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PubMedDate not supplied

Clinical presentation, diagnosis, and pharmacotherapy of patients with primary brain tumors.

OBJECTIVE: To briefly review the clinical presentation and diagnosis of patients with primary brain tumors, followed by an in-depth survey of the pertinent pharmacotherapy. DATA SOURCES: A detailed search of the neurologic, neurosurgical, and oncologic literature for basic science research, clinical studies, and review articles related to chemotherapy and pharmacotherapy of primary brain tumors. STUDY SELECTION: Relevant studies on tissue culture systems, animals, and humans examining the mechanisms of action, pharmacokinetics, clinical pharmacology, and treatment results of chemotherapeutic agents for primary brain tumors. In addition, studies of pharmacologic agents administered for supportive care and symptom control are reviewed. DATA SYNTHESIS: Primary brain tumors derive from cells within the intracranial cavity and generally present with headache, seizure activity, cognitive changes, and weakness. They are diagnosed most efficiently with magnetic resonance imaging. After diagnosis, the most common supportive medications include corticosteroids, gastric acid inhibitors, and anticonvulsants. Chemotherapy is adjunctive treatment for patients with malignant tumors and selected recurrent or progressive benign neoplasms. In general, the most effective chemotherapeutic drugs are alkylating agents such as the nitrosoureas, procarbazine, cisplatin, and carboplatin. Other agents used include cyclophosphamide, methotrexate, vincristine, and etoposide. Angiogenesis inhibitors and gene therapy comprise some of the novel therapeutic strategies under investigation. CONCLUSIONS: The efficacy of chemotherapy for primary brain tumors remains modest. Novel agents must be discovered that are more specific and attack tumor cells at the molecular level of tumorigenesis. Furthermore, strategies must be developed to counteract the pervasive problem of brain tumor chemoresistance.

Antineoplastic Agents↗

PubMedDate not supplied

The rhetoric and reality of gap closing: when the "have-nots" gain but the "haves" gain even more .

Many forms of intervention, across different domains, have the surprising effect of widening preexisting gaps between disadvantaged youth and their advantaged counterparts--if such interventions are made available to all students, not just to the disadvantaged. Whether this widening of gaps is incongruent with American interests and values requires an awareness of this gap-widening potential when interventions are universalized and a national policy that addresses the psychological, political, economic, and moral dimensions of elevating the top students--tomorrow's business and science leaders--and/or elevating the bottom students to redress past inequalities and reduce the future costs associated with them. This article is a first step in bringing this dilemma to the attention of scholars and policymakers and prodding a national discussion.

Adolescent↗

PubMed2006

Causes of nutrition-related public health problems of preschool children: available diet.

The primary goal of this review is to examine the timing and nature of dietary inadequacy during the first 5 years of life. An important issue is that many children in developing countries are already nutritionally depleted by the end of the first year of life, because maternal undernutrition can cause low fetal accumulation of nutrient stores and secretion of inadequate amounts of some micronutrients in breast milk. Improvement of maternal diet and micronutrient status is required to remedy this situation. During the period of complementary feeding, most households may be able to provide their young children with sufficient energy and protein from home-produced complementary foods, but many do not feed foods with an adequate energy density or a sufficient number of meals per day. Inadequate micronutrient intakes and resulting deficiencies are common in preschoolers because of a lack of sufficient animal source foods, and have been associated with delayed child development. Dietary diversity is an especially important determinant of micronutrient intakes when animal source food intake is low. Interventions with animal source foods have produced improvements in growth, micronutrient status, cognitive performance and activity of children. Although much is now known about the role of inadequate diets in preschooler malnutrition, on a global scale the ability of households to apply this knowledge to improve the diets of their children is still limited.

Breast Feeding↗

PubMed2003

Presence and place of main ideas and examples in study texts.

