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PubMed1990

Qualitative evaluation of an AIDS health education poster. A rapid assessment method for health education materials.

In January 1989, the Johannesburg City Health Department developed an AIDS education poster. The poster was adapted from a cartoon in the Sowetan newspaper and was formally evaluated before its final production. As a result of this evaluation further editing and restructuring of the poster proved necessary. The methodology used in the evaluation is outlined, and some of the findings that emerged during the evaluation are discussed, since few formal evaluations of health education material seem to have been documented in South Africa. This study highlights the importance of formative evaluation of printed health educational media by a sample of the target audience before production and distribution.

Acquired Immunodeficiency Syndrome↗
PubMed1976

An audio-tutorial aid for dietary instruction in renal dialysis.

Four 10-min, color, video-tape cassettes, which include graphics, cartoon characters with dialogue, and live demonstrations, were developed to improve dietary adherence by patients receiving maintenance hemodialysis. The format of the tapes was directed primarily to the needs of educationally deprived patients. The tapes were assessed for efficacy following presentation to sixteen randomly selected patients in he University of Tennessee Artificial Kidney Center, Memphis. Highly significant, positive changes were revealed when post-test informational scores were compared with pre-test scores. In the behavioral scores, some positive changes were observed, although further reinforcement would be needed to achieve sufficient application of the information.

Adolescent↗
PubMed2003

Formative evaluation of an intervention to increase compliance to HIV therapies: the ALP project.

Non-adherence to highly effective antiretroviral medications can lead to treatment failure and the development of drug-resistant strains of HIV, and may result in an epidemic of treatment resistant HIV. This article describes a theory-based intervention (ALP) that was developed to increase adherence to HIV therapies among low-literacy populations of HIV positive African American women. The ALP intervention consists of a cartoon book and a cassette tape suitable for individuals with less than a 3rd-grade reading level. Qualitative data were collected through focus groups and expert panel interviews to conduct a formative evaluation. The results indicated that constructs of the Health Belief Model and Social Cognitive Theory were recognizable by behavioral scientists and that the materials would be used as intended by the target population to achieve the desired behavior change. This type of evaluation is a cost-effective method that can be used to develop effective interventions and obtain community buy-in.

Black or African American↗
PubMed1998

Using multimedia for patient information--a program about nocturnal enuresis.

OBJECTIVES: To identify the information needs of children with nocturnal enuresis, and to design, produce and evaluate an interactive computer program to provide this information. SUBJECTS AND METHODS: The program was developed over an 18-month period using information provided by children, parents and professionals, and was evaluated in a hospital-based enuresis clinic in 65 children. Usability and knowledge gained were also evaluated in 43 healthy children aged 8-10 years attending a local inner-city primary school. RESULTS: An interactive program about nocturnal enuresis was developed, which runs on a personal computer and uses sound, voice, cartoon drawings and animation in a modular design. Knowledge scores increased in clinic attendees and in schoolchildren after using the program (Wilcoxon matched pairs test, P < 0.001). This improvement was maintained when the program was re-tested 6-10 months later. CONCLUSION: This interactive computer program holds children's attention and increases their understanding of enuresis. Interactive multimedia may be useful to complement the information provided by health professionals. This method of communication may be particularly useful for children with a low level of literacy.

CD-ROM↗
PubMed2006

The effects of caffeine, dextroamphetamine, and modafinil on humor appreciation during sleep deprivation.

STUDY OBJECTIVES: Sleep loss consistently impairs performance on measures of alertness, vigilance, and response speed, but its effects on higher-order executive functions are not well delineated. Similarly, whereas deficits in arousal and vigilance can be temporarily countered by the use of several different stimulant medications, it is not clear how these compounds affect complex cognitive processes in sleep-deprived individuals. DESIGN: We evaluated the effects of double-blind administration of 3 stimulant medications or placebo on the ability to appreciate humor in visual (cartoons) or verbal (headlines) stimuli presented on a computer screen following 49.5 hours of sleep deprivation. SETTING: In-residence sleep-laboratory facility at the Walter Reed Army Institute of Research. PARTICIPANTS: Fifty-four healthy adults (29 men, 24 women), ranging in age from 18 to 36 years. INTERVENTIONS: Each participant was randomly assigned to 1 of 3 stimulant medication groups, including caffeine, 600 mg, n = 12; modafinil, 400 mg, n = 11; dextroamphetamine, 20 mg, n = 16; or placebo, n = 14. MEASUREMENTS AND RESULTS: Humor appreciation for cartoon stimuli was enhanced by modafinil relative to both placebo and caffeine, but there was no effect of any stimulant medication on the appreciation of verbal humor during sleep loss. In contrast, all 3 stimulants improved psychomotor response speed, whereas only caffeine and dextroamphetamine improved ratings of subjective sleepiness. CONCLUSIONS: Findings suggest that, despite similar alerting and vigilance-promoting effects, these 3 compounds have significantly different effects on those highly complex cognitive abilities mediated by the pre-frontal cortex.

