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The concept of mental illness.

In recent years it has often been suggested that there is no such thing as mental illness. In naive Cartesianism this assertion starts out from the assumption that illness may develop solely from physical causes. Before clarifying what mental illness is, we should ask what is understood by the general notion of 'illness'. A constituent of the general disease concept is an unvoluntary and sufficiently serious disturbance of vital functions that needs to be defined in detail-and not just any region of disease causes or symptoms. The general disease concept can be defined in the context of everyday life and in the social and legal context and be filled with detailed normative and threshold values in the medical context. A society with a humanitarian orientation responds to the incapacity of its members owing to illness with attempts at institutionalization, which find their expression in norms, privileges and duties. Special disease concepts were developed for defining specific diseases and distinguishing them from others. Since solely the general disease concept, on which the distinction between illness and deviations from moral or legal norms is founded, is aetiologically neutral, it can be filled with any explanation model at the physical or at the mental level in the frame of specific disease concepts: e.g. with the one cause--one disease model, with multifactorial models or behavioural dysfunction models.

Humans↗

The merits and problems with the concept of projective identification.

This paper reviewed the merits of and problems with the concept of projective identification. On the negative side, lack of universal meaning of the term was cited. Personal countertransference receives little regard, while an isomorphic reading of patient feelings may be used to gratify omnipotent symbiotic analyst and patient fantasies. On the positive side, the concept offers a framework that can lead to deeper understanding of difficult therapeutic situations. It helps the analyst process and contain distressing feelings and eschews interpretation that can be destructive to the analytic process. Proper use of projective identification should engage the patient's ego rather than foster passivity and merger wishes. Case material was presented which illustrated problems with and merits of the concept. Personal countertransference, especially therapeutic omnipotence, was shown to receive insufficient attention. The important role of complementarity in projective identification was illustrated in the treatment of depression, a disorder which can offer difficult treatment resistances. In conclusion, the concept should not be used as a justification for analyst omnipotence and avoidance of countertransference responsibility. The concept, however, can lead to a deepening of the analytic situation if it is used with caution and respect for the patient's separateness.

Countertransference↗

[The selection of a concept of occlusion].

The choice of a functionally and morphologically faultless concept of occlusion is of primary importance in crown and bridge prosthodontics. Generally speaking we can choose between two concepts:--the concept of harmonious occlusion--the gnathological concept of organic occlusion. A case study was used to illustrate in depth the range of application of these two concepts.

Adaptation, Physiological↗

An iso-effect table for radiation tolerance of the human thoracic spinal cord. A new approach on the basis of the DFT conception.

Forty-four cases of well documented progressive radiation myelopathy of thoracic spinal cord were analyzed in terms of the new DFT conception (Dose-Fraction-Time). The DFT conception is a new radiobiological cell tissue kinetic model comprising explicitly repopulation. The conception has been previously tested against many animal experimental data. Good agreement could be demonstrated. The comparison with clinical data enabled us to establish human thoracic spinal cord tolerance DFT value of DFT = 70. For all cases of thoracic progressive spinal cord radiation myelopathy where the radiation fields were up to 20 cm of the cord length the value of the DFT has been found above the proposed value. Tolerance irradiation doses of various regular irradiation schemes were calculated from the DFT = 70 for practical use. Our predictions are in agreement with tolerance irradiation regimes recommended by various authors on the basis of their clinical experience. Moreover, such an approach enabled to establish safe tolerance doses in cases where currently used NSD or ED conceptions could lead to dangerous consequences--mainly for shorter irradiation schedules. This is the first attempt to utilize the DFT conception in the clinical practice.

Dose-Response Relationship, Radiation↗

[The effect of the microclimate in the insemination facility on conception in sows after the first insemination].

