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PubMed2002

Dementia epidemiology.

Determining the incidence and prevalence of dementia is an inexact science. Dementia is difficult to define and detect in the population. Even with the difficulties of determining prevalence and incidence, it is clear that dementia causes a substantial burden on our society. Problems with diagnostic inaccuracy and insidious disease onset influence our ability to observe risk factor associations; factors related to survival may be mistaken for risk/protective factors. Current studies suggest that factors influencing brain development or cognitive reserve may delay the onset of AD, perhaps through a protective mechanism or a delay in diagnosis caused by improved performance on cognitive tests. The recent identification of genes that cause dementia suggests that these genes or their biochemical pathways may be involved in the pathogenesis of nonfamilial cases. The contribution of genes that cause disease in and of themselves may be smaller than that of genes that act to metabolize or potentiate environmental exposures. The interaction between gene and environment should be increasingly well studied in the future. Epidemiology must take advantage of these molecular advances. The tasks of public health and epidemiology should still involve prevention, the nonrandom occurrence of disease, and its environmental context in addition to heredity. The tools to address these tasks should continue to be refined.

Aged↗
PubMed2007

Promoting more integrative strategies for leadership theory-building.

The agenda for theory and research in the field of leadership studies has evolved over the last 100 years from focuses on the internal dispositions associated with effective leaders to broader inquiries that include emphases on the cognitions, attributes, behaviors, and contexts in which leaders and followers are dynamically embedded and interact over time. Leadership theory and research has reached a point in its development at which it needs to move to the next level of integration--considering the dynamic interplay between leaders and followers, taking into account the prior, current, and emerging context--for continued progress to be made in advancing both the science and practice of leadership.

Character↗
PubMed2004

A systematic literature review of factors affecting outcome in older medical patients admitted to hospital.

INTRODUCTION: The ACMEplus project aims to devise a standardised system for measuring case-mix and outcome in older patients admitted to hospitals in different parts of Europe for primarily 'medical' (i.e. not surgical or psychiatric) reasons. As a first step in this project, a systematic review was carried out to identify factors which had a significant influence on outcome in such patients. METHODS: The systematic search used Medline 1966-2000, Cinahl 1982-2000, Web of Science 1981-2000, reference lists of relevant papers and a hand search of Age and Ageing 1974-2000. A six-category grading system was devised to classify the 313 identified papers with regard to their relevance to the ACMEplus project, study design and power. The analysis of the 14 'category 1' papers is presented. RESULTS: The main areas of assessment of case-mix were function, cognition, depression, illness severity, nutrition, social elements, aspects of diagnosis and demographic details. Statistically significant predictors, for the four outcome measures, listed below were: For length of stay: functional status score, illness severity, cognitive score, poor nutrition, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender. For mortality: functional status score, illness severity, cognitive score, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender. For discharge destination: functional status score, cognitive score, diagnosis or presenting illness and age. For readmission rate: functional status score, illness severity, co-morbidity, polypharmacy, diagnosis or presenting illness and age. CONCLUSIONS: Factors affecting outcome in older medical patients are complex. When looking at outcomes of hospital admission in older people it is important not just to look at routinely available statistics such as age, gender and diagnosis but also to take into account multifaceted aspects such as functional status and cognitive function.

Aged↗
PubMed2004

Equating rehabilitation outcome scales: developing common metrics.

Transparency with regard to measuring devices is one of the fundamental requirements for progress in science. The ability to derive comparable measures from different measuring devices is the cornerstone of transparency. To this end, progress in measuring and understanding rehabilitation outcomes requires that there is a method of measuring outcomes that is independent of the particular collection of items that is used to assess the outcomes. The purpose of this study is to develop a equivalence between the PECS Motor Skills and Cognition and Communication LifeScales with the FIM Motor Skills and Cognitive items. However, only the results of the Motor Skills Scale are reported here in the interest of brevity. This equating is based on approximately 500 simultaneous evaluations using bout the PECS and FIM scales on admission and discharge. The patients in this study were consecutive admissions to a free-standing rehabilitation hospital in early 1998. Patients from five diagnostic groups were included in this study, Brain Injury, Spinal Cord Injury, Stroke, Neuromuscular, and Musculoskeletal. The results indicate that it is possible to construct a common equal interval translation between the PECS and FIM for the two scales. Measures on the common metric can be based to either scale and are independent of the number of items completed. This use of these anchored scales will allow institutions using either the PECS and FIM to make direct comparisons of clinical outcomes with other institutions, independent of the particular outcome tool used to evaluate patients.

Activities of Daily Living↗
PubMed2004

The concept of vulnerability in disaster research.

