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PubMed1996

Clinical studies of pervasive developmental disorders in Japan.

Articles on pervasive developmental disorders (PDD) published mainly by Japanese child psychiatrists in international journals for the last 20 years were reviewed for the purpose of clarifying the accomplishment and aims of Japanese PDD research. Although Japanese child psychiatrists investigated PDD in various specialties, their contributions to international archives were much fewer than those of Japanese professionals in other branches of medical sciences. This may be accounted for by the absence of an authorized education system of child psychiatrists and strong clinical orientation together with some reluctance of Japanese child psychiatrists to perform research. However, the epidemiology of PDD subtypes, the speech loss in PDD and the psychopathology of persons with high-functioning PDD seem to be providing promising research areas for Japanese child psychiatrists based on their clinical experiences.

Autistic Disorder↗
PubMed2006

Simple and multiple P-splines regression with shape constraints.

In many research areas, especially within social and behavioural sciences, the relationship between predictor and criterion variables is often assumed to have a particular shape, such as monotone, single-peaked or U-shaped. Such assumptions can be transformed into (local or global) constraints on the sign of the nth-order derivative of the functional form. To check for such assumptions, we present a non-parametric regression method, P-splines regression, with additional asymmetric discrete penalties enforcing the constraints. We show that the corresponding loss function is convex and present a Newton-Raphson algorithm to optimize. Constrained P-splines are illustrated with an application on monotonicity-constrained regression with both one and two predictor variables, using data from research on the cognitive development of children.

Algorithms↗
PubMedDate not supplied

Dietary Approaches to Stop Hypertension (DASH) intervention reduces blood pressure among hypertensive African American patients in a neighborhood health care center.

The purpose of this study was to pilot-test DASH-Dinner with Your Nutritionist, a university-neighborhood health care center intervention to promote the Dietary Approaches to Stop Hypertension (DASH) diet. Study participants were low-income African American adults (N = 82) with poorly controlled blood pressure. Six groups, each consisting of 12 to 15 participants taking antihypertensive medications, met for 1 to 2 hours per week for 8 weeks. The intervention followed constructs of Social Cognitive Theory and featured dinners based on the DASH diet plan. Blood pressure was significantly lowered (P < .05) among participants who missed no more than 2 of 8 sessions. Extension of the DASH-Dinner model could improve blood pressure control among low-income hypertensive African Americans and reduce health disparities.

Black or African American↗
PubMed1983

Predicting contraceptive behavior from attitudes: a comparison of within- versus across-subjects procedures.

Within- versus across-subjects procedures for predicting behavior from attitudes were contrasted. Each procedure requires a comparison among attitudes in order to generate a prediction; the comparison is either among the same attitudes held by different people (across subjects) or among different attitudes held by the same person (within subject). It was hypothesized that the within-subject model provides a more adequate explanation of behavior from attitudinal constructs and, hence, more accurate prediction of behavior from attitudes than does the across-subjects model. To test this view, a sample of 349 married couples was administered a questionnaire containing measures of three attitudinal components--affect, cognition, and conation--toward each of four contraceptive methods--oral contraceptives, IUD, diaphragm, and condoms. Contraceptive behavior was assessed 1 year later. In support of the hypothesis, the within-subject predictions bore a significantly stronger relation to the behavioral criteria than did the across-subjects predictions. This effect was consistent for each of the three components of attitude, for the prediction of behavior and behavioral intention, for male and female respondents, and for a variety of contraceptive behaviors. In addition, both the within- and the across-subjects analyses demonstrated a clear rank ordering in the predictive validity of the three attitudinal components: Conation was a better predictor of behavior than was affect, which, in turn, was better than cognition.

Affect↗
PubMed1984

On the centenary of Charcot: hysteria, suggestibility and hypnosis.

