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PubMed2006

Vaccination coverage and reasons for non-vaccination in a district of Istanbul.

BACKGROUND: In order to control and eliminate the vaccine preventable diseases it is important to know the vaccination coverage and reasons for non-vaccination. The primary objective of this study was to determine the complete vaccination rate; the reasons for non-vaccination and the predictors that influence vaccination of children. The other objective was to determine coverage of measles vaccination of the Measles Immunization Days (MID) 2005 for children aged 9 month to 6 years in a region of Umraniye, Istanbul, Turkey. METHODS: A '30 x 7' cluster sampling design was used as the sampling method. Thirty streets were selected at random from study area. Survey data were collected by a questionnaire which was applied face to face to parents of 221 children. A Chi-square test and logistic regression was used for the statistical analyses. Content analysis method was used to evaluate the open-ended questions. RESULTS: The complete vaccination rate for study population was 84.5% and 3.2% of all children were totally non-vaccinated. The siblings of non-vaccinated children were also non-vaccinated. Reasons for non-vaccination were as follows: being in the village and couldn't reach to health care services; having no knowledge about vaccination; the father of child didn't allow vaccination; intercurrent illness of child during vaccination time; missed opportunities like not to shave off a vial for only one child. In logistic regression analysis, paternal and maternal levels of education and immigration time of both parents to Istanbul were found to influence whether children were completely vaccinated or non-vaccinated. Measles vaccination coverage during MID was 79.3%. CONCLUSION: Efforts to increase vaccination coverage should take reasons for non-vaccination into account.

Attitude to Health↗
PubMed2004

The development of a brief and objective method for evaluating moral sensitivity and reasoning in medical students.

BACKGROUND: Most medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning between school years among medical students and residents. METHODS: Questionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan. RESULTS: PIT results showed an increase in moral sensitivity in 4th and 5th year students followed by a decrease in 6th year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires. CONCLUSION: This study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan.

Attitude of Health Personnel↗
PubMed1976

The reasons people give for taking overdoses.

This study investigates the reasons people give for taking overdoses of drugs. A representative sample of 128 subjects were interviewed immediately after their recovery from an overdose. During the interview they were given alternative reasons for taking overdoses and asked to choose any that applied to them. Spontaneous comments about suicidal intent were also recorded. Of the subjects, 44% indicated that they had wanted to die. On the basis of their choices 33% were 'seeking help', 42% 'escaping from the situation', 52% 'obtaining relief from a terrible state of mind' and 19% 'trying to influence someone'. The association between these various reasons and other expected effects or feelings associated with the act were examined by means of multidimensional scaling analysis. In addition, the characteristics of those expressing suicidal intent and other reasons were studied, together with such consequences as toxic effects and psychiatric after-care. The possibility is discussed that a large proportion of those indicating suicidal intent do so either to gain social acceptability for their act or to influence helping agencies.

Adolescent↗
PubMedDate not supplied

Combining geometric and probabilistic reasoning for computer-based penetrating-trauma assessment.

OBJECTIVE: To ascertain whether three-dimensional geometric and probabilistic reasoning methods can be successfully combined for computer-based assessment of conditions arising from ballistic penetrating trauma to the chest and abdomen. DESIGN: The authors created a computer system (TraumaSCAN) that integrates three-dimensional geometric reasoning about anatomic likelihood of injury with probabilistic reasoning about injury consequences using Bayesian networks. Preliminary evaluation of TraumaSCAN was performed via a retrospective study testing performance of the system on data from 26 cases of actual gunshot wounds. MEASUREMENTS: Areas under the receiver operating characteristics (ROC) curve were calculated for each condition modeled in TraumaSCAN that was present in the 26 cases. The comprehensiveness and relevance of the TraumaSCAN diagnosis for the 26 cases were used to assess the overall performance of the system. To test the ability of TraumaSCAN to handle limited findings, these measurements were calculated both with and without input of observed findings into the Bayesian network. RESULTS: For the 11 conditions assessed, the worst area under the ROC curve with no observed findings input into the Bayesian network was 0.542 (95% CI, 0.146-0.937), the median was 0.883 (95% CI, 0.713-1.000), and the best was 1.00 (95% CI, 1.000-1.000). The worst area under the ROC curve with all observed findings input into the Bayesian network was 0.835 (95% CI, 0.602-1.000), the median was 0.941 (95% CI, 0.827-1.000), and the best was 0.992 (95% CI, 0.965-1.000). A comparison of the areas under the curve obtained with and without input of observed findings into the Bayesian network showed that there were significant differences for 2 of the 11 conditions assessed. CONCLUSION: A computer-based method that combines geometric and probabilistic reasoning shows promise as a tool for assessing ballistic penetrating trauma to the chest and abdomen.

