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PubMed1976

Classification of suicidal behaviors. II. Dimensions of suicidal intent.

A factor analysis of a scale to assess suicidal intent showed four major dimensions: expectancies and attitudes, premeditation, precautions against intervention, and oral communication. Certain types of actions associated with attempted suicide such as seeking help or social isolation appear to be revealing of particular behavioral patterns or motives. Dealing with intent only as a global concept is an oversimplification. Suicidal ideation and suicidal acts are seen as complex patterns of behavior requiring increasingly thorough analyses for better understanding, prediction, and prevention.

Attitude↗

PubMed2000

Changes in youth cigarette use and intentions following implementation of a tobacco control program: findings from the Florida Youth Tobacco Survey, 1998-2000.

CONTEXT: Many states are developing tobacco use prevention and reduction programs, and current data on tobacco use behaviors and how these change over time in response to program activities are needed for program design, implementation, and evaluation. OBJECTIVES: To assess changes in youth cigarette use and intentions following implementation of the Florida Pilot Program on Tobacco Control. DESIGN, SETTING, AND PARTICIPANTS: Self-administered survey conducted prior to program implementation (1998), and 1 and 2 years (1999, 2000) later among a sample of Florida public middle school and high school students who were classified as never users, experimenters, current users, and former users of cigarettes based on survey responses. MAIN OUTCOME MEASURES: Changes in cigarette use status, intentions, and behaviors among students over a 2-year period. RESULTS: Surveys were completed by 22,540, 20,978, and 23, 745 students attending 255, 242, and 243 Florida public middle and high schools in 1998, 1999 and 2000, respectively. Response rates for the 3 survey years ranged from 80% to 82% and 72% to 82% for the middle school and high school surveys, respectively. After 2 years, current cigarette use dropped from 18.5% to 11.1% (P<.001) among middle school students and from 27.4% to 22.6% (P =.01) among high school students. Prevalence of never use increased from 56.4% to 69. 3% (P<.001) and from 31.9% to 43.1% (P =.001) among middle school and high school students, respectively. Prevalence of experimenting decreased among middle school and high school students from 21.4% to 16.2% (P<.001) and from 32.8% to 28.2% (P<.001), respectively. Among never users, the percentage of committed nonsmokers increased from 67.4% to 76.9% (P<.001) and from 73.7% to 79.3% (P<.001) among middle school and high school students, respectively. Among experimenters, the percentage of students who said they will not smoke again increased from 30.4% to 42.0% (P<.001) in middle school and from 44.4% to 51.0% (P<.001) in high school. CONCLUSIONS: Progress toward reduction of youth tobacco use was observed in each of the 2 years of Florida's Pilot Program on Tobacco Control. Our results suggest that a comprehensive statewide program can be effective in preventing and reducing youth tobacco use. JAMA. 2000;284:723-728

Adolescent↗

PubMed2004

Effect of a computer-based decision aid on knowledge, perceptions, and intentions about genetic testing for breast cancer susceptibility: a randomized controlled trial.

CONTEXT: As the availability of and demand for genetic testing for hereditary cancers increases in primary care and other clinical settings, alternative or adjunct educational methods to traditional genetic counseling will be needed. OBJECTIVE: To compare the effectiveness of a computer-based decision aid with standard genetic counseling for educating women about BRCA1 and BRCA2 genetic testing. DESIGN: Randomized controlled trial conducted from May 2000 to September 2002. SETTING AND PARTICIPANTS: Outpatient clinics offering cancer genetic counseling at 6 US medical centers enrolled 211 women with personal or family histories of breast cancer. INTERVENTIONS: Standard one-on-one genetic counseling (n = 105) or education by a computer program followed by genetic counseling (n = 106). MAIN OUTCOME MEASURES: Participants' knowledge, risk perception, intention to undergo genetic testing, decisional conflict, satisfaction with decision, anxiety, and satisfaction with the intervention. Counselor group measures were administered at baseline and after counseling. Computer group measures were administered at baseline, after computer use, and after counseling. Testing decisions were assessed at 1 and 6 months. Outcomes were analyzed by high vs low risk of carrying a BRCA1 or BRCA2 mutation. RESULTS: Both groups had comparable demographics, prior computer experience, medical literacy, and baseline knowledge of breast cancer and genetic testing, and both counseling and computer use were rated highly. Knowledge scores increased in both groups (P<.001) regardless of risk status, and change in knowledge was greater in the computer group compared with the counselor group (P =.03) among women at low risk of carrying a mutation. Perception of absolute risk of breast cancer decreased significantly after either intervention among all participants. Intention to undergo testing decreased significantly after either intervention among low-risk but not high-risk women. The counselor group had lower mean scores on a decisional conflict scale (P =.04) and, in low-risk women, higher mean scores on a satisfaction-with-decision scale (P =.001). Mean state anxiety scores were reduced by counseling but were within normal ranges for both groups at baseline and after either intervention, regardless of risk status. CONCLUSIONS: An interactive computer program was more effective than standard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying a BRCA1 or BRCA2 mutation. However, genetic counseling was more effective than the computer at reducing women's anxiety and facilitating more accurate risk perceptions. These results suggest that this computer program has the potential to stand alone as an educational intervention for low-risk women but should be used as a supplement to genetic counseling for those at high risk.

