This article discusses the role of intrapreneurial self-capital (ISC) as a possible primary preventive resource to effectively deal with the complexity of the current entrepreneurial environment. The article deepens both the similarities and differences between ISC and psychological capital and thus proceeds to present the most recent empirical evidence that connects ISC to (a) employability and career decision making, (b) innovative behavior, and (c) well-being. The possibilities for further research and interventions are additionally discussed.

The first longevity revolution began in the middle of the 19th century, accelerated through the first half of the 20th century, and led to the first and only quantum leap in human life expectancy.In the 20th century alone, life expectancy at birth in most developed nations rose by about 30 years. The first three quarters of the century were notable for gains made at younger and middle ages, and in the last quarter century, old age mortality declined. Nothing in history (...) has ever come close to the magnitude of this benefit to humanity. The rise in life expectancy occurred swiftly because the primary beneficiaries of advances in public health and... (shrink)

Clinical primary prevention eliminates or preempts either a susceptibility or risk (synergistically a cause) in order to avoid a specific harm. Philosophically, primary prevention gets caught in the metaphysical controversy of the “hard questions” of whether it is possible to “cause not” both through a positive action (preventive act causes no harm) or no action (avoiding something causes no harm). I examine my previously proposed four-step definition of the process of prevention, discuss its limitations in (...) light of the “hard questions,” and then offer a revised five-step process definition that eliminates the “cause not” concerns by changing the goal of prevention from avoiding harm, a negative state, to achieving optimal health, a positive state. (shrink)

Ethical issues flow from and are embedded in contexts of practice. Contexts of practice refer to the diverse social settings where interventions occur. Primary prevention activities require new professional roles in these diverse social settings. These new roles engage the professional in new activities, which in mm allow new ethical issues to arise. This article takes an ecological perspective on ethical issues arising from the enactment of new preventive roles intended to affect groups or communities. Within this perspective, (...) the concepts of context and culture take on special conceptual significance. Four ecological assumptions about preventive interventions intended to affect groups or communities are offered as a means of framing ethical issues in such interventions. Finally, several approaches to developing ecological knowledge about the contexts of practice are presented as ways of furthering our ability to conceptualize and cope with ethical issues in preventive interventions intended to affect groups or communities. (shrink)

Oxytocin (OT) is one of the most intensively researched neuropeptides during the three past decades. In benign social contexts, OT exerts a range of desirable socioemotional, stress-reducing, and immunoregulatory effects in mammals and humans and influences mammalian parenting. Consequentially, research in potential pharmacological applications of OT toward human social deficits/disorders and physical illness has increased substantially. Regrettably, the results from the administration of exogenous OT are still relatively inconclusive. Research in rodent maternal developmental programming has demonstrated the susceptibility of offspring (...) endogenous OT systems to maternal somatosensory stimulation, with consequences for behavioral, epigenetic, cognitive, and neurological outcomes. A translation of this animal research into practically feasible human parenting recommendations has yet to happen, despite the significant prevention potential implied by the maternal developmental programming research. Extended physical contact with full-term healthy infants in the months following birth (infant carrying) might constitute the human equivalent of those specific rodent maternal behaviors, found to positively influence emerging OT systems. Findings from both OT and maternal programming research parallel those found for infants exposed to such extended parental physical contact, whether through skin-to-skin contact or infant carrying. Clinical support of parents to engage in extended physical contact represents a feasible intervention to create optimum conditions for the development of infant OT systems, with potential beneficial long-term health effects. (shrink)

What solutions can we find in the research literature for preventing sexual violence, and what psychological theories have guided these efforts? We gather all primary prevention efforts to reduce sexual violence from 1985 to 2018 and provide a bird’s-eye view of the literature. We first review predominant theoretical approaches to sexual-violence perpetration prevention by highlighting three interventions that exemplify the zeitgeist of primary prevention efforts at various points during this time period. We find a throughline (...) in primary prevention interventions: They aim to change attitudes, beliefs, and knowledge (i.e., ideas) to reduce sexual-violence perpetration and victimization. Our meta-analysis of these studies tests the efficacy of this approach directly and finds that although many interventions are successful at changing ideas, behavior change does not follow. There is little to no relationship between changing attitudes, beliefs, and knowledge and reducing victimization or perpetration. We also observe trends over time, including a shift from targeting a reduction in perpetration to targeting an increase in bystander intervention. We conclude by highlighting promising new strategies for measuring victimization and perpetration and calling for interventions that are informed by theories of behavior change and that center sexually violent behavior as the key outcome of interest. (shrink)