Adolescent↗
PubMed2000

News coverage of alcohol and other drugs in U.S. college newspapers.

This study investigated the substance use-related content of a sample of student-run college newspapers. Two independent coders examined 157 news stories, features, editorials, commentaries, letters, photographs, and cartoons. Items about alcohol appeared in one out of every two issues, while items about other drugs appeared in one out of every five issues. Basic information about alcohol and other drug (AOD) use was reported in about one-fifth of the items, while three-fourths dealt with social, legal, safety, or health problems associated with AOD use, especially alcohol consumption. Just over half referred to some type of control policy, most often an enforcement action. Around one-fourth mentioned educational efforts to promote AOD prevention. Very few dealt with detection, intervention, or treatment. Most college newspapers are missing good opportunities for more extensive coverage of AOD issues that would better inform their readers, especially about factors contributing to campus AOD problems and specific program and policy options.

Adult↗
PubMed2006

Inferring thought and action in motor neurone disease.

The traditional assumption that classical motor neurone disease (MND) invariably spares cognitive function is now recognised to be incorrect. Deficits have most commonly been demonstrated on executive tasks suggesting impaired function of frontal systems. Yet, crucial aspects of frontal lobe function have not hitherto been explored. The study used tests of theory of mind (ToM) (interpretation of cartoons and stories) to examine the ability of 16 patients with MND to interpret social situations and ascribe mental states to others. Only minor differences were elicited in the MND group as a whole compared to controls, and performance was not differentially affected for cartoons and stories requiring inference of another's mental state (mental) compared to control (physical) cartoons and stories. However, abnormalities were elicited on both mental and physical tasks in a subgroup of patients with bulbar signs. Moreover, examination of individual patient scores revealed a spectrum of performance ranging from normal to severely impaired. Errors were qualitatively similar to those seen in frontotemporal dementia (FTD). Performance on the ToM tasks was significantly correlated with conventional, untimed measures of executive function, suggesting that ToM deficits in MND are likely to be linked to a more general executive failure. The findings contribute to the understanding of ToM performance in neurodegenerative disease and provide further evidence of the association between MND and FTD.

Aged↗
PubMed2005

Sex differences in brain activation elicited by humor.

With recent investigation beginning to reveal the cortical and subcortical neuroanatomical correlates of humor appreciation, the present event-related functional MRI (fMRI) study was designed to elucidate sex-specific recruitment of these humor related networks. Twenty healthy subjects (10 females) underwent fMRI scanning while subjectively rating 70 verbal and nonverbal achromatic cartoons as funny or unfunny. Data were analyzed by comparing blood oxygenation-level-dependent signal activation during funny and unfunny stimuli. Males and females share an extensive humor-response strategy as indicated by recruitment of similar brain regions: both activate the temporal-occipital junction and temporal pole, structures implicated in semantic knowledge and juxtaposition, and the inferior frontal gyrus, likely to be involved in language processing. Females, however, activate the left prefrontal cortex more than males, suggesting a greater degree of executive processing and language-based decoding. Females also exhibit greater activation of mesolimbic regions, including the nucleus accumbens, implying greater reward network response and possibly less reward expectation. These results indicate sex-specific differences in neural response to humor with implications for sex-based disparities in the integration of cognition and emotion.

Adult↗
PubMed2003

Guidelines for developing and implementing humor in nursing classrooms.

The three teachers in this study selected many types of humor to exemplify their points. To avoid predictability, they varied their humor presentation styles and frequency by using simple cartoons projected on a screen, jokes and stories, and songs and dance routines. All three teachers engaged in a continuous search for new material to further expand their repertoire. Careful not to overuse humor, they never lost sight of the learning objectives, but they added enough humor to sustain students' attention. The teachers gradually increased their use of classroom humor as they felt more comfortable with the content and setting. All of the students' and teachers' comments corroborate the conclusions reached by Bryant and Zillmann 1989), "It would appear that success in teaching with humor...depends on employing the right type of humor, under the proper conditions, at the right time, and with properly motivated and receptive students' (p. 74). Not all types of humor are appropriate for all teachers. However, for teachers who carefully invest time and effort into learning to teach with humor, the reward can be a successful and enjoyable experience for all involved.

