Behavioral Domains Research Articles

Racial and ethnic disparities in healthcare utilization among children in U.S. foster care: Recommendations to challenge the status quo based on a scoping review

Prior work has examined racial and ethnic disparities in the access to and utilization of healthcare services. However, evidence across studies is mixed, making it challenging to precisely identify where the racial and ethnic disparities in healthcare utilization are amongst children in foster care, and which race and ethnicity groups are most impacted by such disparities. As such, the purpose of the current study was to conduct a scoping review to synthesize evidence on the topic of racial and ethnic disparities in the physical and mental or behavioral healthcare utilization for children in the U.S. foster care system (PROSPERO ID: CRD42021272072). Comprehensive literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 414 studies identified, 23 met inclusion criteria: peer-reviewed journal article, published between 1991 and 2023, written in English, examined healthcare access or utilization of children in the U.S. foster care system as outcomes, included and disaggregated results by children’s race and ethnicity, conducted quantitative analysis, and was observational in study design. In the physical healthcare utilization domain, Black children were less likely to utilize routine and preventative check-ups and more likely to utilize medical services for treating chronic illnesses such as asthma, compared to White children. In the mental or behavioral healthcare utilization domain, Black and Hispanic/Latine children were less likely to utilize both inpatient and outpatient mental health services, compared to White children. Furthermore, notable variations were observed by specific service types and continuity of services over time. Implications include additional research and education about racial and ethnic disparities in healthcare utilization amongst children in foster care, as well as implementing regulations and oversights that mandate racial equity in the child welfare and healthcare service pathways.

Student Engagement in an Online Class

The present study used descriptive research design to assess student engagement in an online class of a city college in Southern Philippines. It underscored the critical role of student engagement in shaping the various educational outcomes in an online learning environment. A sample of 239 college students were randomly selected to respond to a researcher-made questionnaire, which was pilot-tested and passed the test of validity and reliability. With at least two years’ experience of attending online classes that started during the COVID-19 era, the students’ Internet profile was characterized as having used cellphones and phone Internet to attend online classes and having spent more than 2 to 4 hours daily on the Internet for non-academic purposes. The findings of this study have further shown that the students are engaged in the cognitive, affective, and behavioral domains of online learning. Using the Kruskal-Wallis test for Likert-scale data, no significant difference was found in student engagement in an online class when grouped according to access to Internet, time use of Internet for non-academic purpose, and types of gadgets used. Based on these findings, the study has recommended the following: a) the use and mastery of teaching strategies that promote active listening, asking direct questions to the teachers, greater talking time of the students, and more interaction between teacher and students; and b) the use of breakout rooms in an online classroom for small group discussions and greater collaborative learning among students.

Comparison of Financial Hardship and Healthcare Utilizations Associated with Cancer in the United States Medicare Programs during the COVID-19 Pandemic.

In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic. We utilized data from the 2020-2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM. Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM. While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape.

Integrated Intensive Intervention: Academic and Behavioral Support in Tier 3

Students who require intensive individualized intervention often demonstrate needs in both academic and behavioral domains. However, practices around assessment and development of interventions are often siloed and separate, which can be a barrier to implementing intensive individualized support in an integrated manner to maximize efficiency. In this article, we provide a blueprint for educators to work collaboratively to complete an integrated assessment that can lead to developing a truly integrated individualized intervention. We also share a vignette demonstrating how team members might create a team to complete an integrated assessment and create a corresponding intervention plan.

Towards an understanding of the embedded nature of everyday ethical reasoning in paramedic education and practice

Paramedicine is increasingly complex in affective, behavioural, and cognitive domains of practice. The ability to navigate this complexity is essential for paramedics who are required to simultaneously practice assertively, dynamically, sensitively, and professionally. Although these may seem to be superficially incongruent ways of practising, through insightful and reflexive practice underpinned by appropriate ethical approaches, paramedics can navigate the complexity inherent in paramedic work whether care episodes are routine or extreme. In what follows, we discuss the potential of virtue ethics as a way of navigating complexity in paramedic practice and preparing clinicians for the varied work they manage as paramedics. We do this by first describing some of the issues faced by the modern paramedic, outlining ethical approaches to practice, then working through a vignette showing how a deeper understanding of ethics and utilising a virtue ethics approach may have helped the clinicians navigate a typical ethical dilemma found in practice.

Validating a theory of planned behavior questionnaire for assessing changes in professional behaviors of medical students.