Globally, chronic disease and conditions such as diabetes, cardiovascular disease, depression and cancer are the leading causes of morbidity and mortality. Why, then, are public health efforts and programs aimed at preventing chronic disease so difficult to implement and maintain? Also, why is primary care—the key medical specialty for helping persons with chronic disease manage their illnesses—in decline? Public health suffers from its often being socially controversial, personally intrusive, irritating to many powerful corporate interests, and structurally designed to be (...) largely invisible and, as a result, taken for granted. Primary care struggles from low reimbursements, relative to specialists, excessive paperwork and time demands that are unattractive to medical students. Our paper concludes with a discussion of why the need for more aggressive public health and redesigned primary care is great, will grow substantially in the near future, and yet will continue to struggle with funding and public popularity. (shrink)

In this article we address torture in military and police organizations as a public health and human rights challenge that needs to be addressed through multiple levels of intervention. While most mental health approaches focus on treating the harmful effects of such violence on individuals and communities, the goal of the project described here was to develop a primary prevention strategy at the institutional level to prevent torture from occurring in the first place. Such an approach requires understanding (...) and altering the conditions that cause and sustain “atrocity producing situations”. Given the persistence of torture across the world and its profound health consequences, this is an increasingly important issue in global health and human rights. (shrink)

BackgroundWork stress is a serious problem in primary education. Decades of research underline the importance of participatory, organizational-level work stress prevention approaches. In this approach, measures are planned to tackle causes of work stress in a participatory manner and implemented by a working group consisting of members of the organization. This approach can only be effective if the measures contain effective ingredients to decrease work stress risks and are successfully implemented. The aim of this paper is to present (...) an outline of a work stress prevention approach that is evaluated in primary education. To ensure the appropriateness of measures, a logic model of change is built as part of the risk assessment to facilitate the selection of appropriate measures. Progression on target behaviors as well as implementation factors are real-time monitored during implementation and fed back to the working groups, to provide the opportunity to adjust action plans when needed to optimize implementation.MethodsThe approach consists of five steps: preparation: installing an advisory board and working groups, risk assessment: inventory of work stress risks. In addition, a behavioral analysis is performed to build a logic model of change to facilitate selection of measures, action planning: conducting an action plan with appropriate measures, implementation: implementing the action plan. During implementation progression on target behaviors and implementation factors are monthly monitored and fed back to the working groups, and evaluation: effects of the approach are studied in a controlled trial with measurements at baseline, 1 year, and 2 years follow-up. A process evaluation is carried out using quantitative and qualitative data to study the implementation process of all steps of the work stress approach.DiscussionWe believe that building a logic model of change and real-time monitoring of implementation could be of added value to improve the success of the work stress prevention approach. With this study, we aim to provide more insights into work stress intervention research, especially in primary education.Clinical Trial RegistrationThe study is registered in Netherlands Trial Register. (shrink)

The precautionary principle brings a special challenge to the practice of evidence-based public health decision-making, suggesting changes in the interpretative methods of public health used to identify causes of disease. In this paper, precautionary changes to these methods are examined: including discounting contrary evidence, reducing the number of causal criteria, weakening the rules of evidence assigned to the criteria, and altering thresholds for statistical significance. All such changes reflect the precautionary goal of earlier primary preventive intervention, i.e. acting on (...) insufficient evidence, the least amount, or minimum level, of evidence for causation. Evaluating the impact of these changes will be difficult without a careful study of how well the current methods of causal inference work, their theoretical foundations, and the ethical implications of their applications. That research program will be most productive if it is jointly developed by public health professionals trained in the ethics and philosophy and by bioethicists and philosophers trained in the theories, methods, and practice of public health. (shrink)

Research and intervention involving primary prevention have grown dramatically in the past 10 years. However, little attention has been paid to ethical issues in primary prevention. This article proposes a framework for increasing awareness of such issues. The framework centers on explicating the contexts where prevention activities occur and the roles adopted by interventionists engaging in these activities. Several assumptions underlying primary prevention are stated, and ways of clarifying ethical issues are proposed.

