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Organizational culture in sports affects well-being, performance, and overall success. Although team culture has been explored within able-bodied teams, little is known about culture development within parasport. Using a descriptive case study approach, our study examined the culture development and experiences of an elite parasport team. Two semistructured individual telephone interviews were conducted with nine participants (athletes and staff), and one athlete-participant completed one interview. An inductive thematic analysis revealed two themes: approach to culture development and team culture components. Culture development was linked with facilitative leadership and important resources. This supported the team to create their shared values and mechanisms, including a behavioral framework, other artifacts (e.g., shared language and team motto), and a relaxed environment. These helped to maintain their agreed culture and benefited their well-being, progress, and team cohesion. Our results offer a starting point regarding research into the culture of elite parasport and have practical implications for managers, coaches, and psychologists. [ABSTRACT FROM AUTHOR]

Purpose: To propose a paradigm change for the validation procedures of medication adherence questionnaires. Methods: A total of 121 validation procedures of unique questionnaires for medication adherence were analyzed. Results: "Construct validity" and "internal consistency" were most often assessed, and test results varied largely. A more in-depth analysis indicated that the assessment of medication non-adherence included distinct but related constructs, such as the extent to which doses are missed, and the attempt to identify different facets of medication-taking behavior. Consequently, each construct requires a different measurement approach with different psychometric tests for establishing its validity and reliability. Conclusion: Results show that assessing the validity and reliability of adherence questionnaires with standard procedures including statistical tests is inconclusive. Refinement of the constructs of non-adherence is needed in pharmacy and medical practice. We suggest a distinction between the (i) extent of missed doses over the past 2 weeks, (ii) modifiable reasons for non-adherence behavior, and (iii) unmodifiable factors of non-adherence. Validation procedures and corresponding statistical methods should be selected according to the specific single constructs. [ABSTRACT FROM AUTHOR]

Aims: To investigate the ways that nurses engage with referral letters and discharge summaries, and the qualities of these documents they find valuable for safe and effective practice. Design: This study comprised a qualitative, case‐study design within a constructivist paradigm using convenience sampling. Methods: Interviews were conducted with nurses to investigate their practices relating to referral letters and discharge summaries. Data collection also involved nurses' examination and evaluation of a diverse range of 10 referral letters and discharge summaries from medical records at two Australian hospitals through focus‐group sessions. The data were transcribed and analysed inductively. Results: In all, 67 nurses participated in interviews or focus groups. Nurses indicated they used referral letters and discharge summaries to inform their work when caring for patients at different times throughout their hospitalisation. These documents assisted them with verbal handovers, to enable them to educate patients about their condition and treatment and to provide a high standard of care. The qualities of referral letters and discharge summaries that they most valued were language and communication, an awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. Conclusion: Nurses relied on referral letters and discharge summaries to ensure safe and effective patient care. They used these documents to enhance their verbal handovers, contribute to patient care and to educate the patient about their condition and treatment. They identified several qualities of these documents that assisted them in maintaining patient safety including clarity and conciseness of information. Implications for the Profession and Patient Care: It is important that referral letters and discharge summaries are written clearly, concisely and comprehensively because nurses use them as key sources of evidence in planning and delivering care, and in communicating with other health professionals in relaying goals of care and implementing treatment plans. Impact: Nurses reported that they regularly used referral letters and discharge summaries as valuable sources of evidence throughout their patients' hospitalisation. The qualities of these documents which they most valued were language and communication styles, awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. This research has important impact on the patient experience in relation to encouraging effective referral letter and discharge summary writing. Reporting Method: We have adhered to the relevant EQUATOR guidelines through the SRQR reporting method. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Introduction: Feedback is crucial to promote learning and improve performance. However, we lack a nuanced understanding of how medical teachers reflect on and internalise (or not) student feedback (SF). This study aims to fill this gap by exploring how teachers make sense of SF to improve their performance and nurture their personal and professional development. Methods: In this cross‐sectional qualitative study based on a constructivist paradigm, 14 medical teachers individually drew a Rich Picture (RP) of a feedback experience in which they received informal or formal feedback from students, resulting in a personal or professional change. After the drawing, we interviewed the participants to deepen our understanding of teachers' experiences. We analysed the drawings and interview transcripts using an iterative process of thematic analysis. Results: SF that culminated in personal or professional change is a highly emotional experience for teachers, often with long‐lasting consequences. It may threaten or reassure their self‐concept and professional identity, generating feedback avoidance or feedback‐seeking behaviour. SF is particularly powerful in transforming teaching practices when teachers feel connected to students through an honest and constructive relationship. Remarkably, some teachers intentionally build relationships with certain (selected) students to get 'qualified' feedback. SF acceptance also increases when teachers are open to receiving feedback and there is an institutional culture that values feedback. Finally, medical teachers believe that formal (planned) feedback is relevant to improve the curriculum, while informal (spontaneous) feedback is important for promoting teachers' personal and professional development. Discussion: SF has the potential to become a transformative learning experience for teachers. The student–teacher relationship and teachers' emotional reactions affect the way teachers make sense of and internalise SF and enact behavioural change. Understanding the complexity surrounding SF is vital for supporting teachers in seizing opportunities for growth and in nurturing a meaningful relationship with the act of teaching. Receiving students' feedback is detailed to be an emotional process that happens in the context of a relationship and can nurture teachers' professional and personal development. [ABSTRACT FROM AUTHOR]

Family-centered intervention can help families facing illness-related issues. We investigated the feasibility of Family and Network Conversations (FNCs) in high-grade glioma patients and their families. Quasi-experimental feasibility study with longitudinal mixed-methods design. Patients and families were invited to three FNCs over 1 year. They completed questionnaires at four time points and expressed their perspectives on the intervention through telephone interviews. Nurses' perspectives were collected in a focus group. Twenty-one patients and 47 family members were included. On average, patients were 66 years old, mainly male, married, living with caregivers, with unifocal cancer. On average, caregivers were 47 years old, mainly female, being spouses or children of the patient. Quantitative and qualitative data did not always match and expanded each other. Nurse-delivered FNCs holistically addressed families' needs while strengthening family's dialogue and union. Nurses felt empowered, underling that advanced competencies were required. Nurse-delivered FNCs are feasible to provide family-centered care, but they should be tailored to each family's needs. [ABSTRACT FROM AUTHOR]

