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This study explores psychiatrists’ perceptions of Attention-Deficit Hyperactivity Disorder (ADHD) through the lens of evolutionary psychiatry, a growing field that reframes mental disorders in the context of adaptation and survival. Evolutionary theories suggest that traits associated with ADHD, such as impulsivity, hypercuriosity and novelty-seeking, may have been adaptive in ancestral environments, though they manifest as maladaptive in structured modern contexts.
Method:
A bespoke 10-item questionnaire was developed to assess psychiatrists’ attitudes following a presentation on evolutionary perspectives of ADHD by an expert. The questionnaire allowed rating in 5-point Likert fashion and was followed by a free text box for qualitative analysis. Basic descriptive statistics and One-Way ANOVA pairwise comparisons between groups was used to test for statistical significance. A p value of <0.05 was deemed statistically significant.
Results:
Forty-two participants, including 21 consultants and 19 psychiatry trainees completed the questionnaire. All participants rated their comprehension of the presentation as high/very high. Most strongly agreed that the information presented could improve psychiatry and therapeutic outcomes. However, consultants with more than 10 years of experience were less likely than trainees to report optimism about the practical applications of evolutionary frameworks. Qualitative feedback emphasized the relevance of evolutionary perspectives in clinical practice, particularly in reducing stigma and enhancing therapeutic engagement with patients and families.
Conclusions:
While the results from this study were positive, limitations include the small sample size and lack of prepresentation baseline data. However, this study has formed part of the first step in investigating the perceptions and attitudes of psychiatrists on evolutionary perspectives on ADHD.
The popularity of keeping domesticated cats (Felis catus) indoor-only or outdoor-indoor varies according to geographical location, and both have risks and benefits. Walking cats (e.g. on leashes) may enable mitigation of roaming risks while providing outdoor access, but the practice of walking cats appears relatively uncommon and is yet to be examined in the literature. Semi-structured online interviews (21 participants across seven countries) were conducted to explore cat walking perceptions and experiences in owners who currently practise it. Interview recordings were transcribed and analysed using reflexive thematic analysis. Five main themes were generated: (1) Benefits of walking; (2) Challenges around walking; (3) Safety for walking; (4) Cat individuality and walking; and (5) Attitudes about walking across geographic contexts. Themes highlighted that participants perceived benefits of walking for both cat and owner but faced challenges largely due to dogs and their owners in addition to judgment from others in the community. The main priorities of walking were seen to be ensuring safety and attending to the individual needs of each cat. Reactions to cat walking appeared to vary according to local norms and attitudes about cats and owner-cat relationships. The subjective nature of both the concept and practice of cat walking was also emphasised. These findings provide an initial base for what the experience of walking cats can be like and highlight that further research to directly investigate the welfare impacts of walking on cats and their owners is now needed.
Interventions based on testing and communication training have been developed to reduce antibiotic prescribing in primary healthcare (PHC) for the treatment of acute lower respiratory infections (ALRTIs). However, research based on the experiences of PHC clinicians participating in ALTRIs interventions to reduce antibiotic prescribing in Barcelona is scanty.
Aim:
This study aimed to explore the perceptions and experiences of clinicians (physicians and nurses) on an intervention to reduce antibiotic prescription in PHC in Barcelona (Spain). This intervention was a randomised controlled study (cRCT) based on three arms: 1) use of a C-reactive protein (CRP) rapid test; 2) enhanced communication skills; and 3) combination of CRP rapid test and enhanced communication skills. In addition, the study aimed to explore the impact of COVID-19 on the detection of ALRTIs.
Methods:
This qualitative study used a socio-constructivist perspective. Sampling was purposive. Participants were selected based on age, sex, profession, intervention trial arm in which they participated, and the socioeconomic area of the PHC where they worked. They were recruited through the healthcare centres participating in the study. Nine participants (7 women and 2 men) participated in two focus groups, lasting 65–66 min, in September–October 2022. Framework analysis was used to analyse the data.