BACKGROUND: How indispensable are examples and main ideas in study texts? In research into comprehension of expository texts examples are sometimes considered as cognitive support, sometimes as seductive details. According to the cognitivist view, text comprehension is based on main ideas, whereas the constructivist view holds that examples are the basis of understanding. AIMS: This study explored how text comprehension is influenced by main ideas and examples in study texts, in relation to Vermunt's (1992, 1998) 'concrete elaboration' learning style. In Experiment 1, concrete texts with many examples were compared with abstract texts with many main ideas. In Experiment 2, idea-oriented texts, in which main ideas preceded examples, were compared with example-oriented texts, in which examples preceded main ideas. SAMPLES: In both experiments, undergraduate social sciences students studied various versions of an introductory text on educational psychology. METHODS: The text contained sections with a varying number of relevant and irrelevant examples and with or without a main idea (Experiment 1), and sections with a main idea followed by examples, sections with a main idea without examples, or sections with examples followed by a main idea (Experiment 2). After studying the text, students completed a verbatim recognition test and an explanation test. RESULTS: Best results were obtained after studying sections with a main idea and two or five examples. Irrelevant examples were detrimental to understanding. Students used examples to construct knowledge or to activate prior knowledge. Students with a strong habit of concrete elaboration used main ideas to recollect episodes of personal experience. This may interfere with understanding underlying concepts and principles by relating main ideas to examples in the text. Students with a low score on the concrete elaboration scale were sensitive to the presence of examples in the study text. CONCLUSION: In expository texts, examples are indispensable. The findings suggest that main ideas are useful, and, in order to prevent interference effects, the more so when they are put at the end of sections.

Adult↗

PubMedDate not supplied

[Wellbeing, health and autonomy in old age: the Basal IDA Study (Interdisciplinary Aging Study)].

Current research on successful aging reflects a multicriteria approach, although a consensus on the interrelationship between different factors has not yet been achieved. The longitudinal-sequential study presented here aims at identifying psychological, biological and sociobiographical predictors of well-being, health and autonomy in old age and their interdependency. The concern of this study is thus a multidisciplinary approach including psychology, psychiatry, geriatrics and sports sciences. The ongoing study is described and first findings are reported. Four hundred and forty-two people, aged 65 to 94, were tested twice (1993 and 1995). Since this project is a pursuit of a medical longitudinal study (Basler-Studie), bio-medical parameters from former status measurements (1960, 1965, 1971, 1985, 1990) are available and taken into account for comparison with the newly collected data from 1993 and 1995. The tests included both a medical examination and cognitive and personality measurements. The medical test battery included: clinical and anthropometrical data, bio-chemical data as well as the medical history, health behaviour, complaints and subjective health. The psychological assessment included psychological well-being, health-related control beliefs, causal attribution, religiosity, etc. For memory assessment a computerized test was used which allows to test 1) perceptual error-scanning, 2) naming speed, and memory resources in terms of 3) capacity, 4) explicit and 5) implicit components. It therefore integrates direct (free recall, recognition) and indirect memory tests (perceptual identification: clarification), that were used previously in different experimental and quasi-experimental studies to investigate memory performance over the life-span. Furthermore, the following three experimental interventions are performed: memory and reattribution training, physical training and psychoanalytical group therapy. First descriptive results are presented concerning age-correlated changes in biological and medical parameters, health behavior, cognitive performances and psychological well-being and functional autonomy. The results show the strongest age effects in the cognitive variables (with the exception of priming). Beside age effects in speed variables and episodic memory we also find an age-correlated decline in semantic memory. Psychological well-being however, is not affected by age.

Activities of Daily Living↗

PubMed2026

Use of wearable technologies for physical activity promotion in older adults: A systematic review.

This systematic review, conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251055299), examined the use of wearable technologies for promoting physical activity (PA) in adults aged 60 years and older. Searches across five databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane) identified 2438 records, of which only six randomized controlled trials published between 2021 and 2025 met inclusion criteria, with sample sizes ranging from 36 to 551 participants and mean ages between 65 and 79 years. Given the small number of included studies, findings should be interpreted as preliminary. The studies ranged from the standalone use of commercial trackers (Fitbit, Polar, ActiGraph) to multicomponent interventions combining wearables with physiotherapist feedback, telephone counseling, web-based platforms, or interactive cognitive-motor training. Wearables used alone, as in the REACT trial, produced small or non-significant PA effects. In contrast, interventions integrating devices with personalized feedback, professional support, or digital platforms, such as PROMOTE and TASMANIA, were associated with more consistent improvements in PA, physical function, and cognitive outcomes. Multicomponent programs, such as PEER and ICMT, reported broader benefits, including cognition, balance, and reductions in sedentary behavior, though these findings derive from individual trials and require replication. Risk of bias, assessed with the Cochrane Risk of Bias tool version 2 (RoB 2.0), was rated as "some concerns" for five studies and low for only one, mainly due to gaps in randomization reporting, missing data, and lack of preregistration. Tentatively, and based on a very limited evidence base, wearables may have greater impact when embedded within broader behavioral systems, incorporating feedback, coaching, or interactive components, rather than when used in isolation as passive monitoring tools. Adherence and psychosocial outcomes appeared related to comfort and perceived usefulness among older adults, though larger and more robust trials are needed to confirm these patterns.

