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An introductory 'survival course' for first-year medical students: a brief account of the course.

At the School of Medicine, Tromsø, Norway, an intensive 2-day week-end course was offered to students in the first year of their studies. The content covered study approaches and study skills, learning issues, strategies for improving the current curriculum, and preparing for the first comprehensive final examination. A brief account of the content and outcome is presented.

Attitude of Health Personnel↗

Training case managers to deliver focused psychological strategies.

Anxiety and mood disorders are prevalent in the Australian community and can be functionally disabling. Access to treatment for these disorders can be difficult, particularly in rural areas where there is limited availability of specialist mental health practitioners such as psychiatrists and clinical psychologists. One way to address this problem is to improve the skills of local mental health practitioners in recognizing and providing treatment for these disorders. This paper describes a program that aimed to enhance access to psychological treatment for depression and anxiety by improving the skills of rural mental health case managers through training and education and support by psychiatrists and clinical psychologists. Thirty-two case managers participated in the program which delivered 10 training modules using a cognitive behavioural therapy framework. Case managers consisted primarily of psychiatric nurses, with others having social work or psychology backgrounds. Participants were assessed pre- and post-training using quantitative and qualitative measures. The effect of the training was noted in several areas including attitudinal changes, improved knowledge of psychological therapies, and changes to stated practice. However, there was concern expressed by participants about their competence and confidence to translate skills learned into practice. While the results of such a program are promising, they highlight some of the complexities of delivering such programs in rural settings.

Adult↗

Effects of removal of phenytoin, carbamazepine, and valproate on cognitive function.

Changes in cognitive function were noted in a double-blind, prospective, placebo-controlled study of discontinuation of phenytoin (PHT), carbamazepine (CBZ), and valproate (VPA) in 58 patients with active epilepsy, receiving multiple antiepileptic drugs (AEDs). A control group of 25 patients continued with existing therapy. A simple test battery, which would be directly applicable to a clinical setting, with measures of mental speed, attention, performance of a learned skill, short-term memory, concentration, and simple coordinated hand movements was used. Cognitive assessments were made before and at the end of discontinuation of a drug and 4 weeks later. Simple motor skills became faster on discontinuation of PHT, CBZ, and VPA (p less than 0.0005), with a further improvement in the subsequent 4 weeks (p = 0.03) and no significant difference between the AEDs. Performance on a measure of attention and concentration improved on discontinuation of PHT (p = 0.005) and did not alter with removal of CBZ or VPA; the improvement in the PHT discontinuation group was significantly different from that in the control group (p = 0.001). These results suggest that all three AEDs studied may adversely affect motor function and that PHT may be more deleterious to function in higher cognitive tasks than in CBZ or VPA.

Adolescent↗

News from health research: toward a better understanding.

News about health research findings, especially regarding controversial topics, can seem confusing and conflicting to students and the general public. Many people eventually develop a "turned-off" attitude toward all health news. Yet medical information is one of the key factors involved in health decision-making, because it influences a person's judgment about the potential health impact of a behavior choice. As part of their health education, youngsters need to learn skills to better understand and evaluate reports of research news, so the information available for health decision-making will be more complete and accurate. Such news is already abundant in television, radio, newspaper and magazine reports and will continue to increase as research advances, knowledge expands and health "facts" are revised. This article outlines concepts and skills to help teachers and students understand the changes and controversies in health news. To most effectively use new information generated by medical research, students need to: 1) understand basic concepts about the nature of research and the research process; 2) apply critical thinking approaches to health news; and 3) locate additional health information resources. Generating ways to address these needs is a high priority of the school health education work at the National Heart, Lung and Blood Institute. Comments are invited on this approach.

Adolescent↗

Oral health for people with intellectual disability and high support needs: positive outcomes.

This qualitative study, based on phenomenological approaches, explored and documented four situations in which positive oral health outcomes occurred for people with mental retardation and moderate to high support needs. Strategies and environmental factors that contributed to these oral health outcomes were identified through 10 semistructured interviews conducted with 'key-players' supporting the oral health of the people with disabilities. Participants included dental professionals, direct support workers, and other professionals who cared for their four people with disabilities. Common strategies expressed in the interviews included "giving it a go"; maintaining consistency; facilitating positive experiences; taking as much time as needed; respecting and encouraging choice making; timeliness and frequency of dental appointments; communication between support workers, dental professionals and the person with mental retardation; problem solving; assisting the person with disability to learn skills; and desensitisation. Contributing factors in the physical, social, and organizational environment also were identified.