This study deals with the experience of men coping with violence toward them in heterosexual relationships. The research was conducted using a qualitative paradigm. It was based on 12 in-depth, semi-structured interviews with Israeli men. The analysis focused on the participants' self-perception in the context of domestic violence toward them. The findings demonstrated the effect of internalizations of socially constructed structural gender expectations on the participants' self-perception, as a men, spouses and parents. The participants' narratives exhibited deferent degrees of dichotomist gender perceptions, delegitimacy for emotional vulnerability, traditional male roles as responsible spouses and parents. These elements intensified frustration and emotional repression of their experience which engendered helplessness and hopelessness. The knowledge generated should serve service providers by enabling professionals to examine IPV in a more holistic and flexible way, and to tailor interventions with men and women, that consider their unique cross-gender characteristics and difficulties. [ABSTRACT FROM AUTHOR]

Background: It is estimated that each year in Ireland, approximately 29 million consultations occur in general practice with a patient satisfaction level of 90%. To date, research has been lacking on how GPs assess the quality of care. Aim: To examine how GPs assess care quality during routine practice with respect to the following pillars of quality improvement: effectiveness, safety, timeliness, equity, efficiency, sustainability, and person-centredness. Design & setting: Qualitative study of GPs in Ireland. Method: In this qualitative study, semi-structured interviews were conducted with 10 GPs who were recruited via a snowball sampling strategy. Interviews were recorded, transcribed, and analysed. Quality 'assessment points' were identified and themes were synthesised to produce a theoretical framework. Results: Five female and five male GPs practising in a variety of settings were interviewed. The age range was 33-68 years. In total, 122 assessment points emerged from the data and were collated into the following eight themes: the GP as a professional person factors; the patient and coproduction factors; care team factors; direct care factors; outcome factors; practice environment and organisation factors; external environment factors; and improvement approach factors. Conclusion: This is the first study to examine how GPs in Ireland assess care quality as a holistic construct during daily care. The qualitative approach applied yielded rich and diverse insights into the many assessment points that GPs use to inform their approach and actions as clinicians, managers, collaborators, and leaders to maximise patient care. The theory produced is likely useful and applicable for practising GPs, healthcare administration, policymakers, and funders in planning and executing changes for quality improvement. [ABSTRACT FROM AUTHOR]

Positive health (PH) has been described as a promising transformative innovation to address the challenges of promoting well-being and reducing the burden of disease. For this study, we conducted a scientific literature review of the current state of knowledge about PH as introduced by Huber and colleagues, following the Cochrane Rapid Review recommendations. Three databases were searched (PubMed, Google Scholar, and CINAHL). Data were extracted and synthesised using a narrative approach. A total of 55 articles were included. The initial evaluation revealed promising results at both the individual and collective levels. However, several articles gave reason for further refinement of the conceptualisation of PH and of ways to measure the effects of PH interventions in greater detail. Professionals also expressed a desire for a more informed application and elaboration of the PH method, in various settings and populations, to increase its effectiveness in practice. The results from the rapid review highlight the transformative potential of PH in shifting from a disease-oriented to a health-oriented paradigm of healthcare. This underlines the need for continued research regarding further development of the concept and its practical method, along with the necessity for methodological innovation. [ABSTRACT FROM AUTHOR]

There is a lack of knowledge about factors that play a role in ethical decision-making of physiotherapists internationally. The purpose of this study was to explore, describe and map factors in ethical decision-making of physiotherapists from around the globe. A descriptive research design and constructivist research paradigm was applied. Elements of both a coding reliability thematic analysis and a reflexive thematic analysis method were used deductively and inductively to analyse the content of responses to an optional open question in an internationally distributed online survey with 559 participants from 72 countries through several steps and cycles. A spectrum of 43 factors was identified within 200 individual responses, allocated to five themes: individual factors (19 factors); relational factors (6 factors); organisational factors (6 factors); situational factors (6 factors); and societal factors (6 factors). The importance of context on organisational, situational and societal levels, interrelatedness of physiotherapists, individual characteristics and situatedness of patients/clients and physiotherapists, as well as aspects and features of the patient/client-physiotherapist relationship became apparent throughout analysis. To meet the emerging requirements for ethical physiotherapy practice, we advocate that both physiotherapy students and practicing physiotherapists internationally need to be trained as moral agents in integrated manners. Based on the results of this study we conclude that such training should embrace professionalism, professional values, ethical codes, ethical theories and ethical decision-making frameworks that acknowledge interrelatedness, epistemology and situatedness, self-reflective and communicative techniques, critical thinking, social/societal determinants of health, social responsibility, cultural competence and self-care techniques. [ABSTRACT FROM AUTHOR]

With the aim of providing evidence about doctor-managers' resilience during the Covid-19 pandemic, this study analyzes the characteristics of 114 doctor-managers operating within the Italian National Health Service (NHS). During the emergency, doctor-managers had to show adaptive capacities to deal with unexpected situations and develop new paradigms, procedures, and quick responses to patients' needs. This is in line with resilience, and in this perspective, it is crucial to investigate resilience determinants. The paper, therefore, provides an identikit of the resilient doctor-manager. The research was conducted between November and December 2020. Primary data were collected through an online questionnaire consisting of six sections. Participation was voluntary and anonymous. Data were analyzed using quantitative techniques and employing Stata 16. Confirmatory Factor Analysis was employed to test construct validity and scale reliability. Results show that increasing levels of individual resilience are related to increasing levels of managerial identity. Moreover, physicians' individual resilience has a positive association with commitment, knowledge diffusion, and Evidence-Based Medicine adoption. Finally, physicians' individual resilience has a negative association with their role in the university, their specialty, and their gender. The study suggests some practical implications for healtcare organizations. In general, career paths are decided primarily on competency assessment, while an important role should be devoted to behavioral characteristics. Furthermore, organizations should take care of the levels of individual commitment and encourage professional networking because both help doctor-managers cope with uncertainty. The originality of the study relies on a fresh look at all previous work. There are currently few contributions in the literature to explore and investigate resilience elements in doctor-managers during the pandemic era. [ABSTRACT FROM AUTHOR]

