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The ultimate goal of our public health system is to reduce the incidence of disability and premature death. Evidence suggests that, by this standard, the USA falls behind most other developed countries largely as a function of disparities in health outcomes among significant portions of the US population. We present a framework for addressing these disparities that attributes them, not simply to differences in the behavioral and physical risk factors, but to social, environmental, and structural inequities such as poverty, discrimination, toxic physical setting, and the marketing of harmful products. These inequities result from de facto and instituted public policies. An analysis of the NIH research portfolio indicates a relative lack of investment in experimental evaluations of preventive interventions—especially studies targeting disadvantaged populations. Moreover, experimental research on reducing social inequities is almost entirely lacking. A line of research focusing on the drivers of inequities and their dissolution must include experimental evaluation of strategies for getting policies adopted that will reduce inequities. In conclusion, a summary is provided of the types of research that are needed and the challenges involved in conducting the experimental research that is essential for reducing inequities and disparities and, in turn, prolonging life. [ABSTRACT FROM AUTHOR]

Background: Mevidalen is a selective positive allosteric modulator (PAM) of the dopamine D1 receptor subtype. Objective: To assess the safety and efficacy of mevidalen for treatment of cognition in patients with Lewy body dementia (LBD). Methods: PRESENCE was a phase 2, 12‐week study in participants with LBD (N = 344) randomly assigned (1:1:1:1) to daily doses of mevidalen (10, 30, or 75 mg) or placebo. The primary outcome measure was change from baseline on Cognitive Drug Research Continuity of Attention (CoA) composite score. Secondary outcomes included Alzheimer's Disease Assessment Scale‐Cognitive Subscale 13 (ADAS‐cog13), Movement Disorder Society‐Unified Parkinson's Disease Rating Scale (MDS‐UPDRS), and Alzheimer's Disease Cooperative Study‐Clinical Global Impression of Change (ADCS‐CGIC). Numerous safety measures were collected. Results: Mevidalen failed to meet primary or secondary cognition endpoints. Mevidalen resulted in significant, dose‐dependent improvements of MDS‐UPDRS total score (sum of Parts I−III, 10 mg P < 0.05, 30 mg P < 0.05, 75 mg P < 0.01, compared to placebo). The 30 mg and 75 mg mevidalen doses significantly improved ADCS‐CGIC scores compared to placebo (minimal or better improvement: 30 mg P < 0.01, 75 mg P < 0.01; moderate or better improvement: 30 mg P < 0.05, 75 mg P < 0.001). Increases in blood pressure, adverse events, and cardiovascular serious adverse events were most pronounced at the 75 mg dose. Conclusions: Mevidalen harnesses a novel mechanism of action that improves motor symptoms associated with LBD on top of standard of care while improving or not worsening non‐motor symptoms associated with traditional dopaminergic therapy. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Mevidalen (LY3154207) is a positive allosteric modulator of the dopamine D1 receptor that enhances the affinity of dopamine for the D1 receptor. The safety, tolerability, motor effects, and pharmacokinetics of mevidalen were studied in patients with Parkinson disease. Mevidalen or placebo was given once daily for 14 days to 2 cohorts of patients (cohort 1, 75 mg; cohort 2, titration from 15 to 75 mg). For both cohorts, the median time to maximum concentration for mevidalen plasma concentration was about 2 hours, the apparent steady‐state clearance was 20–25 L/h, and mevidalen plasma concentrations were similar between the 1st and 14th administration in cohort 1, indicating minimal accumulation upon repeated dosing. Mevidalen was well tolerated, and most treatment‐emergent adverse events were mild. Blood pressure and pulse rate increased when taking mevidalen, but there was considerable overlap with patients taking placebo, and vital signs normalized with repeated dosing. In the Movement Disorder Society–United Parkinson's Disease Rating Scale, all patients taking mevidalen showed a better motor examination sub‐score on day 6 compared to only some patients in the placebo group. These data support examining mevidalen for symptomatic treatment of patients with Parkinson disease and Lewy body dementia. [ABSTRACT FROM AUTHOR]

Background: This paper describes the development and psychometric evaluation of a behavioral assessment instrument primarily intended for use with workgroups in any type of organization. The instrument was developed based on the Nurturing Environments framework which describes four domains important for health, well-being, and productivity; minimizing toxic social interactions, teaching and reinforcing prosocial behaviors, limiting opportunities for problem behaviors, and promoting psychological flexibility. The instrument is freely available to use and adapt under a CC-BY license and intended as a tool that is easy for any group to use and interpret to identify key behaviors to improve their psychosocial work environment.Methods: Questionnaire data of perceived frequency of behaviors relevant to nurturance were collected from nine different organizations in Sweden. Data were analyzed using confirmatory factor analysis, Rasch analysis, and correlations to investigate relationships with relevant workplace measures.Results: The results indicate that the 23-item instrument is usefully divided in two factors, which can be described as risk and protective factors. Toxic social behaviors make up the risk factor, while the protective factor includes prosocial behavior, behaviors that limit problems, and psychological flexibility. Rasch analysis showed that the response categories work as intended for all items, item fit is satisfactory, and there was no significant differential item functioning across age or gender. Targeting indicates that measurement precision is skewed towards lower levels of both factors, while item thresholds are distributed over the range of participant abilities, particularly for the protective factor. A Rasch score table is available for ordinal to interval data transformation.Conclusions: This initial analysis shows promising results, while more data is needed to investigate group-level measurement properties and validation against concrete longitudinal outcomes. We provide recommendations for how to work in practice with a group based on their assessment data, and how to optimize the measurement precision further. By using a two-dimensional assessment with ratings of both frequency and perceived importance of behaviors the instrument can help facilitate a participatory group development process. The Group Nurturance Inventory is freely available to use and adapt for both commercial and non-commercial use and could help promote transparent assessment practices in organizational and group development. [ABSTRACT FROM AUTHOR]

