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PubMed2001

Enhancing analogic reasoning with rTMS over the left prefrontal cortex.

The authors utilized repetitive transcranial magnetic stimulation (rTMS) in 16 normal volunteers to investigate the role of the left dorsolateral prefrontal cortex (PFC) in analogic reasoning. rTMS over the left and right PFC, over the left motor cortex, and sham stimulation over the left PFC were administered during memory and analogic reasoning conditions. rTMS over the left PFC led to a significant reduction in response times only in the analogy condition without affecting accuracy. These results indicate that the left PFC is relevant for analogic reasoning and that rTMS applied to the PFC can speed up solution time.

Adult↗
PubMed2003

The many faces of access: reasons for medically nonurgent emergency department visits.

Investigating why people use the hospital emergency department (ED) for visits considered medically nonurgent can enhance our understanding of people's expectations of health care services, of their conceptions of prudent lay judgment, and of difficulties in negotiating the logistics of primary care services. This study identified reasons for such ED use from users' perspectives in both pediatric and adult visits. Respondents were asked to explain what brought them to the ED and to define an emergency. The study was conducted in two northeastern U.S. hospital EDs. The analysis drew on a convenience sample of 408 (331 pediatric, 77 adult users) face-to-face interviews that employed both open- and closed-ended questions. Findings indicate most patients had medical insurance and a regular place of care and most arrived by car or taxi. Twelve main themes emerged under three main categories: conceptions of needs, appropriateness, and preference for the ED. The findings indicate that various reasons for ED use may be construed as access issues. These include beliefs regarding limited availability of after-hour consultation services and of timely appointments at one's primary care site. Drawing on the findings, a typology that distinguishes between groups of users according to their preference for the ED, a level of congruence between their own reason and their definition of an emergency was developed. The typology suggests that people's concerns that influence their decision to come to the ED cannot be solved simply by expanding primary care services or by educational interventions. Its application yields recommendations for services and interventions.

Adolescent↗
PubMed1998

Reasons for HIV antibody testing: plus ca change?

Patient records in a central London genitourinary medicine (GUM) clinic relating to HIV testing were examined and compared for the 3 months immediately before and after World AIDS Day (WAD) in 1994, according to gender and sexual orientation, and the reasons given for testing. Additionally, patient-identified risk was compared with counsellor-identified risk in each case in 1994. Findings were compared with data from the initial HIV awareness campaign in 1986-87. In the 1994 study period, there were no significant differences in overall numbers attending or gender of test-seekers before and after WAD, or proportions of heterosexual, bisexual and gay test-seekers across the time periods. Within each of these groups, gay test seekers were significantly more likely to be HIV positive than heterosexuals, although there were no differences in numbers found positive in each group before and after WAD. Thirty-five per cent (n=268) reported a history of safer sex only, 32% (n=247) said 'sometimes', and 33% (n=249) said 'no'. Overall, the main reasons given for HIV test-seeking included having part of a sexual health screen, having episodes of unprotected sex and/or casual partners, concern over partner's status/monogamy, and intravenous drug user (IDU) contact. Reasons for testing in 1994 reflected greater awareness of HIV transmission compared to 1986-87, although only one-third of those tested reported a history of safer sex.

AIDS Serodiagnosis↗
PubMed1992

Reported reasons for retirement: a study of recently retired workers.

The normal retirement age in the United States is gradually increasing from 65 to 67 (by the year 2027) as provided by the 1983 Amendments to the Social Security Act. One can raise the question, "Who will be the most affected by this change?" This article presents the findings from a study that investigated the relationship between the primary reason given by recently retired workers for their retirement and their economic and demographic backgrounds. A logistic regression analysis was performed using data from the 1982 New Beneficiary Survey concerning involuntary reasons. A major finding was that economically disadvantaged workers tended to retire for involuntary reasons. Therefore, policymakers need to consider the establishment of policies that would protect such workers from the adverse financial impact of the increase in the normal retirement age.

Age Distribution↗
PubMed1998

Reason, the life-world, and health care delivery.

