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PubMed2000

Re-thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework.

Re-thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework The dramatic effects of a stroke can have far-reaching implications for patients and carers. Effective recovery involves a considerable array of coping strategies that facilitate and promote engagement in the social world. Their development is a long-term process that requires considerable effort, motivation and enterprise on the part of patients and their families. Traditional approaches to the provision of stroke rehabilitation services, however, appear to be underpinned by frameworks that are short-term in outlook. As a consequence, nursing interventions often focus on the progression of the patient through the care system, rather than on facilitating future recovery. Much of the work of stroke recovery is consequently done by patients and their families at home, with little provision of ongoing professional help and advice. This paper explores the application of the Corbin and Strauss Chronic Illness Trajectory Framework for stroke. In particular, the major concepts of the framework are applied to a vignette derived from a longitudinal study of patients' experiences of recovery. The trajectory framework is shown to be a useful structure that has the potential to enhance the appropriateness of nursing interventions for stroke patients. However, the validity of the framework can only be established through its application and evaluation in clinical practice. The purpose of this paper is to contribute to a debate that encourages consideration of the framework's utility for nurses to enhance the stroke rehabilitation experience.

Activities of Daily Living↗

PubMedDate not supplied

Perceived risk of breast cancer: influence of heuristic thinking.

PURPOSE: The purpose of this study was to examine the influence of heuristic reasoning on women's perceived risk for developing breast cancer, and to test for an expected bias in the direction of optimism that is predicted by recent research on human cognition. DESCRIPTION OF STUDY: In total, 770 women recruited in community settings were surveyed regarding cancer screening behavior and their perceived risk of developing breast cancer. RESULTS: Most women perceived their risk of breast cancer to be lower than that of other women (3:1), confirming the expected bias toward optimism, and this finding was not attributable to the personality trait of optimism. Women following mammography guidelines showed greater optimism that their risk was low. Cancer knowledge and education diminished unwarranted optimism. Women with a history of benign breast disease, with a female relative with breast cancer, or both overestimated their risk. All findings suggest that heuristic thinking is being used to estimate personal cancer risk. CLINICAL IMPLICATIONS: Clinicians should expect women to be optimistic about their personal risk of developing breast cancer. As a result, women may put off breast cancer screening or delay the evaluation of breast symptoms that may signal breast cancer. Helping women to understand their relative risk is an essential part of a health promotion visit.

Adult↗

PubMed2003

Use of the think-aloud method to identify factors influencing purchase of bread and cereals by low-income African American women and implications for whole-grain education.

The think-aloud method was used to determine factors influencing bread and cereal purchase by low-income African American women that have implications for whole-grain education. Women (N=70) were audiotaped as they thought aloud while purchasing groceries. Because bread and cereal account for the majority of whole-grain products consumed, transcribed verbalizations regarding purchase of bread and cereals were analyzed using content analysis procedures. Cost, preferences, eating and buying habits, and nutrition were the most important factors that influenced purchase. Nutrition issues included a general desire to eat healthy foods and specific concerns about fat, calcium, and calories, but no mention of wanting to purchase whole-grain products. Whole-grain education should focus on identification of whole-grain products, health benefits, and low-cost and tasty whole-grain options for mothers and children.

Adolescent↗

PubMed2000

The Th1-Th2 classification of cellular immune responses: concepts, current thinking and applications in haematological malignancy.

The finding that T cell immune responses could be divided into those promoting cell mediated immunity (Th1) and humoral responses (Th2) has had a profound effect on the understanding of immune response generation over the last 15 years. With ever increasing knowledge of the immune system, the model has come under criticism, as not all responses easily fit the classification. Nonetheless, the model still provides a valuable framework on which to base immunological research. In this review we update the model with current thinking regarding the generation and maintenance of immune responses. We then examine how the Th1-Th2 paradigm may be applied in developing new understanding of several topical issues in haematological malignancy-control of graft-versus-host disease; cytokine control of proliferating clones in B and T cell diseases; and suppression of T cell responses in multiple myeloma.

Cytotoxicity, Immunologic↗

PubMed1985

[Medical thinking and ways of acting in national socialism].

The historical background of the legislative measures to purify the Germanic race and the "practical measures to strengthen the German people" is the biologistic way of thinking in the 19th century. This evolved from Darwinism, leading to the so-called Social Darwinism. Its final consequence was the murdering of "inferior" human beings, which included murdering mentally ill and mentally retarded people. The latter is extensively described in recent literature and is usually considered as a specifically National Socialist or psychiatric action. These view points are discussed, and the literature on this subject is thoroughly reviewed.

