This preliminary study examined intervention effects of a universal prevention program offered by classroom teachers to public elementary school students. The Unique Minds School Program (M.B. Stern, 1999) is a teacher-led program designed to promote cognitive-social-emotional (CSE) skills, including student self-efficacy, problem solving, social-emotional competence, and a positive classroom climate, with the dual goal of preventing youth behavioral problems and promoting academic learning. During 2 consecutive school years, 119 students and their teachers were assessed in the fall and spring of Grade 4 and again in the spring of Grade 5. As compared to students in the comparison school, students in the intervention showed gains in student self-efficacy, problem solving, social-emotional competencies, and math grades. Incremental gains within CSE domains were found after 1 and 2 years of intervention. (Contains 1 table.)
Study objectivesTo determine whether distraction therapy with nature sights and sounds during flexible bronchoscopy (FB) reduces pain and anxiety.
Design
Randomized controlled trial.
Setting
Teaching hospital in Baltimore, MD.
Patients
Consecutive adult patients (n = 80) undergoing FB with conscious sedation.
Intervention
Nature scene murals were placed at the bedside, and patients were provided a tape of nature sounds to listen to before, during, and after the procedure. Patients assigned to the control group were not offered either the nature scene or the sounds.
Measurements and results
The primary outcomes were patient ratings of pain control (a 5-point scale ranging from poor to excellent) and anxiety. In a multivariate ordinal logistic regression model, the odds of better pain control were greater in the intervention patients than in the control patients (odds ratio [OR], 4.76; 95% confidence interval [CI], 1.35 to 16.7), after adjustment for age, gender, race, education, health status, and dose of narcotic medication. Older patients and patients with better health status reported significantly less pain. There was no difference in patient-reported anxiety between the two groups (OR, 0.87; 95% CI, 0.39 to 1.96).
Conclusions
Distraction therapy with nature sights and sounds significantly reduces pain in patients undergoing FB. Although the precise mechanism of this beneficial effect requires further investigation, clinicians should consider this nonintrusive strategy in addition to standard analgesic medications in patients undergoing painful, invasive procedures.
BACKGROUND:Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial.
OBJECTIVES:
To establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT's acceptability and mechanism of action.
DESIGN:
Single-blind, parallel, individual randomised controlled trial.
SETTING:
UK general practices.
PARTICIPANTS:
Adult patients with a diagnosis of recurrent depression and who were taking m-ADM.
INTERVENTIONS:
Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT's acceptability and mechanism of action.
MAIN OUTCOMES MEASURES:
The primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities.
RESULTS:
In total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation.
CONCLUSIONS:
There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group.
BACKGROUND:Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial.
OBJECTIVES:
To establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT's acceptability and mechanism of action.
DESIGN:
Single-blind, parallel, individual randomised controlled trial.
SETTING:
UK general practices.
PARTICIPANTS:
Adult patients with a diagnosis of recurrent depression and who were taking m-ADM.
INTERVENTIONS:
Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT's acceptability and mechanism of action.
MAIN OUTCOMES MEASURES:
The primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities.
RESULTS:
In total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation.
CONCLUSIONS:
There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group.
TRIAL REGISTRATION:
Current Controlled Trials ISRCTN26666654.
FUNDING:
This project was funded by the NIHR Health Technology Assessment programme and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula and will be published in full in Health Technology Assessment; Vol. 19, No. 73. See the NIHR Journals Library website for further project information.
BackgroundMobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers.
Methods and Findings
We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990–Sept 2010). Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence, use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI 0.72–0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47–1.32]). In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77–2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature.
Conclusions
Text messaging interventions increased adherence to ART and smoking cessation and should be considered for inclusion in services. Although there is suggestive evidence of benefit in some other areas, high quality adequately powered trials of optimised interventions are required to evaluate effects on objective outcomes.
