Low Perception Research Articles

A Comprehensive Investigation of Social Anxiety and Social Evaluative Stress in Autistic Children and Adolescents and Specific Learning Disorders.

The aim was to investigate trait social anxiety and social evaluative stress in autistic children and adolescents and Specific Learning Disorders (SLD). This was done by evaluating behavioral, subjective, and autonomic responses to the Trier Social Stress Test (TSST). Study 1 included 280 children and adolescents: 60 autistic without intellectual disability (ID), 70 SLD, and 150 non-diagnosed (ND) peers. Study 2 involved 55 participants: 15 autistic without ID, 15 SLD, and 20 ND. The sample was predominantly male. In Study 1, behavioral (quality of public speech) and subjective (valence, arousal, perceived competence, and worries) aspects of social stress were examined. Study 2 expands upon the first study, as physiological responses to social stress were also measured. Trait social anxiety was investigated using both parents' and children's reports in the two studies. Parents of autistic participants and with SLD reported higher trait social anxiety in their children than the parents of ND. No differences emerged from the participants' self-reports, though those autistic and with SLD were assigned lower scores in the public speech quality than ND. Autistic children and adolescents reported lower arousal and higher perceived competence than ND, while those with SLD reported a lower perception of competence. Autistic participants had a decreased cardiac reactivity across the TSST when compared to SLD and ND. Our findings show unique patterns of responses within each group, confirming that the combined investigation of trait anxiety and social stress responses could be a valuable insight in research and clinical practice.

어머니 일-가정 양립 갈등과 부부 갈등이 학령초기 아동의 학교적응에 미치는 영향: 사회적 지원의 조절된 매개효과

Objectives The purpose of this study was to examine the mediating effect of marital conflict and the moderated mediating effect of social support in mothers’ work-family conflict and school adjustment in children. Methods Among the data from the Panel Study on Korean Children(PSKC), the final sample consisted of 400 respondents who answered questions on work-family conflict, marital conflict, child school adjustment, and social the 8th year, when the children were in the first grade. SPSS Macro’s Model 4 was used to confirm the mediating effect of marital conflict in the relationship between mothers’ work-family conflict and school adjustment in children, and SPSS Macro’s Model 1 and 7 were used to analyze the moderating effect and moderating mediating effect of social support. Results First, mothers' work-family conflict showed a positive correlation with marital conflict and a negative correlation with social support and children's school adjustment. Marital conflict negatively correlated with social support and children's school adjustment, while social support did not show a significant correlation with children's school adjustment. Second, marital conflict mediated the relationship between mothers' work-family conflict and children's school adjustment. This means that work-family conflict directly affects school adjustment and also has an indirect effect through marital conflict. Third, in the relationship between work-family conflict and marital conflict, the group with a higher perception of social support showed a mitigating effect on marital conflict compared to the group with a lower perception of social support. Fourth, the study confirmed the presence of moderated mediating effects, indicating that the relationship between work-family conflict and children's school adjustment via marital conflict varies based on the level of social support. Conclusions Parents with children entering school may experience higher marital conflict in dual-income families than at other times, which can make it difficult for children to adapt to the new environment of school. Therefore, it suggests the need for social support and systems that can reduce work-family conflict and marital conflict experienced by the primary caregiver, as well as emotional support.

Cardiac risk confrontation in primary care as a teachable moment towards improved health outcomes

