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Creative activity and sex-role identity in elementary school children.

The relationship of creative activity to sex-role identity was examined in boys (N = 80) and girls (N = 56), aged nine to twelve, of above average intelligence. Endorsement of personal characteristics that cut across sex stereotypes was associated with participation in a wide variety of creative activities. When analyzed by specific activity, the relationship with sex-role followed a consistent pattern for boys and girls combined: male activities such as sports with scores on the masculine scale, female activity such as dance or art with scores on the feminine scale, and sexually indeterminate activities such as drama or social leadership with scores on both scales.

Aptitude↗

Influence of play on creative thinking.

The immediate influence of flexible and highly structured play on the creative thinking of 184 fourth-grade boys and girls was investigated. Following either flexible or highly structured art, drama, and playground activities, children's performances on the Torrance Tests of Creative Thinking were evaluated. Children who participated in flexible play experiences showed significantly greater creative thinking than children participating in the highly structured play experiences. No significant differences were found between boys and girls related to effects of flexible and structured play on creative thinking. Implications for curriculum are explored.

Child↗

The meaning of life-threatening disease in the area of the head and neck.

The revelation that one has a life-threatening disease creates a sentient flood of emotions that infuse the patient with fear, confusion and depression. It contains the spectrum of pain, suffering, deterioration of life-style, crippling and possible annihilation. This burden falls first on the patient and his family, and then on his doctor. The drama is a dilemma of cure or palliation wrapped about the emotional core of that person with science, drugs, technology, mysticism and hope. The ongoing process is the most dynamic encounter of being alive, and before it is finished will have used and drained a large percentage of the vulnerable emotions that identify our humanness. An overview of these involvements as they relate to the area of the head and neck shows how complex the process has become, the remoteness of its solution and the truth of its experience.

Attitude to Death↗

[Inoculation at 18th century Geneva].

As it was introduced in 18th century Europe, the smallpox inoculation, presented by its supporters as a masterpiece of enlightened rationality , gave rise to passionate philosophical, medical, and theological debates. The history of inoculation deals with public health as well as individual experience and medical, progress. Too young to provide us with first-hand evidence, children are central, yet absent figures in this history. Focusing essentially on Geneva, this article firstly indicates what, according to doctors, the theoretically ideal age to be inoculated is. It then turns to the inoculators, who hesitate to operate on children because of their weak constitution, for fear of the negative publicity a failure would bring. It finally presents the reception of inoculation by the public within two different contexts: the public initiatives taken in Geneva in the field of inoculation, and the case of a family drama ensuing from the failure of an inoculation. The purpose of this article is to: (1) summarize the chronology and social aspects of the history of inoculation in Geneva; (2) demonstrate that the reputation of the inoculating physician is a fundamental parameter guiding parents in their choice; and (3) raise the question of what inoculation can teach us about the perception of childhood during the Ancien Régime.

Allergy and Immunology↗

The re-appearing shadow of 1918: trends in the historiography of the 1918-19 influenza pandemic.

This article traces the ways in which the subject of the "Spanish" Influenza pandemic of 1918-19, the worst short-term pandemic of modern times, has been treated (or ignored) by historians over the last 86 years. In doing so , it identifies four distinct surges of interest in the topic, each producing a different conception of this pandemic as history: as epidemiology, as high drama, as social science and ecology, and as scientific saga. It seeks to explain these differing conceptions as part of a wider phenomenon, viz., how an event can be neglected, discovered, made, and re-made as history.

Disease Outbreaks↗

[The illness experience of women in advanced uterine cancer].

