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PubMed1995

Neuropsychologic predictors of competency in Alzheimer's disease using a rational reasons legal standard.

OBJECTIVE: To identify neuropsychologic predictors of competency performance and status in Alzheimer's disease (AD) using a specific legal standard (LS). This study is a follow-up to the competency assessment research reported in this issue of the archives. DESIGN: Univariate and multivariate analyses of independent neuropsychologic test measures with a dependent measure of competency to consent to treatment. SETTING: University medical center. SUBJECTS: Fifteen normal older control subjects and 29 patients with probable AD. MAIN OUTCOME MEASURES: Subjects were administered a battery of neuropsychologic measures theoretically linked to competency function, as well as two clinical vignettes testing their capacity to consent to medical treatment under five different LSs. The present study focused on one specific LS: the capacity to provide "rational reasons" for a treatment choice (LS4). Neuropsychologic test scores were correlated with scores on LS4 for the normal control group and the AD group. The resulting univariate predictors were then analyzed using stepwise regression and discriminant function to identify the key multivariate predictors of competency performance and status under LS4. RESULTS: Measures of word fluency predicted the LS4 scores of controls (R2 = .33) and the AD group (R2 = .36). A word fluency measure also emerged as the best single predictor of competency status for the full subject sample (n = 44), correctly classifying 82% of cases. Dementia severity (Mini-Mental State Examination score) did not emerge as a multivariate predictor of competency performance or status. Interestingly, measures of verbal reasoning and memory were not strongly associated with LS4. CONCLUSIONS: Word fluency measures predicted the normative performance and intact competency status of older control subjects and the declining performance and compromised competency status of patients with AD on a "rational reasons" standard of competency to consent to treatment. Cognitive capacities related to frontal lobe function appear to underlie the capacity to formulate rational reasons for a treatment choice. Neuropsychologic studies of competency function have important theoretical and clinical value.

Aged↗
PubMed1996

Ambulatory visits to hospital emergency departments. Patterns and reasons for use. 24 Hours in the ED Study Group.

OBJECTIVES: To characterize the reasons ambulatory patients use hospital emergency departments (EDs) for outpatient care and to determine the proportion of ED patients who initially are assessed as having nonurgent conditions, but subsequently are hospitalized. DESIGN: Cross-sectional survey during a single 24-hour period of time. SETTING: Fifty-six hospital EDs nationwide. PATIENTS OR OTHER PARTICIPANTS: Consecutive ambulatory patients presenting for care. Patents who arrived by ambulance were excluded. RESULTS: Of 6441 ambulatory patients (79 percent of all ED visits) who were eligible for study, interviews were obtained from 6187 (96 percent). A total of 5323 patients (86 percent) had clinical reasons or preferences for seeking care at an ED, including 2799 (45 percent) who thought they had an emergency or an urgent condition or were too sick to go elsewhere. Nineteen percent (n=1199) reported that they were sent to the ED by a health care professional. Patients with a regular clinician or with insurance cited similar reasons for seeking care at an ED. A total of 3062 patients (50 percent) cited 1 or more nonfinancial barriers to care as an important reason for coming to the ED, and 949 (15 percent) cited financial considerations. A total of 3045 patents (49 percent of ambulatory patients and 37 percent of total ED visits) were assessed at triage as having a nonurgent condition; 166 of them (5.5 percent; 95 percent confidence interval, 4.7 percent-6.3 percent) were admitted to the hospital. CONCLUSIONS: Most ambulatory patients seek care in an ED because of worrisome symptoms or nonfinancial barriers to care. Although many ambulatory patients appear to have nonurgent conditions based on triage classification, a small but disturbing percentage of nonurgent patients are hospitalized.

Adolescent↗
PubMed1978

A comparison of moral reasoning in drug addicts and nonaddicts.

