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PubMed1993

Praxis makes perfect: illness as a bridge between biological concepts of disease and social conceptions of health.

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as "action failure", drawing directly on the internal structure of action. The practical applications of this theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy.

Disease↗
PubMed1999

Radial approach: a new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of a procedure.

BACKGROUND: The maze procedure cures atrial fibrillation; however, it isolates the pulmonary vein area and results in discordant activation in certain adjacent left atrial segments, which affects left atrial function. To preserve a more physiologic atrial transport function, we developed a new concept of surgical treatment for atrial fibrillation-the radial approach. The atrial incisions radiate from the sinus node toward the atrioventricular annular margins to allow a more physiologic atrial activation sequence and parallel the atrial coronary arteries to preserve blood supply to most atrial segments. METHODS: We examined the atrial coronary arteries and the activation sequence during sinus rhythm in normal canine hearts to design the atrial incisions according to the concept of a radial approach. RESULTS: The pattern of coronary artery distribution was centripetal, branching from the right coronary or left circumflex coronary artery at the right or left atrioventricular groove and spreading toward the sinus node. The endocardial mapping of the atria disclosed some important findings in designing the atrial incisions of the radial approach: the activation sequence at the left atrial septum and at the posterior left atrium between the pulmonary vein orifices. The atrial incisions were designed according to these findings. CONCLUSIONS: The radial approach may represent a more physiologic atrial transport function.

Animals↗
PubMed1990

Concepts of caring and caring as a concept.

If caring is to be retained as the "essence" of nursing, and if research in this area is to advance, then the various perspectives of caring must be clarified, the strengths and the limitations of these conceptualizations examined, and the applicability of caring as a concept and theory to the practice of nursing identified. Examination of the concept of caring resulted in the identification of five epistemological perspectives: caring as a human state, caring as a moral imperative or ideal, caring as an affect, caring as an interpersonal relationship, and caring as a nursing intervention. Two outcomes of caring were identified: caring as the subjective experience and as the physiologic responses in patients. The authors concluded that knowledge development related to caring in nursing is limited by the lack of refinement of caring theory, the lack of definitions of caring attributes, the neglect to examine caring from the dialectic perspective, and the focus of theorists and researchers on the nurse to the exclusion of the patient.

Altruism↗
PubMed1994

Effects of sodium monensin on reproductive performance of dairy cattle. I. Effects on conception rates, calving-to-conception intervals, calving-to-heat and milk production in dairy cows.

A total of 1061 lactating dairy cows in six different herds were randomly allocated to treatment and control groups. One herd was lot-fed on total mixed rations; three herds were fed on pasture with significant amounts of supplementary concentrates, and two herds were primarily pasture fed. Treated cows received a slow-release, intraruminal capsule containing 32 g sodium monensin within 7 days of calving. Conception rates at first service, days to first oestrus and calving-to-conception interval did not differ significantly between untreated and monensin-treated cows in the 5 herds, 3 herds and 4 herds, respectively, in which these outcomes were examined. Treatment of lactating cows immediately after calving may not be the optimal method to achieve fertility responses with capsules containing sodium monensin. Monensin treatment significantly increased milk yield in one of the six herds. Milk fat or milk protein production was not significantly affected by treatment.

Animals↗
PubMedDate not supplied

[The concept of motivation--an analysis of the concept and metatheoretical considerations].

In this paper we analysed the concept of motivation pointing to the two broader conceptual frames that can comprise it and enable us to understand its theoretical meaning. Two paradigms of scientific reasoning--the dynamic conceptualization of the world and the theory of evolution--have been used in the explanation of human behavior since the very beginning of the scientific dealing with the problem. The difference between these two metatheoretical positions is rich in consequences. The object of research of the same problem--the reason (cause) of human behavior--in the two metatheoretical conceptualizations is situated at adjacent but completely different strata of reality. The object of research of motivation as a dynamic explanation of behavior is contained in the psychic layer of reality. On the other hand, the conception of behavior as an adaptation to the biological heritage understands investigations of the objects situated at the organic or biological stratum. We also pointed to a complementary relation of the two research approaches to human behavior.

Humans↗
PubMed1963

Current concepts in conception control.

