Climate change is an emerging threat to global public health. It is also highly inequitable, as the greatest risks are to the poorest populations, who have contributed least to greenhouse gas (GHG) emissions. The rapid economic development and the concurrent urbanization of poorer countries mean that developing-country cities will be both vulnerable to health hazards from climate change and, simultaneously, an increasing contributor to the problem. We review the specific health vulnerabilities of urban populations in developing countries and highlight the range of large direct health effects of energy policies that are concentrated in urban areas. Common vulnerability factors include coastal location, exposure to the urban heat-island effect, high levels of outdoor and indoor air pollution, high population density, and poor sanitation. There are clear opportunities for simultaneously improving health and cutting GHG emissions most obviously through policies related to transport systems, urban planning, building regulations and household energy supply. These influence some of the largest current global health burdens, including approximately 800,000 annual deaths from ambient urban air pollution, 1.2 million from road-traffic accidents, 1.9 million from physical inactivity, and 1.5 million per year from indoor air pollution. GHG emissions and health protection in developing-country cities are likely to become increasingly prominent in policy development. There is a need for a more active input from the health sector to ensure that development and health policies contribute to a preventive approach to local and global environmental sustainability, urban population health, and health equity.
It is now widely accepted that climate change is occurring as a result of the accumulation of greenhouse gases in the atmosphere arising from the combustion of fossil fuels. Climate change may affect health through a range of pathways, for example as a result of increased frequency and intensity of heat waves, reduction in cold related deaths, increased floods and droughts, changes in the distribution of vector-borne diseases and effects on the risk of disasters and malnutrition. The overall balance of effects on health is likely to be negative and populations in low-income countries are likely to be particularly vulnerable to the adverse effects. The experience of the 2003 heat wave in Europe shows that high-income countries may also be adversely affected. Adaptation to climate change requires public health strategies and improved surveillance. Mitigation of climate change by reducing the use of fossil fuels and increasing a number of uses of the renewable energy technologies should improve health in the near-term by reducing exposure to air pollution.
The decision to share resources is fundamental for cohesive societies. Humans can be motivated to give for many reasons. Some generosity incurs a definite cost, with no extrinsic reward to the act, but instead provides intrinsic satisfaction (labelled here as ‘altruistic’ giving). Other giving behaviours are done with the prospect of improving one's own situation via reciprocity, reputation, or public good (labelled here as ‘strategic’ giving). These contexts differ in the source, certainty, and timing of rewards as well as the inferences made about others' mental states. We executed a combined statistical map and coordinate-based fMRI meta-analysis of decisions to give (36 studies, 1150 participants). Methods included a novel approach for accommodating variable signal dropout between studies in meta-analysis. Results reveal consistent, cross-paradigm neural correlates of each decision type, commonalities, and informative differences. Relative to being selfish, altruistic and strategic giving activate overlapping reward networks. However, strategic decisions showed greater activity in striatal regions than altruistic choices. Altruistic giving, more than strategic, activated subgenual anterior cingulate cortex (sgACC). Ventromedial prefrontal cortex (vmPFC) is consistently involved during generous decisions and processing across a posterior to anterior axis differentiates the altruistic/strategic context. Posterior vmPFC was preferentially recruited during altruistic decisions. Regions of the ‘social brain’ showed distinct patterns of activity between choice types, reflecting the different use of theory of mind in the two contexts. We provide the consistent neural correlates of decisions to give, and show that many will depend on the source of incentives.
The decision to share resources is fundamental for cohesive societies. Humans can be motivated to give for many reasons. Some generosity incurs a definite cost, with no extrinsic reward to the act, but instead provides intrinsic satisfaction (labelled here as ‘altruistic’ giving). Other giving behaviours are done with the prospect of improving one's own situation via reciprocity, reputation, or public good (labelled here as ‘strategic’ giving). These contexts differ in the source, certainty, and timing of rewards as well as the inferences made about others' mental states. We executed a combined statistical map and coordinate-based fMRI meta-analysis of decisions to give (36 studies, 1150 participants). Methods included a novel approach for accommodating variable signal dropout between studies in meta-analysis. Results reveal consistent, cross-paradigm neural correlates of each decision type, commonalities, and informative differences. Relative to being selfish, altruistic and strategic giving activate overlapping reward networks. However, strategic decisions showed greater activity in striatal regions than altruistic choices. Altruistic giving, more than strategic, activated subgenual anterior cingulate cortex (sgACC). Ventromedial prefrontal cortex (vmPFC) is consistently involved during generous decisions and processing across a posterior to anterior axis differentiates the altruistic/strategic context. Posterior vmPFC was preferentially recruited during altruistic decisions. Regions of the ‘social brain’ showed distinct patterns of activity between choice types, reflecting the different use of theory of mind in the two contexts. We provide the consistent neural correlates of decisions to give, and show that many will depend on the source of incentives.