Findings:
Three themes were identified: ‘(The intervention) gave us reassurance’: intervention experiences among health professionals. This theme includes accounts of clinicians’ satisfaction with the intervention, particularly with CRP testing to support clinical diagnoses; ‘We don’t have time in primary healthcare’: structural and community resources in healthcare services. This theme encompasses clinicians’ experiences on healthcare pressures and PHC organisational structures barriers to PHC interventions; and ‘I only did three CRP’: impact of COVID-19 pandemic on the intervention. The last theme focuses on the impact of the COVID-19 pandemic on the intervention’s implementation.
Conclusions:
CPR testing and promoting communication skills can be useful tools to support clinical decisions for ALRTIs. Structural barriers (e.g., healthcare pressures) and social inequities amongst service users were acknowledged as the main barriers for the implementation of ALRTIs interventions.
Scholars have identified several temporal challenges in foreign policymaking, such as variable time horizons and maintaining commitment or resolve over time. While the behavioural turn has emphasised leaders and their subjective perceptions, research often relies on rationalist conceptions of objective and linear time and struggles to assess leaders’ subjective perceptions of it. This paper theorises time as an intrinsic aspect of narrative reasoning in foreign policy, introducing a ‘temporal definition of the situation’ (TDoS) framework to capture leaders’ situation-specific subjective time perceptions. I then operationalise the TDoS framework’s key temporal features and show how it can be empirically examined. The value of the TDoS is illustrated by assessing the temporal perceptions of Bush and Obama regarding Iran’s nuclear programme, showing how their distinct definitions of the foreign policy situation shaped their subjective time perceptions and their corresponding responses. I conclude by discussing how this advancement can enhance behavioural research, provide insights into the ‘why now?’ questions surrounding leaders’ actions, and challenge existing understandings of time’s impact on foreign policymaking.
To assess the current state of knowledge and perceptions towards heatwaves of emergency department (ED) health care workers in Singapore and investigate potential strategies and solutions to improve the knowledge and readiness.
Methods
A qualitative study conducted in Khoo Teck Puat Hospital in Singapore, using semi-structured, face-to-face interviews with an open-ended interview guide on emergency physicians and registered nurses of various lengths of work experience actively working in the ED. Thematic analysis was employed involving memo-writing, coding, and theme-development with constant comparison.
Results
Six themes— (1) Knowledge and understanding of Extreme Weather Events, (2) Knowledge and risk-assessment of Heatwaves, (3) Impressions of increased vulnerability to heatwaves, (4) Preventive measures for acute heat related illness, (5) Heatwave impact on the emergency department, and (6) Potential strategies and solutions—emerged and were presented in an interactive framework. Overall, it emerged that there is basic foundational knowledge, with more education and training required, especially targeting the knowledge gaps identified. There is also a need to increase awareness of heatwaves and their impact on health, and to develop comprehensive extreme heat response plans.
Conclusions
The findings provide a framework for emergency departments to guide their preparations for inevitable heatwaves and their associated health impacts.
Using examples from Germany, Austria, France, the Netherlands, and Belgium, this chapter discusses how Jewish leaders were chosen, how these organizations changed over time, the dilemmas they faced, and how decisions were made regarding cooperation or negotiations with Nazis, often on the basis of “preventing something worse.”
Gender stereotyping has captured public attention, from the courtroom to the everyday workplace – but the term encompasses a variety of beliefs, motivations, and contexts. This chapter first discusses prominent theories of gender stereotyping that have been primarily used in employment discrimination contexts (e.g., social role theory, the stereotype content model). I then identify how adjudicators across a variety of legal contexts (e.g., judges, juries, employers, social services officers) behave in a stereotyped fashion, according to those theories. An understanding of where stereotyping occurs across underexplored contexts is ultimately valuable for our understanding of how and where researchers might intervene in disparities research.
Settlement, not trial, is the predominant way in which most legal disputes are resolved. Despite this, very little research has examined how the public thinks about settlement. This chapter discusses the need for such research and describes the first few projects trying to fill that need. People hold complex and fairly accurate beliefs about the nature and prevalence of settlement. They also show remarkable willingness to draw inferences when parties settle, including inferences about a defendant’s responsibility. Some avenues for the future of this burgeoning field are also discussed.
