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PubMedDate not supplied

Beyond global order.

Patriarchal disciplines dominate in territorial species when they outgrow environmental habitats. This started for mainstream human societies some 6,000 years ago. A few food gatherer-hunter communities still inhabit stable ecosystems. Arts, crafts, languages, creeds and other traditions launched them into cultural diversity. This brought about territorial distinctions. With territorial challenges came uniquely human destruction, conflict and instability. Competitive male-dominated crafts progressively controlled and eliminated species, ecosystems and rival cultures to increase the progeny of dominant males. Technologies, including verbal hierarchies, peculiar to humans, create power pyramids converging in transnational elites. They invade and erode the resources and self-sufficiency of more egalitarian communities, which then strive defensively to join the elites. We need goals and institutions to develop a multiculturally tolerant, intergenerational and ecologically sustainable global co-operative with widening participation and inculcation of social value standards beyond money and male-centred dominance. Some promising techniques are emerging.

Culture↗
PubMed1999

The functional neuroanatomy of comprehension and memory: the importance of prior knowledge.

Stories are a common way in which humans convey and acquire new information. Their effectiveness and memorability require that they be understood which, in turn, depends on two factors-whether the story makes sense and the prior knowledge that the listener brings to bear. Comprehension requires the linking of related pieces of information, some provided within the story and some by the listener, in a process establishing coherence. In this study, we examined brain activations associated with story processing. During PET scanning, passages of prose were read twice to subjects during successive scans with the requirement to remember them. These were either standard stories that were readily comprehensible, or unusual stories for which the global theme was very difficult to extract without prior knowledge of the mental framework. This was manipulated by the provision of relevant, irrelevant or no visual cues shortly before the story. Ratings of comprehension provided by the subjects just after each scan confirmed that standard stories were more comprehensible than the unusual stories, as were unusual stories with a mental framework compared with those without. PET results showed activation of anterior and ventral parts of the medial parietal/posterior cingulate cortex in association with hearing unusual stories when subjects were given prior knowledge of what it might be about. Medial ventral orbitofrontal cortex and left temporal pole activations were found to be associated with more general aspects of comprehension. Medial parietal cortex (precuneus) and left prefrontal cortex were associated with story repetition. We suggest that while the temporal pole is involved in the linking of propositions to build a narrative, the anterior medial parietal/posterior cingulate cortex is concerned with linking this information with prior knowledge. All of this occurs in the context of a general memory processing/retrieval system that includes the posterior parietal (precuneus) and prefrontal cortex. Knowledge of how distinct brain regions contribute differentially to aspects of comprehension and memory has implications for understanding how these processes break down in conditions of brain injury or disease.

Acoustic Stimulation↗
PubMed2000

A comparison of physician examiners', standardized patients', and communication experts' ratings of international medical graduates' English proficiency.

