What works in prevention. Principles of effective prevention programs

The high prevalence of drug abuse, delinquency, youth violence, and other youth problems creates a need to identify and disseminate effective prevention strategies. General principles gleaned from effective interventions may help prevention practitioners select, modify, or create more effective programs. Using a review-of-reviews approach across 4 areas (substance abuse, risky sexual behavior, school failure, and juvenile delinquency and violence), the authors identified 9 characteristics that were consistently associated with effective prevention programs: Programs were comprehensive, included varied teaching methods, provided sufficient dosage, were theory driven, provided opportunities for positive relationships, were appropriately timed, were socioculturally relevant, included outcome evaluation, and involved well-trained staff. This synthesis can inform the planning and implementation of problem-specific prevention interventions, provide a rationale for multi-problem prevention programs, and serve as a basis for further research.     

Left ventricular assist devices: An ethical analysis

United States statistics continue to indicate that the human donor heart pool does not and will not meet the great demand for hearts. For those patients unresponsive to maximal medical therapy (approximately 60,000 patients per year), cardiac transplantation is currently their best hope for increased survival. To address the need for additional end-stage congestive heart failure (CHF) therapy options, three medical device manufacturers have developed implantable left ventricular assist devices (LVAD) which act as a pump for hemodynamic support of the patient’s diseased heart. Although LVADs have been shown to improve patient disease state prior to organ transplantation. LVADs do nothing to increase the pool of human donor hearts, and they negatively impact the United Network for Organ Sharing (UNOS) waiting list by increasing the size of the waiting pool. This paper identifies and explores the ethical challenges presented by the use of LVADs as a bridging technology for heart transplant candidates. Although LVADs raise some ethical concerns, these concerns are outweighed by the proven medical efficacy of these devices. Thus, this technology should continue to be used and further developed. This paper was written by the author while in the Masters degree progrm at Loma Linda University (Dept. of Biomedical and Clinical Ethics), 11234 Anderson Street, Coleman Pavillion, Loma Linda, CA 92354, USA. The author is currently an Ethies Fellow (pre-doctoral) in UCLA’s program in Biomedical and Research Ethics.     

A PERFORMANCE-BASED LOTTERY TO IMPROVE RESIDENTIAL CARE AND TRAINING BY INSTITUTIONAL STAFF

Two experiments were conducted on four units of a residential facility for the multiply-handicapped retarded in an attempt to improve daily care and training services. Experiment I compared the effects of two procedures in maintaining the work performance of attendants, using an A-B design on two units. One procedure consisted of implementing specific staff-resident assignments, the other consisted of allowing attendants who had met performance criteria to be eligible for a weekly lottery in which they could win the opportunity to rearrange their days off for the following week. Results showed that the lottery was a more effective procedure as measured by the per cent of time attendants engaged in predefined target behaviors, and by their frequency of task completion in several areas of resident care. Experiment II replicated and extended these results to the area of work quality on two additional units, using a multiple-baseline design. The performance lottery was found to be an effective economical procedure that could be implemented by supervisory staff on a large scale.     

The Self-efficacy for Parenting Adolescents Scale: Development and Initial Validation

Journal of Child and Family Studies - Adolescence can be a difficult developmental period for children and their parents. During this time, parents need to develop new skills, and their perceived...     

Reduced Contact Cognitive-Behavioral Interventions for Adult Depression: A Review

Depression is a highly prevalent and debilitating mental health condition. Evidence suggests that there is a widening gap between the demand for and availability of effective treatments. As such, there is a vast need for the development and dissemination of accessible and affordable treatments for depression. In the past decade, there has been a proliferation of reduced client-therapist contact protocols for depression. In this article, the authors review and compare the efficacy of reduced contact cognitive-behavioral interventions for adult depression across two degrees of therapist-client contact (i.e., no therapist-client contact versus minimal therapist-client contact interventions). The authors also discuss the methodological and theoretical limitations of this research base. The present review suggests that a) reduced contact interventions for depression can be effective in remediating the symptoms of depression; b) the effect sizes of some reduced contact protocols may approximate those reported in traditional protocols involving significantly greater client-therapist contact; and c) protocols which employ some form of client-therapist contact, on average, generate higher effect sizes than those that are purely self-help in nature. A discussion of the theoretical and applied implications of such findings, as well as areas in need of further research, is provided.     