The progressive increase in world population has become a most urgent global problem in recent years. Man has, however, been interested in controlling his reproductivity at the family level for many centuries. Historical aspects of this saga are reviewed.The modern era of conception control was ushered in by Makepeace et al. in 1937 when ovulation inhibition by progesterone was demonstrated. Confirmation of this by Pincus and associates, and development of the potent oral progestational agents, the 19-norsteroids, have made efficient reliable contraception a reality.Experience with one of these agents (Ortho-Novum, 2 mg.) in 115 patients through 805 cycles is presented. Conception control was 100% effective at this dosage. Side effects were minimal. Only three of the women discontinued the tablets because of these effects. All but five in this group of 115 preferred the oral contraceptives to methods previously employed.

Contraception↗
PubMed1989

Conceptional age, menstrual age, and ultrasound age: a second-trimester comparison of pregnancies of known conception date with pregnancies dated from the last menstrual period.

Ultrasound dating-curve analysis was performed for the biparietal diameter, mean head diameter, and mean trunk diameter in individual singletons, twins, and triplets from in vitro fertilization (IVF) pregnancies and pregnancies with ultrasonographic determination of ovulation. Linear growth was found for all parameters prior to 28 weeks' conceptional age. No differences were observed among singletons, twins, or triplets. Using linear equations, no significant difference was found in systematic errors between pregnancies with a known date of conception and pregnancies dated from the last menstrual period (LMP). Pregnancies with reliable LMPs had only a slight and nonsignificant increase in random errors when compared with pregnancies from IVF. Current polynomial dating equations produced considerable systematic and random errors as well as errors related to fetal growth. Acceptable results were obtained with a new linear equation based on two examinations. We conclude that gestational age based on good menstrual records supported by a pelvic examination in the first trimester may be more reliable than even the best ultrasound method for dating.

Embryonic and Fetal Development↗
PubMed1994

[Critical review of theories on cell aging. From Hayflick's basis concept to the concept of critical threshold of accumulation of errors].

The goal of this review of the theories of cellular ageing is first to distinguish the theories on the basis of logical criteria following the dichotomies genetic/environmental and deterministic/stochastic. The second purpose is to show, from such criteria, that these theories can be integrated in a more general concept, which is the concept of critical threshold of error accumulation, taking into account the protective role of defenses systems avoiding a quick increase in the level of intracellular errors.

Cellular Senescence↗
PubMed1996

[Risk assessment and risk management according to the HACCP (Hazard Analysis and Critical Control Point) concept: a concept for safe foods].

The volume of official hygiene regulations for food processing establishments has been growing continuously over the past 20 to 30 years. This led to a decrease in hygiene risk awareness in food processing establishments which was partly replaced by a strong reliance on legislative measures in food hygiene. After experiences in industrialized nations had shown that even numerous and detailed hygiene regulations could not prevent the increase of infections and intoxications of consumers by food products, new solutions had to be found. On the one hand, the implementation of intensified control measures by the producers themselves is required. Such a control much then be "controlled" by the state authorities. On the other hand, the so-called HACCP (Hazard Analysis and Critical Control Point) system has been introduced as a new quality assurance principle for the avoidance of health hazards. This concept was developed in the 1960s in the United States of America in order to produce safe foods for the space programme. For the production of a particular food according to the HACCP system informations on hazards and situations leading to their presence are collected and evaluated in order to decide which are significant for food safety and therefore should be addressed in the HACCP plan. According to this analysis the necessary preventive measures which lead to the prevention, elimination or reduction to an acceptable level of identified health hazards have to be defined. All steps of food processing have to be included in the HACCP system. Raw materials, storage of foods, types of distribution and the intended usage of the final product by the consumer have to be considered in this system. However, the introduction of the HACCP system into European hygiene regulations does not constitute an entirely new development. It can rather be regarded as a renaissance of traditional scientific concepts. This is demonstrated by the example of drinking milk processing as it was practised sixty years ago.

Food Contamination↗
PubMed1982

Multivariate concept of psychosomatic illness the self-concept of asthmatic children.

The self-concept of asthmatic children was studied in order to demonstrate the complicated nature of the psychosomatic syndrome; that of 18 asthmatic children was compared to those of three other groups': 20 healthy children, 20 children with emotional difficulties and 11 children with cystic fibrosis. Measures reflecting the psychological self-acceptance differentiated the healthy children significantly from the two groups with emotional difficulties (asthmatics, and children with adjustment difficulties). Measures reflecting physical self acceptance differentiated the healthy group significantly from the two groups with somatic complaints (asthmatics and cystic fibrosis children).

Adolescent↗
PubMed1998

The concept of nation-state in Italian elementary school children: spontaneous concepts and effects of teaching.