PURPOSE: To assess the quality of ratings of interviewing skills and oral English proficiency provided on a clinical skills OSCE by physician examiners, standardized patients (SPs), and communication skills experts. METHOD: In 1998, 73 candidates to the Ontario International Medical Graduate (OIMG) Program completed a 29-station OSCE-type clinical skills selection examination. Physician examiners, SPs, and communication skills experts assessed components of oral English proficiency and interview performance. Based on these results, the frequency and generalizability of English-language flags, physician examiners' indications that spoken English skills were bad enough to significantly impede communication with patients; the reliability of the OIMG's Interview and Oral Performance Scales and generalizability of overall interview and oral performance ratings; and comparisons of repeated assessments by experts were calculated. Principal-components analysis was applied to the panels' ratings to determine a more economical expression of the language proficiency and interview communication skills results. RESULTS: The mean number of English-language flags per candidate was 2.1, the median was 1.0, and Cronbach's alpha of the ratings was 0.63. Means, SDs, and alphas of the physician examiners' and SPs' ratings of the interview performance scale were 9.15/10, 0.43, 0.36, and 9.30/10, 0. 56, 0.50, respectively. Corresponding values for overall interview performance ratings were 3.08/4, 0.30, 0.33, and 3.34/4, 0.32, 0.47. Means, SDs, and alphas of the physician examiners' and SPs' ratings of the oral performance scale were 8.54/10, 0.74, 0.78, and 8.74/10, 1.00, 0.76. Corresponding values for overall ratings of oral performance were 3.85/5, 0.51, 0.68, and 4.08/5, 0.60, 0.68. For the two experts' ratings of two contiguous five-minute interview stations, internal consistencies were 0.88 and 0.78. For the two experts' ratings of standardized ten-minute interviews, internal consistencies were 0.81 and 0.92. Correlations between the mean values of the experts' ratings of the ten- and five-minute stations were 0.45 and 0.51. Three factors emerged from the PCA, language proficiency, physician examiners' ratings of interview proficiency, and SPs' ratings of interview proficiency. CONCLUSIONS: Consistency between the physician examiners' and SPs' ratings of English proficiency was observed; less agreement was observed in their ratings of interviewing skills, and little agreement was observed between the experts' ratings. Communication skills results may be validly expressed by three measures: one overall global rating of language proficiency provided by physician examiners or SPs, and overall global ratings of interview proficiency provided separately by physician examiners and SPs.

Clinical Competence↗
PubMed2005

Preliminary validation of the Chinese version of the Pediatric Quality of Life Inventory.

The Pediatric Quality of Life Inventory (PedsQL) is a scale for assessing health-related quality of life of children and adolescents aged 2--18 years. Three reports of PedsQL for the age ranges 2--4 years and 5--7 years were translated into Chinese and their validities were examined. A total of 186 children and parents were involved in the study. Content validity, test-retest reliability, internal consistency reliability and construct validity were assessed. The correlation of parents' and children's reports was also examined. The results showed that the internal consistency is generally good, test-retest reliability ranged from moderate to good, differences between disabled and non-disabled individuals are significant in total scores and in all subscales except for the physical functioning subscale for the children's self-report for the age ranges of 2-4 years and 5-7 years and the correlation between the reports of the parents and children for the age range of 5-7 years is moderate to high. This suggests that the newly translated Chinese PedsQL for children aged 2-4 years and 5-7 years seems to be reliable and valid to be used as a measure of health-related quality of life in Chinese pediatric research and clinical applications.

Asian People↗
PubMed2005

Reliability of the Chinese version of the perceived family burden scale.

The study examined reliability of the 24-item Chinese version of the perceived family burden scale (CPFBS), which is a measure of behaviors associated with Chinese people with schizophrenia and the impacts of these behaviors on caregivers and relatives. Many patients with mental illness are returning to the community and living with families. Unfortunately, family members who have to live with the patients experience a sense of burden. The CPFBS is able to measure the perceived burden of the family, which enables therapists to formulate the most appropriate family intervention for them. The CPFBS was translated and culturally adapted from the English version. Some 21 main caregivers of individuals with schizophrenia were asked to rate the items on the scale by a competent administrator through a telephone interview (this was carried out twice, with 1 day between each interview). The results showed that CPFBS had high internal consistency (alpha=0.85) and acceptable test-retest reliability (r=0.86). We suggest that the CPFBS is ready to be used by clinicians and researchers in the study on family burden of individuals with schizophrenia in Hong Kong and in Chinese communities in other countries.

Adolescent↗
PubMedDate not supplied

Reliability and validity of the Dutch version of the American Burn Association/Shriners Hospital for Children Burn Outcomes Questionnaire (5-18 years of age).