Eugenics↗

PubMed2006

The role of health promotion: between global thinking and local action.

ISSUE ADDRESSED: The persistence of health inequities provides an ongoing challenge for health promotion. The dictum 'think globally, act locally' fails to recognise the significance of infrastructure and policy in linking global issues and local practices as a means of addressing health inequities. METHODS: Commentary and opinion. RESULTS: Through analytic tools and methods, health promotion has much to contribute to facilitating health-improving changes in social, economic and physical environments. Local actions provide excellent illustrations of organisational change and intersectoral action, and present the possibility that such actions could be widely implemented. While this has occurred on some issues, this is not usually the case. Political support, policy and infrastructure are required to link global ideas and local actions and overcome the impasse. Media advocacy is one example of an approach with potential to make these links and mobilise political support. CONCLUSIONS: Reframing media and political discussion, away from the dichotomy of individual responsibility and government intervention and towards acknowledging the social context of human behaviour, could contribute to policy and social environments with greater capacity to address inequities.

Australia↗

PubMed2005

Feeding people is easy: but we have to re-think the world from first principles.

OBJECTIVE: Agriculture designed to make best use of landscape and to be maximally sustainable would also provide food of the highest nutritional and gastronomic standards, and would inevitably employ a great many people. Thus it would solve the world's food problems, and its principal social problem, at a stroke. But agriculture in practice is designed for a quite different purpose--to generate wealth, in the cause of 'economic growth'. The pressing need is not for more science and technology, but to recognise the true cause of the problems and to re-think priorities. CONCLUSION: We could all be well fed. Indeed, everyone in the world who is ever likely to be born could be fed to the highest standards of gastronomy as well as of nutrition until humanity itself comes to an end. We already have most of the necessary technique--perhaps all that is needed. We could always do with more excellent science but we need not depend, as we are often told from on high, on the next technological fix. The methods that can provide excellent food would also create a beautiful environment, with plenty of scope for other creatures, and agreeable and stable agrarian economies with satisfying jobs for all. In reality, in absolute contrast, we have created a world in which almost a billion are chronically undernourished; another billion are horribly overnourished, so that obesity and diabetes are epidemic, and rising; a billion live on less than two dollars a day; and a billion live in urban slums--a figure set to increase and probably at least to double over the next half century; while other species are disappearing so fast that biologists speak of mass extinction.

Agriculture↗

PubMed1976

Medication, logic, and schizophernic thinking: a reply to Marini.

This article attempts to answer Marini's critique of my paper and to clarify the issue of medication in the study of the role of logic in the production of schizophrenic thought. It is argued that clinical observations do not lead one to believe that either the form or the content of schizophrenic thought disorder changes in any fundamental way as a result of medication. Consequently, the fact that most of the schizophrenic Ss were medicated at the time of the original research does not negate the conclusion that the thinking pathology found in schizophrenics cannot be accounted for by positing a basic defect in their deductive reasoning process.

Antipsychotic Agents↗

PubMed1992

Delirium and acute psychosis. Mental states calling for clear diagnostic thinking and careful management.

Management of a delirious or acutely psychotic patient calls for rapid but well-considered decision making by the treating physician. Clear diagnostic thinking is vitally important in making a presumptive diagnosis and forming a treatment plan. Appropriate treatment usually returns patients to a less agitated state and allows for definitive treatment of any underlying illness.

Acute Disease↗

PubMed1980

Private self-consciousness, attribution of responsibility, and perfectionistic thinking in secondary erecticle dysfunction.

Sex therapists have observed that men who develop secondary erectile dysfunction (SED) are often self-focused in attention and self-blaming for problems in the sexual situation. Further, it has been observed that men with SED seem to believe that they must always perform perfectly in sex. This investigation reports on whether such observations of sexually dysfunctional men in the sexual situation tend to be true of them in general, that is, whether they tend generally to be more self-conscious, to attribute responsibility for negative outcome situations to themselves, and to be perfectionistic in their thinking more than do men who are sexually functional. A discriminant analysis of the combined effect of the three variables is also presented.

Adult↗

PubMed2001

Description of an expert teacher's constructivist-oriented teaching: engaging students' critical thinking in learning creative dance.

