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Evolution of the American concept of schizoaffective psychosis.

A brief survey is given of the evolution of the concept of schizoaffective psychosis in the United States. The following phases are singled out: a first, 'prehistorical', one including description of 'mixed' psychotic syndromes regarded as subtypes of manic-depressive psychosis; a second, which covers the subsequent 30 years, in which the concept of schizoaffective psychosis is gradually included under the heading of schizophrenia, in accordance with the broad Bleulerian concept of this illness prevailing in those years; a third one, in which, under the influence of a number of factors, schizoaffective psychosis is shifted from the schizophrenic to the affective area, and even good-prognosis schizophrenia and DSM III schizophreniform disorder (a syndrome characterized by the same clinical picture of schizophrenia, but which lasts less than 6 months) are regarded as variants of affective illness. It is emphasized that the history of the evolution of the American concept of schizoaffective psychosis is, indeed, the history of the vicissitudes of the American conceptions of schizophrenia and manic-depressive psychosis.

Bipolar Disorder↗

The concept of patient motivation: a qualitative analysis of stroke professionals' attitudes.

BACKGROUND AND PURPOSE: The purpose of this work was to investigate how stroke rehabilitation professionals understand the concept of motivation and the ways that they use this concept in their clinical practice. METHODS: This qualitative study used semistructured, in-depth interviews with the professionals working in the stroke unit of an inner-city teaching hospital in the UK. RESULTS: Motivation was a frequently used concept and was described as an important determinant of rehabilitation outcome. Motivation was attributed to patients on the basis of their demeanor (proactivity was equated with motivation, passivity with lack of motivation) and their compliance with rehabilitation (compliance was seen as indicative of motivation, noncompliance as a lack of motivation). These criteria were found to have blurred boundaries. The determinants of motivation were located partly in personality factors but also in social factors. Central among the social factors were aspects of the professionals' own behavior taken to positively and negatively affect motivation. Some professionals reported treating unmotivated patients differently from motivated ones, especially if these unmotivated patients were elderly. Motivation was described as a potentially dangerous label. CONCLUSIONS: Professionals are wary of the concept of motivation yet commonly use it in their clinical practice. The blurred boundaries of the criteria used to identify motivation mean that patients must strike a delicate balance between proactivity and compliance to avoid being categorized as unmotivated. The way the concept of motivation is used in clinical practice might have negative implications for patient care, eg, when reticent yet motivated patients are labeled unmotivated.

Attitude of Health Personnel↗

The development of the drive object concept in Freud's work: 1905-1915.

In 1905 Freud established the idea of an object of an instinctual drive as the basic object concept of psychoanalysis. He also introduced the derivative concepts of object directedness, object choice, and object finding. While taking these steps he simultaneously deemphasized the importance of drive objects in sexual life, contradicted himself on whether drives are autoerotic or object-directed in infancy, and made incompatible statements about whether or not object choice occurs before puberty. Freud's clinical work, reflected especially in the major case reports and a series of papers on fantasy, led to an apparent recognition of complexity in the mental life of children far greater than had been described earlier. The increased attention to and appreciation of mental content in childhood especially augmented Freud's understanding of the role of drive objects, object directedness, and object choice in infancy. This, in turn, led him to postulate a sequence of organizations of sexual life, named according to the zonal drive source plus the mode of object directedness, a process of theory development that continued through 1924. Object choice and, to a lesser extent, object directedness are concepts derived from and dependent upon the concept of drive object. Both require, however, explanatory constructs besides drive constructs. In 1915 Freud defined the term "object" in the context of stating his drive theory. Freud used the term object with several new modifying words during this decade. No new object concept was introduced, however, in this work, although some steps in that direction appeared to be in progress.

Child↗

Concepts of illness causality in a pediatric sample. Relationship to illness duration, frequency of hospitalization, and degree of life-threat.

In this study, we evaluated whether previous medical experience is associated with more sophisticated conceptions of illness causality among 64 children ages 4 to 16 years old. Although age and prorated IQ were found to be strongly related to children's illness causality concepts, duration of medical condition, total hospitalization days, and higher life-threat medical conditions were not associated with more sophisticated illness concepts in this pediatric sample. Using multiple regression analysis, age and IQ accounted for 59% of the variance in illness causality scores; contrary to expectations, medical experience variables (i.e., diagnosis, illness duration, hospitalizations) were not significant predictors of children's illness concepts. These findings highlight the need for pediatricians to guard against overestimating the illness concepts of children with prior medical experience.

