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PubMed2006

A systematic review of intentional delivery in women with preterm prelabor rupture of membranes.

OBJECTIVE: To evaluate the effect of intentional delivery versus expectant management in women with preterm prelabor rupture of membranes (PPROM). METHODS: We searched electronic databases and trials registries, contacted experts, and checked reference lists of relevant studies. Studies were included if they were randomized controlled trials comparing intentional delivery versus expectant management after PPROM, the gestational age of participants was between 30 and 36 weeks, and the study reported one of several pre-determined outcomes. RESULTS: Four studies were included in the meta-analysis. No difference was found between intentional delivery and expectant management in neonatal intensive care unit (NICU) length of stay (LOS) (weighted mean difference (WMD) -0.81 day, 95% confidence interval (CI) -1.66, 0.04), respiratory distress syndrome (risk difference (RD) -0.01, 95% CI -0.07, 0.06), and confirmed neonatal sepsis (RD -0.01, 95% CI -0.05, 0.04). One study found a significantly lower incidence of suspected neonatal sepsis among the intentional delivery group (RD -0.31, 95% CI -0.50, -0.12; number needed to treat (NNT) 3, 95% CI 2, 8). Maternal LOS was significantly shorter for the intentional delivery group (WMD -1.39 day, 95% CI -2.03, -0.75). There was a significant difference in the incidence of clinical chorioamnionitis favoring intentional delivery (RD -0.16, 95% CI -0.23, -0.10; NNT 6, 95% CI 5, 11). There was no significant difference in the incidence of other maternal outcomes, including cesarean section (RD 0.05, 95% CI -0.01, 0.11). CONCLUSIONS: Intentional delivery may be favorable to expectant management for some maternal outcomes (chorioamnionitis and LOS). There is insufficient evidence to suggest that either strategy is beneficial or harmful for the baby. Large multicenter trials with primary neonatal outcomes are required to assess whether intentional delivery is associated with less neonatal morbidity.

Cesarean Section↗

PubMed1999

Prospective study of intentional weight loss and mortality in overweight white men aged 40-64 years.

Although 25% of US men indicate that they are trying to lose weight, the association between intentional weight loss and longevity in men is unknown. The authors analyzed prospective data from 49,337 overweight (initial body mass index > or =27) white men aged 40-64 years who, in 1959-1960, answered questions on weight change direction, amount, time interval, and intent. Vital status was determined in 1972. Proportional hazards regression estimated mortality rate ratios for men who intentionally lost weight compared with men with no weight change. Analyses were stratified by health status and adjusted for age, initial body mass index, smoking status, alcohol intake, education, physical activity, health history, and physical symptoms. Among men with no reported health conditions (n = 36,280), intentional weight loss was not associated with total, cardiovascular (CVD), or cancer mortality, but diabetes-associated mortality was increased 48% (95% confidence interval (CI) -7% to +133%) among those who lost 20 pounds (9.1 kg) or more; this increase was largely related to non-CVD mortality. Among men with reported health conditions (n = 13,057), intentional weight loss had no association with total or CVD mortality, but cancer mortality increased 25% (95% confidence interval -4% to +63%) among those who lost 20 pounds or more. Diabetes-associated mortality was reduced 32% (95% confidence interval -52% to -5%) among those who lost less than 20 pounds and 36% (95% confidence interval -49% to -20%) among those who lost more than 20 pounds. These results and those from our earlier study in women (Williamson et al., Am J Epidemiol 1995;141:1128-41) suggest that intentional weight loss may reduce the risk of dying from diabetes, but not from CVD. In observational studies, however, it is difficult to separate intentional weight loss from unintentional weight loss due to undiagnosed, underlying disease. Well-designed observational studies, as well as randomized controlled trials, are needed to determine whether intentional weight loss reduces CVD mortality.

Adult↗

PubMed1995

Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40-64 years.

