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PubMed2006

Psychosocial treatments of suicidal behaviors: a practice-friendly review.

Worldwide, almost a million people die by suicide each year. Intentional, nonfatal, self-inflicted injury, including both suicide attempts and acts without suicide intent, also has very high prevalence. This article provides a practice-friendly review of controlled studies of psychosocial treatments aiming to prevent suicide, attempted suicide, and nonsuicidal self-inflicted injuries. Despite relatively small sample sizes for a low-base-rate outcome such as self-inflicted injury, several psychotherapies have been found effective, including cognitive therapy, dialectical behavior therapy, problem-solving therapy, and interpersonal psychotherapy, as well as outreach interventions, such as sending caring letters. The clinical implications of the review are discussed with the goal of translating the science to service-particularly the importance of outreach and treatment of non-compliance, the assessment and management of suicide risk, and competency in effective psychotherapies. These are critical steps for clinical psychology and psychotherapists to take in their role in suicide prevention.

Humans↗
PubMed2000

Responses of older adults to theory-based nutrition newsletters.

OBJECTIVE: To evaluate the effect of a theory-based newsletter on knowledge, attitude, and behavior change in older adults. DESIGN: Pretest-posttest, random assignment, and treatment-control design with 2 treatment groups: 1 that received newsletters only and 1 that received newsletters with follow-up telephone interviews. Control group completed pretest-posttest surveys only. SUBJECTS/SETTING: Four hundred eighty men and women, aged 60 to 74 years, were recruited to participate in a home-based educational intervention using a patient list generated from a rural tertiary care hospital database, Geisinger Medical Center in Danville, Pa. INTERVENTION: Five nutrition newsletters designed using the nutrition communication model and adult learning theory principles were mailed biweekly. Telephone interviews followed each of the 5 newsletters 10 to 14 days after distribution. OUTCOME MEASURES: Nutrition knowledge and interest, food behavior related to dietary fat, and stages of change for dietary fat and fiber. STATISTICAL ANALYSES PERFORMED: Analysis of covariance was used to determine group differences in posttest outcome measures using pretest as covariate. RESULTS: In addition to achieving higher scores than the control group, the treatment groups were significantly different from each other in correct and perceived nutrition knowledge at posttest. Those in the treatment group receiving telephone calls scored higher (mean change = 19.0% for correct and 20.3% for perceived) than those who received the newsletters only (mean change = 12.5% for correct and 14.3% for perceived; P < .05). Treatment groups also rated their interest in nutrition higher than the control group did; there was no between-treatment difference. Treatment groups performed significantly better than the control group for dietary fiber stage of change (P < .05). Those receiving only newsletters scored significantly better than the control for the "avoid fat" food behavior (P < .05). APPLICATIONS/CONCLUSIONS: This study provides an example of the incorporation of a theoretical model in development and evaluation of newsletters. Home-delivered nutrition newsletters based on this model can communicate health and nutrition information to older adults. Consumers today have more opportunities than ever before to access nutrition information quickly and inexpensively. Newsletters can help dietetics professionals filter and limit what consumers must process, saving clients time and improving the accuracy of information obtained. Dietetics professionals in both clinical and community practice are uniquely positioned to provide highly focused and understandable information to consumers via a newsletter format.

Aged↗
PubMed2002

Development of cytomegalovirus vaccines: prospects for prevention of congenital CMV infection.

Congenital cytomegalovirus (CMV) infection is an important cause of hearing, cognitive, and motor impairments that cannot be effectively prevented or treated by any current medical or public health interventions. A review of priorities for vaccine development by The Institute of Medicine of the National Academy of Sciences concluded that a vaccine to prevent congenital CMV infection should be a top priority for the United States. Evidence from clinical studies indicates that immunity to CMV can reduce the frequency and severity of disease. Laboratory investigations have identified structural and nonstructural CMV proteins that play a key role in eliciting protective immunity. The rationale for development of a CMV vaccine has been strengthened further by studies in experimental animals demonstrating the ability of immunization with subunit vaccines to prevent disease and transplacental transmission of virus. At least 4 CMV vaccines are in clinical trials, and advances in biotechnology are paving the way for additional novel vaccines.

Cytomegalovirus↗
PubMed2006

The small group in problem-based learning: more than a cognitive 'learning' experience for first-year medical students in a diverse population.