The concept of vulnerability in research derives from a specific set of historical circumstances relating to abuses in biomedical research. Now so many people and groups have been labeled vulnerable that the concept has lost much of its force. In disaster research, participants should not be automatically considered vulnerable unless they are legally designated as such, for example, children. Instead specific aspects of the research should be thoroughly examined. Examples are the potential for the participants to be pressured to participate in several protocols, political or social turmoil surrounding the disaster, and cognitive impairments or mental health problems. In addition to a careful consent process, there should be procedures in place to provide assistance to participants who experience serious distress.

Adult↗
PubMedDate not supplied

[Drinking water hardness and chronic degenerative diseases. I. Analysis of epidemiological research].

For many years a causal relation between drinking water hardness and cardiovascular or other chronic degenerative diseases in humans has been hypothesized. In order to evaluate the association between the concentration of minerals (calcium and magnesium) responsible for the hardness of drinking water and human health, a review of all the articles published on the subject from 1980 up to today has been carried out. The retrieved articles have been divided into 4 categories: geographic correlation studies, cross-sectional studies, case-control and cohort studies, and clinical trials. The methods for the selection of the articles and the extraction and analysis of the data are detailed in this paper. Epidemiological studies have been reviewed critically, and some conclusions have been drawn taking into account the research in basic sciences and experimental studies. However, a formal meta-analysis has not been performed, due to the heterogeneity of measures of effect among the different studies.

Adult↗
PubMed2001

[Problems of strain and coping of breast cancer patients--demands on nursing concepts of care].

Over the last decades the number of breast cancer patients has dramatically increased. Attention has been drawn especially in research literature in the field of psychological medicine to the patients ' severe problems of strain and coping. In comparison to that, at least German intervention research in nursing science has to make up for lost time. This essay is, above all, a report on research literature. It summarizes study findings concerning emotional and physical problems associated with the disease and treatment for breast cancer. They result in a need for nursing care and support. Some practical conclusions for the nursing profession will be drawn in order to evolve comprehensive concepts of care both at a cognitive-emotional and tactile level of perception.

Adaptation, Psychological↗
PubMedDate not supplied

[The "Well-being paradox" in quality-of-life research].

In quality-of-life research an empirical phenomenon has been observed independently in medicine and in the social sciences which is so contrary to what intuition tells us that it has been called paradoxical. In medicine it is called the "satisfaction paradox" and in the social sciences the "well-being paradox". What is meant in both cases is that objectively negative factors in one's life have relatively little effect on subjective quality of life. In the present paper examples are given of relevant research findings from both fields. An attempt is then made to explain the phenomenon, with the topic being examined not only from a methodological but also from a personality, cognition and social psychology perspective. Finally, the implications for research and clinical work are discussed.

Cognition↗
PubMed2005

A memory span of one? Object identification in 6.5-month-old infants.

Infants' abilities to identify objects based on their perceptual features develop gradually during the first year and possibly beyond. Earlier we reported [Káldy, Z., & Leslie, A. M. (2003). Identification of objects in 9-month-old infants: Integrating 'what' and 'where' information. Developmental Science, 6, 360-373] that infants at 9 months of age are able to use shape information to identify two objects and follow their spatiotemporal trajectories behind occlusion. On the other hand, another recent study suggests that infants at 4-5 months of age cannot identify objects by features and bind them to locations [Mareschal, D., & Johnson, M. H. (2003). The "what" and "where" of object representations in infancy. Cognition, 88, 259-276]. In the current study, we investigated the developmental steps between these two benchmark ages by testing 6.5-month-old infants. Experiment 1 and 2 adapted the paradigm used in our previous studies with 9-month-olds that involves two objects hidden sequentially behind separate occluders. This technique allows us to address object identification and to examine whether only one or both object identities are being tracked. Results of experiment 1 showed that 6.5-month-old infants could identify at least one of two objects based on shape and experiment 2 found that this ability holds for only one, the last object hidden. We propose that at this age, infants' working memory capacity is limited to one occluded object if there is a second intervening hiding. If their attention is distracted by an intervening object during the memory maintenance period, the memory of the first object identity appears to be lost. Results of experiment 3 supported this hypothesis with a simpler one-screen setup. Finally, results of experiment 4 show that temporal decay of the memory trace (without an intervening hiding) by itself cannot explain the observed pattern of results. Taken together, our findings suggest that at six months of age infants can store but a single object representation with bound shape information, most likely in the ventral stream. The memory span of one may be due to immaturity of the neural structures underlying working memory such that intervening items overwrite the existing storage.

Cognition↗
PubMed2004

Neonatal dexamethasone therapy: short- and long-term consequences.

