Visual persistence and information pick-up in learning disabled children.
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Is statistical significance always significant?
One way in which we learn new information is to read the medical literature. Whether or not we do primary research, it is important to be able to read literature in a critical fashion. A seemingly simple concept in reading is to interpret p values. For most of us, if we find a p value that is <.05, we take the conclusion to heart and quote it at every opportunity. If the p value is >.05, we discard the paper and look elsewhere for useful information. Unfortunately, this is too simplistic an approach. The real utility of p values is to consider them within the context of the experiment being performed. Defects in study design can make an interpretation of a p value useless. One has to be wary of type I (seeing a "statistically significant" difference just because of chance) and type II (failing to see a difference that really exists) errors. Examples of the former are publication bias and the performance of multiple analyses; the latter refers to a trial that is too small to demonstrate the difference. Finding significant differences in surrogate or intermediate endpoints may not help us. We need to know if those endpoints reflect the behavior of clinical endpoints. Selectively citing significant differences and disregarding studies that do not find them is inappropriate. Small differences, even if they are statistically significant, may require too much resource expenditure to be clinically useful. This article explores these problems in depth and attempts to put p values in the context of studies.
Clinical Trials as Topic↗
Informal diabetes education: impact on self-management and blood glucose control.
PURPOSE: The purpose of this study was to determine if participation in screening clinics to detect and treat diabetes-related eye disease also led to informal patient learning that had an impact on self-management behavior and blood glucose control. METHODS: To evaluate the evidence for patient learning over time, the data of patients who returned as advised for 2 subsequent annual diabetes disease screenings were analyzed. Evaluation measures included medication use, self-management behavior, and hemoglobin A1c (A1C). RESULTS: During the 2-year study period, the use of insulin increased by 37% at the first exam, 43% at the second exam, and 42% at the third exam (P = .02). No significant changes were found in the use of oral medication. Glucose self-monitoring also increased by 61% at the first exam, 71% at the second exam, and 76% at the third exam (P < .01). Mean A1C values for returning participants declined by 9.2% at the first exam, 8.9% at the second exam, and 8.6% at the third exam (P = .03). CONCLUSIONS: The screening clinics had an educational impact associated with behavior change (improved self-management and glucose control) even though the clinics were not intended to produce such change. Therefore, caregivers should consider that patient learning can and should be part of every diabetes care encounter.
Black or African American↗
Becoming a living-learning organization.
The journey of becoming a living-learning organization brings forth many challenges while relating with community. Parse's nursing theory of human becoming provides a framework for understanding meaning, rhythmicity, and cotranscendence while relating with others. In this column the authors discuss how the theory of human becoming and the key components of a learning organization informed the cocreation of a shared vision for Sioux Valley Hospitals and Health System. Parse's community change concepts, moving-initiating, anchoring-shifting, pondering-shaping, are intertwined within story as discovery, intention, innovation, and fostering human potential in this organizational change process is explored.
Community-Institutional Relations↗
The ABCs of low blood cell count.
Children with cancer often receive treatment that may include both chemotherapy and radiation. These agents primarily can affect the body's hematopoietic system. The authors designed a teaching poster, in both English and Spanish, to assist in teaching the key concepts of low blood cell counts to pediatric patients and their families. Having a child with cancer often is an overwhelming experience, and most parents and family members need to learn new information in a variety of ways to maximize their understanding and retention. This poster was not designed to be a substitute for patient-family teaching but, rather, to serve as a reinforcement tool.
Child↗
Amnesia: organic and psychogenic.
This paper describes the clinical features of selected examples of organic and psychogenic amnesia, and it discusses the nature of the dysfunction that these amnesias entail. The anterograde component of organic amnesia involves a severe impairment in acquiring (or learning) new information, rather than accelerated forgetting, and this may reflect an underlying limbic or neurochemical dysfunction. Retrograde amnesia has a basis which is (at least partially) independent of anterograde amnesia--in some patients, it appears to involve a failure to reconstruct past experience from contextual cues, and this may reflect a super-imposed frontal dysfunction. Two types of confabulation are discussed, one of which ('provoked') is a normal response to poor memory, and the other ('spontaneous') appears to reflect incoherent, context-free retrieval, associated with more severe frontal pathology. It is argued that many cases of psychogenic amnesia may resemble organic amnesia, in that they result from an impaired acquisition of information at the time of initial input, perhaps thereby predisposing the subject to subsequent retrieval difficulties.
