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Long-term study of smoking by secondary schoolchildren.

We report the methodology and some first year results of a 5-year longitudinal study of smoking. In 6330 Derbyshire secondary schoolchildren aged 11-16 years, 6% of boys and 2.5% of girls were smoking one or more cigarettes per week. Higher rates of regular smoking and of children who had tried smoking were found in secondary modern schools, followed by middle, comprehensive and grammar schools. The results clarify the relationship between children's smoking habits and those of the parents and siblings. Boys were more likely to smoke if their fathers smoked and girls were more likely to smoke if their mothers smoked. Irrespective of parental smoking, whether or not siblings smoked had a great influence on whether the child would smoke. Having more money to spend, working at a part-time job, spending more evenings out with a mixed-sex peer group, at a youth club, or out dancing, and playing truant from school were all associated with an increased risk of smoking.

Adolescent↗

The aftermath of Angie's overdose: is soap (opera) damaging to your health?

In a study designed to evaluate the behavioural impact of a fictional parasuicide--namely, Angie's overdose on the popular television soap opera EastEnders--information about cases of deliberate overdose treated in accident and emergency departments in 63 hospitals throughout Britain was obtained for the week after the televised overdose (experimental period) and the week before the overdose (control period). After adjusting for trends in the equivalent weeks in a control year (1985) the increase in the cases of parasuicide treated by hospitals during the experimental week was not found to be significant. A significant increase (31%) was found among people aged greater than or less than 45, but this is not thought to be reliable. The increase among women alone (21%) was significant with a one tailed test. Contrary to expectations there was a positive association between trends in overdose and distance from London--that is, the further the distance of the region from London the greater the increase in cases of overdose during the experimental period--and a negative association between trends in overdose and viewing figures--that is, the higher the viewing figure the less the impact on the incidence of overdoses. These findings do not lend support to the claim that there was a strong imitation effect after this televised parasuicide.

Adult↗

Media coverage as a risk factor in suicide.

A total of 293 findings from 42 studies on the impact of publicized suicide stories in the media on the incidence of suicide in the real world were analyzed by logistic regression analysis. Studies measuring the effect of either an entertainment or political celebrity suicide story were 14.3 times more likely to find a copycat effect than studies that did not. Studies based on a real as opposed to fictional story were 4.03 times more likely to uncover a copycat effect. Research based on televised stories was 82% less likely to report a copycat effect than research based on newspapers. A review of recent events in Austria and Switzerland indicates that suicide prevention organizations can successfully convince the media to change the frequency and content of their suicide coverage in an effort to reduce copycat effects.

Age Factors↗

Media coverage as a risk factor in suicide.

A total of 293 findings from 42 studies on the impact of publicized suicide stories in the media on the incidence of suicide in the real world were analyzed by logistic regression analysis. Studies measuring the effect of either an entertainment or political celebrity suicide story were 14.3 times more likely to find a copycat effect than studies that did not. Studies based on a real as opposed to fictional story were 4.03 times more likely to uncover a copycat effect. Research based on televised stories was 82% less likely to report a copycat effect than research based on newspapers. A review of recent events in Austria and Switzerland indicates that suicide prevention organizations can successfully convince the media to change the frequency and content of their suicide coverage in an effort to reduce copycat effects.

Guidelines as Topic↗

Can compassion be taught?

Socrates (in the Meno) denied that virtues like courage could be taught, whereas Protagoras defended this claim. Compassion is discussed below in this context; it is distinguished from related, but different, moral qualities, and the role of imagination is emphasised. 'Sympathy's and role-modelling views of compassion's acquisition are criticised. Compassion can indeed be taught, but neither by the example of a few, isolated physicians nor by creation of Departments of Compassion. In replying to one standard objection to teaching compassion, it is emphasised that scientific competence and compassion aren't mutually exclusive.

Education, Medical↗

Brain activation during ideomotor praxis: imitation and movements executed by verbal command.