This pilot study evaluated the impact of mindfulness groups on 20 Latino middle school students who participated in 8-session structured groups using the Mindfulness-Based Stress Reduction for Teens curriculum. The participants’ scores on the Mindful Attention Awareness Scale; the Self-Compassion Scale; the Perceived Stress Scale; and the Depression, Anxiety, and Hostility subscales of the Symptom Check List–90–R were examined at 3 points in time. There were no significant changes during the baseline period. Following participation in the groups, the adolescents’ mindfulness and self-compassion scores significantly increased, and their perceived stress and depression significantly decreased.
This pilot study evaluated the impact of mindfulness groups on 20 Latino middle school students who participated in 8-session structured groups using the Mindfulness-Based Stress Reduction for Teens curriculum. The participants’ scores on the Mindful Attention Awareness Scale; the Self-Compassion Scale; the Perceived Stress Scale; and the Depression, Anxiety, and Hostility subscales of the Symptom Check List–90–R were examined at 3 points in time. There were no significant changes during the baseline period. Following participation in the groups, the adolescents’ mindfulness and self-compassion scores significantly increased, and their perceived stress and depression significantly decreased.
This pilot study evaluated the impact of mindfulness groups on 20 Latino middle school students who participated in 8-session structured groups using the Mindfulness-Based Stress Reduction for Teens curriculum. The participants’ scores on the Mindful Attention Awareness Scale; the Self-Compassion Scale; the Perceived Stress Scale; and the Depression, Anxiety, and Hostility subscales of the Symptom Check List–90–R were examined at 3 points in time. There were no significant changes during the baseline period. Following participation in the groups, the adolescents’ mindfulness and self-compassion scores significantly increased, and their perceived stress and depression significantly decreased.
Environmental ethics is the discipline in philosophy that studies themoral relationship of human beings to, and also the value and moralstatus of, the environment and its non-human contents. This entrycovers: (1) the challenge of environmental ethics to theanthropocentrism (i.e., human-centeredness) embedded in traditionalwestern ethical thinking; (2) the early development of the disciplinein the 1960s and 1970s; (3) the connection of deep ecology, feministenvironmental ethics, animism and social ecology to politics; (4) theattempt to apply traditional ethical theories, includingconsequentialism, deontology, and virtue ethics, to supportcontemporary environmental concerns; (5) the preservation ofbiodiversity as an ethical goal; (6) the broader concerns of somethinkers with wilderness, the built environment and the politics ofpoverty; (7) the ethics of sustainability and climate change, and (8)some directions for possible future developments of thediscipline.
BACKGROUND: Treatment-related symptoms and decreased health-related quality of life (HRQoL) frequently occur during chemotherapy for breast cancer. Although research findings suggest that yoga can reduce symptoms and Improve HRQoL after treatment, potential benefits of yoga during chemotherapy have received minimal attention.OBJECTIVE: To estimate accrual, adherence, study retention, and preliminary efficacy of a yoga intervention compared with an active control group for breast cancer patients during chemotherapy.
METHODS: Women with stage I-III breast cancer were recruited from 3 community cancer clinics and randomized to 10 weeks of gentle yoga or wellness education. Depressive symptoms, fatigue, sleep, and HRQoL were assessed at baseline, mid-intervention (Week 5), and after intervention (Week 10).
RESULTS: 40 women aged 29-83 years (median, 48 years; 88% white) were randomized to yoga (n = 22) or wellness education (n = 18). The groups did not differ significantly on baseline characteristics, adherence, or study retention. Participant feedback was positive and comparable between groups. Meaningful within-group differences were identified For sleep adequacy and quantity in yoga participants and for somnolence in wellness-education participants.
LIMITATIONS: Small sample size and lack of a usual-care control group.
CONCLUSIONS: This study established Feasibility of a community-based randomized trial of yoga and an active comparison group for women undergoing chemotherapy for breast cancer. Preliminary efficacy estimates suggest that yoga improves sleep adequacy Symptom severity and interference remained stable during chemotherapy for the yoga group and snowed a trend toward increasing in the control group. The study highlighted obstacles to multisite yoga research during cancer treatment.
