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PubMed2006

Reasons for permanent tooth extraction in the North of Afghanistan.

OBJECTIVES: The aim of this study was to study the pattern of and reasons for permanent tooth extraction in a group of Afghan patients attending a dental clinic in the North of Afghanistan. METHODS: A simple clinical survey was done in Afghan population sample that has undergone or planned for tooth extraction. RESULTS: A total of 184 permanent teeth were extracted from 123 patients ranging in age from 9 to 62 years during the three-month study period. Males were 54.5% while females formed 45.5%. Overall, caries was the most frequent reason for tooth extraction (59.2%), followed by periodontal disease (35.3%), surgical indications (4.9%) and patient request (0.5%). Caries was the main reason for tooth loss up to 50 years of age. However, periodontal disease became the principal reason in 51 years old and over. Posterior teeth represented the highest percentage (84.2%) of extraction. CONCLUSIONS: Both caries and periodontal disease were the main reasons for tooth extraction in the North of Afghanistan, so that proper oral health system including efficient programs focusing on prevention and treatment of these diseases should be created and developed.

Adolescent↗
PubMed2003

Reciprocal neural response within lateral and ventral medial prefrontal cortex during hot and cold reasoning.

Logic is widely considered the basis of rationality. Logical choices, however, are often influenced by emotional responses, sometimes to our detriment, sometimes to our advantage. To understand the neural basis of emotionally neutral ("cold") and emotionally salient ("hot") reasoning we studied 19 volunteers using event-related fMRI, as they made logical judgments about arguments that varied in emotional saliency. Despite identical logical form and content categories across "hot" and "cold" reasoning conditions, lateral and ventral medial prefrontal cortex showed reciprocal response patterns as a function of emotional saliency of content. "Cold" reasoning trials resulted in enhanced activity in lateral/dorsal lateral prefrontal cortex (L/DLPFC) and suppression of activity in ventral medial prefrontal cortex (VMPFC). By contrast, "hot" reasoning trials resulted in enhanced activation in VMPFC and suppression of activation in L/DLPFC. This reciprocal engagement of L/DLPFC and VMPFC provides evidence for a dynamic neural system for reasoning, the configuration of which is strongly influenced by emotional saliency.

Adult↗
PubMed2006

The neural basis of conditional reasoning: an event-related potential study.

The spatiotemporal analysis of brain activation during the execution of conditional reasoning tasks (the four inference forms: Modus Ponens (MP), Modus Tollens (MT), affirming the consequent (AC), and denying the antecedent (DA)) and one baseline task (BS) was performed in 12 normal young adult participants using high-density event-related brain potentials (ERPs). Results showed that the early components elicited by the five task types were not significantly different. Reasoning tasks elicited a more negative EPR deflection (N600) than did the BS task in the time window of 500-700 ms after onset of the minor premise. Dipole source analysis of the difference wave (MP-BS) suggested that a generator localized in the left anterior cingulate cortex (BA 24) was involved in the activation and the application of the inference rules. ERP components of the five tasks were similar in the subsequent time period between 700 and 1700 ms. Following that period, a greater negativity in the reasoning tasks, in comparison to the BS task, developed between 1700 and 2000 ms poststimulus over the left fronto-central scalp regions. A generator of this effect was located in the right anterior cingulate cortex (BA 24) and was possibly related to cognitive control. The results indicate that the cingulate cortex was activated by conditional reasoning tasks with purely abstract materials and support the view that human reasoning is not a unified phenomenon but is content-sensitive.

Adolescent↗
PubMed2006

Moral reasoning as a model for health promotion.

The paper describes a model of moral reasoning used to guide the conduct of health researchers and recommends that this model be applied in health promotion. It argues that this model is a more appropriate and sound way of thinking about the means and ends of health education, with implications for both research and practice. When faced with ethical dilemmas about the most appropriate course of action in health research, investigators and bioethicists conduct normative analyses to identify good reasons for choosing one option over another. These reasons provide the grounds for determining what one should do, and for changing past practices in light of new moral considerations. Since the research community seems to think that this is a good way to guide and change their own behavior, this model of moral reasoning appears to have relevance and potential application to the field of health education, which engages in analogous processes of seeking to inform and change the behaviors of the lay public. The article sets this approach in the context of a humanistic understanding of human motivation and presents two case examples to illustrate the process of moral reasoning. The humanistic model outlined here helps to explain why health promotion has not made much progress in developing effective behavior change programs and it offers a more promising prospect for demonstrating success by identifying a broader range of relevant outcomes. The paper concludes by recommending that greater attention be paid to the ethical dimensions of human agency in order to develop a more coherent body of knowledge to advance both research and practice in health promotion.