Reason is illustrated to be conceived traditionally in an abstract manner. The attempt has been made to make rationality appear value-neutral and universal. In the end, however, this version of reason is ineffective, because the human element is overlooked. Contemporary philosophy is shown to have abandoned this ethereal view of knowledge and reason. Furthermore, interventions that are based on this shift in theory are more socially sensitive and appropriate.

Attitude to Health↗
PubMed2005

The prediction of hallucinatory predisposition in non-clinical individuals: examining the contribution of emotion and reasoning.

BACKGROUND: Emotion, especially anxiety, has been implicated in triggering hallucinations. Reasoning processes are also likely to influence the judgments that lead to hallucinatory experiences. We report an investigation of the prediction of hallucinatory predisposition by emotion and associated processes (anxiety, depression, stress, self-focused attention) and reasoning (need for closure, extreme responding). METHOD: Data were analysed from a questionnaire survey in a student population (N = 327). RESULTS: Higher levels of anxiety, self-focus, and extreme responding were associated with hallucinatory predisposition. Interactions between these three variables did not strengthen the predictive effect of each. Depression, stress, and need for closure were not found to be predictors of hallucinatory experience in the regression analysis. CONCLUSION: Emotional and reasoning processes may both need to be considered in the understanding of hallucinatory experience.

Adult↗
PubMed1989

Positive justice reasoning in deaf and hearing children before and after exposure to cognitive conflict.

The development of positive justice reasoning in profoundly deaf, signing Australian 7- to 12-year-olds and hearing children was compared. Reactions to cognitive conflict were also assessed. The performance of those deaf children whose signed English skills were adequate to give detailed justifications for reward allocation was examined separately. The deaf children were delayed relative to hearing children in number and liquid conservation, but equally mature in justice reasoning. Spontaneous conflicts with signing peers over sharing possessions conceivably could be responsible for the fluently signing deaf children's development of positive justice reasoning on pace with their normally-hearing counterparts. Experimentally-induced conflict resulted in progress for the hearing but not the deaf children. Results are discussed in relation to factors that promote deaf children's tolerance for ambiguity (Brice, 1985) and impede their resolution of cognitive conflict (Liben, 1978).

Adolescent↗
PubMed2006

Reasons for testing and clinical and demographic profile of adolescents with non-perinatally acquired HIV infection.

OBJECTIVES: We sought to examine the demographic, clinical, and behavioral characteristics; reasons for HIV testing; and factors that contribute to delays in entry into specialized HIV care after diagnosis of HIV infection among adolescents in an urban clinic in Georgia. METHODS: All of the data for this study were obtained solely by medical chart review. Demographic, clinical, behavioral, and HIV testing data were abstracted from medical charts of 59 non-perinatally HIV-infected adolescents who were aged 13 to 18 years and entered care at the pediatric and adolescent HIV clinic of a Georgia hospital during 1999-2002. HIV-infected adolescents were compared by demographic, clinical, and behavioral characteristics as well as by circumstances surrounding HIV testing. Recent seroconversion was defined as having a documented negative or indeterminate HIV antibody test (confirmed) or a self-reported negative HIV test (probable) < or =6 months before HIV diagnosis. RESULTS: Of 59 HIV-infected adolescents, 35 (59%) were female and 56 (95%) were black/African American. Fifteen (25%) had > or =1 sexually transmitted infection when they entered care. All female (vs 38% male) adolescents were infected through heterosexual sexual intercourse; 9 (26%) were pregnant at the time of HIV diagnosis. Adolescents whose HIV was diagnosed at non-health care facilities entered HIV care much later than adolescents whose HIV was diagnosed at health care facilities (median: 108 vs 25 days). Approximately one half of adolescents had CD4+ T-cell counts <350 cells per microL and/or HIV-1 viral loads >55,000 copies per mL at entry into care. Twenty-seven (46%) adolescents had a previous negative HIV test; 7 had confirmed recent seroconversion, and 3 had probable recent seroconversion. Among adolescents with a documented reason for testing, routine medical screening was the most frequent reason for HIV testing; few adolescents were documented as having self-initiated HIV testing. CONCLUSIONS: Strategies are needed to implement timely linkage to medical services of adolescents who receive a diagnosis of HIV infection at non-health care facilities and to increase HIV testing, prevention efforts, and recognition of recent HIV infection among sexually active adolescents.