The American Burn Association/Shriners Hospital for Children Burn Outcomes Questionnaire (BOQ) is a self-administered questionnaire to monitor functional outcome after burns in children and adolescents. This study aimed to assess feasibility, reliability, and validity of the Dutch BOQ. The BOQ was adapted into Dutch and tested in a population of children and adolescents aged 5 to 15 years who were primary admissions to a Dutch or Belgian burn center (n = 6) during the period of March 2001 through February 2004. To assess validity, the Child Health Questionnaire (CHQ) and the EuroQol-5D (EQ-5D) were included. Response rate was 53% among parents (n = 145) and 48% among adolescents (n = 52). Internal consistency of the BOQ scales was good (Cronbach's alpha >0.7 in all but one scale). Test and retest results were similar; there were no significant differences between parents and adolescents in this respect. Expected high correlations between BOQ scales and conceptually equivalent CHQ and EQ-5D scales were found in eight of 12 comparisons. Eleven scales showed significant differences in the expected direction between children with a long length of stay versus those with a short length of stay. The Dutch BOQ can be used to evaluate functional outcome after burns in children aged 5 years and older. Our study showed that the Dutch BOQ is a feasible instrument with good reliability and validity.

Adolescent↗
PubMed2005

Construction of the Mandarin version of the International Prostate Symptom Score inventory in assessing lower urinary tract symptoms in a Malaysian population.

BACKGROUND: The purpose of the present study was to validate the Mandarin version of the International Prostate Symptom Score (Mand-IPSS) in a Malaysian population. METHODS: The validity and reliability were studied in patients with lower urinary tract symptoms (LUTS; benign prostatic hyperplasia [BPH] group) and without LUTS (control group). Test-retest methodology was used to assess the reliability while Cronbach alpha was used to assess the internal consistency. Sensitivity to change was used to express the effect size index in the preintervention versus post-intervention score in patients with LUTS who underwent transurethral resection of the prostate. RESULTS: For the control group and BPH group, the internal consistency was excellent and a high degree of internal consistency was observed for all seven items (Cronbach alpha = 0.86-0.98 and 0.90-0.98, respectively). Test-retest correlation coefficients for all items were highly significant. Intraclass correlation coefficient (ICC) was high for the control (ICC = 0.93-0.99) and BPH group (ICC = 0.91-0.99). The sensitivity and specificity showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significance between baseline and post-treatment scores was observed across all seven items in the BPH group but not in the control group. CONCLUSIONS: The Mand-IPSS is a suitable, reliable, valid and sensitive instrument to measure clinical change in the Malaysian population.

Aged↗
PubMed2004

Psychometric and methodological characteristics of a culturally adjusted gastroesophageal reflux disease questionnaire.

Population-based data regarding the prevalence of gastroesophageal reflux disease (GERD) in Turkey is lacking. Therefore, a valid and reliable instrument for population-based study of GERD is important. The purpose of the study is to establish the feasibility, reproducibility, reliability and validity of the Turkish version of the GERD questionnaire. The study sample of 630 people was randomly recruited from the 20- to 65-year-old-population of Menderes, Izmir. Face to face interviews were conducted using the Turkish GERD questionnaire. The questionnaire was translated into Turkish, and then test-retest reliability of the study was carried out with 25 individuals. Internal reliability was measured using Cronbach's alpha. Additionally, a validity study was performed at the gastroenterology outpatient clinic at Ege University, Faculty of Medicine (45 people). This Turkish GERD questionnaire was easily understood and completed in a reasonable time by members of the population for whom the survey was intended. For all questions (omitting the demographic questions) kappa statistics were calculated; the median kappa for the outpatient assessment was 0.82. The sensitivity of the questionnaire concerning heartburn was strong and the specificity of the test was weak. By calculating Cronbach's alpha coefficient, we estimated the internal consistency or the reliability of each component. The Cronbach's alpha coefficients were above 0.70. This instrument can be used for large-scale population based studies in Turkey.