In problem-based learning (PBL) curricula, first-year students need to adapt to a new learning environment and an unfamiliar new pedagogy. The small-group tutorial potentially offers a learning environment where students can become self-directed learners, collaborating with other group members to achieve individual and group learning goals. At the end of the first six-week theme in a relatively new PBL curriculum, new medical students were canvassed about coping with PBL (self-directed learning; content; time management; resources) and the value of the small-group tutorial, the latter of which is currently being reported. Almost 84% of students (n = 178) responded. The benefits of participating in small groups were categorized into three domains-cognitive, affective and social-as identified from student responses. Results were analysed in terms of gender and prior educational experience (secondary school vs. prior tertiary educational experience). For almost 94% of students, the small-group tutorial provided a conducive learning environment that influenced their personal development (i.e. tolerance, patience) and socialization into the faculty. Significantly more males indicated that they had developed social skills, while more school-leavers (matriculants) than mature students felt more receptive to the views of others. More mature students claimed to have made friends. Irrespective of some conflicting opinions in the literature, the present results suggest that the PBL tutorial may be important in facilitating student socialization into a new and unfamiliar academic environment, particularly when the pedagogy differs markedly from their past educational experiences. Through interacting with fellow students from diverse origins who hold different views in the intimate setting of the small group, students felt that they had not only increased their knowledge but had also developed personally and socially. It is proposed that the small group may be useful for integrating a diverse population of students into a new academic environment.

Adaptation, Psychological↗
PubMed2005

Schoolteachers' awareness about scholastic performance and nutritional status of Egyptian schoolchildren.

Malnutrition disorders affect more than 30% of schoolchildren in Egypt. This problem appears to be largely attributable to poor dietary quality and micronutrient deficiencies, such as iron and vitamin A. Inadequate nutrition intake has important implications because malnutrition has been shown to negatively affect the cognitive development of primary schoolchildren. This study assesses the awareness of schoolteachers about the impact of malnutrition on the scholastic performance of primary schoolchildren living in Egypt. Two focus group discussions were conducted with Egyptian schoolteachers from the Quena and Kharbia Governorates. The study indicates that schoolteachers consider low body weight and thinness as the primary signs of malnutrition. They do not prioritize malnutrition as a factor for poor scholastic performance. They also suggest that unhealthful eating habits, especially a lack of breakfast, negatively affect children's interaction with schoolteachers and their ability to excel in their studies. Schoolteachers endorse a more reliable and nutritionally valuable school-feeding program as a way to increase the scholastic performance of their students. The teachers advocate developing integrated programs between the Ministry of Education, the Ministry of Health and Population, teachers, children, and parents that provide nutrition education. A lack of awareness among teachers about the relationship of nutrition and cognitive function can lead to the misdiagnosis or delayed management of malnourished and scholastically challenged schoolchildren. This paper suggests that proper school-feeding programs and nutrition education programs, which integrate government ministries, teachers, children and parents, should be developed to improve the physical and cognitive health status of Egyptian schoolchildren.

Absenteeism↗
PubMed1982

Guided imagination as an intervention in hopelessness.

Individual participants have returned to share the improvements made in scholastic and personal endeavors after continued use of the exercises/methods presented at the workshop. Other students requested repeated workshops/sessions directed toward reducing personal stress of negative expectations and for use with clients. Spreading the exercises over time appears to enhance integration and change. Future research is needed to document the efficacy of using imagery in nursing for students as well as for patients. For some clinical populations immediate results are often needed, for example those presenting with "giving up" behaviors in critical care areas. This concern remains for future research. It is speculated also that in the extreme of the data from this study, as evidenced in the unequal regression slopes, some significance may be hidden or masked. It is recommended that research continue utilizing academic as well as clinical populations identified as experiencing hopelessness. Indicators of short-term change must be developed and tested. It also is recommended that nurses interested in mind/body interaction pursue studies using imagery as a potential nursing intervention and begin the development of tools to document these interventions. Clients, staff, and students who experience hopelessness tend toward "giving up" behaviors. The purpose of this study was to investigate the effects of a workshop in guided imagination techniques on the condition of hopelessness. Although no statistically significant results can be reported from this study, nurses need to continue to develop imagery intervention techniques and to investigate, through research, the efficacy of these interventions. It is hoped that nurses in psychiatric and non-psychiatric settings will read the abundant, rich literature on the uses of imagery in the health sciences and will begin to explore the possibilities that exist for its application in nursing.

Affective Symptoms↗
PubMed1978

Instructional objectives for a teaching program in cancer for primary care physicians.

