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1.
J Surg Oncol ; 120(8): 1318-1326, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31701535

RESUMO

BACKGROUND: While better outcomes at high-volume surgical centers have driven regionalization of complex surgical care, access to high-volume centers often requires travel over longer distances. We sought to evaluate travel patterns of patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer to assess willingness of patients to travel for surgical care. METHODS: The California Office of Statewide Health Planning database was used to identify patients who underwent PD between 2005 and 2016. Total distance traveled, as well as whether a patient bypassed the nearest hospital that performed PD to get to a higher-volume center was assessed. Multivariate analyses were used to identify factors associated with bypassing a local hospital for a higher-volume center. RESULTS: Among 23 014 patients who underwent PD, individuals traveled a median distance of 18.0 miles to get to a hospital that performed PD. The overwhelming majority (84%) of patients bypassed the nearest providing hospital and traveled a median additional 16.6 miles to their destination hospital. Among patients who bypassed the nearest hospital, 13,269 (68.6%) did so for a high-volume destination hospital. Specifically, average annual PD volume at the nearest "bypassed" vs final destination hospital was 29.6 vs 56 cases, respectively. Outcomes at bypassed vs destination hospitals varied (incidence of complications: 39.2% vs 32.4%; failure-to-rescue: 14.5% vs 9.1%). PD at a high-volume center was associated with lower mortality (OR = 0.46 95% CI, 0.22-0.95). High-volume PD ( > 20 cases) was predictive of hospital bypass (OR = 3.8 95% CI, 3.3-4.4). Among patients who had surgery at a low-volume center, nearly 20% bypassed a high-volume hospital in route. Furthermore, among patients who did not bypass a high-volume hospital, one-third would have needed to travel only an additional 30 miles or less to reach the nearest high-volume hospital. CONCLUSION: Most patients undergoing PD bypassed the nearest providing hospital to seek care at a higher-volume hospital. While these data reflect increased regionalization of complex surgical care, nearly 1 in 5 patients still underwent PD at a low-volume center.


Assuntos
Comportamento de Escolha , Hospitais com Alto Volume de Atendimentos , Pancreaticoduodenectomia/estatística & dados numéricos , Viagem , Centros Médicos Acadêmicos , Idoso , California/epidemiologia , Feminino , Acesso aos Serviços de Saúde , Número de Leitos em Hospital , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Análise Multivariada , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Salas Cirúrgicas/estatística & dados numéricos
2.
Dev Neuropsychol ; 44(6): 468-480, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31539285

RESUMO

Children with ADHD and ASD may present differences in the affective-motivational processes. We systematically review the literature regarding temporal discounting in children up to 12 years with ADHD and ASD. Six articles were included, five studies with ADHD children (n = 231), one with ASD children (n = 21), all including typically developing children as controls (n = 210). Five studies (four with ADHD and one with ASD) found greater temporal reward discounting for clinical groups. Occurrence of ADHD appears to rush even more the decision-making process at this stage of development, but there is still a lack in the literature, especially evaluating individuals with ASD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Espectro Autista/psicologia , Comportamento de Escolha/fisiologia , Desvalorização pelo Atraso , Recompensa , Criança , Feminino , Humanos , Masculino
3.
Ann Agric Environ Med ; 26(3): 469-503, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31559810

RESUMO

OBJECTIVES: The aim of the study is to determine the scale of interregional migrating patients' hospitalizations in Poland in 2013-2017, as well as their demographic and medical factors, total costs and time changes. MATERIAL AND METHODS: Data from the NHF (National Health Fund) regarding hospitalizations in a given province of patients registered in another province in Poland in 2013-2017 were statistically analyzed. Times series analyses as well as coefficients of correlation, determination and variation were used. RESULTS: The number of patients hospitalized outside their regional registration and the cost of their hospitalization increased from year-to-year during 2013-2017. There was a large variation in provinces in terms of inflow of patients and costs of their hospitalization, while there was only a small variation in terms of outflow of patients and costs of their hospitalization in the analyzed years. Among the patients hospitalized outside the province where they were registered, there were more women then men, while the age group was dominated by 60-year-olds and their share in the subsequent years increased, while the share of other age groups remained unchanged or decreased. The most and increasingly more from year-to-year hospitalizations outside the regional registration were due to neoplasms and diseases of the circulatory system. CONCLUSIONS: The results of the study may significantly contribute to the proper planning of securing the health needs of the inhabitants of particular regions, and to improving the quality and economic efficiency of health services in individual NHF branches.


