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PubMed1986

Should the intent of testing influence its interpretation?

A test is often interpreted as "normal" or "abnormal" by a single criterion, regardless of the intent of testing. The discriminate accuracy of this convention was critically analyzed using information content (I), likelihood ratio and the area under the receiver-operating characteristic curve. Three ejection fraction variables were assessed--ejection fraction at rest, exercise ejection fraction and the change in ejection fraction from rest to exercise--each relative to three intentional goals: diagnosis of coronary artery disease in 929 patients without previous myocardial infarction, prediction of multivessel disease in these same 929 patients and prediction of multivessel disease in 507 patients with previous myocardial infarction. The information content of exercise ejection fraction (IEX) was higher than for ejection fraction at rest (IR) or for the change from rest to exercise (IEX-R), and was relatively constant regardless of the goal of testing. In contrast, neither IR nor IEX-R was constant. IR was lowest for diagnosis of coronary artery disease, whereas IEX-R was highest for this same goal. These empiric observations are consistent with the quantitative relation predicted by information theory: IEX = IR + IEX-R. Thus, ejection fraction at rest has little discriminate value relative to the diagnosis of coronary artery disease, but does have value in evaluating the extent of disease in patients after myocardial infarction. Exercise ejection fraction and change in ejection fraction are nearly equally useful for purposes of diagnosis, whereas the former is most useful for functional evaluation in postinfarction patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

Intentional iron overdose in pregnancy--management and outcome.

The objectives of our study were to 1) determine if peak maternal serum iron level or toxicity stage after intentional overdose is associated with adverse maternal-fetal outcome, and 2) describe the use of deferoxamine antidote therapy in obstetric patients. A computer search of the English language literature from 1966-1998 used the key words iron toxicity, iron poisoning, deferoxamine, and pregnancy to identify peer-reviewed papers reporting intentional iron overdoses in pregnancy. Two investigators independently extracted data from articles and their references including stage of toxicity (0 = asymptomatic, 1 = gastrointestinal symptoms, 2 = metabolic disturbance, 3 = organ failure), with differences resolved by consensus. Statistical analysis used the Student t-test, Fisher exact test, or ANOVA, as appropriate. Fourteen publications were identified, describing 61 cases of obstetric iron overdose, including one recent case at our institution. Compared with women who had lower peak levels, women with peak serum iron levels > or =400 mcg/dL were more frequently symptomatic (12/13 vs. 5/10, respectively, p = 0.05). Peak iron level > or =400 mcg/dL was not associated with increased risk of spontaneous abortion, preterm delivery, congenital anomalies, or maternal death. However, patients with stage 3 toxicity were more likely to spontaneously abort (1/3 vs. 1/56, respectively), deliver preterm (2/3 vs. 6/56, respectively), or experience maternal death (3/3 vs. 0/56, respectively). The proportions of patients treated with deferoxamine and total dosages of deferoxamine were similar by peak iron level (> or =400 vs. <400 mcg/dL) and toxicity stage (0-3). Peak iron levels > or =400 mcg/dL are associated with symptomatic iron overdose. Stage 3 toxicity is associated with spontaneous abortion, preterm delivery, and maternal death.

Adolescent↗

PubMed1989

Second-intention healing.

Second-intention healing (contraction and epithelization) is most appropriate for heavily traumatized, contaminated wounds that may have a prolonged debridement phase. Therapy during healing can promote rapid debridement and faster healing. Healing of lower limb wounds by second intention may be protracted, owing to poorer wound contraction and excessive granulation tissue production as compared with body wounds.

Animals↗

PubMed1997

Three Centuries of Category Errors in Studies of the Neural Basis of Consciousness and Intentionality.

