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PubMed1996

Healing by secondary intention of auricular defects after Mohs surgery.

OBJECTIVE: To evaluate secondary intention healing of full-thickness skin defects of the auricle. Immediate reconstruction of full-thickness skin defects after cancer surgery is an accepted surgical method used to preserve function and to minimize cosmetic deformity. However, healing by secondary intention offers the advantages of optimal cancer surveillance, simplified wound management, and avoidance of reconstructive procedures with their associated costs and potential complications. Accurate prediction of the course of wound healing would allow a rational approach to selection of patients for surgical or nonsurgical repair. DESIGN: We observed 133 patients with full-thickness auricular defects (helix, antihelix, concha, pretragal and tragal area, lobule, and posterior aspect) after Mohs surgery and documented a variety of parameters affecting wound healing, including the location, depth, and size of the wound and use of antibiotics. Patients were examined at intervals and determination was made regarding cosmesis at least 6 months after surgery. RESULTS: All wounds healed by secondary intention within 10 weeks. Analgesics were generally not required. Antibiotics were arbitrarily used in 13% of the patients. Three infections occurred with no permanent disfigurement. CONCLUSIONS: The location of the wound in the auricular subunit is predictive of the cosmetic result. Exposed cartilage is not a contraindication for secondary intention healing. Prophylactic antibiotics are not routinely required when exposed cartilage is present. The results of secondary intention healing are often more cosmetically pleasing than those of surgical repair.

Adult↗

PubMed2001

To be rather than not to be--that is the problem with the questions we ask adolescents about their childbearing intentions.

OBJECTIVE: To demonstrate that rephrasing the questions used to assess childbearing intentions to quantify the strength of the intent to remain nonpregnant, rather than the strength of the intent to become pregnant, would make teenagers' responses more useful to health care providers, family planning counselors, and health policy makers. METHODS: Examples from the teen pregnancy prevention literature are used to support the recommendations for change. RESULTS: Teenagers rarely plan their pregnancies. However, because those who are having sexual intercourse must actively try not to become pregnant or they will likely conceive, teenagers often become pregnant because they lack a firm commitment not to do so. Thus, to accurately profile the antecedents of adolescent pregnancy, (1) the questions used to assess childbearing intentions must be rephrased so that teenagers who intend to remain nonpregnant can be distinguished from those who do not and (2) separate differential diagnoses must be developed for inconsistent contraceptive use within these 2 groups of teenagers who are at risk for unintended pregnancy. CONCLUSION: Asking sexually active teenagers about the strength of their intent to remain nonpregnant will make the results of office interviews and national surveys more useful because the responses such questions elicit will enable health care providers and policy makers to target common, modifiable antecedents of inconsistent contraceptive use for interventions.

Adolescent↗

PubMed2002

Intracranial hemorrhage in children younger than 3 years: prediction of intent.

OBJECTIVE: To determine whether certain computed tomographic imaging patterns in infants and young children with intracranial hemorrhage help predict intentional compared with unintentional injuries. DESIGN: Retrospective consecutive case series over a 10-year period. PATIENTS: Two hundred ninety-three children younger than 3 years with intracranial hemorrhage. MAIN OUTCOME MEASURES: The sensitivity and specificity of computed tomographic imaging patterns for intentional head injury. SETTING: Regional pediatric medical center. RESULTS: Four variables used in the multiple logistic regression analysis for predicting intentional head injury were statistically significant (P<.05): subdural hematoma located over the cerebral convexities, hematoma within the interhemispheric subdural space, hygroma (nonhemic subdural fluid) with intracranial hemorrhage, and absence of a skull fracture with intracranial hemorrhage. The prediction model for the diagnosis of intentional head trauma using combinations of these 4 variables and a.45 probability cutoff point indicated a sensitivity of 84% (95% confidence interval, 78%-90%) and a specificity of 83% (95% confidence interval, 74%-89%). CONCLUSION: Computed tomographic imaging patterns of intracranial hemorrhage in children younger than 3 years help predict whether the injury was intentional.

Age Distribution↗

PubMed1976

Hopelessness, depression, and suicide intent.