Adult↗

PubMed1998

Do unsuccessful dieters intentionally underreport food intake?

OBJECTIVE: A bogus pipeline paradigm was utilized to assess whether food intake underreporting by unsuccessful dieters is intentional. METHOD: Twenty-eight subjects completed 1-week food diaries. Then, 17 subjects in the experimental condition kept 2-week food diaries while being told the researcher was verifying their report. Eleven subjects in the control group were asked merely to self-monitor for two more weeks. RESULTS: Results indicate that subjects in the experimental group reported significantly greater intake than control subjects, when controlling for reported intake during the screening phase and weight change. DISCUSSION: Thus, the belief that the researcher could verify their report improved the accuracy of patients' self-report. However, all subjects continued to underreport their dietary intake. In summary, underreporting may be an intentional attempt to manage presentation to others in a society that is increasingly critical of overweight persons.

Adult↗

PubMed2001

Chemotherapy alone with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1-T4N0M0 complete clinical responders.

BACKGROUND: The current studies documented the results achieved with chemotherapy alone with curative intent in a series of 67 patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1-T4N0M0 complete clinical responders after a platin-based induction chemotherapy regimen. METHODS: Group I consisted of 36 patients with tumors originating from the glottis. Group II consisted of 31 patients with tumors originating from sites within the pharyngolarynx other than the glottis. A minimum of 3 years of follow-up was achieved. Statistical analyses of survival, local control, lymph node control, distant metastasis, and second primary tumor rates were based on the Kaplan-Meier life-table method. Laryngeal preservation rates and local control rates are presented. RESULTS: The 5-year actuarial survival estimate was 85.1% in Group I patients and 54.8% in Group II patients. Survival was statistically more likely to be reduced in Group II patients compared with Group I patients (P = 0.01). The 5-year actuarial local control estimate was 65.7% in Group I patients and 37.5% in Group II patients. Local failure was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.02). Local control rates after salvage treatment were 100% in Group I patients and 83% in Group II patients. Laryngeal preservation rates after salvage treatment were 100% in Group I patients and 64% in Group II patients. The 5-year actuarial lymph node control estimate was 90% in Group I patients and 73.7% in Group II patients. Lymph node failure was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.04). The 5-year actuarial estimate for patients without distant metastasis was 100% in Group I patients and 90% in Group II patients. Distant metastasis was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.03). The 10-year actuarial estimate for patients without metachronous second primary tumors was 56.4% in Group I and 46.1% in Group II. CONCLUSIONS: The current report 1) contradicts the old dogma of nonchemocurability for invasive squamous cell carcinoma of the upper aerodigestive tract and 2) suggests that the use of a platin-based chemotherapy-alone regimen with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx who are classified as T1-T4N0M0 complete clinical responders after receiving an induction chemotherapy regimen is best indicated when the tumor originates from the glottis.

Adult↗

PubMed1989

Missed medication doses in rheumatic arthritis patients: intentional and unintentional reasons.

A survey of 200 rheumatoid arthritis (RA) patients was conducted to identify the kinds and frequencies of intentional and unintentional reasons for missed medication dose. Planned and unplanned changes in usual activity routines accounted for most of the unintentionally missed doses, while side effects attributed to the medication accounted for most of the intentionally missed doses. Patients who did not miss medication doses were different from those who did by tending to have more financial resources and social support available to them.

