Strong Intent Research Articles

Wanting to and Doing So: Parental Intent to Change Weight Does Not Translate Into Behavior

Objective: Because poor parental recognition of overweight is so common in young children, we sought to determine whether demographics or family behaviors differed in children whose parents were actively trying to reduce excess weight in their child compared with those who were unaware there was an issue. Methods: Parents of 271 overweight (body mass index≥85th) children aged 4-8 years completed questionnaires on demographics, weight, feeding practices, social desirability, dietary intake, and home food availability. Children wore accelerometers over 7 days to measure physical activity/inactivity. Results: 113 parents (41.7%) classified their child as overweight, 96 (35.4%) indicated at least some concern, but only 66 (24.4%) parents were trying to (probably or definitely) change their child’s weight. In total, 56 children met all three criteria. These children were older, heavier and more likely to be female (P<0.001), but did not differ in socioeconomic status (P=0.614), maternal education (P=0.615), or ethnicity (P=0.051), compared to the remaining children. Few differences in feeding practices were observed, except for higher food restriction in those trying to change their child’s weight (P<0.001). These children were significantly less physically active (P=0.033) and more sedentary (P=0.002) than the other children. Despite strong intent to change the diet (P<0.001), this did not translate to differences in home food availability or dietary intake. Social desirability was also not related to efforts to change. Conclusion: Parental awareness of excess weight in young children and attempts to address the issue do not appear to translate into healthier behaviors in the home.

Characteristics of Chinese rural young suicides: Who did not have a strong intent to die

BackgroundIn exploration of the risk factors of the Chinese rural young suicide, previous researchers found low prevalence of mental problems, high degree of impulsivity, and great proportion of lethal pesticide consumption. It noticed that some of the young suicides in rural China did not intend to die from the suicidal behavior which was only instrumentally used for certain gains. AimsThis study aims to look into the characteristics of those young suicides who did not really intend to die and compare them with those young suicides who had a strong intent to die. MethodsSubjects were 386 suicides aged 15–34years in the rural areas of three provinces in China. The data were obtained by psychological autopsy method. The degree of suicidal intent of the subjects was evaluated by the first 8 items of Beck's Suicide Intent Scale (SIS). ResultsIt was found that those suicides that had a strong intent of death were more likely to have higher age, more years of education, live alone, and suffer mental disease. On the other hand, the low intent suicides were more likely to have pesticides at home and to be impulsive. In other words, pesticides and impulsivity killed some Chinese rural young men and women who did not really want to die by suicide. ConclusionFindings of the study may be translated into practical measures in suicide prevention in China as well as elsewhere in the world.

Understanding if, how and why non-adherent decisions are made in an Australian community sample: a key to sustaining medication adherence in chronic disease?

Adherence to medications for chronic disease is sub-optimal. Current adherence-enhancing strategies do not seem to adequately address the fundamental need to sustain adherence or prevent non-adherence. Intentional non-adherence, involving active medication-taking decisions, is not well described within the Australian community setting. Understanding if, how and why non-adherent decisions are made may help develop strategies to sustain adherence in chronic disease. This study aimed to describe intentional non-adherent behavior in chronic disease within the Australian community setting and identify the factors that promote and prevent non-adherent decisions. In-depth, semi-structured interviews were conducted with 21 patients (12 rural, 9 metropolitan; New South Wales) prescribed medications for a diverse range of chronic conditions. Using the Theory of Planned Behavior as the theoretical framework, an iterative thematic framework analysis method was used to characterize the intentions and the decisions underlying non-adherent behavior. Data were indexed and charted within the thematic framework using Excel, and linked themes were combined, and associations and explanations drawn. Although there was a strong intent to follow prescribers' recommendations, most patients described instances of intentionally non-adherent behavior. Trading between perceived treatment inefficacy, unfavorable side effects and unaffordable medication costs promoted non-adherent decisions; trusting prescriber-patient relationships, positive family values and lack of perceived control over treatment choice maintained adherent intentions. Intentional non-adherence was mostly temporary. Intentional medication non-adherence in chronic disease appears reversible and amenable to interventions that address treatment-related barriers such as medication affordability. Strategies that strengthen patient-prescriber relationships and empower patients as informed decision-makers may help maintain adherence intentions. Crucially, regular and sustained interventions that are refreshed to meet the changing needs of patients are needed to curb the temporal decline in adherence to chronic disease medications.

