Theoretical Consensus Research Articles

Preparing for future public health crises by fostering a conducive environment

Abstract Vaccination is considered one of the most cost-effective public health interventions. Zoonotic diseases, which are transmitted from animals to humans, represent an escalating global health concern. Environmental degradation, wildlife trade, and intensified farming practices have disrupted natural ecosystems. This has not only heightened the risk of pathogens crossing species barriers but exacerbated the migrant crisis and deepened global inequalities, as vulnerable populations disproportionally bear the environmental and health burdens. Despite decades of awareness about these risks, the COVID-19 pandemic highlighted our lack of preparedness. At the same time, vaccination hesitancy has been revealed as an important factor in implementing universal vaccination coverage at the population level. Urgency drove innovation. Within months, new multidisciplinary and interdisciplinary approaches were implemented that enhanced our capacity to understand, treat, and protect against the virus. This led to deploying novel technologies, curbing the crisis, and even opening the door to emerging health technologies across a wide spectrum of innovation, from new medicinal products, including vaccines, to evidence synthesis tools, including for modelling and forecasting. Shifting from emergency measures to long-term management of COVID-19, there lies a critical opportunity to strengthen resilience and to increase preparedness against future health threats. The EUVABECO project seeks to harness this momentum by initiating pilot projects that test innovative vaccination tools in evidence-based selected reference practices. These pilots are planned to use suitable theoretical frameworks and consensus meetings to design and develop comprehensive implementation plans that will be shared with EU MS, thereby enhancing Europe’s preparedness and response capabilities against communicable diseases.

Ballasts of the entrepreneurial ecosystem

Entrepreneurial ecosystem research has developed into a distinct field of study and extant frameworks and models consider the heterogeneous characteristics of ecosystems as a focal point for policymakers seeking to bolster regional entrepreneurial performance. Despite theoretical consensus on these issues, however, entrepreneurial ecosystem research has achieved only modest results in practice for catalyzing entrepreneurial activity. This is largely due to current models providing opaque targets for policymakers to focus their energies, a quandary that this qualitative study attempts to resolve. This research suggests that practical results can be improved by concentrating resource allocations on regional entrepreneurial ecosystem ballasts, which represent the various stakeholders who serve important roles as connectors, vettors, promoters, and chroniclers to catalyze entrepreneurial activity and support cultural heterogeneity. Concomitantly, this research also builds upon previous scholarship which has attempted to connect ecosystem attributes with the benefits that they provide to entrepreneurs.

The Dynamics of Debris Disk Creation in Neutron Star Mergers

The detection of GW170817/AT2017gfo inaugurated an era of multimessenger astrophysics, in which gravitational-wave and multiwavelength photon observations complement one another to provide unique insight into astrophysical systems. A broad theoretical consensus exists, in which the photon phenomenology of neutron star mergers largely rests upon the evolution of the small amount of matter left on bound orbits around the black hole or massive neutron star remaining after the merger. Because this accretion disk is far from inflow equilibrium, its subsequent evolution depends very strongly on its initial state, yet very little is known about how this state is determined. Using both snapshot and tracer particle data from a numerical relativity/MHD simulation of an equal-mass neutron star merger that collapses to a black hole, we show how gravitational forces arising in a nonaxisymmetric, dynamical spacetime supplement hydrodynamical effects in shaping the initial structure of the bound debris disk. The work done by hydrodynamical forces is ∼10 times greater than that due to time-dependent gravity. Although gravitational torques prior to remnant relaxation are an order of magnitude larger than hydrodynamical torques, their intrinsic sign symmetry leads to strong cancellation; as a result, hydrodynamical and gravitational torques have a comparable effect. We also show that the debris disk’s initial specific angular momentum distribution is sharply peaked at roughly the specific angular momentum of the merged neutron star’s outer layers, a few r g c, and identify the regulating mechanism.

