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PubMed1990

Undergraduate medical education in obstetrics and gynaecology in the USA and Canada, 1985.

Many factors have led to a movement from the emphasis of the 1960s and 1970s on departmental expansion towards an emphasis on cost-effective undergraduate medical education emphasizing the 'art' as well as the 'science' of medicine. In January 1985 a questionnaire was sent under the auspices of the Undergraduate Education Committee of the Association of Professors of Obstetrics and Gynecology to all chairmen of departments of obstetrics and gynecology in the USA and Canada seeking their opinions about these trends and information about the educational programmes in their departments. The information from this study indicates that the chairmen are aware of and responding to this new direction in medical education. A stabilization of teaching staff and clerkship sizes and the emphasis on clinical as well as cognitive evaluation, despite recognition of the cost of the former, shows active interventions towards these ends. An emphasis on education in 'basic' as compared to 'subspecialty' areas which is independent of the subspecialty of the academic chairman also supports this trend.

Canada↗
PubMed2006

The challenge of integrating disparate high-content data: epidemiological, clinical and laboratory data collected during an in-hospital study of chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a debilitating illness characterized by multiple unexplained symptoms including fatigue, cognitive impairment and pain. People with CFS have no characteristic physical signs or diagnostic laboratory abnormalities, and the etiology and pathophysiology remain unknown. CFS represents a complex illness that includes alterations in homeostatic systems, involves multiple body systems and results from the combined action of many genes, environmental factors and risk-conferring behavior. In order to achieve understanding of complex illnesses, such as CFS, studies must collect relevant epidemiological, clinical and laboratory data and then integrate, analyze and interpret the information so as to obtain meaningful clinical and biological insight. This issue of Pharmacogenomics represents such an approach to CFS. Data was collected during a 2-day in-hospital study of persons with CFS, other medically and psychiatrically unexplained fatiguing illnesses and nonfatigued controls identified from the general population of Wichita, KS, USA. While in the hospital, the participants' psychiatric status, sleep characteristics and cognitive functioning was evaluated, and biological samples were collected to measure neuroendocrine status, autonomic nervous system function, systemic cytokines and peripheral blood gene expression. The data generated from these assessments was made available to a multidisciplinary group of 20 investigators from around the world who were challenged with revealing new insight and algorithms for integration of this complex, high-content data and, if possible, identifying molecular markers and elucidating pathophysiology of chronic fatigue. The group was divided into four teams with representation from the disciplines of medicine, mathematics, biology, engineering and computer science. The papers in this issue are the culmination of this 6-month challenge, and demonstrate that data integration and multidisciplinary collaboration can indeed yield novel approaches for handling large, complex datasets, and reveal new insight and relevance to a complex illness such as CFS.

Adult↗
PubMedDate not supplied

[Aspects of psychotherapies. Music therapy and its specificity].

Musicotherapy, associating art and science, concerns a sensorial approach, in a therapeutic aim, through sound and music, to psychological difficulties, of numerous somatic and psychosomatic troubles, as well as neurotic and psychotic disease. Music therapy is one of the art-therapy methods, all of them dealing with mediation in reference to Winnicott, leading the patients to active and creative participation and being most of the time shorter than classical verbal therapies. It may be considered as being related to the main theories of modern psychotherapies, and refers either to Psychoanalysis or to behaviour therapies, or to cognitive therapies, or to humanistic therapies ... but, whatever its main basic theory, musicotherapy shows its specificity. Its specific features are: the variety and complexity of its techniques; the specificity of the therapeutic relation; patient, music, and therapist are united through a triangular relationship; transference is of a special quality; the way the therapist answers the patient and helps him may be either verbal or musical. Practising music and listening to music must not be considered as a therapy. Music is not therapeutic in itself. It becomes so when music is used in techniques organised in a therapeutic aim. Musicotherapy may be necessary for a patient who suffers, who asks to be helped and who finds through music a way of expression and communication. The therapeutic aim has nothing to do with musical training. Musicotherapy concerns children as well as adults and elderly people, but requires different techniques adapted to the category of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1996

Nutritional management of eating disorders.

Abnormal nutritional status and dietary patterns are central features of the eating disorders. Normalization of these features are key components of treatment and recovery because they are powerful perpetuating factors. Restrictive diets, fat avoidance, and abnormal cognitive and perceptual patterns are typically present, in addition to altered nutritional parameters because of hormonal and metabolic factors. The primary goal of nutrition intervention in the patient with anorexia nervosa is to promote weight gain through increased energy intake, expansion of the diet, and knowledgeable and empathetic dietary counseling. A regular pattern of nutritionally balanced, planned meals and snacks, and the avoidance of restrictive dieting, are essential elements of treatment for the patient with bulimia nervosa. As a member of the multidisciplinary treatment team, the dietitian or nutrition professional with knowledge of nutritional science, counseling skills, and a nonjudgmental attitude can provide expertise in this area.