Abstract W P337: Going to War for Stroke: The Experience of Establishing a Comprehensive Stroke Center in the United States

Background: Leading cultural change and performance improvement within a Stroke Center is often associated with resistance to increased workload and resources. We sought to understand neurologists’ experiences with transition to high performing U.S. Comprehensive Stroke Centers (CSC). Methods: Qualitative interviews were used to develop a survey for physicians currently or formerly working in CSC leadership positions identified thru listserv, fellowship directors, and web. The survey was 29 items with 6 items tied to DSM-IV PTSD experiential criteria and 3 qualitative items. Quantitative data were entered and analyzed in SPSS; qualitative data were analyzed to determine themes. Results: 48 CSC directors responded: 60% fellowship trained vascular neurologists (VN); 65% certified VN; 8% neurocritical care certified; 6% interventionalists. Sites were 67% academic; this was the first leadership position for 54%, with 9.3+6.5 (median 8) years as program leader. Prior to assuming leadership, tPA rates averaged 2.8%+4.8%, median 1.2%, with 40% not giving tPA; leader tPA rates averaged 12.1%+8.7%, median 9.5% (mean diff 9.1; 95% CI 6.9-11.3; p&lt;0.001). Perceptions were dichotomized by agreement (Table); 21% met 1 PTSD criterion, while 12.5% met 6 criteria. Neurologists were identified as most supportive (44%), but also most commonly (27%) seen as least supportive. Strong intent to leave was 20%, while 33% were intent on staying. Insufficient pay (33%) and lack of hospital/physician administrative support (33%) were the most common reasons for dissatisfaction. Qualitative themes included need for “Authentic Support” from hospital/physician administrators’ and “Vigilante’ Caring” tied to persistence/work ethic. Conclusions: Despite challenges, CSC leaders are highly motivated, although rates of experiences tied to PTSD approaches that of soldiers. Hospital/physician administrators must improve support of stroke warriors to ensure optimal performance.

Integrating robustness and resilience in change and competitive advantage framework: insights from Indian pharmaceutical industry

Understanding of enablers which dynamically configure the organisational capabilities of change and adaptation in the current hypercompetitive environment constitutes a key research agenda for researchers in strategic management. Based on data obtained from 216 senior executives from Indian pharmaceutical industry, this paper shows how the constructs of alternate economic logic, strong future focus and flexible intent configure the attributes of robustness and resilience in organisations. This paper therefore reviews and examines the themes of resilience and robustness and its impact on organisational change capability to drive competitive advantage by using confirmatory factor analysis (CFA). The study resulted in useful insights into the field of factors contributing to robustness, resilience and change, leading to superior performance which is an indicative of competitive advantage. The contribution of this research is significant as it will guide strategy practitioners to synergistically configure their organisations with attributes of robustness and resilience for competitive advantage.

Examination of psychosocial predictors of Virginia pharmacists' intention to utilize a prescription drug monitoring program using the theory of planned behavior

Little is known about the main drivers of pharmacists' intention to utilize prescription drug monitoring programs (PDMPs) when making care decisions and the actual contribution of these factors in explaining intention and behavior. This study examined what theory of planned behavior (TPB) model constructs (i.e., attitude, subjective norm [SN], perceived behavioral control [PBC]), past utilization behavior (PUB) and perceived moral obligation (PMO) were significant predictors of Virginia community pharmacists' intention to utilize a PDMP. A cover letter with a link to a 28-item online survey was e-mailed to 600 members of the Virginia Pharmacists Association. Multiple regression analyses were used to determine the association between pharmacists' intention to utilize the PDMP database and attitude, SN, PBC, PUB and PMO. Ninety-seven usable responses were received, for a response rate of 16.2%. A majority of the respondents were Caucasian (96.4%), female (50.5%), working in independent community pharmacies (60.4%) with an average age of 49.5 ± 13.4 years. Overall, pharmacists intended to utilize a PDMP (mean = 5.3 ± 4.6; possible range: -9 to 9), had a positive attitude toward utilizing PDMP (mean = 6.3 ± 5.3; possible range: -12 to 12), perceived that others wanted them to utilize a PDMP (SN score = 3.7 ± 2.4; range: -6 to 6), and believed that they had control over utilization behavior (PBC score = 4.5 ± 4.0; range: -9 to 9). Attitude (β = 0.723, P < 0.001), SN (β = 0.230, P = 0.014) and PBC (β = -0.215, P = 0.026) significantly predicted pharmacists' intent, accounting for 56.7% of the variance in intention to utilize the PDMP database (P < 0.001). The addition of PMO (P < 0.001) significantly contributed to explaining the variance in intention but PUB did not. Members of the Virginia Pharmacists Association who responded to the survey showed a strong positive intent to utilize PDMP database. Pharmacists' attitudes, subjective norm, perceived behavioral control and perceived moral obligation were significant predictors of intention but past utilization behavior was not. The TPB is a useful theoretical framework when predicting PDMP utilization behavior of community pharmacists, accounting for 56.7% of the variance in intention.