Teaching professionalism is a fundamental aspect of medical undergraduate education, delivering important domains of professional attitudes, ethics, and behaviors. The effects of educational interventions can be assessed by measuring the change in such domains, but validated assessment tools for these professionalism domains are lacking. In this study, we constructed and conducted expert validation of a modified theory of planned behavior (TPB) questionnaire to assess changes in professional behaviors (PBs) in medical students. To validate that, we modified an existing TPB questionnaire, and an 18-item questionnaire was subjected to expert panel evaluation using the content validation method. The clarity and relevance of items were assessed using a four-point rating scale (i.e., 1 = not relevant to 4 = highly relevant). Ratings of experts and free-text comments were analyzed. Quantitative evaluation of relevance and clarity was undertaken through analyses of the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index (S-CVI). A qualitative assessment of the comments of experts was conducted to refine items, any disagreements were discussed, and a consensus decision was developed among authors for item changes. Quantitative evaluation of the Item-level Content Validity Index (I-CVI) scored 0.9-1 for relevance and 0.7-1 for clarity. Qualitative evaluation resulted in (i) changes to the wording of items (e.g., choices such as "worthless/worthwhile" were replaced with "not important/important"); and (ii) suggestion of the addition of social media in the construct of subjective norms. The proposed tool exhibits content validity and can assess TPB constructs in professionalism education. This study of content validity may help to ensure the modified TPB questionnaire accurately measures the TPB constructs, ensuring its effectiveness in accurately measuring the TPB constructs for PB in diversified educational medical institutions.

The association of cancer-preventive lifestyle with colonoscopy screening use in border Hispanic adults along the Texas-Mexico border.

The relationship between engaging in two domains of cancer-preventive behaviors, lifestyle behaviors and colonoscopy screening, is unknown in Hispanic adults. Accordingly, the study examined the association between lifestyle and colonoscopy screening in Hispanic adults along the Texas-Mexico border, where there is suboptimal colorectal cancer prevention. Lifestyle behavior adherence and compliance with colonoscopy screening schedules were assessed using 2013-2023 data from the Cameron County Hispanic Cohorta population-based sample of Hispanic adults living along the Texas-Mexico border. The 2018 World Cancer Research Fund scoring system characterized healthy lifestyle engagement. Multivariable logistic regression quantified the association between lifestyle behaviors and colonoscopy screening. Among 914 Hispanic adults, there was a mean adherence score of 2.5 out of 7 for recommended behaviors. Only 33.0% (95% CI 25.64-41.39%) were up-to-date with colonoscopy. Complete adherence to fruit and vegetable (AOR [adjusted odds ratio] 5.2, 95% CI 1.68-16.30; p = 0.004), fiber (AOR 2.2, 95% CI 1.06-4.37; p = 0.04), and ultra-processed foods (AOR 2.8, 95% CI 1.30-6.21; p = 0.01) consumption recommendations were associated with up-to-date colonoscopy screening. Having insurance versus being uninsured (AOR 10.8, 95% CI 3.83-30.62; p < 0.001) and having local medical care versus in Mexico (AOR 7.0, 95% CI 2.26-21.43; p < 0.001) were associated with up-to-date colonoscopy. Adherence to dietary lifestyle recommendations was associated with being up-to-date with colonoscopy screenings. Those with poor dietary behavior are at risk for low-colonoscopy use. Improving lifestyle behaviors may complement colonoscopy promotion interventions. Healthcare accessibility influences up-to-date colonoscopy prevalence. Our findings can inform cancer prevention strategies for the Hispanic population.

Development of Restricted and Repetitive Behaviors from 2-19: Stability and Change in Repetitive Sensorimotor, Insistence on Sameness, and Verbal Behaviors in a Longitudinal Study of Autism.

