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PubMed1983

[Clinical aspects of depressive states].

During the last 4 years (1979-1982), 4117 patients have been examined in our out-patient department. Since the most important dates of each patient are electronically registered, it was easy to ascertain the frequency of the depressive conditions with the computer. This amounts to 819 and corresponds to 19.9% of the patients examined during that period. The depressive states were divided in 4 categories: 1. depressive reactions, 2. depressive developments, 3. neurotic depressions, and 4. endogenous depressions. Of all depressive patients, only 27 were treated with drugs. The others were treated with the classical methods of the child- and youthpsychiatry, that is psychotherapy including family-therapy, educational measures and interventions in the social field. Patients with a depressive reaction never received any drugs. The few patients who suffered from an endogenous depression all received thymoleptica in combination with a Lithium salt. However, one dozen patients with a neurotic depression respectively with a depressive personality development received various drugs, whereby the antidepressants were leading, but not prescribed alone. Neuroleptica as well as psychotonica were prescribed, especially for children suffering from an infantile psychoorganic syndrome (MBD, ADD) with a depression. Psychotrope substances have their place in the treatment of depressive conditions in childhood. Their scarce and critical use is in the interest of the children.

Adolescent↗

PubMedDate not supplied

Personality profiles and leadership potential of medical-surgical and psychiatric nursing graduate students.

When personality profiles and leadership potential of psychiatric and medical-surgical nursing graduate students were compared, using the California Psychological inventory (CPI) and the Managerial Key for the CPI, medical-surgical majors scored significantly higher on the CPI scale (p greater than .05). Overall, both groups scored higher than the norm and showed a more optimal personality development than has been observed in earlier studies of this kind. In the Managerial Key for the CPI, the test of leadership potential on both groups received a high rating, comparable to that of the top-management group in the original research.

Chicago↗

PubMed1994

[People in divorce and their ambivalence: initial use of a newly developed couples inventory].

It has been reported that intact internal, external and social accommodation is related to a stable partnership between men and women. Every partnership, however, is also characterized by a certain potential towards separation that may develop despite of the named stabilizing factors. This led to the question of how the accommodation is constituted in men and women during separation. A written questionnaire was, therefore, sent to a total of 35 men and women in separation. The Bradburn inventory was used to define the well-being of the volunteers in relation to a representative sample. Using a newly developed inventory, a number of items had to be rated twice: once to reflect the condition at the beginning of the partnership and once to reflect the situation during the last year. In addition, the relative contribution of a particular item in favor or against separation was asked. The Bradburn inventory shows that the general well-being of the test sample is more impaired than that of the representative sample. The evaluation of the 80% returned questionnaires revealed worsening of all items. Most important reasons to finish the partnership were i) the lack of verbal communication, ii) extramarital affairs, and iii) the impression that the partnership limits the personal development. Reasons to continue the partnership were different between those who initiated the separation and those who were left: The initiators predominantly mentioned structural factors such as financial situation, living conditions and care for children, whereas the non-initiators predominantly mentioned internal qualities of the partnership.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1982

On fear in the countertransference.

The rational and irrational aspects of fear in the countertransference will be discussed. Arguments are presented for the potent force of fear in personality development and psychotherapy hitherto underemphasized in the literature. Manifestations of unacknowledged fear in clinical settings are identified and discussed. Recommendations are made for dealing with rational and irrational fears. These include supervision and interpretation in the case of irrational fear and effective security in the case of rational fear.

Adult↗

PubMed2005

Self-reflection in multicultural training: be careful what you ask for.

Self-reflection in multicultural education is an important means to develop self-awareness and ultimately to change professional behavior in favor of more equitable health care to diverse populations. As conceptualized by scholars in the field of psychology, racial identity theory is critical to understanding and planning for the potentially wide range of predictable reactions to provocative activities, including those negative reactions that do not necessarily herald a flaw in programming. Careful consideration of racial identity developmental phases can also assist program planners to optimally meet the needs of individual physician trainees in their ongoing constructive professional and personal development, and in strategically mobilizing and having ready the type of institutional leadership that supports trainees' change processes. The authors focus on white physician trainees, the largest racial group of U.S. physicians and medical students. They first explain what they mean by the terms white and nonwhite. Racial identity theory is then applied, with true case examples, to explore such issues as where the self-proclaimed "color-blind" trainee fits into this theoretical schema, and how medical educators can best serve trainees who are resistant or indifferent to discussions of racism in medicine and equity in health care delivery. Ultimately, the authors' goal is to demonstrate that engendering genuine self-reflection can substantively improve the delivery of health care to the nation's diverse population. To help achieve that goal, they emphasize what to anticipate in effecting optimal trainee education and how to create an institutional climate supportive of individual change.

