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PubMed1982

Sexual experience, sex guilt, and sexual moral reasoning.

Two studies are described in which the relations between sexual experience, sex guilt, and sexual moral reasoning were examined. Subjects were asked to articulate their opinions on each of six sexual activities, and then choose one of six statements (corresponding to Kohlberg's six stages of reasoning) that most clearly reflected why they had, or had not, engaged in three of those activities. An analysis of the moral reasoning present in each of the six articulated responses indicated that level of reasoning was inversely related to sex guilt. Analysis of the preference data indicated that subjects endorsed reasoning (statements) at a higher stage than they had articulated, and that this "gap" between articulation and preference was much greater for less experienced subjects. Results are discussed in terms of the utility of using situation-specific moral dilemmas when assessing moral reasoning, and in terms of the possible role that lack of sexual experience plays in inhibiting sexual moral development.

Adult↗
PubMedDate not supplied

Children's beliefs about everyday reasoning.

Two studies investigated children's metacognition about everyday reasoning, assessing how they distinguish reasoning from nonreasoning and "good" reasoning from "bad." In Study 1, 80 1st graders (6-7 years), 3rd graders (8-9 years), 5th graders (10-11 years), and adults (18+ years) evaluated scenarios where people (a) used reasoning, (b) solved problems with nonreasoning approaches, or (c) reacted appropriately but automatically to events. All age groups distinguished reasoning from type (b) nonreasoning cases, but age-related improvement occurred for type (c) cases. Study 2 tested 160 1st, 3rd, 5th graders' and adults' evaluation of good and bad reasoning processes, finding 2 developmental changes: initial improvement in discriminating thinking processes by 3rd grade, and emergence of an adult-like, process-focused (vs. outcome-focused) concept of thinking quality by 5th grade.

Child↗
PubMed2005

Teaching medical students the important connection between communication and clinical reasoning.

BACKGROUND: Medical students are rarely taught how to integrate communication and clinical reasoning. Not understanding the relation between these skills may lead students to undervalue the connection between psychosocial and biomedical aspects of patient care. OBJECTIVE: To improve medical students' communication and clinical reasoning and their appreciation of how these skills interrelate in medical practice. DESIGN: In 2003, we conducted a randomized trial of a curricular intervention at Johns Hopkins University School of Medicine. In a 6-week course, participants learned communication and clinical reasoning skills in an integrative fashion using small group exercises with role-play, reflection and feedback through a structured iterative reflective process. PARTICIPANTS: Second-year medical students. MEASUREMENTS: All students interviewed standardized patients who evaluated their communication skills in establishing rapport, data gathering and patient education/counseling on a 5-point scale (1=poor; 5=excellent). We assessed clinical reasoning through the number of correct problems listed and differential diagnoses generated and the Diagnostic Thinking Inventory. Students rated the importance of learning these skills in an integrated fashion. RESULTS: Standardized patients rated curricular students more favorably in establishing rapport (4.1 vs 3.9; P=.05). Curricular participants listed more psychosocial history items on their problem lists (65% of curricular students listing > or =1 item vs 44% of controls; P=.008). Groups did not differ significantly in other communication or clinical reasoning measures. Ninety-five percent of participants rated the integration of these skills as important. CONCLUSIONS: Intervention students performed better in certain communication and clinical reasoning skills. These students recognized the importance of biomedical and psychosocial issues in patient care. Educators may wish to teach the integration of these skills early in medical training.

Clinical Competence↗
PubMed1993

Moral reasoning in social context.

Scholarly thinking about morality has been deeply affected by the confrontation with practical moral problems epitomized by bioethics. Attention to social context is increasingly seen as vital to sound moral reasoning. The dominant model in bioethics assumes that moral reasoning proceeds downward, from fundamental principles to specific cases. This top-down model, deductivism, is flawed both as a description of moral reasoning, and as a prescription for how moral reasoning should be done. In recent years, another model known as casuistry and based on case-centered moral reasoning has emerged to challenge deductivism. Casuistry suggests new lines of empirical and conceptual research into the history of moral disputes and the practice of moral reasoning and debate.

