Background: People living with progressive supranuclear palsy (PSP) can experience considerable difficulties with movement, walking, balance, and oculomotor control. The role of exercises and physical activities in mitigating the motor and non-motor symptoms of PSP remains uncertain.Aims: The aim of this study was to identify the perspectives and beliefs of health professionals about the benefits, enablers, and barriers to participation in exercise and physical activity across the course of disease progression of PSP.Methods: Qualitative methods, within a phenomenological framework, were used to obtain nursing and allied health professional perspectives and recommendations. Focus group and in-depth interview questions were derived from a systematic review on exercise for PSP. Expert opinions also guided the interviews, which were audio-recorded, transcribed verbatim, and de-identified. Two researchers independently conducted a thematic analysis.Results: Nineteen health professionals participated from the disciplines of nursing, physiotherapy, occupational therapy, and speech pathology. Four main themes emerged: (i) exercise and physical activities are important for living well with PSP; (ii) provision of information about the benefits of exercise and physical activities facilitates uptake; (iii) interdisciplinary teams work together to improve outcomes; and (iv) care partners can assist with the implementation of exercise and physical activities.Conclusion: Health professionals advocated physical therapies for people living with PSP. The expectation is that structured exercises and physical activities can help to optimize health and well-being, enabling people to continue to participate in social roles. The actual merits of such interventions must now be tested in large-scale controlled clinical trials. Progressive supranuclear palsy (PSP) is one of the most debilitating forms of atypical parkinsonism , 2. AffeSymptomatic treatment is based on alleviating specific symptoms or signs and aims to optimize health, well-being, and quality of life . TreatmeStructured exercises can improve strength, mobility, and balance in people living with PSP . PhysicaOne of the challenges for nurses and allied health professionals is to know how best to facilitate exercise, physical activities, and movement rehabilitation in people living with PSP. In a recent study on barriers and facilitators to exercise, people with PSP and their care partners reported that long delays in receiving a definitive diagnosis of PSP had a negative impact on exercise participation. Access to allied health and nursing professionals with expertise in PSP was also a barrier. Because each person with PSP has a unique array of symptoms and co-morbidities, a need was expressed for access to specialist care. The care provided also needs to consider the stage of disease progression , 10.What are not known are the views of nurses and allied health professionals about the factors that facilitate and enable participation in structured exercises, physical activities, and motor skill training across the course of disease progression in PSP. This study aims to address that need through in-depth interviews with nurses, physiotherapists, occupational therapists, and speech pathologists.Ethical approval was granted by the La Trobe University human ethics committee (HEC18333). All participants received a Participant Information Sheet and provided written informed consent prior to data collection. Each participant was assigned a code number and advised that all information was confidential and anonymous. Hard copy consent forms, demographic data, and participant master list were stored in a locked filing cabinet at the university. The audio-recordings, de-identified transcriptions were stored on a secure university research drive. Data collection consisted of a mixture of focus groups and in-depth individual interviews according to workplace and participant availability. The Consolidated Criteria for Reporting Qualitative studies (COREQ) checklist was used to inform study design and reporting .A phenomenological theoretical framework was selected to explore the lived experience of the participants , 19. ThiThe study team included clinical and research experts in parkinsonism and movement disorders . It also included allied health professionals with qualitative research skills  and exercise prescription expertise . Members of the research team were not known to the participants.via purposive sampling in Melbourne, Australia until data saturation was reached. There was representation of the health professionals most likely to advise people living with PSP about exercise and physical activity. These included nurses, occupational therapists, physiotherapists, and speech pathologists. Movement disorders clinics, neurological rehabilitation clinics, private practices, the not-for profit sector, and the Parkinson's association were approached by email and/or telephone and provided with information about the research.Registered nursing and allied health professionals were recruited An experienced facilitator (SS), who was not known to the participants, conducted the audio-recorded focus groups and individual interviews. A set of interview questions was informed by a systematic review , exercisTwo researchers (SS and CB) independently conducted inductive, step-by-step thematic analysis of the de-identified transcripts  , 19, 21.Control of risk of bias was enhanced by defined eligibility criteria; participant recruitment that provided a range of experiences to answer the research question, reproducible data collection, and analysis steps; audio-recording and verbatim transcription; independent data analysis by two researchers and team consensus; and findings supported by participant data , 23.There were 19 participants, and the overall saturation of ideas and findings was achieved in the total pool of participants. Two focus groups were conducted with a total of seven movement disorders physiotherapists. One focus group was also conducted with two speech pathologists, and an additional focus group was conducted with two occupational therapists. All of the clinicians worked in movement disorders in the public sector. In-depth individual interviews were additionally conducted with a total of eight health professionals working in movement disorders in the public, private, and not-for profit sectors . The interviews and focus groups were facilitated by SS in the participant workplaces. They were audio-recorded and transcribed verbatim. The focus groups had a mean duration of 65.8 min and standard deviation of 15.9 min. The individual in-depth interviews had a mean duration of 55.5 min and standard deviation of 10.7 min. Participant demographic data are summarized in Data were stored on a secure university research drive that could be accessed only by the lead researcher and the facilitator. There were perspectives and experiences common to all of the participants, with no dissonant cases. Saturation was reached after 19 participants who all volunteered their ideas and beliefs. Member checking of the transcripts was not conducted because of the risk of recall bias.The overarching theme to emerge from this study was that nursing and allied health professionals believed that exercise, physical activities, movement rehabilitation, and functional activities are important components of therapy to enable people with PSP to live well. Nevertheless, there was uncertainty about exactly how these should be delivered and how they should be tailored to individual needs and the stage of disease progression.Four main themes were identified: (i) exercise and physical activities are important for living well with PSP; (ii) provision of information about the benefits of exercise and physical activities facilitates uptake; (iii) interdisciplinary teams work together to improve outcomes; and (iv) care partners can assist with the implementation of exercise and physical activities. The themes and accompanying sub-themes are presented in the following text and supported by quotations linked to the participants by code number and transcription line numbers.Exercise and physical activity engagement were viewed as being helpful for health and wellbeing, especially in the early stages of disease progression, and when adjusted to individual needs and preferences.The participants reported that exercise and physical activity are best tailored to each individual with PSP, their physical capacity, preferences for exercise, and prior exercise participation . They alBOX 1The model of care we used was always to ask the person their priority.” P1, line 1,133“It helps if they've had an experience with exercise then they know what's involved.” P2, line 489“Some people are gym people, some people are not gym people. Some people like exercising in groups, some people don't, so we'll get their thoughts on what sort of exercise they would like to do.” P4, line 117–120“It's all patient dependant... if it was someone who came in that has been to the gym all their life, and their want is to have exercise is better to do with using dumbbells or some weights, then they will get those exercises to do, because that's what drives them.” P7, line 157“I might take photos of them doing the exercise... laminate it and send it out to the patient. And they love that. Because they're, ‘Right that’s me. I can do that'.” P12, line 361“Music engagement, interaction with people, something that's fun to do, it doesn't seem like boring lifting weights or anything, but you still get muscles working.” P15, line 642“I'm not sure that I've got a sense with people with this particular disorder of what might be best. I tend to think maybe they're going to have to have individualized things.” P11, line 665“We started the groups... the cost of the class is significantly less. So the idea was to be able to keep people coming along and exercising in a group environment.” P12, line 218“It's finding something that they enjoy that they might actually do.” P16, line 811“The clinicians also believed that exercise early in the time course of PSP is important for optimizing strength and motor function. They advised that it would be easier to introduce before potential complications of cognitive impairment .BOX 2The good thing about early diagnosis and treatment is that there's not, usually there's not as many things going on, so you can focus on starting to implement exercise as a starting block. If you can start early enough, then they can focus on that because they don't have many other things to focus on.” P5, line 967–970“I think the other issue with early vs. late referrals is because there are so many more barriers later, if you are getting referred someone who has those barriers and hasn't exercised in the 3 years of their diagnosis, it's very difficult to make that change.” P3, line 796–798“It would be great to get them in early when they can really participate quite actively in the group... building up strength before losing it, or getting as strong as possible and moving more earlier, rather than waiting for the decline to happen, to then try and maintain.” P12, line 58“I think coming back to that early prescription for exercise and activity for people is a great idea and that's something that I think that could be a game changer for a lot of people.” P15, line 581“The clinicians advised that maintaining exercise and fitness could be empowering and beneficial to health, including over the long term .BOX 3It's (exercise) something that is a tangible thing they can do. I think it really does matter that you give them a sense of empowerment that they are doing what they can do.” P3, line 307“I think strength training is important for anyone. You want to maintain someone's function and mobility as much as possible within this condition. For function–bed transfers, chair transfers, walking–I feel there's a place for strength training within an exercise program.” P4, line 767“She certainly has some other issues with arthritis and so forth. That had an impact on the rate of deterioration... some of that disability wasn't from PSP. It was due to weakness.” P11, line 321“I think there's the physical aspect (of exercise), the physical benefits, the cardiac benefits—just being mobile is so much better for all your body systems... for the psychological, the sense of being able to do some physical activity... Sense of achievement, just the fact that they can achieve something themselves.” P13, line 431“The stronger they are, the better their muscles are, and point out that when people—when we're younger and we lose our balance, we don't always fall because we can correct our balance because we have good muscles.” P15, line 138“Participants discussed the importance of finding regular times for structured exercise, as well as finding individual motivators for exercise. It was recommended that people incorporate exercise into daily activities or a home program, to become a routine activity .BOX 4You try and drum into anyone in our program that those people that exercise regularly and consistently do have better outcomes functionally than those that don't. We try and link their goals at home to exercise.” P4, line 222“It's the advice on finding exercise that works for you that is less of chore, that you can do every day.” P12, line 307“The idea