Activation of the brain dopamine D1 receptor has attracted attention because of its promising role in neuropsychiatric diseases. Although efforts to develop D1 agonists have been challenging, a positive allosteric modulator (PAM), represents an attractive approach with potential better drug‐like properties. Phase 1 single‐ascending‐dose (SAD; NCT03616795) and multiple‐ascending‐dose (MAD; NCT02562768) studies with the D1PAM mevidalen (LY3154207) were conducted with healthy subjects. There were no treatment‐related serious adverse events (AEs) in these studies. In the SAD study, 25‐200 mg administered orally showed dose‐proportional pharmacokinetics (PK) and acute dose‐related increases in systolic blood pressure (SBP) and diastolic blood pressure DBP) and pulse rate at doses ≥ 75 mg. AE related to central activation were seen at doses ≥ 75 mg. At 25 and 75 mg, central penetration of mevidalen was confirmed by measurement of mevidalen in cerebrospinal fluid. In the MAD study, once‐daily doses of mevidalen at 15‐150 mg for 14 days showed dose‐proportional PK. Acute dose‐dependent increases in SBP, DBP, and PR were observed on initial administration, but with repeated dosing the effects diminished and returned toward baseline levels. Overall, these findings support further investigation of mevidalen as a potential treatment for a range of neuropsychiatric disorders. [ABSTRACT FROM AUTHOR]

This paper describes the culture and components of the PAX Good Behavior Game and offers it as one model for how to enhance the well-being of populations through the diffusion of nurturing practices into several venues of society. The PAX components, also known as evidence-based kernels, are proposed to be useful in classrooms, families, organizations, criminal justice, and in improving public discussion and government. Kernels affect behavior in the short- and long-term through combinations of antecedents, reinforcers, relational networks, and physiological effects. Identifying common strategies, tools, and clear targets of change is suggested as a way to work towards evolving freely available evidence-based tools that can be combined to improve social conditions in multiple contexts. [ABSTRACT FROM AUTHOR]

Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America's children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas. [ABSTRACT FROM AUTHOR]

This paper examines the misalignment between modern human society and certain male phenotypes, a misalignment that has been highlighted and explored in great detail in the work of Tom Dishion. We begin by briefly enumerating the ongoing developmental difficulties of many boys and young men and how these difficulties affect them and those around them. We then suggest that the qualities that have been advantageous for men and their families in our earlier evolution but that are often no longer functional in modern society are a source of these problems. Finally, we provide a brief review of prevention programs that can contribute to preventing this type of problematic development and eliciting more prosocial behavior from at-risk boys and men. We conclude with an overview of research and policy priorities that could contribute to reducing the proportion of boys and young men who experience developmental difficulties in making their way in the world. [ABSTRACT FROM AUTHOR]

Cross-sectional, longitudinal, and experimental studies have found a link between youth exposure to cigarette marketing and youth initiation of smoking. These decisive research findings led to regulations of cigarette marketing to youth-including no television or radio ads, prohibitions on the use of cartoons, bans on transit and billboard advertisements, and disallowing tobacco brand sponsorships of sporting events or concerts. Similar products that may cause more harm than benefits include alcohol, electronic cigarettes, and opioids. We review the evidence linking problematic use of these products with exposure to marketing and discuss standards for assessing the potential harmfulness of marketing. We next address how public health agencies might apply regulatory principles to these harmful products similar to those applied to cigarette advertising, in the advancement of public health. [ABSTRACT FROM AUTHOR]

Type II translational research tends to emphasize getting evidence-based programs implemented in real world settings. To fully realize the aspirations of prevention scientists, we need a broader strategy for translating knowledge about human wellbeing into population-wide improvements in wellbeing. Far-reaching changes must occur in policies and cultural practices that affect the quality of family, school, workplace, and community environments. This paper describes a broad cultural movement, not unlike the tobacco control movement, that can make nurturing environments a fundamental priority of public policy and daily life, thereby enhancing human wellbeing far beyond anything achieved thus far. [ABSTRACT FROM AUTHOR]

Disparities in access to health care, particularly specialist care, exist worldwide. As the prevalence of chronic neurological disorders increases with ageing populations, access to neurologist care is likely to worsen in many regions if there are no changes to models of care. Telemedicine-defined here as the use of real-time, synchronous videoconferencing to deliver medical care-could be used to improve access to neurologist care for patients with a range of chronic neurological disorders. In Parkinson's disease, several studies have shown the feasibility and potential benefits of telemedicine-delivered care. Further research is needed to establish whether telemedicine can deliver on the promise of improved access to neurologist care and whether telemedicine-delivered care is comparable to in-person care in terms of clinical outcomes. Many barriers to widespread implementation of telemedicine services remain to be addressed, including reimbursement, legal considerations, and technological issues. [ABSTRACT FROM AUTHOR]