In studying hysteria by means of hypnosis, Charcot placed emphasis on the psychological aetiology of the neuroses. Among his pupils, Freud alone grasped this epistemological turning-point, from which he made his great discoveries. But hysteria and hypnosis still remain today largely unknown. We have not yet elucidated the 'mysterious leap' between the psychological and the somatic for the former, and between the relational and the instrumental for the latter. While psychoanalysts have constantly concerned themselves with hysteria, they have shown a lack of interest in hypnosis after Freud abandoned its practice. According to Freud, thanks to transference, affect would be controlled by cognition, a viewpoint eminently suited to satisfy his rationalistic outlook. Affect, however, remains an unknown realm. The affective relationship has, at all events, acquired an ever-increasing importance in psychoanalysis during the last few years, with the emphasis on the early mother-child relationship. The 'affective locus' remains the basic, as well as the most obscure, element in the hypno-suggestive relationship. The behaviourist approach, which quantifies the 'vertical' dimension in depth, is a limited one. The study of the 'horizontal' dimension of subjective experience represents a new line of research, which may make it possible to distinguish different forms of hypnosis. The understanding of hypno-suggestion may throw light on psychoanalysis, psychotherapy, and the human sciences in general.

France↗
PubMed2005

Nonmodularity of the central auditory nervous system: implications for (central) auditory processing disorder.

This response to A. T. Cacace and D. J. McFarland (2005) identifies points of agreement and disagreement regarding the concept of modularity in the diagnosis of (central) auditory processing disorder [(C)APD]. We concur that the evaluation of (C)APD must take into consideration the influence of higher order global or pansensory issues on performance on tests of central auditory function. To accomplish this goal, multidisciplinary (e.g., multimodal) testing is an integral part of differential diagnosis of (C)APD. We also agree that the efficiency of diagnostic tests of (C)APD should not be evaluated by imprecise criteria [e.g., "presumed" or "suspected" (C)APD], which do not provide accurate measures of the true sensitivity and specificity of these tests. Our conceptualization and recommendations for clinical practice in this area diverge, however, from that of Cacace and McFarland in a number of pivotal ways. Based on the current limitations of multimodal assessment relative to issues related to scope of practice and test efficiency, as well as the accumulated basic science and clinical literature that demonstrates the nonmodularity and interactive organization of the brain, we recommend use of the sensitized test battery of the central auditory nervous system (CANS) in combination with multidisciplinary testing to differentially diagnose (C)APD and to guide treatment of the disorder. We assert that sensitivity and specificity measures derived from individuals with well-circumscribed lesions of the CANS provide an important guide to establishing the validity of central auditory diagnostic tests. We note that researchers in the area of auditory science and (C)APD must acknowledge the challenges of the clinical arena, and we encourage their continued help to develop diagnostic tools that are both efficient and practical for the differential diagnosis of (C)APD. We conclude that our approach, which combines multidisciplinary evaluation and specific tests of central auditory function that have demonstrated sensitivity and specificity for disorders of the CANS, allows us to identify (and thus rehabilitate) the auditory deficits present in individuals with (C)APD in its "purest" form. It also permits the identification and rehabilitation of auditory deficits in individuals who exhibit auditory perceptual problems that coexist with other processing problems, while ruling out those who perform poorly on auditory tests because of a global, supramodal problem involving cognition, attention, language, memory, or related skills.

Auditory Diseases, Central↗
PubMed1987

The contribution of hospital library information services to clinical care: a study in eight hospitals.

Hospital health sciences libraries represent, for the vast majority of health professionals, the most accessible source for library information and services. Most health professionals do not have available the specialized services of a clinical medical librarian, and rely instead upon general information services for their case-related information needs. The ability of the hospital library to meet these needs and the impact of the information on quality patient care have not been previously examined. A study was conducted in eight hospitals in the Chicago area as a quality assurance project. A total of 176 physicians, nurses, and other health professionals requested information from their hospital libraries related to a current case or clinical situation. They then assessed the quality of information received, its cognitive value, its contribution to patient care, and its impact on case management. Nearly two-thirds of the respondents asserted that they would definitely or probably handle their cases differently as a result of the information provided by the library. Almost all rated the libraries' performance and response highly. An overview of the context and purpose of the study, its methods, selected results, limitations, and conclusions are presented here, as is a review of selected earlier research.