was to try and make things (exercises) as normal as can be in such a situation but not to sort of turn it into another therapy room.” P11, line 228“Ensure... does 20 minutes of bike every day, and does five minutes of arm exercises every day and then aims for 10,000 steps a day.” P5, line 745“The ones who don't want to exercise, I would encourage them to do those sit to stands every now and again, and those functional movements to encourage them to stay as independent and safe as possible.” P7, line 163“It was football that he played as a younger man, and was passionate about sport. So sport and exercise was his thing. So going to the gym on a frequent basis was part of their regular week.” P9, line 509“Each day or five days a week... you need to spend a bit of time doing exercise each day.” P12, line 307“All of the health professionals agreed on the importance of access to evidence-based information and resources supporting therapy for PSP. This was sometimes challenging due to the small amount of research on physical therapies for PSP and the absence of clinical guidelines on exercise for PSP .BOX 5I've found that from an exercise and a speech pathology point of view, it's hard to know what to recommend. I've searched for guidelines and not really found anything clear.” P17, line 247“In terms of treatment, they mostly get treated as per the Parkinson's patients. We run Parkinson's groups and we would have PSP patients in the Parkinson's groups.” P7, line 80“I'll definitely use Dr Google first of all, but I will be looking for national organizations and things like that. Cochrane I find very helpful if I just want to get a reasonably quick idea of what's out there and also probably Pub Med.” P11, line 590“I'm probably not that good at accessing all the research... But as far as relaying that–relaying information from–on research papers on the issue of exercise, it's mainly been informal learning.” P13, line 200“From an OT perspective, we tend to look at things from a more practical perspective. I always try and see whether the Parkinson's skills or strategies are transferable to someone with PSP, and either it works or it doesn't.” P18, line 320“There just hasn't been a lot out there PSP-specific to get to. It's great that it's available but when you need that specific information, it can be hard to find.” P4, line 698“The participants also advised that timing the delivery of exercise information to people living with PSP should take into account the stage of disease progression, individual needs, and suitable amounts of information .BOX 6At the start, it's a very tricky thing for a lot of people to come to terms with, having a diagnosis of PSP compared to Parkinson's, so you don't want to overload them. It's more just taking a graded approach, and identifying where they are in that journey, at what stage, and the most appropriate things that they need at that point.” P4, line 51–55“Sometimes people actually don't want too much information early, and we've got to be so sensitive to where are they in what they want, and what they can manage... there's a lot of inaccurate information out there.” P9, line 234“The manual that we have has got a whole range of—all the different symptoms that can be experienced. Some of us in the health team are more reluctant to send out the whole entire folder. I think the others in the team feel that it's too much information, so it is better to trickle out the information as the time moves on.” P13, line 71“One of the things that we do with our clients here as a priority, is to encourage health literacy, so the minute they come to our service, we're starting to empower them.” P17, line 626“The clinicians in this study indicated that access to reliable information through formal research and education channels was sometimes a challenge for health professionals. Regular staff meetings and informal and formal professional networks and special interest groups were helpful for knowledge transfer .BOX 7I do get calls from physios around town, calls or emails saying do you know anyone who knows anything about this condition.” P1, line 146“Through Parkinson's XXXX, we have the physiotherapist group that meets every two months. If I've got questions, I will just email people through that and say, “Do you have any more information about this?” or, “What do you think about this?” Bounce back a lot on the colleagues.” P4, line 678“It has an—that's right, emotional toll, and you do. You come back and you'll debrief with your colleagues within the team. You do have to get it off your chest a little. It's quite emotionally draining.” P4, line 889“We normally have our own physio meeting, between us physios once a week … to talk about anything's to raise, anyone's got any concerns, anyone's got a problem with a patient or needs a bit of brainstorming.” P5, line 228“There's also hospital wide, sometimes a neurologist would run specific in services and things, about different topics, and we're always free to ask them to talk about certain topics if we want to.” P6, line 411“Part of our service is supposed to be educating local therapists as well, as part of our service, we do have a role in what they call secondary consultation, so people can call us about a patient that we don't know about, for advice et cetera.” P6, line 1,058“We're also quite lucky that our gym was quite large, and everyone treated in the same place. We were able to, even watch and hear how people coach patients … you could learn from not just seniors, but just other colleagues and juniors, on how different things are being said and done, and not just technical skills.” P7, line 265“We do them (in-services) monthly, but they go for an hour and a half. So we really try and delve into a topic and change our clinical practice.” P12, line 800“Every client, we would tell them to contact Parkinson's XXXX. I can't think of a client that we wouldn't say that to, unless they'd already told us that they've been there done that. So it's very much our standard practice to alert them to it.” P16, line 214“Nursing and allied health professionals discussed having a range of skills to offer and noted how interdisciplinary communication and teamwork can be beneficial .BOX 8I personally say that amongst our multidisciplinary health team with physiotherapist, speech pathologist, two nurse consultants, we have many years of experience.” P10, line 51“So we'll refer on to OTs and speechies and neuropsychs who are probably the main loop that we have. And depending on the client, we might have team meetings… We were talking earlier about linking up with musculoskeletal colleagues more.” P12, line 184“It's very important to be reviewed by an occupational therapist or a physiotherapist, to not go out and buy anything (assistive devices) until they've been assessed.” P13, line 391“Unless they come to us later and it's very obvious, then we'll talk about the diagnosis and very quickly talk about allied health as the most important aspect of their management.” P36, line 74“Once I've found out what the physio's recommendations are, then I can reinforce them. That's how I see my role.” P17, line 334“All of the participants acknowledged that care partners can be a valuable asset in providing advocacy and re-enforcement of care plans and exercise programs. The clinicians provided resources and explanations to educate care partners and emphasized the benefits of support groups. However, there were variable levels of care partner knowledge and support. Individual characteristics of resilience and being proactive were seen as facilitators to successful care giving for people living with PSP .BOX 9Having a family member there, or a carer there means that that person will be able to implement the recommendations at home. Also, they can be more actively engaged in therapy or intervention that you're offering, so they can be a therapy partner.” P16, line 74“If you've got a really supportive partner that's engaged and helping to kind of overcome some of those barriers that makes a huge difference or family support of some kind.” P3, line 591–592“Our social worker a few times a year does run a carer support group for ten weeks... They feel like they're stretched thin, carers.” P4, line 251“Another factor to account for is their cognition and that environment that might support them best, and whether their carer is trained to really accommodate, not just the new exercises or the exercises we might be asking them to do.” P8, line 199“And the number of calls that we have that will say, “Where can I meet other people with this condition?” Or “As a carer I'm really struggling, where can I go? Where can I go to meet with other people who can support me?” P9, line 170“The major issue we always stumble on is trying to find a practice partner or a someone who is not their main caregiver because the idea I've always worked on is trying to give the caregiver a bit of a break and not always be responsible for things.” P11, line 156“We are pretty big on getting patients to bring someone with them to the appointments, so that they can take all that information away as well.” P12, line 295“A couple of partners of people with PSP were still coming (to support groups) after their partner had died. They were still attending the group because they had formed a connection.” P13, line 357“We have a carers group that meets once a month where they can come and have some time talking and discussing with other people in the same situation as themselves.” P15, line 92“Nurses and allied health clinicians expressed positive views about the contribution of structured exercises, physical activities, and movement rehabilitation for people living with PSP. Especially in the early stages of the condition, physical therapies were argued to improve health and quality of life. Some professionals advised that high intensity structured exercises might slow the rate of disease progression in people living with PSP, in agreement with studies hinting at the possibility of neural plasticity in Parkinson's disease and related conditions , 25. ForHealth professionals in the current investigation cited barriers and facilitators to exercise participation in people living with PSP. A barrier to the uptake of physical therapies was difficulty in accessing evidence-based resources. This was particularly challenging for PSP due to the paucity of research and the absence of clinical guidelines for this progressive neurological condition. In the absence for this evidence-based resource, nurses, and allied health professionals often turn to the European Clinical Guidelines for Parkinson's Disease to help inform therapy content, dosage, and mode of delivery , 20, 27.Facilitators to exercise in PSP included an early diagnosis, information on individual goals, access to structured exercise, and professional advice from therapists skilled in the management of PSP and related conditions. Furthermore, the effectiveness of treatment was enhanced through regular staff meetings and informal and formal professional networks and special interest groups. In other disciplines, teaching for example, professional learning networks have been reported to enhance a sense of worker autonomy, as well as increasing motivation, by offering access to support and information both locally and on a global scale .There were several limitations to this study. The health professional participants who were recruited had experience with PSP and were actively involved in PSP care. This situation is probably different among generically trained therapists who have less expertise with this complex condition. Although we interviewed nurses, physiotherapists, occupational therapists, and speech pathologists, we did not obtain the views of movement disorders neurologists and some other allied health professionals, such as psychologists, dieticians, social workers, and exercise scientists. This would be very helpful in developing comprehensive inter-professional guidelines for the management of PSP. With regard to response bias, participants may have responded in a way that may have overemphasized their views, given the aim of the study was to investigate participation in structured exercises and physical activities. Additionally, more needs to be done to better understand the content of exercise programs specifically for PSP, optimal delivery modes, and how programs should be tailored depending on the disease stage.To conclude, exercise and physical therapies appear beneficial for people living with PSP and have the potential to improve health and well-being in this debilitating condition. Co-producing evidence with people living with PSP and their care partners on the effects of physical therapies is a high priority for implementation research.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by La Trobe University Human Ethics Committee (Project: HEC18333). The patients/participants provided their written informed consent to participate in this study.MM and SS conceived the idea for the study. MM, SS, CB, and BB were responsible for the study design, study implementation, writing, manuscript revisions, and read and approved the final manuscript. MM was guarantees that the authorship statement is correct. All authors contributed to the article and approved the submitted version.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.


