Information constraints in medical encounters

This article describes three kinds of information constraints in medical encounters that have not been discussed at length in the medical ethics literature: constraints from the concept of a disease, from the diffusion of medical innovation, and from withholding information. It describes how these limit the reliance rational people can justifiably put in their doctors, and even the reliance doctors can have on their own advice. It notes the implications of these constraints for the value of informed consent, identifies several procedural steps that could increase the value of the latter and improve diffusion of innovation, and argues that recognition of these constraints should lead us to devise protections which intrude on but can improve these encounters.     

An analysis of some sensitizing agents in the pathogenesis of stress-induced gastric erosive disease

Prior surgical implantation of a venous catheter sensitized rats to coldimmobilization stress. Three of six catheterized females succumbed during the stress. The remaining rats fell into two groups in terms of their core temperature at the end of the stress period: Male uncatheterized rats had higher temperatures than rats in the other three groups. No relation was found between catheter patency and magnitude of hypothermia. Degree of gastric disease paralleled the core temperature findings in that the male uncatheterized rats had significantly fewer gastric erosions than the rats in the other three groups. Additionally, a robust effect of gender was found with uncatheterized females showing more hypothermia and more gastric disease than uncatheterized males. A subsequent experiment was conducted to evaluate whether anesthesia or wearing the protective spring was responsible in part for the sensitization seen. Here, the gender difference was less although females consistently averaged lower core temperatures after stress than did males. Despite similar core temperatures after stress, females that were prepared with the protective spring apparatus developed more gastric disease than female controls or similarly treated males. Thus, the additional sensitization exhibited by females in the first experiment may relate to the fact that both catheterization and the taping procedure were sensitizers while only catheterization was a sensitizer for males.     

The relationship of parental drug use and parents' attitude concerning adolescent drug use to adolescent drug use

The purpose of this study was to examine the relationship of two variables, parental drug use and parental attitude toward adolescent drug use, both as perceived by the adolescent respondent to his or her own use or nonuse of drugs. A sample of 106 drug-using and 96 nondrug-using adolescents was obtained through the use of the anthropological " snowball " technique. All respondents were administered a drug use history profile and a personal data questionnaire. In order to be classed as drug users, respondents had to have been using two or more recreational substances on a regular basis. Nondrug users were those who used no recreational drugs, although individuals who had tried alcohol or tobacco experimentally were included in this group. On the personal data form, respondents were asked to describe their parents' use of alcohol, tobacco, or other substances, and to indicate their parents' attitudes concerning adolescent use of drugs. Parental attitudes were classed as permissive if the respondent indicated that parents were indifferent about drug use, if they accepted a certain range of drugs, or if the decision were left up to the youth. A nonpermissive attitude was defined as one which would not accept drug use by the adolescent. Four 2 x 2 Chi-square analyses were used to determine significance of the relationship between adolescent drug use and parents' use or nonuse of drugs, parents' attitudes about adolescent use or nonuse and actual adolescent use or non-use, and this same attitudinal relationship looking at parent users and nonusers separately.(ABSTRACT TRUNCATED AT 250 WORDS)     

Achieving sex education program outcomes: points of view from students and alumni

Several inherent limitations to secondary school sex education program evaluations are: limited generalizability, lack of longitudinal research, and no clear consensus of program outcomes. With a Bureau of Health Education, Center for Disease Control study as the criterion for program outcomes, a study was undertaken to examine the immediate and long-term impact of sex education upon program participants. Two of the 20 schools in the CDC study identified as having exemplary sex education programs provided access to their students and alumni. Inventories which measured perceived achievement of 33 sex education outcomes were piloted for reliability and validity. Each inventory examined participant changes in knowledge, understanding of self, values, interaction skills, self-esteem, and fear of sex-related activities. Students were surveyed in school; alumni were surveyed through the mail. Response rates ranged from 30 to 100 percent for students and alumni at both schools. Overall there was no statistically significant difference between the perceptions of students and alumni as to achievement of investigated outcomes. Alumni responses at one school did, however, indicate some potentially weak areas of their school's program with respect to values and interaction skills outcomes. It appears that program impact may decrease with time. Thus, isolating and addressing the factors involved may be necessary. This would assist program planners and instructors to strengthen curricula and program activities in order to enhance the overall impact of sex education. The present study supports the notion that positive gains are achieved as a result of each school's sex education program, and these gains remained over time.     

Decision making styles and progress in occupational decision making

This study provides a reexamination of the role of different decisional strategies in facilitating progress in occupational decision making. Although the assumptions that a rational decision making style is the preferred mode of vocational functioning has been endorsed in a variety of career theories and interventions, there has been conflicting evidence about the validity of this assumption. To examine the role of different decisional approaches in the progress of making an occupational decision, the rational, intuitive, and dependent decision making style scores of 71 undergraduate students were used to predict progress in occupational decision making. The results of the regression analyses failed to provide support for the assumption that a rational style is the most effective in accomplishing this careerrelated task, but indicated strong support for the conclusion that the use of dependent decisional strategies is damaging, particularly in early stages of the decisional process.     

Developmental analysis of the effects of reward on selected Wechsler subscales

The authors recently proposed that adverse effects of material rewards on Wechsler subscale performance may be the result of a reward-produced developmental regression. The present study further explores that idea through an attempt to replicate earlier findings with adults and to extend the inquiry to children. Selected Wechsler subscales were administered to 32 subjects at each of three ages (5, 10, and 18 years) under either reward or nonreward conditions. Subscales were chosen to represent both algorithmic and heuristic types of tasks. Reward and nonreward groups (8 males and 8 females per group at each age) were matched initially on age and ability. For adults, consistent with earlier findings, reward had an adverse effect on performance on the heuristic subscales and tended to facilitate performance on the algorithmic subscales. However, rewards generally had no effect at the fourth-grade level and had a reverse effect at the nursery school level, i.e., rewards facilitated heuristic and hampered algorithmic performance. These findings appear to be more consistent with an explanation based on developmental regression than on any available alternative mechanism.     

Concurrent validity of the Woodcock-Johnson psycho-educational battery with regular and learning-disabled students

A comparison of the WISC-R and the Woodcock-Johnson Psycho-Educational Educational Battery (W-J) was made for children with regular and learning-disabled (LD) class placement. The W-J and Wechsler Intelligence Scale for Children-Revised (WISC-R) evidence low to moderate correlations and significant mean differences, indicating that the two tests are measuring somewhat different abilities to somewhat differing degrees. W-J—WISC-R correlations for the regular students exceed those of the LD students in the greater majority of the cases. Rank ordering of the WISC-R subtests and the W-J clusters indicate, as might be expected, that the LD students fare the worst in the WISC-R academic subtests (Arithmetic, Information and Vocabulary) and in the W-J academic clusters. More research needs to be conducted with the W-J before it should be adopted for use in the placement of exceptional children.     

Science as a justification for psychology as a social institution

Psychology seeks to justify its claims to privilege as a social institution largely on the basis of its scientific knowledge claims. These knowledge claims tend to be based on, and to reflect a particular view about the nature of science which is under increasing challenge. This situation is discussed and some of its implications examined.