Assuntos
Hospitalização/economia , Pacientes/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Comportamento de Escolha , Feminino , Custos Hospitalares , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Polônia , Fatores de Tempo , Adulto Jovem
4.
Hu Li Za Zhi ; 66(5): 44-53, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31549380

RESUMO

BACKGROUND: Although the Taiwan government has subsidized the provision of palliative care at home since 2000, the utilization rate of this service has been low. PURPOSE: The purpose of this research is to explore the experiences of palliative care at home as perceived by family caregivers. METHODS: This qualitative study used semi-structured interviews to collect the data. Six family caregivers who had been providing home-based palliative care services for at least 2 weeks were invited to participate. RESULTS: Four themes related to the care experiences of the participants emerged: (1) Choosing palliative care at home for the end-of-life journey: Considering the wishes of patients and the capacities of caregivers, with hospitals providing powerful support to caregivers; (2) Facing the burdens of providing palliative care in a home setting: Determining the caring skills while feeling fear and stress, and needing to resolve this stress and achieve a respite; (3) Pursuing stable home palliative care: Relying on consultations with the professional palliative care team for information, support, and insights regarding the value of home palliative care; and (4) Fulfilling the promise of a good death at home: Preparing the patient to say goodbye and to experience a peaceful death and family members to express their sadness and adapt to a new life. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Home palliative care services help provide patients and their families convenience, intimate care, and reassurance at home. However, all caregivers must be properly trained in caring skills and the skills necessary to sustain their long-term care responsibilities. Home palliative care services have been described as the internal and external needs that patients and families require to maintain a stable quality of life and as the comfort required by the bereaved family members. The findings of this study demonstrate the value of home palliative care and of promoting home palliative care at the end of life.


Assuntos
Cuidadores/psicologia , Assistência Domiciliar/psicologia , Cuidados Paliativos/psicologia , Comportamento de Escolha , Humanos , Pesquisa Qualitativa , Taiwan
5.
J Int Bioethique Ethique Sci ; Vol. 30(2): 169-180, 2019 07 02.
Artigo em Francês | MEDLINE | ID: mdl-31460734

RESUMO

Faced with complex situations, caregivers test one of the oldest philosophical questions: how to prove the freedom of a decision? In the care, it is a question of determining if the patient has understood the situation, evaluated the consequences of his choice and if his decision is taken in the absence of any constraint. In other words, is the patient's decision an autonomous decision? But what are the tools that make it possible to evaluate this autonomy precisely and objectively? And also, how to promote a greater autonomy?


Assuntos
Tomada de Decisões , Metafísica , Autonomia Pessoal , Relações Médico-Paciente/ética , Comportamento de Escolha , Liberdade , Humanos
6.
Khirurgiia (Mosk) ; (8): 41-45, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464273

RESUMO

AIM: To determine the optimal surgical approach to insulin-producing pancreatic tumors via an analysis of early postoperative results. MATERIAL AND METHODS: There were 134 patients with insulin-producing pancreatic tumors followed by organic hyperinsulinism who have undergone surgery in the faculty-based surgical clinic of the Sechenov First Moscow State Medical University for the period 1990-2017. Patients were divided into three groups depending on type of surgical intervention. Surgical procedure was determined after comprehensive preoperative and intraoperative examination including intraoperative ultrasound. RESULTS: Incidence of postoperative complications was 32.8%. Ten (7.5%) patients required redo surgical interventions. Overall postoperative mortality was 4.5%. The best immediate results were observed in patients undergoing distal pancreatectomy. There was a correlation between incidence of early postoperative complications and tumor location depth in the enucleation group. CONCLUSION: Enucleation is advisable for insulinoma of pancreatic head or uncinated process, as well as superficial tumors of the left half of the pancreas. Distal pancreatectomy is indicated for deep tumors of the left half of the pancreas. Indications for pancreatoduodenectomy are individual.