Clinical Trials as Topic↗
PubMed2006

A systematic review of reasons for nonentry of eligible patients into surgical randomized controlled trials.

BACKGROUND: The low recruitment rates into surgical randomized controlled trials (RCTs) threaten the validity of their findings. We reviewed the reasons for nonentry of eligible patients into surgical RCTs that would form the basis for future prospective research. METHODS: A systematic review of the English language literature for studies reporting reasons for nonentry of eligible patients into surgical RCTs and of recommendations made to improve the low recruitment rates. RESULTS: We reviewed 401 articles, including 94 articles presenting the results of 62 studies: 23 reports of recruitment into real surgical RCTs, 11 surveys of patients regarding hypothetical surgical RCTs, 10 surveys of clinicians and 18 literature reviews. The most frequently reported patient-related reasons for nonentry into surgical RCTs were preference for one form of treatment, dislike of the idea of randomization, and the potential for increased demands. Distrust of clinicians caused by a struggle to understand, explicit refusal of a no-treatment (placebo) arm, and the mere inability to make a decision were frequently reported in studies of real RCTs and patient surveys, but were not emphasized in surveys of clinicians and review articles. Difficulties with informed consent, the complexity of study protocols, and the clinicians' loss of motivation attributable to lack of recognition were the most commonly reported clinician-related reasons. CONCLUSIONS: There seems to be a discrepancy between real reasons for nonentry of eligible patients into surgical RCTS and those perceived by the clinicians, which require further prospective research. A summary and discussion of main recommendations sighted in the literature is presented.

Health Status↗
PubMed2004

Reasons given by relatives of colorectal cancer patients for not undergoing screening.

BACKGROUND: Relatives of colorectal cancer (CRC) patients are at increased risk of developing CRC themselves. Although this increased-risk group could benefit from screening, many do not undergo screening. Little is known about the reasons why this group chooses not to be screened, and understanding these reasons has implications for the development of tailored interventions. METHODS: Telephone interviews were conducted with 132 nonscreening relatives of CRC patients. Variables collected included reasons for not screening, intent to be screened in the future, potential prompts to future screening, and perceived benefits and barriers to screening as well as perceived CRC risk. RESULTS: We were able to categorize the majority of nonscreeners into four discrete types: a group who cite feeling healthy as their reason for not screening (n = 40), a group whose physicians have not endorsed screening (n = 18), a younger group who were told to wait to be screened (n = 21), and a group who anticipate discomfort and pain with screening (n = 20). CONCLUSIONS: It is possible to identify distinct groups of nonscreeners according to their particular barriers and reasons for not screening. Tailored interventions can be designed to address the specific issues in each of these groups.

Adult↗
PubMed2000

If you suffer from a headache, then you have a brain tumour: domain-specific reasoning 'bias' and hypochondriasis.

We explored whether hypochondriacal patients selectively search for threat-confirming information when asked to judge the validity of conditional rules in the context of general and health threats. We also explored several factors that may underly participants' information selection (e.g., believability of the rule). Hypochondriacal patients (n = 20) and healthy controls (n = 20) were presented with modified Wason Selection Tasks (WSTs). The WSTs contained safety rules and danger rules. In the context of general threat, both groups of participants adopted a verificationistic strategy in the case of danger rules and a Popperian strategy in the case of safety rules. Importantly, only hypochondriacal persons showed a similar threat-confirming reasoning pattern in the context of health threat. The latter finding contrasts with the earlier study of de Jong et al. (1998) [de Jong, P. J., Haenen, M.-A., Schmidt, A., & Mayer, B. (1998a). Hypochondriasis: the role of fear-confirming reasoning. Behaviour Research and Therapy, 36, 65-74; de Jong, P. J., Mayer, B., van der Hijden, B., Bögels, S., & van den Hout, M. (1998b). Better safe than sorry: reasoning with conditionals in the context of threat. Submitted for publication.] in which both hypochondriacs and healthy controls showed a threat-confirming strategy in the domain of health threat. The WSTs in that study however, contained a (unintended) worry manipulation ("after hearing this, you get worried"), which might have induced a reasoning strategy in controls that is normally restricted to hypochondriacs. Taken together, the present results sustain the idea that the perception of threat activates a better safe than sorry strategy. In the case of phobic threats, such a reasoning strategy immunizes against refutation of phobic convictions.