Background: Parental participation in their young children's rehabilitation has been promoted to increase intervention intensity, but parents' perspectives on increased involvement remain unclear. The objective of this study was to explore parents' experiences partnering with physical therapists (PTs) to administer early, intensive rehabilitation to their young children with cerebral palsy (CP). Methods: Twelve mothers and one father of children between 8 months and 3 years old with CP were interviewed. Semistructured interviews were conducted before and after parents partnered with a PT to deliver a 12 week activity‐based intervention targeting their child's lower extremities. The intervention occurred in the child's home and in PT clinical sites. Interviews were audio recorded and transcribed verbatim. Interpretive description was used as the methodological framework. Results: The three themes were (1) focus on maximizing the child's potential, (2) participation in intensive rehabilitation is challenging, and (3) the importance of a positive experience with therapy. Families discussed a number of barriers and facilitators to participating in intensive rehabilitation. Conclusions: These results provide considerations for clinicians and researchers to facilitate meaningful engagement of parents in their young children's rehabilitation. This is especially important with increasing evidence for early, activity‐based interventions for young children with CP. [ABSTRACT FROM AUTHOR]

Determining the psychological, computational, and neural bases of confidence and uncertainty holds promise for understanding foundational aspects of human metacognition. While a neuroscience of confidence has focused on the mechanisms underpinning subpersonal phenomena such as representations of uncertainty in the visual or motor system, metacognition research has been concerned with personal-level beliefs and knowledge about self-performance. I provide a road map for bridging this divide by focusing on a particular class of confidence computation: propositional confidence in one's own (hypothetical) decisions or actions. Propositional confidence is informed by the observer's models of the world and their cognitive system, which may be more or less accurate—thus explaining why metacognitive judgments are inferential and sometimes diverge from task performance. Disparate findings on the neural basis of uncertainty and performance monitoring are integrated into a common framework, and a new understanding of the locus of action of metacognitive interventions is developed. [ABSTRACT FROM AUTHOR]

Introduction: Black communities are deeply underrepresented in research, due, in large part, to research mistrust. It is critical to shift the burden of trust building from communities to researchers and research institutions, which have perpetrated harm against Black communities for centuries. In this study, we examine researchers' perspectives on how to become trustworthy to Black-identifying participants and communities. Methods: We conducted semi-structured interviews with researchers affiliated with our institution's Clinical and Translational Science Institute. Participants were recruited through email and responded to the study team if they wished to participate. Interviews occurred through Zoom, took 60 minutes, and were audio recorded. We used an inductive thematic data analysis approach. Results: Sixteen researchers, who were affiliated with medicine, public health, psychology, education, and nursing, participated in this study. Participants agreed that researchers bear the responsibility for building trust and noted how critical it is to address the underrepresentation of Black participants in research through equitable recruitment and that researchers must be transparent and engage in reciprocal research practices. Community-partnered research was highlighted as a way to develop trustworthiness. Finally, participants noted that trustworthiness must also be built at the institutional level, rather than just by individual researchers. Discussion: To our knowledge, this is one of the first studies to examine researchers' perspectives on how to build their own trustworthiness, with a specific focus on trust-building with Black communities. Explicit training and resources are needed to build trustworthiness into academic centers. [ABSTRACT FROM AUTHOR]

Purpose: Equality is a basic human right. However, LGBTQ individuals often have their human rights violated because of their gender identity or sexual orientation. They also experience discrimination because of homophobic and transphobic attitudes. They frequently deal with derisive attitudes at school, are discriminated against in the workplace and struggle to access health services. This paper aims to determine the discriminatory attitudes of nurses in their social and professional lives toward LGBTQ individuals. Design/methodology/approach: This study involved 503 nurses and used a questionnaire to examine their views regarding members of the LGBTQ community. The questionnaire consisted of 24 questions. Ten experts from the fields of social psychology, sociology, and nursing provided the necessary inputs, which were subsequently incorporated into the questionnaire. Findings: The nurses were found to have a negative attitude toward LGBTQ individuals; they felt that they should not be allowed to live in comfort in Turkey and that they disrupted the social order and compromised public morality. It was observed that married (in general), male (in particular), and have fewer nursing education nurses are much more likely to have a discriminatory attitude toward LGBTQ people, and they were more discriminatory in their society rather than in their professional lives. Originality/value: According to the principles of justice and equality, which are a prominent part of the nursing code of ethics – "With the awareness that all people have equal rights, the nurse serves regardless of race, language, religion, age, gender, belief, social and economic status and political opinion" – nurses should not have a discriminatory attitude. This study reveals the inequality and the ethical problems that riddle Turkey's health sector. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to explore how physical therapists use movement as a component of their clinical reasoning. Additionally, this research explored whether movement as a component of clinical reasoning aligns with the proposed signature pedagogy for physical therapist education, human body as teacher. Methods The study utilized qualitative, descriptive methods in a multiple case studies design (each practice setting represented a different case for analysis purposes) with cross-case comparisons. Researchers conducted 8 focus groups across practice settings including acute care, inpatient neurological, outpatient orthopedics, and pediatrics. Each focus group had 4 to 6 participants. Through an iterative, interactive process of coding and discussion among all researchers, a final coding scheme was developed. Results Through exploration of the research aims, 3 themes emerged from the data. These primary themes are: (1) movement drives clinical reasoning to optimize function; (2) reasoning about movement is multisensory and embodied; and (3) reasoning about movement relies on communication. Conclusions This research supports a description of movement as the lens used by physical therapists in clinical reasoning and the integral role of movement in clinical reasoning and in learning from and through movement of the human body while learning from clinical reasoning experiences in practice. Impact As the understanding of the ways physical therapists use and learn from movement in clinical reasoning and practice continues to emerge, it is important to continue exploring ways to best make this expanded, embodied conception of clinical reasoning explicit in the education of future generations of physical therapists. [ABSTRACT FROM AUTHOR]

