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The conceptions of the nature of learning of first-year physiotherapy students and their relationship to students' learning outcomes.

Research shows that students' conceptions of what 'learning' is influences both their approaches to learning and their learning outcomes. Lower level conceptions of learning are associated with surface approaches to learning, encouraging poor quality learning outcomes. However, more advanced conceptions are associated with deep learning approaches and high-quality learning outcomes. The Structure of Observed Learning Outcomes (SOLO) taxonomy was used to analyse the conceptions of learning of a new intake of physiotherapy students. The presence of a relationship between these and assessment outcomes was also investigated. As in other studies, a majority of students had lower level conceptions of learning than desired in higher education. However, a larger proportion of students had higher levels of conception than has been found in other research. A direct relationship between conceptions of learning and learning outcomes was also identified. The implications of these findings for achievement of high-quality learning are discussed.

Journal Article↗

The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists' perspective.

PURPOSE: The Bobath concept, usually known as neuro-developmental treatment (NDT) in America, is one of the major approaches used to rehabilitate patients following stroke; however since the last publication of Bobath (1990), the concept has been taught via an oral tradition on postgraduate courses. This study therefore aimed to explore with experienced therapists firstly how the Bobath concept had changed since 1990, and secondly what they considered its main theoretical assumptions to be using a focus group research design. METHOD: Eight peer-nominated expert physiotherapists agreed to participate in two focus groups organized according to specialist interest in either neurology (group A) or elderly care (group B). Therapists were asked to discuss six topics based on a review of published literature. Data analysis involved several readings of verbatim transcriptions, from which key themes and concepts were developed. RESULTS: All therapists agreed on the following core themes defining Bobath: analysis of normal movement, control of tone and facilitation of movement. Neuroplasticity was described as the primary rationale for treatment with therapists using afferent information to target the damaged central nervous system. In addition group A discussed motor learning, whereas group B discussed patient focused goals and relating treatment to function. CONCLUSIONS: This study highlighted changes in theory, terminology, and techniques. Tone remained a major problem in the rehabilitation management of the hemiplegic patient; however much attention was also directed towards the musculoskeletal system. Both facilitation of normal movement components and task specific practice using specific manual guidance were considered critical elements of the Bobath concept. For Bobath therapists, physiotherapy has an important impact on both the performance components of movement and functional outcomes. In view of the small numbers involved in this preliminary study, further studies are now needed to determine if these themes and concepts are congruent with the majority of physiotherapists' interpretation of the Bobath concept in stroke rehabilitation.

Adult↗

Systematic review of measures and their concepts used in published studies focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities.

PURPOSE: To identify outcome measures cited in published studies focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities, and to identify and quantify the concepts contained in these measures using the ICF as a reference. METHODS: Electronic searches of Medline, Embase, CINAHL, Pedro and the Cochrane Library from 1997 to March 2002 were carried out. In a first step, abstracts of the retrieved studies were checked and data on the outcome measures and certain characteristics of the included studies were extracted. In a second step, the items of the questionnaires and their underlying concepts were specified. These concepts were then linked to ICF categories using standardized linkage rules. RESULTS: From the 1,657 abstracts retrieved, 259 studies met the inclusion criteria. In a second step, 277 formal assessment instruments and 351 single clinical measures were retrieved. A total of 1,353 concepts were extracted from the clinical and technical measures. Ninety-six percent of these concepts could be linked to ICF categories. Fifty-six second-level ICF categories representing the concepts contained in the measures. Twenty-six (46%) of the 56 categories belong to the component Body Functions, five (9%) to the component Body Structures, and 25 (45%) to the component Activities and Participation. CONCLUSIONS: The ICF provides a valuable reference to identify and quantify the concepts of outcome measures focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities. Our findings indicate a need to define and to agree on 'what should be measured' in rehabilitation care to allow for a comparison of patient populations.

Activities of Daily Living↗

Current practice and future interest of GPs and prospective parents in pre-conception care in The Netherlands.