PURPOSE: This hermeneutical inquiry was aimed at understanding the experience of women with advanced uterine cancer and providing sociocultural data on hospice nursing for these Korean women. We adopted hermeneutic phenomenological approach of van Manen. The research question was "What do women with advanced uterine cancer experience in their life?". METHOD: The data for this paper came from interviews with 11 participants between February, 2000 and May, 2001 and reviews of secondary text of essay and drama, poet, memorandum. Each informant was interviewed three or more times for 30 min.-2 hours. In the process of analysis we did reflective thinking and used line-by-line and highlighting analysis techniques. RESULT: The substantial themes of illness experience of women in advanced uterine cancer were 'Endless suffering', 'In the midst of chaos and darkness,' 'on the wish of new possibility', 'finding new transformed self. CONCLUSION: Women with Advanced uterine cancer suffer with complex problems and wonder in the midst of chaos and darkness, but they find a new transformed self by the wish of new possibility and experience human becoming.

English Abstract↗

Prognostic significance of HLA-DR antigen in dysplasia, carcinoma in situ and invasive carcinoma of the gallbladder.

OBJECTIVE: Prognosis of gallbladder carcinoma is poor. The two most important factors having the greatest effect on survival are pathologic stage of disease and histologic grade of the tumour. Our study points towards the value of HLA-DR antigen in the prognosis of gallbladder carcinoma. DESIGN: Thirty one cases of dysplasia of the gallbladder, 12 cases of carcinoma in situ, and 39 cases of invasive carcinoma for the detection of HLA-DR monoclonal antigen were studied. T helper (TH) marker (CD4) in the tumour stroma of the relevant cases was also studied, given that it is now known that the dependence of immune responsiveness on the class II antigens reflects the central role of these molecules in presenting antigen to TH cells. SETTING: Pathology Departments of Drama General Hospital and Ippokration Hospital of Salonica in twelve years period (1990-2002). RESULTS: HLA-DR was expressed in 20 of 31 dysplasias (64.5%), four of 12 in situ (33.3%), and in 10 of 39 invasive carcinomas (25.6%). CD4 was expressed in nine of 31, dysplasias (29%), five of 12 in situ (42%), and in 26 of 39 invasive carcincomas (67%). CONCLUSIONS: The results showed decreased expression of HLA-DR and increased expression of CD4 as the lesion progressed to malignancy. The aberrant expression of HLA-DR by epithelial cells of dysplasias, of carcinomas in situ and of invasive carcinomas agrees with the hypothesis of the dysplasia-carcinoma in situ sequence as the usual route for the development of invasive carcinoma. The immune attract mechanism by low HLA-DR signalling seems to be of minor importance in the malignant and metastatic potential of the gallbladder, epithelial tumours.

CD4 Antigens↗

Play techniques with neurologically impaired preschoolers.

A pilot project was undertaken to study the effect of educational play as an intervention approach. The study was conducted with 14 neurologically impaired, physically handicapped preschool children, parents, community teachers, and developmental center staff. Educational play consisted of art and drama group activities presented according to the normal sequence of play development, from sensorimotor, to symbolic, to sociodramatic play. After a 7-week course of intervention, the children's performance, as measured by items in the Vulpe Assessment Battery, improved in six areas of development. Overall improvement was statistically significant. In addition, participating adults began to value the use of play as an essential component of child development. Results suggest the need for a systematic study of play in intervention with preschool, neurologically impaired, and physically handicapped children.

Child↗

The expert witness in medical malpractice litigation.

The experience of serving as an expert witness can add considerably to a physician's knowledge of medicine and the forces that affect the profession. Each case compels the physician to examine carefully all the clinical data. The physician must assess the quality of care given and render an opinion that is consistent with the facts and pertinent literature. He must defend his position under close questioning by an informed attorney aided by expert witnesses on the opposing side. This rigorous exercise requires considerable skill and experience. It has many of the characteristics of a well-conducted clinicopathological conference, with the added drama of the interplay of personalities. Despite the stimulating atmosphere, it is critical to maintain objectivity by asking yourself repeatedly, "What would I have done if placed in the same circumstance as the accused physician?" If you accept the responsibility of serving as an expert witness, it should be one of the best consultations you have ever given.

Attitude of Health Personnel↗

Literature and medicine: contributions to clinical practice.

Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine.

Clinical Medicine↗

Introduction. Time and medicine.

