Children who live on the margins of society are disadvantaged in achieving their developmental potential because of the lack of a necessary stable environment and nurturing care. Many early prevention programs aim at mitigating such effects, but often the evaluation of their long-term effect is missing. The aim of the study presented here was to evaluate such long-term effects in two prevention programs for children-at-risk growing up in deprived social environments focusing on child attachment representation as the (...) primary outcome as well as on self-reflective capacities of teachers taking care of these children. The latter was a key component for promoting resilient behavior in children. Five hundred and twenty-six children aged 36 to 60 months at risk due to immigration status, low family socio-economic status and child behavior were examined in a cluster-randomized study comparing two preventions, the psychodynamic, attachment-based holistic approach EARLY STEPS (ES) with the classroom based FAUSTLOS (FA) for their efficacy. Primary outcome was the child attachment representation measured by the Manchester Child Attachment Story Task (MCAST). Secondary outcomes were derived from (a) the Caregiver-Teacher Report Form (C-TRF: problem behaviors, including anxiety/depressive symptoms, emotional-reactive and somatic problems, social withdrawal, aggressive behavior, and attention deficit), from (b) the Strength and Difficulties Questionnaire (SDQ, parent version: resilience and wellbeing) and (c) Self-Reflective Scales for teachers (SRS: self-reflective capacities of teachers). Compared to baseline, attachment and behavioral problems improved in both programs. ES led to more secure and more organized attachment representations (medium effect sizes). Aggressive behavior and externalizing problems were reduced in the FA group compared with ES, particularly in boys (medium effect sizes). Self-reflective capacities of the teachers increased only in the ES group. High correlation between children’s attachment type with the number of social risk factors and the increase of problematic social behavior strongly indicate that an increase in teachers’ self-reflective capacities helps to change children’s attachment patterns which thus strengthens the resilience of these children-at-risk [An ethical vote from LPPKJP 2009-02-25 was obtained and the trial registered; Clinical trial registration information: The trial was registered 14.02.2012 (DRKS00003500;https://www.drks.de)]. (shrink)

BackgroundIn many Western countries like Germany, the social integration of children with an immigrant background has become an urgent social tasks. The probability of them living in high-risk environments and being disadvantaged regarding health and education-related variables is still relatively higher. Yet, promoting language acquisition is not the only relevant factor for their social integration, but also the support of earlier developmental processes associated with adequate early parenting in their first months of life. The Emotional Availability Scales measure the (...) quality of caregiver-child-interactions as an indicator of the quality of their relationship and thus of such early parenting, focusing on mutual and emotional aspects of their interaction.MethodThis pilot study examined in a randomized controlled trial the effects of the prevention project First Steps regarding the hypothesis that the Emotional Availability improved to a greater extent in “difficult-to-reach” immigrant mother-child dyads in a psychoanalytically oriented early intervention compared to a usual care intervention offered by paraprofessionals with an immigrant background. A sample of N = 118 immigrant women in Germany from 37 different countries and their children was compared with regard to the parental EA-dimensions sensitivity, structuring, non-intrusiveness and non-hostility and the child dimensions responsiveness to and involvement of the caregiver in the pre-post RCT design.Results and ConclusionDifferent from what was expected, repeated ANOVAs revealed no significant pre-post group differences for the parental dimensions. For the child dimensions the effect of time of measurement was highly significant, which can be interpreted as mostly natural developmental effects. Still, on the level of simple main effects for each intervention, only in the FIRST STEPS groups child responsiveness significantly improved. When controlled for confounding variables, a significant interaction effect for maternal sensitivity in favor of the FIRST STEPS intervention was found. The systematic group differences indicate that the more extensive and professional intervention, focusing on the individual needs of the participants, is more suitable to support the quality of the mother-child-relationship amongst immigrant mother-child dyads than usual care. The results are discussed taking into account the context of the maternal migration process and potential maternal traumatization.Clinical Trial Registration[https://clinicaltrials.gov], identifier [DRKS00004632]. (shrink)

ABSTRACT This contribution examines the implementation of the ‘British’ values agenda within Early Childhood Care and Education settings in England, as introduced by the Prevent Duty. It begins by tracing the rise of the ECEC setting as the primary place of education of the young child, as this has shifted from the home environment. It examines the place of values education, culminating in the Government directive on the promotion of ‘British’ values, and how these values must be seen as (...) integral to effective ECEC provision. Using a case study of two focus groups and subsequent in-depth semi-structured interviews, the implications of the introduction of this strategy are identified, focusing in particular on the relationships between the ECEC leaders and parents. This presents clear evidence of the potential for a negative impact on interpersonal professional relationships. (shrink)