Lack of social support is a known risk factor for postpartum depression (PPD). However, the association between lack of social support from a partner or others and PPD remains unknown. We examined this association among Japanese mothers. We distributed an original questionnaire to mothers participating in a three- or four-month health check-up program over October to November 2012 in Aichi Prefecture, Japan. Of the 9707 eligible mothers, 6590 responded to the questionnaire (response rate: 68%). Social support from a partner or others was assessed based on whether the mother can consult with her partner or others  on childcare. PPD was assessed with the Edinburgh Postnatal Depression Scale. The data were analyzed using multiple logistic regression analysis for four categories: no social support from either a partner/others, social support from a partner only, social support from others only, and social support from both, adjusted for possible covariates. Mothers who have no social support from either a partner/others, have social support from a partner only, and have social support from others only were 7.22 , 2.34 , and 3.13  times more likely to show PPD, respectively, in comparison with mothers who have social support from both, after adjustment of possible covariates. Mothers with no social support from a partner, but have social support from others, showed significant risk for PPD, which may be invisible. Further prevention effort is needed to detect PPD cases, with a focus on mothers without support from their partner. Postpartum depression (PPD) is a serious mental disorder with a prevalence of approximately 10–15% worldwide ,3. WomenRecent studies indicated several risk factors for PPD, including low levels of social support, stressful life events, childcare stress, low income and marital dissatisfaction ,14,15. OAdult attachment style is one of the major determinants of levels of social support . Women wFurthermore, although it can be assumed the partner is the closest person to the mother, the relevance of social support from a partner for PPD has been rarely explored. The risk of PPD in mothers who lack a partner’s support, but have support from others, is often overlooked, since they receive support from several sources other than their partner, such as parents and friends. Therefore, mothers who have support from others, but not from their partner, may be an important high-risk group. To date, there are few studies that have indicated that both a partner’s support and friends’ and family’s support are independently associated with a lower risk of PPD ,26,27,28Participants were recruited from Aichi Prefecture, Japan. All 54 municipalities in Aichi were asked to participate in this study, and 45 municipalities agreed, which resulted in 80% coverage of the total population in the prefecture. The target subjects were all mothers (N = 9707) who were registered in a three- or four-month health check-up program for their children between October and November 2012, in participating municipalities. In 34 municipalities, an anonymous questionnaire was mailed directly to the target mothers before the health check-up program, and answered questionnaires were collected at the health check-up site. In the remaining 11 municipalities, the questionnaires were distributed at the check-up sites and the participants sent completed questionnaires by mail to each health center. In total, the participation rate for the three- or four-month health check-up in Aichi Prefecture was 97.9%, and 6590 women responded to the questionnaire . Single mothers  (n = 104) and mothers with missing responses to questions about marital status or social support (n = 395) were excluded from the sample, resulting in a sample size of 6195 mothers.This study was approved by the Ethics Committee of the National Center for Child Health and Development (code: 611). The Ethics Committee approved that personal informed consent could be exempted if participants responded anonymously to the questionnaire.The questionnaire assessed women’s social support regarding the number of persons they can consult about childcare and whether mothers can consult with their partner, parents, relatives, and friends who are close by or far away, respectively. The following questions were asked (in Japanese): “How many relatives or friends can you consult with about childcare?” and “If you have someone to consult, who can you consult with? Please circle ‘Yes’ or ‘No’ based on whether or not you can consult with for each of the following person(s): partner, your parents or your partner’s parents, relatives , friends who are close by, and friends who are far away”. Mothers who can consult with their partner were defined as “mothers having social support from partner”. Likewise, mothers who can consult with at least one person other than their partner  were defined as “mothers having social support from others”.The Japanese version of the Edinburgh Postnatal Depression Scale (EPDS), a 10-item self-report questionnaire, was used to evaluate PPD . Items wThe questionnaire also assessed the parental characteristics, gestational and perinatal characteristics, maternal history of intimate partner violence and history of mental disorders. Parental demographics include maternal and paternal age, whether expectant mothers had someone who supported them during pregnancy (yes/no), subjective economic status , maternal and paternal employment status , cohabitation status . Gestational and perinatal characteristics include having infertility treatment (yes/no), feeling when they noticed the pregnancy , sex of the child , birth order , delivery satisfaction (yes/no), low birth weight of the child (<2500 g), preterm birth (<37 weeks), maternal smoking and drinking history during pregnancy (yes/no), history of miscarriage and termination of pregnancy (yes/no). Maternal history of intimate partner violence includes verbal and physical violence . Maternal history of mental disorders includes whether women had depressive symptoms during one year prior to pregnancy and whether women had previously been diagnosed with a mental disorder or had received treatment for a mental disorder before getting pregnant. Age difference between parents was calculated by subtracting maternal age from paternal age. As for subjective economic status, “difficult to manage” and “unstable” were collapsed for the analysis, since a low percentage of participants answered “unstable” (2.2%) . The resp-value of <0.05 was considered to be statistically significant. All analyses were performed using the STATA/SE 13.1 software package .The associations between possible risk factors and PPD were analyzed using multiple logistic regression, especially regarding four categories of mothers, . In addition to an initial bivariate model, adjusted models were employed. Model 1 was adjusted for demographic and social covariates, including parental demographics . Model 2 was further adjusted statuses for covariates in model 1 plus gestational and perinatal covariates . Model 3 was adjusted for covariates in model 2 plus both verbal and physical intimate partner violence. Finally, model 4 was adjusted for covariates in model 3 plus mental health status . Paternal age was not used due to multicollinearity with maternal age (r = 0.71). As a reference group, a category with the lowest risk of PPD or that with the largest number of participants in each variable was used. A Participant characteristics are presented in As shown in To the best of our knowledge, this is the first study investigating the association between social support from a partner and others, such as grandparents or friends, and PPD using a large number of subjects in Japan. This study found that the lack of either social support from a partner or others showed higher risk of PDD in mothers, compared with those who have social support from both a partner and others. Furthermore, mothers that do not have social support from either a partner or others showed high risk of PPD, that is, 7 times more likely to have PPD.Several studies reported that a lack of support from a partner was associated with PPD ,27, and There may be several possible mechanisms between the lack of support from a partner and PPD. First, parenting stress can be higher among a nuclear family, thus, expectation for support from a partner might be high, resulting in a lack of it posing more stress, which can be a risk of PDD. In fact, among the families raising child(ren) in Japan in 2017, 82.7% of them were nuclear, whereas only 14.2% were living with grandparent(s) . In nuclOur results also showed that mothers who did not have support from others have higher risk of PPD. Several mechanisms between a lack of support from others and PPD can be considered. First, relative stress due to comparison with other mothers might be a risk for PPD, and support from others can mitigate the relative stress. For example, if they were unable to breastfeed, they may blame themselves and lose their confidence as a mother. Mothers who have support from relatives or friends share their challenges and difficulties in childcare and receive comfort and encouragement. This reassurance can be considered as a protective factor against PPD. Therefore, mothers without support from others may have a higher risk of PPD than those with support from others. Second, mothers with insecure adult attachment, especially avoidant attachment style, tend to have lower levels of support from others. Thus, mothers with avoidant attachment style are thought to have higher risk of PPD. In fact, several studies identified insecure attachment style as a risk factor for PPD ,23. Furtp = 0.14 and 0.26 in model 4, respectively). This might imply that a lack of support from a partner and others independently increased the risk of PPD, and those who do not have support from a partner or others can be considered as the highest risk group in terms of social isolation.Our results also revealed that mothers without support from either their partner or others had a higher risk of PPD than those with support from both. The OR of mothers without any support tended to be higher than that of mothers with their partner’s support only or that of mothers with others’ support only, although the difference did not reach statistical significance (In addition, our results also showed that both young mothers aged <25 years and old mothers aged ≥40 years were associated with PPD . Young mThe present study has several limitations. First, it is not possible to determine the causality between a lack of social support from a partner or others and PPD due to a cross-sectional design. It is possible that depressed mothers tend to evaluate levels of social support more negatively than non-depressed mothers. Thus, longitudinal studies with more frequent measurements of both levels of social support and PPD are required to estimate the causality. Second, although the EPDS is a well-validated screening scale , it is nDespite these limitations, the current study provides insights into the protective effects of social support on PPD. In Japan, approximately 8–15% of mothers experience PPD ,42. JapaIn conclusion, a lack of social support from a partner or others, which is defined as women not being able to consult with their partner or others, increases the risk of PPD. Additional longitudinal research, including more frequent assessment of these factors and PPD, is needed to determine the causality between these risk factors and PPD.