Adult↗

Stress inoculation training: a case study in gymnastics.

A young female gymnast of regional squad potential had ceased to make progress when she resumed training after a series of injuries and was given stress inoculation training to help her to regain her form. Preliminary interviews revealed that she had developed a number of negative self-statements and images which, it was hypothesised, may have been contributing towards her lack of progress. In order to replace these with positive self-statements and images a treatment programme of eight training sessions was implemented. Recorded interviews and subsequent comparison of comments made by the subject before and after the intervention programme, indicated that the training had been successful. This was endorsed by the coaches who reported an improved attitude to training and rapid progress in skill learning.

Child↗

Cognitive neuroscience of human memory.

Current knowledge is summarized about long-term memory systems of the human brain, with memory systems defined as specific neural networks that support specific mnemonic processes. The summary integrates convergent evidence from neuropsychological studies of patients with brain lesions and from functional neuroimaging studies using positron emission tomography (PET) or functional magnetic resonance imaging (fMRI). Evidence is reviewed about the specific roles of hippocampal and parahippocampal regions, the amygdala, the basal ganglia, and various neocortical areas in declarative memory. Evidence is also reviewed about which brain regions mediate specific kinds of procedural memory, including sensorimotor, perceptual, and cognitive skill learning; perceptual and conceptual repetition priming; and several forms of conditioning. Findings are discussed in terms of the functional neural architecture of normal memory, age-related changes in memory performance, and neurological conditions that affect memory such as amnesia. Alzheimer's disease, Parkinson's disease, and Huntington's disease.

Amnesia↗

Adaptability and flexibility of the human motor system: implications for neurological rehabilitation.

This article stresses the plasticity of the adult sensorimotor cortex in response to various injuries or environmental changes. The dominant role of sensory input is discussed. A number of studies are presented that show how input may lead to learning and change. Learning is discussed in relation to recovery. It is shown how concepts from the field of motor control and learning may be used for improving neurological rehabilitation. Specific attention is given to the variability of input, the meaningfulness of input, and the role of the learning context. The learning context and the application context should have essential characteristics in common, otherwise transfer of learning will be non-optimal. It is argued that learning landscapes are necessary in order to treat patients in such a way that the learned skills are transferable to situations outside the hospital.

Humans↗

Examination of potential overlap in autism and language loci on chromosomes 2, 7, and 13 in two independent samples ascertained for specific language impairment.

Specific language impairment is a neurodevelopmental disorder characterized by impairments essentially restricted to the domain of language and language learning skills. This contrasts with autism, which is a pervasive developmental disorder defined by multiple impairments in language, social reciprocity, narrow interests and/or repetitive behaviors. Genetic linkage studies and family data suggest that the two disorders may have genetic components in common. Two samples, from Canada and the US, selected for specific language impairment were genotyped at loci where such common genes are likely to reside. Significant evidence for linkage was previously observed at chromosome 13q21 in our Canadian sample (HLOD 3.56) and was confirmed in our US sample (HLOD 2.61). Using the posterior probability of linkage (PPL) to combine evidence for linkage across the two samples yielded a PPL over 92%. Two additional loci on chromosome 2 and 7 showed weak evidence for linkage. However, a marker in the cystic fibrosis transmembrane conductance regulator (7q31) showed evidence for association to SLI, confirming results from another group (O'Brien et al. 2003). Our results indicate that using samples selected for components of the autism phenotype may be a useful adjunct to autism genetics.

Autistic Disorder↗

Imaging cognition II: An empirical review of 275 PET and fMRI studies.

Positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) have been extensively used to explore the functional neuroanatomy of cognitive functions. Here we review 275 PET and fMRI studies of attention (sustained, selective, Stroop, orientation, divided), perception (object, face, space/motion, smell), imagery (object, space/motion), language (written/spoken word recognition, spoken/no spoken response), working memory (verbal/numeric, object, spatial, problem solving), semantic memory retrieval (categorization, generation), episodic memory encoding (verbal, object, spatial), episodic memory retrieval (verbal, nonverbal, success, effort, mode, context), priming (perceptual, conceptual), and procedural memory (conditioning, motor, and nonmotor skill learning). To identify consistent activation patterns associated with these cognitive operations, data from 412 contrasts were summarized at the level of cortical Brodmann's areas, insula, thalamus, medial-temporal lobe (including hippocampus), basal ganglia, and cerebellum. For perception and imagery, activation patterns included primary and secondary regions in the dorsal and ventral pathways. For attention and working memory, activations were usually found in prefrontal and parietal regions. For language and semantic memory retrieval, typical regions included left prefrontal and temporal regions. For episodic memory encoding, consistently activated regions included left prefrontal and medial temporal regions. For episodic memory retrieval, activation patterns included prefrontal, medial temporal, and posterior midline regions. For priming, deactivations in prefrontal (conceptual) or extrastriate (perceptual) regions were consistently seen. For procedural memory, activations were found in motor as well as in non-motor brain areas. Analysis of regional activations across cognitive domains suggested that several brain regions, including the cerebellum, are engaged by a variety of cognitive challenges. These observations are discussed in relation to functional specialization as well as functional integration.

Adult↗

Enlisting indigenous community supporters in skills training programs for persons with severe mental illness.

OBJECTIVE: This study evaluated the generalization of skills training for severely and persistently mentally ill individuals who were paired with indigenous supporters. The supporters monitored the individuals' environments and prompted them to use their skills. METHODS: A total of 85 individuals with severe and persistent mental illness received six months of skills training. Forty-five of the participants received support from an individual of their choosing. The other 40 participants did not have supporters. At the end of the six-month skills training period, the supporters' participation was officially terminated, although they were encouraged to remain in their role for as long as both parties felt comfortable. The effects of the support were measured in terms of interpersonal functioning, acquisition and retention of the skills, psychopathology, global functioning, and satisfaction. Several process measures were also collected. RESULTS: The support procedures were evaluated favorably by both patients and supporters. The interpersonal functioning of the group with supporters was found to be significantly better than that of the nonsupported group at six- and 12-month follow-ups. No differences were found between the groups in symptoms-which were minimal during the entire training period-or skills learning and retention. CONCLUSIONS: The effects of support are likely applicable for a variety of individuals, supporters, and facilities. Indirect evidence suggested the importance of providing support for the supporters.

Adult↗

Social skills training for chronic mental patients.

Social skills training has proved to be effective in increasing the social competence of chronic mental patients. The authors describe three models of social skills training, all of which involve role playing by the patient and modeling, prompting, feedback, and reinforcement by the therapist. Many patients can benefit from the basic training model. For patients functioning at a higher level, the problem-solving model provides general strategies for dealing with a variety of social situations. The attention-focusing model, designed for highly distractible and withdrawn patients, teaches skills through constant repetition of tasks and minimizes demands on cognitive abilities. The authors emphasize the importance of taking steps to ensure that the skills learned during training are generalized to other situations and settings.

Adaptation, Psychological↗

The maintenance of weight loss after behavioral treatment. A review.

This article reviews the recent empirical literature on the behavioral treatment of obesity in an attempt to delineate those variables that are most closely related to the posttreatment maintenance of weight loss. Such variables were found to fall into three general categories: adherence to treatment and use of behavioral skills, posttreatment vigilance regarding both weight fluctuation and the skills learned in therapy, and intraindividual physical and emotional factors. An attempt is made to develop a rational understanding of these findings, which appear to be consistent with Kanfer's self-regulation model of self-control. Implications for treatment and future research are discussed.

Behavior Therapy↗

Plasticity in the human cerebral cortex: lessons from the normal brain and from stroke.

The adult brain maintains the ability for reorganization or plasticity throughout life. Results from neurophysiological and neuroanatomical experiments in animals and noninvasive neuroimaging and electrophysiological studies in humans show considerable plasticity of motor representations with use or nonuse, skill learning, or injury to the nervous system. An important concept of reorganization in the motor cortex is that of a distributed neuronal network in which multiple overlapping motor representations are functionally connected through an extensive horizontal network. By changing the strength of horizontal connections between motor neurons, functionally different neuronal assemblies can form, thereby providing a substrate to construct dynamic motor output zones. Modulation of inhibition and synaptic efficacy are mechanisms involved. Recent evidence from animal experiments indicates that these functional changes are accompanied by anatomical changes. Because plasticity of the brain plays a major role in the recovery of function after stroke, the knowledge of the principles of plasticity may help to design strategies to enhance plasticity when it is beneficial, such as after brain infarction.

