The Kennedy Krieger lead paint study is a landmark case in human experimentation and a classic case in research ethics. In this paper I use the lead paint study to assist in the analysis of the ethics of research on less expensive, less effective interventions. I critically evaluate an argument by Buchanan and Miller who defend both the Kennedy Krieger lead paint study and public health research on less expensive, less effective interventions. (...) I conclude that Buchanan and Miller’s argument is flawed but that does not mean that research designed to find less effective interventions cannot be justified in some situations. Based on my analysis, I suggest questions to ask when considering such research and I offer some principles to guide us. In the process, light is shed on the various debates and issues raised by the lead paint study; e.g. standards of care, researchers’ responsibilities to research subjects, the distinction between treatment and research and the question of what it is that legitimizes public health research. (shrink)

This project considers whether and how research ethics can contribute to the provision of cost-effective medical interventions. Clinical research ethics represents an underexplored context for the promotion of cost-effectiveness. In particular, although scholars have recently argued that research on less-expensive, less-effective interventions can be ethical, there has been little or no discussion of whether ethical considerations justify curtailing research on more expensive, more effective interventions. Yet considering cost-effectiveness at the research stage can (...) help ensure that scarce resources such as tissue samples or limited subject popula- tions are employed where they do the most good; can support parallel efforts by providers and insurers to promote cost-effectiveness; and can ensure that research has social value and benefits subjects. I discuss and rebut potential objections to the consideration of cost-effectiveness in research, including the difficulty of predicting effectiveness and cost at the research stage, concerns about limitations in cost-effectiveness analysis, and worries about overly limiting researchers’ freedom. I then consider the advantages and disadvantages of having certain participants in the research enterprise, including IRBs, advisory committees, sponsors, investigators, and subjects, consider cost-effectiveness. The project concludes by qualifiedly endorsing the consideration of cost-effectiveness at the research stage. While incorporating cost-effectiveness considerations into the ethical evaluation of human subjects research will not on its own ensure that the health care system realizes cost-effectiveness goals, doing so nonetheless represents an important part of a broader effort to control rising medical costs. (shrink)

This article examines a fundamental question of justice in global health. Is it ethically preferable to provide a larger number of people with cheaper treatments that are less effective (or more toxic), or to restrict treatments to a smaller group to provide a more expensive but more effective or less toxic alternative? We argue that choosing to provide less effective or more toxic interventions to a larger number of people is favored by the (...) principles of utility, equality, and priority for those worst-off. Advocates are mistaken to demand that medical care provided in low-income and middle-income countries should be the same as in high-income countries. (shrink)

We consider an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority (...) to the worst off. (shrink)

Background and ObjectivesBecause of high skin cancer risks for young women, it is vital that effective interventions reach and influence this demographic. Visual social media platforms, like Instagram, are popular with young women and are an appropriate intervention site; yet, they also host competing images idealizing tan skin. The present study tested the ability of digital sun-safety interventions to affect self-control-related emotions and visual attention to subsequent tan-ideal images as well as sun-safety attitudes.MethodsWomen were recruited from a (...) large public Mid-Atlantic university in the United States. Participants were randomly assigned to view an appearance benefits intervention, a self-control emotions intervention, or a control message, each designed to look like an Instagram sponsored story. After self-reporting self-compassion and anticipated pride, participants then viewed seven pairs of Instagram posts featuring either tan or pale women while an eye tracker assessed visual attention. Finally, participants self-reported their responses to questions assessing sun-safety-related norms, efficacy, and attitudes.ResultsA mixed design analysis of covariance revealed that women who first viewed the appearance benefits intervention story spent less time visually fixated on Instagram images of tan women than did those who viewed the self-control emotions intervention or control message. Regressions also revealed interactions between the intervention conditions and feelings of anticipated pride on both visual attention and sun-safety attitudes.ConclusionSponsored stories on Instagram can promote sun-safety attitudes, depending on the emotional responses they generate. Additionally, sponsored interventions can affect subsequent visual attention. (shrink)

Orphans and vulnerable children fall under the category of children who are at risk of exposure to more stressful circumstances and receive less social assistance compared to other children. This study aims to investigate the impact of group counseling based on social intervention and psychological therapy on social support and the perceived stress growth of orphans and vulnerable children. In one special educational needs school in Nanning, China, the SSGPC was developed and implemented. Using the social support and post-stress (...) growth scales, the researchers investigated the effects of SSGPC on orphans and vulnerable children. Twenty-seven orphans and vulnerable children between the ages of nine and 12 were arbitrarily assigned to the experimental and control groups. A pre-test post-test method of quasi-experimental design was applied, with 13 participants in the experimental group and 14 in the control group. The results revealed that the intervention group had significantly higher scores for social support and post-stress growth than the control group. The SSGPC had significantly improved the levels of social support for orphans. The findings indicated that the SSGPC provided an effective way to improve social support and post-stress growth of orphans and vulnerable children. (shrink)

Tinnitus refers to the perception of sound in the absence of an external stimulus. This can be problematic and can lead to health problems in some sufferers, including effects on cognitive functions such as attention and memory. Although several studies have examined the effectiveness of tinnitus interventions, e.g., cognitive behavioral therapy and sound therapy, it is still unclear as to the overall quality and limitations of these studies and whether their results could be generalized. Clarification is also needed as (...) to whether poor cognitive function will lead to a less favorable intervention outcome in tinnitus patients. The present systematic review was therefore designed to critically appraise and synthesize findings from randomized controlled trials of tinnitus intervention and its effects on cognition. The methodology followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Medline, Embase, and PsycINFO were searched. Only RCTs that compared the effectiveness of a tinnitus intervention and a measure of cognitive function in adult participants with tinnitus were included. A total of 8 studies involving 610 participants tested using 11 cognitive function assessment tools and 5 tinnitus intervention outcome measurements were included and analyzed. The outcomes of the review suggest that tinnitus intervention not only facilitates tinnitus management but also improves cognitive functions. It is likely that cognition and emotion play an important role in a patient's adjustment to tinnitus. Whether cognition can predict treatment outcomes is unclear due to insufficient evidence. Future research is needed using a standardized assessment protocol focusing on the effect of sound-based interventions on tinnitus severity and cognitive functions. Studies on whether cognitive function measurement can be used as a predictor for the effectiveness of tinnitus therapy are also needed. (shrink)

Ethical guidelines for conducting clinical trials have historically been based on a perceived therapeutic obligation to treat and benefit the patient-participants. The origins of this ethical framework can be traced to the Hippocratic oath originally written to guide doctors in caring for their patients, where the overriding moral obligation of doctors is strictly to do what is best for the individual patient, irrespective of other social considerations. In contrast, although medicine focuses on the health of the person, public health is (...) concerned with the health of the entire population, and thus, public health ethics is founded on the societal responsibility to protect and promote the health of the population as a whole. From a public health perspective, research ethics should be guided by giving due consideration to the risks and benefits to society in addition to the individual research participants. On the basis of a duty to protect the population as a whole, a fiduciary obligation to realise the social value of the research and the moral responsibility to distribute the benefits and burdens of research fairly across society, how a public health perspective on research ethics results in fundamental re-assessments of the proper course of action for two salient topical issues in research ethics is shown: stopping trials early for reasons of efficacy and the conduct of research on less expensive yet less effective interventions. (shrink)