Although 40% of US women indicate they are currently trying to lose weight, the association between intentional weight loss and longevity is unknown. The authors analyzed prospective data from 43,457 overweight, never-smoking US white women aged 40-64 years who in 1959-1960 completed a questionnaire that included questions on weight change direction, amount, time interval, and intentionality. Vital status was determined in 1972. Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight. Women who died within the first 3 years of follow-up were excluded. Analyses were stratified by preexisting illness and adjusted for age, beginning body mass index, alcohol intake, education, physical activity, and health conditions. In women with obesity-related health conditions (n = 15,069), intentional weight loss of any amount was associated with a 20% reduction in all-cause mortality, primarily due to a 40-50% reduction in mortality from obesity-related cancers; diabetes-associated mortality was also reduced by 30-40% in those who intentionally lost weight. In women with no preexisting illness (n = 28,388), intentional weight loss of > or = 20 lb (> or = 9.1 kg) that occurred within the previous year was associated with about a 25% reduction in all-cause, cardiovascular, and cancer mortality; however, loss of < 20 lb (< 9.1 kg) or loss that occurred over an interval of > or = 1 year was generally associated with small to modest increases in mortality. The association between intentional weight loss and longevity in middle-aged overweight women appears to depend on their health status. Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality, whereas among women with no preexisting illness, the association is equivocal.

Adult↗

PubMed2002

Intentionality: applications within selected theories of nursing.

Intentionality is an important concept for nurses to study for professional and theoretical reasons. Lewis states that intentionality is best studied within an active, rather than reactive, worldview. This article is a level-by-level outline of Lewis' five-level model for the study of intentionality. These levels are: necessity, interactive necessity, action intent, divergent intent, and conscious intent. Newman's tri-part categorization of nursing theory paradigms (particularate-deterministic, interactive-integrative, and unitary-transformative) proves to be a useful framework to compare the Lewis model of intentionality with nursing theory. Examples from nursing theory development, such as the Roy adaptation model, chronotherapeutics, Rogers' theory of unitary human being, health as expanding consciousness, and therapeutic touch, are used to support all five levels of intentionality in providing guidance for practice and research by nurse theorists.

Consciousness↗

PubMed1997

Psychopathologic risk factors for intentional and nonintentional injury.

OBJECTIVE: Trauma has a high rate of recurrence, suggesting that some people are more injury-prone than others. This study was performed to evaluate some of the psychological and social factors that might influence the likelihood of traumatic injury. METHODS: A case-control study was conducted to evaluate the relationship between selected psychosocial factors and traumatic injury. At a Level I trauma center, victims of intentional trauma (excluding attempted suicide), victims of nonintentional trauma, and patients undergoing elective surgery were interviewed by a person blinded to the purposes of the study. They were given an intelligence test and underwent a structured interview, yielding psychiatric diagnostic categories established in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, Revised (DSM-III-R). RESULTS: Trauma patients were younger than elective surgery patients (p < 0.01) and were more likely to be men (p < 0.01). Victims of intentional injury had a higher probability of alcohol use (p < 0.01) and admitted illicit drug use (p < 0.001) than either nonintentional injury victims or elective surgery patients. Victims of intentional injury were more likely to be unemployed than those in the other two groups (p < 0.02), whereas elective surgery patients were more likely to be retired (p < 0.05) or to be disabled (p < 0.0001). The average intelligence score was slightly above the median in the nonintentional trauma group and in the control group (55th percentile and 54th percentile, respectively), compared with a mean intelligence score equivalent to the 35th percentile in the victims of intentional trauma (p < 0.001). Thirty percent of elective surgery patients met diagnostic criteria for at least one category of psychopathology, compared with 50% of nonintentional trauma patients, and 63% of intentional trauma patients (p < 0.01, trauma vs. elective surgery). Logistic regression analysis identified six variables that were independently associated with an increased tendency to be a victim of trauma: younger age, lower intelligence, antisocial personality, mental retardation, depression, and low income. CONCLUSIONS: Victims of trauma, both nonintentional, and especially intentional, have a high incidence of psychopathology. Victims of intentional trauma have significantly lower intelligence scores than either nonintentional injury or elective surgery patients. The high incidence of unemployment, alcohol abuse, and illicit drug use in victims of intentional injury might provide several opportunities for trauma prevention programs. Underlying psychological disorders will have to be addressed to reduce the likelihood of becoming a victim of trauma.