Many health organisations seek social media engagement through their online health promotion campaigns, but there is little understanding of what engagement means in relation to the uptake of health messages. To understand the relevance of social media engagement, we need to look at the reasons why people engage with health content via social media. This exploratory study examined people's motivations for engaging with health content through a case study of the Healthy Lunch Box campaign. Data was collected via online focus groups (n  = 7), with participants being a convenience sample of people who had seen or engaged with the Healthy Lunch Box resources (n  = 24). The discussions covered reasons for engaging with the Healthy Lunch Box campaign, and more broadly with health content on social media in general. The data was analysed using a reflexive approach to thematic analysis, with themes developed inductively. The study found that some of the reasons for engagement aligned with the paradigm of social media engagement being an intermediary step in the process towards health behaviour change. However, people also described other reasons, such as alignment with their personal values, consideration of their online presentation, or as a way of curating the content they wanted to be shown on social media. These results demonstrate that people's decision to engage with health-related social media content involves more than consideration about the usefulness of the content, suggesting the need for a deeper examination of the assumptions made about the value of social media engagement in health campaign evaluations. [ABSTRACT FROM AUTHOR]

Introduction. Delayed diagnosis of gut disease is a continuing problem, variously attributed to a range of patient, doctor, and health system factors. Gut disease often begins with indeterminate gut behaviours that are hard to classify. Aim. This study aimed to investigate delayed diagnosis from the point of view of the patient, or prospective patient. How gut and gut disease was understood, what might prompt them to seek care, and their experiences of seeking care. Methods. Using a qualitative design, we interviewed 44 people in New Zealand. Thirty-three had a diagnosis of gut disease, and 11 did not, though some of the patients in this latter group had symptoms. Results. Some participants had a smooth trajectory from first noticing gut symptoms to diagnosis. However, a subgroup of 22 participants experienced long periods of troublesome gut behaviours without a diagnosis. For this subgroup of 22 participants, we found people struggled to work out what was normal, thus influencing when they sought health care. Once they sought health care, experiences of that care could be frustrating, and achieving a diagnosis protracted. Some who remained undiagnosed felt abandoned, though had developed strategies to self-manage. Discussion. Indeterminate gut behaviours remain complex to deal with and it can difficult for both patients and doctors to assess when a symptom or group of symptoms need further investigation, watchful waiting or the use of other supportive strategies. Effectively communicating with healthcare staff can be a significant problem and there is currently a gap in support for patients in this regard. [ABSTRACT FROM AUTHOR]

Mixed methods research (MMR) has the potential to be a powerful tool to expand the ways early intervention/early childhood special education (EI/ECSE) scholarship understands and informs practice. Integration, or the purposeful combination of quantitative and qualitative research approaches, is central for rigorous MMR. However, it can be challenging to identify and enact integration because integration processes and procedures can vary greatly depending on a study's purpose(s), design, and underlying philosophical assumptions and priorities. In this article, we offer guidance on ways EI/ECSE researchers can engage in meaningful and purposeful integration. We highlight three critical decision-making points: integration dimension or type, integration timing, and relative emphasis of methods when integrating. Additionally, we discuss related considerations to particularly ensure strong qualitative designs and integration within MMR. [ABSTRACT FROM AUTHOR]

This article examined the techniques used in preserving traditional medicinal knowledge in UMhlathuze in KwaZulu Natal, South Africa. Four research objectives guided the study: to determine the types of traditional medicinal knowledge owners in uMhlathuze area; to determine techniques used by traditional medicinal knowledge owners in preserving their traditional medicinal knowledge; to establish the effectiveness of the techniques used by traditional medicinal knowledge owners in preserving their traditional medicinal knowledge and to identify the challenges associated with the preservation of traditional medicinal knowledge. The study adopted qualitative research approach underpinned by the interpretivism research paradigm, in order to understand the techniques or strategies used to preserve traditional medicinal knowledge, guided by Nonaka's knowledge creation model. Qualitative data was collected through interviews (primarily through open-ended questions incorporated in semi-structured interviews with traditional medicinal knowledge practitioners) and content analysis was used for qualitative data obtained from lliterature review and document analysis. The study interviewed fifteen (15) traditional medicinal knowledge practitioners in the province of KwaZulu-Natal, included diviners (Izangoma), herbalists (Izinyanga), and faith healers/prophets (Abathandazi). The study identified the abundance, accessibility, and usage of traditional medicinal knowledge for the benefit of both owners and users of this knowledge. The findings reveal that the traditional medicinal practitioners employed various strategies, such as notebooks and diaries to record and preserve their knowledge. Traditional medicinal knowledge practitioners also passed on their therapeutic experiences to their loved ones. Even though most traditional medicinal knowledge practitioners used a written form of preservation, several obstacles were recognised when conserving knowledge. The lack of education, skills and ability to use technological gadgets to their full potential made conserving traditional medicinal knowledge challenging. The study recommends that traditional medicinal knowledge should be captured, stored, retrieved, and disseminated via technological devices. [ABSTRACT FROM AUTHOR]

The use of prediction can aid language comprehension through preactivation of relevant word features. However, predictions can be wrong, and it has been proposed that resolving the mismatch between the predicted and presented item requires cognitive resources. Older adults tend not to predict and instead rely more on passive comprehension. Here, we tested, using an intraindividual approach, whether older adults consistently use this less demanding processing strategy while reading or whether they attempt to predict on some trials. We used a cross-task conflict paradigm. Younger and older participants self-paced to read sentences that ended with either an expected or unexpected word. Each sentence was then followed by a flanker stimulus that could be congruent or incongruent. We examined responses within and across the two tasks. Unexpected words were in general read as quickly as expected words, indicating that typical processing of these words was similar. However, for both younger and older adults, there was a greater proportion of very slow trials for unexpected words, revealing different processing on a subset of trials. Critically, in older adults, these slowly read unexpected words engaged control, as seen in speeded responses to incongruent flanker stimuli. Using a cross-task conflict paradigm, we showed that older adults are able to predict and engage cognitive resources to cope with prediction violations, but do not opt to use these processes consistently. [ABSTRACT FROM AUTHOR]