The discovery of the adrenal steroid hormones was one of the momentous events of science and medicine in the 20th century, highlighted by the awarding of the Nobel Prize in Physiology or Medicine to Kendall, Reichstein and Hench in 1950. Therapy using endogenous and synthetic corticosteroids was thought to be a miracle cure for several illnesses. We now recognize the many short- and long-term side effects of glucocorticoid therapy in neonates, children and adults, including growth retardation, insulin resistance, metabolic disturbances, cognitive and psychological problems, rapidly-progressing and profound osteoporosis, and iatrogenic Cushing's syndrome. Significant attention is now being paid to the long-term consequences of glucocorticoid therapy in premature and full-term neonates.

Animals↗
PubMed2002

Use of cognitive interview techniques in the development of nutrition surveys and interactive nutrition messages for low-income populations.

The effectiveness of dietary surveys and educational messages is dependent in part on how well the target audience's information processing needs and abilities are addressed. Use of pilot testing is helpful; however, problems with wording and language are often not revealed. Cognitive interview techniques offer 1 approach to assist dietitians in understanding how audiences process information. With this method, respondents are led through a survey or message and asked to paraphrase items; discuss thoughts, feelings, and ideas that come to mind; and suggest alternative wording. As part of a US Department of Agriculture-funded nutrition education project, 23 cognitive interviews were conducted among technical community college students in North Carolina. Interview findings informed the development of tailored computer messages and survey questions. Better understanding of respondents' cognitive processes significantly improved the language and approach used in this intervention. Interview data indicated 4 problem areas: vague or ineffective instructions, confusing questions and response options, variable interpretation of terms, and misinterpretation of dietary recommendations. Interviews also provided insight into the meaning of diet-related stages of change. These findings concur with previous research suggesting that cognitive interview techniques are a valuable tool in the formative evaluation and development of nutrition surveys and materials.

Adolescent↗
PubMed2004

The neurobiology of pleasure, reward processes, addiction and their health implications.

Modern science begins to understand pleasure as a potential component of salutogenesis. Thereby, pleasure is described as a state or feeling of happiness and satisfaction resulting from an experience that one enjoys. We examine the neurobiological factors underlying reward processes and pleasure phenomena. Further, health implications related to pleasurable activities are analyzed. With regard to possible negative effects of pleasure, we focus on addiction and motivational toxicity. Pleasure can serve cognition, productivity and health, but simultaneously promotes addiction and other negative behaviors, i.e., motivational toxicity. It is a complex neurobiological phenomenon, relying on reward circuitry or limbic activity. These processes involve dopaminergic signaling. Moreover, endorphin and endogenous morphinergic mechanisms may play a role. Natural rewarding activities are necessary for survival and appetitive motivation, usually governing beneficial biological behaviors like eating, sex and reproduction. Social contacts can further facilitate the positive effects exerted by pleasurable experiences. However, artificial stimulants can be detrimental, since flexibility and normal control of behavior are deteriorated. Additionally, addictive drugs are capable of directly acting on reward pathways. Thus, the concrete outcome of pleasant experiences may be a question of dose. Moderate pleasurable experiences are able to enhance biological flexibility and health. Hence, pleasure can be a resistance resource or may serve salutogenesis. Natural rewards are mediated by sensory organ stimulation, thereby exhibiting a potential association with complementary medical approaches. Trust and belief can be part of a self-healing potential connected with rewarding stimuli. Further, the placebo response physiologically resembles pleasure phenomena, since both involve brain's reward circuitry stimulation and subjective feelings of well-being. Pleasurable activities can stimulate personal growth and may help to induce healthy behavioral changes, including stress management. However, more research is needed to better understand the nature, neurobiology and maybe dangerous aspects of pleasure. Also, a possible involvement of endogenous morphinergic signaling has to be studied further.

Behavior, Addictive↗
PubMedDate not supplied

[I.S. Beritashvili (Beritov) is one of the founders of the modern biobehavioral science (to the 120th anniversary)].

Ivan Solomonovich Beritashvili (Beritov) is one of the great Russian physiologists who have created the Russian route of the modern science of behavior. He has proposed and experimentally substantiated a concept of psychoneural activity according to which the behavior controlled by images is the main and higher form of the behavior of vertebrates. Behaviors on the basis of conditioned reflexes and images are qualitatively different activities underlain by different neural substrates. Recently, the Beritashvili's principle ideas have been confirmed by multiple experimental studies of the animal and human cognitive behavior. At present, the concept of the procedural memory formed by training and acquisition and episodic memory formed on the basis of images is commonly accepted. The episodic memory stores the environmental events and phenomena perceived by an animal or a human. Each time when the image is reproduced during perception of environment or its part, an animal performs the same behavioral act as during the actual perception. Beritashvili's viewpoint that the procedural and declarative memories are controlled by different brain structures has been confirmed by experiments.

Animals↗
PubMed2004

The contribution of narrative ethics to issues of capacity in psychiatry.