This study examined trajectories of repetitive sensorimotor (RSM), insistence on sameness (IS), and verbal RRBs from ages 2-19 in a well-characterized longitudinal cohort. We also tested the factor structure of the ADI-R restricted and repetitive behavior (RRB) domain at age 19 and the inclusion of a verbal RRBs factor, in addition to previously identified RSM and IS factors, at ages 9 and 19. The ADI-R was administered to 193 participants at five timepoints from 2 to 19. Confirmatory factor analysis (CFA) was used to examine the factor structure of ADI-R RRB data. Change in RRB subtypes was examined using group-based trajectory modeling and multilevel modeling. RSM and IS behaviors generally decreased from 2 to 19, with some participants experiencing increases from ages 2-9. 46.46% of participants experienced increasing verbal RRBs from 2 to 9, followed by a plateau from 9 to 19. The remaining participants had few to no verbal RRBs throughout development. Multilevel modeling indicated ADOS CSS scores were associated with change in RSM trajectories only. Child IQ was not associated with change in any RRB trajectories. CFA indicated previously-derived RSM and IS factors fit age 19 ADI-R data well. The inclusion of a third factor, verbal RRBs, worsened goodness-of-fit statistics and was ultimately omitted. Our findings suggest the RRB factor structure of the ADI remains consistent into early adulthood and illustrate developmental continuity and change in RRBs. For autistic individuals with fluent speech, RRB presentation may be influenced by verbal ability in ways that are highly variable, but clinically meaningful.

MANAGEMENT BEHAVIOR OF SCHOOL HEADS AND PSYCHOLOGICAL CAPITAL OF PUBLIC SECONDARY TEACHERS IN PANABO CITY DIVISION

The study explored the relationship between management behavior of school heads and psychological capital of teachers in public secondary schools of Panabo City Division. Also, it investigated the association of the involved variables and the domains of management behavior of school heads that significantly influenced psychological capital of teachers. With the use of probability sampling, 150 secondary teachers in the public schools were selected as the respondents. Utilizing the descriptive-correlational survey method, the data collated were analyzed through the use of Mean, Product-Moment correlation and Regression Analysis. Results revealed that there was a very extensive management behavior of school heads and a very extensive psychological capital of teachers. Furthermore, there was a significant relationship between the management behavior of school heads and psychological capital of teachers. Moreover, all domains of management behavior of school heads were found to have significantly influenced on the psychological capital of teachers. Based on the findings, it was further suggested that higher officials in the Department of Education may identify means on how to help the school heads in strengthening their management behavior to help teachers reinforce their psychological capital. KEYWORDS: Management behavior, psychological capital, descriptive correlation, Panabo City Division, Philippines

Exploring Health-Related Social Needs and Components of Social Competence Following Childhood Traumatic Brain Injury.

Health-related social needs (HRSNs) impact general health care and educational outcomes for children with traumatic brain injury (TBI) and their families. Furthermore, children with TBI of all severities experience negative social competence outcomes chronically postinjury. However, studies have not investigated the relationship between HRSNs and social competence outcomes for children after TBI. The aim of this study was to identify the relationship between HRSNs and components of social competence (i.e., social skills, social communication, family functioning, and behavioral domains per the biopsychosocial framework for social competence) for children with TBI, per parent report. This study used a prospective, cross-sectional study design with a convenience sample. Online surveys were completed by parents of children with TBI (N = 22). On average, children with TBI were 4.84 years old at the time of their TBI and 9.24 years old at the time of study participation. Having a parent identify an HRSN in the domain of mental health was associated with social communication and family functioning difficulties for children with TBI. Statistically significant relationships were found between social communication and family functioning, externalizing behavior, and total behavior; family functioning and social relations; and family functioning and externalizing behavior. The findings of this study support that children with TBI experience chronic deficits in components of social competence, and HRSNs are associated with these outcomes. Further research needs to consider HRSNs to improve equitable prevention, supports, and services for children with TBI.

Age-specific reference scores for the PISQ-12 on female sexual functioning in the Netherlands: a retrospective population-based survey.

