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PubMed1999

Impact of physicians' perceptions of malpractice and adaptive changes on intention to cease obstetrical practice.

Physicians who provide obstetrical care in rural areas face exposure to liability action and confront a critical decision--whether to continue to offer these services. This paper draws upon social-psychological and decision theories to investigate this decision. Ninety-four percent of all obstetricians and family and general physicians practicing in the 12 nonmetropolitan counties of one state responded to a mail survey that asked about their intention to continue or discontinue obstetrical practice, two dimensions of subjective risk (perceived likelihood of threats in the malpractice environment and perceived magnitude of negative consequences from being sued), and adaptive changes to protect against malpractice. The results suggest that (a) perceived extent of negative consequences (but not perceived likelihood of malpractice threats) drives intention to leave obstetrics, (b) the professional and reputational impacts of a suit--not the dollar amount of award or settlement--predicts intention to stop practicing obstetrics, and (c) physicians planning to continue providing obstetrical care in the future have made recent practice changes that may further exacerbate access problems.

Adult↗

PubMed1986

Attitudes and normative beliefs as predictors of smoking intentions and behaviours: a test of three models.

This paper considers three potentially important modifications to the theory of reasoned action (Fishbein, 1980). It was hypothesized that behavioural norms, or beliefs about the behaviours of others, are important influences above and beyond subjective norms; the effects of attitudes and normative beliefs on intentions and behaviours are interdependent and interactive rather than additive; and the beliefs underlying subjective and behavioural norms are multidimensional rather than unidimensional. These hypotheses were tested in two surveys of smoking intentions and behaviour. The respondents in the first study were primary school children and those in the second study were college students. In both cases behavioural norms and the attitude-normative belief interactions led to significant increases in the prediction of smoking intentions and behaviour. Exploratory factor analyses also suggested that the beliefs underlying subjective norms may be multidimensional rather than unidimensional. These results thus support the hypotheses and suggest that the theory of reasoned action should be modified accordingly.

Adolescent↗

PubMed2002

Socioeconomic differences in injury risks in childhood and adolescence: a nation-wide study of intentional and unintentional injuries in Sweden.

STUDY OBJECTIVE: To measure socioeconomic differences in injuries among different age groups of children and adolescents. SUBJECTS: Children under 20 living in Sweden between 1990 and 1994 (about 2.6 million). METHOD: A cross sectional study based on record linkage between 15 Swedish national registers. Children were divided into four age groups and allocated to four household socioeconomic status groups. Absolute and relative risks were compiled using children of high/intermediate level salaried employees as the comparison group. Four diagnostic groups were considered: fall, traffic, interpersonal violence, and self inflicted injuries. RESULTS: Injury incidences were relatively low and socioeconomic differences negligible in the 0-4 year olds. Thereafter, significant socioeconomic differences were observed in all diagnostic groups except falls. The highest absolute differences were in traffic injuries, especially among 15-19 year olds, and in self inflicted injuries among 15-19 year old girls. Relative differences were highest in both categories of intentional injuries for the age group 10-14. Social circumstances in the household other than family socioeconomic status affected the social pattern of intentional but not that of unintentional injuries. CONCLUSIONS: Socioeconomic differences in injury risks are not necessarily constant over age. Inequalities are particularly high in absolute terms among adolescents 15-19 years old for traffic injuries and in relative terms among 10-14 year olds for intentional injuries.

Accidental Falls↗

PubMed2001

Conflict of intentions due to callosal disconnection.

OBJECTIVES: Three patients with callosal syndrome manifested a peculiar symptom in that they were unable to perform intended whole body actions because another intention emerged in competition with the original one. Attempts were made to clarify the symptomatology of this manifestation and its possible mechanism is discussed. METHODS: The three patients are described and previous reports on patients with callosal damage were reviewed. Four additional patients with similar symptoms were found and the clinical features common to all seven patients were examined. RESULTS: This symptom could not be attributed to unilateral movement disorders such as unilateral apraxia, intermanual conflict, or compulsive manipulation of tools. The manifestations included marked hesitation in initiating actions, interruption of actions, repetitive actions, and performance of unintended actions with difficulty in correcting them. All patients, except one, had a lesion in the posterior half of the body of the corpus callosum, and there was no significant involvement of the cerebral cortex. The symptom became manifest later than 4 weeks after callosal damage. It occurred during spontaneous actions, but not during well automated actions nor when following instructions. CONCLUSION: This symptom, tentatively named "conflict of intentions", can be regarded as a fragment of diagonistic dyspraxia originally described by Akelaitis, although it can occur independently of intermanual conflict. Normally, the right and left cerebral hemispheres may be complementarily modifying automated whole body actions in order to adapt behaviour to changes of the environment as well as to the intention. Partial callosal disconnection without significant cortical involvement would exaggerate the disparity between the role of each hemisphere through the reorganisation of neural systems after callosal damage. Such double, often contrary, behavioural tendencies may sometimes simultaneously enter the patient's awareness.

