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PubMed1984

Alcoholism in the elderly.

Alcohol abuse and dependence can be both cause and result of many problems of physical and mental health in old age. In order to develop a comprehensive understanding of the complex and mutually dependent relationships between aging and alcoholism, biologic as well as psychosocial factors must be taken into consideration. Sleep physiology, sexuality, and sensory function have received considerable attention in respect to the changes occurring with increasing age. These areas of functioning seem to be particularly vulnerable when the impact of chronic alcohol abuse is added to the effects of normal aging. The aging brain is another sensitive target for the influence of alcohol, and alcoholism has the potential to significantly aggravate cognitive deterioration. In susceptible individuals, the psychosocial stresses of growing old may erode self-esteem and precipitate depressive disorders. Thus, certain aspects of aging may become pathogenic factors in the development of alcoholism. Our current knowledge in this respect, however, is rather hypothetical and needs validation. Further systematic research is required. The momentum to generate interest in the science of aging, and thus stimulate research into age-related problems, may be provided by demographic developments. The number of Americans aged 65 and older is projected to increase markedly over the next four decades. A substantial part of this growing segment of our population suffers from alcohol dependency. The percentage of alcoholics is particularly high among the elderly in institutionalized care settings. An investment in efforts to better understand the interaction between aging and alcohol, and to develop more effective primary and secondary prevention concepts, could prove most rewarding.

Aged↗
PubMedDate not supplied

Research in psychopathology: epistemologic issues.

Etiologic research in psychiatry relies on an objectivist epistemology positing that human cognition is specified by the "reality" of the outer world, which consists of a totality of mind-independent objects. Truth is considered as some sort of correspondence relation between words and external objects, and mind as a mirror of nature. In our view, this epistemology considerably impedes etiologic research. Objectivist epistemology has been recently confronting a growing critique from diverse scientific fields. Alternative models in neurosciences (neuronal selection), artificial intelligence (connectionism), and developmental psychology (developmental biodynamics) converge in viewing living organisms as self-organizing systems. In this perspective, the organism is not specified by the outer world, but enacts its environment by selecting relevant domains of significance that constitute its world. The distinction between mind and body or organism and environment is a matter of observational perspective. These models from empirical sciences are compatible with fundamental tenets of philosophical phenomenology and hermeneutics. They imply consequences for research in psychopathology: symptoms cannot be viewed as disconnected manifestations of discrete localized brain dysfunctions. Psychopathology should therefore focus on how the person's self-coherence is maintained and on the understanding and empirical investigation of the systemic laws that govern neurodevelopment and the organization of human cognition.

Humans↗
PubMed2006

Care of hospitalized older patients: opportunities for hospital-based physicians.

BACKGROUND: Half of patients admitted to hospital for reasons unrelated to childbirth are age 65 years or older. Nonetheless, few hospital-based physicians have received training in geriatric medicine, and few geriatricians practice in the hospital. This paper describes the state of the science of hospital care for older patients, and identifies opportunities and barriers to improving their care. METHODS: General medical journals from 1980 to the present were selectively reviewed to identify original articles on the treatment of specific diseases and syndromes on hospitalized persons age 65 years or older. Information was synthesized to describe the course of these patients during and after hospitalization, and to identify effective management strategies and gaps in knowledge. RESULTS: Older persons in hospitals pose substantial clinical challenges: they have high rates of cognitive impairment, delirium, disability, and difficulty walking, and they often require increased attention, longer lengths of stay, and higher hospital costs than younger patients with the same diagnoses. Disease-specific interventions have not been studied extensively in those older than 75 years. Multicomponent interventions can reduce short-term rates of disability and delirium without increasing costs, but they have not been widely disseminated. Interventions to treat or prevent other common conditions in hospitalized older patients have not been proven effective. CONCLUSIONS: Fundamental discoveries in the science of hospital medicine are needed to prevent or treat geriatric syndromes, to treat common diseases in the very old, and to put into practice what is known. Hospital-based physicians can address these gaps in knowledge and practice with geriatricians, building from their shared perspectives on the care of the aged in complex health systems.

Aged↗
PubMed1995

Hemispheric dominance for melody recognition in musicians and non-musicians.

In two experiments, one with instrumental and one with synthesized tunes, 20 musicians and 20 non-musicians were requested to identify popular melodies presented dichotically. When the tempo of the melodies is fast enough to render their identification difficult, a right-ear advantage appears in the former group and a left-ear advantage in the latter, a pattern observed with both types of stimuli. It is suggested that these lateralization effects depend not only on the level of competence of the subjects, as hypothesized by Bever and Chiarello (Science, Vol. 185, pp. 537-539, 1974), but also on the musical features of the stimuli.

Acoustic Stimulation↗
PubMed1987

Intuitive knowing as a dimension of nursing.