Anti-Inflammatory Agents↗

PubMed2005

Systematic review of dressings and topical agents for surgical wounds healing by secondary intention.

BACKGROUND: The best dressing for postoperative wounds healing by secondary intention is unknown. METHODS: A systematic review was conducted to assess the effectiveness of dressings and topical agents on such wounds. Main endpoints were wound healing, pain, patient satisfaction, costs and hospital stay. Systematic methodological appraisal and data extraction were performed by independent reviewers. RESULTS: Fourteen reports of 13 randomized clinical trials on dressings or topical agents (gauze, foam, bead, alginate and hydrocolloid dressing) for postoperative wounds healing by secondary intention were identified; they were of weak methodological quality. In general, no statistically significant differences in wound healing were found for various dressing comparisons (11 of 13 trials). Patients experienced significantly more pain (four of six trials) and were less satisfied when gauze was used (three of six trials). Gauze was inexpensive, but its use was associated with significantly more nursing time than dressing with foam (two of three trials). No substantial differences in hospital stay were found (four of five trials). CONCLUSIONS: Only small, poor-quality trials exist, rendering the evidence insufficient. Foam is best studied as an alternative to gauze and appears to be preferable in terms of pain reduction, patient satisfaction and nursing time.

Administration, Topical↗

PubMed2005

Prostate cancer progression after therapy of primary curative intent: a review of data from prostate-specific antigen era.

BACKGROUND: Radical prostatectomy and radiotherapy (RT), both radical therapies, are the standard treatments of curative intent for early prostate cancer. However, these therapies are not curative in all patients and, consequently, a substantial proportion of treated patients remain at risk of disease progression and/or cancer-related death. METHODS: This article presents contemporary data on the incidence of prostate-specific antigen (PSA) and clinical disease progression after primary therapy of curative intent in relation to commonly assessed pretreatment or pathologic disease characteristics. RESULTS: The data highlight the substantial risk of progression for certain patient groups, such as those with Gleason score 8-10, cT3 disease, lymph node metastases, and/or pretreatment PSA levels > 20 ng/mL. CONCLUSIONS: Improved and/or additional treatment options are needed for these patient groups.

Brachytherapy↗

PubMed1999

Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation.

Liver transplantation is proposed as the best therapy for early hepatocellular carcinoma in cirrhotic patients. However, the confrontation with the results obtained by surgical resection has never been done on an intention-to-treat basis. Between 1989 and 1997, 164 out of 1,265 patients with hepatocellular carcinoma were evaluated for surgery. Seventy-seven (48 men, mean 61 years of age, 74 Child-Pugh class A, size 33 +/- 18 mm) were resected (first line option) and 87 (65 men, mean 55 years of age, 50 Child-Pugh class B/C, size 24 +/- 14 mm) were selected for transplantation. The 1-, 3-, and 5-year "intention-to-treat" survival was 85%, 62%, and 51% for resection and 84%, 69%, and 69% for transplantation (8 drop-outs on waiting list). Bilirubin and clinically relevant portal hypertension were independent survival predictors after resection. Thereby, the 5-year survival of the best candidates (absence of clinically relevant portal hypertension, n = 35) was 74%, whereas it was 25% for the worst candidates (portal hypertension and bilirubin >/=1 mg/dL, n = 27) (P <.00001). The variable "drop-out on waiting list" was the sole survival predictor after transplantation. The 2-year survival rate of patients evaluated for transplantation was 84% in the 1989 to 1995 period (mean waiting time, 62 days; no drop-outs) and 54% during 1996 to 1997 (mean waiting time, 162 days; 8 drop-outs)(P <.003). This outcome was significantly lower than that of the best candidates for resection (P =.002). In conclusion, a proper selection of candidates for resection promotes better results than transplantation, in which the results are significantly hampered by the growing incidence of drop-outs because of the increasing waiting time.

Bilirubin↗

PubMed1999

Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study.