Assuntos
Hiperinsulinismo/cirurgia , Insulinoma/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Comportamento de Escolha , Tomada de Decisão Clínica , Humanos , Hiperinsulinismo/etiologia
7.
Int J Equity Health ; 18(1): 129, 2019 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426808

RESUMO

BACKGROUND: Hierarchical medical systems are common in developed countries, but it's not optimistic in China. This study aimed to identify the factors affecting healthcare-seeking behavior among pregnant women in Guangdong, China. METHODS: We conducted a cross-sectional, observational survey, developed using the Andersen's behavioral model. Pregnant women were randomly selected using a two-stage, stratified, random sampling method from hospitals in Guangdong, China. A multinomial logistic regression was used to identify statistically significant variables from aspect of environmental, demographic and pregnancy characteristics associated with pregnant women seeking healthcare at primary, secondary or tertiary hospitals. RESULTS: A total of 1393 pregnant women returned the survey after attending 1 of 12 hospitals within 4 cities of the Guangdong province: 537 (38.5%) of the respondents attended a primary hospital, 437 (31.4%) a secondary hospital, and 419 (30.1%) a tertiary hospital. Women attending primary hospitals were more likely to live closer to the hospital, live rurally, and be educated to a lower level. Several factors were significantly associated with attendance at a secondary vs a primary hospital: the woman's perceived necessity to seek maternal healthcare (OR 1.73, 95% CI [1.1,2.74]), the woman's choice of delivery hospital (OR 1.45, 95% CI [1.01,2.07]), or urban living (OR 1.39, 95% CI [1.03,1.88]). Characteristics associated with attendance at a tertiary vs a primary hospital were: a history of pregnancy complications (OR 2.35, 95% CI [1.43,3.86]), travel to the hospital by public transport/taxi (OR 2.09/2.67, 95% CI [1.35,3.22]/ [1.45,4.92]), urban living (OR 1.58, 95% CI [1.14,2.18]), or a planned current pregnancy (OR 1.53, 95% CI [1.07,2.19]). CONCLUSION: Medical needs and convenience both play a role in the choice of hospital for antenatal care, and impact on equity utilization of health services. Pregnant women without risk factors and with higher levels of education should be a target population for guiding to choose a more proper level of hospital.


Assuntos
Comportamento de Escolha , Assistência à Saúde , Hospitais , Serviços de Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde , Gestantes , Adolescente , Adulto , China , Estudos Transversais , Parto Obstétrico , Escolaridade , Feminino , Equidade em Saúde , Humanos , Modelos Logísticos , Gravidez , Complicações na Gravidez , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Transportes , Viagem , População Urbana , Adulto Jovem
8.
Niger Postgrad Med J ; 26(3): 182-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441457

RESUMO

Background: Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. Aim: This study was aimed at assessing the use and preferences of FP services among women. Subjects and Methods: A community-based, descriptive, cross-sectional survey was carried out among 367 women (15-49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. Results: Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). Conclusion: Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.