In the course of the year, the temperature and relative humidity of the insemination hall of a large pig farm were studied in ten three-week periods. The results were compared with the conception rate of sows inseminated in these periods. The macroclimatic conditions were also studied, and the influence of macroclimate (including temperature and relative humidity) on the microclimate of insemination hall was evaluated. The studied microclimate parameters were found to influence the conception of sows in the first three weeks after insemination. Highly significant differences (significance level of alpha = 0.01) were recorded in the conception of sows after the first insemination, in the occurrence of optimum and increased temperatures, in the occurrence of optimum and increased relative humidity in the summer and winter months. A significant difference at the significance level of alpha = 0.05 was found when the occurrence of increased relative humidity was compared. A high temperature was recorded only in the summer months. In summer and in the first half of autumn (from the 9th of June to the 13th of October) when increased to high temperatures and increased to high relative humidity prevailed in the insemination hall (optimum temperature only in 2.0 to 23.3% of the period; optimum relative humidity in 11.1 to 50.0% of the period), the sow conception rate after the first insemination was low (45.5 to 49.7%). In autumn the microclimatic conditions in the insemination hall returned to the optimum. From the 4th of November to the 16th of February the optimum temperature (optimum in 71.6 to 89.7% of the period) and optimum relative humidity (optimum in 74.2 to 90.7% of the period) prevailed in the insemination hall, enabling an improvement in the conception of sows after the first insemination (71.4 to 80.1%). The temperature inside the insemination hall was influenced by changes in outside temperatures whereas the relative humidity inside the insemination hall was influenced mainly by internal factors.

Animals↗

[Illness concepts of patients].

The term "Illness concept" compromises all assumptions, interpretations, explanations, and predictions in regard to one's health status. Therapists and patients hold illness concepts which may differ from each other. Illness concepts can be described under formal, phenomenological and psychological-functional aspects. Illness concepts influence perception of illness, cooperation and satisfaction with treatment by the patient. To respect the illness concepts of patients means to respect the patient himself. The patient's perspectives are valuable completions of the therapist's perspectives and should, therefore, be integrated in the planning of therapy.

Adaptation, Psychological↗

The current status of the psychoanalytic theory of instinctual drives. I: Drive concept, classification, and development.

The evolution of Freud's theory of instinctual drives, with the accompanying models of a mental apparatus, is remarkable for its tenacious adherence to addressing the fundamental problems of human psychology, here phrased as the problems of body-mind-environment relationships. The concept of instinctual drives continues to be one of the most pervasive concepts of psychoanalysis, weathering considerable attack over the last several decades, although losing some clarity in the process. I have cited and discussed as basic issues of the concept of instinctual drives: the relationship of observational data and theoretical constructs in psychology; whether our construct of drives is or should be or can be purely psychological; the problem of conceptualizing the ontogenetic origin of mind; the issues of the "force-meaning conjunction" and the problem of psychic energy in psychoanalytic constructs; and the relation of our concept of instinctual drives to the concept of instincts in general. It seems that progress with these fundamental issues might be made by utilizing models that are more homologous with present knowledge in related fields than is Freud's reflex arc model of the nervous system, in order to build a better drive construct within the framework of psychoanalysis. The classification of instinctual drives remains a problem. Clinically, aggression seems to be a factor in conflict, very much like sexuality. Despite widespread acceptance of the idea of aggression as simply parallel to sexuality in all respects, there are major discrepancies. Perhaps aggression cannot be viewed as a drive after all; perhaps our drive construct needs to be modified to accommodate aggression. Certainly, controversy in this area has interfered with the production of good clinical studies which could begin to increase our understanding of aggression and its place in the human personality. The psychoanalytic theory of drive development has probably undergone less change in the last forty years than other aspects of drive theory, although careful observational work has led to alterations of our views of the age of onset of genital awareness, of female sexual development and function, and of the latency period. This is the conclusion of the first of two papers examining the post-Freud development of the theory of instinctual drives in psychoanalysis. The companion paper follows on p. 402 of this issue of The Psychoanalytic Quarterly.

Aggression↗

The superego concept. Part II: Superego development, superego pathology summary.

