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*Japan*

**Neural Mechanisms for Dual-Process**

Takeo Tsujii and Kaoru Sakatani *Nihon University School of Medicine,*

**Reasoning: Evidence from the Belief-Bias Effect**

Recent neuroimaging studies have increasingly focused on the neural mechanisms of human deductive reasoning (see Goel, 2006 for recent review). Deductive reasoning is the cognitive process of drawing valid conclusions from a given set of premises. Although it should be performed independently of prior knowledge and intuitive beliefs, actual human reasoning often relies on them. Sometimes such beliefs provide valid solutions to problems, though they can also bias our judgment. This tendency toward bias in human reasoning has been experimentally studied through the demonstration of belief-bias effect in syllogistic

Belief-bias effect refers to the tendency of subjects to be more likely to accept the conclusion to a syllogism if they find it believable than if they disbelieve it, irrespective of its actual logical validity (De Neys, 2006a, 2006b; Tsujii et al., 2006). The experiment of belief-bias effect includes two types of syllogisms: one in congruent trials, in which the logical conclusion is consistent with beliefs about the world (valid-believable and invalidunbelievable), the other in incongruent trials, in which the logical conclusion is inconsistent with beliefs (valid-unbelievable and invalid-believable). A typical material design was presented in Fig.1. Belief-bias thus facilitates logical responses in congruent trials, while it opposes logically correct responses in incongruent trials (De Neys et al., 2008; De Neys & van Gelder, 2009b; Goel & Dolan, 2003; Tsujii & Watanabe, 2009, 2010; Tsujii et al., 2010a,

One explanation for the belief-bias effect is offered by the dual-process theory of reasoning, which proposes the existence of two different human reasoning systems (Evans, 2003, 2008; De Neys, 2006a, 2006b). The first system, often called the heuristic system, tends to solve problems by relying on prior knowledge and belief. The second system, often called the analytic system, engages in reasoning according to logical standards. The schematic representation of the dual-process theory was presented in Fig. 2. The heuristic default system is assumed to operate rapidly and automatically, whereas operations of the analytic system are believed to be slow and heavily demanding of computational resources (De Neys, 2006a, 2006b; Tsujii & Watanabe, 2009, 2010). The aim of this chapter was to summarize the recent neuroimaging findings which supported the dual-process account of

**1. Introduction**

2010b, 2011).

reasoning (De Neys, 2006a, 2006b; Tsujii et al., 2006).

deductive reasoning, focusing on studies of the belief-bias effect.


*3.2.1 Organizational level*

Organizational variables concern the context in which work is carried out. As long as WI is lacking, technological innovation is regarded a necessary but not sufficient prerequisite for change and improvement. As a result, WI refers to the essential organizational adjustments that will enable employees to properly incorporate and apply technological innovation. Most of the respondents (79,5%) indicated that during the last three years their companies had introduced new product or new process to the market. Furthermore, 60,2% of the respondents confirmed that additionally, their entities introduced organizational and marketing innovation strategies as shown in **Figure 2**.

The majority of the product and process innovations were developed by the companies' themselves, and these innovations resulted from collaborative work with other entities and institutions. Companies should go beyond their internal processes and develop cooperation with external organizations or professionals. This means combining their internal knowledge with external knowledge to move forward in their strategy. In this sense, it should be highlighted that not many rail entities focus their innovation on modifying other entities innovative solutions and this is shown in **Figure 3**.

**Figure 4** shows how each company has its own approach to organize their innovations. Based on the results, most of the entities involve different departments in

**Figure 2.**

*Innovations introduced during the last three years in EU entities.*

**Figure 3.** *Innovation's development in EU rail entities.*

their innovation processes. However, in most of the cases, the engineering department is the one that leads the innovations.

Among organizational innovation, entities mostly implement new business practices for organizing procedures (62,3%). More than half of the respondents confirmed their organization had used new methods for organizing work assignment and decision making in their enterprises. These improvements were focused on the use of a new system of employee responsibilities, teamwork, decentralization, integration or de-integration of departments, as well as education/training systems. The remaining 40,7% introduced new methods of organizing external relations with other firms or public institutions. These changes were mostly focused on the use of alliances, partnerships, outsourcing or subcontracting.

The improvement of quality goods or services (60%), the reduction of time to respond to customer or supplier needs (57,5%), and the improvement of the ability to develop new products or processes were assigned the highest priority among the objectives for firms addressing organizational innovations over the previous three years (47%). An open culture will allow to face the challenge of launching innovative products, offering quickness and flexibility to respond to changing demands from their customers, as shown in **Figure 5**.

#### **Figure 4.**

*Departments in charge of the product and process innovations development.*

**Figure 5.**

*Objectives for organizational innovations introduced in EU railway enterprises during the last three years.*

#### *Innovation Methodologies to Activate Inclusive Growth in the Organization DOI: http://dx.doi.org/10.5772/intechopen.99150*

Companies that work in the railway sector are prompt to introduce changes in their internal processes. In particular, great changes in relation to the use of technology, the way to coordinate and allocate the work to employees, the remuneration system, recruitment policies and in the working time arrangements have been confirmed (**Figure 6**).

As mentioned in Section 2, WI is a complex process which depends on various organizational and management factors. With regards the changes in the external processes, these seem to be less important than the internal ones. More than half of the respondents have confirmed their organizations had adopted new strategies for organizing job responsibilities and decision making. The most used information methods are internal sources and public sector sources. Both of them are used by more than a half of the respondents. Market sources (e.g. suppliers of equipment, materials, components, or software) and opinion of clients or customers from the public sector are very frequent also (both have more than 40% of positive answers). Nevertheless, information provided by consultants and commercial labs were not considered relevant source of the information for innovation projects, as shown in **Figure 7**.

**Figure 6.**

*Internal changes introduced in EU railway enterprises during the last three years.*

#### **Figure 7.**

*Information sources used for new innovation projects or contributed to the completion of existing projects during the last three years.*

#### *Advances in Decision Making*

According to the achieved results, brainstorming sessions are the most common tools the entities implement in their innovation practices (61,9%), followed by multidisciplinary or cross functional work teams (56,7%). These methods are based on staff rotation through different departments, financial and non-financial incentives, and public recognition, among others (**Figure 8**).

The most common method to involve the employees are regular meetings between employees and immediate managers (73%). The Committees or task forces are less common, as well as the communication methods such as internal newsletters, notice boards and email. Additionally, open meetings to all employees, suggestions schemes for collection of ideas and employee surveys are the most used ones by big entities (**Figure 9**).

### *3.2.2 Process level*

At process level is measured the development of new approaches/practices as a result of the implementation of various WI instruments, analyzing the effect of methods on the staff's ability to generate new ideas. Autonomy and participation concern the degree to which employees can decide the way their work is carried out.

#### **Figure 8.**

*Methods of staff stimulation in order to develop new ideas or creativity.*

#### **Figure 9.**

*Methods of involving employees into enterprises' innovation activities.*

*Innovation Methodologies to Activate Inclusive Growth in the Organization DOI: http://dx.doi.org/10.5772/intechopen.99150*

Almost half of respondents indicated that daily work decisions are taken in collaboration between employees and managers. However, the number of employees involved in the follow up is not really relevant. Normally, it is the manager the responsible of monitoring the tasks, as it is shown in **Figure 10**:

Innovation behavior concerns the extent to which employees feel they are involved in the development of innovation. For all job levels, highest percentage of employee's involvement was in the development of process innovation (58,45%), as well as for product innovation (57,67%). However, the study reveals that employees do not feel really engaged in organizational innovation. **Table 1** shows the obtained results.

#### **Figure 10.**

*Difference between decision taking for daily work tasks and follow up results.*

#### **Table 1.**

*Type of developed innovation/role in entity income crosstabulation.*

**Figure 11** show the position perspective on involvement of employees into development of different types of innovations.