Accident Proneness↗

PubMed2002

Intentional nonadherence due to adverse symptoms associated with antiretroviral therapy.

OBJECTIVE: To estimate the frequency and possible predictors of patient-mediated intentional alterations in antiretroviral medication regimens in direct response to symptoms associated with antiretroviral therapy use. DESIGN: Cross-sectional survey of a population-based dynamic cohort of antiretroviral recipients in a province-wide HIV drug treatment program, the only source of free-of-charge antiretroviral medications in the province of British Columbia. METHODS: Program participants voluntarily complete program surveys on an annual basis. Study subjects were those who responded to the annual treatment program survey between January 1 and November 1, 2001. Patients reported on the occurrence and severity of symptoms of 42 side effects of antiretroviral agents. Symptoms were classified into four subgroups based on whether they were considered subjective or objective and whether they would or would not prompt clinical action. For each of the four symptom categories, patients reported what their physician recommended in response to symptoms in that group and what the patient actually did in response to these same symptoms. Intentional nonadherence was defined as reporting either skipping or altering dosages of selective regimen components or temporary cessation of therapy that was not recommended by the physician in response to adverse drug effects in the past year. RESULTS: Of 638 study subjects, 70 (11%) reported intentional nonadherence with between 4% and 7.4% reporting this activity over the preceding year depending on the symptom group. Multivariate analysis revealed that a plasma viral load of <400 copies/mL (adjusted odds ratio [AOR], 0.35; 95% CI, 0.21-0.61) and completion of high school (AOR, 0.43; 95% CI, 0.24-0.78) were both inversely associated with intentional nonadherence. Those subjects reporting at least one severe symptom were more than twice as likely to report intentional nonadherence (AOR, 2.24; 95% CI, 1.16-4.33). Similarly, each additional symptom considered to be objective and to require clinical action was associated with a 25% increase in the risk of intentional nonadherence (AOR, 1.25; 95% CI, 1.10-1.43). CONCLUSION: Intentional nonadherence to antiretroviral therapy is common among persons experiencing therapy-related side effects. Although the type and severity of adverse effects impact intentional nonadherence, this activity occurs in relation to symptoms regardless of their strict clinical relevance.

Adult↗

PubMed2005

Role of the right and left hemispheres in recovery of function during treatment of intention in aphasia.

Two patients with residual nonfluent aphasia after ischemic stroke received an intention treatment that was designed to shift intention and language production mechanisms from the frontal lobe of the damaged left hemisphere to the right frontal lobe. Consistent with experimental hypotheses, the first patient showed improvement on the intention treatment but not on a similar attention treatment. In addition, in keeping with experimental hypotheses, the patient showed a shift of activity to right presupplementary motor area and the right lateral frontal lobe from pre- to post-intention treatment functional magnetic resonance imaging (fMRI) of language production. In contrast, the second patient showed improvement on both the intention and attention treatments. During pre-treatment fMRI, she already showed lateralization of intention and language production mechanisms to the right hemisphere that continued into post-intention treatment imaging. From pre- to post-treatment fMRI of language production, both patients demonstrated increased activity in the posterior perisylvian cortex, although this activity was lateralized to left-hemisphere language areas in the second but not the first patient. The fact that the first patient's lesion encompassed almost all of the dominant basal ganglia and thalamus whereas the second patient's lesion spared these structures suggests that the dominant basal ganglia could play a role in spontaneous reorganization of language production functions to the right hemisphere. Implications regarding the theoretical framework for the intention treatment are discussed.

Aphasia↗

PubMed1999

Ipsilesional intentional neglect and the effect of cueing.

