Datasets:

mimiklee

/

masterthesis_under_16k

like 0

(UWM), Ruth always intended to be a teacher, like her mother. But when she graduated in 1970, there was a glut of teachers in Milwaukee, and on a whim, she applied for a nonprofessional position at Columbia Hospital in Milwaukee. Because she had a library science minor, she was offered a paraprofessional job in the hospital library, where she would spend the next thirty-two years and work under a total of thirteen supervisors. Three years after being hired, she earned a master's of science in library science from UWM. In 1970, the library at Columbia Hospital held a reprint collection accumulated by Harry Beckman, who for twenty years had been editor of the Yearbook of Drug Therapy. The reprint collection had been used to help compile one of the popular ''yearbook'' series. Beckman was an important mentor to Ruth. He saw the need for the library to hold a core list of health sciences material, using a list published in the New England Journal of Medicine. He was followed by a second significant mentor, George C. Owen, who encouraged Ruth professionally, understood the importance of an effective hospital librarian, and increased her responsibilities in both the library and the hospital. Owen continued to update the reprint file until his retirement in 1981. Because the reprint collection was so popular with the staff physicians, Ruth continued to work with approximately twenty physicians to keep this quick reference service up to date until 1992. The 1970s were a time when health sciences librarians would often spend hours on only 1 literature search-3 hours per search was not unusual-and as a result, searching took up a good bit of the librarian's time each week. As library services were increasingly used at Columbia Hospital, Ruth was able to hire more staff. She always saw to it that staff were well trained. The library eventually grew to house 10,000 volumes. By 1983, Ruth was named manager of the Columbia Hospital library that by then had a staff of 3.8 fulltime equivalents. Ruth saw the value of a hospital librarian being involved in many of the functions of a hospital. She was active in a variety of committees and quality improvement projects at Columbia Hospital. She contributed to such diverse groups as the Columbia Hospital Radiation Oncology Planning Task Force, Practice Patterns and Outcomes Committee, and, more directly related to the library, Health Information Materials Committee. Ruth worked on a wide range of projects, from coordinating a pilot project aimed at improving the quality of physician documentation of the patient record to providing leadership and administrative support to fifteen cross-functional teams that developed, implemented, and evaluated eighteen research-based clinical pathways (practice guidelines) for key patient populations. As director of the Women's Health Care Service, she was responsible for coordinating women's health programs for the hospital. Ruth has always seen the value of working in groups to accomplish goals, and she calls herself a ''group process junkie.'' In 1970, there were few hospital librarians in either Milwaukee or southeastern Wisconsin. It was, therefore, only natural that in 1974 she became cofounder of the Southeastern Wisconsin Health Science Library Consortium. One of the activities of the consortium was to help coordinate interlibrary loans, which were so important to hospital libraries at that time. At the height of the consortium's activity, the group loaned 55,000 items to each other in 1 year. Ruth went on to serve as the presiding officer of the consortium. She also taught a number of courses in health sciences librarianship in the UWM School of Library and Information Science. A librarian mentor Ruth speaks fondly of is Virginia Holtz, AHIP, FMLA, who was at the time direc-tor of the health sciences library at the University of Wisconsin in Madison. Virginia introduced Ruth to MLA leaders who helped her become professionally active in MLA. Through her Regional Medical Library (RML) activity, Ruth met Jana Bradley, FMLA, and was invited to join Jana and Judith Messerle, AHIP, FMLA, in coediting Hospital Library Management, which was published in 1983 by MLA. As Ruth worked on her first significant publication, she knew that her editor-mentor, Beckman, would be ''looking over her shoulders.'' Ruth's skills were rewarded with an invitation to be the first hospital librarian to give the prestigious Janet Doe Lecture, at the MLA annual meeting in 1990. Ruth has served on numerous MLA task forces and committees and was named a Fellow of MLA in 2002. She has served on a number of boards, notably the New England Journal of Medicine's Library Advisory Board. She has won a place as a ''Notable Alumnus'' in the School of Library and Information Science at UWM. She has a strong interest in the history of medicine and was invited to be an associate member of the Milwaukee Academy of Medicine in recognition of her work as the facilitator of the Columbia Hospital History of Medicine Club during the 1990s. Ruth was pleased with her position at Columbia Hospital and, for many years, felt that it was one of the best jobs a librarian could have. It was, therefore, with mixed emotions in 2002 that she and her family left Wisconsin for Illinois, where she began her current position as associate director of the Greater Midwest Region of the National Network of Libraries of Medicine located at the University of Illinois at Chicago (UIC). Ruth continues to be a prolific author and speaker, coediting The Medical Library Association Guide to Managing Health Care Libraries in 2000 and contributing to such publications as the Journal of the Medical Library Association, Journal of Hospital Librarianship, and Journal of Nursing Care Quality. She is a soughtafter speaker at MLA annual meet-ings and Midwest Chapter meetings. She has taught many MLA continuing education (CE) courses on topics such as grant writing, clinical pathways, and measurement of the impact of one's work. Like most good leaders, Ruth is not all work and no play. Ruth met her future husband, Bob Thiel, in college. Ruth and Bob dated off and on from 1966 until 1977, when they married. Bob, who works for the Book Stall at Chestnut Court in Winnetka, describes Ruth as a detail-oriented person who takes responsibility seriously: ''If she takes on a task, Ruth completes it.'' Few things can keep Ruth away from MLA's annual meeting, but in 1983 the birth of her daughter Alexandra did just that. And Alex's birthday continues to collide with the annual meeting to this day. Alex says the upside to that is ''that I got to have birthday parties a full two or three weeks early, thanks to MLA meetings.'' Alex has a degree in mathematics/biostatistics from the University of Iowa and currently works at Trader Joe's in Charlotte, North Carolina. She acquired a love of reading from both her parents and misses her mother's weekend cooking sprees. Ruth's interests outside of work include cooking, reading murder mysteries, anything to do with Jane Austen, and singing. Ruth toured Rome in 2003 with her church choir and prior to that was a member of the Bach Chamber Choir. In Ruth's biography printed in the August 2009 issue of the MID-LINE newsletter [1], Ruth confesses that, in her fantasy, she's a cabaret singer, but as her husband Bob reminds her, ''cabaret singers have to stay up past 10 at night.'' Ruth's warmth, kindness, and charming sense of humor make her a joy to work with and know. Her colleagues consistently describe her in the same glowing terms. Mary Rice, the first doctor of pharmacy in Milwaukee, who worked with Ruth during her years at Columbia Hospital describes Ruth as a ''fun, up-beat person to be around.'' She notes that Ruth always enjoyed a very collegial working relationship with President's page members of the medical staff. She attributes this to Ruth's professionalism, her sense of humor, and the fact that she is knowledgeable: ''Ruth is always willing to learn and take on a challenge.'' Mary Wegner, the state librarian of Iowa, remembers first meeting Ruth at an MLA meeting in Chicago, where they sat next to each other at a CE class. She comments on Ruth's great people skills, which make her an easy person to talk to. She describes Ruth as a natural big picture thinker who is able to analyze how things fit together and as a great writer who is always working in a broad-er context. Mary sees Ruth's clear thinking and willingness to look into the future, along with her analytic ability as great assets for a future MLA president: ''I'm excited not only for Ruth but for MLA. Ruth's forward thinking will carry MLA forward.'' The members of MLA are in for a treat-they will enjoy a leader who takes on a task and completes it, one who takes her responsibility seriously, and one who may jokingly ask herself, ''What would Jane [Austen] do?'' Carol S. Scherrer, MLS, AHIP (corresponding author), cscherre@uic.edu, Head of Information Services, Library of the Health Sciences, University of Illinois at Chicago, 1750 West Polk (m/c 763), Chicago, IL 60612; Ann C. Weller, MA, acw@uic.edu, Director, Special Collections, Library of the Health Sciences and Daley Library, University Library, 801 South Morgan (m/c 234), Chicago, IL 60607

Ruth Holst, AHIP, FMLA, has always reached for the heights, from age four, when she climbed to the top of the grain silo on her family farm, to being the first hospital librarian selected to deliver the prestigious Janet Doe Lecture, to being elected the Medical Library Association's (MLA's) 2010/11 president. Like a number of her predecessors as MLA pres-ident in the last ten years, Ruth grew up in a small rural town. The second of five children born to Wisconsin dairy farmers, Ruth is intelligent, funny, conscientious, and friendly and is the embodiment of Midwest common sense and warmth. A math major with a minor in library science from the University of Wisconsin in Milwaukee

INTRODUCTION Physical functioning represents an integrated marker of aging, influenced by a broad array of physiological and clinical char-acteristics interacting with behavior and the social environment [1]. In old age, decreased muscle strength predisposes people to functional limitations and disability [2]. Older people had less appendicular skeletal muscle than younger, the decline in muscle mass of -0.4 kg/decade in women and 0.8 kg/decade in men starting at the age of 20 [3]. According to Rantanen et al. [4], the intra-individual strength changes over time were significant in all ages. Muscle strength was found to influence life-span. Those who have higher grip strength during midlife remain stronger than others in old age [4] and people who have greater muscle strength during midlife then have a lower risk of becoming disabled because of their greater ability to maintain that strength regardless of chronic conditions that may develop [5]. Grip strength is known as a good predictor of unhealthy Epidemiology and Health 2013; 35:e2013001 outcomes such as mortality and may indicate subclinical disease, which later develops into clinical disease [5] and functional limitation [6]. Grip strength is also known to be correlated with bone mineral density (BMD) in middle-aged men [7]. Agerelated bone loss is reported to be associated with decreased BMD [8] and with weakened muscle strength [9]. Grip strength tests are convenient, safe, and reliable, and do not require large or expensive equipment [10]. Consequently, grip strength has been used as an indicator of overall muscle strength in many population studies [11]. Smoking is one of the major components determining BMD [12]. Smoking is associated with lower BMD of neck and spine in both male and female elderly and is known to increase hip fracture rates compared with nonsmokers [10]. In Ward and Klesges [11] study, absolute effects at most bone sites were greatest for current smokers compared with those who had never smoked. Elderly with lower socioeconomic status (SES) according to educational attainment, income, and occupation have significantly higher morbidity and mortality than individuals with higher SES [13,14]. A study has shown that SES is related to mobility disability in later life [15]. Levels of education and/or income have also been significantly associated with decreased physical function [14,16]. Studies have found that higher SES is associated with higher BMD at total hip [17], femoral neck [18], and spine [19]. This study was conducted to elucidate whether smoking and social economic status are associated with grip strength in community-dwelling elderly men in Korea. --- METHODS AND MATERIALS --- Subjects Subjects in this analysis were recruited in the Hallym Aging Study (HAS). HAS is a population-based study of Koreans aged 45 years or older dwelling in Chuncheon. The first wave began in 2003 and an in-depth clinical study was started in 2004. The city was divided into 1,408 areas based on the 2000 census and 200 were randomly selected. The first-wave participants were selected by systematic sampling: 30% of subjects were sampled from individuals aged 45 to 64 and 70% were sampled from individuals aged 65 years or older. Participants of the first-wave survey in 2003 numbered 1,520. Among them, 918 had participated in an in-depth clinical study in 2004. A physical performance test was administered in the second wave of the clinical study in 2007, whereby the subjects were limited to elderly men aged 65 years or older, excluding 93 individuals who did not test for hand grip or had a score of activities of daily living score> 10. Finally, 218 subjects were available for the final analysis (Figure 1). Demographic characteristics included age, marital status, average monthly income and education. Age was divided into 65 to 69, 70 to 74, 75 to 79, and 80 years and older groups. Monthly income was divided into fewer than 500,000, 500,000 to 1,490,000, 1,500,000 to 2,990,000 and more than 3,000,000 Korean won (1,000 Korean won is about 1.00 US dollar). Education level was divided into 0 to 6, 6, and more than 6 years. Smoking status was categorized as current smo ker, past smoker, and never. --- Test of grip strength To test grip strength, each participant sat on a chair and put one arm on the table in front of him. The wrist and forearm were in neutral anatomical position and the arm was flexed at 90˚. In this position, the participants were encouraged to exert their maximal grip [20]. Grip strength was measured for both hands and every hand measured twice. We checked the main hand, let participants rest for 15 seconds before the second test, then swapped hands. Grip strength measurement was performed with the digital dynamometer (TKK-5401; Takei, Tokyo, Japan) in kilograms, and the better numerical value of the main hand was used in the analysis. --- Statistical analysis Characteristics of study participants according to grip strength were expressed by mean with standard deviation for continuous variables and by number with percentages for categorical variables. Least-squares mean for grip strength according to smoking status was calculated by the PROC GLM program (SAS Inc., Cary, NC, USA). Since some factors, such as age, lifestylerelated factors, genetic background, physical activities, and previous medical diseases, may affect grip strength decline [21], odds ratios (OR) for risk of decline of grip strength were computed by logistic regression analysis after adjustment for potential covariates. Grip strength was divided into low and high groups by median. Data analyses were performed with the SAS version 9.1 (SAS Inc., Cary, NC, USA). --- RESULTS Table 1 shows overall characteristics of study subjects according to level of grip strength. The subjects with high grip strength were younger, more educated, more likely to be smokers, and more likely to participate in regular exercise than those with low grip strength (Table 1). The grip strength of nonsmokers adjusted for age, smoking status, level of education, and obesity was higher than that of past and current smokers (Figure 2). After adjustment for age, education, income, regular excise, and body mass index, the risk of decreased grip strength gradually increased among current smokers (aOR, 4.5; 95% CI, 1.10 to 9.17), those with low educational attainment (aOR, 2.88; 95% CI, 1.08 to 7.66) and those with low monthly income (aOR, 2.86; 95% CI, 1.08 to 7.54), compared with non-smokers, those with high educational attainment, and those with high monthly income, respectively (Table 2). --- DISCUSSION Current smokers were found to have higher risk of decreased grip strength compared with non-smokers. Education and in- come also affected the risk of the decline of grip strength among the elderly men in this study. Hands have many physiological and anatomical changes associated with aging. Impaired hand abilities are observed among the elderly with metabolic and skeletal diseases such as osteoarthritis and rheumatoid arthritis [22]. Starting in middle age, men lose approximately a fifth of BMD over their lifetimes [23]. Smokers were reported to have less bone mass at all measured sites, and smoking cessation had a beneficial effect on bone mass as past smokers had an intermediate bone phenotype compared with either lifelong non-smokers or current smokers [24]. Smoking is significantly associated with BMD in middleaged men [25,26] since the nicotine from cigarettes is involved in the metabolism of calcium and vitamin D and affects bone health [27]. Smokers may have different taste perception, leading them to choose unhealthy food [28], and may take less exercise [29] compared with non-smokers. Kanis et al. [30] reported that current smoking was associated with a 25% increase in fracture risk compared with the risk in subjects who had never smoked. One study of elderly men and women reported grip strength can predict BMD of the proximal radius [31] and another study of athletes also reported that grip strength was a predictor of radial BMD [32]. Low income and low educational attainment can affect the risk of overall health and functional limitations among the elderly [33] and are known to be associated with lower levels of self-efficacy in specific behavioral domains [34]. High income and educational attainment are more likely to have a higher level of perceived control and thus situation-specific self-efficacy [35]. This means that higher socioeconomic status may increase the likelihood of individuals having the confidence nec-essary to attempt socially prescribed behavioral changes and having the resources necessary to ease the adoption process (e.g., time, money) [33]. Higher education may allow someone to access more knowledge on health, practice more healthy behaviors, have more employment opportunities, and earn higher income, which all affect health [36]. Income affects health in various ways, such as availability of material resources and health services [15]. Given the public health implications of smoking on bone health, it is important that this information be incorporated into smoking prevention and cessation efforts targeting the elderly [37]. Elderly people commonly have difficulties in terms of hand function and hand strength can affect simple everyday actions. Grip strength is a simple test and an important index of the body's muscle situation and can predict disability in the nearer future. Declining physical fitness as a natural aging process may not be completely prevented, however. One of the strengths of this study is that the long-term effect of smoking on physical function and occurrence of chronic diseases can be assessed in a relatively short time through a test of grip strength, which can be regarded as a surrogate indicator predicting these health conditions. This study may not appropriate to demonstrate the effect of smoking on health outcomes directly since we observed them at the same time in this crosssectional study. A limitation of this study is that there may be residual confounding owing to categorical variables such as smoking (non-, ex-, and current) and socioeconomic status. It is hard to exclude the possibilities of unknown confounders between groups with high and low grip strength. In addition, because participants in this study at least maintained their health, it was not representative of all elderly people, but the findings can be applied to healthy elderly people residing in the community. Though we cannot change some factors such as age and education among the elderly, we can improve health behaviors such as smoking, and reverse or delay the process of decline of muscle strength. --- CONFLICT OF INTEREST The authors have no conflicts of interest to declare for this study.

Low grip strength is associated with decline in bone mineral density (BMD) and increased risk of spine fracture among the elderly. Smoking, a major factor determining BMD, is also known to have an indirect effect on bone loss. This study investigated whether smoking is associated with grip strength in the community-dwelling elderly in Korea.This study was an outcome of the second of three waves of the Hallym Aging Study from January to May 2007, a population-based study of Koreans aged 45 years and upwards dwelling in Chuncheon. Its 218 subjects comprised men aged 65 years or over. They were evaluated at a general hospital for socioeconomic status, smoking history, and various clinical measures including grip strength.Grip strength was higher in non-, ex-, and current smokers (33.7 kg, 30.6 kg, and 29.3 kg, respectively). Current smoking was found to increase the risk of decreased grip strength (adjusted odds ratio [aOR], 4.58; 95% confidence interval [CI],1.31 to 16.04) compared with non-smoking, after adjustment for potential covariates including socioeconomic status. After adjustment for smoking effect, education of fewer than six years and monthly income of fewer than 500,000 Korean won increased the risk of decreased grip strength compared with education of more than six years (aOR, 2.88; 95% CI, 1.08 to 7.66) and monthly income of more than 1,500,000 Korean won (aOR, 2.86; 95% CI, 1.08 to 7.54).These results showed that current smoking, low education and low income were independent risk factors for decreased grip strength among elderly men in Korea.

