Judging the possibility of the onset of diabetes mellitus type 2 from reported behavioral changes and from family history.

BACKGROUND: Undiagnosed type 2 diabetes is common and can lead to unrecognized health complications. Given that earlier detection can reduce the damage to vital organs, it is important for all persons to be able to make the connection between certain new manifestations in their bodies and the possibility of diabetes. This study examined the extent to which people use the behavioral changes they observe in others (or in themselves), as well as relevant family history, to judge the possibility of the onset of diabetes. METHODS: One hundred and fifty-six adults living in France examined a set of realistic vignettes describing a person with (or without) signs suggestive of diabetes (e.g., increased thirst, family antecedents) and judged the possibility of the disease in each case. RESULTS: Overall, 36% of participants focused on reported symptoms when judging the possibility of diabetes, 37% focused on family history, and 29% were not able to use the information or tended systematically to minimize the possibility of diabetes. CONCLUSIONS: People in France and probably around the world need a greater awareness not only of the factors putting them at risk of diabetes, but also of the specific signs and symptoms suggesting that they might be developing it.

Mapping Colombians' positions on sentencing for substance offenses.

BACKGROUND: In Colombia, a person caught in possession of an illicit substance is not judicially sanctioned as long as the quantity does not exceed the maximum allowable amounts. Given that the public is divided on the appropriateness of this policy, an examination of the various public positions was undertaken. METHOD: A convenience sample of 302 adults were presented with 48 vignettes depicting a situation of everyday life easily recognizable by all in Colombia; that of a male person who is apprehended in the street by the police because he is suspected of illicit trafficking. These vignettes were created by orthogonal variation of four factors: Type of substance, amount of substance, type of charge against the offender, and offender's age. RESULTS: Through cluster analysis, six qualitatively different positions were found. These positions corresponded to three distinct, classical philosophies (a) a libertarian, free-market philosophy - punishment should never be extremely severe because the trade in psychotropic substances is a trade like any other (6%), (b) a moralistic, conservative philosophy - punishment should always be extremely severe except perhaps in certain cases (52%), and (c) a progressive, human rights-inspired philosophy - punishment should always be proportional to the seriousness of the facts (42%). CONCLUSION: Half of Colombian people supported a control policy according to which the use of psychotropic substances is considered profoundly immoral. Most of the other segment of the population express views similar to those of international organizations. It is therefore desirable that legislators rely on progressive international legislation to support domestic policies that are not strictly moralistic and conservative.

Young Indians' Willingness to Make a Living Organ Donation.

BACKGROUND: The large unmet need in India for organs to transplant calls for an increase in living organ donations. This study examined the positions of Indian university students on making a living organ donation. METHODS: A convenience sample of 339 students from Karnatak University rated willingness to be a living donor in 48 scenarios consisting of all combinations of 5 factors: recipient's identity (close family member vs stranger), level of surgical risk for the donor, possible long-term health consequences for the donor, probability of transplant success, and likelihood of finding other donors (the subject is one of the rare compatible donors or one donor among others). RESULTS: Cluster analyses showed the existence of 4 qualitatively distinct positions called nondonors (9%); family donors (21%), for whom willingness was very high when recipients were family members and very low when they were strangers; universal donors (30%), for whom willingness was also quite high when a stranger was involved; and conditional donors (23%), who took a risk-benefit perspective. CONCLUSIONS: These finding suggest that the fundamental reason for the current shortage of organs in India is neither psychological nor cultural but more likely organizational.

Assessing hospitalized patients' quality of life from external indices: the perspectives of lay people and health professionals.

PURPOSE: We examined the way people assess hospitalized patients' quality of life from what they immediately observe when entering the patient's room, from what they learn by conversing with the patient, and from what they know about the patient's social life. METHODS: A sample of 474 adults (among them 7 physicians, 57 nurses, and 42 nurse's aides) aged 18-90 years was presented with 54 realistic scenarios depicting the situation of a terminally ill patient, and created by orthogonally combining the levels of four factors: chronic pain (e.g., requiring powerful painkillers), social support (e.g., some visits), mental status (e.g., alterations of consciousness), and physical autonomy. In each case, they assessed the patient's health-related quality of life. RESULTS: Through cluster analysis, three different positions related to what is important when judging the quality of life of a hospitalized patient were found. They were labeled Almost Always Low (40%), Depends on Personal and Social Circumstances (49%), and Depends Mainly on Social Support (11%). Health professionals did not differ fundamentally from lay people in their positions regarding what determines the health-related quality of life of their patients. CONCLUSION: Many people take a particularly pessimistic view of the quality of life of people whose health is unlikely to improve. Others think that, in certain circumstances, a certain quality of life can be preserved but for this to happen, the situation must be nearly ideal. A minority expressed a position consistent with the insistence of voluntary patient-visiting associations on the importance of providing hospitalized patients with social support.