Precise instructional objectives are critical to the success of educational programs in medicine. Adequate attention to the development of instructional objectives prompts careful consideration of course methods, helps define means of evaluation, and results in realistic long-term goals. Current curricula often focus on the teaching of facts and the diagnosis and treatment of advanced and uncommon diseases; behavioral science skills are rarely taught and, in general, content is unrelated to the kinds of problems physicians see in practice. This paper presents instructional objectives in cancer which attempt to answer these criticisms. The objectives, covering cognitive, psychomotor, and affective domains, emphasize the areas of prevention and early diagnosis.

Family Practice↗
PubMed2004

Animal expertise, conscious or not.

Rossano (Cognition 89:207, 2003) proposes expertise as an indicator of consciousness in humans and other animals. Since there is strong evidence that the development of expertise requires deliberate practice (Ericsson in The road to excellence: the acquisition of expert performance in the arts and sciences, sports and games 1996), and deliberate practice appears to be outside of the bounds of unconscious processing, then any signs of expertise development in an animal are indicators of consciousness. Rossano's argument may lead to an unsolvable debate about animal consciousness while causing researchers to overlook the underlying reality of animal expertise. This article provides evidence indicative of animals meeting each of the three definitions of expertise established in the scientific literature: expertise as a social construction, expertise as exceptional performance, and expertise as knowledge. In addition, cases of deliberate practice by non-human animals are offered. Acknowledging some animals as experts, regardless of consciousness, is warranted by the research findings and would prove useful in solving many issues remaining in the human expertise literature.

Animals↗
PubMed1983

[Science and art in the supervision of a thesis for a degree].

The thesis required for the licenciature, master's degree and doctorate in any field of university education involves three components: the adviser, the student, and the research project that constitutes the subject matter of the thesis. In this paper the author examines in detail how each of these should be in the ideal situation and the defects they can have in real situations. Unfortunately, he observes, many institutions are neglecting--for a variety of reasons--the importance and significance of a well worked out thesis, and thus vitiating its original purpose in addition to depriving the student of an excellent opportunity for exercising his intelligence and imagination, and his adviser of one for imparting to him the cognitive, analytic and personal qualities needed to do good work. The article emphasizes that, particularly in medicine and biology, the research required for any thesis, done under a concerned and conscientious adviser, helps to produce a scientist who is truly able, studious, disciplined and, above all, humane. This, says the author, is how, from that combination of knowledge and behavior, of science and art, the student and his adviser unite to produce a thesis, a research project, the results of which can be of direct or indirect benefit to humanity.

Academic Dissertations as Topic↗
PubMed2006

Cognitive functioning in delusions: a longitudinal analysis.

BACKGROUND: This study explored the longitudinal course of the relationship between delusions and different aspects of cognitive functioning. METHODS: Deluded patients were compared to psychiatric and non-clinical controls on three tasks: negative priming, a probabilistic judgement task (the 'beads' task), and the pragmatic inference task (PIT). All groups were tested at two time points, once when actively symptomatic, and once when in remission. RESULTS: Deluded individuals exhibited a 'jump-to-conclusions' (JTC) reasoning bias: i.e., they made decisions on the basis of limited evidence and were more likely to revise their estimates when faced with disconfirmatory evidence. This JTC bias remained stable over time, although probability judgments seemed to normalise in remission. No deficits in cognitive inhibition were found on negative priming. The deluded group displayed an excessive self-focus on the PIT at both time points, but did not show a depressive attributional style. Only a small sub-sample, characterised by the "bad-me" type of paranoia [Trower & Chadwick, 1995 Clinical Psychology: Science and Practice, 2, 263-278.], demonstrated depressive schemas when symptomatic, but no longer did so when remitted. Few relationships were found between tasks, suggesting that different areas of functioning are relatively independent. The only measures associated with delusion symptom scores were from the 'beads' task. CONCLUSIONS: Overall these findings suggest that the JTC bias is a stable factor associated with delusional thinking, while the depressive attributional style characteristic of a small sub-sample of paranoid patients fluctuates with delusional course.

Adult↗
PubMed1976

Towards the simulation of clinical cognition. Taking a present illness by computer.