With an estimated 12.1% of children aged 2–5 years already obese, prevention efforts must target our youngest children. One of the best places to reach young children for such efforts is the early care and education setting. More than 11 million U.S. children spend an average of 30 hours per week in ECE facilities. Increased attention at the national, state, and community level on the ECE setting for early obesity prevention efforts has sparked a range of (...) innovative efforts. To assist these efforts, CDC developed a technical assistance and training framework – the Spectrum of Opportunities for Obesity Prevention in the ECE setting – which also served as the organizing framework for the Weight of the Nation ECE track. Participants highlighted their efforts at national, state, and local levels pursuing opportunities on the Spectrum, the standards and best practices that had been the emphasis of their efforts, and common steps for developing, implementing, and evaluating initiatives. Strong leadership and collaboration among a broad group of stakeholders; systematic assessment of needs, opportunities and resources; funding sources; and training and professional development were reported to be integral for successful implementation of standards and best practices, and sustainability. (shrink)

In 2004, the first ever multi‐sited clinical trials studied the prospect of HIV biomedical prevention (referred to as pre‐exposure prophylaxis—‘PrEP’). The trials were implemented at several international sites, but many officially closed down before they completed. At most sites, both scientists and community AIDS advocates raised concerns over the ethics and scientific rationales of the trial. Focusing on the Nigerian trial site, we detail the controversy that emerged among mostly Nigerian research scientists who scrutinized the research design and protocol. (...) While some of the disputes, especially those pertaining to community engagement mechanisms, were ultimately resolved in international fora and implemented in later PrEP trials, concerns over science rationales and assumptions were never addressed. We argue that scientific rationales should be treated as ethical concerns and suggest that such concerns should be deliberated at host sites before the trial protocol is finalized. (shrink)

In this Correspondence, I argue that given that scarcity has existed both for critical care resources and for vaccines, allocating critical care resources to prioritize the prevention of early COVID-19 deaths (i.e. COVID-19 deaths among younger patients) could valuably counterbalance the disproportionate exclusion of minority patients and those with life shortening disabilities that age-based vaccine allocation produces. -/- Covid-19 deaths early in life have overwhelmingly befallen minorities and people with life-shortening disabilities. Policies preventing early deaths prevent (...) an outcome widely recognized as worse—dying earlier in one’s life rather than later—while counteracting intersecting forms of injustice. Ultimately, prohibiting the use of age as a tiebreaker in critical care allocation, as Brown et al. propose, will worsen disparities and is not mandated by law. (shrink)

El artículo constituye un acercamiento a las razones que sustentan la necesidad de elevar la calidad de la orientación a las familias de niños en la primera infancia y su objetivo consistió en capacitar al personal de la salud para desarrollar la orientación familiar en función de la prevención de desviaciones en el desarrollo en esta etapa. En él se aborda el rol que tiene la familia en la formación de los niños y la incidencia de los médicos y enfermeras (...) en su orientación; se encuentran reflexiones y comentarios sobre cómo elevar la calidad de la orientación para que la familia pueda desarrollar, en las condiciones de convivencia familiar, la prevención de desviaciones en el desarrollo mediante la realización de un proceso educativo de calidad. The article is an approach to the reasons that support the need to improve the quality of the guidance given to families of early childhood children and its objective consisted on training health staff to develop family guidance according to the prevention of deviations in development during this stage. It deals with the role family plays in children's education and the impact of doctors and nurses on its guidance. Thoughts and comments on how to improve the quality of guidance can also be found so that the family can develop, on family living conditions, the prevention of deviations in development through a quality educational process. (shrink)

Caring for unrepresented patients encompasses legal, ethical, and moral challenges regarding decision-making, consent, the patient’s values, wishes, best interest, and the healthcare team’s professional integrity and autonomy. In this article, I consider the impact of the aging population and the effects of the social determinants of health and suggest that without preventive intervention, the number of unrepresented patients will continue to increase. The health, social, and legal risk factors for becoming unrepresented require a multidisciplinary response. Medical-Legal Partnerships (MLPs) bring healthcare (...) and legal professionals together to address risk factors and health-harming legal needs. The article discusses the role of MLPs in identifying at-risk individuals, providing preventive interventions, and providing support. I make recommendations and conclude that proactive MLPs offer a sustainable approach to the ethical challenges in caring for unrepresented patients by providing interventions to prevent individuals from becoming unrepresented. (shrink)