One hundred fifty-four suicide attempters, threateners, and psychiatric controls were rated on suicide intent scales and given tests to assess hopelessness, depression and self-rated suicide risk. Ninety-four subjects were retested one month later. Both hopelessness and depression were significantly greater in suicidal subjects. In threatenets, hopelessness and depression scores differed significantly between high and low suicide intent subjects. In attempters ranked by suicide intent at time of testing, more and less suicidal subjects differed significantly in hopelessness and depression scores. Both depression and hopelessness were sensitive to changes in suicide risk during the one-month follow-up. In all analyses, hopelessness correlated more highly with suicide intent than did depression. The data were regarded as supporting the hypothesis that hopelessness is more closely related to suicide intent than is depression.

Depression↗

PubMed1996

Factors associated with intention to undergo annual prostate cancer screening among African American men in Philadelphia.

BACKGROUND: This study assesses whether African American men in Philadelphia are receptive to annual prostate cancer screening. Factors associated with intention to undergo prostate cancer screening are also identified. METHODS: The authors randomly selected 218 African American men from the patient population of a large primary care practice in Philadelphia. The men were 40 to 70 years of age and were available for a telephone survey. Responses to survey items defined by the Preventive Health Model were collected from 154 respondents (71%). Univariate and multivariate analyses of screening intention were performed using survey data on sociodemographic background and medical history; knowledge, attitudes, and beliefs about prostate cancer and screening; social support and influence; and, intention to undergo a screening examination. RESULTS: Overall, 69% of subjects reported that they intended to have annual prostate cancer screening. Logistic regression analyses showed that subject belief in screening efficacy (P=0.0002) were positively and significantly associated with intention to screen. CONCLUSIONS: Findings reported here show that African American men in an urban primary care practice setting are receptive to annual prostate cancer screening and that psychologic and social influence factors are associated with screening intention. The data highlight the need for health care professionals to provide education and advice regarding prostate cancer care to men in this population.

Adult↗

PubMed1999

Explaining women's intentions and use of hormones with menopause.

The purposes of this theoretically-based study were (a) to examine the contributions of psychosocial variables (i.e., affect, beliefs, and norms), habit, and facilitating conditions to explaining women's intentions and use of hormones with menopause and (b) to assess whether clinical or demographic factors explained intentions and use, when controlling for psychosocial, habit, and facilitating conditions variables. In a cross-sectional design, 184 pre-, peri-, and postmenopausal women completed questionnaire measures. To explain intentions, data from 124 participants who were not using hormones were analyzed. To explain use, data from 125 peri- and postmenopausal participants were analyzed. In multivariate analyses, anxiety was associated inversely with use; norms were associated positively with intentions and use. Age was associated inversely with intentions; hot flashes were associated inversely with use. Future researchers can examine the combined influences of affect, beliefs, and norms on decisions about hormones. Clinicians can address anxieties and assess social influences about hormone use, as well as offer ways to deal with hot flashes.

Anxiety↗

PubMed2004

Dressings and topical agents for surgical wounds healing by secondary intention.

BACKGROUND: Many different wound dressings and topical applications are used to cover surgical wounds healing by secondary intention. It is not known whether these dressings heal wounds at different rates. OBJECTIVES: To assess the effectiveness of dressings and topical agents on surgical wounds healing by secondary intention SEARCH STRATEGY: We sought relevant trials from the Cochrane Central Register of Controlled Trials, Cochrane Wounds Group Specialised Trials Register, MEDLINE, EMBASE, and CINAHL databases in March 2002. SELECTION CRITERIA: All randomised controlled trials (RCTs) evaluating the effectiveness of dressings and topical agents for surgical wounds healing by secondary intention. DATA COLLECTION AND ANALYSIS: Eligibility for inclusion was confirmed by two reviewers who independently judged the methodological quality of the trials according to the Dutch Cochrane Centre list of factors relating to internal and external validity. Two reviewers summarised data from eligible studies using a data extraction sheet, any disagreements were referred to a third reviewer. MAIN RESULTS: Fourteen reports of 13 RCTs on dressings or topical agents for postoperative wounds healing by secondary intention were identified. WOUND HEALING: Whilst a single small trial of aloe vera supplementation vs gauze suggests delayed healing with aloe vera, the results of this trial are un interpretable since there was a large differential loss to follow up. A plaster cast applied to an amputation stump accelerated wound healing compared with elastic compression, WMD -25.60 days, 95% CI -49.08 to -2.12 days (1 trial). There were no statistically significant differences in healing for other dressing comparisons (e.g. gauze, foam, alginate; 11 trials). PAIN: Gauze was associated with significantly more pain for patients than other dressings (4 trials). PATIENT SATISFACTION: Patients treated with gauze were less satisfied compared with those receiving alternative dressings (3 trials). COSTS: Gauze is inexpensive but its use is associated with the use of significantly more nursing time than foam (2 trials). LENGTH OF HOSPITAL STAY: Four trials showed no difference in length of hospital stay. One trial found shorter hospital stay in people after amputation when plaster casts were applied compared with elastic compression (WMD -30.10 days; 95% CI -49.82 to -10.38). REVIEWERS' CONCLUSIONS: We found only small, poor quality trials; the evidence is therefore insufficient to determine whether the choice of dressing or topical agent affects the healing of surgical wounds healing by secondary intention. Foam is best studied as an alternative for gauze and appears to be preferable as to pain reduction, patient satisfaction and nursing time.