Existing approaches to the organizations' Knowledge and Information Management (KIM) were also evaluated. These aspects are focused on keeping and sharing best practices among the entity. In most of the cases (66,8%), there is an established procedure for keeping records of the good practices or lessons learned. Additionally, 56,7% of the entities that implemented these documenting procedures for monitoring external ideas or technological developments are doing it as a part of the responsibilities of general staff and 28,4% are using staff assigned specifically to this task, as shown in **Figure 12**.

Organizations have the need for new models of relationships based on sharing and making information accessible, the exchange of ideas and open collaboration. Most of the respondents had their own technology surveillance systems (69,9%) for monitoring market trends and technological developments. Among the methods used for monitoring external sources, the following are highlighted: Internet (58,6%), seminars and trade fairs (57,1%) and personnel training (49%). Other methods such as visits to other workplaces, reading publications in both professionals' journals and research and scientific magazines are not relevant for rail industry (**Figure 13**).

#### **Figure 11.**

*Position perspective on involvement of employees into development of different types of innovations (in frequency of participation).*

#### **Figure 12.**

*Particularities of KIM in EU railway enterprises (organization of work of employees who document and keep records of their good work practices.*

*Innovation Methodologies to Activate Inclusive Growth in the Organization DOI: http://dx.doi.org/10.5772/intechopen.99150*


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**Author details**

María Evarista Arellano-García1 \*, Olivia Torres-Bugarín2 , Maritza Roxana García-García3 , Daniel García-Flores3 , Yanis Toledano-Magaña4 , Cinthya Sofia Sanabria-Mora3 , Sandra Castro-Gamboa5 and Juan Carlos García-Ramos4

1 Autonomous University of Baja California, Ensenada, Mexico

2 Department of Internal Medicine II, Dean of Health Sciences, Autonomous University of Guadalajara, Guadalajara, Mexico

3 School of Medicine, Autonomous University of Guadalajara, Guadalajara, Mexico

4 School of Health Sciences, Autonomous University of Baja California, Ensenada, Mexico

5 School of Medicine, Autonomous University of Guadalajara, and University Center for Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico

\*Address all correspondence to<EMAIL_ADDRESS>
© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Genomic Instability and Cyto-Genotoxic Damage in Animal Species DOI: http://dx.doi.org/10.5772/intechopen.99685*


FIGURE 1 | Results of the metabarcoding analysis of grapevine in Chile. The study analyzes 6 vines from three Chilean geographic areas, and sclerophyllous trees from the adjacent forest area. Vines are sampled from both leaves and fruits. All analysis are replicated 3 times, leading to 54 samples, of which 36 grapevine and 18 controls. 2 samples are discarded due to quality issues. Principal coordinates analysis plot is reported to visualize relationships between samples (A). We also show the relative abundance of operational taxonomic units, assigned using QIIME feature classifier, at phylum level (B), together with the median abundance values obtained for the most significant species in the differential analysis between sampling sites (C) and plant species (D).

differences in phylogenetic or species diversity, permutational MANOVA with 1,000 permutations was used to test significant differences between sample groups based on weighted UniFrac. No significant differences could be found in terms of alphadiversity between hosts (p = 0.18) and sample sites (p = 0.41), and beta-diversity between sample sites (p = 0.13), however a significant difference in beta-diversity could be observed between host species (p = 0.03).

OTUs were assigned using QIIME feature classifier, which employs a Naive Bayes classifier to map each sequence to a taxonomy. The classifier was trained on a qiime-compatible Silva database (release 119), which includes sequences from 16S/18S rRNA. Any OTU representing less than 0.001% of the total filtered sequences was removed to avoid inclusion of erroneous reads, leading to inflated estimates of diversity. In **Figure 1B** we report the relative frequency of OTUs for each sample, sorted by site and host. Significant taxonomic differences between sample conditions were tested using ANCOM (Mandal et al., 2015). All results are available in **Figures 1C,D**.

Results shown in **Figure 1B** are consistent with Miura et al.. We are able to retrieve the three main bacterial phyla (Actinobacteria, Firmicutes and Proteobacteria), and relative abundances are consistent. Furthermore, grapevinerelated bacterial communities are similar to the phyllosphere of sclerophyllous trees when OTUs clustering is carried out at high bacterial taxonomic levels. This is not surprising since plants are known to show similar pattern at phylum level (Turner et al., 2013). Nonetheless, several differences can be detected at the genus, species or strain level. It is possible to make distinction between bacterial communities living on different plant species. This reflects the finely tuned metabolic adaptations required to live in symbiosis with the host (**Figure 1D**), but also between microbial communities living on different organs, reflecting the adaptations required to live in

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# 5. CONCLUSIONS AND PERSPECTIVES

Gaining wider knowledge about plant-microbiota interactions at a molecular scale is an urgent task, since it can lead to the development of new biotechnological approaches, enhancing agriculture productivity and sustainability. NGS technologies together with bioinformatics are fundamental tools in this process. They have the potential to reveal new details concerning interactions between microbial communities and plants with unprecedented resolution. The characterization of microbial communities in grapevines at various conditions using high throughput sequencing technologies will sooner lead to the identification of disease-specific, cultivar-specific and climatespecific grapevine microbiota. Their exploitation in the field of viticulture could lead to the discovery of new applicable microbial strains, and could help us gaining a holistic and more complete view of plant-microbiome interactions at a genetic level. This would allow not only to potentiate antagonisms against phytopathogens and crop yield, but also to positively affect economically important traits, such as flowering time, and quality and flavor of grapes, must and wine.

#### AUTHOR CONTRIBUTIONS

AP conceived developed and coordinated the research. AP, SA, AF, and RG analyzed the data. SA and GM wrote the paper. All authors read and approved the final version of the manuscript.

#### FUNDING

Sviluppo Regionale (PO-FESR 2007-2013), Linea di intervento <IP_ADDRESS>. Grant number: CUP G23F11000840004.

development of a draft physical map of the grapevine genome. Theor. Appl. Genet. 113, 344–356. doi: 10.1007/s00122-006-0301-7

**Conflict of Interest Statement:** The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2018 Alaimo, Marceca, Giugno, Ferro and Pulvirenti. This is an openaccess article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

digital media

of impactful research

article's readership


**2. Conclusion**

The research carried out to study the *in vitro* and *in vivo* antimicrobial activity of essential oils against *P. larvae*, their toxicity in adult honey bees, as well as their mode of action (degradation of the cell wall, affecting cell morphology and damaging the cytoplasm membrane, coagulation of the cytoplasm, etc.) and anti-QS activity (inhibiting the production of proteases, inhibiting transportation and secretion of proteases, inhibiting the detection of quorum, etc.), has been thoroughly reviewed throughout this chapter. As far as honeybee larvae are the target of AFB disease, future research should focus on studying the effect of essential oils that are effective *in vitro* and non-toxic for adult honey bees on honeybee larvae. In addition, more studies are still needed on the distribution and effects of these natural products in hives, adult honey bees, larvae, honey, royal jelly and other bee products to understand the pharmacokinetics and pharmacodynamics within the hive. As well, research on the effectiveness of these natural antimicrobials in field conditions is imperative. Moreover, further studies should be conducted on the sporicidal properties of these natural substances to destroy spores of *P. larvae* for the prevention of AFB disease. And last but not least, the development of adequate delivery modes of the essential oils within the hives for *in vivo* treatment and prevention of the disease is another important issue that requires further research, to put these natural strategies into practice under true hive conditions.

