Making peace in gestational conflicts

Mary Anne Warren's claim that there is room for only one person with full and equal rights inside a single human skin ([1], p. 63) calls attention to the vast range of moral conflict engendered by assigning full basic moral rights to fetuses. Thereby, it serves as a goad to thinking about conflicts between pregnant women and their fetuses in a way that emphasizes relationships rather than rights. I sketch out what a care orientation might suggest about resolving gestational conflicts. I also argue that the care orientation, with its commitment to the significance of the partial and the particular, cannot be absorbed within standard, impartialist moral theory.     

The health needs of the majority versus the health needs of the individual: The reorganization of medical education in Colombia

The challenge of excellence in community health services has been taken up by medical educators in Colombia. Confronted with a nation where the primary indicators of disease mortality and morbidity (cardiovascular disease and infant mortality) were characteristic of First and Third World patterns, respectively, the Ministry of Health and La Asociacion Colombiana de Facultades de Medicina (ASCOFAME), representatives of institutions of medical education, have collaborated to conduct a needs assessment of the country's health needs and devised an implementation plan designed to better address the needs of the majority of that nation's people.As a model, the Colombian reorganization of medical education is an example which could be emulated by the U.S. where policy makers are struggling with troublesome questions of cost, equity and quality.     

AN ALTERNATING TREATMENTS COMPARISON OF ORAL AND TOTAL COMMUNICATION TRAINING WITH MINIMALLY VERBAL RETARDED CHILDREN

This study was a comparison of the effects of oral speech with total communication (speech plus sign language) training on the ability of mentally retarded children to repeat 4-word sentences. Three children were chosen who used single words to communicate but who did not combine words into complete sentences. Three sentence pairs were trained, with each pair having one sentence trained using oral methods and an equivalent one trained using the total communication approach. Both training procedures involved chaining sentence parts, reinforcement, and prompting. Oral methods involved presenting vocal stimuli and requiring vocal responses whereas total communication methods involved presenting vocal and signed stimuli and requiring vocal and signed responses. For the initial sentence pair with each child, an alternating treatments design was used to determine the relative efficacy of the two language training approaches. This was repeated with a second and third sentence pair using a multiprobe technique within a multiple baseline design. Results pointed to the superiority of the total communication approach in facilitating sentence repetition. Possible explanations of these results are offered and the utility of the alternating treatments experimental design is discussed.     

Reciprocal relationships between personality traits and psychological well-being

This study used an American sample collected over a period of approximately 2 decades (at 3 time points) to examine the temporal relationships between psychological well-being and personality traits (i.e., neuroticism, extraversion, agreeableness, conscientiousness, and openness to experience). The random-intercept cross-lagged panel model was used to separate between-person and within-person sources of variation. Between-person correlations were comparable to those of previous studies. New insights were gained at the within-person level. There were reciprocal relationships between psychological well-being and openness and extraversion, suggesting the joint development of plasticity-related traits and well-being over time. The relationships between psychological well-being and conscientiousness and agreeableness were unidirectional, with psychological well-being preceding these traits. Despite a strong between-person association between neuroticism and psychological well-being, the two were not related at the within-person level.     

The elderly and high technology medicine: A case for individualized,autonomous allocation

The issues involved in decision making about the aggressiveness of future medical care for older persons are explored. They are related to population trends, the heterogeneity of older persons and a variety of factors involved in individual preferences. Case studies are presented to illustrate these points, as well as a review of pertinent literature. The argument is offered that, considering these many factors, a system of flexible, individualized care by informed patient preference, is more rational than the rationing of technological services by age.     

Ethics in health care and medical technologies

In this paper a case is used to demonstrate how ethical analysis enables health care professionals, patients and family members to make treatment decisions which ensure that medical technologies are used in the overall best interests of the patient. The claim is made and defended that ethical analysis can secure four beneficial outcomes when medical technologies are employed: (1) not allowing any medical technologies to be employed until the appropriate decision makers are identified and consulted; (2) insisting that medical technologies be employed not merely to promote the medical interests of the patient but rather on the basis of their ability to contribute to the overall well-being of the patient; (3) challenging caregivers to reflect on the dynamic interplay between their conscious and unconscious values and consequent determinations of what is in the patient's best interests; and (4) providing a justification for selected interventions which makes possible rational dialogue between caregivers espousing different viewpoints about treatment options.     

CHANGING PROTECTIVE AND RISKY BEHAVIORS TO PREVENT CHILD-TO-PARENT TRANSMISSION OF CYTOMEGALOVIRUS

Child-to-parent transmission of cytomegalovirus may be reduced by increasing protective behaviors (handwashing and glove use) and decreasing risky behaviors (intimate contact between child and parent). This study showed that an educational intervention resulted in increases in reported and objective measures of protective behaviors and decreases in reported risky behaviors. Further study must determine if changes in protective and risky behavior are maintained and prevent cytomegalovirus transmission.     

The Future of Psychology in Medicaid's Health Delivery System for People with Disabilities

State Medicaid programs are rapidly converting fee-for-service health delivery systems to managed care for people with disabilities. In theory, managed care models of health delivery will substantially improve the quality of care for people with disabilities, but in reality, few successful models exist. This period of transition holds both opportunities and challenges for psychologists in medical settings. Because Medicaid reforms for people with disabilities may herald similar reforms for both the public and the private sectors, psychology's response will determine its role in the future of health care delivery for this population. Changes in training and increased attention to outcomes research, innovations in practice, and advocacy will be the keys to success.