Objective To describe the rationale for a novel study design and baseline characteristics of a disease-modifying trial of isradipine 10 mg daily in early Parkinson disease ( PD). Methods STEADY- PDIII is a 36-month, Phase 3, parallel group, placebo-controlled study of the efficacy of isradipine 10 mg daily in 336 participants with early PD as measured by the change in the Unified Parkinson Disease Rating Scale ( UPDRS) Part I- III score in the practically defined ON state. Secondary outcome measures include clinically meaningful measures of disability progression in early PD: (1) Time to initiation and utilization of dopaminergic therapy; (2) Time to onset of motor complications; (3) Change in nonmotor disability. Exploratory measures include global measures of functional disability, quality of life, change in the ambulatory capacity, cognitive function, and pharmacokinetic analysis. Rationale for the current design and alternative design approaches are discussed. Results The entire cohort of 336 participants was enrolled at 55 Parkinson Study Group sites in North America. The percentage of male participants were 68.5% with a mean age of 61.9 years (sd 9.0), mean Hoehn and Yahr stage of 1.7 (sd 0.5), mean UPDRS total of 23.1 (sd 8.6), and Mo CA of 28.1 (sd 1.4). Interpretation STEADY- PD III has a novel and innovative design allowing for the determination of longer duration benefits on clinically relevant outcomes in a relatively small cohort on top of the benefit derived from symptomatic therapy. Baseline characteristics are similar to those in previously enrolled de novo PD trials. This study represents a unique opportunity to evaluate the potential impact of a novel therapy to slow progression of PD disability and provide clinically meaningful benefits. [ABSTRACT FROM AUTHOR]

Behavior analysis has produced a robust theoretical analysis of the contingencies involved in cultural evolution. Yet, thus far, the empirical yield of this work remains quite limited. With this paper, I attempt to provide specific examples of the ways to advance an experimental analysis of the contingencies involved in cultural evolution. I begin with a review of the theoretical analyses developed by behavior analysts and other contextually oriented scientists. Next, I submit that, if the goal of our science is both predicting and influencing cultural phenomena, we must produce experimental analyses of the impact of meta-contingencies on organizations' practices. There is no more pressing reason for doing this than the threat of climate change posed by the continuing growth in human use of fossil fuels. Therefore, the paper provides an analysis of the contingencies influencing organizational practices now affecting continued use of fossil fuels and the contingencies for organizations seeking to prevent their use. One concrete step to advance a science of cultural change relevant to climate change would be to create a database of organizations that are promoting vs. working to prevent fossil fuel consumption and the consequences that seem to maintain their practices. I call for experimental analysis of the impact of altering consequences for these practices and for experimental analyses of interventions intended to change the norms, values, and behavior of organizational leaders who can influence fossil fuel consumption. I then discuss the role of prosocial behavior and values in affecting behavior relevant to reducing fossil fuel consumption because the empirical evidence shows that prosociality favors more 'green' behavior. Recent advances in prevention research have identified interventions to promote prosociality, but we need experimental analyses of how advocacy organizations can be more effective in getting these interventions widely adopted. [ABSTRACT FROM AUTHOR]

The author comments on Timothy M. Waring and Ethan Tremblay's article "An Evolutionary Approach to Sustainability Science" and mentions topics including the role of the fossil fuel industry and the need for a coalition of governments, corporations and other entities to ensure human well-being.

We comment on the 2015 Society for Prevention Research standards of evidence document, summarizing major changes from the previous 2005 Standards, and point to ways in which the Standards could be further improved. We endorse important new standards, such as those on testing the causal theory and mechanisms of the intervention, improved trial reporting standards, and added attention to scale-up research and cost analyses. Despite discussion of replication in the new Standards, we are concerned about the lack of stand-alone replication standards, and the deletion of an explicit requirement for replication before an intervention is considered efficacious. Finally, we are deeply concerned about the lack of attention to the unit or level of aggregation of the intervention target. It is a major conceptual oversight. The unit targeted by an intervention (whether a cell, person, organization, community, state, nation) is a fundamental feature shaping intervention theory, research design, data collection, analyses, effect sizes, diffusion possibilities and patterns, and scale-up issues. Future Standards updates should eliminate the implicit assumption in the current text that effective preventive interventions inherently target individual persons. [ABSTRACT FROM AUTHOR]

This paper reviews evidence that behavioral family interventions are effective at improving child-rearing in distressed families and families with children exhibiting disruptive behavior. Essential therapeutic strategies offered within a collaborative therapeutic process are identified. Exemplary materials for parents and clinicians are identified. Differences between behavioral family interventions and two popular press parenting approaches are highlighted, including the lack of empirical support for these widely used programs and the advice they offer which runs counter to behavioral approaches. Recommendations are offered for combining behavioral family interventions with other empirically supported approaches, promoting more widespread use of empirically supported treatments, such as behavioral family interventions, and the need for a public health perspective on family functioning, involving collaboration among clinicians, policy makers, and researchers. [ABSTRACT FROM AUTHOR]