BACKGROUND: Evidence for the effectiveness of pre-conception care is growing. GPs are among the possible providers of pre-conception care. OBJECTIVES: Our first aim was to investigate current pre-conception care activities of GPs and to determine whether prospective parents would visit the GP in the existing health care system. A further aim was to determine the interest of GPs and prospective parents in the introduction of pre-conception care clinics. METHODS: A survey was conducted among 200 GPs and 303 recently married couples (606 individuals). RESULTS: Of the eligible GPs, 52% (n = 102) participated, as did 70% (n = 381) of the eligible individuals who are planning a pregnancy. In the current situation, only a few individuals visit their GP pre-conceptionally, and many GPs do not discuss family history or consanguinity with prospective parents. In general, the GPs and prospective parents had a positive attitude towards the introduction of pre-conception care clinics. CONCLUSION: Since most GPs and prospective parents favoured the introduction of pre-conception care, future research should focus on the most appropriate way of implementation.

Family Practice↗

Urinary estrogen and progesterone metabolite concentrations in menstrual cycles of fertile women with non-conception, early pregnancy loss or clinical pregnancy.

BACKGROUND: Knowledge is limited of how estrogen and progesterone variability in fertile women are associated with achieving pregnancy. METHODS: From 1996 to 1998, we enrolled 347 textile workers without hormone treatment in Anhui, China, who provided daily urine and data upon stopping contraception for up to 1 year until clinical pregnancy. Urinary hCG was assayed to detect conception and early pregnancy losses. We compared urinary concentrations of estrone conjugates (E(1)C) and pregnanediol-3-glucuronide (PdG) in 266 clinical pregnancies, 63 early pregnancy losses and 272 non-conception cycles from 347 women and also in 94 clinical pregnancy and 94 non-conception cycles from the same women. RESULTS: Using generalized estimating equations and relative to 266 clinical pregnancy cycles, log(E(1)C) was lower in 272 non-conception cycles [beta = -0.3 ng/mg creatinine (Cr); SE = 0.1; P < 0.0001]. On average, daily E(1)C was 18 ng/mg Cr lower in non-conception cycles than in clinical pregnancy cycles. Relative to 94 clinical pregnancy cycles, log(E(1)C) was lower in 94 non-conception cycles (beta = -0.4 ng/mg Cr; SE = 0.1; P < 0.0001) from the same women (average difference in daily E(1)C was 20 ng/mg Cr). The odds of E(1)C less than the 10th percentile (<30 ng/mg Cr) were higher in early pregnancy loss cycles [odds ratio (OR) = 4.8; P = 0.0027] than in clinical pregnancy cycles in the early luteal phase. Compared with clinical pregnancy cycles, log(PdG) concentrations were lower in non-conception cycles during the follicular phase, but this analysis lacked power for multiple testing. CONCLUSIONS: Estrogen concentrations varied from cycle to cycle, and higher estrogen was associated with achieving clinical pregnancy.

Abortion, Spontaneous↗

Medical and veterinary students' structural knowledge of pulmonary physiology concepts.

PURPOSE: The goal of this study was to assess quantitatively medical and veterinary students' knowledge structures of 12 pulmonary physiology concepts before and after receiving a focused instructional block. The "goodness of fit" and internal consistency reliability of the students' knowledge structures were evaluated. Indexes of the students' structural knowledge were correlated with customary measures of student learning of the same concepts. METHOD: Knowledge structures were assessed using a questionnaire that requested similarity judgments about all possible pairs of the concepts: n(n - 1)/2 = 66 pairs. The similarity judgment data were analyzed using the individual differences (INDSCAL) model of multidimensional scaling (MDS). Dimension weights for individual students were then correlated with their final examination scores. RESULTS: A four-dimensional MDS solution provided the best structural fit to the pairwise concept-similarity data. Dimension 1 ranges from control of breathing to lung gas exchange. Dimension 2 ranges from control of breathing to respiratory mechanics. Dimension 3 separates perfusion from diffusion. Dimension 4 addresses ventilatory control. Hierarchical concept clusters are located within this framework. However, indexes of structural learning did not correlate with other measures of knowledge about the same concepts. CONCLUSION: The study outcomes, in contrast to research in other fields, suggest that structural knowledge in this domain differs from knowledge assessed by standard examinations. Further research involving other basic science or clinical concept sets is needed to verify or refute this finding.