Advisory Committees↗
PubMed1993

In vitro determination of the forceps level for extraction of teeth for periodontal reasons.

The aim of the present study was to validate dentists' periodontal reasons for extraction by comparison with the in vitro periodontal status of extracted teeth. A national systematic random sample of Norwegian dentists (n = 500) was requested to record primary, secondary and tertiary reasons for tooth extraction for a period of 2 weeks in 1988. The response rate was 70%. The extracted permanent teeth from the first 2 patients of each dentist were collected. Of the 365 teeth, 329 satisfied the criteria for assessment of periodontal attachment after staining. Using a dissecting microscope (10x), 4 to 8 linear measurements were recorded per tooth. 159 of the 329 teeth had loss of periodontal support. Of the 93 teeth for which the dentists' reason for extraction included periodontal considerations, 1% had 1-10% loss of attachment, 59% had 11-50% loss and 40% had 51-76% loss of periodontal support. There was a significant correlation between in vitro measurements of attachment loss and a ranking of teeth on a scale from 1 to 3 based on the dentists' emphasis on periodontal reasons for extraction (The Spearman Rs = 0.29, p < 0.01). The results suggest that the forceps level for removal of teeth for periodontal reasons was set at a relatively early stage of the disease process by Norwegian dentists, and that there was a weak association between attachment loss and the dentists' emphasis on periodontal reasons for extraction.

Age Factors↗
PubMed1996

Survey of reasons for extraction of permanent teeth in Italy.

The purpose of the study is to collect information on the reasons given by dentists, randomly selected from the Italian Dental and Maxillo-Facial Association's, for extracting permanent teeth in Italy. From the 164 dentists responding, 1056 teeth in 839 patients were extracted during two weeks of working activity. More than two-thirds of the teeth were extracted for dental caries (34.4%) and periodontal disease (33.1%). The mean number of teeth extracted per patient showed a significant increasing trend with increasing age, being 1.09 in those from 16 to 39 yr, 1.25 in the 40-59-yr-old group, to 1.54 in those over 59 yr of age (F = 21.44; P < 0.0001). The third molar was the most frequently extracted tooth and 41.3% were removed due to impaction reasons, in particular from the mandible. The first and second molars and the premolars were extracted most often because of caries; more than half of the incisors and the canines were extracted for periodontal reasons; the majority of the teeth removed for prosthetic reasons, 57.1%, were incisors and canines, especially in the mandible; of the teeth extracted for orthodontic reasons, 47.4% were first and second premolars. The prevalence of subjects with at least one tooth extracted for dental caries and for orthodontic reasons were respectively significantly higher in the irregular than the regular attenders (chi-square = 46.55; P < 0.0001), and in the regular than the irregular dental attenders (chi-square = 63.12; P < 0.0001). Dental practitioners should promote targeted initiatives for prevention and treatment of diseases in order to reduce in particular the incidence of tooth extraction because of caries and periodontal disease.

Adolescent↗
PubMed2003

An analysis of expert nurse practitioners' diagnostic reasoning.

PURPOSE: To examine whether the Information Processing Model or the Hermeneutical Model or a combination of the two models best describes expert nurse practitioners (NPs) diagnostic reasoning. DATA SOURCES: Content analysis of "think-aloud" verbalizations elicited while diagnosing a patient were used to describe diagnostic reasoning behaviors. Post-session interviews were also used to identify diagnostic reasoning behaviors in NPs' practice. CONCLUSIONS: Results indicate that NPs use the Information Processing Model 55% of the time and the Hermeneutical Model 45% of the time. Reasoning behaviors do not strictly exemplify individual components of either model. IMPLICATIONS FOR PRACTICE: Educators may need to devise additional methods to develop novice NPs' clinical reasoning. This may require changes in the NP curriculum. Students need to identify significant clinical data, determine the meaning of data, and reason about patient problems in ways aligned to those of expert practitioners.

Clinical Competence↗
PubMed2000

Reasons for replacement of restorations in permanent teeth in general dental practice.