OBJECTIVE: To examine the effect of a large, long standing and intentional weight reduction on the incidence of diabetes, hypertension and lipid disturbances in severely obese individuals as compared to weight-stable obese controls. RESEARCH METHODS AND PROCEDURES: The ongoing prospective SOS (Swedish Obese Subjects) intervention consists of a surgically treated group and a matched control group obtaining conventional obesity treatment. This report is based on 845 surgically treated patients and 845 controls (BMI 41.0+/-4.6 kg/m2 (mean+/-standard deviation [S])) followed for 2 years. RESULTS: Surgically treated patients lost 28+/-15 kg and controls 0.5+/-8.9 kg (p<0.0001). Two-year incidence of hypertension, diabetes, hyperinsulinemia, and lipid disturbances was compared in the two treatment groups. Adjusted odds ratios (95% CI) for the surgically treated group versus controls were 0.38 (0.22, 0.65) for hypertension, 0.02 (0.00, 0.16) for diabetes, 0.10 (0.03, 0.28) for hyperinsulinemia, 0. 10 (0.04, 0.25) for hypertriglyceridemia, 0.28 (0.16, 0.49) for low HDL-cholesterol and 1.24 (0.84, 1.8) for hypercholesterolemia. Compared to controls, the 2-year recovery rates from hypertension, diabetes, hypo-HDL, and hypertriglyceridemia were significantly higher in the surgically treated group. DISCUSSION: Intentional weight loss in the obese causes a marked reduction in the 2-year incidence of hypertension, diabetes and some lipid disturbances. The results suggest that severe obesity can and should be treated.

Adult↗

PubMed1997

Intention-to-treat analysis in randomized trials: who gets counted?

This article discusses the rationale and implications associated with the selection and use of analysis strategies for randomized clinical trials as they relate to protocol deviations. The topics addressed specifically are the conceptual and methodologic approaches and biases of clinical efficacy and effectiveness assessment. Examples are provided that highlight the consequences of different analytic strategies, particularly regarding intention-to-treat analysis. Favored by statisticians intention-to-treat analysis seeks to answer the question, "Is it better to adopt a policy of treatment A if possible, with deviations if necessary, or a policy of treatment B if possible, with deviations if necessary?" This is a relevant question, sometimes more relevant than "Is treatment A better than treatment B?" The authors suggest that different analytic strategies may be more or less appropriate depending on the intended audience.

Drug Therapy↗

PubMed2007

On estimating treatment effects under non-compliance in randomized clinical trials: are intent-to-treat or instrumental variables analyses perfect solutions?

In this report, we compared four estimators (intent-to-treat, as treated, per protocol, and instrumental variables estimators) that are conventionally considered for treatment effect estimation by simulation under different non-compliance scenarios in typical clinical trial settings. We found that intent-to-treat and instrumental variables estimators are not perfect and can be problematic in some situations although these two estimators carry desirable properties as we assume.

Humans↗

PubMedDate not supplied

Intentionally incomplete longitudinal designs: I. Methodology and comparison of some full span designs.

Longitudinal designs are important in medical research and in many other disciplines. Complete longitudinal studies, in which each subject is evaluated at each measurement occasion, are often very expensive and motivate a search for more efficient designs. Recently developed statistical methods foster the use of intentionally incomplete longitudinal designs that have the potential to be more efficient than complete designs. Mixed models provide appropriate data analysis tools. Fixed effect hypotheses can be tested via a recently developed test statistic, FH. An accurate approximation of the statistic's small sample non-central distribution makes power computations feasible. After reviewing some longitudinal design terminology and mixed model notation, this paper summarizes the computation of FH and approximate power from its non-central distribution. These methods are applied to obtain a large number of intentionally incomplete full-span designs that are more powerful and/or less costly alternatives to a complete design. The source of the greater efficiency of incomplete designs and potential fragility of incomplete designs to randomly missing data are discussed.

Longitudinal Studies↗

PubMed2001

Role of Self-Efficacy and Task-Value in Predicting College Students' Course Performance and Future Enrollment Intentions.

Predictive utility of self-efficacy and task-value beliefs was compared among 168 Korean female college students. The study assessed the constructs longitudinally and attempted consolidation of self-efficacy and expectancy-value theories. Self-efficacy perceptions were assessed at varying levels of measurement specificity. Exploratory factor analyses showed that self-efficacy items were reliably differentiated into separate factors of a priori specificity. These self-efficacy factors were positively correlated among themselves and, with an exception of problem-specific self-efficacy, also with the task-value factor. A correlation coefficient between any two self-efficacy factors tended to decrease, as these factors were associated with increasingly different measurement levels. Path analysis showed that students' midterm scores and enrollment intentions at T1 were better predicted by the task-value factor. However, the typically stronger links of self-efficacy to performance and of task value to intentions were observed with T2 variables. Copyright 2001 Academic Press.