Consulting manuals of the History of Nursing, it can be appreciated how it is from Nightingale when considering the birth of modern or professional Nursing. However, this belief could be a black legend, because before the 19th century there was already awareness of Nursing as a profession, being this initiated by Juan de Dios, the one from Granada, in the Spanish 16th century. For this reason, in this article we have set the objective of describing the care of Juan de Dios following the model of human needs described by Henderson, together with care in agony and post-mortem. To do this, we use the historiographical methodology following the current of the history of mentalities, so that we can go from the past to the present, and vice versa. In the documentary analysis we have been able to observe how what we find today systematized in a theoretical way was already carried out at the beginning of the nursing reform of the Spanish 16th century, being a valid model for current Nursing, since it is found in its being, knowing, and doing, the concepts of the current nursing metaparadigm, although not explicitly, since its intention, more than theoretical, was care, although behind it there was a corpus of doctrine independent of other socio-health disciplines. [ABSTRACT FROM AUTHOR]

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The article examines the ongoing paradigm shift on enhancing diversity climates in Swedish human services organizations. Traditional social policy arrangements based on a monocultural style of service provision has been challenged by the growing need for cultural competence and ethnic sensitivity. A study of cultural competence enhancement finds the recruitment of ethnic social workers to be the most efficient strategy for making social services more culturally sensitive. At both the operational and the managerial level, ethnic staff contribute to regular training and the updating of staff cultural competences, as well as to the strategic diversity plans of entire organizations. [ABSTRACT FROM AUTHOR]

The life-history narratives of 10 Mexican American men with mobility limitations, age 55–77 years (mean = 63.8, SD = 5.8), were explored using a qualitatively driven, life-history mixed-methods study to understand perceptions of mobility limitations over the life course. Within that methodological and paradigmatic framework, conceptualizations of alterity and masculinity guided interpretation of data. Through an iterative, thematic analysis, we detail the way the men's lives were influenced by growing familial responsibility with age. Quantitative data were integrated into themes of narrative inheritance, family, and masculinity. It was posited that masculinity with mobility limitations shaped and was shaped by ethnic identity and responsibility. This has implications for understanding the experience of Mexican American men over the life course. [ABSTRACT FROM AUTHOR]

Background Vessel tortuosity poses a challenge during endovascular treatment of neurovascular lesions. Bendit Technologies (Petah Tikva, Israel) has developed flexible, steerable microcatheters designed with unique bending and torquing capabilities. Objective To describe our first-in-human trial of Bendit21. Methods Bendit21 was used in our exploratory, prospective, multicenter, open-label, single-arm clinical study, and in two compassionate use cases. Procedures were conducted at four centers in Austria, Germany, Israel, and the United States between May 2021 and March 2022, in patients with neurovascular conditions. The primary endpoints were device-related safety events, successful navigation through the neurovasculature, and, when intended, successful delivery of contrast or therapy. Results Two patients with giant aneurysms were treated successfully under compassionate use approval. The clinical study included 25 patients (mean age: 63.4±11.8 years; 32.0% female). Fourteen patients (56.0%) had aneurysms, two had arteriovenous malformations/fistulas (8.0%), one had a stroke (4.0%), four (16.0%) had intracranial stenosis, and four (16.0%) had other conditions. Bendit21 was used without a guidewire in 12/25 (48.0%) procedures. Bendit21 was successfully navigated through the vasculature without delays or spasms in all cases (100%). Contrast was delivered as intended in 7/7 (100%) cases. Therapeutic devices were delivered successfully with Bendit as intended in 14/18 (77.8%) cases; four deficiencies occurred in three patients with aneurysms, in whom delivery of coils, an intrasaccular device, or a flow diverter was attempted. There were no device-related safety events or mortalities. Conclusions Our initial clinical experience with the Bendit21 microcatheter demonstrates its usefulness in achieving technical success in patients with challenging neurovascular conditions. [ABSTRACT FROM AUTHOR]

Objective: Communication about patients' values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations. Methods: Qualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions. Results: We completed 30 interviews across palliative care, oncology, primary care, and hospital medicine. Participants identified four culture-related domains that influenced serious illness communication improvement: (1) clinical paradigms; (2) interprofessional empowerment; (3) perceived conversation impact; (4) practice norms. Changes in clinicians' beliefs, attitudes, and behaviors in these domains supported values and goals conversations, including: shifting paradigms about serious illness communication from 'end-of-life planning' to 'knowing and honoring what matters most to patients;' improvements in psychological safety that empowered advanced practice clinicians, nurses and social workers to take expanded roles; experiencing benefits of earlier values and goals conversations; shifting from avoidant norms to integration norms in which earlier serious illness discussions became part of routine processes. Culture-related inhibitors included: beliefs that conversations are about dying or withdrawing care; attitudes that serious illness communication is the physician's job; discomfort managing emotions; lack of reliable processes. Conclusions: Aspects of clinical culture, such as paradigms about serious illness communication and inter-professional empowerment, are linked to successful adoption of serious illness communication. Further research is warranted to identify effective strategies to enhance clinical culture and drive clinician practice change. [ABSTRACT FROM AUTHOR]

To identify consequences of unmet housing needs in the period following cancer diagnosis. Qualitative descriptive design. New York City-based cancer patients and survivors (n = 21) who reported experience of unmet housing needs while receiving cancer treatment. Key informants (n = 9) with relevant expertise (e.g. oncology social workers). One-time semi-structured telephone or in-person interviews were conducted with all participants. Inductive thematic coding was conducted using a pragmatic paradigm. Four categories of consequences emerged: 1) cancer management and health (rest and recovery, illness/injury risk, medical care); 2) psychological (stress and anxiety, lack of control and independence, self-esteem/pride, sadness/depression, cancer coping); 3) social (relationships, consequences for others, isolation); and 4) standard of functional living. The simultaneous experience of cancer and unmet housing needs is broadly burdensome. Screening and resources for addressing unmet housing needs must be prioritized to holistically care for patients. [ABSTRACT FROM AUTHOR]

Despite the increase in older adults receiving kidney transplantation (KT), little is known about their experience and adaptation process after KT. The current study aimed to explore the process of adaptation after KT in older adult recipients using a qualitative design and grounded theory methodology. Sixteen recipients who had KT at age ≥60 years and received follow-up care were recruited at a university hospital in South Korea. Data were collected from July to December 2017 through in-depth interviews with individual participants. The core theme of the adaptation process after KT in older adult recipients was A Journey of Straining to Save the Last Lifeline. The adaptation process comprised three stages: confusion, depression, and compromise. Tailored interventions based on the in-depth understanding of the adaptation process found in the current study are needed to improve adaptation after KT in older adult recipients. [Research in Gerontological Nursing, 16(4), 183–193.] [ABSTRACT FROM AUTHOR]

