Impacts of childhood malocclusion on the family

PURPOSE

To analyze the effects of children's malocclusions and associated quality of life on family relationships by evaluating psychometric characteristics of the Family Impact Scale (FIS) in adolescents seeking orthodontic treatment.

MATERIALS AND METHODS

Included were 334 participants (children aged 11-14 years; 53% female and 47% male) and their parents (84% mothers, 16% fathers) who were recruited at two dental clinics in Croatia. The Child Perception Questionnaire, Parental-Caregiver Perception Questionnaire, and FIS were administered. Malocclusion severity was estimated using the Index of Orthodontic Treatment Need Dental Health Component. The presence of caries was also recorded. Factor analysis, t‑test, Pearson correlation, and multiple linear regression analysis were used for statistical analysis.

RESULTS

Unidimensional FIS measuring global family impacts had higher internal consistency (α = 0.73-0.81) compared to the specific dimensions of family impacts (α = 0.60-0.69). Global family impacts were higher in children with more severe malocclusions and existing dental caries, primarily influencing parental activity, and parental emotions dimensions (p < 0.05). In multiple regression, parental perception of child's emotional well-being, oral symptoms, and social well-being (p < 0.001) were significant predictors of global family impacts, whereas child's quality of life perception, malocclusion severity, or child sex were not. Reduction of an increased overjet by orthodontic treatment affected changes in the global family impacts, mainly by reducing the emotional issues of parents (p < 0.05).

CONCLUSIONS

The child's malocclusion influenced the family, primarily parental emotions. Family influences were mostly determined by parental perception of the child's altered psychosocial well-being. The FIS had adequate psychometric properties.

Anger regulation in patients with functional neurological disorder: A systematic review

BACKGROUND

Functional neurological disorder (FND) has been associated with predisposing psychological factors, including dysregulation of anger-related processes. This paper provides a systematic review of the literature on anger regulation in FND. We evaluated anger-related research on patient self-report, observational, and laboratory based measures in FND. The review also addresses adverse childhood experiences and their relation with anger regulation, and the effects of therapies targeting anger regulation in FND.

METHODS

MEDLINE, EMBASE, and PsycINFO were searched for both quantitative and qualitative research, published in a peer-reviewed journal with a sample size of at least 5 (registered under Prospero protocol CRD42022314340).

RESULTS

A total of 2200 articles were identified. After screening, 54 studies were included in this review (k = 20 questionnaire-based studies, k = 12 laboratory studies, k = 21 using other methods, and k = 1 used both questionnaires and other methods) representing data of 2502 patients with FND. Questionnaire-based studies indicated elevated levels of state anger and trait hostility in patients with FND. Laboratory studies showed a higher tendency to avoid social threat cues, attentional bias towards angry faces, difficulties reliving anger, and preoccupation with frustrating barriers among FND patients versus controls. No specific childhood experiences were identified related to anger regulation in FND, and too few small and uncontrolled studies were available (k = 2) to assess the effects of anger-related interventions in FND. The overall quality of the studies was fair (k = 31) to poor (k = 18). Five studies (k = 5) were rated as having a good quality.

CONCLUSIONS

This review suggests that patients with FND have maladaptive anger regulation compared to individuals without FND. The findings also highlight the need for further research on the prevalence and consequences of anger-related processes in the development, diagnosis and treatment of FND.

The Overlooked Contributors to Climate and Biodiversity Crises: Military Operations and Wars

The military-industrial complex, military operations, and wars are major contributors to exacerbating both climate change and biodiversity crises. However, their environmental impacts are often shadowed due to national security reasons. The current paper aims to go through the devastating impacts of military operations and wars on climate change and biodiversity loss and challenges that hinder the inclusion of military-related activities into environmental crisis mitigation efforts. The information blind spot induced by concerns about national security reasons jeopardizes the efforts to involve the military-industrial complex and military operations in the global climate and biodiversity agendas. Besides that, many military-related challenges, such as specificity of operational requirements and lifecycles, dependence on fossil fuels, complex supply change, inadequate civilian technologies and innovations, and requirements of structural changes, can hinder emission reduction. Meanwhile, wars and conflicts not only threaten to drain all human and material resources available to tackle environmental problems but also inflict long-lasting destructions, pains, and trauma that can lead to hatred and distrust among nations and parties. With the rising hatred and distrust, global agreement and commitment to address climate change and biodiversity will hardly be achieved. Thus, promoting peace is the humanistic and planetary conscience.

When dying does not go well: a qualitative study

BACKGROUND

Several studies deal with the question of what constitutes a "satisfactory death". A smaller number of studies deal with unsatisfactory dying processes. And only a few shed light on unsatisfactory deaths that take place in hospices and palliative care units, which see themselves as places conducive to a "good" death. What also remains largely undiscussed are the ethical aspects that accompany the observation of an unsatisfactory course of death.