Female sexual dysfunction is common in the general population, with age emerging as a significant determinant of sexual activity and functioning. To establish age-specific reference scores for the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in the general Dutch female population. A retrospective, cross-sectional, questionnaire-based study was conducted in the Netherlands. The study population comprised 2518 Dutch-speaking women aged ≥18years, representing a cross section of the general Dutch population. The PISQ-12 was used to assess sexual functioning in heterosexual women. The Groningen Defecation and Fecal Continence questionnaire was utilized to demonstrate demographic factors. We established age-specific reference scores for the PISQ-12 in the general Dutch population. Of the 2518 women, 1592 (63.2%) were sexually active and 926 (36.8%) were not. Further analysis focused on the sexually active group: we found a decrease in mean total PISQ scores, ranging from 38.34 among 18- to 34-year-olds to 36.98 among ≥65-year-olds. Older women scored lower in the behavior domain, specifically pertaining to sexual desire (P < .001) and sexual excitement (P <.001). They also had lower scores in the partner-related domain regarding partner problems of erection (P < .001) and orgasm perception (P < .001). With increasing age, negative emotional reaction scores were higher (P <.001). In the physical domain, we observed significantly different scores for pain during sexual intercourse (P < .001) and restrictions in sexual activity due to fear of urinary leakage (P < .001), with the lowest scores in the youngest group. These age-specific references scores of the PISQ-12 provide an overview of sexual functioning of a general population, which enables caregivers to assess and interpret patients' individual scores more accurately. We included only sexually active women in our subanalyses, potentially introducing selection bias for older women with better physical conditions. The study's strength lies in its extensive sample size, representing a cross section of the general Dutch population. Furthermore, the self-administered questionnaire approach helped minimize embarrassment and obtain realistic responses. Our study demonstrated age-specific PISQ-12 reference scores and highlighted associations between aging and diminishing scores of sexual desire, sexual excitement, erection problems, and orgasm perception, while women aged 18 to 34years reported the lowest scores for pain during intercourse and limited sexual activity due to fear of urinary leakage.

Consumer Behavior Analysis and Open Innovation on Actual Purchase from Online Live Selling: A case study in the Philippines

Live selling in the e-market has been dominating e-commerce consumer behavior, raising competition among brands. Given that online purchasing and live selling rose significantly in the Philippines, this study aimed to assess the actual purchase of Filipinos from online live sellers. Specifically, an extended and modified theory of planned behavior was utilized and measured with 316 valid responses analyzed through partial least squares structural equation modeling. Based on the results, it was seen that the factors under customer perceived value and purchasing intention presented a significant effect on the customer’s actual purchase. The feeling of relaxation, trust, confidence, and service quality obtained from purchasing from online live sellers posed a significant influence. In addition, utilitarian motivation was deemed significant while hedonic motivation was seen otherwise. Among the behavioral domains, attitude was deemed the highest significant variable, followed by perceived behavioral control, and subjective norm. E-market and e-businesses could consider the outcome of this study to build on strategies for live selling and participation among online live sellers in the e-market. Implications were discussed for practical approaches in the e-market. Lastly, the application and extension of the framework used may be considered by future researchers to completely assess online market consumer behavior.

Transitioning from the Emergency Department to a General Internist Outpatient Clinic for Paracentesis: A Qualitative Inquiry

BackgroundRepeated paracentesis for ascites can place significant demands on the emergency department (ED). A new general internist-led outpatient procedure clinic to alleviate this demand required ED staff and patients to accept this transition of care.AimThis qualitative study evaluates barriers and facilitators to implementing the FLuid ASPiration (FLASP) clinic in a safety net hospital.MethodsThe FLASP clinic opened during the COVID-19 pandemic in March 2021. From February to April 2022, semi-structured interviews were conducted with: 10 ED physicians and nurses; 5 FLASP clinic patients; and 4 patients receiving paracentesis in the ED. Interviews were recorded, transcribed, and analyzed using a Grounded Theory approach for themes categorized by Theory of Planned Behavior (TPB) domains including: attitudes/knowledge; social norms; and logistics.ResultsThematic analysis found that ED staff appreciated reduced demand for paracentesis, but barriers included: lack of knowledge; concerns about unstable patients and patient expectations (norms); and scheduling logistics. FLASP clinic patients had only favorable themes: belief in clinic safety; positive relationship with staff; and clinic efficiency. Patients using the ED for paracentesis expressed only concerns: possible need for testing or hospitalization; care usually in the ED; and unclear clinic scheduling.ConclusionThis study reveals challenges to transitioning sites of care for paracentesis including the need for greater ED staff education and standardizing methods to triage patients to appropriate site of care. Greater support and education of ED patients about the benefits of an outpatient procedure clinic may also reduce ED burden for paracentesis.

Health-related social needs, medical financial hardship, and mortality risk among cancer survivors.