Five studies investigated the links among narcissism, self-esteem, and love. Across all studies, narcissism was associated primarily with a game-playing love style. This link was found in reports of general love styles (Study 1a) and of love in ongoing romantic relationships (Studies 1b–3, 5). Narcissists’ game- playing love style was the result of a need for power and autonomy (Study 2) and was linked with greater relationship alternatives and lesser commitment (Study 3). Finally, narcissists’ self-reports of game playing were confirmed by their partners in past and current relationships (Studies 4, 5). In contrast, self-esteem was negatively linked to manic love and positively linked to passionate love across studies. Implications for the understanding of narcissism in relationships are discussed.
This study aimed to examine the relationship between mindfulness and the request for job accommodations among individuals with disabilities. One hundred fifty individuals with disabilities who needed a job accommodation completed a survey assessing the cognitive, affective, and mindfulness factors involved with requesting job accommodations. Pearson correlations were calculated between scales and subscales measuring mindfulness, positive affect, self-efficacy, outcome expectations, and intentions to request accommodations. The results showed significant correlations between mindfulness and all other scales. In addition, multiple regression and logistic regression analyses were conducted to examine the impacts of cognitive, affective, and mindfulness factors on an individual’s intention and decision to request or withhold a request for an accommodation. Mindfulness was not found significant in predicting the intention to request accommodations; however, positive affect, self-efficacy, and outcome expectations accounted for 35% of the variance in intention to request. The interaction between mindfulness and intention to request, along with self-efficacy, was found significant in predicting request behavior. Mindfulness and the interaction between mindfulness and intention to request contributed an additional 8% of the variance in requesting behavior. The results of this study indicate the need for more research into the relationship of mindfulness and the decision to request accommodations.
Mindfulness is becoming more popular as emerging research demonstrates its benefits for self-care, by cultivating calmness and decreasing stress or anxiety. This pilot study aimed to measure the impact of a six-week Mindfulness course, modelled on the manualised treatment programme developed by Kabat-Zinn on the mental well-being, stress and resilience of undergraduate social work students in Northern Ireland. This was a mixed methods study involving two groups: (1) intervention group participants who attended a six-week Mindfulness course (April–May 2016) and (2) control group participants. Basic socio-demographic data were collected from all participants and all were invited to complete the Warwick-Edinburgh Mental Well-being Scale, the Perceived Stress Scale and the Resilience Scale during weeks 1 and 6. Statistical tests were used to compare mean scores from the scales, and qualitative data were manually analysed using thematic content analysis. Findings indicated significant changes in the scores for well-being, stress and resilience for the intervention group, but not for the control group. Mindfulness may not appeal to all students so it should not be a mandatory component of training, but may be offered as one of the wider approaches to self-care for undergraduate social work degree students.
The present study is a waitlist-controlled investigation of the impact of a Mindfulness-Based Stress Reduction (MBSR) program on mindful attentiveness, rumination and blood pressure (BP) in women with cancer. Female post-treatment cancer patients were recruited from the MBSR program waitlist. Participants completed self-report measures of mindfulness and rumination and measured casual BP at home before and after the 8-week MBSR program or waiting period. MBSR group participants demonstrated higher levels of mindful attentiveness and decreased ruminative thinking following the intervention but no difference in BP, when compared to controls. In the MBSR group, decreases in rumination correlated with decreases in SBP and increases in mindful attention. When participants were assigned to “Higher BP” and “Lower BP” conditions based on mean BP values at week 1, “Higher BP” participants in the MBSR group (n = 19) had lower SBP at week 8 relative to the control group (n = 16). A MBSR program may be efficacious in increasing mindful attention and decreasing rumination in women with cancer. Randomized controlled trials are needed to evaluate an impact on clinically elevated BP.