Education, Medical↗

Using "concept sorting" to study learning processes and outcomes.

PURPOSE: First, to evaluate "concept sorting" as a tool for assessing knowledge organization in the memories of first-year medical students, and second, to study the relationship between knowledge organization and examination performance. METHOD: During 2001, first-year medical students taking the Renal Course at the University of Calgary Faculty of Medicine were given a questionnaire on scheme use and were given a concept-sorting task in the domain of metabolic alkalosis. The sophistication of their concept sorting was graded using the number of physiology-based groups they formed. Review of the course's examination scores allowed correlation with concept-sorting scores. Statistical analyses used Fisher's exact test and the two-sample t-test. Pearson's correlation coefficient and the kappa statistic were used for correlation between raters. RESULTS: A total of 81 of 99 students completed the study. The concept-sorting score (mean +/- SEM) for students who used the scheme was higher than was the score for students who did not (2.5 +/- 0.14 versus 1.91 +/- 0.12, p =.016). Students who scored higher in the concept-sorting task, referred to as "deep learners," scored higher than did "surface learners" on exam questions on metabolic alkalosis (2.81 versus 2.29, p =.02). There was no difference in the overall examination performances between the two groups. CONCLUSIONS: Concept sorting may be a useful tool for studying the learning process. Scheme use by students produces a positive outcome on examination performance.

Education, Medical, Undergraduate↗

The concept of somatization as a cultural and historical product of Western medicine.

Somatization is handled as a concept that plays an important role in the contemporary clinical theory and practice of psychiatry and general medicine. A distinct biomedical epistemology and model of illness underlies use of the concept and gives it meaning. First, the nature of the assumptions about the medical problems described by the concept are outlined. Then, some of the cultural and historical aspects of Western medical history that shaped the concept and its epistemology are reviewed. The concept is seen to arise as a consequence of the development of the modern ontological view of disease, the shift in the role ascribed to the nervous system and theoretical developments involving the explanation of psychoses through a descriptive language of psychopathology and bodily states. A discussion of non-Western perspectives of illness is pursued in order to highlight the differences in the conditions that led to the evolution of the concept in Western medicine. Some of the theoretical quandaries associated with the concept are briefly reviewed.

Cross-Cultural Comparison↗

Seasonal variation in preeclampsia based on timing of conception.

OBJECTIVE: Studies have suggested that the incidence of preeclampsia may be partially dependent on the month or season of delivery. We sought to evaluate whether preeclampsia occurs seasonally in our population and whether the timing of conception or delivery is more strongly associated with risk. METHODS: Between January 1995 and August 2003, we identified 142 primiparous women with singleton pregnancies who met the American College of Obstetricians and Gynecologists' definition for preeclampsia and compared them with 7,762 primiparous control deliveries. We analyzed rates of preeclampsia by individual month and 3-month seasonal blocks based on conception and delivery. Data were analyzed with the chi2 test, and logistic regression and odds ratios were calculated where appropriate. RESULTS: Preeclampsia occurred in 1.8% of singleton primiparous gestations (142/7,904). Cases were younger than controls (26.5 +/- 5.6 versus 28.0 +/- 0 6.0 years, P < .003), of similar race (97% white versus 96% white, P = .69), and equally likely to have a female child (45% versus 48%, P = .41). We found no significant association of month (logistic regression P = .20) of delivery with the risk of preeclampsia. There was a significant association of month (P = .003) of conception with risk of preeclampsia. Conception during the summer months had the highest risk (incidence 2.3%; odds ratio 1.7; 95% confidence limits 1.06, 2.75) compared with spring (incidence 1.4%). Fall (1.7%) and winter (1.6%) conceptions were associated with intermediate rates of preeclampsia. CONCLUSION: We identified a seasonal variation in preeclampsia that appears to be more strongly related to timing of conception than to the timing of delivery. The highest incidence of preeclampsia was associated with conception in the summer months. LEVEL OF EVIDENCE: II-2.

Female↗

Health literacy: concept analysis.