Adult↗

PubMed2004

Out of the Smokescreen: does an anti-smoking advertisement affect young women's perception of smoking in movies and their intention to smoke?

OBJECTIVE: To evaluate the effect of an anti-smoking advertisement on young women's perceptions of smoking in movies and their intention to smoke. SUBJECTS/ SETTING: 2038 females aged 12-17 years attending cinemas in New South Wales, Australia. DESIGN/ INTERVENTION: Quasi-experimental study of patrons, who were surveyed after having viewed a movie at their local cinema. The control group was surveyed during week 1 and the intervention group, during week 2. Before seeing the movie in week 2, a 30 second anti-smoking advertisement was shown, which featured a well known female actor drawing attention to the prevalence of smoking in movies. OUTCOMES: Attitude of current smokers and non-smokers to smoking in the movies; intention of current smokers and non-smokers to be smoking in 12 months time. RESULTS: Among non-smokers, 48.2% of the intervention subjects thought that the smoking in the movie they viewed was "not OK" compared with 28.3% of the control subjects (p < 0.0001). However, there was no difference among smokers in the intervention (26.4%) and control (16.9%) groups (p = 0.28). A higher percentage of current smokers in the intervention group indicated they were unlikely to smoke in 12 months time (47.8%) than smokers in the control condition (31.9%) (p = 0.03). For non-smokers, there was no difference in smoking intentions between conditions, with 95% saying they would be unlikely to be smoking in 12 months time. CONCLUSIONS: This "real world" study suggests that placing an anti-smoking advertisement before movies containing smoking scenes can help to "immunise" young women against the influences of film stars smoking.

Adolescent↗

PubMed2002

Single-neuron analysis of human thalamus in patients with intention tremor and other clinical signs of cerebellar disease.

Tremor that occurs as a result of a cerebellar lesion, cerebellar tremor, is characteristically an intention tremor. Thalamic activity may be related to cerebellar tremor because transmission of some cerebellar efferent signals occurs via the thalamus and cortex to the periphery. We have now studied thalamic neuronal activity in a cerebellar relay nucleus (ventral intermediate-Vim) and a pallidal relay nucleus (ventralis oral posterior-Vop) during thalamotomy in patients with intention tremor and other clinical signs of cerebellar disease (tremor patients). The activity of single neurons and the simultaneous electromyographic (EMG) activity of the contralateral upper extremity in tremor patients performing a pointing task were analyzed by spectral cross-correlation analysis. EMG spectra during intention tremor often showed peaks of activity in the tremor-frequency range (1.9-5.8 Hz). There were significant differences in thalamic neuronal activity between tremor patients and controls. Neurons in Vim and Vop had significantly lower firing rates in tremor patients than in patients undergoing thalamic surgery for pain (pain controls). Other studies have shown that inputs to Vim from the cerebellum are transmitted through excitatory connections. Therefore the present results suggest that tremor in these tremor patients is associated with deafferentation of the thalamus from cerebellar efferent pathways. The thalamic X EMG cross-correlation functions were studied for cells located in Vim and Vop. Neuronal and EMG activity were as likely to be significantly correlated for cells in Vim as for those in Vop. Cells in Vim were more likely to have a phase lag relative to EMG than were cells in Vop. In monkeys, cells in the cerebellar relay nucleus of the thalamus, corresponding to Vim, are reported to lead movement during active oscillations at the wrist. In view of these monkey studies, the present results suggest that cells in Vim are deafferented and have a phase lag relative to tremor that is not found in normal active oscillations. The difference in phase of thalamic spike X EMG activity between Vim and Vop may contribute to tremor because lesions of pallidum or Vop are reported to relieve cerebellar tremor.

Action Potentials↗

PubMed1996

Motor intention activity in the macaque's lateral intraparietal area. II. Changes of motor plan.