Bandages↗

PubMed1992

Application of the Health Belief Model in a study on parents' intentions to utilize prenatal diagnosis of cleft lip and/or palate.

Parents of children with cleft lip and/or palate (42 women and 35 men) participated in a study on intentions to use prenatal diagnosis of cleft by ultrasound in subsequent pregnancies. Based on the Health Belief Model (HBM) [Rosenstock, 1974], parents' cognitions on 4 factors were measured by questionnaires: "susceptibility" and "severity perceptions," "benefits" and "barriers" evaluations. Most parents perceived the defect as severe. Over-estimation of recurrence risks was predominant even among parents who had received genetic counseling. Results showed that most parents intend to utilize prenatal diagnosis but do not intend to abort an affected fetus. Subjects' reported reasons represented 3 thematic categories: cognitive (the need to know), emotional, and behavioral. Parents' intentions to diagnose and to terminate were related to the factors predicted by the HBM model. Regression analyses indicated that 38% of the variance in intentions to diagnose and 56% of the variance in intentions to terminate could be explained by the studied variables. The best predictor of both intentions was the perceived benefits of the diagnosis. Implications of these findings for genetic counseling are discussed.

Abortion, Therapeutic↗

PubMed1996

Developmental Accounts of Intentionality: Toward Integration

A variety of developmental accounts of intentionality, arising from disparate theoretical perspectives, can now be found in the literature. This paper argues that this diversity is undermining the ability of developmental psychologists to construct a coherent developmental account of the capacity and that it would be more productive to pursue an integrated approach. To this end, the dominant theoretical positions on the development of intentionality are reviewed and evaluated: intentionality as goal-directedness, a result of parental scaffolding, an innate capacity for intersubjectivity, and behavioral object-directedness. Particular attention is given to comparing three key features of each position: the definition of intentionality adopted, the types of behaviors considered to be evidence of intentionality, and the proposed developmental sequence. The possibility of constructing an integrated approach based on these components is explored.

Journal Article↗

PubMed1997

Late adolescent risk-taking: effects of perceived benefits and perceived risks on behavioral intentions and behavioral change.

To assess the predictive utility of perceived benefits and risks of risk-taking behaviors (RTBs) on behavioral intentions and behavioral change, data were collected from 187 male and female late adolescent college students (ages 17-20). Perceived benefits, perceived risks, behavioral intentions, and involvement for 18 RTBs were assessed at T1 and T2 (3 months later). Factor analyses were performed on T1 involvement data, and six RTB factors emerged: Alcohol RTBs, Illegal Drug RTBs, Stereotypic Male RTBs, Social RTBs, Sex RTBs, and Imprudent RTBs. Regression analyses indicated that perceived benefits accounted for significant variance in behavioral intentions for each of the six factors and Overall RTB; perceived risks accounted for significant variance in behavioral intentions for five of the factors. Similar regression analyses indicated that perceived benefits accounted for significant variance in behavior change (over a 3 month period) for each of the six factors and the Overall RTB score, whereas perceived risks accounted for significant variance for only one factor (Illegal Drug RTBs). The result suggest that, among late adolescents, perceived benefits are better determinants of behavior change for RTBs than are perceived risks. Both perceived benefits and perceived risks, however, are important determinants of behavioral intentions. These findings support previous work identifying adolescents as "sensation seekers". Interventions should address perceived benefits of RTB, rather than relying solely on promoting knowledge of the risks. Assessment of adolescent RTB should continue to use multi-item measures to obtain a broad picture of the variety of behaviors commonly endorsed by adolescents.