AIDS Serodiagnosis↗
PubMed1992

[Characteristics of the demand for cranial computerized tomography: reasons and costs of the exam].

It was reviewed a series of 2860 cerebral computed tomography (CCT) in order to compare the main reasons at referral to investigation with the CCT results and the costs with normal and abnormal CCT. It was also studied the age and sex of the patients. Data were collected from one out of three diagnostic centers in Salvador, Brasil, for a three years period. The 2860 CCT exclude all investigation carried out for the follow-up of a previously diagnosed abnormality. CCT abnormalities were detected in 1152 (40.3%). The following reasons showed the highest proportion of abnormal CCT, for males and females respectively: demential syndrome (91.7 and 83.3%); cerebrovascular accidents (85.1 and 73.6%); infectious and parasitary diseases (76.5 and 78.6%); tumors (65.8 and 55.4%); and head injuries, 63.6% for males. In the female group, 65.0% of the CCT were normal, in a range of 65.0 to 80.0% for the age groups under 54 years old. In the male group, the highest proportion of normal CCT was found in the age groups: 25-34 (68.4%), < 15 (62.9%) and 35-44 (62.7%). The most common reasons for normal CCT for males and females were: headache (81.3 and 87.5%); dizziness/vertigo (79.3 and 78.6%); seizures (67.3 and 70.0%); psychomotor deficiency (72.0 and 67.7%) and "endocrine disorders", 75.0% for each sex. The highest proportion of normal CCT (65.3%) was requested by medical "convenios". The cost with normal CCT reached US$565,225 and with the abnormal ones, US$381,247. Costs with normal CCT were 2.2 higher for medical "convenios" as compared to those of the National Institute of Security requests and 2.8 more than those of private medicine.

Adolescent↗
PubMed2001

[Reasons for cataract surgery cancellation].

To study the reasons for cancelling cataract surgeries, and to suggest actions to improve the efficiency of patient care. A cross-sectional study was carried out in a university hospital's ophthalmology clinic of the state of São Paulo, Brazil. Two hundred subjects were randomly selected. The mean age was 68+/- 11.4 years old. The reasons for cancelling surgery were: unpropitious clinical condition (23.1%); tight schedule (35.9%); and patient non-attendance (41%). Most of the reasons related to social issues and the hospital's administrative aspects.

Adult↗
PubMed2004

[Dental pain as the reason for visiting a dentist in a Brazilian adult population].

OBJECTIVE: The occurrence of orofacial pain and chronic pain are frequent subjects for study today, but few studies have been made on dental pain in Brazil. The objective of the study was to assess the prevalence of dental pain and the associated factors as the reason for visiting a dentist among adults. METHODS: A cross-sectional study was carried out among 860 workers aged 18-58 years at a cooperative located in the State of Santa Catarina, in 1999. The clinical examinations and interviews were carried out by dentists who had received prior guidance. Complaints of dental pain as the reason for the last visit to a dentist were analyzed as the dependent variable, in relation to the socioeconomic and demographic conditions, access to dental services, shift pattern and caries (via the DMFT index), as the independent variables. Non-conditional multiple logistic regression analysis was utilized. RESULTS: The prevalence of dental pain as the reason for the last visit to a dentist was 18.7% (CI 95%: 15.9-20.1) and the mean DMFT index (decayed, missing and filled teeth) was 20.2 (CI 95%: 19.7-20.7), with 54% represented by the 'missing' component. The following were independently associated with the presence of dental pain: schooling of less than or equal to eight years (OR=1.9; CI 95%: 1.1-3.1); four to fifteen teeth lost due to caries (OR=2.6; CI 95%: 1.4-4.9); 16 to 32 teeth lost due to caries (OR=2.5; CI 95%: 1.1-5.8); and not having visited the company's dental service (OR=2.8; CI 95%: 1.6-5.1). CONCLUSIONS: Dental pain reflects the severity of the dental caries, expressed by the 'missing' component of the DMFT and non-usage of the company's dental services. These factors are determined by social conditions and represented by the schooling level.

