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PubMed2000

Kohlberg's theory of moral development: insights into rights reasoning.

Kohlberg's theory of moral development was based on extensive research done on the reactions of people of all ages to specific moral situational dilemmas. Kohlberg was specifically interested in reasoning processes involved in decision-making. The way in which children perceive their rights is also based on reasoning processes that are inextricably linked to their level of development and more specifically to their level of moral development since the area of human rights can be considered essentially moral. Since Kohlberg's theory is primarily concerned with development, a great deal of insight can be gained into the developmental shift that occurs in children's reasoning about the rights to which they feel they should be entitled. This article focuses on Kohlberg's six-stage theory, specifically as it pertains to reasoning processes similar to those that would be used in rights reasoning. At each stage the authors propose a potential view of how children at each developmental stage might perceive their rights based on the description Kohlberg gives of the developmental trends associated with each stage. A critical assessment of Kohlberg's work is also given in order to highlight certain considerations about the limitations of this theory that need to be considered for future research.

Adolescent↗
PubMed2000

Moral and evaluative reasoning across the life-span.

In a longitudinal/cross sectional study of moral and evaluative reasoning, Armon interviewed 23 females and 19 males, ages ranging from 5 at the first test time (1977) to 86 at the 4th (1989) test-time. Rasch analysis of Armon's data demonstrated that Armon's and Kohlberg's measures tap a single underlying dimension of reasoning; that individual stages across five items measure the same levels of reasoning, and that development on all items progresses at about the same rate. Participants found it easier to apply already available reasoning structures to new areas than to reason at a new stage, implying that stage transition is step-like.

Adolescent↗
PubMed2003

[Reason for encounter and diagnosis of depression in patients in general practice].

The present study investigates the extent to which the physicians' diagnosis of depression was influenced by the reason that patients gave for seeking help, i.e. the reason for encounter. The level of correspondence between the somatic diagnoses of 20 GPs and the self-ratings of 862 patients from the regions of North Rhine and Southern Baden in regard to the presence of a depressive syndrome was recorded. In addition to the somatic diagnosis of depression (yes/no), the reason for encounter as well as primary and secondary diagnoses of the participating GPs were also documented. The results show that approximately 10% of the GPs' patients judged themselves to be depressed and that in these patients, the GPs diagnosed depression in only 39% of cases. This low level of correspondence between physician and patient in regard to depression can be accounted for by the finding that first, there is little difference between depressed and non-depressed patients in the manner in which they distinguish themselves in regard to their reason for encounter and that second, depressed patients expressed more somatic (57%) than mental symptoms (20%). A depressive disorder was only reported for 5% of the patients who had judged themselves to be depressed. On the whole, the results have shown that the reasons for seeking treatment expressed by patients had a significant influence on correspondence between the physician and patient: for patients who had been judged by a physician and themselves to be depressed, mental complaints (34%) were more likely to be reported than for patients who had not been diagnosed with depression by their GPs (10%). Additional questions addressed to the physicians revealed that they were more likely to diagnose depression on the basis of the patients' self-ratings and behaviour than to routinely question the patients for symptoms of depression. Hence, the study underlines the need for training in criteria-orientated diagnosis and the application of suitable screening instruments for depressive disorders in general practice.

Depressive Disorder↗
PubMed2003

[Sickness absence in persons who leave their jobs due to various reasons].