Identifying the theoretical foundations of coaching as a form of ongoing professional development in early childhood education: a meta-narrative review

ABSTRACT Despite evidence of the effectiveness of coaching as a form of ongoing professional development for educators, including in early childhood education, the field lacks an understanding of what the key components of coaching are and how and why they ‘work’. An improved theoretical basis for coaching would assist in identifying these underlying mechanisms of change. However, the field has been largely undertheorised, and an awareness of which theories have been applied in the field is lacking. This study entailed a meta-narrative review of the literature to identify which theories have informed the study of ongoing professional development in education, with a focus on coaching for early childhood educators. We identified 11 foundational papers addressing ongoing professional development in education that proposed or applied theories, and 69 papers on coaching for early childhood educators with a theoretical focus published between 2002 and 2022. Among both groups of papers, there were 47 different main theories applied or proposed. The findings indicate that coaching and other forms of ongoing professional development in education remain undertheorised and theoretical consensus is lacking. The findings suggest that further empirical testing of theories is required before any path towards building a theoretical consensus will become clearer.

Persuasive Systems Design Trends in Coronary Heart Disease Management: Scoping Review of Randomized Controlled Trials.

Behavior change support systems (BCSSs) have the potential to help people maintain healthy lifestyles and aid in the self-management of coronary heart disease (CHD). The Persuasive Systems Design (PSD) model is a framework for designing and evaluating systems designed to support lifestyle modifications and health behavior change using information and communication technology. However, evidence for the underlying design principles behind BCSSs for CHD has not been extensively reported in the literature. This scoping review aims to identify existing health BCSSs for CHD, report the characteristics of these systems, and describe the persuasion context and persuasive design principles of these systems based on the PSD framework. Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, 3 digital databases (Scopus, Web of Science, and MEDLINE) were searched between 2010 to 2022. The major inclusion criteria for studies were in accordance with the PICO (Population, Intervention, Comparison, and Outcome) approach. Searches conducted in the databases identified 1195 papers, among which 30 were identified as eligible for the review. The most interesting characteristics of the BCSSs were the predominant use of primary task support principles, followed by dialogue support and credibility support and the sparing use of social support principles. Theories of behavior change such as the Social Cognitive Theory and Self-Efficacy Theory were used often to underpin these systems. However, significant trends in the use of persuasive system features on par with behavior change theories could not be established from the reviewed studies. This points to the fact that there is still no theoretical consensus on how best to design interventions to promote behavior change in patients with CHD. Our results highlight key software features for designing BCSSs for the prevention and management of CHD. We encourage designers of behavior change interventions to evaluate the techniques that contributed to the success of the intervention. Future research should focus on evaluating the effectiveness of the interventions, persuasive design principles, and behavior change theories using research methodologies such as meta-analysis.

Shedding light on relations between teacher emotions, instructional behavior, and student school well-being – Evidence from disadvantaged schools

BackgroundDespite broad theoretical consensus on the direct and indirect relevance of teacher emotions for instructional behavior and student outcomes, empirical evidence is inconclusive. Moreover, there is limited research in this area involving disadvantaged and younger student populations, and addressing students’ school well-being as an outcome explicitly. AimsThis study investigates associations between teacher emotions (joy, anger, anxiety), teacher-reports of instructional behavior (cognitive and motivational stimulation, classroom management, and social support), and students' reported school well-being (positive emotions and intrinsic motivation experienced at school), hypothesizing effects of teacher emotions on student school well-being, mediated via teachers’ instructional behavior. SampleParticipants were 1550 primary school students and their 134 homeroom teachers from 50 Austrian disadvantaged schools. MethodsData were collected using written online questionnaires and analyzed applying Bayesian multilevel mediation analysis. ResultsTeachers' joy positively related to aspects of all assessed dimensions of instructional behavior. Anger and anxiety related negatively only to aspects of classroom management. No associations were identified between teachers' instructional behavior and student school well-being, or teachers’ joy or anxiety and student school well-being, rejecting the mediation assumption. Surprisingly, teacher anger positively related to student intrinsic motivation. ConclusionsThis study supports theoretical assumptions on the role of teacher emotions for instruction but did not replicate theorized indirect effects of teacher emotions via instructional behavior on student outcomes. In contrast, the identified direct association between teacher anger and student intrinsic motivation represents a valence-incongruent link which evokes interesting perspectives and stimulates a further differentiation of established theoretical assumptions.

Values as Motives: Implications for theory, methods, and practice.

