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PubMed2004

Content and strategy in syllogistic reasoning.

Syllogistic reasoning has been investigated as a general deductive process (Johnson-Laird & Byrne, 1991; Revlis, 1975; Rips, 1994). However, several studies have demonstrated the role of cognitive strategies in this type of reasoning. These strategies focus on the method used by the participants (Ford, 1995; Gilhooly, Logie, Wetherick, & Wynn, 1993) and strategies related to different interpretations of the quantified premises (Roberts, Newstead, & Griggs, 2001). In this paper, we propose that content (as well as individual cognitive differences) is an important factor in inducing a certain strategy or method for syllogistic resolution. Specifically, we suggest that syllogisms with a causal conditional premise that can be extended by an agency premise induce the use of a conditional method. To demonstrate this, we carried out two experiments. Experiment 1 provided evidence that this type of syllogism leads participants to draw the predicted conditional conclusions, in contrast with control content syllogisms. In Experiment 2, we demonstrated that the drawing of conditional conclusions is based on a causal conditional to an agent representation of the syllogism premises. These results support the role of content as inducing a particular strategy for syllogistic resolution. The implications of these results are discussed.

Analysis of Variance↗
PubMed1997

The practice of dentistry: an assessment of reasons for premature retirement.

AIM: To assess reasons for premature retirement among practising dentists and to evaluate their association with occupational stress. DESIGN: Retrospective analysis. SETTING: Records from one organisation operating in the private medical sickness industry in the UK. MATERIALS: Reasons for premature retirement of 393 dentists due to illness between 1981 and 1992. RESULTS: The most frequent causes of premature retirement were musculoskeletal disorders (29.5%), cardiovascular disease (21.1%), and neurotic symptoms (16.5%), 82.7% of cases examined were in the > 50 years age group. CONCLUSIONS: Musculoskeletal disorders and stress related illnesses were the two most important groups which influenced premature retirement.

Adult↗
PubMed1997

Application of fuzzy reasoning in an expert system for ultrasonography.

OBJECTIVES: To apply fuzzy reasoning in a computer-assisted diagnostic system for ultrasonography and to evaluate its clinical utility as a diagnostic aid for the unskilled clinician. METHODS: A computer-assisted diagnostic system for ultrasonography was constructed to differentiate metastatic from inflammatory lymph nodes. The pattern of a skilled clinician's considerations was simulated with the fuzzy expert system. Three fuzzy production rules were set up according to the diagnostic criteria for lymphadenopathy. Each rule was transformed into a membership function. The max-min composition method was used for inference and the centroid method for defuzzification. The system was tested with 20 clinicians who were one to three years after graduation and inexperienced in ultrasonography. Accuracy, sensitivity and specificity were evaluated. RESULTS: The average increase in accuracy was 8.5%, and the sensitivity and specificity 10.7% and 6.4% respectively. These scores were significant for accuracy (P = 0.005), sensitivity (P = 0.02) and specificity (P = 0.036). CONCLUSIONS: Application of fuzzy reasoning in an expert system for ultrasonography improves the diagnostic performance of inexperienced clinicians.

Clinical Competence↗
PubMed2002

Reasons among older Swedish women of not participating in a food survey.

OBJECTIVES: To (a) examine participation rate as a function of municipality, age group and living status; and (b) investigate the main reasons for exclusion and declining as stated by the women themselves. DESIGN: Analysis of participation rate and content analysis of statements given in phone calls explaining exclusion or declination from a project in which 24 h recalls and food-diaries were used. SUBJECTS: Self-managing Swedish women (n=505) were systematically selected from a stratified random sample covering single living and cohabiting women aged 64-68, 74-78 and 84-88 y living in three municipalities. RESULTS: No significant differences were found among included and declining women when municipalities and living status was analysed, but significantly more women in the oldest group were excluded (P>0.01). Among those in their 80s living at home, the usual reasons for exclusion were illness, disability or dementia, and many lived in institutions for old people. The four most used explanations to decline participation were 'lack of time', 'tired, fragile, sick or having bad memory', 'not willing to participate in scientific studies' and 'too old and nothing to contribute'. CONCLUSIONS: The participation rate was, compared with other food surveys in the older generation, fairly good, especially among those in their 80s. However, the most active and the very ill and disabled did not participate. SPONSORSHIP: The Swedish Council for Social Research, the Swedish Council for Forestry and Agricultural Research, the Swedish Foundation for Health and Care Sciences and Allergy Research and Uppsala University.