Bayes Theorem↗
PubMed1999

Reasons for relinquishment of companion animals in U.S. animal shelters: selected health and personal issues.

In personal interviews, people surrendering their dogs and cats to 12 animal shelters in 4 regions of the country discussed their reasons for relinquishing their companion animals and answered questions about their own characteristics and those of their pet. The interviews identified 71 reasons for relinquishment. Personal issues lead the class of reasons for relinquishment of cats and ranked 3rd among those given for relinquishment of dogs. The top 3 health and personal issues cited for giving up cats were allergies of a family member to cats, owner's personal problems, and anew baby. For dogs, the top 3 reasons cited were lack of time for the dog, owner's personal problems, and allergies. Analysis of these health and personal issues suggests that education and counseling before and after acquisition of a pet, as well as the availability of temporary accommodations for pets during times of personal crisis, may reduce relinquishments.

Journal Article↗
PubMed2005

Reasons for unsafe sex among a community sample of people with HIV/AIDS.

In a sample of 117 HIV positive men and women, 34 (29%) were identified as engaging in risky sexual behavior in the past six months and were asked for reasons they did so. Analysis using broad categories revealed that partner-related reasons and hedonistic reasons were the most frequent reasons overall (71%). More male (87%) than female (60%) responses were captured by those two categories. Differences by partner status, viral load and age were not as pronounced. Specific interventions and intervention frameworks are suggested.

Acquired Immunodeficiency Syndrome↗
PubMed2001

An overview of reasons for the placement and replacement of restorations.

AIM: Surveys on reasons for the placement and replacement of restorations have been conducted in various countries. The purpose of this paper is to bring together and review the data of 10 such surveys with similar methodology. METHOD: The studies reviewed are all based on the protocol described by Mjör in 1981. RESULTS: The surveys reviewed provide data on the reasons for the placement and replacement of a total of 32,777 restorations. Notwithstanding differences between countries, different groups of practitioners and minor variations in methodology, the data included in the selected surveys indicate that everyday clinical practice in Scandinavia, UK and USA during the 1980s and 1990s has involved more replacement than initial restorations, with the ratio of initial to replacement restorations ranging from 1:1.1 to 1:2.4 for amalgam and 1:1.1 to 1:3.8 for composite materials. Primary caries has been consistently found to be the principal reason for the provision of initial restorations of amalgam and composite. The principal reason for the replacement of restorations of amalgam and composite has remained secondary caries as diagnosed clinically. Material failures (marginal degradation, discoloration, bulk fracture and loss of anatomic form) accounted for the replacement of more restorations of composite than amalgam. Recent surveys have reported secondary caries as the principal cause of failure of restorations of glass-ionomer cements and related materials. CONCLUSIONS: The clinical diagnoses of caries may continue to be found to account for the placement and replacement of most intracoronal restorations. Surveys of the type reviewed provide valuable insight into patterns of provision of dental care and highlight research priorities in relation to direct restorations.

Composite Resins↗
PubMed2002

Deductive reasoning from uncertain conditionals.