Antibiotic use triggers evolutionary and ecological responses from bacteria, leading to antibiotic resistance and harmful patient outcomes. Two complementary strategies support long-term antibiotic effectiveness: conservation of existing therapies and production of novel antibiotics. Conservation encompasses infection control, antibiotic stewardship, and other public health interventions to prevent infection, which reduce antibiotic demand. Production of new antibiotics allows physicians to replace existing drugs rendered less effective by resistance.In recent years, physicians and policymakers have raised concerns about the pipeline for (...) new antibiotics, pointing to a decline in the number of antibiotics approved since the 1980s. This trend has been attributed to high research and development costs, low reimbursement for antibiotics, and regulatory standards for review and approval. Professional societies and researchers around the world have called for renewed emphasis on antimicrobial stewardship, while also supporting antibiotic research and development through grants, changes to intellectual property laws to extend market exclusivity periods, and modification of premarket testing regulations to reduce antibiotic development time and expenses. (shrink)

Under the innovation-driven development strategy, the improvement of the core competitiveness of enterprises demonstrates increasing dependence on the ability of technological innovation. In this article, data of A-share listed companies in Shanghai and Shenzhen stock markets from 2008 to 2018 were selected as research samples for the analysis of the influencing factors and mechanism of enterprise technological innovation from the dual perspectives of the external economic environment and internal management system based on the use of the fixed-effect model. The results (...) show that government intervention significantly hinders enterprises' investment in resources for technological innovation, and less government intervention can improve the innovation investment of enterprises. The intervention of internal control fails to bring institutional advantages; rather, it aggravates the negative effect of government intervention on enterprise technological innovation. The research enriches the existing academic research results on government intervention, internal control quality, and enterprise technological innovation. The findings provide experience for accelerating the marketization process in China, enterprise governance, and improving the level of enterprise technological innovation. (shrink)

Despite a wide range of restorative practices in use around the world, most recent research has been focused on one model, family group conferencing. In part due to the salience and appeal of Braithwaite’s reintegrative shaming theory, this important emphasis on the role of structured dialogue with family and intimates privileges an emotional connection that elicits reintegrative shame on the part of the offender, accompanied by group support. In this paper, I argue that reintegrative shaming as practiced in family group (...) conferencing in the youth justice context is based on a theory of “strong ties” associated with the extended families of Gemeinschaft societies. This important emphasis on the family/extended family unit as an affective focus, however, may have inadvertently diverted attention from the importance in Gessellschaft societies of “weak ties.” In modernity, such ties provide instrumental support that leads to connections that link offenders and victims to broader “bridging” relationships associated with social and human capital. This paper briefly considers two ostensibly “weak” restorative practices that effectively engage these broader connections for young offenders and families that may be fundamental to reintegration and other prosocial outcomes, while also mobilizing and strengthening the parochial controls and social support of neighbors and other adults. Ultimately, the sustainability of restorative justice will require an openness to practices that accomplish restorative goals, while also facilitating a more flexible, problem solving, and community-building focus. (shrink)

G. A. Cohen argues that egalitarians should compensate for expensive tastes or for the fact that they are expensive. Ronald Dworkin, by contrast, regards most expensive tastes as unworthy of compensation — only if a person disidentifies with his own such tastes (i.e. wishes he did not have them) is compensation appropriate. Dworkinians appeal, inter alia, to the so-called ‘first-person’ or ‘continuity’ test. According to the continuity test, an appropriate standard of interpersonal comparison reflects people's own assessment of their relative (...) standing: Person A can only legitimately demand compensation from person B if he regards himself as worse off, all things considered, than B. The typical bearer of expensive tastes does not regard herself as being worse off than others with less expensive tastes. Hence, in the typical case, pace Cohen, compensation for expensive tastes is inappropriate. The article scrutinizes this rationale for not compensating for expensive tastes. Especially, we try to bolster the continuity test by relating it to Dworkin's distinction between integrated and detached values, pointing out that an argument for the continuity test can be built on the assumption that equality has integrated value. In brief, the point is that a metric of equality should be assessed, partly, in virtue of its consequences for related ideals. One of these is the kind of justificatory community promoted by the continuity test. We defend this view against an objection to the effect that equality is a detached value. We conclude that the continuity test constitutes a strong foothold for the resourcist egalitarian reluctance to compensate people for their expensive tastes. (shrink)

In Europe the elderly population is projected to increase from 18.5% (93.9 million) in 2014 to 28.7% (149.1 million) by 2080. In the USA it is estimated that by the year 2030 more than 20% of the population will be aged 65 years or over. This specific population is at high risk of unrecognised or untreated psychiatric illnesses and suicide. It is well known that completed suicide rate increases with age in both men and women. Although elderly people attempt suicide (...) less often than other age groups, they show a higher completion rate. Generally the methods chosen by elderly are more lethal, the intent is more serious, they are more determined and they show fewer warning sign than the younger population. A recent systematic review and meta-analysis of psychosocial intervention following self-harm in adults found that cognitive behavioural therapy was the most effective in these patients. Unfortunately there have been few reported trials of other potentially effective interventions. Because the scientific literature on psychosocial suicide prevention interventions in the elderly is still scant we decided to conduct a mini-review in order to take stock of the situation. Studies were identified through electronic searches of the Cochrane library, MEDLINE, Scopus and Web of Science databases. PRISMA guidelines were followed and only 7 articles met the inclusion criteria. No firm conclusions can be drawn about this topic because there is still little data and studies used inconsistent outcome measures and designs. Nonetheless, the existing data suggests that psychosocial interventions are promising. (shrink)

abstract G. A. Cohen argues that egalitarians should compensate for expensive tastes or for the fact that they are expensive. Ronald Dworkin, by contrast, regards most expensive tastes as unworthy of compensation — only if a person disidentifies with his own such tastes (i.e. wishes he did not have them) is compensation appropriate. Dworkinians appeal, inter alia, to the so‐called ‘first‐person’ or ‘continuity’ test. According to the continuity test, an appropriate standard of interpersonal comparison reflects people's own assessment of their (...) relative standing: Person A can only legitimately demand compensation from person B if he regards himself as worse off, all things considered, than B. The typical bearer of expensive tastes does not regard herself as being worse off than others with less expensive tastes. Hence, in the typical case, pace Cohen, compensation for expensive tastes is inappropriate. The article scrutinizes this rationale for not compensating for expensive tastes. Especially, we try to bolster the continuity test by relating it to Dworkin's distinction between integrated and detached values, pointing out that an argument for the continuity test can be built on the assumption that equality has integrated value. In brief, the point is that a metric of equality should be assessed, partly, in virtue of its consequences for related ideals. One of these is the kind of justificatory community promoted by the continuity test. We defend this view against an objection to the effect that equality is a detached value. We conclude that the continuity test constitutes a strong foothold for the resourcist egalitarian reluctance to compensate people for their expensive tastes. (shrink)