Abstract Background Urgent life events, such as acute coronary events, can evoke a teachable moment (TM) for lifestyle change. This study aims to investigate whether less urgent events, such as being confronted with an increased risk of cardiovascular disease, can evoke a TM, what psychosocial factors are associated with it, and whether experiencing such a TM predicts improved health outcomes. Methods The study included 114 patients who were informed about their elevated cardiovascular risk during a primary care visit. Participants completed a survey assessing whether they experienced a TM and several psychosocial factors linked to experiencing it: perceived risk, affective impact, changed self-concept. Participants monitored their weight and blood pressure for six months using an at-home self-monitoring device. Univariate and multivariate regression analyses were conducted to examine the associations between the psychosocial factors and the lifestyle change intentions with changes in blood pressure and weight. Results Of the participants, 55.3% experienced increased lifestyle change intentions. Lower risk perception ((B = -0.27; CI = -0.39-(-0.15)) and higher change in self-concept (B = 0.34; CI = 0.23-0.44) were associated with higher intention to change lifestyle. Higher risk perception (B = 0.23; CI = 0.06-0.42) and higher change in self-concept (B = 0.54; CI = 0.37-0.72) predicted a lower weight reduction at six months. A higher change in self-concept predicted a higher blood pressure reduction (B = -3.32; CI = -6.55-(0.09)). Lastly, a higher lifestyle change intention predicted bigger reductions blood pressure (B = -5.04; CI = -9.08-(-0.29)). Conclusions Results suggest that less urgent cardiac events, such as a confrontation with an increased cardiac risk, can be experienced as a TM that urges lifestyle change intentions and affects health outcomes. Risk confrontations in primary care therefore offer a unique opportunity to provide lifestyle counseling at the right moment. Key messages • A confrontation with an increased cardiac risk in primary care can be experienced as a teachable moment. • Experiencing a teachable moment after a cardiac risk confrontation in primary care affects health outcomes.

Musculoskeletal Tissue Asymmetries Following Anterior Cruciate Ligament Reconstruction

OBJECTIVE: To compare musculoskeletal tissue asymmetries between those who had undergone ACLR and non-surgical controls, and to evaluate the influence of sex on asymmetries and perceptions of knee function in ACLR patients. DESIGN: Cross-sectional cohort analysis. METHODS: Individuals (female n=11, male n=11) with a history of ACLR and matched controls (female n=10, male n=9) completed Dual-energy X-ray Absorptiometry (DXA) scans to measure lower-body bone mineral content (BMC), Fat%, and lean mass (LM). Perceptions of knee function were captured via the International Knee Documentation Committee (IKDC) instrument and inter-limb asymmetry indices (AI%) were calculated for each DXA outcome. Surgical groups and sexes were compared using independent t-tests ( p<0.05) and Cohen’s effect sizes ( d). Additionally, Pearson’s Correlation Coefficients evaluated the association between AI% and IKDC scores. RESULTS: The ACLR group showed greater lower-body asymmetries, specifically less BMC and LM and greater Fat% in the ACLR limb ( p≤0.044; d=0.63–0.87). ACLR group sex comparisons found that females had lower IKDC scores, greater asymmetries for BMC and LM ( p≤0.027, d=0.40–0.74), and these asymmetries were negatively correlated with IKDC scores (all r≥0.755; p≤0.007) while males demonstrated no such correlations. CONCLUSIONS: Individuals with a history of ACLR had persistent musculoskeletal tissue asymmetries that favored the non-surgical leg. The asymmetries were greater in female versus male patients and were associated with lower perceptions of knee function. Thus, musculoskeletal imaging may provide complementary information to the current standard of care during ACLR rehabilitation.

Users' Experience of Treatment and Coercion in an Inpatient Medium-Stay Psychiatric Rehabilitation Unit: A Mixed Methods Study.

Coercion influences mental health services users' experience of care and can hinder their recovery process, so it is essential to understand how it is perceived in rehabilitation settings oriented towards recovery. To describe and measure users' experience of coercion and explore their perception of the treatment received in an inpatient medium-stay psychiatric rehabilitation unit (IMSPRU). This study, in which 75 service users participated, used a mixed methods approach. Twenty participants were administered a semistructured interview and completed quantitative measures for coercion and 55 additional service users completed the quantitative measurements only. The perception of coercion was measured using the Coercion Experience Scale. The content analysis of qualitative data resulted in two main themes: treatment received and experience of coercion in the IMSPRU. The participants made a distinction between good treatment and mistreatment or unfair treatment. Experience of coercion in the IMSPRU included the feeling of freedom or lack thereof in the unit, forms of formal and informal coercion, and the positive or negative impact of rules on the unit. The quantitative data revealed a low perception of formal coercion among the users. Individuals had different views of what it meant to be treated well, but all agreed on the importance of communication and the need to feel respected. Informal coercion was the most frequent type of coercion identified, but users were often unaware of its existence. Knowledge of how IMSPRU users experience the treatment received from nursing staff and how they perceive coercive situations will help to lay the foundations of a system of care oriented towards good treatment and noncoercive practices.