Since the initiation of its Belt and Road Initiative, China’s economic statecraft has drawn considerable attention in academic circles. Yet less attention has been given to why the Chinese leadership first chose to pursue its national interests through economic means in the post-Mao period. This underexplored part of China’s economic statecraft can serve as a useful starting point to understand China’s foreign economic policies on their own terms. Employing a neoclassical realist framework and surveying statements made by Chinese leaders throughout the reform era, this study argues that the country’s leaders have gradually modified the strategic importance of the country’s economic statecraft in response to changes in their perceptions of the world order. Meanwhile, China’s form of economic statecraft has largely been determined by reform of its state-owned enterprises in the domestic realm.
The literature in political science considers (sometimes inaccurate) perceptions of immigrants as a factor in anti-immigration attitudes among natives, but much less is known about perceptions regarding immigrants from specific regions. In this paper, I explore Americans’ perceptions about immigrants from Africa, Asia, Europe, Latin America, and the Middle East. To measure these perceptions, I apply a conjoint experiment with a multinomial outcome, in which respondents are asked to categorize hypothetical immigrants as coming from one of the five regions. Results from a nationally diverse sample demonstrate that immigrants from all regions other than Europe are associated with speaking poor English. Immigrants from Latin America are also associated with welfare dependency and rule-breaking behavior, while the opposite is true for immigrants from Asia. These negative perceptions may at least partly explain opposition to non-European, and specifically Latin American, immigration in the United States.
There have been strong proponents and opponents in academic debates about the use of social science in legal practice. However, in such academic discussions, little attention has been paid to what legal practitioners think about social science and its use in law. The present study shows that legal practitioners have complex views about social science. Drawing on in-depth interviews, it shows that there are five ideal-types of ‘social science consciousness’: enthusiast, pragmatist, indifferent, critical optimist and opponent. The paper shows what the implications are for law and social science, as well as a new research agenda on social science consciousness.
To understand healthcare staff perspectives of their hospital food environment and the impact of these perceptions on their food choice, health and well-being.
Design:
A narrative systematic review.
Setting:
Publications were eligible for inclusion if participants were hospital-based staff, and all job roles were eligible, including both clinical and non-clinical staff. Both public and private hospitals in the UK, the USA or Australia were included.
Participants:
Clinical and non-clinical staff employed in hospitals.
Results:
A systematic search was carried out across four databases: OVID Medline, CINAHL, PsycInfo and Scopus. Grey literature screening was completed via Google and Google Scholar. Eleven studies were included and were predominantly from the UK. Setting sizes varied or were unknown, and participant numbers varied (n 16 to n 1158) or were unknown. Most participants were nurses. Methods included reports, surveys, focus groups and interviews. The main themes identified were accessibility to food, diversity of food choices, free foods used to boost staff morale and job role influencing engagement with the food environment. Staff reported issues around canteen opening hours, limited healthy food options and free food on wards, causing extra calories to be consumed. Irregular breaks and staffing shortages affected hospital staff’s ability to engage with the wider food environment, resulting in reliance on convenience foods and snacks.
Conclusions:
The current hospital food environment does not facilitate healthy dietary practices and is perceived by staff as a barrier to healthy eating. The hospital food environment requires adaptation to reflect a 24-hour workplace.
This review aimed to chart existing literature and identify gaps in the evidence base concerning palliative and end-of-life care perspectives and experiences among different generations of African migrants residing outside the continent.
Methods
This review adhered to a predefined protocol, utilizing the Arksey and O’Malley 5-stage framework, as refined by Danielle Levac and colleagues. A systematic search of 5 bibliographic databases (from inception to December 2022) yielded 79 published studies. After title, abstract, and full-text screening using Covidence®, 7 studies met the inclusion criteria. Data extraction was guided by a conceptual framework tailored to the research topic and questions, with results presented in the narrative form.
Results
Cultural and religious beliefs and practices significantly shaped African migrants’ perspectives on end-of-life care. A nuanced boundary between palliative and curative care emerged, with the former often stigmatized and stereotypically associated with death and dying. Common barriers to accessing end-of-life care included limited awareness, low literacy, and perceived inadequacy of culturally sensitive care, resulting in disparities in both access and outcomes. Additionally, reluctance to discuss death and dying, along with mistrust of Western healthcare systems, constituted significant obstacles. The studies underscored the necessity of enhancing provider–patient communication by engaging with migrants to raise awareness of services and fostering inclusive healthcare environments for improved care outcomes.