With the rapid and widespread uptake of physical literacy (PL), there is potential for instructors to devalue participation of children who experience disability. The aim of the investigation was to understand how instructors who facilitate physical activity for children experiencing disability make sense of PL, and more specifically, how these instructors bring meaning to PL. Using interpretive phenomenological analysis, six instructors engaged in individual, semi-structured interviews. The study rationale was underpinned by the conceptual framework of ecological systems theory, which provided a foundation for the research, guided the structure of the interview guide, and facilitated a reflexive interpretation of the findings. Four themes were generated: Recognizing unique embodiments, The importance of context, Beyond physical competence, and Navigating PL's dominant discourse. The instructors' meaning of PL, impacted by relational and environmental influences, reflected the importance of movement skill development, while also embracing diverse embodiment and pedagogical flexibility by giving value to exploratory play, partial participation, family involvement, and willingness to abandon rigid lessons plans. [ABSTRACT FROM AUTHOR]

The burden of health inequities borne by Indigenous peoples can be overwhelming, especially when mothers and newborns' lives are at stake and health services seem slow to invest in responsiveness. In Aotearoa (New Zealand), urgent action is required to eliminate persistent systemic inequities for Māori (Indigenous) whānau (family collectives that extend beyond the household). This Kaupapa Māori (by Māori, for Māori) qualitative study aimed to explore the views of health practitioners identified as champions by whānau of preterm Māori infants. Ten health practitioners were interviewed and asked about their involvement with the whānau, their role in explanations and communication, and their thoughts on whānau coping. Interview data were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: working together in partnership, a problem shared is a problem halved, and sacred space. Collaboration between health practitioners and with whānau was important to the champions and central to their goal of enabling whānau autonomy. This was built on a foundation of connectivity, relationships, and a full appreciation that childbirth is a sacred time that is potentially disrupted when an infant is born prematurely. The values- and relationship-based practices of these champions protected and uplifted whānau. They showed that health practitioners have important roles in both the elimination of inequities and the sustaining of Māori self-determination. This championship is an exemplar of what culturally safe care looks like in day-to-day practice with Māori and is a standard that other health practitioners should be held to. [ABSTRACT FROM AUTHOR]

Children living in out‐of‐home care are at greater risk of poor educational outcomes compared to other children. To address their educational needs, several programs have been developed. Within a qualitative paradigm, this study explored the experiences of students about their involvement in TEACHaR (Transforming Educational Achievement for Children at Risk), a specialized education programme. Eight students (aged 13 to 18 years) from the programme participated in individual, semi‐structured interviews. Responses were analysed using Interpretive Phenomenological Analysis. Participants indicated that the programme provided individualized and flexible academic support, reduced their shame and embarrassment and provided them with more than academic support. They highlighted the importance of the student–educator relationship, and the need for encouragement and motivation to pursue their educational goals. Finally, findings report on how COVID‐19 impacts on student experiences of the programme. Recommendations for the development and improvement of education programs for students in out‐of‐home care conclude this paper. [ABSTRACT FROM AUTHOR]

PURPOSE As outcomes improve in early-stage breast cancer, clinical trials are undergoing a paradigm shift from intensification trials (more therapy) to improve survival to optimization trials, which assess the potential for using less toxic therapy while preserving survival outcomes. However, little is known about physician perspectives in community and academic settings about possible barriers and facilitators that could affect accrual to optimization clinical trials and the generalizability of future findings. METHODS We conducted a qualitative study with semistructured interviews of medical oncologists from different academic and community practices to assess their perspectives on optimization trials. Interviews were audiorecorded and transcribed. Three independent coders used a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted. RESULTS All 39 physicians reported that they would enroll patients in optimization clinical trials. Oncologists highlighted specific reasons to consider optimization trials. These included quality-of-life improvement by reducing toxicity, reduction in financial toxicity, fertility preservation, ability to avoid chemotherapy, minimization of overtreatment in patients with comorbid conditions, personalized treatment, opportunities to test novel therapies, and leveraging the availability of targeted therapies. Oncologists also identified accrual barriers, such as tumor-specific biology, individual (host) factors, prognostic markers of risk, access to therapies, provider experience, and system constraints. They voiced recommendations regarding preliminary data, trial design, and tools to support enrollment in optimization trials. CONCLUSION Although oncologists are generally willing to enroll patients on optimization clinical trials, barriers affect their acceptance. A scientific focus on overcoming these barriers is needed to support future enrollment on trials tailoring therapy on the basis of risk and potential benefit to allow true personalization of treatment. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Onomastics is traditionally treated as a subdiscipline of linguistics. Despite the close relationship between onomastics and methods of research on names derived from linguistics, a current in the development of onomastics based on other traditions and achievements in various scientific disciplines has also become popular in recent years. Given Antoni Furdal's concept of open linguistics, one can refer to them as onomastics becoming open to perspectives and methodological frameworks beyond linguistics. In this article, the most significant types of such achievements in contemporary Polish onomastics are discussed, and a brief comment on them is made. The author discusses the changes in the subject of the research, including the methodology, as well as the processes of the permeation of paradigms and drawing inspiration from other social sciences. [ABSTRACT FROM AUTHOR]

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The author explores humanbecoming hermeneutic sciencing and provides exemplars of paradoxes that are used by scholars in this mode of inquiry. [ABSTRACT FROM AUTHOR]