Material gathered in a qualitative study of seven holistic nurses' perceptions of holistic nursing suggests that nonrational, intuitive knowing is a dimension of the state of the art in nursing. This dimension resonates with emerging theory in nursing and other sciences. Intuitive knowing is an aspect of the pattern of personal knowledge and as such may be found credible through reflection and actualization by individual nurses.

Cognition↗
PubMed2000

Cognitive outcomes and long-term follow-up results after enhanced chemotherapy delivery for primary central nervous system lymphoma.

OBJECTIVE: Patients with non-acquired immunodeficiency syndrome-related primary central nervous system lymphomas have the potential to achieve durable complete responses without radiotherapy, with treatment using enhanced chemotherapy delivery with blood-brain barrier disruption (BBBD). Reported 5-year survival rates with combined chemotherapy and radiotherapy were generally only 9 to 22% and were associated, in one study, with an overall 32% incidence of overt dementia and ataxia, which are dramatically increased among patients more than 60 years of age. METHODS: At the Oregon Health Sciences University, 111 consecutive patients with non-acquired immunodeficiency syndrome-related central nervous system lymphomas were prospectively treated with methotrexate-based, BBBD-enhanced chemotherapy and underwent formal neuropsychological evaluations. Of those, 74 patients had no systemic lymphoma and had received no prior irradiation; those 74 patients are described in this report. RESULTS: The estimated 5-year survival rate for this group was 42%, and the median survival time was 40.7 months. Overall, 48 patients (65%) exhibited complete responses and 36 patients continued to exhibit complete responses after 1 year of BBBD-enhanced chemotherapy. Of those 36 patients, none demonstrated evidence of cognitive loss in neuropsychological tests and/or clinical examinations. CONCLUSION: BBBD-enhanced chemotherapy delivery, without subsequent radiotherapy, resulted in favorable survival and cognitive outcomes for patients with primary central nervous system lymphomas who had not previously undergone irradiation. A cooperative multicenter study of intravenous chemotherapy without radiotherapy versus BBBD-enhanced chemotherapy would address the feasibility and necessity of performing a Phase III study for these rare central nervous system malignancies.

Antimetabolites, Antineoplastic↗
PubMed2005

Improvement in knowledge, social cognitive theory variables, and movement through stages of change after a community-based diabetes education program.

The objective of this program was to demonstrate the impact of a community-based diabetes education program. Participants were adults (N=239; mean age+/-standard deviation=63+/-10 years) with diabetes or caretakers. Community-based education incorporating Social Cognitive Theory and Stages of Change Theory included three group sessions focused on meal planning with cooking demonstrations. Knowledge and Social Cognitive Theory/Stages of Change variables were assessed pre- and postintervention. At posttest, significantly more (P<.05) used herbs in place of salt, cooked with olive or canola oils, used artificial sweeteners in baking (Stages of Change Theory), and were confident to change their diet and to prepare healthful meals. Knowledge of diabetes and nutrition increased (P<.05) and was a factor in postintervention belief in ability to use food labels and that meal planning was helpful. This community-based diabetes education intervention resulted in positive impacts on knowledge, health beliefs, and self-reported behaviors. Improvement in knowledge can be instrumental in moving individuals to an action or maintenance stage and in improving self-efficacy.

Cognition↗
PubMed2003

Developmental psychobiology and response to threats: relevance to trauma in children and adolescents.

Interest in developmental and psychobiological aspects of trauma has grown with recent research in adults with mood and anxiety disorders reporting histories of trauma during childhood. Studies conducted directly in children and adolescents could add much to ongoing research in this area. This review summarizes data in three areas of developmental science that might inform future studies. First, the review briefly summarizes current data on clinical aspects of trauma in juveniles, focusing on associations with psychopathology and moderators of outcome. Second, the review summarizes data from the basic sciences delineating experiential and developmental changes in brain systems involved in threat perception and response. This review incorporates knowledge gained from research examining the effects of rearing manipulations on regulation of the stress response in rodents and primates. Third, the review summarizes data from cognitive neuroscience studies among both adults and children, again focusing on studies examining aspects of the threat response. This summary includes a review from studies in patients with posttraumatic stress disorder.

Adolescent↗
PubMed2006

Seizures and antiepileptic drugs: does exposure alter normal brain development?

Seizures and antiepileptic drugs (AEDs) affect brain development and have long-term neurological consequences. The specific molecular and cellular changes, the precise timing of their influence during brain development, and the full extent of the long-term consequences of seizures and AEDs exposure have not been established. This review critically assesses both the basic and clinical science literature on the effects of seizures and AEDs on the developing brain and finds that evidence exists to support the hypothesis that both seizures and antiepileptic drugs influence a variety of biological process, at specific times during development, which alter long-term cognition and epilepsy susceptibility. More research, both clinical and experimental, is needed before changes in current clinical practice, based on the scientific data, can be recommended.