Significance of results
Existing research on racial and ethnic disparities underscores the unequal quality and outcomes of end-of-life care across various racial groups. However, there is still insufficient understanding of these diverse end-of-life care needs, particularly in host countries. Bridging this knowledge gap is crucial for reducing health disparities and enhancing the delivery of culturally sensitive care within Western healthcare systems.
The emphasis in L2 learning has mainly focused on individual writers and monomodal academic genres (e.g. narration, argumentation), neglecting the potential of collaborative composing and the use of digital genres that introduce additional semiotic sources, for fear of having to deal with “a messy transition to digital multimodal communication” (Lotherington, 2021: 220). Yet, because Web 2.0 technological upgrades have enabled interactivity, literacy has morphed from discretely reading and writing a static page to dynamically reading and writing a multimodal one, which underpins collaborative authorship and (local and global) audience awareness. Considering the inclusion of working collaboratively with multimodal tasks in the L2 classroom, the question of how to help students effectively incorporate multimodal with academic monomodal texts remains unanswered. In response to this challenge, this study examines the design and implementation of an online task to foster multiliteracies. Thirty-seven international students of diverse disciplines (e.g. economics, engineering, history), enrolled in a Spanish as a second language course, worked collaboratively to create multimodal texts based on previously created monomodal texts. Informed by a student questionnaire and a teacher focus group, we analyzed both students’ and teachers’ perceptions to ascertain the effectiveness of the intervention and the possibilities these kinds of tasks bring to the foreign language classroom. Both sets of participants reported positive results concerning linguistic advancement, motivation, and multiliteracies development. Pedagogical recommendations related to the inclusion of this pedagogical practice are provided.
Why, and to what extent, are states more or less likely to comply with international law? No overarching state compels compliance, and the international institutional context is thin, yet states seem largely to comply. How do we explain this behaviour? Developed through interviews with eighty State Department senior officials from across five recent administrations, Philip Moremen provides a qualitatively and quantitatively rich study of the extent to which and under what conditions the United States and other countries comply with international law. US policymakers consider legal issues, national interest, and other factors together when making decisions-law is not always dispositive. Nevertheless, international law constrains states. In State Department policymaking there is a strong culture of respect for international law, and lawyers play a highly influential role. In this context, the book concludes by investigating the effect of the Trump Administration on the culture and processes of the State Department.
To investigate healthcare workers’ perceptions of the integrated disease surveillance and response (IDSR) strategy.
Methods
A cross-sectional survey of healthcare workers (HCWs) was conducted from December 2021 to June 2022 to assess their perceptions of the IDSR system attributes.
Results
Of the 409 respondents, 12 (2.9%) reported no prior training on disease surveillance. The IDSR was deemed simple, acceptable, useful, and timely by most participants. There were sharp differences in perceptions of flexibility and simplicity between doctors and the other healthcare professionals. However, acceptability, timeliness, and usefulness were uniformly perceived. Healthcare workers with at least 11 years of experience perceived the usefulness of the IDSR system significantly higher than those with lesser years of experience. However, work experience did not have an impact on HCWs perceptions of the simplicity, timeliness, and flexibility of the IDSR system.
Conclusions
Most healthcare workers have positive perceptions of the IDSR approach. However, there are reservations about how well the system can adapt to changing conditions and demands (flexibility) and how well it simplifies the implementation processes. These findings demonstrate the necessity of adopting cutting-edge strategies for capacity building as well as ongoing professional development of healthcare professionals responsible for the implementation of the IDSR strategy.