1. In the companion paper we reported that the predominant signal of the population of neurons in the lateral intraparietal area (area LIP) of the monkey's posterior parietal cortex (PPC) encode the next intended saccadic eye movement during the delay period of a memory-saccade task. This result predicts that, should be monkey change his intention of what the next saccade will be, LIP activity should change accordingly to reflect the new plan. We tested this prediction by training monkeys to change their saccadic plan on command and recording the activity of LIP neurons across plan changes. 2. We trained rhesus monkeys (Macaca mulatta) to maintain fixation on a light spot as long as this spot remained on. During this period we briefly presented one, two, or three peripheral visual stimuli in sequence, each followed by a delay (memory period, M). After the final delay the fixation spot was extinguished, and the monkey had to quickly make a saccade to the location of the last target to have appeared. The monkey could not predict which stimuli, nor how many, would appear on each trial. He thus had to plan a saccade to each stimulus as it appeared and change his saccade plan whenever a stimulus appeared at a different location. 3. We recorded the M period activity of 81 area LIP neurons (from 3 hemispheres of 2 monkeys) in this task. We predicted that, if a neuron's activity reflected the monkey's planned saccade, its activity should be high while the monkey planned a saccade in the neuron's motor field (MF), and low while the planned saccade was in the opposite direction. The activity of most of the neurons in our sample changed in accordance with our hypothesis as the monkey's planned saccade changed. 4. In one condition the monkey was instructed by visual stimuli to change his plan from a saccade in the neuron's preferred direction to a saccade planned in the opposite direction. In this condition activity decreased significantly (P < 0.05) in 65 (80%) of 81 neurons tested. These neurons' activity changed to reflect the new saccade plan even though the cue for this change was not presented in their RF. 5. As a control we randomly interleaved, among trials requiring a plan change, trials in which the monkey had to formulate two consecutive plans to make a saccade in the neuron's preferred direction. The activity remained unchanged (P < 0.05) in 22 of 31 neurons tested (79%), indicating that the neurons continued to encode the same saccade plan. 6. In a variant of the task, the cue to the location of the required saccade was either a light spot or a noise burst from a loudspeaker. Of 22 neurons tested in this task, 16 (73%) showed activity changes consistent with plan changes cued by visual or auditory stimuli. 7. Alterations in the monkey's intentions, even in the absence of overt behavior, are manifested in altered LIP activity. These activity changes could be induced whether visual or auditory cues were used to indicate the required plan changes. Most LIP neurons thus do not encode only the locations of visual stimuli, but also the intention to direct gaze to specific locations, independently of whether a gaze shift actually occurs.

Acoustic Stimulation↗

PubMedDate not supplied

Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care.

AIMS: The study examined how prenatal screening tests are presented to women, factors associated with women's participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. METHODS: Questionnaires were given to pregnant women visiting maternity centres in two Finnish towns in which serum screening was offered (n = 1,035) and in one town where midtrimester ultrasound screening was offered (n = 497). Response rates to the questionnaires were 88 and 85%, respectively. Other questionnaires asking about selective terminations following detected fetal disorders were sent in 1993 to all public hospitals with obstetrics or gynaecology departments (response rate 100%). RESULTS: The serum screening test had usually been offered to women as a free choice, but for 22% of them it was presented as a routine procedure. Most women (92%) underwent serum screening and most (86%) found the decision to participate or not easy. In almost every aspect of presentation and participation studied, serum and ultrasound screening differed from each other. 85% of respondents to ultrasound screening answered that it was offered as a routine procedure. Close acquaintance with a person with congenital disability was negatively associated with participation in serum screening and with the intention to terminate pregnancy in case of a detected disability. 27% of women in the serum screening survey and 22% in the ultrasound survey declared that they would have declined pregnancy termination if a fetal disorder had been detected. However, according to the hospitals' data, only 13% of pregnancies with a serious fetal disorder detected were continued. CONCLUSIONS: All prenatal screening tests, including ultrasound examinations, require an adequate process of informed consent. Because the aim of such tests is to detect fetal malformations and syndromes, health care professionals should discuss the implications with women before they decide. Because acquaintance with a disabled person was found to associate with participation in screening and with intentions about selective termination, women's perceptions of lives of the disabled should receive more attention in future studies.

Abortion, Induced↗

PubMed2002

Components of switching intentional set.