AIM: This paper reports an analysis of the concept of health literacy in order to clarify its meaning, reduce ambiguities associated with references to it, and promote consistency in using the concept in nursing dialogue and research. BACKGROUND: Health literacy is a relatively new concept in health promotion research. Only within the last decade have researchers identified the problems associated with health literacy, the role it plays in an individual's ability to comprehend health and self-care information, and its relationship to health outcomes. Clarifying the concept is essential so that nurses develop an awareness of the phenomenon and its relationship to the outcomes of their communication and health education efforts. METHOD: The method used for this concept analysis was that of Walker and Avant (1995). FINDINGS: Health literacy empowers people to act appropriately in new and changing health-related circumstances through the use of advanced cognitive and social skills. The defining attributes of health literacy are reading and numeracy skills, comprehension, the capacity to use information in health care decision-making, and successful functioning as a healthcare consumer. Antecedents of health literacy are literacy and a health-related experience. Consequences of health literacy include improved self-reported health status, lower health care costs, increased health knowledge, shorter hospitalizations, and less frequent use of health care services. Empirical referents of the concept are the Test of Functional Health Literacy in Adults and the health literacy component of the National Assessment of Adult Literacy. CONCLUSIONS: An analysis of the concept of health literacy enhances nurses' ability to assess more accurately their clients' levels of health literacy, thus identifying those at risk for misunderstanding health care instructions, shame associated with inadequate reading skills, and inability to adhere to health care recommendations.

Adult↗

Evaluation of the concept of supervision related to public health nurses in Norway.

AIM: The aim of the study is to clarify the concept of supervision by means of concept analysis, in order to evaluate the concept's application to the practise of public health nurses. BACKGROUND: According to the World Health Organization, a change in strategies for improving public health is necessary. This change demands new strategies. There exists little research concerning intervention strategies in public health. The concept of supervision is well used, but neither well-defined nor well described, either within the nursing discipline or across disciplinary boundaries. METHODS: The method is a review of literature. Twenty scientific papers covering the years 1996-2001 are analysed, using a concept-analysis methodology. FINDINGS: Supervision can be defined as a formal, pedagogical, relational enabling process, related to professional competence. Relationship and dialogue are central aspects. Supervision is based on theory and humanistic values, has a normative, formative and restorative function. The supervisor's competence is of great importance. Supervision has unclear boundaries with concepts such as psychotherapy, consultation and counselling. CONCLUSION: The concept of supervision as described in the selected papers is applicable to public health nurses' supervision of clients, with adaptation caused by the contextual variation of the relationship. Related to clients, supervision can be defined as a formal, pedagogical, relational enabling process with the purpose to strengthen resources, enhance assertiveness and improve independence and coping. It is necessary that registered public health nurses have the competence to supervise.

Humans↗

Early singleton pregnancy outcome: effects of maternal age and mode of conception.

PURPOSE: To assess the effect of prognostic factors on the outcome of singleton pregnancies. MATERIALS AND METHODS: First-trimester ultrasonographic (US) scans that demonstrated a living fetus in 4,156 consecutive singleton pregnancies were studied. The relationship between outcome and maternal age, mode of conception, maternal symptoms, and US findings was evaluated. RESULTS: Spontaneous abortion occurred in 371 of 4,156 (8.9%) cases. Higher pregnancy-loss rates were associated with older maternal age (P < 10(-5)), assisted mode of conception (P < 10(-8)), maternal symptoms of pain and/or bleeding (P < .001), and abnormal US findings (P < 10(-8)). US abnormalities were more frequent in older women than in younger women (P < 10(-5)) and in assisted conceptions than in natural conceptions (P < 10(-8)). At stepwise logistic regression, with gestational age as a covariate, US abnormalities and maternal symptoms independently affected pregnancy outcome. Maternal age and mode of conception had no further statistically significant effect on pregnancy outcome. CONCLUSION: The prognosis for older mothers and for those with assisted conception is not statistically significantly different from that for younger mothers and for those with natural conception if maternal symptoms, US findings, and gestational age are the same.

Abortion, Spontaneous↗

Four concepts that distinguish pediatric oncology care in Japan from that in the United States: telling the diagnosis, length of hospitalization, home care, and support systems.