To Durkheim, language was a “social thing in the highest degree” that enabled general ideas and intermediated them to people. Abstract human ideals like the civil religion since the French Revolution could be shared through (a common) language. Thus, Durkheim took the exclusive use of French in the Third Republic’s laic public education for granted, ignoring the patois in the country: This “child of the Enlightenment” considered French to be a universal language of Gesellschaft and, beyond ethno-communal elements, to work as a basis for the organic solidarity of French national civil society where the social division of labor was progressing. Durkheim’s theory was predicated on civil-linguistic, not ethnolinguistic, nationalism.When Thomas Luckmann, a pioneer of the “linguistic turn” in sociology, regarded Émile Durkheim as a source for the sociology of language, he had lifeworldly community–building in mind. However, the French sociologist himself understood language in the context of  An honorable fact for France is that it has never sought to obtain the unity of the language by means of coercion. Can’t we have the same feelings and thoughts, love the same things in different languages? […] Let’s not abandon the fundamental principle that a human being is a rational and moral being before being cooped up in this or that language, before being a member of this or that race, an adherent of this or that culture. Before the French culture, the German culture, the Italian culture, there is the human culture.What is a Nation?  integration; French makes it possible for French citizens to share civil religion, a system of ideals, that Durkheim called moral individualism and that leads to organic solidarity despite the social division of labor. Third, I will also indicate that, as a prerequisite to sharing civil morality, Durkheim suggested the exclusive use of French in laic school education, although France in those days was a multilingual country. In his view, those who shared the Revolution’s modern human ideals beyond lifeworldly ethno-communal elements were free and equal members of French civil, yet national, society and, therefore, had to share the French language as a universal medium beyond patois. As I suggest above, one could name this view civil-linguistic nationalism to distinguish it from ethnolinguistic nationalism that, as seen in Germany, identifies the nation with a community in which the people ethnically share a language (and the Volksgeist based on it).First, I articulate the theoretical position of language for Durkheim. Less famously, he characterized language as a society’s soul. Durkheim’s view on language seems to have been closely associated with this national goal, underlying his sociology of education and that of religion, and it would therefore have to receive special attention. On the other hand, from a sociological perspective, it should not be overlooked that the self-identification of French national society as a “community of citizens” can, in this globalized era, lead to or be abused for exclusionism. In the conclusion, I will refer to this actual, paradoxical phenomenon of French modern human ideals instilled through a laic education—but similar phenomena may more or less be found in other national societies today.In the French Third Republic, French monolingualism was a presupposition for laic education to make all the people  a posteriori into French citizens who hold common civil-religious ideals or ein gesellschaftliches Apriori)” (Luckmann Gemeinschaftsbildung) without language is inconceivable”  to which I have not collaborated, that is, a knowledge more than personal; and it surpasses me to such an extent that I cannot even completely appropriate all its results for myself” ,” which Dominik Schnapper ([1994] communion des esprits)”  by citizens who shared modern human ideals and spoke French, the “common language of citizens for free communication”   institutions based on collective lives, representations, and ideas, into six more specialized fields: religious sociology, moral sociology, legal sociology, economic sociology, aesthetic (artistic) sociology, and Language, which depends on organic conditions in certain respects, is, however, a social phenomenon: because it is also always the work of a group whose mark it carries. Language is, in general, even one of the elements characteristic of the appearance of societies, and it is not without reason that the affinity of languages is often used as a means to establish the kinship of the peoples. There is, therefore, a material for a sociological study of language, which has, furthermore, started.  and the signified (signifié), that the bond has binding force for individuals. “The signifier, though appearing as freely chosen concerning the idea that it represents, is on the other hand fixed, not free, concerning the linguistic community that uses it. […] [T]hey [the masses] are bound to the language as it is”  of the bond between the signifier  ideas; and (thereby) bringing human beings into intellectual existence:In learning a language, we learn a whole system of ideas, distinguished and classified, and we inherit all the work from which have come these classifications that summarize centuries of experiences. There is more: without language, we would not have, so to speak, general ideas; for it is the word which, in fixing them, gives to concepts a consistency sufficient for them to be able to be handled conveniently by the mind. It is, therefore, language which has allowed us to raise ourselves above pure sensation; and it is not necessary to demonstrate that language is, in the highest degree, a social thing. (Durkheim théorie sociologique de la connaissance)” . Durkheim’s following statement appears to suggest this affinity:[L]anguage is not a sort of external garment that would clothe thought from the outside without ever being able to satisfactorily fit. In reality, language is rather an integral element of thought. Language makes possible thought at least as much as it presupposes it. Without language, thought could not go up very high; for all the somewhat complex forms of mental life could not have been constituted without the help of words. Hence, with words, with language, we have something of thought and, consequently, to study language is, if one knows how to do it, to study thought itself. ” for language also appears. Neither should Durkheim’s reference to Rousseau’s linguistic view be ignored  and society (Gesellschaft), arguing that the former is superior to the latter in terms of morality and solidarity: Community is a living organism and genuine living-together, while society is merely a mechanical artifact and an apparent living-together  as a natural foundation for solidarity:Durkheim’s linguistic view, too, fits this thought. To clarify, the comparison of his social theory with Ferdinand Tönnies’s might be useful. This German sociologist famously distinguished between Verständnis)linguistic expression is the spontaneous outcome of deep feelings and prevailing thoughts, and it does not work, as an artificial tool with no natural underlying understanding, for the intention for one to make oneself understood. ”  contained in the German concept of Gemeinschaft. With French society in mind, Durkheim remarked, “To be attached to society is to be attached to the social ideal”  would usually come into existence through a cross-cultural linkage of communities (Gemeinschaften), which would respectively have their own vernacular and Volksgeist. Therefore, to presume the linguistic homogeneity of society to be a natural given is naïve. Durkheim’s French society achieved linguistic unity by artificial means like school education, and the French language thereby became the language of Gesellschaft with which society’s soul is shared beyond the languages of Gemeinschaften.Durkheim then thought that the common language must be pre-shared for the moral unity of France so that the common ideal can be shared in national society despite its differentiation and individualization. Important here is that society could contain a linguistic diversity at least at the beginning, because it is not always the grown form of one linguistically homogeneous community. Rather, society (l’État) as the control entity of the social organism, calling it the “cerebrospinal system” controlling other organs ” (Durkheim [1925] laïcisation) of morality through school education (Durkheim [1925] laïcité (laicism) in the Third Republic:Durkheim’s argument about education had the goal of building French civil society: “[E]ducation must assure, among the citizens, a sufficient community of ideas and sentiments without which any society is impossible”  had virtually given up modernizing (laicizing) primary education while nonetheless creating a prototype for an elite-education system: the