Health Care Expenditure and Economic Growth in SAARC Countries (1995–2012): A Panel Causality Analysis

The aim of this paper is to investigate the relationship between health care expenditure (HCE) and economic growth and to the causality between HCE and economic growth in the selected South Asian Association for Regional Cooperation (SAARC) countries by employing the Panel cointegration and panel causality analysis over the period 1995–2012. Per capita income, labor force, literacy rate, and elderly population of age 65 and above are used an independent variables, as these variables are considered as main indicator of human and physical capital. For examining the time series properties of the data and long run relationships between HCE and economic growth, the panel unit root and panel cointegration tests are employed. The panel Dynamic Ordinary Least Squares (DOLS) method is used to estimate long run parameters, whereas the Seemingly Unrelated Regression (SUR) method is employed to estimate the short run parameters. For the panel causality among HCE and per capita GDP, a new technique developed by Dumitrescu and Hurlin (2012) is used. The results reveal that income elasticity of HCE is less than unity in the long run as well as in the short run. Furthermore, there is an evidence of unidirectional causality running from per capita GDP to HCE in the South Asian countries in the short run. Two-way causation between per capita GDP, labor force, literacy rate, and elderly population of age 65 and above is also observed. We also found two-way causality between labor force, elderly population of age 65 and health care expenditure.     

Scepticism and self-transformation in Nietzsche – on the uses and disadvantages of a comparison to Pyrrhonian scepticism

Scepticism is central to Nietzsche’s philosophical project, both as a tool of criticism and, through its role in self-transformation, as a tool for responding to criticism. While its importance in his thought and its complexity have been acknowledged, exactly what kind of scepticism Nietzsche calls for still stands in need of analysis. Jessica Berry’s [Nietzsche and the Ancient Skeptical Tradition. New York: Oxford University Press, 2011] comparison between Nietzsche and Pyrrhonian scepticism recognized the importance of the practical dimension of Nietzschean scepticism but distorted Nietzsche’s philosophy in attempting to paint it as Pyrrhonian in character. Earlier discussions recognize Nietzsche’s opposition to Pyrrhonian suspension of judgement and tranquillity. They have not, however, explored in sufficient detail Nietzsche’s sceptical practice and how it affects the individual. In this article, I combine Berry’s emphasis on scepticism as a practice with attention to the important differences between Nietzsche and Pyrrhonism. I outline Nietzsche’s scepticism as a transformative practice, arguing that its differences from Pyrrhonian scepticism are as illuminating as any similarities. The scepticism that Nietzsche advocates involves not just destruction of our beliefs but destruction of who we are, and at the same time as cultivating the capacity to do without certainty, requires an experimental engagement with our drives – allowing the creation of new values.     

Moderating Effects of Mathematics Anxiety on the Effectiveness of Explicit Timing

Explicit timing is an empirically validated intervention to increase problem completion rates by exposing individuals to a stopwatch and explicitly telling them of the time limit for the assignment. Though explicit timing has proven to be effective for groups of students, some students may not respond well to explicit timing based on factors such as mathematics anxiety. The present study examined the effects of explicit timing on mathematics performance for 81 fourth and fifth graders with differing levels of mathematics anxiety. Students completed more digits correct during explicit timing as compared to baseline and control. Additionally, results indicated there was a significant linear relationship between mathematics anxiety and mathematics performance. Students with low and medium mathematics anxiety completed more digits correct with higher accuracy than students with high mathematics anxiety. Lastly, digits correct and accuracy remained consistent during baseline, control, and explicit timing when condition and anxiety level were both considered. Educational professionals must be cognizant not only of academic variables impacting students learning, but also mental health variables, such as mathematics anxiety, in order to provide a comprehensive treatment package capable of ameliorating academic difficulties.     

Women's neuroethics? Why sex matters for neuroethics

The Neuroethics Affinity Group of the American Society for Bioethics and Humanities (ASBH) met for the third time in October 2007 to review progress in the field of neuroethics and consider high-impact priorities for the future. Closely aligned with ASBH's own goals of recruiting junior scholars to bioethics and mentoring them to successful careers, the Neuroethics Affinity Group placed a call for new ideas to be presented at the Group meeting, specifically by junior attendees. One group responded with the idea to probe a new direction for neuroethics focused on the neuroscience of gender differences. In the spirit of full disclosure, two of the authors are a student (Chalfin) and fellow (Murphy) of the program I formerly directed at Stanford University. The third (Karkazis) is junior faculty there. The intellectual ownership of the ideas in the report below, however, are entirely theirs. Like lit torches in a juggling act, there are many directions this project can go. The report is a snapshot of these authors' first iteration of the concept of women's neuroethics. Many thanks are extended to participants of the ASBH Neuroethics Affinity Group meeting whose enthusiasm and feedback was immensely helpful in shaping the concept and moving it ahead.