Mapping French people and health professionals' positions regarding the circumstances of morphine use to relieve cancer pain.

BACKGROUND: Cancer patients suffer in part because some health professionals prescribe or administer amounts of analgesics, namely opioids, which are too small or too widely spaced to be fully effective. Patients' reluctance to use opioids for pain treatment is often mentioned as a reason not to apply the official guidelines, but very few studies have been conducted on people's attitudes about opioid use to relieve cancer pain. METHODS: One hundred twenty lay participants and 30 health professionals (7 physicians and 23 nurses) were presented with a set of vignettes describing a terminally ill woman with cancer who is in pain. The vignettes were composed according to a four within-subject factor design: (a) level of pain reported by the patient, (b) patient's explicit request for additional administration of analgesics, (c) the physicians' final decision (e.g., to use a stronger analgesic combining paracetamol and codeine), and (d) the way the decision was made (collectively or not). Participants were asked to assess the extent to which the physician's decision was, in their view, acceptable. RESULTS: Seven qualitatively different positions were found among participants. They were called as follows: tend to disagree with any decision (9%), increase the strength of the painkiller in any case (16%), give morphine preferentially (9%), partly depends on pain level (23%), fully depends on pain level (6%), depends on decision process and on pain level (22%), and tend not to disagree with any collective decision (25%). CONCLUSIONS: Overall, 91% of participants agreed with the use of morphine in terminally ill cancer patients when the pain level was high (score of 7) and the decision to increase the strength of the painkiller was taken collectively. This percentage dropped to 69% when the team was not involved in the decision and to 40% when the pain level was lower (score of 4). If opposition to the use of morphine exists, it is not opposition to morphine itself but opposition to the circumstances of its use.

The acceptability of ending a patient's life: a France-Portugal-Spain comparison.

The views of French, Portuguese, and Spanish people on end-of-life decisions were compared. Two hundred seventy-seven adults from Barcelona, Oporto, and Toulouse judged the acceptability of life-ending procedures in 42 scenarios composed of all combinations of 3 factors: the patient's age (30 or 80 years), the patient's life expectancy (days, weeks, or months), and the type of procedure (suicide, suicide assisted by the physician, euthanasia by the physician at the request of a suffering patient, euthanasia of a comatose patient at the family's request, euthanasia of a comatose patient as stipulated in the patient's advance directives, euthanasia of a comatose patient without advance directions and without a request from the family, or euthanasia of a suffering patient without a request from the patient). In all 3 countries, the type of procedure had the major effect. The 4 procedures implemented by the patient or at the patient's request were, on average, considered acceptable. The 2 procedures not implemented at the patient's request were considered unacceptable. Euthanasia of a comatose patient at the request of the family was judged mildly acceptable. The attitudes of the people in Toulouse, Oporto, and Barcelona concerning the acceptability of ending a patient's life have now largely converged, although Spanish participants were statistically significantly more accepting than French and Portuguese participants.

Driving anger, emotional and instrumental aggressiveness, and impulsiveness in the prediction of aggressive and transgressive driving.

The present study investigates the potential contribution of three predictors of aggressive and transgressive behaviors on the road: driving anger, impulsiveness and aggressiveness. A total of 455 participants (laypersons), of all age and gender, filled self-reported measures evaluating driving anger, impulsiveness, two forms of aggressiveness (instrumental and emotional forms), driving behaviors and aggressive and transgressive behaviors. Main results indicate: (1) a significant gender effect for almost all variables; (2) gender was involved in the prediction of Lapses and Errors; (3) driving anger, impulsiveness and aggressiveness were involved in a complementary manner in the prediction of aggressive and transgressive driving; (4) Aggressiveness and Impeded Progress were the best predictors of violations and aggressive violations. Results support that transgressive driving behaviors are relevant indicators of aggressive driving.