Adolescent↗

A feminist approach to concept analysis.

Concept analysis is an important device for clarifying the meaning of concepts and the foundations of nursing theory, research, and practice. Exploration of traditional approaches to concept analysis reveals the limitations of these methods for contextual analysis that acknowledges the social construction of the concept and acknowledges gender, class, and racial bias. Concept analysis conducted from a feminist perspective overcomes these weaknesses and becomes a powerful tool for the development of nursing knowledge.

Female↗

Concepts from eastern philosophy and Rogers' Science of Unitary Human Beings.

A brief outline of Buddhist thought is presented. Four concepts from early Indian philosophy which contributed to the development of the middle way consequence (Madhyamika Prasangika) school of Tibetan Buddhist philosophy are discussed. These are: action (karma), direct perception, emptiness, and dependent arising. An overview of Martha Rogers' science of unitary human beings is given, followed by a discussion of the concepts of energy field and integrality within her worldview. Buddhist concepts of action, direct valid perception, and emptiness are considered in relation to Rogers' notion of energy field; the concept of dependent arising is compared to Rogers' principle of integrality. It is proposed that Rogers' worldview includes areas of similarity with concepts used in Tibetan Buddhist philosophy.

Buddhism↗

Exercise: a unitary concept.

Nursing science provides the opportunity to frame one's vision of humans and health and create interventions that facilitate wellness. This article contributes to nursing science by reconceptualizing exercise as a unitary concept using Parse's process of concept inventing. Concept inventing is a way to uncover the uniqueness of particular concepts and articulate their essence within the simultaneity paradigm. It differs from traditional, linear processes that are derived from the totality paradigm. Through the process of concept inventing, exercise is described within Rogers's science of unitary human beings and conceptualized as the purposeful, rhythmic flow of human movement.

Exercise↗

Early detection of breast cancer by self-examination: the influence of perceived barriers and health conception.

PURPOSE/OBJECTIVES: To discover the factors that influence the decision to perform breast self-examination (BSE). DESIGN: Quantitative, correlational. SETTING: Institutional; urban and suburban. SAMPLE: A nonrandomized convenience sample of 93 women. METHODS: Willing participants were asked to complete by mail a short demographic form, the Reduced Laffrey's Health Conception Scale, Champion's Health Belief Instrument, and a BSE questionnaire. MAIN RESEARCH VARIABLES: Health conception, barriers to BSE, frequency and thoroughness of BSE practice. FINDINGS: A wellness conception of health and frequency were not significantly related, nor did a significant relationship exist between a wellness conception of health and thoroughness of BSE. A negative relationship between barriers and thoroughness was highly significant. A statistically significant relationship did not exist between barriers and frequency of BSE. CONCLUSIONS: Those with a clinical conception of health practiced BSE less frequently. If health is viewed as the absence of disease, BSE may be perceived as looking for trouble. Subjects with greater barriers were less thorough when they practiced BSE. The specific barriers tested in this study (i.e., feelings about practicing BSE, worry about breast cancer, embarrassment, time, unpleasantness of procedure, lack of privacy) interfered more with the thoroughness of the behavior than with the frequency of the behavior. The most reported barrier was worry about breast cancer. The data suggest that worry may interfere with performing BSE thoroughly. IMPLICATIONS FOR NURSING: This work offers insight into the thoughts and behavior of women to promote a behavior that could save their lives. Potential implications for nursing practice could include issues related to better education and assessment of barriers to practicing BSE in women.

Adult↗

A comparative evaluation of full-text, concept-based, and context-sensitive search.