Age Factors↗
PubMed2003

Relationship between habitual breakfast and intellectual performance (logical reasoning) in well-nourished schoolchildren of Madrid (Spain).

OBJECTIVE: To determine the relationships between habitual breakfast habits and performance in verbal aptitude, logical reasoning and mathematical tests in a group of well-nourished scholars from Madrid. DESIGN: The study subjects were 180 children between 9 and 13 y of age. A dietetic study was undertaken using a 7-day food record. Scholastic aptitude was examined using the scholastic aptitude test (SAT-1) test. RESULTS: Breakfast made up 19.1% of total daily intake. No differences were found between subjects in terms of personal data or total diet with respect to whether they habitually took adequate breakfasts (AB) (ie, more than 20% of daily energy being provided by this meal) or inadequate breakfasts (IB) (less than 20%). However, AB subjects achieved better reasoning scores in the SAT-1 test. CONCLUSIONS: The normal breakfast habits of schoolchildren should be taken into account when studying diet-mental function relationships, even when studying well-nourished populations.

Adolescent↗
PubMed1998

Drop-out reasons and complications in self-injection therapy with a triple vasoactive drug mixture in sexual erectile dysfunction.

The usefulness, complications and reasons for discontinuing the self-injection program with a combination of papaverine, phentolamine and prostaglandin E1 were evaluated in 189 patients (mean age 57.2 y), who were included from April 1993 to September 1995 (mean follow-up 10.25 months). Patients were split into two groups: Active, those who continued with the program (48%); and Inactive, those who discontinued treatment or failed to attend consultation after five months from the last visit (52%). Only 30% of the inactive group reported failure to achieve response with the self-injected doses. Fibrosis in 5.3% and prolonged erection in 3.7% were the most severe complications. Patients lacking organic pathology showed a clear tendency to reduce the drug dose during treatment, recover spontaneous erections and discontinue the program for reasons unrelated to drug efficacy. The triple drug mixture provides an effective alternative in the treatment of impotence, with a low rate of complications.

Adult↗
PubMed2006

Aim, design and methods of the 'reasons for not intensifying antihypertensive treatment' (RIAT): an international registry in essential hypertension.

Failure of physicians to adhere to hypertension guidelines may partly account for the failure to achieve blood pressure (BP) goals in clinical practice. The aim of this trial is a comprehensive description of the approach of physicians in the management of high BP among primary care patients. It will primarily assess what are the Reasons for not Intensifying an Antihypertensive Treatment (RIAT), when predefined individual BP goals are not achieved. Open intervention survey was conducted in 17 countries in Latin America, Eastern Europe, Africa and Asia in family practices, government and private clinics. The registry is based on a three-step epidemiological design. Step one shall identify guidelines and recommendations taken as reference in each country for the management of hypertension. Step two will assess the variance between individual targets defined by physicians in their practice compared to guidelines and recommendations. Step three is a prospective registry where physicians collect patient data at baseline; determine individual target BP values. Several follow-up visits are proposed to monitor achievement of these targets. Step three of RIAT aims at providing responses to several key objectives. Recruitment is under way aiming at enrolling 33,000 patients. To identify, what is the BP targeted according to the risk factor profile and what are the reasons for not modifying an antihypertensive treatment when BP goals are not reached, and to analyse the type of antihypertensive drugs prescribed according to compelling indications and to assess the percentage of patients reaching target figures.

Antihypertensive Agents↗
PubMed2003

Thermodynamic characterization of yeast triosephosphate isomerase refolding: insights into the interplay between function and stability as reasons for the oligomeric nature of the enzyme.