BACKGROUND: Contralesional hemispatial neglect may be induced by an attentional deficit where patients are inattentive to or unaware of stimuli in contralesional hemispace, an intentional deficit where patients are unable to act in or towards contralesional hemispace, or both. The deficits associated with ipsilesional neglect have not been as well characterized. Because cueing may be used as a rehabilitative assistive device, we wanted to learn whether the efficacy of an attentional or intentional cue was related to the type of bias. METHODS: We studied a patient with a right frontotemporal stroke who had ipsilesional neglect by using a video apparatus that dissociates sensory-attentional and motor-intentional systems. We also performed a cueing experiment with primarily sensory-attentional cues (i.e., read the letter at the end of the line) and primarily motor-intentional cues (i.e., touch the end of the line). RESULTS AND CONCLUSIONS: Ipsilesional neglect was primarily a motor-intentional deficit with a motor-action bias to the left and a secondary sensory-attentional bias for stimuli to the right. With cueing we found a double dissociation: the rightwards motor-intentional cue improved the primary left-sided intentional bias and the leftwards sensory-attentional cue improved the secondary right-sided attentional bias. Effective rehabilitation strategies need to address both sensory-attentional and motor-intentional deficits in patients with neglect.

Attention↗

PubMed2005

Intentional and unintentional nonadherence to antihypertensive medication.

BACKGROUND: Hypertension is poorly controlled in the US due to medication nonadherence. Recent evidence suggests that nonadherence can be classified as intentional or unintentional and different patient characteristics, such as the experience of adverse effects, may be associated with each. OBJECTIVE: To examine associations between patient characteristics, including reported adverse effects, and both intentional and unintentional nonadherence among 588 hypertensive patients. METHODS: Baseline data from a clinical trial, the Veterans' Study To Improve the Control of Hypertension, were examined. Intentional and unintentional nonadherence were assessed using a self-report measure. Participants were presented with a list of adverse effects commonly associated with antihypertensive medication and asked to indicate which symptoms they had experienced. Logistic regression analyses were used to examine adjusted associations between patient characteristics and type of nonadherence. RESULTS: Approximately 31% of patients reported unintentional nonadherence and 9% reported intentional nonadherence. Non-white participants, individuals without diabetes mellitus, and individuals reporting > or = 5 adverse effects were more likely to report intentional nonadherence than their counterparts. Individuals with less than a 10th-grade education and non-white participants were more likely to report unintentional nonadherence than their counterparts. When symptoms of increased urination and wheezing/shortness of breath were reported, patients were more likely to report intentional and unintentional nonadherence compared with those who were adherent. Unintentional nonadherence was also associated with reports of dizziness and rapid pulse. CONCLUSIONS: Both intentional and unintentional nonadherence are common and related to perceived adverse effects. Furthermore, different interventions may be necessary to improve adherence in unintentionally and intentionally nonadherent patients.

Aged↗

PubMed1995

Predicting adolescents' intentions to drink alcohol: outcome expectancies and self-efficacy.

OBJECTIVE: This article examines the relationship between intention to drink alcohol, alcohol outcome expectancies and alcohol-related self-efficacy among Norwegian adolescents. The relationship of expectancies, intention and self-efficacy was assessed for respondents of different ages and different drinking experience. METHOD: Data were collected from all seventh and ninth graders in 12 randomly selected schools in Norway. The self-administered questionnaire contained a short version of the Alcohol Expectancy Questionnaire for Adolescents and measures of intentions to drink in the next 12 months, current alcohol use and alcohol-related self-efficacy (e.g., ability to refuse alcohol). RESULTS: Results showed that both alcohol outcome expectancies and previous experience with alcohol were related to intentions to drink alcohol in the near future. Drinking experience had a larger impact than a 2-year age difference on the associations between alcohol outcome expectancies, alcohol-related self-efficacy and intention to drink. A significantly higher proportion of adolescents with drinking experience reported positive alcohol expectancies, poor alcohol-related self-efficacy and strong intention to drink alcohol than did those adolescents without drinking experience. CONCLUSIONS: Personal drinking experience was a stronger predictor of drinking intentions than was age. Still, both alcohol outcome expectancies and alcohol-related self-efficacy are significant predictors of intention to drink among both seventh and ninth graders, independent of previous drinking experience. This study indicates that postponing the onset of alcohol experimentation could be a major goal in primary alcohol prevention among adolescents, although longitudinal confirmation of these results is needed.