Assuntos
Comportamento Contraceptivo , Anticoncepção/psicologia , Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente , Adolescente , Adulto , Atitude do Pessoal de Saúde , Comportamento de Escolha , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Escolaridade , Feminino , Humanos , Governo Local , Estado Civil , Pessoa de Meia-Idade , Nigéria , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Inquéritos e Questionários , Adulto Jovem
9.
Rev. psicol. trab. organ. (1999) ; 35(2): 75-83, ago. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184732

RESUMO

Multidimensional forced-choice questionnaires are widely regarded in the personnel selection literature for their ability to control response biases. Recently developed IRT models usually rely on the assumption that item parameters remain invariant when they are paired in forced-choice blocks, without giving it much consideration. This study aims to test this assumption empirically on the MUPP-2PL model, comparing the parameter estimates of the forced-choice format to their graded-scale equivalent on a Big Five personality instrument. The assumption was found to hold reasonably well, especially for the discrimination parameters. In the cases in which it was violated, we briefly discuss the likely factors that may lead to non-invariance. We conclude discussing the practical implications of the results and providing a few guidelines for the design of forced-choice questionnaires based on the invariance assumption


Los cuestionarios de elección forzosa multidimensionales son bastante apreciados en la literatura de selección de personal por su capacidad para controlar los sesgos de respuesta. Los modelos de TRI desarrollados recientemente normalmente asumen que los parámetros de los ítems permanecen invariantes cuando se emparejan en bloques de elección forzosa, sin dedicarle mucha atención. Este estudio tiene como objetivo poner a prueba empíricamente este supuesto en el modelo MUPP-2PL, comparando las estimaciones de los parámetros del formato de elección forzosa con su equivalente en escala graduada, en un instrumento de personalidad Big Five. Se encontró que el supuesto se cumplía razonablemente bien, especialmente para los parámetros de discriminación. En los casos en los que no se cumplió se discuten brevemente los posibles factores que pueden dar lugar a no invarianza. Concluimos discutiendo las implicaciones prácticas de los resultados y proponiendo algunas pautas para el diseño de cuestionarios de elección forzosa basados en el supuesto de invarianza


Assuntos
Humanos , Seleção de Pessoal/métodos , Competência Profissional , Psicometria/métodos , Habilidades para Realização de Testes/psicologia , Descrição de Cargo , Autoeficácia , Interpretação Estatística de Dados , Comportamento de Escolha , Testes Psicológicos/estatística & dados numéricos
10.
J Food Sci ; 84(8): 2269-2277, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339566

RESUMO

The objective of this study was to explore the drivers of choice and perceptions of healthiness that specific ingredient or energy content information displayed on the front-of-pack label of cereal bars triggers among different groups of consumers. The participants (18 to 50 years old), classified as exercisers (n = 103, 52 women) or nonexercisers (n = 101, 51 women), completed a questionnaire and then rated their interest using images of cereal bars that varied in four characteristics ("With fruit," "With chocolate," "High protein," and calorie content). Conjoint analysis showed that the most important motives were associated with the convenience, pleasure/indulgence and liking dimensions, which did not differ between groups. These were followed by two other motives introduced in this study: energy/physical activity and satiety, in which the exercisers showed a distinctively higher level of interest than the nonexercisers. Chocolate and a low calorie content were the outstanding drivers of interest, at similar levels for both groups. A high protein content claim increased the interest of all participants, but more so for exercisers and for men. Fruit had a low impact on interest, which was only significant for women. These results indicate that front-of-pack label information influences choice in a distinctive way for some targeted population groups. PRACTICAL APPLICATION: This study contributes knowledge about the impact that front-of-pack label information about certain ingredients and the energy content has on the motives and drivers for snack choices and perceptions of healthiness. The results contribute interesting results on the behavior of some consumer segments, in particular, exercisers and people involved in fitness activities, who are supposed to have special dietary needs.