The authors' approach to a common limitation in health services research related to health care disparities is creative and mitigates the confounding related to the overlap between cost of diabetes management devices and the association between SES and use of the devices. 1 By noting that, even with universal financial coverage for insulin pump-related costs, individuals from neighborhoods with higher levels of material deprivation remained less likely to start using insulin pumps, the authors reported on what eludes health services researchers studying the use of diabetes management devices in countries without such expansive financial support for insulin pumps. This research design supports the conclusion that SES factors other than pure financial cost (ie, parental educational level, employment, race and ethnicity, and family structure) play a greater role in levels of insulin pump uptake than cost alone. The authors aptly characterize this finding in the discussion, stating that "disparities may not be strictly owing to monetary concerns" 1 The US literature is lacking in its capacity to separate the association between the cost of devices and family income from other SES variables; although authors have attempted to conduct similar analyses using stratification by insurance type or poverty level, the health care system financing in the US precludes conclusive analyses such as those conducted by Ladd et al. 1 However, even with this improved capacity to partially eliminate confounding, the authors were unable to control for what remains a challenging variable to capture and quantify in health care disparities research: implicit bias. Multiple findings within the study suggest the persistence of bias despite financial support (eg, the association between race and ethnicity and insulin pump uptake in Québec); yet, as the authors acknowledge, without explicit data about family preference and/or health care professional biases, they cannot measure its outcome. Studies that establish the role of implicit bias in the uptake of diabetes management devices among pediatric patients with T1D are limited. In one recent study out of Hasbro Children's Hospital, Fredette et al 2 conducted a survey of 192 pediatric endocrinology clinicians across the US and found that 70% reported using personal guidelines to select patients to whom to prescribe insulin pumps. The use of such guidelines, rather than explicit and unbiased criteria, opens the door to unacknowledged implicit biases and more explicit prejudices. Limited studies have begun to investigate the perspectives of patients and families from low SES and diverse backgrounds, and their findings suggest the importance of shared decision-making and understanding of patient and family preferences. 3,4 The study conducted by Ladd et al 1 further reinforces the importance of expanding research questions to better characterize and minimize the biases present in prescribing practices. --- + Related article In addition, although mitigating some of the disparate access to diabetes management devices based on cost, the pump financing programs described in this article perpetuate underlying disparities. 1 The insulin pump funding programs in both provinces had prohibitive requirements for eligibility, including the ability to regularly monitor blood glucose levels and attend pump trainings and diabetes visits. In Manitoba, the pump program also required patients to maintain hemoglobin A 1c levels less than 10% and have fewer than 2 episodes of diabetic ketoacidosis in the past year. Although the authors conducted a sensitivity analysis to assess the diabetic ketoacidosis requirement, they were unable to address the hemoglobin A 1c level restrictions. 1 It is important to recognize that the limits on patients with high hemoglobin A 1c levels in Manitoba (which are not present under the Québec program) may be associated with more of the difference in material deprivation in Manitoba than the degree of financial support for insulin pumps. With the advent of diabetes management devices and advancement of the field in the early 21st century, health care professionals were taught to view use of continuous glucose monitoring and insulin pumps as a privilege to be earned by patients through demonstration of excellent diabetes control. However, we must shift this thinking by viewing this issue through a health equity lens. With the recognition that these requirements for tight metabolic control may be less achievable by individuals from areas of high material deprivation who may benefit the most from insulin pumps, it is time to adjust this teaching to characterize access to diabetes technology as a right, rather than a privilege. 5 The pediatric diabetes literature has repeatedly established the significant disparities in T1D care and outcomes that exist based on SES and race and ethnicity as well as the improvements in metabolic control and short-and long-term complications of diabetes afforded by use of insulin pumps. [5][6][7] This article by Ladd et al 1 adds to that literature by noting the benefits achieved through comprehensive government assistance for financial costs associated with insulin pump use and disparities in access to insulin pumps based on material deprivation. In addition, the analysis encourages researchers to look deeper at variables that are more difficult to measure, including parental educational level and employment and family structure, as well as implicit bias and prejudice. --- ARTICLE INFORMATION --- Disclaimer: The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.

In their study on the use of insulin pumps among children with type 1 diabetes (T1D) in Canada, Ladd et al 1 used an interprovincial comparison to examine whether disparities in socioeconomic status (SES) were associated with use of insulin pumps despite government assistance. The authors assessed factors associated with insulin pump uptake in Québec and Manitoba and the use of province-level programs to support the financial costs associated with insulin pump use. The analysis first notes that markers of low SES (measured by material deprivation index) are associated with lower levels of insulin pump uptake in both provinces. Taking advantage of the differential levels of financial support for diabetes management devices between 2 otherwise comparable provinces (ie, similar population level distribution of SES) within the same national health care system, the authors suggest that provision of comprehensive financial support for use of insulin pumps is associated with decreased SES-based disparities in insulin pump uptake in Québec, which provides full coverage, compared with Manitoba, which provides partial support.

Introduction Social media has given a great way to protect and build our digital reputations. Today it have the ease of searching conversations, the ability to set alerts to help a monitor our names, the constant availability of learning opportunities and more ways to communicate and interact with others. All of these tools, which were not available just a few years ago, now make it possible to be proactive in maintaining, building and protecting the personal brand and help spread word-of-mouth about the books. Social media comes up different perception that reveals that the digital networks are best suitable only for the communication and information sharing. Only few networks are suiting for marketing purpose rest are not an appropriate tool for marketing. The major use of digital networks are communication only. According to the past studies through digital networks made easier the frequent communication, so it play vital role in the initial communication between the business and the customer. Once they connect each other it builds a strong bond in the relationship. On the other hand, the business can create brand community page and start discussion with the staffs, friends, and relatives, this will lead to vocal member participation and furthermore it develops the relationship with the member and the brand. This communication between the brand and the online customer can able to understand the product and services provided by brand and became loyal customer for the brand. So this will illustrate us without the information sharing and initial conversation about the brand, there is no possibility for the serious engagement for the brand. However, the dilemma struggling business planning for proper interaction with digital networks how to manage communication environment in the community then it will help to protect their brand image. Past studies also identified that perfect network should possess bonding and track out the lead head with prospective for utilize the member network properly and beneficial. Then that will be effective network for business or brand. To achieve the extreme Planning and execution should be clear. --- Statement of the problem Using the internet, social media, mobile apps, and other digital communication technologies ~ 2 ~ has become part of billions of people's daily lives. For instance, the current rate of internet use among Indian is about 87% respondents and is closer to 100% respondents for demographic groups such as college-educated and higher-income adults. Younger people-the next generation of mass consumers-have similarly high levels. People also spend increasing time online. The main problem of the study is that whether the Social media is effectively used with online shopping to attract the youths. The respondents using social media have diversified information's but it has to be categorized according to age, qualification, occupation etc., and that has been taken as a problem towards the study. --- Objectives of the study  To study the role of social media networks in Coimbatore.  To know about the perception of youths towards social media.  To analyse about the awareness and level of satisfaction on service provided by social media.  To identify whether social media networks can create brand awareness better than offline advertisements. --- Scope of the study The research study entitled "Influence of social media marketing on the youth buyer behavior with reference to Coimbatore city" is undertaken to know the impact of social media on the respondents' behavior. It also studies, the factors influencing the respondents to access social media sites and challenges faced by the respondents in social media. It provides various information required for the growth of the respondent's empowerment. The respondents behavior based on social media provides more information and positive impact which helps in growth of the respondents in society. --- Research methodology Source of data Primary data The study is primarily based on primary data. The data have been collected from 250 respondents by adopting. --- Reliability analysis The Cronbach's Alpha for each factor is computed. --- Secondary data Secondary data have gathered from various journals, magazines and websites. --- Area of study The area of study is restricted to Coimbatore city. --- Sampling technique Convenient sampling technique has been used. --- Hypothesis A suitable null hypothesis has been framed and tested in the relevant places. --- Tools for analysis The following tools used for analysis are,  Percentage Analysis  Chi-square analysis Limitations of the study  The respondents are restricted to Coimbatore city.  The findings of the study solely depend on the response given by the respondents.  The limitations of the statistical tools applied are applicable for the study. The above table shows about acceptance of advertising on social media were out of 102 respondents 0.98% said that they strongly agree for advertising on social media, 0.98% agree, 3.92% are neutral, 55.88% disagree, and 38.24% strongly disagree on social media advertising. --- Analysis and Interpretation --- Suggestions  The survey revealed that most of the respondents are from Face book which shows that face book is the effective media to know about customers and the companies can choose this particular media for marketing their products.  The respondents said that they don't have a feasibility of easy access which shows that the company has to design it much user friendly to satisfy the users in future period of time.  The respondent feel that the advertisement page I not attractive and if the company tries to change as per the taste then the number of viewers can be increased in future period of time. --- Conclusion The conclusion is that the respondents said that they don't have a feasibility of easy access which shows that the company has to design it much user friendly to satisfy the users in future period of time and the respondent feel that the advertisement page I not attractive and if the company tries to change as per the taste then the number of viewers can be increased in future period of time.

Social media has given us great ways to protect and build our digital reputations. Today we have the ease of searching conversations, the ability to set alerts to help us monitor our names, the constant availability of learning opportunities and more ways to communicate and interact with others. The main objective of the study to know about the perception of customers towards social media and to identify whether social media networks can create brand awareness better than offline advertisements. Primary data is been collected from 102 respondents who are using social networking in Coimbatore region and percentage analysis was used as a tool to analyses the data. The conclusion is that the respondents said that they don't have a feasibility of easy access which shows that the company has to design it much user friendly to satisfy the users in future period of time and the respondent feel that the advertisement page I not attractive and if the company tries to change as per the taste then the number of viewers can be increased in future period of time.

The discrepancies in outcomes between CALD and non-CALD populations evident through the COVID-19 pandemic were also seen during the 2009 H1N1 pandemic. 5, 6 It has long been argued that the principles of social justice and corrective justice must be applied in pandemic planning, to enable risk reduction in populations where the need is greatest. 7 Families and communities are the ultimate recipients of the effects of pandemic plans, and thus need to be involved in their development. Any pandemic health policy or plan must address the public's real concerns and needs, especially among groups who are at higher risk, because this will lead to a reduction in risk for the whole population. 8, 9 Not engaging with vulnerable communities when developing health policies or plans is not only unfair but also endangers the health of the broader population. 9 This article presents a rapid assessment of COVID-19 pandemic plans applicable to the region of the public health unit (PHU) conducting the study. It explores whether the needs, expectations and challenges of CALD communities are represented in these plans. The terms "immigrant" and "CALD communities" are used interchangeably here. The study did not include a review of all relevant literature or research papers; ties and addressing real health needs and challenges. None of the reviewed plans reported any voices, views or consultations with CALD community groups in the development phase. There was some mention of the significance of community engagement in the process of policy-making, but there were no details on which communities or how to engage with them. The assessed plans included no acknowledgement of the diversity of CALD populations. When immigrant or CALD communities were named, they were presented incorrectly as generalized and homogeneous communities. The vulnerability of immigrant and refugee or CALD communities was noted in three plans (the two WHO plans and the COVID-19 Pandemic Plan for the Victorian Health Sector). However, none of the documents discussed CALD community challenges in accessing health information or health services during the pandemic or other structural barriers such as social determinants of health. Also, the documents did not mention factors such as unemployment, crowded housing, visa status, low health literacy, racism and cultural beliefs. A few references were made to challenges in communication between health organizations and immigrant communities, but the plans tended to fall short of addressing solutions for overcoming barriers to reduce risk. Only two plans (the NSW Health Influenza Pandemic Plan and the COVID-19 Pandemic Plan for the Victorian Health Sector) talked about the necessity of providing translated information. --- DISCUSSION In general, Australian policies and plans do not engage with CALD communities, and there is little data regarding the needs of these communities and the challenges they face in accessing health-care systems. This may be an indication of structural racism in the system. 10 Policies and plans that address and consider the complex needs of and challenges faced by CALD communities are essential, 8,9 and their development must include the knowledge and expertise of diverse groups from CALD communities and multicultural service providers. We call for health plans and policies to be redeveloped to be inclusive, culturally responsive and based on consultation with CALD communities. There must be a clear process of engagement, respectful and meaningful rather, the focus was on pandemic plans and policies at multiple settings and levels (from regional to international). --- METHODS Pandemic plans at regional, state, national and international levels were selected, accessed and then critically assessed through a "CALD lens". The selection criteria included plans that were: • available online at the time of assessment; • updated or published within the past 5 years; and • applicable to the region or state of the PHU undertaking the review, to a neighbouring state or to international plans published by the World Health Organization (WHO). As part of using a CALD lens, discussions with representatives from four CALD communities informed the development of the search and selection criteria. These key informants were emailed a series of questions. Four consumer representatives of local multicultural health services then discussed the emailed questions with the informants to finalize the assessment questions. The final questions were as follows: 1. Does the plan describe a governance structure that includes CALD community representatives? 2. Does the plan describe any consultation with CALD communities before or during the development of the plan? 3. Does the plan outline how it reflects and embraces the diversity of CALD communities? 4. Does the plan reference the challenges CALD communities encounter in accessing health systems? 5. Does the plan describe how CALD communities would be involved in the oversight, implementation or review of the plan when it is operationalized? --- RESULTS Six plans met the inclusion criteria and were critically reviewed (Table 1). All were found to have major gaps in terms of engaging with immigrant or CALD communi- --- CONCLUSION Despite the health inequities faced by people from CALD communities, their voices and needs were not reflected in the pandemic plans assessed in this study. The plans failed to address embedded inequities, which are particularly important in health emergencies. It is recommended that CALD communities be included in the development and implementation of pandemic plans. Further research should be undertaken with diverse communities to enable effective public health actions for COVID-19 and future pandemics. --- Conflicts of interest The authors declare no conflicts of interest.

n Australia, as in other developed nations, the coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected culturally and linguistically diverse (CALD) communities. In many countries, immigrant communities have experienced higher rates of COVID-19 infection, hospitalization, severity of disease and death. 1-3 We know that, in Australia, the risk of transmission and serious illness from COVID-19 is not equal across the population -one vulnerable population disproportionately impacted by COVID-19 is people from CALD backgrounds. 4