The role of ethics in organizational crisis management has received limited but growing attention. However, the majority of research has focused on applications of ethical theories to managing crisis events after they have occurred, as opposed to the implications of ethical theories for the primary prevention of these situations. The relationship between concepts derived from a contemporary ethic of care, pp. 141–158, Gilligan, C.: 1990, ‘Preface’, in C. Gilligan, N. P. Lyons and T. J. Hanmer, pp. 6–29, Gilligan, (...) C.: 1991, ‘Women’s Psychological Development: Implications for Psychotherapy’, in C. Gilligan, A. G. Rogers and D. L. Tolman, pp. 5–32), and, concepts derived from a classic theory of organizational decline and recovery ) is described. The relevance of these notions for signal detection and uptake in organizational crisis prevention is discussed. Implications for prevention are highlighted through consideration of a case involving organizational crisis, the explosion of the space shuttle Challenger. Directions for both business practice and future research are identified. (shrink)

The article “Prevention of corruption in public procurement: importance of general legal principles” examines the importance of general legal principles in the sphere of public purchases. The purpose of the work is to analyse the information on possible methods of prevention of and fight against corruption. The main result of the work is the conclusion that strict adherence to the general legal principles is one of the corruption-reducing factors. While combating corruption in the field of public procurement, general (...) legal principles should not be divided into primary and secondary principles, because they are all equally important and complement each other. Audit of the normative acts regulating public procurement shall be performed in the Member States of the European Union; positivisation of the following principles will effectively prevent manifestations of corruption in the area of public procurement: the principle of responsibility; principle of permanent composition of the procurement commission; the principle of in dubio pro reo; the principle of compensation; the principle of control; the principle of objectivity; the principle of completing the procurement procedure within a reasonable time period. (shrink)

This essay makes three claims about preventive war, which is demarcated from preemptive war and is part of a broader class of ?anticipatory? wars. Anticipatory wars, but especially preventive war, are ?hard cases? for traditional Just War theory; other puzzles for this tradition include nuclear deterrence, humanitarian intervention, and provability a priori of the success of Tit-for-Tat. First, and despite strong assertions to the contrary, it is far from clear that preventive war is absolutely prohibited in traditional Just War Theory, (...) and it is also dubious that it is in all cases ?clearly illegal?. Second, the morality of both preemptive and preventive wars is shown to turn on epistemological considerations: on what degree and kind of justification the primary metaphysical facts of threat can be reasonably believed. Third, an argument is made that whatever epistemic threshold is held to be necessary, some preventive wars will exceed it, and that this is more likely with advancing technologies of information acquisition. Finally, the common argument that allowing all nations to follow policies of preventive war would result in more wars than barring such policies is shown to be mistaken by simulations in game theory. Suggestions are made about the derivation of traditional Just War criteria from more basic moral principles, and about their subtle failures as jointly necessary conditions for the morality of war. (shrink)

Ethics dumping is the practice of undertaking research in a low- or middle-income setting which would not be permitted, or would be severely restricted, in a high-income setting. Whilst Kenya operates a sophisticated research governance system, resource constraints and the relatively low number of accredited research ethics committees limit the capacity for ensuring ethical compliance. As a result, Kenya has been experiencing cases of ethics dumping. This article presents 11 challenges in the context of preventing ethics dumping in Kenya, namely (...) variations in governance standards, resistance to double ethics review, resource constraints, unresolved issues in the management of biological samples, unresolved issues in the management of primary data, unsuitable informed consent procedures, cultural insensitivity, differing standards of care, reluctance to provide feedback to research communities, power differentials which facilitate the exploitation of local researchers and lack of local relevance and/or affordability of the resultant products. A reflective approach for researchers, built around the values of fairness, respect, care and honesty, is presented as a means of taking shared responsibility for preventing ethics dumping. (shrink)

During sudden school closures in spring 2020 due to the COVID-19 pandemic, teachers had to move to distance teaching. This unprecedented situation could be expected to influence teacher well-being and schools as organizations. This article reports a qualitative study that aims at understanding how changes in teachers’ professional lives that were related to school closure affected Swiss primary teachers’ professional well-being. In semi-structured online-interviews, 21 teachers from 15 schools sampled by snowball method reported their experiences during school closure and (...) distance teaching and how this situation influenced their professional well-being. Results showed that medium to high levels of teacher well-being could accompany a general negative evaluation of the move to distance teaching. Factors such as high work-load, social distancing and feelings of lack of competence and self-efficacy were among the most aversive aspects of distance teaching and associated with deteriorating professional well-being. Among a plethora of factors that supported teachers in maintaining their well-being, contextual work-related aspects such as school resources, collegial support or leadership support along with individual aspects such as resilience, coping strategies, and clear work structures were important. Additionally, it was found that teacher well-being was nourished by positive experiences with the new forms of distance teaching and feelings of professional mastery. Despite methodological limitations (snowball sampling, retrospective interviews), the findings of this study could inform schools and authorities about what is needed to support teacher well-being and might help to develop organizational strategies that aim at preventing harmful declines in teacher well-being during challenging and difficult times such as a pandemic. (shrink)