This paper begins with a review of the literature on plausible reasoning with deductive arguments containing a conditional premise. There is concurring evidence that people presented with valid conditional arguments such as Modus Ponens and Modus Tollens generally do not endorse the conclusion, but rather find it uncertain, in case (1) the plausibility of the major conditional premise is debatable, (2) the major conditional premise is formulated in frequentist or probabilistic terms, or (3) an additional premise introduces uncertainty about the major conditional premise. This third situation gives rise to non-monotonic effects by a mechanism that can be characterized as follows: the reasoner is invited to doubt the major conditional premise by doubting the satisfaction of a tacit condition, which is necessary for the consequent to occur. Three experiments are presented. The first two aim to generalize the latter result using various types of conditionals and the last shows that performance in conditional reasoning is significantly affected by the representation of the task. This third point is discussed along with various other issues: we propose a pragmatic account of how the tacit conditions mentioned earlier are treated in plausible reasoning; the relationship of this account with the conditional probability view on conditional sentences is examined; an application of the same account to the Suppression Effect (Byrne, 1989) is proposed and compared with the counter-example availability explanation; and finally, some suggestions on how uncertainty could be implemented in a mental logic system are presented.

Adolescent↗
PubMed2001

Predicting self-damaging and suicidal behaviors in female borderline patients: reasons for living, coping, and depressive personality disorder.

The aims of this study are to examine (1) whether reasons for living predict self-damaging and suicidal behaviors, (2) the associations of reasons for living with coping strategies and depressive personality disorder (PD), and (3) the unique predictive validity of reasons for living in a multivariate predictor model. Reasons for living (RFL), coping strategies, and depressive personality disorder were measured at baseline in 38 patients who met DSM-IV criteria for borderline personality disorder (BPD). Frequency of self-damaging and suicidal behaviors in the 6-month period following baseline was measured prospectively at 3- and 6-month follow-ups. The RFL has only one subscale that predicts parasuicidal behaviors (i.e. Survival and Coping Beliefs [SCB]). Participants who scored low on this subscale were 6.8 times more likely to exhibit self-damaging and suicidal behaviors in the follow-up period than their high-scoring counter-parts. However, SCB was substantially correlated with the coping strategies "reassuring thoughts," "active coping," and "palliative reaction pattern," as well as with depressive personality traits. In a multivariate model, the predictive power of SCB appeared to be accounted for by reassuring thoughts and depressive PD. Coping scales might be preferable over the RFL as a predictor of self-damaging and suicidal behaviors in borderline patients.

Adaptation, Psychological↗
PubMed1998

In search of the good: narrative reasoning in clinical practice.

Based on ethnographic work among North American occupational therapists, I compare two forms of everyday clinical talk. One, "chart talk," conforms to normative conceptions of clinical rationality. The second, storytelling, permeates clinical discussions but has no formal status as a vehicle for clinical reasoning. I argue that both modes of discourse provide avenues for reasoning about clinical problems. However, these discourses construct very different clinical objects and different phenomena to reason about. Further, the clinical problems created through storytelling point toward a more radically distinct conception of rationality than the one underlying biomedicine as it is formally conceived. Clinical storytelling is more usefully understood as a mode of Aristotle's "practical rationality" than the technical rationality of modern (enlightenment) conceptions of reasoning.

Adult↗
PubMed2000

Booster seat use and reasons for nonuse.

BACKGROUND: Many children 4 to 9 years old are inappropriately restrained in vehicles and are at risk for injury in crashes. OBJECTIVES: This study was undertaken to determine the rate of booster seat use and the reasons for nonuse. METHODS: Observations were conducted at a random sample of day care centers, and drivers of unrestrained children 4 to 8 years old were interviewed to determine the reasons for lack of booster seat use. RESULTS: Observations were conducted on 149 children. Shoulder belt use significantly increased with the age of the child; 28.3% of 4-year-olds and 70.0% of 6- to 8-year-olds used lap-shoulder belts. Overall, 27.7% of children in the target age group used booster seats; only 10% of children 6 to 8 years old were restrained with booster seats. Booster seat use decreased when there were 3 or more passengers in the vehicle. The most common reason for lack of booster seat use was that parents thought the child was large enough to use the regular lap-shoulder belt system, or problems with attempting to use the seat in the vehicle. More than one half of parents who were not using booster seats at the time of the survey reported owning seats. CONCLUSION: This study indicates that parental misconceptions about size and safety of regular restraint equipment are the most common reason that children are not appropriately restrained in vehicles. This information can be used to guide community intervention programs.