Although much of the focus on responsible conduct in research has been defined by courses or online training, it is generally understood that this is less important than what happens in the research environment. On the assumption that providing faculty with tools and resources to address the ethical dimensions of the practice of research would be useful, a new workshop was convened ten times across seven academic institutions and at the annual meeting of a professional society. Workshops were attended (...) by 91 faculty, 71 of whom completed evaluations strongly supportive of the value of the workshop. Surveys of trainees identified by the faculty allowed for invitations to complete an online survey before and 6 months after the workshops, respectively resulting in response rates of 43 and 51%. Faculty and trainees were highly supportive of the feasibility, relevance, and effectiveness of the implementation by the faculty of one or more of the five strategies featured in the workshop. However, surprisingly over 70% of the trainees reported use of one or more of those strategies prior to faculty participation in the workshops. In sum, the workshops for faculty were successful, and the proposed strategies were deemed of value, but it is likely that the faculty voluntarily choosing to participate in these workshops were perhaps not surprisingly faculty who are already engaging in some of these strategies. This model is likely a useful adjunct to encouraging a culture of ethics, but it is not by itself sufficient to do so. (shrink)

Framing effects occur when people respond differently to the same information, just because it is conveyed in different words. For example, in the classic ‘Disease Problem’ introduced by Amos Tversky and Daniel Kahneman, people’s choices between alternative interventions depend on whether these are described positively, in terms of the number of people who will be saved, or negatively in terms of the corresponding number who will die. In this paper, I discuss an account of framing effects based on ‘fuzzy-trace (...) theory’. The central claim of this account is that people represent the numbers in framing problems in a ‘gist-like’ way, as ‘some’; and that this creates a categorical contrast between ‘some’ people being saved (or dying) and ‘no’ people being saved (or dying). I argue that fuzzy-trace theory’s gist-like representation, ‘some’, must have the semantics of ‘some and possibly all’, not ‘some but not all’. I show how this commits fuzzy-trace theory to a modest version of a rival ‘lower bounding hypothesis’, according to which lower-bounded interpretations of quantities contribute to framing effects by rendering the alternative descriptions extensionally inequivalent. As a result, fuzzy-trace theory is incoherent as it stands. Making sense of it requires dropping, or refining, the claim that decision-makers perceive alternatively framed options as extensionally equivalent; and the related claim that framing effects are irrational. I end by suggesting that, whereas the modest lower bounding hypothesis is well supported, there is currently less evidence for the core element of the fuzzy trace account. (shrink)

The growth of autistic self-advocacy and the neurodiversity movement has brought about new ethical, theoretical and ideological debates within autism theory, research and practice. These debates have had genuine impact within some areas of autism research but their influence is less evident within early intervention research. In this paper, we argue that all autism intervention stakeholders need to understand and actively engage with the views of autistic people and with neurodiversity as a concept and movement. In so doing, intervention (...) researchers and practitioners are required to move away from a normative agenda and pay diligence to environmental goodness-of-fit, autistic developmental trajectories, internal drivers and experiences, and autistic prioritized intervention targets. Autism intervention researchers must respond to these debates by reframing effectiveness, developing tools to measure autistic prioritized outcomes, and forming partnerships with autistic people. There is a pressing need for increased reflection and articulation around how intervention practices align with a neurodiversity framework and greater emphasis within intervention programmes on natural developmental processes, coping strategies, autonomy, and well-being. (shrink)

This paper examines the effectiveness of public enforcement by studying the effects of regulatory intervention to curb tunneling through intercorporate loans in China. Specifically, we explore whether public enforcement efforts in 2006 resulted in less tunneling, and ultimately in increased performance for tunneling firms. We show that tunneling is among the dominant factors increasing the likelihood of becoming blacklisted. We also find that firms’ tunneling mechanisms decreased significantly after the regulatory shock, and that their performance increased significantly compared to (...) non-tunneling firms after the regulatory shock. Finally, we find a positive market reaction to the public announcement of tunneling both for firms that have been blacklisted and other tunneling firms that are not blacklisted. Collectively, these results suggest that public enforcement in the presence of a credible threat succeeds in deterring the effect on tunneling behavior in China. (shrink)

Questions embedded under responsive predicates and definite descriptions both give rise to a variety of phenomena which can be grouped under the term plurality effects: quantificational variability, cumulativity, and homogeneity effects. This similarity has not gone unnoticed, and many proposals have taken inspiration in theories of definite plurals to account for these effects with embedded questions. Recently these phenomena have received less attention, as the field has focused on the so-called intermediate exhaustive reading of embedded questions instead, after Spector (...) called into question the traditional dichotomy between weak and strong exhaustive readings. As a result, the intermediate exhaustive reading has been accounted for at the expense of empirical coverage in other areas. In this paper, I propose a modular theory which derives the currently much discussed exhaustive readings without giving up the rich semantics necessary to account for plurality effects. My account of quantificational variability, cumulativity, and homogeneity effects builds on recent work on these phenomena in the nominal domain by adopting a categorial approach to embedded questions, while the strong and intermediate exhaustive readings are implemented using an independent strengthening mechanism suggested in Klinedinst and Rothschild :1–23, 2011). The resulting theory not only recovers important results on plurality effects; it offers new, simple solutions for some puzzles presented in George :166–177, 2013) and Paillé and Schwarz Proceedings of WCCFL 36, vol 36, Cascadilla Proceedings Project, Somerville, 2018), naturally derives readings that had been postulated in previous literature, makes correct predictions in many unexplored cases, and is compatible with recent results in psycholinguistics. In the last sections I justify my assumptions and show how possible limitations I inherit from the theories I build on can be accommodated under standard assumptions. (shrink)