Most Australian school students take a packed lunch to school(1). However, parents have reported many barriers to packing a healthy lunch(2). Subsequently, foods eaten during school hours are not consistent with the Australian Dietary Guidelines, with discretionary foods providing about 44% of energy consumed during this time(3). In addition, some children go to school without any food for lunch or money to buy lunch. The Tasmanian School Lunch Project provides free nutritious cooked lunches for Kinder to Year 10 students attending 30 government schools (15 commenced 2022, 15 commenced 2023) in areas of high socioeconomic disadvantage. The lunches were provided 1-3 days/week. The menu and recipes were designed by dietitians. This analysis aimed to describe parents’ perceptions of the School Lunch Project during the first year. Six of the 15 schools that commenced in term 2 2022 were invited, and agreed, to participate in the evaluation. During term 3 or 4 2022, parents completed online or written surveys (n = 159) and/or participated in discussion groups (n = 26) to share their thoughts on the menu, their concerns, likes, and willingness to pay. Survey data were analysed descriptively and open-ended survey responses and discussion group data thematically. During 2022, 78,832 nutritious cooked lunches were provided to 1,678 students. Most parents felt there was enough variety on the menu (66%) and the right amount of food was served (69%). Most students (79%) ate the lunches every day they were provided yet 52% of parents continued to provide a packed lunch. Parents enjoyed that their child was having a healthy lunch (66%) and trying new foods (74%). Some parents in the discussion groups indicated positive flow on effects at home with students trying new foods and sitting down together as a family to eat the evening meal. Half the parents (50%) had no concerns about the school providing lunches. The most commonly reported concerns were their child might not like the food (36%) or their child does not try new foods (8.6%). These concerns were also raised in the discussion groups. Most parents (93%) were prepared to pay for the lunches in future (median $3, range $1-$12) and 85% thought there should be a family discount. Parents acknowledged some payment was necessary for the sustainability of the program but some expressed concern for those who may struggle to pay. More direct communication with families about the meals offered, the availability of bread (from term 4 2022) for students who choose not to eat the cooked lunch or want more to eat, and allowing families time to adjust to the new lunch system, may address some of the concerns raised. Further data on parents’ perceptions of the school lunches will be collected during term 3 2023.
To synthesise current evidence on knowledge, perceptions and practices towards type 2 diabetes risk in sub-Saharan Africa
Design:
Mixed-methods scoping review, which included 101 studies (seventy-three quantitative, twenty qualitative and eight mixed methods) from seven electronic databases.
Setting:
Sub-Saharan Africa, 2000–2023.
Participants:
Men and women without diabetes with mean ages ranging from 20 to 63 years.
Results:
The majority of participants in most studies knew the three main diabetes modifiable risk factors – excess weight, unhealthy diet and physical inactivity. However, most people with excess weight in almost all studies underestimated their weight. Further, the self-described ideal body weight was between midpoint of normal weight and the upper limits of overweight in most quantitative studies and was described as not too skinny but not too fat in qualitative studies. In the majority of studies, participants reported low engagement in weight control, high regular sugar intake, and low regular fruit and vegetable intake but moderate to high engagement in physical activity. Barriers to reducing diabetes risk were social (e.g. societal perceptions promoting weight gain) and environmental (e.g. limited affordability of healthy foods, high accessibility of Western diets and lack of physical activity facilities).
Conclusion:
There is a need for multicomponent type 2 diabetes prevention interventions that increase knowledge of identifying diabetes risk (e.g. what constitutes excess weight) and create social and physical environments that support healthy lifestyles (e.g. societal perceptions that promote healthy living, increased availability and affordability of healthy foods and physical activity facilities).
The principle of distinction in International Humanitarian Law sets up two entities, the civilian and the combatant, and organises the relationship between them. This socio-legal chapter draws on original research from South Sudan to explore how this principle is operationalised in humanitarian–peacekeeper interactions. Humanitarian actors routinely invoke ‘distinction’ as they navigate operational dilemmas with respect to the use of military assets, and in their relationship with the UN Mission in South Sudan more generally. Two ‘ideal types’ of humanitarian actor emerge here. The first type takes a strict approach to distinction, thinking long term and eschewing military asset use that undermines distinction. The second type interprets distinction flexibly and balances it with other goals such as reaching people in need; this exposes a hidden conflict between the principles of distinction and humanity. Through these everyday interactions – which sometimes involve drawing lines within the civilian category – humanitarian actors produce distinction in law, in practice, and in perception.
To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers.
Design:
A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data.
Setting:
Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online.
Participants:
Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually.
Results:
Consumers and food operators perceived a high-salt intake within Malaysia’s out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality.
Conclusions:
These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia’s out-of-home sectors.