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PubMed1996

Reasonable accommodation for employees with mental disabilities: a mandate for effective supervision?

Reasonable accommodation under Title I of the Americans with Disabilities Act (ADA) for employees with mental disabilities is explored from a behavior analytic perspective. Although much of the attention in issues of reasonable accommodation is concentrated on persons with physical disabilities, it is argued that the needs of individuals with mental disabilities are in greater need of further study. The criteria for successful accommodation in the workplace for employees with mental disabilities is seen to be structurally different, but functionally similar to successful accommodations for employees with physical disabilities, and is based on the development of enabling environments. Behavior analysis offers a theoretical basis and performance management presents a methodological basis for analyzing, developing, implementing, and evaluating reasonable accommodation for persons with mental disabilities, largely in terms of effective supervision. It is concluded that Title I of the ADA may be seen as providing a mandate for effective supervision, which may also be extended to all employees.

Adult↗
PubMed1981

Logical reasoning deficits in schizophrenia and brain damage.

Von Domarus and Arieti have theorized that failure to reason by conventional logical rules is at the root of schizophrenic thought disorder, but the available research on this view is inconclusive. We compared the performance of schizophrenics (N = 100), brain-damaged patients (N = 50) and psychiatric controls (N = 50) on closely matched measures of Overexpansive and "Von Domarus" (similarity implies identity) syllogistic reasoning errors. Before the samples were matched for education and intelligence, the brain-damaged and schizophrenic patients made more Overexpansive errors than the controls, but the Von Domarus error difference was not significant. After matching, both differences were nonsignificant. The results indicate that inability to use syllogistic reasoning properly is probably not the root cause of schizophrenic thought disorder.

Adult↗
PubMed1994

Reasoning abilities in Psy.D. and Ph.D. clinical graduate students: a preliminary study.

Clinical students in regionally representative Psy.D. and Ph.D. programs responded to a questionnaire that assessed everyday reasoning and psychological knowledge. Ph.D.s scored higher on the Methodology Reasoning test and the Conditional Probability test, while there were no differences on the Verbal or Statistical Reasoning tests or the Psychology questions. Calibration curves indicated that Psy.D.s tended to be somewhat more overconfident in their responses than Ph.D.s. Similarities and differences between the performance of the Psy.D.s and Ph.D.s are discussed, as well as the limitations and implications of the study.

Adult↗
PubMed2003

Detecting acute confusion in older adults: Comparing clinical reasoning of nurses working in acute, long-term, and community health care environments.

In an article on a previous study involving hospitalized older adults (McCarthy, 2003), it was argued that the theory of situated clinical reasoning explains why nurses often fail to recognize acute confusion. Further, the theory illuminates how nurses' perspectives toward health in aging affect the ways they regard and ultimately deal with older people in this particular clinical situation. The purpose of the current study was to challenge and refine the theory by exploring the influence of different care environments on clinical reasoning related to acute confusion. Following a period of participant observation, a purposive sample of 30 nurses, 10 each from a teaching hospital, a long-term facility, and a home care agency, participated in semistructured interviews. Dimensional analysis provided the methodological framework for data collection and interpretation. The results reinforce prior findings that the ability of nurses to recognize acute confusion and to distinguish it from dementia can be attributed to their personal philosophies about aging. Care environment was identified as a factor that influenced clinical reasoning in limited ways under certain conditions and within certain contexts.

Acute Disease↗
PubMed2005

Accepting or declining the offer of prenatal screening for congenital defects: test uptake and women's reasons.

OBJECTIVES: Prenatal screening for Down syndrome has become standard practice in many western countries. In the Netherlands, however, prenatal screening tests for congenital defects are not offered routinely. The present study aims to assess test uptake in a large, unselected population of pregnant women, and to give more insight into the decision for or against prenatal screening through nuchal translucency measurement or maternal serum screening. PATIENTS AND METHODS: The study is part of a randomized controlled trial with two groups, each being offered a different prenatal screening test, and a control group. Pregnant women received postal questionnaires at three stages of their pregnancy. RESULTS: Of the women being offered the nuchal translucency measurement or the second trimester maternal serum test, 53 and 38% respectively accepted the test offer. The main reasons for accepting were 'gaining knowledge about the health of the foetus/curiosity' (50%), 'favourable characteristics of the screening test' (18%), and 'increased risk of having a child with DS' (15%). The main reasons for declining were 'unfavourable characteristics of the screening test' (42%), 'not applicable/not necessary' (35%), 'anxiety/uncertainty' (36%), 'adverse characteristics of the invasive tests' (32%), and 'being against abortion' (15%). DISCUSSION: The uptake of prenatal screening was relatively low, and different distributions of reasons were reported, compared to other studies. These differences may be due to the specific Dutch situation in which prenatal screening is not part of standard prenatal care. The question arises as to whether informed decision-making would be reduced if prenatal screening became routinised.