Adolescent↗

PubMed1992

Analysis of job satisfaction, burnout, and intent of respiratory care practitioners to leave the field or the job.

BACKGROUND: Increased stress, burnout, and lack of job satisfaction may contribute to a decline in work performance, absenteeism, and intent to leave one's job or field. We undertook to determine organizational, job-specific, and personal predictors of level of burnout among respiratory care practitioners (RCPs). We also examined the relationships among burnout, job satisfaction (JS), absenteeism, and RCPs' intent to leave their job or the field. METHODS: A pilot-tested assessment instrument was mailed to all active NBRC-credentialed RCPs in Georgia (n = 788). There were 458 usable returns (58% response rate). A random sample of 10% of the nonrespondents (n = 33) was then surveyed by telephone, and the results were compared to those of the mail respondents. Variables were compared to burnout and JS scores by correlational analysis, which was followed by stepwise multiple regression analyses to determine the ability of the independent variables to predict burnout and JS scores when used in combination. RESULTS: There were no significant differences between respondents and sampled nonrespondents in burnout scores (p = 0.56) or JS (p = 0.24). Prediction of burnout: The coefficient of multiple correlation, R2, indicated that in combination the independent variables accounted for 61% of the variance in burnout scores. The strongest predictor of burnout was job stress. Other job-related predictors of burnout were size of department, satisfaction with work, satisfaction with co-workers and co-worker support, job independence and job control, recognition by nursing, and role clarity. Personal-variable predictors were age, number of previous jobs held, social support, and intent to leave the field of respiratory care. Prediction of job satisfaction: R2 indicated that, in combination, the independent variables accounted for 63% of the variance observed in satisfaction with work, 36% of the variance observed in satisfaction with pay, 36% of the variance in satisfaction with promotions, 62% of the variance in satisfaction with supervision, and 48% of the variance in satisfaction with co-workers. Predictors of work-satisfaction level were recognition by physicians and nursing, age, burn-out level, absenteeism, and intent to leave the field. Predictors of level of satisfaction with pay were actual salary, job independence, organizational climate, ease of obtaining time off, job stress, absenteeism, intent to leave the field, and number of dependent children. Predictors of level of satisfaction with promotions were recognition by nursing, participation in decision making, job stress, intent to leave the field, past turnover rates, and absenteeism. Predictors of level of satisfaction with supervision included supervisor support, role clarity, independence, and ease of obtaining time off. The strongest predictor of level of satisfaction with co-workers was co-worker support. As overall level of JS increased, level of burnout decreased significantly (r = -0.59, p less than 0.001). As burnout level increased, increases occurred in absenteeism (r = 0.22, p less than 0.001), intent to leave the job (r = 0.48, p less than 0.001), and intent to leave the field (r = 0.51, p less than 0.001). CONCLUSIONS: Reduced job stress, increased job independence and job control, improved role clarity, and higher levels of JS were all associated with lower levels of burnout. Managerial attention to these factors may improve patient care and reduce absenteeism and turnover among RCPs.

Analysis of Variance↗

PubMed1999

Physician intention to recommend complete diagnostic evaluation in colorectal cancer screening.

