Heart Failure. METHOD: Concepts were identified in a previously developed automated clinical pathway and associated tools. Once identified, concepts were categorized according to the conceptual domains identified by Campbell et al. (1997). A review of evolving national standardized terminologies and coding systems was initiated to determine if the identified concepts had corresponding representation in one of these coding systems. Available codes were then evaluated for adequacy with respect to national guideline adherence measures put forth by the Centers for Medicare/Medicaid Services (CMS) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO). RESULTS: The concept domain model put forth by Campbell et al. (1997) worked well for organizing concepts and for providing a useful framework for data analysis. Using our method, 260 unique pathway concepts were identified, of which, 91.9% (239) are represented by one or more of the standardized coding systems. Logical Observation Identifiers Names and Codes (LOINC) and SNOMED CT alone represented 86.2% of the concepts. Seventy percent (70%) of the clinical pathway concepts are represented using the Health Insurance Portability and Accountability Act (HIPAA) mandated national terminologies alone. Less than 50% of CMS and JCAHO guideline adherence concepts were found to have representation in the HIPAA mandated terminologies. The addition of Logical Observation Identifier Names and Codes (LOINC) and SNOMED CT improved representation up to 86.4%, but did not include representation of all concepts necessary for complete electronic monitoring of guideline adherence. CONCLUSIONS: Evolving national standardized terminologies provided matching terms for the majority of the data elements in the automated clinical pathway. Standard clinical terminologies with granular terms such as LOINC and SNOMED CT are required to represent the depth and detail of certain procedures and guideline-based care. Gaps exist in Health Insurance Portability and Accountability Act (HIPAA) mandated terminologies for representing interdisciplinary concepts in national adherence measures.

Computational Biology↗
PubMed2005

Representation of ophthalmology concepts by electronic systems: adequacy of controlled medical terminologies.

OBJECTIVE: To assess the adequacy of 5 controlled medical terminologies (International Classification of Diseases 9, Clinical Modification [ICD9-CM]; Current Procedural Terminology 4 [CPT-4]; Systematized Nomenclature of Medicine, Clinical Terms [SNOMED-CT]; Logical Identifiers, Names, and Codes [LOINC]; Medical Entities Dictionary [MED]) for representing concepts in ophthalmology. DESIGN: Noncomparative case series. PARTICIPANTS: Twenty complete ophthalmology case presentations were sequentially selected from a publicly available ophthalmology journal. METHODS: Each of the 20 cases was parsed into discrete concepts, and each concept was classified along 2 axes: (1) diagnosis, finding, or procedure and (2) ophthalmic or medical concept. Electronic or paper browsers were used to assign a code for every concept in each of the 5 terminologies. Adequacy of assignment for each concept was scored on a 3-point scale. Findings from all 20 case presentations were combined and compared based on a coverage score, which was the average score for all concepts in that terminology. MAIN OUTCOME MEASURES: Adequacy of assignment for concepts in each terminology, based on a 3-point Likert scale (0, no match; 1, partial match; 2, complete match). RESULTS: Cases were parsed into 1603 concepts. SNOMED-CT had the highest mean overall coverage score (1.625+/-0.667), followed by MED (0.974+/-0.764), LOINC (0.781+/-0.929), ICD9-CM (0.280+/-0.619), and CPT-4 (0.082+/-0.337). SNOMED-CT also had higher coverage scores than any of the other terminologies for concepts in the diagnosis, finding, and procedure categories. Average coverage scores for ophthalmic concepts were lower than those for medical concepts. CONCLUSIONS: Controlled terminologies are required for electronic representation of ophthalmology data. SNOMED-CT had significantly higher content coverage than any other terminology in this study.

Humans↗
PubMed1996

Concept hierarchy memory model: a neural architecture for conceptual knowledge representation, learning, and commonsense reasoning.