ABSTRACT Therapeutic decision-making in Huntington's disease (HD) is often guided by clinical experience, because of the limited empirical evidence available. The only medication for HD that has met the regulatory hurdle for approval is tetrabenazine, indicated for the treatment of chorea. However, its use has limitations, and in the setting of specific contraindications or comorbidities the treatment of choice for chorea is still the multipurpose antipsychotics. For the management of psychiatric disturbances, selective serotonin reuptake inhibitors (SSRIs) and mood stabilizers are often used, although empirical evidence is lacking. Finally, no known effective treatment is available for cognitive dysfunction in HD. We discuss the limited evidence available and current expert opinion on medical treatment of the dominant motor, psychiatric, and cognitive features of HD. This follows a brief introduction on the general principles of HD management and on evidence-based medicine in relation to clinical practice. © 2014 International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Therapeutic decision-making in Huntington's disease (HD) is often guided by clinical experience, because of the limited empirical evidence available. The only medication for HD that has met the regulatory hurdle for approval is tetrabenazine, indicated for the treatment of chorea. However, its use has limitations, and in the setting of specific contraindications or comorbidities the treatment of choice for chorea is still the multipurpose antipsychotics. For the management of psychiatric disturbances, selective serotonin reuptake inhibitors (SSRIs) and mood stabilizers are often used, although empirical evidence is lacking. Finally, no known effective treatment is available for cognitive dysfunction in HD. We discuss the limited evidence available and current expert opinion on medical treatment of the dominant motor, psychiatric, and cognitive features of HD. This follows a brief introduction on the general principles of HD management and on evidence-based medicine in relation to clinical practice. © 2014 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

The article presents information on how a fourth grade teacher at Shady Side Academy uses license plates and road trips in mathematics education in Pittsburgh, Pennsylvania. The authors looks at small group discussions and math games and activities involving license plates, such as adding up the digits, creating number patterns, and writing sentences using the letters on license plates.

High stress and burnout are common for early childhood special educators, contributing to high rates of attrition, diminished educational effectiveness, and high turnover. Acceptance and Commitment Therapy (ACT) is a promising approach for the prevention and treatment of a wide variety of problems. Using a randomized wait-list control design, this pilot study evaluated whether ACT workshops delivered to preschool teachers who serve children with developmental disabilities would improve stress-related problems of teachers (i.e., stress, depression, and burnout) and increase collegial support. At pretest, measures of experiential avoidance (EA) and mindful awareness (MA) showed significant relationships to reports of depression, stress, and burnout. The intervention reduced staff members’ EA, increased teachers’ MA and valued living (VL), and improved teachers’ sense of efficacy. This suggests that ACT workshops can help influence factors affecting depression, stress, and burnout in an early childhood special education setting. [ABSTRACT FROM PUBLISHER]

The recent Institute of Medicine report on prevention (National Research Council & Institute of Medicine, 2009) noted the substantial interrelationship among mental, emotional, and behavioral disorders and pointed out that, to a great extent, these problems stem from a set of common conditions. However, despite the evidence, current research and practice continue to deal with the prevention of mental, emotional, and behavioral disorders as if they are unrelated and each stems from different conditions. This article proposes a framework that could accelerate progress in preventing these problems. Environments that foster successful development and prevent the development of psychological and behavioral problems are usefully characterized as nurturing environments. First, these environments minimize biologically and psychologically toxic events. Second, they teach, promote, and richly reinforce prosocial behavior, including self-regulatory behaviors and all of the skills needed to become productive adult members of society. Third, they monitor and limit opportunities for problem behavior. Fourth, they foster psychological flexibility-the ability to be mindful of one's thoughts and feelings and to act in the service of one's values even when one's thoughts and feelings discourage taking valued action. We review evidence to support this synthesis and describe the kind of public health movement that could increase the prevalence of nurturing environments and thereby contribute to the prevention of most mental, emotional, and behavioral disorders. This article is one of three in a special section (see also Muñoz Beardslee, & Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012) representing an elaboration on a theme for prevention science developed by the 2009 report of the National Research Council and Institute of Medicine. [ABSTRACT FROM AUTHOR]

Replication research is essential for the advancement of any scientific field. In this paper, we argue that prevention science will be better positioned to help improve public health if (a) more replications are conducted; (b) those replications are systematic, thoughtful, and conducted with full knowledge of the trials that have preceded them; and (c) state-of-the art techniques are used to summarize the body of evidence on the effects of the interventions. Under real-world demands it is often not feasible to wait for multiple replications to accumulate before making decisions about intervention adoption. To help individuals and agencies make better decisions about intervention utility, we outline strategies that can be used to help understand the likely direction, size, and range of intervention effects as suggested by the current knowledge base. We also suggest structural changes that could increase the amount and quality of replication research, such as the provision of incentives and a more vigorous pursuit of prospective research registers. Finally, we discuss methods for integrating replications into the roll-out of a program and suggest that strong partnerships with local decision makers are a key component of success in replication research. Our hope is that this paper can highlight the importance of replication and stimulate more discussion of the important elements of the replication process. We are confident that, armed with more and better replications and state-of-the-art review methods, prevention science will be in a better position to positively impact public health. [ABSTRACT FROM AUTHOR]

