Developing guidelines for HIV antibody testing among victims of pediatric sexual abuse

The incidence of human immunodeficiency virus (HIV) infection acquired by children through sexual abuse is presently unknown. A telephone survey of 63 practitioners of pediatric sexual abuse (PSA) assessment in the five U.S. regions with highest prevalence of HIV infection was conducted to determine the present status of guidelines for HIV antibody testing of PSA victims. No formal protocol was used by any of those surveyed, and a literature review found no existing guidelines for HIV antibody testing of PSA victims. A standard set of clinical situations was presented to practitioners to assess whether a consensus exists of indications for HIV antibody testing of abused children. Seven clinical profiles with 12 criteria were presented including HIV antibody status, AIDS/ARC clinical profile, and behavioral profile of the assailant; clinical profile of the victim; pre-assault victim behavioral profile compatible with high risk of HIV infection (exclusively adolescents); parent/guardian anxiety/psychosocial profile; and profile of the assaultive act with respect to potential transmissibility of HIV. We found an 85% or greater consensus for 6 testing criteria, and based upon these propose an interim set of HIV antibody testing guidelines for PSA victims. There was no consensus about five testing criteria, but their frequent citation merits further consideration. Clinical application of interim guidelines and design of prospective studies to quantitatively evaluate them are reviewed.     

Expectations,observations, and violations: Comparing their effects on course ratings

Knowledgeable observers generally agree that students can give reasonably unbiased assessments of their classes, as long as proper instruments and procedures are used. These same observers agree, however, that more research is needed to understand the subtle dynamics which affect evaluations. Students' expectations (obtained on the first day) and the violation of these expectations are two possible factors. Their effects on students' final interest and future intentions are compared with students' actual reports of the class given at the end of the semester (n=196). Regression analysis using a simultaneous entry of expectations, expectancy violations, and final reports shows that students' reports at the end of the course account for almost all of the explained variance in the course rating items.     

Controlled choice assignments: A new and more effective approach to school desegregation

The authors argue that conventional mandatory and voluntary school desegregation techniques have failed to provide minority students with maximum feasible relief from invidious discrimination because they do not redress the root causes of segregation. They demonstrate that residential-based student assignment plans as well as plans that give students limited access to a few educationally enriched magnet schools are not asymmetrical remedies to wrongful segregation and thus work to perpetuate the racial and social inequities that they purport to correct. The authors offer an alternative approach to school desegregation—controlled choice—that operates independently from residential housing patterns and which explicitly seeks to maximize personal choice within a racially unitary, equitable, and educationally enhanced system of public schooling. Controlled choice was originally pioneered in Cambridge, Mass. during the early 1980s and has recently been adopted in Little Rock, Ark., and Fall River, Mass. The policy is also being actively reviewed by several of the nation's largest school districts including Seattle, Memphis, and Boston.     

Behavioral medicine and health psychology in a changing world

Despite long-established roots in experimental psychophysiology and psychosomatic medicine, behavioral medicine and health psychology have only recently emerged as recognized, highly visible disciplines within medicine and the behavioral sciences. The rapid development of these fields has resulted partly from important scientific advances in the biomedical and behavioral sciences and partly from changing societal concerns and values. The latter include a greater preoccupation with individual self-expression and self-fulfillment, a decline in respect for authority per se, and an increased skepticism about social institutions. Coupled with these changes has been an increasing desire to take responsibility for one's own life and, in matters of health, of one's own body. The ways in which scientific advances and social changes have influenced the shape of contemporary behavioral medicine and health psychology are explored with the aid of two illustrations: the growth of a developmental perspective in behavioral medicine and health psychology; and work and health, including the effects of job stress and unemployment. Finally, the author stresses the need for a greater sense of community and concern for others, if we are to succeed in creating a growth-enhancing, health-producing climate for society as a whole and for each of us as individuals.     

University autonomy and public policies: A system theory perspective

This article addresses problems facing universities because of external pressures for changes in their teaching, research, and governance and management policies and practices to align them with public policies. The view is put that governments are introducing public policies in times of economic recession to achieve rationalisation of human, physical and financial resources in higher education and to foster initiatives that shape university teaching and research to serve the needs of society and assist in national economic recovery. Examples of these external pressures, which have resulted in intrusions into the autonomy of university governance and management, are provided in the context of general system theory. It is assumed that the pressure of public policies on universities will continue and that each university should have a development plan for its present and future teaching and research activities, which has the endorsement of the government higher education advisory agency so that university management can function on a secure basis. The effectiveness and efficiency of functioning at the various levels of the university system should be assessed by periodic evaluative reviews. The quality of management by academic leaders should be fostered by the establishment of national centres for the study of higher education management and policy. The relationship between government higher education advisory agencies and universities should be renegotiated so that, as interdependent and interrelated parts of the higher education system, they work in joint co-operation to ensure the most effective and appropriate development of each institution. Nevertheless, a state of equilibrium between the university system and the supra (social) system within which it exists will never fully be achieved. The fundamental role and functions of a university require that it be concerned with teaching and researching both ageless and current phenomena. Hence, a perfect equilibrium state cannot exist if external social pressures are for the main weight of university activities to be shifted to providing service for the current needs of society.