Academic literature on the topic 'Difficult behaviours'

The attributions parents make about the problem behaviour of their children have been shown to be important determinants of their emotional and behavioural reactions to such behaviour. However, this relationship has not been studied in carers of children in residential settings. In this paper we apply Weiner's attributional model of helping to the self-predicted behaviour of 47 carers in residential children's homes in the U.K. Participants identified causes for four children's behaviours, made attributions about these behaviours on dimensions of internality, controllability, globality and stability, reported their emotional reactions to the behaviours on the dimensions of anger and sympathy and reported their likelihood of making extra effort to help in working with these behaviours. Results showed that attributions of controllability and globality, and the emotional response of sympathy were important in predicting reported likelihood of helping. The implications of these results for carer training are discussed.

Background: Some patients are stigmatised as difficult patients by healthcare professionals. This phenomenon has great many negative consequences. The behaviours of healthcare professionals towards difficult patients are important. Objective: To explore the behaviours of all healthcare professionals towards difficult patients. Research Design: This study was based on a cross-sectional research design using structural equation modelling. Participants and Research Context: Two hundred and fifty-four healthcare professionals were involved in the study in Turkey. ‘Participant Information Form’ and the ‘Healthcare Professionals Behaviour Assessment Questionnaire For Difficult Patient’ were used to collect data from participants. Ethical Consideration: Ethical approval was obtained from Gazi University Ethics Committee for the study. Informed consent of the participants in the study was taken and the confidentiality of the participants was ensured. Findings: It was explored that the behaviours of healthcare professionals towards difficult patients were categorised into ethical, supportive and negative. The highest mean score was supportive behaviour and the least mean score was negative. According to structural equation modelling, the most important predictor of difficult encounters was an ethical dimension. One-unit increase in ethical behaviour contributed to 0.92 unit increase in positive patient behaviour. Discussion: Patients generally are perceived as ‘difficult patient’ by the healthcare professionals, so the patients’ treatment and care services are affected negatively due to healthcare professionals’ negative beliefs and attitudes. The healthcare professionals should behave supportively towards difficult patients. Conclusion: Healthcare professionals should be aware of management strategies in dealing with difficult encounters. The behaviours of healthcare professionals should be improved in a positive way and awareness of ethical dimension of difficult encounters should be increased.

AbstractTraditional Functional Analytic procedures rely upon the identification of one or two ‘target’ behaviours for examination via observation and analysis. From these data, multiple functions are identified for each target behaviour via antecedent-behaviour-consequence data collection. However, although these methodologies have been shown to be effective with a wide range of inappropriate behaviours in classrooms, they have limitations when the inappropriate behaviours are so many and varied that selection of one or two as ‘targets’ becomes unreliable in terms of obtaining an accurate representation of the child's overall behavioural repertoire. A variation on this procedure is described and data from a case example are presented as a suggested alternative way of obtaining the kind of data required for effective classroom management of difficult behaviour.

AbstractDetailed analyses of dolphin foraging behaviour have typically been difficult due to researchers' inability to observe entire foraging sequences. Using a new observational tool I was able to observe sequences of behaviours leading to successful prey captures, including behaviours not previously described in Sarasota Bay dolphins. I defined a set of specific foraging behaviours and demonstrated their position in successful sequences by analyzing the conditional probability of their occurrence based the occurrence of a capture. The sequences of behaviours dolphins used were not deterministic, and individual dolphins displayed different behavioural repertoires. Foraging behaviours occurred at rates of up to 0.5 per minute during general activity categories commonly used in odontocete research, and the current results could assist in the interpretation of these activities.

When child protection caseworkers make first contact with the parents of a child (or children) who is suspected of being at ‘significant risk of harm’ they may encounter a range of hostile, angry and aggressive verbal responses from parents. If this contact results in a child being removed from parental care, it is not unknown for these responses to escalate into attempts at verbal intimidation and loud threats of personal violence. These behaviours then get recorded in case files and in materials submitted to the Children's Court to support the case for permanent removal of a child from parental care; these behaviours being presented as evidence of the parents’ unsuitability and unwillingness to comply with demands for changes in their child rearing practices. But how should child protection caseworkers view these less-than-helpful parental responses, and how should they, in turn, respond? This article explores this issue and offers a number of ways of understanding these behaviours, and canvasses new ways for caseworkers to respond when these behaviours occur.