Hostile $855 Million Bid For Ferro

Plastics compounder A. Schulman has made a hostile bid to acquire ailing specialty chemical maker Ferro Corp. for $855 million, including debt. Ferro’s board, which turned down an unpublicized bid from Schulman in mid-February, says shareholders will do better if they let the company carry out its current turnaround strategy. News of the $6.50-per-share offer pushed Ferro’s stock price up 34% from its previous close to a high of $6.95 on March 4, the day Schulman went public with its offer. However, Ferro’s shares dropped to $6.57 the next day, when it became clear the company would put up a fight. Schulman said it could adjust its offer if it got a look at Ferro’s accounting books. Akron, Ohio-based Schulman first contacted Cleveland-based Ferro about a merger in November 2012. On Feb. 13, it sent Ferro’s board a letter expressing its “strong intent” to pursue a business combination. Rejected, Schulman ...

‘A hypnotic viewing experience’. promotional features in the language of exhibition press announcements

Museums have become fully active cultural agents, pursuing educational aims but also trying to attract the largest number of visitors. Exhibition press announcements (EPAs) issued by museums reflect this tendency and address journalists as if they were ‘customers’ in a very competitive market. Building on Bhatia’s work on promotional genres (1993, 2004) and recent corpus-based studies devoted to press releases (Catenaccio 2008; Lindholm 2008; McLaren and Gurâu 2005), this paper investigates lexico-grammatical forms typical of EPAs with the aim to demonstrate that they carry a strong promotional intent and reflect the value-system of the professional communities involved, i.e. art journalists and museum professionals. The study was carried out on a corpus of contemporary Anglo-American EPAs and shows the recurrent use of linguistic features that express positive evaluation of the exhibition, especially with regard to the semantic areas of novelty, quality, extensiveness and exclusiveness. Emotional linguistic features are also used in order to create ‘news value’ and excite curiosity around the artists and their artworks.

Suicide of elderly persons: Towards a framework for prevention

Suicide is an act of intentionally terminating one's own life. Although suicide rates vary across demographic categories, they have increased by approximately 60% in the last 50 years. Many studies of adolescent suicidal behavior have noted impulsivity to be a common feature in the younger age group, while with older people there is evidence of planning and a strong intent to die. In fact, older people are most successful as an age group with approximately one in four attempts resulting in death. While very comprehensive statistics are available on many aspects of this problem for the Turkish population as a whole, this data does not include physical factors like illnesses, legal domiciles like nursing homes, economic standards and history of attempted suicides. This necessary data would add greatly to the available data and accuracy of research in this area. Whereas Turkish national risk factor procedures are available, precaution procedures and suicide attempt data is not. There is no way of knowing how many deceased had a history of repetitions. It is suggested that this could be attributed to routine failure to observe and mitigate risk factors. The size of this problem is being demonstrated with this presented case report about a planned complex suicide with multiple sharp forced injuries and substance intoxication; a completed suicide that was potentially preventable with timely detection and intervention. In accordance, suicidal risk factors in the old age population, precautions, along with the characteristics of this suicidal case, are evaluated within existing published work.

Examination of pharmacists’ intention to report serious adverse drug events (ADEs) to the FDA using the theory of planned behavior