From its inception the superego concept has been historically at the center of a process of scientific convergence-yet it has always presented difficulties in conceptualizing. In this paper, a condensed literature review selectively explore: (1) Freud's fundamental contributions to this concept; (2) major trends in the psychoanalytic exploration of the concept, as they derived from Freud's germinal ideas and; (3) some "stumbling blocks" which may have interfered with efforts at intergration of the superego concept. An object-relational frame of reference, incorporating Kernberg's recent contributions and his efforts at integration in this field at large, as well as Jacobson's contributions as they relate to superego concept in particular are briefly considered. Such a frame of reference is then applied in an effort at describing a sequential development of the superego in four progressively differentiated and integrated phases: (1) agressively derived primitive sadistic superego forerunners; (2) integration of aggressively derived, primitive superego forerunners and ideal self-object representations; (3) oedipally-derived superego and (4) post-oedipal superego individualization. Toward the end some succinct considerations regarding superego pathology are given and paths for possible further integration and exploration are suggested.

Adolescent↗

The immunologic concept of EPH-gestosis.

Edema proteinuria hypertension gestosis represents a disease syndrome that is defined by its occurrence in association with pregnancy and by its patient population. Although the difference between true and superimposed EPH-gestosis remains poorly defined clinically, a clearer definition seems feasible if epidemiological data, which have been developed in long-term follow-up studies, are utilized. These circumstances permit the identification of a well-defined, young, primiparous population that is afflicted during pregnancy with a disease syndrome of unknown etiology. Among many suggested theories, the immunologic concept of EPH-gestosis has attracted increasing attention over the recent past. Assuming an immunologic etiology for this disease syndrome, EPH-gestosis is understood to represent a partial or total malfunction or maladaptation of the immune system of the mother and/or the fetus. According to this concept, EPH-gestosis is considered to represent partial rejection of the fetal allograft. In the present review evidence for an immunologic etiology of EPH-gestosis has been summarized. It may be concluded that, in spite of a large body of available information, no definitive proof for an immunologic etiology of EPH-gestosis has yet been presented. Only the further clarification of the immunologic processes involved in the tolerance of normal pregnancy will allow the detection in those mechanisms of abnormalities associated with EPH-gestosis. Until then, EPH-gestosis will remain a condition of unknown etiology. The immunologic concept, similar to other concepts, needs further clarification until the "concept" can become an etiology.

Antigen-Antibody Complex↗

A concept of humoral immunity among ruminants and an approach to its investigation.

My goal has been to piece together bits of information, both old and new, so as to provide you with some concepts of humoral immune function. Specifically I have described concepts of secretory immunity in two different organ systems, the lower respiratory tract and the mammary gland. Should these concepts not even survive this meeting or be proven incorrect by future research, I hope I have at least stimulated your thinking with an alternative view and challenged you to saw off the limb I have put myself on with the concepts I have presented. More than mere conjectural hypotheses, I have presented some data on the ELISA out of my belief that one approach to establishing concepts in humoral immunity depends on the ability to accurately and quantitatively measure the distribution of antibodies among isotypes. I have also shared with you some preliminary data on the transport of SIgA into bile and other secretion which will hopefully encourage others to finally establish the quantitative significance of locally synthesized versus serum-derived IgA in the various exocrine secretions of ruminants. Finally, I have dared to take ruminant immunoglobulin homology "back to sea"; perhaps this last topic will stimulate your palate if not your mind.

Animals↗

The significance of Kleinian contributions to psychoanalysis II. Freudian and Kleinian conceptions of early mental development.

This paper discusses and compares Freudian and Kleinian conceptions of the development of early mental life from the vertices of the genetic hypothesis (and reconstruction), the infantile neurosis, the conception of the evolution of the infant, the issue of reality, and the oedipus complex. In so doing, some of the newer findings of infant development are considered. We can now correlate Kleinian conceptions of early infantile reconstruction in light of these new developments; this paper seeks further to demonstrate that the classical notion of primary narcissism, which is laterally known as the conception of the self-object representation, is incompatible with notions of infantile psychology and therefore leaves the classical conception of early mental life in an ambiguous state. An attempt is made to redress this by reconciling the classical and Kleinian notions via a "dual-tract" theory.