Assuntos
Comportamento de Escolha , Rotulagem de Alimentos , Percepção , Lanches/psicologia , Adolescente , Adulto , Comportamento do Consumidor , Grão Comestível/química , Grão Comestível/metabolismo , Ingestão de Energia , Feminino , Ingredientes de Alimentos/análise , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
11.
Hosp Pract (1995) ; 47(3): 163-169, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31340694

RESUMO

Background: Aneurysmal subarachnoid hemorrhage (ASAH) and unruptured aneurysm (URA) are particularly important because of the high mortality rates, and physical and cognitive impairment, which affect the economically active population. The present work aims at describing the scenario regarding in-hospital indicators related to the following therapeutic approaches: vascular microsurgery (VMS) and endovascular therapy (EVT) in the state of Minas Gerais, Brazil, in order to gather information to construct hypotheses and plan actions. Methods: The study has an ecological design and it is also analytical for the time trends of 2008-2014. Trends for VMS and EVT therapies and mortality are estimated using linear regression, followed by the Prais-Winsten procedure. Data were obtained through Hospital Information System (Sistema de Informações Hospitalares - SIH) of Brazilian Public Health System (Sistema Único de Saúde - SUS). Results: In 2014, 601 procedures were performed, and out of these, 373 (62%) were triggered by SAH and 228 (38%) by URA. The frequency of procedures performed in males and in females results in a ratio of 1:2 for SAH procedures and 1:3 for URA procedures. A heterogeneous distribution of therapeutic approaches was seen among the hospital studied, suggesting a technological preference, which determines the therapeutic approach. Conclusion: Technological bias was observed for aneurysm treatment in Minas Gerais's hospitals. EVT is seen to have a growing trend to detriment of VMS (ß1 = 0.024; p = 0.025), with a stable mortality for both therapeutics in both pathologies (SAH and URA). EVT has been associated with a shorter hospital stay, with higher expenses for both ASAH and URA treatment. EVT showed an inverse correlation with in-hospital fatality for ASAH treatment.


Assuntos
Tomada de Decisão Clínica , Procedimentos Endovasculares , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos , Adulto , Idoso , Brasil , Comportamento de Escolha , Bases de Dados Factuais , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Sistemas de Informação Hospitalar , Humanos , Pacientes Internados , Aneurisma Intracraniano/fisiopatologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Resultado do Tratamento
12.
Psychopharmacology (Berl) ; 236(8): 2543-2556, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31256220

RESUMO

RATIONALE: Pairing rewarding outcomes with audiovisual cues in simulated gambling games increases risky choice in both humans and rats. However, the cognitive mechanism through which this sensory enhancement biases decision-making is unknown. OBJECTIVES: To assess the computational mechanisms that promote risky choice during gambling, we applied a series of reinforcement learning models to a large dataset of choices acquired from rats as they each performed one of two variants of a rat gambling task (rGT), in which rewards on "win" trials were delivered either with or without salient audiovisual cues. METHODS: We used a sampling technique based on Markov chain Monte Carlo to obtain posterior estimates of model parameters for a series of RL models of increasing complexity, in order to assess the relative contribution of learning about positive and negative outcomes to the latent valuation of each choice option on the cued and uncued rGT. RESULTS: Rats which develop a preference for the risky options on the rGT substantially down-weight the equivalent cost of the time-out punishments during these tasks. For each model tested, the reduction in learning from the negative time-outs correlated with the degree of risk preference in individual rats. We found no apparent relationship between risk preference and the parameters that govern learning from the positive rewards. CONCLUSIONS: The emergence of risk-preferring choice on the rGT derives from a relative insensitivity to the cost of the time-out punishments, as opposed to a relative hypersensitivity to rewards. This hyposensitivity to punishment is more likely to be induced in individual rats by the addition of salient audiovisual cues to rewards delivered on win trials.