'I heard the news today, oh boy. Four thousand holes in Blackburn, Lancashire…' In 1967, the lyrics of the Lennon/McCartney song were influenced by a news article and the reference to 4,000 holes was then linked to fitting them in the Albert Hall. 1 Was this an early example of 'fake news'? Roll on to the present and 'fake news' is a term that is used widely so much so that it was named the 2017 word of the year. 2 Fake news is defined as false stories that masquerade as bona fide news stories. They circulate both on the internet and on social media convincing many unsuspecting readers that they are real. They are typically created to influence political views or portrayed as a joke. 2 The reporting of an accidental or nonintentional situation that can be corrected is called misinformation. While the act of deliberately producing and spreading material that is wrong in order to intentionally influence people's opinions in a malicious way and/or obscure the truth is considered disinformation. 3 This is otherwise known as fake news. The issue is topical, and the European Commission brought together a group of experts to understand better the implications of the fake news problem. In their report, they define disinformation as all forms of false, inaccurate, or misleading information, presented and promoted to cause public harm or for profit. 4 While the population is beginning to understand how the spread of fake news stories may influence elections, people's habits and opinions throughout the world, the problem is still persistent, and it looks as if it is here to stay. But, how does the proliferation of fake news work? Internet search engines are forever capturing information with the intent of refining and adjusting their results to an individual's behaviour pattern. Content is also offered depending on its engagement and popularity. The number of times that something has been cited, liked, disliked, tweeted, retweeted or shared, will increase its chance of reaching internet users. This activity may be automated by robots (bots) or humans (trolls) and therefore some news activity will gain undue importance. Bots are autonomous programmes designed to interact with computer systems without requiring human intervention. It acts as an automatic social media account. Thousands of bots liking, sharing and retweeting a post, will promote messages related to a specific topic, via a hashtag, making it disproportionately popular. While bots are a nuisance, trolls do even greater damage. Trolls represent evil because of their role in middle earth tales and dungeons and dragons' role-playing games. Internet trolls are similar. Trolls unlike bots are not robots, they are individuals driven by passion or money. Trolls will write social posts to push a plan or an idea, which will be amplified by hundreds of thousands of bots. The destructive effects of fake news on important events, such as national elections, may have the potential to cause considerable real life changes. Facebook has been pressured to remove and block fake accounts and other forms of disinformation spreading on its network. 5 Also, newsgathering platforms have been used by different agencies to help detect fake news such as the spread of disinformation in national elections, observed in USA (2016), Pakistan (2016) UK (2017), and Mexico in 2018. 6,7 It may have serious public health consequences especially if it involves a potentially contentious issue such as child vaccination. The Wellcome Trust is collaborating with the charity Shift, researching into how parents with young children made decisions on whether or not to vaccinate their children. 8,9 The main avenue that parents access health information is via social media. Child vaccination is an area where disinformation is rife and is known to influence decisions potentially harming the health of families. Such fake news stories are easy to find, and they will hide behind a badge of authenticity even though the information is factually incorrect. Is fake news a problem in dentistry? The quick answer is that it is already present and is not a new issue. Before Google, people talked to a health professional to discuss problems. Now everything is online, immediately accessible and can be read in the comfort of your home. Fake news advertising statements often have the tag line 'the home treatment that dentists don't want you to know about. ' Strong financial or ideological interests are quick to influence the more vulnerable individuals within the population. 10 There has been a rapid growth of dental health 'fads' such as the use of charcoal toothpaste or other seemingly healthy products to improve the strength of teeth. The latter products are often recommended without the use of fluoride, which is wrongly considered a 'poison' . These products are promoted incessantly over a wide range of social media channels, which in turn promotes a sense of authority about them. While there is a lack of poorly scientifically supported information around such items, it this does not stop them from being used. Recently, recognised brands have started to sell charcoal toothpaste adding fluoride to the list of ingredients. Such commercial companies are capitalising on the popularity that began with little or no scientific support. The problem is that someone stands to benefit from the spread of fake news. 11 In dentistry, universities are no longer seen as the privileged knowledge holders, and there has been a growth in new institutes and foundations that have established their role in the distribution of evidence around the practice of dentistry. Evidence-based dentistry is recognised as the gold standard for providing high quality information about treatments via randomised controlled trials and meta-analysis. This ensures that various clinical treatments are scientifically proven. 12 However, many of the procedures in dentistry are based on historical practice rather than having undergone rigorous evidencebased research. Practitioners and the public become impatient waiting for procedures to be fully tested and this leads to demand for positive answers. The proliferation of opinion-based statements or presentations aims to influence people with a favourable and often attractive message. This influencing may occur at several levels. For example, bloggers may put forward new ways to whiten teeth. Ordinary online searches for dental content will easily result in the 'discovery' of supposedly newer, faster, better and cheaper treatments. Homemade teeth whitening preparations, miraculous facial treatments and amazing dental implant-related success stories are some of the most commented examples when searching for dentistry. These, fake news items may also carry a quasi-scientific element making the proposed treatments or therapies look more reliable. --- Why does fake news have the power to convince people? Information is being pushed from one person to the other so fast that most people just briefly check and repass the content received without reflecting on it or verifying its reliability or veracity. Sensationalistic titles and 'information overload' mislead the public and they believe that something that seems reasonable must be correct. Humans are influenced by confirmation bias, as a result fake news stories often confirm people's beliefs, especially if an item has been seen several times previously, and it starts to be more convincing than the evidenced-based truth. 13 --- Is fake news the dark side of evidence-based dentistry? The problem may be older than most people believe. The European Journal of Oral Implantology published an editorial describing what they call a scientific plague. Within this editorial, Esposito (2017) defines the problem as involving many studies that are fully or partially faked being published in prestigious peer reviewed journals. Such material is often difficult to check and therefore difficult to quantify. 14 Evidence-based dentistry checklists are available, but they need to adapt to the speed of delivery of fake news. In such turmoil, it is hoped that there will be organisations that are trustworthy and such examples may include the British Dental Association, the General Dental Council and the Royal Colleges. With the persistence of fake news stories, will the public consider the information on their websites or journals to be trustworthy? The list of such organisations can be widened to the BBC, ITV and CNN. How can the general public be sure that such sites are trustworthy when opposing fake news stories start circulating? Patients, students and dental professionals are being affected in one way or another. Dangerous fake news stories are being disseminated rapidly via social media and even trying to discredit reliable sources, such as the Cancer Research UK website. 15,16 --- How do we tackle disinformation? The European Commission has suggested several avenues including enhancing the transparency of online content. They suggest simple methods to check that the information is from a credible source and is not fake news. 4 The first way is simple: 'check the source'. Develop a sceptical mind and do not believe the news on first reading or hearing. This may be difficult as fake news stories aim to play on your emotions. A simple trick for spreading fake news is to confirm suspicions or prejudices. It is worth knowing that any health-related content published by unreliable sources is shared more widely than evidenced-based information. 17 The second way is by continuing to read and carefully checking the content. Do not rely just on the title alone. Fake news may become so familiar that the majority of people share it as if it was an accurate statement. 18 If you have received an audio or video file about dentistry that is too good to be true, then try to search for more information online. Check the information against other reliable sources ensuring that the content you are reading has a peer reviewed background to it. The statistics show that 40% of the health content shared on social media is considered to be fake news and 20% of such stories came from the same source. 10 For example, a quick way to check if any published photographs in the article have been used elsewhere is to use https://reverse. photos. The third way is a simple check on the date of the publication. Sometimes old news will be reintroduced as new or recurrent content. Even if you follow these simple rules, it is still often difficult to spot the problem. Undoing the problem will take time and that means educating both yourself, your students, colleagues and your patients. If you are involved with undergraduate or postgraduate courses, then encourage your students to spot fake news and discuss these issues with their peers or their patients. By discussing the issues around health-related information, it will enable them to become better informed. Such small steps will make a difference. By reaching out to your students, fellow professionals and patients, you have the power to provide information rather than disinformation. Stay focused. Humans tend to pay more attention to news that reinforces their own ideas. In addition, people will react to the same news in different ways, according to their own beliefs. In our post-truth era, the purportedly fixed and durable concepts are loosening their hold. Predatory scientific journals publish non-peer-reviewed 'scientific' content. Last but not least, even recognised scientific journals publish polarised research, which potentially can be used to spread only one version of the facts. The best way to deal with fake news influence is to empower individuals to publish and create an environment of 'real news' . --- Conclusion Fake news is a global issue and may require a concerted international effort to discredit it and promote real news. However, it is also up to each of us in our everyday professional life to tackle the problem, as we are the ideal front-line soldiers to take on the fight against fake news dissemination.

Describes the mechanisms behind the spread of fake news. Identifies the problems of fake news in dentistry. Provides simple strategies to help dental professionals tackle fake news stories.

Background and Theoretical Framework According the World Health Organisation (WHO), there are an estimated 1 billion migrants in the world, of whom 258 million are international migrants. Drivers leading to large scale population movement include climate change, conflict, political oppression and desire for greater economic opportunity. Although COVID-19 has disrupted all forms of human mobility, many of these drivers are likely to increase in the future and the needs of asylum seekers, migrants and refugees (AMRs) must be embedded in all healthcare systems. AMRs' health needs are often complex and previous literature has identified barriers to accessing health services such as inadequate information on how to navigate healthcare systems in host countries, language, stigma, and poor continuity of care [1][2][3][4][5][6]. General Practitioners (GPs) provide front line healthcare in the UK and are the gateway to all other specialist services. A study on AMRs' experiences of accessing general practice over a decade ago identified a need for professional interpreters; information on how to access healthcare; and education for GPs on refugee health [4]. The current study provides an up-to-date exploration of whether these suggestions have been implemented during the intervening years. Our focus of interest was in a region designated as a UK 'City of Sanctuary' where healthcare systems should be equipped to provide high quality care for AMRs [7]. We explored the views of AMRs and third sector workers (TSW) supporting them. Previously, we reported on local doctors' knowledge of AMR health [8]. This triangulation helps identify gaps and improves our understanding of whether healthcare infrastructures are meeting the needs of the local population. --- Method 22 adult AMRs and 10 TSWs were recruited through The Red Cross and International Care Network (ICN), who together supported 483 adult AMRs. The charities were accessed through contracted work from the council, other local agencies and word of mouth. Bournemouth, Christchurch and Poole is not only designated as a 'City of Sanctuary' but also home to unaccompanied young refugees and has resettled 8 families (16 adults) as part of the Syrian Vulnerable Person Resettlement Scheme. The council serves a general population of 187,503 people. In the AMR group, there were 18 females, 2 males and 2 did not answer. Countries of origin included Iran, Afghanistan, Turkey, Portugal, China, Brazil, Korea, Albania, Iraq, Eritrea, and Sudan. Age range 18-69 years. Time in the UK varied from less than 1 year to 6 years. Demographic data for TSWs was not collected. Participants were given an information sheet and author RS attended drop-in sessions to provide information and answer questions. All questionnaires were anonymous. Some participants completed these alone and others with help from a relative or TSW. Early drafts of the questionnaire were screened by TSWs to help reduce medical jargon. Questions were typically 'yes/no/not sure' or 5 point Likert scales. For example, rating experience from 'very good' to 'very bad'. Likert scales also included thumbs up/down/neutral and smiling/frowning/neutral faces to help improve communication. Ethics approval was obtained from Bournemouth University's Science, Technology and Health Research Ethics committee. --- Results --- Access to Primary Care AMR: 95% were registered with a GP. 5% had been refused registration and did not know why. 36% had a general health check. Of those who had not, 82% would like one. 74% eligible had cervical screening and 100% mammograms, as part of routine NHS programmes. TSW: 70% reported difficulties in registering clients with a GP. The reasons included surgeries asking for proof of ID/address when none was available (40%), language barriers (20%) and practices not being aware of entitlements to care (20%). --- Understanding Rights to Care and the Local Healthcare System AMR: 95% knew that they had a right to free primary care. Only 36% knew how to access a GP out of hours. 41% had called 999 (UK emergency service for acute serious problems) and 36% had been to Accident & Emergency, higher than the general population. TSW: Only 30% felt confident in their knowledge of AMRs' rights to care. Only 10% were correct in who can access free primary care. 90% felt that AMRs use of GP services was 'frequent/very frequent' compared to the general population and 50% rated use of A&E as 'frequent/ very frequent'. One TSW commented: "I know people who have given up on their GPs and who fail to seek care even when they really need it. This has sometimes ended in needing to go to A&E." --- Experience of Primary Care AMR: 79% reported their GP experience as 'good/very good'. Regarding 'what was good?' AMRs commented on GPs being friendly and kind with good listening skills. On 'what could have been better?' comments included doctors having a greater awareness of other cultures, giving medicine, access to interpreting services and with the doctor being more patient. 32% agreed with the statement "The GP had problems understanding me", 18% felt "the GP did not understand my cultural background" and 32% did not "fully understand the advice or treatment given". 68% AMRs reported needing someone to help translate and 82% of the time this was a relative. Only 27% AMRs reported a professional translator being available. 36% AMRs felt their health was better than when they had arrived in the UK but 36% felt it was worse. 23% reported having longterm physical illnesses and 60% felt they were receiving help. 23% reported having mental health problems and only 40% reported receiving help. TSW: 60% felt that AMRs' health needs were met in GP consultations most or all of the time. Physical (60%) and social needs (60%) were more likely to be met than mental health needs (10%). Regarding 'what was good?, TSWs reported that GP staff were generally helpful and welcoming, some gave extra time and spoke slowly. However, many aspects could have been better: doctors addressing the client rather than TSW; access to translators; more time. TSWs were specifically asked about a range of challenges highlighted in previous literature (see Table 1). 90% of TSW said an interpreter was required and in only 10% cases a professional translator was available. 100% felt that GPs needed more education and AMRs needed more information about how the NHS works, as well as professional translators. 90% agreed it would be useful to have a local GP with specialist knowledge of refugee health. Other suggestions included: female doctors for female patients; women's health clinics, antenatal classes, improved access to mental health services; better understanding, diagnosis and treatment on the first visit rather than "brushing them off with a prescription"; specialist referrals before a problem deteriorated; multilingual doctors. --- Discussion The majority of AMRs were registered with a GP and linked into NHS screening programmes. They were generally positive about GP consultations, particularly the personal characteristics of doctors being kind and showing good listening skills. This is important as trust and respect are key facilitators to good health [5]. One limitation of our report is the relatively small sample size, although comparable with other studies [4,5], and similar levels of registration were reported in a recent policy report in Wales [2]. Interestingly, 79% AMRs in Wales had an initial health assessment, as recommended by the WHO and the UK government [9]. However, only 36% AMRs had in our study, suggesting this provision is patchy across the UK. All studies recruiting participants through charitable organisations may have a positive bias, as people not accessing support could be even more marginalized and face greater challenges accessing healthcare [6]. For this reason, we sought an alternative window into AMR health through TSWs. They reported difficulties registering patients, as well as specific challenges such as language barriers and differing expectations. Some TSWs and local doctors [8], were not confident in AMRs entitlements to NHS care. In response, we have introduced Doctors of the World 'Safe Surgeries' education [10] for all GP trainees in our region. Author RS ran a session on how to navigate the healthcare system for local AMRs. Our report highlights that people seeking sanctuary still need information on local healthcare systems, consistent access to routine health checks, professional translators and mental health services. Further work is needed to measure and improve AMRs access to primary care, particularly in places designated as 'Cities of Sanctuary'. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. --- Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The World Health Organisation estimate there are about 1 billion migrants in the world today. The scale of population movement and a global refugee crisis presents an enormous challenge for healthcare provision, and too often the specific health needs of refugees and migrants are not met. This study assessed refugee, asylum seeker and vulnerable migrants' (AMRs΄) experience of front line primary healthcare in a region of the United Kingdom designated as a 'City of Sanctuary'. A questionnaire study explored the views of people seeking refuge and third sector workers supporting them. The majority of AMRs were registered with a GP and positive about their consultations. The views of third sector workers provided a less favourable window into their experience of primary care. In conclusion, the work highlighted patchy experience of primary care, even in a region of the UK designated as a 'City of Sanctuary' for people seeking refuge. There is a need for further education of rights to care in the UK, information for people on how to navigate local healthcare systems, consistent access to routine health checks and translation services.1. Are AMRs able to access primary care? 2. Do they understand their rights to free primary care and how to navigate local healthcare systems? 3. What is their experience of primary healthcare in a 'City of Sanctuary'? 4. Do TSWs provide an alternative view? * Emer Forde

INTRODUCTION The World is aging and so is its population. Increasing awareness, better health care, improved living conditions lead to increase life expectancy and geriatric population. By 2025, the number of elderly people is expected to rise more than 1.2 billion with about 840 million of these in low-income countries. 1 In India, according to the Sample Registration System (2005) 7.2 percent of the total populations were above the age of 60 years 2 . Aging is a natural process and with the process of aging most organs decline in function resulting increase in chronic illness and disability. As the numbers of older and disabled persons grew and the prevalence of chronic disease increased, the importance of function in health and illness was recognized. 3 Chronic illness and functional ability have an influence on the quality of life in elderly populations. There is also evidence that older people have the risk of multiple co-morbidities, 4 which may lead to increased disability among them. Disability could be prevented either by preventing the disease or by preventing the impairment. As the chronic conditions are the major causes of disability, assessment of chronic diseases and its association with disability will help in implementation of different preventive programmes and reduce the burden of the nation. This study was undertaken to determine the prevalence of different chronic diseases and disability; and the association between chronic diseases and disability among the geriatric population in a rural community of India. --- METHODS A community based cross-sectional study was carried out in the Tarakeswar block, at Hooghly district, West Bengal, the rural field practice area of Medical College Kolkata, India in the year 2007. Tarakeswar is situated around 50 Km from Kolkata covering a population of 175,523. Considering the prevalence of chronic diseases among geriatric people as 45% 5 in rural areas, 95% confidence limit and allowable error 10%, the sample size was calculated using Epi Info version 3.5.1 and it became 454. Adding 10% non-response, the total number came out to be 500. Aged 60 years or more was considered as geriatric population in India. The list of all persons aged 60 years or more was prepared from the voter list and it was 13,516. By using simple random sampling technique, total number of sample (500) was selected from the voter list with name and address. After taking verbal consent, geriatric people were interviewed by house-to-house visit, using a pre designed semistructured proforma. First part of the proforma included socio-demographic and personal characteristics like age, sex, level of education, per capita income, religion and mother tongue. Second part of proforma contained questions about morbidity and disability. Morbidity was assessed by clinical examination and verified by the records, if available. Cured morbidity was excluded from the study. Diseases were coded according to ICD-10. Later it was grouped under different system related diseases. Disability was ascertained by self reporting in performing ten non-instrumental activities of daily living (ADL) 6 . Based on ADL score the individuals were divided into two groups -(a) score > 10 -Independent/functionally not disabled, (b) score < 10dependent/functionally disabled. Association between different risk factors and disability were assessed by binary logistic regression model. Data were analysed using Epi Info version 3.5.1 and SPSS version 14. --- RESULTS Due to incompleteness of proforma and non-response, ultimately final sample came to 495. Data of 495 samples were analysed. Table I shows the basic characteristic of sample and disabled population. Mean age and SD of the study population was 66.89 ± 7.38 years; 77.5 % of disabled population was female. Most of the population were Hindu by religion (96.4%) and Bengali speaking (90.9%). 88.8% of disabled populations were illiterate, 22.4% were living alone and 51.3% belonged to socio-economic class -IV & V. More than half (56.2%) of the disabled population had 3 or more chronic diseases and 7.5% of study population did not have any chronic condition. Prevalence of disability was16.16% as per ADL scale. Among the disabled population, 67.5% had the involvement of musculoskeletal system, followed by Diseases of circulating system (43.8%), Diseases of eye & adnexae (33.8%), Diseases of blood and blood forming organs (22.5%) and Endocrine, nutritional and metabolic disorder (22.5 %). --- DISCUSSION Of the study population 92.5% had one or more chronic conditions, consistent with 89% among Kashmiri people in India 7 and 88.9% in northern India 8 whereas in different studies in the United States the prevalence varied from 82% to 88%. 9,10 But among rural people of Chandigarh-India, the prevalence of morbidity was 77.6%. 11 This wide variation of prevalence of morbidity may be due to the differences in the racial and ethnic origin of the study populations, socioeconomic status, criteria for considering older people and the questionnaires used. In our study, musculoskeletal system disorder was the most prevalent morbidity among the disabled population, similar to the study conducted at four US clinics, Winston-Salem, NC, Hagerstown, MD, Pittsburgh, PA, and Sacramento, CA. 12 The reason may be that when the people become older, there is deterioration of function of musculoskeletal system leading to restricted mobility, which adversely affects the older people to sustain independently in the society. The present study observed that Osteoporosis, Anaemia, Acid peptic disorder, Osteoarthritis, Diabetes, Tuberculosis, Neuropathy, IHD and Hypertension were associated with disability. In a cross-sectional survey of the entire population aged 70 and over, living in Ospitaletto Brescia, northern Italy similar association with anaemia, diabetes, hypertension and heart disease was reported. 13 In another longitudinal study among older Americans, association of heart disease, diabetes and arthritis with disability was observed. 14 Joshi et al, in a crosssectional study at rural and urban area of Chandigarh (India), found that morbidities like asthma, COPD, hypertension, osteoarthritis, gastrointestinal disorders, anaemia, and eye and neurological problems were significantly associated with disability. 8 In a study among African Americans association between hypertension and disability was also seen. 15 This may be due to fact that morbidity and disability can differ from country to country and also in different places with in the country due to different ethnic factors, educational status, life style, nature of work & working conditions of the study population and availability and utilization of health care services. In our study an attempt has been made to find out the association between different risk factors with disability by binary logistic regression analysis. The study revealed that age, sex, osteoarthritis, anaemia, C.O.P.D, scabies, prostate hypertrophy, I.H.D, osteoporosis and acid peptic disorder were significantly associated as risk factors with disability and 58.2% of the disabilities were explained by these factors. In this regards, studies showing association of chronic conditions with disability by this regression model are scarce in Indian context. --- CONCLUSION As this was a descriptive study, the factors found as associated with disability could be suggestive, not a causal one. A little over half (58.2%) of the risk factors of disability were explained by the present study. There may be other factors for disability, which were not identified in this study. Future analytical study with large sample would be conclusive for causal factors of disability. However, the study highlighted that the different chronic conditions like osteoporosis, anaemia, C.O.P.D, scabies, prostate hypertrophy, I.H.D, osteoarthritis, acid peptic disorder, age and sex were significantly associated with functional disability of the geriatric population. These analysis emphasized allocation of society's financial resources for the future programme of the geriatric population focusing preventive measures at the early stage and adequate treatment of such chronic diseases for their betterment and improving quality of life. National programmes and policies on prevention of these chronic conditions and risk factors among the geriatric population should be prioritized.