Background Adverse drug event (ADE) reporting by pharmacists is an indispensable part of the drug safety system. U.S. pharmacists may submit reports of serious ADEs that they encounter to the Food and Drug Administration (FDA) through MedWatch. However, underreporting of serious ADEs is a common problem. Little is known about pharmacists’ decision making with respect to ADE reporting. Objectives This study explored the utility of the theory of planned behavior (TPB) model in predicting Texas pharmacists’ intention to report serious ADEs to the FDA. Methods Data were collected from practicing Texas pharmacists using a mail questionnaire. A total of 1500 surveys were mailed, and 377 usable responses were obtained for a response rate of 26.4%. Results A majority (70.2%) of the 377 respondents were white/Caucasian, and 52.9% were male. Overall, pharmacists intended to report serious ADEs (mean = 15.87 ± 4.22; possible range: 3-21), had a positive attitude toward reporting (mean = 4.62 ± 4.92; possible range: −15 to +15), perceived that important others wanted them to report (subjective norm [SN] score = 5.65 ± 2.99; possible range: −9 to +9), and believed that they had control over their reporting behavior (perceived behavioral control [PBC] score = 3.54 ± 2.69; possible/actual range: −6 to +6). Attitude ( β = 0.221, P < .001) and SN ( β = 0.438, P < .001) significantly predicted intent; however, PBC ( β = 0.028, P > .05) did not. Attitude, SN, and PBC together accounted for 34.0% of the variance in intention to report serious ADEs ( P < .001). The addition of past reporting behavior ( P = .021) and perceived moral obligation ( P < .001) significantly increased the variance in intention explained by the TPB model. Conclusions Pharmacists showed a strong positive intent to report serious ADEs to the FDA. Strategies to increase pharmacists’ intentions to report serious ADEs should focus on helping them see the value of reporting and altering their perception of social pressure toward reporting. The TPB may have utility in predicting ADE-reporting behavior.

Learning trajectory in offshore OEM cooperation: Transaction value for local suppliers in the emerging economies

AbstractWe focus on the unique role of offshore OEM cooperation as a learning opportunity for local suppliers in the emerging economies. In particular, we conceptually argue and empirically confirm the links between learning intent, capability enhancement, governance mode, and overall innovativeness from the perspective of local suppliers in offshore OEM cooperation in China as well as the influence of local business culture within these links. We address two issues: (1) offshore OEM cooperation can be a unique opportunity for local suppliers with strong intent to learn from foreign buyers for capability enhancement and (2) the moderating effects of trust and contact as two distinctive governance modes. Addressing the two issues, we make two specific contributions to the research on inter‐firm cooperation, both of which derive from the often‐neglected theoretical lens of transaction value. Our general contribution lies in the extension of the transaction value perspective by specifying its dual tenets of inter‐firm co‐specialization and shared‐trust as the central theme of inter‐firm cooperation to complement the transaction cost economics and also contextualize the research on inter‐firm cooperation in terms of different partners’ perspectives as well as different governance modes.

最近の殻物メジャーの動向とＧＭＯ

“Grain Majors” developed as the dominant players in the global agribusiness arena in the 1970's, but their real strategies and activities have not been widely known due partly to the complex natureof these entities and partly to significant changes in the global food system including the introductionand rapid expansion of biotechnology in the form of GM products.This article focuses on three dimensions of these leading grain companies; 1) the evolutions oftraditional grain majors, 2) their current strategies including their stance toward GMOs, and 3) theirpossible future directions. As specific cases, Cargill, ADM, and Bunge are selected, and theirstrategies are explained respectively. Cargill's long-term vision with strong strategic intent, pursuingvalue-added products and services through global supply chain network, and managing worldwide“Cargill” brand, ADM's traditional focuses on processing and particularly recent shifts towards bioenergies, and Bunge's logistics-based expansions and intensive shift of assets to South America arestressed for their evolutions. In addition, each company has established strong ties with genedevelopment companies such as Monsanto and DuPont through either formal or informal alliances. In today's highly competitive market, effective alliances as well as strong product developmentabilities are the key factors of success.From the viewpoint of effective strategy, today's global companies must show strength on threedimensions: 1) “market understanding” including customers and competition, 2) “customer interface”including technology and business system, and 3) “organizational resources”. Cargill appears to bewell balanced along these three dimensions. ADM's most important competencies are processingknow-how (they see even GM grains through the eyes of processing.), but now their strategic focushas shifted to biofuels. Bunge's aggressive investment in Brazil has been based on a deepunderstanding of their local customer's needs, and what and how they could respond to these needs.

Degree of Suicide Intent and the Lethality of Means Employed: A Study of Chinese Attempters

This study was designed to determine if there is a relationship between the degree of suicide intent and the lethality of means employed by those who try to kill themselves. The study sample consists of 74 suicide attempters admitted to emergency rooms in a northeastern area of China. Structured interviews were performed with the patients and their companions to the hospital if necessary. It was found that the reason for the suicide attempt claimed by the highest percentage of attempters (35 of 74) was love/marriage issues, and there were significant gender differences in suicide reasons. It also was found that the choice of suicide means is generally independent of gender, and the lethality of means is positively correlated with the degree of suicide intent. One of the implications of the findings is a better understanding of the higher suicide rates for Chinese women than Chinese men. A hypothesis for future study on Chinese suicide may be that the high fatality rate of Chinese women who have swallowed poisonous pesticide is a function of the strong intent of death of the victim coupled with the well-known lethality of the pesticides.

