Quality-of-life measures: hospital interview versus home questionnaire

Measures adapted from social survey research were used to assess the quality of life of 33 end-stage renal disease (ESRD) patients in a 2-week test-retest design that varied both location and format of administration (hospital interview vs. home self-administered questionnaire). The measures were found to have substantial consistency over time, location, and format. These results indicate that quality of life is a stable construct and support the usefulness of questionnaire quality-of-life measures for evaluating medical interventions.     

Health as a value: methodological and theoretical considerations

The concept of value placed on health is very important in several different theoretical approaches to the study of health behavior. In practice, however, health value is generally assumed to be universally high rather than being directly measured. If this assumption is incorrect, then theories that include health value have rarely been adequately tested. This paper presents a short 4-item Likert scale designed to measure the value placed on health. Norms from the utilization of this scale in five different samples are presented. Health value is found to increase with age among girls, but the increase apparently stops by late adolescence, before full adult levels of health value are achieved. Middle-aged women place a higher value on health than do middle-aged men, although no comparable sex difference appears in a sample of undergraduates. Consistent with theoretical predictions, both health locus of control beliefs and beliefs in the efficacy of certain preventive health behaviors correlate more highly with the performance of those same behaviors 5 to 9 months later among respondents who place a high value of health relative to those who do not value health so highly. However, this interaction is found only when it can be safely assumed that health is the primary value underlying the behavior. The importance of considering a variety of values in addition to health as possible motivators of preventive health behavior is stressed.     

A comparison of three predictors of an individual's memory performance: the individual's feeling of knowing versus the normative feeling of knowing versus base-rate item difficulty

Distinctions are drawn between different predictors of an individual's memory performance, with emphasis on the notion of privileged access to idiosyncratic knowledge. Research is reported in which undergraduates attempted to recall the answers to general-information questions, then made feeling-of-knowing judgments on nonrecalled items, and subsequently had a criterion test (relearning, perceptual identification, or one of two versions of recognition). For predicting an individual's criterion performance, the individual's own feeling-of-knowing predictions were intermediate between two kinds of normative predictions: The individual's feeling-of-knowing predictions were more accurate than predictions derived from normative feeling-of-knowing ratings but were less accurate than predictions derived from base-rate item difficulty (normative probabilities of correct recall). Subsidiary analyses showed that factors other than unreliability are responsible for the partial inaccuracy of the individual's feeling of knowing. Ramifications are discussed for possible ways to improve the accuracy of an individual's feeling-of-knowing predictions.     

Cognitive, motivational, social, and environmental influences on children's food choices

This study tested the applicability of a cognitive-motivational model of health behavior to children's food choices. A sample of 107 elementary schoolchildren provided ratings of 15 foods in terms of possible choice criteria (e.g., how tasty or healthful specific foods were) and social or environmental influences (e.g., whether foods were eaten by friends or were easy to get). Several measures of food consumption were taken, and cognitive-developmental level was assessed. Within-person correlations were calculated between food choices and each choice criterion and social/environmental factor. These "correlational indices" of influences on food choice subsequently were used to identify five distinct subgroups in the sample. Children at the operational level of cognitive development tended to be in one of three groups characterized by health orientation in food choice, taste orientation, or multiple-motive orientation. Dietary quality was poorest in the taste-oriented group. Children at the preoperational level tended to have one of two undifferentiated patterns of values across the correlational indices. Results provide evidence of: the viability of cognitive-motivational models to explain children's food choices, the promise of within-person research methodology, and the potential for enhanced health behavior-change programs by use of population segmentation and tailored interventions.     

Relationship of physicians' nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload

A field study of 28 residents in family practice was conducted. Physicians' self-reports of empathy, self-monitoring ability, and affective communication skill as well as their objectively measured nonverbal communication skills were examined as predictors of patient satisfaction, appointment noncompliance, and physician workload (schedule density). Physicians completed the Hogan Empathy Scale, Snyder Self-Monitoring Scale, Affective Communication Test, short form of the Profile of Nonverbal Sensitivity, and a nonverbal encoding task. Patient satisfaction with communication, affective care, and technical care was assessed using a 25-item, visit-specific satisfaction scale. Appointment records were used to determine the number of patients seen by each physician and the compliance of patients with scheduled appointments. Results indicated that the three self-report measures were unrelated to the measures of patient noncompliance and patient satisfaction, but self-reported affective communication ability was significantly correlated with physician workload. Objectively measured physician sensitivity to audio communication predicted patient compliance: More sensitive physicians experienced fewer unrescheduled appointment cancellations. Nonverbal encoding skill was significantly related to patient satisfaction with affective care and to physician workload.     