Despite the intuition that we can shift cognitive set on instruction, some behavioral studies have suggested that set shifting might only be accomplished once we engage in performance of the new task. It is possible that set switching consists of more than one component cognitive process and that the component processes might segregated in time. We recorded event-related potentials (ERPs) during two set-switching tasks to test whether different component processes were responsible for (i) set initiation and reconfiguration when presented with the instruction to switch, and (ii) the implementation of the new set once subjects engaged in performing the new task. The response switching (RS) task required shifts of intentional set; subjects selected between responses according to one of two conflicting intentional sets. The results demonstrated the existence of more than one constituent process. Some of the processes were linked to the initiation and reconfiguration of the set prior to actual performance of the new task. Other processes were time locked to performance of new task items. Set initiation started with modulation of medial frontal ERPs and was followed by modulation over parietal electrodes. Implementation of intentional set was associated with modulation of response-related ERPs.

Adult↗

PubMed1995

The last appointment before suicide: is suicide intent communicated?

OBJECTIVE: The authors' goal was to determine whether people who committed suicide within 4 weeks after having made contact with a health care professional communicated their intent to commit suicide during that final contact. METHOD: Using data from a nationwide psychological autopsy study of all suicides in Finland that occurred in 1 year, the authors examined the 571 cases of suicide victims whose last appointment with a health care professional took place up to 28 days before suicide, including 100 cases of victims who had appointments on the day of suicide. RESULTS: Suicide intent was reportedly discussed in only 22% of the cases; it was particularly uncommon in general practice and nonpsychiatric specialist settings. CONCLUSIONS: The majority of patients who commit suicide do not seem to communicate their intent to do so during their last appointment.

Adolescent↗

PubMed2005

Relief of expressed suicidal intent by ECT: a consortium for research in ECT study.

OBJECTIVE: This study assessed the incidence, severity, and course of expressed suicidal intent in depressed patients who were treated with ECT. The data are from the first phase of an ongoing, collaborative multicenter study, the overall aim of which was to compare continuation ECT with pharmacotherapy in the prevention of relapse after a successful course of ECT. METHOD: Suicidal intent, as expressed by patients during an interview, was scored at baseline and before each ECT session with item 3 on the 24-item Hamilton Depression Rating Scale in 444 patients with unipolar depression. RESULTS: One hundred thirty-one patients (29.5%) reported suicidal thoughts and acts (score of 3 or 4) at baseline. Scores decreased to 0 after 1 week (three ECT sessions) in 38.2% of the patients, after 2 weeks (six ECT sessions) in 61.1%, and in 80.9% at the end of the course of treatment. CONCLUSIONS: Expressed suicidal intent in depressed patients was rapidly relieved with ECT. Evidence-based treatment algorithms for major depressive mood disorders should include dichotomization according to suicide risk, as assessed by interview. For patients at risk, ECT should be considered earlier than at its conventional "last resort" position.

Adult↗

PubMed2000

Informed consent and neuroanatomic correlates of intentionality and voluntariness among psychiatric patients.

The authors examine the less-studied components of patients' autonomous decision making, or decisional autonomy, in the light of current research in psychiatry and neuropsychology and developments in the construct of informed consent. The three components of decisional autonomy-understanding, intentionality, and noncontrol or voluntariness-are related to clinical constructs in psychiatry and neuropsychology, in particular to executive control functions. The authors review studies that examine deficits in prefrontal cerebral function in schizophrenia, depression, and some anxiety disorders that are related to intentionality and voluntariness. Assessment of decisional autonomy should encompass evaluation of impaired intentionality and voluntariness, not simply impaired understanding. The main response to finding such impairments should be to provide treatment to ameliorate them. New strategies for psychiatric care should be developed to address the clinical challenges of an increasingly complex view of decisional autonomy.

Anxiety Disorders↗

PubMed2001

Factors affecting psychiatric nurses' intention to leave their current job.

Using the National Institute for Occupational Safety and Health job stress questionnaire, the authors examined psychiatric nurses' intention to leave their job in relation to their perceived risk of assault, their job satisfaction, and their supervisory support. Respondents were 1,494 nurses (response rate, 76.5 percent) employed in 27 psychiatric hospitals in Japan. Forty-four percent reported intention to leave their job, and 89 percent of those perceived a risk of assault. Younger age, fewer previous job changes, less supervisory support, lower job satisfaction, and more perceived risk of assault were significant predictors of intention to leave. Organizational efforts are necessary to retain frontline professional staff.

Adult↗

PubMed1985

Identity theory, functionalism and intentionality: three modes of psychological explanation used in psychiatry.