METHOD

The research was carried out as an exploratory and qualitative study. The data collection and analysis were based on the methods of the "grounded theory".

RESULTS

Notions of a bad death are articulated here, though hardly by the affected persons and their relatives themselves, but rather by the professionals. Principally, descriptions of unsatisfactory dying processes refer to deficient success in symptom control, whereby the principle of autonomy is of particular importance. The focus here is not only on the needs of patients, but also on the needs of staff. The manifestation of such notions is related to the requirements arising from a practice that apparently evokes a need for accountability in the form of communicative reassurance.

CONCLUSION

An idealised definition of "dying well" is in danger of losing sight of the contextual specifics of the practice involved, which can lead to ethically problematic situations.

Exploring the effects of climate change and government stability on internal conflicts: evidence from selected sub-Saharan African countries

Climate change has been linked to water scarcity, land degradation, and food insecurity, exacerbating existing tensions and creating new conflicts in countries with weak political institutions. Despite the critical need for effective conflict management and climate adaptation measures, prior studies failed to emphasize the role climate change plays in civil clashes in conflict-affected countries. In this research, we undertake a comprehensive investigation of the effects of climate change and government stability on internal conflicts in 14 selected SSA nations between 1996 and 2016. The study embraces contemporary heterogeneous panel techniques to address heterogeneity and cross-sectional dependence issues that usually appear in panel data estimates. We employed second-generation unit root tests, such as CADF and CIPS, to determine the order of integration of the variables. In addition, Pedroni and Westerlund cointegration tests confirmed the long-run relationship among the variables. Although temperatures were insignificant, the long-run results of the pooled mean group (PMG) approach suggested that civil conflicts decline when precipitation increases. In addition, the outcomes indicate that environmental degradation and population growth are long-run aggravators of social unrest. The short-run results suggest that rising temperatures exacerbate civil conflicts in the selected SSA countries. However, the study found that government stability lessens internal conflicts in the short run, but not in the long run. The DOLS technique validated the long-run outcomes of the PMG technique. Based on the findings of the study, conflict-prone SSA countries should integrate climate change adaptation and conflict prevention strategies, implement sustainable water resource management practices, and endorse climate-related conflict resolution.

Impacts of rainfall shocks on out-migration are moderated more by per capita income than by agricultural output in Türkiye

Rural populations are particularly exposed to increasing weather variability, notably through agriculture. In this paper, we exploit longitudinal data for Turkish provinces from 2008 to 2018 together with precipitation records over more than 30 years to quantify how variability in a standardized precipitation index (SPI) affects out-migration as an adaptation mechanism. Doing so, we document the role of three potential causal channels: per capita income, agricultural output, and local conflicts. Our results show that negative SPI shocks (droughts) are associated with higher out-migration in rural provinces. A mediated-moderator approach further suggests that changes in per capita income account for more than one quarter of the direct effect of droughts on out-migration, whereas agricultural output is only relevant for provinces in the upper quartile of crop production. Finally, we find evidence that local conflict fatalities increase with drought and trigger out-migration, although this channel is distinct from the direct effect of SPI shocks on out-migration.

Area level indirect exposure to extended conflicts and early childhood anthropometric outcomes in India: a repeat cross-sectional analysis

BACKGROUND

Protracted, internal conflicts with geographic variations within countries, are an important understudied community exposure for adverse child health outcomes.

METHODS

Violent events from the Uppsala Conflict Data Program (UCDP) between January 2016-December 2020 and January 2010-December 2015, were included as exposure events for children sampled in National Family Health Surveys (NFHS) 5 (2019-21) and NFHS 4 (2015-16), respectively. Geocoded data from UCDP were merged with residential clusters from NFHS, to identify children living in villages or urban blocks situated at <= 50 km from conflict sites. Within these clusters, which we defined as conflict exposed, we studied risks of stunting, underweight and wasting in children, prenatally, and in 0-3 years. We assessed sensitivity on a subsample of siblings with discordant conflict exposures.

RESULTS

For NFHS 5, exposure to violence between 0 and 3 years was associated with 1.16 times (95% CI 1.11-1.20) higher risks of stunting, 1.08 (1.04, 1.12) times higher risks of underweight, and no change in wasting. In-utero violence exposure was associated with 1.11 times (95% CI 1.04-1.17) higher risks of stunting, 1.08 (95% CI 1.02-1.14) times higher risks of underweight, and no change in wasting, among children <= 2 years. In 17,760 siblings of 8333 mothers, exposure to violence during 0-3 years, was associated with a 1.19 times higher risk of stunting (95% CI - 0.24 to 0.084). Incremental quartiles of violence exposure had higher risks of stunting and underweight until quartile 3.