Child Development↗

Using POSTDOC to recognize biomedical concepts in medical school curricular documents.

Recognition of the biomedical concepts in a document is prerequisite to further processing of the document: medical educators examine curricular documents to discover the coverage of certain topics, detect unwanted redundancies, integrate new content, and delete old content; and clinicians are concerned with terms in patient medical records for purposes ranging from creation of an electronic medical record to identification of medical literature relevant to a particular case. POSTDOC (POSTprocessor of DOCuments) is a computer application that (1) accepts as input a free-text, ASCII-formatted document and uses the Unified Medical Language System (UMLS) Metathesaurus to recognize relevant main concept terms; (2) provides term co-occurrence data and thus is able to identify potentially increasing correlations among concepts within the document; and (3) retrieves references from MEDLINE files based on user identification of relevant subjects. This paper describes a formative evaluation of POSTDOC's ability to recognize UMLS Metathesaurus biomedical concepts in medical school lecture outlines. The "precision" and "recall" varied over a wide range and were deemed not yet acceptable for automated creation of a database of concepts from curricular documents. However, results were good enough to warrant further study and continued system development.

Curriculum↗

[The Hazard Analysis Critical Control Point concept for food production].

A future standardized EU food controlling concept demands additional efforts in food controlling systems. The Hazard Analysis Critical Control Point (HACCP) concept has already been introduced to the EU food hygiene directive 93/43/EEC as a tool to ensure food safety during production. Primarily, it is a preventive measure for health risks in food. The start of any HACCP application is the collection of data, a risk assessment, the determination of Critical Control Points (CCPs), the specification of critical limits to separate acceptable and unacceptable values for each CCP and finally keeping of records and the verification of the implemented HACCP concept. As shown in the present paper, the application of the HACCP concept should be carried out according to the specific conditions of the individual factory. It is still not known, how small food producers will be able to implement the HACCP concept and how the official food inspection service will adapt to the required inspection procedures.

Animals↗

Extraction of SNOMED concepts from medical record texts.

Clinicians have traditionally documented patient data using natural language text. With the increasing prevalence of computer systems in health care, an increasing amount of medical record text will be stored electronically. However, for such textual documents to be indexed, shared, and processed adequately by computers, it will be important to be able to identify concepts in the documents using a common medical terminology. Automated methods for extracting concepts in a standard terminology would enhance retrieval and analysis of medical record data. This paper discusses a method for extracting concepts from medical record documents using the medical terminology SNOMED-III (Systematized Nomenclature of Human and Veterinary Medicine, Version III). The technique employs a linear least squares fit that maps training set phrases to SNOMED concepts. This mapping can be used for unknown text inputs in the same domain as the training set to predict SNOMED concepts that are contained in the document. We have implemented the method in the domain of congestive heart failure for history and physical exam texts. Our system has a reasonable response time. We tested the system over a range of thresholds. The system performed with 90% sensitivity and 83% specificity at the lowest threshold, and 42% sensitivity and 99.9% specificity at the highest threshold.

Algorithms↗

[An analysis of nursing research with a focus on concepts and methods (1961-1990)].