The concept of human values is central to the study of culture, ethics, politics, anthropology, sociology, social psychology, environmental studies, health policy, education, management, and human capital. Because it represents the ultimate "why" behind decisions and behaviors, as a concept it plays an outsized role in both theory and practice in each of these fields. Despite the centrality of human values in these domains, the concept lacks theoretical consensus among scholars and practitioners. Like the concepts of subjective well-being, organizational culture, employee engagement, and leadership, the values literature suffers from concept proliferation and cries out for clearly stated definitions that embed the concept within a solid theoretical framework. In this article, we advocate for a fundamental reconsideration of the concept of values, anchoring it within a new psychological theory of human motivation based on first principles. Our primary contribution lies in demonstrating that the operational definitions utilized by academics and practitioners alike can be thought of as attempts to approach concepts of human motivation, specifically, emotional needs, without fully getting there. We review the leading definitions of human values in the literature, concluding that they can be distilled to a fundamental set of human emotional needs, each associated with extensive literatures of their own. We introduce a comprehensive framework of 12 human emotional needs and argue that a comprehensive motivational framework offers significant advantages over current theoretical approaches, which tend to spin off an ever-expanding list of concepts. We consider the impact of embedding values concepts within existing motivational constructs with clear benefits for: (a) theory development, (b) method development, and (c) practical applications, emphasizing the advantages of clear operational definitions.

Designing a Paradigmatic Model of Nostalgic Emotions and Preferences of Sports Consumers with a Grounded Theory Approach

Objective: The aim of this research was to design a model of nostalgic emotions and preferences of sports consumers using the grounded theory approach. Methodology: This research is qualitative in nature and applied-developmental in its aim. The participants in the study included academic experts in the field of sports marketing management, managers and executive marketers of sports organizations, and 22 relevant scientific articles, selected for interviews through theoretical sampling. Data analysis was conducted over more than three rounds of interviews until reaching theoretical saturation and consensus on identifying constructs, categories, concepts, and indicators within six constructs: causal conditions, the central and core phenomenon, strategies, contextual and intervening conditions, and outcomes, following the systematic model of Strauss and Corbin. Findings: At the open coding stage, 180 indicators (initial concepts) were identified. In axial coding, considering the semantic proximity of the identified concepts, 160 secondary concepts and 31 categories were classified into four main axes (drivers, barriers, stimulants, and requirements) through selective coding, within the six constructs of the Strauss and Corbin paradigmatic model. Conclusion: The results of the study can enhance the awareness of sports marketing managers regarding the optimal development of nostalgic dimensions of sports products and the preferences of sports consumers.

Professional Gender Segregation in Scientific Discourse: Trends and Contradiction

Introduction. The article examines current ideas about professional gender segregation in Russian and foreign scientific discourses. Comparative analysis of various approaches to understanding gender issues allows us to identify new potentials for their study, as well as to pay attention to the development of the optics of Russian science in considering gender differences. Gender issues in the field of information technology require the closest attention and study, since this area is at the forefront of scientific, technological and social development.Methodology and sources. The theoretical and methodological basis for interpreting the results of the study was the main provisions of sociological and economic theories: the theory of social representations (S. Moscovici), the concept of habitus (P. Bourdieu), role theory (R. Linton), and rational choice theory. To work with empirical data, we used the methods of comparative text analysis, analysis of documents and research reports (The Gender Inequality Index, The Global Gender Gap Index, Global Gender Gap Report, “Women and Men of Russia-2022”), and discourse analysis.Results and discussion. In foreign studies, with the long-established vision and acceptance of gender problems, there is an understanding that past steps to achieve gender parity in the labor market lead to a new configuration of gender differences, which requires new efforts to eliminate them. In Russian scientific literature, the main emphasis is on monitoring the current situation of women in the professional environment, analyzing statistics and searching for hidden mechanisms of professional gender segregation.Conclusion. The results of the analysis show that in the presence of demonstrative statistics and large-scale empirical research, there is no theoretical consensus in the scientific discourse about the professional gender situation. There is a clear dissonance between the statement of problems by theorists and the lack of a request to find their solution on the part of practice, where gender “neutrality” or “indifference” reigns in some professional contexts. Conclusions are drawn about the nature of the Russian scientific gender discourse, which needs to develop a thesaurus of nonbinarity and develop an effective way of reasoning about gender issues.