The concepts of telling the diagnosis, length of hospitalization, home care, and support systems are described and compared in this article as they currently exist in pediatric oncology care in Japan and the United States. These four concepts were selected because they best convey differences in the care given in these two countries. These concepts are also integral to care goals related to improving the quality of life of pediatric oncology patients in both countries. Although quality of life and related concepts have been actively studied for the past two decades in the United States, these concepts have only recently begun to appear in the scientific literature in Japan. Continuing efforts to study related concepts may assist researchers and pediatric oncology patients and their families. A clear difference was found on these four concepts. Based on these comparisons and analysis, some strategies for developing well-being are described.

Adolescent↗

A small-scale concept-based laboratory component: the best of both worlds.

In this article, we describe an exploratory study of a small-scale, concept-driven, voluntary laboratory component of Introductory Biology at the Massachusetts Institute of Technology. We wished to investigate whether students' attitudes toward biology and their understanding of basic biological principles would improve through concept-based learning in a laboratory environment. With these goals in mind, and using our Biology Concept Framework as a guide, we designed laboratory exercises to connect topics from the lecture portion of the course and highlight key concepts. We also strove to make abstract concepts tangible, encourage learning in nonlecture format, expose the students to scientific method in action, and convey the excitement of performing experiments. Our initial small-scale assessments indicate participation in the laboratory component, which featured both hands-on and minds-on components, improved student learning and retention of basic biological concepts. Further investigation will focus on improving the balance between the minds-on concept-based learning and the hands-on experimental component of the laboratory.

Humans↗

Providing concept-oriented views for clinical data using a knowledge-based system: an evaluation.

OBJECTIVE: Clinical information systems typically present patient data in chronologic order, organized by the source of the information (e.g., laboratory, radiology). This study evaluates the functionality and utility of a knowledge-based system that generates concept-oriented views (organized around clinical concepts such as disease or organ system) of clinical data. DESIGN: The authors have developed a system that uses a knowledge base of interrelationships between medical concepts to infer relationships between data in electronic medical records. They use these inferences to produce summaries, or views, of the data that are relevant to a specific concept of interest. They evaluated the ability of the system to select relevant information, reduce information overload, and support physician information retrieval. MEASUREMENTS: The sensitivity and specificity of the system for identifying relevant patient information were calculated. Effect on information overload was assessed by comparing the amount of information in each view with the amount of information in the entire record. Information retrieval accuracy and cost (time) were used to measure the effect of using concept-oriented views on the efficiency and effectiveness of retrievals. RESULTS: The sensitivity and specificity of the system for identifying relevant clinical information were generally in the range of 70 to 80 percent. Concept-oriented views are effective in reducing the amount of information retrieved (over 80 percent reduction) and, compared with source-oriented views, are able to improve physician retrieval accuracy (p=0.04). CONCLUSION: Computer-generated, concept-oriented views can be used to reduce clinician information overload and improve the accuracy of clinical data retrieval.

Artificial Intelligence↗

Effects of body condition score in cows peripartum on the onset of postpartum ovarian cyclicity and conception rates after ovulation synchronization/fixed-time artificial insemination.

The aim of this study was to examine whether the nutritional state of cows peripartum was associated with the recovery of ovarian function and conception rates after synchronization of ovulation and fixed-time artificial insemination (OVSYNCH/TAI). The effect of the interval in days from calving to the first ovulation on conception rates after OVSYNCH/TAI was also investigated. Conception rates of cows after OVSYNCH/TAI (n=39) were 43.6%. The conception rates of cows with a body condition score (BCS) of 2.75-3.25 at 30 d postpartum and on the day of OVSYNCH treatment were significantly higher than in cows with a BCS < or =2.5 (P<0.05). The percentage of cows establishing ovarian cyclicity before 55 d postpartum in cows with a BCS of 2.75-3.25 at 30 d postpartum and on the day of OVSYNCH treatment were significantly higher than in cows with a BCS < or =2.5 (P<0.05). The conception rates after OVSYNCH/TAI in cows which recovered ovarian cyclicity within 34 d postpartum were significantly higher than in cows with first ovulation > or =56 d (P<0.05). These results indicated that the nutritional state in cows peripartum influenced the conception rates after OVSYNCH/TAI and the postpartum ovarian cyclicity and also suggested that the conception rates after OVSYNCH/TAI decreased in cows with delayed recovery of ovarian cyclicity.