This book arises from a three-year study of Preventive Justice directed by Professor Andrew Ashworth and Professor Lucia Zedner at the University of Oxford. The study seeks to develop an account of the principles and values that should guide and limit the state's use of preventive techniques that involve coercion against the individual. States today are increasingly using criminal law or criminal law-like tools to try to prevent or reduce the risk of anticipated future harm. Such measures include criminalizing conduct (...) at an early stage in order to allow authorities to intervene; incapacitating suspected future wrongdoers; and imposing extended sentences or indefinate on past wrongdoers on the basis of their predicted future conduct - all in the name of public protection and security. The chief justification for the state's use of coercion is protecting the public from harm. Although the rationales and justifications of state punishment have been explored extensively, the scope, limits and principles of preventive justice have attracted little doctrinal or conceptual analysis. This book re-assesses the foundations for the range of coercive measures that states now take in the name of prevention and public protection, focussing particularly on coercive measures involving deprivation of liberty. It examines whether these measures are justified, whether they distort the proper boundaries between criminal and civil law, or whether they signal a larger change in the architecture of security. In so doing, it sets out to establish a framework for what we call 'Preventive Justice'. (shrink)

A ‘spatial turn’ is observed as taking place across a range of disciplines. This article discusses the relevance of this ‘spatial turn’ to the issue of early school leaving prevention and engagement of marginalised students and their parents within the educational system and other support services. Building on reconceptualisation of an aspect of structural anthropology a specific dynamic spatial interaction between diametric and concentric structures of relation is proposed. Reification is interpreted as involving a diametric space of assumed (...) separation, closure and mirror image inversions. Concentric relational space as assumed connection and relative openness is a precondition for trust, care and voice. Diametric and concentric spatial features of school and related systems are interrogated for early school leaving issues, such as the importance of relational supports to keep students in the system; the precondition of trust for parental involvement of more marginalised parents, including a lifelong learning and family support aspect; the need to challenge the school as a closed system with reified hierarchies. (shrink)

This paper seeks to highlight the benefits of prioritizing moderate African communitarian principles as partly demonstrated in the HIV prevention strategies implemented in Uganda in the late 1980s. Pertinent lessons could be drawn so as to achieve the HIV prevention targets envisioned in the post-2015 development era. Communitarianism emphasizes the importance of communities as part of healthy human existence. Its core ethical values include the virtues of generosity, compassion, and solidarity. Persuasion through communication, consensus through dialogue, and the (...) awareness and commitment to responsibilities towards other members of the community, are chief practices relied upon to achieve appropriate social behaviour. All these elements signify individual rootedness in communities and contribute to the healthy existence of its members. Communitarianism is usually classified as either authoritarian/radical or responsive/moderate, depending on the primacy given to either community interests or the individual will and rights. Moderate communitarianism recognizes the individual's capacity for moral reasoning, virtue and free choice. The ensuing form of society is deemed more ethical as it relies on education in the virtues, moral persuasion and informal social controls, without stifling individual identity, agency, and capacity for self-determination. If moderate African communitarianism, in particular, can to a certain extent be associated with the significant aspects of Uganda's HIV prevention strategies in the stated period, then its present-day relevance for HIV prevention and other public health interventions may be emphasized accordingly. This applies especially in view of the ongoing efforts to achieve a balance between individual and collective interests in bioethics. (shrink)

When the state aims to prevent responsible and dangerous actors from harming its citizens, it must choose between criminal law and other preventive techniques. The state, however, appears to be caught in a Catch-22: using the criminal law raises concerns about whether early inchoate conduct is properly the target of punishment, whereas using the civil law raises concerns that the state is circumventing the procedural protections available to criminal defendants. Andrew Ashworth has levied the most serious charge against civil (...) preventive regimes, arguing that they evade the presumption of innocence. After sketching out a substantive justification for a civil, preventive regime, I ask what Ashworth’s challenge consists in. It seems that there is broad disagreement over the meaning and requirements of the presumption of innocence. I thus survey the myriad possibilities and extract two claims that have potential bearing on preventive regimes. One claim is that of substantive priority—the criminal law comes first when assessing blame. This is the claim at the root of objections to pretrial detention based on consideration of the crime charged. The second strand of argument is one of procedural symmetry. This is the concern that with respect to citizen/state relations, certain procedures are required, including, for example, proof beyond a reasonable doubt as to the offense or defense. Having extracted these claims, I then assess their applicability with respect to the preventive regime defended. I first conclude that the criminal law must share blame and censure with other fora, and thus, the criminal law only has substantive priority when criminal proceedings have been instituted. I then survey whether procedural symmetry is required, specifically assessing whether the preventive regime I defend requires proof beyond a reasonable doubt. My tentative conclusion is that proof beyond a reasonable doubt is warranted. (shrink)

Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, (...) Switzerland. A Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives. (shrink)

