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In Chapter 3 I introduce the basics of causal modelling and Bayes nets. I show how formal causal models support various types of inference, including prediction, diagnosis, intervention-based reasoning and counterfactuals. The framework serves several purposes: helping us to build formal models of legal cases, giving us a benchmark against which to assess human inference, and suggesting how people can improve their reasoning.
Transcatheter ventricular septal defect closure remains a complex procedure with potential complications like complete heart block and aortic regurgitation. The ideal device design for such intervention is still evolving.
To assess the safety, efficacy, and short-term outcome of ventricular septal defect closure using LifeTechTM multifunctional (KONAR-MFTM) VSD Occluder.
Patients and methods:
In a multicenre study, 44 patients with haemodynamically significant, restrictive ventricular septal defects underwent closure with the KONAR-MFTM device from April, 2019 to March, 2020. Clinical, echocardiographic, and angiographic data were collected and reviewed. Patients were followed up at 1, 3, 6, and 12 months.
The median age and weight were 8 (1.7–36) years and 20 (11–79) kg. Of 44 patients, 8 (18%) had a high muscular and 36 (82%) had a perimembranous defect, of which 6 had mild prolapse of the right coronary cusp. The median ventricular septal defect size was 8.8 (3.9–13.4) mm. A retrograde approach was adopted in 39 (88.6%) patients. Nine patients (20.5%) had a small residual leak and there was a slight increase in aortic regurgitation in one patient. One device, which embolised to pulmonary artery was retrieved, and the defect was closed with a larger device. At a median follow-up of 13 (5–18) months, the residual leak persisted in 1 (2.3%) patient. Mild aortic regurgitation in one patient remained unchanged. There were no major complications.
Percutaneous closure of ventricular septal defect using KONAR-MFTM device is safe and effective in short and midterm follow-up including selected patients with perimembranous defect and mild prolapse of the right coronary cusp.
Despite its global importance and the recognition of dementia as an international public health priority, interventions to reduce stigma of dementia are a relatively new and emerging field. The purpose of this review was to synthesize the existing literature and identify key components of interventions to reduce stigma of dementia. We followed Arksey and O’Malley’s scoping review process to examine peer-reviewed literature of interventions to reduce dementia-related stigma. A stigma-reduction framework was used for classifying the interventions: education (dispel myths with facts), contact (interact with people with dementia), mixed (education and contact), and protest (challenge negative attitudes). From the initial 732 references, 21 studies were identified for inclusion. We found a variety of education, contact, and mixed interventions ranging from culturally tailored films to intergenerational choirs. Findings from our review can inform the development of interventions to support policies, programs, and practices to reduce stigma and improve the quality of life for people with dementia.
Between 5% and 14% of women suffer from fear of childbirth (FOC) which is associated with difficulties during birth and in postnatal psychological adjustment. Therefore, effective interventions are needed to improve outcomes for women. A systematic review and meta-analysis was used to identify effective interventions for treating women with FOC.
Literature searches were undertaken on online databases. Hand searches of reference lists were also carried out. Studies were included in the review if they recruited women with FOC and aimed to reduce FOC and/or improve birth outcomes. Data were synthesised qualitatively and quantitatively using meta-analysis. The literature searches provided a total of 4474 citations.
After removing duplicates and screening through abstracts, titles and full texts, 66 papers from 48 studies were identified for inclusion in the review. Methodological quality was mixed with 30 out of 48 studies having a medium risk of bias. Interventions were categorised into six broad groups: cognitive behavioural therapy, other talking therapies, antenatal education, enhanced midwifery care, alternative interventions and interventions during labour. Results from the meta-analysis showed that most interventions reduced FOC, regardless of the approach (mean effect size = −1.27; z = −4.53, p < 0.0001) and that other talking therapies may reduce caesarean section rates (OR 0.48, 95% CI 0.48–0.90).
Poor methodological quality of studies limits conclusions that can be drawn; however, evidence suggests that most interventions investigated reduce FOC. Future high-quality randomised controlled trials are needed so that clear conclusions can be made.