The full benefit of prevention science will not be realized until we learn how to influence organizational practices. The marketing of tobacco, alcohol, and food and corporate advocacy for economic policies that maintain family poverty are examples of practices we must influence. This paper analyzes the evolution of such practices in terms of their selection by economic consequences. A strategy for addressing these critical risk factors should include: (a) systematic research on the impact of corporate practices on each of the most common and costly psychological and behavior problems; (b) empirical analyses of the consequences that select harmful corporate practices; (c) assessment of the impact of policies that could affect problematic corporate practices; and (d) research on advocacy organizations to understand the factors that influence their growth and to help them develop effective strategies for influencing corporate externalities. [ABSTRACT FROM AUTHOR]

The current study examined how maternal catecholamine levels and perceived stress, and anxiety during pregnancy were related to indices of infant temperament at 3 months postpartum. Forty-three (n = 43) pregnant women completed stress and anxiety questionnaires at 28-30 weeks gestation and consented to a blood draw that yielded estimates of sympathetic and parasympathetic nervous system function, epinephrine (E) and norepinephrine (NE), respectively. At 3 months postpartum, these women reported on their newborn's temperament using the Infant Behaviour Questionnaire. Maternal catecholamine levels obtained during pregnancy were not significantly associated with maternal report of perceived stress, life event, or pregnancy-related anxiety. However, maternal NE during pregnancy was associated with higher report of infant soothability and maternal E was marginally associated with lower ratings of infant soothability. Exploratory analyses revealed that infant sex moderated the relationship between maternal catecholamines and infant temperament. Mothers with higher levels of prenatal NE rated infant boys as having lower activity levels than girls, and mothers with higher levels of prenatal E rated infant boys as having higher distress to limitations. These findings support future research on the relationship between maternal catecholamine levels during pregnancy and the development of infant temperament. [ABSTRACT FROM AUTHOR]

The goal of our study was to characterise the relationships between trait anxiety symptoms of women during their pregnancies and birth outcomes of their offspring using a longitudinal cohort from the Maternal Health Practices and Child Development Project. We used the State-Trait Personality Index anxiety measure that is based on Spielberger's State-Trait Anxiety Inventory to measure self-reported trait anxiety at two gestational assessments (fourth and seventh months, representing the first and second trimesters, respectively) and at a third assessment shortly after delivery (representing the third trimester). Demographic, social, psychological, substance use and medical factors were assessed prenatally, and outcomes of the 763 live, singleton births were determined at delivery. In regression models, trait anxiety at the second and third trimesters predicted lower birthweight and shorter birth length, controlling for confounders. Anxiety reported at the third trimester predicted shortened gestational age, controlling for confounders. At the first and second trimesters, the relationship of birthweight and birth length to maternal trait anxiety was only significant for severe anxiety. Women whose anxiety reached severe levels for at least two trimesters were significantly more likely to deliver offspring of lower birthweight and shorter birth length than those women who reported severe anxiety at none or only one of the trimesters. Additionally, offspring of women who experienced severe anxiety during all three trimesters had shorter mean gestational age than offspring of women who did not report severe anxiety at any trimester. Women who report chronic, severe trait anxiety are at the highest risk of having shorter gestations and delivering smaller babies. [ABSTRACT FROM AUTHOR]

The PREDICT-HD study seeks to identify clinical and biological markers of Huntington's disease in premanifest individuals who have undergone predictive genetic testing. We compared baseline motor data between gene-expansion carriers (cases) and nongene-expansion carriers (controls) using t-tests and Chi-square. Cases were categorized as near, mid, or far from diagnosis using a CAG-based formula. Striatal volumes were calculated using volumetric magnetic resonance imaging measurements. Multiple linear regression associated total motor score, motor domains, and individual motor items with estimated diagnosis and striatal volumes. Elevated total motor scores at baseline were associated with higher genetic probability of disease diagnosis in the near future (partial R2 0.14, P < 0.0001) and smaller striatal volumes (partial R2 0.15, P < 0.0001). Nearly all motor domain scores showed greater abnormality with increasing proximity to diagnosis, although bradykinesia and chorea were most highly associated with diagnostic immediacy. Among individual motor items, worse scores on finger tapping, tandem gait, Luria, saccade initiation, and chorea show unique association with diagnosis probability. Even in this premanifest population, subtle motor abnormalities were associated with a higher probability of disease diagnosis and smaller striatal volumes. Longitudinal assessment will help inform whether motor items will be useful measures in preventive clinical trials. © 2009 Movement Disorder Society [ABSTRACT FROM AUTHOR]

An externality is a cost that a corporation's actions impose on society. For example, a power plant may emit mercury but might not pay for the cost of that pollution to the people living near the plant. It is possible to analyze a diverse range of problems of society in these terms, including the health effects of corporate practices, the unsustainability of manufacturing processes, and the marketing of products contributing to environmental damage, and economic policies that maintain high levels of poverty due to effective lobbying by the business community. This article examines the problem of externalities in terms of metacontingencies. Externalities continue precisely because there is no cost to the organizations for practices that impose these costs on third parties. The article describes the cultural practices needed to motivate governments to make corporations bear the true costs of their practices—costs that are currently imposed on others. [ABSTRACT FROM AUTHOR]