Assessed moral reasoning of 20 male addict patients and 17 nonprofessional male hospital employees by Kohlberg's methods. The mean level of moral reasoning of the drug addict group (2.97) was not found to differ significantly from that of the nonaddict comparison group (2.88). Furthermore, moral reasoning in addicts was not found to be related significantly to a number of background and personality characteristics. The findings, therefore, indicated that moral reasoning and moral behavior are not related significantly in drug addicts. It was concluded that the deviant behavior of this group is more likely the result of a deficiency in ego controls.

Adult↗
PubMed1983

Improvement in clients who have given different reasons for dropping out of treatment.

Addressed the dropout problem by (a) directly asking clients their reasons for dropping out; and (b) assessing pretherapy to follow-up symptom change in clients grouped by dropout reason. Forty-six dropouts who had been administered the Brief Symptom Inventory at intake were contacted 3 months later. At follow-up they were asked their reasons for dropping out and readministered the Brief Symptom Inventory. It was found that 39% quit due to "no need for services," 35% due to "environmental constraints," and 26% due to "dislike of services." The "no need for services" and "environmental constraints" groups had significant decreases in intake to follow-up Brief Symptom Inventory scores. Dropouts were found to be a heterogeneous group whose follow-up adjustment was related to termination reason. This contradicts prevailing notions that consider all dropouts as treatment failures.

Adjustment Disorders↗
PubMed2001

Reasons for placement and replacement of amalgam restorations in Jordan.

AIMS: To record the reasons for placement and replacement of amalgam restorations in Jordan, to determine the use of amalgam restorations in common cavity types and to collect data on the age of the replaced amalgam restorations. SUBJECTS AND SETTING: Dentists in Jordan (n=241). METHOD: Cross-sectional study using postal survey backed up with personal contact. Data was recorded for all restorations placed or replaced over a period of one month. RESULTS: Information was collected on 3,166 restorations from patients aged 9 to 66 years. Of all restorations, 54.8% were first time placements while 45.2% were replacements of old restorations. The major reason for the first time restorations was primary caries, while that for replacement was secondary caries (28.5%) followed by broken and lost restorations (20.4%), root canal therapy (17%), tooth fracture (12%), pain or sensitivity (8.8%), poor margins (8.5%). CONCLUSIONS: In Jordan, the main reason for first placement of amalgam restoration is primary caries, the main reason for replacement is secondary caries.

Adolescent↗
PubMed2002

Reasons for therapy termination in a university psychology clinic.

This study examined the reasons for therapy termination documented by graduate student therapists. The closed case files of individual adult clients who had terminated their therapy experience at a university-based psychology clinic were reviewed. Results indicated that the most frequent reasons for termination documented by graduate student therapists were that clients stopped attending therapy sessions without providing their therapists with notice or reason and that clients reached a satisfactory termination point in their therapy experience. A substantial number of clients terminated therapy because of difficulties unrelated to therapy, seeking services elsewhere, or dissatisfaction with therapy services. Level of depressive symptomatology and the number of sessions attended differed across clients who had different reasons for termination. By addressing such client concerns early in the therapy experience, premature termination may be prevented.

Adolescent↗
PubMed2006

The nature of the scientific evidence leading to drug withdrawals for pharmacovigilance reasons in France.

INTRODUCTION: Because of design, objectives and number of included subjects, clinical studies are insufficient to assess the safety of new drugs. Sometimes, serious adverse drug reactions (ADRs) led to withdrawal of the drug from the market after their approval. The objective of our study was to determine the scientific evidences leading to drug withdrawal for pharmacovigilance reasons in France. METHODS: Data coming from French Health Products Safety Agency, literature and Toulouse Pharmacovigilance Center allowed to identify all drugs withdrawn from the French market for pharmacovigilance reasons from 1998 to 2004. We classified data according to their study design (Randomized Clinical Trial [RCT], case serie or case report, case-control study, cohort study, observational study, animal study), the organ/system affected and the type of ADR. RESULTS: A total of 21 drugs were withdrawn for safety reasons between 1998 and 2004 in France. The most frequent ADRs were hepatic (n = 7), cardiovascular (n = 4) or neurological (n = 3) ones. Eleven withdrawals were due to type-B ('unexpected') reactions (52%). For 19 out of 21 drugs, scientific evidence leading to drug withdrawal came from spontaneous case reports (or case series). Among these, case reports were the sole evidence in 12 cases. Withdrawals were based on evidence from case reports in combination with case-control or cohort study in four cases, in combination with observational study in two cases or in combination with animal study in two other cases. In only one case, a RCT supported the decision. CONCLUSIONS: This study underlines the importance of spontaneous case reports in detecting signals and supporting withdrawal of drug for pharmacovigilance reasons in France. Health authorities suffer from lack of comparative data resource. In this perspective, a pharmaco-epidemiological population-based database could represent a helpful tool to both generate and test safety hypotheses.