OBJECTIVE: The analysis of reasons for the replacement of 9,805 amalgam, composite, glass ionomer, resin modified glass ionomer and 'other' restorations in permanent teeth in general dental practice. DESIGN: The data were subdivided on the bases of age and gender of the patients, the types of restorations and the clinicians' gender, experience and practice setting. RESULTS: The clinical diagnosis of secondary caries was the main reason for replacement of all types of restorations studied, followed by fracture of restorations, especially bulk fracture, irrespective of patient's age. Bulk discoloration was the third most common reason for replacement of resin based materials in adults, but it rarely occurred in adolescents 18 years and younger. The reasons for replacement of restorations were not associated with the gender of the patients. Subgroupings based on the clinicians' gender showed that female clinicians diagnosed secondary caries more often than male clinicians. Otherwise, the reasons for replacements were similar for both genders of clinicians. Subdivision of restorations based on the years since graduation of the clinicians resulted in small groups. The youngest group of clinicians diagnosed relatively more secondary caries both for amalgam and composite restorations than the most experienced group. CONCLUSION: The clinical diagnosis secondary caries was the main reason for replacement of all types of restorations studied.

Adolescent↗
PubMed1994

Explaining why negative events will happen to oneself: parasuicides are pessimistic because they can't see any reason not to be.

Parasuicides (N = 18) were compared with matched controls (N = 18) on their subjective probability judgements for nine future, negative, self-relevant events. Prior to the probability judgements, subjects were asked to think of reasons why the events would or would not happen. The ease with which they were able to think of reasons was assessed by time taken to think of the first reason, number of different reasons given in 90 seconds and a subjective rating of difficulty. Relative to controls, parasuicides judged negative events to be more likely. They also showed evidence of finding it more difficult to think of why those events might not happen, but were no different from controls in their ability to think of reasons why the events would happen. The effect of thinking of reasons against negative events happening was to reduce the pessimism of parasuicides. It is suggested that parasuicide subjects may not actively anticipate future negative outcomes, but when presented with the possibilities, they judge them to be likely because of an inability to think of positive aspects of themselves or their circumstances which would prevent those events happening.

Adolescent↗
PubMed1991

Variables relating to the allocation of pocket money to children: parental reasons and values.

This study was concerned with relations among parents' beliefs, values and practices in regard to the allocation of pocket money to their children. Mothers and fathers in 133 Adelaide families provided information about the pocket money allowance they gave to each child in their family and they completed items designed to measure the importance of various possible reasons for their allocations (family concern, independence training, child's needs), as well as items that assessed value dimensions (work ethic, social welfare, compassion). Results showed that social welfare values were associated with family concern reasons, and that individualistic work ethic values were associated with independence training reasons but were antagonistic to reasons concerned with meeting the child's needs. The amount of pocket money provided was positively related to both the age of the child and to the importance of family concern reasons. Parents saw independence training and meeting the child's needs as more important reasons for older children and mothers emphasized children's needs more than fathers. These results were discussed in relation to other research on distributive justice, allocation decisions, pocket money and household tasks.

Adolescent↗
PubMed1998

Denial and its reasoning.

This work is aimed at analysing the motivated reasoning underlying denial of some piece of information. Denial is first distinguished from both repression and biased interpretation; then an analysis is provided of the reasoning devices typical of denial. The rules on which reasoned denial is based are similar to those governing the individual's normal cognitive activity. Reasoned denial is here represented in the form of if-then implications, where the to-be-denied belief plays the role of a consequence drawn from a given premise. So, in order to deny such a consequence one may either deny its premise, or search an alternative consequence, or search an alternative premise, or deny the very relation of implication, and so on. Each type of reasoning is logically biased, while at the same time psychologically plausible and convincing. A typical feature shared by all the reasoning strategies considered is the identification of 'unproven' with 'false'.

Defense Mechanisms↗
PubMedDate not supplied

Evaluation of a new method for cardiovascular reasoning.