**39**

**Author details**

Argentina

La Plata, Argentina

Buenos Aires, Argentina

*Prevention and Control of American Foulbrood in South America with Essential Oils: Review*

Sandra Rosa Fuselli1,2, Pablo Gimenez Martinez1,3\*, Giselle Fuentes1

1 Facultad de Ciencias Exactas y Naturales, Centro de Investigación en Abejas Sociales (IIPROSAM) , Universidad Nacional de Mar del Plata, Mar del Plata,

2 Comisión Investigaciones Científicas de la Provincia de Buenos Aires (CIC),

4 Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET),

3 Agencia Nacional de Promoción Científica y Tecnológica, Buenos Aires, Argentina

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Rosa María Alonso-Salces1,4 and Matías Maggi1,4

\*Address all correspondence to<EMAIL_ADDRESS>
provided the original work is properly cited.

,

*DOI: http://dx.doi.org/10.5772/intechopen.85776*

*Prevention and Control of American Foulbrood in South America with Essential Oils: Review DOI: http://dx.doi.org/10.5772/intechopen.85776*


**5. Enhancing safety via utilization of the electronic medical record, medication ordering algorithms, and artificial intelligence**

Health systems with built-in mechanisms for system-wide learning and improvement tend to perform better in general and especially so in the area of patient safety [23]. The Wired for Health Care Quality Act of 2005 appropriated funding in the US to promote adoption of medical information technology to enhance patient safety and improve quality of care [10]. As a consequence, healthcare networks have committed billions of dollars into the adoption of EHR systems, supposing that these systems would transform the incorporation of science-based practices into medical care, thereby resulting in better, safer care at reduced costs [12]. Highly effective and safe healthcare institutions promote and operate safely in multifaceted clinical milieus despite inherently complicated procedures and the potential for error [19]. The implementation of EHR has enhanced communication between providers systemically throughout the healthcare network and between the different specialties while limiting diagnostic errors through utilization of artificial intelligence algorithms [8]. Ongoing plans to maximize medical information technology as a method to incorporate the best science into the clinical arena incorporates decision-making guidance adjuncts, such as specialized disease order sets, documentation guidelines, and best practice algorithms [12].


**9. Electronic medical records and improvements in the prevention of VTE**

Predicting individual VTE risk is extremely challenging because no single variable is strongly predictive, and we are investing on systems that incorporate multiple variables to produce significant predictive values for VTE. The medical records waistband Electronics (EMR) Scoring systems with use of artificial intelligence should be seen as an opportunity to support clinical decision. Some studies indicate that computer alert interventions may increase the adherence to appropriate risk stratification for VTE, reduce costs and avoiding unnecessary thromboprophylaxis in low-risk patients [15].


*2.2. Hypothesis Development*

#### 2.2.1. ESG and Corporate Green Innovation

This paper believes that the increasingly stringent social responsibility challenges brought about by the requirements of sustainable development will provide some enterprises that respect environmental, social, and governance factors and gradually accumulate and establish specific ESG performance in practicing the ESG concept with a brand-new competitive advantage in transnational investment. This ESG rating performance deviates from the profit maximization motivation (only applicable to shareholders), which is completed when we promote the enterprise to meet the social responsibility requirements and actively respond to all stakeholders [45]. The term "ESG rating performance" specifically refers to the sum of the valuable and scarce resources, systems, and capabilities established by enterprises in ESG practice, such as green technology, brand, social responsibility system, and other ESG asset advantages and institutional advantages. ESG differs from conventional monopolistic advantages as it emphasizes meeting the demands of shareholders, consumers, suppliers, communities, and other stakeholders and pursues inclusive development, which contributes to economic and social development through interaction with non-market factors. Therefore, we found that the benefits of ESG promoted the green innovation of enterprises by encouraging them to develop new competitive advantages in the following two aspects: First, they surpassed the limitations of traditional asset ownership advantages and created unique asset ownership advantages. ESG practices can assist businesses in modernizing their technology and products, enhancing their capacity for green innovation, and fostering better ties with their employees, suppliers, and other stakeholders [13]. In exceptional circumstances (such as the period of COVID-19), an enterprise will obtain tremendous development if it treats upstream and downstream producers and other stakeholders with sincerity. Meanwhile, ESG practices account for a high proportion of the development of intangible assets [46], and the enhancement of the reputation value for those enterprises that emphasize ESG will actively disclose the information about their social responsibility to the public, both objectively and subjectively, so that the public can judge the social responsibility behavior of the enterprise, and the enterprise can establish a trustworthy reputation [47]. Compared with other wary enterprises, those that have benefited in their asset advantage and reputation due to ESG practices will seize market share in addition to the pursuit of ESG by investors and customers [48]. For example, the financing convenience brought about by the favor of investors and creditors can encourage the green innovation of enterprises as it copes with the stress of capital constraints in green innovation [49]. Therefore, the ESG rating performance can significantly reduce the cost of financing, enhance a company's overall competitiveness, and help it gain more market share. Schuler and Cording (2006) have proposed that enterprises equipped with a better corporate social performance will be more competitive, and those with a good ESG performance that satisfy the requirements of stakeholders may incur lower financing costs and hold greater market share [50].

Second, they enhance the legitimacy of green innovation investment. The enterprise ESG advantage's most distinctive feature is its legitimacy. Environmental protection, stakeholders' rights and the protection of interests, and upholding social obligations are not just what customers and investors expect from corporations but are also slowly becoming what regulatory agencies require of them [51]. Impacted by ESG practices, enterprises regard green innovation investment as an important driving force to promote economic growth and believe that they have made contributions to overall social welfare due to protecting the interests of stakeholders [51]. On the contrary, if an enterprise violates the ESG concept, it may result in the rapid spread of public concern, impairing its enterprise image and brand reputation significantly; hence, the legitimacy of enterprise operations will become more prominent [52].

In addition, the endogenous institutional advantages derived from social responsibility formed around the ESG concept are also conducive to embedding the value system of the business strategy, thus reducing the pressure of institutional isomorphism [52]. ESG advantages address the legal issue of green innovation and endow enterprises with flexible green innovation strategies, which in turn, improve the level of green innovation. In addition, the general recognition of the legitimacy of the ESG concept lowers the transfer costs of the green technology, brand reputation, and institutional mechanism obtained through ESG practices, facilitating the production of green innovation resources and realizing the driving effect of ESG advantages on enterprise strategy [53]. The green innovation method utilizes internal transfer in addition to ESG advantages and can internalize open market transaction expenses to obtain internalized advantages [53]. Enterprises that adopt market mechanisms will run into issues with market failures such as information asymmetry between parties in technology license agreements and horizontal externalities brought on by brand sharing. Green innovation can minimize market transaction costs and take advantage of organizations economies of scale and scope by placing essential assets under shared control. Therefore, hypothesis 1 is proposed:

#### **Hypothesis 1.** *ESG rating performance has a positive impact on corporate green innovation*.

#### 2.2.2. Moderation Effect of Institutional Environment

According to institutional theory, the institutional environment has a crucial influence on the structure and behavior of an organization [54]. An efficient legal system, good government market relations, and well-developed product and factor markets can support healthy market development by facilitating information flow, supporting competition, and minimizing externalities [55]. Firms that respond effectively to institutional pressures and comply with norms and rules have easier access to the external resources needed for survival and growth by ensuring social legitimacy [56]. Accordingly, in order to operate smoothly and stably, firms need to respond to institutional pressures [57] and the level of institutional pressures affects the strategic choices and effectiveness of firms [58]. Meanwhile, the resources and regulations on which green innovation depends are key variables for innovation, whereas the access to core resources depends on a combination of market-based and non-market-based strategies and is determined by the institutional environment [39]. For example, companies need to improve their ESG rating performance to respond to stakeholder pressure [59]. Therefore, the impact of firm ESG ratings on green innovation may vary depending on the role of the pressures from the institutional environment, and it is necessary to investigate the impact of each type of institutional pressure [60], which can be classified as coercive, normative, or imitative, on green innovation by interacting with firm ESG ratings.