Allied Health Personnel↗
PubMedDate not supplied

Social cognitive theory in an after-school nutrition intervention for urban Native American youth.

OBJECTIVE: To improve dietary self-efficacy through a 7-month nutrition intervention for Native American children (5 to 10 years) and adolescents (11 to 18 years). DESIGN: Single-group pretest, posttest design. SETTING: An after-school program in a local community center for urban Native American youth. PARTICIPANTS: 104 urban Native American youth (65 children and 39 adolescents). INTERVENTION(S): A 9-month project with pre-post evaluation and a 7-month intervention. MAIN OUTCOMES MEASURE(S): Dietary self-efficacy and 24-hour recalls. ANALYSIS: Descriptive statistics were computed for comparability analysis of dietary self-efficacy and diet at baseline. For the normally distributed data, independent t tests were used for gender comparisons, whereas 1-way analysis of variance with post hoc Tukey adjustment was used to compare responses among body mass index (BMI) categories. Non-normally distributed data were analyzed with Kruskal-Wallis tests with post hoc pairwise Mann-Whitney analyses. For non-normally distributed data, the Bonferroni correction was used, and the P values were set at .025 for gender comparisons and .016 for BMI comparisons. Wilcoxon signed rank tests determined whether fat and sugar intake changed significantly between pre- and postintervention time points among adolescents. RESULTS: Both children and adolescents exhibited moderate levels of dietary self-efficacy at baseline, with no variation by BMI. The nutrition intervention significantly improved the self-efficacy of children. Overweight children significantly improved their dietary self-efficacy. The intervention was not successful among adolescents. CONCLUSIONS AND IMPLICATIONS: Social Cognitive Theory is an effective model from which to explore influential constructs of health behavior. This project demonstrates that a nutrition intervention provided at monthly intervals is an effective way to significantly improve dietary self-efficacy among urban Native American children. The lack of intervention effect among adolescents reiterates the need for greater comprehension of personal, environmental, and behavioral constraints, influencing dietary self-efficacy and behavior.

Adolescent↗
PubMed1981

Ludwik Fleck's "On the question of the foundations of medical knowledge".

According to Fleck, a fact is not something objectively given but rather a social event. Scientific facts are no exception, as can be seen through the annals of medicine. Fleck argues that if the physical sciences initially appear to be immune to such social conditioning, this misconception can be corrected by recognizing the similarities between the natural sciences and medicine both historically and epistemologically. Fleck's ideas are not new, having been presented by him in 1935, but it was only recently that they have begun to strike a responsive chord. Kuhn was aware of Fleck's work when he began to promulgate his own ideas in the 1960s. But there are important differences as well as similarities which can only be appreciated once Fleck's own work has had a proper hearing. To this end the University of Chicago Press has published a translation-edition of the full monograph in 1979. In "On the question of the foundations of medical knowledge', Fleck's own précis to this major work, he correctly foretold the dawning of the sociology of cognition.

History, 20th Century↗
PubMed1994

Professional nursing education in the future: changes and challenges.

Trends in health care suggest changes in nursing practice and implications for nursing education. Changing demographics, emphasis on health promotion, health care costs, movement toward community-based care, and expanding technology are factors that shape the health care system of the future and educational preparation of nurses. This article examines these trends and implications for nursing education. Faculty are faced with preparing students for future practice that will be more complex and specialized than it now is; will be provided in multiple settings; and will require extensive knowledge, critical thinking and other cognitive skills, technologic and psychomotor skills, and a value system for making ethical decisions. Other outcomes of nursing education program include learning to learn, handling ambiguity, thinking like a professional, and accepting responsibility for decisions made in practice. For nursing to assume a central role in the health care system of tomorrow, reform in nursing education is needed today.

Clinical Competence↗
PubMed1999

Use of course-embedded projects for program assessment.