Primary care physicians (PCPs) often do not recommend complete diagnostic evaluation (CDE; i.e., diagnostic colonoscopy or the combination of flexible sigmoidoscopy and barium enema X-ray procedures) for patients with an abnormal screening fecal occult blood test (FOBT+) result. Information is needed to understand why PCPs do not recommend CDE. In the spring of 1994, a telephone survey was carried out using a random sample of 520 PCPs in Pennsylvania or New Jersey who had patients that were targeted for an FOBT screening program. Survey data were obtained from 363 (70%) PCPs on physician practice characteristics; personal background; perceptions concerning FOBT screening, CDE performance, and patient behavior; social influence related to CDE; and intention to recommend CDE for FOBT+ patients. Physician CDE intention scores were distributed as follows: low (22%), moderate (51%), and high (27%). Multivariate analyses demonstrate that physician board certification status, time in practice, belief in CDE efficacy, and belief that CDE is standard practice were positively associated with CDE intention, whereas concern about CDE-related costs was negatively associated with CDE intention. Among physicians in larger practices, perceived FOBT screening efficacy was negatively associated with CDE intention, and belief in the benefit of CDE was positively associated with outcome. There is substantial variability in CDE intention among PCPs. Physician perceptions about FOBT screening and follow-up are associated with CDE intention, are likely to influence CDE performance, and may be amenable to educational intervention. Additional research is needed to evaluate the impact of educational interventions on CDE intention and performance.

Adult↗

PubMed1984

The assessment of intention-cue detection skills in children: implications for developmental psychopathology.

A reliable measure of children's skills in discriminating intention cues in others was developed for this investigation in order to test the hypothesis that intention-cue detection skill is related to social competence in children. Videotapes were prepared in which one child provoked another child. The intention of the first child varied across videotapes. The subject's task was to discriminate among types of intentions. Care was taken to ensure that scores on this measure were not confounded by a child's verbal capacity or general discrimination skill. This instrument was administered to 176 children in kindergarten, second grade, and fourth grade, who were identified by sociometric measures as having a peer status as popular, average, socially rejected, or socially neglected. Scores on this measure were found to increase as a function of increasing age, and normal children (popular and average) were found to score more highly than deviant children (neglected and rejected). The errors by deviant children tended to consist of erroneous labels of prosocial intentions as hostile. Also, children's statements about their probable behavioral responses to provocations by peers were found to vary as a function of subjects' perceptions of the intention of the peer causing the provocation, not as a function of the actual intention portrayed by the peer. Sociometric status differences in these responses were also found. These findings were consistent with a hypothesis of a developmental lag among socially deviant children in the acquisition of intention-cue detection skills.

Child↗

PubMed2026

Parenting styles and fertility intention: Mediating effects of childbearing beliefs and psychological resilience.

China's declining fertility rate is partly due to low fertility intention among childbearing population. To understand family influence on young people's fertility intention and its underlying mechanisms, this study examines how parenting styles (authoritarian vs. permissive) affect Chinese college students' fertility intention, with traditional childbearing beliefs and resilience as mediators. Data were collected from 839 participants (Age: M = 21.1, SD = 1.7 years) using structured questionnaires. Logistic regression found that a positive correlation between permissive parenting style and fertility intention, with authoritarian parenting having no impact. Mediation analysis showed the association between permissive parenting style and fertility intention was fully mediated through resilience ( = 0.0, 95%CI = [0.0,0.1]) and greater childbearing beliefs ( = 0.0, 95%CI = [0.0,0.1]). The findings indicate that permissive parenting is related to higher fertility intention in youth via resilience and childbearing beliefs. Promoting positive family environments and permissive parenting may enhance childbearing intention.

Humans↗

PubMed2003

Judging mens rea: the tension between folk concepts and legal concepts of intentionality.

Concepts such as intention, motive, or forethought have generated a great deal of doubt, dispute, and confusion in legal decision making. Here we argue for an empirically based strategy of defining and using such mens rea concepts. Instead of the standard approach of settling these concepts by theoretical argument and the debaters' own intuitions, we rely on social psychological research to determine the meaning and significance of folk concepts concerning mens rea. We demonstrate the reliable and systematic use of people's concept of intentionality, contrast it with the bewildering variety of related legal concepts, and apply the folk model of intentionality to debated distinctions between intention and intentionality, desire and intention, and belief and intention. This folk-conceptual approach promises clarity of mens rea concepts and a reconciliation of the legal and layperson's view of human behavior.