Misconceptions about hepatitis C in the Togolese public.

OBJECTIVE: To characterize the Togolese public's understanding of hepatitis C (HC). METHOD: Two convenience samples in Togo-282 lay people and 30 health professionals (22 nurses, 8 physicians)-indicated in 2006 their level of agreement with the same 94 statements about HC evaluated by French hepatologists (the reference group of experts) in 2003 and by French lay people in 1997. Their mean responses were compared using Student's T-test, and correlations were calculated between each group's series of responses and between their significant differences from the experts. RESULTS: The mean absolute differences between experts and Tologese lay persons, nurses, and physicians were 4.33, 3.72, and 2.57 (on a scale of 0-10). The correlations between the mean responses of experts and Togolese lay persons, nurses, and physicians were .34, .42, and .44. For the significant differences from experts, the correlation between Tologese lay persons and French lay people in 1997 was .94, and the correlations between Tologese lay persons and Togolese nurses and doctors were .94 and .74. For all these results, p<.001. CONCLUSIONS: Togolese lay persons, and even health professionals, appear to have misconceptions about HC that may lead to stigmatization and incorrect treatment of persons infected with HC.

End-of-life preferences: a theory-driven inventory.

The study aimed at making a theory-driven inventory of end-of-life preferences. Participants were asked about a variety of preferences representing all eight motivational states described in Apter's Metamotivational Theory (AMT; Apter, 2001). Data from a convenience sample of 965 community participants and a convenience sample of 81 persons suffering from a terminal illness were examined using exploratory and confirmatory factor analysis. Ten factors were evidenced; they were easily interpretable in the AMT framework. In decreasing order of importance, people would, at the time of their death, like to have an understanding doctor, to be at peace with themselves, to remain autonomous, to keep a sense of humor, to remain able to oppose any decision taken without their consent, to remain an object of love, to remain a reference for others, to have resolved conflicts with others, to leave their businesses in good order, and to find themselves at peace with God.

Is it acceptable for a psychiatrist to break confidentiality to prevent spousal violence?

STUDY QUESTION: When is it acceptable for a psychiatrist to break confidentiality to protect the wife of a potentially violent patient? METHODS: 153 lay persons, 13 nursing personnel, 10 physicians, and 10 psychologists in France indicated this acceptability in 48 scenarios. The scenarios were all combinations of 5 factors: gravity of threat (death or beating), certainty of mental illness (certain or not), time spent talking with patient (considerable or little), his attitude toward psychotherapy (rejection, indecision, or acceptance), and whether the physician consulted an expert. RESULTS: Lay people favored breaking confidentiality more than did nursing personnel or psychologists. Consulting an expert had greatest impact. Lay participants were composed of groups that found breaking confidentiality "always acceptable" (22 participants), "depending on many circumstances" (106), requiring "consultation with an expert" (31), and "never acceptable" (27). CONCLUSION: Lay people in France are influenced by situational factors when deciding if a psychiatrist should break confidentiality to protect a patient's wife.

Acceptability in France of induced abortion for adolescents.

BACKGROUND: This study investigated the factors affecting the acceptability in France of abortions. METHOD: 80 study participants from Toulouse and 124 from Metz judged the acceptability of abortion in 64 vignettes composed of five factors: 1) the adolescent's age (15 or 17.5 years), 2) the adolescent's plans to continue schooling or not, 3) the fetus' age (1, 2, 3, or 4 months), 4) the adolescent's parents' agreement or not, and 5) the agreement or not of baby's father. RESULTS: Three clusters were noted: 1) abortion is never acceptable (8% of participants), 2) abortion is always acceptable (23%), and 3) acceptability of abortion depends on the circumstances (63%). In the majority cluster (3), all five factors had significant effects, but the fetus's age accounted for most of the variance (78%). CONCLUSION: Most subjects in this study judged, in accordance with French law, that the acceptability of induced abortion in minors depends on the circumstances and, in particular, on the fetus' age.

Cognitive processes involved in blame and blame-like judgments and in forgiveness and forgiveness-like judgments.