This paper aims to promote the use of Dialogic Sessions in Physical Education to prevent the spread of COVID-19 in Primary Education and Compulsory Secondary Education by creating healthy habits related to the pandemic. Using Dialogic Sessions in Physical Education encourages discussion, debate, reasoning and decision-making to prevent the spread of the pandemic.

This paper provides a systematic and critical review of the existing literature on the phenomenon of ‘commercial contract cheating’ (CCC). Unlike some existing systematic reviews _generally_ on CCC, this paper focuses on the potential causes and suggested preventative measures specifically, intending to develop effective interventions on the basis of empirical insights. We reviewed primary studies with empirical data and systematic reviews focusing on higher education published between 2012 and 2020. A logic model is developed to graphically indicate the complex (...) and dynamic interplay between a variety of factors identified. Our inquiry reveals a highly specified, uncoordinated and fragmented research landscape that urgently needs integrated, holistic and critical reflection. It shows that the current research is still far from establishing causal relationships as the scholarship opts to reveal an abundance of contextual factors identified only, without probing the relational dynamics or striving for causality. A range of broad and tentative recommendations are proposed on that basis but are barely empirically examined. We also attend to lack of conceptual clarity and work towards a more inclusive and future-proof definition of CCC beyond assignment-based conceptualisation. It is argued that CCC should never be reduced to plagiarism (a natural inclination inspired by the plagiarism research tradition) nor neutralised as a legitimate business (a potential risk revealed mostly by the supply side research). As an interdisciplinary field, CCC should move beyond student perceptions of education cheating and affordability, while including more inquiries into the exploitative, predatory nature of the industry. (shrink)

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 (...) class='Hi'>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)

How can we register the participation of a range of elements, extending beyond the human subject, in the production of HIV events? In the context of proposals around biomedical prevention, there is a growing awareness of the need to find ways of responding to complexity, as everywhere new combinations of treatment, behavior, drugs, norms, meanings and devices are coming into encounter with one another, or are set to come into encounter with one another, with a range of unpredictable effects. (...) In this paper I consider the operation of various framing devices that attribute responsibility and causation with regard to HIV events. I propose that we need to sharpen our analytic focus on what these devices do, their performativity—that is, their full range of worldly implications and effects. My primary examples are the criminal law and the randomized control trial. I argue that these institutions operate as framing devices: They attribute responsibility for HIV events and externalize other elements and effects in the process. Drawing on recent work in science and technology studies as well as queer theory, I set out an analytic frame that marks out a new role for HIV social research. Attentiveness to the performative effects of these devices is crucial, I suggest, if we want better to address the global HIV epidemic. (shrink)

Despite the commonality of moral injury (MI) across diverse work settings, it has received limited attention within business and management research, and such research has tended to focus upon post-injury moral repair or recovery, rather than on primary prevention. Additionally, despite the relational and spiritual dimensions and harms of MI, there has been limited attention to relational-spiritual perspectives for its prevention. Therefore, the purpose of this article is to elucidate the relational and spiritual dimensions of MI, and (...) identify the potential of a relevant, related perspective for the primary prevention of MI within organizational settings, namely that of agape. First, an overview of the nature and types of MI is provided, including discussion of its relational and spiritual dimensions and harms. Second, Gilligan’s (Gilligan, Journal of Social Philosophy 45:89–106, 2014; Gilligan and Snider Gilligan and Snider, Why does patriarchy persist?, Polity, New York, 2018) care ethics framework for understanding MI as an outcome of relational and spiritual violation involving the fear-based betrayal of love is described. Third, given this conceptualization of MI as a fear-based betrayal of love, consideration is given to the potential of agape as a form of spiritual love for the prevention of MI within organizations. This includes consideration of three interrelated areas: intentional cultivation of an agapeic organizational culture; the development of an agapeic organizational conscience; and, agapeic responsiveness to healthy and health-sustaining, politically aware and engaged forms of relational resistance against potentially morally injurious events. Directions for future research are discussed. (shrink)