This article introduces a neural network based cognitive architecture termed Concept Hierarchy Memory Model (CHMM) for conceptual knowledge representation and commonsense reasoning. CHMM is composed of two subnetworks: a Concept Formation Network (CFN), that acquires concepts based on their sensory representations; and a Concept Hierarchy Network (CHN), that encodes hierarchical relationships between concepts. Based on Adaptive Resonance Associative Map (ARAM), a supervised Adaptive Resonance Theory (ART) model, CHMM provides a systematic treatment for concept formation and organization of a concept hierarchy. Specifically, a concept can be learned by sampling activities across multiple sensory fields. By chunking relations between concepts as cognitive codes, a concept hierarchy can be learned/modified through experience. Also, fuzzy relations between concepts can now be represented in terms of the weights on the links connecting them. Using a unified inferencing mechanism based on code firing, CHMM performs an important class of commonsense reasoning, including concept recognition and property inheritance.

Algorithms↗
PubMed1995

Diabetes and pregnancy. Factors associated with seeking pre-conception care.

OBJECTIVE: To define sociodemographic characteristics, medical factors, knowledge, attitudes, and health-related behaviors that distinguish women with established diabetes who seek pre-conception care from those who seek care only after conception. RESEARCH DESIGN AND METHODS: A multicenter, case-control study of women with established diabetes making their first pre-conception visit (n = 57) or first prenatal visit without having received pre-conception care (n = 97). RESULTS: Pre-conception subjects were significantly more likely to be married (93 vs. 51%), living with their partners (93 vs. 60%), and employed (78 vs. 41%); to have higher levels of education (73% beyond high school vs. 41%) and income (86% > $20,000 vs. 60%); and to have insulin-dependent diabetes mellitus (IDDM) (93 vs. 81%). Pre-conception subjects with IDDM were more likely to have discussed pre-conception care with their health care providers (98 vs. 51%) and to have been encouraged to get it (77 vs. 43%). In the prenatal group, only 24% of pregnancies were planned. Pre-conception patients were more knowledgeable about diabetes, perceived greater benefits of pre-conception care, and received more instrumental support. CONCLUSIONS: Only about one-third of women with established diabetes receive pre-conception care. Interventions must address prevention of unintended pregnancy. Providers must regard every visit with a diabetic woman as a pre-conception visit. Contraception must be explicitly discussed, and pregnancies should be planned. In counseling, the benefits of pre-conception care should be stressed and the support of families and friends should be elicited.

Adult↗
PubMed2000

A randomized controlled trial of concept based indexing of Web page content.

OBJECTIVE: Medical information is increasingly being presented in a web-enabled format. Medical journals, guidelines, and textbooks are all accessible in a web-based format. It would be desirable to link these reference sources to the electronic medical record to provide education, to facilitate guideline implementation and usage and for decision support. In order for these rich information sources to be accessed via the medical record they will need to be indexed by a single comparable underlying reference terminology. METHODS: We took a random sample of 100 web pages out of the 6,000 web pages on the Mayo Clinic's Health Oasis web site. The web pages were divided into four datasets each containing 25 pages. These were humanly reviewed by four clinicians to identify all of the health concepts present (R1DA, R2DB, R3DC, R4DD). The web pages were simultaneously indexed using the SNOMED-RT beta release. The indexing engine has been previously described and validated. A new clinician reviewed the indexed web pages to determine the accuracy of the automated mappings as compared with the human identified concepts (R4DA, R3DB, R2DC, R1DD). RESULTS: This review found 13,220 health concepts. Of these 10,383 concepts were identified by the initial human review (78.5% +/- 3.6%). The automated process identified 10,083 concepts correctly (76.3% +/- 4.0%) from within this corpus. The computer identified 2,420 concepts, which were not identified by the clinician's review but were upon further consideration important to include as health concepts. There was on average a 17.1% +/- 3.5% variability in the human reviewers ability to identify the important health concepts within web page content. Concept Based Indexing provided a positive predictive value (PPV) of finding a health concept of 79.3% as compared with keyword indexing which only has a PPV of 33.7% (p < 0.001). CONCLUSION: SNOMED-RT is a reasonable ontology for web page indexing. Concept based indexing provides a significantly greater accuracy in identifying health concepts when compared with keyword indexing.

