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Biomedical subjects

E Meland

Publications and source records attributed to E Meland.

At least 19 recordsLinked to original sources
PubMed2001

[What happens when medical students set their own exam papers?].

BACKGROUND: In the section for general practice at the University of Bergen, Norway, we want to emphasise learning more than control in our work with students. As a step in this direction we invited students to come up with proposals for exam papers, papers that usually include six to nine multiple steps for clinical reasoning. We guaranteed that one out of three proposals would be included as a paper in the written examination, possibly slightly modified. This article is an evaluation of the consequences of letting medical students set some of their own exam papers. MATERIAL AND METHODS: The process was evaluated using 1) grades given, 2) students' assessment of whether this mode of setting papers influenced their exam preparations, and 3) students' free-text comments on the process. RESULTS: 57 out of 64 students (89%) took part in the evaluation. All knew that their fellow students had set one of the exam papers, but only 34 (60%) reported that this knowledge had changed the way they prepared for the exam. The mean grade was 9.9 (range 5-12, on a scale from 1 to 12, 6 being the lowest pass grade) for the paper set by students, and 9.5 (range 5-11) for all papers combined. Mean difference in score was 0.32 (95% confidence interval 0.08-0.64). Students' free-text comments showed that they specifically prepared for the three known paper topics. They drew comfort from knowing at least one of the papers set, and the student-set papers were found relevant for general practice. INTERPRETATION: Letting medical students set one of the exam papers makes them feel more confident. Student-set papers were seen as relevant for clinical practice. The control function of the exam seemed to have been preserved.

Educational Measurement↗
PubMed2001

[Adolescents living on their own--social control and health related behavior].

BACKGROUND AND OBJECTIVES: Social control is an important dimension in the interaction between members of social groups. Such control may contribute to adherence to group norms and prevent health related risk behaviour. Adolescents moving out from home to live on their own may become left to themselves and lose their social network and mechanisms of control. We wanted to examine to what extent high school students living in lodgings were different from students living at home concerning health and health related behaviour. MATERIAL AND METHODS: The study was based on data from a cross sectional inquiry among 828 high school students (91% of all students) in Førde carried out in 1997. One in four students lived alone in bedsitters. Bivariate analyses were performed separately for the two age groups 15-17 and over 18 years of age. Students living on their own were compared with students living at home concerning self-reported health and health behaviour. Multivariate analyses were performed to control for confounding. RESULTS: Students living in bedsitters more often reported health risk behaviour than their home-living peers. The differences was most conspicuous in the youngest age group. Differences were found for cigarette smoking, alcohol use, unhealthy diet, and age of sexual debut. Health-risk behaviour was most prevalent among students in vocational courses living alone. Self-reported health and emotional wellbeing were as good among students living alone as it was among their home-living peers. CONCLUSION: Reduction of social control among students living alone in lodgings seem correlated with increased health risk behaviour. Students in vocational courses may be at particular risk. Social planning of education should consider the need to belong and the need for new social networks among students leaving home to continue their education.

Adolescent↗
PubMed2000

[Smoking, self-experienced health and social integration among adolescents].

BACKGROUND AND OBJECTIVE: In spite of increased preventive efforts against smoking in the Norwegian population, a substantial number of adolescents starts smoking. This study was meant to increase our understanding of smoking behaviour among adolescents by examining the relationship between subjective and emotional health and social integration on the one hand and smoking on the other. METHOD: The study was based on data from a cross-sectional survey of 828 students in upper secondary schools (91% of all students) in Førde carried out in 1997 (age group 16-19). Univariate and multivariate analyses were used to examine the relationship between smoking and relevant predictor variables. RESULTS: Self-assessed health, emotional and psychosomatic health were lower among smokers than non-smokers. Female students were also worse off concerning these health complaints. Smoking prevalence was three times higher among students attending vocational secondary schools compared to students attending college proparatory programmes. Smokers reported better social integration and intimacy with friends than did non-smokers. They also reported greater problems with intimacy with parents. CONCLUSION: In preventive work among adolescents, we have to be aware of an important ambiguity: Smoking is associated with reduced subjective and emotional health, but also with better social integration and intimacy with friends.

Adolescent↗
PubMed2000

[Pharmacological prevention of cardiovascular diseases in general practice].

BACKGROUND: In this paper the Norwegian College of General Practitioners, Working Group on Hypertension report recommendations for primary preventive drug treatment of elevated cardiovascular risk. MATERIAL AND METHODS: Updated metaanalyses and randomised controlled trials are the main basis for the recommendations. The purpose of treating hypertension is prevention of cardiovascular diseases. Drug treatment with documented effect on morbidity and mortality is therefore recommended. We have also evaluated the cost effectiveness of drug treatment. RESULTS: An estimate of the total risk of future cardiovascular disease is a necessary basis for treatment decisions. This paper presents tools for estimating total cardiovascular risk. Drug treatment is recommended if ten-year risk exceeds 20% or blood pressure equals or exceeds 170/100 mmHg. Drug treatments include antihypertensive, antithrombotic, antidiabetic and lipid-lowering drugs with documented effect on hard endpoints. Aspirin, thiazides, betablockers, metformin, calcium blockers, ACE inhibitors and statins are all drugs with documented effects on significant endpoints, but the costs of these treatments differ substantially. INTERPRETATION: Drug treatment to prevent cardiovascular disease should be recommended for patients at significant risk of cardiovascular disease. Drugs with documented effect on morbidity and mortality should be used. Considerations of costs are important in treatment decisions.

Adult↗
PubMed2000

[Life style advice provided by primary health care to prevent cardiovascular diseases].