FUNDING/SPONSORSHIP: National Cancer Institute (3U10 CA081851, PI; Shaw; R25 CA122061, PI: Avis); Translational Science Institute, Wake Forest School of Medicine.
This book uses the study of philosophical texts to raise and explore metaphysical issues. On one level, each essay addresses a scholarly issue in a classical text, often a text of Aristotle's. On a deeper level, the issues Halper considers are metaphysical. However, unlike thinkers who have brought linguistic analysis and contemporary metaphysical notions to these texts, Halper approaches them to find their formulations of issues and their strategies of pursuit. Halper is not concerned with the defense of metaphysical commitments but with finding and exploring paths of metaphysical inquiry. The essays in this volume are exploratory and exegetical rather than decisive. Their contribution to metaphysics lies in the issues they raise, the methods they explore, and their conception of metaphysics as a discipline rooted in philosophical problems.
Our world is far richer than previously conceived, yet so ravaged by human activity that half its species could be gone by the end of the present century. These two contrasting truths–unexpected magnificence and underestimated peril–have become compellingly clear during the past two decades of research on biological diversity.In this timely and important new book, Wilson describes exactly what treasures of the natural world we are about to lose forever and what we can do right now to save them. Destruction of natural habitats, the rampant spread of invasive species, pollution, uncontrolled population growth, and over-harvesting are the main threats to our natural world. Wilson explains how each of these elements works to undo the web of life that supports us, and why it is in our best interest to stop it. In the process, he explores the ethical and religious base of the conservation movement and deflates the myth that environmental policy is antithetical to economic growth by illustrating how new methods of conservation can ensure long-term economic well-being.
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<p>The leading resource for the field, this handbook provides a comprehensive and critical review of more than three decades of theory development, research, and practices in transformative learning. The starting place for understanding and fostering transformative learning, as well as diving deeper, the volume distinguishes transformatvie learning from other forms of learning, explores future perspectives, and is designed for scholars, students, and practitioners.</p>
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The leading resource for the field, this handbook provides a comprehensive and critical review of more than three decades of theory development, research, and practice in transformative learning. The starting place for understanding and fostering transformative learning, as well as diving deeper, the volume distinguishes transformative learning from other forms of learning, explores future perspectives, and is designed for scholars, students, and practitioners.
Well-being is a complex construct that concerns optimal experience and functioning. Current research on well-being has been derived from two general perspectives: the hedonic approach, which focuses on happiness and defines well-being in terms of pleasure attainment and pain avoidance; and the eudaimonic approach, which focuses on meaning and self-realization and defines well-being in terms of the degree to which a person is fully functioning. These two views have given rise to different research foci and a body of knowledge that is in some areas divergent and in others complementary. New methodological developments concerning multilevel modeling and construct comparisons are also allowing researchers to formulate new questions for the field. This review considers research from both perspectives concerning the nature of well-being, its antecedents, and its stability across time and culture.
Amidst the doom and gloom that dominates the headlines, a different kind of story about an alternative future is unfolding. The players are activists, visionaries and cultural innovators, the backdrop is the tipping point of our global and environmental challenges, and the narrative is the molding of a new paradigm to shape our collective future.
ethical and sustainable fashion and lifestyle
Jazz, America’s original art form, can be a catalyst for creative and spiritual development. With its unique emphasis on improvisation, jazz offers new paradigms for educational and societal change. In this provocative book, musician and educator Edward W. Sarath illuminates how jazz offers a continuum for transformation. Inspired by the long legacy of jazz innovators who have used meditation and related practices to bring the transcendent into their lives and work, Sarath sees a coming shift in consciousness, one essential to positive change. Both theoretical and practical, the book uses the emergent worldview known as Integral Theory to discuss the consciousness at the heart of jazz and the new models and perspectives it offers. On a more personal level, the author provides examples of his own involvement in educational reform. His design of the first curriculum at a mainstream educational institution to incorporate a significant meditation and consciousness studies component grounds a radical new vision.
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