Self-control enhancement in children:Ethical and conceptual aspects

Childhood self-control is currently receiving great scientific and public attention because it could predict much of adult’s life success and well-being. Specialized interventions based on findings in social psychology and neuroscience potentially enhance children’s capacity to exercise self-control. This perspective triggers hopes that self-control enhancement allows us to say good-bye for good to potentially unsafe psychopharmacological agents and electronic brain stimulants. This chapter provides an in-depth ethical analysis of pediatric self-control enhancement and points toward a series of serious conceptual and ethical concerns. First, it gives an overview of current psychological as well as neuroscientific research on self-control, and it presents longitudinal studies that emphasize the importance of childhood self-control for adult life success. Second, it critically discusses the concept of self-control presupposed in these approaches and points to crucial limitations. Going beyond an understanding of self-control as a sophisticated means of goal-achievement, i will argue for a comprehensive understanding that takes the inherent normativity of self-controlled behavior seriously. In that context, self-control enhancement appears as not necessarily desirable and occasionally even detrimental. Finally, this chapter questions the notion of childhood implicit in current research and how values typically put on this phase of life could get affected by self-control enhancement. I finish with an exploration of the conditions under which pediatric self-control enhancement is either impermissible, permissible, or maybe obligatory

Identifying children with Special Health Care Needs in Alexandria, Egypt

ObjectiveTo test the feasibility of using an Arabic version of CSHCN Screener in identifying CSHCN in the Egyptian setup and to estimate the prevalence of CSHCN among children aged 6-14 years in Alexandria, Egypt using the Arabic version of the CSHCN Screener.IntroductionChildren with special health care needs (CSHCN) are defined as: “those who have or are at increased risk for a chronic physical, developmental, behavioural, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” (1) The care of CSHCN is a significant public health issue. These children are medically complex, require services and supports well beyond those that typically developing children require, and command a considerable proportion of the pediatric health care budget. (2)Different tools were used to identify CSHCN. (3, 4) One of them is the CSHCN screener (5) which uses a non-condition specific approach that identifies children across a range and diversity of childhood chronic conditions and special needs. (6) It identifies children with elevated or unusual needs for health care or educational services due to a chronic health condition. It focuses on health consequences a child experiences as a result of having an ongoing health condition rather than on the presence of a specific diagnosis or type of disability. It allows a more comprehensive assessment of the performance of the health care system than is attainable by focusing on a single diagnosis. (7) The CSHCN screener is only available in English and Spanish. (8)In developing countries, obtaining reliable prevalence rates for CSHCN is challenging. Sophisticated datasets associated with governmental services and high quality research studies are less common due to fewer resources. Egypt has no screening or surveillance systems for identifying CSHCN. (9)MethodsA community based survey was conducted among a representative sample of children aged 6-14 years from the 8 health districts of Alexandria, Egypt using a multistage cluster sampling technique. The final sample amounted to 501 children from 405 families. Data about the children and their families were collected by interviewing the mothers of the selected children using a pre-designed interviewing questionnaire. The questionnaire included their personal and family characteristics in addition to the Arabic translation of CSHCN screener. Permission to translate the questionnaire into the Arabic language was obtained from the Child and Adolescent Health Measurement Initiative. Validation and cultural adaptation of the translated CSHCN screener were done. The survey questions were generally understandable by Arabic speakers. As for the screener questions, the Arabic translation was straightforward and clear. The difference between the Arabic translation for the words “health conditions” and “medical conditions” in the 1st follow up questions was not clear for the respondents and the interviewers had to give an explanation for the two terms to help the respondents. So, it was easier for the respondents to answer the screener questions than the follow up questions.ResultsOut of the 501 children included in the study, 61 were identified by the screener to be CSHCN, making a prevalence of CSHCN of 12.2%. The prevalence of children with dependency on prescription medicine was 11.8%, while the prevalence of children with service use above that considered usual or routine was 11.8%. The prevalence of children with functional limitations was 12%. Among these domains, in almost all children, the reason was a medical, behavioral or health condition (98.3%) and the condition has continued or is expected to continue for at least 12 months in all children. Among CSHCN, the majority (91.8%) had these three domains combined.Sensory impairments ranked first among the most prevalent conditions requiring special health care with a prevalence of 2.8% which represented 23% of the conditions, followed by cognitive impairments with a prevalence of 2% representing 16.4% of all conditions requiring special health care. Impaired mobility was the third most common condition requiring special care with a prevalence of 1.8%.The table shows that CSHCN were more likely to be in the younger age group (6-<10 years), to be males, to be the first in order among their siblings and to have an illiterate or just read and write father. On the other hand, CSHCN were less likely to have a university educated mother, to be living with both parents and to be from a family without an enough income. The only significant factor was the type of family (cOR=0.88, 95% CI = 0.85-0.91).ConclusionsThe study showed the feasibility to use the CSHCN screener in the Egyptian National health care services to easily identify the majority of children that need to be the focus of the National health care services. It could also be an easy tool to assess the quality of the ongoing school health programs in responding to the overall needs of school children.With the present Egyptian policy of reform giving special attention to people in need particularly sensitive groups such as school children, it is therefore recommended that the school health services, in addition to the ongoing diagnostic, preventive and curative services add an additional measure, namely the screener for CSHCN, which is a simple easily administered screening tool which will also assist to depict existing gaps in the health care system to ensure being comprehensive.ReferencesMcPherson M, Arango P, Fox C, et al. A new definition of children with special health care needs. Pediatrics 1998;102:137-40.Goldson E, Louch G, Washington K, et al. Guidelines for the care of the child with special health care needs. Adv Pediatr 2006;53:165-82.Newacheck PW, Strickland B, Shonkoff JP, et al. An epidemiologic profile of children with special health care needs. Pediatrics 1998;102:117-23.Stein REK, Silver EJ. Operationalizing a conceptually based noncategorical definition. A first look at U.S. children with chronic conditions. Arch Pediatr Adolesc Med 1999;153:68-74.Child and Adolescent Health Measurement Initiative. The children with special health care needs (CSHCN) screener. Baltimore: CAHMI; 1998. 10p.Child and adolescent initiative. Who are children with special health care needs (CSHCN). Baltimore: CAHMI; 2012. 2p.Bethell CD, Read D, Neff J, et al. Comparison of the children with special health care needs screener to the questionnaire for identifying children with chronic conditions–revised. Ambul Pediatr 2002;2:49-57.Read D, Bethell C, Blumberg SJ, et al. An evaluation of the linguistic and cultural validity of the Spanish language version of the children with special health care needs screener. Matern Child Health J 2007;11(6):568-85.Kennedy P, editor. The Oxford Handbook of Rehabilitation Psychology. Oxford, New York: Oxford University Press; 2012.