Cognitive and rational assessments of competence do not fully capture the way in which individuals normally make decisions. Human beings have always used stories to explain their experiences and values. Narrative ethics should be used to understand the perspective in context of a patient whose competence is in question, and so avoid a destructive clash. Psychiatry and professionals within it also have a narrative that may join with that of science, but there is no special privilege for these narratives unless survival is at stake. The narrative approach should be used to try to make different stories compatible. This article examines the background to this approach, and indicates some ways in which it could be used in the specific cases addressed in the series.

Ethics, Medical↗
PubMedDate not supplied

Evaluation of insomnia and daytime napping in Iranian Alzheimer disease patients: relationship with severity of dementia and comparison with normal adults.

OBJECTIVE: Alzheimer disease (AD) is among the most common and disabling diseases in adulthood, and it has been largely neglected in traditional societies like Iran. Exacerbation of AD symptoms creates many severe problems, especially in traditional Iranian extended families. One of these problems is insomnia, which can very significantly affect patients' family members because of disturbing insomnia-related behaviors. METHODS: The authors studied 53 patients with probable AD who had been interviewed for dementia and depression in the Neurology Clinic of Roozbeh Psychiatric Hospital (Tehran University of Medical Sciences). Excluding patients with overlapping multi-infarct dementia, 35 AD patients (22 men, 13 women) and 21 adults without dementia were studied as a comparison group (11 men, 10 women). RESULTS: There was a significant relationship between duration of informant-reported symptoms and severity of dementia with daytime napping and more daytime napping among AD patients than in the comparison group. There was also a significant relationship between cognitive decline and daytime napping in the comparison group. Our study showed a relationship between insomnia and aggression, between daytime napping and paranoid delusions; and between onset of insomnia and anxiety. The comparison group showed a significant relationship between depression and daytime napping. CONCLUSIONS: Daytime napping and insomnia are very common among Iranian AD patients, much more so than in normal adults. There is also a significant relationship among psychiatric symptoms, daytime napping, and insomnia, but it seems that daytime napping and insomnia in depressed AD patients are caused more by the progress of AD than by depression.

Aged↗
PubMed1992

Psychoanalysis and psychosomatics: a new synthesis.

The usefulness of psychoanalysis to psychosomatic medicine has been limited by the longstanding assumption that the psychological disorder in psychosomatic patients resembles the conflict-based psychopathology that Freud identified in psychoneurotic patients. Recent investigations of the alexithymia construct, and the discovery that social relationships can influence health over the entire life span, have challenged this assumption and created an opportunity for a new and active involvement of psychoanalysis with psychosomatic medicine. In this contribution, I offer a synthesis of contemporary psychoanalytic observations and theories with concepts and research findings from developmental psychology, developmental biology, and the biomedical sciences. The proposed synthesis is consistent with the view that living organisms are self-regulating cybernetic systems; it also extends an evolving new psychosomatic model that conceptualizes illnesses and diseases as disorders of psychobiological regulation. A modern psychoanalytic approach to physically ill and disease-prone individuals focuses less on the resolution of neurotic conflicts, and more on correcting deficits in these patients' self and object representations and capacity cognitively to process emotions.

Affective Symptoms↗
PubMed2001

[Problem based learning in the teaching of physics to medical students. Comparison with traditional teaching].

BACKGROUND: Problem based learning, integrating basic science with clinical problems, is one of the most recommended forms of teaching for medical schools. AIM: To compare a problem based learning program for physics with traditional teaching methods. MATERIAL AND METHODS: In the physics course, first year medical students were separated in groups with traditional learning and problem based teaching. Both groups were subjected to the same knowledge and qualitative evaluations. RESULTS: At the end of the course, cognitive performance in both groups was similar (60.8 and 61.3% among traditional teaching and problem based learning groups respectively). However, students assigned to the problem based learning group evaluated significantly better the teaching methodology and process. CONCLUSIONS: Physics education, using problem based learning, obtains the same cognitive results but a higher degree of satisfaction than traditional teaching among students.

Curriculum↗
PubMed2004

[The gender debate from the pedagogic perspective].

The question of form and extent of biological and/or cultural influences on female and male behaviour and performance is marking a major focus in present scientific research. Accordingly, a broad spectrum of approaches in research and interpretations of results is available. The recent debate on sex and gender is offering two basic objectives for research in education science: First, the critical review of the data and results on sex specifics presented in respect to the articulation of educational aims, topics and methods. Second, the intensified research focus on the developmental consequences of gender and gender roles for boys and girls, women and men. The pedagogical focus is discussed regarding the following three objectives: 1. developmental conditions in early ontogeny, 2. the question of sex specific differences in cognitive abilities in respect to school performance of adolescents, and 3. teaching knowledge on "sex" and "gender" in schools.

Adolescent↗