Two experiments were conducted. In Experiment 1, the definitions given by kindergarteners, third graders, and sixth graders (N = 60) for several political terms were searched for a characteristic-to-defining-shift (Keil, 1989). The children were presented with seven words: kingdom, king, border, tax, soldier, capital city, and policeman and were asked (a) if and where they had ever heard each of them and, if they had, (b) to explain their meanings. Kindergarten children did not know most of the terms or defined them mainly by means of characteristic but nondefining features. The third graders appeared to represent the state only in physical terms. Soldiers and policemen were described as employees but not as public servants. In Experiment 2, the extent to which children's misconceptions can be changed through explicit instruction was examined. A curriculum lasting about 16 hr was implemented with a group of fourth graders (N = 30). On pretest, most of the children depicted the state in the same ways as the third graders had in Experiment 1. After the curriculum implementation, nearly all of the children showed a political conception of the state, describing it not only in terms of a territory in which a population is settled but also in terms of government.

Age Factors↗
PubMed1979

Folk concepts of mental disorder among the Lao: continuities with similar concepts in other cultures and in psychiatry.

Folk concepts for mental disorder were studied among rural Lao people. While predominatly inferring etiology (e.g. spirit-caused disorder), certain terms also emphasized particular descriptive psychopathology or behavioral abnormality. Preventive strategies were stressed for insanity due to "excessive worry' or "broken taboo'. These broad folk categories of disorder bore considerable similarity to some psychiatric and neurologic categories within medicine. These includes psychosis, mania, neurosis, organic brain syndrome, mental retardation, cerebral palsy, epilepsy, and childhood autism. Lao folk terms for mental disorder also closely resembled those of other southern Asian cultures, although illiterate tribal peoples appeared to have fewer terms than literate peasant peoples. Folk terms from more distant regions had broad similarity to those of southeast Asia, but lacked the specificity found within the region.

Attitude↗
PubMed2002

The NIH Consensus concept of chronic prostatitis/chronic pelvic pain syndrome compared with traditional concepts of nonbacterial prostatitis and prostatodynia.

The new National Institutes of Health (NIH) consensus classification identifies chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) based on the presence or absence of leukocytes in expressed prostatic secretions (EPS), postprostatic massage urine (VB3), or seminal fluid analysis. The purpose of this review is to determine the effect of the new classification on the proportion of symptomatic patients diagnosed with inflammation. We compare and contrast the new consensus classification with the traditional classification of prostatitis syndromes, then review how these changes effect patient classification in our clinical practice. Thorough clinical and microbiologic examination of 140 patients attending the University of Washington Prostatitis Clinic included evaluation of first void urine, mid-stream urine, EPS, VB3, and semen specimens. Inflammation was documented in 111 (26%) of 420 samples including 39 EPS samples, 32 VB3 samples, and 40 SFA specimens. Of the 140 patients, 73 (52%) had inflammatory CP/CPPS according to the NIH consensus criteria, but only 39 (28%) had nonbacterial prostatitis according to traditional EPS criteria (P < 0.001). The new NIH consensus concept of inflammatory CP/CPPS includes almost twice as many patients as the traditional category of nonbacterial prostatitis.

Chronic Disease↗
PubMed2002

The consensus concept for thermostability engineering of proteins: further proof of concept.

Previously, we calculated a consensus amino acid sequence from 13 homologous fungal phytases. A synthetic gene was constructed and recombinantly expressed. Surprisingly, consensus phytase-1 was 15-26 degrees C more thermostable than all parent phytases used in its design [Lehmann et al. (2000)Protein Eng., 13, 49-57]. In the present study, inclusion of six further phytase sequences in the amino acid sequence alignment resulted in the replacement of 38 amino acid residues in either one or both of the new consensus phytases-10 and -11. Since consensus phytase-10, again, was 7.4 degrees C more thermostable than consensus phytase-1, the thermostability effects of most of the 38 amino acid substitutions were tested by site-directed mutagenesis. Both stabilizing and destabilizing mutations were identified, but all affected the stability of the enzyme by <3 degrees C. The combination of all stabilizing amino acid exchanges in a multiple mutant of consensus phytase-1 increased the unfolding temperature from 78.0 to 88.5 degrees C. Likewise, back-mutation of four destabilizing amino acids and introduction of an additional stabilizing amino acid in consensus phytase-10 further increased the unfolding temperature from 85.4 to 90.4 degrees C. The thermostabilization achieved is the result of a combination of slight improvements from multiple amino acid exchanges rather than being the effect of a single or of just a few dominating mutations that have been introduced by chance. The present findings support the general validity of the consensus concept for thermostability engineering of proteins.