Multimodal therapy in an inpatient setting

Inpatient Multimodal Therapy (imt) is a residential treatment program, lasting a maximum of 36 weeks, for patients with severe neurotic symptoms. A group of 44 chronic obsessive-compulsive patients and a group of 40 chronic phobic patients were treated in order to assess the outcome and the process of treatment and to identify prognostic factors associated with the effect. At follow-up—on average, eight months after discharge—it was found that 60% had improved, 32% had remained the same, and 8% had deteriorated, indicating that, in general, the treatment was beneficial. That these effects were long-lasting is supported by the fact that, at follow-up, 78% of all patients were no longer receiving treatment, 18% were receiving outpatient or day treatment, and 4% were receiving inpatient treatment. Phobic patients appear to have gained more from the multimodal approach than did obsessive-compulsive patients, as indicated by the fact that the severity of symptoms decreased as they improved in rational thinking, assertiveness, and arousal. By contrast, obsessive-compulsive patients relapsed more than phobic patients did. This was attributed to the fact that the former gained less from the rational-emotive training, denied problems with assertiveness, and did not practice the acquired relaxation skills. It further appeared that a favorable outcome could be induced in patients who (1) expressed relatively mild symptoms in this otherwise severe group, (2) reported relatively few additional complaints, (3) could clearly indicate interpersonal problems, and (4) did not use psychotropic drugs. These prognostic factors are so widespread that not much weight can be ascribed to them. Yet they are useful for indication ofimt until better predictors are found.     

The relative contributions of rods and cones in sensory memory under photopic and scotopic conditions

Brief presentations of letter arrays were probed by bar markers within or outside the fovea after various time delays. Figural information presented to the foveal region was retained better under a photopic condition than information in the parafoveal region, but under a scotopic condition parafoveal information demonstrated superior retention. However, decay rates over time of all functions were similar, demonstrating that figural information in the rods and cones decays at similar rates.     

The right to refuse treatment: Paradox,pendulum and the quality of care

This clinical and theoretical overview of the right to refuse treatment will address some of the themes that have dominated this area of interface between psychiatry and the law, and have, perhaps, obscured the real concern of the right to refuse treatment question; i.e., the issue of quality of care. Central themes include factors present in the medicolegal context and recent events, origin of the concept of the right to treatment, the separation of confinement from treatment, and the changing models of vicarious decision making. This review also addresses judicial conceptualizations of treatment, including the concept of quarantine, judicial risk-aversiveness, and judicial fantasies of drug action. Some possible directions for the future are also examined.     

Criminal profiling from crime scene analysis

Since the 1970s, investigative profilers at the FBI's Behavioral Science Unit (now part of the National Center for the Analysis of Violent Crime) have been assisting local, state, and federal agencies in narrowing investigations by providing criminal personality profiles. An attempt is now being made to describe this criminal-profile-generating process. A series of five overlapping stages lead to the sixth stage, or the goal of apprehension of the offender: (1) profiling inputs, (2) decision-process models, (3) crime assessment, (4) the criminal profile, (5) investigation, and (6) apprehension. Two key feedback filters in the process are: (a) achieving congruence with the evidence, with decision models, and with investigation recommendations, and (b) the addition of new evidence.     

Naturalistic psychophysics: thresholds of ducklings (Anas platyrynchos) and chicks (Gallus gallus) to tones that resemble mallard calls

Neonatal ducklings and chickens were tested for responsiveness to a pulsing pure tone that was as similar as possible to the mallard maternal alarm call. It is known that ducklings momentarily cease vocalizing when they hear the alarm call and that chicks do the same when they hear pure tones. The duration of peep suppression can thus be used as a measure of whether subjects of either species heard the stimulus. Chicks might not be as sensitive as ducklings to a mallard alarm call because the signal is less significant to them. An adaptive or staircase procedure was used to estimate absolute thresholds, and group psychometric functions were reconstructed for each species from the trial-by-trial data. Ducklings had lower thresholds than chickens as well as steeper psychometric functions to this stimulus. The results suggest that more sensitive and consistent behavioral responses can be elicited by naturalistic sounds than by more arbitrary acoustic stimuli.