Abnormalities, Drug-Induced↗
PubMed2002

[Evidence based treatment of epilepsy].

OBJECTIVE: Evidence based medicine is becoming popular in all fields of medicine. Through systematic reviews, critical evaluation, and statistical strategies such as meta analysis it aids to take decisions in clinical practice. We revise the information on the treatment of epilepsy found in the main sources of evidence based medicine. DEVELOPMENT: After commenting some basic concepts such as systematic review, meta analysis, odds ratio, relative risk and numbers needed to treat, we describe the main primary, secondary and tertiary drug information sources with emphasis on sources of evidence based medicine. Some representative examples are given about the information on treatment of epilepsy found in the main sources of evidence based medicine such as TRIP, DARE, Cochrane Library, clinical practice guidelines, Clinical Evidence or Bandolier. Most clinical trials analyze the efficacy and tolerability of add on new antiepileptic drugs in partial refractory epilepsy. However, we found few trials on efficacy and tolerability of these drugs in monotherapy, in newly diagnosed partial epilepsy, on other types of epilepsy or in children. There are also few trials comparing the new antiepileptic drugs between them or in relation to the old ones. CONCLUSION: Treatment of epilepsy is yet an art more than a science because clinical practice decisions depends on therapeutic habits and clinical expertise more than on the results emerging from randomized and controlled clinical trials. Large comparative trials are needed but relevant criteria of efficacy and validated procedures to evaluate quality of life, tolerability or cognitive function outcomes should be used in these trials.

Anticonvulsants↗
PubMed1992

The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis.

OBJECTIVE: This article defines stress and related concepts and reviews their historical development. The notion of a stress system as the effector of the stress syndrome is suggested, and its physiologic and pathophysiologic manifestations are described. A new perspective on human disease states associated with dysregulation of the stress system is provided. DATA SOURCES: Published original articles from human and animal studies and selected reviews. Literature was surveyed utilizing MEDLINE and the Index Medicus. STUDY SELECTION: Original articles from the basic science and human literature consisted entirely of controlled studies based on verified methodologies and, with the exception of the most recent studies, replicated by more than one laboratory. Many of the basic science and clinical studies had been conducted in our own laboratories and clinical research units. Reviews cited were written by acknowledged leaders in the fields of neurobiology, endocrinology, and behavior. DATA EXTRACTION: Independent extraction and cross-referencing by the authors. DATA SYNTHESIS: Stress and related concepts can be traced as far back as written science and medicine. The stress system coordinates the generalized stress response, which takes place when a stressor of any kind exceeds a threshold. The main components of the stress system are the corticotropin-releasing hormone and locus ceruleus-norepinephrine/autonomic systems and their peripheral effectors, the pituitary-adrenal axis, and the limbs of the autonomic system. Activation of the stress system leads to behavioral and peripheral changes that improve the ability of the organism to adjust homeostasis and increase its chances for survival. There has been an exponential increase in knowledge regarding the interactions among the components of the stress system and between the stress system and other brain elements involved in the regulation of emotion, cognitive function, and behavior, as well as with the axes responsible for reproduction, growth, and immunity. This new knowledge has allowed association of stress system dysfunction, characterized by sustained hyperactivity and/or hypoactivity, to various pathophysiologic states that cut across the traditional boundaries of medical disciplines. These include a range of psychiatric, endocrine, and inflammatory disorders and/or susceptibility to such disorders. CONCLUSIONS: We hope that knowledge from apparently disparate fields of science and medicine integrated into a working theoretical framework will allow generation and testing of new hypotheses on the pathophysiology and diagnosis of, and therapy for, a variety of human illnesses reflecting systematic alterations in the principal effectors of the generalized stress response. We predict that pharmacologic agents capable of altering the central apparatus that governs the stress response will be useful in the treatment of many of these illnesses.

Adaptation, Physiological↗
PubMedDate not supplied

The effectiveness of self-instruction versus traditional classroom instruction: a comparison in an associate of science degree program in radiologic technology.

A comparison of methods in teaching a Radiographic Anatomy and Positioning course was made using students who were randomly assigned to experimental and control groups. The experimental group was taught by a self-instructional method, and the control group was taught using traditional lecture instruction. The study showed that there was no significant difference statistically in cognitive and practical competency scores between the experimental and control groups.

Educational Measurement↗
PubMed2005

A great pioneer of clinical science remembered: introduction to the special issue in honor of Paul E. Meehl.

In this special issue, the seminal contributions to clinical psychology of Paul E. Meehl, who passed away in 2003, are commemorated. The nine articles comprising this special issue chronicle Meehl's remarkable intellectual biography and examine his influence on diverse domains of psychology, including the clinical versus actuarial prediction debate, the cognitive activity of the clinician, personality assessment and trait theory, the etiology of schizophrenia, the shortcomings of statistical significance testing, and the use of metascientific methods to evaluate competing models of human nature. These articles illustrate not only Meehl's legendary brilliance but also his pivotal role in forcing clinical psychologists to think more clearly and incisively about their subject matter.