CONCLUSION

In-utero and early childhood indirect exposure to protracted conflicts were associated with increased stunting and underweight in India. Given the continued exposures of such historically and contextually rooted internal conflicts in many LMICs, chronic violence exposures should be targeted in public health policies as important social and political determinant of child health.

Equity in provision and access to obstetric anaesthesia care in Nigeria

Nigeria has a high maternal mortality rate, yet there is wide variation in the proportion of births by caesarean section between zones, states, and cities within Nigeria. This review examines the pattern of the COVID-19 pandemic and the impact of mitigation measures on women's health in Nigeria. The combined impact of COVID-19 and conflicts on maternal healthcare and access to obstetric care, as well as the availability of obstetric anaesthesia in Nigeria, are discussed. There is a vicious cycle, intensified by unwanted pregnancy, abortion, and preventable maternal death.

The process of overcoming conflicts among teachers in the implementation of comprehensive sexuality education at ordinary public senior high schools in Mataram City, Indonesia: a qualitative study

BACKGROUND

Comprehensive sexuality education (CSE), which aims to help young people make responsible choices and acquire scientific knowledge and skills, has been promoted by UNESCO. Teachers experience conflicts in implementing CSE when teaching sexual topics in the local context, especially as the delivery of sexual knowledge and contraceptive methods is often prohibited by religious and traditional cultural norms. It was reported that there were multiple challenges in the implementation of sex education due to the religious and cultural background of societies and communities in Islamic countries. This study aimed to clarify the process of overcoming the conflicts, explore teachers' recognition and perception related to the implementation of CSE, and to suggest recommendations for promoting CSE in Islamic areas.

METHODS

This qualitative study combined the methods of focus group discussions (FGDs) and in-depth interviews (IDIs) to explore the conflict among teachers. Ten ordinary public senior high schools in Mataram City, Indonesia, agreed to participate, and in total, 59 participants were involved in this study. FGDs were conducted with teachers (n = 49), and IDIs were focused on school principals (n = 10) in each school. The collected interview data were analyzed using a deductive thematic analysis and the findings triangulated for both the FGDs and IDIs.

RESULTS

Overall, the teachers experienced conflicts in relation to religion, cultural background, and gender inequality in implementing CSE. The present study revealed the mutual recognition among teachers and acceptance of diverse backgrounds in the implementation of CSE at ordinary public senior high schools in Mataram City. Despite teachers reporting multiple conflicts, they made efforts to overcome these conflicts through mutual recognition and provided comprehensive guidance. The present findings indicated that teachers adapted CSE to follow multiple religions and cultural backgrounds.

CONCLUSIONS

The teachers accepted diverse backgrounds and provided CSE by collaborating with related educational subjects and external institutions to overcome conflicts. To provide more specialized education, it would be necessary to advocate a formal policy that might be accepted by diverse societies. Further research is necessary to apply the findings and recommendations for CSE implementation globally in the contexts of different countries.

Conflict-related environmental damages on health: lessons learned from the past wars and ongoing Russian invasion of Ukraine

On 24 February 2022, Russian military forces invaded Ukraine. The fighting has already caused unimaginable conditions and millions of people were forced to flee their homes. For decades, conflicts have been linked to environmental pollution, exposure to radioactivity and heavy metals as well as infectious diseases. The invasion may cause specific environmental risks, like the release of radioactive substances from nuclear power plants and contaminated soils. Because international collaboration is one of the most effective ways to address environmental problems, it is critical to establish scientific bodies within a global framework to identify concrete actions and tangible measures to provide immediate assistance to citizens. This commentary discusses the above issues from lessons learned from the past wars and the way forward in the Russian invasion of Ukraine.

Conflicts and ecological footprint in MENA countries: implications for sustainable terrestrial ecosystem

Conflicts are socio-political pressures that alter wellbeing, social structure, and economic sustenance. However, very limited studies have assessed the long-term impact of conflicts on environmental sustainability. This study investigates the role of internal and external conflicts on ecological footprint in the Middle East and North African countries (MENA) over the period 1995-2016. Here, we test whether the environmental Kuznets curve (EKC) hypothesis is valid for MENA countries during the period of internal and external conflicts-characterized by energy disasters and deteriorating income levels. Using robust econometric tools based on 12 MENA countries, the results show that income growth has negative impact with evidence of inherent heterogeneity across quantile distribution of ecological footprint. However, the positive impact of the square term of income decreases ecological footprint, thus, confirming U-shaped relationship between income and environmental indicator across MENA countries. The results further show that excessive energy consumption is attributed to a rising level of urbanization, while increase in conflicts  stimulates environmental degradation. These findings are essential for effective conflict resolution and environmental policies across conflict-prone countries.

