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Testing knowledge of human gross anatomy in medical school: an applied contextual-learning theory method.

The traditional gross anatomy laboratory experience, with modifications in evaluations that we outline later, meets the criteria of contextual-learning theory, expands the repertoire of core objectives we identify for our students, and may increase the likelihood of cognitive permanence of anatomical data. Our subjects included approximately 54 first-year medical students from each of three sequential class years (1996, 1997, 1998). As an alternative to more typical written and practical exams, examinations in a major portion of our gross anatomy program consist of two approximately 30 minute oral expositions by each student to his or her peers and a faculty member. Students demonstrate specific detail on cadaver, x-ray, cross sections, or a model. Clinical applications, spatial relationships, nomenclature, and functions are strongly emphasized. The results of this teaching approach to the utilization of anatomical knowledge in clinical situations requires further assessment: however, new attributes have been afforded our students with implementation of the present program: First, students learn anatomical detail equally well as the students of the more traditional system (based on board exam results). Second, students who completed the program indicate that this approach provides a useful simulation of what is expected later in their training. Third, students gradually gain confidence in verbal presentation, they demonstrate cognitive synthesis of separate conceptual issues, they retain information, and they are quite visibly more enthusiastic about anatomy and its importance in medicine. Our program demonstrates that the learning of applicable human anatomy is facilitated in a contextual-learning environment. Moreover, by learning anatomy in this way, other equally beneficial attributes are afforded the medical student, including, but not limited to, increases in communication skills, confidence in verbal presentation, synthesis of anatomical concepts, appreciation of the clinical importance of anatomy, and the general development of professionalism.

Anatomy↗

IQ scores among homeless older adolescents: characteristics of intellectual performance and associations with psychosocial functioning.

Intellectual performance and the associations of IQ with the quality of psychosocial functioning were studied in a sample of homeless older adolescents. Fifty homeless older adolescents (ages 16-21) completed the Wechsler Adult Intelligence Scale-Revised (WAIS-R) and a questionnaire assessing psychosocial functioning and sexual risk factors. The WAIS-R scores were comparable to population means, with performance IQ scores tending to be higher than verbal IQ scores. The IQ was unrelated to the duration of homelessness. Higher IQ scores were significantly correlated with only a minority of the measures of psychosocial functioning, including less self-reported depression and lower reported delinquency, but also less self-control in high-risk sexual situations, less perceived peer support for safer sex, and a higher perceived likelihood of acquiring HIV.

Adolescent↗

Changes in perceived health of children with congenital heart disease after attending a special sports camp.

Sports camps for children with cardiac anomalies have existed for many years. However, no formal evaluation of the benefits of attending such camps has been undertaken heretofore. We assessed potential changes in the self-perceived health of children with congenital heart disease who attended a special sports camp. Thirty-one children with cardiac anomalies attended a 3-day multisports camp. Sixteen children, all of whom were 10 years or older, literate, and Dutch- or French-speaking, completed the Child Health Questionnaire (CHQ-CF87) before and after attending the camp. The scores of the children were compared with those of healthy peers by calculating mean standardized differences. After attendance at the sports camp, the children achieved significant improvements in the self-perception of their physical functioning, role functioning due to emotional problems, role functioning due to behavioral problems, mental health, and general behavior. The children's self-esteem and general behavior after the camp were significantly better than that of their healthy counterparts. We conclude that children with congenital heart disease who participate in activities at special sports camps may reap benefits in terms of their subjective health status. Although further research is needed, we recommend the participation in sport activities by children with heart defects, and more specifically their participation in sports camps.

Adolescent↗

A psychometric normative database for pre-liver transplantation evaluations. The Florida cohort 1991-1996.

In this study, the authors describe the psychological characteristics of a large sample (N = 407) of adult patients evaluated for liver transplantation, and provide normative data on commonly used measures of cognitive functioning, affective status, psychosocial adjustment, coping, quality of life, and life satisfaction. The normative data suggest that the study's liver transplant candidates have poorer cognitive functioning and health-related quality of life when compared with available normative comparison groups, yet the former group is more comparable to medically ill peers on measures of anxiety, depression, psychosocial adjustment, and coping. Data also suggest a high rate of affective disturbance in liver transplant candidates. Results indicate the utility of normative data, such as the authors', for providing an appropriate comparison group for liver pretransplant candidates.