Adult↗
PubMed1990

Prenatal diagnosis for psychological reasons: comparison with other indications, advanced maternal age and known genetic risk.

In Sweden, about 20 per cent of women undergoing prenatal diagnosis (PND) have the test for 'psychological reasons', which means that they strongly fear giving birth to a disabled child, but have not reached the age limit. Women undergoing amniocentesis or chorionic villus biopsy for these reasons (n = 38) were studied by questionnaires with regard to distress during test procedures. They were compared to women examined because of a known or strongly suspected high risk of giving birth to a congenitally disabled child (n = 27) and to women examined because of an age more than 37 years (n = 144). The most distressed were women who had a high genetic risk. The women who had the test because of their age reported less distress. Women examined for psychological reasons, were moderately distressed, but reported the highest frequency of influence by the distress on their daily living. Women in all groups, however, felt a similar support by the normal test result and reported the whole procedure as rather easy. Different psychological determinants of anxiety of giving birth to a disabled child are discussed. The 'psychological indication' for PND means that the women's private interpretation of her risk, and not only the statistical limit, motivates PND.

Anxiety↗
PubMed2002

Results of a postal survey of the reasons for non-response by doctors in a Prescription Event Monitoring study of drug safety.

PURPOSE: A Prescription Event Monitoring (PEM) study was carried out by the Drug Safety Research Unit (DSRU) to monitor the safety of irbesartan, an angiotensin II antagonist, immediately after launch in the United Kingdom in September 1997. The DSRU 'green form' questionnaire response rate was lower than expected. The manufacturer was conducting a concurrent postmarketing surveillance study. The aim of this cross-sectional study, was to identify reasons for non-response by general practitioners in England. METHODS: In PEM, questionnaires are posted to the prescribing general practitioner approximately 6 months after the date of the first prescription for each patient, requesting details of clinical events recorded in the patients' notes since starting treatment. Those that failed to respond were sent a second questionnaire, including tick box questions to elucidate reasons for non-response. RESULTS: A total of 21.3% (3088/14502) second send forms were returned. There were 1747 tick box responses. The most common reason specified for non-response was 'I was too busy' (31.2%) followed by 'no payment included' (13.4%). Participation in another study accounted for only 3.4%. CONCLUSIONS: The concurrent postmarketing surveillance study was not a significant factor. The general practitioner's workload appeared to have a far larger impact. While research remains a non-core activity and receives no payment, participation is likely to fall. Researchers need to find means of benefiting the general practitioner if participation is to continue.

Angiotensin Receptor Antagonists↗
PubMed1997

Image and language in human reasoning: a syllogistic illustration.

Existing accounts of syllogistic reasoning oppose rule-based and model-based methods. Stenning and Oberlander (1995) show that the latter are isomorphic to well-known graphical methods, when these are correctly interpreted. We here extend these results by showing that equivalent sentential implementations exist, thus revealing that all these theories are members of a family of abstract individual identification algorithms variously implemented in diagrams or sentences. This abstract logical analysis suggests a novel individual identification task for observing syllogistic reasoning processes. Comparison of the results of this task with the Standard Task confirms that the tasks are psychologically closely related, throwing light on sources of error, on subjects' sensitivity to metalogical properties, and on term-ordering phenomena. Since it avoids posing the subtask of formulating a quantified conclusion, the new task allows comparison of explanations of problem difficulty in terms of the number of models (e.g., Johnson-Laird & Bara, 1984) with alternatives in terms of the difficulty of choosing a quantifier for the conclusion. Logical concepts of source and conditional premisses provide a comprehensive account of term order data, including figural effects, at a level abstract with regard to imagistic or sentential representations. These results argue that much richer empirical evidence will be required to discriminate phenomenologically distinct reasoning processes than has hitherto been supposed.

Humans↗
PubMed2001

Diversity-based reasoning in children.

One of the hallmarks of inductive reasoning by adults is the diversity effect, namely that people draw stronger inferences from a diverse set of evidence than from a more homogenous set of evidence. However, past developmental work has not found consistent diversity effects with children age 9 and younger. We report robust sensitivity to diversity in children as young as 5, using everyday stimuli such as pictures of objects with people. Experiment 1 showed the basic diversity effect in 5- to 9-year-olds. Experiment 2 showed that, like adults, children restrict their use of diversity information when making inferences about remote categories. Experiment 3 used other stimulus sets to overcome an alternate explanation in terms of sample size rather than diversity effects. Finally, Experiment 4 showed that children more readily draw on diversity when reasoning about objects and their relations with people than when reasoning about objects' internal, hidden properties, thus partially explaining the negative findings of previous work. Relations to cross-cultural work and models of induction are discussed.