The purpose of this study is to summarize the trend and status of the nursing research in Korea during the last 30 years. Six hundred seventy three papers published in "The Korea Nurse" and "The Journal of Nurses Academic Society" from 1961 to 1990 were included for retrospective descriptive analysis. The questionnaire developed by Sigma Theta Tau was utilized for data collection. Nursing research in Korea in 1960's can be characterized by simple research methods, lack of team project, and lack of research funding. The nursing concepts used frequently were "person" and "nursing". In 1970's, the research method became more diversified. Also, funding was available from the government (Ministry of Education) and industry. Most often studied nursing concepts in 1970's were "person" and "nursing", but "health" was also important concept. Many papers published in 1980's were utilizing more sophisticated research methods and conceptual frameworks based on nursing theories. Also, the society recognized the importance of nursing research and more fundings were available from non-governmental agencies such as university research centers, industry, universities, and hospitals. These fundings allowed the larger scale nursing research projects which required team research. The important nursing concepts employed in nursing research in 1980's were similar to 1970's. the least investigated concept in last 30 years was "environment". The major improvement in nursing research from 1960's to 1970's is quantitative and from 1970's to 1980's is advancement in research methodology. Also, areas of research interest diversified from clinical practice to nursing education and community health care system. As a result of graduate nursing programs, nursing research in 1980's in Korea showed much improvement in quality and quantity. However, majority of nursing research in 1980's was still carried out by individual master's or doctorate student. Thus, main characteristics of nursing research in Korea during the last 30 years can be summarized as training and education of nurse researchers. Nursing research in 1990's should focus on development and expansion of our own unique knowledge. Included in this paper are strategies and plans for future nursing research.

Korea↗

Student nurses' conceptions of computer use in hospitals.

In this article, the author reports on a study that investigated the conceptions and attitudes of community college diploma nursing students toward the use of computers in hospitals. Data were collected during 35 audio-taped interviews, which were analyzed using the constant comparative method. Findings indicated that students had little understanding of how computers are used by nurses today and how they might be used in the future. Four categories of student conceptions of the use of computers by hospital-employed nurses emerged: workload, patient care, image, and professionalism. Conceptions within each category were grouped into subcategories that supported the notion that hospital employed nurse's work was enhanced or detracted from by computer use. Although the majority of students had a positive attitude toward computer use by nurses, their conceptions differed in quality or complexity in direct proportion to the year in the program and their amount of clinical experience. Nurse educators have a two-fold responsibility: 1) to foster positive attitudes toward computer use; and 2) to facilitate the learning process so that students' levels of conception increase throughout the nursing program.

Adult↗

[The evolution of the concept of archetypes in Jungian psychology].

The concept of archetype is basic in the Junguian conception of the human mind. Without archetypes the Junguian theory of the collective unconscions is absurd. Jung himself recognized that the concept of archetype had originated the worst misunderstandings of his theories. Within Junguian schools there is an archetypal school which has originated archetypal conceptions quite apart from the initial junguian ideas. In this paper the evolution of the concept of archetype is studied, and its implications for the practice of Junguian psychotherapy are considered.

Humans↗

Quality assurance concepts and skill development: results of a national study.

PURPOSE: Knowledge of quality assurance concepts and development of evaluation skills are essential to demonstrating professional accountability. Evaluation skills include self-assessment and peer review, both of which need to be specifically taught and practiced. The purpose of this study was twofold: 1) to determine if quality assurance concepts were taught and opportunities to develop evaluation skills were provided to associate and baccalaureate dental hygiene graduates, and 2) to determine if differences exist between these two groups. METHODS: In fall 1993, a 90-item survey instrument based on quality assurance concepts, skills, and the dental hygiene process and standards of care was validated and administered to a national stratified random sample of 1993 graduates (n=500). Responses were analyzed using descriptive statistics, chi-square, and the Wilcoxon rank sum test. For all statistical procedures, the .05 level of significance was established. RESULTS: A 65% response rate was obtained. No graduate reported having a specific course on quality assurance. Significant differences were found between the two groups, with a higher percentage of baccalaureate graduates reporting that self-assessment and peer evaluation concepts were taught and opportunities to practice peer review skills provided. No differences were found regarding opportunities to practice self-assessment. Perhaps more important, less than 44% of both groups reported experience in peer review and 66% in self-assessment activities related to specific courses. CONCLUSION: In order to better prepare practitioners to be accountable for care provided to the public, quality assurance concepts and opportunities to develop skills must be incorporated into the curricula for all dental hygiene students.

Chi-Square Distribution↗