Recent interest in consciousness and the mind-brain problem has been fueled by technological advances in brain imaging and computer modeling in artificial intelligence: can machines be conscious? The machine metaphor originated in Cartesian "reflections" and culminated in 19th century reflexology modeled on Newtonian optics. It replaced the Aquinian view of mind, which was focused on the emergence of intentionality within the body, with control of output by input through brain dynamics. The state variables for neural activity were identified successively with animal spirits, élan vital, electricity, energy, information, and, most recently, Heisenbergian potentia. The source of dynamic structure in brains was conceived to lie outside brains in genetic and environmental determinism. An alternative view has grown in the 20th century from roots in American Pragmatists, particularly John Dewey, and European philosophers, particularly Heidegger and Piaget, by which brains are intrinsically unstable and continually create themselves. This view has new support from neurobiological studies in properties of self-organizing nonlinear dynamic systems. Intentional behavior can only be understood in relation to the chaotic patterns of neural activity that produce it. The machine metaphor remains, but the machine is seen as self-determining.

Journal Article↗

PubMed1999

Adolescents' pregnancy intentions: relations to life situations and caretaking behaviors prenatally and 2 years postpartum.

PURPOSE: This study explores if and how adolescents' pregnancy intentions relate to life situations and health-related behaviors prenatally and up to 2 years postpartum. METHODS: Adolescent girls who reported that they had "wanted a baby" (n = 75) as their reason for pregnancy were compared with those who reported that the pregnancy "just happened" (n = 79) at four separate time periods: prenatally, at 6 and 24 months postpartum, and at 18 months postpartum for teens who became pregnant again subsequent to the study pregnancy. RESULTS: Those who stated that they wanted a baby were more likely to be Hispanic, married, and out of school before becoming pregnant. They were less likely to receive welfare as their primary means of support and to have run away from home in the past than teens who stated that their pregnancy just happened. Self-reported reason for pregnancy was unrelated to repeat pregnancy by 18 months postpartum, but those who had wanted the study baby were less likely to undergo elective termination of a subsequent pregnancy and less likely to become pregnant by a different partner. The groups diverged at 24 months postpartum when those who wanted a baby were more likely to be married to the father of the baby, be financially supported by him, receive child care assistance from him, and have attempted or succeeded at breastfeeding the study child. CONCLUSION: Self-reported reason for pregnancy reveals many important characteristics of pregnant adolescents both at the time of presentation and up to 2 years postpartum. Young women in this study who reported intentional pregnancy seem to fare better with regard to their financial status and their relationship with the father of the baby.

Adolescent↗

PubMedDate not supplied

Predicting intentions and condom use among Latino college students.

To understand the factors that predict Latinos' risk-associated behavior, this study examined whether favorable beliefs about condoms and select moderator variables are related to stronger intentions to use condoms and more reported condom use at most recent vaginal and anal intercourse among Latino college students. Latino students who attended a public university in the northeast United States were mailed a paper-and-pencil questionnaire. Results from completed questionnaires (n = 199) indicated that students who perceived greater partner approval of condom use, perceived greater peer approval of condom use, and expressed confidence in their ability to control themselves reported stronger intentions to used condoms. Perceived partner approval and impulse control was related to self-reported condom use at most recent vaginal intercourse, impulse control was related to self-reported condom use at most recent vaginal intercourse, and impulse control was related to self-reported condom use at most recent anal intercourse. These relations did not significantly differ by Hispanic ethnicity, religiosity, gender, or age. Results suggest that normative beliefs and control beliefs regarding impulse control may be especially salient in both predicting and changing condom use behavior and should be incorporated into nursing assessments and tailored interventions.

Adult↗

PubMed2004

Intentional seizure interruption may decrease the seizure frequency in drug-resistant temporal lobe epilepsy.

We investigated the nature of preictal subjective phenomena and whether they had any effect on the seizure frequency in 95 adult patients with medial temporal lobe epilepsy. Seventy-three (77%) patients indicated that they experienced seizure-provoking factors. Ten patients (11%) had prodromas independent of auras, while auras occurred in 89%. Forty-four patients (46%) reported that that they had tried to stop their seizures in the presence of prodroma or aura and this action had resulted in success at least once. Twenty-one patients (22%) regularly tried to stop their seizures because this effort was often successful according to their interpretation. Patients who reported that they could frequently inhibit their seizures had 1.8 +/- 1.6 seizures/month, a significantly lower mean seizure frequency than those 74 patients who did not do it regularly (4.6 +/- 4.8 seizures/month, P<0.001). Patients who reported regular experience in inhibiting intentionally their seizures more often had affective (P=0.05) and vertiginous auras (P<0.01) as well as isolated auras (P<0.05). Patients who experienced provoking factors showed the same seizure frequency as those who did not. Our results suggest that intentional seizure inhibition had an impact on the severity of drug-resistant epilepsy.