Ethically constructed laboratory paradigms can provide behaviorally based opportunities to study sexual violence as an addition to questionnaires. One such paradigm invites male participants to watch and show sexual materials to a female confederate as an analog of sexual perpetration. However, there has been inconsistency in the confederate's presentation, such that she either expresses a dislike of sexual material or her preferences are omitted. Some researchers have also questioned whether an expressed dislike is analogous to an expressed nonconsent. As such, the primary goal of the current study was to determine whether confederate expressions of dislike, nonconsent, or the omission of a preference, differentially affect male participants' behavior within a well-established paradigm. That is, we attempted to clarify the appropriate methodology for future researchers (i.e., the validity of the paradigm) and determine the impact of such a situational manipulation on laboratory-based sexual violence. Participants were 276 adult men, who were randomly assigned to one of three conditions: (1) dislike, (2) nonconsent, or (3) said nothing (the omission of a preference) and then asked to show a brief video clip to the female confederate who expressed these preferences. Overall, exposure to experimental condition predicted sexual video-showing over and above that of social desirability, hostile sexism (HS), and sexual violence history, suggesting that situational variables can play a significant role in laboratory-based sexual violence. Greater HS was associated with greater likelihood of sexual video-showing in the nonconsent condition relative to the dislike condition. Sexual video-showing was most frequent in the said nothing condition. In sum, researchers should be mindful of the confederate expression (or lack thereof) of preferences for sexual materials when using the sexual imposition paradigm. [ABSTRACT FROM AUTHOR]

The ability to grasp relevant patterns from a continuous stream of environmental information is called statistical learning. Although the representations that emerge during visual statistical learning (VSL) are well characterized, little is known about how they are formed. We developed a sensitive behavioral design to characterize the VSL trajectory during ongoing task performance. In sequential categorization tasks, we assessed two previously identified VSL markers: priming of the second predictable image in a pair manifested by a reduced reaction time (RT) and greater accuracy, and the anticipatory effect on the first image revealed by a longer RT. First, in Experiment 1A, we used an adapted paradigm and replicated these VSL markers; however, they appeared to be confounded by motor learning. Next, in Experiment 1B, we confirmed the confounding influence of motor learning. To assess VSL without motor learning, in Experiment 2 we (1) simplified the categorization task, (2) raised the number of subjects and image repetitions, and (3) increased the number of single unpaired images. Using linear mixed-effect modeling and estimated marginal means of linear trends, we found that the RT curves differed significantly between predictable paired and control single images. Further, the VSL curve fitted a logarithmic model, suggesting a rapid learning process. These results suggest that our paradigm in Experiment 2 seems to be a viable online tool to monitor the behavioral correlates of unsupervised implicit VSL. [ABSTRACT FROM AUTHOR]

This qualitative study explored the experiences of transracial Korean adoptee returnees who were born in Korea, separated from their biological families, raised in the United States and three European countries by White families, and given an Anglicized or Germanic name at the time of their adoption. This study focused on participants' journeys of reclaiming their Korean birth names and the various influences that factored into this decision. Data were collected from in-depth, semi-structured interviews (in-person or via Skype) and coded using grounded-theory methods that integrated a constructivist-interpretivist and critical epistemological paradigm. Participants (N = 12) were transracial Korean adoptees with ages ranging from 22 to 42 years (M = 32.67 years) who were between 0 and 88 months (M = 22.33 months) at the time of adoption, all of whom had returned to Korea. Results from the interviews revealed 11 axial categories and 2 overarching selective categories related to the name reclamation process: (a) name reclamation was part of a larger identity development process; (b) factors that prevented or slowed the name reclamation process. Limitations and future areas of research are discussed. [ABSTRACT FROM AUTHOR]

The purpose of this article is to report the findings of a Parse research method inquiry on the universal living experience of feeling peaceful. The Parse research method was used to answer the question: What is the structure of the living experience of feeling peaceful? Ten participants from the American Indian population were recruited. The central finding of the inquiry was the structure: The living experience of feeling peaceful is serene contemplation surfacing with gratifying engagements while enduring hardship. The findings are discussed in relation to the humanbecoming paradigm and related literature. [ABSTRACT FROM AUTHOR]

Background and Purpose: Physical activity (PA) promotion is not routine practice for physical therapists. Understanding the PA promotion beliefs of physical therapists may offer targets for behavior change interventions to improve PA promotion. The purpose of this study was to explore outpatient US physical therapists' beliefs about PA promotion and determine which Theoretical Domains Framework (TDF) domains can inform implementation efforts. Methods: We used a descriptive qualitative research design. A TDF-based interview guide was developed to identify beliefs about PA promotion. Twenty-six outpatient US physical therapists (13 regular PA promoters and 13 irregular PA promoters) completed semistructured interviews. Directed content analysis identified specific beliefs by grouping similar belief statements. Specific beliefs were mapped to TDF domains. Results and Discussion: Five TDF domains were identified as likely relevant to changing physical therapists' PA promotion behaviors. Key beliefs within those domains included conflicting comments about PA guidelines being evidence based, a lack of confidence to promote PA due to perceived deficits in communication skills, and time constraints as key barriers. Beliefs about improving PA promotion included incorporating screening for baseline PA and continuing education targeting confidence and communication. Conclusions: We identified key beliefs that influence outpatient US physical therapists' PA promotion. These beliefs identify targets for behavior change interventions to improve PA promotion rates among outpatient US physical therapists including incorporating baseline screening for PA and the development of continuing education training programs. [ABSTRACT FROM AUTHOR]

This study was undertaken to understand South African family caregivers' lived experiences of individuals living with dementia in a predominantly Black African township. A homogenous sample of thirty family caregivers was recruited using purposeful sampling methods and interviewed using a semi-structured approach. Reflective Thematic Analysis (RTA) yielded four broad themes: Understanding Dementia, Struggles and Sacrifice, Mental Health and Protective Factors. Findings reflect how dementia is understood by family caregivers and their community, the struggles and sacrifices that they endure, the impact of caregiving on caregiver mental health and the protective factors that enable caregivers to cope, despite their difficulties. Our findings lead to new insights regarding dementia caregiving amongst family caregivers in South Africa. First, there appears to be a shift in perception – away from a cultural/spiritual paradigm – and a lack of pressure to conform to community conceptualizations of dementia among individual caregivers. Second, dementia caregiving had a negative effect on caregiver mental health and elicited stress, anxiety and grief reactions. Third, caregivers did not feel emotionally supported and expressed not receiving any assistance with their daily practical tasks. Fourth, before receiving a diagnosis, family caregivers were viewed as the perpetrators of abuse and/or neglect against their family members with dementia, instead of individuals with dementia being stigmatized by the community due to their behavioural symptoms. Additionally, help-seeking was not hindered by fear or stigma, but was motivated by caregiver distress as dementia-related behaviours began to manifest and caregivers feared being perceived as perpetrators of abuse. Psychoeducational interventions should be tailored to targeted population groups that are in need of further training to address the lack of awareness in communities, insufficient knowledge of dementia amongst healthcare professionals and the practical, emotional and psychological difficulties that family caregivers endure to facilitate mental health care and resilience. [ABSTRACT FROM AUTHOR]