We show that early vision can use monocular cues to rapidly complete partially-occluded objects. Visual search for easily detected fragments becomes difficult when the completed shape is similar to others in the display; conversely, search for fragments that are difficult to detect becomes easy when the completed shape is distinctive. Results indicate that completion occurs via the occlusion-triggered removal of occlusion edges and linking of associated regions. We fail to find evidence for a visible filling-in of contours or surfaces, (...) but do find evidence for a "functional" filling-in that prevents the constituent fragments from being rapidly accessed. As such, it is only the completed structures—and not the fragments themselves—that serve as the basis for rapid recognition. (shrink)

The early warning of financial risk is to identify and analyze existing financial risk factors, determine the possibility and severity of occurring risks, and provide scientific basis for risk prevention and management. The fragility of financial system and the destructiveness of financial crisis make it extremely important to build a good financial risk early-warning mechanism. The main idea of the K-means clustering algorithm is to gradually optimize clustering results and constantly redistribute target dataset to each clustering center (...) to obtain optimal solution; its biggest advantage lies in its simplicity, speed, and objectivity, being widely used in many research fields such as data processing, image recognition, market analysis, and risk evaluation. On the basis of summarizing and analyzing previous research works, this paper expounded the current research status and significance of financial risk early-warning, elaborated the development background, current status and future challenges of the K-means clustering algorithm, introduced the related works of similarity measure and item clustering, proposed a financial risk indicator system based on the K-means clustering algorithm, performed indicator selection and data processing, constructed a financial risk early-warning model based on the K-means clustering algorithm, conducted the classification of financial risk types and optimization of financial risk control, and finally carried out an empirical experiments and its result analysis. The study results show that the K-means clustering method can effectively avoid the subjective negative impact caused by artificial division thresholds, continuously optimize the prediction process of financial risk and redistribute target dataset to each cluster center for obtaining optimized solution, so the algorithm can more accurately and objectively distinguish the state interval of different financial risks, determine risk occurrence possibility and its severity, and provide a scientific basis for risk prevention and management. The study results of this paper provide a reference for further researches on financial risk early-warning based on K-means clustering algorithm. (shrink)

While ethical conflicts in the provision of healthcare are common, the current third-party mediator model is limited by a lack of expert ethical mediators, who are often not on site when conflict escalates. In order to improve clinical outcomes in situations such as conflicts at the end of life, we suggest that clinicians—physicians, nurses and social workers—be trained to prevent and deescalate emerging conflicts. This can be achieved using a mediation model framed by a communication-training approach. A case example is (...) presented and the model is discussed. The implication of this preventative/early intervention model for improving clinical outcomes, in particular end-of life conflict, is considered. (shrink)

Over sixty years ago, it was written of early Greek tyranny that it ‘had arisen only in towns where an industrial and commercial regime tended to prevail over rural economy, but where an iron hand was needed to mobilize the masses and to launch them in assault on the privileged classes… But tyranny nowhere endured. After it had performed the services which the popular classes expected of it, after it had powerfully contributed to material prosperity and to the development (...) of democracy, it disappeared with an astonishing rapidity… The people regarded tyranny only as an expedient. They used it as a battering ram with which to demolish the citadel of the oligarchs, and when their end had been achieved they hastily abandoned the weapon which wounded their hands.’ Thus Gustav Glotz, whose view found favour with de Ste Croix. He too concluded with appeal to Aristotle, who in a famous passage declared that unlike monarchy, which arises to help ‘the great and good’ against the People, and the monarch who is appointed as one of ‘the great and good’, ‘the tyrant comes from the People and the multitude to confront the men of note and prevent the People being unjustly treated by them. This is clear from what actually happened, for, generally speaking, the majority of the tyrants became tyrants from being demagogues so to speak, having got themselves trusted by their abusive attacks on the men of note.’ Against this view of Aristotle and all his latter-day satellites, this paper is directed. (shrink)

During the early twentieth century, otologists began collaborating with organizers of the New York League for the Hard of Hearing to build a bridge to “adjust the economic ratio” of deafness and create new research avenues for alleviating or curing hearing loss. This collegiality not only defined the medical discourse surrounding hearing impairment, anchoring it in hearing tests and hearing aid prescription, but, in so doing, solidified the notion that deafness was a “problem” in dire need of a “solution.” (...) Public health campaigns thus became pivotal for spreading this message on local and national levels. This paper focuses on how, from the 1920s to 1950s, as otologists became more involved with social projects for the deaf and hard of hearing — advocating lip-reading, community work, and welfare programs — at the same time, they also mandated for greater therapeutic regulation, control of hearing aid distribution, and standardization of hearing tests. The seemingly paradoxical nature of their roles continued to reinforce the stigmatization of deafness: with widespread availability of effective help, the hearing impaired were expected to seek out therapeutic or technological measures rather than live with their affliction. (shrink)