The purpose of this study was to investigate the relationships among mindfulness, parenting stress, and parental responsiveness. The national sample included 128 adult parents of children under the age of 18. Results indicated that the more mindful parents are, the more attuned and responsive they are to their child’s needs, and that this phenomenon is explained by the lower levels of parenting stress associated with higher levels of mindfulness. Additionally, results indicated particular importance of the recursive relational aspect (i.e., parent–child interaction) of the constructs. Findings of this study provide further support for the benefits of mindfulness and add to the emerging body of research indicating the beneficial impacts of mindfulness in interpersonal relationships. Implications of these findings include practical utility in both clinical and nonclinical populations, including using mindfulness skills to attenuate parenting stress and enhance effective parenting. The current findings offer support for the possibility of increasing parental responsiveness, a parenting practice well established to be largely beneficial for the child, through reducing parenting stress with mindfulness.
This book outlines 101 tried-and-true strategies for making teaching more effective. Grounded in research from the cognitive sciences and best classroom practices, the strategies are divided into the following areas: "Beginning With What Students Know: Activating Prior Knowledge" (e.g., visual sequencing, speaking categorically, and guided anticipation); "Active Learning: An Essential Classroom Ingredient" (e.g., visual story mapping, guided learning, and conducting scientific inquiry); "Ensuring Gender-Fair Instruction: For Female and Male Students" (e.g., seeking student feedback on gender dynamics, quality questioning, and peer support networks); "Teaching Diverse Students: Addressing Language, Class, Culture, and Ability Differences in the Classroom" (e.g., leveling lessons, engaging the gifted, and collaborative note taking); and "Assessing Student Performance" (e.g., test-taking matters, test-taking rules for students, and making rubrics). Each section presents strategies and examines what the research says about using such strategies.
CONTEXT:Current therapies for traumatic brain injury (TBI) include pharmacotherapy, psychotherapy, and cognitive rehabilitation. Unfortunately, psychological and emotional issues regularly go untreated in individuals with TBI even after they receive treatment for physical, behavioral, and cognitive issues. Mindfulness-based cognitive therapy (MBCT) may offer new rehabilitation opportunities for individuals with TBI.
OBJECTIVE:
To demonstrate the efficacy of MBCT in the treatment of clinically diagnosed depression in a TBI population.
DESIGN:
The research team measured depression, pain frequency and intensity, energy levels, health status, and function preintervention and postintervention.
SETTING:
The research team conducted the study at the Ottawa Hospital Rehabilitation Centre, Ontario, Canada.
PARTICIPANTS:
The research team recruited 23 participants from two sources: (1) the brain injury program at the hospital and (2) the local head-injury association. Twenty participants completed the study.
INTERVENTION:
The intervention was 8 weeks in length, with a 90-minute MBCT session once a week. The research team based the specific content of the study's intervention on a combination of Kabat-Zinn's manualized mindfulness-based stress reduction program and Segal and colleague's manual for MBCT.
OUTCOME MEASURES:
The research team determined statistical significance using paired t-tests for continuous outcomes and the McNemar chi-square test for dichotomous categorical outcomes. They also calculated effect sizes for all depression measures.
RESULTS:
Postintervention, the study found that MBCT significantly reduced (P < .050) depression symptoms on all scales compared to baseline. The study demonstrated medium to large effect sizes for each depression measure. Participants indicated reduced pain intensity (P = .033) and increased energy levels (P = .004). No significant changes occurred in anxiety symptoms, pain frequency, and level of functioning postintervention.
CONCLUSION:
MBCT was efficacious in reducing depression in the TBI population, providing ample rationale for further research with more robust designs. This study marks an important step toward the development and provision of MBCT on a wider scale to support the rehabilitation efforts of people who have depression symptoms following TBI.
CONTEXT:Current therapies for traumatic brain injury (TBI) include pharmacotherapy, psychotherapy, and cognitive rehabilitation. Unfortunately, psychological and emotional issues regularly go untreated in individuals with TBI even after they receive treatment for physical, behavioral, and cognitive issues. Mindfulness-based cognitive therapy (MBCT) may offer new rehabilitation opportunities for individuals with TBI.