Background: Geriatric population and chronic diseases are increasing throughout the world especially in developing countries like India. Because of social change and urbanization, disability is also a problem in India. As the major reasons for geriatric disabilities are chronic diseases, a study was undertaken. Objectives: To find out the prevalence of different chronic diseases and disability among the geriatric population in a rural community of India and to determine the association between chronic diseases and disability of the geriatric population. Method: A cross-sectional, observational community based study was conducted in a rural area of West Bengal, India through house to house visit for Clinical examination, observation and interview with a predesigned pre-tested proforma Results: Out of 495 study population, 80 (16.16%) were found to be functionally disabled as per ADL scale and more than half (56.2%) of them had 3 or more chronic conditions. 92.5% of study populations had one or more chronic conditions Conclusion: Association between different risk factors and disability was found with age, sex, anaemia, Chronic Obstructive Pulmonary Diseases(C.O.P.D), scabies, hypertrophy of prostate, ischaemic heart disease, osteoporosis, osteoarthritis and acid peptic disorder were the risk factors of disability. These data suggest the significant chronic conditions and risk factors associated with disability. Measures to reduce such chronic conditions and impairment would be the useful approach for the prevention of disability.

Background: The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by healthcare professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation. --- Methods: Online cross-sectional survey design. Healthcare professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict the frequency of delivery). Data were visualized using Confidence Interval-Based Estimates of Relevance (CIBER). --- Results: Seventy-nine percent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R2 = .34), the significant enablers of intervention delivery were 'professional role' (OR = 1.86 [1.10, 3.15]) and 'intentions/goals' (OR = 4. 75 [1.97, 11.45]); significant barriers included 'optimistic beliefs about consequences' (OR = .41 [.18,.94]) and 'negative emotions' (OR = .50 [.32,.77]). In the multiple linear regression (R2 = .29), the significant enablers of frequency of MECC delivery were 'intentions/goals' (b = 10.16, p = .02) and professional role (b = 6.72, p = .03); the significant barriers were 'negative emotions' (b = À4.74, p = .04) and 'barriers to prioritisation' (b = À5.00, p = .01). CIBER analyses suggested six predictive domains with substantial room for improvement: 'intentions and goals', 'barriers to prioritisation', 'environmental resources', 'beliefs about capabilities', 'negative emotions' and 'skills'. --- Conclusions: High levels of brief intervention delivery were identified, however, there were also many missed opportunities and significant barriers to delivery. --- Key messages: Implementation Greek nationality and those who were very satisfied with their living conditions during quarantine reported having more confidence in prerequisite ''skills''. Moreover, students aged > 21 years old, those studying non-health sciences, those who were very satisfied with their living conditions and those whose decision concerning their place of residence was influenced by health reasons related to the pandemic and financial reasons, had more positive ''beliefs'' about online learning. Patients with pulmonary fibrosis (PF) are recommended pulmonary rehabilitation which improves health outcomes. Such physical activity (PA) programmes are meant to promote sustainable behavioural change as exercise activities are valued, enjoyed and considered meaningful. Dance is one exercise form, but COVID-19 may have negatively impacted participation and quality of life of vulnerable populations due to lockdown and consequent isolation. This qualitative study aimed to investigate the perspectives of adults living with PF who had participated in a dance intervention. In partnership with the Irish Lung Fibrosis Association (ILFA), A group of 16 patients with PF, members of ILFA, participated in 75 minutes online dance intervention for eight weeks delivered by an experienced choreographer. An exploratory qualitative study using thematic analysis of semi structured interviews was carried out to understand feasibility as well as health and wellbeing impacts of dancing among the participants. Eight participants (6 Female, 2 male; mean age 72.3 years) completed one to one semi-structured qualitative interviews. Four key themes emerged: 1) Dance is fun -we're not exercising 2) Improved sense of wellbeing 3) Positive impact of own online social space 4) Connecting dance impacts to clinical health. Overall, participants mentioned that our virtual dance intervention was acceptable, enjoyable, preferable, and feasible. They strongly perceived health benefits especially breathing efficiency and mental health improvements for managing their day-to-day struggles with PF. Emerging themes could influence the development and evaluation of dance as an alternate form of PA for patients with PF, exploring its benefits and sustainability. As dance is a low-cost activity that can be done at home, dance interventions may be used as an exercise pathway for patients with pulmonary diseases. More organised and continuous events in future may reveal cost-benefit ratio and impact on health outcomes. Key messages: Dance -More favourable, higher adherence rate, better health and wellbeing outcomes and achieve higher targets of recommended PA levels in the community. Social prescribing -Creating and promoting alternative exercise forms which patient's can and should enjoy an activity of their choice and have a choice. Abstract citation ID: ckad160.1450 Social capital as an element of impact on public health: a gender gap analysis for Spain The recent COVID-19 pandemic highlighted the importance of health, not only for physical but also mental well-being. The isolation to which the population was subjected in many countries drastically reduced social interaction at that time and emphasized the relevance of social capital. The aim of this article is to study the importance of social capital in health, and its impact in gender inequalities, in order to provide guidance on social policy that contributes to the reduction of the gender health gap. We used the Spanish data from the European Survey on Living Conditions (EU-SILC). Spain is a representative country of Southern Europe, where there are strong gender inequalities in health, especially among the elderly. The selected sample includes the population aged 25 years and over. In total, 25,054 individuals were considered, of whom 47% were men and 53% were women. Self-rated health was used as a general indicator of health status. Different sociodemographic variables and various social capital variables, such as satisfaction with social relationships or meeting with family and friends, were included in the analysis. In order to carry out this analysis, several multivariate logistic estimations were performed. In our results, social capital variables were highly significant and positively associated with perceived health. In the case of women, there is a strong positive association, especially relevant for older women (over 75) and those with lower levels of education (no education or primary education). In both cases, these are the most vulnerable women, who report a poorer health status, with a gender gap in health particularly intense in our estimations for older women. In conclusion, social policies supporting elderly women, promoting participation in group activities and facilitating relationships with others, constitute a strategy of great impact on their perception of health. Key messages: Social capital variables were highly significant and positively associated with perceived health, especially relevant for older women and those with lower levels of education. Social policies supporting elderly women, promoting participation in group activities and facilitating relationships with others, constitute a strategy of great impact on their perception of health. Abstract citation ID: ckad160.1451 Using the QATCHEPP quality assessment tool to critically reflect on health promotion practice --- Lily OHara L OHara 1 , J Taylor 2 1 QU Health, Qatar University, Doha, Qatar 2 University of the Sunshine Coast, Sippy Downs, Australia Contact: lohara@qu.edu.qa --- Issue: Critical health promotion is required to reduce health inequities and is distinguished from selective health promotion by its focus on the unequal distribution of structural and systemic privilege and power. This approach is central to progressing global priorities of health equity and sustainable development. However, much practice remains selectively oriented to a biomedical-behavioural approach. The Quality Assessment Tool for Critical Health Promotion Practice (QATCHEPP) was designed to support practitioners to

This research is the first inter-institutional collaboration of its kind to inform the implementation of the Healthy Campus Framework within two HEIs in Ireland (N > 37,000 students, N > 4,700 staff). Emerging international frameworks recognise universities as potent, and highly-scalable, life course conduits through which to monitor and address public health priorities.

INTRODUCTION In the view of the modern world, people living in society are always on the move, and society is always developing. This situation means that the social structure of society is constantly changing. In the history of mankind, not only the change of the position of a single person in social life, but also the change of the social position of entire social groups is observed. This includes the arrival of the financial bourgeoisie instead of the aristocracy of large landowners, small producers with a narrow range of knowledge and skills, i.e. instead of crafts, engineers, programmers (programmers), production controlled by robotics, operators, to be more precise, the arrival of advanced innovative scientific techniques or XIX-We know from history that as a result of the wars and revolutions that occurred in the 20th century, the economy of some countries developed, while others faced a crisis. We are witnessing such changes in Uzbekistan. A clear example of this is the arrival of the elite of owners, entrepreneurs and businessmen who are owners of large property after independence. As a result of the independence of Uzbekistan and the construction of a new state and a new society in the country, the problems of social mobility became especially relevant in the period of modernization of the society of Uzbekistan. Under the conditions of independence, favorable conditions for the rapid implementation of the concept of social mobility have arisen in Uzbekistan. The actions and political struggles for the country's independence and strengthening of its independence have ended, and now humanity has entered the stage of high intellectual development. This stage of social development is new, the construction of society based on its own laws has become VOLUME03 ISSUE12 DOI: https://doi.org/10.55640/jsshrf-03-12-13 Pages: 54-57 a reality. As Abu Rayhan Beruni stated, "In fact, science arises from the need to satisfy people's vital needs. After knowing the true history of the people, they began to realize their identity." Today, the scientists of our country are conducting effective work on the analysis of socio-professional and economic mobility, including its subjective aspect, considering the trends of social mobility of various strata and groups of modern Uzbekistan society, and developing methods of empirical measurement of various forms of social mobility in modern conditions. In the life of the population of our country, the most intensive social mobility occurs partially from the age of 14 and completely from the age of 16 to 30. Factors that make women a socio-demographic group with high levels of social mobility include: 1. Transition from education to work, integration of the individual into the socio-professional structure of the society, gaining an independent economic status. A number of researchers consider the time of transition to work as the lowest limit of women's age. "Women," says M. Rutkevich, "generally mean a socio-demographic group whose members, in their physical and spiritual maturity, unlike children and teenagers, are ready to actively and independently participate in society's life, primarily in production." A similar opinion was put forward by F.Filippov, in his opinion, the social nature of women is largely determined by work. 2. Usually, by the age of 30, as a result of a person's personal achievements, the ground is laid for his future service career, and he realizes increasing vertical mobility. 3. Women's entry into the labor force makes it possible to compare the social achievements of parents for people from different backgrounds, determine the level of influence of social background on future professional and other success, and other aspects of intergenerational social mobility. 4. Until the age of 30, women build their families and give birth to their children. In this way, compared to other groups, it is women who occupy the main place in the growing social mobility, activity and social mobility. All this makes it possible to describe women as the most dynamic group and explains the relevance of researching the mechanisms of regulation of social mobility of this socio-demographic group. The concept of "Women's social mobility" in a broad sense, social mobility is the social dynamics of women, that is, the social movement of women and their separate groups under the influence of various factors. The fact that the structure of society includes many social positions explains the diversity of social mobility processes. Based on the direction of actions, the spheres of social life in which they occur, the number of participants and other criteria, women's social mobility is divided into transition to higher layers, classes, strata (increasing mobility) and transition to lower layers, classes, strata (decreasing mobility). In social reality, only vertical movement is not widespread, and in many respects the ideal type, which is explained by the withdrawal from science in the study of these processes. Individuals, families, social groups Political mobility refers to changes in individuals or social groups. The political position is explained by the powers of authority that this or that person has. At the moment, not only officials in the state administration system, but also leaders of political parties, managers of military and law enforcement agencies, large corporations, media leaders, etc. have high political positions. Increasing powers of authority is an integral aspect of moving up the service ladder, one of the indicators of professional mobility. Therefore, models of political stratification and political mobility are explained with great uncertainty. Actions affecting the change of professional positions of individuals or social groups are manifested in professional mobility. One of the types of professional mobility of women is job change. This mobility may be associated with a change in job or specialty, or with the persistence of these symptoms. One of the important indicators of professional mobility is the service career -the transition from an executive job to a managerial job. Professional mobility is explained by an increase in the individual's qualifications, the improvement of professional skills, thereby gaining a higher rank, title, academic degree, etc. One of the most important aspects characteristic of an individual in modern societies is the level of education, and its change is educational mobility. The educational status of a person in Uzbekistan is explained by the existence of basic, general secondary, secondary special vocational, higher education and post-university education levels. An additional factor affecting education and professional mobility is training and retraining courses. As one of the directions of women's educational mobility, moving from one educational institution to another based on the prestige of the educational place, such actions can increase or decrease the educational status of a person. The change in the social status of women in various spheres of society's life compared to their parents' status constitutes intergenerational mobility. Intergenerational mobility is an important factor of social change and a manifestation of social activity of individuals. The change in the social status of children compared to the social status of their parents is one of the indicators of a rapidly developing society. Based on the number of participants, social mobility is divided into individual mobility (actions of individuals) and collective mobility (changes in the status of social groups, classes). Various factors influence the mobility of individuals and groups.

This article provides information about the sources of social mobility, the motivation to achieve, the law of increasing needs, and the hierarchical system of distribution of social results. The presence of channels of social mobility in society, including various social institutions -the military, religion, education, political organizations, trade unions, family, marriage, art, sports, inheritance, elections, mass media, social networks, social networks of individuals and their groups. creates conditions for movement.

Introduction: Informal employment, characterized by unregistered and unprotected employment arrangements, can be detrimental to the health and well-being of workers and their families. Because non-standard work with ambiguous employment arrangements is growing more common across Europe, informal employment is becoming a health risk for an increasing number of people. The aim of this study is to explore the link between informal employment and health, focusing on the effect of employment precariousness and accounting for macrostructural contextual factors. --- Methods: A sample of workers aged 15-64 in Europe from the latest European Working Conditions Survey of 2021, will be used. Using logistic regression models, with standard employment as the reference, the consequences of informal employment on physical health, psychosocial health, and family well-being will be assessed. The effects of precarious conditions (employment insecurity, low material rewards, lack of rights and opportunities, and disempowerment) on the relationship will be tested. --- Results: Based on existing theory, the results should reveal that informal employment is associated with adverse outcomes. Precarious employment conditions should have a stronger effect for informal workers and their families as opposed to workers in standard employment. The results will be analyzed in relation to country-based structural factors such as welfare state policies and labour market trends. --- Conclusions: The study will have implications for both research and policy. It will fill a critical research gap of the underexplored association between informal employment, workers' health, and family well-being. Since non-standard work is growing in the European countries, the results should also demonstrate the importance of targeted policies to reduce the negative effect of this type of work to protect the health of not only workers, but the well-being of their families. --- Background: A non-negligible share of workers is affected by adverse health at the end of their careers. While many of them drop out of the labor force, others remain, prompting the question of how various health indicators interact to influence these different pathways. Therefore, we investigate the effect of multidimensional health patterns on labor force participation among older workers. --- Methods: We used six-year-longitudinal data from 5007 older workers (Mean age: 55.8 years; 55.9 % female) from the Survey of Health, Ageing and Retirement in Europe. First, we conducted a latent transition analysis with four indicators (chronic diseases, limitations with activities, perceived health, and depression) to identify multidimensional health patterns. Second, we examined individual change in these patterns over time and their association with workers' job situations and changes in work hours four years later using Wald-tests. --- Results: We identified four multidimensional health patterns with high structural stability over time (ranging from <.005 to .25): (1) Overall healthy workers, (2) workers with moderate activity limitations and low perceived health, (3) overall unhealthy workers, and (4) physically healthy workers with low perceived health and depressive symptoms. Furthermore, individuals predominantly remain in the same pattern over time, except for pattern (4), where 56% of the individuals transition to pattern (1). Moreover, we found differences between the patterns in job situation (p < .001) and changes in work hours (p < .001) four years later with patterns (2) and ( 4) showing the greatest reduction in working hours. --- Conclusions: The high rate of transitions from the pattern (4) to the more favorable pattern (1) may be explained by the relatively high potential for recovery from depression. Our findings suggest that interventions among older workers with depressive symptoms and moderate activity limitations may improve their chances to remain in the labor force. --- Key messages: We identified four largely stable multidimensional health patterns over time. Older workers with moderate activity limitations and low perceived health reduced their work hours most strongly. ii532

examined as well as the mediating role of the work stressors by using a counterfactual framework. Results: 2.8% (N = 172) of the participants without T2DM at baseline reported incident T2DM. People with lower SEP were more likely to report T2DM during the follow-up course (e.g.; education HR = 2.21, 95%CI: 1.53-3.20) and more often had prevalent T2DM. Low job control was associated with prevalent T2DM (OR = 1.44 95%CI: 1.25-1.67), but not with incident T2DM. Job control explained 7.23% of the relationship between income and prevalent T2DM. Job demand suppressed the relationship of education (3.65%) and occupation (3.72%) with prevalent T2DM.Our findings provide modest evidence for environmental injustice in T2DM exposome. The substantial higher risks of diabetes in low SEP is to a small extent explained by lower control at work. Furthermore, by having lower psychosocial job demands, they are protected against T2DM.Job demands and control play a role in SEP and prevalent T2DM relationship. Work stressors might not be a major target for tackling socioeconomic inequalities in type 2 diabetes.