First, coercive pressures are defined as "formal or informal pressures arising from the institutions and regulations of the society to which the firm belongs" [61]. Coercive pressures resulting from the influence of those in power, such as regulations by government agencies, can shape the standards of corporate behavior and encourage firms to adopt or reinforce certain behaviors [60]. In this regard, ESG-related government policies and regulations constitute coercive pressures on firms and influence their expectations for green innovation strategies. Second, imitation pressures refer to the pressure to imitate competitors' behavior, which is identified as success. A firm that adapts to imitation pressures is more likely to protect itself from potential losses and gain legitimacy in its decisions. Thus, it imitates leading competitors to ensure social legitimacy and decision legitimacy [61,62]. From this perspective, the ESG rating performance reflects the imitation of peer organizations' behavior, which is perceived as successful by stakeholders in a similar organizational structure [62]. For example, manufacturers tend to imitate their competitors in managing extended supply chain activities in order to achieve sustainably managed carbon reduction targets. This measure can increase corporate green innovation by enhancing the legitimacy and legality of corporate activities [63]. Normative pressures come from the values and standards of behavior recommended and expected by external stakeholders [64]. Firms must understand and comply with the standards, norms, and expectations of external stakeholders in order to achieve social legitimacy. In particular, customer demands form a key normative pressure [65], which can be an important driver for companies to enhance certain activities [60]. For example, positive consumer perception of a firm's environmentally friendly products and socially responsible activities can change a firm's green innovation decisions by acting as a normative pressure [66].

Thus, on the one hand, in regions with relatively well-developed institutional environments, the three institutional pressures mentioned above enhance the impact of ESG ratings on a firm's reputation and image, and the key factors of the ESG rating performance depend mainly on its market-oriented operations and management capabilities, which are consistent with entrepreneurs' knowledge and social legitimacy perception structures. This will undoubtedly strengthen the role of the ESG rating performance in promoting corporate green innovation strategies. On the other hand, a sound institutional environment can provide the necessary property rights protection, guarantee the benefits of strategic decisions, enhance the long-term orientation of decision makers, further strengthen the motivation of enterprises to engage in green innovation driven by ESG performance [67], effectively protect the green innovation achievements of enterprises, and enhance their willingness to adopt green innovation. Therefore, hypothesis 2 is proposed.

**Hypothesis 2.** *The more perfect the institutional environment, the stronger the positive relationship between the ESG rating performance and corporate green innovation*.

#### 2.2.3. Moderation Effect of Redundant Organizational Resources

Resource redundancy in organizations is defined as resources kept within an organization beyond their usefulness and serves as a practicable or potential resource buffer to enhance an organization's ability to respond to unexpected changes in the external environment and devise strategies [68]. At the organizational level, green innovation strategies emphasize that organizations should make greater resource investments [64], and having more disposable resources facilitates an organization's ability to operate and that an organization's redundant resources can provide resource support for green innovation strategies. In particular, the increasing level of redundant resources for disposal coincides with an organization's ability to implement green innovation behaviors and behavioral freedom [69]. Gruber (2010) showed that a higher degree of redundancy in organizational resources facilitates an organization to try more unpredictable occurrences and supports an organization to search for opportunities and problem solutions on a larger scale [70]. At the managerial level, redundant organizational resources increase the risk perception of managers' decisions. For decision makers, the degree of risk perception is an important reference point for their strategic choices, and managers' preferences for strategic decisions depend on the impact of the same decision risk on different organizations [71]. Managers may make riskier strategic choices when organizations are more resilient to external risks as a result of the high level of redundant organizational resources, whereas they tend to be more conservative when making decisions [72]. Consequently, the ESG rating performance may have a greater impact on corporate green innovation in the context of abundant redundant organizational resources. Figure 1 shows the theoretical research model, as follow.

**Figure 1.** Theoretical research model.

**Hypothesis 3.** *The higher degree of redundant organizational resources will strengthen the positive relationship between ESG rating performance and corporate green innovation*.


**Abstract**

This review examines the relationship between life adversities, parental well-being, parental self-efficacy, and social support as potential factors mediating parent-child relationships and children's outcomes. Generally, research on adversity has focused on children's experiences and the long-term impact of adversity on development and health trajectories. More recently, a focus on resilience and growth after adversity has received increasing attention. Existing literature has identified how parents can best support their children through adverse events and suggested parenting programs that emphasize skill-building to parent children who have experienced adversity. Yet often overlooked is the critical impact of adverse events on the parent and how this may interfere with the cultivation of an environment of support and increase stigmatization due to unmet parenting expectations. While parenting occurs in context, it is often judged based upon societal expectations of childrearing practices and optimal outcomes with little understanding of the factors that contribute to parenting behaviors. The experience of adversity has the potential to impact parental sense of competence and parenting practices. However, parental self-efficacy and social supports can play mediating role in the experience of adversity and parenting stress. The integration of these contextual factors allows for the development of expectations that are best suited to meet the needs of vulnerable family systems.

**Keywords:** parenting, adversity, parental self-efficacy, resilience, parenting stress, cumulative risk, competence

#### **1. Introduction**

Parenting is a role that is often perceived as having both great rewards and significant demands. The role of a parent requires that an individual has the resources necessary to ensure the well-being of their child(ren) for many years. This includes not only competence in childrearing practices but also the ability to respond to the physical and behavioral cues and the emotional needs of the child(ren). Parenting is best viewed as a multidimensional concept that incorporates parenting behaviors and perceptions of oneself as a parent [1, 2]. Positive parenting practices, such as warmth, acceptance, belonging, and responsiveness are correlated with healthy development and outcomes even in the face of adverse life situations [3–6]. According to Yamaoka and Bard, positive parenting practices can provide a buffer against the negative impact of adversities particularly in early development and the absence of this type of parenting can be viewed as an adversity itself [6]. Success in the parenting role creates an internalized sense of safety and trust for the child,

which is a critical ingredient to the development of self-regulation responses and adjustment throughout the lifespan [7].

The expectations of a parent to effectively manage the day to day demands of childrearing can create a moderate stress reaction even in situations that are considered relatively normative [8, 9]. Abidin's parenting stress model identifies the connection between stress and parenting practices, suggesting that increased parental stress leads to less optimal parenting behaviors [2]. Further, this model highlights the connection between parental appraisal of their experiences in the parenting role and the emergence of parenting stress with parenting stress serving as a motivating force for parent's that have resources to draw upon [2]. The purpose of this chapter is to explore the factors that influence the relationship between adverse experiences and parenting behaviors on parent–child relationships and outcomes for children.

Many parents navigate this stress effectively and find satisfaction and positive regard for this role. Yet parental stress can become exacerbated when parenting is occurring in the face of adverse life situations. Parental stress levels and behaviors are influenced by the level of self-efficacy that a parent experiences in their role [10] and may be mediated by the social supports that occur in context [11]. Parental selfefficacy, the confidence that one can manage effectively the parental role and assist their children in managing problems that occur, has been found to be correlated to adaptive family environments and positive outcomes for children [12]. Parental expectations and the perception of stigma can increase the stress experienced by adverse situations and deplete already taxed resources. In a society that places great emphasis on the quality of childrearing practices, the pressure that is placed upon parents to ensure optimal outcomes for their children is immense, and the way these practices and outcomes are judged can be harsh [13, 14].

While adversity is a routine part of the human experience, the impact that it has on individual and family functioning is quite varied, with much research dedicated to understanding why some individuals adapt more effectively than others. An exploration of parenting in adverse situations, parental self-efficacy, resilience, and parenting in context will allow for the development of supports that can improve outcomes for families and decrease vulnerabilities. Understanding the way parents experience stress in the face of adversity provides insight into the resources that parents can access for parenting practices and behaviors and the impact of adverse events on the parents themselves. When planning interventions and services, this knowledge can aid in recommendations that add value and additional resources in order to decrease individual stress responses and adverse family dynamics. It is essential to understand the factors that influence the ability to maintain healthy trajectories amid stressful life situations as even though the experience of adversity cannot be eradicated, the sensitivity by which we provide support and understand the experiences of parents can be enhanced.