This symposium contribution offers a reconsideration of a range of “vice crime” legislation from late nineteenth and early twentieth century American law, criminalizing matters such as prostitution, the use of opiates, illegal gambling, and polygamy. According to the standard account, the original justification for these offenses was purely moralistic and paternalistic ; and it was only later, in the late twentieth century, that those who supported such legislative initiatives sought to justify them in terms of their ability to prevent (...) harms. This piece argues that the rationale for these vice crimes laws was much more complicated than has traditionally been thought, encompassing not just moralistic justifications but also a wide range of harm-based rationales—similar to those that underlie modern, technocratic, “preventive justice” legislation involving matters such as anti-social behavior orders, sex offender registration, stop-and-frisk policing, and the fight against terrorism. (shrink)

It may soon be possible to diagnose neurodegenerative disorders, such as early onset Alzheimer's disease, with a high degree of accuracy well before these conditions become symptomatic. In a carefully argued and thought-provoking piece, Dena Davis maintains that preemptive suicide may be a rational option for those confronted with a preclinical diagnosis of impending dementia, and consequently that withholding the results of dementia research until effective treatments become available constitutes an unjustified infringement on patient autonomy. If suicide is indeed (...) a rational course of action for some people diagnosed with dementia, then contrary to received wisdom, biomarker information indicating a high risk of dementia may be ‘actionable’ even if there is no known treatment for the condition. Preemptive suicide, Davis argues, may be motivated and justified by a mixture of other-regarding and self-regarding considerations. These include, inter alia, the wish to avoid imposing significant financial or psychological hardships on one's family, the unwillingness to live without the capacities for meaningful independence or agency, and the desire to write a final chapter that is consistent with one's stable values and that does not distort or eclipse the overarching narrative of one's life. Dementia raises an ethical dilemma that does not arise in connection with other diseases with respect to which many believe suicide is a rational course of action. This dilemma arises from the fact that a person with impending dementia cannot wait until the disease takes hold to issue and carry out a decision to end his or her life, since dementia destroys the capacities that underpin rational decision-making. Because jurisdictions permitting suicide require, quite reasonably, that a …. (shrink)

Genomic and neuro-scientific research into the causes and course of antisocial behaviour triggers bioethical debate. Often, these new developments are met with reservation, and possible drawbacks and negative side-effects are pointed out. This article reflects on these scientific developments and the bioethical debate by means of an exploration of the perspectives of one important stakeholder group: juveniles convicted of a serious crime who stay in a juvenile justice institution. The views of juveniles are particularly interesting, as possible applications of current (...) and future scientific findings are considered to be most effective if applied early in life. Based on their statements we come to the following provisional conclusions. Concerns about labelling and stigmatization are recognized and widely shared. Possible effects on one's identity are acknowledged too. Yet, a possible biological underpinning of one's antisocial behaviour is not considered to result in the development of a criminal identity. Nonetheless, psychopharmacological interventions are experienced as endangering one's current self. Concerns regarding the refusal of responsibility and the blaming of one's genes or brain can be put into perspective. Instead, participants emphasize the motive of own choice as underlying their criminal behaviour. Moreover, bioethical debate should pay attention to the role of parents of children at risk and the parent-child relationship in families at-risk. We argue that the short-term and long-term interests of children at risk, as well as their interests and those of society at large, may conflict. In order to deal appropriately with newly arising dilemmas, a normative framework needs to be developed. (shrink)

Incarcerated offenders are categorically high-risk patients who are disproportionately more likely to suffer from chronic illnesses than members of the general population. The conditions of confinement (e.g., overcrowding, poor nutrition, risky sexual practices) furthermore make them increasingly susceptible to acquiring an infectious disease. Past research has linked preventive care, including the early detection and treatment of such diseases, with better long-term health outcomes; however, such care is not universally provided to this population. The benefits and current availability of preventive (...) care for incarcerated offenders is discussed and several questions are raised for future discussion within a global context. In particular, these questions include whether or not incarcerated offenders should receive preventive care, the underlying reason for such provision, who should advocate for and for be responsible for their access to preventive care, and the mechanisms through which access could be attained. (shrink)

The ongoing COVID-19 pandemic and resulting health and economic crisis has caused major disruptions in the functioning of food systems and revived the discussion on what forms balanced, effective and responsible crisis management. As part of its thought leadership and its social responsibility in times of crisis, WUR is uniquely placed to contribute to the scientific knowledge base and data collection mechanisms required for early recognition and rapid response. In addition, WUR takes on the challenge to generate timely insights (...) into the possible scenarios for the prevention of a crisis and during and after emergencies to enable our clients and stakeholders to make informed decisions. Lastly, WUR can provide a better understanding of the mechanisms of spillover, and tangible and practical tools to help reduce the risk of spillover events from occurring, prevent pathogen spread, or mitigate the impacts of a future pandemic. In its research institutes and university, WUR brings together expertise in human, animal, plant and environmental health, the global agri-food system, economics, social sciences, food safety and security, ethics, and policy. Here, in the knowledge that COVID-19 will not be the last pandemic, we present WUR’s ambition and capabilities towards an integrated global multi-stakeholder approach to the prevention and management of potentially pandemic diseases, across the four phases of crisis management; prevention, preparedness, response, and recovery and learning. (shrink)