Education, Nursing↗
PubMed1986

Comprehension of humorous and nonhumorous materials by left and right brain-damaged patients.

Right hemisphere-damaged (RHD) and left hemisphere-damaged (LHD) aphasic patients were tested on a nonverbal cartoon completion task that included a humorous (Joke) and a nonhumorous (Story) condition. In both conditions, RHD patients performed worse than LHD patients. More importantly, the qualitative difference between the errors produced by the two groups suggests that right and left hemisphere brain damage impairs different components of narrative ability. RHD patients showed a preserved sensitivity to the surprise element of humor, and a diminished ability to establish coherence. Conversely, LHD patients, when they erred, showed an impaired sensitivity to the surprise element of humor, and a preserved ability to establish coherence by integrating content across parts of a narrative. These results suggest that the observed humor comprehension deficits of RHD patients result specifically from right hemisphere disease and not from brain damage irrespective of locus. The performances of the RHD and LHD patients groups together support a separation of narrative ability from the traditional aspects of language ability typically disrupted in aphasia.

Aphasia↗
PubMed1990

[An assessment of the acceptance of a face graph as a health education device].

With the aging of society, an increasingly greater number of people receive health evaluations organized by the community. Results of health evaluations are usually obtained as multiphasic numerical figures which are usually written down directly into a prescribed results form by which the community health personnel inform examinees of their health status. Most of aged examinee, however, cannot fully comprehend their own health status expressed as multiphasic numerical figures. Community health personnel also have difficulty in explaining these numerical results. Although the cartoon of face has been shown to be an effective device to help understand multiphasic numerical values, its use is not yet popular among community health personnel. The use of a face graph as an aid for health information and education activities by community health personnel was studied using a simple face drawing system developed for lap-top microcomputers. In this study, the acceptability of this face was evaluated by 29 community health nursing students and 31 community health nurses, studying and/or working in Nagasaki Prefecture, Japan. The first evaluation was made of a newly developed prescribed health evaluation result form using a face graph (facial form). All subjects evaluated the acceptability of this facial form by comparing it to the usual numerical form on the basis of the following five items: (1) discrimination of abnormal range, (2) evaluation of the degree of abnormality, (3) discrimination of normal range, (4) provocation of interest in one's own health status, and (5) stimulation of familiarity in one's own health status.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Health Nursing↗
PubMed2006

A visual joke fMRI investigation into Theory of Mind and enhanced risk of schizophrenia.

Theory of Mind (ToM) or mentalizing is the ability of individuals to determine the intentions and behavior of others. This ability is known to be compromised in schizophrenia and has been shown to fluctuate with symptom severity. Neuropsychological investigations into relatives of individuals with schizophrenia have shown that some relatives also show a deficit in this area of social cognition. In order to address this state and trait issue, we investigated the performance of high-risk relatives of individuals with schizophrenia to those of a matched control group (n = 13) on a blocked design visual joke fMRI paradigm. The task involved looking at two sets of cartoon jokes, one set which required mentalizing abilities to understand the jokes and another set that did not require such abilities. Relatives were divided into two groups based on the presence (HR+, n = 12) or absence (HR-, n = 12) of positive symptoms. The task provided robust activations across the groups in areas previously associated with mentalizing abilities, such as the PFC, precuneus, and temporal lobes. Significant between-group activations were observed in the PFC (primarily BA6, 8, and 9) with the HR- activating significantly greater than the HR+ in these regions. Both a secondary state-specific analysis and a third post hoc analysis further investigating state effects showed significant PFC between-group differences. This study is the first time relatives of individuals with schizophrenia have been imaged using a ToM paradigm, and the results provide evidence of both a state and state-mediated trait effect.

Adult↗
PubMed1999

Practical methods to increase use of advance medical directives.

OBJECTIVE: To compare the effectiveness of two means for increasing the use of advance medical directives: written materials only versus written materials and an educational videotape. DESIGN: Population-based, randomized controlled trial with 3-month follow up. SETTING: Kaiser Permanente Colorado Region, a not-for-profit group-model health maintenance organization. PARTICIPANTS: A population-based sample of all 1,302 members aged 75 years and older who used the Franklin Medical Office, excluding 55 persons who died or disenrolled during the study period or were identified by their physicians as blind or cognitively impaired. INTERVENTIONS: All subjects were mailed a 10-page cartoon-illustrated educational pamphlet on patient choices, a selection of Colorado advance medical directive forms, and a guide to their completion; 619 subjects also were mailed a 20-minute videotape on advance directives. Both groups had access to a study nurse for assistance in completing and placing advance medical directives. MEASUREMENTS AND MAIN RESULTS: The main outcome measure is the proportion of subjects who placed a directive in their medical record for the first time. Placement rates increased almost identically, from 21.2% to 35.0% in the written materials-only group and from 18.9% to 32.6% in the group receiving the videotape (95% confidence interval for difference -0.04, 0.04, p =.952). CONCLUSIONS: In an elderly population with a substantial baseline placement rate, mailing of written materials substantially increased placement of an advance directive in the medical record, but the addition of a videotape did not. Mailing the video did increase the use of treatment trials and made patients more aware of reasons not to use advance directives.

