Empowering Patients Through Access to Information

The United States federal government is in the midst of an e- government revolution characterized by a shift from paper-based citizen-government interactions to electronic-based interactions. Driven by the demands of citizens and supported by the President and Congress, federal departments are redesigning the look and feel of their Internet presences, moving away from traditional bureaucracy- centred presentation of information to more usable citizen-centred presentations. The Department of Health and Human Services (HHS), the USA's principal federal agency tasked with protecting the health of all Americans and providing essential human services, has undertaken a massive reorganization of its e-health enterprise. The most publicly visible component of this reorganization is the hhs.gov portal website. This desperately needed portal - usability testing indicated that more than 60 per cent of visitors to the Department's original website failed to find the information they sought - provides easy access to the wealth of HHS information and links its diverse operating agencies. The new HHS portal simplifies citizen access to the Department by: decompartmentalizing information by removing content from bureaucratic silos² and rearranging it in a natural navigation scheme; tuning content and navigation features to ensure that all users have access to information tailored for them; presenting content in appropriate and citizen-preferred formats; and complying with federal accessibility regulations for blind and vision-impaired users. This paper presents a series of lessons learned during the development of the HHS portal, and results of usability testing to determine what common design features present accessibility problems particular to the blind and vision-impaired communities. These discussions of practical avenues to improving the accessibility and usability of e-health websites through appropriate and effective information designs are followed by our thoughts on the future of Internet architectures and the limitations of 'layering' technologies when striving for universal accessibility.     

PARENTS,PEERS, PERCEIVED PRESSURE,AND ADOLESCENT SELF-CONCEPT: IS A DAUGHTER A DAUGHTER ALL OF HER LIFE?

Data collected in 1981 from 316 high-SES junior and senior high students suggest support for traditional perspectives regarding sex-differentiated self-esteem. While a significant proportion of the variance in self-esteem level is predicted by perceived approval and support from family for both girls and boys in junior high school, high school females and males drawn from the same community differ substantially. Cues of family approval continue to predict a large proportion of the variance in high school girls' self-concept, but are no longer significant for high school boys. Acceptance by friends is an important element for males at all school levels, and accounts for a small but significant proportion of the variance in high school but not junior high school girls' self-esteem scores. Daughters may not "be daughters' all of their lives, but our data suggest that young females still going to school and living at home are much more dependent on family approval and support than are young males in the same situation.     

Applying Social Cognitive Career Theory to Training Career Counselors

This article applies the social cognitive career theory formulated by Lent, Brown, and Hackett (1994) to training career counselors. Specifically, the authors propose extending the theory to understand and influence trainees' interest, engagement, and performance in career counseling. An initial offering of an advanced career counseling seminar is described as an example of an intervention designed to increase interest and involvement in career counseling and to improve performance among career counselors. Suggestions are made for future research and for training students to be interested, involved, and skilled in providing career counseling.     

A Quantitative Estimate of Leukemia Mortality Associated with Occupational Exposure to Benzene3

In 1980, the U.S. Supreme Court vacated a revised occupational standard for benzene, stating that the Occupational Safety and Health Administration (OSHA) had failed to demonstrate that significant health risks existed under the current standard. This decision has been interpreted by OSHA as requiring the consideration of quantitative risk assessments, whenever possible, in the development of regulations for occupational carcinogens. In light of this decision, the available epidemiologic evidence was used to generate a quantitative risk assessment for benzene. Uncertainties regarding the levels and lengths of benzene exposure for the studied cohorts were incorporated into the analysis. Based on the one-hit model, the assessment indicates that a working lifetime exposure to benzene at the current permissible exposure level (10 ppm) poses a substantial excess risk of death from leukemia. This report discusses the calculation of the risk estimates, the basis for relying on certain assumptions, and the inherent limitations of using epidemiologic studies to quantify cancer risks.     

Treatment of psychogenic seizures in adolescents

This article will review the problem of psychogenic seizures in adolescents and the impact of family therapy and individual therapy on treatment. Why particular individuals are prone to psychogenic seizures, the relationship between psychogenic seizures and family dynamics, and unresolved individual issues will be covered. The article will address a selected case, with a specific clinical paradigm for treatment.     

Urban congregations as incubators of service organizations

A growing body of research has begun to describe the variety and pervasiveness of community services offered by religious congregations across the United States. This study investigated the process whereby a congregation forms a new community service entity by tracing patterns in its development from formation through emancipation. Based on a sample of twenty‐three spin‐off organizations engaged in housing services in three cities (Cleveland, Pittsburgh, and St. Louis), this exploratory study found that religious congregations provided very limited forms of incubation for new entities. Although the congregations exhibited considerable involvement in governance, their inability to undertake management of daily spin‐off operations notably contributed to the eventual separation between parent and organizational offspring.