#### **2. Adversity and its impact on parenting**

#### **2.1 The experience of adversity**

Adversity is part of the normal life cycle**,** and very few individuals will live their entire existence without experiencing an adverse life event. The lived experience of adversity is universal in the human experience [15]; however, the impact of these experiences on individuals and families is quite varied. Adversity has been widely defined as experiences that have the potential to disrupt normative functioning and create undesirable life outcomes [16, 17]. In other words, when individuals experience situations that work against their ability to maintain a sense of balance, safety, and security, the ability to maintain a healthy life trajectory may be compromised.

**169**

*Parental Self-Efficacy and Parenting through Adversity DOI: http://dx.doi.org/10.5772/intechopen.91735*

upon all of their resources to cope with and manage stress.

competence and lead to less effective parenting [31, 32].

**2.2 Adversity in the parenting role**

lasting effects [15, 19, 24].

Adversity can occur on the individual and family levels and in many environmental contexts.  At the family level, adversity can take the form of family instability/divorce, family discord lack of safety, substance abuse, and parental incarceration [18]. At the contextual level, adversity in childhood is often related to disadvantaged socioeconomic status, poor school systems, violent neighborhoods, and a resulting lack of resources that can negatively influence health trajectories [18]. The concept of adversity is not easy to construct as it can have many sources, as well as varying levels of intensity and duration. Individuals who experience adverse life events are more likely to have poorer health outcomes, decreased quality of life, and increased risk factors for psychological, emotional, and physical effects [9, 18–20]. In order to maintain functioning in the face of adversity, individuals and families must draw

Adversity has often been utilized interchangeably with trauma [21]; however, there is a distinction that is important to draw as not all adverse situations will lead to the experience of trauma. Further, some attempts at the operationalization of resilience have described the absence of pathology [22, 23], such as posttraumatic stress disorder, as a key factor yet this detracts from the multiple levels of coping and reduces the concept to a binary construct [23]. Yet both trauma and adversity have the potential to impact health and social outcomes negatively and to have

Children can experience adversity as early as birth, and some might argue in utero. This experience will continue throughout the lifespan, with estimates from the National Survey of Children's health reporting that 46 percent of children under the age of 18 have experienced an adverse event, and 11 percent have experienced three or more adverse events [25]. Some adverse events are more common than others with disadvantaged socioeconomic status being experienced by 1 in 4 children, and 25 percent of children have experienced parental separation or divorce [25]. While these numbers are significant, the likelihood that an individual will experience an adverse life situation increases exponentially with age. Although there is a connection between the experience of adverse life situations and negative health outcomes, not all individuals who experience adversity have long-lasting adverse effects. Research has attempted to identify the characteristics that allow some individuals to manage adversity more effectively than others as well as the contextual and social factors that contribute to less optimal outcomes in the face of adversity [15, 18–20, 26, 27]. The effects of adversity can be long-lasting and include excessive and prolonged stress responses, making the discovery of mediating factors critical. Under the right circumstances, experience adversity can lead to an increase in resilience in the future; with resilience being defined as the ability to manage and adaptively function in the face of adverse life events [23, 28, 29]. Luthar, a seminal author on resilience, emphasized that the development of resilience emerges from the presence of an adverse life event and the resulting functional adaptation [29]. Resiliency is not necessarily an innate quality, but rather the result of the interaction between life contexts, protective and psychosocial factors [23, 30]. While resiliency is a possible outcome, more often than not, adversity undermines parents' sense of

The vast majority of literature on adversity and children's outcomes focuses on parenting, creating a wealth of knowledge about the environments that contribute best to development in adverse situations and what children need to build resilience

#### *Parental Self-Efficacy and Parenting through Adversity DOI: http://dx.doi.org/10.5772/intechopen.91735*

*Parenting - Studies by an Ecocultural and Transactional Perspective*

practices and outcomes are judged can be harsh [13, 14].

**2. Adversity and its impact on parenting**

**2.1 The experience of adversity**

adjustment throughout the lifespan [7].

which is a critical ingredient to the development of self-regulation responses and

The expectations of a parent to effectively manage the day to day demands of childrearing can create a moderate stress reaction even in situations that are considered relatively normative [8, 9]. Abidin's parenting stress model identifies the connection between stress and parenting practices, suggesting that increased parental stress leads to less optimal parenting behaviors [2]. Further, this model highlights the connection between parental appraisal of their experiences in the parenting role and the emergence of parenting stress with parenting stress serving as a motivating force for parent's that have resources to draw upon [2]. The purpose of this chapter is to explore the factors that influence the relationship between adverse experiences and parenting behaviors on parent–child relationships and outcomes for children. Many parents navigate this stress effectively and find satisfaction and positive regard for this role. Yet parental stress can become exacerbated when parenting is occurring in the face of adverse life situations. Parental stress levels and behaviors are influenced by the level of self-efficacy that a parent experiences in their role [10] and may be mediated by the social supports that occur in context [11]. Parental selfefficacy, the confidence that one can manage effectively the parental role and assist their children in managing problems that occur, has been found to be correlated to adaptive family environments and positive outcomes for children [12]. Parental expectations and the perception of stigma can increase the stress experienced by adverse situations and deplete already taxed resources. In a society that places great emphasis on the quality of childrearing practices, the pressure that is placed upon parents to ensure optimal outcomes for their children is immense, and the way these

While adversity is a routine part of the human experience, the impact that it has on individual and family functioning is quite varied, with much research dedicated to understanding why some individuals adapt more effectively than others. An exploration of parenting in adverse situations, parental self-efficacy, resilience, and parenting in context will allow for the development of supports that can improve outcomes for families and decrease vulnerabilities. Understanding the way parents experience stress in the face of adversity provides insight into the resources that parents can access for parenting practices and behaviors and the impact of adverse events on the parents themselves. When planning interventions and services, this knowledge can aid in recommendations that add value and additional resources in order to decrease individual stress responses and adverse family dynamics. It is essential to understand the factors that influence the ability to maintain healthy trajectories amid stressful life situations as even though the experience of adversity cannot be eradicated, the sensitivity by which we provide support and understand the experiences of parents can be enhanced.

Adversity is part of the normal life cycle**,** and very few individuals will live their entire existence without experiencing an adverse life event. The lived experience of adversity is universal in the human experience [15]; however, the impact of these experiences on individuals and families is quite varied. Adversity has been widely defined as experiences that have the potential to disrupt normative functioning and create undesirable life outcomes [16, 17]. In other words, when individuals experience situations that work against their ability to maintain a sense of balance, safety, and security, the ability to maintain a healthy life trajectory may be compromised.

**168**

Adversity can occur on the individual and family levels and in many environmental contexts.  At the family level, adversity can take the form of family instability/divorce, family discord lack of safety, substance abuse, and parental incarceration [18]. At the contextual level, adversity in childhood is often related to disadvantaged socioeconomic status, poor school systems, violent neighborhoods, and a resulting lack of resources that can negatively influence health trajectories [18]. The concept of adversity is not easy to construct as it can have many sources, as well as varying levels of intensity and duration. Individuals who experience adverse life events are more likely to have poorer health outcomes, decreased quality of life, and increased risk factors for psychological, emotional, and physical effects [9, 18–20]. In order to maintain functioning in the face of adversity, individuals and families must draw upon all of their resources to cope with and manage stress.

Adversity has often been utilized interchangeably with trauma [21]; however, there is a distinction that is important to draw as not all adverse situations will lead to the experience of trauma. Further, some attempts at the operationalization of resilience have described the absence of pathology [22, 23], such as posttraumatic stress disorder, as a key factor yet this detracts from the multiple levels of coping and reduces the concept to a binary construct [23]. Yet both trauma and adversity have the potential to impact health and social outcomes negatively and to have lasting effects [15, 19, 24].