Did it work? Effective decisions in the workplace

Effective decisions are key in professional contexts as they significantly determine firms' long-term health and survival. Consequently, holding a clear understanding of the components that define decision effectiveness may be highly beneficial for organizations. However, the multidimensional nature of the construct has led to the lack of theoretical consensus on the defining components of decision effectiveness. The present work sought to identify some of the factors that may intervene in determining decision effectiveness, specifically taking into account factors that are intrinsic in managers’ attitudes and skills. Three relevant factors were identified and discussed, encompassing analytic versus synthetic approach to decision-making, time-management and decision promptness, and active procrastination, and applicability of the investigated dimensions to employees' assessment organizational practices is proposed.

Observation of the effect of gravity on the motion of antimatter

Einstein’s general theory of relativity from 19151 remains the most successful description of gravitation. From the 1919 solar eclipse2 to the observation of gravitational waves3, the theory has passed many crucial experimental tests. However, the evolving concepts of dark matter and dark energy illustrate that there is much to be learned about the gravitating content of the universe. Singularities in the general theory of relativity and the lack of a quantum theory of gravity suggest that our picture is incomplete. It is thus prudent to explore gravity in exotic physical systems. Antimatter was unknown to Einstein in 1915. Dirac’s theory4 appeared in 1928; the positron was observed5 in 1932. There has since been much speculation about gravity and antimatter. The theoretical consensus is that any laboratory mass must be attracted6 by the Earth, although some authors have considered the cosmological consequences if antimatter should be repelled by matter7–10. In the general theory of relativity, the weak equivalence principle (WEP) requires that all masses react identically to gravity, independent of their internal structure. Here we show that antihydrogen atoms, released from magnetic confinement in the ALPHA-g apparatus, behave in a way consistent with gravitational attraction to the Earth. Repulsive ‘antigravity’ is ruled out in this case. This experiment paves the way for precision studies of the magnitude of the gravitational acceleration between anti-atoms and the Earth to test the WEP.

Race, risk, and American religious groups' views of Nazi Germany in 1935.

What explains American religious groups' views of Nazi Germany before the U.S. entered the Second World War? Using a comparative-historical approach, we employ a novel set of data on 25 of America's most prominent religious denominations to answer this question. We find that two factors were crucial in explaining religious elite discourse about Hitler in the U.S. in 1935: whether leaders believed inwhite supremacy and whether their denominations were incumbents or challengers in the American religious field. Our findings underscore the growing theoretical consensus that racial resentment is key to support for authoritarianism and call attention to religious groups' complicity in its growth, both active and passive.

Is scepticism a barrier to green purchase behaviour? Testing a comprehensive model in the Indian context

PurposeThis study aims to intend to contribute to the literature by testing the effect of scepticism on green consumer behaviour through environmental concern, knowledge, value and willingness to pay more in the Indian context. Thus, the comprehensive model with new directions of antecedents of green consumer purchase behaviour and direct and indirect effects was examined using structural equation modelling.Design/methodology/approachThe study adopted the hypo-deductive research design to test the proposed structural model. Cross-sectional data were collected through a predesigned questionnaire from the households living in Visakhapatnam city using a purposive sampling method. The proposed theoretical model was tested using structural equation modelling.FindingsThe results support five antecedents’ direct and indirect effects on green purchase behavioural intentions and actual buying behaviour, except for the indirect effect of green scepticism on green purchase behaviour (GPB). Similarly, scepticism is responsible for significant variation in GPB.Practical implicationsThe present study’s findings imply the role of scepticism on GPB, and the policies of adopting green products need to be addressed. Green buying is an obscure task; however, it can be evident by adding eco-friendly aspects and persuading consumers of a win-win situation for themselves, the environment and the company.Originality/valueThis study adds to the field of knowledge by exploring and testing the factors affecting GPB, which was not emphasized earlier in the Indian context and second, by developing a theoretical consensus on testing the antecedents of GPB. The results strengthen the argument that scepticism is an antecedent that drives GPB.