This article combines a philosophical critique of the idea that public health nurses are primary technicians who neutrally hand over scientifically established facts on risks to the public and an empirical analysis of the actual work of public health nurses. It is argued that the relationship between facts and values in public health is complex and that, despite the introduction of several scientifically-based standards and guidelines, public health nurses are not technicians. They do moral work and experience ethical dilemmas. (...) To get a grip on the specific character of this moral work, we distance ourselves from the idea that there are ethical dilemmas in public health nursing for which we can provide general ethical rules and principles. Instead we suggest a contextual ethical approach, in which several different kinds of consideration may be important. To illustrate this, we analysed 15 in-depth interviews with nurses involved in the prevention of cot deaths in the Netherlands. It is shown that these nurses do not neutrally pass on the epidemiological facts on the risks of prone sleeping, warm bedclothes and passive smoking, but they are the moral architects of this preventive practice. It is also shown that this moral work and the ethical dilemmas they experience cannot be characterized in terms of general ethical rules and principles. It becomes clear that the moral work of nurses differs according to the three main risks at stake: the balance between virtue, risk taking and responsibility depends on the specific context. (shrink)

Despite numerous initiatives and significant resource investment, violence remains a pervasive threat to public health. The burgeoning field of epigenetics may offer an exciting new possibility for violence prevention efforts by illuminating the mechanisms of gene-environment interactions. In particular, it may improve our ability to design more effective primary interventions, facilitate improved intervention tailoring, and better position communities to be active agents in their well-being. However, without attention to the distinction between awareness, self-efficacy, and agency, it risks encouraging (...) a false sense of individual accountability for violence, a perception that may perpetuate or increase existing inequities. Thus, embracing epigenetic insights in public health raises new opportunities but also new concerns. Ultimately, I argue public health should embrace epigenetics’ potential, but only with an equal commitment to state responsibility and systemic justice. (shrink)

Cardiovascular diseases present the leading cause of death worldwide. Over the last decade, their preventio has become not only a central medical and public health issue but also a matter of political concern as well as a major market for pharma, nutrition, and exercise. A preventive assemblage has formed that integrates diverse kinds of knowledges, technologies, and actors, from molecular biology to social work, to foster a specific healthy lifestyle. In this article, the authors analyze this preventive assemblage as a (...) heterogeneous engineer, that is, as an attempt to order complex everyday life into an architecture of modernism. This article draws on research conducted as part of the interdisciplinary research cluster ‘‘preventive self’’ bringing together analyses from social anthropology, history, linguistics, sociology of knowledge, and medicine. The authors report here primarily from ethnographic investigations into biomedical research, primary care, and educational practices in kindergartens. The authors conclude that the preventive assemblage largely fails to install any kind of singular order. Instead, it is translated into existing orderings producing heterogeneity of a different nuance. (shrink)

This study investigates the classroom climate in two settings of the 6th?grade class (a setting of children with special needs and a setting without children with special needs), focusing on aspects of satisfaction and cohesiveness on one side and friction, competitiveness and difficulties on the other. The study results indicate the existence of both positive and negative consequences of the integration of hearing?impaired pupils. Heterogeneity achieved by the presence of children with special needs included positive benefits for all pupils in (...) the mainstream classroom and helped to prevent friction and a competitive atmosphere, and provided opportunities for accepting exceptionalities, and developing social skills, ethical values and empathic abilities among school peers. On the other hand was concern related to difficulties of cognition, the only dimension on which comparative settings statistically and significantly differed concerning the classroom climate with integrated pupils. (shrink)

Preventing mother to child transmission of HIV (PMTCT) is an issue that has come to the forefront in the global response to the HIV pandemic. This is particularly true for countries in sub-Saharan Africa and in Asia, which account for the largest proportion of people living with HIV. The relative success of PMTCT efforts to date have encouraged policy makers and donors alike to push for a rapid scaling up of the program in countries with a high prevalence of HIV. (...) However, it is increasingly apparent that the relative success of the program has been at the expense of the rights and well-being of the mothers who are the primary recipients of the intervention. This article examines the nature and scope of the ‘research enterprise’ in PMTCT and shows how it has influenced intervention design and policy in India. It will also include the voices of ‘target’ women to convey the extent to which the research has impacted on their lives. Finally, this article indicates priorities for research that can help the situation of women as well as reduce MTCT of HIV. (shrink)