Operational considerations for the management of non-communicable diseases in humanitarian emergencies

Non-communicable diseases (NCD) represent an increasing global challenge with the majority of mortality occurring in low- and middle-income countries (LMICs). Concurrently, many humanitarian crises occur in these countries and the number of displaced persons, either refugees or internally displaced, has reached the highest level in history. Until recently NCDs in humanitarian contexts were a neglected issue, but this is changing. Humanitarian actors are now increasingly integrating NCD care in their activities and recognizing the need to harmonize and enhance NCD management in humanitarian crises. However, there is a lack of a standardized response during operations as well as a lack of evidence-based NCD management guidelines in humanitarian settings. An informal working group on NCDs in humanitarian settings, formed by members of the World Health Organization, Médecins Sans Frontières, the International Committee of the Red Cross, the International Federation of the Red Cross and others, and led by the United Nations High Commissioner for Refugees, teamed up with the University of Geneva and Geneva University Hospitals to develop operational considerations for NCDs in humanitarian settings. This paper presents these considerations, aiming at ensuring appropriate planning, management and care for NCD-affected persons during the different stages of humanitarian emergencies. Key components include access to treatment, continuity of care including referral pathways, therapeutic patient education/patient self-management, community engagement and health promotion. In order to implement these components, a standardized approach will support a consistent response, and should be based on an ethical foundation to ensure that the "do no harm" principle is upheld. Advocacy supported by evidence is important to generate visibility and resource allocation for NCDs. Only a collaborative approach of all actors involved in NCD management will allow the spectrum of needs and continuum of care for persons affected by NCDs to be properly addressed in humanitarian programmes.

Quantifying anthropogenic threats affecting Marine Protected Areas in developing countries

Conservation's capacity to deal with anthropogenic environmental threats within Marine Protected Areas (MPAs) varies enormously, especially in developing countries that are often immersed in weak enforcement, ineffective management and shortages of resources. A deeper understanding of the causes of these threats is fundamental for identifying effective management solutions. Here, we investigate the presumptive drivers of environmental threats across 40 Brazilian MPAs. We categorized and quantified environmental threats from two independent sources: i) the results of systematic social surveys carried out as part of WWF's RAPPAM assessment, as primary data source, and; ii) data gathered from news media articles related to the MPAs (secondary data source). We identified 461 reports of threats that we classified into three general categories: overexploitation, urbanization and land use threats. The presence of overexploitation threats was strongly associated with extreme poverty of local communities close to the MPAs. Threats also seem to be more frequent in category V MPAs, which in Brazil are Environmental Protection Areas (EPA), with multiple use objectives. Threats were concentrated on the North and Southeast coasts of Brazil. We found that data from news media can be used for qualitative assessment of threats, but has limited potential for quantification. Our findings highlight the need for policy makers and MPA managers to adopt a broader perspective that considers the role of social inequalities in promoting and exacerbating environmental threats. While recognizing that conservation has limited capacity to address the widespread social inequalities found in many tropical developing countries, if the socioeconomic context of local communities is significantly compromising conservation efforts it may be necessary to target and prioritize social interventions as a prerequisite for effective MPA management and governance.

The effects of left-turn traffic-calming treatments on conflicts and speeds in Washington, DC

INTRODUCTION

Left-turning vehicles pose considerable safety risks to pedestrians at intersections. Left-turn traffic-calming treatments are designed to slow left-turn traffic. This study examined the effects of one type of left-turn calming, the hardened-centerline treatment, on the numbers of conflicts between left-turning vehicles and pedestrians and left-turn speeds in Washington, DC.

METHOD

Numbers of conflicts between left-turning vehicles and pedestrians, as well as left-turn speeds, were collected at selected intersections in Washington, DC, where the hardened centerline was installed, as well as at control intersections in the city where no treatment was installed, before and after installation. Poisson regression evaluated the change in numbers of conflicts associated with the hardened-centerline treatment. The effect of the treatment on left-turn speeds was estimated by a log-linear regression model, and the effect on the odds of left-turning vehicles exceeding 15 mph was estimated by a logistic regression model.

RESULTS

The treatment was associated with a 70.5% reduction in conflicts between left-turning vehicles and pedestrians, a 9.8% reduction in mean left-turn speeds, and a 67.1% reduction in the odds of left-turning vehicles exceeding 15 mph. All the reductions were statistically significant.

CONCLUSIONS

The study demonstrates that the hardened-centerline treatment can reduce conflicts between left-turning vehicles and pedestrians, and slow down left-turn traffic at intersections. Practical applications: The treatment should be added to the toolbox for communities looking to improve pedestrian safety at intersections.