Adaptation, Psychological↗

PubMedDate not supplied

Intention to screen for colorectal cancer among white male employees.

BACKGROUND: This study identifies factors associated with employee intention to participate in a company-sponsored program of continuous screening for colorectal cancer. Automobile industry pattern and model makers who had been offered screening for over a decade were included in the study. METHODS: Data were collected at the outset of a randomized trial of screening and nutrition interventions. A baseline survey was mailed to 4,490 white men without a history of colorectal cancer. This mailing generated complete responses from 2,693 (60%) individuals. Survey data obtained for these men, including measures of cognitive and psychological representations related to colorectal screening, social influence, and intention to screen, were supplemented by background information gathered from employment records of these men. Workplace screening services were documented via a survey of plant health care professionals. RESULTS: Fifty-eight percent of respondents reported a high level of intention to screen. Multivariate analyses showed that intention to screen was positively associated with employee past participation in screening, belief in the salience and coherence of screening, belief in screening efficacy, perceived self-efficacy, belief that polyp removal prevents colorectal cancer, perceived personal susceptibility to colorectal cancer or polyps, receptivity to family member support for screening, and workplace scheduling of screening examinations. CONCLUSIONS: Factors associated with intention to screen may contribute to participation in continuous screening programs. Research is needed to assess the impact of interventions that facilitate appointment scheduling, provide tailored education about screening, and encourage lay support.

Adult↗

PubMed2004

Intention-based and stimulus-based mechanisms in action selection.

Human actions can be classified as being either more stimulus-based or more intention-based. According to the ideomotor framework of action control, intention-based actions primarily refer to anticipated action effects (in other words response-stimulus [R-S] bindings), whereas stimulus-based actions are commonly assumed to be more strongly determined by stimulus-response [S-R] bindings. We explored differences in the functional signatures of both modes of action control in a temporal bisection task. Participants either performed a choice response by pressing one out of two keys in response to a preceding stimulus (stimulus-based action), or pressed one out of two keys to produce the next stimulus (intention-based action). In line with the ideomotor framework, we found intention-based actions to be shifted in time towards their anticipated effects (the next stimulus), whereas stimulus-based actions were shifted towards their preceding stimulus. Event-related potentials (ERPs) in the EEG revealed marked differences in action preparation for the two tasks. The data as a whole provide converging evidence for functional differences in the selection of motor actions as a function of their triggering conditions, and support the notion of two different modes of action selection, one being exogenous or mainly stimulus-driven, the other being endogenous or mainly intention-driven.

Adult↗

PubMedDate not supplied

Prediction of suicide intent in hospitalized parasuicides: reasons for living, hopelessness, and depression.

This study examined the risk prediction efficiency of the Reasons for Living Inventory Survival and Coping Beliefs Scale, Beck Hopelessness Scale, Beck Depression Inventory, and the Life Experiences Survey with a sample of 51 newly hospitalized parasuicides. The index of suicidal potential chosen for this study was suicide intent as measured by Beck's Suicide Intent Scale. Regression analyses indicated that the Survival and Coping Beliefs Scale emerged as the single most important predictor of suicide intent. Hopelessness and depression made secondary and nonsignificant contributions. Hopelessness was a significant predictor of suicide intent when analyzed apart from Survival and Coping Beliefs, but not among a subsample of 43 repeat parasuicides. Classification analyses showed that neither hopelessness nor survival and coping beliefs were accurate at classifying low- or high-intent parasuicides. Factors contributing to the efficacy of survival and coping beliefs as a risk prediction index are discussed, as is the false-negative dilemma in suicide risk assessment and prediction.

Adaptation, Psychological↗

PubMed1991

Prescription intentions in relation to therapeutic information: a study of 117 French general practitioners.