Exposure to e-cigarette and heated tobacco product advertisements via digital, traditional media, and points-of-sale: An examination of associations with use intentions and perceived risk among adults in Armenia and Georgia.

E-cigarette and heated tobacco product (HTP) marketing often leverages digital media and points-of-sale (POS) and advertises risk reduction, including in Armenia and Georgia where male cigarette use rates are high. Using 2022 survey data from Armenian and Georgian adults (n=1468, mean age=42.92 years, 51.4% female; and past-month use of e-cigarettes 3.2%, HTPs 2.7%, and cigarettes 31.6%), multivariable linear regression examined 4 outcomes - e-cigarette and HTP use intentions and perceived risk (1=not at all, to 7=extremely) - in relation to past-month e-cigarette or HTP advertisement exposure via digital media, traditional media, and POS, controlling for covariates (country, age, gender, education level, relationship status, children, past-month cigarette and e-cigarette/HTP use). E-cigarette and HTP use intentions were low (mean score=1.47, SD=1.39 each), while perceived risk was high (mean score=5.83, SD=1.6, and mean score=5.87, SD=1.56, respectively). Past-month exposure to e-cigarette and HTP advertisements, respectively, were 12.9% and 11.2% via digital media, 6.1% and 4.8% traditional media, and 22.5% and 21.1% POS. For e-cigarettes, ad exposure via digital media was associated with greater use intentions (β=0.24; 95% CI: 0.03-0.44), ad exposure via traditional media (β= -0.32; 95% CI: -0.55 - -0.09) and POS (β= -0.30; 95% CI: -0.60 - -0.004) was associated with lower risk perceptions. For HTPs, ad exposure via digital media (β=0.35; 95% CI: 0.14-0.56) and POS (β=0.21; 95% CI: 0.04-3.63) was associated with greater use intentions, and ad exposure at POS was associated with lower risk perceptions (β= -0.23; 95% CI: -0.42 - -0.03). Tobacco control efforts should monitor and regulate e-cigarette and HTP marketing, particularly via digital media which may effectively promote use, and via POS which may target and influence risk perceptions.

Teacher education in Israel: a fifty-year journey (1974–2024)

ABSTRACT This study explores the evolution of teacher education in Israel from 1974 to 2024, analysing key policy actions, reforms, and initiatives that have shaped the field over the past five decades. During these years, extensive efforts were undertaken at the state level by the Ministry of Education and the Council for Higher Education to elevate the status of the teaching profession by advocating for the professionalisation and professionalism of teaching and teachers. These efforts include the academisation process of all teacher education colleges, the establishment of task forces and standing committees to address challenges, continuous upgrades and adjustments to the initial teacher education curriculum, support mechanisms for newly qualified teachers, ongoing professional development for practicing teachers, including master’s degree programmes, salary adjustments, and the decision to move the colleges of education to the sole auspices of the Council for Higher Education and the Planning and Budgeting Committee. Despite these numerous attempts, the status of teachers has continued to decline, and the profession has struggled with low public perception and prestige, leading to both quantitative and qualitative teacher shortages. The repeated policy shifts and inconsistent implementation strategies have often exacerbated rather than resolved these issues. By providing a comprehensive historical analysis, the study offers insights into the successes and significant shortcomings of past initiatives, aiming to inform future policy-making and strategic planning to enhance the effectiveness and appeal of the teaching profession in Israel.