Adolescent↗

PubMed1996

Influence of magnetic resonance imaging on diagnosis and therapeutic intention.

RATIONALE AND OBJECTIVES: We assessed the contribution of magnetic resonance (MR) imaging to diagnostic and therapeutic decision making. METHODS: In a before-after observational study, we collected information from clinicians before and after patients were given MR examinations. We studied 406 cases selected from consecutive referrals to a single MR imaging facility in Manitoba between November 1, 1991, and October 30, 1992, for diagnosis of suspected brain, spinal column, or large-joint disorder. We examined changes in diagnoses, changes in clinician diagnostic confidence, and changes in therapeutic intentions after MR examinations. RESULTS: Overall, MR imaging findings contributed to a change in referring physicians' diagnoses or diagnostic confidence in 76% of the cases. Referring physicians reported a change in provisional diagnosis in 42% of the cases. In 67% of these cases, the referring physician's provisional diagnosis was ruled out by normal examination findings; in the remaining 33% of the cases, an alternate diagnosis was offered by the consulting radiologist. In the 58% of the cases in which the provisional diagnosis was not altered by MR imaging findings, clinical confidence in the provisional diagnosis increased in 46% of the cases and decreased in 12% of the cases. Management plans were reported to be altered in 54% of the cases; in 24% of the cases, therapeutic intentions changed from lower to higher levels of intervention. CONCLUSION: Although MR imaging had a substantial influence on clinicians' decisions concerning diagnoses, the influence of MR imaging findings on therapeutic decision making, and therefore on patients' health status, was more moderate.

Brain Diseases↗

PubMed2001

Children's judgements about intentionally and unintentionally broken promises.

Astington (1988) found that seven- to nine-year-olds often fail to distinguish between promises and predictions when judging the utterances of characters in simple stories. Instead, these children attend only to the outcome of the story (i.e. whether the promised event occurred) when deciding whether a promise has been made and, to a lesser extent, when deciding whether the speaker is responsible for the outcome. The purpose of the present study was to examine whether seven- to nine-year-olds (a) vary their judgements of responsibility according to the reason that the promised action was not completed, and (b) recognize that an unfulfilled promise is a promise regardless of whether the speaker's failure is unavoidable or intentional. Seven-year-olds, nine-year-olds, and adults were asked to make promise and responsibility judgements for two story types: stories in which the promiser intentionally failed to fulfill his or her promise and stories in which an unforeseen event prevented the promiser from fulfilling the promise. Participants at all ages assigned responsibility correctly across both story types. In making promise judgements, however, the seven-year-olds' decisions about promises reflected a misguided attention to the outcome of a promise or the obstacle to its fulfillment. The nine-year-olds recognized that an unfulfilled promise is a promise but only when there was a clear reason for the speaker's failure to fulfill his or her obligation. We suggest that children consider only sincere promises to be instances of promising and make inferences about speaker sincerity by looking to external factors in the communicative context.

Behavior↗

PubMed2002

Intentional parenthood: responsibilities in surrogate motherhood.

In recent years, a number of writers dealing with questions over parenthood that arise in the context of reproductive technologies and surrogate motherhood, have appealed to the notion of "intentional parenthood". Basing their argument on liberal values such as individual autonomy, the freedom to enter contracts, the right to privacy, and individual self-fulfilment, they argue that contractually stated intentions, rather than genetic or gestational relationships, should form the basis of parental rights. Against this I argue that parental rights do not derive from contractual agreements, but are based in their obligations towards the child. I then examine the nature of the obligations that the various parties have towards the child both pre- and postnatally.