The reasons underlying the oligomeric nature of some proteins such as triosephosphate isomerase (TIM) are unclear. It has been proposed that this enzyme is an oligomer, mainly because of its stability rather than for functional reasons. To address this issue, the reversible denaturation and renaturation of the homodimeric TIM from baker's yeast ( Saccharomyces cerevisiae ) induced by guanidinium chloride and urea have been characterized by spectroscopic, functional and hydrodynamic techniques. The unfolding and refolding of this enzyme are not coincident after 'conventional' equilibrium times. Unfolding experiments did not reach equilibrium, owing to a very slow dissociation and/or unfolding process. By contrast, equilibrium was reached in the refolding direction. The simplest equilibrium pathway compatible with the obtained data was found to be a three-state process involving an inactive and expanded monomer. The Gibbs energy changes for monomer folding (delta G (0)(fold) = -16.6+/-0.7 kJ x mol(-1)) and monomer association (delta G (0)(assoc) = -70.3+/-1.1 kJ x mol(-1)) were calculated from data obtained in the two denaturants. From an analysis of the present data and data from the literature on the stability of TIM from different species and for other beta/alpha barrels, and model simulations on the effect of stability in the catalytic activity of the enzyme, it is concluded that the low stability of the monomers is neither the only, nor the main, cause for the dimeric nature of TIM. There is interplay between function and stability.

Animals↗
PubMed1999

Reasons for requesting laser removal of unwanted tattoos.

Laser removal of tattoos is not generally or readily available on the National Health Service and removal in privately run clinics is expensive. For those seeking removal of their tattoo this can create significant financial hardship. We investigated the psychological, social and financial impact of tattoos on the lives of those patients requesting laser removal. Sixty-eight patients with a mean age of 36 years participated. Twenty-seven (40%) had one tattoo, whereas eight (12%) possessed 10 or more; 54% had an amateur tattoo. Only 18% had received an explanation of the procedure or side-effects. The mean age at application of the first tattoo was 16 years; 48 (71%) were tattooed below the legal age limit of 18 years. Most tattoos were applied for the sake of fashion. The median duration of regret was 14 years before seeking removal. The main reasons for removal were enhancement of self-esteem and social, domestic and family reasons. In those patients attending for removal, most tattoos are applied impulsively and inexpensively in youth. They are often regretted for decades and create significant psychological, social and financial burdens.

Adult↗
PubMed2003

Reasons for referral and attitudes toward hearing aids: do they affect outcome?

Many patients attending for a hearing aid are not self motivated, but in the majority of cases motivated by a relative. In this study, we have examined whether the reason for referral (self motivated or other) and the attitude toward a hearing aid at assessment affect outcome measures. One hundred and forty first-time hearing aid users were assessed at their initial hearing aid consultation and at review 3 months later. The reason for referral was not found to affect outcome measures. However, attitude towards a hearing aid was found to be significantly related to both satisfaction with it and its use at review. The importance of the attitude toward a hearing aid supports previous work and reiterates the importance of tailoring auditory rehabilitation towards the needs of the individual.

Adult↗
PubMed2001

Qualified nurses' smoking prevalence: their reasons for smoking and desire to quit.

UNLABELLED: AIM AND RATIONALE: The preventable nature of smoking related diseases places a major responsibility for health promotion on all health professionals. This study used a questionnaire to survey qualified nurses in Northern Ireland as to smoking prevalence and their desire to quit the habit. It also explores their knowledge base relating to smoking related diseases and their motivation to act as health promoters with patients who smoke. METHODS: A random sample (n=1074) of qualified nurses employed by the Health and Social Services Trusts, private, and voluntary organizations in the province were surveyed. RESULTS: Results show that 25.8% were smokers, 19% were ex-smokers and 55.2% were nonsmokers. Three quarters expressed a wish to stop within 6-months. Almost all smokers and half of ex-smokers had taken up the habit prior to commencing nursing. 'Addiction' and 'enjoyment' were given as the principle reasons for continued smoking. Health reasons were paramount in smokers' desire to stop smoking. CONCLUSIONS: These findings suggest that smoking prevalence among qualified nurses in no greater than that reported by females in the general Northern Ireland population. Results also indicate that those nurses who smoke were less willing to take on the role of a health promoter with patients who smoke. Implications and recommendations for practice, education and research are explored.

Attitude to Health↗
PubMed1999

Ideas and ideals in medicine: fruits of reason or props of power?