Assuntos
Sinais (Psicologia) , Tomada de Decisões/fisiologia , Jogo de Azar/psicologia , Punição/psicologia , Recompensa , Animais , Comportamento de Escolha/fisiologia , Condicionamento Operante/fisiologia , Humanos , Masculino , Ratos , Ratos Long-Evans , Fatores de Tempo
13.
J Cancer Res Clin Oncol ; 145(8): 2157-2166, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31273512

RESUMO

PURPOSE: Adjuvant chemotherapy for gastric cancer, particularly stage III, improves survival after curative D2 gastrectomy. We investigated the clinical value of the lymph-node ratio (LNR; number of metastatic lymph nodes/number of lymph nodes examined) for selecting the appropriate adjuvant chemotherapy regimen in patients with D2-resected stage II/III gastric cancer. METHODS: We reviewed the data of 819 patients who underwent curative D2 gastrectomy followed by adjuvant chemotherapy. Of them, 353 patients received platinum-based chemotherapy and 466 received TS-1. The patients were categorized into three groups according to their LNR (LNR 1, 0-0.1; LNR 2, > 0.1-0.25; and LNR 3, > 0.25), and their disease-free survival (DFS) was evaluated. RESULTS: The DFS curves of the patients were well separated according to stage and LNR. In multivariate analyses, an LNR > 0.1 was strongly associated with the 3-year DFS (hazard ratio 2.402, 95% confidence interval 1.607-3.590, P < 0.001). Platinum-based chemotherapy improved the 3-year DFS compared to TS-1 in patients with LNR 3 group in stage III gastric cancer (platinum vs. TS-1, median DFS 26.87 vs. 16.27 months, P = 0.028). An LNR > 0.1 was associated with benefiting from platinum-based adjuvant chemotherapy in stage III gastric cancer patients with lymphovascular invasion (platinum vs. TS-1, median DFS 47.57 vs. 21.77 months, P = 0.011). CONCLUSIONS: The LNR can be used to select the appropriate adjuvant chemotherapy regimen for patients with D2-resected gastric cancer, particularly in stage III.


Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Comportamento de Escolha , Desoxicitidina/análogos & derivados , Fluoruracila/análogos & derivados , Gastrectomia , Linfonodos/patologia , Neoplasias Gástricas/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante/classificação , Cisplatino/uso terapêutico , Terapia Combinada , Desoxicitidina/uso terapêutico , Feminino , Fluoruracila/uso terapêutico , Gastrectomia/métodos , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Análise de Sobrevida , Tegafur/uso terapêutico , Uracila/uso terapêutico
14.
BMC Public Health ; 19(1): 924, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291919

RESUMO

BACKGROUND: In Eritrea, facility delivery rates show great discrepancy within urban centers. This study was conducted in Akordet, a multi-cultural lowland town of Gash-Barka Region, aiming at assessing the factors influencing facility delivery. METHODS: A community based analytical cross-sectional study was conducted among a total of 282 mothers who gave birth within the 2 years preceding the data collection time. Data collection was carried out by going house-to-house and interviewing the mothers using a structured closed ended questionnaire. Bivariate and multivariate logistic regressions were used to determine the magnitude of the relationship between place of delivery and the explanatory variables (Religion, Ethnicity, Mother's educational level, Husband's Educational level, Place of delivery preceding last pregnancy, Birth order of last child, Any complications during previous delivery, First ANC Visit during last pregnancy, Number of ANC visits during last pregnancy and Any complication during last pregnancy.). For this study, p-value ≤0.05 was considered as statistically significant. RESULTS: The rate of facility delivery in this setting was found to be 82.3%. Almost all (96.1%) the mothers had at least one ANC visit during their last pregnancy, with the majority (59.7%) visiting ANC clinics during second trimester for the first time. Mothers whose educational level is junior and above (AOR 8.8, CI: 1.18-65.64), whose husband's educational level is junior and above (AOR 3.92, CI: 1.03-14.54), who gave birth in health facility before the last pregnancy (AOR 8.16, CI: 3.41-19.48), and those who had complications during last pregnancy (AOR 2.24, CI: 1.04-4.82) were more likely to deliver in a health facility. Mothers whose last child's birth order was 4th -6th were less likely (AOR 0.24, CI: 0.090.62) to deliver at health facility. CONCLUSIONS: Early initiation of ANC and regularity in attendance should be emphasized. Health educations given to pregnant mothers should try to persuade the mothers that each pregnancy and ensuing delivery is unique. Empowering the community in general and women in particular by increasing the level of participation in education might payoff in high level of facility delivery.