Working memory (WM) is a fundamental cognitive ability to support complex thought, but it is limited in capacity. WM training has shown the potential to make benefit for those in need. Many studies have shown the potential of transcranial direct current stimulation (tDCS) to transiently enhance WM performance by delivering low current to the brain cortex of interest via electrodes on the scalp. TDCS has also been revealed as a promising intervention to augment WM training in a few studies. However, (...) those few tDCS-paired WM training studies focused more on the effect of tDCS on WM enhancement and its transferability after training but paid less attention to the variation of cognitive performance during the training procedure. The current study attempted to explore the effect of tDCS on the variation of performance during WM training in healthy young adults. All the participant received WM training with the load-adaptive verbal N-back task for five days. During the training procedure, active/sham anodal high-definition tDCS (HD-tDCS) was used to stimulate the left dorsolateral prefrontal cortex (DLPFC). To examine the training effect, pre- and post-test were performed respectively one-day before and after the training sessions respectively. At the beginning of each training session, stable-load WM tasks were performed to examine the performance variation during training. Compared to the sham stimulation, higher learning rates of performance metrics during the training procedure were found when WM training was combined with active anodal HD-tDCS. The performance improvements (post-pre) of the active group were also found to be higher than those of sham group and were transferred to a similar untrained WM task. Further analysis revealed that the negative relation between the training improvements and baseline performance. These findings show the potential that tDCS may be leveraged as an intervention to facilitate WM training for those in need of higher WM ability. (shrink)

Side effects are a concern in medical decision making and a robust area of biomedical research. However, there is relatively little philosophical investigation into side effects as such, especially given that side effects are appealed to for various applications in philosophy of medicine. In addition, health authorities like the FDA, CDC, and WHO have contrary definitions of ‘side effect.’ Moreover, these definitions have clear counterexamples. This dissertation aims to provide a complete account of what side effects are. I posit that (...) an account of side effects ought to draw clean conceptual lines between side effects and related treatment outcomes. I contend that an account of side effects must address two components: the reasons behind an intervention that produced the side effect, and the causal powers of the intervention that brought about that effect. With this account in mind, I address contemporary philosophical models that distinguish placebo effects from side effects. These arguments, respectively in chapters 2 and 3, yield a more complete, less problematic account of side effects than previous accounts. The dissertation then turns to the process of discovering side effects, specifically in the post-market context. Given the paucity of external validity in pre-market drug trials, chapter 4 argues that post-market ‘phase IV’ trials blur the received distinction of ‘confirmatory’ versus ‘exploratory’ experimentation in philosophy of science. The other component of post-market drug research is spontaneous reporting, or the voluntary reporting of a suspected side effect to a regulatory body. Chapter 5 uses the framework of risks and values in science to examine why clinicians underreport, which hinders our ability to prevent drug-related harms. Chapter 6 looks at how patients could mitigate underreporting and develops a social-epistemic, pragmatic, and ethical framework which can evaluate proposals to engage patients to spontaneously report their suspected side effects. In short, this dissertation aims to firstly address the conceptual problems in how we define ‘side effect’ and relate it to other treatment outcomes, and secondly it addresses issues that hinder the scientific investigation of side effects. (shrink)

Two experiments with undergraduates as subjects were carried out with the aim of replicating and extending previous results showing that the implication of the behavioral life-cycle hypothesis (H. M. Shefrin & R. H. Thaler, 1988) that people classify assets in different mental accounts (current income, current assets, and future income) may explain how consumption choices are influenced by temporary income changes. In both experiments subjects made fictitious choices between paying for a good in cash or according to a more expensive (...) installment plan after they had received an income which was either less, the same, or larger than usual. In Experiment 1 subjects were supposed to have savings so that the total assets were equal, whereas in Experiment 2 the total assets varied. The results of both experiments supported the role of mental accounts in demonstrating that subjects were unwilling to pay in cash after an income decrease even though they had access to saved money. Thus, in effect they chose to pay more for the good than they had to. Indicating a need for further refinement of the concept of mental account, choices to pay in cash after an income decrease tended to be more frequent when the consumption and savings motives were compatible than when they were incompatible. Furthermore, increasing the total assets made subjects more willing to pay in cash after an income decrease. (shrink)

School-aged children with Developmental Coordination Disorder (DCD) are at greater risk for physical inactivity, lower global self-worth, and internalizing problems, such as depression and anxiety. Based on the Environmental Stress Hypothesis (ESH), recent research has shown that physical inactivity and lower global self-worth sequentially mediate the relationship between DCD and internalizing problems, suggesting that DCD leads to lower levels of physical activity, which in turn, leads to lower levels of global self-worth, and ultimately, a greater amount of internalizing problems. However, (...) physical activity and global self-worth may also buffer (i.e., moderate) the adverse effect of DCD on internalizing problems. To date, this has yet to be tested. Participants were 1206 children aged 12-14 years (611 boys, 79 with probable DCD (pDCD)). All children received assessments of motor coordination, physical activity, global self-worth, and internalizing problems. Children with pDCD were less physically active, had lower self-worth, and experienced more internalizing problems compared to typically developing (TD) children (p’s <.05). Furthermore, the moderated moderating effect (three-way interaction) of physical activity and global self-worth was also evident (p <.05), indicating that internalizing problems in both TD and pDCD groups decreased with concurrent increases in physical activity and global self-worth. Importantly, when compared to TD children, increases in physical activity and global self-worth were associated with a greater reduction in internalizing problems among children with pDCD. The findings support several pathways in the ESH and highlight that, in addition to improving motor skills, interventions should also target both physical activity and global self-worth to mitigate potential mental health issues for children with motor difficulties. (shrink)

As a result of the COVID-19 pandemic people have endured potentially stressful challenges which have influenced behaviors such as eating. This pilot study examined the effectiveness of two brief interventions aimed to help individuals deal with food cravings and associated emotional experiences. Participants were 165 individuals residing in United Kingdom, Finland, Philippines, Spain, Italy, Brazil, North America, South Korea, and China. The study was implemented remotely, thus without any contact with researchers, and involved two groups. Group one participants were (...) requested to use daily diaries for seven consecutive days to assess the frequency of experience of their food cravings, frequency of giving in to cravings, and difficulty resisting cravings, as well as emotional states associated with their cravings. In addition to completing daily food diaries, participants in group two were asked to engage in mindful eating practice and forming implementation intentions. Participants assessed their perceived changes in eating, wellbeing, and health at the beginning and end of the intervention. Repeated measures MANOVAs indicated that participants experienced significantly less food cravings, as well as lower intensities of unpleasant states associated with cravings across time. In contrast to our hypothesis, the main effects of the group were not significant. Participants reported less eating and enhanced wellbeing at the end of the study. Our findings can be used to inform future remote interventions to manage food cravings and associated emotions and highlight the need for alternative solutions to increase participant engagement. (shrink)

