On the 4-H Study of Positive Youth Development

The research reported in this issue advances our understanding of the multiple interactive influences on young people’s development. The study invokes Relational Developmental Systems Theory to show, among other findings, how the impact of out-of-school time depends on the number and range of different types of activities young people engage in. The study also demonstrates that developmental assets (the 5 Cs) can co-exist with problem behavior, an important contribution to the positive youth development perspective. Readers will also find in these articles diverse strategies of data analysis and exemplars of research that informs practice as well as theory.     

Therapeutic response to assisted suicide request

The authors review the first publicly reported case of legal assisted suicide in the United States and discuss possible clinical responses other than assistance in suicide. Psychiatric observers have noted that acceptance of assisted suicide or euthanasia as a medical option has resulted in loss of knowledge about how to respond to suicidal ideation in the seriously ill. The authors discuss specific therapeutic interventions that may be appropriate for seriously ill patients requesting suicide.     

Cost-utility assessment: Planning with local decisionmakers in developing countries

In the past decade countries and donor agencies have endorsed health policies which (1) give a very broad definition of health, (2) see the pursuit of health as part of the development process, and (3) emphasize the local community's and local decision-maker's participation in the planning of health projects. Despite these broad principles, health delivery systems in developing countries have access to a very limited set of resources. Health planners are faced with the dilemma of creating cost-effective programmes while recognizing the need to take into account the broad definition of health and the importance of local participation in planning. This dilemma has led to a division between those planners who put greater emphasis on the use of cost analysis techniques in which the decision-making process rests more with professional planners (often outside consultants) vs those who emphasize greater local control of the decision-making process. The purpose of this paper is to present a study in which two alternative approaches to cost utility analysis were used. Consideration was given both to the actual cost analysis strategy and to the integration of the cost variable into the total decision-making process. Finally, major emphasis was placed on including local decision-makers in the planning process and providing them with feasible and understandable decision-making tools.