Experiment 1 compared the cognitive processes involved in blame and forgiveness judgments under identical experimental conditions. Experiment 2 was a replication of Experiment 1 with 4 judgment scales: willingness to prosecute, willingness to avenge, resentment level, and willingness to make up. Participants were presented with 32 scenarios in which a doctor made a medical error. These situations contained 5 items: the degree of proximity with the doctor (e.g., a family doctor known since childhood), the degree of negligence, the severity of consequences, apologies or contrition, and cancellation of consequences. Functional cognitive analysis grouped judgments into 2 categories: blame-like judgments (blame, prosecution, and revenge) and forgiveness-like judgments (resentment, forgiveness, and reconciliation). Blame-like judgments were characterized by additive integration rules, with negligence followed by apologies as the 2 main cues. Forgiveness-like judgments were characterized by an interactive integration rule, with apologies followed by negligence as the 2 main cues.

Changes in French people's misconceptions about hepatitis C, 1997-2003.

OBJECTIVE: The French health authorities instituted in 1999 a campaign to educate physicians, high-risk populations, and the public about hepatitis C (HC). To what extent has knowledge about HC increased among members of the French public? METHOD: A convenience sample of 706 French adults, aged 18 to 87, completed in 2003 a questionnaire designed to assess their knowledge of HC. Their responses were compared to those in 1997 of a different group of French adults on an identical questionnaire. RESULTS: Between 1997 and 2003, knowledge significantly improved on 13 of the 26 items for which strong expert-public differences were found in 1997 and significantly worsened on 3 items. CONCLUSIONS: France's public education campaign led to only a limited increase in knowledge about HC. Further public education is needed.

Does choosing a treatment depend on making a diagnosis? US and French physicians' decision making about acute otitis media.

BACKGROUND: The classic sequential processing model of clinical decision making-in which the treatment choice follows and depends on the diagnostic judgment-may in some cases be replaced by a processing model in which the treatment choice depends on an independent assessment of the diagnostic and other cues. The aim of this study was to determine which processing model would better describe physicians' treatment choices in a simulated clinical task. METHODS: Seventy-five US and French primary care physicians were presented twice, in a different order, with the same set of 46 scenarios of 15-month-old children suspected of having acute otitis media (AOM). They rated in one set the probability of AOM and in the other set whether they would treat the child with antibiotics (and how confident they felt in their decision). Linear regression analyses revealed the individuals' 2 judgment policies. Hierarchical discriminant analysis was used to analyze the variance explained in the treatment choice by, 1st, the diagnostic judgment, 2nd, the cues specific to treatment, and 3rd, the cues specific to diagnosis. RESULTS: Even when choosing treatment, the participants placed greatest weight on diagnostic cues, especially the ear findings. Only 28% used the cues that reflected parental issues. For 36%, the diagnostic cues had an effect on the treatment choice independent of the effect (if any) of the diagnostic judgment. CONCLUSION: In deciding how to treat AOM, the majority of the participating US and French primary care physicians followed the classic sequential processing model, but a substantial minority used instead an independent processing model.

Do parents and physicians differ in making decisions about acute otitis media?

OBJECTIVES: We wanted to discover how parents differ from physicians in making decisions about how to treat a child who may have acute otitis media (AOM). STUDY DESIGN: We used questionnaires that required participants to judge the probability of AOM or choose treatment for 2 sets of 46 paper scenarios of hypothetical children aged 15 months who might have AOM, and they subsequently rated the importance of individual cues and described their attitudes and opinions related to health care and AOM. POPULATION: Convenience samples of 19 US family physicians, 35 French generalists, 21 French pediatricians, 52 US parents, and 86 French parents were included. OUTCOMES MEASURED: The primary outcomes were the judgment policies-the weights placed on each of the scenario cues when making decisions-that were derived for each individual and each group by multiple linear regression. RESULTS: The mean judged probabilities of AOM were nearly the same for all groups: 50% for the US physicians, 51% for the US parents, 52.5% for the French physicians, and 52% for the French parents. The percentages of cases treated with antibiotics did not differ: 53% for US physicians, 45% for US parents, 53% for French physicians, and 51% for French parents. All groups gave greatest weight to the physical examination cues for decisions about both diagnosis and treatment. The parents paid little attention to the cues that reflected parental concerns. CONCLUSIONS: US and French parents were very similar to physicians in their judgments and treatment choices regarding AOM. They appear to be able to adopt the physician's point of view and to be selective in the use of antibiotics.