Negative school experiences of Late Millennial Korean medical students: a qualitative study using the critical incident technique

PURPOSE

Today's students have distinctive generational characteristics and increased psychopathology and generational tension. The authors investigated the negative experiences of Late Millennial students in medical school to draw implications for student support.

METHODS

The authors explored medical students' negative experiences using the critical incident technique. The authors conducted semi-structured in-depth interviews with 13 medical students, between February and May 2016. The authors focused on occurrences that significantly influenced medical students' school lives negatively from the students' perspective. All interviews were recorded and transcribed. The authors classified incidents into frames of reference for the use of faculty development for student support.

RESULTS

The authors extracted 22 themes from a total 334 codes and classified them into eight subcategories. Finally, four categories emerged from frames of reference. Students manipulate relationships and colluding for better specialty choice. They experience uncontrolled rifts in interpersonal relationships between peers including lawsuits, sexual assaults, and social network service conflicts. Today's students feel resentment towards dependent hierarchical relationships with seniors. They struggle with gender discrimination but perpetuate outdated gender role toward the opposite gender.

CONCLUSION

Faculty members should understand today's students' level of career stress and desire for work life balance. They should motivate students' professional identity, promote assertiveness against unfair authorities, and focus on mental health, teamwork, and relationship building. All generations need to understand other generations and develop appropriate leadership and gender sensitivity.

Refugees, water balance, and water stress: Lessons learned from Lebanon

The Syrian crisis caused a massive influx of displaced people into neighboring countries, with Lebanon hosting the highest per capita number of refugees (3:10). Water remains the most critical natural resource that influences the resilience of host and refugee communities. We provide a new GIS-based updated water balance and water scarcity analysis at the national and the watershed level in Lebanon by comparing current conditions to no-refugee levels. Results show a small (6%) increase in water stress in an average water year at the national level that masks hot spots of water scarcity at the local geography. While domestic water use increased by 20%, we find that refugees' water use is only 10% of agricultural water use in summer. We also show that interventions to rehabilitate the water networks can reduce water stress to better than pre-conflict levels (3% less stress).

Scientific priorities and shepherds' perceptions of ungulate's contributions to people in rewilding landscapes

Nature's contributions to people (NCP) are all the contributions of living nature, both beneficial and detrimental, to the societies' life's quality. Ungulates play this dual role of providers of beneficial and detrimental NCP, as they are responsible of the supply of benefits (e.g. extractive experiences, habitat maintenance) and detriments (e.g. crops damage, traffic collisions). Our aim was to analyze the NCP provided by wild ungulates through examining the scientific priorities and the shepherds' perceptions in peninsular Spain. We reviewed scientific articles of NCP provided by ungulates in Spain and conducted questionnaires regarding NCP to shepherds in farming systems where domestic and wild ungulates cohabit. Then, we compared whether the scientific priorities match with those perceived by shepherds. Both stakeholders highlight more detrimental than beneficial NCP, although there are some mismatches between scientific priorities and shepherds' perceptions. Regarding detrimental NCP, soil alteration, silvicultural damage, human safety or traffic collision were included in scientific literature but not mentioned by shepherds. Contrarywise, shepherds mainly considered grazing competence and damage to animals (i.e. game species and livestock) as important detrimental NCP. Concerning beneficial NCP, whilst hunting was prominent in the publications, shepherds did not conceived it as an important beneficial contribution and considered the regulation of organisms (i.e. scavenging alternative prey) important benefits. These results can have twofold implications. The emphasis on detrimental NCP (studied and perceived) can reinforce the idea that ungulates can threaten humans rather than contribute to societies' wellbeing. The fact that research does not address the interests of shepherds can affect the social tolerance towards ungulates as the damages experienced or perceived by shepherds are not studied. Our results show the relevance of considering local knowledge held by shepherds and their perceptions, something highlighted by the NCP approach.

The Consequences of COVID-19 and Other Disasters for Wildlife and Biodiversity

We review the economic channels by which the COVID-19 pandemic and subsequent policy responses may affect wildlife and biodiversity. The pandemic is put in the context of more than 5,000 disease outbreaks, natural disasters, recessions and armed conflicts in a sample of 21 high biodiversity countries. The most salient feature of the pandemic is its creation of multiple income shocks to rural and coastal households in biodiverse countries, correlated across sectors of activities and spatially. Various research and policy opportunities and challenges are explored .