When life-saving medical resources are scarce and not everyone can be saved, is the only relevant goal saving the most lives? Or can other factors be considered, at least as tiebreakers, such as how early in life the people we don't save will die or how much future life they are likely to lose? This commentary defends a multiprinciple allocation approach that considers objectives in addition to saving more lives, including preventing early death and preventing harm in the (...) form of lost future life. Particularly compared to an arbitrary, coin-flip tiebreaker, this multiprinciple approach more effectively prevents harm, prioritizes the worst-off, mitigates socioeconomic and racial health disparities, and tracks public values regarding allocation under scarcity—and is legally sound. -/- . (shrink)

The increasing role that new technologies play in intimate relationships has led to the emergence of a new form of couple violence, cyber dating abuse, especially among adolescents and young adults. Although this phenomenon has received increased attention, no research has investigated predictors of cyber dating abuse taking into account the interdependence of the two partners. The study examines adverse childhood experiences and early maladaptive schemas as possible predictors of young adults’ perpetrated and suffered cyber dating abuse. Adopting a (...) dyadic approach, mediational models in which adverse childhood experiences were assumed to be related to individual and partner’s cyber dating abuse through individual early maladaptive schemas were tested. 134 couples completed online self-reports of the variables of interest, including a bidimensional measure of cyber dating abuse assessing pressure-aggression and control-monitoring. Actor-partner interdependence mediation model analyses were conducted. Results indicated that the emotional deprivation schema mediated the association between adverse childhood experiences and cyber dating abuse, whereas the abandonment schema did not. Specifically, more frequent experiences of emotional abuse and physical neglect during childhood were indirectly related to increased likelihood of perpetrating cyber dating pressure-aggression as well as of perpetrating and suffering cyber dating control-monitoring in both males and females. These associations were mediated by a stronger internalization of the emotional deprivation schema and were supported by both self-reported and partner-reported data. Also, a strong and direct association was found between childhood exposure to intimate partner violence by the opposite-sex parent and cyber dating pressure-aggression by females or control-monitoring by both males and females. These findings help to clarify the potential negative effects of specific adverse childhood experiences and early maladaptive schemas on the tendency to perpetrate and suffer cyber abuse in romantic relationships. The implications for prevention and treatment programs are noted and avenues for future research are described. (shrink)

The aim of this study was to assess the predictive capacity of some of the most relevant cognitive skills pertaining to the academic field as measured by the Spanish Primary School Aptitude Test Battery. This psychometric tool was applied to all students who were enrolled in the final year of Early Childhood Education in the public schools of the province of Alicante and a follow-up of their academic progress was carried out when they completed Primary Education. The results obtained (...) show that medium-high and high scores in Verbal Aptitude and Numerical Aptitude tests in Early Childhood Education, can predict academic success at the end of Primary Education in instrumental subjects such as: Language and Mathematics. We have determined the importance of developing pedagogical programs that stimulate the development of these skills during Early Childhood Education, while implementing support strategies during Primary Education, for those students who present underdeveloped aptitudes in these areas. In this way, school difficulties would be prevented in the instrumental subjects that provide access to other academic areas. (shrink)

The authors argue that in preventing and controlling the pandemic of Covid‐19, we should have taken an offensive or proactive strategy rather than a defensive or reactionary one because the former type of approach can bring about more health benefits and fewer harms than can the latter. The offensive or proactive approach consists of two parts: The first part is to preemptively establish a barrier between a novel virus and humans in order to prevent the spillover of the virus into (...) humans, and the second part is that, when a spillover fails to be prevented, we should take public interventions, such as contact tracing, social distancing, and quarantine and isolation, as early as when there are several dozens or one hundred or more cases that manifest symptoms with an unknown etiology in order to prevent an epidemic that is still limited to relatively small groups from developing into an outbreak. (shrink)

Emerging child welfare policies promoting preventive and early intervention services present a challenge to professional ethics, raising questions about how to balance respect for service users with concern for social justice. This article explains how the UK policy involves shifting the balance of power away from families towards state and professional decision making. The policy is predicated on sharing information between professionals to inform risk and need assessment and so poses a problem for the ethic of confidentiality in a (...) helping relationship. This article examines the arguments for information sharing and questions whether the predicted benefits for children outweigh the cost of eroding family privacy and changing the nature of professional relationships with service users. (shrink)