BACKGROUND: The present analysis is a continuation of studies carried out in the same plant during the economic transformation and after the restructure. It is aimed at indicating variations in sickness absence, its extent and morbid causes in persons who leave their jobs due to various reasons (disability pension, retirement pension, plant under economic constraint, agreed change of affiliation, or a worker's notice to terminate the employment contract). MATERIALS AND METHODS: The study was carried out in a large transport industrial plant during its economic transformation (1989-1994) in a group of 8588 workers, and after its restructure (1997-1999) in a group of 2702 workers. The analysis was based on such absence parameters as the age standardized sickness absence rate, sickness absence cases and the average duration of sickness absence. The linear regression and Poisson regression models were used in the analysis. RESULTS: The onset of the transformation was characterized by a growing number of workers who got retired or applied for disability pension prior to the period of redundancy procedures. After the restructure, affiliation changed to the private sector prevailed (44% of the staff), and the second place was occupied by the termination of employment contracts due to economic reasons (25%). The analysis revealed that sickness absence among workers who left the plant in 1989-1994 was twice as high as that among workers who continued their employment, whereas among workers who left their jobs in 1997-1999 it was 50% higher in men and 20% higher in women than that among workers who continued their employment. The highest rate of sickness absence was noted in 1989-1994, when workers applied for or left due to disability pension. This rate accounted for about 25, which means that those workers had failed to work one fourth of the required time. Diseases of the circulatory, respiratory and musculoskeletal systems formed the major group of causes of applying for disability pension. A high rate of sickness absence was noted in the group of workers discharged because of economic reasons. Interestingly, after the restructure of the plant sickness absence in this group of workers did not diminish, on the contrary it increased both in men (21%) and women (8%) mostly due to mental disorders and diseases of the musculoskeletal system. In 1989-1994, the sickness absence rate among men who continued their employment was 3.46 on average, and it remained low during the whole period covered by the study. In 1997-1999, this rate fell to 3.09. In the former period, the sickness absence rate among women was higher accounting for 5.87 and in the latter it decreased to 3.89% (a 34% decrease). The lowest rates were observed in workers who joined the private sector in 1997-1999 (2.29 for men and 3.48 for women). An analysis of dynamics showed that the decrease in the risk of sickness absence was significantly depended on the proportion of workers leaving the job because of the enterprise's economic constraints, and the increase in the average duration of sickness absence, especially in the onset of economic transformation, was also dependent on the percentage of workers discharged because of economic reasons. CONCLUSIONS: The plant restructure as a result of economic transformation in Poland contributes to the increase in sickness absence mostly through earlier retirement, disability pensions and discharge because of economic reasons. The increase in sickness absence is determined by still longer duration of sickness absence, as the number of identified cases decreases with the increasing lapse of time following the transformation.

Absenteeism↗
PubMedDate not supplied

"I don't really know, so it's a guess": women's reasons for breast cancer risk estimation.

Women of all ages have been found to overestimate both the incidence and the mortality rate from breast cancer and the reasons for this are unclear. A qualitative study asked eighty three women (mean age = 44 years) how likely they thought they were to get breast cancer and to explain the reasoning behind their choice. Based on their responses, women's perceptions were categorised as: no risk (5%); reasonably accurate (30%); overestimated (22%); and greatly overestimated (43%). Four main themes emerged from the reasons given: 'Don't know/guess', 'family history' of breast cancer,'age' related reasoning, and making their decision from the information sheet read prior to answering the questions. The information currently available to women may be creating falsely high estimates of their risk of developing breast cancer as the risk factors of age and family history appear to be poorly understood. Meaningful communication of health risk in need of further improvement if it is to be useful in changing health related knowledge and behaviours.

Adult↗
PubMed1992

Reasons for changing employment positions among practicing North Carolina dental hygienists.

This study sought to identify factors associated with dental hygienists' decisions to leave one dental office and commence practice in another. Although dental hygienists' decisions to leave the profession have been examined in some detail, this more common phenomenon of changing positions has not been carefully examined. All currently practicing dental hygienists in North Carolina were surveyed in 1990, as a part of a cooperative project addressing retention of dental office team members. The survey collected information concerning the 976 respondents' (51% response rate) employment experience, reasons associated with leaving past positions, current job and career satisfaction, and personal characteristics. These data were analyzed to determine factors associated with both reported position changes and respondents' predictions of their professional activity status five years hence. No one reason or group of related reasons predominated among respondents' indicated reasons for leaving past positions. Approximately 25% of all changes were related to family responsibilities or spouse relocation. A larger proportion of changes was associated with a variety of job-related factors. Length of time in current position was not strongly related to job or career satisfaction, or to specific employment arrangements. The satisfaction measures were strongly associated with respondents' predictions of future activity status, while the employment arrangements were not. The results indicate that position changes occur for a variety of reasons, most, but not all, of which represent problems amenable to resolution through interventions designed to improve aspects of management within the practice.

Adult↗
PubMed2005

Primary reason for tooth extraction in a Brazilian adult population.

