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Developing a dual diagnosis service in Cork, Ireland by way of participatory action research (PAR) background: internationally there is a growing consensus regarding the ideal of integrated treatment. In Ireland, recommendations identified the need for multi-disciplinary team integration and client participation being central to service development. Such recommendations collectively fit most appropriately with PAR, the methodological and theoretical framework best suited to achieve the objectives of the inquiry. PAR's inclusive philosophy creates processes of negotiation, self-reflexivity and exploration of power issues with the lived experience of communities. Key elements of this approach facilitate the development of emancipatory and participatory democracy whilst highlighting identified social issues through research, learning and action. The paper aims to discuss these issues.

Cyclical processes of planning, action, observation and reflection in cycle one have facilitated the introduction of PAR's methodological framework into the existing public health (Health Service Executive) system of primary care addiction and mental health services. Developing stakeholder relationships in decision making processes has been pivotal in cycle 1 as the process of collective engagement evolves. Stakeholders begin to experience their collective participation in the methods adopted and a collective sense of ownership and commitment to the iterative process begins to take shape. Stakeholders in cycle 1 have participated in multiple data generation methods including: informal interviews, planned discussion and focus groups, multidisciplinary team meetings, testimonials, observations and reflections.

Cycle 1 of this PAR inquiry has engaged stakeholders (service users and their families, practitioners including; academic/practitioners, a consultant psychiatrist, psychologist, mental health nurses, an occupational therapist, psychotherapists, an acupuncturist, an addiction counsellor, an art therapist) in an integrated process of inquiry. PAR methods adopted in this cycle have facilitated particular dual diagnosis service developments and emerging initiatives (previously unidentified). Actions collaboratively planned for and illustrated in this paper include: the implementation of a psychotherapy group and implementing direct access to an acupuncture clinic.

Stakeholders collaboratively experience PAR's methodological and theoretical approach which has facilitated service developments in cycle 1 of the inquiry. This sets the stage for the completion of actions already in motion and for further initiatives to continue to evolve as cycle 2 processes emerge.

Explains that current public health policy puts so much emphasis on food and nutrition because the single largest cause of death is nutrition‐related, and also because it is easier for a government to promote public health through nutrition than to address ailing health infrastructures or get to grips with adult literacy. Reports, however, the gaps in health equality between different socio‐economic and ethnic groups, and across gender and age. Discusses cultural expectations of a meal and the ideal body. Infers that the higher educational level a person has, the more likely they are to be thin and to occupy a higher place in a hierarchical social structure. Suggests that more food is consumed as snacks – a triumph for mass production, marketing and advertising. Defines what is meant and understood by diet, and evaluates good and bad food. Focuses briefly on traditional food exchanges in Western Samoa and on the use of olive oil in the traditional Mediterranean diet. Indicates that choice of food may be a result of production processes rather than consumer pressure. Explores also the social and cultural interactions of meal times and the role women’s emancipation has played in changing household food and meals. Points out that the lowest socioeconomic groups favour informal takeaways, while the highest socioeconomic groups prefer formal meals out, and, therefore, that the distribution of health and illness is shaped by cultural, social, economic and political forces.

This study explored the feasibility of developing scaled inspection tools for use during external inspection of health and social care facilities to give improved accuracy in identifying facilities “at risk”, a tool for risk-adjusted frequency of inspection, and greater consistency of judgements.

This paper summarises the development through working groups and workshops involving 20 experienced inspectors (nurses and social workers) of the Regulation and Quality Improvement Authority who inspect the 206 nursing and 182 residential care homes in Northern Ireland. A brief evaluation survey, including response to a case vignette, gathered inspectors' views after using the tools for six months.

Eight two-dimensional Scaled Inspection Tools were created, each embodying a scale of performance (seriousness of risk issue) and a scale of the ability of the facility to manage that issue, each axis comprising four points. The Scaled Inspection Tools were used for on-site inspections during 2017–18. Evaluative comments were generally positive. The case vignette seemed to highlight greater risk aversion amongst newer inspectors.

The creation of scaled inspection tools adds credibility to the potential for developing risk-based governance in service regulation. Further testing of domains and their scope is required.

Prompts for each domain were found essential to guide inspectors. Despite the challenge of change, inspectors became enthusiastic about use for evaluating risks, and managers about improvements in consistency of inspection.

Knowledge derived from statistical approaches needs to be incorporated into inspection and regulation, just as in other aspects of professional practice.

Scaled inspection tools, with two orthogonal axes corresponding to seriousness of risk and ability to manage the risk (inverse of likelihood of harm), proved acceptable and intuitive in use. The study gives credibility to the possibility of developing screening and surveillance approaches to risk-based governance in service regulation.