Assuntos
Comportamento de Escolha , Parto Obstétrico/estatística & dados numéricos , Mães/psicologia , Adolescente , Adulto , Estudos Transversais , Eritreia , Feminino , Humanos , Mães/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
15.
Behav Processes ; 166: 103894, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31278969

RESUMO

Two of Timberlake's major contributions, amongst numerous other good notes, are Behavior Regulation Theory (BRT), and Behavior Systems Theory (BST). BRT was a refinement of the Premack Principle. What both got right was that reinforcers are responses, not stimuli. For BRT, they were responses that were occurring below the rate at which they otherwise would given free access to them. BST was a larger ethological framework for our science of behavior. We have always needed it, as it opens an important window on our field. With that window closed, it is easy to stumble over a half-dozen anomalies in the dark, ones that we say humph to, scratch our heads, and then move on. When illuminated by BST, however, such anomalies become keys to a deeper understanding of our subject. This paper reviews numerous anomalies that make sense within the joint framework of BST and BRT, and Dickinson's Dual-Process theory of learned behavior. No longer anomalous in that context, all that is now left to do is test the validity and productivity of this general framework for those many strange cases.


Assuntos
Comportamento de Escolha , Teoria Psicológica , Humanos
16.
Acta Psychol (Amst) ; 198: 102876, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31280037

RESUMO

In a series of decisions, people tend to show choice perseveration, that is, they repeat their choices. This choice perseveration is assumed to emerge due to residual activity from the previous decision. Here, we use a computational model with attractor dynamics to describe this process and to predict how choice perseveration can be modulated. We derive two qualitative predictions: Choice perseveration should decrease under longer (vs. shorter) inter-trial intervals and positive (vs. negative) mood. We test these predictions in a dynamic decision task where we modulate decisions across trials via sequentially manipulated reward options. Our findings replicate our previous study in showing choice perseveration in value-based decision making. Furthermore, choice perseveration decreased with increasing inter-trial interval as predicted by the model. However, we did not find clear evidence supporting mood effects on choice perseveration. We discuss how integrating decision process dynamics by the means of applying the neural attractor model can increase our understanding of the evolution of decision outcomes and therefore complement the psychophysical perspective on decision making.


Assuntos
Afeto/fisiologia , Tomada de Decisões/fisiologia , Estimulação Luminosa/métodos , Adolescente , Adulto , Comportamento de Escolha/fisiologia , Simulação por Computador , Feminino , Humanos , Recompensa , Fatores de Tempo , Adulto Jovem
17.
Br J Nurs ; 28(11): 728-729, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31188666

RESUMO

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers whether childhood immunisation should be made compulsory or left to parental choice.


Assuntos
Programas de Imunização , Programas Obrigatórios , Vacinas/administração & dosagem , Criança , Comportamento de Escolha , Humanos , Programas Obrigatórios/legislação & jurisprudência , Pais/psicologia , Saúde Pública , Reino Unido
18.
J Sport Exerc Psychol ; 41(3): 159-166, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31189427

RESUMO

This study examines whether the positive effect of choice on motor learning in a dart-throwing task varies by intrinsic motivation. Participants were allocated to a highly motivated or less-motivated group based on measured task motivation and randomly to a Choice or No Choice group. In Experiment 1, participants in the Choice group chose their dart color. In Experiment 2, they chose when to observe a model demonstration. Results showed that the effect of choice on motor learning differed between highly and less-motivated participants in Experiment 1 (i.e., interaction between motivation and choice) but not Experiment 2 (i.e., main effects of motivation and choice). Specifically, motor learning was enhanced in less-motivated but not highly motivated participants when choosing dart color, while it was enhanced regardless of initial intrinsic motivation when choosing model-demonstration time. Therefore, external provision of choice in a motor-learning situation may not be equally effective across learners.