Adoption↗

PubMed2003

The Norwegian Breast Cancer Screening Program: re-attendance related to the women's experiences, intentions and previous screening result.

OBJECTIVE: To survey factors of importance for attendance in the Norwegian Breast Cancer Screening Program (NBCSP). METHODS: Simple forced choice questionnaires were sent to 1221 women, in four categories: not attended, screened negative, false positive, and breast cancer cases. The response rate was 80.7%. RESULTS: Women who were invited to the NBCSP reported positive opinions about being invited and the provided information. This response was independent of attendance and screening result. An experience of pain during screening examination was reported in the same proportion among women who were screened negative and false positive (p = 0.27). Unsatisfactory care was reported in a significantly lower rate among women who were screened negative, compared to the false positive (p = 0.02) and breast cancer cases (p < 0.01). Re-attendance was significantly higher among women who were screened negative (91.8%), compared to the false positive (83.9%, p < 0.01). Experienced pain seemed to influence re-attendance among the false positive, while care seemed to influence re-attendance among women who were screened negative. Intention to re-attend was significantly associated with the rate of re-attendance (p < 0.01) and it was the only significant predictor for re-attendance (OR = 5.4, 95% CI: 1.8-16.7) in a multiple logistic regression analysis with intention, age, experienced pain, experienced care and waiting time included in the model. Age did not have much influence on results. CONCLUSION: Women, who were invited to the NBCSP, reported positive opinions about the program. Re-attendance was related to previous screening results, partly by, experienced pain and care.

Aged↗

PubMed1997

Application of Azjen's theory of planned behavior to predict sunbathing, tanning salon use, and sunscreen use intentions and behaviors.

Ajzen's (1988) theory of planned behavior (TOPB) was used to examine psychological determinants of high-risk UV radiation exposure-related behaviors (sunbathing, tanning salon use, and sunscreen use). Undergraduates at a midsized southeastern university were assessed on their psychological and behavioral tendencies toward high-risk UV radiation exposure-related behaviors. The results generally supported the utility of the TOPB as an explanatory model for high-risk behavior. Attitudes were strongly associated with high-risk intentions (e.g., not utilize sunscreen, use salons), whereas subjective norms were less so. Perceived behavioral control was found to moderate the relationship among attitudes, norms, and intentions to sunbathe and tan at a salon. Implications for intervention strategies and future model building in this area are discussed.

Adolescent↗

PubMed2004

Predictors of breastfeeding intention among low-income women.

OBJECTIVE: Breastfeeding rates are below the Healthy People 2010 goals despite recognized benefits of breastfeeding. This study determined factors that predict breastfeeding initiation among low-income pregnant women. METHODS: A self-administered closed-ended questionnaire was introduced to 694 pregnant women who were certified for WIC in Mississippi. The questionnaire collected data about demographics, breastfeeding intention, breastfeeding knowledge, self-efficacy, and three recognized barriers to breastfeeding: embarrassment, time and social constraints, and lack of social support. RESULTS: In bivariate analysis, women who intended to breastfeed were more often white and had at least some college education, higher income, a smaller family size, fewer children, and previous breastfeeding experience than women who did not intend to breastfeed. Intenders had higher levels of breastfeeding knowledge and self-efficacy and reported fewer barriers to breastfeeding than nonintenders. In multivariate logistic regression, fewer children, past breastfeeding experience, breastfeeding knowledge, self-efficacy, and perceived social support were independent predictors of breastfeeding intention. CONCLUSIONS: Women at high risk for not wanting to breastfeed can be identified for additional support. Interventions should focus on improving breastfeeding knowledge, enhancing confidence in one's ability to breastfeed, and overcoming barriers to breastfeeding, especially lack of social support, among low-income women.

Adult↗

PubMed1996

Verbally expressed intentions of parasuicide: II. Prediction of fatal and nonfatal repetition.