Animals↗

[Construction and its characteristic on the concept of a 'health culture'].

Toward the 21st century, subjects and methods of hygiene and public health will be specialized and subdivided. However, practical approaches to human health need an integrated method focusing to a structure of human life. Under these circumstances, the concept of 'health culture' becomes prevalent. The role of hygiene related to the improvement of life style, the development of re-cycle system, and fulfillment of a barrier-free system focussed on the handicapped and the elderly have become increasingly important. Therefore, an increase in the recognition to the concept of 'health culture' is essential to the research of hygiene. The purpose of this paper is to make a historical and theoretical analysis of health culture', in order to promote it as the leading concept of all activities concerned with health in the 21st century. The methods of this paper are mainly historical and theoretical review. 'Health culture' was introduced in American and European societies a hundred years ago. Health culture in the USA involves knowledge and skills applied to actual daily life, refrecting pragmatism as the ideal feature of American society. In Germany, the concept of 'Hygienishe Kultur' was established at the field of social hygiene by Grotjahn and by Fischer in the early 20th century. This concept recognized the importance of the development of culture and independence of life in labour based on the evolution of the concept of 'Hygienishe Kultur'. In Japan, under the influence of German social hygiene, the social hygienic theory flourished. A social hygienist, Tetsuo Hoshino used the term 'hygienic culture' in the context of life creation toward a healthy life. Health culture is the total system concerning knowledge, experience, skill, and norms related to health, which has developed with the development of society. It has fundamental function promotes the creation of culture and self-cultivation of living man, whereas, it contributes to the realization of health based on individuality, in conjunction with the co-operation of medical and health sciences. The contemporary representation of health culture includes new health care activities such as self-care, a self-help movement, and health volunteer activities. It means the basic shift of the function of health culture is from that of life style to life movement. Nowadays, the role of hygiene in the total health care system is seriously considered. The goal, objects, and methods of hygiene should be re-evaluated under the concept of 'health culture', in order to re-define hygiene as the science for people living in a society.

Attitude to Health↗

Reasons for first teen pregnancies predict the rate of subsequent teen conceptions.

OBJECTIVE: To identify reasons for inconsistent contraceptive use that antedate conception and continue to predispose participants in adolescent-oriented maternity programs to unsafe sexual practices after delivery. We hypothesized that teens who attributed their failure to use contraceptives before their first conception exclusively to concerns about their side effects and/or their own lack of motivation to prevent conception would report less consistent contraceptive use and more repeat conceptions than would teens who attributed their previous failure to use contraceptives to their lack of capacity to do so. METHOD: We conducted a 2-year, prospective, longitudinal study of contraceptive use and repeat conceptions in a racially/ethnically diverse population of poor 13- to 18-year-olds. The 198 study participants were enrolled consecutively during their first pregnancies from an adolescent-oriented maternity program. RESULTS: The majority (84%) of the teens attributed their failure to use contraceptives before their first pregnancy partially to a lack of capacity to do so. As hypothesized, these teen mothers were significantly more likely to use hormonal contraceptives (85% vs 62%), (particularly Norplant, 47% vs 19%) and less likely to conceive again (13% vs 41%). Most teens attributed their inconsistent contraceptive use during the postpartum study period to three factors: side effects, plans to abstain from sexual intercourse, and their lack of motivation to postpone additional childbearing. CONCLUSIONS: The reasons teen mothers give for not using contraceptives consistently before their first pregnancies predict the occurrence of subsequent conceptions during adolescence. Those who attribute their previous failure to use contraceptives consistently to side-effect concerns and their own lack of motivation to postpone childbearing are least likely to use hormonal contraceptives after delivery and most likely to conceive again. Our findings suggest that future research should focus on the development of more effective interventions for preventing repeat conceptions among adolescent mothers who had the capacity to prevent their first pregnancies.

Adolescent↗