Indigenous Diffuse Support and Descriptive Representation in the Canadian House of Commons

Abstract Do Indigenous peoples in present-day Canada display lower levels of diffuse support than non-Indigenous settlers? Given settler colonial relations (both historic and contemporary) and Indigenous peoples’ own political thought, we can expect that Indigenous peoples would have even lower perceptions of state legitimacy than non-Indigenous peoples. However, there are conflicting expectations regarding whether the descriptive representation of Indigenous peoples in settler institutions is likely to make a difference: on one hand, Indigenous people may see themselves reflected in these institutions and consequently feel better represented; on the other hand, these forms of representation do not challenge the underlying colonial nature of these institutions. Using data from the 2019 and 2021 Canadian Election Studies, our statistical analysis demonstrates that: (1) diffuse support is significantly lower among Indigenous peoples than non-Indigenous peoples, including people of color; (2) Indigenous respondents across multiple peoples have similarly low levels of diffuse support, and (3) being represented by an Indigenous Member of Parliament does not change the levels of diffuse support among Indigenous peoples. Overall, our research highlights the outstanding challenges to achieving reconciliation through the Canadian state and points to ways large-N analyses may be made more robust.

The Role of Human Values in the Relationship Between Industry 4.0 and Job Insecurity in an Emerging Economy

ABSTRACTThis study analyses the relationship between Industry 4.0, human values and job insecurity in Colombia against significant technological changes and global economic challenges. It aims to understand how human values mediate the relationship between Industry 4.0's technological advances and the perception of job security in the current era of economic and social uncertainty. Utilising a Likert scale, the study gathered 714 survey responses from employees in medium and large Colombian companies. The study used a multistage multivariate analysis approach, starting with unidimensionality analysis, followed by reliability and validity analysis to measure accuracy. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were subsequently employed to test the underlying factor structures of the data. Finally, structural equation modelling integrated the findings, forming a model that sheds light on the relationships among the studied variables. The analysis revealed strong human values such as commitment, collaboration, tolerance, honesty and loyalty in the workplace. Interestingly, participants had a low perception of job insecurity, indicating a more complex relationship between technological advancements and job security perceptions. This study offers valuable insights into how human values shape the workforce's response to the rapid changes of Industry 4.0, particularly in an emerging economy like Colombia.

An expository analysis of biomechanical and subjective impacts induced by shoe inserts in asymptomatic subjects: A systematic review on functionality and mechanisms of action

AbstractThis systematic review explores the biomechanical and subjective effects of shoe inserts, including foot orthotics (FOs) and insoles, in asymptomatic subjects. Aimed at understanding their implications, the review poses two key research questions: (i) the influence of shoe inserts on lower extremity biomechanics and subjective perception and (ii) the effects of different design characteristics on these aspects. Following Preferred Reporting of Systematic Reviews and Meta‐Analysis guidelines, a meticulous search of Scopus and PubMed from August 2022 to March 2023 yielded 34 articles, with 26 focusing on biomechanical effects and eight on comfort effects. The studies, conducted during static and dynamic activities, such as standing, walking, jogging, running, jumping, and cycling, reveal significant reductions in rearfoot eversion, knee joint forces, and lower extremity muscle forces through postings and wedging in FOs. Changes in stiffness impact rearfoot kinematics, plantar pressure distribution, and ankle–foot power distribution. Conversely, surface texture and arch variations demonstrate limited significance. FOs and shoe inserts, characterized by geometric, material, location, size, and fabrication features, effectively regulate forces and moments on the lower extremity. This control promotes uniform plantar pressure distribution and enhances comfort during various activities. These insights benefit manufacturers, clinicians, and stakeholders, providing a deeper understanding of the positive benefits of FOs and shoe inserts. However, further well‐designed studies on clinical populations are necessary to validate these findings and establish their clinical efficacy, as the current focus remains on healthy subjects.

