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PubMed2005

Evaluation of empowerment processes in a workplace health promotion intervention based on learning in Sweden.

The aim of this study was to evaluate a theory-based method for workplace health promotion (WHP) with regard to possible facilitation of empowerment processes. The intervention tool was the pedagogic method known as problem-based learning (PBL). The aim of the intervention was to promote empowerment and health among the employees. The intervention was implemented in three organizations within the public sector in Sweden, in a bottom-up approach. All employees, including management, in each organization, were offered the opportunity to participate (n = 113) and 87% (n = 97) participated. The intervention was implemented in 13 groups of six to eight participants who met once a week over a period of 4 months. The predetermined overall goal of the intervention was to promote employee health within the organizational setting. A facilitator in each group and a group-specific mutual agreement guided the intervention, as did the problem solving process. The participants set goals and developed strategies to reach their goals between the meetings. Thirty informants were interviewed in seven focus groups after the intervention about the intervention method and the process, following a semi-structured theme guide. The phenomenographic analysis resulted in six descriptive categories: reflection, awareness and insight, self-direction and self-management, group coherence, social support and actions. The results correspond to established theories of components of empowerment processes. The method initiated processes of change at organizational, workplace and individual levels as the participants examined their work situation, determined problems and initiated solutions. Social support and group coherence were expressed as essential in order to transform challenging strategies into action and goal realization. The findings indicate that systematic improvements of social support and group coherence among employees ought to be facilitated by the organization as a health-promoting arena. PBL appears to be a profitable and powerful instrument with the potential to enable empowerment.

Adult↗
PubMed1997

Critical thinking: a central element in developing action competence in health and environmental education.

In the field of educational philosophy, health and environmental education share many common goals and challenges on the level of curriculum theorizing as well as the level of pedagogical practice. One of these challenges is to develop a radical philosophy of education which is critical and takes a controversial point of departure rather than the one of accommodation. It highlights, in other words, the socially critical role of education. From this point of view some key concepts are discussed in the paper in relation to health and environmental education: democracy as means and end, critical thinking, the critical orientation, and the action perspective. One of these concepts, critical thinking, is elaborated in particular as it is considered to be essential to pupils' development of action competence. A description is given how it can be seen from four perspectives: the epistemological, the transformative, the dialectical and the holistic.

Child↗
PubMed1999

A story/dialogue method for health promotion knowledge development and evaluation.

Arguments have been made in favour of a constructivist or postpositivist approach to health promotion knowledge development and program evaluation, but little has been articulated about what such an approach would look like. This article describes a 'story/dialogue method' that was created with and for practitioners in response to their concerns that much of their practice did not lend itself to a positivist, or conventional, methodology. Derived from constructivist, feminist and critical pedagogical theory, and with roots in qualitative methods, the method structures group dialogue around case stories addressing particular generative practice themes. While intended for practitioner training, organizational development and evaluation, the method to date has been used primarily for training purposes. This article describes the method, provides an example of its application, and discusses its strengths, weaknesses and relevance to health promotion.

Anecdotes as Topic↗
PubMed1991

The Swedish study circle--possibilities for application to health education in the United States.

There has been a growing recognition over the past decade of the need to broaden the focus of health promotion by placing greater emphasis on the social context in which individual behavior change interventions occur. As a result, health educators are being required to look for innovative pedagogical methods to address this broader focus. A model of education that is used extensively in Sweden and that takes a broader approach to health matters is the study circle. Because of its simple, flexible structure and its capacity to address lifestyle as well as social and environmental factors, the study circle could serve as a model for health education efforts undertaken in the United States. The first part of this article presents an overview of the literature from the field of public health that calls for a broader concept of health promotion. The second part of the article looks at the principles and concepts of the study circle. The role of the study circle in health promotion is discussed and use of the method is illustrated in three different case examples. In addition, possibilities for application of the model to health education in the United States are also addressed.

Health Behavior↗
PubMed2001

Social support: a critical factor in women's health and health promotion.