Adult↗
PubMed2004

G. T. 1878-1960: master of language and surgery.

Sir Gordon Gordon-Taylor was the pre-eminent British surgeon of the first half of the twentieth century. He became known for his daring cancer surgery which he perfected at the Middlesex Hospital, and he promoted early operation for abdominal gunshot wounds in World War I. During World War II, as a surgeon rear admiral, he was not only an active surgeon in the London region, but he also acted as a significant ambassador for Allied surgery. After the War he was in great demand as an eponymous orator throughout the length and breadth of Great Britain and abroad, and he encouraged many Commonwealth surgeons, particularly those from Australia and New Zealand, to further their training in Britain and then he actively supported them in their later careers. His death following an accident in 1960 was mourned through the surgical world.

Australia↗
PubMed2005

Time, human being and mental health care: an introduction to Gilles Deleuze.

The French philosopher, Gilles Deleuze, is emerging as one of the most important and influential philosophers of the 20th century, having published widely on philosophy, literature, language, psychoanalysis, art, politics, and cinema. However, because of the 'experimental' nature of certain works, combined with the manner in which he draws upon a variety of sources from various disciplines, his work can seem difficult, obscure, and even 'willfully obstructive'. In an attempt to resist such impressions, this paper will seek to provide an accessible introduction to Deleuze's work, and to begin to discuss how it can be employed to provide a significant critique and reconceptualization of the theoretical foundations and therapeutic practices of psychiatry, psychotherapy, and mental health nursing. In order to do this, the paper will focus upon Deleuze's masterwork, and the cornerstone to his philosophy as a whole, Difference and Repetition; in particular, it will discuss how his innovative and challenging account of time can be employed to provide a conception of human life as a 'continuity', rather than as a series of distinct 'moments' or 'events'. As well as discussing the manner in which his work can provide us with an understanding of how life is different and significant for each human being, this paper will also highlight the potential importance of Deleuze's work for logotherapy, for the recent 'turn' to 'narrative' as a psychotherapeutic approach and for contemporary mental health care's growing interest in 'social constructionism'. As such, this paper also seeks to stimulate further discussion and research into the importance and the relevance of Deleuze's work for the theory and practice of psychiatry, psychotherapy, and mental health nursing.

France↗
PubMed2005

Brief report: Resident recognition of low literacy as a risk factor in hospital readmission.

BACKGROUND: Low literacy is associated with poor self-management of disease and increased hospitalization, yet few studies have explored the extent to which physicians consider literacy in their patient care. OBJECTIVE: To examine trainee recognition of low literacy as a potential factor in patient adherence and hospital readmission. DESIGN AND PARTICIPANTS: Randomized study of 98 Internal Medicine residents and medical students. Trainees reviewed a case history and completed a questionnaire pertaining to a fictional patient's hospital readmission. Case version A contained clues to suggest limited patient literacy skills, while version B did not. Responses were reviewed for mention of low literacy and educational strategies recommended for low-literate patients. RESULTS: Few trainees raised the possibility of low patient literacy, even when provided clues (25% in Group A vs 4% in Group B, P=.003). Furthermore, while most trainees listed patient education as an important means of preventing another readmission, only 16% suggested using a strategy recommended for low-literate adults. CONCLUSION: Few trainees recognized low literacy as a potential factor in patient nonadherence and hospital readmission, and few recommended low-literate educational strategies. Medical residents and students may benefit from additional training in the recognition and counseling of low-literate patients.

Academic Medical Centers↗
PubMed2005

Developmental dyslexia--recurrence risk estimates from a german bi-center study using the single proband sib pair design.

OBJECTIVE: Several studies have demonstrated a genetic component for dyslexia. However, both segregation and linkage analyses show contradictory results pointing at the necessity of an optimal ascertainment scheme for molecular genetic studies. Previously, we have argued that the single proband sib pair design (SPSP) would be optimal. The aims of this paper therefore are to demonstrate the practicability of the SPSP design and the estimation of recurrence risks for reading and writing. METHODS: We assessed spelling and reading in a family sample ascertained through the SPSP design. 287 families with at least two siblings and their parents were recruited. At least one child was affected with spelling disorder according to a one standard deviation (1SD) discrepancy criterion. RESULTS: Mean values for probands and their siblings were different for both the spelling and the reading phenotype. For the probands, variances of the phenotype spelling were smaller. These effects became stronger with more extreme selection criteria. Both siblings fulfilled the 1SD criterion for spelling and reading in 60.3 and 28.9% of the families, respectively, indicating a low cost efficiency of the double proband sib pair approach. A recurrence risk of 4.52 (CI: 4.07-4.93) was obtained for spelling when the 1SD criterion was applied to both siblings. Recurrence risk estimates were similar for reading. CONCLUSION: The study demonstrates the suitability of the SPSP design for genetic analysis of dyslexia. The recurrence risk estimates may be used for determining sample sizes in gene mapping studies.