OBJECTIVE:
To demonstrate the efficacy of MBCT in the treatment of clinically diagnosed depression in a TBI population.
DESIGN:
The research team measured depression, pain frequency and intensity, energy levels, health status, and function preintervention and postintervention.
SETTING:
The research team conducted the study at the Ottawa Hospital Rehabilitation Centre, Ontario, Canada.
PARTICIPANTS:
The research team recruited 23 participants from two sources: (1) the brain injury program at the hospital and (2) the local head-injury association. Twenty participants completed the study.
INTERVENTION:
The intervention was 8 weeks in length, with a 90-minute MBCT session once a week. The research team based the specific content of the study's intervention on a combination of Kabat-Zinn's manualized mindfulness-based stress reduction program and Segal and colleague's manual for MBCT.
OUTCOME MEASURES:
The research team determined statistical significance using paired t-tests for continuous outcomes and the McNemar chi-square test for dichotomous categorical outcomes. They also calculated effect sizes for all depression measures.
RESULTS:
Postintervention, the study found that MBCT significantly reduced (P < .050) depression symptoms on all scales compared to baseline. The study demonstrated medium to large effect sizes for each depression measure. Participants indicated reduced pain intensity (P = .033) and increased energy levels (P = .004). No significant changes occurred in anxiety symptoms, pain frequency, and level of functioning postintervention.
CONCLUSION:
MBCT was efficacious in reducing depression in the TBI population, providing ample rationale for further research with more robust designs. This study marks an important step toward the development and provision of MBCT on a wider scale to support the rehabilitation efforts of people who have depression symptoms following TBI.
BackgroundClinically significant psychological distress in pregnancy is common, with epidemiological research suggesting that between 15 and 25 % of pregnant women experience elevated symptoms of stress, anxiety, and depression. Untreated psychological distress in pregnancy is associated with poor obstetrical outcomes, changes in maternal physiology, elevated incidence of child physical and psychological disorders, and is predictive of maternal postpartum mood disorders. Despite the wide-ranging impact of antenatal psychological distress on mothers and their children, there is a gap in our knowledge about the most effective treatments that are available for psychological distress experienced in pregnancy. Additionally, no trials have focused on potential physiological changes that may occur as a result of receiving mindfulness training in pregnancy. The proposed trial will determine the effectiveness of an 8-week modified Mindfulness-based Cognitive Therapy (MBCT) intervention delivered during pregnancy.
Methods
A randomized controlled trial (RCT) design with repeated measures will be used to evaluate the effectiveness of MBCT to treat psychological distress in pregnancy. A sample of 60 consenting pregnant women aged 18 years and above will be enrolled and randomized to the experimental (MBCT) or control (treatment as usual) condition. Primary (e.g., symptoms of stress, depression, and anxiety), secondary (cortisol, blood pressure (BP), heart rate variability (HRV), and sleep) and other outcome data (e.g., psychological diagnoses) will be collected via a combination of laboratory visits and at-home assessments from both groups at baseline (T1), immediately following the intervention (T2), and at 3 months postpartum (T3). Descriptive statistics will be used to describe sample characteristics. Data will be analyzed using an intention-to-treat approach. Hierarchical linear models will be used to test intervention effects on primary and secondary outcomes.
Discussion
The trial is expected to improve knowledge about evidence-based treatments for psychological distress experienced in pregnancy and to evaluate the potential impact of mindfulness-based interventions on maternal physiology.
BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder of the lower gastrointestinal (GI) tract affected by stress, which may benefit from a biopsychosocial treatment approach such as mindfulness-based stress reduction (MBSR).PURPOSE: A treatment as usual (TAU) wait-list controlled trial was conducted in Calgary, Canada to investigate the impact of MBSR on IBS symptoms. It was hypothesized that MBSR patients would experience greater reduction in overall IBS symptom severity and self-reported symptoms of stress relative to control patients.
METHOD: Ninety patients diagnosed with IBS using the Rome III criteria were randomized to either an immediate MBSR program (n = 43) or to wait for the next available program (n = 47). Patients completed IBS symptom severity, stress, mood, quality of life (QOL), and spirituality scales pre- and post-intervention or waiting period and at 6-month follow-up. Intent-to-treat linear mixed model analyses for repeated measures were conducted, followed by completers analyses.