Amnesia↗
Play therapy in health care settings: promises never kept?
This article examines the variety of claims made about the effectiveness of play therapy in health care settings. The claims are organized into four categories of "promises": (a) mastery, autonomy, and control; (b) cooperation and communication; (c) coping with anxiety and fear; and (d) learning and information giving. The empirical questions within each promise are identified and relevant experimental research is discussed. The conclusion is that play therapy has not yet delivered on its promises in health care settings.
Anxiety↗
The community benefits of farm safety day camps.
In addition to the direct impact of a farm safety day camp on its participants' knowledge and safety awareness, there are extended and indirect effects that occur through the wider dispersion of information and the involvement and cooperation of community members. Reports completed by 228 coordinators of farm safety day camps, report forms completed by 5,037 volunteers at farm safety day camps, and telephone interviews with 924 parents of farm safety day camp participants were analyzed for evidence of the impact of the camps beyond the immediate knowledge gained by the children who participated. These data indicate that the indirect benefits to a community include enhanced safety awareness within the wider community as children and adult volunteers disseminate the information they learned, as well as enhanced community strength and cohesiveness resulting from the cooperation of many individuals and organizations in achieving a common goal.
Accident Prevention↗
Asthma therapy during pregnancy.
Numerous pregnant women suffer from asthma and the use of asthma medications during pregnancy may be a necessity. Although some information is known about the effects of asthma medications during pregnancy, there is still a significant amount of information to learn and particular attention is required when prescribing drugs to these patients. In addition, physiological changes associated with pregnancy may affect airway responsiveness in some individuals. Guidelines on the management of asthma are published regularly, the most popular being the Global Initiative for Asthma (GINA), and medication can be prescribed during pregnancy when the apparent benefit of the drug is greater than the apparent risk. Usually, there is at least one 'safe' drug from each major class used to control symptoms. We will review the current literature on this subject.
Adrenergic beta-Agonists↗
Fathers and the well-child visit.
OBJECTIVE: Societal and economic shifts have expanded the roles that fathers play in their families. Father involvement is associated with positive cognitive, developmental, and sociobehavioral child outcomes such as improved weight gain in preterm infants, improved breastfeeding rates, higher receptive language skills, and higher academic achievement. However, father involvement in health care has been studied little, especially among nonmarried, minority fathers. Fathers are a significant part of the child's medical home, and comprehensive involvement of both parents is ideal for the child's well-being and health. Well-child visits (WCVs) represent opportunities for fathers to increase their involvement in their child's health care while learning valuable information about the health and development of their child. The objective of this study was to explore fathers' involvement in, experience and satisfaction with, and barriers to WCVs using qualitative methods. METHODS: In-depth, semistructured, qualitative interviews were conducted in 2 cities with a subsample of fathers who were participating in the national Fragile Families and Child Wellbeing Study. The 32 fathers who participated in our study come from a nested qualitative study called Time, Love, and Cash in Couples with Children. Fathers in our study reside in Chicago or Milwaukee and were interviewed about health care issues for 1.5 hours when the focal child was 3 years of age. Questions focused on the father's overall involvement in his child's health care, the father's attendance and experiences at the doctor, health care decision-making between mother and father, assessment of focal child's health, gender/normative roles, and the father's health. The open-ended questions were designed to allow detailed accounts and personal stories as told by the fathers. Coding and analysis were done using content analysis to identify themes. Particular themes that were used for this study focused on ideals of father involvement and dis/satisfaction, barriers to, and experiences in the health care system. RESULTS: Of the 50 fathers from the Time, Love, and Cash in Couples with Children study in the 2 cities, 3 had moved out of the state, 6 were in jail, 7 had been lost in earlier follow-up, and 1 had died, leaving 33 eligible respondents. Of those, 1 refused to participate, resulting in a final sample of 32 fathers and an adjusted response rate of 97%. The mean age was 31 years, and the sample was 56% black, 28% Hispanic, and 15% white; 53% were nonmarried. Only 2 