Multilevel processes and cultural adaptation Reyes-García, Victoria; Balbo, Andrea L.; Gómez-Baggethun, Erik ...
Ecology and society,
12/2016, Letnik:
21, Številka:
4
Journal Article, Publication
Recenzirano
Odprti dostop
The last two decades have seen a proliferation of research frameworks that emphasise the importance of understanding adaptive processes that happen at different levels. We contribute to this growing ...body of literature by exploring how cultural (mal) adaptive dynamics relate to multilevel social-ecological processes occurring at different scales, where the lower levels combine into new units with new organizations, functions, and emergent properties or collective behaviors. After a brief review of the concept of “cultural adaptation” from the perspective of cultural evolutionary theory, the core of the paper is constructed around the exploration of multilevel processes occurring at the temporal, spatial, social, and political scales. We do so by using insights from cultural evolutionary theory and by examining small-scale societies as case studies. In each section, we discuss the importance of the selected scale for understanding cultural adaptation and then present an example that illustrates how multilevel processes in the selected scale help explain observed patterns in the cultural adaptive process. The last section of the paper discusses the potential of modeling and computer simulation for studying multilevel processes in cultural adaptation. We conclude by highlighting how elements from cultural evolutionary theory might enrich the multilevel process discussion in resilience theory.
Introdução: O tiro com arco é um esporte caracterizado pela execução de padrões de movimentos estáveis, com o objetivo de disparar uma flecha com precisão em um alvo. Dessa forma compreender fatores ...físicos e psicológicos relacionados ao desempenho na modalidade se faz necessário. Objetivo: Examinar as associações entre estresse, resiliência, fatores de personalidade, atenção (difusa e concentrada) e com desempenho no tiro com arco. Métodos: Participaram nove praticantes de tiro com arco, de ambos os sexos, com média de idade de 38,22±16,40 anos, com no mínimo um ano e meio de prática na modalidade. Para a caracterização da amostra, foram analisadas: envergadura, tamanho da puxada, equilíbrio unipodal e frequência cardíaca. Durante a simulação de competição foram realizadas avaliações do desempenho, do estresse, da resiliência, dos fatores de personalidade e da atenção. Resultados: Foi encontrado um aumento (p=0,008) da atenção concentrada do momento pré para o pós-simulação de competição de tiro com arco. Já na atenção difusa não foi encontrada diferença significativa. Houve correlações positivas entre envergadura e tamanho da puxada (rho=0,902; p= 0,001), tempo de prática do esporte e pontuação total (rho=0,786; p=0,012), pontos2 e pontos total (rho= 0,782; p=0,013). Já as correlações negativas foram entre extroversão e pontos2 (rho=-0,730; p=0,026) e entre resiliência e atenção concentrada pré-simulação (rho=-0,676; p=0,045). Conclusão: Dadas às associações encontradas entre resiliência e atenção concentrada, extroversão e pontuação da segunda série, é possível concluir que fatores de personalidade podem afetar o desempenho final de participantes de uma competição simulada de tiro com arco.
BACKGROUND:Physician’s prescribing preference is increasingly used as an instrumental variable in studies of therapeutic effects. However, differences in prescribing patterns among physicians may ...reflect differences in preferences or in case-mix. Furthermore, there is debate regarding the possible assumptions for point estimation using physician’s preference as an instrument.
METHODS:A survey was sent to general practitioners (GPs) in The Netherlands, the United Kingdom, New Zealand, Ireland, Switzerland, and Germany, asking whether they would prescribe levothyroxine to eight fictitious patients with subclinical hypothyroidism. We investigated (1) whether variation in physician’s preference was observable and to what extent it was explained by characteristics of GPs and their patient populations and (2) whether the data were compatible with deterministic and stochastic monotonicity assumptions.
RESULTS:Levothyroxine prescriptions varied substantially among the 526 responding GPs. Between-GP variance in levothyroxine prescriptions (logit scale) was 9.9 (95% confidence interval8.0, 12) in the initial mixed effects logistic model, 8.3 (6.7, 10) after adding a fixed effect for country and 8.2 (6.6, 10) after adding GP characteristics. The occurring prescription patterns falsified the deterministic monotonicity assumption. All cases in all countries were more likely to receive levothyroxine if a different case of the same GP received levothyroxine, which is compatible with the stochastic monotonicity assumption. The data were incompatible with this assumption for a different definition of the instrument.