OBJECTIVE: Evaluate the accuracy of the detailed diagnostic reasoning of the Heart Failure Program incorporating a new mechanism to handle temporal relationships and severity constraints. DESIGN: Tools were developed to summarize diagnoses and automatically generate evaluation forms. Five expert cardiologists were asked to review the reasoning of the program, with two analyzing each case. Cases were gathered retrospectively for diversity and difficulty and 26 randomly selected cases were evaluated. The underlying issues were identified and classified. RESULTS: Both reviewers rated the first diagnosis correct in 25% of the cases and at least one rated it wrong in 10%. Analyzing the detailed reasoning, 137 issues were raised, about 5.3 per case. Of these, 53% were possible concerns raised by one reviewer. Of the 5.3 issues per case, 2.5 were attributable to controversies, misunderstandings, or mistakes; 1 was due to the overly simplistic representation of the summaries; and 1.8 were issues related to the program. CONCLUSION: Overall, the program is capable of providing high-quality detailed diagnostic hypotheses for complex cardiovascular cases. The results highlight several issues: 1) the difficulty of effectively summarizing hypotheses, 2) the nature of a physician's causal explanation, and 3) some problems in evaluating detailed diagnostic reasoning. The mistakes the program made imply that some additional refinement is needed but that the reasoning mechanisms developed can support the appropriate reasoning. The appropriate next step is a prospective evaluation addressing the program's usefulness.

Aged↗
PubMed2005

A developmental perspective on the ideal of reason in American constitutional law.

The ideal of reason is central to contemporary accounts of citizenship in American constitutional law. The individual capacity for reasoned choice lies closely aligned with the constitutional values of personal liberty and democratic self-government as they have evolved in Supreme Court decisions over the past century. Yet as presently conceived, the ideal of reason in constitutional law overlooks the process by which individuals actually acquire the capacity to choose their own values and commitments or to engage in reasoned thinking about collective ends. This paper argues that we cannot hope to sustain and foster a constitutional polity committed to the principles of individual liberty and democratic self-government without knowing something about how individual citizens come to possess this requisite skill of mind. A developmental perspective on reason in constitutional law provides a framework for examining the source and contours of the psychological skills that make it possible to lead an autonomous, self-directed life and to participate meaningfully in the processes of democratic self-government. Developmental psychology, together with research in related fields, provides empirical support for the proposition that the psychological capacity for reasoned thinking has its roots in the early caregiving relationship. Thus, a comprehensive and integrated constitutional family law must recognize the role of early caregiving in the political socialization of children. This developmental approach offers a substantial reworking of constitutional doctrine in the areas of family privacy, parental rights, congressional power, and affirmative welfare rights.

Child↗
PubMed2005

Is the statistical association between sex and the use of services for mental health reasons confounded or modified by social anchorage?

OBJECTIVE: Confounding and interaction have differing implications for the interpretation of findings and the design of research, mental health services, and policy. This study aimed to verify whether the association between sex and the use of services for mental health reasons is confounded or modified by social anchorage. METHODS: We undertook a case-control study nested in Cycle 1.2 of the Canadian Community Health Survey. Cases were defined as users of general medical services for mental health reasons in the previous 12 months, and control subjects were defined as never-users of any services for mental health reasons. The pattern of social anchorage was described by the roles of parent, spouse, worker, and their combination. RESULTS: Overall, women are 2.9 times more likely than men to use general services for mental health reasons. However, this inequality between women and men decreases substantially or subsides in individuals who are less anchored to Canadian society. For instance, in single parents and in unemployed parents, the odds of using general services for mental health reasons are similar in women and in men. The pattern of social anchorage tends to modify, but not to confound, the association between sex and the use of services. CONCLUSIONS: Ignoring the interaction between sex and the pattern of social anchorage distorts the interpretation of the inequality between women and men in the use of general medical services for mental health reasons and may affect the design of comprehensive mental health services and policy.

Adolescent↗
PubMed2005

Service use for mental health reasons: cross-provincial differences in rates, determinants, and equity of access.