The predictive value of verbally expressed intentions of parasuicide was studied in 925 patients admitted after deliberate self-harm to one of the health care facilities in the county of Sør-Trøndelag, Norway. Repetition of the suicidal act was studied prospectively, and the results showed that verbally expressed intention to die at the index parasuicide did predict fatal repetition (suicide) but not nonfatal repetition (parasuicide) of the suicidal act.

Adolescent↗

PubMed2003

Intentional replantation for periodontally involved hopeless teeth.

The aim of this study was to evaluate the clinical and radiographic results of intentional replantation of periodontally involved teeth after conditioning of root surfaces with tetracycline-HCl. Thirteen patients (seven female, six male; age range: 35-52 years) with 15 periodontally involved hopeless teeth were included in this study. During the replantation procedure, the affected teeth were gently extracted, then the granulation tissues, calculus, remaining periodontal ligament and necrotic cementum on the root surfaces were removed. Tetracycline-HCl, at a concentration of 100 mg ml(-1), was applied for 5 min to the root surfaces. The teeth were then replaced into the socket and splinted. Patients were clinically and radiographically evaluated at baseline (time of surgery) and 6 months after the surgery. The following measurements were recorded: probing depth (PD), gingival recession (R), the amount of bone loss (BL) and bone gain (BG). Results indicated a reduction in PD and in the amount of bone loss and healthy gingiva. Mean PD was decreased from 5.25 to 2.36 mm, gingival recession was increased from 3.73 to 4.0 mm, and BL was reduced from 73.20 to 56.86%. At the end of 6 months, no root resorption or ankylosis was observed radiographically. Even during the short period of evaluation, it may be suggested that intentional replantation can be an alternative approach to extraction in cases where advanced periodontal destruction is present and no other treatments could be considered.

Adult↗

PubMed2003

Intentional replantation of a mandibular second molar with long-term follow-up: report of a case.

A case is reported of a mandibular second molar that underwent non-surgical endodontic treatment and intentional replantation in an effort to relieve continued symptoms. A 15.5-year follow-up clinical examination revealed the patient to be asymptomatic, the tooth to be still functional, and a recall film showed no evidence of root resorption. The indications for and limitations of intentional replantation as well as recommended literature on the subject are discussed.

Female↗

PubMed2001

Is early differentiation of human behavior a precursor to the 1-year-old's understanding of intentional action? Comment on Legerstee, Barna, and DiAdamo (2000).

In a recent issue of Developmental Psychology, M. Legerstee, J. Barna, and C. DiAdamo (2000) reported a study showing that 6-month-olds expect people to talk to persons rather than to inanimate objects and to manipulate inanimates rather than persons. They interpreted this ability as a "precursor" to later understanding of intentionality. The present article takes issue with the authors' 2 different levels of interpretation that contradict each other and raise problems in their own right. It is suggested that M. Legerstee et al.'s finding is most parsimoniously explained by associative learning and may not constitute a precursor to later understanding of intentionality in any well-defined sense of the term. The present article argues for the importance of differentiating between associative and inferential processes and reviews evidence that the understanding of goal-directed action around 9 months of age involves principle-based inferences.

Behavior↗

PubMed2002

The role of intentional forgetting in reducing children's retroactive interference.

Preschool and kindergarten children's retention of stories was examined in the presence of interfering information and instructions to forget. Children learned 2 stories and, 24 hr later, were asked to recall the 1st or 2nd story learned. Some of the children were instructed, either following acquisition or just prior to the retention test, to forget the 2nd, or interfering, story. A model was used to isolate storage and retrieval effects, and the results showed that (a) retroactive interference affected both storage- and retrieval-based forgetting rates for the younger children but only storage-based forgetting rates for the older children, (b) intentional forgetting reduced retroactive interference primarily by attenuating storage-based forgetting regardless of age, (c) intentional forgetting instructions were effective only at acquisition for preschoolers but at both acquisition and retention for kindergarteners, and (d) all children recalled the to-be-forgotten story as well as they recalled the to-be-remembered story. These results are interpreted in terms of reorganization and distinctiveness effects in storage.

Child↗