Growing green: Exploring the drivers of citizens’ participation in Italian urban and peri-urban forestation governance

Urban and peri-urban forests (UPUFs) are essential components of urban landscapes that offer multiple benefits to local communities, above all to those who live in large cities. This realization has fueled the interest of the scientific community in understanding citizens’ attitudes and perceptions towards UPUFs, focusing on the diverse ecosystem services they provide in social and environmental terms. However, less attention has been paid to the citizens’ perceptions and attitudes about UPUFs in relation to their willingness to participate in their governance. This quantitative study aims to address this gap by identifying the main factors that affect citizens’ participation in UPUFs governance. Conducted in large Italian Metropolitan Functional Urban Areas, composed of a city and its commuting zone, with a population above 500,000 inhabitants, this study provides valuable insights into citizens’ willingness to participate in UPUFs governance. Results indicate that citizens' socio-demographic factors (especially education, age, and income) and the frequency of visits impact their perception of UPUFs. High positive perceptions of environmental quality and low perceptions of the negative impact of UPUFs promote active participation in governance, especially among young citizens with heightened green space sensitivity, among those dissatisfied with current green space management and those advocating for effective communication campaigns. These findings can provide a practicable scientific reference for municipalities to refine their corresponding decision-making and communication, and to devise effective urban forest programs.

Inflammation biomarkers and neurobehavioral performance in rural adolescents.

Systemic inflammation has been associated with lower neurobehavioral performance in diverse populations, yet the evidence in adolescents remains lacking. Cytokines can alter neural network activity to induce neurocognitive changes. This work seeks to investigate the association between inflammation and neurobehavior in adolescents living in a rural region of Ecuador. We examined 535 adolescents in rural communities of Ecuador (ESPINA study), 508 of which had neurobehavioral assessments (NEPSY-II) and circulating plasma levels of inflammatory markers (CRP, IL-6, TNF-⍺, sICAM-1, sVCAM-1, SAA, and sCD14). Associations between inflammatory biomarker concentrations and neurobehavioral scores were examined using adjusted bivariate semi-parametric models with generalized estimating equations. A partial least square regression approach was used to create composite variables from multiple inflammation biomarkers and model their association with cognitive outcomes. Higher sCD14 and TNF-α concentrations were significantly associated with lower social perception scores, by -0.47 units (95% CI: -0.80, -0.13) and -0.42 (-0.72, -0.12) for every 50% increase in inflammatory marker concentration, respectively. Similarly, every 50% increase in the inflammation summary score was associated with a significantly lower Social Perception score by -0.11 units (-0.19, -0.03). A unit increase in inflammatory composites of seven markers were associated with lower scores in language (-0.11 units, p=0.04), visuospatial processing (-0.15, p= 0.09), and social perception (-0.22, p=0.005) domains. Higher levels of inflammation were associated with lower neurobehavioral performance in adolescents, especially with social perception. In addition, using a robust analytic method to examine an association between a composite inflammatory variable integrating seven markers led to additional findings, including the domains of language and visuospatial processing. A longitudinal follow-up of such investigations could unveil potential changes in inflammation-neurobehavior performance links through developmental stages and intervention opportunities.