OBJECTIVES: In 2002, Canada undertook its first national survey on mental health and well-being, including detailed questioning on service use. Mental disorders may affect more than 1 person in 5, according to past regional and less comprehensive mental health surveys in Canada, and most do not seek help. Individual determinants play a role in health resource use for mental health (MH) reasons. This study aimed to provide prevalence rates of health care service use for MH reasons by province and according to service type and to examine determinants of MH service use in Canada and across provinces. METHODS: We assessed the prevalence rate (95% confidence interval [CI]) of past-year health service use for MH reasons, and we assessed potential determinants cross-sectionally, using data collected from the Statistics Canada Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). We estimated models of resource use with logistic regression (using odds ratios and 95%CIs). RESULTS: The prevalence of health service use for MH reasons in Canada was 9.5% (95%CI, 9.1% to 10.0%). The highest rates, on average, were observed in Nova Scotia (11.3%; 95%CI, 9.6% to 13.0%) and British Columbia (11.3%; 95%CI, 10.1% to 12.6%). The lowest rates were observed in Newfoundland and Labrador (6.7%; 95%CI, 5.3% to 8.0%) and Prince Edward Island (7.5%; 95%CI, 5.8% to 9.3%). In Canada, the general medical system was the most used for MH reasons (5.4%; 95%CI, 5.1% to 5.8%) and the voluntary network sector was the least used (1.9%; 95%CI, 1.7% to 2.1%). No difference was observed in the rate of service use between specialty MH (3.5%; 95%CI, 3.2% to 3.8%) and other professional providers (4.0%; 95%CI, 3.7% to 4.3%). In multivariate analyses, after adjusting for age and sex, the presence of a mental disorder was a consistent predictor of health service use for MH across the provinces. CONCLUSIONS: There is up to a twofold difference in the type of service used for MH reasons across provinces. The primary care general medical system is the most widely used service for MH. Need remains the strongest predictor of use, especially when a mental disorder is present. Barriers to access, such as income, were not identified in all provinces. Different sociodemographic variables played a role in service seeking within each province. This suggests different attitudes toward common mental disorders and toward care seeking among the provinces.

Adolescent↗
PubMed2006

Reasons for intimate partner violence perpetration among arrested women.

There are limited empirical data regarding the reasons or motives for the perpetration of intimate partner violence among women arrested for domestic violence and court referred to violence intervention programs. The present study examined arrested women's self-report reasons for partner violence perpetration and investigated whether women who were victims of severe intimate partner violence were more likely than were women who were victims of minor partner violence to report self-defense as a reason for their behavior. In all, 87 women in violence intervention programs completed a measure of violence perpetration and victimization and a questionnaire assessing 29 reasons for violence perpetration. Self-defense, poor emotion regulation, provocation by the partner, and retaliation for past abuse were the most common reasons for violence perpetration. Victims of severe partner violence were significantly more likely than were victims of minor partner violence to report self-defense as a reason for their violence perpetration. The clinical implications of these findings are discussed.

Adult↗
PubMed2002

Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing.

BACKGROUND: Antibiotics are being overprescribed in ambulant care, especially for respiratory tract infections (RTIs). Gaining insight into the actual reasons for prescribing remains important for the design of effective strategies to optimise antibiotic prescribing. We aimed to determine items of importance for the antibiotic prescribing decision and to make them operational for an intervention trial. METHODS: A postal questionnaire based upon focus group findings was sent to 316 Flemish general practitioners (GPs). On a verbal rating scale the GPs scored to what extent they consider the questionnaire items in decision making in case of suspected RTI in a coughing patient and how strongly the items support or counter antibiotic treatment. Factor analysis was used to condense the data. The relative importance of the yielded operational factors was assessed using Wilcoxon Matched Pairs test. RESULTS: 59.5% completed the study. Response group characteristics (mean age: 42.8 years; 65.9% men) approximated that of all Flemish GPs. Participants considered all the items included in the questionnaire: always the operational factor 'lung auscultation', often 'whether or not there is something unusual happening' - both medical reasons - and to a lesser extent 'non-medical reasons' (P < 0.001). Non-medical as well as medical reasons support antibiotic treatment, but non-medical reasons to a lesser extent (P < 0.001). CONCLUSION: This study quantified, condensed and confirmed the findings of previous focus group research. Practice guidelines and interventions to optimise antibiotic prescribing have to take non-medical reasons into account.

Adult↗
PubMed2006

Implementation science: a role for parallel dual processing models of reasoning?

BACKGROUND: A better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making. DISCUSSION: Parallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctor's judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice. SUMMARY: It is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice.

Journal Article↗