fathers had attained a college degree or higher, and 84% of the fathers were employed at the time of the interview. The majority (53%) had attended a WCV and 84% had been to see a doctor with their child in the past year. Reasons for attending a WCV included (1) to gather information about their child, (2) to support their child, (3) to ask questions and express concerns, and (4) to gain firsthand experience of the doctor and the WCV. Fathers reported positive and negative experiences in their encounters with the health care system. The 3 main contributors to fathers' satisfaction with health care professionals were (1) inclusive interactions with the physician, (2) the perception of receiving quality care, and (3) receiving clear explanations. The negative experiences were often specific instances and noted along with positive comments. The negative experiences that were mentioned by the fathers included feeling viewed suspiciously by health care staff, being perceived as having a lesser emotional bond with their child than the mother, and the perception that they were receiving a lower quality of service compared with the mother. Major barriers to attending WCVs include employment schedules as well as their relationship with the focal child's mother. For example, some fathers stated that they did not attend WCVs because that was a responsibility that the mother assumed within the family. Other fathers lacked confidence in their parenting skills, which resulted in lower involvement levels. Also mentioned were health care system barriers such as inconvenient office hours and a lack of access to their child's records. Despite the presence of several barriers that seem to prevent fathers from attending WCVs, many fathers (20 of 32;63%) mentioned "situational flexibility," which enables them to overcome the stated barriers and attend doctor visits. For example, some fathers viewed the seriousness of the visit such as "ear surgery" as a reason to rearrange their schedules and attend a doctor visit with their child. CONCLUSION: The majority of fathers from our sample have attended a WCV, and most have been to their child's doctor in the past year; WCVs and doctor appointments are ways in which fathers are involved in their child's health care. Fathers detailed specific reasons for why they attend WCVs, such as to support their child, ask questions, express concerns, and gather information firsthand. The fathers reported more positive than negative experiences with the health care staff, and, overall, they are satisfied with their experiences with the health care system. Reasons for satisfaction include feeling as though their questions had been dealt with seriously and answered appropriately. However, the fathers in our study did report a variety of barriers to health care involvement, including conflicting work schedules, a lack of confidence in their parental role, and health care system barriers. Professionals who care for children and families need to explore creative ways to engage fathers in the structured health care of their children. For example, pediatricians can stress the benefits of both parents being involved in their child's health care while reframing the importance of WCVs. Understanding that many fathers have situational flexibility when it comes to health care encounters may encourage physicians to suggest more actively that fathers attend WCVs. Pediatricians can also support existing public policies such as the national 2003 Responsible Fatherhood Act that provides grants and programs that promote the father's role in the family and advocate for additional policies that would foster quality father involvement. Continued collaboration among families, physicians, and other health care professionals is essential to support father involvement and ensure positive health outcomes for children.
Adult↗
[Education and prevention of occupational risk; a study with nursing students].
A study has been done with nursing students on occupational risk, investigating bio-security measures. It has involved a sample of 30 students who had taken the basic subjects, being understood, they had already had the pre-requirements demanded: knowledge, techniques and the necessary procedures for HIV infection prevention. A semi-structured interview has been applied, obeying the ethics standards, about risk and reducing occupational risk, vulnerability, education and prevention. After analysing the speeches, it has been perceived that the nursing students learned their information, sought for information, therefore, they had cognitive level knowledge, but, had no inner knowledge. There have not been any conscious action able to generate a safe behavior. When dealing with the risk of contracting AIDS, they have not been able to have a political position as to Institutions in order to question occupational risk they would possibly be exposed, both as to a more conscious orientation about teaching practise and the Institution lack of protection measures.
HIV Infections↗
[The stimulated recall method: a research tool applicable to learning at science museums].