IntroductionIn this study, we tested a simple, active “ethical consistency” intervention aimed at reducing researchers’ endorsement of questionable research practices (QRPs).MethodsWe developed a simple, active ethical consistency intervention and tested it against a control using an established QRP survey instrument. Before responding to a survey that asked about attitudes towards each of fifteen QRPs, participants were randomly assigned to either a consistency or control 3–5-min writing task. A total of 201 participants completed the survey: 121 participants were recruited from a (...) database of currently funded NSF/nih scientists, and 80 participants were recruited from a pool of active researchers at a large university medical center in the southeastern US. Narrative responses to the writing prompts were coded and analyzed to assist post hoc interpretation of the quantitative data.ResultsWe hypothesized that participants in the consistency condition would find ethically ambiguous QRPs less defensible and would indicate less willingness to engage in them than participants in the control condition. The results showed that the consistency intervention had no significant effect on respondents’ reactions regarding the defensibility of the QRPs or their willingness to engage in them. Exploratory analyses considering the narrative themes of participants’ responses indicated that participants in the control condition expressed lower perceptions of QRP defensibility and willingness.ConclusionThe results did not support the main hypothesis, and the consistency intervention may have had the unwanted effect of inducing increased rationalization. These results may partially explain why RCR courses often seem to have little positive effect. (shrink)

Although the neural bases of the brain associated with movement disorders in children with developmental coordination disorder are becoming clearer, the information is not sufficient because of the lack of extensive brain function research. Therefore, it is controversial about effective intervention methods focusing on brain function. One of the rehabilitation techniques for movement disorders involves intervention using motor imagery. MI is often used for movement disorders, but most studies involve adults and healthy children, and the MI method for children (...) with DCD has not been studied in detail. Therefore, a review was conducted to clarify the neuroscientific basis of the methodology of intervention using MI for children with DCD. The neuroimaging review included 20 magnetic resonance imaging studies, and the neurorehabilitation review included four MI intervention studies. In addition to previously reported neural bases, our results indicate decreased activity of the bilateral thalamus, decreased connectivity of the sensory-motor cortex and the left posterior middle temporal gyrus, bilateral posterior cingulate cortex, precuneus, cerebellum, and basal ganglia, loss of connectivity superiority in the abovementioned areas. Furthermore, reduction of gray matter volume in the right superior frontal gyrus and middle frontal gyrus, lower fractional anisotropy, and axial diffusivity in regions of white matter pathways were found in DCD. As a result of the review, children with DCD had less activation of the left brain, especially those with mirror neurons system and sensory integration functions. On the contrary, the area important for the visual space processing of the right brain was activated. Regarding of characteristic of the MI methods was that children observed a video related to motor skills before the intervention. Also, they performed visual-motor tasks before MI training sessions. Adding action observation during MI activates the MNS, and performing visual-motor tasks activates the basal ganglia. These methods may improve the deactivated brain regions of children with DCD and may be useful as conditioning before starting training. Furthermore, we propose a process for sharing the contents of MI with the therapist in language and determining exercise strategies. (shrink)

The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored (...) to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen–Taylor Hand Function Test ], ipsilesional grip strength, contralesional arm impairment level [Fugl–Meyer Assessment ], and functional independence [Functional independence measure ]. Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study. (shrink)

ObjectiveTo further delineate risk and resilience factors contributing to trajectories of mental health symptoms experienced by college students through the pandemic.Participantsn = 183 college students.MethodsLinear mixed models examined time effects on depression and anxiety. Propensity-matched subgroups exhibiting “increased” versus “low and stable” depression symptoms from before to after the pandemic-onset were compared on pre-pandemic demographic and psychological factors and COVID-related experiences and coping strategies.ResultsStudents experienced worsening of mental health symptoms throughout the pandemic, particularly during Fall 2020 compared with Fall 2019. (...) The propensity-matched subgroup exhibiting relative resilience reported less alcohol use prior to the pandemic, greater use of active coping strategies, and less of an impact on their college progress.ConclusionsResults point to several potential targets of screening and intervention to decrease residual impacts of the pandemic. (shrink)

Performance Generating Systems (PGS) are rule- and task-based approaches to improvisation on stage in theatre, dance, and music. These systems require performers to draw on predefined source materials (texts, scores, memories) while working on complex tasks within limiting rules. An interdisciplinary research team at a large Western Canadian university hypothesized that learning to sustain this praxis over the duration of a performance places high demands on executive functions; demands that may improve the performers’ executive abilities. These performers need to continuously (...) shift attention while remaining responsive to embodied and environmental stimuli in the present, they are required to inhibit automated responses and impulses using the rules of the system, and they strive towards addressing multitasking challenges with fluidity and flexibility. This study set out to test the mentioned hypothesis deductively and identify mediating processes inductively, using mixed empirical methods. In a small sample experiment with a control group (28 participants; 15 in intervention group, 13 in control group), standardized quantitative tests of executive functions (D-KEFS) were administered before and after an eight-week intervention. Participant-reported qualitative observations from the praxis were also collected throughout the intervention for grounded analysis. Within the limitations of small sample data, we found both statistically significant and trending effects on inhibition, problem-solving initiation, fluidity, and cognitive flexibility. Examining the mediating process, we found that participants experienced significant challenges sustaining the practice halfway through the intervention. The participant-reported solutions to these challenges, which emerged as the strongest behavioural patterns when coding the qualitative data to saturation, were strategies of problem-solving and of re-directing attention. These strategies support and advance our understanding of the effects measured in the standardized tests. In terms of application, our results identify characteristics of PGS that could potentially maintain and strengthen executive functions over and above less demanding performing arts interventions. The results also deliver new insight into how PGS works, which may contribute to the development and teaching of this artistic practice. (shrink)

Coaching is a systematic and goal-oriented one-on-one intervention by a coach aimed to guide clients in their professional and personal development. Previous research on coaching has demonstrated effects on a number of positive outcomes, including well-being and performance, yet little is known about the processes that underlie these outcomes, such as the type of questions coaches use. Here, we focus on three different types of coaching questions, and aim to uncover their immediate and sustained effects for affect, self-efficacy, and goal-directed (...) outcomes, using a between-subjects experiment. One hundred and eighty-three medical residents and PhD students from various medical centers and healthcare organizations in the Netherlands were recruited to participate in a self-coaching writing exercise, where they followed written instructions rather than interacting with a real coach. All participants were randomly allocated to one of three conditions: either one of two solution-focused coaching conditions or a problem-focused coaching condition. Self-report questionnaires were used to measure key outcomes of coaching, that is positive and negative affect, self-efficacy, goal orientation, action planning and goal attainment. Two follow-up measurements assessed if the effects of the self-coaching exercise led to problem-solving actions within an initial follow-up period of 14 days and a subsequent follow-up period of 10 days. Findings showed that participants experienced more positive affect, less negative affect, and higher approach goal orientation after the solution-focused coaching exercise compared to the problem-focused coaching exercise. In all conditions, goal attainment increased as a consequence of the self-coaching intervention. We discuss the implications of our findings for the science and practice of contemporary coaching. (shrink)