Individuals with Parkinson's disease (PD) often require nursing home care, where access to neurologists is limited. Telemedicine uses information and communication technologies to provide health care to individuals who are geographically separate from providers. We present a video report of a nursing home resident with PD who received telemedicine visits over 8 months from a movement disorders specialist. The visits resulted in improvements in motor and cognitive symptoms and suggest that telemedicine may be useful for delivering care to this population. © 2009 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Executive dysfunction (ED) is a prominent and often disabling feature of cognitive impairment in Parkinson's disease (PD). Few studies have examined treatments. Given the role of noradrenergic pathology in ED, atomoxetine, a norepinephrine reuptake inhibitor indicated for attention deficit hyperactivity disorder (ADHD), may be a potential treatment for PD-related ED. Twelve patients with PD and disabling ED completed an 8-week pilot open-label, flexible dose (25-100 mg/day) trial of atomoxetine. On primary outcome measures, atomoxetine was associated with improved ED based on the Clinical Global Impression-Change Scale (75% positive response rate; 95% CI: 43-95%, P < 05) and behavioral measures of ED [Frontal Systems Behavior Scale (FrSBE) Executive Dysfunction and Connors Adult ADHD Rating Scale (CAARS) inattention/memory subscales]. Adverse effects included sleep and gastrointestinal disturbances and hypomania. Atomoxetine is tolerable in PD and may benefit clinical manifestations of ED, warranting further study in controlled trials. © 2008 Movement Disorder Society [ABSTRACT FROM AUTHOR]

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior. [ABSTRACT FROM AUTHOR]

Abstract  Recent research in behavior analysis and clinical psychology points to the importance of language processes having to do with the control of negative cognition and emotion and the commitment to valued action. Efforts to control unwanted thoughts and feelings, also referred to as experiential avoidance (EA), appear to be associated with a diverse array of psychological and behavioral difficulties. Recent research shows that interventions that reduce EA and help people to identify and commit to the pursuit of valued directions are beneficial for ameliorating diverse problems in living. These developments have the potential to improve the efficacy of many preventive interventions. This paper reviews the basic findings in these areas and points to some ways in which these developments could enhance the impact of preventive interventions. [ABSTRACT FROM AUTHOR]

Abstract  In a randomized controlled trial, we evaluated the effect on tobacco use onset among middle school students of Family Communications (FC) activities designed to mobilize parental influences against tobacco use and Youth Anti-tobacco Activities (YAT) designed to market anti-tobacco norms to adolescents. We conducted a simple, two-condition experimental design in which 40 middle schools, with a prevalence of tobacco use at or above the Oregon median, received, by random assignment, either the intervention or no intervention. State, county, and local prevention coordinators around Oregon served as liaisons to schools. To generate interest, staff made presentations to these groups and distributed marketing packets at several conferences. Dependent variables were indices of smoking prevalence and use of smokeless tobacco (ST) in the prior month. Additionally, we created an intervention manual so that other communities could replicate this study. The findings suggest that efforts to influence parents to discourage their children’s tobacco use and efforts to market an anti-tobacco perspective to teens are effective in preventing smoking. The impact of YAT is consistent with experimental and nonexperimental evaluations of media campaigns to influence young people not to smoke. [ABSTRACT FROM AUTHOR]

The objective of this analysis was to identify variables that predict the initiation of smoking among adolescents, and the development of susceptibility to smoking, over a 2-year period. We assessed variables that might predict later smoking among nonsmoking students in grades 7 and 9 and assessed their smoking status 2 years later, when they were in grades 9 and 11, thus receiving data from 4,130 students at two time points. Initiation of weekly smoking over the 2 years was associated with having a parent, sibling, or close friend who smokes; low school grades; higher levels of deviant behavior; susceptibility to smoking; use of smokeless tobacco; and for 7th graders, perception of higher levels of normative smoking. Susceptibility, defined as not being able to rule out the idea of smoking a year after the survey, was identified as a strong predictor of smoking and a valuable intermediary measure. We also assessed factors associated with the prediction of susceptibility 2 years post-test. Susceptibility to smoking was associated with deviant behavior, low grades, lower parental monitoring, relaxed parental attitude toward youth smoking, ease of access to tobacco, and lower exposure to anti-tobacco messages. This study provides support for the idea that susceptibility to smoking could be a useful outcome variable for tobacco research, as an intermediary to the initiation of smoking. In addition, evidence indicates that theoretically manipulable variables, including access to tobacco and exposure to anti-tobacco information, have the potential to influence susceptibility to smoking over a time. [ABSTRACT FROM AUTHOR]