The article reports on preliminary research aimed at developing a methological tool applicable to studies of learning in informal educational settings. The study was conducted at two science museums, using a modified version of the stimulated recall method. Digital photographs replaced the traditional video in the final phase, during which eight interviews were conducted, with satisfactory results. The digital photos efficaciously and efficiently stimulated visitors to narrate their experiences and to convey the meanings they took with them from their interactions with the exhibits.
Brazil↗
Insecticidal paint and fumigant canisters for Chagas' disease control: community acceptance in Honduras.
This study assessed public acceptance for two new vectorial control techniques for Chagas' disease: insecticidal paint and fumigant canisters. The study compared the two with traditional fenitrothion insecticide spraying. An experimental field study was performed in an endemic area of central Honduras from August to November 1992, a year after the initial application of the treatments. The objectives of the study were to determine the acceptability of the tools on the part of the population whose homes were treated, and on the part of the personnel applying the treatments. The sample size was drawn up according to a uniform protocol applied in six Latin American countries. For this study a total of 651 persons were surveyed in 15 rural communities. Along with the surveys, focus groups were used to collect information to learn the reasons for accepting or rejecting particular treatments. The survey was done with heads of households. Focus groups were done with heads of households and also with the field operators who applied the treatments. The research showed that insecticidal paint had a low level of community acceptance (28.8%). Field operators strongly disliked the paint because of problems with its transport, application, unpleasant smell, and very low effectiveness against triatomines and pest insects. The traditional insecticide was more acceptable to the community (93.9%) and to the field operators, especially for its strong effect against the triatomines and pest insects. The results showed that in order to increase the public acceptance for insecticidal paint, it would be necessary to make the paint easier to transport and apply and to increase its effectiveness. Because of their very low effectiveness, fumigant canisters did not represent an acceptable alternative for triatomine vector control. A public educational effort should be a component of any new control method developed.
Chagas Disease↗
A case of simvastatin-associated pancreatitis and review of statin-associated pancreatitis.
Reduction of low-density lipoprotein cholesterol (LDL) concentration has become the primary goal and a standard of care in the practice of cholesterol management. The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, are the most frequently prescribed lipid lowering agents on the market. As more information is learned through the results of clinical trials, LDL goals become more stringent and difficult to attain. Large doses of high-potency statins, sometimes given in combination with other lipid-lowering agents, are frequently necessary to achieve these goals. As a result, the frequency of adverse effects from statin therapy may be expected to increase, and less common adverse effects may occur more often. As statins are used more aggressively, rare and possibly dangerous adverse effects must be identified, especially those that are becoming more frequently encountered. Increased awareness may lead to earlier diagnosis and management of diseases that may be caused by the statins. We describe a 58-year-old man who was hospitalized with idiopathic pancreatitis 4 months after starting simvastatin therapy. His oral drug therapy was withheld, and he was treated with bowel rest. The patient was discharged on hospital day 5, and his oral drug regimen, including simvastatin, was resumed. He was admitted again 16 months later with a second diagnosis of acute pancreatitis and was discharged after 3 days of bowel rest with no oral drug therapy. Simvastatin was restarted on discharge, but the patient stopped taking it after experiencing muscle soreness and weakness in his arms. He recalled having similar arm pain that preceded the previous episode of acute pancreatitis. All other causes of the pancreatitis had been ruled out; thus, the correlation between simvastatin-induced myalgia and onset of acute pancreatitis on two separate occasions made simvastatin the suspected instigating agent. Pancreatitis is a rare adverse effect of statin therapy, but it has been documented in several case reports involving most of the statins. Continued reporting is necessary to increase awareness of this rare adverse effect of simvastatin so that it may be promptly managed or avoided in the future.
Humans↗
Utility of drug leaflets for elderly consumers.
A mail survey of 1,650 elderly consumers evaluated prescription drug leaflets for antihypertensives, tranquilizers, and arthritis medicines. Of those who said they received the leaflet, 95 per cent read it, 76 per cent kept it, and 56 per cent discussed it with another person. Respondents taking antihypertensive medicine were more apt to keep the leaflet and say they learned new information from it. Those taking tranquilizers were less likely to say the leaflet made them feel better about using the drug.