Attitude of Health Personnel↗

PubMedDate not supplied

[Psychosomatic aspects of stomatology in the aged].

Elderly people form a very large portion (43.2%) of the out-patients of the research institute for dental psychosomatics and psychopathology. Abnormal personality developments could be observed in the group of 40-60-year-old patients as often as in the over-60 group, whereas there was a noticeable rise in the number of depressions and abnormal reactions in the older age group. As one case demonstrates, the situation and life-history of an elderly patient, too, are important factors influencing his psychosomatic disturbance, in some cases however, an organic psychosyndrome may supervene, thus further complicating psychotherapy and psychagogical measures. These therapeutical methods have to be made suitable to the personality of a patient of advanced age, while medicamentous therapy and prosthetic care have to be modified in the same way.

Aged↗

PubMed2003

Pathogenesis of acne: recent research advances.

The pathogenesis of acne is complex and dependent on the interplay of multiple factors. Ductal epidermal hyperproliferation, excess sebum, inflammation, and the presence of P acnes all contribute to the development of acne vulgaris. Isotretinoin, arguably the most effective acne treatment, normalizes ductal hyperproliferation, greatly diminishes sebum production and sebocyte terminal differentiation, and manifests decreased numbers of P acnes organisms. Isotretinoin also exhibits anti-inflammatory properties. A positive response to isotretinoin is durable in 85% of patients after one course of therapy, despite the reversal of many of these observed changes. The exact mechanism of isotretinoin is unknown. Much remains unknown in our understanding of the pathogenesis of acne. What is the initial stimulus for follicular hyperproliferation? Why do some persons develop acne and others do not despite similar serum hormone levels and similar P acnes counts? What determines the severity of acne in a given patient? Is acne primarily an inflammatory dermatosis? Much progress has been made in the study of acne, but many questions remain. Perhaps the most important question is, how do we treat our patients with acne more effectively and safely than we are now? The answer to this question lies in the development of a deeper understanding of the pathogenesis of acne vulgaris.

Acne Vulgaris↗

PubMed2003

[Workflow involving preventive health care promotes the economic development of a company].

Today's working society obviously develops from industrial production to knowledge-intensive service. In service-oriented working conditions, the importance of the human being as a main performer of economic success increases. Thus, the development leads to a changing spectrum of occupational health risks. Together with socio-demographic developments, individual strain-oriented health disorders connected to one's occupation might endanger an enterprise's capacity of performance and innovation as well as its sustainable enterprise development. Only healthy, motivated and qualified employees are able and ready to keep their creative and customer-oriented potential harnessed and thereby work to the best of their ability. Consequently, occupational health gains a more important role within the enterprise. Although in many enterprises the benefit contribution of preventive work design has not yet been considered that relevant, enterprises have realised that a preventive health-oriented work design might help to better manage current business challenges. An up-to-date definition of health includes the goals of health improvement, personality development as well as a comprehensive well-being. Health is a prerequisite and result of a productive reflection upon the conditions and challenges of work. Business practice shows that a preventive work design should involve an economic benefit for the enterprise. If occupational health is seen as a characteristic of quality and a prerequisite for sustainable enterprise development, economic potentials of preventive work designs will expand considerably.

Humans↗

PubMed2005

Clinical holistic medicine: holistic rehabilitation.

Quality of life, health, and ability are often lost at the same time and most often in one decaying existential movement over 5 or 10 years. This "loss of life" is mostly too slow to be felt as life threatening, but once awakened to reality, it provokes the deepest of fears in patients: the fear of death itself and destruction of our mere existence. The horrible experience of having "lost life", often without even noticing how it happened, can be turned into a strong motivation for improvement. Personal development is about finding the life deeply hidden within in order to induce revitalization and rehabilitation. Rehabilitation is about philosophy of life with the integration of the repressed painful feelings and emotions from the past and the letting go of the associated negative beliefs and decisions. The holistic medical toolbox builds on existential theories (the quality of life theories, the life mission theory, the theory of character, the theory of talent, and the holistic process theory) and seems to have the power to rehabilitate the purpose of life, the character of the person, and fundamental existential dimensions of man: (1) love; (2) strength of mind, feelings, and body; and 3) joy, gender, and sexuality; allowing the person once again to express and realize his talents and full potential. The principles of rehabilitation are not very different from other healing, but the task is often more demanding for the holistic physician as the motivation and resources often are very low and the treatment can take many years.