Method • • • • --- Results and Discussion --- Conflict of Interest

Corona virus disease (COVID-19) is a disease that was first identified in China and has become infectious worldwide. For almost two years, this disease is still an unfinished problem in several areas in Indonesia, including Aceh Province especially in Southwest Aceh Regency. This virus attacks all age groups, including children. Therefore, education about COVID-19 to children is a necessity that must be met. This activity aims to minimize the prevention and control of the COVID-19 virus by providing socialization in order to prevent the spread of COVID-19. The location of this activity was in Kaye Aceh, Southwest Aceh Regency, Aceh Province, Indonesia. The respondents were 40 elementary and junior high school children who lived in this area. The method used in this community services program was learning by doing to the children. The children were given explanations of how to wash hands properly, wear masks, using hand sanitizer, and physical distancing. Results showed that the children understand about COVID-19 and how to break the chain of the spread of COVID-19. It is recommended for children to get used of the good behavior to stop the spread of COVID-19 on their daily life throughout the pandemic.

Progress report The Israel Journal of Health Policy Research (IJHPR) was launched in January 2012 and it is now publishing its 100 th article. We are gratified that the journal was accepted into PubMed after only six months of publication and that it has now also been accepted by Thomson Reuters for inclusion in the Web of Science as well as the Social Science Citation Index. It is rare for a new journal to reach these milestones at such an early stage in its development. One of the key factors in the journal's acceptance into these prestigious databases has been its unique national/ international approachexploring both what Israel can learn from health systems in other countries and what other countries can learn from Israeli health care. Another key factor has been its ability to attract high quality contributions from virtually all of the Israeli universities and research centers involved in health policy. A third important factor has been the journal's ability to engage leading international scholars as contributors and/or editorial board members. This end-of-the-year editorial is a natural opportunity to thank all those who have contributed to the journal's success. These include, but are not limited to, the Israel National Institute for Health Policy (the journal's sponsor), BioMed Central (the journal's publisher), the editorial board, and our many contributors, reviewers and readers from around the world. --- The unique contributions of a journal focused on Israeli health care In the IJHPR's inaugural editorial [1], which was published in January 2012, we discussed why we sensed a need for a new journal which would have Israeli health care as its primary focus. With the journal about to celebrate its second birthday (and with this editorial constituting the IJHPR's 100 th article), this is an opportune time to reflect on the extent to which the journal's experience has validated those intuitions. In the paragraphs that follow we present quotes from the inaugural editorial in bold and our current reflections in italics. "First, we wanted to promote a new interdisciplinary synergy between studies of different aspects of Israeli health care where the results of studies done by scholars in a number of health-relevant fields would be gathered in the same publication". The journal has clearly succeeded in pulling together contributions from a wide range of fields such as economics, political science, sociology, epidemiology, environmental health, etc. IJHPR articles have also benefited from interdisciplinary synergy through the review process, in which we often involve reviewers from disciplines other than those of the manuscript's authors. We are also beginning to see new IJHPR articles that build on the findings of previouslypublished IJHPR articles that are substantively related but written from a different disciplinary perspective; we hope to see more of this as the journal matures. "Second, we wanted to create a journal in which the publication criteria simultaneously include the contribution to both health systems around the world and to Israeli health care". We are pleased to have been able to provide a forum for excellent articles about Israel that also have relevance beyond Israel. In many cases, reviewer comments have helped authors better explicate the international relevance of their studies of developments in Israel. Their implications for health systems around the world have been further elucidated by commentaries by leading international scholars. Some of these "local" articles have even gone on to receive BioMed Central's "highly accessed" designation, reflecting substantial international readership. "Third, IJHPR provides us with an opportunity to focus attention on specific areas of particular interest to Israel. Some of these will be areas in which Israel has important accomplishments in the field and/or research… Others will be areas in which Israel is grappling with challenges similar to those in many other countries". The IJHPR's article collections were instituted to take advantage of this opportunity. To date we have launched three article collections: 1) Quality of care in Israel and beyond; 2) The healthcare workforce; and 3) Health promotion and disease prevention. A fourth collection, on prioritization, is due to be launched in early 2014 and the editorial board is prepared to consider proposals for additional article collections. Moreover, sometimes individual articles are sufficiently powerful to focus attentionon their ownon a specific area of particular interest to Israel. This would seem to be the case for the 20 IJHPR articles published to date that have been accessed over 2,000 times (see www.ijhpr.org/mostviewed/ alltime). "Fourth, we are interested in using IJHPR as a vehicle for engaging scholars from around the world in the health policy development process in Israel". The invited commentaries have been the IJHPR's main vehicles for engaging scholars from around the world, and these have proven to be successful beyond our hopes and expectations. Thus far we have had 7 such contributions from Harvard-based scholars, 5 from scholars at the London School of Hygiene and affiliated institutions, 3 from Johns Hopkins, 2 from Yale, etc. The commentaries have been extremely wellreceived by the authors on whose works they have commented, as well as by the IJHPR's readers, and by reviewing bodies such as Thomson Reuters. For 2014, we are exploring the possibility of building on this success by publishing a few articles by leading international scholars about recent health policy developments in their own countries in areas of particular relevance to Israel. These would then be accompanied by commentaries by Israeli health care thought leaders. The editorial board would welcome suggestions of possible topics, and possible authors, for this experimental venture. --- The year ahead Other plans and hopes for the year ahead include: Continuing to attract, review and publish a steady flow of high-quality original research articles, integrative articles and commentaries Publishing a supplement with abstracts from the 2013 Jerusalem International Health Policy Conference Sharing, with our international scholarly audience, the eagerly awaited recommendations of the "Advisory Board for Strengthening the Public Health System" Publishing articles on topics of particular interest to Israel at this time, such as e-health; the publicprivate mix in health care; and the changing roles and boundaries of the health care professions Organizing occasional symposia which would feature outstanding IJHPR articles and their implications for health policy Experimenting with new ways to disseminate our research findings, including those involving social media --- The ongoing opportunities and challenges in cross-national learning We conclude by reiterating two quotes from the journal's inaugural commentary [2] by Martin McKee of the London School of Hygiene and Tropical Medicine, as they are as relevant today as they were when initially written: "There is enormous scope to learn lessons from health systems in other countries. The challenge is to learn the right lessons. The Israel Journal of Health Policy Research offers an important new platform where researchers and policy makers from different countries can come together to understand each other and share their experiences". "As a regular visitor to Israel, I am aware of the remarkable capacity of the Israeli health research community, its willingness to innovate, and its capacity to learn lessons from elsewhere. Yet lesson learning is not straightforward… It demands that we ask not just "will it work?" but "what are the conditions in which it will work?" and "do those conditions exist in my situation?" …. Above all, it requires a process of enquiry and reflection, ideally one that involves those from elsewhere who can challenge one's assumptions and ask "why does it have to be so". We plan to engage in continuous improvement and to provide an increasingly valuable resource for all those who share the journal's interest in health policy in Israel and beyond. Accordingly, we welcome your thoughts on how the journal might be even more effective in future years. In particular, in light of Martin McKee's remarks quoted above, we would welcome your suggestions on how we can best foster cross-national dialogue that is simultaneously vigorous and circumspect. --- Authors' information

The Israel Journal of Health Policy Research (IJHPR) was launched in January 2012 and it is now publishing its 100 th article. It was accepted into PubMed after only six months of publication and it has now also been accepted by Thomson Reuters for inclusion in the Web of Science as well as the Social Science Citation Index. It is rare for a new journal to reach these milestones at such an early stage in its development. One of the key factors in the journal's acceptance into these prestigious databases has been its unique national/ international approachexploring both what Israel can learn from health systems in other countries and what other countries can learn from Israeli health care. Another key factor has been its ability to attract high quality contributions from virtually all of the Israeli universities and research centers involved in health policy. A third important factor has been the journal's ability to engage leading international scholars as contributors and/or editorial board members. The Israel Journal of Health Policy Research is now completing its second year of publication. We are pleased to take this opportunity to report on the progress of the IJHPR, to reflect on one of the journal's unique roles, to share some of our plans for the year ahead, and to reiterate some of the ongoing challenges in cross-national learning.

Introduction Makassar City in Indonesia is the capital of South Sulawesi Province which is also a major center for drug distribution. Drugs such as shabu-shabu, ecstasy pills and marijuana have been distributed throughout the city of Makassar, making the city of Makassar a national narcotics agency (BNN) to strive to prevent drug trafficking [1], in collaboration with the police [2]. The increasing demand for drugs in making drug trafficking is also increasingly involving child couriers [3], as a form of child exploitation. The crime that ICHELSS often occurs in society is the exploitation of children [4]. The research found that the city of Makassar has been flooded with drug dealers, although it is fluctuating because from year to year it fluctuates [2]. Drug trafficking not only makes children as drug couriers but also victimizes children [5], the goal is to maximize profits in drug distribution [6]. On the other hand, it costs the South Sulawesi government up to 1.9 trillion due to drug trafficking and drug users up to 131,200 [1]. This phenomenon poses a critical challenge to the government, the national narcotics agency, the police and the general public for not only making children victims but also dealers, see [7] [8] [9]. In a research report [10] Drug abuse in Indonesia has reached a very worrying stage. Drugs no longer recognize age limits. Parents, young people, adolescents, and even children are drug abusers and traffickers. About 1.5 percent of the total population of Indonesia are drug users. Although the applicable law in Indonesia regarding the trafficking of narcotics is subject to a minimum sentence of 15 years in prison [11]. However, not only the Indonesian people, but even the world community in general is currently faced with a very worrying situation due to rampant illegal use of various types of narcotics [10]. Drug trafficking not only involves adults but also involves children as drug couriers [3]. This is a form of exploitation of children. The results of research found by the commercial sexual exploitation of children [12] requires knowledge, beliefs and actions of parents who tend to take protective action against their children. The research results found by [4] Parents have the responsibility to care for the child and on the other hand the child has the right to be protected from exploitation, both economic and sexual exploitation, not only government parents and has the responsibility to provide protection for children from exploitation, so the government needs to do so. socialization to the community about the importance of children's rights and imposing sanctions on perpetrators and parents need to review various jobs performed by children [4]. The research results found by [13] Commercial sexual exploitation of children presents risks, dangers and challenges in providing care for children. The research results found by [14] the economic system creates opportunities for child exploitation, children are used by parents as a means of making money, because damage to family institutions encourages exploitation of children in addition to economic, social or political factors [14]. The research results found by [15] Economic exploitation of children can lead to sexual abuse of children such as children who work on the streets to beggars and even live at home. While the research results found by [16] changes in household structure can lead to child exploitation, especially when the first child has the obligation to help increase the income of their parents, girls tend to experience sexual violence. All these DOI 10.18502/kss.v9i2.14940 ICHELSS studies focus more on economic and criminal exploitation by families, namely fathers and mothers. Criminal exploitation of children as drug couriers is closely related to family, because the parents of drug users have a contribution to make children as drug couriers. [17], even if there are children who are drug couriers because of debt bondage, coercion, intimidation, or violence. This article aims to explore the contribution of parents to making children as drug couriers, as a form of economic exploitation and child criminalization by analyzing findings of children's commercial exploitation. [12], [4] [13], child criminal exploitation [14] and economic exploitation of children [15] [16]. Very few have explored the economic and criminal exploitation of children by their own families. The article describes going beyond the focus of the problem investigated by the researcher and neglected in the study. For this purpose, the authors used the data to answer two research questions: (1) how family causes children to choose to become drug couriers; (2) The reason why children choose to be drug couriers and (3) how is the mechanism of exploitation for children to become drug couriers? --- Methods --- ICHELSS data and percentage of questionnaire data. The validity of the qualitative data used source triangulation, time triangulation and method triangulation, while quantitative data used reliability (accuracy) and validation (correct) tests. --- RESULTS AND DISCUSSION --- Exploitation of children by parents to become drug couriers The work carried out by children as drug couriers in Makassar City is economic exploitation as well as criminal exploitation. Parents use children as drug couriers to improve the family economy and provide many benefits to drug dealers. Even so, there are pros and cons from drug courier families, child drug couriers and the general public, especially community development apparatus and child empowerment against child labor as drug couriers which is against children's rights. The results of the responses of parents, children, child empowerment and community development officials showed that there were families and children who agreed to work as drug couriers. --- Exploitation of children by parents to become drug couriers Research on child exploitation is divided into five forms, namely (1) sexual exploitation [6], sexual exploitation of children [19], sexual exploitation of children (Hodgson, 1995), [21] [22] [23] [24] [25] [26] [27], (2) commercial exploitation of children [12], [4] [13], (3) child criminal exploitation [14] dan (4) sexual and commercial exploitation of children The mechanism of exploitation of children to become drug couriers --- Physical abuse Psychic violence threat giŌ-giving freedom of associaƟon have been carried out by parents to use child labor for work in order to gain economic benefits. Not just the first child [16] but also all children to change the family structure. So that children have a social role in contributing to the family economy but on the other hand are victims of exploitation [39]. Work performed by children, such as couriering illegal drugs, is both economic exploitation as well as criminal exploitation [6], using children as drug couriers is a series of conspiracies [40] and ways to increase profits in drug distribution [6]. --- Factors that cause children to become drug couriers Internal factors of children choosing work as couriers of drugs and goods resulting from theft because (1) fear of parents who always commit acts of physical and psychological violence against children if the child does not work and makes money every day, more physical violence is committed by fathers [41] who is a drug addict [17], resulting in the destruction of family institutions that lead to child exploitation [14] and cause all kinds of problems for the child [42]. Economic factors are one of the causes for children to experience physical violence, including neglect [43], One of the causes of child exploitation is economic, social and economic factors [4] or encourage child exploitation [14] (2) Willingness of children to help parents. Children help their parents as a form of participation in the economic aspect [41], because the father who works odd jobs doesn't even work [44], or father and mother are not working [43], both families of divorced and intact parents [41], (3) Children's awareness and desire to fulfill personal needs [45], which parents cannot fulfill. Parents who cannot meet the economic needs of their children because the father is a drug addict [17] (4) Easy job with lots of financial DOI 10.18502/kss.v9i2.14940 ICHELSS rewards [45], also as one of the effects of parents who use drugs so that children become involved in drug trafficking [17]. The external factor is that the child chooses to work as a drug courier and goods resulting from theft (1) The social environment of the children, where the majority of the children work to help the family economy so that working as a child is considered normal or normal, the social environment is also a factor in the exploitation of children [4] [14], Drug courier children are not playing like children in general, although playing is very important for child development and the relationship between parents and children [45] (2) Motivation and coercion of parents to children to work in any way, including being a drug courier, (3) The lack of parental concern for children, so that whatever the children do is not very important for parents, (4) The low socioeconomic status of parents so that children's education is disrupted, socioeconomic status greatly affects children's education, children's education is not the main thing for poor families but works to make money for the family, economic difficulties of parents affect children's behavior to help parents [43] Parents have the perception that education does not provide guarantees for children to work in the future, so it is very social security [14]. --- The mechanism of exploitation of children to become drug couriers The mechanism of economic exploitation of children to become drug couriers is carried out in various ways such as (1) Physical and psychological abuse. Children get physical and psychological violence if they don't work and make a lot of money, one way to get a lot of money but the easy way is to become a drug courier [45], more physical violence done by fathers [41], meanwhile, psychological violence is mostly committed by mothers. Every child is given an economic target by the parents every day, the results of the child's work are taken by the parents [15], achievement of economic targets is a way of avoiding physical violence such as beatings and psychological violence such as being scolded and yelled at. --- Conclusions The work that children do as drug couriers is economic exploitation as well as criminal exploitation for the sake of improving the family economy. The contributing factor is the child's fear of parents who always commit violence, even though there are children who work as drug couriers because of their own desire to help the family economy and personal needs. The social environment contributes to the exploitation of children because it is in the social environment of children that helps parents work, thereby degrading parents' care for their children. Various methods are used if the child does not want to work as a drug courier, such as physical violence, psychological violence and threats, although sometimes giving gifts and freedom of association, the actions of parents are economic exploitation and crime against children.

Many studies have examined the sexual exploitation of children few have explored the economic and criminal exploitation, mostly using qualitative research. In addition, not many studies have been done on children who are economically exploited by their own parents who force them to work as drug couriers. This study used a mixed methods concurrent embedded model to obtain more comprehensive data with 15 child victims of exploitation and 150 respondents as informants. Data collection, data analysis, and data validity were done using qualitative and quantitative methods. The results showed that drug couriers were a form of economic exploitation as well as criminal exploitation of children by families. The contributing factor is the child's fear of parents who always commit violence, although children worked as drug couriers because of their own desire to help the family economy and personal needs. The social environment contributes to the exploitation of children because it is in the social environment of children that helps parents work, thus undermining parents' care for their children. Various methods are used if the child does not want to work as a drug courier, such as physical violence, psychological violence and threats, and sometimes giving gifts and freedom of association. The actions of parents are economic exploitation and crime against children.

Introduction A powerful instrument, design has the potential to significantly alter people's lives, communities, and the environment. Designers have a duty to produce systems, places, and products that uphold social and cultural norms and benefit both the environment and society. The strategy of "Design for social and cultural sustainability" aims to accomplish these objectives. Design for social and cultural sustainability acknowledges the social and cultural effects of design choices. --- It takes into account how design affects people's values, beliefs, and behaviors and works to advance environmental sustainability, cultural diversity, and social cohesion. A holistic approach to design that takes into account the social and cultural context of designs as well as their effects on people's lives is known as design for social and cultural sustainability.

An approach to design known as "design for social and cultural sustainability" aims to develop systems, places, and products that are socially and culturally responsible and benefit both society and the environment. This paper examines the idea of design for social and cultural sustainability, as well as its significance and difficulties. It emphasizes the part that designers play in advancing social and cultural sustainability and offers instances of innovative design projects that have positively impacted communities and the environment. In order to promote and execute design for social and cultural sustainability, the paper offers guidelines for designers, educators, and policymakers.