Social networks and social support have been found to be beneficial to the health of individuals in a variety of ways--reducing mortality rates, improving recovery from serious illness, and increasing use of preventive health practices. Social relationships appear to be particularly important to women. Suggestions for health promotion and disease prevention activities include the use of buddy systems, feminist pedagogical techniques, group activities, and linkage to natural supports. Health promotion with women is an underdeveloped area of social work practice with great potential to increase the health of client populations.

Culture↗
PubMed1983

Occupation and smoking as risk determinants of lung cancer.

The standardized incidence ratio (SIR) of lung cancer was determined for different occupational groups in Finland. The data on all cases of lung cancer diagnosed in Finland in age groups of 35-69 years in 1971-1975 were supplemented by information on occupation from the 1970 census (Central Statistical Office). The expected numbers of cases were based on the sex, age and occupation-specific numbers of person-years computed in the Central Statistical Office, and sex- and age-specific incidence rates of lung cancer among the economically active population (as defined 1 January 1971). Compared with the risk of the total economically active population, the relative risk of those not active (SIR) was 1.69 for men and 0.86 for women. Lower than expected relative risks were encountered among highly educated and white-collar male workers (religious, legal, pedagogical, medical, technical and administrative work), in sales work, transport service work and among farmers. High SIRs were found in mining and quarrying, forestry, woodworking (joiners), construction, painting and among unskilled workers. Among women the numbers of cases were small and only one significant SIR was obtained; the risk was lower than expected in farming. Data on the smoking habits of males in different main occupational categories in Finland show that variation between different occupational groups in the prevalence of smoking closely corresponds to that in the SIR for lung cancer (R = 0.96).

Adolescent↗
PubMed1991

Getting down to cases: the revival of casuistry in bioethics.

This article examines the emergence of casuistical case analysis as a methodological alternative to more theory-driven approaches in bioethics research and education. Focusing on The Abuse of Casuistry by A. Jonsen and S. Toulmin, the article articulates the most characteristic features of this modern-day casuistry (e.g., the priority allotted to case interpretation and analogical reasoning over abstract theory, the resemblance of casuistry to common law traditions, the 'open texture' of its principles, etc.) and discusses some problems with casuistry as an 'anti-theoretical' method. It is argued that casuistry so defined is 'theory modest' rather than 'theory free' and that ethical theory can still play a significant role in casuistical analysis; that casuistical analyses will encounter conflicting 'deep' interpretations of our social practices and institutions, and are therefore unlikely sources of increased social consensus on controversial bioethical questions; that its conventionalism raises questions about casuistry's ability to criticize norms embedded in the societal consensus; and that casuistry's emphasis upon analogical reasoning may tend to reinforce the individualistic nature of much bioethical writing. It is concluded that, not-withstanding these problems, casuistry represents a promising alternative to the regnant model of 'applied ethics' (i.e., to the ritualistic invocation of the so-called 'principles of bioethics'). The pedagogical implications of casuistry are addressed throughout the paper and include the following recommendations: (1) use real cases, (2) make them long, richly detailed and comprehensive, (3) present complex sequences of cases, (4) stress the problem of 'moral diagnosis', and (5) be ever mindful of the limits of casuistical analysis.

Bioethical Issues↗
PubMed1991

The irreducibly clinical character of bioethics.

Current bioethics scholarship and pedagogy suffers from an insufficient correlation with the realities and variables of clinical medicine, particularly in its dominant paradigm of patient autonomy. Reference to various basic clinical factors will be made here toward proposing certain conceptual, tactical and pedagogical modifications to this paradigm.

Beneficence↗
PubMed1997

Medical ethics in the courtroom: a reappraisal.

Following up on a 1989 paper on the subject, this essay revisits the question of ethical expertise in the court room. Informed by recent developments in the use of ethics experts, the authors argue 1) that the adversarial nature of court proceedings challenges the integrity of the ethicist's pedagogical role; 2) that the use of ethics experts as normative authorities remains dubious; 3) that clarification of the State's interest in "protecting the ethical integrity of the medical profession" is urgently required; and 4) that the expertise of the ethicist may be more appropriately used in advising the legislature that in influencing the court.

Bioethical Issues↗
PubMed1999

Singing as a Therapeutic Agent, inThe Etude, 1891-1949.