Adult↗
PubMed1997

Reasoning strategies for suppositional deductions.

Deductive reasoning shares with other forms of thinking a reliance on strategies, as shown by the results of three experiments on the nature and development of control strategies to solve suppositional deductions. These puzzles are based on assertors who may or may not be telling the truth, and their assertions about their status as truthtellers and liars. The first experiment shows that reasoners make backward inferences as well as forward inferences, to short-cut their way through the alternatives, and the generation of suppositions is a source of difficulty. The second experiment establishes that the elimination of the suppositional status of an individual does not render problems easier. The third experiment shows that reasoners can improve their reasoning accuracy and speed spontaneously, without feedback, and it clarifies the transfer of strategies and their development. We discuss the implications of these data for alternative theories of suppositional deduction and for the relationship between reasoning and other forms of thinking such as problem solving.

Adolescent↗
PubMed1998

Can any ostrich fly?: some new data on belief bias in syllogistic reasoning.

According to one version of the mental models theory (Oakhill, J.V., Johnson-Laird, P.N., Garnham, A., 1989. Believability and syllogistic reasoning. Cognition 31, 117-140) beliefs exert their influence on reasoning in three ways. First they can affect the interpretation of the premises, for example by conversion. Second, they can curtail the search for alternative models of the premises, if an initial model supports a believable conclusion. Third, they can act as a filter on any conclusion that is eventually generated. This last influence is important in explaining the effects of belief bias in one-model syllogisms with no convertible premises, since such syllogisms, by definition, have no alternative models. However, the most natural interpretation of such a filter is that it filters out conclusions and leads to the response 'no valid conclusion'. The present study, which was conducted with groups of both British and Italian subjects, looked at the effect of prior knowledge on syllogistic reasoning, and showed that: (1) invalid conclusions for such one model syllogisms, either thematic or abstract, are typically not of the type 'no valid conclusion', but state invalid relations between the end terms; (2) belief-bias is completely suppressed when previous knowledge is incompatible with the premises, and therefore the premises themselves are always considered. The results are compatible with a version of the mental models theory in which a representation of prior knowledge precedes modelling of the premises, which are then incorporated into the representation of this knowledge. The relation between this theory and other accounts of belief bias in syllogistic reasoning, and the implications of these findings for reasoning more generally, are considered.

Adult↗
PubMed1998

Reasons for non-compliance with screening for infection with Helicobacter pylori, in a multi-ethnic community in Leicester, UK.

In this study, we aimed to identify reasons for non-compliance with a screening programme for Helicobacter pylori (H pylori), in a multi-ethnic community and to assess the effectiveness of Asian language materials towards increasing compliance. A serological screening test for infection with H pylori was offered to 200 Asians and 200 non-Asians (mainly Europeans), aged 21-55 y, registered at a single general practice. Reasons for non-attendance for screening were identified by reply slip or interview. A second group of 200 Asians who were offered screening were sent information in Gujarati as well as English. When information was mailed in English only, 30% Asians and 22% non-Asians attended (P = 0.09, ns). Stated reasons for non-attendance in the Asian group were not generally language related; reasons were similar in the Asian and non-Asian groups and were most frequently related to other commitments. The use of materials in Gujarati did not improve compliance. Language problems should not be assumed to dominate reasons for non-compliance with screening in ethnic minority groups. In common with those of UK origin, subjects from ethnic minority groups may more generally have insufficient interest in preventive medicine for them to prioritise health screening above other commitments.

Adult↗
PubMed2003

Pilot study of a survey of US residents purchasing medications in Mexico: demographics, reasons, and types of medications purchased.

BACKGROUND: Medications sold only by prescription in the United States are easily obtained in Mexican pharmacies without prescriptions. Few studies have researched the impact of this phenomenon in the United States. OBJECTIVE: The aim of this pilot study was to determine the demographics of Americans traveling to Mexico to purchase medications, their reasons for doing so, and which medications they purchased. METHODS: US residents purchasing medications in Nuevo Progreso, Mexico, were given a voluntary, self-administered questionnaire. Some questions had more than 1 potential answer. RESULTS: A total of 103 pharmacy consumers were approached, of whom 100 agreed to participate; no data were gathered on the 3 pharmacy consumers who declined to participate. The survey results indicated that 60.0% of participants (60 participants) had private insurance, 18.0% (18 participants) had Medicare, 3.0% (3 participants) had some other form of insurance, and 19.0% (19 participants) had no insurance at all. The primary reason cited by participants for traveling to Mexico to purchase medications was lower prices (accounting for 66.7% of all reasons given). Infection was the primary disease treated, accounting for 28.2% of types of conditions cited (42/149), and ampicillin was the drug most frequently purchased, accounting for 16.8% (25/149) of all medication purchases. CONCLUSIONS: This pilot study indicates that US residents travel to Mexico to purchase medications for many reasons and for many different medical conditions, including chronic conditions. The most frequently cited reason for purchasing medications in Mexico was lower prices, even among participants with some form of health insurance. This finding suggests that until drug pricing is further addressed in the United States, residents will continue to seek lower-cost alternatives for purchasing their medications, including travel to Mexico.

