Medical Decision Making and Elective Surgery: The Case of Hysterectomy

Review and analyses of three sources of data are presented indicating that 25% of hysterectomies are elective. Annual mortality associated with elective hysterectomy is estimated to be 319, or about 12,122 woman years. Cost-benefit analyses of mortality, life expectancy, morbidity, psychological sequelae, as well as dollar expenditures, reveal high costs and relatively limited benefits. Explanations for this apparent anomaly in decision making are explored and include economic incentives, system structure, sexism, and cancer prophylaxis. Principles of risk perception are discussed in terms of potential biases associated with the cancer prophylaxis motive. It is suggested that physicians' judgements of risk may be more salient to the decision process than those of prospective patients.     

On place utility and the normative allocation of intra-urban migrants

This paper arises out of the fact that place utility, a basic factor in behavioral conceptualizations of migration processes, has not been specified in operational terms. This is done here through a model that assigns intraurban migrants to destination areal units within the city, using a normative linear programming framework based on behavioral considerations. Measures of place utilities for each areal unit and of comparative place utilities for each pair-wise permutation of areal units are provided by the shadow prices of the dual of the linear programming model. The primal of the model allocates migrants so as to maximize the household’s gain from migration. This is measured by the increase in its realized aspirations with respect to a residence site, tempered by the search effort involved in acquiring the site. Implementation of the model utilizes both questionnaire and published data from Cedar Rapids, Iowa for the year 1966 to 1967. Conformity between predictions of the model and real-world characteristics is such that it is concluded that the basic form of the model is sound. It is also concluded that the posited relationships between place utility and behavior in searching for and selecting a new residential site are reasonable and can lead to valuable insights into place utility and its functioning in the intra-urban system. Due to some misallocation of migrant flows, however, we further conclude that the model should be revised into a recursive format for future use.     

Social Relativity: The Motion of Groups and Actors*

The bulk of sociological theory is based on a notion of “state”: mechanical-organic solidarity, feudalism, capitalism, socialism, folk-urban, and so forth. We propose a theory that social systems consist of actors and groups in constant motion. Further, we propose that the duality of actor and society generate a system that can be understood by using the concepts of complementarity, indeterminacy and the principle of relativity. Such a system is defined and the issue of social change is addressed. Basically, change is defined as an alteration in the motion of actors relative to the motion of groups. As the number of groups increases relative to the number of actors, the velocity of actors increases and the velocity of groups decreases. The increasing disparity of these velocities indicates greater social change.     

Sex Stratification and Male Biography: From Deprivation to Ascendance*

This essay examines some of the implications of early childhood confinement to the household for the development of male character structure. The argument developed is that assignment to women and the household makes small boys outsiders, who receive less comprehensible and positive forms of socialization than small girls. This deprivation experience contributes to the competitiveness and assertiveness of the male response to more favored treatment during the school years, leading to their eventual ascendance, in contrast females greater centrallty and more supportive treatment in early childhood may contribute to "passive" acceptance of male ascendance.     

Workers' compensation for psychological injury: personal and environmental correlates

The aim of this study was to determine the personal and environmental factors that contribute to the lodging of a workers' compensation claim for psychological injury. Four groups were compared: individuals who had lodged a workers' compensation claim, people who had sought psychological assistance for the management of work-related stress reactions but who had not lodged a workers' compensation claim; people who had experienced stress symptoms but who had not lodged a claim or sought help; and people who experienced stressful work events but who had not developed symptoms. Examination was made of cognitive distortion, irrational beliefs and coping resources as individual factors, and stressful life events, daily hassles and work environment factors as environmental variables. The Compensation group was distinguished from other groups only on the basis of work environmental factors. The implications of these results in the understanding of the decision to lodge a workers' compensation claim are considered.     

Concept mapping the needs of foster parents

This study describes the needs of foster parents as perceived by the foster parents themselves. Forty-nine parents from 30 foster families were asked to describe their needs in response to the question: "What do you need to be a good foster parent?" Five themes were apparent in their answers: (1) good working relationships; (2) cultural sensitivity; (3) harmonious and stable family relationships; (4) adequate payment for services; and (5) a range of personality characteristics and parenting skills. These themes are consistent with the literature, with the notable exception of respite, a need identified in the literature but not by the sampled foster parents. The study results lend credibility to the existing literature on the needs of foster parents.     

(Mis) representations of the long-term effects of childhood sexual abuse in the courts

This study addresses the (mis) representations made by pro-false memory attorneys and expert witnesses in court regarding the long-term effects of childhood sexual abuse (CSA). Five pro-false memory positions were identified: (1) there is no causal connection between CSA and adult psychopathology; (2) the evidence is insufficient; (3) CSA does not cause specific trauma-related outcomes like borderline and dissociative identity disorder; (4) other variables than CSA explain the variance of adult psychopathology; and (5) the long-term effects of CSA are general and non-specific. Examining the testimony revealed that such pro-false memory testimony was based solely on a partial understanding of retrospective data and that pro-false memory experts do not cite the more recent prospective data. Reviewing the totality of the scientific evidence demonstrates that such pro-false memory testimony is inaccurate and has the potential of misleading the jury. Prospective studies provide sufficient evidence to causally link CSA to a number of areas of adult psychopathology including multiple, co-morbid psychiatric conditions, and possibly to link early parent-infant attachment pathology to the development of borderline and dissociative identity disorder.