What does it take? The influence of rural upbringing and sense of rural background on medical students' intention to work in a rural environment

There is abundant evidence that rural origin is an influence on rural career choice. Rural origin is widely used to select students to be supported into programs designed to address the rural medical workforce shortage. What is not as clear is how many years of rural upbringing are required to have a maximal effect on rural career choice. Neither is the place of having a sense of rural background well understood. A cross-sectional self-completed paper-based survey of all students in years one through four of the Monash University medical course was undertaken in 2003. The survey included a scale to measure stated rural career intention as well as questions about the number of years of rural upbringing and whether students had a sense of rural background. The Rural Intention score was divided into three categories: strong urban intent, strong rural intent, and an intermediate, less certain intent. There was an 88% (n = 399) response rate from students holding Commonwealth Supported Places. Approximately 30% of these claimed a sense of rural background, and 28% had more than 8 years of rural upbringing. Twenty-five percent stated a strong intention to choose a rural career and 34.5% had strong urban intent. The remaining 40.5% were in the intermediate group. Almost all students (97.5%) with over 5 years of rural upbringing had developed a sense of rural background, and almost all (97.5%) with less than 5 years' rural upbringing denied a sense of rural background. Rural intent was high for those with a sense of rural background and those with more than 8 years of rural upbringing, but the students who had had from 4 to 8 years of rural upbringing mainly fell into the 'uncertain' category. In this cohort of almost 400 Australian medical students, a sense of rural background developed at a clear point, around 5 years of rural upbringing. Students with a sense of rural background were likely to develop a strong rural intent several years before similar students who had failed to make this connection with a rural community. This latter group displayed uncertainty toward a rural career choice, possibly due to unfamiliarity. Unlike those with strong urban intent, these students have not excluded a rural career and should be supported. The inclusion of a measure of the intention of students to work in a rural environment is likely to increase the reliability and validity of selection procedures.

Hospital admissions and deaths relating to deliberate self-harm and accidents within 5 years of a cancer diagnosis: a national study in Scotland, UK

The risk of suicide in cancer patients has been reported as elevated in several countries. These patients are exposed to many medicines that may confuse or provide a means for harm, potentially also increasing their risk from accidents. Ratios of observed/expected numbers of hospital admission and death events relating to deliberate self-harm (DSH) and accidents were calculated in the 5 years from a cancer diagnosis in Scotland 1981–1995, compared to the matched general population. The relative risk (RR) of suicide was 1.51 (95% confidence interval (CI): 1.29–1.76). The RR of hospital admissions for DSH was not significantly increased, suggesting a strong suicidal intent in DSH acts in cancer patients. Accidental poisonings and all other accidents were both increased (RR death=3.69, 95% CI: 2.10–6.00; and 1.58, 95% CI: 1.48–1.69, respectively) (RR hospital admissions=1.32, 95% CI: 1.19–1.47; and 1.55, 95% CI: 1.53–1.57, respectively). The association of only certain tumour types (e.g. respiratory) with suicide and accidental poisoning, and a broad range of tumour types with an elevated risk of all other accidents, suggests accidental poisoning categories may be a common destination for code shifting of some DSH events. A previous history of DSH or accidents, significantly increased the RR of suicide or fatal accidents, respectively (RR suicide=14.86 (95% CI: 4.69–34.97) vs 1.16 (95% CI: 0.84–1.55)) (RR accidental death=3.37 (95% CI: 2.53–4.41) vs 1.29 (95% CI: 1.12–1.49)). Within 5 years of a cancer diagnosis, Scottish patients are at increased RR of suicide and fatal accidents, and increased RR of hospital admissions for accidents. Some of these accidents, particularly accidental poisonings, may contain hidden deliberate acts. Previous DSH or accidents are potential markers for those most at risk, in whom to target interventional techniques.

Factors that influence emergency department doctors' assessment of suicide risk in deliberate self-harm patients.