Activities of Daily Living↗

Department of Health Research Initiative on Nutrition Phase 2: overview of findings and recommendations.

OBJECTIVE: The purpose of this overview is to synthesise and summarise the findings and recommendations of all 14 projects funded between 1997 and 2002 under Phase 2 of the Department of Health's Policy Research Programme Nutrition Initiative. This is aimed at end users, including policy makers, practitioners, researchers and research funding bodies. DESIGN: The main findings and recommendations for policy and practice, as well as for future research, contained in the peer-reviewed final report of each project are summarised under headings identified as being useful for policy groups and practitioners: Maintenance of a healthy weight; Functional outcomes related to different markers of iron status; Nutritional aspects of bone health in humans; and Dietary interventions. RESULTS: The overview draws together the key findings and recommendations for current and future policy and practice from the second phase of the research programme and identifies research gaps. CONCLUSIONS: The findings and recommendations of the Department of Health's Nutrition Research Initiative have contributed to the scientific evidence base for policy development, policy evaluation, and will inform practitioners as well as researchers and research funding bodies.

Evidence-Based Medicine↗

The Participation Scale: measuring a key concept in public health.

PURPOSE: To develop a scale to measure (social) participation for use in rehabilitation, stigma reduction and social integration programmes. METHOD: A scale development study was carried out in Nepal, India and Brazil using standard methods. The instrument was to be based on the Participation domains of the International Classification of Functioning, Disability and Health (ICF), be cross-cultural in nature and assess client-perceived participation. Respondents rated their participation in comparison with a "peer", defined as "someone similar to the respondent in all respects except for the disease or disability". RESULTS: An 18-item instrument was developed in seven languages. Crohnbach's alpha was 0.92, intra-tester stability 0.83 and inter-tester reliability 0.80. Discrimination between controls and clients was good at a Participation Score threshold of 12. Responsiveness after a "life change" was according to expectation. CONCLUSIONS: The Participation Scale is reliable and valid to measure client-perceived participation in people affected by leprosy or disability. It is expected to be valid in other (stigmatised) conditions also, but this needs confirmation. The scale allows collection of participation data and impact assessment of interventions to improve social participation. Such data may be compared between clients, interventions and programmes. The scale is suitable for use in institutions, but also at the peripheral level.

Algorithms↗

Characteristics of persistent smoking among pregnant teenagers followed to young adulthood.

Pregnant teenagers (N=344) were interviewed during first and third trimesters (average age=16.2 years) and interviewed again as young adults (average age=23.0 years). Nearly 47% were smokers during the first trimester, 58% smoked during the third trimester, and 61% were smokers in their early adult years. Some 40% (n=137) continued smoking into young adulthood (persistent smokers); 7% quit. Average number of cigarettes per day was 10.0 among persistent smokers and 6.8 among quitters (p<.05). Nearly 20% started smoking by young adulthood (late-onset smokers). Persistent smokers and quitters were most similar to one another, and they differed from the late-onset smokers and persistent nonsmokers on demographic, psychological, and behavioral measures. These variables from the teenage years included White race, lower maternal education, lower school grades, more aggression and delinquency problems, and earlier and more peer use of substances. Characteristics from the adult years included White race; lower education; and more anxiety, hostility, and alcohol use. Multivariate analyses using discriminant function analyses showed that three characteristics from the teenage years discriminated across the three smoking groups (persistent, late-onset, quitters): White race, friends' smoking, and lower maternal education. The same analyses using the adult characteristics showed that White race and lower personal educational level discriminated the persistent smokers and quitters from the late-onset smokers. Lower gravidity discriminated the persistent smokers from the quitters. Characteristics of women who are at highest risk of persistent smoking can be identified in both the teenage years and the early adult years, and appropriate interventions can be targeted to those women at highest risk of persistent smoking.

Adolescent↗

A cognitive neurobiological account of deception: evidence from functional neuroimaging.