OBJECTIVES: Study comparatively (1) concept-based search, using documents pre-indexed by a conceptual hierarchy; (2) context-sensitive search, using structured, labeled documents; and (3) traditional full-text search. Hypotheses were: (1) more contexts lead to better retrieval accuracy; and (2) adding concept-based search to the other searches would improve upon their baseline performances. DESIGN: Use our Vaidurya architecture, for search and retrieval evaluation, of structured documents classified by a conceptual hierarchy, on a clinical guidelines test collection. MEASUREMENTS: Precision computed at different levels of recall to assess the contribution of the retrieval methods. Comparisons of precisions done with recall set at 0.5, using t-tests. RESULTS: Performance increased monotonically with the number of query context elements. Adding context-sensitive elements, mean improvement was 11.1% at recall 0.5. With three contexts, mean query precision was 42% +/- 17% (95% confidence interval [CI], 31% to 53%); with two contexts, 32% +/- 13% (95% CI, 27% to 38%); and one context, 20% +/- 9% (95% CI, 15% to 24%). Adding context-based queries to full-text queries monotonically improved precision beyond the 0.4 level of recall. Mean improvement was 4.5% at recall 0.5. Adding concept-based search to full-text search improved precision to 19.4% at recall 0.5. CONCLUSIONS: The study demonstrated usefulness of concept-based and context-sensitive queries for enhancing the precision of retrieval from a digital library of semi-structured clinical guideline documents. Concept-based searches outperformed free-text queries, especially when baseline precision was low. In general, the more ontological elements used in the query, the greater the resulting precision.

Abstracting and Indexing↗

Sex-role-related differences in self-concept and mental health.

Examined the differences in serf-concept and psychological health between androgynous, sex-typed, cross-sex-typed, and undifferentiated males and females. Two hundred forty-nine students who were enrolled in introductory psychology classes were classified according to sex type on the basis of their scores on the Bem Sex-Role Inventory. Nine aspects of self-concept and five aspects of psychological health, obtained, from the Tennessee Self-Concept Scale, were analyzed as a function of Sex and Sex Type. A series of analyses of variance and subsequent individual comparisons across groups revealed a clear pattern wherein androgynous subjects manifested more positive self-concepts and more positive psychological health than sex-typed subjects. Undifferentiated subjects manifested the poorest self-concepts, while results for sex-typed and cross-sex-typed subjects varied more as a function of the sex of the subject. The data are discussed as appearing to be consistent with Bem's hypothesis that androgynous people may represent a more appropriate societal definition of mental health than strongly sex-typed people. Qualifications of this support are also discussed.

Journal Article↗

Hormonal profiles of natural conception cycles ending in early, unrecognized pregnancy loss.

Loss of a conceptus early in development can be detected by very sensitive assays specific for hCG. We examined 20 menstrual cycles ending in early loss of a conceptus in order to identify hormonal correlates of loss. Each loss cycle was compared to a successful conception cycle in the same woman, using daily concentration of urinary estrone-3-glucuronide and pregnanediol-3-glucuronide (PdG). The estrone-3-glucuronide and PdG profiles in cycles of early pregnancy loss were very similar to those in successful conception cycles until late in the luteal phase. Early pregnancy loss was not related to a midluteal deficiency in PdG. hCG tended to be detected later in cycles of early pregnancy loss than in successful conception cycles, presumably indicating later implantation. Ten of the early pregnancy losses implanted after luteal-day-10; only one of the successful pregnancies implanted that late. The corpus luteum responded to the conception in only 2 of the 10 loss cycles with late implantation. In contrast, the corpus luteum responded in 8 of 10 loss cycles with normally timed implantation. The similarity of preimplantation hormonal profiles in cycles of early pregnancy loss and in cycles with successful conceptions suggests that most early losses in reproductively normal women do not result directly from deficiencies in ovarian steroid production.

Abortion, Spontaneous↗

Biological variation and quantification of health: the emergence of the concept of normality.

Historical research on the concept of normality, its roots and its development show that this concept has its sources in very different areas of scientific and medical thinking. Of great importance were: (i) a new theory of disease arising early in the 19th century supposing a continuous change from the healthy to the diseased state; (ii) the examination of variation within and between species of plants and animals; (iii) the clinical theory of constitution developed to describe the wholeness of the individual determined both by genetic factors and the influence of the environment; (iv) the development of mathematical and statistical tools starting with the adaptation of Bernoulli's "law of the great numbers" and Gauss' and Legendre's "law of errors" to biological measurements by the Belgian astronomer Quetelet. At the end of the First World War the concept of normality was first discussed. An idealistic "value norm" was set against a statistical "frequency norm". Between 1920 and 1930 the principles of our present concept were accepted and the mathematical tools developed. It took several decades to introduce this concept into practical medicine finally being recommended by the IFCC.

Clinical Laboratory Techniques↗

[Cultural conceptions on dengue in urban contexts in Mexico].