Although historians work with the record of events in public time, they have not developed an explicit understanding of lived time. To set the stage for the other essays in this issue of Annals, this introductory essay explores how an understanding of lived or "private" time began to emerge in the early 20th century in the works of that era's major thinkers: Henri Bergson's philosophy of duration, Emile Durkheim's social time, Sigmund Freud's five psychoanalytic temporal narratives, and Eugene Minkowski's exploration of lived time. This essay then considers the reaction against the burden of history that began with the great 19th-century historicizers: Comte, Hegel, Marx, Darwin, and Spencer. It reflects on the effort, beginning in those years, of modern artists and intellectuals to focus on the personal past in place of the overbearing burden of the historical past. New ways of experiencing the present, made possible by new communication technologies, including the telephone and telegraph, have centered on the experience of simultaneity. Norbert Wiener's cybernetics, Marshall McLuhan's globalism, and the Internet have further transformed how both the medical and lay communities experience past, present, and future, as well as near and far. The discussion concludes with consideration of Eurotransplant, an Internet-based information and action network used by physicians to coordinate organ transplantation; it is a system that integrates cybernetics, globalism, and the Internet in an everyday, real drama of the electronic age of simultaneity.

Cybernetics↗

The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?

In alternative medicine, the main question regarding placebo has been whether a given therapy has more than a placebo effect. Just as mainstream medicine ignores the clinical significance of its own placebo effect, the placebo effect of unconventional medicine is disregarded except for polemics. This essay looks at the placebo effect of alternative medicine as a distinct entity. This is done by reviewing current knowledge about the placebo effect and how it may pertain to alternative medicine. The term placebo effect is taken to mean not only the narrow effect of a dummy intervention but also the broad array of nonspecific effects in the patient-physician relationship, including attention; compassionate care; and the modulation of expectations, anxiety, and self-awareness. Five components of the placebo effect--patient, practitioner, patient-practitioner interaction, nature of the illness, and treatment and setting--are examined. Therapeutic patterns that heighten placebo effects are especially prominent in unconventional healing, and it seems possible that the unique drama of this realm may have "enhanced" placebo effects in particular conditions. Ultimately, only prospective trials directly comparing the placebo effects of unconventional and mainstream medicine can provide reliable evidence to support such claims. Nonetheless, the possibility of enhanced placebo effects raises complex conundrums. Can an alternative ritual with only nonspecific psychosocial effects have more positive health outcomes than a proven, specific conventional treatment? What makes therapy legitimate, positive clinical outcomes or culturally acceptable methods of attainment? Who decides?

Anxiety↗

Attitudes towards a high security hospital.

AIM: To study attitudes towards Rampton Hospital by reviewing the attitudes of external students and professionals in training following an arranged guided tour of the hospital; and examining media coverage of the hospital over one year. METHOD: All visitors had a guided day tour of Rampton. Everyone was given a questionnaire to complete at the end of the tour, and responses were reviewed. Rampton public relations department collects all print media coverage and monitors broadcasts in the UK. The department then assimilates this information into an annual report, which was examined for the relevant year. RESULTS: Questionnaires were given to 995 visitors and completed by 416 (42 per cent). Of those that returned the questionnaires, 95 per cent (n = 395) rated their satisfaction with the tour as either 'satisfied' or 'very satisfied'. A positive change in attitude was indicated by approximately one quarter of respondents (n = 105) following their tour. There were no negative changes in attitude expressed. Of the 203 press cuttings relating specifically to the hospital, 59 (29 per cent) were classed as positively enhancing and building the reputation of the hospital, 86 (42 per cent) were classed as negative and 58 (29 per cent) were classed as neutral. CONCLUSION: The tour of Rampton was valuable in bringing about a positive attitude change in the visitors. Although some media coverage assessed was negative, it had been expected to be more so. The authors wonder whether people's negative impressions are formed from the wider media, such as television dramas and movies.

Attitude to Health↗

An art therapy group for bereaved youth in hospice care.

Through art, music, and drama children can creatively express the feelings of sadness and anger that occur when a family member dies. In so doing, they can often avoid later difficulties resulting from unresolved emotions. Hospices may want to develop an art therapy group to facilitate this process with clients and their families.