Advance Directives↗
PubMed1985

[EEG mapping during a visuo-spatial task. Averaged maps and group statistics].

Twenty young volunteers (10 men, 10 women), righthanded, students, have been recorded in EEG cartography in different situations. We have compared the quantified EEGs when the subjects were resting, eyes closed and later, eyes opened, looking at a cartoon. The EEGs were quantified by spectral Fourier analysis and submitted to data reduction. Ten spectral parameters were computed, yielding 51 variables allowing computations and drawings of 90 EEG maps. Mean parameters, mean variables, averaged EEG maps have been computed for the entire group, between sub-groups, between hemispheres. Non-parametric permutation Fisher tests have been applied for statistical comparisons and statistical validations of the EEG maps computed between subjects. The activation of EEG tracings produced by the opening of the eyes were caracterized topographically by: mean alpha frequencies increased over temporal and rolandic areas; mean alpha amplitudes in microV divided by a factor 3 for occipital areas but unchanged in topography; mean relative amplitudes divided by a factor 2 but with a topography being more parietal than occipital for the alpha rhythm; a resonance coefficient greater over the left parietal than the right (alpha more regular), whereas it was greater over the right occipital than the left during the resting condition. Statistically for the whole group, the left hemisphere, recorded after the right, is more 'activated' in the eyes closed situation. During visual attention, the left hemisphere is less activated than the right.

Adult↗
PubMed2001

Print media coverage of California's smokefree bar law.

OBJECTIVE: To assess the print media coverage of California's smokefree bar law in the state of California. DESIGN: Content analysis of newspaper, trade journal, and magazine items. SUBJECTS: Items regarding the smokefree bar law published seven months before and one year following the implementation of the smokefree bar law (June 1997 to December 1998). Items consisted of news articles (n = 446), opinion editorials (n = 31), editorials (n = 104), letters to the editor (n = 240), and cartoons (n = 10). MAIN OUTCOME MEASURES: Number and timing of publication of items, presence of tobacco industry arguments or public health arguments regarding law, positive, negative, and neutral views of opinion items published. RESULTS: 53% of items published concerning the smokefree bar law were news articles, 47% were opinion items. 45% of items regarding the smokefree bar law were published during the first month of implementation. The tobacco industry dominated coverage in most categories (economics, choice, enforcement, ventilation, legislation, individual quotes), except for categories public health used the most frequently (government role, tactics, organisational quotes). Anti-law editorials and letters to the editor were published more than pro-law editorials and letters. Region of the state, paper size, presence of local clean indoor air legislation, and voting on tobacco related ballot initiatives did not have an impact on the presence of opinion items. CONCLUSIONS: The tobacco industry succeeded in obtaining more coverage of the smokefree bar law, both in news items and opinion items. The tobacco industry used historical arguments of restricting freedom of choice and economic ramifications in fighting the smokefree bar law, while public health groups focused on the worker protection issue, and exposed tobacco industry tactics. Despite the skewed coverage, public health groups obtained adequate attention to their arguments to keep the law in effect.

Bibliometrics↗
PubMed2001

[Does subcutaneous cellular tissue exist?].

BACKGROUND: The definition of the "subcutaneous cellular tissue" is still debated. METHODS: In order to establish the localisation and composition of this tissue, or, merely its existence, we interviewed French dermatologists and conducted a bibliographic study on the historical definitions of the so-called "subcutaneous cellular tissue". A questionnaire was sent to French professors of dermatology to assess their definition of the "subcutaneous cellular tissue". They were also asked to make a simple cartoon showing the anatomy of the skin and "subcutaneous cellular tissue". RESULTS: We obtained 37 answers which could be classified in three main categories: 1) "subcutaneous cellular tissue" and hypodermis are synonymous, 2) "subcutaneous cellular tissue" is an autonomous tissue which separates the hypodermis from the tissues below and 3) "subcutaneous cellular tissue" designates all structures located below the hypodermis. In an historic perspective, the "cellular system" was a macroscopic concept described in the eighteenth century as whitish fibrils delimitating "cells". It was renamed loose connective tissue in the twentieth century and thus "cellular" became obsolete. The definition of skin, and of "subcutaneous cellular tissue" in particular, has greatly changed over time. In the eighteenth century, only epidermis and dermis were considered as belonging to the skin, although some included the tela subcutanea. In the twentieth century, the "subcutaneous cellular tissue" is considered either as a part of the hypodermis, or as the hypodermis itself or as a tissue located between the hypodermis and the fascia. DISCUSSION: The difficulty in defining "subcutaneous cellular tissue" is the result of a French semantic problem. The "cellular tissue" became loose connective tissue. For French dermatologists, the skin is composed of epidermis, dermis and hypodermis and the hypodermis can therefore not be subcutaneous. In order to check whether an autonomous tissue could be evidenced under the skin, we conducted an histologic study, which is presented in a second article.