The COVID-19 global crisis has occurred swiftly with far-reaching consequences in terms of public health, economies, communities and families. The differential mortality risks suggest that this is largely a "geropandemic," which has brought the field of aging into center-stage, in both pathogenic and salutogenic contexts. Canadian older adults are highly diverse, and generally, healthy, engaged and active. Yet, there are high risk groups of older adults who are the most affected by COVID-19 in terms of both infection risk and negative health outcomes, especially mortality. Older adults living in congregate living environments, including longterm care, supportive housing or assisted living, are exposed to increased infection risk from living in institutions designed around short physical distancesamong residents. Infection risk is exacerbated when staff are required to re-use personal protective equipment because of shortages, and still further when low level staff are so poorly paid they must have jobs at multiple sites. The outcomes of institutionalized older adults are worse in large measure because of the high prevalence of multimorbidity. However, many seniors living in the community also face elevated morbidity and mortality risks. Even those not experiencing COVID-19 face challenges meeting their basic needs such as obtaining food, medications, and health care. Some of the most vulnerable subgroups of older adults are those with physical or mental health challenges and mobility restrictions; those living in poverty; alone or with few informal supports; and those providing care for another without the needed resources. As of the second week of June, 2020, COVID-19 cases are approaching 100,000 in Canada and surpassing 7 M worldwide; and these are underestimates because of the current testing limitations. Furthermore, more detailed data for other forms of inequality and social deprivation, such as race, ethnicity, income, education, work status, sexual orientation, and living arrangement are not currently available. This has placed attention on age and to a lesser degree sex (55 per cent of cases are female, probably because they are more likely to be tested, and/or have genetic, immune system or hormonal protection). Although COVID-19 knows no borders, physical or social, it has clearly become an aging-related disease. On the one hand, gerontologists have already become important contributors to COVID-19 knowledge, practice and research. On the other hand, there is a backlash of younger and working populations, fed by media and political hype, who believe that they are less susceptible, and if they do become infected, the symptoms will be less serious than for older populations. Some of these views have been articulated as part of the "ok boomer" movement, which has pitted younger and older generations against each other. Other individuals and groups have expressed the view that the COVID-19 pandemic is largely a "seniors problem" and as such should not shut down the economy and society to the level that has occurred. Some politicians have even gone so far as to suggest that older people ought to consider sacrificing themselves for the health of others, including that of the economy. Older persons comprise the bulk of COVID-19 cases, as with many other infectious and chronic diseases. However, focusing on older patients conveniently ignores the number of younger adults including scores of frontline healthcare workers who have also fallen ill. Unfortunately, as soon as the COVID-19 pandemic is presented in stark generational terms it has the potential to significantly accentuate ageism in society. In 1968, the public housing authority in Chevy Chase, Maryland applied to convert a building in a white, middle-class suburb into housing for older citizens. The public hearings degenerated into a riot as residents of the area fought to keep "all those old people" out of their community. As a result of this incident, Butler (1969) coined the term "ageism." Butler defined ageism as a process of systematic stereotyping of and discrimination against people because they are old. He considered ageism to be similar to racism and sexism in that inherent biological factors are used to define personality or character traits. Ageism can be expressed, fostered, and perpetuated by the media, by public policies, in the workplace, and in casual daily interactions with older people. Where ageism exists, older people are devalued, and their human rights are compromised. In short, there is both individual ageism, the acceptance of negative feelings and beliefs that COVID-19 and Aging Research influence our thinking and behaviour, and institutionalized (or structural) ageism, as expressed in legislation and mass media, all of which can lead to social and economic inequalities across society (Bytheway 2005). The many ways in which this pandemic will influence ageism and discrimination require attention by those studying human aging. The COVID-19 crisis has resulted in our communities coming together to leverage medical, social and technological resources. Families, friends, and many community groups, often relying on volunteers (including gerontology students), are providing supports to older adults and their families to meet basic needs in a safe manner. Although there are technological solutions available to assist people to remain connected to others, and obtain necessay products and services, there is a digital divide, such that many older adults do not have access to or the ability to use smart phones, tablets, or computers. Older "low tech" solutions like the telephone may be more effective in reaching the most vulnerable older adults, such as those who live alone. The government, health authorities, and non-governmental organizations are also taking important steps to serve the needs of seniors during the COVID-19 crisis. For example, policy changes to restrict health workers from working at more than one long term care facility, and ramped up testing of these workers, are reducing the risk and spread of the disease in these particularly at-risk facilities. We also need to learn from this crisis for the future, especially examining the positive adaptation of people and societywhat we might call COVID-19 resilience. This begs the question: how and why do some older adults adapt and thrive better than others? This question addresses those who have experienced the disease firsthand and those who experience the social (isolation), psychological (chronic stress) and economic (loss of income) outcomes of COVID-19. The enormous variation in risk and response to the disease suggests that aging-related intra-variability may be as important as comparing ages or age groups. COVID-19 resilience occurs at the individual, family, community, and societal/system level. At the individual level, resilience models can be useful in understanding the role of cycles of disruption and reintegration in rebalancing health and well-being, and the key resources that need to be available and harnessed to help individuals bounce back from adversity (Wister et al., 2016). Resilience and aging research has established support for the importance of emotional/positive affect (Ong et al., 2006), social/family support (Rybarczyk, 2012), health behaviours (Wister et al., 2019), community connectedness (Wiles et al., 2012), and system level components of disaster resilience (Linkov and Kott, 2019). Applications of this research to the COVID-19 pandemic has potential to balance the deleterious consequences with positive adaptation and growth. We need to continue to develop innovative ways to provide the necessary supports to older adults most at risk, and to learn from those most resilient. Most older adults are healthy and were previously socially connected; however, in the COVID era, like everyone else, they face the adverse effects of stress and isolation. Social problems that many older people currently face, such as elder abuse, social isolation, loneliness, anxiety, depression, food insecurity, and spousal caregiving burden, may be exacerbated by COVID-19. Understanding the nexus of risk, vulnerability, and resilience has potential to identify key questions and shape a path forward, including but not limited to the following. How and why are some individuals, families, and communities able to adapt to a COVID-19 era? What can we learnboth positive and negative -from societies with large proportions of older persons, such as Italy and Japan? What are the most important resilience resources (e.g., family/community supports)? What policies have worked (or not worked) to reduce risk and enhance resilience (e.g., long term care policies for health workers)? How has social isolation and loneliness affected older people and their families? What systemlevel preparedness, responses and adaptations have promoted the most positive responses to the pandemic? How has ageism and discrimination been affected by COVID-19? And how can we be better prepared for future disasters? Surveillance, innovative research, and training are fundamental. New data, such as those collected in a COVID-19 sub study, part of the ongoing Canadian Longitudinal Study of Aging (www.clsa-elcv. ca), (following more than 51,000 Canadians for 20 years and collecting interdisciplinary data from cell to society) will support this work. Under the leadership of principal investigators, P. Raina, C. Wolfson and S. Kirkland, and the collaboration of 11 universities and over 150 researchers across Canada, the CLSA is positioned to fill knowledge gaps pertaining to the epidemiology, social, psychological, and economic aspects of this pandemic. This crisis has provided new opportunities by mobilizing the community of aging-related basic and applied researchers, as well as the spectrum of program and policy makers, to generate innovation in knowledge and its translation.

La crise mondiale de la COVID-19 remodèle la société canadienne de manière inattendue et profonde. Les risques significativement plus élevés de morbidité et mortalité en fonction de l'âge suggèrent qu'il s'agit en grande partie d'une «géro-pandémie», qui a propulsé le domaine du vieillissement à l'avant-scène. Cet éditorial souligne que les personnes âgées vulnérables sont également les plus touchées par la COVID-19 en termes de le risque d'infection, d'effets négatifs sur la santé et de conséquences délétères potentielles sur une gamme de facteurs sociaux, psychologiques, économiques -de l'âgisme à l'isolement social. Nous soutenons également que l'analyse pathogène de cette pandémie doit être équilibrée avec une approche salutogène qui examine l'adaptation positive des personnes, des systèmes et de la société, appelée Résilience COVID-19. Ceci soulève la question: comment et pourquoi certaines personnes âgées et communautés s'adaptent et réussissent mieux que d'autres? Cet examen mènera à l'identification et à la réponse aux lacunes dans la recherche et les données, aux défis et aux opportunités innovantes alors que nous planifions un avenir dans lequel la COVID-19 est devenue une autre infection endémique dans la liste croissante des pathogènes émergents et ré-émergents.

Introduction Sickle cell anemia is a genetic disorder characterized by a mutant type of hemoglobin, called hemoglobin S (HbS), that causes the sickling of red blood cells. 1 Sickle cell anemia is the most common hereditary disease in Brazil and worldwide. [2][3][4][5] In Brazil, it is estimated that more than two million people carry the gene for HbS, and over 8,000 individuals have the severe form (SS). Approximately 700,000 new cases of sickle-cell disease occur annually. 6 The disease is prevalent among African descendents. 6,7 Sickle cell anemia, although treatable, is a chronic incurable disease involving medical, dental, genetic, and psychosocial factors. 7,8 Dentists play an important role in preventing complications and improving the quality of life of patients with sickle cell disease 9 because these patients are more susceptible to infections and periodontal disease. 10 These patients are also at a higher risk of developing dental caries because of the high prevalence of dental opacities (changes in the formation and calcification of enamel and dentin), the frequent and continuous use of medication containing sucrose, and the high frequency of complications and hospitalization brought about by the absence of proper oral hygiene. 11 In the last two decades, there has been a marked decline in caries in Brazil and worldwide. [12][13][14] Among the reasons for this are the addition of fluoride to toothpaste, 15 changes in caries diagnoses, 16 water fluoridation and improvements in socioeconomic conditions. 12,14,15 The literature provides little information on various aspects of sickle cell disease. For example, few studies have examined the increased prevalence of caries in individuals with sickle cell disease. [17][18][19][20][21][22] Given the peculiarities of sickle cell anemia and its sequelae in the oral cavity, this study examined caries and socioeconomic factors in children with this disease. --- Methodology This study was approved by the Ethics in Research Committee of the Center of Hematology of Pernambuco (HEMOPE) (number 036/2007). The investigation was designed as a cross-sectional study. This sample consisted of 160 patients with a clinical and laboratory diagnosis of sickle cell anemia treated at the HEMOPE in Recife, Brazil. The children were examined as they sought care at HEMOPE, and the inclusion criteria were subjects aged 3 to 12 years, which allowed intra-oral examinations, and consent of the parents or guardians to participate in the study. The exclusion criteria were other systemic diseases, psychiatric or neurological disorders, or other factors that precluded oral examinations. For the examination, we used medical records containing the odontogram to determine the dmft (number of decayed primary teeth, teeth extracted, and teeth that were filled) and DMFT (number of decayed permanent teeth, missing teeth, and teeth that were filled) indices in accordance with the World Health Organization (WHO) criteria. 23 During the clinical examination, the examiner wore personal protective equipment (PPE) that met biosecurity standards and used a dental mirror and probe with a 0.5-mm ball tip and black-ring between 3.5 and 5.5 mm from the tip to determine the Community Periodontal Index (CPI). The interexaminer calibration consisted of a theoretical stage with the presentation of images and the criteria of the DMFT and dmft indices. A second stage was devoted to clinical practice, resulting in a Kappa of 0.825. Intraexaminer calibration consisted of reviewing one in every ten children, resulting in a Kappa of 0.85. Data on socioeconomic characteristics were collected through a previously validated form by the validation method of face with 20 parents or guardians, addressing questions about home address, gender, age, education level of parents or guardians and family income. Individuals interviewed in the validation were not included in the final sample. The Brazilian minimum wage (BMW) was considered in calculating family income, and subjects were classified into 3 groups: less than one BMW, one to two times the BMW and more than two times the BMW. Educational level was classified as follows: elementary, high school and college education. Data analyses were performed to obtain the following percentage measures and statistics: mean, median, and standard deviation. Kruskal-Wallis tests were used for comparisons. Pearson's chisquare tests were used to evaluate associations between categorical variables and groups, including the odds ratio (OR) and confidence interval values for the measures. The margin of error used was 5.0%, and the intervals were obtained with a reliability of 95.0%. Data were entered into an Excel 2003 (Microsoft Corporation, USA) spreadsheet, and SPSS (Statistical Package for Social Sciences) version 13 (SPSS Inc., Chicago, USA) was used for all statistical calculations. --- Results This study included 160 children (42.5% boys and 57.5% girls). The response rate was 100% of all invited children; all subjects met the inclusion criteria. The mean dmft results showed that 78.7% of teeth were decayed, and 16.9% had been filled. The mean DMFT results for permanent teeth showed that 56% of the teeth were decayed, and 32% had been filled (Table 1). Over half (56.3%) of the parents and guardians had not completed their elementary education, 18.1% had completed elementary school, and 18.1% had completed high school (Table 2). The income of the majority of families was one to two times the BMW, and only 15.0% earned a salary. There were no significant relationships between parental education levels and any of the examined variables (p > 0.05, Table 3). An examination of the influence of income on the average dmft and DMFT values (Table 4) revealed that decayed permanent teeth were more prevalent among those who had a family income of one to two times the BMW. The averages were correspondingly higher among children whose family income was less than the BMW. Income influenced dmft; the mean dmft was 4.57 in children whose family income was less than the BMW, whereas in children with a family income more than twice the BMW, the mean dmft was 2.27. However, the only significant differences between income categories occurred in the mean dmft (p < 0.05). As Table 5 shows, more than half (55.0%) of the sample had teeth with untreated caries. The prevalence of caries increased with age; caries prevalence was 36.0% among children 3 to 5 years old and 72.3% among those 9 to 12 years old. Caries prevalence was 6.6% higher in boys than in girls (58.8% versus 52.2%). Caries prevalence varied little between categories based on the education levels of parents and guardians. Caries prevalence was higher (62.5%) among children with family incomes below the Brazilian minimum wage compared with those who had incomes more than twice the BMW (50.0%). The only variable significantly associated with caries occurrence was age (p < 0.05). --- Discussion Although sickle cell anemia is the most common hematologic disease in Brazil, 4 few studies have ex- amined the oral health of children with this disease. These studies have observed an association between sickle cell anemia and dental caries, especially in children. However, these studies use different methodologies and samples, making it difficult to compare their results with the current results. The main limitation of this study was that we examined a specific population and small number of cases. Therefore, the results should be interpreted cautiously, following the principles of special and external validity. 16 We were forced to adopt this sampling model because of the difficulty in locating the study population. Socioeconomic factors have been shown to influence caries risk. 24,25 Low income may be associated with education levels and the value placed on health, lifestyle, and access to health care information. As a result, income may be an indirect factor for determining the susceptibility to dental caries. 25,26 Laurence 21 found that poor Africans with sickle cell anemia were at an increased risk of tooth decay. These results provide evidence that low-income individuals are more likely to have more decayed teeth compared with individuals without the disease. These results concur with our findings, in which the mean dmft was 4.57 and the mean DMFT 1.81 in children whose family incomes were less than the Brazilian minimum wage. In children from families with incomes more than twice the BMW, the mean dmft and DMFT were 2.27 and 0.30, respectively. Although education is the indicator most widely used to measure socioeconomic status in epidemiological studies, we did not find a significant positive association between the education level of the parents and guardians (Table 3) and the mean dmft or DMFT, unlike other research conducted in the same subject area. 27,28 In a pilot study, Laurence et al. 19 found that patients with sickle cell anemia were more susceptible to dental caries than patients without the disease; the mean DMFT indices were 12.0 and 9.9, respectively. The results of the present study suggest that patients with sickle cell anemia are more susceptible to dental caries, although none of these differences was statistically significant. The mean DMFT and dmft in our study were lower (DMFT = 1.50, dmft = 2.12) than those found by Laurence. 19 However, this finding should be interpreted with caution, as the sample in the aforementioned pilot study included adults, limiting comparisons because of the wide age range involved (6 to 92 years). This older sample was likely associated with much higher caries rates. The prevalence of untreated caries in our group was 55.0%, which was higher than the 22.95% prevalence found in a study of children aged 6 to 96 months in Bahia, Brazil. 17 In Nigeria, Okafor 18 reported that the caries prevalence in individuals with sickle cell anemia was 35.13%, but they did not describe how they measured decay or how the statistical comparisons were made. One of the goals of WHO in relation to oral health for 2010 was to obtain DMFT scores ≤ 1.0 at 12 years of age. 29 In our subjects, only the children aged 3-5 and 6-8 years attained the average recommended by WHO for 2010. Although socioeconomic status is considered a risk factor for caries, 24,25 there are other biological, dietary and behavioral variables that were not considered in this study. These factors should be investigated in future studies. An important aspect to consider is that the prolonged use of drugs treating chronic diseases that are sweetened for children can cause harmful dental health effects, influencing caries activity. 4,30 It is noteworthy that 45.0% of the children in the present study were free of caries. The implementation of health promotion strategies appropriate to children with sickle cell anemia is important to obtain significant reductions in dental caries. These strategies should result in children with good oral health, growth, and development, less morbidity and fewer episodes of pain, infections, and sickle cell crises. Oral health status can have a great impact on the overall health and life quality of people with sickle cell anemia. 11 --- Conclusions As expected, our results, which showed a significant association between the prevalence of dental caries and socioeconomic factors, were similar to those reported by previous authors. This study found a high caries prevalence. There was a statistically significant difference between the mean dmft and family income; however no significant differences were found between the education level of parents and guardians and caries prevalence.

The aim of the present study was to investigate caries prevalence and socioeconomic factors in children with sickle cell anemia. This study was conducted in 160 children with sickle cell anemia aged 3 to 12 years attending the Center for Hematology in Recife, Brazil. Data collection included interviews with guardians concerning social factors and oral examinations to determine the caries prevalence. Statistical analyses were performed using the Kruskal-Wallis and Pearson's chi-square tests at a 5% significance level. The caries prevalence was 55.0%. The dmft index was 2.12, and the DMFT index was 1.50. Income significantly influenced dmft; the mean dmft was 4.57 in children whose family income was less than the Brazilian minimum wage (BMW), whereas in children with a family income three times the BMW or higher, the mean dmft was 2.27. No statistically positive association was found between the educational level of parents and guardians and the caries indices. A statistically significant association was found between dental caries prevalence and family income.