• In a bid to resist a medical-moralist paradigm dominating public health ideologies, we make a case for understanding chemsex among men in Singapore vis-à-vis Deleuzean lines of flight. • Through a queer deleuzean framing, we illustrate how chemically inflected sexual encounters can offer deterritorialising flights of fantasy and freedom from a heteronormative social structure that stigmatises gay sex, among other normative regimes. • We explored how lines of flight generated by chemsex are dynamic (i.e. they can turn into lines of non-flight) and have to be unpacked contextually (i.e. in relation to unfolding senses of self and the social environment). We have also demonstrated that such deterritorialising flights of freedom can catalyse unplanned outcomes, including the propensity to reterritorialise. • Our analysis has not shied away from incorporating heartfelt anecdotes that perpetuate medico-moral, public health perspectives even as we are committed to a critical-political discussion on chemical-sexual intimacies. • Future research in this arena could potentially investigate the complicated, conflicted and protracted intimate relationships that users may have with their drug(s) of choice, as well as the varied lines of (non-)flight that these chemicals can endow over a longitudinal study. Public health scholars informed by a dominant biomedical paradigm have in their 'rush to risk' emphasised the problematic aspects of chemsex. Meanwhile, critical chemsex scholars have attemped to destigmatise such sexual-chemical practices and foreground how they can be transformative. Taking these two perspectives as points of departure, we make a case for understanding chemsex vis-à-vis Deleuzean lines of flight. Semi-structured in-depth interviews were conducted with 33 purposively sampled sexual minority men seeking therapy for chemsex dependency in Singapore. Interview topics included participants' experiences and histories of chemsex, substance use, and their ongoing recovery. Interviews were audio-recorded, transcribed and then analysed according to key themes. We illustrate how chemically inflected sexual encounters can offer deterritorialising flights of fantasy and freedom from a heteronormative social structure that pathologises gay sex. At the same time, we argue that these flight lines are not static, neither do they extend indefinitely in space-time. Rather, we show how flights of freedom can evolve into lines of fright (or non-flight) when chemsex practitioners are met with critical thresholds that reveal the less-than-desirable aspects of being intoxicated. Consequently, they may eventually consider the reterritorialisation of their lives (i.e. abstinence and recovery) as a more constructive option. Regardless of their decisions to ride on chemically-induced flight lines or to take a step back from such deterritorialising pathways, they have troubled stereotypical perspectives of drug users as passive automatons. This paper enriches the chemsex scholarship by presenting a Deleuzean conceptualisation of chemical-sexual intimacies without romantacising and/or overstating the 'escape'/'freedom' that chemsex can facilitate. Future research in this arena could explore the complicated intimate relationships that users may have with their drug(s) of choice, and their varied lines of (non-)flight over a longitudinal study. [ABSTRACT FROM AUTHOR]

In this article, I explore the concept of axiology in the context of adapted physical activity research and analyze its connection to the more commonly discussed paradigmatic assumptions of epistemology and ontology. Following methodological scholars, I argue for an acknowledgment of the pivotal role that axiology already plays in adapted physical activity research and for the potential interdisciplinary and transdisciplinary opportunities that could be enabled by engaging with axiology in more explicit ways. I discuss a number of potential axiological gaps between the field of adapted physical activity and disability communities, arguing that such differences may undermine attempts at doing meaningful transdisciplinary research with such communities. I offer strategies for bridging these axiological gaps, encouraging us to work together in axiologically reflexive ways in order to increase meaningful opportunities for more people with disabilities to be engaged in the movement-based activities and communities of their choice. [ABSTRACT FROM AUTHOR]

Quantitative study and descriptive approach, whose purpose was to investigate the paradigmatic conception that influences the daily professional practice of the students that work within the hospital environments and shapes their actions. The population was 54 units of analysis that comprised students of the Bachelor of Nursing degree cohort 2014 who worked as active workers in Health Organizations of the city of Posadas, Misiones. The variable under analysis was: Orientation of praxis. The analysis of the data was done by description, taking into account the substantial aspects of the nursing paradigms. The results showed that the professional praxis of the students analyzed is in the process of change, noting the evolution in thinking and doing of nursing professionals. [ABSTRACT FROM AUTHOR]

Intimate partner homicide is a major public health concern around the world and the most lethal outcome of domestic violence. Its impact on the surviving bereaved offspring is immense, yet there is a significant gap in the literature regarding the long-term effects of this type of loss. The current qualitative study is aimed at filling this gap. The study used the constructivist paradigm of bereavement as a theoretical background to reveal the meanings constructed by bereaved Israeli daughters whose biological mothers were killed in acts of intimate partner homicide by their biological fathers. Three main themes of meaning emerged from 12 in-depth semi-structured interviews: "destruction of one's home"; "blast injury"; and "in doubt". An examination of the three themes in the current study reveals a deep shatter in participants' world of meaning to its very basic foundations. In light of intense psychological and social forces, the participants constructed and reconstructed such narratives of meaning in a continuous process of meaning making throughout their lives, years, and decades post loss. Derived from the findings are implications for practice. Mental healthcare professionals must attend to this basic shatter with an extreme level of caution, as they help homicide survivors reconstruct a world of meaning shattered by loss. Moreover, the long-lasting effects emphasize an appropriate legal and political involvement; specifically, policy regulations and rights should provide psychosocial care programs that are suited to the needs of offspring co-victims of intimate partner homicide in particular. In light of the strong social influence on participants' loss experience, further efforts are required to raise social awareness about this burning social concern and to fight the stigmatization of co-victims of homicide in general and co-victims of intimate partner homicide in particular. [ABSTRACT FROM AUTHOR]

Copyright of Shenakht Journal of Psychology & Psychiatry is the property of Kurdistan University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)