Anorexia Nervosa↗
PubMed1996

Interrelationships of food, nutrition, diet and health: the National Association of State Universities and Land Grant Colleges White Paper.

Nutrition and food science have each enhanced the development of an abundant, nutritious, safe food supply. A healthy diet should contain all of the required nutrients and sufficient calories to balance energy expenditure and provide for growth and maintenance throughout the life cycle. Importantly, dietary factors are associated with 5 of the 10 leading causes of death, including coronary heart disease, certain types of cancer, stroke, noninsulin dependent diabetes mellitus and atherosclerosis. National health care expenditures for 1990 totaled $666 billion of which 30% are related to inappropriate diet. Identification of external factors that contribute to premature death would aid preventive efforts, improve the quality of life, and reduce health care costs. Even though genetic predisposition increases susceptible people's risk for many of these chronic diseases, these conditions may be diminished or prevented by improvements in the American diet. Each stage of the life cycle has specific nutrient needs. Throughout infancy, childhood and adolescence nutrients are required to meet the growth processes as well as cognitive function. During pregnancy nutrients are required for both mother and developing infant needs. Adult nutrition focuses on tissue maintenance, nutrient and energy needs, and disease prevention. As the population of elderly increase in number and greater age, nutritional needs must be met to minimize certain disease states and assure the quality of life. Nutrition associated health risks have been identified for coronary heart disease, cancer and diabetes mellitus. Recommendations for each includes a decrease in dietary fat, awareness of caloric intake and enhancement of nutrient density including an increase in fruit and vegetables. These recommendations also impact obesity and diminish the compounding of other disease states affected by excessive body weight. Calcium intake at early ages affects development of bone density and manifestation of osteoporosis. Current gaps in knowledge are also identified that could improve health. Numerous nutrients are being examined for their regulation of specific gene expressions and in the processes of transcription and translation. To offer food products with greater nutrient density or improved functional health ingredients, modification of existing foods is needed to assure an improved diet. Policies to improve health require integration of nutrition needs with economic growth and development, agriculture and food production, processing, marketing, health care and education, and includes changing life styles and food choices. Increased research support is required to achieve national health goals with emphasis on nutrition and food sciences. Education methods must be improved to better inform consumers, to encourage food producers and manufactures to produce healthier foods, to assure training of future professionals and to provide legislators with the basis to make informed decisions. Recommendations to CFERR are identified. Improved quality and availability of nutritious foods will result in a healthier, more productive population. A decrease in the occurrence and duration of chronic disease should diminish the cost of health care and allow these resources to further benefit the nation. International concerns about undernutrition include 780 million people who are malnourished, lacking sufficient food to meet their basic nutritional needs for protein and energy, and 2 billion people who subsist on diets lacking essential nutrients needed for growth, development and physiological maintenance. National concerns about undernutrition exist based on incomplete data identified by indices of hunger and characterized by an increased demand for food assistance for women, children and the elderly. Major health problems in the US impacted by diet and nutrition include coronary heart disease, atherosclerosis, some types of cancer, non-insulin dependent diabetes mellitus, hypert

Diet↗
PubMed1983

Opiate analgesia and its antagonism in dental event-related potentials: evidence for placebo antagonism.

The analgesic effects of the synthetic opiate fentanyl citrate (0.1 mg) on subjective pain reports (SPR) and late-wave event-related potentials (ERP) recorded during painful dental stimulation were examined in human subjects. Such waves have been shown to reflect the contribution of cognitive variables, such as expectancy and belief, to perception. In addition, the study was intended to demonstrate a dose-related narcotic antagonism with injection of naloxone (1.2 or 0.4 mg) or normal saline (double-blind) following IV fentanyl administration. Fentanyl reduced both ERP waveform amplitudes and SPR as have previously studied analgesic agents, such as nitrous oxide, acupuncture, and aspirin. Naloxone injection reversed both ERP and SPR changes, but surprisingly, a reversal of narcotic analgesia equal to that of 0.4 mg naloxone was seen with saline injection. By chance, all subjects were health-science students or professionals who were knowledgeable in opiate pharmacology, and so placebo reversal was hypothesized. Alternatively, it was hypothesized that fentanyl cleared more rapidly than predicted, thus, producing apparent reveal. In a second experiment involving similarly knowledgeable subjects with identical procedures and testing intervals, subjects received 0.1 mg fentanyl, but no reversal injection. The fentanyl effect was constant across this time period. The data, thus, support the hypothesis where the subjects were knowledgeable in opiate pharmacology, was placebo opiate antagonism.