Automobile Driving↗
PubMed2004

Surgery or general medicine--a study of the reasons underlying the choice of medical specialty.

CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP). METHODS: A randomized sample of resident doctors in general medicine (30) and surgery (30) was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30%) choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%). Most residents in both fields (73% general medicine, 70% surgery) said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%), intellectual activities (30%) and knowledge of the field (27%). For surgeons the main reasons were practical intervention (43%), manual activities (43%) and the results obtained (40%). Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries with different social and educational characteristics. This congruence indicates that the choice involves very similar desires and needs in different settings and has little dependence on the students' educational context.

Adult↗
PubMed2006

Dynamic reasoning to solve complex problems in activated sludge processes: a step further in decision support systems.

Decision support systems (DSS) have generated high expectations as a tool to support activated sludge operation because of their ability to represent heuristic reasoning and to handle large amounts of qualitative, uncertain and low-accuracy data. Previous applications have been satisfactory to control simple problems, when static reasoning and literature-based solutions were enough. However to face complex operational problems with biological origin and slow dynamics (e.g. solids separation problems), it is necessary to use dynamic reasoning and apply long-term control strategies, monitoring the evolution of the process and adjusting the action plan according to the feed back of the process. This paper presents a dynamic reasoning DSS to face solids separation problems in the activated sludge system. The DSS is capable of identifying the complex problem affecting the process, determining if the current situation is new or a continuation from the previous one, assessing what is the specific cause of the situation, and recommending a long-term control strategy, which is daily adjusted according to the evolution of the process.

Artificial Intelligence↗
PubMed1996

Reasons for living and coping abilities among older adults.

Older adults have successfully resisted inclinations to commit suicide; however, little research has focused on their ability to cope or their reasons for living. In the present study, seventy-nine (fifty-five women, twenty-two men, two unknown) older adults (M = 60.6 years) recruited from churches, retirement groups (n = 22), and relatives of college psychology students (n = 57), completed the Reasons for Living and the Cope inventories. Overall coping was significantly positively correlated with total reasons for living, r(78) = .19, p < .05, although the low correlation suggests that the constructs are moderately unique. Further, coping was positively correlated with two RFL subscales, Survival and Coping Beliefs, r(78) = .27, p < .01, and Child-Related Concerns, r(78) = .28, p < .01. Women were higher than men in total reasons for living, t(75) = 2.16, p < .05, but not significantly different in coping abilities. Older women may underrate their ability to cope. An implication is that suicide prevention strategies should target men and bolster their cognitive deterrents to suicide.

Adaptation, Psychological↗
PubMed2000

Case-based reasoning computer algorithm that uses mammographic findings for breast biopsy decisions.

OBJECTIVE: We present case-based reasoning computer software developed from mammographic findings to provide support for the clinical decision to perform biopsy of the breast. SUBJECTS AND METHODS: The case-based reasoning system is designed to support the decision to perform biopsy in those patients who have suspicious findings on diagnostic mammography. Currently, between 66% and 90% of biopsies are performed on benign lesions. Our system is designed to help decrease the number of benign biopsies without missing malignancies. Clinicians interpret the mammograms using a standard reporting lexicon. The case-based reasoning system compares these findings with a database of cases with known outcomes (from biopsy) and returns the fraction of similar cases that were malignant. This malignancy fraction is an intuitive response that the clinician can then consider when making the decision regarding biopsy. RESULTS: The system was evaluated using a round-robin sampling scheme and performed with an area under the receiver operating characteristic curve of 0.83, comparable with the performance of a neural network model. If only the cases returning a malignancy fraction of greater than a threshold of 0.10 are sent to biopsy, no malignancies would be missed, and the number of benign biopsies would be decreased by 25%. At a threshold of 0.21, 98%, of the malignancies would be biopsied, and the number of benign biopsies would be decreased by 41%. CONCLUSION: This preliminary investigation indicates that the case-based reasoning approach to computer-aided diagnosis has the potential to improve the accuracy of breast cancer diagnosis on mammography.