Child↗
PubMedDate not supplied

The case for course substitutions as a reasonable accommodation for students with foreign language learning difficulties.

It has been observed for decades that some students have a particularly difficult time learning another language. Colleges and universities have an obligation to offer special language programs designed to help these students succeed in their attempts to learn another language. However, for those few students who cannot learn another language even with special instruction, allowing them to meet the foreign language requirement though the substitution of related courses is appropriate and does not constitute a fundamental alteration of the goals of a liberal education.

Adult↗
PubMedDate not supplied

Students classified as LD and the college foreign language requirement: replication and comparison studies.

Two studies examined students classified as having learning disabilities (LD) who had received course substitutions for the college foreign language (FL) requirement. In the first study, 42 students at one university were divided into groups and compared on measures of IQ, academic achievement, FL aptitude, college grade point average (GPA), and FL and English grades. Findings showed that most of the 42 students had been classified as LD in college after experiencing problems in FL courses. Comparisons based on students' performance on measures of FL aptitude, native language skill, and performance in FL courses showed few significant group differences. In the second study, the 42 students from the first study were compared with 86 students at another university who had also been classified as LD and received course substitutions for the college FL requirement. Comparisons on demographic information and measures of IQ, academic achievement, FL aptitude, college GPA, and FL GPA showed few significant differences between the two groups. Both studies suggest that students classified as LD at different universities exhibit similar demographic, cognitive, academic achievement, and FL aptitude profiles and that educators should not make the a priori assumption that students classified as LD require course substitutions for the FL requirement or experience problems with FL learning.

Adolescent↗
PubMed2005

Hereditary neuromuscular disease and multicomposite subjective health status: feasibility, internal consistency and test-retest reliability in the French version of the Nottingham Health Profile, the ISPN.

OBJECTIVE: To evaluate the feasibility, internal consistency and reproducibility of the French version of the Nottingham Health Profile (NHP) completed by adults with hereditary neuromuscular disease. DESIGN: Cross-sectional study with evaluation at 15 +/- 7 days for NHP test-retest. SETTING: Multidisciplinary rehabilitation consultations in Reims. SUBJECTS: Sixty-four neuromuscular disease outpatients completed the NHP consecutively between April 2002 and December 2003. MAIN MEASURES: French version of the Nottingham Health Profile (NHP), Barthel Index and sociodemographic characteristics. RESULTS: The average completion percentages for the different dimensions was 84.2% (range 72-97%). With respect to the completion feasibility of the physical mobility subscale, 7-20% of neuromuscular disease patients failed to complete four items out of eight. In the pain subscale, the same difficulty was encountered for three items out of eight. Internal consistency as assessed by Cronbach's alpha was acceptable for the subscales physical mobility (0.88), emotional reaction (0.74), sleep (0.77), and pain (0.81); it was less reliable for the subscale social isolation (0.61), and poor for the subscale energy (0.47). Test-retest agreement measured by intraclass correlation coefficient was in all instances greater than 0.70. CONCLUSION: Some items in the pain and physical mobility subscales pose problems related to the relevance of the wording for patients confined to wheelchairs. Recoding of the measure makes it possible to avoid missing data from these dependent patients. Scores differ statistically according to the coding used. In study reports, details of such procedures should be provided for comparison of ISPN results with those from other studies in the literature.

Adolescent↗