Adverse Drug Reaction Reporting Systems↗
PubMed2000

Automated sleep stage scoring using hybrid rule- and case-based reasoning.

We propose an automated method for sleep stage scoring using hybrid rule- and case-based reasoning. The system first performs rule-based sleep stage scoring, according to the Rechtschaffen and Kale's sleep-scoring rule (1968), and then supplements the scoring with case-based reasoning. This method comprises signal processing unit, rule-based scoring unit, and case-based scoring unit. We applied this methodology to three recordings of normal sleep and three recordings of obstructive sleep apnea (OSA). Average agreement rate in normal recordings was 87.5% and case-based scoring enhanced the agreement rate by 5.6%. This architecture showed several advantages over the other analytical approaches in sleep scoring: high performance on sleep disordered recordings, the explanation facility, and the learning ability. The results suggest that combination of rule-based reasoning and case-based reasoning is promising for an automated sleep scoring and it is also considered to be a good model of the cognitive scoring process.

Computers↗
PubMed1994

Reasoning in middle childhood: a dynamic model of performance on transitivity tasks.

An overview of the models and data relevant to children's transitive reasoning is provided. We propose a new conceptual framework, one which is embedded in a dynamic model that accounts for children's failures to reason transitively. It is assumed that rather than reasoning in a transitive manner, children often encode both relational and absolute stimulus information and use stimulus generalization as a transfer mechanism. The model is applied to new and extant data. The model provides an adequate and parsimonious account of children's failures on these tasks. We conclude that progress in understanding children's reasoning is dependent on operationalizing constructs in formal models so that assumptions can be evaluated and rejected.

Age Factors↗
PubMed2000

Counterfactual syllogistic reasoning in normal 4-year-olds, children with learning disabilities, and children with autism.

Instruction encouraging imagery improves logical reasoning with counterfactual premises by normal preschool children. In contrast, children with autism have been reported to reason accurately with counterfactual premises in the absence of such instruction (F. J. Scott, S. Baron-Cohen, & A. M. Leslie, 1999). To investigate this pattern of findings, we compared the performance of children with autism, children with learning disabilities, and normally developing 4-year-olds, who were given reasoning problems both with and without instruction in two separate testing sessions 2 to 3 weeks apart. Overall, instruction to use imagery led to persistent logical performance. However, children with autism displayed a distinctive pattern of responding, performing around chance levels, showing a simple response bias, and rarely justifying their responses by elaborating on the premises. We propose that instruction boosts logical performance by clarifying the experimenter's intention that a false proposition be accepted as a basis for reasoning and that children with autism have difficulty grasping this intention.

Adolescent↗
PubMed1993

Predictors and reasons for relapse in smoking cessation with nicotine and placebo patches.