It is argued that there are three modes of psychological explanation that are available and in wide use, but that the three are often unwittingly confounded. These are, identity theory, functionalism and intentionality. Identity theory explains by viewing psychological events as direct products of design, that is, manifestations of brain events. The stance of functionalism is to study psychological events and those past and current stimuli that evoke them. In other words, functionalism studies the way in which psychological events are programmed. Intentionality approaches psychic events as a product of both conscious and unconscious purposes, beliefs, wishes, reasons and meanings, and concludes that it is of considerable worth to treat persons as intentional systems. It is claimed that the demarcation between these explanatory modes is crucial in psychiatric, and especially psychotherapeutic practice and research.

Psychoanalytic Theory↗

PubMed1986

Motives and intent: a comparison of views of overdose patients and their key relatives/friends.

The purpose of the study was to compare the perceptions of patients with those of key relatives or friends as regards motives for self-poisoning and intent to die, in ninety-eight overdose cases. Patients admitted to the accident and emergency department of a district general hospital in the county of Warwickshire, England, were interviewed following their recovery. Their key relatives/friends were also interviewed concerning their views of the emergency. Analysis of the responses of patients and key persons indicated that there was a significant association between the perceptions of the two classes of subjects as regards selection of escape/relief motives, warning prior to the attempt and intention to die. There was also a significant association between patient and relative perceptions of suicidal intent and relief at being alive. The implication of these findings as regards follow-up therapy is discussed.

Adult↗

PubMed2005

Country of origin and race/ethnicity: impact on breastfeeding intentions.

This article reports on breastfeeding intentions of Hispanic and black women by country of origin (continental US born or foreign born) in a low-income population that has experienced demographic shifts. Data were derived from prenatal interviews with 382 women from 2 community clinics. Primary outcome measures were intentions to formula feed, breastfeed, or formula and breastfeed. Foreign-born women were significantly more likely to intend to only breastfeed (42% vs 24% for continental US born, P < .05). In multivariate analyses, country of origin and having breastfed a previous child were the only significant predictors of breastfeeding intention. In contrast to previous work, black (non-Hispanic) and Hispanic women's breastfeeding plans were similar. This finding coincides with dramatic increases in the numbers of blacks from West Indian countries-where breastfeeding is the norm-in the study locale.

Adult↗

PubMed2006

Promoting smoking cessation among the elderly: what are the predictors of intention to quit and successful quitting?

PURPOSE: To assess the predictors of smoking cessation and intention to quit among the Chinese elderly smokers. DESIGN: A cross-sectional survey of elderly smokers. SETTING: Shamsuipo district, Hong Kong. SUBJECT: A total of 1,318 elderly were interviewed (response rate = 83%). MEASURES: A structured questionnaire was used for data collection. The questionnaire sought information on the subject's sociodemographic background and smoking habits. The predictors for successful quitting and intention to quit were assessed by chi-square tests and multiple logistic regression. RESULTS: Of the respondents, 20.2% were current smokers, 25.4% were ex-smokers, and 54.4% were never smokers. Of the smoker (current and ex-smokers) respondents, 55.7% (335/601) had successfully quit at the time of enumeration. The predictors of quitting were living with others, receiving assistance for mobility, being nondrinkers, smoking for shorter duration, and smoking more cigarettes per day. Having health problems in the past, smoking for shorter duration, and smoking fewer cigarettes per day were predictors of intention to quit smoking. CONCLUSION: The study identified several predictors of successful quitting that could help improve the provision of current smoking cessation services. Population-based smoking cessation programs, especially those targeted to elderly, should take these predictors into consideration in the design of interventions.

Aged↗

PubMed2003

Knowledge, attitude and intentions related to colorectal cancer screening using faecal occult blood tests in a rural Australian population.

A telephone survey with 604 men and women without history of colorectal cancer (CRC) (age 50-74 years) explored knowledge of, attitudes toward, and intention to screen for CRC using faecal occult blood tests (FOBT) in a rural Australian population. Overall, 53% intended to participate in and 86% would follow a doctor's recommendation for FOBT screening. In contrast, only 18% had ever had a FOBT, and fewer than 60% of those with high-risk family history had undergone appropriate screening for CRC. Prior use of FOBT (OR=3.2), high perceived susceptibility to CRC (OR=2.4), belief in the importance of screening despite the absence of symptoms (OR=2.1) were positively and older age (OR = 0.5) was negatively related to screening intention in multivariate logistic regression analysis. A doctor's recommendation improved screening intention among those who never tested for CRC before but believe in the importance of early treatment. This study highlights the lack of compliance with standard CRC screening recommendations in Australia and provides evidence for the importance of continued educational efforts, with the particular emphasis on older adults and the medical community.

Aged↗