The Etude music magazine, founded by Theodore Presser, was one of a number of popular music magazines published in the years prior to the establishment of the music therapy profession in 1950. During its publication run from 1883 to 1957, over 100 music therapy related articles appeared, including 13 on the health benefits of singing published between 1891 and 1949. Written by authors with diverse backgrounds, such as the famous Battle Creek, Michigan physician John Harvey Kellogg and Boston music critic Louis C. Elson, the articles contained consistent and adamant support regarding the health benefits of singing. The advantages described were both physical and psychological, and were recommended prophylactically for well persons and therapeutically for ill persons. Although the articles varied in perspective, from philosophical to theoretical to pedagogical, there is a consistent holistic medicine theme that appeared almost ahead of its time and no doubt linked to the push for vocal music education in that era. The importance of The Etude in promulgating ideas that helped shape the early practice of music therapy should not be underestimated. For much of its publication run The Etude was the largest music periodical in print, reaching its peak circulation of 250,000 copies per month in 1924.

Journal Article↗
PubMed1994

Back-propagation and counter-propagation neural networks for phylogenetic classification of ribosomal RNA sequences.

A neural network system has been developed for rapid and accurate classification of ribosomal RNA sequences according to phylogenetic relationship. The molecular sequences are encoded into neural input vectors using an n-gram hashing method. A SVD (singular value decomposition) method is used to compress and reduce the size of long and sparse n-gram input vectors. The neural networks used are three-layered, feed-forward networks that employ supervised learning paradigms, including the back-propagation algorithm and a modified counter-propagation algorithm. A pedagogical pattern selection strategy is used to reduce the training time. After trained with ribosomal RNA sequences of the RDP (Ribosomal Database Project) database, the system can classify query sequences into more than one hundred phylogenetic classes with a 100% accuracy at a rate of less than 0.3 CPU second per sequence on a workstation. When compared to other sequence similarity search methods, including Similarity Rank, Blast and Fasta, the neural network method has a higher classification accuracy at a speed of about an order of magnitude faster. The software tool will be made available to the biology community, and the system may be extended into a gene identification system for classifying indiscriminately sequenced DNA fragments.

Algorithms↗
PubMed1987

Butoctamide hydrogen succinate and intensive learning sessions: effects on night sleep of Down's syndrome patients.

Mentally retarded children present a reduction in percentage of REM sleep and of oculomotor frequencies. These sleep patterns are probably relevant for their cognitive activities. The effects of butoctamide hydrogen succinate and intensive learning sessions on the night sleep of five Down's syndrome patients was studied by the authors. They found an increase in percentage of REM sleep after pharmacological treatment and an increase in oculomotor frequencies after learning sessions. The authors' hypotheses of REM sleep as a neurophysiological indicator of cerebral "plasticity" and of oculomotor frequencies as an indicator of "organization" abilities are discussed in this article. Pedagogical implications and therapeutical perspectives are also outlined.

Amides↗
PubMed2001

Timbre-specific enhancement of auditory cortical representations in musicians.

Neural imaging studies have shown that the brains of skilled musicians respond differently to musical stimuli than do the brains of non-musicians, particularly for musicians who commenced practice at an early age. Whether brain attributes related to musical skill are attributable to musical practice or are hereditary traits that influence the decision to train musically is a subject of controversy, owing to its pedagogic implications. Here we report that auditory cortical representations measured neuromagnetically for tones of different timbre (violin and trumpet) are enhanced compared to sine tones in violinists and trumpeters, preferentially for timbres of the instrument of training. Timbre specificity is predicted by a principle of use-dependent plasticity and imposes new requirements on nativistic accounts of brain attributes associated with musical skill.

Acoustic Stimulation↗
PubMed1976

Introducing quality assurance and medical audit into the UCSF medical center curriculum.

The experience gained by a medical school faculty in developing and piloting a course for undergraduate medical students in medical care evaluation led to a similar effort for house staff. It is recognized that if the profession is to fulfill the demand by society for social accountability in the use of resources for health care, medical care assessment and quality assurance mechanisms must become an intimate part of the clinical experience of medical students and house officers. Teaching these subjects requires a theoretical framework; introduction of content and skills appropriate to the level of the student and continuation of progressively more advanced training throughout medical education; use of assessment and quality assurance techniques by clinician-teachers themselves to provide models for the student; and continued evolution of pedagogic approach and course content based on developments in the area.