6-Phytase↗
PubMed2000

Acupuncture and Oriental body work: traditional and biomedical concepts in holistic care: history and basic concepts.

Acupuncture and related forms of Oriental body work, such as shiatsu and acupressure, have become increasingly part of the complementary and alternative health care in the last twenty years in the United States. Yet most consumers and professionals, nurses included, know little or nothing about the philosophical and diagnostic underpinnings of these forms of treatment. The frameworks underlying these modalities are intrinsically holistic, and provide an interesting model for nurses and others who are looking for different ways to think about data from patient care. Part I of two articles presents descriptions of practices, and an introduction to the history and basic concepts underlying Chinese acupuncture and related forms of Oriental body work.

Acupressure↗
PubMed1973

Effect of cerebrospinal fluid shunts on intracranial pressure and on cerebrospinal fluid dynamics. 2. A new technique of pressure measurements: results and concepts. 3. A concept of hydrocephalus.

Part 2 describes measurements of intracranial cerebrospinal fluid (CSF) pressure in 18 adult patients with CSF shunts, all pressure measurements being referred to a horizontal plane close to the foramina of Monro. All 18 patients had normal CSF pressure by lumbar puncture; however, in one patient an intracranial pressure of +280 mm was subsequently measured after pneumoencephalography. Twelve patients had pre-shunt CSF pressures measured intracranially: 11 ranged from +20 to +180 mm H(2)O and one was +280 mm H(2)O in the supine position. In the upright posture nine patients had values of -10 to -140 mm H(2)O, while three others were +60, +70, and +280 mm H(2)O. After CSF shunting in these 18 patients the pressures were -30 to +30 mm H(2)O in the supine position and -210 to -370 mm in the upright position. The effect of posture on the siphoning action of these longer shunts in the erect, adult patient is a major uncontrollable variable in maintenance of intracranial pressure after shunting. Other significant variables are reviewed. In Part 3 a concept of the hydrocephalus phenomenon is described. Emphasis is placed on the pressure differential (P(d)) and force differential (F(d)) causing pre-shunt ventricular enlargement and post-shunt ventricular size reduction. The site of P(d), which must be very small and not to be confused with measured ventricular pressure, P, must be at the ventricular wall.

Adult↗
PubMed1986

The concept of 'bouffée délirante' with special reference to the Scandinavian concept of reactive psychosis.

The nosological concepts of 'bouffée délirante', first described by Magnan in the 1880s, and of 'psychogenic psychosis', first described by Wimmer in 1916, are still in use in their countries of origin, France and the Scandinavian countries. Both refer to psychotic episodes of good prognosis, not connected with schizophrenia, appearing in a special fragile personality. An examination of the diagnostic criteria of the two categories shows, however, that important differences exist. Contrary to what has been claimed, Wimmer's original description, although showing an encyclopedic knowledge of the international literature of the day, has not been directly influenced by Magnan. Bouffée délirante and psychogenic psychosis, whatever their differences, have survived in their respective countries of origin against the pressure of the psychiatric consensus of the rest of the world, as evidenced by the frequency of the present use of the two diagnoses. The two categories, after having been considered for a long time as idiosyncratic peculiarities of individual national schools, are now submitted internationally to empirical studies and have become the center of a renewed interest.

Adjustment Disorders↗
PubMed1980

The child and family eight years after undesired conception. The child and family after undesired conception.

This survey is a follow-up study, up to the age of 8 years of children reported to have been born from pregnancies not desired by the mother, in Northern Finland in 1966. The data were collected by means of a postal questionnaire sent separately to families and school teachers. Each child was signed a control, born from a desired pregnancy and similar at the time of birth as regards mother's marital status, parity, and place of residence and also the social class of the father. No difference between the groups was found in the emotional development of the children. School performance was poorer among the unwanted children, but the difference was statistically significant only in respect of the need for additional instruction in writing. Evidence was also found that the parents in the control families worried more about the health of their children than did those of the unwanted children. Even when the social standing of the families was matched as regards time of birth, the families with unwanted children showed more downward and less upward social mobility during the intervening 8 years than did the control families, and there were also indications of differences in lifestyle preference between the families. The conclusion was therefore drawn that undesired conception selects a subgroup of less capable families from each social class, and that the differences found in the children can also be explained by differences in social and economic standing between these two groups of families.

Attitude↗