There is increasing demand on science faculty to develop authentic assessment measures for both individual courses and undergraduate programs. We report here on a quarter-long group project used in a neurophysiology course that can be used for either purpose. Small groups of four to five students critically analyze at least 10 articles from the primary scientific literature. The end result of this process is the equivalent of a scientific review article that is presented in two formats, a 10-min oral presentation and a scientific poster presentation. Students perform better on application tasks than on analysis, synthesis, or evaluation tasks associated with the project (P < 0.025) and generally respond positively to process questions (59-82%) but less positively to task questions (36-76%) about group dynamics. The cognitive skills and basic content knowledge required to complete this project are developed throughout the undergraduate program. Thus the project is a type of culminating program experience. However, the project also assesses basic course proficiency, because students cannot analyze primary neuroscience research without an understanding of neurophysiological principles.

Education, Medical, Undergraduate↗
PubMed2002

The role of complementary and alternative therapies in women's mental health.

The advent of the newly evolving field of Integrative Medicine has provided women with an opportunity to expand the health care resources available to prevent and treat mental health conditions. Aided by evidence-based science, practitioners can now broaden the scope of their therapeutic armamentarium and allow women to use the best of what western and complementary medicine has to offer in the field of mental health care. Acupuncture, medication, herbalism, and guided imagery are included in a list of therapeutic modalities designed to augment traditional care. It is clear that by providing such comprehensive care, a woman's physical and mental wellness and her longevity are optimized.

Anxiety Disorders↗
PubMed1992

Testing of nursing theory: critique and philosophical expansion.

The authors first critique Silva's 1986 article in Advances in Nursing Science entitled "Research Testing Nursing Theory: State of the Art." They specifically focus on her evaluation criteria for the empirical testing of nursing theory and then develop evaluation criteria for three alternative approaches to theory testing in nursing. In addition, they describe how philosophy in general, and epistemology in particular, affect testing of nursing theory. Finally, they raise philosophical issues and state conclusions related to the testing of nursing theory within the discipline and practice of nursing.

Cognition↗
PubMed1987

The consciousness of being conscious.

Starting with the therapeutic advantage gained when insight acquires consciousness, an investigation of the nature and function of consciousness is undertaken. Consciousness is a state of awareness, having a range of higher mental functions serving a regulatory, controlling, and integrating role in mental activity. There are high levels of thinking, reality testing, experiencing, judging, anticipating; self-awareness and self-reflection enter into these controlling activities. Psychoanalysis has rightly been a science that studies the workings and contents of the unconscious portions of the mind. It has perhaps overlooked the important role that consciousness plays in ordinary life and in providing the levels of control and self-awareness individuals both experience and require. That pathology and disturbances of function may accompany normal states of consciousness as well as altered states of consciousness is a common clinical phenomenon. Psychoanalysis as a therapy widens the scope of the conscious control systems.

Awareness↗
PubMed2001

Auditory P300 event-related potentials and number connection test for evaluation of subclinical hepatic encephalopathy in patients with cirrhosis of the liver: a follow-up study.

BACKGROUND AND AIMS: The P300 event-related potentials (P3ERP) have been recently advocated for detection of cognitive disturbances in early encephalopathy. However, no systematic follow-up study has been conducted to understand the clinical significance of subclinical hepatic encephalopathy (SHE) detected by this or other methods. The present study was therefore undertaken to examine the diagnostic usefulness of auditory P3ERP in the detection of SHE, to compare it with that of the number connection test (NCT), and to investigate the clinical outcome of patients with SHE in terms of progression to overt encephalopathy. METHODS: P300 event-related potential latencies were measured and the NCT time was recorded in 81 non-encephalopathic cirrhotic patients (Aged 43.8 +/- 11 years, 23 alcoholic and 58 non-alcoholics) attending the outpatient department at our tertiary care hospital (All India Institute of Medical Sciences Hospital). Cut-off values for abnormality in the tests were developed from age-, sex- and education-matched controls. Patients were followed up at regular intervals for the development of overt encephalopathy, and the identifiable precipitating factors were noted. The P3ERP latencies (363 +/- 34 msec vs 349 +/- 23 msec), as well as NCT time (54.6 +/- 30.6 s vs 39.5 +/- 15.8 s) were significantly prolonged (P< 0.01) in patients with liver cirrhosis when compared with the non-cirrhotic controls. RESULTS: The P3ERP defects were seen in 24.6% of cirrhotic patients, while NCT time was prolonged in 19.7% of the patients. Nearly 43% of the patients with SHE progressed to overt encephalopathy within a mean duration of 5 months, while only 3.9% of the non-SHE patients did so. Of the patients who developed overt encephalopathy, 64.2% had P3ERP latency prolongations while 35.7% had abnormal NCT. CONCLUSIONS: The results of the present study suggest that P3ERP and NCT are valid tools for the screening of SHE in cirrhotic patients as there is a greater likelihood of overt encephalopathy development in patients with an abnormality detected by these tests than in patients with no such abnormality.