First let me backtrack for a moment and try to articulate what is meant by research culture. --- What is a Research Culture? According to one definition (University of Aberdeen, 2023), "Research culture encompasses the behaviours, values, expectations, attitudes and norms of our research communities". It influences researchers' career paths and determines the way that research is conducted, communicated and used for social development. A research culture is a culture that looks towards new knowledge and new research for addressing problems identified by the research community, industry, social activists, the policy makers, and the public at large. Also, it incorporates a tradition of interrogating existing knowledge and exploring alternative ways of understanding issues from different perspectives. I see this as a key feature of liberal arts education and the social science mindset that should guide knowledge production and application of the knowledge so produced for addressing human problems. --- Knowledge Production in the Global Periphery Knowledge production in the contemporary world is by and large determined by inequalities in knowledge production originating from the colonial era. For instance, an article on research culture in the Caribbean universities stated the following: "We contend that research culture in the Caribbean comes up against the strictures of post-colonial dependence, university education in the region being largely a one-way traffic of ideas from metropolitan centers to island peripheries." (Lewis & Simmons, 2010: p. 337, emphasis added). The structural inequality in scientific knowledge production in the contemporary world and the resulting dependency syndrome in knowledge production are increasingly recognized as key challenges all sciences are facing. This should, however, not be seen as a deterrent for developing a research culture in countries in the global south. On the contrary, a proactive research culture is one way in which researchers in the global south can collectively seek to redirect and reorient as an analytical framework grounded in the Global South. The postcolonial turn in social analysis is just one such effort to critically engage with social analysis from the viewpoint of Global South. Subaltern perspective emanating from India is a specific application of postcolonial theory with its own research culture tied up with Indian social reality. Its specific aim is to liberate social analysis from coloniality grounded in metropolitan interests. --- June 2023 Sri Lanka Journal of Social Sciences 46(1) --- A Brief Overview of the Evolution of Social Sciences in Sri Lanka Sri Lanka is one of the earliest Asian countries to introduce social sciences after India and the Philippines (Pieris, 1976) This indicates that not only there are many higher education institutions engaged in social science teaching, but there is also a diversity of organizations engaged in social science research on a regular basis. --- Gaps in Research Culture in Social Science Practice in Sri Lanka A proactive social science research culture encompassing these different institutions is yet to be evolved. This is reflected in a number of deficiencies in knowledge production in relation to social issues affecting the country. First, there is no open discussion about pressing social issues affecting the country from a diversity of viewpoints. For instance, the current economic crisis affecting the country is approached by different analysts using a strictly neoliberal angle, a political economy perspective and dependency theory. However, there is no debate among them or an adequate questioning of these perspectives to provide a balanced analysis that can guide policy makers. Second, the research process is by and large handled by established individual researchers rather than groups of researchers with a common understanding of the issues at hand, also ensuring continuity of research when the lead researcher retires or takes on some other responsibilities. One empirical indicator of this is that many of the publications are single authored unlike in natural sciences where the pattern is different and many of the publications are authored by many contributors. There are, however, some signs that this pattern is changing. For instance, in the current issue of Sri Lanka Journal of Social Sciences, the number of multi-authored articles is 6 as compared to 2 single authored articles. Third, cross cutting research networks actively engaged on vital issues like gender, environment, social inequality, urbanization, demographic trends, migration and identity politics are largely non-existent or non-active for the most part. Sri Lanka Journal of Social Sciences 46(1) June 2023 Fourth, there is inadequate interaction between research and policy development in Sri Lanka. In an ideal setting, research should inform policy formulation and policy dialogue should generate new ideas for research. On the contrary, policy formulation and social science research have tended to ignore each other in ways that is harmful to each other and created a hiatus between the process of economic and social development and knowledge production in the country. Fifth, as a long-established social science journal, Sri Lanka Journal of Social Sciences experience many difficulties in identifying reviewers, getting manuscript reviews on time and a shortage of quality submissions from within Sri Lanka on a regular basis. This is despite the substantial expansion of social science higher education in the country as reported earlier in this editorial. While the real problems the academic community is encountering in the light of the current economic crisis may be partly responsible for this situation, this also indicates the fact that the absence of a satisfactory research culture where society as a whole is eagerly waiting for new knowledge and the application of limited social science knowledge available is largely absent in Sri Lanka at present. More importantly neither the researchers nor the policy makers consider it necessary to consult each other and develop a feedback mechanism whereby research can contribute to practice and vice-versa. This is an ultimate indicator of an absence of a proactive research culture in Social Sciences in Sri Lanka.

This editorial points to the need for developing a positive research culture for advancing social science research in Sri Lanka. This is not to say that a positive attitude towards research is absent among social scientists and the scientific community in general in Sri Lanka. On the contrary, there is an emerging recognition that social science inputs are necessary for tackling the various challenging problems facing the country today. However, what is lacking is a firm faith in building a local social science knowledge base for exploring various approaches for understanding critical issues facing the country, constant debates about relevant issues and a critical engagement with the social, economic, and political environment in which we find ourselves. This is what I call a "proactive research culture" where we constantly turn to new research for generating new knowledge and finding answers to serious problems affecting the current and future generations.

Vol. 2 No. 2 | 342 Copyright © 2023 | Muslim Politics Review th major brands finally beginning to recognise the ready to wear needs of pious consumers, as well as for education purposes, the differentiation in Muslim head coverings becomes important. The niqab has recently emerged as one of the most ubiquitous sy barbarity, backwardness, exploitation and oppression of women, and political radicalisation. Yet all these notions are assigned to women who wear the niqab niqab framing the niqab heard and valued, and, when they do speak, their views are dismissed. Niqab wearers have long been pictured as difficult group to study, and scholars ha -Despite this challenge, Piela was able to conduct research relying on interviews with niqabi women. Women who choose to wear the niqab talked to her about the long and complex process of self-reflection and questioning prior to their adoption of the niqab. Studies have shown that Muslim women more likely to experience prejudice when dressing religiously in public spaces and workplaces, and are sometimes discriminated against in accessing services. Over 80% of form of harassment in public, such as hostile stares, having their niqab ripped off, or being verbally abused or physically injured. Legislation that bans religious face coverings in public has been passed in some countries and territories in recent years, including in France and the Canadian French-speaking province of Quebec. Advocates of such laws have argued that face-covering is a sign of religious extremism, social separation, failed assimilation, and patriarchal oppression of Muslim women. There is a common misconception in the West that this is an oppressive, patriarchal practice forced upon Muslim women. In reality, several studies have shown that many women choose to wear the niqab nces. The picture painted by the stories in this book demonstrates that, for these women, religious symbols such as the niqab are deeply personal, freely chosen, multilayered, and socially situated. Wearing the niqab gives voice to these women and their stories, and sets the record straight, enhancing understanding of the complex picture around niqab and religious identity and agency. The niqab is not mentioned by the Quran, which mandates only modest clothing for both men and women more generally. The Quran (24:31) gaze and guard their chastity, and not to reveal their adornments except what normally appears. Let them draw their veils over their chests, and not The 40 niqab wearers Piela interviewed for her book considered wearing the niqab to be a religious practice. Many said that the wives of Prophet Muhammad reportedly wore it regularly. Some of those women choose to follow what they believe to be the most ly practice: that women who cover their faces will be rewarded for going the extra mile to fulfil this additional duty. niqab is a highly individual practice to which the women came after a long reflection. They acknowledged that while the niqab may be suitable for them, it might not work for others. A woman from the UK explained why some women choose Quran says to cover yourself modestly. Now, the interpretation of that is different to every group of Muslims. Some people believe it just to be the loose dress. Others believe it to be an outer garment as well as headscarf. Yet others would go one step further Quran] says to cover you Piela, who also authored Muslim Women Online: Faith and Identity in Virtual Space (2012), provides a rich and nuanced examination of spiritual and social experience of British and American niqabis amidst prevalent Islamophobic cultural settings. At the backdrop of ill-informed and opinionated media debate and public discourse, Piela sheds muchneeded light to niqab-wearing women in the Global North. She offers important insights about the role of agency, authority, race, and identity in religious practice. The book is essential reading for scholars and anyone else seeking to understand the diverse, complex, and critical engagements of women with religion and society. Piela concludes that women who choose to wear the niqab historically embedded cultural norms. By providing an analysis of different nfixed quality of the niqab as a religious artefact to negotiate gender boundaries. At the end, discontinuities between political agenda-oriented and everyday gendered readings of Islam may facilitate women claiming authority over their religious experiences, without pride and prejudice, only sense of piety and sensibility.

This book is about narratives on various topics voiced out by niqab wearers in the private and public spheres, including in the mainstream media, in the United Kingdom (UK) and United States (US). Featured narratives include ones on religious agency, identity, social interaction, community, and urban spaces. The author, Anna Piela, situates the narratives in the social and political context in the two countries. The Arabic word ‫َاب‬ ‫ِق‬ ‫ن‬ transliterated as nikab, or niqaab refers to a face covering worn by some Muslim women as part of their religious garments. It is a piece of cloth tied over the headscarf and comes in a variety of styles and colours. It is sometimes mistakenly labelled as the burqa, which largely entered the popular imagination during the USled invasion of Afghanistan, when the Western media, often while depicting burqa-clad women, wrote about how the war would help advance the rights of Afghan women. The Western obsession with the burqa, an all-enveloping piece of fabric with a grille covering the eyes, can be explained by the fact that the Afghan-style burqa touches the Western -revealing niqab (Inglis 2017:289). It is so because the burqa obscures the eyes, rendering the wearer

Introduction The maternal mortality rate in Bali Province in the last 5 years is below the national rate and below the target set at 100 per 100,000 live births, but every year it has not been significantly reduced. The maternal mortality rate in 2017 was 68.6 per 100,000 live births, the lowest rate in the last three years (Dinkes Kota Denpasar, 2017). Government programs have been implemented to reduce MMR and AKB through P4K, antenatal care and pregnant women classes (Kementrian Kesehatan Republik Indonesia, 2014). The pregnant women class program is one of the government's programs for Increase knowledge of pregnant women through meetings with health workers and other pregnant women. Classes for pregnant women is a means to learn together to improve the knowledge and skills of mothers regarding maternity care, childbirth, postpartum care, newborn care, myths, infectious diseases, maternal and fetal health, high-risk pregnancy, danger signs, complications that can occur, empowerment of mothers, families in planning for prevention of complications and referrals and birth certificate (Kementrian Kesehatan RI, 2014). Research data in Malang found that 50% of Puskesmas in Malang ultimately did not hold classes for pregnant women due to the low participation of pregnant women to attend classes for pregnant women (Kusbandiyah et al., 2013). Puskesmas in Bali according to Bali provision data in 2017 is as many as 120 puskesmas and all Puskesmas have carried out classes for pregnant women. --- Literature Review Based on the results of previous research It is known that the implementation of pregnant women classes in Puskesmas for the Denpasar region only reached 27.2% (three out of 11 Puskesmas) with the average participation of pregnant women to take part in pregnant women classes reached 50% followed by five out of ten target participants (Widiantari, 2015). The involvement of family members or closest people can help change to behave towards a healthy life and be able to increase awareness of change (E. P Sarafino & Smith, 2014). Women with greater support from their husbands and mothers-in-law generally have an increased ability to use ANC services (Ghaffar et al., 2015). Research by Rima Melati and Raudatussalamah found a significant relationship between the husband's social support and maintaining health during pregnancy (Melati & Raudatussalamah, 2012). By involving the husband, it is hoped that the participation of pregnant women in participating in the class for pregnant women can increase. The purpose of this study was to determine the relationship between husband's social support and participation in classes for pregnant women in Denpasar City in 2019. --- Research Method This study is a type of observational analytical research. This study design used a crosssectional time approach. This research was conducted in four Puskesmas in Denpasar City, namely Puskesmas I Denpasar Utara, Puskesmas I Denpasar Barat, Puskesmas I Denpasar Selatan, and Puskesmas I Denpasar Timur on April 1 -May 1, 2019. The sample size was 78 people with a non-probability sampling technique in the form of consecutive sampling. The data collected is in the form of primary data with questionnaire guidelines. Kolmogorov-Smirnov normality test results with a value of (p) = 0.000, so the data are abnormally distributed and the data are presented with the median value. Univariate analysis to explain the distribution and frequency of each variable. The statistical test used is the correlation of contingency coefficients. Data analysis using computer software, with significance (α) = 0.05 and 95% confidence level. The significance value in this test is p<0.05. --- Result The characteristics of respondents based on the results of research at the Denpasar City Health Center can be presented in Table 1, which are as follows: Based on the table above, from 78 respondents, it is known that most respondents have high school / vocational education equivalent (65%), multigravida or have had 1 or more children (62%) and are dominated by Balinese (67%). All respondents were housewives and healthy reproductive groups of 20-35 years. The distribution of pregnant women who receive their husband's social support can be seen in Table 2 below. Based on the table above, of the 78 respondents more received weak emotional support (51%), instrumental support was also weaker (54%), informational support was also mostly weak (67%) and companionship support was weak (60 %). Overall support was obtained as a result of weak husbands' social support (56%), this shows that more respondents received weak husbands' social support The frequency distribution of pregnant women who attend the pregnant women class can be presented in tables and narratives as follows: Based on the table above, 78 respondents have never attended a class for pregnant women (56%), while 34 respondents have attended a class for pregnant women at least once (44%). So it can be concluded that more mothers do not participate in pregnant women's classes. The results of the bivariate analysis test with the contingency coefficient correlation method are presented in the form of a table. The following describes about the relationship between the husband's social support and participation in classes for pregnant women in Table 4. The table above shows that the contingency coefficient correlation test obtained a value of ρ = 0.000 and a value of r = 0.707, because p < 0.05 it can be concluded that there is a strong relationship between the husband's social support variable and participation in the class for pregnant women in Denpasar City in 2019. --- Discussion The study involving 78 respondents found that pregnant women who received strong husband social support 100% participated in pregnant women's classes at least one meeting, while pregnant women who received weak husband social support 100% did not participate in pregnant women's classes. The results of this study got a value of ρ = 0.000 which means that there is a meaningful relationship between the husband's social support and participation in classes for pregnant women. The value of the contingency coefficient between the two --- Relationship between Husband's Social Support and Participation in Pregnant Women Class in Denpasar City in 2019 variables is r = 0.707 which means that there is a strong relationship between the two variables. The value of the correlation strength of the contingency coefficient is in the range of 0-1, the closer to one, the stronger the correlation strength. It can be said that when the husband provides strong support to the mother, the mother will attend the class for pregnant women, while mothers who get low husband social support do not participate in the class for pregnant women. This research is in line with research by Septiani, and Rani, which examines the factors of knowledge, attitudes, and support of husbands by participating in classes for pregnant women with the result that the most dominant factor is husband support, namely values ρ = 0.000 (Septiani, 2013). Another supporting research is research by Widiantari which examines the relationship between maternal characteristics and husband support with participation in pregnant women's classes, finding that husband support is the most dominating factor in women's participation in pregnant women's classes with grades ρ = 0.001. Based on multivariate analysis, husband support gets a PR score of 27.1 times, which means pregnant women who get husband support are 27.1 times more likely to attend classes for pregnant women (Widiantari, 2015). Husband's social support can be seen from four forms of support, namely emotional support in the form of affection, appreciation, praise given by the husband to the mother, instrumental support in the form of providing easy infrastructure facilities such as providing vehicles or delivering directly so that mothers can attend classes for pregnant women, informational support in the form of providing advice or health information to mothers, and mentoring support in the form of accompanying and assisting mothers in doing Her daily job includes accompanying mothers to attend classes for pregnant women. The husband's social support also helps the mother feel comfortable and motivates the mother to always maintain and care for the health of her pregnancy (Edward P. Sarafino & Smith, 2011). Support from the husband and a good relationship can make an important contribution to the mother's health. The social support needed is in the form of emotional support that underlies the action. It will make people feel cared for, loved, glorified, and valued (E. P Sarafino & Smith, 2014). One of the husband's roles in the presence of mothers in conducting pregnant women classes is to provide motivation to mothers in the form of psychological support and real support for mothers to be able to participate in the pregnant women class program11. Research on husband social support by Risneni, R & Helmi Yenie said that pregnant women who received husband support were more present in pregnant women's classes (Risneni & Yeni, 2017). --- Conclusion Based on the results of research and discussion, it can be concluded that there is a relationship between husband's social support and participation in classes for pregnant women. Pregnant women are advised to be able to participate in regular pregnant women class activities, to MCH program holders at Puskesmas to further increase pregnant women's awareness of the importance of attending pregnant women's classes for mothers and involving husbands during pregnancy checks and providing socialization about pregnant women class programs so that husbands are also aware of the importance of pregnant women's classesand motivation to pregnant women and husbands regarding the implementation of classes for pregnant women and providing education to pregnant women to maintain their pregnancy and prepare for childbirth properly, and further researchers are expected to conduct further and indepth research on other factors related to the participation of mothers in the class of pregnant women. --- Declaration of conflict interest The author declare that there is no conflict of interest in this work.

The Pregnant Women class program is one of the government programs to increase the knowledge of pregnant women about pregnancy, preparation for childbirth, postpartum, newborns, and toddler development so that mothers are expected to be able to identify health problems experienced, but maternal participation in the class of pregnant women is low. The husband's social support is a strengthening factor for mothers to be able to participate in classes for pregnant women. This study aims to see whether there is a relationship between a husband's social support and participation in classes for pregnant women. This study is an observational analytical study with a cross-sectional approach. The sampling technique is non-probability sampling by consecutive sampling of 78 people. This research was conducted from April 1 to May 1, 2019, at the Denpasar City Health Center. The results showed that most of the husband's social support was weak (56%) and mothers did not participate in classes for pregnant women (56%). Statistical tests with the correlation of contingency coefficients obtained ρ = 0.000 value and r value = 0.707, meaning that there is a strong relationship between the husband's social support and participation in pregnant women's classes. The implication of this study is to increase knowledge related to husbands' social support factors that play a role in women's participation in pregnant women's classes.