Awareness↗

PubMed2006

Goals and intentions mediate efficacy beliefs and declining physical activity in high school girls.

BACKGROUND: According to theory, girls who set goals about increasing their physical activity and who are dissatisfied with their current activity level are likely to form intentions to be active and to carry out those intentions, especially if they have high efficacy and control beliefs about being physically active. We tested those ideas while observing naturally occurring change during high school. METHODS: A cohort of 431 black and white girls was tested at the end of their 9th- and 12th-grade academic years. Confirmatory factor analysis established the structural invariance of the measures across the 3-year study period. Structural equation modeling and panel analysis were used to determine whether changes in goal setting and satisfaction would mediate relations of self-efficacy and perceived behavioral control with changes in intention and physical activity. Testing occurred between February and May in 1999 and 2004. Data were analyzed in 2006. RESULTS: Goal setting and intention mediated the indirect relation between self-efficacy and change in physical activity. Perceived behavioral control and physical activity change were related directly and also indirectly by a path mediated through satisfaction and intention. Black girls had lower self-efficacy, but changes in other variables were unrelated to race. CONCLUSIONS: These observations of longitudinal relations elaborate application of self-efficacy theory and the theory of planned behavior to physical activity by showing that goal setting and satisfaction mediate the relations of self-efficacy and perceived behavioral control with changes in intention and physical activity. The results encourage additional research to identify the sources and development of physical activity goals, and their attainment, among girls, and whether experimental manipulation of goals and intentions can mitigate the decline in girls' physical activity during high school.

Adolescent↗

PubMed2004

Adolescents' health beliefs are critical in their intentions to seek physician care.

BACKGROUND: The examination of predictors of adolescents' intentions to use health care for different types of health issues has received little attention. This study examined adolescents' health beliefs and how they relate to intentions to seek physician care across different types of health problems. METHODS: Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the seriousness of the health problem, physician effectiveness, and intentions to seek physician care. RESULTS: Most adolescents believed all health problems were serious except for planning to initiate sex (P < 0.001). Adolescents believed that physicians were most effective in diagnosis and treatment for pneumonia, followed by cigarette use, depression, and sex, respectively (P's < 0.001). Adolescents' intentions to seek physician care were greatest for physical as compared to risk behavior or mental health problems (P < 0.001). Multiple regression analyses revealed that adolescents had greater intentions to seek physician care for cigarette, sex, and depression when they believed physicians were effective and they perceived these as health problems after controlling for age and gender (all P's < 0.001). Health beliefs explained 12% to 49% of the variance in intentions to seek care (all P's < 0.001). CONCLUSIONS: Adolescents' health beliefs are important when understanding intentions to seek physician care. Health care use may be improved by increasing adolescents' beliefs that physicians are effective in areas other than physical health, including risk behaviors and mental health.

Adolescent↗

PubMed2003

Intentional action: conscious experience and neural prediction.

Intentional action involves both a series of neural events in the motor areas of the brain, and also a distinctive conscious experience that "I" am the author of the action. This paper investigates some possible ways in which these neural and phenomenal events may be related. Recent models of motor prediction are relevant to the conscious experience of action as well as to its neural control. Such models depend critically on matching the actual consequences of a movement against its internally predicted effects. However, it remains unclear whether our conscious experience of action depends on a precise matching process, or a retrospective inference that "I" must have been responsible for a particular event. We report an experiment in which normal subjects judged the perceived time of either intentional actions, involuntary movements, or subsequent effects (auditory tones) of these. We found that the subject's intention to produce the auditory tone produced an intentional binding between the perceived times of the subject's action and the tone. However, if the intention was interrupted by an imposed involuntary movement, followed by the identical tone, no such binding occurred. The phenomenology of intentional action requires an appropriate predictive link between intentions and effects, rather than a retrospective inference that "I" caused the effect.

Adolescent↗