Adult↗
PubMed1999

Common reasons why peer education fails.

Peer education frequently fails. The reasons are numerous and can usually be avoided with clear planning. The most common reasons cited for failure relate to project design and implementation difficulties. The aim of this review is to identify the primary reasons for the failure of peer education programmes in order to help project managers avoid making similar mistakes in the future.

Adolescent↗
PubMed2000

Moral reasoning, perceived competence, and adolescent engagement in risky activity.

Relations among moral reasoning, domain specific perceived competencies, and self-reported engagement in risky activity (substance use and antisocial behavior) were examined with 110 10th-12th grade students. An exploratory model demonstrated that perceived behavioral competence mediated the relation of moral reasoning and engagement in risky behavior such that preconventional moral reasoning predicted perceptions of low behavioral competence, which was associated with engagement in risky activity. The results support contentions of moral theorists that a comprehensive theory of moral development must include self-regulatory mechanisms such as perceptions of competence in order to predict moral conduct.

Achievement↗
PubMed1997

The roles of personal investment and reasoning competence in career-relevant everyday problem solving.

To examine developmental differences in practical problem-solving, 51 late adolescents and 52 young adults were presented measures of everyday problem-solving that were either self-relevant or self-neutral. Results indicated: (a) a developmental shift in everyday problem-solving strategies, such that adolescents rated higher than adults those strategies that involved reconsideration of the problem situations and adapting to the conditions of the problems. By contrast, young adults rated higher more goal-defensive strategies than adolescents; (b) reasoning competence was more strongly related to ratings of self-relevant problems than to ratings of self-neutral problems, but only for the adolescents, providing some support for a relation between reasoning competence and everyday problem-solving; and (c) relevance effects on strategy ratings were clearly evidenced as both age groups rated planning for the future and shaping the present environment to correspond to their current goals higher for self-relevant than for neutral problems. These findings are discussed in terms of the possible roles of domain specifically, personal investment, age, and reasoning competence in adolescent and adult everyday problem-solving.

Adolescent↗
PubMed2002

Developmental and content effects in reasoning with causal conditionals.

Two predictions derived from Markovits and Barrouillet's (2001) developmental model of conditional reasoning were tested in a study in which 72 twelve-year-olds, 80 fifteen-year-olds, and 104 adults received a paper-and-pencil test of conditional reasoning with causal premises ("if cause P then effect Q"). First, we predicted that conditional premises would induce more correct uncertainty responses to the Affirmation of the consequent and Denial of the antecedent forms when the antecedent term is weakly associated to the consequent than when the two are strongly associated and that this effect would decrease with age. Second, uncertainty responding to the Denial of the antecedent form ("P is not true") should be easier when the formulation of the minor premise invites retrieval of alternate antecedents ("if something other than P is true"). The results were consistent with the hypotheses and indicate the importance of retrieval processes in understanding developmental patterns in conditional reasoning with familiar premises.

Adolescent↗
PubMed2002

Reasons for delayed discharge of trauma patients.

BACKGROUND: In the trauma population, increased length of stay is associated with age, comorbidities, and injury severity. We hypothesized that a significant contributor to a delay in length of stay was unrelated to these variables. MATERIALS AND METHODS: All trauma patients admitted for > 48 h with acute injury from 7/1/2000 to 9/30/2000 were evaluated daily for discharge readiness. Actual discharge time was recorded from the time discharge orders were written. A discharge-ready patient not discharged within 24 h was a Delay discharge. Discharge delay was categorized as availability of rehabilitation beds, family reasons, or system-related delay. Payer was classified as commercial, government, Medicare, or uninsured. Actual hospital costs were used. RESULTS: One hundred twenty-eight patients were evaluated; 30 patients had a delay in discharge. The average delay was 2 days (range 1-15 days). Mean hospital stay for Delay patients was 13.4 days, and 8.1 days for Timely patients (P < 0.05). Injury severity, age, and comorbidities were not different among groups. The main reason for delay was lack of a rehabilitation bed. Hospital costs were $39,013 per patient in the Delay group and $24,414 in the Timely group. Delay patients were more likely to be uninsured, have an orthopedic injury, and require ICU care. CONCLUSION: Discharge delays significantly lengthen hospital stay for nonmedical reasons in trauma patients. Improved efficiency in a trauma system will require changes from acute care to rehabilitation.

Adult↗
PubMed1995

Reasons for early recurrence following laparoscopic hernioplasty.