Many epistemologists agree that even very young children sometimes acquire knowledge through testimony. In this paper I address two challenges facing this view. The first (building on a point made in Lackey (2005)) is the defeater challenge, which is to square the hypothesis that very young children acquire testimonial knowledge with the fact that children (whose cognitive immaturity prevents them from having or appreciating reasons) cannot be said to satisfy the No-Defeaters condition on knowledge. The second is the extension challenge, (...) which is to give a motivated, extensionally-adequate account of the conditions on testimonial knowledge in early childhood. Neither challenge can be met merely by endorsing externalism about knowledge; but we can meet both by reconceiving the process that eventuates in the child’s consumption of testimony. My central thesis is that this process should be seen as implicating features of the child's social environment. The result is a novel anti-individualistic externalism about knowledge. (shrink)

Many epistemologists agree that even very young children sometimes acquire knowledge through testimony. In this paper I address two challenges facing this view. The first (building on a point made in Lackey (2005)) is the defeater challenge, which is to square the hypothesis that very young children acquire testimonial knowledge with the fact that children (whose cognitive immaturity prevents them from having or appreciating reasons) cannot be said to satisfy the No‐Defeaters condition on knowledge. The second is the extension challenge, (...) which is to give a motivated, extensionally‐adequate account of the conditions on testimonial knowledge in early childhood. Neither challenge can be met merely by endorsing externalism about knowledge; but we can meet both by reconceiving the process that eventuates in the child’s consumption of testimony. My central thesis is that this process should be seen as implicating features of the child’s social environment. The result is a novel anti‐individualistic externalism about knowledge. (shrink)

Access to abortion care has been hugely affected by the COVID-19 pandemic. This has prompted several governments to permit the use of telemedicine for fully remote care pathways, thereby ensuring pregnant people are still able to access services. One such government is that of England, where these new care pathways have been publicly scrutinised. Those opposed to telemedical early medical abortion care have raised myriad concerns, though they largely centre on matters of patient safeguarding. It is argued that healthcare (...) professionals cannot adequately carry out their safeguarding duties if the patient is not in the room with them. These concerns lack empirical support. Emerging evidence suggests that safeguarding processes may, in fact, be more effective within telemedical abortion care pathways. In this article, we address two specific safeguarding concerns: (1) that a remote consultation prevents a healthcare professional from identifying instances of abuse, and (2) that healthcare professionals cannot reliably confirm the absence of coercion during a remote consultation. We demonstrate that such concerns are misplaced, and that safeguarding may actually be improved in telemedical care pathways as victims of abuse may find it easier to engage with services. It is inevitable that some individuals will fall through the net, but this is unavoidable even with in-person care and thus does not constitute a strong critique of the use of telemedicine in abortion care. These safeguarding concerns set aside, then, we argue that the current approval that enables telemedical early medical abortion should be afforded permanence. (shrink)

Background Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. Methods To identify key ethical (...) considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher’s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. Results After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. Conclusions The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies. (shrink)

Depression is the principal cause of illness and disability in the world. Studies charting the prevalence of depression among children and adolescents report high percentages of youngsters in both groups with depressive symptoms. This review analyzes the construct and explanatory theories of depression and offers a succinct overview of the main evaluation instruments used to measure this disorder in children and adolescents, as well as the prevention programs developed for the school environment and the different types of clinical treatment (...) provided. The analysis reveals that in mental classifications, the child depression construct is no different from the adult one, and that multiple explanatory theories must be taken into account in order to arrive at a full understanding of depression. Consequently, both treatment and prevention should also be multifactorial in nature. Although universal programs may be more appropriate due to their broad scope of application, the results are inconclusive and fail to demonstrate any solid long-term efficacy. In conclusion, we can state that: (1) There are biological factors (such as tryptophan—a building block for serotonin-depletion, for example) which strongly influence the appearance of depressive disorders; (2) Currently, negative interpersonal relations and relations with one's environment, coupled with social-cultural changes, may explain the increase observed in the prevalence of depression; (3) Many instruments can be used to evaluate depression, but it is necessary to continue to adapt tests for diagnosing the condition at an early age; (4) Prevention programs should be developed for and implemented at an early age; and (5) The majority of treatments are becoming increasingly rigorous and effective. Given that initial manifestations of depression may occur from a very early age, further and more in-depth research is required into the biological, psychological and social factors that, in an interrelated manner, may explain the appearance, development and treatment of depression. (shrink)