Cancer survivors may face challenges affording food, housing, and other living necessities, which are known as health-related social needs (HRSNs). However, little is known about the associations of HRSNs and mortality risk among adult cancer survivors. Adult cancer survivors were identified from the 2013-2018 National Health Interview Survey (NHIS) and linked with the NHIS Mortality File with vital status through December 31, 2019. HRSNs, measured by food insecurity, and nonmedical financial worries (e.g., housing costs), was categorized as severe, moderate, and minor/none. Medical financial hardship, including material, psychological, and behavioral domains, was categorized as 2-3, 1, or 0 domains. Using age as the time scale, the associations of HRSNs and medical financial hardship and mortality risk were assessed with weighted adjusted Cox proportional hazards models. Among cancer survivors 18-64 years old (n=5855), 25.5% and 18.3% reported moderate and severe levels of HRSNs, respectively; among survivors 65-79 years old (n=5918), 15.6% and 6.6% reported moderate and severe levels of HRSNs, respectively. Among cancer survivors 18-64 years old, severe HRSNs was associated with increased mortality risk(hazards ratio [HR], 2.00; 95% confidence interval [CI], 1.36-2.93, p < .001; reference = minor/none) in adjusted analyses. Among cancer survivors 65-79 years old, 2-3 domains of medical financial hardship was associated with increased mortality risk (HR, 1.58; 95% CI, 1.13-2.20, p = .007; reference = 0 domain). HSRNs and financial hardship are associated with increased mortality risk among cancer survivors; comprehensive assessment of HRSN and financial hardship connecting patients with relevant services can inform efforts to mitigate adverse consequences of cancer.

499. Identification of a Composite Latent Dimension of Reward and Impulsivity Across Clinical, Behavioral and Neurobiological Domains Among Youth

499. Identification of a Composite Latent Dimension of Reward and Impulsivity Across Clinical, Behavioral and Neurobiological Domains Among Youth

Role of the prefrontal cortical protease TACE/ADAM17 in neurobehavioral responses to chronic stress during adolescence.

Chronic adolescent stress profoundly affects prefrontal cortical networks regulating top-down behavior control. However, the neurobiological pathways contributing to stress-induced alterations in the brain and behavior remain largely unknown. Chronic stress influences brain growth factors and immune responses, which may, in turn, disrupt the maturation and function of prefrontal cortical networks. The tumor necrosis factor alpha-converting enzyme/a disintegrin and metalloproteinase 17 (TACE/ADAM17) is a sheddase with essential functions in brain maturation, behavior, and inflammatory responses. This study aimed to determine the impact of stress on the prefrontal cortex and whether TACE/ADAM17 plays a role in these responses. We used a Lewis rat model that incorporates critical elements of chronic psychosocial stress, such as uncontrollability, unpredictability, lack of social support, and re-experiencing of trauma. Chronic stress during adolescence reduced the acoustic startle reflex and social interactions while increasing extracellular free water content and TACE/ADAM17 mRNA levels in the medial prefrontal cortex. Chronic stress altered various ethological behavioral domains in the observation home cages (decreased ingestive behaviors and increased walking, grooming, and rearing behaviors). A group of rats was injected intracerebrally either with a novel Accell™ SMARTpool TACE/ADAM17 siRNA or a corresponding siRNA vehicle (control). The RNAscope Multiplex Fluorescent v2 Assay was used to visualize mRNA expression. Automated puncta quantification and analyses demonstrated that TACE/ADAM17 siRNA administration reduced TACE/ADAM17 mRNA levels in the medial prefrontal cortex (59% reduction relative to control). We found that the rats that received prefrontal cortical TACE/ADAM17 siRNA administration exhibited altered eating patterns (e.g., increased food intake and time in the feeding zone during the light cycle). This study supports that the prefrontal cortex is sensitive to adolescent chronic stress and suggests that TACE/ADAM17 may be involved in the brain responses to stress.

Undergraduate nursing students’ perception of bullying behavior and its relation to their academic achievement

Background Bullying among students is certainly not a new notion, however, due to its high incidence rates and the short-term and long-term implications. Students were subjected to a lot of factors during their study, either academic or clinical, that revealed them suffering high levels of depression, anxiety, and stress. Aim Assess undergraduate nursing students’ perception of bullying behavior and its relation to their academic achievement. Design A descriptive correlational research design was used. Sample A convenience sample (n=1255) of undergraduate nursing student out of N=3108. Setting The study was conducted in an accredited Faculty of Nursing which is affiliated to Cairo University. Tools Three tools were used personal characteristics data sheet, Bullying Behavior in Nursing Education Questionnaire, and academic achievement checklist Grade Point Average form. Results The main findings indicated that the bullying highest mean percent (58.33 and 55.14%) as perceived by the study sample was regarded as direct negative behaviors domains and attack on academic achievement domains, respectively. While the lowest mean percent (8.7%) was in regard to types of bullying domain. Data added that there was no statistically significant relationship (P=0.72) between the total perception of bullying in nursing education and students’ academic achievement. Conclusion The study concluded that there was no statistically significant relationship between total bullying as perceived by undergraduate nursing students in nursing education and their academic achievement. Recommendations Develop training programs to educate clinical instructors and assistant lecturers on how to achieve the academic objectives and advocate students’ rights. Design educational workshops to inform nursing students how to report bullying and how to overcome it.