The health status of children in the United States varies by racial and ethnic, shaped by an interrelated set of systems that disadvantage children of color in the United States. In this article, we argue for a broad view of resilience, in both research and policy, that views resilience not just as a property of individuals but also as a characteristic of social contexts and policies. Accordingly, we describe the empirical evidence for policies and contexts as factors that can improve health among children and families that are deprived of equal opportunities and resources due to structural racism. We discuss the evidence and opportunities for policies and interventions across a variety of societal systems, including programs to promote economic and food security, early education, health care, and the neighborhood and community context. Based on this evidence and other research on racism and resilience, we conclude by outlining some directions for future research.
To systematically review the literature with the primary aim of identifying behavioural interventions to improve vitamin D stores in children from at-risk ethnic groups.
Review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PROSPERO registration number: CRD42017080932. Health Behaviour Model and Behaviour Change Wheel framework constructs used to underpin evaluation of interventions. Methodological quality evaluated using Cochrane Risk of Bias, Cochrane ROBINS-I and NHLBI tools.
Databases Cochrane Library, MEDLINE, EMBASE, CINAHL with secondary search of Google Scholar. No country limits set. Papers between January 1990 and February 2018, published in English included. Anticipating study heterogeneity, outcome measures not pre-specified and identified from individual full papers. Updated literature search November 2020.
Patient or population including pregnant women, newborns and children aged under 18 years, from Asian or African ethnic groups.
Of 10 690 articles screened, 298 underwent full-text review, with 24 ultimately included for data extraction. All identified studies conducted a vitamin D pharmacological supplementation intervention, with two also incorporating a behavioural intervention strategy. No study explicitly defined a primary aim of evaluating a behavioural intervention, undertaken to study its effect on vitamin D supplement uptake.
There is a need to address the paucity of data in ethnic at-risk children on how behavioural interventions ideally developed and co-produced with the community under study, affect and help improve vitamin D uptake, within the antenatal and pregnancy phase as well as during childhood.
The conventional wisdom that human growth is optimal when adequate amounts of all nutrients, minimal infection, and adequate psychosocial stimulation are available is too simplistic. The extensive interacting networks of material, biological, social, and ideological variables that comprise human life give rise to a hugely complicated matrix of factors that shape human phenotypes. There is no single optimal pattern of growth. There are ranges of possibilities with a multitude of local optima within the developmental matrix. The importance of social-economic-political-emotional (SEPE) factors is discussed in relation to new hypotheses of community effects and strategic growth adjustments on human development.
A student’s hope – their ability to both envision paths to desirable future goals and believe that they will get there – is a powerful force within the school context. In this chapter, I discuss the relevance and utility of hope within the school setting for school psychologists. The chapter begins with an overview of hope theory, including how it is typically measured and its documented relationships with the achievement, academic engagement, mental health, and socioemotional functioning of students. Next, I discuss several ways school psychologists can promote hope schoolwide through various school policies and actions. Lastly, I go over several research-based hope interventions that can be employed in small groups as well as several informal hope-based interventions that can be utilized by school personnel more broadly. There are many ways that hope can be useful to school psychologists. This chapter provides a starter hope toolkit for how it can be leveraged.
Asthma is increasing in prevalence in school-aged children. Causes for it include psychological triggers such as anxiety, stress, and depression. Interventions that are derived from education and psychology appear promising for symptom reduction. These treatments include written emotional expression, relaxation and guided imagery, gratitude exercises, mindfulness, and yoga, amongst others. This chapter reviews the myriad causes and treatments for childhood asthma.
In this chapter, we provide an overview of the theoretical basis of, barriers to, and interventions aimed at improving belonging in schools. Our discussion focuses on interpersonal relations and individual perceptions as fundamental to the sense of belonging. We review research on belonging as a fundamental human motive as well as newer work exploring variability in the experience of belonging. We also address barriers to belonging, illustrating the relational role of peers and teachers. We conclude by highlighting three interventions shown to foster belonging in an educational context, focusing on challenging psychological perceptions of threat (Walton & Cohen, 2011), changing the climate (Walton et al., 2015), and promoting cross-group friendships (Page-Gould, Mendoza-Denton, & Tropp, 2008). Throughout the chapter, we highlight the importance of the roles of the institution, community, and individuals involved.