Abstracting and Indexing↗
PubMed2003

Indexing anatomical concepts to OMIM Clinical Synopsis using the UMLS Metathesaurus.

As a first step toward the quantitative comparison of clinical features of diseases, we indexed the text descriptions in the Clinical Synopsis section of the Online Mendelian Inheritance in Man (OMIM) with concepts for the body parts, organs, and tissues contained in the Metathesaurus of the Unified Medical Language System (UMLS). We also indexed the text with the diseases and disorders having links to body parts specified in the thesaurus. The vocabulary size was approximately 177,540 representations for 81,435 concepts, and 2,161 concepts were indexed to 3,779 OMIM entries. The indexed concepts included 134 concepts for the noun forms of anatomical concepts and 985 indexed concepts for diseases and disorders that were linked to 132 and 408 anatomical concepts, respectively. We report herein that the retrieval of OMIM entries for diseases affecting specific organs can be made more comprehensive through the anatomical concepts indexed to the Clinical Synopsis or linked to the indexed concepts, as compared to simply matching organ names to the Clinical Synopsis text. The recall and precision of identifying relevant body parts in the Clinical Synopsis were calculated as 78% and 92.5%, respectively, based on random sampling. The examination of the unidentified body parts due to lack of indexed diseases and disorders showed that although most of the concepts for diseases and disorders were contained in the Metathesaurus, their relations to body parts were not. The indexing result proved the effectiveness of the Metathesaurus as a resource for the identification of concepts indicating body parts, diseases, and disorders.

Abstracting and Indexing↗
PubMedDate not supplied

The changing self-concept of pregnant and parenting teens.

Self-concept has been recognized and researched as a powerful variable in relation to teenage pregnancy. Low self-concept frequently has been identified as a cause and consequence of teenage pregnancy as well as a factor in participation and compliance with health care recommendations. Most of the research on self-concept and teenage pregnancy occurred in the 1970s to mid-1980s, and all found lower self-concept in pregnant and parenting teens when compared with their nonpregnant contemporaries and normative data. This study found the opposite to be true. The 126 pregnant and parenting teens in this study had higher self-concepts than the reported normative group. Also, important variations in self-concept were found in relation to sociodemographics. This potentially suggests that what was once known about this aggregate is no longer true, and a reinvestigation is warranted. The purpose of this study was to reinvestigate the self-concept of pregnant and parenting teens and compare them with published normative data and to examine the relationship between sociodemographics and self-concept. The study employed a survey methodology. Data were analyzed using frequencies, percentages, measures of central tendency and dispersion, t test, chi-square test, and analysis of variance. This study found that pregnant and parenting teens had a higher self-concept than the normative data on nonpregnant teens reported by the research instrument authors. Furthermore, this older sample of pregnant and parenting teens (mean age, 17.83 years) had self-concepts more similar to the junior high school normative sample than their senior high school-age contemporaries. Also, this study found that self-concept varies according to the pregnant and parenting teens; ages, years of schooling, types of schools attended, income sources, and receipt of public assistance. This study has implications for health care providers, health and public educators, and nursing researchers in terms of program development and evaluation, health marketing, and development of primary prevention strategies.

Adolescent↗
PubMed2002

Retrieval of concepts in script-based texts and narratives: the influence of general world knowledge.

The goal of the present experiments was to examine the accessibility of concepts embedded within text. J. A. Albrecht and E. J. O'Brien (1991) found that with narrative texts central concepts are more quickly retrieved than peripheral concepts. In contrast, F. R. Yekovich and C. H. Walker (1986) found that when concepts are embedded within scripts, peripheral concepts are more quickly retrieved than central concepts. Over 13 experiments, central concepts were generally more quickly accessed than peripheral concepts. The only exception occurs when (a) script-based texts are used, (b) the number of mentions or elaboration of central and peripheral concepts is held constant, and (c) the measure of centrality is theme relatedness rather than degree of interconnectedness. Under those conditions, central concepts are more difficult to access than peripheral concepts.

Attention↗
PubMed2004

The association between global self-esteem, physical self-concept and actual vs ideal body size rating in Chinese primary school children.