In the last decade the public health movement has bolstered efforts to prevent interpersonal violence through bringing social policy attention and needed dollars to prevention initiatives. Features in a public health approach to prevention include an evidence-based conception of the risks and so-called ?protective? factors associated with the unwanted problem and the use of sophisticated evaluation tools to monitor prevention efforts. This article critically reviews public health prevention methodology as applied to interpersonal violence prevention at (...) the primary level through drawing on findings from a qualitative inquiry into the moral dimensions of violence prevention education. It examines the premise that an empirical evidence base can determine what is desirable in relationships, together with the assumption that expert violence prevention educators can use this evidence to teach others about relationship desirability. In relying on a scientific and empirical evidence base, it is argued that the public health prevention model fails to recognize important moral dimensions of human relationships. (shrink)

In many countries health policy and health system reforms are giving primary health care (PHC) a more prominent role in the health system. As a result, policy towards PHC is becoming more contested and is posing bigger and more contradictory demands of PHC (e.g. that PHC should at once be more accessible and of higher quality and cheaper). International and professional bodies have responded to the debates about what the role of PHC should be partly by promulgating redefinitions of (...) ‘primary health care’. However, such definitions tend simply to assert a policy standpoint of their own, thereby begging the policy questions noted above. This paper tests some better-known current definitions of ‘primary health care’ against various criteria of validity, including the requirement not to prejudge the aforementioned policy debates. It then constructs a fresh definition from the materials which survive that test and from a general theory of the function of health care. The resulting definition is:Primary health care: goods or services which individuals obtain for maintaining their personal functioning or preventing pain; which they can access directly and receive in settings which allow them to continue their other normal activities of daily life at home and (when applicable) at work.Whilst its present conclusions relate specifically to PHC, the paper’s method for generating and testing definitions applies to health services research generally. (shrink)

For the first time in 20 years, the prefectural level 2001 LDP primaries offer a chance to reevaluate the relationship between Diet members and the LDP rank and file. Since 1982, scholars have agreed that Diet members use their support organizations to control how rank and file vote in LDP leadership contests; and the absence of any suitable data from the 1980s and 1990s has prevented a reassessment of this hypothesis in Japan's evolving political environment. This study uses regression analysis (...) on prefectural-level primary ballot totals in order to measure Diet member influence over the rank-and-file primaries. The results suggest while national politicians did influence voters, their impact was too small to affect the outcome of the election. This implies that the relationship between LDP Diet members and the rank and file is changing and suggests directions for further study. (shrink)

Proponents of the emerging field of P4 medicine argue that computational integration and analysis of patient-specific “big data” will revolutionize our health care systems, in particular primary care-based disease prevention. While many ambitions remain visionary, steps to personalize medicine are already taken via personalized genomics, mobile health technologies and pilot projects. An important aim of P4 medicine is to enable disease prevention among healthy persons through detection of risk factors. In this paper, we examine the current status (...) of P4 medicine in light of historical and current challenges to predictive and preventive medicine, including overdiagnosis and overtreatment. Moreover, we ask whether it is likely that in silico integration of patient-specific data will be able to better deal such challenges and to turn risk predictions into disease-preventive actions in a wider social context. Given the lack of evidence that P4 medicine can tip the balance between benefits and harms in preventive medicine, we raise concerns about the current promotion of P4 medicine as a solution to the current challenges in public health. (shrink)