Humans↗

PubMed2006

Therapeutic potential of neurogenesis for prevention and recovery from Alzheimer's disease: allopregnanolone as a proof of concept neurogenic agent.

A major challenge not yet addressed by current therapeutic interventions for Alzheimer's disease (AD) is the regeneration of lost neurons and neural circuitry to restore cognitive function. Therapies that lead to cessation of the degenerative process still leave the brain riddled with deteriorated neural circuits and reduced neuron number. The discovery of neurogenesis in the adult brain and the regenerative potential of neural stem cells holds the promise for restoration of neural populations and regeneration of neural circuits necessary for cerebral function. While the regenerative potential of neural stem cells is great, so too is the challenge of delivering neural stem cells to the brain. Basic science analyses and human trials indicate that constituents of microenvironments within the brain determine the neurogenic potential, phenotypic differentiation of neural stem cells and magnitude of the neural stem cell pool. Multiple analyses have documented that dentate neurogenesis is regulated by multiple growth factors which are abundant during development and which dramatically decline with age. While the cause(s) of age-associated decline in neurogenesis remains to be fully determined, loss in growth factors, FGF-2, IGF-1 and VEGF, in the microenvironment of the subgranular zone (SGZ) are prime contributors to the reduced neurogenic potential. The decline in dentate neurogenesis can be observed as early as middle age. In the aged and AD brain, both the pool of neural stem cells and their proliferative potential are markedly diminished. In parallel, the level of potential regenerative factors is diminished in the brains of Alzheimer's patients compared to age-matched controls. Our efforts have been directed towards discovery and development of small, blood brain barrier penetrant molecules to promote endogenous proliferation of neural stem cells within the brain. These endeavors have led to the discovery that the neurosteroid alloprognanolone (APalpha) is a potent and highly efficacious proliferative agent in vitro and in vivo of both rodent and human neural stem cells. Results of our in vitro studies coupled with our more recent analyses in the triple transgenic mouse model of AD suggest that APalpha is a promising strategy for promoting neurogenesis in the aged brain and potentially for restoration of neuronal populations in brains recovering from neurodegenerative disease or injury. A brief overview of issues impacting the therapeutic potential of neurogenesis and the factors used to promote neurogenesis in the aging and degenerating brain is presented. Also included is a review of our current research into the neurogenic potential of the small molecule, blood brain barrier penetrating, neurosteroid allopregnanolone (APalpha).

Aging↗

PubMedDate not supplied

School reentry and the child with a chronic illness: the role of the pediatric nurse practitioner.

Being attentive to the educational needs of chronically ill children is a relatively recent development in American education. Advances in medical sciences that have improved survival rates for some conditions and increased public acceptance of people who are different or disabled and legislation that has established education as an entitlement for all children have allowed for the entrance of many chronically ill children into mainstream education. Successful school reentry is essential if the child is to develop normally, in terms of intellect, social skills, and peer relationships. Caregivers must not lose sight of the fact that school provides opportunities for social, emotional, and cognitive development. Thus the pediatric nurse practitioner can promote the benefits gained from schooling in numerous ways and provide the child, family, and school personnel with the support and information needed for a smooth transition back into the school system.

Child↗

PubMed2005

The depth of history and explanation as benefit and bane for psychological control theories.

A longstanding debate has recently re-erupted in the self-regulation literature around the concept of self-efficacy. This article presents an argument that the debate emerges from a lack of understanding of the history of control theories within both the social and physical sciences and the various levels of explanation to which phenomena can be subjected. This history, coupled with the issues of determinism, materialism, and empiricism evoked by the deeper level of explanation that some versions of control theory provide, has led some critics to mis-apply non-psychological properties to control theories and obscure their usefulness. Here, the usefulness of a deeper control theory level of explanation is illustrated using comparisons with explanations found in goal-setting theory and social cognitive theory.

Cognition↗

PubMed2006

Mood and neuropsychological changes in women with midlife depression treated with escitalopram.