An organism may use misinformation, knowingly (through deception) or unknowingly (as in the case of camouflage), to gain advantage in a competitive environment. From an evolutionary perspective, greater tactical deception occurs among primates closer to humans, with larger neocortices. In humans, the onset of deceptive behaviours in childhood exhibits a developmental trajectory, which may be regarded as 'normal' in the majority and deficient among a minority with certain neurodevelopmental disorders (e.g. autism). In the human adult, deception and lying exhibit features consistent with their use of 'higher' or 'executive' brain systems. Accurate detection of deception in humans may be of particular importance in forensic practice, while an understanding of its cognitive neurobiology may have implications for models of 'theory of mind' and social cognition, and societal notions of responsibility, guilt and mitigation. In recent years, functional neuroimaging techniques (especially functional magnetic resonance imaging) have been used to study deception. Though few in number, and using very different experimental protocols, studies published in the peer-reviewed literature exhibit certain consistencies. Attempted deception is associated with activation of executive brain regions (particularly prefrontal and anterior cingulate cortices), while truthful responding has not been shown to be associated with any areas of increased activation (relative to deception). Hence, truthful responding may comprise a relative 'baseline' in human cognition and communication. The subject who lies may necessarily engage 'higher' brain centres, consistent with a purpose or intention (to deceive). While the principle of executive control during deception remains plausible, its precise anatomy awaits elucidation.

Brain↗

The Strengths and Difficulties Questionnaire: a research note.

A novel behavioural screening questionnaire, the Strengths and Difficulties Questionnaire (SDQ), was administered along with Rutter questionnaires to parents and teachers of 403 children drawn from dental and psychiatric clinics. Scores derived from the SDQ and Rutter questionnaires were highly correlated; parent-teacher correlations for the two sets of measures were comparable or favoured the SDQ. The two sets of measures did not differ in their ability to discriminate between psychiatric and dental clinic attenders. These preliminary findings suggest that the SDQ functions as well as the Rutter questionnaires while offering the following additional advantages: a focus on strengths as well as difficulties; better coverage of inattention, peer relationships, and prosocial behaviour; a shorter format; and a single form suitable for both parents and teachers, perhaps thereby increasing parent-teacher correlations.

Adolescent↗

New horizons: future directions in neurotoxicology.

Neurotoxicology is a relatively young discipline that has undergone significant growth during the last 25 years. During the late 1970s and 1980s, numerous national and international conferences and meetings were devoted to the topic of neurotoxicology, the formation of societies or specialty sections related to neurotoxicology, and the establishment of two independent peer-reviewed journals devoted to neurotoxicology. This decade was also associated with a rapid increase in our knowledge of chemical effects on the structure and function of the nervous system. During the 1990s, regulatory agencies such as the U.S. Environmental Protection Agency accepted neurotoxicology as a crucial end point and neurotoxicity testing and risk assessment guidelines were published. Neurotoxicology has also been accepted at the international level as evidenced by environmental criteria documents published by the International Programme on Chemical Safety and testing guidelines by the Organization of Economic Cooperation and Development. In recent years, there has been increased concern that the etiology of some neurodegenerative diseases may be associated with exposure to neurotoxic agents and that subpopulations of humans such as children and the elderly may be differentially sensitive to neurotoxic exposure. In the future, mechanistic information derived from basic research will be used in the identification and characterization of chemicals with neurotoxic potential.

Environmental Health↗

Problem Knowledge Couplers: reengineering evidence-based medicine through interdisciplinary development, decision support, and research.

The rapid growth of medical knowledge is creating a demand for new ways of providing information in support of evidence-based medical practice. Problem Knowledge Couplers are a clinical decision support software tool that offer a new approach to this growing problem. Couplers are developed through a collaboration among clinicians, informaticians, and librarians. They recognize that functionality must be predicated upon combining unique patient information, gleaned through relevant structured question sets, with the appropriate knowledge found in the world's peer-reviewed medical literature. Two pilot studies indicate that couplers can meet the gold standards of decision making within both a primary care and a specialty practice. Issues remain about how to best integrate Problem Knowledge Couplers into clinical practice and whether large-scale outcomes research will support the findings of pilot studies. However, Problem Knowledge Couplers represent a promising approach that might portend a new model for health care delivery in the next millennium.