The HIV/aids pandemic has brought global attention to the ethical challenges of conducting research involving socially vulnerable participants. Such challenges require not only ethical deliberation but also an empirical evidentiary basis for research ethics policies and practices. This need has been addressed through the Fordham University HIV and Drug Abuse Prevention Research Ethics Institute, a National Institute on Drug Abuse–funded program that trains and funds early career scientists in conducting research on HIV/drug abuse research ethics. This article describes (...) the ethical framework guiding Institute training and introduces readers to six empirical articles in this special issue that illuminate and help foster the responsible conduct of research. (shrink)

This article explores the evolution of a major longitudinal ‘high risk for schizophrenia’ research programme, started over 50 years ago, which has been largely ignored in recent debates over ‘psychosis risk’ and early intervention. Studying mainly the offspring of individuals with schizophrenia, high-risk investigators aimed to identify a range of precursors of schizophrenia in the hope that the findings would eventually facilitate effective primary prevention. Specifically, the article examines the origins and impact of the pioneering Copenhagen High-Risk Project (...) and thus provides an important contribution to the sparse historical literature on schizophrenia research, including the study of milder conditions and at-risk states in the borderlands of psychosis. (shrink)

The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions (...) about the ethics and the feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)

The purpose of this study is to encourage and highlight discussion on how to improve the teaching of research ethics in institutions of higher education in Malaysia. Drawing on semi-structured interviews with 21 academics in a research-intensive university in Malaysia, interviewees agreed on the importance of emphasizing the subject of research ethics among students, as well as academics or researchers. This study reveals that participants felt that there is an urgent need to improve the current awareness and knowledge of issues (...) related to misconduct in research among students and academics. The results of this study indicate a need for better teaching on the subject of research ethics in order to prevent misconduct in research. Finally, it concludes with suggestions that there should be a clear definition of research misconduct, to include consequences when engaging in misconduct; a separate research ethics syllabus for pure and social sciences should be conducted; research ethics should be implemented as a core subject, and there should be an early intervention and continuous learning of research ethics, with an emphasis on ethics training. (shrink)

Children with developmental dyslexia and at its risk have difficulties in the acquisition of foreign languages, especially non-transparent English. The problems of such pupils concern various aspects of the language system but in particular relate to the ability to read and spell. The research literature dedicated to effective preventative methods and dyslexia treatment suggests that both children with dyslexia and at its risk need phonological awareness training and multi-sensory learning. It is also known that prevention and early treatment (...) is more effective than therapeutic intervention used in older students. Experts in foreign language acquisition recommend that children have contact with longer oral texts and live language. A recently-published report on the methods of English language teaching in Polish primary schools shows that the lessons conducted there do not realise the majority of the aforementioned recommendations. As a consequence, they do not serve any pupils including those with dyslexia and at its risk. A method which meets most of the demands mentioned above is “The Good Start Method for English”. It is a new program of teaching the English language designed for five to seven-year-olds, which at the same time ensures support for the psychomotor development of children, leading to acceleration in learning progress. (shrink)

With the improvement of citizens’ risk perception ability and environmental protection awareness, social conflicts caused by environmental problems in large-scale construction projects are becoming more and more frequent. Traditional social risk prevention management has some defects in obtaining risk data, such as limited coverage, poor availability, and insufficient timeliness, which makes it impossible to realize effective early warning of social risks in the era of big data. This paper focuses on the three environments of diversification of stakeholders, risk (...) media, and big data era. The evolution characteristics of the social risk of environmental damage of large-scale construction projects are analyzed from the four stages of incubation, outbreak, mitigation, and regression in essence. On this basis, a social risk early warning model is constructed， and the multicenter network governance mode of social risk of environmental damage in large-scale construction projects and practical social risk prevention strategies in different stages are put forward. Experiments show that the long short-term memory neural network model is effective and feasible for predicting the social risk trend of environmental damage of large-scale construction projects. Compared with other classical models, the long short-term memory model has the advantages of strong processing capability and high early warning accuracy for time-sensitive data and will have broad application prospects in the field of risk control research. By using the network governance framework and long short-term memory model, this paper studies the environmental mass events of large-scale construction projects on the risk early warning method, providing reference for the government to effectively prevent and control social risk of environmental damage of large-scale construction project in China. (shrink)

Early intervention aims to identify children or families at risk of poor health, and take preventative measures at an early stage, when intervention is more likely to succeed. EI is concerned with the just distribution of “life chances,” so that all children are given fair opportunity to realize their potential and lead a good life; EI policy design, therefore, invokes ethical questions about the balance of responsibilities between the state, society, and individuals in addressing inequalities. We analyze a (...) corpus of EI policy guidance to investigate explicit and implicit ethical arguments about who should be held morally responsible for safeguarding child health and well-being. We examine the implications of these claims and explore what it would mean to put the proposed policies into practice. We conclude with some remarks about the useful role that philosophical analysis can play in EI policy development. (shrink)