Editors of medical journals play a central role in the promotion -- or suppression -- of ideas and ideals in medicine. Recently eminent among these have been the advocacies of the Evidence-based Medicine (EBM) movement and others concerned with evidence and guidelines for health care. With regard to these topics, it still remains for editors of journals either to advance or to retard even the consolidation of the associated core concepts, most notably those of evidence in medicine, scientific medicine, and rational medicine. I present, first, a case study on the conduct of the editors of three medical journals, specifically their assumption of the role of authority on the scholarly fundamentals of evidence in medicine and their responding to propositions on the topic with commentaries well below the intellectual standards that should prevail in the journals of a learned profession. Then, following a brief review of the Flexnerian and EBM ideas and ideals on the practice of medicine, supplemented by observations drawn from medical sociology and the precepts of the philosophy of science, I posit a way of understanding such behaviour by editors of medical journals. They can have a temptation, and apparently some propensity, to play a regressive role in the development of the fundamentals of medicine. This is prone to occur whenever reason constitutes a threat to power, whether solely to the editors' own or to that of the profession at large. A full realization of the dream of reason in medicine requires an immense integrity of its journal editors and of its other intellectual leaders.

Evidence-Based Medicine↗
PubMed2002

Reasons for poor cataract surgery uptake - a qualitative study in rural South Africa.

OBJECTIVES: To understand the reasons for poor cataract surgery uptake in people with blindness or severe visual impairment in rural South Africa. METHODS: A qualitative analysis of detailed, domiciliary interviews with a community-based random sample of elderly Zulus who were blind or severely visually impaired as a result of operable cataract, who had previously been invited for surgery but had failed to attend. RESULTS: Fear of surgery and a fatalistic attitude to the inevitability and irreversibility of blindness in old age were the main reasons for failure to attend for surgery. There was a lower level of disability and perceived need than had been assumed for people with such poor visual acuity. Non-surgical western style health care for systemic illness was common but few patients had sought any form of assistance for their poor vision. Issues of cost and accessibility were relatively unimportant. CONCLUSION: Provision of affordable and accessible cataract surgery for the blind and severely visually impaired members of a community does not guarantee that it will be taken up. Other barriers to surgery may be revealed when practical issues such as cost and accessibility are addressed. Perceptions of visual disability among subjects with cataract may differ from simple objective clinical standards.

Aged↗
PubMed2003

Testicular-sparing surgery: a reasonable option in selected patients with testicular lesions.

OBJECTIVE: To describe our experience of inguinal exploration in patients who had a reasonable chance of having a benign testicular lesion. PATIENTS AND METHODS: From 1995 to 2002, 11 patients (mean age 43 years, range 27-63) with testicular masses that were suspected to be benign underwent inguinal exploration. RESULTS: In nine of the 11 patients, frozen-section analysis and the final pathological results were similar, and two underwent inguinal orchidectomy. In seven patients the testicle was spared. Finally, because of an uncertain pathological diagnosis and patient age, two patients underwent orchidectomy. CONCLUSIONS: Inguinal exploration and testicular-sparing surgery are reasonable options in patients with peripheral intratesticular lesions, on the basis of preoperative ultrasonographic characteristics, and if there is a possibility of the mass being benign because of age, race, physical examination and tumour markers.

Adult↗
PubMed2002

[Reasons for Hospital Treatment of Psychiatric Patients before and after the Opening of a Satellite Ward].

A satellite ward is a psychiatric ward at a general hospital settled within the catchment area that is administered by a psychiatric hospital. The objective of the satellite model is to approach community treatment on the one hand and somatic medicine on the other hand, consequently diminishing the threshold for hospital treatment. This study investigated whether the diagnostic, psychopathologic and social reasons for admissions changed from this catchment area due to the lower threshold of a satellite ward. The results were controlled with another catchment area's admissions to the 30 km distant psychiatric hospital. The opening of the satellite ward was followed by an 81 % increase of admissions. In particular, admissions of patients with neuroses and personality disorders were more frequent. There was no change of the severity code of psychopathology at admission. From the catchment area of the satellite ward less patients were admitted involuntarily whereas more admissions happened due to social reasons and after patients' own decision.