BACKGROUND: This paper reports the results of a systematic survey of members of a clinical gastroenterology service to determine their perceptions of patients with inflammatory bowel disease (IBD) who were deemed to function poorly and were difficult to manage clinically.OBJECTIVES: To assess objectively the defining characteristics of this perceived subgroup of patients who are encountered in virtually all gastroenterology services.METHODS: A sample of gastroenterologists and gastrointestinal surgeons (n=10), as well as gastrointestinal nurses (n=19), was surveyed regarding their beliefs about the characteristics of patients with IBD who they judged to be extremely ‘difficult to manage’. A survey was developed to assess patient characteristics (eg, symptom presentation, narcotic over-reliance, interpersonal behaviour and illness behaviour) and the emotional impact that this perceived patient group has on individual staff members as well as on the functioning of the gastrointestinal team.RESULTS: The data indicated that patients with IBD who were perceived to be poorly functioning were viewed to have high levels of dysfunctional behaviour. In particular, negative behaviours (eg, manipulative interpersonal behaviours and excessive illness behaviours) were noted. Not only were these categories of behaviours high in frequency, but survey participants also rated these categories of behaviour to be highly distinct from those of typical patients with IBD. Moreover, this perceived patient group was reported to have a negative impact on individual staff and on the gastrointestinal team, and participants confirmed that they experience significant frustration and hostility when they work with these patients.CONCLUSIONS: These data, if replicated, confirm the general clinical opinion that a small subgroup of ‘difficult to manage’ and poorly functioning patients with IBD exists. These patients appear to differ from typical patients with IBD in interpersonal characteristics more than in medical characteristics. If follow-up research, which is currently underway by the authors’ group, shows that groups of poorly functioning gastrointestinal patients and typical gastrointestinal patients actually differ in measures of illness behaviour, then novel treatment approaches to improve the clinical services that are provided to these patients can be developed.

Higher level phylogenetic analyses rarely include behavioural data, predominantly because such groups seldom have complex behaviours that are susceptible to analysis. Even when broad groups do share a complex behaviour, there is skepticism about the appropriateness of using behavioural traits in higher level phylogenetic analyses. The Integripalpia is a suborder of caddisflies and is an appropriate group to investigate the use of behaviour in higher level analyses because all larvae use a complex suite of behaviours to build portable cases. A thorough investigation of case-building in 10 families (19 exemplar genera) yielded 24 behavioural characters. A parsimony analysis produced 87 equally parsimonious trees (length = 56 steps, consistency index (CI) = 0.84, retention index (RI) = 0.88) that supported the monophyly of the integripalpian families, except for the Limnephilidae. Interfamilial relationships, although resolved, were not well supported with behaviour. Certain interfamilial relationships have also been difficult to establish reliably with morphological information, indicating a need for more characters (e.g., molecular) at this taxonomic level. This study indicates that if taxa share a complex behaviour (e.g., case building), then regardless of taxonomic level, one is likely to find shared derived behavioural characters that are useful for phylogeny reconstruction.

The aim of this study was to evaluate the effectiveness of an intervention with CBT in patients with chronic renal disease. The study findings are in the context of previous researches and existing theories. Searches were done in the professional literature related to different chronic diseases and respectively with Chronic Kidney Disease in children and adolescents. Many paediatric chronic diseases are difficult to be managed because of the limitations caused by the disease itself; consequently, some of them need to be subjected to painful and difficult medical procedures as well. Respectively, for children diagnosed with CKD life changes completely because of limitations, mainly physical ones, due to the characteristics of the disease which require constant adaption as well as development of strategies to face the disease. Their behaviours must change accordingly as part of a new life of self-care. Cognitive-Behavioural Therapy is a psychological therapy, which has been investigated extensively and has been found as very effective to reduce psychological symptoms caused by the disease. This therapy integrates the modification of behaviour with the cognitive restructuring, the aim of which is to change the patient’s unhealthy behaviours through cognitive and behaviour techniques. Keywords: children; chronic kidney disease; cognitive behavioural therapy

Forty mothers and their 7-year-old children were video-taped while interacting during the completion of five structured tasks. Half of the children had been rated as having a difficult temperament by their mothers on the Thomas and Chess Temperament Questionnaire during the previous 3 years. The other half had a stable, easy temperament according to these ratings. Observation of mother-child interactions demonstrated that the behaviour of mothers of easy and difficult children did not differ significantly, but difficult-temperament children showed significantly more negative and disputing behaviour than did easy children. Controlling and critical behaviours on the part of the mothers were particularly associated with child negativity, most notably when they occurred in the easy group. Mothers of the children in the easy group were likely to respond to child negativity with the encouragement of autonomy but this was extremely rare in the difficult group. Mothers of difficult children gave more positive encouragement to their children both before and after negative behaviour. Overall, the results indicated a different pattern of contingent responses for easy child-mother pairs, and also offered some support for the validity of mother ratings of difficult temperament.