OBJECTIVE: To explore the conceptual dimensions of dengue in the urban context, aiming at creating hypotheses about community attitudes toward prevention campaigns. METHODS: An exploratory cross-sectional study was carried out between March and April 2003 comprising 130 people selected by proposition sampling in three municipalities with different dengue prevalences in Mexico. Semi-structured interviews were applied using free lists, pile sorts and triads. Dengue-related terms and groups of conceptual dimensions were investigated. A consensual analysis was performed by factorizing the major components as well as a dimensional analysis with hierarchical clustering and multidimensional scales. RESULTS: The consensual model showed high homogeneity in dengue conceptions (values of 14.5 and 13.5 in the most prevalent contexts, and 5.4 in the least prevalent one). The common dimensions of conceptions were: preventive measures, symptoms, causes and reservoirs of Aedes aegypti (goodness of fit test values: <0.28). In the three contexts studied, a conception of basic prevention based on public actions by health officials predominated while individual and community actions were almost never mentioned. A moral dimension also appeared in the conception based on a notion of hygiene as a differentiating mechanism between the nearby community (clean) and outside people and communities (dirty and sick). CONCLUSIONS: The cultural conceptions of dengue do not favor self-managed community involvement in vertical prevention campaigns, and create obstacles to modifying community and individual prevention and control practices.

Adult↗

[Social participation in health services: concepts of users and community leaders in two municipalities of Northeastern Brazil].

Social participation in management of the health care system at different levels of government is one of the key policies promoted by the Unified National Health System (SUS) in Brazil. As with any new policy, success hinges on several factors such as stakeholders' interests and opinions, which have not always been considered in the past. This paper analyzes the underlying concepts of two groups of stakeholders with respect to social participation in health and the potential influence of these concepts on the effectiveness of policy implementation. A case study of two municipalities in Northeast Brazil was conducted using a combination of qualitative and quantitative social science research methods. Health services users and community leaders were interviewed. Various concepts were found in which the participatory approach to health policies was only partially reflected. Likely influences on stakeholders' concepts of social participation in health are the evolution of the broader Brazilian social context and the traditional performance of health services. Particular attention should be paid to stakeholders' opinions and concepts if policy effectiveness is to be improved.

Adolescent↗

[Games as an alternative for teaching basic health concepts].

OBJECTIVE: To determine, for the teaching of basic health concepts to school-age children, the effectiveness of an educational strategy based on traditional children's games. METHODS: Intervention study carried out in the city of Durango, Mexico, in June 2000 with 300 children from 9 to 11 years old. The children were randomly divided into two groups. The children in Group A used a modified version of a Mexican popular game called Serpientes y Escaleras (Snakes and Ladders) that included messages on basic health concepts; the children in Group B made up the control group and did not play the modified game. RESULTS: At baseline there were no significant differences between the two groups in terms of age, grade level, or their scores on a knowledge test of basic health concepts. After the educational intervention, the health concepts test scores, out of a maximum possible of 10, were 9.3 +/- 0.8 for Group A and 7.5 +/- 1.1 for Group B (P < 0.001). CONCLUSIONS: Using games that include health and hygiene messages can be an alternative for teaching basic health concepts.

Child↗

A critical comparison of the current view of Ca signaling with the novel concept of F-actin-based Ca signaling.

A detailed comparative survey on the current idea of Ca signaling and the alternative concept of F-actin-based Ca signaling is given. The two hypotheses differ in one central aspect - the mechanism of Ca storage. The current theory rests on the assumption of Ca-accumulating vesicles derived from the endoplasmic/ sarcoplasmic reticulum, which are equipped with an ATP-dependent Ca pump and IP3- or ryanodine-sensitive Ca-release channels/receptors. The alternative hypothesis proceeds from the idea of Ca storage at the high-affinity binding sites of F-actin subunits. Several prominent features of Ca signaling, which are not adequately described by the current concept, are inherent properties of the F-actin system and its dynamic state of treadmilling. F-actin is the only known biological Ca-binding system that has been proven by in vitro experiments to work within the physiological range of Ca concentrations and the only system that meets all necessary conditions to function as receptor-operated Ca store and as a coupling device between the Ca store and the store-operated Ca influx pathway. The most important properties of Ca signaling, such as store-channel coupling, quantal Ca release, spiking and oscillations, biphasic and "phasic" uptake kinetics, and Ca-induced Ca release, turn out to be systematic features of the new concept but remain unexplained by the classical vesicle storage hypothesis. A number of novel findings, specifically recent reports about direct effects of actin-specific toxins on Ca stores, have strengthened the new concept. The concept of F-actin-based Ca signaling combined with the notion of microvillar regulation of ion and substrate fluxes opens new aspects and far-reaching consequences, not only for cellular Ca signaling but also for various other cell functions, and represents an opportunity to connect several fields of cell physiology on the basis of a common mechanism.