The mass childhood immunization programme has traditionally been viewed as a safe and effective preventative measure by health promoters, primary health care professionals and governments. This consensus has meant that immunization has rarely been viewed as ethically problematic. A number of recent changes in the context of the delivery of health care, particularly the emphasis on consumerism and the effect of the marketization of services, makes timely an examination of ethical, social and political issues. This article examines four main (...) grounds for problematizing the mass childhood immunization programme. These are: clinical research evidence about the safety and efficacy of vaccines; the masking of wider social and political determinants of ill health; the contradictory strictures about collective and individual rights in relation to immunization; and the uniqueness of childhood immunization as a physical intrusion into a healthy body. The implications of these ethical issues are discussed in relation to informed consent and the need for a 'greenfield' review that includes the views of dissenting parents, lawyers and moral philosophers, as well as health professionals. Les promoteurs de santé, les soignants et les gouvernements ont tous traditionellement vu le programme d'immunisation globale des enfants comme sain et efficace. Cela voulait dire que l'immunisation a rarement posé un problème éthique. Pourtant, actuellement des changements dans les contextes de la distribution des soins, le consumérisme et de l'effet de la commercialisation des services de santé, exigent une revue des problèmes éthiques, sociaux et politiques. Cet article discute quatre éléments problématiques du programme d'immunisation globale: les données des recherches médicales sur la sûreté et l'efficacité des vaccins; la dissimulation des déterminatifs sociaux et politiques des maladies; les critiques contradictoires des droits individuels et collectifs concernant l'immunisation; et le caractère unique de l'immunisation des enfants comme une intrusion physique dans un corps sain. Les effets de ces questions éthiques sont repris en rapport du consentement informé et de la nécessité d'une revue 'verte' qui comprend les vues des parents dissidents, des juristes, des philsophes et des membres des professions soignantes. Das Massenimpfungsprogramm von Kindern wurde allgemein von Gesundheits behörden, medizinischem Fachpersonal und Regierungen als sichere und wirksame Vorbeugungsmassnahme betrachtet. Diese Uebereinstimmung bedeutete, dass Imp fungen selten ein ethisches Problem darstellten. Eine Anzahl von Aenderungen im Gesundheitswesen - besonders im Hinblickin auf Konsum und Marktwirtschaft im Dienstleistungsbereich - berechtigen jedoch zu einer Untersuchung der ethischen, sozialen und politischen Fragen. Dieser Artikel untersucht vier Hauptgründe, die das Massenimpfungsprogramm für Kinder in Frage stellen: Forschungsergebnisse über die Sicherheit und Wirksamkeit der Impfstoffe; die Verschleierung von andern sozialen und politischen Krankheitsursachen; die widersprüchlichen Anordnungen über kollektive und individuelle Rechte mit Bezug auf die Impfungen; und die aussergewöhnliche Art der Impfung als physische Verletzung eines gesunden Körpers. Die Bedeutung dieser ethischen Fragen werden hier diskutiert im Zusammenhang mit der informierten Vereinstimmung und der Notwendigkeit eines 'grünen' Ueberblickes, der die Ansichten andersdenkender Eltern, Rechtsanwalte, Philosophen und Gesund heitsexperten einschliesst. (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)

BackgroundThis paper discusses the contentious issue of reuse of stored biological samples and data obtained from research participants in past clinical research to answer future ethical and scientifically valid research questions. Many countries have regulations and guidelines that guide the use and exportation of stored biological samples and data. However, there are variations in regulations and guidelines governing the reuse of stored biological samples and data in Sub-Saharan Africa including Malawi.DiscussionThe current research ethics regulations and guidelines in Malawi do not (...) allow indefinite storage and reuse of biological samples and data for future unspecified research. This comes even though the country has managed to answer pertinent research questions using stored biological samples and data. We acknowledge the limited technical expertise and equipment unavailable in Malawi that necessitates exportation of biological samples and data and the genuine concern raised by the regulatory authorities about the possible exploitation of biological samples and data by researchers. We also acknowledge that Malawi does not have bio-banks for storing biological samples and data for future research purposes. This creates room for possible exploitation of biological samples and data collected from research participants in primary research projects in Malawi. However, research ethics committees require completion and approval of material transfer agreements and data transfer agreements for biological samples and data collected for research purposes respectively and this requirement may partly address the concern raised by the regulatory authorities. Our concern though is that there is no such requirement for biological samples and data collected from patients for clinical or diagnostic purposes.SummaryIn conclusion, we propose developing a medical data and material transfer agreement for biological samples and data collected from patients for clinical or diagnostic purposes in both public and private health facilities that may end up in research centers outside Malawi. We also propose revision of the current research ethics regulations and guidelines in Malawi in order to allow secondary use of biological samples and data collected from primary research projects as a way of maximizing the use of collected samples and data. Finally, we call for consultation of all stakeholders within the Malawi research community when regulatory authorities are developing policies that govern research in Malawi. (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 standard account of informed consent has recently met serious criticism, focused on the mismatch between its implications and widespread intuitions about the permissibility of conducting research and providing treatment under conditions of partial knowledge. Unlike other critics of the standard account, we suggest an account of the relations between autonomy, ignorance, and valid consent that avoids these implausible implications while maintaining the standard core idea, namely, that the primary purpose of the disclosure requirement of informed consent is to (...) prevent autonomy-undermining ignorance. The problem with the standard account, we argue, is that it fails to distinguish between different forms of ignorance–in particular, error and suspending ignorance–that have very different effects on individuals’ ability to provide valid consent. While error often undermines our ability to provide valid consent, suspending ignorance, we argue, does not. Once the moral weight of this distinction is appreciated, it becomes apparent that valid informed consent requires far less knowledge than suggested by the standard account. (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)