The purpose of this study was to evaluate the effectiveness of an educational intervention regarding end-of-life discussion directed at older Japanese adults and their attitude to and acceptance of this intervention. A quasi-experimental design was used. A total of 121 older adults, aged 65 years and over, consented to participate. Data from 55 intervention and 57 control participants were used for the analysis. The intervention consisted of an education program comprising a video, a lecture using a handout, and discussion among (...) participants. The control group received only the handout. Both groups were followed up after one month. The intervention group’s attitude became more favorable towards advance directives, especially living wills (P = 0.024). In addition, their expression of preference for life-sustaining treatment by means of artificial nutrition was less at follow up, demonstrating that these older adults had become more autonomous (P = 0.008). There was greater acceptance of the intervention as a whole by the intervention group compared with the control group (P = 0.011). Although few participants overall completed living wills, at follow up twice as many in the intervention group had discussed end-of-life matters with family members and/or their physician. (shrink)

Background: Healthcare workers in the front line of diagnosis, treatment, and care of patients with coronavirus disease 2019 are at great risk of both infection and developing mental health symptoms. This study aimed to investigate the following: whether healthcare workers in general hospitals experience higher mental distress than those in psychiatric hospitals; the role played by religion and alexithymic trait in influencing the mental health condition and perceived level of happiness of healthcare workers amidst the stress of the COVID-19 pandemic; (...) and factors that influence the resilience of healthcare workers at 6 weeks' follow-up.Methods: Four-hundred and fifty-eight healthcare workers were recruited from general and psychiatric hospitals, and 419 were followed-up after 6 weeks. All participants filled out the 20-item Toronto Alexithymia Scale, five-item Brief-Symptom Rating Scale, and the Chinese Oxford Happiness Questionnaire.Results: Under the stress of the COVID-19 pandemic, 12.3% of frontline healthcare workers in general hospitals reported having mental distress and perceived lower social adaptation status compared with those working in psychiatric hospitals. Christians/Catholics perceived better psychological well-being, and Buddhists/Taoists were less likely to experience mental distress. The results at 6 weeks of follow-up showed that the perceived lower social adaptation status of general hospital healthcare workers was temporary and improved with time. Christian/Catholic religion and time had independent positive effects on psychological well-being; however, the interaction of Christian/Catholic religion and time had a negative effect.Conclusions: Collectivism and individualism in the cultural context are discussed with regard to alexithymic trait and Buddhist/Taoist and Christian/Catholic religious faiths. Early identification of mental distress and interventions should be implemented to ensure a healthy and robust clinical workforce for the treatment and control of the COVID-19 pandemic. (shrink)

The world's population is currently overcoming one of the worst pandemics, and the psychological and social effects of this are becoming more apparent. We will present an analysis of the psychosocial effects of COVID-19: first, a cross-sectional study in an Ecuadorian sample and second, a comparative study between two samples from the Ecuadorian and Spanish populations. Participants completed an online survey to describe how they felt before and after confinement; analyze which emotional and behavioral variables predict depressive symptoms, anxiety, and (...) stress perceived after the confinement; carry out a comparative study in a sample of Ecuadorian and Spanish surveys. Results indicate, first, that Ecuadorians experience significantly more depressive symptoms, anxiety, and stress after confinement. Second, variables which predict depressive symptoms and anxiety are greater public prosocial tendency, less stress as a challenge, and greater stress as a threat, as well as an empathetic tendency that implies greater emotional regulation. Experienced stress after confinement was predicted by a greater public prosocial tendency, as well as an empathetic tendency. Finally, scores for depression, anxiety, and stress are higher after confinement in both countries. However, results reveal the similarity of the psychosocial effects that are being experienced, regardless of the country, and the differences in the variables that can help explain these effects. This can contribute to the constitution of intervention plans which aim to soften and alleviate the effects produced by a situation such as that experienced with COVID-19. (shrink)

The unsustainable growth in U.S. health care costs is in large part attributable to the rising costs of pharmaceuticals and medical devices and to unnecessary medical procedures. This fact has led health reform advocates and policymakers to place considerable hope in the idea that increased government support for research on the comparative effectiveness of medical treatments will eventually help to reduce health care expenses by informing patients, health care providers, and payers about which treatments for common conditions are effective (...) and which are not. Comparative effectiveness research has shown in some cases that expensive but commonly used treatments are significantly less effective than relatively inexpensive alternatives. Critics warn, however, that CER will homogenize patient care, limit patient choices, and lead to improper health care rationing and even to the denial of lifesaving treatments. (shrink)

Children’s readiness for school is often threatened by the occurrence of both externalizing and internalizing problems. Previous research has shown that Positive Behavioral Interventions and Supports is particularly effective for fostering children’s behavioral skills and reducing externalizing problems. However, whether PBIS can enhance children’s emotional skills and reduce internalizing problems is less clear. Therefore, TIME-IN was developed, which extends PBIS by also including emotional support systems. It was tested whether TIME-IN was effective for improving emotion regulation (...) and reducing depressive symptoms. Furthermore, it was tentatively explored whether TIME-IN is accompanied by more than natural fluctuations in both children’s externalizing and internalizing problems. The effectiveness of TIME-IN was evaluated in a non-randomized study, in which an intervention group was compared with a matched control group. Both research questions were addressed in a sample consisting of 81 children between 8 and 12 years of age with special educational needs. Questionnaires for teachers, children, and their parents were administered at the beginning and the end of the school year using multi-informant assessment. Only indicative evidence was found for the hypothesis that TIME-IN improved children’s emotion regulation. Practical implications, strengths, and limitations were discussed.Clinical Trial Registration: This work was retrospectively registered at International Standard Registered Clinical/soCial sTudy Number registry ISRCTN54456609. Registered 28 March 2017. (shrink)

Promoting the ethical formation of engineering students through the cultivation of their discipline-specific knowledge, sensitivity, imagination, and reasoning skills has become a goal for many engineering education programs throughout the United States. However, there is neither a consensus throughout the engineering education community regarding which strategies are most effective towards which ends, nor which ends are most important. This study provides an overview of engineering ethics interventions within the U.S. through the systematic analysis of articles that featured ethical (...) interventions in engineering, published in select peer-reviewed journals, and published between 2000 and 2015. As a core criterion, each journal article reviewed must have provided an overview of the course as well as how the authors evaluated course-learning goals. In sum, 26 articles were analyzed with a coding scheme that included 56 binary items. The results indicate that the most common methods for integrating ethics into engineering involved exposing students to codes/standards, utilizing case studies, and discussion activities. Nearly half of the articles had students engage with ethical heuristics or philosophical ethics. Following the presentation of the results, this study describes in detail four articles to highlight less common but intriguing pedagogical methods and evaluation techniques. The findings indicate that there is limited empirical work on ethics education within engineering across the United States. Furthermore, due to the large variation in goals, approaches, and evaluation methods described across interventions, this study does not detail “best” practices for integrating ethics into engineering. The science and engineering education community should continue exploring the relative merits of different approaches to ethics education in engineering. (shrink)