Gender and Sexual Health-Related Knowledge Gaps and Educational Needs of Parents of Transgender and Non-Binary Youth

Parents can have a substantial impact on adolescent sexual decision-making, but few studies have explored the role of parents in providing sexual health information to transgender and non-binary (TNB) youth, a population that experiences significant sexual and mental health disparities and lower levels of perceived family support compared with other youth. This study aimed to elucidate existing knowledge gaps and content deemed important for a sexual health curriculum and educational materials for parents of TNB youth. We conducted 21 qualitative interviews with five parents of TNB youth, 11 TNB youth aged 18+, and five healthcare affiliates to identify parents’ educational needs. We analyzed the data using theoretical thematic analysis and consensus coding. Parents self-reported multiple knowledge deficits regarding gender/sexual health for TNB individuals and were primarily concerned with long-term impacts of medical interventions. Youth goals for parents included greater understanding of gender/sexuality and sufficient knowledge to support youth through social transition to their affirmed gender identity. Content areas suggested for a future curriculum for parents of TNB youth included: basics of gender/sexuality, diverse narratives of TNB experiences/identities, gender dysphoria, non-medical gender-affirming interventions, medical gender-affirming interventions, and resources for peer support. Parents desired access to accurate information and wanted to feel equipped to facilitate affirming conversations with their child, something that could combat health disparities among TNB youth. An educational curriculum for parents has the potential to provide a trusted information source, expose parents to positive representations of TNB individuals, and help parents support their TNB child through decisions about potential gender-affirming interventions.

Well-being as Need Fulfillment: Implications for Theory, Methods, and Practice.

The most prominent concept championed by human resource professionals, point solution providers, and the mental health care industry is the construct of holistic well-being. Despite the tremendous attention focused on well-being, the concept lacks theoretical consensus among its proponents. Like the concept of engagement, this field cries out for clearly stated definitions that embed the concept within a theoretical framework, allowing theory development to avoid the prolific category errors of the past 50years. This paper argues for a more sophisticated approach to the concept of well-being, grounding it in the vast psychological literature on human motivation. Herein lies the contribution of our paper; we argue that the apparent diversity of operational definitions employed by academics and practitioners can be understood as tentative attempts to draw ever nearer to key motivational concepts, without ever quite getting there. We review the leading definitions of well-being in the literature and find that they are reducible to a core set of human motives, each backed by full research traditions of their own, which populate a comprehensive model of twelve human motivations. We propose that there is substantial value in adopting a comprehensive motivational taxonomy over current approaches, which have the effect of "snowballing" ever more dimensions and elements. We consider the impact of setting well-being concepts in existing motivational constructs for each of the following: (a) theory, especially the development of well-being frameworks; (b) methods, including the value of applying a comprehensive, structural approach; and (c) practice, where we emphasize the practical advantages of clear operational definitions.

Assessing unpredictability in caregiver-child relationships: Insights from theoretical and empirical perspectives.

There has been significant interest and progress in understanding the role of caregiver unpredictability on brain maturation, cognitive and socioemotional development, and psychopathology. Theoretical consensus has emerged about the unique influence of unpredictability in shaping children's experience, distinct from other adverse exposures or features of stress exposure. Nonetheless, the field still lacks theoretical and empirical common ground due to difficulties in accurately conceptualizing and measuring unpredictability in the caregiver-child relationship. In this paper, we first provide an overview of the role of unpredictability in theories of caregiving and childhood adversity and present four issues that are currently under-discussed but are crucial to the field. Focusing on how moment-to-moment and day-to-day dynamics are at the heart of caregiver unpredictability, we review three approaches aiming to address some of these nuances: Environmental statistics, entropy, and dynamic systems. Lastly, we conclude with a broad summary and suggest future research directions. Systematic progress in this field can inform interventions and policies aiming to increase stability in the lives of children.

Review and Prospect of Neuromarketing ERP Research

Neuromarketing (NM) uses neuroscience tools, for example, but not limited to functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) to study, explore, analyze, and explain the neural correlates of consumer’s behavior (i.e., decision-making processes), the cognitive processes (i.e., attention and memory) and emotional processes (i.e., emotion) of interest for marketing research (e.g., advertising, brand, product, price). In the last decades, NM studies appear more often because the researchers are looking for understanding the mechanisms of decision-making in the consumer's brain toward marketing stimuli. This document aims to conduct a systematic review in order to identify evolution and research trends in the area of NM. Besides, on the basis of collating and reviewing the relevant literatures on ERP empirical research in the past 20 years, this paper sorts out and summarizes the neural mechanism of consumer purchase decision and the commonly used ERP components, providing a reference for corresponding brain activity areas for marketing scholars to study consumer purchase decision applying ERP neural technology, which helps marketing scholars better use ERP technology to guide and develop existing marketing management theories and practices. It became evident that NM is still an immature and incipient area with a low degree of theoretical consensus. Additionally, we established corresponding analysis between NM perspective and traditional marketing perspectives.