Adolescent↗
PubMed2004

[In contact with genetic diseases: norm and reason as cultural traditions in medical staff discourse at the Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil].

This study aims to detect the influence of deeply rooted traditions on physicians' discursive constructions concerning children with genetic diseases involving malformations and mental retardation. It also aims to capture the reflections resulting from the professional care for (and contact with) these children. All the physicians work at the Fernandes Figueira Institute, Oswaldo Cruz Foundation, in Rio de Janeiro, Brazil. Data were collected using oral interviews (in the form of conversational narratives) and were submitted to semiotic analysis. Four traditions were found in the medical discourse: norm, reason, family, and religion. This article focuses exclusively on norm and reason, highlighting how dismorphism, congenital malformations, and mental retardation associated with genetic diseases defy the established norms of perfection, beauty, and productivity. Therefore, feelings of uneasiness, powerlessness, and frustration are increased. The article also discusses how reason, one of the most important cultural traditions organizing modern thought, shapes medical discourse on genetic syndromes associated with mental retardation.

Brazil↗
PubMed2005

[Evidence-based practice applied to diagnostic reasoning].

Nurses apply knowledge, perceptual and cognitive skills to analyze patient data and propose nursing interventions. The interventions' outcomes depend on their appropriateness which, in turn, depends on the accuracy of nurses' interpretations. The purpose of this paper is to discuss the use of evidenced-based practice (EBP) for nursing diagnostic reasoning, by means of a written case study. The principles of EBP in diagnostic reasoning are: validity of a diagnostic test; ability of a test to discriminate those who do or do not display a specific response; ability of a test to estimate the magnitude of a response; and the appropriateness of a diagnostic test within the clinical context. Gaps in nursing knowledge jeopardize the application of EBP principles in clinical nursing assessment and diagnosis. The authors present a framework to demonstrate the application of EBP to diagnostic reasoning.

Decision Making↗
PubMed2003

Male or female, we will create them: the ethics of sex selection for non-medical reasons.

The article examines the arguments for and against the practice of sex selection for non-medical reasons (e.g. parental preferences, family balancing, religious reasons) in light of the new technology of Preimplantation Genetic Diagnosis (PGD). It distinguishes between arguments about the risks to the future child, the mother and society, on the one hand, and the inherent wrongness of the practice as an illegitimate interference in the natural course of reproduction, on the other. The article tries to show that at least in the well defined context of sex selection by PGD, when IVF was performed for independent medical reasons, there is no danger to either the child or the mother and hence that the practice should be permitted. Furthermore, the alleged dangers to society are demonstrated to be mostly illusory. On the one hand, the demographic danger is usually overstated and lacks historical support. On the other hand, the feminist claim that sex selection is necessarily discriminatory is found to be both theoretically and empirically groundless. The article's conclusion is that despite widespread intuitive objection to the practice of sex selection, it can be justified in terms of parental autonomy and falls within the value of family planning. This liberal view does not, however, imply that having a child of the desired sex is the parents' right, nor does it apply to sex selection in later phases of gestation (abortions and obviously, infanticide).

Choice Behavior↗
PubMed2005

Physicians' attitudes towards and reasons for participation in the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial.

BACKGROUND: Physicians' perception and attitudes towards a research topic and trial management could influence their participation in a randomized controlled trial. The objectives of this study were to determine the reasons for physicians' participation in and attitudes towards the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial. METHODS: CASE-J's main objective is to compare the effectiveness of an angiotensin II receptor antagonist (candesartan cilexetil) with that of a calcium channel blocker (amlodipine besilate) in terms of the incidence of cardiovascular events among high-risk hypertensive patients. We conducted a questionnaire survey among the physicians (n = 512) participating in that trial to determine the reasons behind their participation and to elicit their reactions to the trial management. RESULTS: Eighty-eight percent of the 512 participating physicians responded to our survey. The main reasons for participation were clear objectives of the trial (85.1%), a simple protocol (61.1%), interest in finding out the inhibiting effects of the drugs on cardiac events (80.2%), and a well-organized support system (59.8%). As for negative factors, case registration and follow-up were considered cumbersome by 28.6% and 10.8%, respectively while 44.2% stated that support by the clinical research coordinators provided by the trial management authority was necessary for case screening, recruitment process, patient registration, and follow-up. Multivariate logistic regression analysis showed that participants who did not use a computer very regularly (odds ratio = 1.9, 95% confidence interval = 1.1-3.6) were more likely to consider the case registration and follow-up procedures as a cumbersome. CONCLUSION: The information generated by this study could be useful in designing future randomized controlled trials in Japan and abroad.