Streaming movies, series and shows: attitudes and beliefs among Gen Zers

Purpose Faster internet and online streaming have changed the way young consumers enjoy their favorite movies, series and shows, and business models must adapt to these changes. This study aims to examine the streaming behaviors, beliefs and piracy intentions of Generation Z, the youngest and largest generation of online entertainment consumers. Research in the area of young consumer behavior and streaming piracy is limited, and for a good reason: current laws and regulations focus on punishing the distributors of pirated content rather than consumers. Design/methodology/approach This study used a self-reported questionnaire administered to 750 Generation Z college students aged 17–25 years. The authors used the scenario-based method to examine the factors explaining the intentions to commit movies, series and shows streaming (MS) piracy. This method has been extensively applied when analyzing digital piracy because sharing streaming account passwords and using illegal streaming websites among consumers is still not unlawful in the U.S. Therefore, an adequate approach to evaluate young consumers’ intentions is through a scenario-based model. All information was coded, and a statistical and econometric analysis was completed. Findings From the statistical analysis, the authors found that only 14% of the young participants indicated their intention to stop sharing account information and using illegal websites to watch their favorite movies and shows if streaming piracy were punishable by law. The key motivations are related to the denial of injury to others and the belief that governments would have a difficult time enforcing the law in online environments. Approximately 80% of the participants who indicated their intention to continue MS piracy expressed a low perception of any type of risk associated with MS piracy. Research limitations/implications The results were obtained using a scenario-based model. A scenario provides the opportunity for the participants to reflect on a specific conflict, but they can recognize that there is little at “stake” when addressing the conflict, potentially producing the bias of “over positive responses.” Nonetheless, the analysis is still reliable, as the number of observations is large (750 responses), and the conflict is expressed as a degree of conformity rather than a yes/no answer. Practical implications The authors believe that future generations’ attitudes and beliefs about streaming entertainment will pose significant economic hardships to the entertainment industry. Similar to other forms of entertainment, streamed movies, series and shows are highly susceptible to digital piracy and it is the most common risky behavior among adolescents. The economic impact of streaming piracy could extend to revenue losses, job losses and national domestic production. Social implications Peer influence, personal or through social media, is a strong predictor of streaming piracy. In fact, social media influencers play an important role in teenagers’ behavior, including the usage of illegal streaming apps or websites and other deviant behavior in the digital world. It is expected that social media influencers will continue to be a relevant explanatory factor of streaming piracy among young Gen Zers. Originality/value This study contributes to the literature on digital piracy in several ways. First, it adds to the understanding of streaming piracy and the views and perceptions of young consumers about entertainment streaming. Second, the authors extend the analysis of digital piracy to streamed movies, shows and series. Third, the authors complete a statistical analysis on the relationships between Gen Zers’ consumption behavior, beliefs and intentions of streaming entertainment piracy. Understanding Gen Zers’ behavior and attitudes toward paid versus unpaid consumption of streaming content will allow the entertainment industry to respond effectively to future changes in copyright laws and technology usage.

HPV Vaccination Stages and Associated Factors Among Children of Immigrant Women.

This study aimed to identify key determinants by stage of implementation of human papillomavirus (HPV) vaccination among children of immigrant women in South Korea. Cross-sectional descriptive study. The sample comprised 262 Chinese, Vietnamese, and Korean-Chinese women with children living in South Korea. The survey was conducted using self-report questionnaires. The HPV vaccination levels in children were classified into four transition stages. Sequential logistic regression analysis was conducted to identify the factors affecting the transition of HPV vaccination status. Social norms had the greatest influence on the intention to vaccinate. Perceived barriers were a significant factor associated with intention or initiation of vaccination, whereas perceived severity and susceptibility were associated with the intention and initiation stages, respectively. Upon the initiation of HPV vaccination, low perception of discrimination in healthcare was associated with continued vaccination. Given the importance of completing multiple doses of the HPV vaccine within a given timeframe, it is important to provide culturally appropriate interventions in stages to prevent dropouts.

Towards equal neighborhood evolution? A longitudinal study of soundscape and visual evolution and housing value fluctuations in shenzhen

The equitable evolution of neighborhood environments is closely linked to housing economics. However, the lack of quantitative and longitudinal evaluation methods makes it challenging to assess residents' neighborhood perceptions and achieve social inclusiveness goals. Using long-time series street view imagery, we quantified Shenzhen residents' multidimensional neighborhood perceptions before and after micro-renovations, including visual and soundscape dimensions, and revealed the association between perceptual evolution and the housing value. We identified inequitable results during neighborhood renewal: Neighborhoods with high soundscape scores are accompanied by low visual perception scores, and vice versa. The spatial inequality is reflected in the perceptual differentiation prevalent between urban and suburbs. Visual aspects showed a stable but weak relationship with housing value fluctuations, while soundscape aspects had a strong but more dynamic impact. The inequitable spatial evolution is facilitated by changes in residents' perceptions: expectations for positive audio-visual perceptions are increasing, but sensitivity for negative soundscape is decreasing. Meanwhile, residents are increasingly seeking diverse and rich visual neighborhood landscapes and atmospheres filled with human voices. This study provides quantitative support for the equitable evolution of neighborhoods and the economics of neighborhood landscapes. It offers a novel method for measuring multidimensional perceptions that can be applied to settlements worldwide.