Assessment of environmental impact of biomass power plants to increase the social acceptance of renewable energy technologies

Objective

The objectives of the European Union (EU) policy agenda are to reduce the greenhouse gas emissions and to decrease the dependence of EU member countries from fossil fuel sources. In order to achieve these policy objectives, in the last decades the number of biomass power plants has increased throughout the EU. This study analyzed the environmental impacts of the bioenergy systems at global and local level to support communication and information strategies to increase social acceptance and to reduce conflicts between stakeholders. The environmental impacts were estimated to a sample of biomass power plants in North Italy selected based on the size, feedstock and type (cogeneration or heating). The study aims to identify and evaluate the environmental impacts associated with the thermal energy production in biomass power plants using a Life Cycle Assessment (LCA) approach.

Materials and methods

For each biomass district plant an LCA analysis was performed to: compare the environmental impacts associated with the production of the same functional unit, quantifying and valuating the environmental performance deriving from the production process life cycle, and highlighting the production phases with greater impact.

Results

The results show an average climate change impact by biomass energy plant of 45.84 gCO_2eq MJ⁻¹ and a range between 14.93 gCO_2eq MJ⁻¹ and 90.70 gCO_2eq MJ⁻¹. The results show that the size of the biomass energy plant (less than 1 MW or more than 1 MW) and the feedstock used (forest or sawmill woodchip) are two main variables that influence many categories of environmental impact.

Forced displacements and the environment: Its place in national and international climate agenda

Countries in the East African region have for decades been synonymous with natural disasters, conflicts and severe environmental degradation. About 10 million out of the 65.6 million displaced persons globally are found in this region. This paper presents an empirical analysis of environmental impacts caused by forced displacements in five East African countries. Contrary to a widely-held opinion, there is sufficient anecdotal and empirical evidence depicting environmental damage caused by refugees and/or Internally Displaced Persons (IDPs). A spatial analysis of current and former refugee and/or IDP camps in these five countries suggests the formation of "deforestation clusters" with concentrations of camps that compound environmental impacts. Technological advancements such as remote sensing capabilities can provide the means for assessing and implementing environmental protection measures. This paper recommends environmental care in humanitarian settings be considered an integral part of the Disaster Risk Reduction (DRR) and climate change/variability agenda, based on cost- and responsibility-sharing, employing technology, and incorporating appropriate monitoring tools.

Image and perception of physicians as barriers to inter-disciplinary cooperation? - the example of German occupational health physicians in the rehabilitation process: a qualitative study

BACKGROUND

In the German rehabilitation system, primary care physicians (PCPs), occupational health physicians (OPs), and rehabilitation physicians (RPs) fulfill different distinct functions and roles. While effective cooperation can improve outcomes of rehabilitation, the cooperation between these groups of stakeholders has been criticized as lacking or insufficient. This article proposes an approach to understand the low levels of cooperation by examining the role of group perception and group identity in intra-professional cooperation as a barrier to cooperation between physicians in different roles. Group perception was evaluated in terms of (1) negative views about another group of medical specialists and (2) differences between the perception of members and non-members of a medical specialty group. To examine this issue, we focused on the role of OPs in the German rehabilitation process.

METHODS

We implemented a qualitative study design with eight focus group discussions with PCPs, OPs, RPs, and patients (two focus group discussions per stakeholder group; 4-10 participants) and qualitative content analysis. We used the Social Identity Approach by Tajfel and Turner as a theoretical underpinning.

RESULTS

While all protagonists reported a positive perception of their own professional group, we found numerous negative perceptions about other groups, especially regarding OPs. Negative perceptions of OPs included 1) apparent conflict of interest between employer and employee, 2) lack of commitment to patient outcomes, 3) lack of useful specialized knowledge which could have a bearing on rehabilitation outcomes, and 4) distrust on the part of their patients. We also found divergent perceptions regarding roles, responsibilities, and capabilities among the specialist groups. Both negative and conflicting perceptions about roles were characterized as barriers to cooperation by study participants.

CONCLUSION

This example of cooperation between RPs, OPs, and PCPs suggests that negative and diverging perceptions about an out-group could create barriers in intra-professional and inter-disciplinary cooperation between physicians. These perspectives might also be useful in explaining problems at intersections between different specialties. We suggest examining the inter-group dimension of perception-based barriers to cooperation in future interventions to overcome problems caused by intra-professional and inter-disciplinary conflicts in addition to other barriers (i.e. organizational hurdles).