Adolescent↗

Spiritual care of the person with AIDS. Literature and art can touch closed hearts.

Spiritual ministers, challenged to find meaningful ways to heal the hearts of persons with AIDS, are turning to some untraditional sources for help. Poetry, art, and stories are among the creative instruments for healing that pastoral ministers are bringing to the bedsides of the terminally ill. The story is the primary tool of spiritual care. Spiritual ministers working with persons with AIDS and their families should elicit and listen to their stories, which serve multiple purposes. Telling the stories is therapeutic for the person with AIDS. For the minister, the stories identify areas that need reconciliation, as well as those which call for celebration. Finally, when the time is right, the minister can tell another story, one that offers consolation and hope to the afflicted. Ritual is another tool of spiritual care. Just as the concrete image symbolizes the spiritual reality, so, too, does ritual facilitate or help celebrate spiritual healing. The Bible is a rich source of ideas for creative ritual. Other effective tools are art, drama, poetry, guided meditations, and dreams. In the hands of sensitive care givers, they are instruments of spiritual healing.

Acquired Immunodeficiency Syndrome↗

Assisted suicide. Kevorkian debate blurs the border between judicial and legislative law.

Staying current with the day-to-day drama surrounding Jack Kevorkian is nearly impossible for a bimonthly newsletter, but several significant events are worth exploring--rulings on the constitutionality of Michigan's law barring suicide assistance, the impact of the 20th Kevorkian-assisted suicide of a physician, and the public's response to the book Final Exit.

Books↗

A source of hope for at-risk youth. A hospital's community outreach efforts provide an alternative for troubled teens.

In 1990 St. Bernardine Medical Center, San Bernardino, CA, initiated a mission project to reach out to youth and families in the hospital's service area. Increased unemployment, escalating crime, and a failing social structure had left many San Bernardino residents with few resources for breaking out of a cycle of crime and poverty fostered by their environment. Responding to the results of a community needs assessment, St. Bernardine mission project planners decided the project's first program should target at-risk youth. Collaborating with the San Bernardino County Probation Department, St. Bernardine began offering a variety of services to youth in the probation department's Regional Youth Educational Facility, which houses boys between the ages of 16 and 18, and the Kuiper Youth Center, which houses girls between 11 and 18 years old. Realizing that a truly effective program would have to maintain contact with youth after they left these facilities, St. Bernardine expanded its outreach efforts to include at-risk families as well. The mission project's 12-week Parenting Re-entry Program builds parenting skills by addressing a variety of topics, including values clarification, communication skills, and positive reentry into the community. In addition to the Parenting Re-entry Program, St. Bernardine, through its Family Focus Center, offers counseling services, an information referral library, and a Teen Focus Component that features evening basketball, a drama club, and other healthy alternatives for teens.

Adolescent↗

A research-based HIV intervention in northeast Thailand.

This paper presents a case study of the development, implementation and evaluation of an HIV prevention strategy for rural, married women in the northeastern, Isan region of Thailand. The strategy is based on established principles of behaviour change, social learning, and community health promotion; grounded in baseline research, that identifies relevant contextual factors; community-based; evaluated; and applicable elsewhere. The methodology of the project includes four phases: data collection, strategy design, implementation, and evaluation. Baseline data were collected from an age-stratified sample of married women from 24 randomly chosen villages in Khon Kaen province in two waves. A total of 654 women participated in structured face-to-face interviews and 150 also participated in focus groups. Using the baseline data, a health promotion strategy including three components was designed: meetings with and training of village leaders and health workers; a five-part week long audio-drama, together with posters and other publicity conducted in villages; and village meetings to discuss the potential impact of HIV/AIDS on the village and to establish a village strategy to address this. This paper reports the results of the baseline data collection, how the data were used to produce an HIV prevention initiative for rural villages, results of the process evaluation and future development in HIV/AIDS prevention initiatives in this region.

Evaluation Studies as Topic↗