Children can experience adversity as early as birth, and some might argue in utero. This experience will continue throughout the lifespan, with estimates from the National Survey of Children's health reporting that 46 percent of children under the age of 18 have experienced an adverse event, and 11 percent have experienced three or more adverse events [25]. Some adverse events are more common than others with disadvantaged socioeconomic status being experienced by 1 in 4 children, and 25 percent of children have experienced parental separation or divorce [25]. While these numbers are significant, the likelihood that an individual will experience an adverse life situation increases exponentially with age. Although there is a connection between the experience of adverse life situations and negative health outcomes, not all individuals who experience adversity have long-lasting adverse effects. Research has attempted to identify the characteristics that allow some individuals to manage adversity more effectively than others as well as the contextual and social factors that contribute to less optimal outcomes in the face of adversity [15, 18–20, 26, 27]. The effects of adversity can be long-lasting and include excessive and prolonged stress responses, making the discovery of mediating factors critical. Under the right circumstances, experience adversity can lead to an increase in resilience in the future; with resilience being defined as the ability to manage and adaptively function in the face of adverse life events [23, 28, 29]. Luthar, a seminal author on resilience, emphasized that the development of resilience emerges from the presence of an adverse life event and the resulting functional adaptation [29]. Resiliency is not necessarily an innate quality, but rather the result of the interaction between life contexts, protective and psychosocial factors [23, 30]. While resiliency is a possible outcome, more often than not, adversity undermines parents' sense of competence and lead to less effective parenting [31, 32].

### **2.2 Adversity in the parenting role**

The vast majority of literature on adversity and children's outcomes focuses on parenting, creating a wealth of knowledge about the environments that contribute best to development in adverse situations and what children need to build resilience and stress hardiness [4–7, 17, 32, 33]. Emphasis has been placed on poor parenting practices in the face of adversity as the reason that adverse events have long-term effects, thereby pathologizing parenting behaviors and ignoring the experiences of parents themselves [34]. Further, Herbers, Cutuli, Supkoff, Narayan and Masten cautioned that during periods of adversity it is important not to interpret parent– child behaviors as maladaptive as while they may seem chaotic, it is reflective of a process of re-stabilization [7]. The experience of childhood trauma can make it difficult to form bonds with their children and parents who have not experienced consistent positive parenting in their own upbringing can have difficulties in creating warmth and connectedness in their relationships with their children [5, 35]. This also can influence perception of parenting competence and coping strategies for managing the challenges that occur in the parent–child dynamic [5, 36].

Despite contributions to knowledge regarding the types of parenting behaviors that lend themselves to the development of resilience and adaptation in children, often overlooked are the contexts and experiences of the parents themselves, which is the critical component to influencing outcomes. Benatov, in a study of parents reactions to their child's victimization via bullying, found that parents emotional responses to the event was correlated to the level of adaptive coping responses with guilt leading to more maladaptive responses such as avoidance and sadness contributing to adaptive coping responses and support for the child [37]. Further, the level of perceived adversity was related to parental self-efficacy with high levels of victimization leading to less adaptive coping strategies and undermining selfefficacy for parents [37].

The exploration of parental resources, i.e., material, social and psychological resources, and influential contextual factors, presents a holistic picture of the potential determinants of parenting behaviors and stress responses. Parent/child relationships exist within the context of the environment and with the resources that are available to them at any given time. Belsky's ecological model identified the importance of understanding the multiple levels of psychosocial factors that influence parenting [38]. This model recognizes the influence of parenting on healthy child development and identified three types of determinants of parenting behaviors including parental psychological resources, child characteristics, and contextual factors such as the environment [38]. Adversity often depletes the psychosocial resources that individuals have available to them, and parents who experience cumulative or co-occurring adverse events have fewer social supports and resources available to manage parenting stressors [36].

Adversity experienced in the parenting role creates obstacles that can disrupt parenting abilities, increase frustrations, and parent stress levels. There is a need to explore the psychosocial factors for parents who are experiencing adverse life situations and the way these factors contribute to parenting behaviors. Research has linked adverse childhood experiences to potential health and psychological issues throughout development, and one of the critical factors to consider is the way that adverse life events impact the parent and change the parent/child relationship dynamic [10]. For example, childhood illness, particularly illness that has an uncertain trajectory, has been found to be related to parenting stress which increased parental perception of the vulnerability of their child [39]. This perception of vulnerability can increase the presence parental overprotection behaviors [39] which decrease opportunities for the development of autonomy for the child. Parenting of children who have behavioral issues or developmental disabilities has been correlated to an increase in parenting stress which can increase parents' experiences of emotional dysregulation [40, 41]. Parenting stress can decrease the likelihood that a parent can respond effectively to the behaviors of their child via overreacting, being

**171**

*Parental Self-Efficacy and Parenting through Adversity DOI: http://dx.doi.org/10.5772/intechopen.91735*

ences will expand opportunities to mediate stress responses.

adversity and increase feelings of competence.

**2.3 Vulnerable parents/vulnerable families**

child risk factors [41].

less sensitive to the needs of the child, using less effective coping strategies, and a decreased ability to seek out support resources for their child which in turn increase

Parenting behaviors and practices vary among individuals, regardless of whether or not adversity is present, and not all parents have access to the same resources to support parenting competence. Parents who lack psychosocial and contextual resources to draw upon in adverse situations may not manage these situations as effectively and may experience increased stress fulfilling the obligations of the parenting role. Parents often find themselves in conflicting and mutually demanding roles, creating stress related to which demand to attend to first and how to choose between competing demands. For example, research has found that the experience of severe socioeconomic hardship has the potential to constrain a mother's ability to engage in sensitive childrearing practices, which can lead to personal distress [8]. Adverse life situations and stressors create intense psychological and physiological demands that can interfere with functioning and increase vulnerability to adverse outcomes [8]. Adversity can lead to disruptions in the parent/child relationship when a parent's resources are taxed by the demands of their own dysregulation and stress responses [8]. Adversity can create situations where parents experience a loss of confidence and feelings of uncertainty about how to respond to their child effectively [43]. This may take the form of fear, apprehension, self-doubt, feelings of inadequacy, etc. [43]. The ability to find balance in parenting demands during stressful life situations can mediate the potential negative outcomes associated with

Exposure to adverse life events by itself is not enough to trigger a long-term negative outcome or prolonged stress response as many individuals who experience adversity adapt effectively with little life disruption. Attempts to explore the types of stressful life situations that evoke adverse outcomes has produced with meager results due to the recognition that it is not the events alone that influence adaptation and coping [21]. Existing research has attempted to quantify risk and protective factors to predict outcomes; however, this fails to consider how the experience is perceived by the individual which plays a critical role in long-term trajectories [18]. Individual differences in vulnerability have been attributed to pre-existing mental health conditions, lifetime exposure to social stressors, the experience of conflict, financial hardships [11, 18, 21]. Barnyard, Williams and Siegel found that experiences of trauma were related to problems in parenting, with physical and sexual abuse resulting in less optimal parenting behaviors and negative perceptions of parenting abilities [3]. Hagan and colleagues identified that socioeconomic adversity and conflict in the parent–child relationship or parental harshness increased the

The influence of adverse events on parenting practices is an overlooked and critical component to successful outcomes for children and their families. Glazer and colleagues explored parenting after the loss of a spouse and found that parents not only question their parenting skills in the face of this adversity but also perceived stigma from others regarding their ability to parent effectively [42]. Not only did these parents question their skills to parent, they also expressed a lack of confidence in parenting a child who was also experience a grief reaction [40]. Research suggests that parental responses, particularly adverse reactions, are connected to the level of distress that is experienced by the child [34, 43]. If parental stress responses can increase the risk of a stress response in the child, then attention to parental experi*Parenting - Studies by an Ecocultural and Transactional Perspective*

and stress hardiness [4–7, 17, 32, 33]. Emphasis has been placed on poor parenting practices in the face of adversity as the reason that adverse events have long-term effects, thereby pathologizing parenting behaviors and ignoring the experiences of parents themselves [34]. Further, Herbers, Cutuli, Supkoff, Narayan and Masten cautioned that during periods of adversity it is important not to interpret parent– child behaviors as maladaptive as while they may seem chaotic, it is reflective of a process of re-stabilization [7]. The experience of childhood trauma can make it difficult to form bonds with their children and parents who have not experienced consistent positive parenting in their own upbringing can have difficulties in creating warmth and connectedness in their relationships with their children [5, 35]. This also can influence perception of parenting competence and coping strategies for managing the challenges that occur in the parent–child dynamic [5, 36].