Antihypertensive Agents↗
PubMed2005

Reasons for working and their relationship to retirement attitudes, job satisfaction and occupational self-efficacy of bridge employees.

Although the Baby Boomers are the fastest growing segment of the U.S. population and they are quickly approaching retirement age, research has widely neglected to look at the reasons as to why many of them intend on opting for bridge employment as opposed to completely retiring. This study examined the relationships among four reasons for working (social, personal, financial, and generative) and three attitudinal responses to bridge employment (job satisfaction, retirement attitudes, and occupational self-efficacy). In a sample of 108 recent retirees holding bridge employment positions, it was found that generativity served as a reliable predictor of job satisfaction and attitudes toward retirement, whereas the social reason for work was only a reliable predictor of attitudes toward retirement.

Age Factors↗
PubMed1997

Reasons adolescents don't use drugs: exploring a "depth of acceptance" model.

Adolescent's reasons for not using drugs were examined for evidence of factors that might lead to differential resistance to drug use. Six thousand eight-hundred and forty-one sixth, eighth, tenth, and twelfth grade students were administered a comprehensive drug survey which included: 1) demographic information, 2) reasons not to use drugs, and 3) self-reports of lifetime and current (30-day) drug use across sixteen drug categories. The reasons for not using drugs were then factor analyzed and the results compared to a "Depth of Acceptance" (DOA) model consisting of four orientations: External Outcome, Social, and Personal. These orientations are thought both to represent distinct immunization factors and to be differentially related in strength to lifetime and current drug use. Confirmatory factor analysis revealed a close fit between the hypothesized orientations and factor loadings among the sixteen items. Collectively, the sixteen items were also found to be excellent predictors of both lifetime and current drug use. While multiple stepwise regression analyses did reveal differential predictive strengths between orientation and drug use, the misclassification of a single item apparently attenuated the results for Social Orientation. The DOA model appears to provide a useful framework for "fine-tuning" prevention messages based on factors that immunize against drug use.

Adolescent↗
PubMed1985

Decrements in logical reasoning performance under conditions of sleep loss and physical exercise: the factor of sentence complexity.

Baddeley's Logical Reasoning Test was used in a series of Sustained Operations (SUSOP) studies involving 100 US Marine Corps enlisted subjects, to assess the effects of sleep loss and long-term physical exercise on the ability to process complex information. The percent correct answers to the eight Logical Reasoning sentence types involving different voice (active vs passive), use of negatives, and outcome (true vs false) were analyzed over three days across three levels of exercise and rest conditions in the seven studies. A multivariate analysis of variance indicated no differences on the baseline day among the seven studies. Analyses on the baseline day and throughout the next two continuous workdays (CWs) showed consistently higher percent correct for the actively worded than for the passively worded sentences. The sleep loss over the two CWs resulted in a significant decrease in percent correct for the statements which had active wording. Sleep loss had no effect on statements with passive wording. There were no differences in comprehension between groups which had different rest conditions (no rest, 3- or 4-hr. nap, 8-hr. sleep) between the two CWs for any of the sentences; and there was no recovery from prerest to postrest. Fatigue due to exercise during either CW had no effect on comprehension for any of the sentence types. The sleep loss effects on comprehension seem due to a lessening of the attention given to those more simple sentences in active voice, whereas increased arousal may have been elicited by the more complex sentences in passive voice. The increased attention to the passive statements may have overcome the effects of sleep loss. The present study shows the usefulness of analyzing responses to the logical reasoning test by sentence complexity for indicating selective cognitive changes in the processing of information.

Adult↗