Adult↗

PubMed1994

Designing a "healthy" diploma in management studies.

Describes the range of issues considered in designing a programme of education and development for NHS managers. The programme took the form of a certificate and diploma in management studies with a very work-based approach using action learning sets and applied theory and techniques. Briefly discusses the recent history and debates in management education together with the tensions caused by academic focus on critical analysis and evaluation and the workplace focus of being effective and making improvements. This programme attempts to recognize and build on the strengths of both approaches and also to add some of the best practice from trainers' experience of designing personal development plans. Discusses the emphasis on reflective learning and the use of research-based assignments instead of conventional exams. Concludes with some indications of possible future developments from this model.

Curriculum↗

PubMed2004

Clinical holistic medicine: developing from asthma, allergy, and eczema.

This paper shows how consciousness-based holistic medicine can be used in the case of asthma, allergy, and eczema. We have many fine drugs to relieve patients from the worst of these symptoms, where many children and adults suffer health problems related to hyper-reactivity of the immune system. Many symptoms remain throughout life because the drugs do not cure the allergy and allergy today is the sixth leading cause of chronic illness. The etiology of the immune disturbances is mostly unknown from a biomedical perspective. Consciousness-based holistic medicine could therefore be used to treat these diseases if the patient is willing to confront hidden existential pain, is motivated to work hard, and is dedicated to improve quality of life, quality of working life, and personal relationships. Improving quality of life is not always an easy job for the patient, but it can be done with coaching from the physician. An increased physical health is often observed after only a few sessions with a physician skilled in using holistic medical tools and able to coach the patient successfully through a few weeks of dedicated homework. Children with allergy and asthma can also be helped if their parents are able to do work on personal development, to improve the general quality of life in the family and their relationship with the child.

Adult↗

PubMed1997

The efficacy and effectiveness of process consultation in improving staff morale and absenteeism.

OBJECTIVES: The purpose of this randomized controlled trial was to test the efficacy and effectiveness of process consultation consisting of a series of nurse manager-consultant problem-solving meetings for leadership development that would lead to their staff's improved morale, quality of care, and reduced absenteeism. METHODS: Thirteen consenting clinical inpatient units were stratified for four variables known to affect outcome and were then randomly assigned to treatment and control conditions. The nurse managers from the seven experimental units were paired with outside nurse consultants from the McMaster University School of Nursing (Hamilton, Ontario, Canada) in a cooperative form of retraining in problem-solving through process consultation. Morale was determined through measures of perceptions of the work environment, an attitude scale concerning work (alienation), a personality measure (hardiness), and one of each scale for work satisfaction and for sources of satisfaction and dissatisfaction. Demographic data and information regarding family life responsibilities were collected as well. Assessment of quality of care was determined by the frequency and type of incident reports and by patients' perception of their satisfaction. A ratio of absence hours to total paid hours of work was used to compare experimental and control units' absenteeism rates. RESULTS: Experimental subjects reported a statistically significant improvement in the characteristics of their work setting and in the quality of working relationships. The consultation process facilitated a perceived change in the organizational context of the experimental hospital units with less centralization of authority and more clarity about expectation. These organizational changes were accompanied by improved working relationships and less alienation from work. There was no statistically significant difference in absenteeism. However, a subanalysis of the units by "dose" of the intervention identified those who benefited from the effects of the consultation. Subjects whose nurse managers participated more actively in the consultation process accounted for the changes in working relationships and perceived organizational changes. The "low-dose" experimental subjects were more like the control subjects, with the exception of absenteeism, for which they had higher rates. CONCLUSIONS: The findings of this study suggest that process consultation can alter the staff's perceptions of the characteristics of the work setting, can reverse negative attitudes (alienation), and can create a more positive and supportive working environment (improved working relationship). However, the results suggest the need to target this type of intervention to managers who have the personal resources to engage in self-evaluation and personal development and thus to participate in the consultative process.