Adult↗
PubMed2006

Summary proceedings from the bronchopulmonary dysplasia group.

Despite improvements in neonatal care, bronchopulmonary dysplasia (BPD) continues to occur in approximately one third of newborns who have birth weights of <1000 g and contributes to significant morbidity in this population. Gaps in knowledge about the prevention and treatment of BPD remain, resulting in unintended short- and long-term sequelae. In addition to chronic lung disease, preterm newborns with BPD are more likely to develop language delay, cerebral palsy, and cognitive impairments compared with preterm newborns without BPD. The pulmonary group identified 3 critical needs to enhance the design of clinical trials in neonates with BPD: (1) identify the stages of BPD; (2) define BPD more clearly; and (3) identify subtypes of BPD patients. The group determined that trials are needed for 3 areas of BPD: (1) prevention of BPD; (2) treatment of evolving BPD; and (3) treatment of established BPD. The severity of BPD is defined as mild, moderate, and severe, and subgroups among those with BPD are described. Here we identify gaps in basic science and pharmacologic knowledge that hamper investigators' ability to conduct effective BPD clinical trials and provide a list of drugs to be studied in BPD trials. Priorities for drug-class evaluation by stage of BPD are given. The pulmonary group proposes a BPD clinical-trials framework that varies according to the different stages of BPD and describes characteristics of the overall design for BPD clinical trials. Finally, we discuss trial-design issues that are common to all neonatal studies.

Adrenal Cortex Hormones↗
PubMed2004

Can fat explain the human brain's big bang evolution?-Horrobin's leads for comparative and functional genomics.

When David Horrobin suggested that phospholipid and fatty acid metabolism played a major role in human evolution, his 'fat utilization hypothesis' unified intriguing work from paleoanthropology, evolutionary biology, genetic and nervous system research in a novel and coherent lipid-related context. Interestingly, unlike most other evolutionary concepts, the hypothesis allows specific predictions which can be empirically tested in the near future. This paper summarizes some of Horrobin's intriguing propositions and suggests as to how approaches of comparative genomics published in Cell, Nature, Science and elsewhere since 1997 may be used to examine his evolutionary hypothesis. Indeed, systematic investigations of the genomic clock in the species' mitochondrial DNA, the Y and autosomal chromosomes as evidence of evolutionary relationships and distinctions can help to scrutinize associated predictions for their validity, namely that key mutations which differentiate us from Neanderthals and from great apes are in the genes coding for proteins which regulate fat metabolism, and particularly the phospholipid metabolism of the synapses of the brain. It is concluded that beyond clues to humans' relationships with living primates and to the Neanderthals' cognitive performance and their disappearance, the suggested molecular clock analyses may provide crucial insights into the biochemical evolution-and means of possible manipulation-of our brain.

Animals↗
PubMed2002

Educational theory and medical education practice: a cautionary note for medical school faculty.

Educational theory is routinely cited as justification for practice in medical education, even though the justification for the theory itself is unclear. Problem-based learning (PBL), for example, is said to be based on powerful educational principles that should result in strong effects on learning and performance. But research over the past 20 years has produced little convincing evidence for the educational effectiveness of PBL, which naturally raises doubts about the underlying theory. This essay reflects on educational theory, in particular cognitive theory, and concludes that the theory is little more than metaphor, not rigorous, tested, confirmed scientific theory. This metaphor/theory may lead to ideas for basic and applied research, which in turn may facilitate the development of theory. In the meantime, however, the theory cannot be trusted to determine practice in medical education. Despite the intuitive appeal of educational theory, medical educators have a responsibility to set aside their enthusiasm and make it clear to medical school faculty and administrators that educational innovations and practice claims are, at best, founded on conjecture, not on evidence-based science.

Education, Medical↗
PubMed1999

Technological applications in the assessment of acquired neurogenic communication and swallowing disorders in adults.