secular system of secondary and higher education like École Centrale (or Lycée), Grande École, and Université Impériale  “are and must be the guardians par excellence of our [French] national type”  […]. [T]he school is the only moral environment where the child could methodically learn to know and love it [the fatherland]”  logic, the moral unity of society requires monolingualism, in which one language is universally shared as the ultimate social thing.Durkheim conceived that state-supervised schools function as modern public facilities for socialization in a way that differs from socialization by the family as well as church: In his view, families do not encourage children to cultivate their own individualities and to grow to respect the dignity of others . For children to adopt this universal morality, they should be released from family and interact with various people in school  and stating that (only) French is suitable for expressing the general ideals of the French Revolution:Nevertheless, Durkheim gave no sociological account to multilingual France, strangely for a pioneer of the sociology of language. He would have known local speech: His hometown, Épinal in Lorraine, was near Alsace,our language [French] itself bears its imprint. Because it [French] is essentially analytical, it is marvelously suited for expressing such a way of thinking. . Durkheim, despite his language-relativist views, seems to have adopted the hierarchy of analytical quality among languages. This belief in the supremacy of French over other languages is already a kind of linguistic nationalism, but it is not limited to Durkheim. Combined with the loyalty to the State, such a belief was seen in the French liberal intelligentsia of those days, as Hughes points out, “[T]he French intellectuals were not even remotely tempted to renounce their national allegiance. […] The French writer or scholar simply assumed that his country was the center of the civilized world, as its language was the most perfect vehicle for intellectual communication”  in 1789 , the revolutionary government insisted on linguistic uniformity as a condition for full French citizenship and nationality Hobsbawm , p. 21. We revolutionized the government, the laws, the customs, the lifestyles, the costumes, the commerce, and the thought itself; thus, we shall also revolutionize the language that is their daily instrument. […] Federalism and superstition speak Low Breton; immigration and hate of the Republic speak German; counter-revolution speaks Italian, and fanaticism speaks Basque. We shall break these instruments of misfortune and fallacy. Barère , p. 8Four months after this, Henri Grégoire, who had known through his cross-country survey in 1790 that the native French speaker was a minority, also declared:langue de la liberté).  of the Third Republic nationalized the children of the peasants in the provinces of France and those of immigrants, teaching them French and calculation, if necessary, brutally, and forbidding them to use the language of their parents.  spoke no French, and another 37% spoke or understood it but could not write it  shows “the normative ambiguity of the nation-state’s position in modernity”  organized in 1900  to be harmful to national unity  no longer exist nor can they exist. The general life of the country [France], definitively unified, is impervious to all dispersion of this sort. We may regret a thing which no longer exists, but those regrets are in vain. It is impossible to artificially resuscitate a particularist spirit which no longer has any foundation.  themselves might have been romantically “imagined” in competition to Paris. However, Durkheim’s sarcastic statement above would then be exaggerative and as such reveal his sense of rivalry with regionalism. He positively evaluated centralization linked with the Revolution, saying that it developed in parallel with civilization  are to liberty what primary schools are to knowledge”  be lost with growing interrelationships between local-territorial, segmental aggregations : He thought that any re-empowerment of local community leads to retrogression from modernity to pre-modernity, since decentralization would disturb the moral leveling of citizens and its underlying linguistic leveling and, in consequence, dissolve the organic whole of civil society into segmental communities again. Thus, in Durkheim’s view, “antisocial provincialism” , which seemed to him to successfully make the social division of labor and organic solidarity compatible with each other beyond the pre-modern spatial arrangement of communities:As is known, Durkheim proposed to revive occupational groups or corporations as an intermediating, secondary organ of the social organism   must know it.The linguistic integration through French was a premise for this occupational decentralization, since common language functions, in organicist manner, like nerves, which smoothly connects all functionally differentiated organs and, for civil solidarity (fraternity), transmits the same moral instructions  from the cerebrospinal system, the primary organ of social organism, to individuals.civil-linguistic nationalism in contrast to ethnolinguistic nationalism in then Central Europe  As Daniel Baggioni says, “[I]n the German conception, in the beginning were language and culture, while in the French conception language is only an instrument of political and cultural, or rather ‘civilizational,’ unification”  to the civic nation (society’s soul). Then, to overcome ethno-communal differences and to form the national civil society by universal ideals, he believed that the linguistic medium for the public life had to be French. French as a social fact was ideal rather than real.Durkheim obviously presumed the “nationalist equation of one language = one nation = one state” Auer , p. 8. Afrancophonie conterminous with the national borders. According to him, “[L]anguage is fixed; it changes only very slowly, and consequently the same applies to the conceptual system that it expresses”  in terms of its national ideal. Non-French languages were treated in the public sphere in the way that the veil worn by some Muslim women  is treated today—however, language may not simply be taken off. As Durkheim believed, it is more than a mere “external garment.”Conseil Constitutionel) judged that ratification of the Council of Europe’s European Charter for Regional or Minority Languages was unconstitutional, Jean-Pierre Chevènement, then interior minister and a member of the socialist party, was also against ratification of the Charter, saying that the recognition of regional languages “balkanizes” the one and indivisible Republic . Before these incidents, the sentence “The language of the Republic shall be French” had been added to Article 2 of the Constitution under the socialist party’s regime in 1992, just before the ratification of the Maastricht Treaty by referendum. The original intention of this amendment was a cultural-differentialist resistance against English imperialism ,a global-social thing in the highest degree, is a form of regionalism.Note that French monolingualism—or, if one may, French linguistic-imperialism—is also common among French leftists Miura /14. HoweConsequently, such a “pro-French” movement would be linked with the ethnicization of the French language such that the line between left and right disappears  ” in support of laicization in public education. In such a national-republican atmosphere, it was no wonder that some young people of immigrant origin were, although sufficiently “secularized” by the French standard, attracted to a different community, one unfortunately containing militant extremism.Meanwhile, in today’s France, another issue concerning national integration has emerged: French society, contrary to the national ideal, has not always allowed immigrants to fully assimilate (not: immigrants themselves have not assimilated); therefore, young people of immigrant origin—especially from a Muslim background—experience a sense of alienation from society. Such a sense is heightened more because they have share both French language and moral individualism. A symbolic and paradoxical incident happened in 1989, the bicentennial year of the Revolution: when three junior-high schoolgirls were expelled from school for refusing to remove headscarves (hijabs) in the classroom, five famous republican intellectuals proclaimed, “Teachers, let’s not give in! ”  opinion on minorities as seen above, also noticed that French cosmopolitanism could become exclusionist patriotism, and had frankly admitted that the French national character, because of its simplifying rationalism, is prone to overlook complexities that cannot be imagined in abstract form  as an optional subject at primary school (Miyajima Yet, Durkheim’s social organicism—we could call it Miyajima , p. 119.