Absenteeism↗

PubMed1997

The minyan as a psychological support system.

Most individuals participate in some of the rituals and/or regular activities of religious institutions such as churches or synagogues. Through such involvements, people are offered vital assistance in dealing with developmental changes, opportunities for personal development and for group support, and more generally, a sense of continuity and of meaning in life. This paper deals with only one small aspect of Jewish observance, an aspect of the centuries-old required weekly prayer groups-the minyan. The prime emphasis resides in the rarely recognized, nonliturgical dimension of this small group experience. Using psychoanalysis in the sense of a general psychology as background, I have considered the minyan as combining elements of a psychological support system and of a small group. In addition to the gratification of affiliative needs (social hunger) and the countering of loneliness and of isolation, this group experience helps its members maintain an intergenerational sense of personal identity and of self-esteem. In the face of marked life stressors such as death in the family, religious institutions such as the minyan, with its prescribed ritual steps for grieving (i.e., kaddish), fulfill especially significant preventive and restitutive mental health functions. I have also hypothesized that on a covert, fantasy level, the caring and nurturing family-like weekday minyan may even represent a mother-symbol (mother group) in line with people's universal need to establish a psychological union with others, thus restoring an earlier, conflict-free state of the child-mother bond. In an extended societal sense, the earlier emphasis in Western cultures on the virtual worship of individuality, autonomy, and independence has given way recently to a renewed appreciation of cooperation, communalism, and altruism. The minyan, as a small religious communal aggregate with its inherent climate of mutuality, reciprocity, and continuity, has, in a sense, anticipated these new developments. For as Herbert Simon (1990), the Nobel laureate, observed, "It is of no little moment for the human future whether people are necessarily and consistently selfish...or whether there is a significant place for altruism in the scheme of human behavior."

Ceremonial Behavior↗

PubMedDate not supplied

Evaluating the use of TalksBac, a predictive communication device for nonfluent adults with aphasia.

This paper describes the design and evaluation of a computer-based communication system called 'TalksBac' with four nonfluent adults with aphasia. Despite the increased availability of computer-based augmentative and alternative communication (AAC) devices, their use with adults with aphasia is limited as few devices have been designed for this population. The TalksBac system was designed specifically for nonfluent adults with aphasia and was used by four nonfluent aphasic individuals for a period of 9 months. The TalksBac system is word-based and exploits the ability of some nonfluent individuals with aphasia to recognize familiar words and short sentences. The system consists of two programs. Personal sentences and stories are entered into the TalksBac database by use of a 'carer program'. The 'user program' assists the nonfluent aphasic user to retrieve these prestored conversational items by offering probable items based on previous use of the system. The database has a hierarchical structure, but the links to individual items adapt automatically to reflect usage by individual users over time. Four nonfluent adults with aphasia were selected to participate in the study. Each subject was assessed by use of a battery of tests to provide pre-intervention data about their comprehension, expression and communication skills. Subjects and their carers were trained to use the TalksBac system and were involved in developing personalized databases. They were supported in use of the personalized systems for an intervention period of 9 months. At the end of this period, subjects' communication skills wre reassessed by use of a battery of tests. Clients' conversational abilities with and without the TalksBac system were also compared to see if use of TalksBac did augment their conversation and allow the aphasic partner to participate more fully within conversations. This was done by analysing videotaped conversations between subjects and non-aphasic partners. Results from the formal assessments indicated that there was little change in the underlying comprehension and expressive abilities of the subjects. An analysis of videotaped conversations showed that 1 subject was unable to carry out conversations using TalksBac independently, so the data for this subject was not included in the results of the analysis of conversations. Results from the video analysis for the remaining three subjects indicated that when using the TalksBac system, the conversational abilities of two subjects improved. The conversational abilities of the other subject were not enhanced by using the system as he had developed his own nonverbal strategies which he found to be more effective. This study has shown that TalksBac has the potential to augment the communication abilities of nonfluent adults with aphasia, who have not been able to develop their own compensatory strategies. Work continues to improve the efficiency of the software and to develop techniques to facilitate the carers' ability to generate conversational information for the system.

Aged↗

PubMed2004

Bringing holism into mainstream biomedical education.