Equilibrium approach towards water resource management and pollution control in coal chemical industrial park

In this study, an integrated water and waste load allocation model is proposed to assist decision makers in better understanding the trade-offs between economic growth, resource utilization, and environmental protection of coal chemical industries which characteristically have high water consumption and pollution. In the decision framework, decision makers in a same park, each of whom have different goals and preferences, work together to seek a collective benefit. Similar to a Stackelberg-Nash game, the proposed approach illuminates the decision making interrelationships and involves in the conflict coordination between the park authority and the individual coal chemical company stockholders. In the proposed method, to response to climate change and other uncertainties, a risk assessment tool, Conditional Value-at-Risk (CVaR) and uncertainties through reflecting parameters and coefficients using probability and fuzzy set theory are integrated in the modeling process. Then a case study from Yuheng coal chemical park is presented to demonstrate the practicality and efficiency of the optimization model. To reasonable search the potential consequences of different responses to water and waste load allocation strategies, a number of scenario results considering environmental uncertainty and decision maker' attitudes are examined to explore the tradeoffs between economic development and environmental protection and decision makers' objectives. The results are helpful for decision/police makers to adjust current strategies adapting for current changes. Based on the scenario analyses and discussion, some propositions and operational policies are given and sensitive adaptation strategies are presented to support the efficient, balanced and sustainable development of coal chemical industrial parks.

Gender differences and stage-specific influence of parent-adolescent conflicts on adolescent suicidal ideation

This study examined familial and peer related factors as predictors of suicidal ideation in school students. Total 2896 participants were included from Taiwan Youth Project released data, a longitudinal survey of adolescent suicidal ideation at ages 15, 18, and 20. Logistic regression analysis risk factors associated with adolescent suicidal ideation reveled differences during the developmental stages. After adjusted for psychological symptoms, effect of quarrels with parents on suicidal ideation lasts in early and middle stages; in the late adolescent stage, only cigarette or alcohol use remained significant. Girls who reported quarrels with parents had the highest level of suicidal ideation before age 18. Stage- and gender-specific differences may provide appropriate intervention strategies for parents and teachers preventing adolescent suicidal ideation.

Discussing End-of-Life Decisions in a Clinical Ethics Committee: An Interview Study of Norwegian Doctors' Experience

With disagreement, doubts, or ambiguous grounds in end-of-life decisions, doctors are advised to involve a clinical ethics committee (CEC). However, little has been published on doctors' experiences with discussing an end-of-life decision in a CEC. As part of the quality assurance of this work, we wanted to find out if clinicians have benefited from discussing end-of-life decisions in CECs and why. We will disseminate some Norwegian doctors' experiences when discussing end-of-life decisions in CECs, based on semi-structured interviews with fifteen Norwegian physicians who had brought an end-of-life decision case to a CEC. Almost half of the cases involved conflicts with the patients' relatives. In a majority of the cases, there was uncertainty about what would be the ethically preferable solution. Reasons for referring the case to the CEC were to get broader illumination of the case, to get perspective from people outside the team, to get advice, or to get moral backing on a decision already made. A great majority of the clinicians reported an overall positive experience with the CECs' discussions. In cases where there was conflict, the clinicians reported less satisfaction with the CECs' discussions. The study shows that most doctors who have used a CEC in an end-of-life decision find it useful to have ethical and/or legal aspects illuminated, and to have the dilemma scrutinized from a new perspective. A systematic discussion seems to be significant to the clinicians.

Reinventing the political role of health professionals in conflict prevention & reconciliation: the Sudanese model

Given the persistent recurrence of armed conflict, influential actors owe it to the affected communities to take action. The legitimacy of health professionals to mitigate the effects of conflict relates to their ability to save lives and address the physical and mental consequences of armed conflict during which thousands of lives may be lost. Medical professionals have unique and potentially far-reaching skills. These become crucial during wartime and disasters in terms of providing medical services and humanitarian aid. However, they are insufficiently used in one area: involvement in politics as a tool to foster peace. Despite this, Sudanese individuals from medical backgrounds have participated actively in conflict resolution and peace-building processes. In fact, their political actions throughout the last six decades have aimed to prevent conflict at four different levels, which are described by Yusuf et al. in their article on the political involvement of health professionals in prevention. Their stand against President Nimeiri's Sharia laws was primordial prevention of religious conflict at the national level. Their leading role in the second Sudanese Intifada uprising was a key factor in saving the country from civil war, and another example of primary prevention. Sudanese physicians were also involved in secondary prevention by being influentially involved in almost all national peace agreements. Avoiding disputes at the tertiary level represents the weakest link in their repeated efforts. This paper outlines the different roles Sudanese medical personnel have taken in peacemaking. It also critically evaluates them in order to consider new methods of political involvement that suit future challenges.

Understanding consistencies and gaps between desired forest futures: An analysis of visions from stakeholder groups in Sweden

Conflicting perspectives on forests has for a long time challenged forest policy development in Sweden. Disagreements about forest futures create intractable deadlocks when stakeholders talk past each other. The purpose of this study is to move beyond this situation through the application of participatory backcasting. By comparing visions of the future forest among stakeholder groups, we highlight contemporary trajectories and identify changes that were conceived as desirable. We worked with four groups: the Biomass and Bioenergy group, the Conservation group, the Sami Livelihood group and the Recreation and Rural Development group; in total representatives from 40 organizations participated in workshops articulating the groups' visions. Our results show well-known tensions such as intrinsic versus instrumental values but also new ones concerning forests' social values. Identified synergies include prioritization of rural development, new valued-added forest products and diversified forest management. The results may feed directly into forest policy processes facilitating the process and break current deadlocks.