This paper is a new step towards understanding why “quantum nonlocality” is a misleading concept. Metaphorically speaking, “quantum nonlocality” is Janus faced. One face is an apparent nonlocality of the Lüders projection and another face is Bell nonlocality . According to the Lüders projection postulate, a quantum measurement performed on one of the two distant entangled physical systems modifies their compound quantum state instantaneously. Therefore, if the quantum state is considered to be an attribute of the individual physical system and if one assumes that experimental outcomes are produced in a perfectly random way, one quickly arrives at the contradiction. It is a primary source of speculations about a spooky action at a distance. Bell nonlocality as defined above was explained and rejected by several authors; thus, we concentrate in this paper on the apparent nonlocality of the Lüders projection. As already pointed out by Einstein, the quantum paradoxes disappear if one adopts the purely statistical interpretation of quantum mechanics (QM). In the statistical interpretation of QM, if probabilities are considered to be objective properties of random experiments we show that the Lüders projection corresponds to the passage from joint probabilities describing all set of data to some marginal conditional probabilities describing some particular subsets of data. If one adopts a subjective interpretation of probabilities, such as QBism, then the Lüders projection corresponds to standard Bayesian updating of the probabilities. The latter represents degrees of beliefs of local agents about outcomes of individual measurements which are placed or which will be placed at distant locations. In both approaches, probability-transformation does not happen in the physical space, but only in the information space. Thus, all speculations about spooky interactions or spooky predictions at a distance are simply misleading. Coming back to Bell nonlocality, we recall that in a recent paper we demonstrated, using exclusively the quantum formalism, that CHSH inequalities may be violated for some quantum states only because of the incompatibility of quantum observables and Bohr’s complementarity. Finally, we explain that our criticism of quantum nonlocality is in the spirit of Hertz-Boltzmann methodology of scientific theories. In the last few decades too many futile technical terms in the context of correlation measurements have been created which are not well defined. They evoke different associations in the discussion on entangled systems and these associations are sometimes rather confusing. As was emphasized in recent paper   reasoning  from theWe remark that the projection postulate is often associated with von Neumann. It is common to speak about the von Neumann projection postulate. However, von Neumann  used it local incompatibility of observables. Thus, the Bell test can be interpreted as a very special test of the Bohr’s complementarity principle. Purely quantum treatment of the Bell type inequalities does not leave any place for nonlocal speculations. A similar conclusion can be found in works of De Muynck )law of cause and effect. It states that for every effect there is a definite cause; likewise, for every cause, there is a definite effect. EM provides a consistent description and prediction for experimental data. As early as in the 19th century, scientists understood well (at least Hertz and following him Boltzmann) that experimental data is statistical and its description and theoretical prediction are probabilistic. For them, it was clear that EMs need not be causal . He started his activity  with a rComing back to the Einstein-Bohr debate, we can say that Einstein said that QM is not a TM, Bohr replied that he did not see a problem, since he knows that QM is a EM. It seems that Bohr did not reject a possibility to construct a consistent TM for QM (treated as EM), but he would not accept the Hertz-Boltzmann-Schrödinger viewpoint on the structure of a scientific theory. He considered such kind of activity as metaphysical, and hence, meaningless. In contrast, Einstein badly wanted a TM for QM, but (as latter Bell) he wanted too much from the map TM→EM.prequantum classical statistical field theory (PCSFT) [As to one of possible TMs for EM = QM, we can point to  (PCSFT) , the claDid Bohr and Einstein  know about the works of Hertz and Boltzmann ,54,55,56Ontic;Epistemic.Finally, we remark that modern philosophers operate with a similar scheme of the two-level structure of scientific theories :Ontic;EpIt is surprising that philosophers  are not aware of the works of Hertz and Boltzmann. However, this not the main problem with the ontic-epistemic approach. The main problem is that the ontic level represents reality “as it is” (when nobody makes measurements). For Hertz and Boltzmann, TM was not about reality as it is, but just its mental “Bild” being consistent and respecting the law of cause and effect.Now, turn to “spooky predictions”. We recall that “spookiness” is related to the impossibility to construct a causal picture of physical phenomena. However, generally it is not EM’s aim to present a causal picture. The latter is given within TM.  Therefore, I think that Plotnitsky’s slogan “spooky prediction at a distance” is misleading, no different to Einstein’s slogan “spooky action at a distance”.Classical optical correlations can reproduce the quantum correlations of the EPR-Bohm experiment , througThus, although at the formal mathematical level the state conditioning in classical optics coincides with quantum state conditioning, their probabilistic meanings are different. The latter (quantum) formalizes probability conditioning based on statistics of discrete events and it is close to classical probability conditioning based on the statistical interpretation of probability.discrete observations (generating quantum phenomena).This is a good place to remark that nowadays the aforementioned crucial difference between quantum and classical measurement procedures is commonly neglected, even in foundational works (maybe besides the works of Plotnitsky who permanently emphasized the role of Bohr’s notion of phenomena in quantum foundations). Personally, I understood the importance of Bohr’s phenomena for quantum foundations only by analyzing the difference between quantum and classical entanglements  . This sort of nonlocality can be considered as apparent quantum nonlocality, in contrast to subquantum  nonlocality. It is important to distinguish these two nonlocalities sharply. They are often mixed in the heads of scientists advertising “quantum nonlocality.” This two-faced Janus is often seen as having just one face—quantum nonlocality.This mental mixing is explainable by taking into account coupling between Lüders and Bell nonlocalities. This coupling was excellently presented in Aspect’s paper . AccordiBell nonlocality was elevated to quantum physics and also was treated as quantum nonlocality. Two-faced Janus of quantum nolocality was born.Bell proposed a class of subquantum models known as models with hidden variables ,7. For sIn , it was  by Bell ,7.In the present paper, it was shown that Lüders nonlocality is the typical “nonlocality” of probability conditioning, similar to “nonlocality” of CP-conditioning. Both faces of nonlocality-Janus were destructed.In this paper, we emphasized the role of two basic interpretations of a quantum state, individual  vs. statistical. Following Aspect’s reasoning and assuming that a quantum state is the physical state of the individual quantum system, one can really confront Lüders nonlocality. On the other hand, the statistical interpretation combined with treatment of quantum mechanics as machinery for probability conditioning (the Växjö interpretation ) impliesprobability conditioning on the basis of the quantum calculus. (We stress, see Coming back to Summhammer’s comment cited in introduction and his question, I say that the right scientifically-justified terminology for “faster-than-light change of statistical correlation” is


Temperament is a key issue in beef cattle production systems, as it defines the responses of animals to human handling and to potentially challenging or fear-eliciting situations. However, little is known about how farmers define or assess temperament. Focus group discussions were carried out in order to analyze the perceptions of farmers regarding a series of temperament traits of animals, focusing on the Pyrenean cattle breed. Farmers described animal temperament using several adjectives such as “strong”, “aggressive”, “nervous”, “fearful”, “brave”, or “smart”, which account for their integrative vision of this concept. They reported a differential long-term development of the temperament of cows and bulls and mentioned that external features are not reliable indicators of temperament as compared with animal behavior. Sensory acuity, such as sight, hearing, and smell, were thought to be related to temperament. The results of this study are useful to better understand the decisions of farmers about cattle buying, selling, or culling, and their perspective about temperament should be considered in the research and design of genetic improvement schemes.Understanding temperament is an important part of cattle production since undesirable temperament may cause serious problems associated with aggression, maternal care, and human safety. However, little is known about how farmers define or assess temperament, especially in autochthonous cattle breeds. The aim of this study was to explore perceptions of farmers about the temperament of the Pyrenean cattle breed with special attention to beef cow-calf systems in Spain. The methodology used to obtain the information was focus group discussions (FGD). Farmers defined temperament as a behavioural response to challenging situations imposed by human handling. Specific terms used were related to active or passive reactions to fear . The speed of response to stimuli was also important. Female temperament was thought to become more docile with age while bull temperament was more variable. Maternal aggressiveness was highlighted as a potential human safety problem, but also desirable in an extensively bred animal who may need to defend calves against predators. Anatomical characteristics were seen as unreliable predictors of temperament, while behavioural indicators were more widely used, such as “alertness”, which was a general trait of the breed, and “gaze”, which, when associated with an alert expression, suggests a potential threat. Sensory acuity, such as sight and smell, were thought to be related with temperament in some FGDs but there was no overall agreement as to whether different behavioural responses were due to differences in sensory acuity. The results from the study could be useful during training programs or in the development of new genetic selection schemes and evaluation protocols involving cattle temperament. The study of individual differences in animal behavior that are consistent across contexts and across time is now wide-spread throughout animal sciences, giving rise to terms such as animal temperament, personality or coping styles ,2,3. AltHowever, there is still little research on cattle temperament from the farmers’ perspective. The progressive industrialization of beef and milk production and the concomitant increase in herd size may affect a farmer’s knowledge about individual cow temperament . In spitPyrenean cattle are an autochthonous Spanish breed that was in danger of extinction during the 1960s and 1970s  but has The Pyrenean cattle breed is an autochthonous breed closely linked to the mountain landscapes of the Pyrenees. Although it has been described in works that go back to the 19th century, it was officially recognized as a breed in 1905, with the creation of the Herd Book, which has been maintained until today. Since 1920, it has been progressively specialized towards meat production, replacing the triple work-meat-milk aptitude that it previously had . AlthougIn each autonomous community, a virtual invitation to participate in the FGD was sent via the National Confederation of Pyrenean Cattle Breed Associations (known by its Spanish acronym CONASPI) to the members of the regional associations. In order to favor a certain compatibility and cohesiveness of the group and to facilitate the free expression of participants, some inclusion criteria were applied. Farmers needed to: (i) be currently employed as cattle owners (no retired farmers), (ii) have at least three years of experience in breeding Pyrenean cattle, (iii) be in charge of handling animals directly, and (iv) not be involved/aware of the scientific study of temperament. The farmers that finally attended the invitation were all male, between 25 and 65 years, from cattle farming families, having had direct contact with cattle of several breeds during most of their lifetime. The number of participants ranged from 8 to 11 people per FGD, an effective group size to encourage open discussion  with a tA common meeting agenda was designed for each FGD to enable a joint analysis of all the material collected. Each FGD lasted between 60 and 90 min and was recorded (with participants’ consent) and facilitated by the same two researchers, a moderator and an assistant, neither having had previous contact with the participants. The moderator introduced each topic, promoted discussion, exhorted excessively talkative participants to let others talk, and encouraged all participants to speak, without introducing bias or pressures , while tA thematic analysis was conducted according to the principles described by Braun and Clarke , in a prEach FGD began by asking participants for a definition of temperament. In all FGDs, that definition was related with the general reaction of animals to a wide range of fear-generating stimuli. Examples of such stimuli were human presence, handling, other animals, unusual sounds or objects in specific situations (opening an umbrella). Particularly in FGD 4, several participants also perceived temperament as a stable condition of cattle character, defining it as “personality, the strength or character of the animal; whether it’s aggressive or not, whether it’s calm or agitated by handling” (P1). In the other FGDs, references about the persistent character of temperament focused on attributes that were seen to be problematic for handling: “A cow that escapes from an enclosure will always do that, it’s rude once, it’ll always be rude” . In all FDGs, the description of temperament included multiple adjectives or descriptors, and elicited several discussions focused on which were general characteristics for the breed. There was a shared opinion that although the temperament of Pyrenean cattle can be differentiated from other breeds, within the breed “each cow is unique, in a world of its own” .When describing the temperament of the Pyrenean cattle, farmers’ discussions focused on temperament traits of the breed and temperament traits observable only in some animals . In termWhile mentioning the above, participants also highlighted the breed’s ability to survive and adapt to changing environmental conditions. This is especially evident when grazing in open lands without human supervision, where Pyrenean cattle are more adapted (than other breeds) to; (i) find the best pastures, (ii) take advantage of poor pastures, (iii) orient themselves and climb the most rugged mountain areas, (iv) give birth in the mountains, care for calves, and flee or face potential calf predators. In this regard, participants described Pyrenean cattle as “braver”, “livelier”, “fiercer” or “smarter” than other breeds. The above temperaments had also been observed in circumstances other than grazing. For example, a participant of FGD 4 pointed out that the Pyrenean cow “is more aware that I’m going to feed her, or pick up the calves, or whatever. She realizes these things are happening before any other cross-breed or pure breed” (P7).However, particularly linked to the “alert” adjective, some participants in all FGDs also mentioned the existence of temperament descriptors such as “avoider”, “nervous” or “fearful”. Those terms were used to refer to animals whose flight behaviour is unusually frequent, reactive, fast, and accompanied by a lot of movement. These descriptors were mentioned more frequently in FGD 1, where some participants related them to a general condition: “For me the temperament of this breed, although you can also see it in other breeds, but more in the Pyrenean breed, is that despite being very docile, at a specific moment, due to some action, it reacts in a way that tends to be… that it reacts very quickly and strongly, very savagely” (P3). In this FGD, some participants reported unexpected situations that, in their opinion, caused exaggerated and unjustified flight reactions in their animals. These include, for example, the opening of an umbrella in a stable, a strange sound or a sudden movement by the owner (bending over). The above observations contrast with the other FGDs where participants argued that those temperament descriptors were not generalizable and that the same traits could be found in any breed. One cattle farmer in FGD 4 suggested, as a possible explanation to the sudden or exaggerated cattle movements, that “due to its shape, its makeup, its agility, it appears to make more sudden movements” (P6)..Another descriptor used in the FGDs was “strong temperament”. Some participants described it as a synonym for “nervous”, focusing on the strength of the movements of fearful or avoider animals, while others referred to cattle with “more temperament” that stand up and do not step away from humans: “A farmer friend used to say that the Pyrenean cow had that gaze, and that people looked at it and said, “it seems quite imposing”. No, the Pyrenean cow stares at you that way since it has nothing to be embarrassed about” . In FGD 3 there was a disagreement about whether a “strong” character was a general condition of the breed because some farmers related that term with having “bad manners” (rude disposition). Additionally, there was an agreement in all focus groups that adjectives such as “strong”, “nervous”, “on guard” were not related to aggressiveness. On the contrary, all participants pointed out that aggressiveness was an exceptional condition , and that aggressive behaviour tended to be observed in specific situations related with reproduction In FGD 1, FGD3, and FGD 4, several discussions arose about the relationship between the breed’s capacity to survive and reproduce without human help  and those related to the rapid detection and fear reaction even to inconspicuous generating stimuli . Some farmers mentioned that the “strong” temperament of this breed can be an advantage for survival, specifically to protect offspring from predators. Others related an “alert” or “on guard” temperament to a greater probability of survival under extensive mountain grazing conditions. This was related to the opinion that the frequency of handling and artificial selection reduces the aforementioned attributes, although they may improve docility. Other farmers, in contrast, pointed out that it is possible to select for animals that combine both conditions, as nervousness (or fearfulness) is different from the capacity to survive and reproduce without human help. In fact, they suggested that a more nervous temperament could force an animal to remain “hidden in the bushes” and not gain weight.To place temperament within a broader context, participants were asked to compare Pyrenean cattle to other breeds. Farmers were familiar with Parda de Montaña, Holstein, Limousin, Blonde d’Aquitaine and Gascon breeds. With the exception of Parda de Montaña, allusions to other breeds tended to highlight the positive aspects of the temperament of Pyrenean cattle. Farmers expressed that there is a generalized idea that Parda de Montaña was more docile. However, while FGD 1 were in agreement with this idea, only some participants in the other FGDs were. According to some opinions, the management of the Parda de Montaña is less extensive, and they have more contact with humans, which could explain these differences. Additionally, in all FGDs some farmers brought up their own or third-party experiences related to truck loading or vaccination, in which Parda animals were nervous and even aggressive. These experiences were used to explain that such behaviour may be similar in all breeds in stressful situations, so that the differences between Pyrenean and Parda breeds could just be a matter of reputation or lack of knowledge. Regarding the other breeds, most farmers focused on their negative temperament characteristics. Holstein cattle was suggested to have a “tricky” or “unpredictable” temperament. Limousin and Gascon were described as stronger and more fearful than Pyrenean cattle, as well as Blond d’ Aquitaine. Hence, in all the FGDs, this debate helped to reinforce the idea that Pyrenean cattle had a non-aggressive temperament.When asked about the role of genetics, age, and sex in temperament, farmers agreed that these factors can make an animal’s temperament different from another. Additionally, sensory acuity of Pyrenean cattle emerged consistently as a new theme in all FGDs, being mentioned as a factor that can influence the way animals perceive stimuli .There was a general consensus that the temperament of parents can be reflected in their offspring. However, there was some disagreement about the degree of this effect, since some participants observed variable effects from the bull or cow parent. Farmers in all FGDs highlighted the heritability of the bull’s temperament in its offspring using explanations like: (i) “if the bull is fearful, the calves are fearful” (FGD 2); (ii) “now we have noticed that, thanks to genetic selection of the bulls, the temperament of the daughters is much better than their mothers” (FGD 4). One participant from FGD 3 suggested a possible explanation for this: “one bull produces many daughters over a short period of time; the bull is the father of all of them and you can relate them to one another, while cows do not have that many daughters” (P5). Most farmers also recognized that cows also affect calf temperament but that it goes beyond genetics, due to the strong cow-calf bond during the first months postpartum. They explained that during this period “if the cow walks, the calf walks, it’s always like that” , while the calf “hardly knows the father” . They explained that the calves observe and learn how their mothers react to stimuli. In the opinion of some participants, that means that the mother can have a greater influence on calf temperament than the bull, especially when calves are born in the mountains and remain isolated with their mother for several months, without human contact.Farmers in all FDGs agreed that temperament evolves differently in females and males, with the former being more reactive during their first years of life and becoming increasingly docile with age. As stated by a farmer from FGD 1 “...and then there are some that are bitter their whole lives, but when they turn three they become more grateful. But those first three years, well! I have one that jumped through window years ago, but now follows behind me as calm as can be” . However, they also acknowledged that there can be a few “problematic” animals, whose nervous or reactive temperament is consistent throughout their lifetime. There was some disagreement about when the relatively higher reactivity in cows  changed towards greater docility, varying from (i) the time of the first calving ; (ii) five or seven years old (FGD 2), and (iii) the third or fourth calving (FGD 3 and 4). The first days after calving were thought to be special risk moments since even the most docile females could become aggressive towards human handlers for 3 to 4 days postpartum, or sometimes even for several weeks.Regarding breeding bulls, they were thought to be docile during their first year of life and either remain so or become stronger and even aggressive as they aged. FGD 1 commented on both types of cases but, as other FGDs, recognized that their temperament usually became stronger with age. As with cows there as some disagreement about when bulls may become stronger, either starting around age three, or later. One participant explained: “a two or three-year old bull, up until about five years, if he has not done anything to you, normally will remain noble forever. But if after turning three he’s had some ugly behaviour, watch out because one day he’ll go after you. The bull is the most dangerous animal in the herd.” . All FGDs agreed that cows over five years old are usually more docile than bulls, while the latter can become more aggressive in the presence of cows, acknowledging the influence of hormones in bulls. Some farmers in FGD 4 mentioned that breeding bulls may not actually be more aggressive than cows, but it can appear so since they are much bigger. Overall, bulls were also described as “resentful” or “spiteful”, referring to their ability to remember past negative experiences  and behave aggressively towards specific handlers even weeks or months after the event.The visual, auditory and olfactory acuity of Pyrenean cattle breed were highlighted in all FGDs: “…and you have to pay attention to their ears, she already knows that I’ve arrived, even though she hasn’t seen me. Or, even if they are all lying down, if there are 20 cows and three look to one side, the other 17 will follow suit and will notice something. And you have not noticed anything, you haven’t seen or heard a thing. And smell, they can smell anything. It’s a truly special cow.” (Navarra). A farmer in FGD 3 also mentioned that cows that cannot see well tend to be more fearful, pointing to a possible relationship between temperament and sensory acuity. All FGDs agreed that the breed has high hearing acuity but there was more disagreement about sight and smell: for FGD 1 and 2 no mention was made of sight while FGD 4 concluded that smell was more important. In FGD 2 there was some debate over this, and no agreement was reached. The following is an example of an exchange in FDG 2 about this topic:P4. “… I’ve always thought and observed that cows see more through their noses than through their eyes. In the field, for example, they don’t need to have their eyes open, they see you with their nose. Their sense of smell is very well developed.”P8. “I think that they differentiate between colours … I’ve seen that they can see a field of alfalfa 500 m away and head directly for it.”P1. “But they smell the grass. In fact, you have a blind animal, and sometimes that happens, … it also gets there.”P8. “You pass by about 200 m away (from the cows) and a crossing barrier is open, and the cows see it open and head for it. In order to see the barrier, they need to be able to see colour.”When asked about how to tell the temperament of an animal, farmers discussed about two themes: external features and behaviour .There was a general consensus that external features such as conformation and body length are not enough to infer temperament. There was more debate about coat colour, however FGD 3 and 4 farmers agreed that coat colour was not associated with temperament, while in both FGD 1 and 2 there were conflicting opinions . There were a variety of opinions regarding horns and their relationship with temperament, human safety during handling, and social behaviour. Most agreed that the size and shape of horns were not associated with any specific temperament (reaction to fear-generating stimuli) or specific behaviour towards humans. However, FGD 1 and 2 pointed out that the presence of horns represents an additional risk since animals are more likely to harm humans, even if they are not aggressive or especially strong. That can happen when cattle try to escape from a stressful situation. One farmer mentioned that cattle prefer to use horns to defend themselves: “I’ve heard that for a cow with horns, its instinct is to protect itself by hitting you with its horns. It does not kick you. The veterinarians tend to say: a cow with horns doesn’t normally kick, it tries to attack you with its horns…” . In FGD 1 and 2 there were contrasting opinions about whether horns may affect social behaviour. Some farmers expressed that aggressive interactions can be observed between horned and/or dehorned animals, with worse consequences when at least one of them is horned. On the contrary, other farmers  were convinced that horned animals tended to be more nervous and fight more frequently. Restricted access to food, water, shade or limitations in space, varying widely among farms, were all considered potential triggers for such confrontations. Finally, only one participant from FGD 1 raised a possible hypothesis about the relationship between bulging or non-symmetrical eyes and tougher temperaments, which was neither rejected nor accepted by the rest of the farmers.Farmers in all FGDs expressed that temperament can be elucidated from facial expressions and body position, which are fairly consistent over time and in different situations. Farmers focused on describing the behaviour of the most nervous or fearful animals, which can easily be detected both in the herd and individually. Nervous animals try to hide behind others when confronted with any fear-generating stimuli, and will move away from foreign objects or explore them only after others. When confronted with a stressful situation alone, such as vaccination, nervous animals move a lot or try to run away. Farmers underlined the “alert body/facial expression” as a key indicator of temperament, being easily differentiated from other facial expressions associated with positive  and negative  emotions. When alert, an animal has its head raised, and ears up and directed forwards , with eyes wide open and looking towards the stimulus. Some explained that this body position denotes alertness associated with fear, and indicating a risky situation, preceding the occurrence of flight behaviour with a lot of movement and even aggressive behaviour. Several farmers agreed that the animal’s gaze is crucial to establish when a situation can become risky, but admitted that is very difficult to describe the particular gaze associated with the described expression. As a speaker explained: “You have to be able to tell, when you look at a bull, for example, it doesn’t let you know by its movement but more by the way that he looks at you, there you can see the danger and the same with a cow. But not everyone is able to perceive it, but it’s there, he is warning you already with that gaze” . A possible description of the alert gaze raised by another participant was: “It’s all in the way he looks at you. If he looks at you in a relaxed way, you’ll be ok. If his eyes are bulging or he seems to be scrutinizing you a lot, watch out.” .Our results help to provide a holistic idea about how farmers perceive and describe the temperament of cattle, in this case, of the Pyrenean breed. In the absence of studies that have previously addressed this issue, this study can represent a starting point for additional research to help understand how farmers approach animal temperament, and how their perceptions affect their handling strategies and their decisions about genetic selection, including the buying, selling, or culling of animals. The definition of temperament provided by farmers in the FGDs is in line with definitions used in farm animal research referring to the consistent response to strange and/or fear-generating stimuli, mainly those associated with humans. Several terms were used that were anthropomorphic, and varied depending on regional differences in language use. However, all the terms seemed related to active and passive reactions to fear , such asWhen asked further about temperament, a consistent theme that emerged in all FGDs was the ability of Pyrenean cattle to obtain resources, survive and reproduce in extensive mountain grazing conditions, where the availability of resources is changing and sometimes restricted. This was also linked by farmers to the speed of response of these animals to all kinds of stimuli (not only fear-generating ones). Since a large part of the breeding herd is still handled extensively, farmers value these adaptive traits in their cattle, coinciding with preferences of many producers of mountain livestock ,42. ThisUndesirable temperament is one reason for culling animals , a decisResults from all FGDs agree with scientific evidence that asserts that maternal aggressiveness is a critical point for human safety that can be related with other maternal care traits and behavioral reactions to different handling practices ,55. FurtRegarding the presence of horns, farmer opinions about the risks associated with the handling of horned animals coincide with other studies  and are Individual observation of animals has been widely used in animal sciences to describe temperament traits ,59. TherThe so-called “alert expression” referred to by farmers as a useful indicator of an animal’s temperament, could be considered an outward sign of vigilance. According to Beauchamp , vigilanFarmers stressed that “gaze” was associated with the alert expression that indicates fear, and that it can be perceived as a threat to humans. Although they failed to describe it in anatomical terms, watching out for these signs could help to reduce the risks of handling. Other authors have measured the area of white of the eyes as a predictor of temperament ,67,68, wTo our knowledge, little has been described about the temperament of this breed. Historically, several documents suggest that it was considered to be quite tame, with animals used for ploughing being kept near people and houses ,74. HoweIn that sense, the emerging shared views and disagreements encourage the formulation and testing of new hypotheses about, (i) the productive or environmental factors that influence individual or breed level differences in animal temperament, or (ii) the role of human-animal relationships in farmer perceptions about cattle temperament. More broadly, our results serve as a starting point for several future directions for research: (i) The farmers’ perspective about the effect of handling practices and human-animal relationship on cattle temperament. (ii) The farmers’ perceptions about cattle temperament from an individual quantitative approach, which would be useful to verify the consistency between findings from FGD and individual perceptions and to identify the individual/farm level factors that could affect such perceptions. (iii) The role of training on cattle temperament assessment on farmers’ perceptions. (iv) Consistency between farmers’ perceptions about the relationship between temperament and traits such as age, sex, sensory acuity, behavioural response, etc., which should be explored in greater depth using animal-based research. Future analyses that compare breeds based on farmers’ perceptions must take into account that farmers tend to highlight some temperament traits that they consider useful of the breed they manage. Both the results from this study and the above-suggested research topics are relevant to develop training and management strategies aimed at improving animal welfare and, at the same time, increasing farmer safety, and reinforcing the relevance of involving farmers in the description and evaluation of cattle temperament.Using FGDs to analyse perceptions about cattle temperament suggests that farmers exhibit a high level of understanding and concern about this topic. They contextualized temperament as a dynamic phenomenon that, although consistent at the individual level, is also subject to changes throughout an individual’s life (ontogeny). They also indicated ontogenetic differences associated with sex, where females tended to become progressively docile, while males were less predictable. An individual’s inherent sensory abilities was thought to play a role in temperament. Farmers did not identify reliable external features that could predict temperament but focused on facial and body expressions, as well as individual behaviours when alone or in a herd context. The reference that farmers make to phenomena such as robustness when describing the temperament of this breed, indicate that the limits they use to delimit the term can be somewhat lax. This should be considered during training programs and when farmers are included in the development of new genetic selection schemes or evaluation protocols.