Journal Article↗

PubMed1997

Impact of a school-based prevention programme on traditional and egalitarian adolescents' safer sex intentions.

The study assessed the impact of a school-based sexual risk reduction program on adolescent's knowledge, need for information, problem-solving and communications skills, intention to talk about and to practise safer sex. The primary goal of working with adolescents in schools was successful, in that significant treatment effects occurred on knowledge, perception of skills and frequency of communication. The program was not effective in improving intentions to use condoms. Evidence for the importance of social context aspects for safer sexual decision-making was found, since the impact of the programme differed for subjects differing in gender role attitudes.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Impact of attitudes and suicidal ideation on adolescents' intentions to seek professional psychological help.

Few adolescents who experience significant psychological distress seek professional psychological help, a finding particularly pertinent in New Zealand which has one of the highest youth suicide rates in the world. In the present study, 221 New Zealand high school students completed a questionnaire which examined the relationship between a variety of approach and avoidance factors associated with professional psychological help-seeking. Suicidal ideation, attitudes, psychological distress, treatment fears, gender and prior help-seeking were significant predictors accounting for approximately 23% of students', self-rated help-seeking intentions. Contrary to expectations, higher levels of suicidal ideation led to lower levels of help-seeking intentions for suicidal thoughts. This findings is discussed in relation to the process of help-negation which has been identified in clinical suicidal samples. The implications of these findings for interventions that increase appropriate professional psychological help-seeking in adolescents are also discussed.

Adolescent↗

PubMed1997

Direct and indirect measures of intentional forgetting in children and adults: evidence for retrieval inhibition and reinstatement.

In two experiments children in grades 3 and 4 and college students were given an item-by-item cued intentional forgetting task (i.e., instructions were to remember some words and to forget others), either a direct (cued recall word-stem completion) or an indirect (repetition priming word-stem completion) test of memory for the words, and a final free recall test for both remember- and forget-cued words. In both age groups, direct and indirect assessments produced better memory for remember- than for forget-cued words, even in Experiment 2 where the opportunity to selectively rehearse had been reduced by having subjects count aloud with each cue. These results suggest that retrieval inhibition plays a role in item-cued intentional forgetting, albeit one that is similar across ages. Furthermore, again in both age groups, performance on the word-stem completion tasks was enhanced in comparison with an immediate free-recall group, but only for material thought to be irrelevant (the forget-cued words). The facilitation on the priming tasks, however, did not carry over to a final free-recall task. These results on the effects of an intervening experience are discussed in terms of their implications for children's eyewitness testimony.

Adolescent↗

PubMed2001

Attention versus intention in the primate premotor cortex.

One challenging issue in cognitive neuroscience has been to dissociate a variety of mental processes from one another in order to elucidate brain functions. Attention, in particular, has been a recurrent issue because of its strong links with perceptual, cognitive, and motor performances. This paper reviews data from neurophysiological experiments designed to dissociate neuronal activity related to visuo-spatial attention from preparatory activity in the monkey brain. Cell activity was recorded from the dorsal premotor area (PMd) and compared to the dorsolateral prefrontal cortex (DLPf), from which it receives inputs. PMd has been implicated in the planing and execution of voluntary movements (PMd), and the majority of its cells are active during tasks with instructed delay time. However, the activity of many PMd cells is not specifically correlated with movement preparation, as is observed when the animal is attending to a visual stimulus, although the proportion of attention-related cells is much lower than in the DLPf. The distribution of attention-related and intention-related neurons within PMd tends to vary along the rostrocaudal axis, with the former more frequent rostrally (PMdr) and the latter more predominant caudally (PMdc). In a functional magnetic resonance imaging (fMRI) study in humans, we compared the premotor activation in two tasks: a spatial attention/memory task and a motor preparation task. The results suggest a rostrocaudal specialization within PMd of the human brain, with attention-related activation rostrally and medially and intention-related activation caudally. These studies indicate strong similarities in the functional organization of dorsal premotor cortex of human and monkey.

Animals↗