RESULTS: While both groups exhibited a decrease in IBS symptom severity scores over time, the improvement in the MBSR group was greater than the controls and was clinically meaningful, with symptom severity decreasing from constantly to occasionally present. Pre- to post-intervention dropout rates of 44 and 23 % for the MBSR and control groups, respectively, were observed. At 6-month follow-up, the MBSR group maintained a clinically meaningful improvement in overall IBS symptoms compared to the wait-list group, who also improved marginally, resulting in no statistically significant differences between groups at follow-up. Improvements in overall mood, QOL, and spirituality were observed for both groups over time.
CONCLUSIONS: The results of this trial provide preliminary evidence for the feasibility and efficacy of a mindfulness intervention for the reduction of IBS symptom severity and symptoms of stress and the maintenance of these improvements at 6 months post-intervention. Attention and self-monitoring and/or anticipation of MBSR participation may account for smaller improvements observed in TAU patients.
BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder of the lower gastrointestinal (GI) tract affected by stress, which may benefit from a biopsychosocial treatment approach such as mindfulness-based stress reduction (MBSR).PURPOSE: A treatment as usual (TAU) wait-list controlled trial was conducted in Calgary, Canada to investigate the impact of MBSR on IBS symptoms. It was hypothesized that MBSR patients would experience greater reduction in overall IBS symptom severity and self-reported symptoms of stress relative to control patients.
METHOD: Ninety patients diagnosed with IBS using the Rome III criteria were randomized to either an immediate MBSR program (n = 43) or to wait for the next available program (n = 47). Patients completed IBS symptom severity, stress, mood, quality of life (QOL), and spirituality scales pre- and post-intervention or waiting period and at 6-month follow-up. Intent-to-treat linear mixed model analyses for repeated measures were conducted, followed by completers analyses.
RESULTS: While both groups exhibited a decrease in IBS symptom severity scores over time, the improvement in the MBSR group was greater than the controls and was clinically meaningful, with symptom severity decreasing from constantly to occasionally present. Pre- to post-intervention dropout rates of 44 and 23 % for the MBSR and control groups, respectively, were observed. At 6-month follow-up, the MBSR group maintained a clinically meaningful improvement in overall IBS symptoms compared to the wait-list group, who also improved marginally, resulting in no statistically significant differences between groups at follow-up. Improvements in overall mood, QOL, and spirituality were observed for both groups over time.
CONCLUSIONS: The results of this trial provide preliminary evidence for the feasibility and efficacy of a mindfulness intervention for the reduction of IBS symptom severity and symptoms of stress and the maintenance of these improvements at 6 months post-intervention. Attention and self-monitoring and/or anticipation of MBSR participation may account for smaller improvements observed in TAU patients.
Abstract: The lack of affordable, available pediatric drug formulations presents serious global health challenges. This article argues that successful pharmacotherapy for children demands an interdisciplinary approach. There is a need to develop new medicines to address acute and chronic illnesses of children, but also to produce formulations of essential medicines to optimize stability, bioavailability, palatability, cost, accurate dosing and adherence. This, in turn, requires an understanding of the social ecologies in which treatment occurs. Understanding health worker, caregiver and patient practices, limitations, and expectations with regard to medicines is crucial to guiding effective drug development and administration. Using literature on pediatric tuberculosis as a reference, this review highlights sociocultural, pharmacological, and structural barriers that impede the delivery of medicines to children. It serves as a basis for the development of an intensive survey of patient, caregiver, and health care worker understandings of, and preferences for, pediatric formulations in three East African countries.
Rediscover the Power of Perfect Breathing. The seemingly simple act of breathing often goes unnoticed and yet it is the most immediately essential process for sustaining life. This informative guide explores the central role of breath in all aspects of the body, mind, and spirit. Learn how it can help improve health, accelerate healing, enhance mental focus, cognitive and creative skills, sharpen athletic performance, heighten sexual enjoyment, and deepen the meditative experience. A variety of exercises for deep, intentional breathing are provided to get you started.
Examines the diverse cultural influences which have shaped the basic philosophical traditions of India
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