Despite increases in our understanding of the pathophysiology and environmental and genetic influences of illness in Parkinson's disease, neuroprotection remains an elusive goal. No interventions are widely accepted as disease modifying in Parkinson's disease. Continued research identifying novel therapeutic targets is likely to result in several putative neuroprotective agents. Assimilating lessons from previous neuroprotection trials will be critical in developing future trials aimed at efficiently identifying neuroprotective treatments. Ultimately, overcoming the unique challenges of a heterogenous, slowly progressive disorder with multiple potential outcome measures will be necessary to identify treatments that have meaningful effects. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the effects of rasagiline as monotherapy on quality of life (QOL) in patients with early Parkinson's disease (PD). Rasagiline, a potent, second-generation, irreversible, selective monoamine oxidase B inhibitor improves PD symptoms in patients with early PD. Patients with early untreated PD were randomly assigned to once-daily rasagiline 1 mg/day, rasagiline 2 mg/day, or placebo in a 6-month, double-blind trial (n = 404). At the end of 6 months, patients entered the preplanned, active-treatment phase in which those receiving 1 mg/day and 2 mg/day of rasagiline continued on their previously assigned dosages and those receiving placebo switched to rasagiline 2 mg/day, while maintaining blinding to treatment assignments. QOL was measured with the Parkinson's Disease Quality of Life questionnaire (PDQUALIF) at 0, 14, 26, and 52 weeks after randomization. Analysis of the change in PDQUALIF scores from baseline to 6 months showed adjusted treatment effects (with 95% confidence interval) favoring rasagiline over placebo of −2.91 units (−5.19, −0.64, P = 0.01) for the 1 mg/day group and −2.74 units (−5.02, −0.45, P = 0.02) for the 2 mg/day. Subscore analysis attributed most of this benefit to the self-image/sexuality domain. At 12 months (n = 266), with all groups receiving rasagiline for at least 6 months, no significant differences in PDQUALIF scores were seen between groups. Rasagiline improved QOL compared with placebo. This QOL improvement appears to be accounted for primarily by the symptomatic benefit of rasagiline. © 2006 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Abstract: The authors calculated binary indicators of seven positive and 23 negative behaviours for 22,898 8th and 15,828 11th grade students who participated in the Oregon Healthy Teens Survey across two school years. Relationships among these variables, using both the Jaccard measure of co-occurrence and the relative risk for each member of each variable pair, given exposure to the other, showed strong inter-relationships within, but not between, the sets of behaviours. The likelihood of negative behaviours given negative behaviours was much stronger than the likelihood of positive behaviours given positive behaviours. Positive behaviours provided little protection against the likelihood of negative behaviors. [Copyright &y& Elsevier]

Modifications of a transconjunctival sutureless vitrectomy system (TSV 25, Bausch & Lomb Surgical) for removing cataracts and performing poster capsulotomy–anterior vitrectomy in children are reported. [Copyright &y& Elsevier]

Objective: To examine the relation between rates of sales of tobacco to minors and youth smoking Design: Repeated annual cross sectional surveys. Setting: Seventy five communities in Oregon. Participants: A random sample of students in grades 8 and 11 (ages 13 and 17 years) and retail outlets in each participating community. Main outcome measures: Thirty day and daily smoking prevalence. Results: The rate of illegal merchant sales in the communities was related to the smoking rate for 11th graders in those communities, but not for 8th graders. For every 10% increase in illegal sales rates there was an estimated 0.8% increase in 11th grade 30 day smoking prevalence and a 0.4% increase in daily smoking. Communities with lower illegal merchant sales rates had expanded use of social sources and reduced use of commercial sources by 11th graders, with the opposite pattern seen in 8th graders. Conclusions: There appears to be a relatively small positive linear relation between the community rate of sales to minors and 11th grade youth smoking prevalence in those communities. Youth adjust their tobacco sources depending on the level of commercial availability. [ABSTRACT FROM AUTHOR]

School surveys conducted to monitor the prevalence of adolescent smoking generally yield higher estimates than home-based surveys. Our goal was to examine the consistency of this mode effect over age for different measures of adolescent smoking behavior. If consistent, it would be feasible to define a simple adjustment factor for comparing overall results across survey modes. We identified three pairs of school- and home-based surveys (two national pairs and one California pair), each pair conducted in the same year, that allowed us to compare three key measures of adolescent smoking across age: (a) Ever tried, (b) smoking in past 30 days, and (c) regular smoking. We also examined male experimentation with smokeless tobacco, for which a mode effect has not been investigated. School surveys yielded higher estimates than in-home surveys for all the tobacco-use measures examined. In general, the mode effect was greater in younger age groups. Estimates for the two modes appeared closer for current and regular smoking measures compared with the ever-tried measure. Considering report of smoking in the past 30 days, the mode effect was much greater for infrequent smoking (1-9 days) than for more frequent (10z days) smoking. Finally, school surveys yielded much higher estimates for male smokeless tobacco use than did home surveys. Because mode effects were related to age and level of reported use, no simple correction factor for comparing across modes is feasible. Social desirability bias of self-reported behavior in the different settings may account in part for the observed mode effects. [ABSTRACT FROM AUTHOR]