The incidence and reasons for early recurrences following laparoscopic hernioplasty have not been studied. Because the incidence is small and the follow up is short, a multi-institutional study was performed among the pioneers in the field. The incidence figures were obtained by survey of surgeons who had significant experience (over 100 cases) and kept concurrent records. Fifty-four recurrences (1.7%) occurred after 3229 laparoscopic hernia repairs. There were 1944 transabdominal preperitoneal (TAPP) repairs with 19 recurrences (1%) and 578 preperitoneal repairs with no recurrences. There were 345 onlay mesh (IPOM) repairs with seven recurrences (2%), and 286 plug and patch repairs with 26 recurrences (9%). Simple closures were performed 76 times with two recurrences (2.6%). Fifty-seven patients (three cases were referred to the author without incidence data but complete records for analysis) had 60 recurrent hernias. Recurrences were noted, on average, 5.1 months postoperatively (range 0-30 months). The most common reason for recurrence was that the mesh was too small - 36 (60%). The mesh was never stapled in 19 instances (32%), and the hernia was never repaired in three cases (20%). The clips pulled through the tissue in six cases (8%), and in 10 cases (15%) the repair has not yet been undertaken because the etiology was unclear. There was more than one reason in 19 patients. Technical factors were responsible for nearly all recurrences.

Hernia↗
PubMed1995

Nonattendance in the Stockholm mammography screening trial: relative mortality and reasons for nonattendance.

The first objective of this study was to analyze the survival rate in a group of 69 breast cancers detected among nonattenders in a randomized mammographic screening trial in relation to 142 clinically detected cancers in a nonscreened control population. By analyzing the cancers of the nonattenders we identified two subgroups, one (A) had actively avoided mammography, had cancers in more advanced stages on diagnosis, and had significantly higher mortality from breast cancer than the control group (p = 0.003). The second subgroup (B) had mammography done outside the screening program. This subgroup had a nonsignificant, slightly better survival (p = 0.19) compared to the control group. Concerning stage the cancers in group B were similar to the cancers by the screening program. The second objective was to analyze women's reasons for nonattendance in the screening program. We interviewed 200 randomly selected nonattenders; 33% stated that they never could imaging having mammography (definite nonattenders), 29.5% that they for various reasons had missed the mammography but could imagine having it next time (possible future attenders), and 32% had been examined outside the program. Reasons for nonattendance included disinterest, medical problems, and fear of X-rays. From this interview investigation we believe that the subgroup of definite nonattenders (33%) is difficult to influence. The second subgroup classified as possible future attenders (29.5%) we believe can be influenced by more information and a new opportunity to receive mammography, i.e., a reminder letter. The third subgroup, those examined outside the screening program (32%) were aware of the benefit of mammography, taking action on their own.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Perceived barriers to care in St. Louis (USA) and Christchurch (NZ): reasons for not seeking professional help for psychological distress.

This paper examines perceived barriers to mental health care reported in two very similar community surveys in two cities that are not only on opposite sides of the world but that differ substantially in their health care systems, their size, and their mix of ethnic groups, namely, St. Louis in the United States and Christchurch in New Zealand. Respondents were asked about mental health care ever received, any failure to seek care when required, and symptoms of 14 psychiatric disorders according to DSM-III. The frequency with which respondents reported not seeking care and the popularity of specific reasons for not seeking care were almost identical in the two sites. A common reason offered for not seeking care was doubt about the need for professional help; this appeared to be particularly common for people with alcohol disorder. Respondents who said that they had failed to seek care when needed gave reasons that were mainly attitudinal, such as believing they should be strong enough to cope without professional help. Structural characteristics of services such as cost, times open, and travel distance were given less often. Sociodemographic factors had small or negligible effect on care seeking.

Adaptation, Psychological↗
PubMed1991

Self-efficacy, reasoned action, and oral health behavior reports: a social cognitive approach to compliance.

The usefulness of a social cognitive approach to compliance with brushing and flossing behavior recommendations was tested with 39 patients recruited from the State University of New York at Buffalo Periodontal Disease Clinical Research Center. Participants completed mailed study instruments assessing Fishbein and Ajzen's theory of reasoned action variables, Bandura's self-efficacy variables, and frequency of brushing and flossing behavior. Results indicated positive attitudes, beliefs, and norms for brushing and flossing and positive intentions to brush but less intention to floss. Hierarchical regression analyses supported the basic usefulness of the theory of reasoned action for oral health behavior reports. Addition of self-efficacy variables to theory of reasoned action variables significantly increased the explained variance of brushing and flossing behavior reports. These results establish a strong basis for future clinical studies investigating social cognitions and the prediction of oral health behavior.

Adult↗