OBJECTIVE: To investigate whether the discrepancy between actual and ideal body size rating is related to Chinese children's global self-esteem and global physical self-concept. DESIGN: A cross-sectional study of school children who completed questionnaires related to global self-esteem, global physical self-concept, and actual vs ideal body size. SUBJECTS: A total of 386 Chinese children (44% girls and 56% boys) aged 7-13 y from a primary school in Hong Kong, China. MEASUREMENTS: Global self-esteem and physical self-concept were measured using the physical self-descriptive questionnaire. Actual vs ideal body size discrepancy was established using the silhouette matching task. RESULTS: No significant relationship was found between global self-esteem and actual-ideal body size discrepancy of children. Global physical self-concept had a moderate negative correlation (r=-0.12) with the body size discrepancy score and the discrepancy score explained very limited variance (R(2)=0.015; F(1, 296)=4.51; P<0.05) in global physical self-concept. Three body size discrepancy groups (none, positive, and negative) were examined to see if there were any significant differences in global self-esteem, global physical self-concept, and specific dimensions of physical self-concept. A significant overall difference was found between groups for global physical self-concept (F=3.73, P<0.05) and the physical self-concept subscales of physical activity (F=3.25, P<0.05), body fat (F=61.26, P<0.001), and strength (F=5.26, P<0.01). Boys scored significantly higher than girls on global physical self-concept-especially in the sport competence, strength, and endurance subscales. CONCLUSION: This study revealed that the actual-ideal body size discrepancy rating of Chinese children was not predictive of global physical self-concept and global self-esteem. These findings are contrary to those reported in Western children, which may mean that culture plays a role in the formation of body attitude.

Adolescent↗
PubMed1995

Self-concept, Class II malocclusion, and early treatment.

Increased overjet has been associated with teasing, negative stereotyping, and low self-concept. Early treatment for children with Class II malocclusion is often recommended under the assumption that an improved dental appearance may benefit a child by increasing his or her social acceptance and hence self-concept. The self-concept of 208 patients, age 7 to 15 years and with increased overjet, was measured before treatment using the Piers-Harris self-concept scale; a subset of 87 of these children were measured again after 15 months of early growth modification. The mean self-concept score for these children was above the population norm, and there was no association between the child's score and the magnitude of his or her overjet or age. Although some significant associations were found between Class II malocclusion features and self-concept scores, the explained variation in self-concept scores was low (R2 from 5% to 8%). There was no change in the mean self-concept score of these children during early treatment, nor was there any association between reduction of Class II malocclusion features and improved self-concept. These findings suggest that children with Class II malocclusion do not generally present for treatment with low self-concept and, on average, self-concept does not improve during the brief period of early orthodontic treatment.

Adolescent↗
PubMed1998

Self-reports of mathematics self-concept and educational outcomes: the roles of ego-dimensions and self-consciousness.

BACKGROUND: There is a need for research to (a) explore more fully the academic outcomes that follow from under-/over-rating of self-concept and (b) identify factors that predict the nature of self-reports of self-concept as well as under- and over-rating of this self-concept. AIMS: The study examines the link between students' self-appraisals of both mathematics self-concept and under-/over-rating of this self-concept and educational outcomes in mathematics such as achievement and motivation (future plans for mathematics). Ego-dimensions (ego-orientation and competence-valuation) and public self-consciousness were examined as two factors that might contribute to predicting these self-appraisals. SAMPLE: Findings are drawn from a sample of 382 male and female high school students ranging in age from 14 to 16 years. METHODS: Students responded to a questionnaire (at Time 1) that assessed self-concept, motivation orientation, competence-valuation, self-consciousness, and mathematics motivation. Teachers rated each student using a brief mathematics self-concept scale. RESULTS: Higher mathematics self-concept and over-rating of this self-concept were predictive of higher levels of mathematics motivation and later mathematics achievement (Time 2). Findings also indicate that ego-orientation and competence-valuation are positively associated with mathematics self-concept and over-rating, whilst public self-consciousness negatively predicts mathematics self-concept and is also associated with a tendency to under-rate oneself in this domain.

Achievement↗