The prevention of youth problem behaviors is increasingly guided by science. Sound epidemiological research is coming to guide preventive efforts. Valid methods of monitoring the incidence and prevalence of youth problems increasingly shape preventive practice. The identification of empirically supported prevention interventions is becoming more sophisticated, and numerous scientific organizations have begun to engage in dissemination activities. These trends will be accelerated by increased media advocacy for the use of scientific methods and findings, the development of a registry of preventive trials, achievement of consensus about the standards for identifying disseminable interventions, and increased research on the factors that influence the effective implementation of science-based practices. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the incidence of secondary membrane formation, factors that lead to its development, and the frequency of procedures to treat these membranes in children after cataract surgery.Setting: Department of Pediatric Ophthalmology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.Methods: Clinical records of 152 patients (190 eyes) who had cataract extraction between January 1986 and 1996 were reviewed retrospectively. The mean follow-up was 6 years (range 2 to 13 years). Cataract surgery was performed through a limbal incision in all cases. Twenty-eight eyes had a primary posterior capsulectomy, and 120 eyes had posterior capsulectomy combined with an anterior vitrectomy. In 42 eyes, the posterior capsule was left intact. Nineteen eyes received a primary intraocular lens (IOL), 15 eyes received a secondary IOL, and 156 eyes were rehabilitated with spectacles or contact lenses.Results: Seventy-two eyes (37.9%) developed secondary membrane a mean of 8.9 months postoperatively (range 3 weeks to 53 months). Membranes occurred in 78.6% of eyes with an intact posterior capsule, 42.9% with posterior capsulectomy, and 22.5% with combined posterior capsulectomy and anterior vitrectomy. Secondary membrane formation was associated with not performing a posterior capsulectomy with anterior vitrectomy (P < .001) and the presence of a primary IOL (P < .001). Younger age at surgery increased the chance of secondary membrane formation in patients who had posterior capsulectomy and anterior vitrectomy (P < .01).Conclusions: The younger the child at cataract surgery, the greater the risk of secondary membrane. Primary posterior capsulectomy combined with an anterior vitrectomy decreased but did not eliminate the incidence of secondary membrane. [Copyright &y& Elsevier]

Describes evaluation of a consultative approach to assisting middle schools in implementing empirically based school-wide behavior management practices. Effective Behavior Support program; Systems for the positive reinforcement of appropriate social behavior; Measures of discipline referrals; Student survey assessment procedures.

The replicability of a model of family and peer influences on adolescent problem behavior was evaluated with samples of adolescent boys and girls from three ethnic groups: American Indians, Hispanics, and Caucasians. Participants were 1,450 seventh-grade students from 16 communities. The model included links between three aspects of family functioning (family conflict, positive family relations, and inadequate parental monitoring) and adolescents' association with deviant peers. Those variables were hypothesized predictors of adolescents' problem behavior (antisocial behavior, poor school performance, and frequency of substance use). The resulting cross-sectional model showed good consistency across the three ethnic groups for both genders, but some subgroup differences emerged in the magnitude of relations between monitoring and adolescents' associations with deviant peers and between substance use and the problem behavior construct. With those qualifications, the model was applicable to Hispanic and Native American adolescents in the sample. [ABSTRACT FROM AUTHOR]

Discusses a study that evaluated the effects of supplemental instruction in reading for students in kindergarten through Grade 3. Need for supplemental instruction; Efficacy of supplemental instruction for Hispanic students; Method used in the evaluation; Screening for reading skill deficits; Value of supplemental instruction in decoding skills for students.

Compares the progress in reducing tobacco use and the prevention of violent crimes in the United States. Influence of cultural practices on the incidence of behaviors in a population; Development of a network of social organizations with programs aimed at reducing tobacco use; Nonexistence of an empirically based analysis for violent crimes.

Presents a study which conducted a randomized controlled trial of a behavioral intervention to reduce the risks of sexual behavior in adolescents in public sexually transmitted disease clinics. Intervention targets in behavior; Reports of sexual activities and marijuana use; Improvement in service systems; Discussion and conclusion.

The stability and validity of early adolescents' reports of 6 parenting constructs were examined: parent-child conflict, positive family relations, parental monitoring, parents' rule making, consistent enforcement of rules, and use of positive reinforcement. Hierarchical confirmatory factor analysis (CFA; H. W. Marsh & D. Hocevar, 1988) on questionnaire data from 3 quarterly assessments of 174 5th-7th grade youth was used to test a multitrait-multimethod (MTMM) model containing 6 parenting constructs as trait factors and 3 assessment occasions as method factors. Youths' reports of these parenting constructs were stable over time, and the CFA approach to MTMM data demonstrated convergent and discriminant validity of the constructs. Each parenting construct was significantly correlated with youths' reports of deviant peer associations, antisocial behavior, and substance use, providing evidence of criterion validity. [ABSTRACT FROM AUTHOR]

Examines the effectiveness of behavior-based parenting skills programs for parents of middle school students in small communities. Evidence of the effectiveness of the programs provided by supervised group leaders who are not mental health clinicians; Impact of the program on improving problem-solving interactions between parents and children.

Examines the value of Parenting Scale for assessing the discipline practices of parents of middle school children. Overactivity factor; Child Behavior Checklist; Factor analysis.

Focuses on the need for behavioral scientists to research on reducing the incidence and prevalence of antisocial behavior. Incidence and prevalence of antisocial behavior; Need for research on community and advocacy organizing; Need to define the concept of advocacy and community organizing.