Social insects are one of the best examples of complex self-organized systems exhibiting task allocation. How task allocation is achieved is the most fascinating question in behavioural ecology and complex systems science. However, it is difficult to comprehensively characterize task allocation patterns due to behavioural complexity, such as the individual variation, context dependency and chronological variation. Thus, it is imperative to quantify individual behaviours and integrate them into colony levels. Here, we applied bipartite network analyses to characterize individual-behaviour relationships. We recorded the behaviours of all individuals with verified age in ant colonies and analysed the individual-behaviour relationship at the individual, module and network levels. Bipartite network analysis successfully detected the module structures, illustrating that certain individuals performed a subset of behaviours (i.e. task groups). We confirmed age polyethism by comparing age between modules. Additionally, to test the daily rhythm of the executed tasks, the data were partitioned between daytime and nighttime, and a bipartite network was re-constructed. This analysis supported that there was no daily rhythm in the tasks performed. These findings suggested that bipartite network analyses could untangle complex task allocation patterns and provide insights into understanding the division of labour.

This study examined the efficacy of a multimodal intervention with conduct disordered boys in the middle primary years. The intervention consisted of a behavioural classroom program; a small group, social skills program; and a behavioural parenting program Resource implications of this model were also evaluated. A review of the current literature on conduct disorders showed that these children account for less than 5% of the population, but they have a strong impact on families, teachers, peers, schools and the wider community. About 50% of children with severe, early behavioural problems will continue with these problems, not only throughout their adult lives, but into the next generation. Early intervention appears to offer our best hope of altering this trajectory. Interventions with this population have been largely unsuccessful. At the present time the most promising intervention is behavioural parent training programs. Combining these with child focused social skills programs, and behavioural programs in the school setting, increases their efficacy. This study used a single subject experimental design to examine the effects of this program on four boys with behavioural difficulties. Continuous measures were taken with parent, and teacher daily record charts, and classroom observations. Pre, post and followup measures were taken with the Child Behaviour Checklist. The results of the study were mixed. Some subjects, according to some respondents, improved in home and school behaviours. All three subjects, for whom there was followup data, had improved. The classroom, and parenting programs appeared to be associated with positive changes in child behaviour, the small group was associated with more disruptive behaviour at school.

The second study focussed specifically upon the provision of statistical offender profiling advice to investigations. A total of 312 detected murder cases from the Serious Crime Analysis Section (SCAS) database were explored to search for patterns regarding what is known about the offence at different stages of an investigation, i.e. the first hour (also known as the golden hour) within the first 24 hours and thereafter. The data were analysed to search for features which could reliably be predicted regarding the offender responsible at each of these stages. In compliance with the Pragmatic Psychology approach, the research was organic, in that the variables regarding the offence (including victim and crime scene), and the variables regarding the offender, were drawn out of the information available to the investigation and practical requirements of the SIO as articulated by the interviewees in study one. Study two was split into two parts - the first undertaking univariate and bivariate quantitative analysis (base rate frequencies; chi square; odds ratios), and the second involving multivariate statistics (configural frequency analysis; logistic regression). As the research was pragmatic, consideration was given not only to statistically significant findings, but also to potential performance if applied to future (undetected) cases. The different statistical techniques were compared to one another, and some of the more complex analyses (e.g. logistic regression) did not significantly enhance predictions from those which could be made on the basis of more simplistic methods (e.g. base rate frequency). As such, pragmatic recommendation was made as to which findings regarding the offender should be reported in different offence situations. Finally, building on previous practice advice, the thesis proposed future recommendations for SIOs, BIAS, the National Policing Improvement Agency (NPIA) and the wider police service. A programme of future research has been suggested that incorporates other aspects of behavioural investigative advice.