Connective Tissue↗
PubMed2001

Elementary school-aged children's reports of their health: a cognitive interviewing study.

There are no standard methods for assessing the quality of young children's perceptions of their health and well-being and their ability to comprehend the tasks involved in reporting their health. This research involved three cross-sectional studies using cognitive interviews of 5-11-year-old children (N = 114) to determine their ability to respond to various presentations of pictorially illustrated questions about their health. The samples had a predominance of children in the 5-7-year-old range and families of lower and middle socio-economic status. The research questions in Study 1 involved children's ability to convert their health experiences into scaled responses and relate them to illustrated items (n = 35); Study 2 focused on the type of response format most effectively used by children (n = 19); and Study 3 involved testing children's understanding of health-related terms and use of a specific recall period (n = 60). The results of Study 1 showed that children identified with the cartoon drawing of a child depicted in the illustrated items, typically responding that the child was at or near their own age and of the same gender, with no differences related to race. Study 2 results indicated that children responded effectively to circles of graduated sizes to indicate their response and preferred them to same-size circles or a visual analogue scale. Tests of three-, four-, and five-point response formats demonstrated that children could use them all without confusion. In Study 3, expected age-related differences in understanding were obtained. In fact, the 5-year-old children were unable to understand a sufficient number of items to adequately describe their health. Virtually all children 8 years of age and older were able to fully understand the key terms and presentation of items, used the full five-point range of response options, and accurately used a 4-week recall period. Six- and seven-year-olds were more likely than older children to use only the extreme and middle responses on a five-point scale. No pattern of gender differences in understanding or in use of response options was found. We conclude that children as young as eight are able to report on all aspects of their health experiences and can use a five-point response format. Children aged 6-7 had difficulty with some health-related terms and tended to use extreme responses, but they understood the basic task requirements and were able to report on their health experiences. These results provide the guidance needed to develop and test a pediatric health status questionnaire for children 6-11 years old.

Analysis of Variance↗
PubMed2006

Knowledge improvement with web-based diabetes education program: brainfood.

BACKGROUND: Health literacy has a direct effect on health outcomes, but the complexity of diabetes education and time constraints on the health care team have made delivery of this education difficult. METHODS: The Florida Initiative in Telemedicine and Education developed an education website (Brainfood) for multiple literacy levels. The site consists of 19 education units, 15 of which provided gradable test scores; a narrated cartoon provides essential information to low reading level learners. Text is presented at both 4th and 10th grade level. Literacy level of the user is not evaluated; rather, users choose their preferred format. The administrative backbone stores user demographics and test scores. Nurses can receive credit hours for completion of Brainfood, 13 tests required. Results were analyzed by a non-paired t test. RESULTS: Five hundred thirteen users have logged in to the site and clicked "I agree" on an informed consent. Of non-nurses, 145 of 389 took pre-tests (range 89-145 depending on module), and 135 took post-tests (range 84-135). For each of the 15 modules, post-test scores improved significantly (P < 0.001 by non-paired t test). Of nurses, 68 of the 124 took pre-tests (range 26-68), and up to 56 (range 24-56) took post-tests. Post-test scores improved significantly (P < 0.05 by non-paired t test) on 13 modules. Post-test scores improved, but were not statistically significant for "Nutrition 101," a module about very basic nutrition. Web-based education about Type 1 diabetes mellitus improved the knowledge level of all users. Nurses had a lower margin of improvement for most modules as they started with a higher base knowledge level. Non-nurses improved significantly on all modules from pre-test to post-test. Post-test scores for the nurses and non-nurses were indistinguishable. CONCLUSION: Brainfood, a web-based diabetes education program, is educationally sound and effective at delivering Type 1 diabetes mellitus education to both professionals and non-professionals. Web access from non-clinic settings can improve access to high-quality education for learners in remote or underserved locations.

Caregivers↗