California↗
PubMed1976

Training teachers in the anatomical sciences.

A number of medical schools have initiated workshops to improve faculty teaching skills. Little effort, however, has been directed toward the pedagogical training of graduate students who are destined to become future medical science teachers. To help solve this problem, the faculty of the Department of Anatomy in the University of Nebraska College of Medicine recently developed a prototype teacher training program for graduate students in anatomy. Through formal course work and practical classroom experience, students are developing the skills requisite for effective teaching of the anatomical sciences. Student and faculty response to the training program has been enthusiastic, and the objectives and structure of the program can be applied to the production of competent and skilled teachers in other areas of the basic and clinical sciences.

Anatomy↗
PubMed1992

What we say and what we do: self-reported teaching behavior versus performances in written simulations among medical school faculty.

Much of the research in medical education is performed through the use of self-reporting questionnaires. Although this can be a valid way to conduct research, little effort has been made to examine the fit between what teachers self-report and what they actually do. In an attempt to investigate this, the authors interviewed 47 preclinical faculty members at two large medical schools in 1990. The faculty members were initially given a questionnaire asking them to self-report in four categories: interactive skills; knowledge or abilities they considered important for students to develop; factors that influenced their curriculum development; and sources from which they sought pedagogical assistance. This was followed by four written simulations that examined four areas of teaching: small-group discussions, course design, lecturing, and test construction. In addition, the authors specifically sought to identify any differences in teaching philosophy and practice between those preclinical faculty who were physicians and those who were not, as well as any interinstitutional differences. Although in certain instances there was a strong correlation between self-reporting and performance as measured by a simulated teaching scenario, in most instances the correlation was quite low. Consequently, the authors suggest that researchers must be careful in their use of self-reporting as a means of assessing teaching behavior, and that whenever possible, researchers should observe the teachers they are studying.

Behavior↗
PubMed1992

How attending physicians make instructional decisions when conducting teaching rounds.

When attending physicians are conducting teaching rounds, they rapidly decide what and how much to teach in response to each case presentation. How do they make these instructional decisions? The author performed a qualitative study of the instructional reasoning and actions of six distinguished clinical teachers in general internal medicine to address this question. Four data sources were used: interviews with teachers and learners, a structured task, transcripts of teaching rounds, and week-long observations of each ward team. The teachers in this study engaged in substantial amounts of planning before rounds and reflected on rounds afterwards. When listening to a case presentation during rounds, they quickly diagnosed the patient's problems and simultaneously diagnosed their learners' levels of understanding. These diagnostic assessments were used to tailor content-specific curriculum scripts for instruction. Throughout the rounds, the teachers also engaged in interactive thinking, decision making, and improvisation. The author's findings allowed him to hypothesize a model of clinical instructional reasoning and action; they contribute new insights into the interplay between reasoning in a discipline and pedagogical reasoning. Instructional reasoning and clinical reasoning were found to be closely linked through the use of scripts. The implications of these and other findings for medical faculty development are discussed.

Clinical Clerkship↗
PubMed1994

Three exemplary models of case-based teaching.

Teaching in response to case presentations is an essential feature of clinical teaching in medicine. Yet, this form of case-based teaching is often done poorly. Using qualitative methods of interviews, observations, and recordings of teaching rounds, the author describes three different yet exemplary pedagogical strategies for organizing teaching rounds in general internal medicine. These include: (1) case-bedside teaching that involves case discussion in a conference room followed by demonstrations at the bedside, (2) case-lecture teaching that blends quick reviews of cases with more formal presentations on relevant topics, and (3) case-iterative teaching that involves discovery-learning using complex cases. From these three case studies, five general principles of experiential learning in clinical settings are derived: anchoring instruction in cases, actively involving learners, modeling professional thinking and action, providing direction and feedback, and creating a collaborative learning environment. These three approaches to teaching rounds overcome common problems associated with learning in clinical settings.

Clinical Competence↗