BACKGROUND: The reasons for relapse to smoking are not fully understood but several factors are of importance. Addiction to nicotine seems to play a prominent role but there are several other contributing factors. METHODS: To determine predictors of outcome in smoking cessation, we performed univariate and multivariate analyses in a large smoking cessation trial comprising 289 subjects. Weight gain and withdrawal symptoms were analyzed separately as predictors. To determine self-perceived reasons for relapse we created a questionnaire, which was answered by 132 relapsers. RESULTS: Previous attempts to quit smoking and a low saliva cotinine concentration were significantly associated with abstinence in the nicotine-treated group. A trend toward higher abstinence rates was found among males and among subjects with a low nicotine dependency score. Logistic regression analysis showed higher success rates in subjects with the largest weight gain during the first weeks of quitting in contrast to higher relapse rates in subjects who had the greatest weight gain after 3 months. A high score on withdrawal symptoms was not predictive of relapse. Subjects with "slips" had a markedly increased relapse rate. Craving for cigarettes was the most often self-reported (48%) reason for relapse. CONCLUSIONS: The relation between weight gain, withdrawal scoring, and outcome seems rather complex. Craving for cigarettes was the most reported reason for relapse.

Administration, Cutaneous↗
PubMed1992

The right-hemisphere bias in conditional reasoning: a short report on multiple failures to replicate previous findings.

The present set of studies attempted to replicate Gellatly's (1985) findings that were supportive of Evan's (1982) hypothesis that the right hemisphere produces a selective bias towards the incorrect solution of a complex reasoning task. Subjects solved problems of the form "if p then q." In four studies, participants simultaneously performed a bottle--balancing task on each hand to interfere with processing of the reasoning task in the right hemisphere. In the fifth study, the bottle--balancing task was replaced by a finger--sequencing task. The results of the five studies did not show that the interference with right-hemisphere activity resulted in better performance on the conditional-reasoning task. It is concluded that the hypothesis of a right-hemisphere bias in conditional reasoning is still in need of reliable findings.

Attention↗
PubMed1981

[Reasons for apprentice dropout in a large industrial enterprise].

641 people employed in a large industrial enterprise of northwestern Switzerland as apprentices for a profession in the chemical or mechanical industry have been examined. 14.5% have discontinued their apprentiship. The most frequent reasons have been difficulties with the formal training (6.2%), unsatisfactory performance (2.7%) and inaptitude/change of the profession (3.0%). After a change of the curriculum for chemical professions "difficulties with the formal training" as a reason for discontinuing the apprentiship dropped from 13 to 2%. Health reasons have been noted more rarely (0.5%) than expected. At the occasion of the medical aptitude examination, 0.5% were considered medically unqualified and have been rejected. The question if this is the cause for the low proportion of later drop-outs for health reasons remains open.

Adolescent↗
PubMedDate not supplied

Quitting smoking: reasons for quitting and predictors of cessation among medical patients.

OBJECTIVE: To describe why medical patients quit smoking and the methods they use. DESIGN: Cross-sectional and prospective cohort design. Patient smokers were enrolled in a study of physician counseling about smoking. One year later, 2,581 of the patients were asked about quit attempts and methods used. Of those, 245 former smokers whose quitting had been biologically validated were interviewed about why and how they had quit. SETTING: Offices of internists and family practitioners in private practice and a health maintenance organization. SUBJECTS: Consecutive sample of ambulatory patients who smoked. MEASUREMENTS AND MAIN RESULTS: Baseline questionnaires included demographic data, smoking history, and symptoms and diagnoses related to smoking. After one year, subjects were interviewed about smoking status and methods used in attempting to quit. Cessation was confirmed by biochemical testing. Those who had quit were asked about reasons for quitting. Seventy-seven percent of successful quitters gave health-related reasons for quitting and the quitters ranked "harmful to health" as the most important reason for quitting. In a multivariate analysis, those who had a college education, who had social pressures to quit, and who had greater confidence in being able to quit were more likely to have quit smoking one year later, while those who smoked their first cigarette within 15 minutes of awakening and who had more diagnoses related to smoking were less likely to have quit smoking one year later. Participation in a treatment program and having been counseled by a physician or nurse practitioner were positively related to successful quitting, while use of filters or mouthpieces was negatively related. CONCLUSIONS: Concerns about health are the most common reason patients give for quitting, and addiction is the most important barrier to quitting. Education, social pressure, provider advice, and formal programs, but not over-the-counter devices, appear to increase the chances that smokers will quit.