The role of technology is expanding rapidly in many aspects of the diagnostic process with patients who have neurogenic communication and swallowing disorders. In this article we discuss a broad selection of technological tools that enhance a wide range of diagnostic tasks, such as taking case histories, administering and scoring tests, performing acoustic, physiologic, cognitive, and linguistic analyses, making normative comparisons, profiling diagnostic results, and making diagnostic decisions. Clinicians are encouraged to scrutinize the relative value of all diagnostic tools to maintaining the quality of service. An appendix includes information for contacting vendors and manufacturers of the products discussed.

Adult↗
PubMed2001

Establishing the experimenting society: the historical origin of social experimentation according to the randomized controlled design.

This article traces the historical origin of social experimentation. It highlights the central role of psychology in establishing the randomized controlled design and its quasi-experimental derivatives. The author investigates the differences in the 19th- and 20th-century meaning of the expression "social experiment." She rejects the image of neutrality of social experimentation, arguing that its 20th-century advocates promoted specific representations of cognitive competence and moral trustworthiness. More specifically, she demonstrates that the randomized controlled experiment and its quasi-experimental derivatives epitomize the values of efficiency and impersonality characteristic of the liberal variation of the 20th-century welfare state.

Ethics, Medical↗
PubMed2000

The collaborative health care team: the role of individual and group expertise.

BACKGROUND: Increasing costs of health care and rapid knowledge growth have led to collaboration among health care professionals to share knowledge and skills. PURPOSES: To characterize the qualitative nature of team interaction and its relation to training health professionals, drawing on theoretical and analytical frameworks from the sociocognitive sciences. METHODS: Activities in a primary care unit were monitored using observational field notes, hospital documents, and audio recordings of interviews and clinical interactions. RESULTS: The demarcation of responsibilities and roles of personnel within the team became fuzzy in practice. Continuous care was provided by primary care providers and specialized care by intermittent consultants. The nature of individual expertise required was a function of the patient problem and the interaction goal. These team characteristics contributed to the reduction of unnecessary and redundant interactions. CONCLUSIONS: Distributed responsibilities allow the team to process massive amounts of patient information, reducing the cognitive load on individuals. The uniqueness of individual professional expertise as it contributes to the accomplishment of team goals is highlighted, suggesting emphasis on conceptual competence in the development of individual professional education programs.

Communication↗
PubMed2001

Task perception as a mediating variable: a contribution to the validation of instructional knowledge.

BACKGROUND: From the perspective of the cognitive mediational paradigm, we focus in this study on students' conceptions of the relationship between instructional interventions and learning: 'instructional knowledge'. AIMS: Task perception has been investigated as a procedural manifestation of instructional knowledge. Four research questions directed the study: (1) how do students perceive a task; (2) by which structure can the relations between categories of task perception be represented; (3) do students differ in their task perception; and (4) is there a significant relationship between students' task perception and the learning activities they plan and/or execute. SAMPLE: The sample consisted of 149 university freshmen in educational sciences. METHODS: Students were confronted with a concrete task in a natural setting. Correlations were searched for by phi coefficient. Hierarchical classes analysis was used to search for hierarchical relations and inter-individual differences. Goodman-Kruskal lambda was calculated to estimate the association between students' task perception and the learning activities they planned and executed. The questionnaire and the design of the coding systems were first tried out in a pilot study. RESULTS: Students' task perception can be described in 11 categories. Correlations between those categories were low, but a simple hierarchical structure was discovered. Students can be distinguished according to their task perception into eight groups. Finally, the results indicate a statistically significant association between students' task perception and the learning activities they plan and execute. CONCLUSIONS: The study provides additional evidence to involve 'instructional knowledge' and students' task perception as part of it, as mediating variables in future research.

Adult↗
PubMed1981

[Can musical feeling be measured? (author's transl)].

The sensation of music as a pure mental reaction is not to be maintained. Some decades ago the research work of music has been concentrated in the different branches of science. Already, the results are astonishing. Since two years, on the psychophysiological department of the "Psychological Institute of the Scientific Faculty" of the "University of Salzburg" investigations are continued to find a possible connection between the sensation of music and the laterality of the bioelectric activity of the brain. We pointed out the following results: there are great differences in the amplitudes and frequencies (in the fronto-temporale lobes) of the evoked responses between musicians and nonmusicians. While musicians show higher amplitudes and lower frequencies in the evoked potentials, nonmusicians show lower amplitudes and higher frequencies. Another astonishing cognition is that the musicians who have been requested to structure the music without any emotion show lower amplitudes like the nonmusicians, but no increase in the frequency like them. Thus we can say that musicality, that means the different impressions of music shows an effect in the evoked responses.

Affect↗
PubMed2003

The relevance of melatonin to sports medicine and science.