Barriers and enablers that influence the uptake of HIV testing among heterosexual migrants in the Netherlands.

Heterosexual migrant men and women in the Netherlands often face barriers to accessing health services, including HIV testing, that may lead to late-stage HIV diagnoses. This study explored factors of influence in the usage of HIV testing among heterosexual migrants. Qualitative evaluation with semi-structured interviews at the Amsterdam-based AIDS Healthcare Foundation (AHF) Checkpoint and one focus group discussion (FGD) conducted during June-July 2023 with 19 participants: interviews with 12 heterosexual migrants from low- or middle-income countries (LMICs) and FGD (n = 5) and interviews (n = 2) with 7 key informants from the (public) health sector. Recorded interviews were transcribed and thematically analyzed, using the framework of Andersen's Expanded Behavioral Model of Health Services Use. In total, 55 themes emerged from the interviews and the FGD. Examples include insufficient availability of information on HIV and testing services, and difficulty in accessing these services (e.g. the barrier of the online appointment system of the Centre for Sexual Health (CSH)). HIV test participants expressed free, rapid testing, no appointment required, and a positive experience during their HIV test as enablers to test in the future. Results from key informants showed that poor health literacy and lack of clarity on the healthcare system's guidelines were barriers for heterosexual migrants in accessing information on HIV and testing services. It also revealed past initiatives and interventions that were successful in reaching at-risk groups such as the integration of HIV testing into sexually transmitted infection (STI) testing, but that were subsequently discontinued due to financial constraints. Factors contributing to a low HIV test uptake were participants' perception of limited accessibility of CSH facilities, insufficient available information on HIV (testing) services, and low perception of HIV risk. Unclear policies on accessing HIV/STI testing services at CSHs, and potential missed opportunities for HIV testing at general practitioners were contributing factors identified by key informants.

Knowledge, competence and educational needs of mental health staff on palliative care for the elderly with dementia.

Dementia is a clinical syndrome for which the benefits of palliative care have been recognized. The aim of this study was to investigate the knowledge and educational needs of mental health physicians and nurses and also their perceptions of their competence regarding palliative care for the elderly with dementia. A total of 96 mental health professionals (doctors, nurses) working in a public psychiatric hospital and its allied community mental health settings participated in the study. The Palliative Care Quiz for Nursing (PCQN) was used to detect their knowledge on palliative care as well as a questionnaire to collect participants' demographics, their perceptions about their competence on palliative care provision and their educational needs on the basics domains of palliative care for the elderly with dementia. Results revealed participants' significant lack of knowledge (PCQN =7.79/20) and low perception of competence regarding palliative care for aged persons with dementia. Participants who were psychiatrists, who had work experience between 16-20 years and provided care to more than ten patients with terminal dementia per year, showed higher PCQN scores in statistically significant level (p=0.001). The majority (93.6%) of participants considered training in palliative care for dementia patients as necessary, particularly in providing information to family/carers, relieving the psychosocial burden of family/carers, managing the terminal stage of dementia, providing information to dementia patients and planning their advanced care. Findings of this study could inform the design of training programs on palliative care for the elderly with dementia in Greece.

An examination of ethical leadership in academia: a study of accounting faculty

ABSTRACT This study reports on accounting faculty perceptions of ethical tone-at-the-top (TATT) – indicative of ethical leadership – and explores the relationship of TATT to faculty job satisfaction. Both constructs have international applicability. A sample of 539 survey responses from United States accounting faculty provided data for the analyses. Job satisfaction and perceptions of TATT, proxy measured with the Ethical Leadership Scale and the Behavioral Integrity scale, were found significantly and positively related. Most accounting faculty perceived an ethical TATT, and most faculty were satisfied with their jobs. Nevertheless, about a third did not affirmatively indicate that their direct supervisor reflected an ethical TATT and about a fifth did not affirmatively indicate that they were satisfied with their jobs. Female faculty compared to male faculty, and tenured faculty compared to non-tenured faculty, had lower perceptions of the TATT of their direct supervisors and had less job satisfaction. By improving the TATT in accounting departments, academic leaders can perhaps retain more faculty, decrease unethical behaviors, and provide improved ethics training to future accountants.