Adult↗
PubMed1998

Offering a randomized trial of intensive therapy for IDDM to adolescents. Reasons for refusal, patient characteristics, and recruiter effects.

OBJECTIVE: To identify reasons adolescents refuse to participate in a randomized trial of intensive therapy (IT) for IDDM, to describe the patient characteristics of those who consent and those who refuse to participate, and to examine recruiter effects on trial participation rates. RESEARCH DESIGN AND METHODS: A total of 99 adolescents, age 11-18 years, were provided with the results of the Diabetes Control and Complications Trial and approached for possible study participation by two nurse recruiters. Adolescents refusing the trial were administered a semi-structured interview to describe reasons for study refusal; responses were recorded and later coded into categories. Patient characteristics of consenters and refusers were collected and compared. The differential enrollment rates of the two nurse recruiters were also compared. RESULTS: A total of 56 patients (approximately 57%) agreed to participate; 43 refused. The four most common reasons for study refusal were 1) increased clinic visits (42%), 2) increased insulin injections (30%), 3) increased frequency of self-monitoring of blood glucose (SMBG) (28%), and 4) transportation difficulties (19%). Concerns about randomization to an unwanted treatment condition and fears of hypoglycemia or weight gain were rarely cited. Consenters and refusers did not differ in demographic characteristics, disease status, or family composition. Large differences were found between the two nurse recruiters: one experienced a 60% refusal rate, while the other experienced a 27% refusal rate. CONCLUSIONS: Issues of convenience (increased clinic visits, transportation difficulties) and concerns about the demands of IT (increased injections and SMBG) were the predominant reasons for trial refusal. Patient characteristics did not differentiate consenters from refusers. However, recruiters differed greatly in study refusal rates, suggesting that provider behavior may be an important but understudied aspect of adolescent acceptance of randomized trials in general and IT in particular.

Adolescent↗
PubMed1988

Effects of depressed mood induction on reasoning performance.

The relationship between depressed mood, reasoning and perceptual performance was examined with 57 undergraduate volunteers. To intensify its effect, Velten's 1968 mood induction procedure was modified by having subjects hear a prerecording of each mood statement prior to saying it themselves. Also, midway through the experiment subjects completed an abbreviated mood induction to ensure continuation of the appropriate mood. Ratings of subjects' mood on a 13-point Likert scale before and after mood induction indicated the mood induction was effective. Subjects completed the reasoning measure of 48 syllogisms, and the perceptual measure involving identification of positive, negative, or neutral stimulus words presented tachistoscopically. "Depressed" individuals showed poorer reasoning performance of marginal significance than "elated" subjects. Mood induction did not appear to affect perceptual performance. Results are discussed in terms of the research on reasoning deficits in depression.

Attention↗
PubMed1990

Relationship between egocentrism, alcohol consumption and reasons given for drinking.

University students, 86 men and 141 women, completed a questionnaire from which their level of egocentrism, amount of alcohol consumed, and number of reasons for drinking could be estimated. Analysis supported earlier findings that men consume significantly more alcohol than do women. Both men and women who were rated as having high egocentrism scores gave significantly more reasons for drinking than did the women scoring low on egocentrism. Also, there was a significant correlation between egocentrism and reasons for drinking but not between egocentrism and amount consumed. The correlation was higher between the number of reasons given for drinking and the amount of alcohol consumed. Since men scoring high on egocentrism report the highest consumption, while high-scoring women report the lowest consumption, it is concluded that egocentrism plays an indirect role in the consumption of alcohol and the role it plays is different for men and women.

Adult↗