OBJECTIVE: This study assessed mood and neuropsychological function in a population of middle-aged women with major depressive disorder treated with escitalopram. METHODS: Psychometric data measuring severity of depression were collected from 19 women and neuropsychological data were collected from 17 women aged between 45 and 65 years with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depression in a study in the Behavioral Neuroendocrinology Program at the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine. All women were treated with escitalopram in an open-label design. Mean age was 55.94 years and mean number of years of education was 16.36 years. Diagnosis of major depressive disorder was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and mood was evaluated with the 21-item Hamilton Depression Rating Scale (HAM-D) at baseline and at weekly follow-ups for 12 weeks. Cognition was assessed at baseline and 3 months after treatment using a neuropsychological test battery, which included an abbreviated measure of Full Scale Intelligence Quotient, measures of attention and processing speed, verbal and nonverbal memory, executive functioning, and verbal fluency. Self-report data were collected on current menopause status and current hormone therapy use in the postmenopausal women. Paired sample t tests were used to analyze the change in total HAM-D scores and neuropsychological variables. RESULTS: Statistically significant improvements were found in total HAM-D score, Wechsler Memory Scale III Logical Memory 1st Recall, I, and II scores, Wechsler Memory Scale III Visual Reproduction I scores, and Trail Making Test Part B scores. There was a statistically significant decrease in Controlled Oral Word Association Test FAS scores. CONCLUSIONS: Treatment of depression with escitalopram in a population of middle-aged women was shown to improve mood and cognitive efficiency in complex attention, short- and long-term recall of contextual information, short-term recall of visual information, and cognitive flexibility; however, it was shown to worsen phonemic fluency.

Antidepressive Agents, Second-Generation↗

PubMed2004

Successful ageing: from cell to self.

Many people see ageing as a time of cognitive and physical decline. For the past three decades, most scientists and the general public have accepted this negative age-stereotype as the norm, but fortunately this view is now challenged. New findings show that well-being and a positive view of ageing are major protective factors against the effects of age on the organism. These results challenge the scientific studies that place emphasis on the negative side of ageing. This ageism view has been observed in each sphere of science, from genetics to social sciences. Perspectives from each domain are described, and new integrative views of successful ageing are summarized.

Aging↗

PubMed2003

Visceral afferent pathways and functional brain imaging.

The application of functional imaging to study painful sensations has generated considerable interest regarding insight into brain dysfunction that may be responsible for functional pain such as that suffered in patients with irritable bowel syndrome (IBS). This review provides a brief introduction to the development of brain science as it relates to pain processing and a snapshot of recent functional imaging results with somatic and visceral pain. Particular emphasis is placed on current hypotheses regarding dysfunction of the brain-gut axis in IBS patients. There are clear and interpretable differences in brain activation following somatic as compared with visceral noxious sensation. Noxious visceral distension, particularly of the lower gastrointestinal tract, activates regions associated with unpleasant affect and autonomic responses. Noxious somatic sensation, in contrast, activates regions associated with cognition and skeletomotor responses. Differences between IBS patients and control subjects, however, were far less clear and interpretable. While this is in part due to the newness of this field, it also reflects weaknesses inherent within the current understanding of IBS. Future use of functional imaging to examine IBS and other functional disorders will be more likely to succeed by describing clear theoretical and clinical endpoints.

Afferent Pathways↗

PubMed1993

Experiential learning: an approach to transcultural education for nursing.

Delivery of culturally appropriate health care in our pluralistic society demands that practitioners develop special attitudes, knowledge, and skills. Experimental learning is a powerful methodology for addressing the affective, as well as the cognitive, domain of learning. The exploration of personal values is an essential first step in developing cultural awareness in order to move learners beyond ethnocentrism through awareness, understanding, acceptance, and appreciation of other cultures if learners are to truly adopt a multicultural approach to their professional practice. The nursing curriculum at McMaster University School of Nursing is based on the principles of adult education and self-directed learning. A series of guided experiences have been undertaken with a variety of health sciences learners, both students and faculty members, to foster an increased appreciation of (their) own values preliminary to embarking on knowledge and skill acquisition for transcultural health care.

Canada↗

PubMed1999

The effect of problem-based learning on the academic performance of students studying podiatric medicine in Ontario.