Self-management in young and middle-aged patients with hypertension: a systematic review and meta-synthesis of qualitative studies

BackgroundThere has been a sharp increase in the prevalence of hypertension in young and middle-aged people at high risk of the disease. Despite the fact that good self-management can be effective in controlling blood pressure, patients do not perform well in this area, resulting in poor blood pressure control. It is therefore particularly important to gain a thorough understanding of patients’ attitudes to self-management and the factors that influence them. The aim of this study was to synthesise the qualitative research on attitudes, motivations and challenges of self-management in young and middle-aged hypertensive patients, to analyse the synthesised results using the COM-B model and to propose appropriate improvement actions.MethodsFrom the time of construction until May 2023, the system searched PubMed, Web of Science, ProQuest, Embase, MEDLINE, CINAHL, PsyCINFO and CNKI databases. The analyses were carried out using a thematic synthesis approach to summarise the key findings. The findings were then mapped and analysed using the COM-B model.ResultsA total of 11 studies were included, involving 250 patients between the ages of 18 and 64. Four themes with ten sub-themes were identified: Poor disease recognition (low disease perception, fuzzy disease knowledge); Barriers to doctor-patient interactions (short communication time, unmet knowledge needs, incomplete guidance for disease management); Living in a hostile environment (heavy workload, lack of companionship, ignorance of families); Expectations for a healthy body (responsibility of family roles, witness the cruelty of illness). Analysis of the composite results based on the COM-B model showed that low disease perceptions, barriers to doctor-patient interactions and life circumstances with enemies on all sides were the main challenges faced by young and middle-aged hypertensive patients, whereas the expectation of a healthy body was a motivation to promote self-management of blood pressure in patients.ConclusionsThis study shows that family responsibilities are a particular motivator for self-management in young and middle-aged hypertensive patients. In response to the problems they face, we believe that meeting patients’ knowledge needs, improving healthcare professionals’ communication skills and valuing the role of community hospitals are effective ways to promote patient self-management. In the future, telemedicine, mobile healthcare and intelligent monitoring devices will provide a solution to reduce the burden on medical resources.Systematic review registrationPROSPERO CRD42018100810.

Associations Between Every day and Medical Setting-Based Discrimination and Religious and Sociodemographic Characteristics of Muslim Americans: Findings from a National Survey.

We investigated the associations between sociodemographic factors, religiosity traits, and the perception of discrimination among Muslim Americans in both everyday life and medical settings. A self-administered web-based questionnaire, comprising validated measures of discrimination and religiosity, was completed by a convenience sample of English-speaking adult Muslim Americans, recruited through both in-person and online channels. Among the 1281 respondents, less than half were born in the USA (46%), and a significant portion displayed visible religious markers, such as wearing a hijab or having a beard (61%). Only 154 (12%) reported never experiencing everyday discrimination, while 358 (28%) reported not experiencing discrimination in medical settings. In a multivariable linear regression model, greater perceived everyday discrimination (β = 1.053, p < 0.01) was positively associated with greater discrimination in medical settings. Participants more comfortable self-identifying as Muslim in hospital settings (β = -0.395, p < 0.05) were less likely to perceive healthcare discrimination. Those visibly expressing their religiosity (β = 0.779, p < 0.01) and those with greater intrinsic religiosity (β = 0.231, p < 0.05) were more likely to encounter everyday discrimination. Conversely, older participants (β = -0.015, p < 0.05), adult immigrants to the US (β = -0.375, p < 0.05), those in better health (β = -0.157, p < 0.05), and those more comfortable identifying as Muslim (β = -0.305, p < 0.05) had lower perceptions of everyday discrimination. This study underscores the significance of the relationship between religiosity characteristics and experiences of both hospital and everyday discrimination for Muslim Americans.