The pineal hormone, melatonin, has widespread effects on the body. The aim of this review is to consider the specific interactions between melatonin and human physiological functions associated with sport and exercise medicine. Separate researchers have reported that melatonin concentrations increase, decrease and remain unaffected by bouts of exercise. Such conflicting findings may be explained by inter-study differences in lighting conditions and the time of day the study participants have exercised. Age and fitness status have also been identified as intervening factors in exercise-mediated changes in melatonin concentration. The administration of exogenous melatonin leads to hypnotic and hypothermic responses in humans, which can be linked to immediate reductions in short-term mental and physical performance. Depending on the dose of melatonin, these effects may still be apparent 3-5 hours after administration for some types of cognitive performance, but effects on physical performance seem more short-lived. The hypothesis that the hypothermic effects of melatonin lead to improved endurance performance in hot environments is not supported by evidence from studies involving military recruits who exercised at relatively low intensities. Nevertheless, no research group has examined such a hypothesis with athletes as study participants and with the associated more intense levels of exercise. The fact that melatonin has also been found to preserve muscle and liver glycogen in exercised rats adds weight to the notion that melatonin might affect endurance exercise in humans. Melatonin has been successfully used to alleviate jet lag symptoms of travellers and there is also a smaller amount of evidence that the hormone helps shiftworkers adjust to nocturnal regimens. Nevertheless, the symptoms of jet lag and shiftwork problems have primarily included sleep characteristics rather than performance variables. The few studies that have involved athletes and performance-related symptoms have produced equivocal results. Melatonin has also been found to be useful for treating some sleeping disorders, but interactions between sleep, melatonin and exercise have not been studied extensively with trained study participants. It is unknown whether melatonin plays a role in some exercise training-related problems such as amenorrhoea and over-training syndrome.

Aging↗
PubMed2003

CSF phosphorylated tau--does it constitute an accurate biological test for Alzheimer's disease?

INTRODUCTION: There is considerable interest in developing a diagnostic test which could differentiate between early Alzheimer's disease (AD) and other causes of memory impairment with more than 80% sensitivity and 80% specificity. OBJECTIVE: To review the studies that have examined CSF phosphorylated tau as diagnostic test of AD vs clinically representative comparison groups. METHOD: A critical review of the literature using Embase, Web of Science, Medline and Psychinfo databases supplemented by handsearching and contact with experts in the field. RESULTS: CSF phosphorylated tau is a marker of AD that improves upon the utility of CSF total tau and clinical examination alone. Studies have found high levels of tau phosphorylated at Threonine 231 and/or Serine 199 in AD but not in other causes of dementia, in depression or in healthy elderly controls. Of particular interest, the test appears equally valid in cases of early AD as in moderate or late stages and may also be of use in predicting future decline in subjects with mild cognitive impairment. CONCLUSION: CSF phosphorylated tau is a promising diagnostic test for AD but this requires replication using pathologically confirmed cases.

Aged↗
PubMed2000

A modern behavioral perspective on child conduct disorder: integrating behavioral momentum and matching theory.

It has been suggested that knowledge produced within the operant laboratory is of little or no use to clinicians. I argue, on the contrary, that laboratory science has provided clinicians with two general principles that may expand the focus of behavioral family therapy to incorporate a wide range of clinical interventions that have heretofore been considered nonbehavioral. These principles, matching theory and behavioral momentum, outline the relativity of reinforcement and the persistence of behavior in the absence of reinforcement, respectively. These principles make specific predictions concerning clinical interventions aimed not only at identified reinforcement contingencies, but also the context within which reinforcement contingencies are operative. This expanded behavioral formulation allows both the clinician and the researcher a framework for designing, implementing, and assessing techniques that target cognition, affect, and interpersonal relationships, as well as specific behaviors.

Behavior Therapy↗
PubMed1983

Evaluating a nutrition education program for pregnant teen-agers: cognitive vs. behavioral outcomes.

A manual-based program of nutrition education for pregnancy and lactation was developed. This program was evaluated in a classroom setting using two measures of effectiveness. A pretest and posttest format was used to assess cognitive outcomes and predietary and postdietary records were used to assess behavioral changes. The difference between cognitive test scores was significant. However, actual dietary improvements were slight and were within the range of normal intake variation. This study emphasizes the need to assess behavior in order to more fully evaluate educational effectiveness. Observations of the study also suggest the desirability of environmental support for the successful translation of classroom knowledge into appropriate behaviors.

Adolescent↗