In Helping a Vulnerable Bot, You Help Yourself: Designing a Social Bot as a Care-Receiver to Promote Mental Health and Reduce Stigma

Helping others can have a positive effect on both the giver and the receiver. However, supporting someone with depression can be complicated and overwhelming. To address this, we proposed a Facebook-based social bot displaying depressive symptoms and disclosing vulnerable experiences that allows users to practice providing reactions online. We investigated how 55 college students interacted with the social bot for three weeks and how these support-giving experiences affected their mental health and stigma. By responding to the bot, the participants reframed their own negative experiences, reported reduced feelings of danger regarding an individual with depression and increased willingness to help the person, and presented favorable attitudes toward seeking treatment for depression. We discuss design opportunities for accessible social bots that could help users to keep practicing peer support interventions without fear of negative consequences.N

Implementation Research to Address the United States Health Disadvantage Report of a National Heart, Lung, and Blood Institute Workshop

Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health—a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders. Recommendations for National Heart, Lung, and Blood Institute consideration were made in several areas including understanding the drivers of the disadvantage, identifying potential solutions, creating strategic partnerships with common goals, and finally enhancing and fostering a research workforce for implementation research. Key recommendations included exploring why the United States is doing better for health indicators in a few areas compared with peer countries; targeting populations across the entire socioeconomic spectrum with interventions at all levels in order to prevent missing a substantial proportion of the disadvantage; assuring partnership have high-level goals that can create systemic change through collective impact; and finally, increasing opportunities for implementation research training to meet the current needs. Connecting with the research community at large and building on ongoing research efforts will be an important strategy. Broad partnerships and collaboration across the social, political, economic, and private sectors and all civil society will be critical—not only for implementation research but also for implementing the findings to have the desired population impact. Developing the relevant knowledge to tackle the U.S. health disadvantage is the necessary first step to improve U.S. health outcomes