Cognition-Emotion-Action model (1980) with Ajzen's Theory of Planned Behaviour ABSTRACT (TpB, 1991) towards understanding helping behaviour of clinical staff who work with clients diagnosed with a personality disorder (PD) who display difficult and challenging behaviour. Design: This is a quantitative study making use of a single group cross-sectional regression design. A regression analysis was used to examine the predictive ability of the primary constructs within the TpB against the constructs of attribution and emotion from Weiner's (1980) model to explain staff helping behaviour. Method: Ninety three clinical staff from all professions took part in a short semi- structured interview regarding an incident of difficult behaviour they had recently experienced involving a client diagnosed with a PD. Participants then completed the Attributional Style Questionnaire Revised (ASQ-R), the Emotional Reactions to Challenging Behaviour scale (ERCB), the Generalised Self-Efficacy Scale (GSE), the Helping Behaviour Questionnaire (HBQ) and two bipolar scales for helping and severity of challenging behaviour. Results: The constructs within the TpB adequately predicted staff helping behaviour, with attitude and perceived control being significant determinants of intention and perceived control and intention significantly predicting helping behaviour. Subjective norm was non-significant in predicting intention. Weiner's (1980) model was also found to significantly predict helping behaviour with controllability being the only significant determinant of helping behaviour. A combination of the TpB and Weiner's model was found to account for greater variance in helping behaviour than the individual models.

Understanding of pulverised coal combustion performance including ash behaviour is very important to design optimum boiler furnaces. In the last decades, remarkable advance of computers and computational fluid dynamics (CFD) codes have been realised and plenty of numerical modelling has been applied. However total performance of pulverised coal fired boilers including burner geometries and ash deposition behaviours is still difficult to predict. There are the limitation of computer performance and unknown phenomenon of ash deposition. Therefore, the new method of modelling to perform the full size furnace simulation has been developed to materialise both reduction of calculation load and improvement in prediction accuracy. It is confirmed that this new technique can express the difference between varied burner conditions. Detailed coal ash deposition behaviours and heat absorption rate are currently unknown and were measured and analysed experimentally by using the horizontal cylindrical furnace with water cooled probes. The experiments gave the better understandings of ash deposition and inhibition of heat absorption and heat absorption model is proposed. Boiler furnace heat absorption with ash deposition will be calculated and ash deposition behaviour will be modelled.

Dissipation mechanisms and dissipative forces play a pivotal role in the operations and performance of human-machine interfaces and particularly in haptic systems. Dissipation is a very difficult phenomenon to model. Coulomb friction in general can be the most influential element in systems involving multiple direct contact connections such as joints with transmissions or mechanically guided components. Coulomb friction includes non-smooth discontinuity and can induce complex dynamic behaviours. Very little attention has been paid to the analysis of the effects of Coulomb friction in haptic devices. In this paper we illustrate, by experiment, analysis and simulation, the nature of the dynamic behaviour caused by Coulomb friction in haptic sampled-data systems. We demonstrate that a simple model can represent this behaviour, and show the effects of the haptic system parameters on this dynamics.

The knowledge of water vapour diffusion in materials is very important in several fields of application (drying, building materials, biofilms…). Regarding the drying process, the value of mass diffusivity, as well as its variations with moisture content, governs the second drying period, which is the most important in terms of drying time, energy consumption and product quality. In the case of biomaterials used for building insulation, this parameter is essential for transformation processes, including drying, but also for the proper design and use of buildings. Concerning biofilms, barrier properties are one of the most important physical properties of these materials to properly ensure a good end use. Nevertheless, experimental data of mass uptake of some biomaterials showed that did not follow the standard Fickian model. The precise determination of this non-Fickian behaviour showed to be a difficult task since the physical phenomena responsible for such behaviours depend on the biomaterial structure and physical properties. In particular, the abnormal macroscopic behaviour could result from the pore morphology (dual-scale effects), from the nano-structure, from the molecular reorganisation, or a combination of these spatial scales. This conference proposes a new methodology to quantify the non-Fickian diffusion. Based on a macroscopic formulation of coupled heat and mass transfer with kernel functions, the model parameters, intrinsic characteristic of the product of interest are determined by inverse analysis. Several complementary transient experiments can be analysed simultaneously, which insures the method robustness. Application examples are proposed for different products, including lignocellulosic materials and nanostructured biofilms.