To the best of our knowledge, the studies on determining adherence to the Mediterranean dietary pattern (MDP) in Iran as a non-Mediterranean country are scarce. Thus, the aim of the study is to determine the adherence to the MDP in a sample of female adolescents who are residents of Tehran, Iran.

In this cross-sectional study, 263 female adolescents aged 15-18 years were studied. Information on socio-demographic, lifestyle and anthropometric variables were obtained using a structured questionnaire. Also, dietary intakes were determined using a validated 168-item food frequency questionnaire. Adherence to MDP was characterized using Mediterranean-style dietary pattern score (MSDPS).

Typically, the mean ± SD MSDPS was low in the present study (15.9 ± 5.6). The mean ± SD age and body mass index of the study population was 16.2 ± 0.9 years and 22.2 ± 4.1 kg/m², respectively. In this study, the maximum MSDPS was 34.3, which was only one-third of maximum possible score (100). Multiple linear regression analyses showed that higher MSDPS scores were positively associated with age (standardized β = 0.1; p = 0.006), higher energy intake (standardized β = 0.2; p < 0.001) and marginally higher physical activity (standardized β = 0.1; p = 0.079).

Understanding low adherence to MDP in Tehranian female adolescents can provide basic knowledge to launch systematic programmes for gravitation toward MDP.

The purpose of this study is to assess the adherence to MedDiet among adults during the COVID-19 pandemic and the economic crisis, using the validated 14-item MedDiet assessment tool.

A quantitative research approach, based on the distribution of an online survey throughout the social media platforms, via networking, was the applied method. The structure of the survey included the socio-economic and demographic data along with the weekly adherence to physical activity; and the validated MedDiet assessment tool. The target population included 1,030 Lebanese adults from all provinces. Descriptive statistics were used to explore the characteristics of the sample population. Adherence to the MedDiet was determined by the Med-Diet score ≥ 9. Significant differences among the variables and the adherence to the MedDiet were examined using the chi-square test.

Mean adherence to the MedDiet was found to be lower than an adequate score among 60.8% of participants [mean adherence 8/14 < 9 (S.D. 2.2)]. Participants from North Province, those aged 45 years and above, university graduates, participants with an average income and those who exercised for a minimum of 30 min for three times/week had a higher mean of adherence compared to other groups. Higher percentage of those who exercised had adequate adherence compared to those who exercised less or did not. More than 50% of the participants consumed olive oil, vegetables, red meat, butter/margarine, sugary drinks, commercial sweets and sofrito according to recommendations. Less than 50% of the participants consumed fruits, nuts, fish and wine according to the MedDiet standards. More men consumed fruits (55.1%), wine (21%), fish (29%) and nuts (48.5%) than women according to the MedDiet recommendations; however, more women consumed legumes (69.7%) and Sofrito (88.4%) than men, in addition more women preferred consuming chicken over meat (72.3%).

The findings call for an urgent need of spreading national awareness among adult population in Lebanon to increase the adherence to MedDiet. To add, information gained from this study serve to help understanding nutritional behavior during the COVID-19 pandemic and the economic crisis, so public health authorities can start planning to save the threatened health-care system and preserve the wellness of the population.

This paper analyses how entrepreneurs recognise and exploit entrepreneurial opportunities following a sustainable approach that respects the equilibrium among environmental, social and commercial purposes, and how their personality affects this process. The main personality traits focused in this study are narcissism, locus of control and sustainability orientation.

This single case study involves Essentia Dimora Rurale, a small agritourism business, located in Molise (Italy), characterised by a sustainable business model that generates value for the local environment, thus revitalising abandoned territories. Data are collected using qualitative and quantitative methods and are analysed using the Gioia methodology.

The Essentia Dimora Rurale's approach is rooted in the concept of sustainability and the development of tourism in the territory. The preservation of traditional values and the creation of a network allow the firm to prosper and survive. The personalities of the two sibling entrepreneurs fuel the process, and the authors show that each personality trait plays a different role in each phase of the firm's growth.

From a theoretical point of view, the study contributes to entrepreneurial, sustainability and personality literature. However, using a single case study can represent a limit for the research.

Various practical implications are recognised concerning several stakeholders, such as the owners and the entities linked to the regional promotion and tourism sectors.

The novelty of the research relies on the importance of entrepreneur opportunity identification, particularly in sustainable firms. Moreover, the authors fill the literature gap investigating the impact of three personality traits in this process.

This paper aims to evaluate macro- and micronutrient intake among Jordanian adults who have metabolic syndrome (MetS) and those MetS-free.