OBJECTIVES: To investigate the effect of problem-based learning (PBL) on student achievement. DESIGN: Two cohorts of students studying podiatric medicine in Ontario were compared - one having undertaken the traditional lecture-based curriculum, and the other the problem-based learning programme. SETTING: The Michener Institute for Applied Health Sciences and The Toronto Hospital. SUBJECTS: Chiropody students. RESULTS: The performance of the students on the written Provincial Registration Examinations of Ontario was analysed utilizing independent t-tests and demonstrated that the PBL cohort of students achieved significantly higher overall examination scores (P < 0.005) than the traditional cohort. Further analysis revealed that no significant difference existed between student cohorts with respect to factual biomedical knowledge (P > 0.5), but that the PBL students performed significantly better in tests of deeper understanding and the cognitive skills related to patient management (P < 0.0005). Additionally, intragroup analysis using Spearman's rank order correlation indicated that there was no rank ordered association between performance on the multiple-choice and essay sections of the examination. CONCLUSIONS: The above results suggest that the PBL cohort of students was more knowledgeable than, and possessed superior cognitively related patient management skills, to their traditional counterparts.

Education, Medical, Undergraduate↗

PubMed1977

A special tutorial for minority medical students: an account of a year's experience.

A small number of minority medical students were referred for a year-long tutorial to improve their problem-solving skills and to assist them in retaking failed basic science courses. Both the operation of the tutorial and attemtps to reconstruct what had gone wrong the previous year brought attention to the crucial importance of affective factors in the students' learning efforts. It proved to be possible to elucidate some of the dynamics whereby affective reactions apparently enter into instructor-student interactions and are significantly involved in the process of adjusting to medical school. Following the tutorial, which dealt with issues of trust and self-esteem as well as with cognitive problems, the students all had a successful year and were able to rejoin the main stream of students entering clinical training. It was concluded that cognitive problems of medical students experiencing academic difficulty may not be resolvable without dealing with affective considerations. Recommendations are given for dealing with affective issues.

Adult↗

PubMed1995

Central auditory processing: a view from auditory neuroscience.

The purpose of this report is to overview some recent advances in basic science that help us understand the roles of the central auditory nervous system in hearing. Particularly at rostral levels, neural representations of the acoustic signal are shaped by convergent inputs and show some degree of plasticity, even in adults. The fidelity with which brain regions represent a stimulus dimension is heterogeneous, and this has demonstrable implications for the perceptual consequences of damage to those regions. So-called higher-level disorders (e.g., phonologic ones) have become increasingly understandable, largely through work in cognitive neuroscience, which has begun to describe the functional architecture of the processes mediating sound recognition and comprehension.

Animals↗

PubMed2002

Attitudes toward biotechnology in the European Union.

Public attitudes toward biotechnology in the European Union have been characterized as negative using Eurobarometer data, but so far little attention has been paid to building a robust metric appropriate for emerging public opinion issues which combine high salience with very limited knowledge by the public. On the basis of the general literature about the formation and structure of attitudes and about public perceptions of science, this article presents a new metric and analysis: first, for estimating the level of awareness and knowledge of biotechnology in Europe; second, for assessing the stability and depth of these evaluative perceptions; and third, for exploring the roles of canonical socio-demographic variables, the knowledge variable and general attitudinal schemas for understanding the perceptions of both benefits and risks of biotech applications. The results show the importance of general value orientations or "worldviews" in shaping positive attitudes, and more of these general cognitive schemas should be measured in future research. The same multivariate model was unable to account for a significant percentage of the total variance in the perception of risks, suggesting that new measures are needed to tap this critical area in the acceptance of biotech in Europe.

Adult↗

PubMed1999

Understanding probabilistic risk in predisposition genetic testing for Alzheimer disease.

The utility of genetic testing in preventing the onset of conditions such as Alzheimer disease (AD) depends upon categorizing individuals based on their "risk" of illness. Although no strategies to prevent the occurrence of AD have been proven effective, the promise of the new molecular medicine is based on the assumption that those "at risk" can be identified, counseled about their likelihood of developing a disease, and prescribed specific preventive interventions. We suggest that this paradigm of disease prevention through risk stratification has limitations that have not been fully explored. Within the fields of cognitive and health psychology, research has addressed how individuals understand the numeric presentation of uncertain future events; this research often focuses on the "perceptual pathology" of lay people. The uncertainty inherent in the risk estimates themselves is rarely considered, nor has research addressed how those risk estimates are created. There has been limited work to date focused on genetic risk assessment, and little is known about how individual might understand the meaning or consequences of being at genetic risk for AD. An emerging social science critique of concepts of risk in genetic medicine offers a broader perspective, examining the process of producing scientific risk estimates as well as the response of individual patients, such as the experience of embodied risk that is central to genetic testing. Making fully informed choices about genetic testing for AD may prove more difficult than our current model of ethical practice suggests.

Alzheimer Disease↗