Adult↗
PubMed2007

Fate of the abstracts presented at three Spanish clinical pharmacology congresses and reasons for unpublished research.

OBJECTIVES: To assess the publication rate of abstracts at 5 years after their presentation at three consecutive clinical pharmacology congresses and to examine the reasons relating to the lack of publication. METHODS: Oral and poster presentations from the congresses of the Spanish Society of Clinical Pharmacology (SSCP) in 1994, 1996, and 1998 were reviewed. Authors were contacted to determine the fate of their presented studies and the reasons for not publishing them. Publications of abstracts with unknown fate were searched the in PubMed database. Determinants of publication were examined by Cox regression. RESULTS: In all, 248 abstracts were analysed. The cumulative publication rate at 5 years was 26%, and the median time for publication was 18 months (range: 2-60). The European Journal of Clinical Pharmacology was the English language medical journal where most abstracts were published. The median impact factor of the articles published was 1.96 (range: 0.29-8.32). The author survey identified a lack of time (38.2%) and a lack of interest (33.3%) as the main reasons for failure to publish. The only predictor of an abstract's publication was to be affiliated with a university department (hazard ratio: 1.98, 95% confidence interval: 1.20-3.27). CONCLUSIONS: Only one-quarter of the abstracts presented at SSCP congresses were subsequently published. A lack of time and interest were the main reasons given for not submitting these presentations for publication. Authors, scientific societies and editorial boards should enhance publications as full papers in peer-reviewed journals of the abstracts presented at meetings.

Abstracting and Indexing↗
PubMed2006

Why are people getting tested? Self-reported reasons for seeking voluntary counseling and testing at a clinic in Chennai, India.

VCT has been shown to be an important HIV risk reduction strategy; however, little is known about who attends VCT or why people seek VCT. A retrospective analysis was performed on charts of 6330 clients who attended VCT between 1994 and 2002 at Y.R. Gaitonde Centre for AIDS Research and Education, a non-governmental organization in Chennai, Tamil Nadu, India. Most clients reported more than one reason for attending VCT, and the most commonly reported reasons were risk behavior, having symptoms, having a current HIV-positive partner, and reconfirming a previous positive HIV test. Reasons varied by gender and over time, and the likelihood of testing positive for HIV varied by reason reported. Understanding why people seek VCT informs an understanding of knowledge and attitudes about HIV and HIV testing, which has implications for the development of education, outreach and other HIV prevention services.

Adolescent↗
PubMed1989

Intuitive reasoning about probability: theoretical and experimental analyses of the "problem of three prisoners".

Among various Bayesian problems of probability, the "problem of three prisoners" (Lindley, 1971; Mosteller, 1965) is an especially good example which illustrates the drastic discrepancy between intuitive reasoning and mathematical formal reasoning about probability. In particular, it raises intriguing questions concerning the mathematical and cognitive relevance of factors such as prior probabilities and the context in which certain information is given. In the current paper, we report a new version of the problem which turned out to be even more counterintuitive. This new version was also designed so that different inferential schemes would lead to separate estimates of posterior probability. The data obtained from questionnaires and theoretical analyses of the original and modified problems suggest that: (1) The psychological processes of intuitive reasoning are qualitatively different from mathematical reasoning. (2) The tendency to neglect prior probabilities (Tversky & Kahneman, 1974, 1982) is not always the critical factor for illusory judgments. (3) Intuitive judgments can be categorized by several, distinctive propositional beliefs from which the judgments are apparently derived. We call these prototypical, crude beliefs "subjective theorems," and discuss their nature and roles in the current paper.

Adult↗
PubMedDate not supplied

Reason-based choice.

This paper considers the role of reasons and arguments in the making of decisions. It is proposed that, when faced with the need to choose, decision makers often seek and construct reasons in order to resolve the conflict and justify their choice, to themselves and to others. Experiments that explore and manipulate the role of reasons are reviewed, and other decision studies are interpreted from this perspective. The role of reasons in decision making is considered as it relates to uncertainty, conflict, context effects, and normative decision rules.

Choice Behavior↗