Silicon (Si) wafers are the most commonly used substrates for manufacturing semiconductor devices. The design rule is miniaturized, and the chip size is increasing to improve the degree of the device integration. Then Si wafer is required to be manufactured with the higher flatness and larger diameter to meet above demands. The double-sided polishing is widely adopted as the finishing process of the wafer manufacturing, because the wafers with the good surface quality and flatness can be obtained economically. However, the polishing technology has serious problems: It is very difficult to set the appropriate conditions for stably polishing the Si wafer and wearing the pad to the high flatness. In our previous work, the optimization of the polishing conditions with the theoretical calculation was conducted, however, the calculation did not consider the relative motion direction having large influence on polishing behaviours. In this study, the optimizing method considering the relative motion direction was newly developed, and it was revealed that the calculation results corresponded well with the experimental results. Furthermore, it was found that the time-fluctuation of the wafer flatness was larger in the case of the wafer having taper shape, compared to that having convex shape in the calculation.

Do targeted transparency interventions reduce corrupt behavior when corrupt actors are few and politically influential; their behavior imposes small costs on numerous individuals; and corrupt behavior is difficult to observe? Results from a study of informal audits and text messages to parents, meant to curb corruption in the School Meals Program of Colombia, suggests that they can. Theory is pessimistic that transparency interventions can change the behavior of actors who exert significant influence over supervisory authorities. Moreover, inherent methodological obstacles impede the identification of treatment effects. Results substantiate the presence of these obstacles, especially considerable spillovers from treated to control groups. Despite spillovers, we find that parental and operator behavior are significantly different between treatment and control groups. Additional evidence explains why operator behavior changed: out of concern that systematic evidence of corrupt behavior would trigger enforcement actions by high-level enforcement agencies outside of the political jurisdictions where they are most influential.

Specialized classes of concrete, such as ultra-high-performance concrete, use volumes of silica fume in concrete that are higher than those in conventional concrete, resulting in increased water demand and mixing difficulty. This study considered the effects of eight different silica fumes in three dosages (10%, 20%, 30%) with three w/b (0.20, 0.30, 0.45) on rheological behavior as characterized by the Herschel-Bulkley model. Results indicated that the specific source of silica fume used, in addition to dosage and w/b, had a significant effect on the rheological behavior. As such, all silica fumes cannot be treated as equivalent or be directly substituted one for another without modification of the mixture proportion. The rheology of cement pastes is significantly affected by the physical properties of silica fume more so than any chemical effects.

This paper aims to provide evidence on the effects of fiscal rules on public investment, fiscal results and growth in Costa Rica and Panama. First, we find that the budget formulation process and the political economy behind the adoption and compliance of fiscal rules explain that Panama has a bias to create and sequentially pile up rules, while Costa Rica has a tendency not to comply with them. Second, a retrospective analysis of the 2018 fiscal rules in both nations finds asymmetric effects on the fiscal results. In Panama it is difficult to separate the effect of fiscal rule designs on public investment; and, in Costa Rica, the application of the fiscal rule will decrease public investment, if the debt to GDP ratio exceeds 60 percent and current expenditure crowds out capital expenditure. Two lessons emerge. First, an effective fiscal rule compliance requires time consistent institutions, solid monitoring, enforcement schemes and improving the quality of public financial management systems. Second, it is necessary to review the design of fiscal rules in both countries to ensure they are investment and growth friendly.

The value added tax (VAT) is supposed to be a tax on consumption that achieves greater economic efficiency than alternative indirect taxes. It is also meant to facilitate enforcement through the ‘self-enforcing mechanism’ – based on opposed incentives for buyers and sellers, and because of the paper trail it creates. Being a rather sophisticated tax, however, the VAT is complex to administer and costly to comply with, especially in lower-income countries. This paper takes a closer look at how the VAT system functions in practice in Rwanda. Using a mixed-methods approach, which combines qualitative information from focus group discussions with the analysis of administrative and survey data, we document and explain a number of surprising inconsistencies in the filing behaviour of VAT-remitting firms, which lead to suboptimal usage of electronic billing machines, as well as failure to claim legitimate VAT credits. The consequence of these inconsistencies is twofold. It makes it difficult for the Rwanda Revenue Authority to exploit its VAT data to the fullest, and leads to firms, particularly smaller ones, bearing a higher VAT burden than larger ones. There are several explanations for these inconsistencies. They appear to lie in a combination of taxpayer confusion, fear of audit, and constraints in administrative capacity.

