Public Discourse and Public Policy: Some Ways That Metaphor Constrains Health (Care)

Since the terms of the health policy debate in the United States and Canada are largely supplied by biomedicine, the current “crisis” in health care is, in part, a product of biomedical rhetoric. In this essay, three metaphors widely identified as being associated with biomedicine—the body is a machine, medicine is war,and medicine is a business—are examined with a view to the ways in which they influence the health policy debate, not only with respect to outcomes, but also with respect to what can be argued at all. The essay proposes that biomedical language itself be foregrounded as the constitutive material of public discourse on health policy.     

The Contribution of Hope and Affectivity to Diabetes-Related Disability: An Exploratory Study

This study examined the relationships of the dispositional variables of hope, positive affectivity (PA), and negative affectivity (NA) with disease status and illness-related psychosocial functioning in a sample of 45 young adults with insulin-dependent diabetes mellitus (IDDM). Canonical analyses revealed one significant canonical function between the dispositional and psychosocial outcome variables. Primary contributors to the relationship were higher NA and lower PA and maladaptive emotional behavior. A linear multiple regression analysis using hope and affectivity as predictors failed to account for a significant proportion of variance in objective disease status as measured by hemoglobin A _1C (HbA_1C). The results support previous findings that affectivity may relate to self-reported, disease-related outcome, but not necessarily to objective measures of health status. Future studies of adaptation to chronic illness should consider including measures of illness-related behaviors (e.g., adherence), as well as subjective and objective measures of health status.     

Insurance Coverage and Mental Health Service Use by Adolescents with Serious Emotional Disturbance

This paper examines the relationships between insurance coverage, need, and mental health services in a community-based sample of 1,015 youths who were 9, 11, and 13 years old at the beginning of the study. They were followed over a two-year period. A strong measure of need based on a standardized diagnostic interview was available and repeated over three annual waves. Data on service use was collected quarterly across two years. Major findings included: (a) high need (serious emotional disturbance [SED]) was strongly related to use of any mental health services; (b) services use was much more likely to occur with public (Medicaid) insurance coverage than either private or no insurance; (c) considerable unmet need was observed even for youths with SED; (d) school-based mental health services potentially substituted for professional mental health services; and (e) there was little unnecessary use of mental health services in the low need group. The major policy implication of these findings is that the regulation of insurance benefits should be based on level of need, rather than on arbitrary limits which are likely to either reduce the probability of or appropriate amount of care for youths who most need mental health services.     

A Comparison of Stress Measures in Children and Adolescents: A Self-Report Checklist Versus an Objectively Rated Interview

A self-report checklist assessing the occurrence of stressful life events in children and adolescents' lives was compared to an objectively rated interview to determine whether the checklist would introduce over-reporting of events or over-rating of event severity as a function of child/parent depressive symptoms, cognitive vulnerability, or anxiety. Participants completed the Children's Life Events Scale (CLES), the Life Events Interview (LEI), and questionnaires assessing cognitive vulnerability and symptoms of depression and anxiety. Findings yielded a positive association between the checklist and the interview. Contrary to hypotheses, depressive symptoms, cognitive vulnerability, and anxiety were not associated with over-reporting of events. Anxiety was associated with over-rating of event severity in parents but not children. Findings suggest that the checklist and interview may be equally viable approaches to assessing the occurrence of life events. Findings have mixed implications with regard to assessing event severity, as subjective reports may be systematically influenced by anxiety.

Rapid visual feedback processing in single-aiming movements

A major line of behavioral support for motor-program theory derives from evidence indicating that feedback does not influence the execution and control of limited duration movements. Since feedback cannot be utilized, the motor-program is assumed to act as the controlling agent. in a classic study, Keele and Posner observed that visual feedback had no effect on the accuracy of 190-msec single-aiming movements. Therefore visual feedback processing time is greater than 190 msec, and, more importantly, limited duration movements are governed by motor programs. In the present paper, we observed that visual feedback can affect the spatial accuracy of movement with durations much less than 190 msec. We hypothesize that visual feedback can aid motor control via processes not associated with intermittent error corrections.     

Exploring issues of personality measurement and structure through the development of a short form of the Eysenck Personality Profiler

In this article, we develop a revised short form of the original Eysenck Personality Profiler (EPP; H. J. Eysenck & Wilson, 1991). In addition, we address topics of broad theoretical importance such as the recurrent empirical finding of correlations between conceptually orthogonal personality dimensions and the possibility that gender differences in these dimensions are partly spurious. In Study 1 (N = 227), we demonstrate that the existing short form of the EPP (EPP-SF; H. J. Eysenck, Wilson, & Jackson, 1996) provides a poor fit to the data and we develop a revised well-fitting version. In Study 2, we retest this version on an independent new sample (N = 3,374) where it is again found to fit the data well. We show that most of the structural and measurement parameters of the revised EPP-SF are invariant across genders. Structured means analysis indicated a significant gender difference in Psychoticism, with men scoring higher than women, but no differences in Extraversion or Neuroticism. Our discussion focuses on issues concerning personality measurement and structure, including an examination of the role of confirmatory factor analysis in personality research.     

Information transmission with a multifinger tactual display

In this work, the tactual information transmission capabilities of a tactual display designed to provide stimulation along a continuum from kinesthetic movements to cutaneous vibrations are assessed. The display is capable of delivering arbitrary waveforms to three digits (thumb, index, and middle finger) within an amplitude range from absolute detection threshold to about 50 dB sensation level and a frequency range from dc to above 300 Hz. Stimulus sets were designed at each of three signal durations (125, 250, and 500 msec) by combining salient attributes, such as frequency (further divided into low, middle, and high regions), amplitude, direction of motion, and finger location. Estimated static information transfer (IT) was 6.5 bits at 500 mseC., 6.4 bits at 250 mseC., and 5.6 bits at 125 msec. Estimates of IT rate were derived from identification experiments in which the subject’s task was to identify the middle stimulus in a sequence of three stimuli randomly selected from a given stimulus set. On the basis of the extrapolations from these IT measurements to continuous streams, the IT rate was estimated to be about 12 bits/seC., which is roughly the same as that achieved by Tadoma users in tactual speech communication.