BACKGROUND: Ideomotor apraxia is a disorder of both imitation movements and movements executed by verbal command. Lesion studies have identified the left parietal lobe as the neural correlate for ideomotor praxis (IP), although there are opposing views. OBJECTIVES: To localise the neural substrates for IP using functional magnetic resonance imaging. Brain regions activated by both imitation and verbal command movements were tested against a simple self paced movement. METHODS: Twenty two young, right handed, healthy subjects were examined. Functional and anatomical data were acquired. The experiment comprised three motor conditions (imitation, movements executed by verbal command, and finger bending/unbending) and a rest condition. All motor tasks were performed using the left hand. Eighteen drawings of left hand postures were presented for the imitation condition. Identical postures were instructed verbally for the verbal command condition. The finger bending/unbending movement was self paced. Blood oxygenation level dependent (BOLD) signal increases were compared during two kinds of IP (imitation and verbal command movements) and during finger bending/unbending movements. RESULTS: The depth of the posterior part of the left intraparietal sulcus and bilateral precunei were activated during both imitation and verbal command movements. The difference in BOLD signal between imitation and verbal command movements was localised in the dorsal and ventral occipital areas. BOLD signal differences for movements executed by verbal command against imitation were observed in the superior temporal areas. CONCLUSIONS: The depth of the posterior part of the left intraparietal sulcus and bilateral precunei are the neural substrates for IP.

Adult↗

Learning a unimanual motor skill by partial commissurotomy patients.

A series of motor tests on four Chinese partial commissurotomy patients is reported. The single-stage commissurotomy in all four patients included the anterior commissures and two-thirds or four-fifths section of the corpus callosum with sparing of the splenium. There was no demonstrable ability to transfer hand posture in these patients. This was the major evidence for functional deconnexion. A newly learned task of one-hand knotting revealed right hand impairment in all four patients. There was no dyspraxia in the right hand for over-learned object-handling tasks in these patients. It is suggested that there might be right hemisphere specialisation for the initial acquisition of unimanual object-handling skills and that the spared callosal fibres in the splenium alone are insufficient to mediate task control under these conditions. This is supported by the finding that one of these patients, who was the only one who had a right parietal lesion, was unable to perform the newly learned task with either hand.

Adolescent↗

Defective imitation of gestures in patients with damage in the left or right hemispheres.

OBJECTIVES: Defective imitation of meaningless gestures has repeatedly been demonstrated in patients with apraxia and has been interpreted as being due to a deficit of motor execution. There is, however, controversy as to whether some impairment of imitation also occurs in patients with right brain damage. The aim was to compare defective imitation in patients with left and right brain damage and to explore whether there are qualitative differences between them. METHODS: Imitation was examined in 80 patients with left brain damage (LBD) and aphasia, 40 patients with right brain damage (RBD), and 60 controls for three types of gestures:hand positions, finger configurations, and combined gestures which required a defined hand position as well as a defined configuration of the fingers. RESULTS: Regardless of whether imitation of hand positions and finger configurations were tested each on their own or together, they showed differential susceptibility to RBD and LBD. Whereas imitation of finger configurations was about equally impaired in RBD and LBD, defective imitation of hand positions occurred almost exclusively in patients with LBD, and whereas controls as well as patients with RBD committed less errors with hand positions than with finger configurations, the reverse was the case in patients with LBD. CONCLUSIONS: The pattern of results goes against a deficit of motor execution as being the cause of defective imitation in patients with LBD, as it is difficult to see why such a deficit should affect proximal movements necessary for reaching hand positions more than differential finger movements. An alternative explanation would be that in patients with LBD errors are due to defective mediation by knowledge about the human body whereas in patients with RBD they stem from faulty visuospatial analysis of the demonstrated gesture.

Adult↗

Imitation and utilisation behaviour.

OBJECTIVE: To investigate the incidence, anatomical correlates, and clinical features of imitation and utilisation behaviour, which are thought by Lhermitte and coworkers to represent a reliable and frequent index of frontal lobe disease. METHODS: 78 patients with hemispheric local lesions were tested in two separate sessions, in which their reactions to a series of gestures performed by the examiner and to the presentation of a set of objects were recorded. The patients were stratified into a frontal (n = 52) and a non-frontal group (n = 26) on the basis of their CT data. RESULTS AND CONCLUSIONS: Imitation behaviour was present in 39% of the frontal patients and was mainly associated with medial and lateral lesions, at odds with the claim of Lhermitte et al that it is a constant accompaniment of lower, mediobasal lesions. In the non-frontal group it was found in three patients, all with damage to the deep nuclei region. Utilisation behaviour was a much rarer phenomenon, present in only two patients, both of whom had frontal damage. Neither imitation behaviour nor utilisation behaviour were found in patients with retrorolandic cortical lesions.