Research on Local Characteristic Industry Construction in Characteristic Towns under Public-Private Partnership Development Mode

In recent years, there’s been a global trend of emphasizing the role of local characteristics in steering economic growth. To foster the advancement of local characteristic industries in characteristic towns, the public-private partnership (PPP) model is being adopted. This strategy leverages social resources and governmental incentives to drive both urban and rural progress, thus becoming a silver bullet to bolster the growth of characteristic towns. However, achieving “town-industry integration” and “sustainable development” necessitates shared consensus and understanding among all stakeholders. Given the intricate nature of the PPP mechanism, a comprehensive theoretical framework tailored to Chinese local characteristics is essential. This study scrutinizes the integration of the PPP model into characteristic industries within small Chinese towns. It follows a framework encompassing theoretical characteristics, feasibility analysis, existing problems, countermeasures, and recommendations, as well as future trends. The study employs both inductive reasoning and comparison. The research findings serve to establish a theoretical consensus for the PPP model’s integration with characteristic industries in these towns, benefiting all involved parties.

Technology Transfer Process in the Context of Open Innovation Paradigm

The technology transfer process has been emphasized as an important driver in innovation and creating sustainable growth. Nevertheless, there is a major research gap in the field of identifying the model of the technology transfer process in the framework of the open innovation paradigm. Identifying this study gap is the aim of the present study. This research has been done using Sandelowski and Barso's metacomposite method and with a systematic review of 26 articles related to the purpose of the research out of 333 primary articles. The final articles were selected based on the inclusion criteria. The validity of the research was confirmed according to the criteria of entering the review, holding meetings with the members of the research team, using an expert and auditing the entire process for theoretical consensus. Reliability was also confirmed through the critical evaluation skills program. In this meta-combination study that was carried out in 1401, from library resources including scientific articles, books, case reports with keywords related to technology transfer and open innovation paradigm in Farsi and English languages in Springer MDPI, Taylor, Wiley databases. Science Direct, Emerald, Google Scholar, SID, Magiran and CIVILICA published in the years 2010 to 2022 were used. The results obtained through the categorization and coding of concepts using the metacomposite method for the three-component technology transfer variable and six sub-components of technology selection and acquisition, technology adaptation, application and absorption of technology (technology adaptation, technology efficiency and technology absorption) and technology development and diffusion. technology dissemination and technology development) with 21 codes and for the open innovation paradigm variable, 2 components with 12 sub-components (licensing purchase, joint venture, venture capital, outsourcing of research and development contracts, merger and acquisition, customer participation, external networking, grant sales, open source licensing and reproductive companies) along with 15 codes were extracted. The use of this model helps senior managers and industry policy makers to have a deeper understanding of the practical mechanisms that support the open innovation strategy while focusing on their organizational capabilities and policies based on technology transfer.

Diagnosis of Burnout Syndrome in professionals from primary to tertiary health care: a bibliographic review

The objective of the research was to analyze, through the scientific method, the criteria for diagnosing Burnout syndrome, in health professionals from primary to tertiary health care, existing in the literature, in order to clarify whether age, gender, workload and religion influence the emergence of BS. Furthermore, a methodological study was carried out based on virtual data existing in the literature, through the Virtual Health Library (VHL), Scielo (Scientific Electronic Library Online), Pubmed (National Library of Medicine) and Google Scholar using the Descriptors in Health Sciences (DeSC), such as Burnout Syndrome, Health Professionals and Diagnosis, in order to elucidate the theoretical diversity on diagnoses and factors that influence the emergence of Burnout Syndrome (BS). Given the above, the study showed that it is still not possible to have a differential diagnosis, since there is no theoretical consensus despite having used the same analysis instrument; sociodemographic questionnaires and Burnout tests revealed that the higher the age, the lower the degree of emotional stress, and the higher the workload, the greater the depersonalization; it was also noted that religion is important for coping with BS. It is concluded that, given the existing diversity, local authorities can implement measures that encourage the reduction of socio-psychological problems of health professionals.