Integrated traffic conflict model for estimating crash modification factors

Crash modification factors (CMFs) for road safety treatments are usually obtained through observational models based on reported crashes. Observational Bayesian before-and-after methods have been applied to obtain more precise estimates of CMFs by accounting for the regression-to-the-mean bias inherent in naive methods. However, sufficient crash data reported over an extended period of time are needed to provide reliable estimates of treatment effects, a requirement that can be a challenge for certain types of treatment. In addition, these studies require that sites analyzed actually receive the treatment to which the CMF pertains. Another key issue with observational approaches is that they are not causal in nature, and as such, cannot provide a sound "behavioral" rationale for the treatment effect. Surrogate safety measures based on high risk vehicle interactions and traffic conflicts have been proposed to address this issue by providing a more "causal perspective" on lack of safety for different road and traffic conditions. The traffic conflict approach has been criticized, however, for lacking a formal link to observed and verified crashes, a difficulty that this paper attempts to resolve by presenting and investigating an alternative approach for estimating CMFs using simulated conflicts that are linked formally to observed crashes. The integrated CMF estimates are compared to estimates from an empirical Bayes (EB) crash-based before-and-after analysis for the same sample of treatment sites. The treatment considered involves changing left turn signal priority at Toronto signalized intersections from permissive to protected-permissive. The results are promising in that the proposed integrated method yields CMFs that closely match those obtained from the crash-based EB before-and-after analysis.

Identifying and measuring land-use and proximity conflicts: methods and identification

ABSTRACT

This text aims to present the methodology of study of land-use conflicts performed in recent years by a multidisciplinary team, and to reveal the methods of survey and data collection, as well as the structure of the resulting database. We first define the scope of our study by providing a definition of these conflicts, of their characteristics and motives, of the ways they manifest themselves and of the actors involved (I). We then present the methodology we have used to identify conflicts; it is based on a spatial analysis and the combined use of different data collection methods including surveys conducted by experts, analyses of the regional daily press and of data from the administrative litigation courts (II). Finally we present the resulting Conflicts © data base, with its tables and nomenclatures, in which the data collected in different fields are reconciled and analyzed (III), before providing a few examples of how this method can be used to analyze case studies in developed and developing countries (IV).

JEL CODES

D74; C83; K41.

Pictorial essay

Conflicts, snapping and instability of the tendons are common, and ultrasound (US) is the method of choice for evidencing these conditions thanks to the possibility to perform dynamic maneuvers during imaging studies. A conflict can occur between a tendon and a bone structure, other tendons, the retinacula or pulleys. Snapping can occur due to instability caused by rupture of the retinaculum, conflict between a thickened retinaculum and a bone prominence or due to an abnormal position of the tendon. Instability can occur due to insufficient ability of the retinaculum to keep the tendons in the bone groove or its failure to hold the tendons applied to the bone.The technique for evidencing conflicts, snapping and instability of the tendons is very demanding because it requires a thorough knowledge of the US appearance and dynamic maneuvers. However, at the present time US examination completed with dynamic maneuvers is the investigation of choice for evidencing these disorders and providing the clinicians with the necessary information.

Assessing interventions available to internally displaced persons in Abia state, Nigeria

Internally displaced persons are faced with several problems, such as sexual violence, and deserve appropriate intervention, especially in view of the increasing prevalence of HIV/AIDS and other infections in Nigeria. This study attempts to assess interventions offered by governmental authorities and organizations to internally displaced persons and to identify gaps in services as well as to identify what needs to be strengthened. Method: The author reviewed relevant published and unpublished documents and collected data by interviews with semi-structured questions. Twenty-five organizations and government and police departments and 55 internally displaced persons were interviewed. Results: None of the organizations, including governmental institutions, provided social services or assistance in prevention of HIV/AIDS to internally displaced persons. The main services provided by 17 (68%) organizations to 43 (78.2%) of internally displaced persons were provision of food, clothing and money, but these were provided on an ad hoc basis. Only 3 organizations (12%) included spiritual counseling and resolution of communal conflicts in their services. Conclusion: The fact that most organizations, including the government, do not have services for internally displaced persons indicates lack of support for internally displaced persons. The government should be urged to include these people in most prevention services, including HIV/AIDS prevention and treatment. This should help reduce the national prevalence of HIV/AIDS