History, 20th Century↗
PubMed2005

Anterior cingulate cortex: an fMRI analysis of conflict specificity and functional differentiation.

In this event-related functional magnetic resonance imaging (fMRI) study, we provide evidence that the role of the anterior cingulate cortex (ACC) in cognitive control may not be unitary, as the responses of different ACC subregions vary depending upon the nature of task-irrelevant information. More specifically, using the color-word Stroop task (congruent, incongruent, and neutral trial types), we examined the degree to which increases in neural activity within ACC are specific to conditions of conflict, as posited by the conflict monitoring theory (Botvinick et al. [1999]: Rev Neurosci 10:49-57; Carter et al. [1998]: Science 280:747-749). Although incongruent and congruent trials both involve two competing sources of color information (color word and ink color), only incongruent trials involve a direct conflict between task-relevant and task-irrelevant information. Although the anterior division of the ACC rostral zone exhibited conflict specific increases in neural activity (i.e., incongruent > congruent = neutral), the posterior division exhibited a more generalized pattern, increasing whenever the task-irrelevant information was color related, regardless of whether it was conflicting (i.e., incongruent and congruent > neutral). Our data thus suggest a possible functional differentiation within the ACC. As such, it is unlikely that the role of the ACC in cognitive control will be able to be accommodated by a single unifying theory.

Adolescent↗
PubMed2004

School entry after a community-wide trauma: challenges and lessons learned from September 11th, 2001.

The purpose of this paper is to describe the implementation of a school-based trauma-specific mental health program in New York City following the terrorist attacks on September 11, 2001. This program aimed to serve children most at risk for developing mental health problems as a result of physical proximity (e.g., evacuation from schools surrounding the World Trade Center) to the trauma. As we present the components of the program, we will review the literature that guided our decision making. The ongoing struggle between searching for answers from established science and immediate needs in a crisis is highlighted. Lastly, a discussion of the lessons learned and recommended next steps is presented.

Adolescent↗
PubMedDate not supplied

Practice guidelines for recreation therapy in the care of people with dementia.

Activity is a basic human need expressed in work and leisure pursuits. Unfortunately, people with dementia have a low rate of activity participation because of associated physical and cognitive constraints. Recently, the American Therapeutic Recreation Association (ATRA) held a consensus meeting to address this issue and formulate practice guidelines for recreation therapy in the care of people with dementia. The consensus document presents an evidence-based intervention theory that draws on the science of two disciplines: nursing and recreation therapy. This article reports on the ATRA guidelines and illustrates their applicability in a case study of a resident with severe aggression associated with dementia.

Aged↗
PubMed2005

Facilitation of students' discussion in problem-based learning tutorials to create mechanisms: the use of five key questions.

Without the appropriate facilitation of discussion in a problem-based learning (PBL) course and the use of specific educational tools that enhance cognitive skills, students might deprive themselves of achieving the deep learning experience expected to take place in a PBL course. One of the educational tasks in PBL is the creation of mechanisms for hypotheses made by the students, based on their knowledge of the basic sciences and the psychosocial issues raised in a particular case scenario. The whole task is student-constructed and should enhance their ability to explain the scientific basis of the symptoms and clinical signs of the patient enlisted in the case. Because students usually discuss the case without enough prior related knowledge, they might find it difficult to address different aspects of their mechanisms. These gaps in knowledge may be considered part of their "learning issues". In tutorial 2 (a PBL case is usually discussed in 2 or 3 tutorials at the maximum; each tutorial is 2 hours long), students should be able to build a comprehensive mechanism reflecting their deep understanding of the problem. However, students might not be able to integrate information learnt and their mechanisms might show a number of shortcuts and/or lack integration of information, and the flow of the pathophysiological changes may not be logical. This manuscript describes 5 key open-ended questions in PBL tutorials to facilitate students' discussions as they create their mechanisms.

Education, Medical, Undergraduate↗
PubMed1977

A comparative study of CLEP scores between MT and MLT students.

CLEP subject examinations for the areas of clinical chemistry, microbiology, hematology and immunohematology were administered to medical technology (MT) and medical laboratory technician (MLT) students. Test scores were analyzed and showed that MT students scored from 25% to 48% higher than MLT students. Mean percentile ranks were compared with college courses completed; these indicated that additional upper division academic courses raised the mean percentile rank. Results indicate that the Microbiology Category Examination evaluates general microbiology rather than clinical microbiology. Data in this study support the use of the CLEP examinations to measure cognitive knowledge of MLTs for upward mobility, thereby eliminating duplication of course content.

Allergy and Immunology↗