PURPOSE: To identify the primary reasons for tooth extraction in a Brazilian adult population. MATERIALS AND METHODS: Interviews and oral examinations were conducted with 466 subjects aged from 18-76 years in the city of Maceió, Brazil. Frequency distributions, means and medians were calculated and the chi-square test was used to determine the level of significance. A logistic regression model was used to evaluate the variables associated with reasons for tooth extraction. RESULTS: Of the 466 extractions, 295 (63.3%) were due to dental caries, 61 (13.1%) due to periodontal disease, 56 (12.0%) for orthodontic reasons, 32 (6.9%) at the patient's request, 15 (3.2%) for pre-prosthetic reasons, four (0.9%) due to pericoronitis, two (0.4%) due to trauma and one (0.2%) for other reasons. Tooth extraction due to caries and other causes (excluding periodontal disease) shows a significant association with family income, toothache, type of health centre (public or private), educational level (P < 0.001) and marital status (P = 0.002). The logistic regression model has shown that patients undergoing treatment at a public health centre, those suffering from toothache or with an incomplete secondary education were more likely to lose their teeth due to caries, with educational level as the strongest indicator. For tooth extraction due to periodontal disease and other causes (excluding dental caries) the variables age, family income, type of health centre, tooth types (anterior or posterior), educational level (P < 0.001) and toothache (P = 0.006) were statistically significant, and age was the only associated variable in the logistic regression model. CONCLUSION: Dental caries was the main cause of tooth extraction in the study group, following tooth extraction due to periodontal disease.

Adolescent↗
PubMed1991

Reasoning in uncertainties. An analysis of five strategies and their suitability in pathology.

In reasoning systems, uncertainty plays a crucial part, especially for those fields in which judgements are essential, as in pathology. Uncertainty has several aspects, such as prevalence of diseases, occurrence of findings and the sensitivity and predictive value of findings. For the functioning of a reasoning system, two aspects are crucial: (1) the internal representation of the uncertainty and (2) the way in which the uncertainty is propagated in the reasoning process when combining formal statements. Five well-known reasoning strategies (Bayes' probability theory, MYCIN's certainty factor model, fuzzy set theory, the theory of Dempster-Shafer and Pathfinder's scoring mechanism) are compared, with particular attention to: (1) Under what conditions will the model function? In particular, what information is to be specified a priori to the system? (2) Can the different aspects of uncertainty be dealt with as separate entities? (3) How are unknown uncertainties dealt with? (4) How is evidence in favor of a hypothesis combined with evidence against it? (5) How does the model treat the simultaneous occurrence of more than one disorder, that is, how does the model support reasoning with compound hypotheses? It is preliminarily concluded that the different aspects of uncertainty are expressed as separate entities only in Pathfinder and probability theory. Hence, the other models do not accurately represent uncertain knowledge. Also, such theoretically attractive models as the Bayes, MYCIN and Dempster-Shafer theory can only function properly under the tight condition of mutual exclusiveness of hypotheses, which is not always suited for broader areas of pathology. They may, however, be suited for smaller areas, with a limited number of defined diseases and a limited number of features. All models but the Bayes model lack a predictable performance since there is no (or only a partial) underlying theory to guarantee minimization of the overall error.

Humans↗
PubMed1988

Comparison of the general moral reasoning of small animal veterinarians vs large animal veterinarians.

This project was developed to gather data on the general moral reasoning of practicing veterinarians and to compare the responses of small animal veterinarians vs large animal veterinarians and of male veterinarians vs female veterinarians. Using the Defining Issues Test for assessing moral reasoning, it was found that there is no significant difference between the levels of moral reasoning of small animal and large animal veterinarians. However, a slightly significant (P = 0.045) difference was found between the levels of moral reasoning of male and female veterinarians. Explanations of these findings are given. This report provides baseline data on the moral reasoning of veterinarians, which can serve as a foundation and stimulus for comparison in other studies.

Adult↗
PubMedDate not supplied

Classification of reasons why persons seek primary care: pilot study of a new system.

In 1978, the World Health Organization formed a group to begin work on the Reason for Encounter Classification (RFEC), which is designed to classify the reasons why patients seek care at the primary level. The relatively simple classification is based on two axes--chapters and components--and uses a three-character alpha-numeric code. Chapters, which are named by body systems or more general terms, are the reasons that health care was sought. Five of the seven components, or subdivisions of chapters, contain rubrics identified by the same two-digit numerical code. A pilot study with a training exercise was carried out in The Netherlands by nine family physicians to confirm the feasibility of using the new classification system in primary care settings. Training consisted of viewing videotapes of encounters and an exercise of coding 76 vignettes by the RFEC. Within 2 months, the physicians in the subsequent pilot study had collected and coded 7,503 reasons for encounters. Results of the pilot study confirm that the RFEC is feasible, easy to use in practice, and different from disease-oriented classifications in its system of classifying the reasons for encounter. The pilot study results have been used to modify the RFEC in preparation for a field trial in ambulatory care settings worldwide.