Adult↗
PubMed2004

Reasons for failure to diagnose colorectal carcinoma at colonoscopy.

BACKGROUND AND STUDY AIMS: Colonoscopy can produce false-negative results, and the reasons for this remain obscure. The aim of this study was to examine why cancers are missed at colonoscopy. PATIENTS AND METHODS: All colonoscopies carried out at Christchurch Hospital, New Zealand, over a 43-month period (1 October 1997 - 30 April 2001) were retrospectively analyzed (the data having been prospectively collected). All cases of colorectal carcinoma during the period 1 October 1997 - 30 July 2001 (3 months longer, to capture delayed diagnoses) were also identified. The two databases were then compared, and all cases in which a colonoscopy had been performed more than 6 weeks before a colorectal carcinoma specimen being received by the pathology department were identified and analyzed. RESULTS: A total of 5055 colonoscopies were undertaken in 4598 patients. Over this period, 630 colorectal carcinomas were identified in the pathology database; 286 of the patients affected were in the colonoscopy and pathology database. Sixty-six patients had had a colonoscopy performed more than 6 weeks before the diagnosis of colorectal carcinoma. Carcinoma was identified in 48 of these 66 patients, and management was being provided. Seventeen cancers (5.9 %) were missed at colonoscopy, and the patients had had an incomplete colonoscopy in nine of these cases. In seven of the 17, an alternative benign cause was recorded. In four patients, a lesion was seen and thought to be benign, although subsequently proven not to be. In another four cases, the cancer was not diagnosed despite adequate bowel preparation and what was thought by the colonoscopist to be an adequate colonoscopy. CONCLUSIONS: Colonoscopy missed 17 of 286 cancers (5.9 %). The reasons why cancers were missed relate to incomplete colonoscopy, poor bowel preparation, misinterpretation of what was seen, failure to carry out adequate biopsy (and follow-up) of lesions seen, and systems failures related to follow-up investigations in patients who had an incomplete colonoscopy. The fact that colonoscopy and barium enema investigations may fail to diagnose cancers has important medicolegal implications. The recognition that colonoscopy may miss a cancer should encourage doctors to reinvestigate patients when there is a lack of correlation between the clinical and investigative findings.

Aged↗
PubMed1988

Adherence to lithium prophylaxis: I. Clinical predictors and patient's reasons for nonadherence.

Of a group of 133 patients given long-term prophylactic lithium treatment, approximately 25 percent discontinued the treatment prematurely within the first six months. Young male patients dominated in the nonadherent group. Clinically the nonadherent patients were characterized by having had an early onset of the illness, a large number of previous hospital admissions and a recent allocation to the diagnostic category of affective disorder. Furthermore, the presence of personality disorders and substance abuses characterized the nonadherent patients. Diagnostic grouping according to polarity did not allow for any distinction between the adherent and nonadherent patients. One half of the nonadherent patients mentioned the development of somatic side effects as their main reason for discontinuing the treatment. Psychological discomfort, such as development of concentration difficulties or impaired memory, was not stated as a reasons for discontinuation. One fourth of the nonadherent patients had their diagnoses, and consequently their treatment, changed by the physician in charge and one fourth neglected instructions and disregarded appointments.

Adult↗
PubMed1979

Paying the physician's fee: Blue Shield and the reasonable charge.

At a time of debate over physicians' fees and income, we describe the evolution of Blue Shield plans and programs to pay physicians' fees. We review how Medicare's "reasonable-charge" formulas fostered Blue Shield "usual, customary, and reasonable" (UCR) contracts. In a three-year period in the Washington, DC, area, Blue Shield UCR protocols permitted "customary" allowances for selected surgical procedures to rise 29 to 75 per cent; charges by two physicians increased allowances for coronary-artery bypass from $2000 to $3500. We find little justification for secrecy in fee-payment protocols. Physicians dominate the District of Columbia Blue Shield Board and its committees, and they control fee-payment formulas. Nationally, 61 per cent of Blue Shield boards have majorities of health-care providers; approximately two thirds of fee-related committees have physician majorities. We urge increased public debate, public representation, and accountability in monitoring and reforming the programs that we describe.

Blue Cross Blue Shield Insurance Plans↗