OBJECTIVES: To determine the patient factors influencing UK Emergency Department doctors' assessment of suicide risk. To establish whether immediate clinical management is consistent with perceived risk. METHODS: The Manchester and Salford Self-Harm project is a multi-centre deliberate self-harm monitoring study. Data collected were used to analyse risk assessments made by Emergency Department doctors between September 1997 and August 1999. We used univariate and logistic regression analyses to determine the factors Emergency Department doctors used to make suicide risk assessments. RESULTS: A total of 3220 deliberate self-harm assessment forms were completed in two years by Emergency Department doctors; 2922 (91%) included a clinical assessment of risk; 28 out of 48 variables were associated with perceived suicide risk. Multiple logistic regression analyses showed that current mental state, high suicidal intent (including medical seriousness of attempt), and male sex were the most important independent predictors of suicide risk. Being referred to psychiatric services directly from the Emergency Department or to surgical/medical services was also strongly associated with a perceived high risk. CONCLUSION: In contrast to the negative findings of previous research, we found that Emergency Department doctors were influenced by key risk factors for suicide in their assessment of deliberate self-harm patients. Emergency Department doctors' assessments reflected the immediate risk of suicide, indicated by factors such as current mental state and strong suicidal intent. Background risk factors such as social adversity and psychiatric history were less influential. We would recommend that training for emergency doctors should emphasize the importance of both immediate and background risk factors.

Factors that influence emergency department doctors' assessment of suicide risk in deliberate self-harm patients.

To determine the patient factors influencing UK Emergency Department doctors' assessment of suicide risk. To establish whether immediate clinical management is consistent with perceived risk. The Manchester and Salford Self-Harm project is a multi-centre deliberate self-harm monitoring study. Data collected were used to analyse risk assessments made by Emergency Department doctors between September 1997 and August 1999. We used univariate and logistic regression analyses to determine the factors Emergency Department doctors used to make suicide risk assessments. A total of 3220 deliberate self-harm assessment forms were completed in two years by Emergency Department doctors; 2922 (91%) included a clinical assessment of risk; 28 out of 48 variables were associated with perceived suicide risk. Multiple logistic regression analyses showed that current mental state, high suicidal intent (including medical seriousness of attempt), and male sex were the most important independent predictors of suicide risk. Being referred to psychiatric services directly from the Emergency Department or to surgical/medical services was also strongly associated with a perceived high risk. In contrast to the negative findings of previous research, we found that Emergency Department doctors were influenced by key risk factors for suicide in their assessment of deliberate self-harm patients. Emergency Department doctors' assessments reflected the immediate risk of suicide, indicated by factors such as current mental state and strong suicidal intent. Background risk factors such as social adversity and psychiatric history were less influential. We would recommend that training for emergency doctors should emphasize the importance of both immediate and background risk factors.

Managerial implications of predicting purchase behavior from purchase intentions: a retail patronage case study

Services managers are dependent on forecasting purchase behavior when making resource allocation decisions. Purchase intentions are commonly used as a basis to forecast purchase behavior. This practice is, however, not without its critics. In a study of restaurant patrons, it was found that the patrons who expressed strong purchase intent and made a subsequent purchase demonstrated distinct attitudes differences when compared to those patrons who also expressed strong purchase intent but failed to make a subsequent purchase. The results suggest that the service manager could be misled, and therefore could make costly service mix mistakes, if purchase intent is used solely to model purchase behavior. Specific strategy implications are discussed.

Toward a Monistic Theory of Science

This article considers the `Strong Programme' account of scientific knowledge from a fresh perspective. It argues that insufficient attention has been paid to the Strong Programme's monistic intent, that is, its aim to unify considerations of instrumental adequacy and social interests in explanations of the development of scientific knowledge. Although sharing the judgment of many critics that the Strong Programme approach is flawed, the article diverges from standard criticisms by suggesting that the best alternative is not a dualistic framework but a more adequate monistic approach.

Determination of treatment disposal for parasuicide patients in a German university hospital.

Within the framework of a psychiatric liaison service attached to a medical emergency unit, initial assessment, immediate crisis intervention and referral to subsequent psychiatric after-care were provided for parasuicide patients. Of a total of 485 such cases admitted in 1981, 7% were discharged without a treatment recommendation, 74% were referred to psychiatric out-patient care and 18% were admitted to psychiatric hospitals. The characteristics of these three categories of patients were compared in order to examine the criteria of treatment disposal. The characteristics found to be associated with a recommendation for psychiatric treatment included old age, previous suicidal behaviour, previous or current psychiatric treatment and a strong intent to die, as inferred from the nature and circumstances of the suicidal behaviour. Sex, addictive behaviour and severity of intoxication were of minor importance in this respect. The treatment disposition revealed a liberal interpretation of the requirements for psychiatric treatment. As regards the outcome of this strategy of care, the frequency of repeated parasuicidal behaviour, though not of completed suicide, was lower than in comparable studies reported in the literature. The implications of these findings for future evaluative research are discussed.