The focus of this study was to investigate how an expert teacher implemented constructivist-oriented teaching strategies to engage students'critical thinking skills in learning creative dance. The data were collected through videotaping 16 creative dance lessons taught by an expert teacher to 2 kindergarten, 2 first-grade, and 4 third-grade classes and conducting two formal interviews and several informal interviews with the teacher. In addition, one group interview was conducted with 4 kindergarten students, 4 first-grade students, and 8 third-grade students. The three salient themes were: (a) relating students' knowledge and ideas to lessons to spark dispositions, (b) encouraging and facilitating students' inquiries and creative products, and (c) engaging students' metacognition in refining the quality of dance movement.

Child↗

PubMed2001

A comparison of suicidal thinking and reasons for living among younger and older adults.

A cross-sectional design was used to examine age-related differences in suicidal thinking and reasons for living among younger (n = 82; M age = 21) and older (n = 82; M age = 68) adults. Volunteers anonymously completed the Beck Scale for Suicide Ideation and the Reasons for Living Inventory. Findings indicated that older adults do not manifest suicidal ideation differently than younger adults. However, there does appear to be some age-related differences in reasons for not committing suicide. Compared to the younger group, the older group reported moral objections and child-related concerns as stronger reasons for not committing suicide. An implication is that the identification of specific reasons that deter individuals from committing suicide may be clinically useful and provide some assistance in suicide prevention efforts.

Adaptation, Psychological↗

PubMed2001

'Don't know' and 'didn't think of it': condom use at first intercourse by Latino adolescents.

We examined the specific reasons Latino adolescents did or did not use condoms at first intercourse and their specific reasons for their perceived risk for contracting HIV. Latino adolescents (n = 618), ages 11-19, completed a face-to-face interview that included information on demographics (sex, age, family-status (lives with both natural parents versus other family structure) and country of birth) and sexual behaviour. The respondents cited 'don't know' (25.9%), 'not available' (25.9%) and 'didn't think of it' (23.5%) as the most frequent reasons for not using condoms at first intercourse. Anyone can get it (41.8%), unknown knowledge of partner's serostatus (24.7%) and unprotected sex (23.8%) were the top three reasons for perceiving oneself as being at risk for contracting HIV. Sexually active adolescents were more likely to perceive themselves at risk for contracting HIV than adolescents that had not had sex. Males were significantly more likely to report using condoms for protection at first intercourse than females. The remaining demographic factors were not significantly related to use of condoms at first intercourse nor to perceived risk for contracting HIV.

Adolescent↗

PubMed2005

'Think before you buy under-18s drink': evaluation of a community alcohol intervention.

Hazardous consumption of alcohol by teenagers is a significant public health problem in New Zealand. Concern about supply of alcohol to minors motivated 'Think before you buy under-18s drink', a campaign to reduce alcohol-related harm by discouraging inappropriate supply of alcohol by adults. Two intervention districts and a comparison district, in the South Island of New Zealand, were selected for the purpose of evaluating the campaign. Primary outcome measures were changes in the prevalence of parent supply to their teenager (13-17 years) for unsupervised drinking (SUD), and changes in the prevalence of binge drinking among teenagers. At baseline, 49% of teenagers reported a recent episode of binge drinking. SUD in the past month was reported by 36% of teenagers. Recent purchases of alcohol by under-18s were common (bottle shops: 16%; pubs/bars: 11%). In contrast to teenagers, only 2% of parents reported SUD in the past month. Levels of binge drinking decreased in all three districts. Analysis of data from 474 teenagers who completed questionnaires, at baseline and follow-up, showed decreased SUD in Ashburton and Waitaki relative to Clutha, although this was not significant (OR=0.73; 95% CI: 0.43, 1.25). Discrepancies between teenager and parent reports of SUD may be due to the latter providing a socially desirable survey response and to differences in the interpretation of what constitutes adult supervision. The lack of a significant association between changes in SUD and binge drinking may be a consequence of teenagers obtaining relatively small amounts of alcohol from their parents and larger quantities from other sources, e.g. peers (some of whom may be able to purchase alcohol legally) and from licensed premises.

Adolescent↗

PubMed2000

Medical education, research, and scientific thinking in the 21st century (part one of three).