Disease↗
PubMedDate not supplied

Reasons for not using contraceptives: an international comparison.

This study presents the main reasons for currently not using contraceptives given by currently in-union, nonpregnant women 15-44 years of age in three Asian countries (Bangladesh, Korea, and Thailand) and three Latin American countries (Barbados, Colombia, and Costa Rica). Desire for next child, side effects or health reasons, and temporary infecundity were the most commonly given reasons for current nonuse. In Korea, Thailand, and Barbados, there is little or no disapproval of contraceptives, but in the other countries there is an appreciable amount. Variations in the reasons given by selected socioeconomic and demographic characteristics of the respondents are examined. Among these characteristics, age of the women, number of living children, and ever use of family planning methods are generally the most powerful discriminators of the main reason for nonuse.

Adolescent↗
PubMed1993

Metacognitive aspects of moral reasoning and behavior.

This study explored the notion that the development of moral reasoning and moral behavior may be linked to metacognition. The awareness of moral processes involved in moral reasoning and behavior was examined in 139 adolescents in three age groups. A number of significant moral metacognition-reasoning-behavior correlations were found. Intercorrelations for all dependent measures increased by age. A factor analysis revealed several components of moral metacognition (person, task, and strategy variables), and these were significantly related to increases in moral reasoning and behavior scores. More important, a contingency analysis supported the notion that specific types of metamoral knowledge (e.g., understanding the purpose, scope, and requirements of moral action) are related to high and low moral reasoning and behavior.

Adolescent↗
PubMedDate not supplied

FLORENCE: synthesis of case-based and model-based reasoning in a nursing care planning system.

In this article, the data structures and reasoning methodologies of FLORENCE, an expert system that advises on the identification of nursing diagnoses in a new client, are described. FLORENCE is primarily a case-based reasoning system, but has an ancillary model-based reasoning system to advise on complex problems. The use of multiple reasoning methods allows for better simulation of the reasoning process of the expert clinician.

Decision Making, Computer-Assisted↗
PubMed1997

Do general practitioners and community pharmacists want information on the reasons for drug therapy changes implemented by secondary care?

BACKGROUND: The content of discharge prescriptions/summaries to improve communication about medication provided at discharge has been the subject of recent studies. To date, the authors are not aware of any literature that assesses the need for primary care health professionals to receive information on reasons for drug therapy changes incurred during hospital admission. Owing to increased emphasis on seamless care, patient education, and increased accountability for drug costs, general practitioners (GPs) and community pharmacists may consider the receipt of information on the reasons for drug therapy changes incurred during hospital admission to be an essential requirement. AIM: To determine whether GPs and community pharmacists want, and receive, information on the reasons for drug therapy changes implemented by secondary care. The preferred method of acquiring this information is also investigated. METHOD: A questionnaire was posted to all GPs and community pharmacists within the catchment area of Glasgow Royal Infirmary University NHS Trust. Data were collected between June 1995 and July 1995. RESULTS: Replies were received from 71 (64%) GPs and 33 (80%) community pharmacists. Of the respondents, 96% of GPs and 94% of community pharmacists would like information on one or more reason types for drug therapy changes, but the majority do not receive the desired information. Ninety per cent of GPs and 85% of community pharmacists seek this information of facilitate continuity of patient care. The preferred method of receiving the information is by postal delivery via a modified hospital discharge prescription. CONCLUSION: The existing hospital discharge prescription requires modification to facilitate the completion of the reasons for drug therapy changes. The issue of patient-held cards requires consideration. These factors may facilitate continuity of patient care on hospital discharge.

Attitude of Health Personnel↗
PubMed1998

'So much post, so busy with practice--so, no time!': a telephone survey of general practitioners' reasons for not participating in postal questionnaire surveys.

BACKGROUND: Response rates by general practitioners (GPs) to postal surveys have consistently fallen, compromising the validity of this type of research. If postal survey work is to continue we need to understand GPs' reasons for not participating and respond appropriately. AIM: To investigate GPs' reasons for not responding to postal surveys. METHOD: A qualitative study was carried out to determine GPs reasons for not participating in postal surveys, which were drawn from a telephone survey of 276 non-responders to a postal questionnaire survey. Practitioners' comments were recorded and reasons for their non-response quantified using content analysis. RESULTS: Primary reasons for GPs not replying to the postal survey were that questionnaires had got lost in paperwork (34%), that GPs were too busy for the extra work involved (21%), and that questionnaires were routinely 'binned' (16%). Higher practice workloads, including increased administration, meant that participation in research had become a low priority. GPs provided some suggestions for researchers that would increase their chances of questionnaires being returned. CONCLUSIONS: Researchers need to be aware of the pressures of service general practice and to rationalize the amount of research material sent to GPs. GPs were most likely to respond to postal surveys that had a high interest factor, that involved localized research relevant to general practice, and that incorporated a personalized approach by researchers, including good-quality explanatory information.