The purpose of this study is to examine whether United States -style regulatory intervention to encourage whistle-blowing can be immediately effective if transplanted into another country with a distinctly different historical cultural background and institutional system. A total of 98 U.S. and 84 German accountants participated in a laboratory experiment relating to a case of financial statement fraud. The provision of anti-retaliation protection and monetary rewards for whistle-blowing were manipulated and participants were asked to assume the role of an (...) internal auditor. We hypothesize and find that the provision of anti-retaliation protection and monetary rewards encourage U.S. accountants to blow the whistle. In contrast, among German accountants, where their country features a historical fear and distrust of whistle-blowers, U.S.-style regulatory interventions are less effective. Together, our findings provide strong support for the theory of path-dependence, suggesting that whistle-blowing regulation should not be uniformly transplanted without due consideration of the unique history and culture of a country. (shrink)

The aim of this study was to examine the interactive effects of situational variables on teams’ technical performance in the UEFA Champion League. Match data of 19 technical actions and events were collected and classified into three groups during eight seasons. Repeated-measures analysis of variance was used to identify the differences in the technical performances among teams. Results showed that the significant differences in the technical performance between the group stage and the knockout stage were only found in dribble and (...) yellow card. However, differences in the variables related to goal scoring and offense were more significant than in the variables related to defense under the comparisons across competition situations, and the differences in the variables related to defense were mainly detected in the yellow card. The number of variables that showed significant differences among match location and match outcome in the group stage were less than in the knockout stage. Therefore, the identified key performance indicators by considering the interactive effects of situational variables may provide detailed and practical insights for coaches to develop useful training interventions and match strategies for upcoming match playing in specific competition situations. (shrink)

School achievement and failure have become growing political and social concerns due to the negative consequences of school failure for individuals and society. The inclusive educational movement, which calls for equal access, permanence, participation, and promotion of all students worldwide, poses many challenges for schools and school systems. As a public policy strategy, some countries have provided additional funds for incorporating non-teaching professionals such as school psychologists and social workers in regular K-12 schools. However, there is lack of research on (...) the effects of these psychosocial professionals on student outcomes. This national multilevel study explored the effect of psychologists (n= 8,469) and social workers (n= 3,524) on indicators of eighth-grade (n= 147,531) and 10th-grade (n= 106,347) students' academic achievement and dropout in Chile. A multilevel secondary analysis was performed using national records of non-teaching professionals working as school staff members, achievement scores on the national SIMCE test, and dropout rates based on official records. Results showed that after controlling for individual and school variables known to affect achievement and dropout, schools with psychologists and social workers working as staff members had lower short- and long-term dropout rates. The presence and higher number of school psychologists per school was positively associated with higher math achievement, with a reduced effect in low-SES schools. Lower-SES schools with more social workers had higher math scores. These results support policies that increase funding for school psychologists and social workers, since their incorporation partly explains better school achievement and less school failure when controlling for individual and school characteristics, but emphasize the need to further explore the mechanisms through which school achievement and failure are developed with the support of psychologists and social workers in schools. We discuss the need to regulate the type of prevention and intervention strategies from a whole-school, evidence-based approach, as well as to incorporate psychosocial training modules and comprehensive guidelines as part of professional training programs and as certified requisites for working in schools. (shrink)

Background:Medical research involving human subjects must be evaluated by a research ethics committee before a study is initiated. However, knowledge of REC decision processes, particularly in relation to evaluating the risk–benefit balance in various study types, appears scant.Methods:The study protocols and records of a Finnish university hospital REC were surveyed for a time span of 5 years. All study procedures in each study plan were examined, and the studies were divided into clinical drug trials, clinical trials with medical devices, studies (...) with other invasive interventions, studies with non-invasive physical procedures, and non-physical procedures only.Results:In clinical drug trials, the REC posed queries more frequently about the risk–benefit ratio and less frequently about study methods and participant-related issues in comparison with other study types. Relative to other studies, those with non-physical procedures were subject to more frequent queries related to reliability of the study... (shrink)

In an age in which the regulatory state frequently deals with spending, licensing, and employment, the use of allocating powers is perceived as an appealing means by which to prevent discriminatory practices against individuals within illiberal communities. In addition to its easy availability, conditional funding is regarded as both an effective and—in comparison with legal prohibitions—less drastic tool for the prevention of discrimination. Such conditions are thought to be efficient because they increase the relative cost of the discriminatory (...) practice and in doing so create an economical incentive to avoid discrimination. Moreover, these conditions are thought to be less-coercive , because they still allow those subject to them to choose between the more expensive option of discrimination and the cheaper option of non-discrimination. In other words, these conditions are perceived as "Less Drastic Means." In this Article, I will argue that such a perception is false. When applied to the poor such conditionality is not less coercive than prohibitions in criminal law. It is more than reasonable to assume that attempts to rectify this flaw by exempting poor people from conditional funding will render such funding ineffective in preventing discrimination. In the final analysis—when one takes into account both the problem of the commodification of values and the inequality between rich and poor—the use of conditional finding as a means of promoting liberal values will, in most cases, be unjust. If we believe that the antidiscrimination principle has a lexical priority over a parent’s right to educate their children in accordance to their culture, we should choose the path of prohibition and abandon that of conditional funding. (shrink)

Researchers studying depression often encounter research participants in serious preexisting distress. Examining investigators' ethical responsibilities to these subjects, Stanton and New found that depression researchers reported actions that ranged from doing nothing to contacting both the distressed subject and a significant other. By experimentally manipulating consent form information regarding potential treatment referral, we examined whether subjects adjusted their responses on depression measures as a function of the level of follow-up they expected to receive. Results reveal that subjects who potentially could (...) receive the most intrusive intervention were less likely to report depressive symptoms than were subjects who anticipated less intrusive follow-up. Willingness to report depressive symptoms in particular conditions varied in part as a function of subject sex. Thus, ethical safeguards used in studies with subjects in preexisting distress may have consequences for the validity of self-report depression measures. (shrink)

Aims The study aims to test the Turkish validity and reliability of the Rushton Moral Resilience Scale (RMRS) and examine the effect of moral resilience on moral distress. Background Moral distress is a phenomenon that negatively affects health workers, health institutions, and the person receiving care. In order to eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience involves developing systems that support a culture of ethical practice in (...) healthcare and aim to increase an individual’s capacity to cope with moral challenges. Methods A methodological and descriptive-predictive study design was adopted. Sociodemographic Information Form, Measure of Moral Distress – Healthcare Professionals (MMD-HP), and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 255 clinical nurses were recruited. Ethical considerations Hacettepe University’s non-interventional ethics committee approved the study’s protocol and informed consent was obtained from the participants. Results The original four-factor structure of the scale was tested with confirmatory factor analysis, and the index values were evaluated and found at an acceptable level. The Cronbach Alpha coefficient of the scale was found to be 0.826. Moral resilience predicted moral distress total, intensity, and frequency levels. A moderate and weak relationship was found in the negative between all sub-dimensions of moral distress and moral resilience. Conclusions The Rushton Moral Resilience Scale Turkish version showed good psychometric properties. Moral resilience has a reducing effect on moral distress. Young nurses who have less experience are at risk because they have lower moral resilience levels, while nurses working in intensive care units are at risk because of their high moral distress levels. A healthy workplace can be created by developing specific approaches to improve moral resilience in reducing the impact of moral distress in the healthcare environment. (shrink)