CONCLUSIONS:Our study supports the existence of physician’s preference as a determinant in treatment decisions. Deterministic monotonicity will generally not be plausible for physician’s preference as an instrument. Depending on the definition of the instrument, stochastic monotonicity may be plausible.
Abstract
Objective
National guidelines advocate referring patients with persistent synovitis to rheumatology within 3 working days of presentation to primary care. This occurs infrequently. We aimed ...to identify modifiable barriers to early referral of suspected RA patients among English general practitioners (GPs).
Methods
We carried out a national cross-sectional survey of 1388 English GPs (RA Questionnaire for GPs RA-QUEST study). Questions addressed GPs’ confidence in diagnosing RA, clinical factors influencing RA diagnosis/referral, timeliness of referrals and secondary care access. Data were captured using 10-point visual analog scales, five-point Likert scales, yes/no questions or free text, and were analysed descriptively.
Results
Small joint swelling and pain were most influential in diagnosing RA (91 and 84% rated the importance of these as 4 or 5 on a five-point Likert scale, respectively); investigations including RF (61% rating 4 or 5) and anti-CCP antibody (72% rating 4 or 5) were less influential. Patient history had the greatest impact on the decision to refer (92% rating this 4 or 5 on a 5-point Likert scale), with acute phase markers (74% rating 4 or 5) and serology (76% rating 4 or 5) less impactful. Despite the importance placed on history and examination, only 26% referred suspected RA immediately without investigations; 95% of GPs organizing further tests opted to test for RF.
Conclusion
For suspected RA patients to be referred within 3 days of presentation to primary care there needs to be a paradigm shift in GPs’ approaches to making referral decisions, with a focus on clinical history and examination findings, and not the use of investigations such as RF.
There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people.
To investigate the variation in GP treatment strategies for older patients with ...subclinical hypothyroidism depending on country and patient characteristics.
Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand.
The treatment strategy of GPs (treatment yes/no, starting-dose thyroxine) was assessed for eight cases presenting a woman with subclinical hypothyroidism. The cases differed in the patient characteristics of age (70 versus 85 years), vitality status (vital versus vulnerable), and thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L).
A total of 526 GPs participated (the Netherlands n = 129, Germany n = 61, England n = 22, Ireland n = 21, Switzerland n = 262, New Zealand n = 31; overall response 19%). Across countries, differences in treatment strategy were observed. GPs from the Netherlands (mean treatment percentage 34%), England (40%), and New Zealand (39%) were less inclined to start treatment than GPs in Germany (73%), Ireland (62%), and Switzerland (52%) (P = 0.05). Overall, GPs were less inclined to start treatment in 85-year-old than in 70-year-old females (pooled odds ratio OR 0.74 95% confidence interval CI = 0.63 to 0.87). Females with a TSH of 15 mU/L were more likely to get treated than those with a TSH of 6 mU/L (pooled OR 9.49 95% CI = 5.81 to 15.5).
GP treatment strategies of older people with subclinical hypothyroidism vary largely by country and patient characteristics. This variation underlines the need for a new generation of international guidelines based on the outcomes of randomised clinical trials set within primary care.
We previously observed an association with Parkinson's (PD), and modification of the effect of smoking on PD, by a polymorphism of the monoamine oxidase B (MAO-B) gene. The A form of monoamine ...oxidase (MAO-A) shares with MAO-B many characteristics that could be relevant to PD, especially proneuroxicant bioactivation and dopamine metabolism. MAO-A is also inhibited by tobacco smoke, which bears an apparent protective effect on PD. We investigated the possibility that MAO-A genetic variants may also be involved in predisposition to PD and in modification of the effect of smoking. Three-hundred and seventy-one subjects--145 idiopathic PD cases and 226 age/gender-matched controls--were genotyped for the EcoRV polymorphism of MAO-A gene which has been related to increased enzyme activity. MAO-A EcoRV polymorphism was neither significantly associated with PD nor did it modify the inverse relationship with smoking. These results suggest that the EcoRV polymorphism of MAO-A is not an important biomarker of PD risk.
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