Adolescent↗
PubMedDate not supplied

Are reasons for the first use of drugs and family circumstances predictors of future use patterns?

The objective of this study was to investigate whether the level of drug dependence in adolescents can be predicted by any of the following factors: the reasons to which the first use or non-use of drugs is attributed, living arrangements, economic situation, family history of alcohol use, or school delay. 213 Brazilian adolescents were classified according to DSM-III-R criteria as: 71 non-drug-dependent users (Group 1), 71 lightly/moderately dependent users (Group 2), and 71 severely dependent users (Group 3). Logistic regression identified the following predictors of current drug use patterns: low economic level, school delay, living only with the mother, having a poor/bad family relationship, and "influence of friends," "pleasure seeking," or "curiosity" as reasons for initial drug use. Among Groups 1 and 2, "never felt like trying," "fear of dying from an overdose," and "religious reasons" were the main reasons for not using other drugs. School delay and troubled family relationships were important predictors of current drug dependence, and "pleasure seeking" was a prominent reason for initial drug use. This suggests that drug use prevention should not simply focus on reducing drug availability but also on helping young people to develop good family/peer relationships and finding healthy ways to enjoy themselves.

Adolescent↗
PubMedDate not supplied

College students' self-reported reasons for why drinking games end.

Previous research has noted that drinking game participation is associated with increased risk of negative alcohol-related consequences. The current study examined the reasons that students give for how drinking games end and/or why students elect to quit playing. Both men and women identified other people quitting and deciding that they have had enough to drink as the most important single item reasons for quitting play. Principal components analysis using a list of 20 reasons identified six factors, four of which contained overlapping items: Conformity/Boredom; Interpersonal Competition; Sexual Contact; Excessive Consumption; Interpersonal Conflict; and External Circumstances. The factors correlated in a theoretically meaningful fashion with measures of alcohol consumption and consequences and personality. Conformity/Boredom reasons and External Circumstances reasons were least associated with negative alcohol-related consequences. Many students apparently play until they get too drunk or too sick to continue. Understanding how games end may offer clues to designing skills training or other prevention interventions to reduce harm associated with drinking games.

Adult↗
PubMed1996

The decision to extract: part II. Analysis of clinicians' stated reasons for extraction.

In a recently reported study, the pretreatment records of each subject in a randomized clinical trial of 148 patients with Class I and Class II malocclusions presenting for orthodontic treatment were evaluated independently by five experienced clinicians (drawn from a panel of 14). The clinicians displayed a higher incidence of agreement with each other than had been expected with respect to the decision as to whether extraction was indicated in each specific case. To improve our understanding of how clinicians made their decisions on whether to extract or not, the records of a subset of 72 subjects randomly selected from the full sample of 148, have now been examined in greater detail. In 21 of these cases, all five clinicians decided to treat without extraction. Among the remaining 51 cases, there were 202 decisions to extract (31 unanimous decision cases and 20 split decision cases). The clinicians cited a total of 469 reasons to support these decisions. Crowding was cited as the first reason in 49% of decisions to extract, followed by incisor protrusion (14%), need for profile correction (8%), Class II severity (5%), and achievement of a stable result (5%). When all the reasons for extraction in each clinician's decision were considered as a group, crowding was cited in 73% of decisions, incisor protrusion in 35%, need for profile correction in 27%, Class II severity in 15% and posttreatment stability in 9%. Tooth size anomalies, midline deviations, reduced growth potential, severity of overjet, maintenance of existing profile, desire to close the bite, periodontal problems, and anticipation of poor cooperation accounted collectively for 12% of the first reasons and were mentioned in 54% of the decisions, implying that these considerations play a consequential, if secondary, role in the decision-making process. All other reasons taken together were mentioned in fewer than 20% of cases. In this sample at least, clinicians focused heavily on appearance-related factors that are qualitatively determinable by physical examination of the surface structures of the face and teeth. They appear to have made primary use of indicators available on study casts and facial photographs and relatively little use of information that is available only on cephalograms or that involves the application of specialized orthodontic theories.