In 1987 we conducted a mailed questionnaire survey involving 250 GPs, randomly drawn from the 3061 GPs in the 'Rhône-Alpes' region in France, in order to study how general practitioners (GPs) react to information about drugs in terms of their prescribing practices. The aim of the questionnaire was to investigate the GPs reactions (prescription intentions) to 25 statements containing information concerning drugs. These included results from randomized clinical trials with adequate clinical criteria (pertinent information), but there were also some statements containing non-relevant information such as intermediate criteria, physiopathological or pharmacological information, and some containing general information such as advice from colleagues, the established position of the drug etc. The GPs were also asked through which channels they commonly received therapeutic information (i.e. medical journals, conferences). A total of 117 GPs returned completed questionnaires. We found the prescription intentions, for pertinent information to be between 76.9% and 95.7%, whilst the intentions, as a result of personal knowledge and/or success with a drug were around 93%. More theoretical information resulted in prescription intentions which were more widely scattered (between 23.1% and 80.3%), and for external advice the intentions were not as high but they were also widely scattered (between 3.4% and 65%). The search for latent dimensions corresponding to GPs reactions to therapeutic information, with both principal component analysis and Rasch Modelling, showed that two orthogonal latent dimensions, i.e. 'sensitivity to clinical and theoretical information', and 'sensitivity to external standards', best explained the responses to the questionnaire. These two dimensions appeared to be independent of age, sex, medical school and type of practice (urban, rural). The use of the journal 'Prescrire' by GPs was found to be significantly associated (P less than 0.005) with low scores, or good quality of perception of pertinent information in the first dimension. The use of specialists' prescriptions was associated with similar scores for the first dimension, but also with poor quality of perception of pertinent information scores (i.e. high scores) for the second dimension. These results could be used to draw up proposals for the improvement of post-graduate medical education, which should take into consideration these two dimensions of therapeutic information assessment by doctors, in order to obtain better quality of perception profiles for information assessment and prescription by doctors.

Adult↗

PubMed1995

Factors affecting pediatric residents' intentions to screen for high risk behaviors.

PURPOSE: To determine the factors associated with the intentions of pediatric residents to: 1) screen adolescents for high risk behaviors using the Guidelines for Adolescent Preventive Services (GAPS) and 2) to record the results in the medical record. METHODS: 64 pediatric residents at a university children's hospital were given seven scenarios and were asked to rate on a five point Likert scale (1 = always, 5 = never) the likelihood that they would ask and document adolescent patient responses about sexual activity/birth control, alcohol/drug use, depression/suicidal ideation, fighting/coping with anger, and nutrition/eating disorders. The association of patient-related factors (e.g., gender, presenting symptom, medical setting, known private provider, and presence of a chronic illness) and resident-related factors (e.g. gender, post graduate level, future plans, and a prior adolescent rotation) on intentions to screen was determined using analysis of variance for ranked data. RESULTS: Residents indicated they were most likely to ask adolescents about sexual activity (mean Likert = 2.6, median Likert = 2, range 1-5) (P=0.014). Residents were more likely to screen for substance use (2.8, 3, 1-5) than nutritional issues (3.5, 4, 1-5) (P < or = 0.0001), and were least likely to ask about depression (3.8, 4, 1-5) and fighting (3.9, 4, 1-5) (P < or = 0.0001). Although residents reported that they were likely to record screening results in the medical record (median Likert score = 1), they noted the most common reasons for not recording to be fear that parents would see the record, lack of time, and the feeling that negative responses to screening need not be recorded. The patient-related factors that significantly affected residents' intentions to screen included: presenting symptom, medical setting, and the presence of a chronic illness (P < or = 0.05). Female gender of the patient increased only the likelihood of nutrition screening. Male residents reported a greater intention to screen for depression (P = 0.046). Post-graduate level and a prior adolescent rotation influenced the intention to screen for most behaviors. CONCLUSIONS: This study found that residents are more likely to indicate that they would screen for sexual activity and substance use than for nutritional disorders, depression, and fighting. Several patient-related and resident-related factors influence the likelihood of residents to screen for various high risk behaviors. Educational efforts are needed to increase residents' screening for high risk behaviors.

