Asthma control, quality of life, and the role of patient enablement: a cross-sectional observational study.

BACKGROUND: Self-assessment of asthma and a stronger doctor-patient relationship can improve asthma outcomes. Evidence for the influence of patient enablement on quality of life and the control of asthma is lacking. AIMS: To assess asthma severity, medication use, asthma control, and patient enablement in patients with asthma treated in primary care and to study the relationship between these variables and quality of life. METHODS: A cross-sectional study was conducted in an urban clinic in northern Portugal. Data were collected from both clinical records and questionnaires from a random sample of asthma patients. The modified Patient Enablement Instrument, the Asthma Quality of Life Questionnaire, and the Asthma Control Questionnaire were used. Peak expiratory flow and forced expiratory volume in one second (FEV1) were measured. Receiver operating characteristic curve analysis was performed to establish cut-off values for the quality of life measurements. The associations between enablement, asthma control, and quality of life were tested using logistic regression models. RESULTS: The study sample included 180 patients. There was a strong correlation between asthma control and quality of life (r=0.81, p<0.001). A weak association between patient enablement and asthma control and quality of life was found in the logistic regression models. Poor control of asthma was associated with female gender, concomitant co-morbidities, reduced FEV1, and increased severity of asthma. CONCLUSIONS: The weak correlation between enablement and asthma control requires further study to determine if improved enablement can improve asthma outcomes independent of gender, severity, and concomitant co-morbidities. This study confirms the strong correlation between asthma control and quality of life.

Conditional content, explicit information and generating cases: Sources for suppressing inferences.

In the present study, we evaluate the suppression effect by asking participants to make inferences with everyday conditionals ("if A, then B"; "if Ana finds a friend, then she will go to the theatre"), choosing between three possible conclusions ("she went to the theatre"; "she did not go to the theatre"; "it cannot be concluded"). We test how these inferences can be influenced by three factors: a) when the content of the conditional induces us to think about disabling conditions that prevent us from accepting the consequent (A and ¬B) or alternative conditions that induce us to think about other antecedents that could also lead to the consequent (¬A and B), b) when explicit information is given about what really happened (e.g. Ana found a friend but they did not go to the theatre; or Ana did not find a friend but she went to the theatre) and c) when participants have to look for concrete disabling (e.g. Ana's friend had to work) and alternative cases (e.g. Ana's sister wanted to go to the theatre) before making the inferences. Previous studies have shown what were called "suppression effects": disabling conditions reduced valid inferences while considering alternatives led to a reduction in fallacies. These two "suppression effects" were shown in Experiment 1: a) in an Implicit condition that included just the content factor of the conditional and b) with a greater magnitude in a second Explicit condition that included the three factors (content, explicit information and search for counterexamples). Experiment 2 compared the same Explicit condition with another in which participants, instead of looking for counterexamples, completed a control task of looking for synonyms. In addition, half the participants looked for a few items (2 cases) and the other half for many items (5 cases). Results again showed the suppressing effect in all the conditions, but the magnitude was greater in the counterexample condition. No relevant differences were obtained according to the number of cases generated; the most relevant result was that the factors provided an additive effect on the suppression.

The Analytic Truth and Falsity of Disjunctions.

Disjunctive inferences are difficult. According to the theory of mental models, it is because of the alternative possibilities to which disjunctions refer. Three experiments corroborated further predictions of the mental model theory. Participants judged that disjunctions, such as Either this year is a leap year or it is a common year are true. Given a disjunction such as Either A or B, they tended to evaluate the four cases in its 'partition': A and B, A and not-B, not-A and B, not-A and not-B, as 'possible' or 'impossible' in ways that bore out the difference between inclusive disjunctions ('or both') and exclusive disjunctions ('but not both'). Knowledge usually concerns what is true, and so when participants judge that a disjunction is false, or contingent, and evaluate the cases in its partition, they depend on inferences that yield predictable errors. They tended to judge that disjunctions, such as follows: Either the food is cold or else it is tepid, but not both, are true, though in fact they could be false. They tended to infer 'mirror-image' evaluations that yield the same possibilities for false disjunctions as those for true disjunctions. The article considers the implications of these results for alternative theories based on classical logic or on the probability calculus.

Counterfactual thinking and functional differences in depression.

The purpose of the studies reported in this paper was to evaluate the function of counterfactual thinking (CT) in depression. In Experiment 1, depressed and non-depressed participants were asked to imagine themselves as the protagonist of a hypothetical situation, and to think counterfactually about three different scenarios. The results showed that there was a similar CT style (in terms of direction, structure and focus of mutation) for the depressed and the non-depressed groups. It was also found that the perceived preparation for a future similar situation increased after CT and, contrary to our hypotheses, this effect was observed in both groups. In Experiment 2, a real-life situation was used (a course examination) in which participants experienced a negative outcome (a poor score on the test). Again, it was observed that depressed and non-depressed participants showed the same CT style, but non-depressed participants were more likely to use CT spontaneously. In addition, the second study showed further differences between the two groups: depressed participants not only showed a lack of cognitive benefits from thinking counterfactually (i.e., after CT they do not feel more prepared for future similar events, nor able to avoid a similar bad outcome, in contrast to the non-depressed participants), but also show a lack of behavioural changes (both intentions to change and actual changes over the subsequent week). In conclusion, these results provide evidence about the function of CT both in depressed and in non-depressed thinking, and highlight both the similarities and differences for these two groups.

The Relation Between Factual and Counterfactual Conditionals.