Attitude of Health Personnel↗
PubMed1998

Reasons for non-compliance in colorectal cancer screening with fecal occult blood test.

OBJECTIVES: To identify the reasons for non-compliance with fecal occultblood test in the screening programme for colorectal cancer. DESIGN AND SETTING: The people who had never participated in the screening programme for colorectal cancer served as the subjects of this study. A structured questionnaire which included the reasons for rejection was sent to each of non-compliers. They were requested to choose two major reasons which were described in a best way that why they did not participate in the programme. The frequency of the stated reasons were analysed from the viewpoint of both sex and age effects. MAIN RESULTS: A total of 439 people was identified as non-compliers, and 356 (81.1%) people completed the questionnaire. No significant difference was noted in response to the questionnaire between male and female as well as aged 40-59 and those 60-79. The most commonest reason was felt well (47.8%) in male, fear or shyness of further examination (40.2%) in female, and also felt well (48.5%) in aged 40-59, fear or shyness of further examination (40.1%) in aged 60-79. Significant differences were observed in the frequencies of felt well (p<0.01), fear or shyness of further examination (p<0. 01), busy for work (p<0.01) and fear of cancer (p<0.01) between male and female, and also felt well (p<0.01), fear or shyness of further examination (p<0.01), busy for work (p<0.01) and coexistent disease (p<0.01) between aged 40-59 and those 60-79. CONCLUSIONS: These results suggest that public education about the concept of asymptomatic illness, the benefits of early detection, the safety and painless colonoscopy, and the effective treatment should be emphasised to increase compliance with screening for fecal occult blood.

Adult↗
PubMed1998

Part-whole reasoning in medical ontologies revisited--introducing SEP triplets into classification-based description logics.

The development of powerful and comprehensive medical ontologies that support formal reasoning on a large scale is one of the key requirements for clinical computing in the next millennium. Taxonomic medical knowledge, a major portion of these ontologies, is mainly characterized by generalization and part-whole relations between concepts. While reasoning in generalization hierarchies is quite well understood, no fully conclusive mechanism as yet exists for part-whole reasoning. The approach we take emulates part-whole reasoning via classification-based reasoning using SEP triplets, a special data structure for encoding part-whole relations that is fully embedded in the formal framework of standard description logics.

Artificial Intelligence↗
PubMed2003

Reasons for not acting on suicidal ideas.

OBJECTIVE: Suicide is a major health problem at present and depression is the most important cause of suicide. What does predispose a person to act on suicidal thoughts has reasonably been studied but little is explored about protective factors against suicidal acts. This study was aimed at finding important protective factors in depressed patients admitted in psychiatry unit of tertiary care hospital against suicide and their comparison with previous studies. DESIGN: Cross sectional descriptive study. PLACE AND DURATION OF STUDY: The study was carried out between 1st March 2002 to 15th August, 2002 in the psychiatry department of Lady Reading Hospital, Peshawar. SUBJECTS AND METHODS: All the patients admitted in psychiatry department of Lady Reading Hospital, Peshawar meeting the ICD -10 criteria for depressive illness and with score greater than 17 on Hamilton depression rating scale were included in the study. Beck hopelessness scale and a modified version of reasons for living Inventory were administered. The Hamilton depression rating scale was used to assess the severity of depression. The data collected was labeled and analyzed with the help of SPSS version 8. RESULTS: The mean score on Hamilton depression rating scale for the sample was 23.30 + 4.32. The responsibility towards family was highly scored subscale of reasons for living inventory (RLI) as a whole as well as separately by males and females while religious beliefs were the next significant subscale of reasons for living inventory (RLI). Moreover, females significantly scored higher than males on fear of social disapproval. CONCLUSION: Responsibility towards family was the strongest protective factor in both males and females against acting on suicidal ideas in our population. Besides this, females had greater fear of social disapproval as compared to males.

Adolescent↗