Parental autonomy and relatedness support are crucial aspects of parental involvement and address core psychological needs. Although parental autonomy support has been incorporated into successful prevention programs, broader preventive possibilities will be examined. Six parental autonomy support intervention studies have been conducted with mostly middle to high socioeconomic status (SES) students in the United States, Canada, and Italy, yielding positive effects on intrinsic motivation, emotions toward learning, engagement, altruism, and mental health. Although cross-sectional and longitudinal studies have indicated that parental autonomy support promotes positive outcomes among students across all SES levels and in diverse countries, it is time to assess whether parental autonomy support interventions are equally or more effective for youth of low-SES backgrounds, diverse ethnicities, and diverse nationalities. The specific components of parental autonomy support will be discussed, as well as the potential to integrate autonomy supportive parenting with other valuable aspects of parent involvement.
Self-regulated learning (SRL) involves a system of cyclically related, goal-directed skills and processes that students can use to overcome academic challenges and to optimize their success in school. Although there are many complex models of SRL, the purpose of this chapter is to distill key themes among prominent SRL theories and to provide practical guidelines for incorporating SRL principles into classroom instruction or direct service activities with students. In this chapter, we describe how students can be taught to engage in a cyclical process of SRL involving the use of metacognitive skills (i.e., setting goals, planning, and evaluating), strategic thinking and action, and adaptive motivational beliefs. The authors also illustrate how educators can support SRL skills by fostering a supportive learning environment encompassing five key principles (e.g., helping students set clear and relevant goals, talking in the language of strategies) and/or by implementing established school-based SRL intervention programs. The characteristics of a SRL intervention program, called the Self-Regulation Empowerment Program (SREP), concrete SRL case scenarios, and supplemental resources are also emphasized.
Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective.
This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269).
A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10–24 years) in LMICs.
Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver–adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only.
Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.
Intimate Partner violence (IPV) is a global major public health problem, exposing women and children to adverse health outcomes. Refugee families are particularly at risk for IPV, a consequence of previous exposure to organized violence as well as migration stress and lack of societal protection. Refugee families from societies with traditional and patriarchal values resettling in secular societies cherishing gender equality and children’s rights face a challenge when women and children adjust to new ideals more rapidly than the men do. It is important to address that migration stress may cause or increase conflicts in the family and learn to handle conflicts in close relationships without violence. Health care procedures developed to recognize women exposed to IPV in general, such as screening for IPV in maternal care and child health care, need to be available for immigrants and refugee women. In the chapter, a case vignette illustrates how clinicians can work to unveil domestic violence and wartime trauma in refugee families and find ways to support a child exposed to both through collaboration with the parents.
Systematic reviews and meta-analyses suggest that behaviour change interventions have modest effect sizes, struggle to demonstrate effect in the long term and that there is high heterogeneity between studies. Such interventions take huge effort to design and run for relatively small returns in terms of changes to behaviour.
So why do behaviour change interventions not work and how can we make them more effective? This article offers some ideas about what may underpin the failure of behaviour change interventions. We propose three main reasons that may explain why our current methods of conducting behaviour change interventions struggle to achieve the changes we expect: 1) our current model for testing the efficacy or effectiveness of interventions tends to a mean effect size. This ignores individual differences in response to interventions; 2) our interventions tend to assume that everyone values health in the way we do as health professionals; and 3) the great majority of our interventions focus on addressing cognitions as mechanisms of change. We appeal to people’s logic and rationality rather than recognising that much of what we do and how we behave, including our health behaviours, is governed as much by how we feel and how engaged we are emotionally as it is with what we plan and intend to do.
Drawing on our team’s experience of developing multiple interventions to promote and support health behaviour change with a variety of populations in different global contexts, this article explores strategies with potential to address these issues.
Psychosocial interventions in families of children with cancer are considered an effective way of empowering family members to tackle the complex hurdles they face. The ability of parents to develop adaptive coping strategies during the child's treatment is not only important to their own mental and physical health, but also to their child's well-being and long-term adjustment with the disease.
The aim of this review was to evaluate the existing literature for the period from 2009 to 2017 on psychosocial interventions targeting families of children with cancer. We searched the PubMed database using the following combination of keywords: “cancer AND children AND (intervention OR training) AND (mothers OR primary caregivers OR parents OR fathers OR siblings).”