BACKGROUND: During the 20th century medical education has been preoccupied largely with discussions of the venues and methods for teaching. Little attention has been paid to what should be learned about the scientific paradigm underlying research and practice. A 17th century model has gradually produced a technically efficient but increasingly narrow, monocausal, reductionistic view of health and disease. This "belief system" fails to accommodate or explain the meaning and impact on patients' health of diverse internal and external experiences and influences. During this period new physics and systemic views of biosystems have extended the Newtonian scientific paradigm beyond its materialistic boundaries, which still determines most of the medical sciences. METHODS: A broad range of historical and contemporary scientific literature is examined in support of four central questions addressed in this three-part series: Is there a reason to examine these matters now? How is medical scientific thinking influenced by the general reorientation of science during the 20th century? Is there is a reason to examine the impact of these changes on medicine now? Will a change of paradigm affect medical practice, research, and education? RESULTS: The extraordinarily productive contemporary biomedical model should be expanded to include meaningful information about how each patient's experiences impinge on health status. CONCLUSIONS: Family physicians, together with collaborators in the biological and behavioral sciences and other health professionals, should undertake rigorous research to establish the validity of the expanded paradigm espoused. Its impact could be profound on practice, research, education, and policies.

Journal Article↗

PubMed2001

Racism and human genome diversity research: the ethical limits of "population thinking".

This paper questions the prevailing historical understanding that scientific racism "retreated" in the 1950s when anthropology adopted the concepts and methods of population genetics and race was recognized to be a social construct and replaced by the concept of population. More accurately, a "populational" concept of race was substituted for a "typological one"--this is demonstrated by looking at the work of Theodosius Dobzhansky circa 1950. The potential for contemporary research in human population genetics to contribute to racism needs to be considered with respect to the ability of the typological-population distinction to arbitrate boundaries between racist society and nonracist, even anti-racist, science. I point out some ethical limits of "population thinking" in doing so.

Genetic Research↗

PubMed2006

How evolutionary thinking affects people's ideas about aging interventions.

Evolutionary theory has guided the development of antiaging interventions in some conscious and some unconscious ways. It is a standard assumption that the body's health has been optimized by natural selection, and that the most benign and promising medical strategies should support the body's efforts to maintain itself. The very concept of natural healing is a reflection of evolutionary thinking about health. Meanwhile, a developing body of experimental evidence points to the startling hypothesis that aging is a metabolic program, under genetic control we are programmed for death. Evolution has provided that the aging program can be abated in times of stress, e.g., caloric restriction. CR mimetics are already recognized as a promising avenue for antiaging research. Beyond this, there are two ancient mechanisms of programmed death in protists that have survived half a billion years of evolution, and still figure in the aging of vertebrates today. These are apoptosis and replicative senescence via telomere truncation. Most researchers have been wary of modifying these mechanisms because they are known to play a stopgap role in cancer prevention. But intriguing evidence suggests that, despite some counter-carcinogenic function, the net result of both these mechanisms may be to shorten lifespan. Thus, interventions that suppress apoptosis and that preserve telomeres may be promising avenues for life extension research. A third element of the body's self-destruction program co-opts the inflammation response. Epidemiological evidence suggests that NSAIDs including aspirin protect against atherosclerosis, arthritis, and some forms of cancer. It may be that aging engages an autoimmune response that can be modified by drugs acting more narrowly on this same pathway. The existence of an evolutionary program that controls aging from the top down supports a new optimism concerning the types of antiaging interventions that are possible, and the likelihood that simple strategies may have dramatic results without dramatic side-effects.

Aging↗

PubMed2005

HMIS and decision-making in Zambia: re-thinking information solutions for district health management in decentralized health systems.

At the onset of health system decentralization as a primary health care strategy, which constituted a key feature of health sector reforms across the developing world, efficient and effective health management information systems (HMIS) were widely acknowledged and adopted as a critical element of district health management strengthening programmes. The focal concern was about the performance and long-term sustainability of decentralized district health systems. The underlying logic was that effective and efficient HMIS would provide district health managers with the information required to make effective strategic decisions that are the vehicle for district performance and sustainability in these decentralized health systems. However, this argument is rooted in normative management and decision theory without significant unequivocal empirical corroboration. Indeed, extensive empirical evidence continues to indicate that managers' decision-making behaviour and the existence of other forms of information outside the HMIS, within the organizational environment, suggest a far more tenuous relationship between the presence of organizational management information systems (such as HMIS) and effective strategic decision-making. This qualitative comparative case-study conducted in two districts of Zambia focused on investigating the presence and behaviour of five formally identified, different information forms, including that from HMIS, in the strategic decision-making process. The aim was to determine the validity of current arguments for HMIS, and establish implications for current HMIS policies. Evidence from the eight strategic decision-making processes traced in the study confirmed the existence of different forms of information in the organizational environment, including that provided by the conventional HMIS. These information forms attach themselves to various organizational management processes and key aspects of organizational routine. The study results point to the need for a radical re-think of district health management information solutions in ways that account for the existence of other information forms outside the formal HMIS in the district health system.

Decision Making↗