Adolescent↗
PubMed2005

Scientific perspectives on music therapy.

What needs to be done on the long road to evidence-based music therapy? First of all, an adequate research strategy is required. For this purpose the general methodology for therapy research should be adopted. Additionally, music therapy needs a variety of methods of allied fields to contribute scientific findings, including mathematics, natural sciences, behavioral and social sciences, as well as the arts. Pluralism seems necessary as well as inevitable. At least two major research problems can be identified, however, that make the path stony: the problem of specificity and the problem of eclecticism. Neuroscientific research in music is giving rise to new ideas, perspectives, and methods; they seem to be promising prospects for a possible contribution to a theoretical and empirical scientific foundation for music therapy. Despite the huge heterogeneity of theoretical approaches in music therapy, an integrative model of working ingredients in music therapy is useful as a starting point for empirical studies in order to question what specifically works in music therapy. For this purpose, a heuristic model, consisting of five music therapy working factors (attention modulation, emotion modulation, cognition modulation, behavior modulation, and communication modulation) has been developed by the Center for Music Therapy Research (Viktor Dulger Institute) in Heidelberg. Evidence shows the effectiveness of music therapy for treating certain diseases, but the question of what it is in music therapy that works remains largely unanswered. The authors conclude with some questions to neuroscientists, which we hope may help elucidate relevant aspects of a possible link between the two disciplines.

Acoustic Stimulation↗
PubMed2004

"Profession": a working definition for medical educators.

PURPOSE: To provide a working definition of professionalism for medical educators. SUMMARY: Thus far, the literature has not provided a concise and inclusive definition of the word profession. There appears to be a need for one as a basis for teaching the cognitive aspects of the subject and for evaluating behaviors characteristic of professionals. Furthermore, a knowledge of the meaning of the word is important as it serves as the basis of the contract between medicine and society, and hence, of the obligations required of medicine to sustain the contract. A definition is proposed based on the Oxford English Dictionary and the literature on the subject. It is suggested that this can be useful to medical educators with responsibilities for teaching about the professions, professional responsibilities, and professional behavior. CONCLUSIONS: The proposed definition is as follows: Profession: An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism, and the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Professions and their members are accountable to those served and to society.

Canada↗
PubMed2002

Modulation and experience of external stimuli: toward a science of experience and interoception.

The concept of interoception can be found in various writing over the past 100 or more years dating back to Sherrington, James and Lange. Professor György Adám that made American scientists increasingly aware of the importance of interoception with his 1967 book Interoception and Behavior. In this article we want to discuss two areas of research from out laboratory that have been influenced from this perspective. First, we will focus on electrocortical correlates of error detection during visuo-motor task and examine the manner in which an individual becomes aware of making an error as well as the way in which this awareness directs behavior on an ongoing basis. Second, we will examine hypnotic modulation of the pain experience and describe the manner in which electrocortical processes reflect the modulation and experience of pain. In this discussion, we suggest the importance of the anterior cingulate in not only modulating these processes in particular but also in its more general role as an interface between the limbic system and the neocortex and the integration of cognitive with emotional stimuli.

Electroencephalography↗