Non-indicated vitamin B12- and D-testing among Dutch hospital clinicians: a cross-sectional analysis in data registries.

OBJECTIVES: To assess the extent of non-indicated vitamin B12- and D-testing among Dutch clinicians and its variation among hospitals. DESIGN: Cross-sectional study using registration data from 2015 to 2019. PARTICIPANTS: Patients aged between 18 and 70 years who received a vitamin B12- or D-test. PRIMARY AND SECONDARY OUTCOME MEASURES: The proportion of non-indicated vitamin B12- and D-testing among Dutch clinicians and its variation between hospitals (n=68) over 2015-2019. RESULTS: Between 2015 and 2019, at least 79.0% of all vitamin B12-tests and 82.0% of vitamin D-tests lacked a clear indication. The number of vitamin B12-tests increased by 2.0% over the examined period, while the number of D-tests increased by 12.2%. The proportion of the unexplained variation in non-indicated vitamin B12- and D-tests that can be ascribed to differences between hospitals remained low. Intraclass correlation coefficients ranged between 0.072 and 0.085 and 0.081 and 0.096 for non-indicated vitamin B12- and D-tests, respectively. The included casemix variables patient age, gender, socioeconomic status and hospital size only accounted for a small part of the unexplained variation in non-indicated testing. Additionally, a significant correlation was observed in non-indicated vitamin B12- and D-testing among the included hospitals. CONCLUSION: Hospital clinicians order vitamin B12- and D-tests without a clear indication on a large scale. Only a small proportion of the unexplained variation could be attributed to differences between hospitals.

Moralized Rationality: Relying on Logic and Evidence in the Formation and Evaluation of Belief Can Be Seen as a Moral Issue.

In the present article we demonstrate stable individual differences in the extent to which a reliance on logic and evidence in the formation and evaluation of beliefs is perceived as a moral virtue, and a reliance on less rational processes is perceived as a vice. We refer to this individual difference variable as moralized rationality. Eight studies are reported in which an instrument to measure individual differences in moralized rationality is validated. Results show that the Moralized Rationality Scale (MRS) is internally consistent, and captures something distinct from the personal importance people attach to being rational (Studies 1-3). Furthermore, the MRS has high test-retest reliability (Study 4), is conceptually distinct from frequently used measures of individual differences in moral values, and it is negatively related to common beliefs that are not supported by scientific evidence (Study 5). We further demonstrate that the MRS predicts morally laden reactions, such as a desire for punishment, of people who rely on irrational (vs. rational) ways of forming and evaluating beliefs (Studies 6 and 7). Finally, we show that the MRS uniquely predicts motivation to contribute to a charity that works to prevent the spread of irrational beliefs (Study 8). We conclude that (1) there are stable individual differences in the extent to which people moralize a reliance on rationality in the formation and evaluation of beliefs, (2) that these individual differences do not reduce to the personal importance attached to rationality, and (3) that individual differences in moralized rationality have important motivational and interpersonal consequences.

Social change as an important goal or likely outcome: how regulatory focus affects commitment to collective action.

The results of three experiments showed that regulatory focus influences the way in which the importance and likelihood of social change affect individuals' commitment to collective action. In Studies 1 (N= 82) and 2 (N= 153), the strength of participants' chronic regulatory focus was measured. In Study 3 (N= 52), promotion or prevention focus was experimentally induced. The results showed that for individuals under promotion focus, commitment to collective action depended on the perceived likelihood that through this action important social change would be achieved. Individuals under prevention focus were willing to commit to collective action when they attached high importance to its goal, regardless of the extent to which they believed that attainment of this goal was likely. Implications of these results for work on regulatory focus and collective action are discussed.

By any means necessary: the effects of regulatory focus and moral conviction on hostile and benevolent forms of collective action.

In two studies, we investigate the effect of individuals' promotion and prevention focus on engagement in collective action. We show that responding to group-based disadvantage out of a sense of moral conviction motivates prevention-oriented- but not promotion-oriented- individuals to engage in collective action. Furthermore, holding such strong moral convictions about the fair treatment of their group causes the prevention-oriented to disregard societal rules against hostile forms of collective action (i.e., forms of action that are aimed at harming the interests of those held responsible for the group's disadvantage). Study 1 showed that prevention-oriented individuals, but not promotion-oriented individuals, with a strong moral conviction about the fair treatment of their group are willing to support both hostile and benevolent forms of collective action. Study 2 replicated this effect and showed that for prevention-oriented individuals but not for promotion-oriented individuals, holding a strong moral conviction about the fair treatment of the group overrides moral objections to hostile forms of collective action in the decision to support these forms of action.