After careful evaluation of 995 papers, 17 full-text papers were found to match our criteria (12 randomized controlled trials and 5 quasi-experimental studies). The quality of the studies was assessed using the Delphi score questionnaire, and the score of the reviewed studies ranged from 3 to 5. The findings suggest that most interventions reduced distress and improved coping strategies among participants. Interventions, mainly cognitive behavioral therapy and problem-solving skills training targeting maternal distress, were associated with improved adjustment outcomes in mothers of children with cancer.
Significance of results
Psychosocial interventions are helpful, and efforts should be made to promote them in a larger scale. Protocols should be implemented to ensure that all parents benefit. Computer-assisted methods may provide additional benefit by improving cancer-related knowledge and cancer-related communication.
Children and adolescents display different symptoms of post-traumatic stress disorder (PTSD) than adults. Whilst evidence for the effectiveness of psychological interventions has been synthesised for adults, this is not directly applicable to younger people. Therefore, this systematic review and meta-analysis synthesised studies investigating the effectiveness of psychological interventions for PTSD in children, adolescents and young adults. It provides an update to previous reviews investigating interventions in children and adolescents, whilst investigating young adults for the first time.
We searched published and grey literature to obtain randomised control trials assessing psychological interventions for PTSD in young people published between 2011 and 2019. Quality of studies was assessed using the Cochrane Risk of Bias tool. Data were analysed using univariate random-effects meta-analysis.
From 15 373 records, 27 met criteria for inclusion, and 16 were eligible for meta-analysis. There was a medium pooled effect size for all psychological interventions (d = −0.44, 95% CI −0.68 to −0.20), as well as for Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) (d = −0.30, 95% CI −0.58 to −0.02); d = −0.46, 95% CI −0.81 to −0.12).
Some, but not all, psychological interventions commonly used to treat PTSD in adults were effective in children, adolescents and young adults. Interventions specifically adapted for younger people were also effective. Our results support the National Institute for Health and Care Excellence guidelines which suggest children and adolescents be offered TF-CBT as a first-line treatment because of a larger evidence base, despite EMDR being more effective.
Cognition changes with age, and the amount and trajectory of change varies across individuals and functions. In this review, we argue that three general principles characterize adult life-span changes in brain and cognition. (1) Dimensionality: Many features of brain and cognition in aging and neurodegenerative disease represent quantitative differences along a continuum and are not unique to pathology. (2) Early influences – developmental origins of health and disease: Genetic dispositions and early environmental factors, likely even from fetal life, can have lasting impact on the brain and cognition. (3) Influences from a multitude of environmental factors: Current brain state and cognitive function will be determined by a combination of early factors and later environmental influences, often in interaction. These principles entail a model of age-associated cognitive decline and dementia based on dimensions rather than categories, life span rather than aging, and multidimensional systems-vulnerability rather than one major “biomarker.”
Aging is marked by cognitive decline, which in the case of Alzheimer’s disease is associated with tremendous global economic burden. Identifying modifiable risk factors for cognitive decline is therefore of paramount importance. In this chapter, we describe how aging compromises sleep quality and sleep architecture at a rate that parallels normal age-related cognitive decline. We argue that understanding the neurocognitive functions of sleep – frontal lobe restoration, memory consolidation, and metabolite clearance – and how such functions change in later life will be key to informing why some older individuals maintain healthy cognitive functioning and other older individuals do not. Critically, by investigating how sleep, cognition, and aging interact, researchers and clinicians can develop sleep-related treatments that target preventing, or at least ameliorating, pathologies such as Alzheimer’s disease.
Because of age-related cognitive declines, people sometimes expect older adults to be incompetent, senile, or extremely forgetful. Research on stereotype threat suggests that these negative expectations can interfere with older adults’ performance on cognitive tests and can cause them to underperform compared to their potential. However, research also shows that not all cognitive domains, and not all older adults, are equally affected by stereotype threat. Stereotype threat effects seem to occur most reliably on cognitive tasks where there are larger deficit expectations and for people who have concerns or negative expectations about aging and cognition. In addition to outlining these task and individual differences, in this chapter we also review potential mechanisms underlying these effects and discuss the applied implications of stereotype threat for how older adults’ memory is assessed in clinical and eyewitness settings.