Animals↗

Fostering youth leadership to address workplace and community environmental health issues: a university-school-community partnership.

Many communities of color are disproportionately exposed to workplace and community environmental hazards. This article presents the results of a pilot project designed by a university-school-community partnership to develop youth leadership to confront these exposures. Using a popular empowerment education approach, students applied peer education, research, and organizing skills learned in the classroom to community-based internships in a service-learning model. Evaluation results from pretests and posttests, focus groups, and in-depth interviews demonstrated that students shared what they learned about young workers' rights and environmental justice with family and friends. They developed a critical analysis of environmental inequities, created a citywide youth coalition that advocates around legal, educational, and environmental issues affecting youth, and implemented campaigns to enforce child labor laws and to prevent school construction on contaminated land. This multifaceted model can serve as an important foundation to develop youth leaders to influence environmental policies in a variety of communities.

Adolescent↗

Adult hypoxaemia in the perioperative period: a review of the literature.

As a group of academic skills, learning to search for, obtain, read and critically review literature represents a considerable achievement. For the many perioperative nurses who may never be able to pursue their own research project, reading literature reviews is an excellent alternative which enables individuals to become better and more critically informed. A review of the available literature may provide answers to questions or indicate where a subject is in need of further research. In this article by Denise O'Reilly, perioperative hypoxaemia is defined and a range of literature about the subject is critically reviewed.

Adult↗

Atypically diffuse functional connectivity between caudate nuclei and cerebral cortex in autism.

BACKGROUND: Autism is a neurodevelopmental disorder affecting sociocommunicative behavior, but also sensorimotor skill learning, oculomotor control, and executive functioning. Some of these impairments may be related to abnormalities of the caudate nuclei, which have been reported for autism. METHODS: Our sample was comprised of 8 high-functioning males with autism and 8 handedness, sex, and age-matched controls. Subjects underwent functional MRI scanning during performance on simple visuomotor coordination tasks. Functional connectivity MRI (fcMRI) effects were identified as interregional blood oxygenation level dependent (BOLD) signal cross-correlation, using the caudate nuclei as seed volumes. RESULTS: In the control group, fcMRI effects were found in circuits with known participation of the caudate nuclei (associative, orbitofrontal, oculomotor, motor circuits). Although in the autism group fcMRI effects within these circuits were less pronounced or absent, autistic subjects showed diffusely increased connectivity mostly in pericentral regions, but also in brain areas outside expected anatomical circuits (such as visual cortex). CONCLUSION: These atypical connectivity patterns may be linked to developmental brain growth disturbances recently reported in autism and suggest inefficiently organized functional connectivity between caudate nuclei and cerebral cortex, potentially accounting for stereotypic behaviors and executive impairments.

Journal Article↗

The language of mentoring in a health care environment.

In this article, 4 models were tested on the relations among mentoring, job expectations, job reward value, job involvement, and organizational commitment of hospital nurses. In the model with the best fit to the data, mentoring and job expectations were positively related to job reward value. Organizational commitment and job involvement were increased by job reward value. A direct effect on organizational commitment was found for mentor assistance in learning skills. Specific methods used by mentors to convey supportive communication to their protégés included encouraging them to do their best, helping them gain additional training, providing support and encouragement when others criticize, helping deal with jealousy, and providing protégés with needed information. Nurse mentors were admired for standing up to administration and for challenging unfair decisions, thoughtless actions, and lack of respect on the part of administrators, doctors, and patients. Nurses indicated that working hard and not having anyone notice, being frequently criticized and rarely rewarded, and being exposed to serious diseases were particularly challenging and stressful aspects of nursing. Implications of this study for nurses and those working in health care environments are that mentoring and organizational commitment may be avenues for increasing the degree to which nurses feel that their job is rewarding.

Journal Article↗