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Intentional harms are worse, even when they're not.

ABSTRACT: People and societies seek to combat harmful events. However, because resources are limited, every wrong righted leaves another wrong left unchecked. Responses must therefore be calibrated to the magnitude of the harm. One underappreciated factor that affects this calibration may be people's oversensitivity to intent. Across a series of studies, people saw intended harms as worse than unintended harms, even though the two harms were identical. This harm-magnification effect occurred for both subjective and monetary estimates of harm, and it remained when participants were given incentives to be accurate. The effect was fully mediated by blame motivation. People may therefore focus on intentional harms to the neglect of unintentional (but equally damaging) harms.

SUBMITTER: Ames DL

PROVIDER: S-EPMC4470288 | biostudies-literature | 2013 Sep

REPOSITORIES: biostudies-literature

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Intentional harms are worse, even when they're not.

Ames Daniel L DL Fiske Susan T ST

Psychological science 20130722 9

People and societies seek to combat harmful events. However, because resources are limited, every wrong righted leaves another wrong left unchecked. Responses must therefore be calibrated to the magnitude of the harm. One underappreciated factor that affects this calibration may be people's oversensitivity to intent. Across a series of studies, people saw intended harms as worse than unintended harms, even though the two harms were identical. This harm-magnification effect occurred for both subj ...[more]

PMID: 23878021

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Project description:Essential tremor (ET) patients regularly inquire about their prognosis. Therefore, physicians have cause to review available medical literature for meaningful answers. Longitudinal studies are ideally suited to provide a glimpse into the evolution of tremor. Despite its high prevalence, there are surprisingly few longitudinal clinical studies of ET. Furthermore, none of them provide data from the patients' perspective. Understanding the patient vantage point is valuable as it is the starting point of personalized medicine. Given the progressive nature of ET, we hypothesized that many patients will experience an increase in symptom severity over time. However, due to a lack of clinical data, the exact nature of this progression is unclear. For example, whether patients experience a worsening at each time interval is simply not known. In this longitudinal study, we assessed whether ET patients felt that their symptoms had worsened between each follow-up evaluation and try to identify specific clinical characteristics associated with this experience.A cohort of 164 ET cases enrolled in a prospective, longitudinal research study. After a baseline in-person assessment, they received regular telephone evaluations for up to 5.25 years, beginning in 2009. During each follow-up evaluation, cases answered the question, "has your ET worsened since our last call?"Two-thirds [104 (63.4%)] of ET cases reported worsening at one-half or more of their follow-up evaluations. Furthermore, one in four cases [44 (26.8%)] reported worsening at every follow-up evaluation. Self-reported worsening was not associated with any of the baseline clinical variables assessed, including age, gender, tremor duration, age at tremor onset, or total tremor score.Little has been written from the patients' perspective on progression of ET. When followed longitudinally at regular intervals, a majority of ET cases we studied reported worsening one-half or more of the time; furthermore, one in four cases reported worsening at each and every assessment, indicating that they felt they were inexorably getting worse and worse with time. That there is so much self-reported worsening in ET argues against the notion that this is a static and benign condition. It suggests that patients experience it as a condition that worsens regularly and consistently.

Project description:IntroductionHealthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes.MethodsITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients < 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare-related infections and infections caused by unusual pathogens of the urinary tract. The main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality.ResultsFour hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p < 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCA-BUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77-6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27-6.44) and Charlson index (aOR 1.11; 95% CI 1.01-1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40-0.93) were less likely to present clinical cure.ConclusionThe rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure.

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Intentional harms are worse, even when they're not.

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Intentional harms are worse, even when they're not.

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