Remarkably little is known about the cognitive processes which are employed in the solution of clinical problems. This paucity of information is probably accounted for in large part by the lack of suitable analytic tools for the study of the physician's thought processes. Here we report on the use of the computer as a laboratory for the study of clinical cognition. Our experimental approach has consisted of several elements. First, cognitive insights gained from the study of clinicians' behavior were used to develop a computer program designed to take the present illness of a patient with edema. The program was then tested with a series of prototypical cases, and the present illnesses generated by the computer were compared to those taken by the clinicians in our group. Discrepant behavior on the part of the program was taken as a stimulus for further refinement of the evolving cognitive theory of the present illness. Corresponding refinements were made in the program, and the process of testing and revision was continued until the program's behavior closely resembled that of the clinicians. The advances in computer science that made this effort possible include "goal-directed" programming, pattern-matching and a large associative memory, all of which are products of research in the field known as "artificial intelligence". The information used by the program is organized in a highly connected set of associations which is used to guide such activities as checking the validity of facts, generating and testing hypotheses, and constructing a coherent picture of the patient. As the program pursues its interrelated goals of information gathering and diagnosis, it uses knowledge of diseases and pathophysiology, as well as "common sense", to dynamically assemble many small problem-solving strategies into an integrated history-taking process. We suggest that the present experimental approach will facilitate accomplishment of the long-term goal of disseminating clinical expertise via the computer.

Computers↗
PubMed1998

Functions of the prefrontal cortex in the human brain.

The prefrontal cortex of the human brain is affected by various pathological conditions, and for the apparent theoretical gains and clinical benefits, brain scientists and clinicians alike have for decades endeavored to understand the precise role of this region of the brain. Recent findings in electrophysiological and functional neuroimaging studies provide a better insight into the neuronal activities during various cognitive processes performed by the prefrontal cortex. Nevertheless, some of these findings are at odds with others, and the theorized roles of the prefrontal cortex remain largely under dispute. On the clinical side, a longer history of research provides a wealth of symptom descriptions on the multifaceted prefrontal dysfunction. In the midst of this abundance, however, there still exists a need for coherent categorization of these seemingly disparate symptoms. This task could be done based on the nature of affected cognitive processes and their putative neural substrates. With this view in mind, the present article selectively reviews major anatomical evidence and experimental data together with clinical observations on prefrontal patients in an attempt to integrate findings in science with behavioral data and ultimately to propose a model of functional organization within the prefrontal cortex.

Brain Diseases↗
PubMed2005

Clinical pharmacology and differential cognitive efficacy of estrogen preparations.

Menopause is associated with a significant decline in levels of estrogen, which reportedly leads to several distressing symptoms and adverse health effects on various target tissues including those on bones, heart, and brain. Although effective, the long-term safety and feasibility of therapy with both unopposed and opposed oral conjugated equine estrogen has been questioned by the recent findings of both the Women's Health Initiative (WHI) and the Women's Health Initiative Memory Study (WHIMS). The findings of both these studies have raised several critical issues related to hormone therapy that need to be systematically evaluated in clinical studies. Specifically, these issues relate to the differential efficacy and adverse-effects profile of various forms of estrogen and progestins, the importance of the route of administration of estrogen, the best timing to initiate postmenopausal hormone therapy, and the efficacy of cyclic versus continuous hormone therapy. This article focuses on estrogen and discusses issues related to selecting the best form and route of administration of the hormone. It includes information on basic clinical pharmacology of various forms of estrogen, neuroendocrinology of the menopause, neurobiology of estradiol and estrone, and results of selected basic science and human intervention studies with relevance to identifying the best form and route of administration of estrogen.

Administration, Cutaneous↗
PubMed2002

Adaptationism--how to carry out an exaptationist program.

Adaptationism is a research strategy that seeks to identify adaptations and the specific selective forces that drove their evolution in past environments. Since the mid-1970s, paleontologist Stephen J. Gould and geneticist Richard Lewontin have been critical of adaptationism, especially as applied toward understanding human behavior and cognition. Perhaps the most prominent criticism they made was that adaptationist explanations were analogous to Rudyard Kipling's Just So Stories (outlandish explanations for questions such as how the elephant got its trunk). Since storytelling (through the generation of hypotheses and the making of inferences) is an inherent part of science, the criticism refers to the acceptance of stories without sufficient empirical evidence. In particular, Gould, Lewontin, and their colleagues argue that adaptationists often use inappropriate evidentiary standards for identifying adaptations and their functions, and that they often fail to consider alternative hypotheses to adaptation. Playing prominently in both of these criticisms are the concepts of constraint, spandrel, and exaptation. In this article we discuss the standards of evidence that could be used to identify adaptations and when and how they may be appropriately used. Moreover, building an empirical case that certain features of a trait are best explained by exaptation, spandrel, or constraint requires demonstrating that the trait's features cannot be better accounted for by adaptationist hypotheses. Thus, we argue that the testing of alternatives requires the consideration, testing, and systematic rejection of adaptationist hypotheses. Where possible, we illustrate our points with examples taken from human behavior and cognition.