This paper discusses a series of important methodological issues in developing targeted health-related quality of life measures in studies of the effects of medical interventions. Such measures cannot be developed unless the evaluator understands the life domains that medical interventions affect. Qualitative discovery methods are needed to obtain this understanding. Once domains are targeted for measurement, careful and systematic laboratory pilot work should be used to select initial scale items. Psychometric evaluation of response patterns in subsequent field tests (...) is needed to assess the measures. Less concern should be directed to internal consistency reliability of scales in the psychometric evaluation and more to the ability of short scales to reproduce total scale variance and to provide precise measurement within the range of the outcome where effects are expected. The paper closes with a discussion of modern methods of item response scaling that can be used to address these issues. (shrink)

Spillover occurs when one environmentally sustainable behaviour leads to another, often initiated by a behaviour change intervention. A number of studies have investigated positive and negative spillover effects, but empirical evidence is mixed, showing evidence for both positive and negative spillover effects, and lack of spillover altogether. Environmental identity has been identified as an influential factor for spillover effects. Building on identity process theory the current framework proposes that positive, negative, and a lack of spillover are determined by perceived threat (...) of initial behaviour and identity process mechanisms evaluating the behaviour. It is proposed, that an environmental behaviour change intervention may threaten one’s existing identities, leading to either (a) integration, (b) compartmentalisation, or (c) conflict between one’s environmental identity and non-environmental identities. Initial evidence for the proposed framework is based on a field intervention which included a meat reduction programme in a canteen of a medium size private sector company. Semi-structured interviews and an explorative visualisation method that aimed at assessing identity change were implemented with thirteen employees (i.e. intervention participants) before and after the intervention. The qualitative data was analysed by using thematic analysis via NVivo12. Results of the visualisation task and interview method provided initial evidence of direct and indirect positive contextual spillover effects, with comparatively less evidence a lack of spillover and a relative absence of reported negative spillover. This paper provides a novel theoretical approach, centred on identity process theory to enhance understanding of positive spillover, negative spillover, and the lack of spillover. (shrink)

BackgroundMultiple sclerosis, the most common neurological disease that causes disability in youth, does not only affect physical functions but is also associated with cognitive impairment, fatigue, depression, and anxiety and can significantly impact health-related quality of life. Since MS is generally diagnosed at a young age—a period of great significance for personal, relational, and professional development—adaptation can become highly challenging. Therefore, enhancing the competence of young people to adaptively cope with these potential challenges is of utmost importance in order to (...) promote their potentialities and talents. It has been shown that psychological interventions targeting MS patients can enhance resilience and HRQoL and that regular physical activity and social engagement can improve psychological well-being. However, literature on the development of global interventions based on the bio-psycho-social model of the disease is missing. Even less attention has been paid to interventions dedicated to young adults with MS and to the involvement of patients in the development of such programs.AimsIn collaboration with MS patients, this study aims to develop a bio-psycho-social intervention for YawMS, aiming to improve their HRQoL and to explore its feasibility, acceptability, and effects.MethodsTo tailor the intervention to the specific needs of YawMS, “patient engagement principles” will be adopted in the co-creation phase, performing a web survey and focus groups with patients and healthcare professionals. In the intervention phase, a pilot sample of 60 young adults with MS will be enrolled. The co-created intervention, composed of group sessions over a 12-week period, will cover psycho-social strategies and include physical activities. Adopting a longitudinal, pre–post evaluation design, self-report questionnaires measuring HRQoL and other bio-psycho-social features will be administered, the quantity and quality of PA will be measured, and a questionnaire developed by the authors will be used to evaluate the feasibility and acceptability of the ESPRIMO intervention. (shrink)

Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for (...) Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised. (shrink)

Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders. FASD is a spectrum of structural, functional, and neurodevelopmental problems with often lifelong implications, affecting communities worldwide. It is a leading preventable form of intellectual disabilities and therefore warrants effective prevention approaches. However, well-intended FASD prevention can increase stigmatization of individuals with FASD, women who consume or have consumed alcohol during pregnancy, and non-biological parents and guardians of individuals with FASD. This narrative review surveyed the literature on stigmatization (...) related to FASD. Public stigma appears to be the most common form of stigma studied. Less is known about FASD-related self-stigma, stigma by association, and structural stigma. Accordingly, the current literature on FASD-related stigma does not appear to provide sufficient guidance for effectively reducing FASD-related stigma. However, lessons can be learned from other related health topics and the use of a systematic approach for the development of health promotion programs, namely Intervention Mapping. (shrink)

Introduction: Probationers, offenders with less serious and non-violent offences, and under statutory supervision, have low levels of self-esteem and physical health, and high level of family conflict, and poorer quality of family relationships. This study examined the effectiveness of the existing probation service and the additional use of a positive family holistic health intervention to enhance physical, psychological, and family well-being in probationers and relationships with probation officers.Methods: Probationers under the care of the Hong Kong Social Welfare Department were (...) randomized into a care-as-usual control group, a brief intervention group receiving two 1-h individual sessions [of a brief theory-based positive family holistic health intervention integrating Zero-time Exercise and positive psychology themes of “Praise and Gratitude” in the existing probation service], or a combined intervention group receiving BI and a 1-day group activity with family members. The outcomes were physical activity, fitness performance, self-esteem, happiness, anxiety and depression symptoms, life satisfaction, quality of life, family communication and well-being, and relationships with probation officers. Self-administered questionnaires and simple fitness tests were used at baseline, 1-month and 3-month follow-up. Linear mixed model analysis was used to compare difference in the changes of outcome variables among groups, adjusted of sex, age, and baseline values. Focus group interviews were conducted. Thematic content analysis was used.Results: 318 probationers were randomized into CAU, BI, or CI group. CAU showed enhanced physical activity, fitness performance and psychological health, and family communication with small effect sizes. BI and CI showed further improved physical activity, family communication and family well-being. Additionally, CI reported greater improvements in the relationships with probation officers than CAU with a small effect size. CI also reported greater increases in physical activity and family communication than BI with small to moderate effect sizes. Qualitative feedbacks corroborated the quantitative findings.Conclusion: Our trial provided the first evidence of the effectiveness of probation service and the additional use of an innovative, relatively low-cost, theory-based brief positive family holistic health intervention. This intervention may offer a new model for enhancing probation service.Trial Registration: The research protocol was registered at the National Institutes of Health. (shrink)

Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, and behavioral (...) modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches. (shrink)