What is the relation between factual conditionals: If A happened then B happened, and counterfactual conditionals: If A had happened then B would have happened? Some theorists propose quite different semantics for the two. In contrast, the theory of mental models and its computer implementation interrelates them. It postulates that both can have a priori truth values, and that the semantic bases of both are possibilities: states that are possible for factual conditionals, and that were once possible but that did not happen for counterfactual conditionals. Two experiments supported these relations. Experiment 1 showed that, like factual conditionals, certain counterfactuals are true a priori, and others are false a priori. Experiment 2 replicated this result and showed that participants selected appropriate paraphrases, referring, respectively, to real and to counterfactual possibilities, for the two sorts of conditional. These results are contrary to alternative accounts of conditionals.

The modulation of disjunctive assertions.

The theory of mental models postulates that disjunctions of the sort, A or B, where A and B are sensible everyday clauses, have a core meaning that allows an inclusive interpretation, referring to three possibilities: A and not-B, not-A and B, and A and B. The meaning of the clauses and knowledge can modulate this meaning by blocking the construction of at least one model of a possibility-for example, "Rui is playing tennis or he is surfing" blocks the model of Rui doing both activities. This theory is implemented in a computer program. Three experiments investigated the core interpretation and interpretations in which the contents of the clauses should block the model of A and B (as in the preceding example), the model of A and not-B, or the model of not-A and B. In Experiment 1, the participants listed the possibilities for each of the four sorts of disjunction. The results corroborated the predicted modulations. In Experiment 2, these predicted interpretations governed the conclusions that participants accepted from disjunctions and categorical premises. In Experiment 3, the predicted interpretations yielded reliable effects on the conclusions that the participants drew for themselves. We relate these results to theories of reasoning.

How Children with Autism Reason about Other's Intentions: False-Belief and Counterfactual Inferences.

We examine false belief and counterfactual reasoning in children with autism with a new change-of-intentions task. Children listened to stories, for example, Anne is picking up toys and John hears her say she wants to find her ball. John goes away and the reason for Anne's action changes-Anne's mother tells her to tidy her bedroom. We asked, 'What will John believe is the reason that Anne is picking up toys?' which requires a false-belief inference, and 'If Anne's mother hadn't asked Anne to tidy her room, what would have been the reason she was picking up toys?' which requires a counterfactual inference. We tested children aged 6, 8 and 10 years. Children with autism made fewer correct inferences than typically developing children at 8 years, but by 10 years there was no difference. Children with autism made fewer correct false-belief than counterfactual inferences, just like typically developing children.

A Priori True and False Conditionals.

The theory of mental models postulates that meaning and knowledge can modulate the interpretation of conditionals. The theory's computer implementation implied that certain conditionals should be true or false without the need for evidence. Three experiments corroborated this prediction. In Experiment 1, nearly 500 participants evaluated 24 conditionals as true or false, and they justified their judgments by completing sentences of the form, It is impossible that A and ___ appropriately. In Experiment 2, participants evaluated 16 conditionals and provided their own justifications, which tended to be explanations rather than logical justifications. In Experiment 3, the participants also evaluated as possible or impossible each of the four cases in the partitions of 16 conditionals: A and C, A and not-C, not-A and C, not-A and not-C. These evaluations corroborated the model theory. We consider the implications of these results for theories of reasoning based on logic, probabilistic logic, and suppositions.

Reasoning about intentions: counterexamples to reasons for actions.

Four experiments tested the idea that people distinguish between biconditional, conditional, and enabling intention conditionals by thinking about counterexamples. The experiments examined intention conditionals that contain different types of reasons for actions, such as beliefs, goals, obligations, and social norms, based on a corpus of 48 intention conditionals established through an extensive materials test (n = 136). Experiment 1 (n = 19) showed that retrieved alternative reasons suppress the affirmation of the consequent and denial of the antecedent inferences from conditional intentions, whereas retrieved disabling reasons suppress the modus ponens and modus tollens inferences from enabling intentions. Experiment 2 (n = 61) showed that the suppression effects also occur for explicitly provided alternatives and disablers, for a large corpus of 80 intention conditionals. Experiment 3 (n = 60) showed that the suppression effects also occur for unfamiliar content, for which participants cannot rely on prior knowledge or beliefs about probabilities. Experiment 4 (n = 26) showed that participants retrieve alternatives and disablers readily for intentions just as they do for causal conditionals. The implications of the results for alternative accounts based on possibilities and probabilities are discussed.

Temporal and spatial relations in sentential reasoning.

The mental model theory postulates that the meanings of assertions, and knowledge about their context can modulate the logical meaning of sentential connectives, such as "if" and "or". One known effect of modulation is to block the representation of possibilities to which a proposition refers. But, modulation should also add relational information, such as temporal order, to models of possibilities. Three experiments tested this prediction. Experiment 1 showed that individuals spontaneously matched the tense of their conclusions (in Portuguese) to embody implied, but unexpressed, temporal relations in conditional premises. Experiment 2 demonstrated the same phenomenon in inferences from disjunctions. Experiment 3 showed that the number of such implicit relations in inferences from conditionals affects both accuracy and the speed of reasoning. These results support the modulation hypothesis.

The modulation of conditional assertions and its effects on reasoning.

The theory of mental models postulates that conditionals of the sort, if A then C, have a "core" meaning referring to three possibilities: A and C, not-A and C, and not-A and not-C. The meaning of a conditional's clauses and general knowledge can modulate this meaning, blocking certain possibilities or adding relations between the clauses. Four experiments investigated such interpretations in factual and deontic domains. In Experiment 1, the participants constructed instances of what was possible and what was impossible according to various conditionals. The results corroborated the general predictions of the model theory and also the occurrence of modulation. The resulting interpretations governed the conclusions that participants accepted in Experiment 2, which also yielded the predicted effects of a time limit on responding. In Experiment 3, the participants drew the predicted conclusions for themselves. In Experiment 4, modulation led to predicted temporal relations between A and C. We relate these results to current theories of conditionals.