A SYSTEMIC REVIEW ON THE MANAGEMENT OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN CHILDREN

ADHD, a tantalising neurodevelopmental disorder documented in the DSM-5, fascinates with its distinctive characteristics: persistent inattention and hyperactivity. Beyond the surface, it intertwines with cognitive, social, and behavioural domains and affects 5.29% globally. Ayurvedic hints like Mano Vibhrama and Raja-Tama guna alignment illuminate a path, offering tridosha-shaman therapy, Medhya rasayana, and Panchakarma. A fusion of modern understanding and ancient wisdom paves the way for unravelling ADHD's enigma, promising novel solutions. This study aims to systematically review the management of attention deficit hyperactivity disorder in Ayurveda. To conduct this study, Ayurveda research articles were obtained from PubMed, Google Scholar and AYUSH portal. A total of 40 studies were obtained, which underwent further screening processes to achieve the quality of inclusion criteria. A total of 14 articles were selected from different publications of the review. Out of 14 articles obtained, 7 studies (n=14) exclusively focused on shaman chikitsa with different single drugs and various drug formulations, 06 studies (n=14) focused on shaman and Panchakarma therapy, which includes shirodhara, abhyanga, matra basti, kashaya basti and nasya, 1 study (n=14) emphasised the importance of Panchakarma. Out of 14 clinical studies, 6 showed highly significant results, 1 showed comparatively insignificant results, and 7 showed moderately significant results. This study combines Ayurvedic insights with modern ADHD research, providing a promising opportunity for integrative treatment approaches. Further investigation of this intersection could reveal new dimensions in the fight against this complex neurodevelopmental disorder.

Systematic Risk Characterisation of Hardware Threats to Automotive System

The increasing dependence of modern automotive systems on electronics and software poses cybersecurity risks previously not factored into design and engineering of such systems. Attacks on hardware components, communication modules and embedded software – many of which are purposefully designed for automotive control and communications – are the key focus of this paper. We adopt a novel approach to characterise such attacks using Gajski-Kuhn Y-charts to represent attack manipulation across behavioural, structural and physical domains. Our selection of attacks is evidence-driven demonstrating threats that have been demonstrated to be feasible in the real-world. We then risk assess impact of such threats using the recently adopted ISO/SAE 21434 standard for automotive cybersecurity risk assessment, including mitigations for potential adoption. Our work serves to provide unique insights into the complex dynamic of hardware vulnerabilities and how the industry may address system-level security and protection of modern automotive platforms.

How family physicians in Singapore recognise complexity during consultations: a qualitative study

BackgroundThe prevalence of persons with complex needs in Singapore is rising. Poor understanding of what constitutes complexity impedes the identification of care gaps and development of interventions to improve care for these individuals. We aim to identify the characteristics contributing to complexity in primary care, from the Family Physicians’ (FP) perspectives.MethodsFocus group discussions (FGDs) were conducted from January to September 2021 with experienced FPs across 14 study sites, employing a qualitative descriptive approach based on a complexity framework. Data were coded independently and categorised using thematic analysis by two independent investigators.ResultsFive FGDs were conducted with 18 FPs aged 32 to 57 years old working in different primary care settings, with a mean of 13.5 years of primary care experience. Participants emphasised the need for a unified definition of complexity. Complexity is characterised by the presence of issues spanning across two or more domains (medical, psychological, social or behavioural) that adversely impact medical care and outcomes. Persons with complex needs contrast with persons with medically difficult issues. Medical domain issues include the number of active medical problems, poor chronic disease control, treatment interactions, ill-defined symptoms, management of end-of-life conditions and functional impairment. Psychological domain issues include the presence of mental health conditions or cognitive impairment. Social domain issues include the lack of social support, competing social responsibilities and financial issues, while behavioural domain issues include a lack of trust in healthcare workers, fixed health beliefs and poor health literacy.ConclusionRecognising the medical, psychological, social and behavioural factors that contribute to complexity aids in discerning the diverse needs of individuals with complex needs. This underscores the need for additional support in these pertinent areas.