Adolescent↗

PubMed1994

Beliefs about condoms and their association with intentions to use condoms among youths in detention.

PURPOSE: Youths in detention have been identified as a high-risk group for AIDS. To help inform AIDS-prevention efforts targeted for these youths, we surveyed youths in detention regarding their sexual behaviors, beliefs about condoms, intentions to use condoms, and actual condom use. We examined race and gender differences in these beliefs and behaviors, and we studied the relationship of these beliefs to condom-use intentions. METHODS: Questionnaires were administered to a sample of 201 youths in detention who were, on average, 16 years old. The sample was stratified on gender and race (African-American and white), with approximately equal numbers in each group. RESULTS: The results indicate that these youths had engaged in behaviors that put them at high risk of acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases. Although they used condoms somewhat more consistently with casual partners than with their steady partners, the majority did not use condoms consistently with either partner type. Very few race or gender differences were found with regard to condom use, intentions to use condoms, or beliefs about the consequences of using condoms. Beliefs associated with intentions to use condoms with steady partners included protection against sexually transmitted diseases (STDs), and the beliefs that condoms reduce pleasure, are artificial, unromantic, and interrupt sex. In contrast, only the belief that condoms prevent pregnancy was related to intentions to use condoms with casual partners. CONCLUSION: The results suggest that interventions targeted at African-American and white males and females in detention need not differ greatly in content as long as they include the most salient concerns of each group; that interventions include content on the two protective benefits of condom use (pregnancy and STD prevention), as well as on how to minimize the perceived negative aspects of condom use; that they stress the need for condom use with steady as well as casual partners; and that they stress that anal intercourse is especially risky with regard to AIDS transmission.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Dropout rates for intent-to-treat and per protocol analyses.

PURPOSE: To describe dropout rates for the intent-to-treat and per protocol analyses from prospective clinical trials. METHODS: Review of prospective multi-center parallel studies of 100 patients or more from 1996 onwards. RESULTS: We identified 33 articles (70 treatment arms) that fit the criteria for this study. No statistical differences in dropout rates were observed among drug classes for either the intent-to-treat (P =.075) or per protocol analyses (P =.40). A difference was observed in the percent dropout rate for the intent-to-treat analyses decreasing with the length of the study (P <.0001). This finding was not observed by the number of study visits (P =.44). However, a statistically greater percent dropout rate was observed for the per protocol analyses increasing with the length of the study (P =.034) and number of study visits (P =.01). No statistical differences were observed or with increasing sample size of the study for either the intent-to-treat or per protocol analyses (P >.05). CONCLUSIONS: Known discontinuation rates for per protocol and intent-to-treat analyses may help in planning sample sizes for future clinical trials.

Antihypertensive Agents↗

PubMed2004

Intentional burn injury: an evidence-based, clinical and forensic review.

Burn injury can be inflicted intentionally either by one person to another whenever one has the ability to physically control the other, or it can be self-inflicted. There is scant evidential basis for much that is written about and practiced in the evaluation and care of patients that have sustained intentional burn injuries. Yet this is an area in which medical personnel must necessarily be trained in both the therapeutic and forensic aspects of a complex problem. Failure to appreciate the complexity of medical and forensic interactions may have far reaching effects. A missed diagnosis can result in inappropriate medical care, on-going abuse and future fatality. Inept management can result on the one hand, in blame levelled inappropriately placing incomparable strain on family units and innocent parties, and on the other, allow abusers to continue unchecked. This is the first review on the subject in which lawyers and doctors collaborate to produce a holistic approach to this subject. In it we describe the legal considerations that medical staff must appreciate when approaching patients who may have suffered intentional burns. We analyse the various scenarios in which intentional burning can be found and challenge the clinical dogma with much of the management of paediatric inflicted burns has become imbued. We suggest a rational and balanced approach to all intentional burn injuries-especially when children are involved. In the light of current case law in which dogmatic medical evidence has been implicated in wrongful convictions for child abuse in the UK, it is imperative that medical professionals gather evidence carefully and completely and apply it with logic and impartiality. This paper will aid clinicians who may not be experienced in dealing with burn injuries, but find themselves in the position of seeing a burn acutely, to avoid common mistakes.

Adult↗