Adolescent↗
PubMed2002

Spatial imagery in deductive reasoning: a functional MRI study.

Various cognitive theories aim to explain human deductive reasoning: (1) mental logic theories claim syntactic language-based proofs of derivation, (2) the mental model theory proposes cognitive processes of constructing and manipulating spatially organized mental models, and (3) imagery theories postulate that such abilities are based on visual mental images. To explore the neural substrates of human deductive reasoning, we examined BOLD (blood oxygen level dependent) contrasts of twelve healthy participants during relational and conditional reasoning with whole-brain functional magnetic resonance imaging (fMRI). The results indicate that, in the absence of any correlated visual input, reasoning activated an occipitoparietal-frontal network, including parts of the prefrontal cortex (Brodmann's area, BA, 6, 9) and the cingulate gyrus (BA 32), the superior and inferior parietal cortex (BA 7, 40), the precuneus (BA 7), and the visual association cortex (BA 19). In the discussion, we first focus on the activated occipito-parietal pathway that is well known to be involved in spatial perception and spatial working memory. Second, we briefly relate the activation in the prefrontal cortical areas and in the anterior cingulate gyrus to other imaging studies on higher cognitive functions. Finally, we draw some general conclusions and argue that reasoners envisage and inspect spatially organized mental models to solve deductive inference problems.

Adult↗
PubMed2001

Multiple representations and multi-modal reasoning in medical diagnostic systems.

The paper examines the motivations for developing medical diagnostic systems exploiting multiple representations and multi-modal reasoning. The analysis is carried on by revisiting the architectural choices of the CHECK system (developed in late 1980s) which combined heuristic and causal knowledge. The results in the theory of diagnosis and in model-based reasoning (MBR) obtained in early 1990s are used for providing a formal characterization of the notion of diagnosis and of the reasoning mechanisms used in CHECK. The paper addresses also the problem of replacing heuristic knowledge provided by human experts with operational knowledge automatically derived from the deep model. In particular, the pros and cons of knowledge compilation and of the integration of case-based reasoning (CBR) with MBR are discussed by summarizing the experience gained in developing AID and ADAPtER. The problem of using an explicit representation of time in diagnostic systems is analyzed and recent work on the different characterizations of diagnosis arising when the temporal dimension is considered is reported. Finally, the implications of the results obtained in MBR and in temporal reasoning on the future of medical diagnostic systems are briefly discussed.

Artificial Intelligence↗
PubMed1997

Reasoning requirements for diagnosis of heart disease.

Over the past dozen years, the Heart Disease Program (HDP) has been developed to assist physicians in reasoning about cardiovascular disorders. Driven by several evaluations, the inference mechanism has progressed from a logic based model, to a Bayesian Probability Network (BPN) and finally a pseudo-Bayesian network with temporal and severity reasoning. Though aspects of cardiovascular reasoning are handled well by BPNs, temporal reasoning, homeostatic feedback mechanisms and effects of disease severities require additional inference strategies. This article discusses how these reasoning problems are handled, and deals with closely linked issues in building the user interface to collect detailed cardiovascular data and provide clear explanations of diagnoses.

Artificial Intelligence↗
PubMed2000

Evidence for cognition without grammar from causal reasoning and 'theory of mind' in an agrammatic aphasic patient.

Understanding the inter-relationship between language and thought is fundamental to the study of human cognition [1] [2] [3]. Some investigators have proposed that propositions in natural language serve to scaffold thinking, by providing, for example, a sequential structure to a massively parallel process [4]. Others have maintained that certain thoughts, such as inferring the mental states of others, termed 'theory of mind' (ToM) reasoning, and identifying causal relationships, necessarily involve language propositions [5]. It has been proposed that ToM reasoning depends upon the possession of syntactic structures such as those that permit the embedding of false propositions within true statements ('Mary knows that John (falsely) thinks chocolates are in the cupboard') [6]. The performance on reasoning tasks of individuals with severe agrammatic aphasia (an impairment of language following a lesion of the perisylvian areas of the language-dominant hemisphere) offers novel insights into the relation between grammar and cognition. We report the unusual case of a patient with agrammatic aphasia of such severity that language propositions were not apparently available at an explicit processing level in any modality of language use. Despite this profound impairment in grammar, he displayed simple causal reasoning and ToM understanding. Thus, reasoning about causes and beliefs involve processes that are independent of propositional language.

Aphasia↗