Despite contributions to knowledge regarding the types of parenting behaviors that lend themselves to the development of resilience and adaptation in children, often overlooked are the contexts and experiences of the parents themselves, which is the critical component to influencing outcomes. Benatov, in a study of parents reactions to their child's victimization via bullying, found that parents emotional responses to the event was correlated to the level of adaptive coping responses with guilt leading to more maladaptive responses such as avoidance and sadness contributing to adaptive coping responses and support for the child [37]. Further, the level of perceived adversity was related to parental self-efficacy with high levels of victimization leading to less adaptive coping strategies and undermining self-

The exploration of parental resources, i.e., material, social and psychological resources, and influential contextual factors, presents a holistic picture of the potential determinants of parenting behaviors and stress responses. Parent/child relationships exist within the context of the environment and with the resources that are available to them at any given time. Belsky's ecological model identified the importance of understanding the multiple levels of psychosocial factors that influence parenting [38]. This model recognizes the influence of parenting on healthy child development and identified three types of determinants of parenting behaviors including parental psychological resources, child characteristics, and contextual factors such as the environment [38]. Adversity often depletes the psychosocial resources that individuals have available to them, and parents who experience cumulative or co-occurring adverse events have fewer social supports and resources

Adversity experienced in the parenting role creates obstacles that can disrupt parenting abilities, increase frustrations, and parent stress levels. There is a need to explore the psychosocial factors for parents who are experiencing adverse life situations and the way these factors contribute to parenting behaviors. Research has linked adverse childhood experiences to potential health and psychological issues throughout development, and one of the critical factors to consider is the way that adverse life events impact the parent and change the parent/child relationship dynamic [10]. For example, childhood illness, particularly illness that has an uncertain trajectory, has been found to be related to parenting stress which increased parental perception of the vulnerability of their child [39]. This perception of vulnerability can increase the presence parental overprotection behaviors [39] which decrease opportunities for the development of autonomy for the child. Parenting of children who have behavioral issues or developmental disabilities has been correlated to an increase in parenting stress which can increase parents' experiences of emotional dysregulation [40, 41]. Parenting stress can decrease the likelihood that a parent can respond effectively to the behaviors of their child via overreacting, being

**170**

efficacy for parents [37].

available to manage parenting stressors [36].

less sensitive to the needs of the child, using less effective coping strategies, and a decreased ability to seek out support resources for their child which in turn increase child risk factors [41].

The influence of adverse events on parenting practices is an overlooked and critical component to successful outcomes for children and their families. Glazer and colleagues explored parenting after the loss of a spouse and found that parents not only question their parenting skills in the face of this adversity but also perceived stigma from others regarding their ability to parent effectively [42]. Not only did these parents question their skills to parent, they also expressed a lack of confidence in parenting a child who was also experience a grief reaction [40]. Research suggests that parental responses, particularly adverse reactions, are connected to the level of distress that is experienced by the child [34, 43]. If parental stress responses can increase the risk of a stress response in the child, then attention to parental experiences will expand opportunities to mediate stress responses.

Parenting behaviors and practices vary among individuals, regardless of whether or not adversity is present, and not all parents have access to the same resources to support parenting competence. Parents who lack psychosocial and contextual resources to draw upon in adverse situations may not manage these situations as effectively and may experience increased stress fulfilling the obligations of the parenting role. Parents often find themselves in conflicting and mutually demanding roles, creating stress related to which demand to attend to first and how to choose between competing demands. For example, research has found that the experience of severe socioeconomic hardship has the potential to constrain a mother's ability to engage in sensitive childrearing practices, which can lead to personal distress [8]. Adverse life situations and stressors create intense psychological and physiological demands that can interfere with functioning and increase vulnerability to adverse outcomes [8]. Adversity can lead to disruptions in the parent/child relationship when a parent's resources are taxed by the demands of their own dysregulation and stress responses [8]. Adversity can create situations where parents experience a loss of confidence and feelings of uncertainty about how to respond to their child effectively [43]. This may take the form of fear, apprehension, self-doubt, feelings of inadequacy, etc. [43]. The ability to find balance in parenting demands during stressful life situations can mediate the potential negative outcomes associated with adversity and increase feelings of competence.


**Acknowledgements**

where *σthermal* is the thermal stress (Pa), *α* is the coefficient of thermal expansion (CTE) (1/k), *E*

For the case where the thermal stress is lower than the yield/fracture stress, then the material will sustain the shock. Therefore, thermal shock could be connected and evaluated via other material's mechanical properties such as Young's modulus, Poisson's ratio, and fracture stress and other thermal properties based on the thermoelastic approach as being expressed in Eq. (7)

(1 − ν)κ \_\_\_\_\_\_\_

Poisson's ratio, and *κ* is the total thermal conductivity (W/m∙k). The higher the *R'* value, the

*Thermal fatigue* is the material's capability to adhere to multiple cycles of heating and cooling. As the material is capable to withstand higher number of cycles, it is said that it has a higher thermal fatigue resistance. The only way to measure this property is currently to subject such

As of the current time, according to our knowledge, there are no references in the study concerning these properties with the actual measured values, and the few that mention them do

Mechanical properties of materials represent the material's responses to different loading conditions and are macroscopic representations of the atomic bonding between the atoms from which they are constructed. It was suggested that the cohesive energy (*E*C) between two particles can be linked to the elastic constants of the materials and other various physical properties (such as melting temperature, atomic volume, lattice constants, and Debye temperature). Such a correlation opens the possibility of interlinking the material's electronic

Measuring or evaluating correctly the mechanical properties of TE materials has the potential to bridge between the atomic (mechanical) and physical (electronic/transport) understanding of these materials to the fully developed working modules that will be optimal from both ends standpoint. That way, the material selection for the proper use will be much easier and efficient. As it was shown in this review, knowing and controlling the mechanical properties of TE materials are paramount necessities for approaching practical TEGs and moving the entire TE technology onward in the Technological Readiness Level (TRL) scale. The material's elastic constants (e.g., Young's modulus and Poisson's ratio), strength, and fracture toughness are the most crucial for the designing practical devices (using finite element analysis). In such an approach, adequate modeling of TEGs could be prepared with lower experimental intervals while saving both money, time, materials, and man power. The elastic constants can provide

a material to thermal cycles and to evaluate its consistency every few cycles.

transport properties with the mechanical ones on the atomic level.

αE (7)

is the material's fracture stress (Pa), *ν* is

is Young's modulus (Pa), and *ΔT* is the temperature difference on the material (k).

R′ = σf

so only in a theoretical fashion as stated earlier.

greater the resistance.

76 Bringing Thermoelectricity into Reality

**3. Summary**

where *R'* is the thermal shock resistance (W/m), *σf*

The authors would like to thank the Ministry of National Infrastructures, Energy and Water Resources for granting this project, grant no. 215-11-022.