BACKGROUND: The Working Group on Hypertension of the Norwegian College of General Practitioners reports in this paper on the documentation on behavioural advice in the prevention of cardiovascular disease. Emphasis is given to hypertension. MATERIAL AND METHODS: The recommendations are mainly based on updated metaanalyses and randomised controlled trials. Hypertension is treated to prevent cardiovascular disease; that is why we put emphasis on documentation with significant end points. The validity of the documentation for general practice is assessed. We have also assessed whether certain methods or theories for behavioural change could be helpful to the general practitioner. RESULTS: The value of advice against smoking, dietary advice (increased intake of grain products, vegetables, fruit, poultry and fish), and advice about exercise are well documented and applicable in general practice. Respect for the patient's autonomy and interest in the patients and their health-related habits seem to be important factors for improving doctor's chances of influencing patient behaviour. INTERPRETATION: The value of life-style advice is well documented and should play an important role in clinical strategies to prevent cardiovascular disease in high-risk patients.

Antioxidants↗
PubMed2000

[Patient centered medicine--a review with emphasis on the background and documentation].

BACKGROUND: In this paper we present the patient centred clinical method from a historical viewpoint with emphasis on its philosophical and ethical foundations. The paper reviews the documentation and discusses the relevance of the method. MATERIAL AND METHODS: Literature review. RESULTS: The patient centred method was introduced in western clinical medicine as a result of a general shift in science and the introduction of systems theory and relational understanding. The ethical basis for the method is humanistic values with emphasis on respect and mutuality in human relations. Observational studies suggest that the method improves outcome for patients. Experimental evidence is sparse and conflicting. The concept of patient centredness is vague with regard to the management phase of consultations. The relationship between doctor-patient communication, the concept of patient centredness, patient satisfaction, empowerment and outcome needs further clarification and research. INTERPRETATION: Clinical medicine has to encompass the personal and relational level of human life in order to help and guide patients. The patient centred method demonstrates how this can be achieved during the diagnostic phase of the consultation. We need, however, firmer knowledge and ethical consideration of how management negotiations may empower patients and improve their outcome.

Communication↗
PubMed2000

[Clinical communication--a structured teaching model].

A 16-hour course of patient-centered consultation skills, aimed at senior medical students and clinicians, is presented. The goal is to train participants in communication skills which at the same time stimulate the development of a good therapeutic relationship and allow effective gathering of relevant clinical information. The article describes a consultation model in five consecutive steps--opening, exploration, hypothesis testing, negotiations over management, and closure. Each phase confronts the doctor with typical tasks to be solved through adequate dialogue with the patient. The course is based on active student participation through role play, dialogue, reciprocal observation and group analysis of videotaped consultations between the participants and real patients. The article gives a detailed presentation of structures and techniques applied in the course, and describes how this training in consultation skills was developed.

Communication↗
PubMed2000

[Consultation course in medical education--students' evaluation].

BACKGROUND: Final-year medical students at the University of Bergen take a 16-hour consultation course. The students are trained in an educational setting focusing on structured elements of the patient-centred consultation method, self evaluation and peer evaluation. The course has a strong emphasis on learning by doing. The objective of this study was to evaluate the learning process and the subjective outcome of the course. We used a focus group technique and a self-administered free text based questionnaire. MATERIAL AND METHODS: Transcriptions from the focus groups and free text from the questionnaires were analysed using qualitative methods. RESULTS: The qualitative analysis revealed three main categories of statements about the learning process: about the process of selfchange in the consultations; about the pain of self evaluation; and about insufficiency faced with clinical uncertainty. INTERPRETATION: We conclude that the course seems to initiate changes in consultation strategies. The students' evaluation also underline the need to take care of the students during a process of change in which they are vulnerable.

Communication↗
PubMed1999

[Experience of family break-up during childhood--health and health behavior in adolescence].

During recent years the prevalence of family break-up has increased. Every third child growing up in Norway today may experience divorce among their parents. In this paper we try to illustrate to what extent experiencing divorce during childhood is related to subjective health and health behaviour in adolescence. The study is based on a self-administered questionnaire among 828 students in secondary schools in Førde (91% of all). Every fifth student reported experience of family break-up, and we compared this group with the rest concerning subjective health and health behaviour. We found significant differences in the disfavour of adolescents whose parents were divorced, with regard to both physical and emotional health complaints. We also demonstrated marked differences concerning health risk behaviour, especially smoking. The subjective assessment of wellbeing and performance in school were lower among adolescents with divorce experience. It is concluded that family break-up represents a major stressful event for children with marked health consequences in adolescence. Such consequences should be considered in plans for preventive health measures and health care for children and adolescents.

Adolescent↗
PubMed1999

The importance of self-efficacy in cardiovascular risk factor change.

SUBJECTS AND DESIGN: The study was based on the total patient sample (n = 110) of a randomized controlled trial comparing two intervention methods advising cardiovascular high-risk men of lifestyle changes in general practice. Behaviour and risk factor changes during the one-year intervention study were analysed using multiple regression and logistic regression analyses with the above-mentioned independent variables. SETTING: Twenty-two general practice centres in the county of Hordaland, western Norway. RESULTS: Self-efficacy of increased physical exercise was the only variable significantly related to exercise change. Age and self-efficacy were statistical significant predictors of smoking cessation success. None of the independent variables was statistically significantly related to blood pressure or cholesterol change. Educational level related negatively, although statistically insignificantly, with total risk change. CONCLUSION: The study confirms the importance of self-efficacy in both human behaviour and motivation for behaviour change. OBJECTIVES: The objectives of the study were to explore the impact of possible predictors for cardiovascular risk behaviour change, predictors such as education, age, self-efficacy, doctors' interpersonal skills, and number of appointments.

Adult↗