Actin Depolymerizing Factors↗

Setting expectations for the ecological condition of streams: the concept of reference condition.

An important component of the biological assessment of stream condition is an evaluation of the direct or indirect effects of human activities or disturbances. The concept of a "reference condition" is increasingly used to describe the standard or benchmark against which current condition is compared. Many individual nations, and the European Union as a whole, have codified the concept of reference condition in legislation aimed at protecting and improving the ecological condition of streams. However, the phrase "reference condition" has many meanings in a variety of contexts. One of the primary purposes of this paper is to bring some consistency to the use of the term. We argue the need for a "reference condition" term that is reserved for referring to the "naturalness" of the biota (structure and function) and that naturalness implies the absence of significant human disturbance or alteration. To avoid the confusion that arises when alternative definitions of reference condition are used, we propose that the original concept of reference condition be preserved in this modified form of the term: "reference condition for biological integrity," or RC(BI). We further urge that these specific terms be used to refer to the concepts and methods used in individual bioassessments to characterize the expected condition to which current conditions are compared: "minimally disturbed condition" (MDC); "historical condition" (HC); "least disturbed condition" (LDC); and "best attainable condition" (BAC). We argue that each of these concepts can be narrowly defined, and each implies specific methods for estimating expectations. We also describe current methods by which these expectations are estimated including: the reference-site approach (condition at minimally or least-disturbed sites); best professional judgment; interpretation of historical condition; extrapolation of empirical models; and evaluation of ambient distributions. Because different assumptions about what constitutes reference condition will have important effects on the final classification of streams into condition classes, we urge that bioassessments be consistent in describing the definitions and methods used to set expectations.

Ecosystem↗

The effect of glycemic control in the pre-conception period and early pregnancy on birth weight in women with IDDM.

OBJECTIVE: To examine data from pregnancies in women with IDDM to assess the relative effects of mean glycosylated hemoglobin levels before conception, at booking, and during the 3 trimesters of pregnancy on birth weight. Good glycemic control during pregnancy in women with IDDM is important to minimize the risk of fetal malformation and macrosomia. Recent studies have suggested that glycemic control in the 1st trimester is more important than glycemic control during the 2nd or 3rd trimesters. RESEARCH DESIGN AND METHODS: The case records of 65 deliveries to women with IDDM were reviewed. Fifty-seven deliveries were included in the present study. Of the deliveries reviewed, 32 women were in their first pregnancy and 25 women were multiparous. Only viable pregnancies were included because the major outcome variable of interest was birth weight. Glycosylated hemoglobin was recorded for each time period. RESULTS: The median standardized birth weight was 1.1 SD higher than the nondiabetic mean. When pregnancies, in which the birth weight was greater than 1 SD above the nondiabetic mean, were compared with pregnancies, in which birth weight was less than 1 SD above the mean, significant differences were observed between the groups in HbA1 at 6-12 months pre-conception (10.0 +/- 2.3 vs. 8.6 +/- 1.4%, P = 0.02), at 0-6 months pre-conception (10.2 +/- 2.4 vs. 8.7 +/- 2.0%, P = 0.03), at booking (9.5 +/- 2.2 vs. 8.4 +/- 1.6%, P = 0.04), and at 0-12 weeks' gestation (9.5 +/- 2.2 vs. 8.0 +/- 1.3%, P = 0.04), but HbA1 later in pregnancy did not differ significantly between the groups. Correlational analysis of all 57 pregnancies revealed significant correlations between birth weight and HbA1 at 0-6 months pre-conception (r = 0.44, P = 0.002), at booking (r = 0.43, P = 0.001), at 0-12 weeks' gestation (r = 0.48, P = 0.001), at 12-24 weeks' gestation (r = 0.45, P = 0.001), and at 24 weeks to term (r = 0.34, P = 0.009). However, with stepwise regression analysis, only HbA1 at 0-12 weeks' gestation entered into the equation with a multiple r value of 0.48. CONCLUSIONS: Glycemic control in the immediate pre-conception period and early 1st trimester appears to have a greater influence on birth weight than does glycemic control during the later weeks of pregnancy.

Adult↗