Adolescent↗

Subtypes of victims and aggressors in children's peer groups.

This study reports an investigation of the behavioral profiles and psychosocial adjustment of subgroups of victims and aggressors in elementary school peer groups. Peer nomination scores for aggression and victimization were used to classify 354 inner-city children (mean age of 10.3 years) into one of four subgroups: aggressive victims, nonaggressive victims, nonvictimized aggressors, and normative contrasts. Subgroup comparisons were then conducted using multi-informant assessment of social behavior, social acceptance-rejection, behavioral regulation, academic functioning, and emotional distress. Children in each of the victim-aggressor subgroups were characterized by a degree of social and behavioral maladjustment. However, impairments in behavioral and emotional regulation were most evident for the aggressive victim subgroup. Aggressive victims were also characterized by academic failure, peer rejection, and emotional distress. The results of this investigation highlight the distinctive nature of the aggressive victim subgroup.

Aggression↗

Promoting social communication in high functioning individuals with autistic spectrum disorders.

This article reviews a range of social communication interventions that have been developed for students with autism at the preschool, school age, and adolescent level. Adult-mediated and peer-mediated methods that use highly structured, child-centered, and hybrid methods are examined. Programs that provide information on generalization and maintenance are identified. A set of recommendations for programs that would seem to be most appropriate for students with Asperger syndrome is presented.

Adolescent↗

The relationship of behavioural undercontrol to alcoholism in higher-functioning adults.

Externalising behaviours, including the personality characteristics of behavioural undercontrol (BU), represent one of several genetically influenced domains that impact on the alcoholism risk. Because genes explain only about 60% of the vulnerability toward alcohol use disorders (AUDs), an optimal understanding of how such behaviours affect the risk requires evaluation of their impact in the context of additional influences. Few studies have addressed this question regarding BU among relatively well-functioning adults. This paper presents results from testing a BU-based mediational model of risk in men from the San Diego Prospective Study. Structured research instruments were used with 430 adult Caucasian males to evaluate the performance of BU in predicting AUDs at the 15-year follow-up using Pearson product - moment correlations among domains and an AMOS-based structural equation model (SEM). While both the family history of AUDs (FHalc) and BU predicted alcohol-related outcome, BU by itself did not mediate the relationship of the FH to alcohol disorders. The impact of BU on alcohol problems was mediated by alcohol expectancies, peer drinking and by coping. The SEM explained 42% of the variance for AUDs. The current results indicate that BU contributed to the risk for alcohol-related problems, even among more highly functional subjects and after excluding the impact of the antisocial personality disorder, but by itself did not mediate the relationship of FH to outcome in these subjects.

Adaptation, Psychological↗

Effects of rearing condition on HPA axis response to fluoxetine and desipramine treatment over repeated social separations in young rhesus monkeys.

Normal hypothalamic-pituitary-adrenal (HPA) axis activity is disrupted in several types of human psychiatric disorders, and has been widely reported to be altered as a result of early experience in rodents. In this study the effects of early social experience on later response of the HPA axis to separations from cagemates and pharmacologic treatments were examined in rhesus monkeys. HPA axis activity was measured in mother-reared and peer-reared monkey infants in conjunction with six repeated separations from and reunions with their cagemates. Within each rearing group, infants were assigned to one of three treatment groups that received continuous treatment with either fluoxetine (2 mg/kg), desipramine (DMI, 5 mg/kg) or placebo (saline) beginning 2 weeks prior to separations. At 2 weeks after drug treatment, fluoxetine increased ACTH and cortisol in the treated groups, while DMI decreased ACTH and cortisol in both treated groups; however, these effects were not persistent over the separations. While these treatment effects tended to be more pronounced in the mother-reared group, the rearing groups did not show a clearly differential response to either of the treatments. The most prominent finding was that mother-reared monkeys showed significantly higher ACTH and cortisol levels than peer-reared monkeys over all samples, an effect that may have mitigated a potential rearing group difference in treatment response. The results add to growing evidence for the influence of primate mothers on the functional development of psychobiological systems in their infants, and suggest that the HPA axis is among the more sensitive of these systems to postnatal experience.

Adrenocorticotropic Hormone↗