Race and Healthcare Disparities: Overcoming Vulnerability

The paper summarizes recently published dataand recommendations about healthcaredisparities experienced by African Americanswho have Medicare or other healthcare coverage.Against this background the paper addresses theethics of such disparities and howdisadvantages of vulnerable populations likeAfrican Americans are typically maintained indecision making about how to respond to suchdisparities. Considering how to respond todisparities reveals much that vulnerablepopulations would bring to the policy-makingtable, if they can also be heard when they getthere. The paper argues that vulnerablepopulations like African Americans need fairrepresentation in bodies deciding what to doabout such disparities and that fairnessrequires proportional representation at alllevels of decisions that affect healthcare – aradical change. In this decision setting, howto provide adequate protection of minoritiesneeds much further attention. The mostattractive decision-making model isdeliberative democracy. The paper shows thatin deliberation, fair representation requiresnot only having a voice in decisions, but afair hearing of those voices. Achieving a fairhearing requires changes in norms ofcommunication and training of all to giveimportance to greetings and other measures ofcivility and trust building, and to be open todiverse forms of expression. Decisions abouthow to respond to healthcare disparities wouldinclude what programs to initiate for whom, howto evaluate the programs, and what to do inresponse to such evaluations. Conclusions arethat achieving such goals will take a seachange in how healthcare institutions andproviders do their business, and that socialactivism at every level will be needed toeffect these changes. The discussionhighlights many ethical issues that need muchgreater attention.     

Father postdivorce well-being: an exploratory model

The purpose of this study was to test a theoretical model of the psychological well-being of fathers following divorce. The theory postulated that father postdivorce well-being was related to father role clarity, role satisfaction, age, income, education level, custody arrangement, encouragement from others, time since divorce, and involvement in an intimate relationship following divorce. Participants were 94 fathers from a midwestern city who completed self-administered questionnaires. Data were assessed using path analytic techniques. Involvement in an intimate relationship was found to have the greatest influence on father postdivorce well-being. Role satisfaction had direct effects on father postdivorce well-being and was important as a mediating variable for 4 constructs within the model. The findings suggest that father well-being following divorce is a complex phenomenon, influenced by all of the model variables except income, education level, and time since divorce. Implications for preventive intervention strategies, based on risk factors identified in this study, and suggestions for further research are discussed.     

Depressive cognition: a test of depressive realism versus negativity using general knowledge questions

This research is an examination of whether cognition in depressed individuals incorporates a realistic view of the world or a general tendency toward negativity. Participants provided two types of probability judgments of the likelihood that they correctly answered general knowledge questions: the probability that they correctly answered each of the individual questions and an aggregate judgment, after completing the questionnaire, of the percentage of all the questions they thought they had correctly answered. These tasks generally elicit overconfidence and accuracy in nondepressives. In accord with theories of both depressive realism and general negativity, in their item-by-item assessments of their answers to the individual questions, depressed participants demonstrated less overconfidence than nondepressed participants. In accord with the theory of general negativity but not with the theory of depressive realism, however, depressed participants demonstrated underconfidence in their aggregate judgments. The implications of these findings on theories of depressive cognition are discussed.     

Prospective memory in dynamic environments: effects of load, delay, and phonological rehearsal

A new paradigm was developed to examine prospective memory performance in a visual-spatial task that resembles some aspects of the work of air traffic controllers. Two experiments examined the role of workload (number of aeroplanes that participants directed), delay (between receipt of prospective instructions and execution), and phonological rehearsal. High workload increased prospective memory errors but increasing delay from 1-3 or 5 minutes had no effect. Shadowing aurally presented text reduced prospective memory performance, presumably because it prevented verbal rehearsal of the prospective instructions. However, performance on the foreground task of directing aeroplanes to routine destinations was affected only by workload and not by opportunity for rehearsal. Our results suggest that ability to maintain performance on a routine foreground task while performing a secondary task--perhaps analogous to conversation--does not predict ability to retrieve a prospective intention to deviate from the routine.