Introducing holism and complementary medicine into mainstream medical education provides many scientific, philosophical, and personal challenges. The growth of new knowledge always necessitates venturing into areas, which are, by definition, unknown, hence arise potential clashes of ideology, knowledge, evidence, interpretation, language, and personality. This paper outlines some of the experience and progress made at Monash University Victoria, Australia, in teaching this material in undergraduate medical education. The Monash medical course has always been known for its commitment to an integrated curriculum, a holistic perspective, and the personal development of its students. Some of the points of integration in the core curriculum already achieved include health enhancement and mindfulness-based stress management programs right from first year, lectures and forums on complementary medicine, integration of this material into weekly case-based teaching, and health promotion and mind-body medicine. For very interested students, electives provide an opportunity to explore subjects in more depth. Experience has taught us that it is as important to learn how to deliver the message as it is to refine its content. This presents challenges that are as much personal as they are intellectual. Areas of particular importance are the academic environment, language, diplomacy, style, relevance, and evidence. In this process, building relationships, collegiality, patience, objectivity, impartiality, and humor are helpful.

Academic Medical Centers↗

PubMed1984

Aging and sleep apnea: action of benzodiazepine, acetazolamide, alcohol, and sleep deprivation in a healthy elderly group.

Ten nonobese, healthy elderly adults (M = 73.3 years) were monitored polygraphically during sleep for sleep state changes, breathing, and the development of cardiac arrhythmias. All participated in 2 baseline nights and 1 night of flurazepam 30 mg ingestion; six underwent 1 night of sleep deprivation; four received ethyl alcohol (.6 mg/kg); and four whose apnea worsened significantly with flurazepam 30 mg were pretreated for 3 days with acetazolamide, taking acetazolamide and flurazepam 30 mg on the fourth night. Elderly adults with an Apnea Index (the number of apneas per sleep hour) between 5 and 7 at baseline experienced a worsening of their apnea with each manipulation. Acetazolamide did not protect individuals whose Apnea Index increased after flurazepam ingestion. One person developed premature ventricular contractions in conjunction with an increased Apnea Index after each manipulation.

Acetazolamide↗

PubMed1985

Current practice in health promotion.

Progress in health promotion and preventive programme planning is limited by a lack of data on the development of current activities. A cross sectional survey of hospitals, community health centres, and other health agencies in New South Wales was therefore undertaken to determine the nature and extent of health promotion programmes being conducted in the period July to December 1983. A subsample of 1198 preventive programmes in child and family health was identified, making up 26% of all programmes operating in this period. Results indicate that three major types of programme are being conducted in child health. These are in the areas of (1) parent education and support, (2) school health education, including drug and alcohol education and personal development, and (3) child safety and first aid. Although the nature of these programmes generally corresponds with current thinking on what priorities in health promotion should be, results also indicate that evaluation of these programmes is limited. Most programmes assess only what participants think of the programme rather than assessing changes in knowledge, attitude, behaviour, or health status. Improvements in evaluation practice are required if preventive intervention programmes are to undertake seriously the task of altering the pattern of diseases and problems in childhood and adolescence.

Adolescent↗

PubMed2005

Relation of blood pressure to risk of incident Alzheimer's disease and change in global cognitive function in older persons.

PURPOSE: To examine the relation of systolic and diastolic blood pressure to incident Alzheimer's disease (AD) and rate of cognitive change. METHODS: Longitudinal cohort study with annual clinical evaluations. At baseline, blood pressure was measured, apolipoprotein E (APOE) genotyping was performed, and medications were reviewed. RESULTS: 824 older Catholic clergy members without baseline dementia were recruited from across the United States. During a mean of about 6 years of observation, 151 persons developed AD. In a proportional hazards model adjusted for age, sex and education, neither systolic (relative risk = 0.995; 95% CI: 0.986, 1.004, p = 0.249) nor diastolic (relative risk = 1.000; 95% CI: 0.985, 1.015, p = 0.975) blood pressure was related to AD incidence. In mixed effects models, neither systolic nor diastolic blood pressure was related to level or to annual rate of change on a global measure of cognition. These results did not change in subsequent models that accounted for the use of medications with antihypertensive properties or for the possession of an APOE epsilon4 allele. CONCLUSIONS: In a cohort of older persons with a majority taking medications with antihypertensive properties, we did not find a relationship between blood pressure and risk of AD or cognitive decline.

Aged↗