Female↗

CLOX: an executive clock drawing task.

OBJECTIVE: To describe a clock drawing task (CLOX) designed to elicit executive impairment and discriminate it from non-executive constructional failure. SUBJECTS: 90 elderly subjects were studied (45 elderly and well persons from the independent living apartments of a continuing care retirement community and 45 patients with probable Alzheimer's disease). The clock drawing performance of elderly patients was compared with that of 62 young adult controls. METHODS: Subjects received the CLOX, an executive test (EXIT25), and the mini mental state examination (MMSE). The CLOX is divided into an unprompted task that is sensitive to executive control (CLOX1) and a copied version that is not (CLOX2). Between rater reliability (27 subjects) was high for both subtests. RESULTS: In elderly subjects, CLOX subscores correlated strongly with cognitive severity (CLOX1: r=-0.83 v the EXIT25; CLOX2: r=0.85 v the MMSE). EXIT25 and MMSE scores predicted CLOX1 scores independently of age or education (F(4,82)=50.7, p<0.001; R2=0.71). The EXIT25 accounted for 68% of CLOX1 variance. Only the MMSE significantly contributed to CLOX2 scores (F(4,72)= 57.2, p<0.001; R2=0.74). CLOX subscales discriminated between patients with Alzheimer's disease and elderly controls (83.1% of cases correctly classified; Wilkes' lambda=0.48, p<0.001), and between Alzheimer's disease subgroups with and without constructional impairment (91.9% of cases correctly classified; Wilkes' lambda=0.31, p<0.001). CONCLUSIONS: The CLOX is an internally consistent measure that is easy to administer and displays good inter-rater reliability. It is strongly associated with cognitive test scores. The pattern of CLOX failures may discriminate clinical dementia subgroups.

Adult↗

Forced hyperphasia and environmental dependency syndrome.

A distinctive, language related fragment of the environmental dependency syndrome is described: compulsive, involuntary, environmentally dependent speaking. Because this syndrome represents the observe of aphasia, it is named forced hyperphasia. An 84 year old woman with acute left frontal infarction was admitted to hospital with gait disturbance, forced grasp reflex, and striking imitation behaviour. After 2 weeks her imitation behaviour disappeared, but an equally striking new behaviour emerged. In the presence of others she would call out the names of objects in the room, and also call out the actions and gestures of people in the room, even though she was not asked to do so, and even though she was asked to stop. For example, if the doctor scratched his nose, she said, "The doctor is scratching his nose." Brain CT, MRI, and SPECT showed cerebral atrophy and a left superior frontal subcortical infarct. It is suggested that "forced hyperphasia" is a clinical fragment of the environmental dependency syndrome and that her compulsive, impulsive, involuntary release of spoken language resulted from the release of frontal inhibition of the complex reflex linking environmental cues to the set of motor, limbic, spatial, and linguistic associations underlying spoken language.

Aged↗

The mirror-neuron system.

A category of stimuli of great importance for primates, humans in particular, is that formed by actions done by other individuals. If we want to survive, we must understand the actions of others. Furthermore, without action understanding, social organization is impossible. In the case of humans, there is another faculty that depends on the observation of others' actions: imitation learning. Unlike most species, we are able to learn by imitation, and this faculty is at the basis of human culture. In this review we present data on a neurophysiological mechanism--the mirror-neuron mechanism--that appears to play a fundamental role in both action understanding and imitation. We describe first the functional properties of mirror neurons in monkeys. We review next the characteristics of the mirror-neuron system in humans. We stress, in particular, those properties specific to the human mirror-neuron system that might explain the human capacity to learn by imitation. We conclude by discussing the relationship between the mirror-neuron system and language.

Animals↗

Firsthand learning through intent participation.

This article examines how people learn by actively observing and "listening-in" on ongoing activities as they participate in shared endeavors. Keen observation and listening-in are especially valued and used in some cultural communities in which children are part of mature community activities. This intent participation also occurs in some settings (such as early language learning in the family) in communities that routinely segregate children from the full range of adult activities. However, in the past century some industrial societies have relied on a specialized form of instruction that seems to accompany segregation of children from adult settings, in which adults "transmit" information to children. We contrast these two traditions of organizing learning in terms of their participation structure, the roles of more- and less-experienced people, distinctions in motivation and purpose, sources of learning (observation in ongoing activity versus lessons), forms of communication, and the role of assessment.

Adult↗