Aged↗
Personality and dietary habits.
BACKGROUND: The personality of healthy individuals has not been well studied in relation to health consciousness, dietary habits and actual food intake, simultaneously. OBJECTIVE: Our objective was to study the association between personality and dietary habits. DESIGN: Information on dietary habits, including taste preferences and the frequency of food consumption, was collected through a questionnaire from 76 male and 394 female students. The personality of students was determined by a modified NEO-FFI test. Health status, height, body weight, body fat percentage and blood pressure were measured by physical examination. Main outcome measures were personality scores as indicators of a healthy dietary pattern. RESULTS: Food intake was influenced by neuroticism (N), extraversion (E), openness (O) and agreeableness (A) of personality. Taste preferences and receptivity to dietary advice were also influenced by personality: the odds ratios (ORs) between the high and low tertiary points of the NEO-FFI scores for salty and sweet taste preferences were significantly higher in the group that scored high for neuroticism (N) (salty taste preference: OR = 2.25, NS in males and OR = 2.39, 95%CI = 1.16-4.93 in females; sweet taste preference: OR = 21.00, 95%CI = 2.40-183.99 in males and OR = 3.33, 95%CI = 1.61-6.91 in females). On the other hand, the groups with high scorer for O and A did not like salty tastes. The groups with high scores for A and C were receptive to dietary advice. High scores of each N, E, O, A, and C factor were characterized by distinguishable, dietary habits and lifestyle. For nutritional or health education, group classes are sufficient for high A and O. High C scorer displayed discrepancies between health consciousness and dietary habits, so intervention or a close follow-up by medical professionals would be necessary to improve the health of individuals in this group. High E scorer possessed a confident attitude towards their health, but they were not interested in developing healthy habits. High N scorer was adverse to receiving health information and learning healthy dietary habits. CONCLUSION: Personality determined by NEO-FFI test was related to dietary habits and health attitude. Effective health education methods must take the personality of the targeted individuals into consideration.
Adult↗
Movements while driving cars around curves.
The eye fixations of 5 experienced and 4 inexperienced car drivers were analyzed while driving curves to the left and to the right. For experienced drivers in a curve to the left the mean duration of eye fixations was longer and the amplitude of the eye movements greater than in a curve to the right. No such difference was observed in inexperienced drivers who manifested neither uniformity within the same curves nor differentiation between the two types of curves. Mean duration of eye fixations of experienced subjects was shorter while driving in a curve to right, but their amplitude of eye movement was greater in a curve to left than those of inexperienced drivers. In Esp. 2, it was pointed out that there is already a change in the pattern of eye movements prior to entering a curve. Upon approaching the curve the mean duration of eye fixation decreased, and the fixations were mainly shifted toward the future driving path. Results are interpreted in terms of the adequacy of the eye fixations (supposedly influenced by prior long-term learning) for information at near distance for vehicle control and at longer distances for setting proprioceptive forward programs for possible future sensomotoric activity.
Adult↗
Neuropsychological sequelae of methyl bromide: a case study.
Methyl bromide (MB) is a pesticide used primarily as a fumigating agent for homes, storage vehicles and soil. Chronic exposure to MB is known to cause damage to the central nervous system and other organs. Previously published post-mortem studies have also revealed significant brain abnormalities in patients whose deaths were attributed to MB. Only one study to date has examined the neuropsychological effects of this potential neurotoxin. The present case report documents the events surrounding an incident of acute and subacute MB exposure following home fumigation and the neuropsychological after-effects associated with that exposure. Behavioural and cognitive correlates of CNS dysfunction revealed by the neuropsychological testing included impairments in concentration, information processing, learning and memory. Emotional sequelae appeared to be a secondary problem associated with fears over physical well-being and impaired cognition. The cognitive symptomatology did not abate after completion of litigation and award of compensation.
Brain Damage, Chronic↗