Adaptation, Physiological↗
PubMed1999

Towards a science of Alzheimer's disease management: a model based upon current knowledge of retrogenesis.

BACKGROUND: General relationships between dotage and infancy and childhood have been acknowledged for more than two millennia. Recent findings indicate precise relationships between functional, praxic, and feeding changes in the course of the degenerative dementia of Alzheimer's disease (AD) and inverse corresponding developmental sequences. Similar inverse relationships between AD and human development can be described for cognition and language skills; for physiologic measures of electroencephalographic activity, brain glucose metabolism, and developmental neurologic reflex changes; and for the neuropathologic and neuroanatomic progression of these processes. In AD, these processes may be termed "retrogenesis." The relevance of the retrogenesis model for AD management is explored. METHOD: The functional stages of AD can be translated into developmental age equivalents that can be utilized to explicate observed changes in the disease. RESULTS: The retrogenesis-based developmental age model can usefully inform an understanding of the general care needs, emotional and behavioral changes, and activity needs of the AD patient. This model must be amended by necessary caveats regarding physical differences, variations in age-associated pathology, differences in social and societal reactions, and differences in background between AD patients and their developmental age "peers." CONCLUSIONS: Knowledge of retrogenesis and the developmental age of the AD patient can form a nidus for the development of a nascent science of disease management. Such a science must ultimately incorporate not only appropriate caveats but also relevant universal human needs, such as those for dignity, love, and movement.

Adolescent↗
PubMedDate not supplied

Formal geriatric assessment, An imperative for the older person with cancer.

PURPOSE: The authors evaluate the role of cognitive, functional, and affective geriatric assessment measures in elderly cancer patients, and analyze the associations between these factors, stage of malignancy, and cancer treatment choices. DESCRIPTION: Fifty consecutive patients older than 65 years of age who were referred to the Geriatric Oncology Clinic at the University of New Mexico Health Sciences Center in Albuquerque were evaluated using standard geriatric assessment tools. Each person underwent a complete history and physical examination. An extensive chart review established the type of cancer, stage at diagnosis, and treatment modalities used. The Karnofsky performance status scale score also was determined at this initial evaluation. RESULTS: The group had a mean age of 74.9 years; 60% were women and 40% were men. The most common cancers were breast (28%) and prostate (16%). Fifty-two percent of the patients had localized disease and 48% had distant disease. Seventy-four percent had received treatment by the time of the initial assessment, with 62% undergoing combination therapy. The most common noncancer diagnoses were cardiovascular disease, hypertension, and osteoarthritis. Scores on standardized measures indicated that the majority of patients were independent. Those who did not receive treatment were more functionally impaired than those who received treatment. Twenty-seven percent of the sample were impaired cognitively and 24% were depressed. There were no statistical differences in functional, cognitive, or affective status between stages of disease for specific malignancies. CLINICAL IMPLICATIONS: Age alone is a poor predictor of outcome in cancer treatment and is an inappropriate factor by which to exclude persons with cancer from clinical trials. Treatment decisions based on age alone may lead to inadequate treatment. In this report, functional dependence was more prevalent in nontreated patients and was unrelated to the stage of disease. These results support the need for formal geriatric assessment, including measures of cognitive, functional, and affective status, in elderly persons with cancer. Further studies on the role of functional, cognitive, and affective status at the time of cancer diagnosis, as well as how these parameters might alter treatment decisions, are warranted. In addition, further investigation to identify which of these multiple variables influence treatment outcome are needed.

Activities of Daily Living↗
PubMed1985

On the stability of cognitive processes.

An empirical and mathematical model for self-organization is proposed, based on elemental properties, on unique interaction and on the combination of hierarchical elements. In the model, higher elements are stabilized by the 'cognitive' (strong) interaction of subelements, disregarding intermediate elements. This is called 'elementary reductionism' and is illustrated by the sequence quarks-elementary particles-atoms-molecules-cells-organisms- societies. Optimal dynamic interaction of nonidentical elements is called 'cognitive stability'. This is compared with thermodynamic equilibrium. The principal differences are outlined.

Actins↗