A total of 154 Jordanian adults aged 20-55 years were enrolled from The National Center for Diabetes, Endocrinology and Genetics in this case control study. In total, 77 newly diagnosed cases of MetS and 77 controls were recruited and matched by age and sex. Dietary data were collected by face-to-face interview using a validated food frequency questionnaire.

After adjustment of the energy intake and macronutrients, the cases reported significantly higher intake of the amount of protein (p < 0.001), carbohydrates (p < 0.001), fiber (p < 0.001), sugar (p < 0.001), fat (p < 0.001), saturated fat (p < 0.001), monounsaturated (p < 0.001), polyunsaturated (p < 0.001), trans-fat (p < 0.029), omega-3 (p < 0.001) and omega-6 (p < 0.001) as compared to the controls. The results also showed that the intake of some micronutrients was significantly higher among cases when compared to the controls. In this study, three dietary patterns have been itemized; “fast food dietary pattern”, “Mediterranean dietary pattern” and “high-protein dietary pattern”. Only a direct significant trend between MetS and fast food pattern was detected (p-trend = 0.001). Neither significant associations nor trends were detected in the Mediterranean and high-protein patterns with MetS risk.

The study findings highlighted the presence of associations between fast food dietary pattern, total energy and some macro- and micronutrients intake and the risk of MetS among population living in the Middle East. Even though the findings of this study bridge the gap between theory and practice, a large scale population-based study is warranted to confirm these findings.

The purpose of this paper is to analyse how sustainability is crucial in maintaining and assigning value to a common good. In particular, the paper identifies several characteristics of a business model that could be adopted to manage sustainable innovation strategies that respect the balance among environmental, social and commercial goals.

This case study involves Fontanafredda, an internationally recognised historical Italian wine company characterised by its highly innovative business approach and sustainable business model.

Fontanafredda’s approach is connected to the broader concept of the common good the winery has internalised to become an element of its competitive advantage and differentiation. The preservation of traditional values – primarily the respect and valuing of one’s own territory – is a key asset of the winery, which attaches great symbolic and concrete importance to these values.

The study uses a single case study approach and a qualitative method without quantifying the impact of every business choice. For theoretical implications, the study emphasises the strong connection between sustainability and innovation in the management of the common good.

Numerous practical implications are identified regarding several stakeholder groups, such as the management, owners, investors and the various entities linked to the regional promotion and tourism sectors.

This research explores how and why Fontanafredda amounts to more than simply wine production by focusing on the characteristics of its business model, which efficiently handles the link between innovation and heritage for common-good development.

The COVID-19 pandemic has actively changed the face of all medical disciplines, including mental health practices. In a matter of days from the introduction of the lockdown, clinicians have to adapt to new working models with many changing the consultation methods clinicians have utilized for years. To best understand the wider clinical impact, a limited study was carried out to assess the effect of coronavirus disease 2019 (COVID-19) on psychiatric clinical practice.

A qualitative study was performed to analyze the impact of COVID-19 on clinician practice at a UK secure care mental health facility. A four-question free-text survey was distributed online to all physicians and seven responses were analyzed using thematic analysis.

Four key themes were identified – use of technology, the importance of face-to-face contact, work/life balance and mental well-being.

Overall, the results of the study reported that although some negative changes to the traditional work–life balance were identified, the clinicians found remote working within a secure care setting cultivated a more efficient working environment while allowing for more effective social distance practices.

This study highlighted some of the challenges faced by clinicians employed in a secure care mental health setting following the introduction of lockdown measures in the UK associated with the COVID-19 pandemic. The study will also inform future work practices, including the potential of longer term remote working in this sector.

The purpose of this paper is to examine how the share of expenditure on foods with high sugar is influenced by purchasing behaviour and household characteristics in Turkey.

Food purchases of a large representative sample of Turkish households (n=10,682) were observed over a two-year time span. A linear mixed effects model is estimated to analyse the drivers of households’ share of expenditure on foods with high sugar in a longitudinal setting.

Lower shopping frequency, larger shopping baskets, more promotional purchasing and higher usage of modern retail formats lead to a higher share of expenditure on foods with high sugar. This share decreases with higher income and education. Households living in urban areas have lower expenditure on foods with high sugar. Households in the Aegean and Mediterranean regions show the highest share of expenditure on foods with high sugar across Turkey. Children within the household lead to a higher share of expenditure on foods with high sugar whereas this share decreases with increasing household size and being in later stages of life.

Analysing household panel data provides a more realistic perspective of longitudinal food purchasing behaviour compared to studies using cross-sectional designs. Furthermore, this large-scale study in Turkey provides valuable insights for health researchers and policymakers to improve public health due to being conducted in a newly industrialised country with high rates of obesity and type 2 diabetes, a fragmented retail environment and diverse geographical regions.