Within one country, it might be expected that the prevalence of laxative use would fall within a narrow range, but this has not been the case in the studies reviewed. For example, two Canadian studies have reported different prevalence rates. In a phone survey of 1149 adults with self-reported constipation over three months [36], 34.3% had used laxatives (laxatives were not defined other than the use of prescribed or OTC medication for constipation during the past three months). However, in another Canadian survey 86.5% of 200 participants self-reporting constipation over the last 12 months had used some form of laxative products which included herbal or homeopathic products, fibre and foods [37]. This disparity illustrates that vastly different results may be obtained from the same country when different survey methods, different sample sizes, different constipation definitions, different time periods and no standard laxative definitions are used.

Differences in study design will influence prevalence results. For example, various data collection methods have been used in studies, the most common being face-to face (FTF) interviews. Similar to constipation prevalence studies [8], the research method used may influence survey results. Because of participant embarrassment, FTF interviews may result in lower prevalence rates compared to mail or internet surveys. For example, in North America [18,36,38] and Europe [14,18,29] internet surveys have reported prevalence rates that were up to twice those of surveys conducted by FTF or phone interviews. Another aspect of study design relates to the sample. As with constipation prevalence [8], the sample size may affect the prevalence of laxative use. Study samples have ranged in size from 200 [37] to 72,000 [33] participants. Because sample size calculations have usually not been provided, it is not clear if the chosen sample sizes are appropriate. It is also not clear in most surveys if the sample used was nationally representative; in over half of the studies, regional populations were surveyed. Nationally representative samples are preferred for estimation of prevalence, along with some evidence of representativeness. Similar to constipation prevalence [8], the age range of the sample is another important consideration. In most studies of the general adult population, participants sampled were at least 15 or 18 years old with no upper limit but in some studies [5,21–23,31–33,39,44], the age of participants was restricted, therefore not all adults in the community were included.

Unfortunately, the majority of studies have not provided definitions of the term "laxative" which means it was self-defined by survey participants. One study of adults with chronic constipation [14] defined the term precisely and included a product list to aid recall; the prevalence was 30% or more higher than most other comparable studies where the meaning was self-defined [22,23,29,36,42,45].

Provision of a product list not only aids definition but also improves recall by providing a useful memory aid [47]. If not defined, it is possible that participants may not regard products such as bulk-forming laxatives and herbal products as laxatives. Also, in some studies where laxatives have not been precisely defined, certain products such as bulk-forming (fibre) products have been either specifically included [22,31,38] or excluded [39]. The ATC laxative definition (A06A: Drugs for constipation) is an international drug classification system, that could be used as a standard definition [11]. The ATC

definition includes all OTC laxative agents including bulk-forming laxatives and herbal laxatives, oral and rectal forms, as well as prescription laxatives. In studies reporting the prevalence of laxative use in constipated populations, the definition of constipation is an important consideration as this will also influence the result [8]. Differentiation is usually made between chronic and any constipation. For chronic constipation, most studies used one of the Rome criteria definitions. The majority of studies have reported laxative use with only one definition of constipation.

The recall period used in surveys is an important consideration when estimating prevalence of laxative use [47]. Most studies did not specify any time period. Yet, some studies enquired about current laxative use [9,14,38], and others defined a time period for laxative use such as the past two weeks [27,28], one month [21,26], 3 months [36] or 12 months [18,19,22,23,29,33,37,40]. Clearly the recall period should be defined, and different recall periods will influence the estimated prevalence of laxative usage [47]. Whenever information is elicited from participants, a potential for recall bias exists.

#### *4.2. Laxative Choice, Utilisation and Satisfaction*

Laxative choice varied by country. In North America, stool softeners such as docusate were popular despite a lack of evidence regarding efficacy [48–50], and prescription products feature prominently in US studies [9,38], possibly because more new products have been approved there than elsewhere. An important consideration with laxative choice is the year in which the study was conducted. Many studies were over ten years old and older studies may be less relevant because of changes in product preference and availability. For example, the increasing world-wide use of macrogol as an OTC osmotic laxative and the recent availability of new prescription laxatives in some countries need to be considered [51].

Most adults attempt self-management in the first instance [9,37]. In most cases, healthcare professionals are not consulted [29,36,52] and importantly, healthcare professionals are usually not involved with OTC laxative product selection [20,53]. It has been postulated that this might be the result of advertising and other media as well as the possibility of patient embarrassment in discussing constipation [54]. Consequently, OTC laxative choice and use may not always be appropriate [20]. Without advice from healthcare professionals, appropriate product selection and directions for use are challenging for the consumer [53] who may be influenced by other less reliable sources of information [20] such as advertising, acquaintances, or relatives.

High levels of dissatisfaction with laxatives have been reported mainly because of poor efficacy with no differences noted in laxative classes. This may be related to how laxatives are being used. Daily use of laxatives indicates use for prevention rather than treatment. Another indication of preventive use is that some adults report laxative use but not constipation. It seems clear that there is a dual purpose for laxative use—prevention and treatment of constipation, apart from any use not related to constipation. However, no studies have investigated this aspect. In particular, no studies have assessed the perceived effectiveness of laxative agents used for treatment compared to those used for prevention of constipation. Appropriate OTC laxative choice for the intended purpose should be based on the onset of action [55]. The high levels of dissatisfied laxative users in several studies suggest that laxatives are not being used appropriately [9,14,37,38]. Knowledge of the effectiveness of laxatives in practice is essential for improving the management of constipation in the community.

#### *4.3. Limitations*

A limitation of the literature review is the risk of bias, whereby the studies included were conducted in an English-speaking context and written in English and were further refined according to the inclusion/exclusion criteria. The risk of bias is acknowledged since some relevant studies may have been excluded from the literature reviewed. The authors also acknowledge potential recall bias because survey results were based on recall of participants, the period of which varied in different studies. Furthermore, differences in healthcare systems in different countries will also influence the results obtained in different studies.

#### **5. Conclusions**

It is difficult to determine the true prevalence of laxative use in the community. Estimates of laxative prevalence in community-dwelling adults vary greatly, whether in general community populations or in constipated populations. Apart from any country differences, a number of other factors may explain the wide variation. One important factor is the lack of a precise laxative definition in most studies which makes it difficult to determine what agents have been included or excluded. Other factors to consider are different recall periods, study designs and sampling differences. For studies in constipated populations, different constipation definitions also affect laxative prevalence estimates.

To estimate the prevalence of laxative use more accurately, an internationally accepted laxative definition such as the ATC definition, a specified recall time period, a nationally representative sample of appropriate size and a questionnaire which includes a list of laxative product names to facilitate recall are recommended. In constipated populations, it is recommended that universally accepted constipation definitions are used such as the Rome criteria for chronic constipation, or self-reported constipation in a specified time period for any constipation.

Few published studies have investigated the choice and utilisation of laxatives, and whether users are satisfied with their use. It appears that laxatives are not always being used for treatment of constipation and that they are also used for prevention of constipation. This distinction in the purpose of laxative use requires investigation along with the sources of influence for choice of laxative. It seems that healthcare professionals are not always involved in laxative choice, but this also needs to be further researched particularly with regard to the dual purpose of laxative use. Studies regarding laxative choice are now outdated and new studies investigating currently available laxatives are required, particularly to assess their effectiveness in preventing and treating constipation in the community.

To improve constipation management in community and primary healthcare settings, knowledge of the true prevalence and utilisation of laxative use is required, and this review indicates the need for further research in these areas.

**Author Contributions:** Conceptualization, B.L.W. and S.-A.C.; methodology, B.L.W. and S.-A.C.; writing—original draft preparation, B.L.W.; writing—review and editing, B.L.W. and S.-A.C. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research did not receive any funding.

**Acknowledgments:** The authors acknowledge guidance received from Murray Fisher, University of Sydney, and Lisa Pont and Kylie Williams, University of Technology Sydney.

**Conflicts of Interest:** The authors declare no conflict of interest regarding publication of this review.

#### **References**

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