Assuntos
Comportamento de Escolha , Aprendizagem , Motivação , Adolescente , Adulto , Feminino , Humanos , Masculino , Destreza Motora , Desempenho Psicomotor , Adulto Jovem
19.
Neuron ; 103(4): 734-746.e3, 2019 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-31253468

RESUMO

Adaptive decision making in dynamic environments requires multiple reinforcement-learning steps that may be implemented by dissociable neural circuits. Here, we used a novel directionally specific viral ablation approach to investigate the function of several anatomically defined orbitofrontal cortex (OFC) circuits during adaptive, flexible decision making in rats trained on a probabilistic reversal learning task. Ablation of OFC neurons projecting to the nucleus accumbens selectively disrupted performance following a reversal, by disrupting the use of negative outcomes to guide subsequent choices. Ablation of amygdala neurons projecting to the OFC also impaired reversal performance, but due to disruptions in the use of positive outcomes to guide subsequent choices. Ablation of OFC neurons projecting to the amygdala, by contrast, enhanced reversal performance by destabilizing action values. Our data are inconsistent with a unitary function of the OFC in decision making. Rather, distinct OFC-amygdala-striatal circuits mediate distinct components of the action-value updating and maintenance necessary for decision making.


Assuntos
Córtex Pré-Frontal/fisiologia , Reversão de Aprendizagem/fisiologia , Tonsila do Cerebelo/fisiologia , Animais , Comportamento de Escolha/fisiologia , Toxina Diftérica/farmacologia , Retroalimentação Fisiológica , Masculino , Modelos Neurológicos , Neurônios/efeitos dos fármacos , Neurônios/fisiologia , Núcleo Accumbens/fisiologia , Ratos , Recompensa
20.
Psychopharmacology (Berl) ; 236(8): 2437-2449, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31254091

RESUMO

BACKGROUND: Aversive stimuli in the environment influence human actions. This includes valence-dependent influences on action selection, e.g., increased avoidance but decreased approach behavior. However, it is yet unclear how aversive stimuli interact with complex learning and decision-making in the reward and avoidance domain. Moreover, the underlying computational mechanisms of these decision-making biases are unknown. METHODS: To elucidate these mechanisms, 54 healthy young male subjects performed a two-step sequential decision-making task, which allows to computationally model different aspects of learning, e.g., model-free, habitual, and model-based, goal-directed learning. We used a within-subject design, crossing task valence (reward vs. punishment learning) with emotional context (aversive vs. neutral background stimuli). We analyzed choice data, applied a computational model, and performed simulations. RESULTS: Whereas model-based learning was not affected, aversive stimuli interacted with model-free learning in a way that depended on task valence. Thus, aversive stimuli increased model-free avoidance learning but decreased model-free reward learning. The computational model confirmed this effect: the parameter lambda that indicates the influence of reward prediction errors on decision values was increased in the punishment condition but decreased in the reward condition when aversive stimuli were present. Further, by using the inferred computational parameters to simulate choice data, our effects were captured. Exploratory analyses revealed that the observed biases were associated with subclinical depressive symptoms. CONCLUSION: Our data show that aversive environmental stimuli affect complex learning and decision-making, which depends on task valence. Further, we provide a model of the underlying computations of this affective modulation. Finally, our finding of increased decision-making biases in subjects reporting subclinical depressive symptoms matches recent reports of amplified Pavlovian influences on action selection in depression and suggests a potential vulnerability factor for mood disorders. We discuss our findings in the light of the involvement of the neuromodulators serotonin and dopamine.


Assuntos
Aprendizagem da Esquiva/fisiologia , Simulação por Computador , Tomada de Decisões/fisiologia , Depressão/psicologia , Modelos Psicológicos , Recompensa , Afeto/fisiologia , Comportamento de Escolha/fisiologia , Humanos , Masculino , Estimulação Luminosa/métodos , Punição/psicologia , Adulto Jovem
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