The transportation studies literature recognizes the relationship between accessibility and active travel. However, there is limited research on the specific impact of walking and cycling accessibility to multi-use paths on active travel behavior. Combined with the culture of automobile dependency in the US, this knowledge gap has been making it difficult for policy-makers to encourage walking and cycling mode choices, highlighting the need to promote a walking and cycling culture in cities. In this case, a clustering effect (“you bike, I bike”) can be used as leverage to initiate such a trend. This project contributes to the literature as one of the few published research projects that considers all typical categories of explanatory variables (individual and household socioeconomics, local built environment features, and travel and residential choice attitudes) as well as two new variables (accessibility to multi-use paths calculated by ArcGIS and a clustering effect represented by spatial autocorrelation) at two levels (level 1: binary choice of cycling/waking; level 2: cycling/walking time if yes at level 1) to better understand active travel demand. We use data from the 2012 Utah Travel Survey. At the first level, we use a spatial probit model to identify whether and why Salt Lake City residents walked or cycled. The second level is the development of a spatial autoregressive model for walkers and cyclists to examine what factors affect their travel time when using walking or cycling modes. The results from both levels, obtained while controlling for individual, attitudinal, and built-environment variables, show that accessibility to multi-use paths and a clustering effect (spatial autocorrelation) influence active travel behavior in different ways. Specifically, a cyclist is likely to cycle more when seeing more cyclists around. These findings provide analytical evidence to decision-makers for efficiently evaluating and deciding between plans and policies to enhance active transportation based on the two modeling approaches to assessing travel behavior described above.

We conduct a randomized controlled trial in Mexico City to determine willingness to pay (WTP) for SMS air quality alerts and to study the effects of air quality alerts, reminders, and a reusable N95 mask on air pollution information and avoidance behavior. At baseline, we elicit WTP for the alerts service after revealing whether the household will receive an N95 mask and participant compensation, but before revealing whether they will receive alert or reminder services. While we observe no significant impact of mask provision on WTP, higher compensation increases WTP, suggesting a possible cash-on-hand constraint. The perception of high pollution days prior to the survey is positively correlated with WTP, but the presence of actual high pollution days is not correlated with WTP. Follow-up survey data demonstrate that the alerts treatment increases reporting of receiving air pollution information via SMS, a high pollution day in the past week, and staying indoors on the most recent perceived high pollution day. However, we observe no significant effect on the ability to correctly identify which specific days had high pollution. Similarly, households that received an N95 mask are more likely to report utilizing a mask with filter in the past two weeks, but we observe no effect on using a filter mask on the specific days with high particulate matter. Although we nd that air quality alerts increased the salience of air quality and avoidance behavior, these results illustrate the difficulty that information treatments face in overcoming perceptions to effectively reduce exposure to air pollution.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.

In this webinar, host Dr. Lucy Sanctuary, Autism Specialist with Clinical Partners, was joined by Clinical Psychologists Dr. Ann Ozsivadjian and Dr. Marianna Murin to discover practical ways to address challenges around difficult emotional behaviours.

Most-at-risk populations (MARPS), including men who have sex with men (MSM) and injecting drug users (IDUs), represent 1 percent of Nigeria’s population yet account for 38 percent of new HIV infections. Despite their elevated risk, MSM and IDUs are less likely than the general population to access HIV prevention and sexual health services because of stigmatization. There is a dearth of data on prevalence of HIV and sexually transmitted infections (STIs) among MSM and IDUs because their behaviors make them difficult to be reached programmatically and engaged in research. While the need for HIV and STI prevalence data is clear, there is also a need to improve the quality and reliability of behavioral data collected for national surveillance, where these stigmatized subpopulations may underreport sensitive behaviors that put them most at risk. This technical report provides details of a study that sought to determine the prevalence of HIV and STIs and sexual and injecting risk behaviors in MSM and male IDUs, and determine if Audio Computer-Assisted Self Interviews provide more accurate reporting of risk behaviors than face-to-face interviewing.

Most-at-risk populations (MARPS), including men who have sex with men (MSM) and injecting drug users (IDUs), represent only 1 percent of Nigeria’s population yet account for 38 percent of new HIV infections. Despite their elevated risk, MSM and IDUs are less likely than the general population to access HIV prevention and sexual health services because of stigmatization. There is a dearth of data on prevalence of HIV and sexually transmitted infections (STIs) among MSM and IDUs because their behaviors make them difficult to be reached programmatically and engaged in research. While the need for HIV and STI prevalence data is clear, there is also a need to improve the quality and reliability of behavioral data collected for national surveillance, where these stigmatized subpopulations may underreport sensitive behaviors that put them most at risk. As noted in this fact sheet, computer-based interviewing systems are becoming an accepted alternative to face-to-face interviews, providing an efficient and replicable research tool for collecting sensitive behavioral data.