Adolescents are increasingly at risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection. The prolonged latency period, sometimes in excess of five years, and the incubation period of up to 10 years before the manifestation of symptoms, may foster adolescents’ false sense of invincibility and denial as they often do not see the devastating effects of the disease in their peers until they are older. In turn, their practice of safer sex may be hindered and thereby contribute (...) to the escalation of this public health crisis among sexually active adolescents. Prevention-focused recommendations were made in the USA as a result of this crisis. Recommendations were made to: (1) include STD/HIV education in the curricula of grades kindergarten to 12; (2) increase to at least 75% the proportion of primary care and mental health professionals who provide age-appropriate STD/HIV prevention counselling to adolescents; and (3) expand HIV prevention services to include age-appropriate HIV education curricula for students in grades 4-12 in 95% of schools. Yet, in the USA, the provision of school-based comprehensive STD/HIV education has been difficult to achieve owing to certain limitations and, in some instances, legal action. These limitations include: limited student access; restricted content; and the implementation of sporadic and/or brief educational programmes. Given these recommendations and the fact that adolescents are acquiring STDs and HIV infections at increasing rates, and despite the limitations and legal actions, do health care professionals not have an ethical obligation to provide adolescents with comprehensive STD/HIV prevention education? This ethical dilemma will be discussed using the ethical decision-making principles of ‘autonomy’ and ‘beneficence’, and a decision-making model proposed by Thompson and Thompson, and by Chally and Loric. (shrink)

Access to treatment, in HIV vaccine trials (HVTs), remains ethically controversial. In most prevention trials, including in South Africa, participants who seroconvert are referred to publicly funded programmes for treatment. This strategy is problematic when there is inadequate and uneven access to public sector antiretroviral therapy (ART) and support resources. The responsibilities, if any, of researchers, sponsors and public health authorities involved in HVTs has been hotly debated among academics, scholars, representatives of international organizations and sponsors. However, there is (...) little published on community perceptions. Recent guidance asserts that communities should make inputs into treatment and care decisions. This qualitative study explored a South African community's perceptions of who should provide what to HVT participants as well as how and why this should be done. Twenty-nine adults working at or attending five primary health care clinics in two rural areas in KwaZulu-Natal participated in in-depth interviews. Respondents expressed that researchers should ‘help participants to access’ treatment and care ‘because they are in a position to do so’ and ‘are in a relationship with’ trial participants. Respondents suggested that researchers could help by ‘facilitating referral’ until such time that participants can access care and treatment on their own. We highlight a series of implications for researchers in HVTs, including their need to be aware of prospective participants' considerable trust in and respect for researchers, the responsibility that this places on them, and the need for clear communication with communities so as not to erode community trust. (shrink)

This dissertation explores the ethics of human subjects research with particular attention to how clinical research on vaccines differs from research on therapies. The major differences are rooted in the fact that the benefits of vaccines and vaccine research accrue to the community to which vaccines belong by inducing herd immunity and thereby protecting both vaccinated and unvaccinated individuals. Therapeutics have no corresponding benefit to the community, the primary beneficiary is the individual. The ethical justification for conducting vaccine research (...) in a given community therefore should include an evaluation of the risks and benefits to the community as well as to involved individuals. Respect for individuals extends to respect for communities and for individuals as members of communities. A three way partnership between investigators, the community, and the community members is suggested as an ethical foundation for vaccine research. ;This model is then applied to the particular and complex case of testing a preventive HIV vaccine. HIV is an unique virus which continues to cause extraordinary devastation worldwide. The characteristics of HIV, its transmission and epidemiology, along with unprecedented scientific possibilities present a formidable challenge to the development and testing of an HIV vaccine. Using the community model, specific suggestions are made for the ethical conduct of clinical efficacy trials of HIV preventive vaccines. (shrink)