Introduction Today, the globalization has almost completely revolutionized human life. The world today has no real geographical boundaries. The connectivity among people cannot be avoided anymore. People from every part of the world can be connected to one another as if it becomes one unity which is called as Global Village. One of the major causes of this phenomenon was the existence of internet-in which born as a result of the rapid development of technology and information in the era of globalization. It is a fact that the internet is said to have revolutionized human life. It is because the internet has become a means of communication as well as brings a new paradigm in human's interaction. The presence of the internet has also led to the transformation of the use of conventional communication into digital platform, not to mention the emergence of smart phone technology so that the internet is increasingly accessible to the public. The Indonesian Internet Service Providers Association (APJII) in collaboration with the University of Indonesia's Communication Studies Center (Puskakom) stated that there was a total of 88.1 million Internet users in Indonesia in 2015. While in the wearesocial.sg data release in 2017, there were 132 million internet users in Indonesia and this number grew by 51 percent in one year [1] - [5]. One feature that has become the main reason why people access the internet is social media. Almost all people use social media and mostly it has become a part of their lifestyle. The nature of social media which is easily accessed, cut distance in communication, and has no limited to space and time, becomes the affirmation that social media comes to be an extension of the human body. Such conditions are in accordance with the Global Village theory by Marshall Mcluhan who called it as the medium of an extension of human faculties-the new interaction hub that provides spaces for people to share, tell stories and channel ideas, which makes virtual migration inevitable. If previously our communication and interaction were limited to faceto-face interaction, then it is now further developed by the presence of social media [6]. Social media is a new prima donna in people's lives which has been disrupted by the information and technology development. The disruption of information and technology through the proliferation of internet access is followed by the consequences that must be faced by the users, including the users of social media. The presence of social media is not balanced out by the wisdom in using it. Fake news (hoaxes), hate speech, curses, verbal abuse, acts of intolerance spread on various social media platforms. This phenomenon is clearly worrying for the sustainability of society in Indonesia since it might harm the stability of the country. Thus, it needs a necessary preventive action to overcome this problem. These preventive actions should not only rule the people's behavior in accessing social media, but also lead to strengthening citizens' competence. It is expected that after the citizens have good competence, they can solve the problems they face wisely, given the demands in their lives that began to be disrupted as a result of life in the 4.0 industrial revolution. --- Method This article uses the literature study method. The library research method is a research method that utilizes library resources to obtain research data by focusing on meeting documents, reading and recording and processing research material [7]. --- 3 Result and Discussion --- Digital citizenship as a disruption of society Bage of globalization has brought the digitalization of people's activities and life patterns, and face them with the era of information disclosure. The geographical boundaries of the country which is now almost invisible surely make the interaction of citizens between countries increasingly congested. Citizens in the "global village" live with various kinds of activities that can be carried out in a matter of a split sec-ond. Old habits are replaced with new habits. Almost all lines of life of citizens has changed. In other words, the lives of citizens have been disrupted by the era of the 4th industrial revolution. Based on the above condition, it is clear that this is a new phenomenon in the citizenship study. Commonly, citizenship is known as the status of citizens which is proved by a certain identity, or a lesson obtained from elementary to higher education that aims to create good and smart citizens. The rapid flow of globalization and the advancement of ICT has led to the birth of Digital Citizenship study. The birth of digital citizenship is the impact of the use of digital technology in almost all life activities of the citizens. Of course the emergence of this term clearly creates new challenges in strengthening and developing the competence of citizens in the era of disruption. Indeed, this new challenge is a necessity that must be faced by any country in the world, considering that the competence of citizens is always needed in facing the demands of life in the 21st century, including the citizens' digital literacy competency. As it is stated by Ferry (2014) hat the era of information disclosure led by the advancement of ICT has brought citizens into conditions that make the process of strengthening and fostering of the citizens increasingly important [8]. The concept of digital citizenship presents as a result of the disruption of people's lives due to the development of the 4th industrial revolution. This concept comes from a thought that although times keep changing but norms and behaviors in the lives of citizens must still considered their norm and behavior such as in the use of technology, abuse of technology, communication ethics and others. Considering the impact of the progress of the times brought by the internet and digital technology, it turns out that new problems can even disrupt the stability of the country such as cybercrime, false news (hoaxes), black campaigns, hate speech and so forth. Therefore, a competency is needed by the citizens as an effort to face the challenges of life in the 21st century, and one of the competencies in the concept of digital citizenship to deal with is digital literacy competence. --- Digital literacy to strengthen the competence of 21st century citizens in the age of disruption The transformation of human life from an agrarian society to an industrial society has revolutionized the life of humanity in the 21st century. Various kinds of sociocultural changes continue to occur due to the flow of globalization and information. Even as a result of this phenomenon, the label of the industrial community has now gone to a knowledgeable society. Of course, this happens not without any reason. The availability of internet and digital technology promises the easier connectivity in the community-starting from how people communicate, collaborate, create work, solve problems, make decisions, to consume information. Thus, it can be said that people's lives have been disrupted (disruption society) [9], [10]. The consequences of people's live that have been disrupted in the 21st century clearly has brought a need that must be fulfilled by humans who live in this era. It is said considering that almost all aspects of life have changed completely, which has resulted in the emergence of new jobs that require new competencies as well. If the community does not have these competencies, it is difficult to be able to compete in the life of the 21st century. One of the competencies that must be possessed by 21st century citizens is digital literacy. The term digital literacy was first used by [11] in his book entitled "Digital Literacy", according to him digital literacy is the ability to understand and use information in various formats from various sources when presented through a computer. Meanwhile, according to [12] digital literacy is the technical skill of accessing, assembling, understanding, and disseminating information. While the [13] defined digital literacy as the ability to use information and communication technology to find, evaluate, create and communicate information where cognitive and technical abilities are the basis. Based on the explanation above, it can be concluded that digital literacy is a set of knowledge and abilities possessed by individuals in understanding, evaluating, and using information obtained by prioritizing ethics in order to communicate and interact in daily life. Digital literacy competence is a necessity that digital citizens must possess in facing the challenges of life in the 21st century. In the book "Digital Citizenhip In School", [14] asserted that digital literacy is the most important aspect of understanding technology so citizens can use it appropriately. It is said that it is often found that the presence of technology that is very sophisticated but not followed by the ability to use it appropriately. In this case, technology is described as a two-sided blade. In one side, it allows people to interact and communicate with family and colleagues yet, on the other hand, it is also followed by the threat of cybercrime, false news (hoaxes), black campaigns, the expression of hatred of radicalism, and fraudulent practices. Therefore, awareness and competence of each citizen is needed, because if citizens are not wise in responding to it, it can interfere other people's rights and even the stability of the country. Thus, it can be said that digital literacy is a life skill that must be owned by citizens so that the order in their lives can lead to a critical-creative mindset and viewpoint so that it has an impact on social and cultural life that is safe and conducive. --- Conclusion The 21st century citizens who are growing with the ease of technology and unlimited digital access of course have a mindset and action that is different from the previous generation. Almost all of their lives are disrupted by the times in it, which demands certain competence if they want to survive through the era. It is not an exaggeration considering that citizens of this century live on two sides of a technological blade-if they are able to use it appropriately, they will get ease of life and if they are not able to use it appropriately, it will have a negative impact on their lives. The flow of information makes a life skill is necessary to make their life order contain a critical-creative mindset and outlook that has an impact on social and cultural life which is safe and conducive. One of the life skills that must be possessed to deal with these all is digital literacy competence. --- Authors Meidi Saputra is a lecturer in Law and Citizenship Department, Faculty of Social Sciences, Universitas Negeri Malang. His research interests range across civic and citizenship education, sociology citizenship, political life and pop culture citizen. Imamul Huda Al Siddiq is a lecturer in Sociology Department, Faculty of Social Sciences, Universitas Negeri Malang. His research interests range across Sociology of Economic and Industry, Islamic Boarding School Issues and Sociology Citizenship.

The rapid development of technology and communication had given birth to a new world order that gave an impact on all aspects of the lives of citizens. This new world order was often known as social media; a new media that was born in the digital era as a result of the existence of the internet. This media made the mobility of citizens' lives became faster so that the interaction among them almost has no boundary, and resulted in the concept of digital citizenship. The emergence of social media certainly brought positive and negative impacts that automatically created disruption to citizens' behavior. The phenomenon of the spread of black campaigns, hate speech, false news (hoaxes), heated arguments toward each other became a common issue as a result of the citizens' unpreparedness in facing an era of disruption. Therefore, digital literacy was a necessity in this era of disrupted society so that becoming a smart and good citizen would not only be a discourse on the issue of citizenship.

Not only are minority Americans dying at higher rates from covid-19, they are also dying at higher rates than whites from chronic diseases. Maternal mortality rates for black women are three or four times higher than for whites. Although black Americans make up about 13% of the population, they account for 24% of deaths from covid-19, when race is known. About half of covid-19 deaths lack racial data, however, said Laurie Zephyrin, an obstetrician-gynaecologist who is vice president of the Commonwealth Fund. Similar disparities exist for Latino and indigenous Americans, she said. Racial data on deaths is incomplete for most states and North Dakota does not report racial data, she said. When reported, deaths among Latino and indigenous people are higher than those for whites. Among the reasons for the disparities are that these minorities are more likely to live in communities with pollution that predisposes them to health problems, less likely than whites to have health insurance, less likely than whites to be able to work from home, and face bias in medical treatment, she said. They are more likely to be unemployed because of the pandemic, and thus lose employment based health insurance. The panel was organised by the Alliance for Health Policy, a nonpartisan, not-for-profit organisation focusing on better understanding of health policy, healthcare problems, and proposals for change; the Commonwealth Fund, which promotes a high performing healthcare system with improved access, quality, and efficiency, particularly for society's most vulnerable; and the National Institute of Health Care Management, a non-profit, nonpartisan organisation aiming to improve healthcare. 1 Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota, said that the pandemic showed what was not working. He said, "We have the opportunity to build a new system." Wizdom Powell, director of the University of Connecticut Health Disparities Institute, said there was a link between people experiencing discrimination and poor physical and mental health. The disparities, both before the pandemic and now, "have significant implications for healthcare spending and worker productivity, and, thus, impact our capacity to compete in the global marketplace," she said. Adaeze Enekwechi, a health policy expert at George Washington University, said that covid-19 infections are continuing to rise and 200 000 people will likely have died by October. The US was unique globally in its dismal outcomes, she said. "We are the richest country in the world but we are seeing outcomes that look like what you might see in a poorer developing country." The current situation shows what needs to be done to combat the next pandemic, natural disaster, or public health crisis, she said. Among the changes the panel recommended are better data, universal healthcare and an end to employment linked health insurance, and increased minority participation in the healthcare workforce. Data on race, ethnicity, and English proficiency are needed to show where problems are. Powell said, "We're not training enough black and minority health workers. We should open new paths into the community health workforce to people unemployed by the pandemic." "We need more people of colour in the health workforce," said Enekwechi. "They are more likely to go back to their communities after training-often in rural areas where trained workers are scarce and hospitals are closing." They will help end antagonism to medical providers because they are trusted in the community and understand the community, she said. Minorities "have been experimented on, not given treatment, disrespected, and not treated for pain," she said. Lingering distrust will impair their responses to contact tracing and even to a vaccine when it becomes available. Universal healthcare could be achieved if the US replaced employment based health insurance with an expansion of Medicare (government health insurance for the elderly) and Medicaid (health insurance paid for jointly by the federal government and some states). The Affordable Care Act encouraged states to expand Medicaid, but 14 states, mostly in the south, did not.

Deaths from covid-19 among black Americans are almost double those of whites, and black, brown, and indigenous people face structural racism and health inequalities, an expert panel has said.

Introduction The urban environment is increasingly mediated through the pervasive and emerging HCI technologies. Within the context of interactive public displays, researchers have provided rich insights in revealing how featured display configurations support social relationship, yet the relationship data itself on shared experiences between participants and the public still need to be clarified. In this paper, we aim to address 1) what is the factors that influence the social interactions and 2) how these factors support different types of social interaction meaningfully. In order to explore these questions, we conducted a literature review to confirm the key factors, and case studies in several relevant projects to identify the perceptional and behavioural influence on participation. We explore the data properties and manifestation in framing and supporting public engagement. In particular, the criteria will be structured through existing bodies of ambient display taxonomies proposed by Pousman and Stasko (12), and Tomitsch et al (13), with a specific perspective in the input and display of information. We focus on 1) the taxonomy of data-related features in ambient display (information capacity, localness, and etc.) and 2) the type of augmented public interaction. Our findings are discussed in regard to social relationships and stress the perceptional and behavioural aspects of interaction. --- Background Research In the light of data contribution, Koeman (6) defined three key elements of information visualisations: 1) addressed topics 2) input technologies and 3) visualisation output. Under these the category, we identify and categorise the data-related features based on the previous study. Extensive research has carried out to build a taxonomy of various features in ambient display. Matthew et al (7) firstly proposed three key characteristics of ambient display with a focus on the "peripherality", namely: abstraction of data, selection of notification levels, and transitions between notification levels. Based on the pioneering work, Pousman and Stasko (12) emphasise on the display of information and add "information capacity", "aesthetic emphasis" to the design dimensions of the display. They plot each dimension with five modes from "high" to "low". Tomitsch et al (13) further expand these dimensions into a more specific taxonomy with nine characteristics in the matter of data manifestation. Several projects contributed to identifying the data attributes that influence social interaction. Netto et al proposed three layers of information-physical, semantic and enacted, according to their description, physical information represents the facts of environment, after interpretation it transfers into the semantic content, and enacted information play as the consequence for direct public use (9). In other aspects, Cleas and Vande Moore (3), and Wouters et al (17) outline that hyperlocality of information have an impact on public awareness and participation. The more relevant of the topic within the situated context, the more attention and understandings will be gained from public. --- Framework of the Criteria Based on previous studies (7)(12)(13), we build on previous work and suggest a taxonomy of key features in an interactive public display regarding to their correlation with data: --- Addressed topics 1. Information content-The meaningfulness of input data: physical, semantic and customised. The definition of first two layers is similar to Netto et al (9), and customised information refers to free content created by participants. 2.Hyperlocality of topic-Social relevance between the topic and the situated context. Metrics: irrelevant, communal, hyperlocal. --- Input Technologies 1. Input action-Input mechanism and behaviour of participants to submit the data. 2.User interface-Type of tangible user interface. Metrics is based on the work by Hespanhol and Tomitsch (4) and Behrens et al (2) as: Mobile interface, performative interface, allotted interfaces, and responsive ambient interface. --- Visualisation Output 1. Modality-Type of visualisation. Metrics: visual, tactile, olfactory, and auditory. 2.Information capacity-The number of information sources that ambient display can present. Metrics: low, medium, high. 3. Visual dynamics-The rate at which data and visuals changes. Metrics: low, medium, high. --- Data-triggered Social Interaction Social interaction in public display has been explored extensively，while only several studies emphasise on the impact of data properties and manifestation on public experience. Based on the previous work (5)(11)(14) (18), the following lists main social phenomena evoked by displayed information. The influence is partitioned into two mingled aspects as "perceptional" and "behavioural" changes. --- Perceptional changes Before participation, people are motivated through the changes of their perception to display: Curiosity and incentives for engagement, collaboration, or competition. In "Honey-pot effect", arising curiosity from spectators plays as a key factor to maintain "action loop". According to Wouters et al (18), The effect is often related to the visibility of input actions and visualisation output. Exaggerative movement and vivid representation have more chances to attract public attention by its clash with surroundings (8) (10). While the incentives for competition, based on the work from Valkanova et al (15), is mainly motivated by visualisation result. These are feedforward under the influence. However, during participation, chances are there to raise "social awkwardness" due to the fear of submitting inappropriate data. According to Valkanova et al (14), this feeling could be amplified by the identifiable personal visualisation. --- Behavioural changes Behavioural changes usually happen during the shift of roles between passers-by, spectators and participators (18). "Honey-pot effect" keeps the cycle of three roles and stimulate both active and passive engagement in the display (11). The passers-by turn into spectators by noticing the interactivity, and the spectators transfer to participators through input actions. After they quit interaction, they may have a discussion with new curious spectators about interaction rules (18). Although some audience are out of "action loop", they might get involved in the social discourse when the addressed topic is hyperlocal or there are discrepancies in understanding the projected information. "Social comparison" often happens between participators and spectators. It is more related to the type of data and visualisation style. Usually, physical and semantic data are more likely to trigger discourse as they are often related to a common issue or experience. --- Case studies To explore how these features in taxonomy support social interaction, we analysed existing projects that we identified as good examples. Drawing on the literature that outlines the project that we selected, we are able to gain an intensive understanding in its social effects. In the following section, we explain briefly the project component and highlight the corresponding changes on passers-by. --- My Position "My Position" is a large interactive poll visualisation aimed to support situated deliberation of citizen opinions. The visualisation is made of a series of square tiles, and each represents the opinion submitted by single participator. According to Valkanova et al (14), several goals have been achieved during projection: 1) Low barrier entry (simple gestures and guidance texts) and playful input action (Kinect sensed movements and options for photo taken) encouraged all participation and 2) it succeed at raising awareness of public opinions and sparking social debates. Reveal-it! "Reveal-it!" is an interactive public projection supporting comparison between energy consumptions of individuals and community averages (15). This project explores how communal data visualisation influence the user awareness, participation and discourse of differentiated understandings to the display. Valkanova et al concluded it successful in raising public awareness and stimuli discussion ( 14), yet, they also emphasized that there are difficulties in visualizing aggregated data as it may decrease public trust to projected information and lead to false input. --- Shadowing Shadowing is an interactive lighting installation published by Chomko and Rosier. It gives memory to city street lights, enabling them to record and play back the shadows of pedestrians who passed underneath. According to the study from Anton (1), it succeeds at using simple input entry to attract diverse participation, and dynamic shadow encourages creative contributions. Based on the recordings from Chomko and Rosier (1), during display, passers-by are paused to watch playful shadows contributed by last user, further many of them participate in creating new shadows. The observation indicates that some users tend to play with their own shadows and make repetitive submission. --- Findings and Discussion The main findings of the case studies indicate that, different data-based features supporting different social experiences: The rising of perceptional changes is mainly evoked by displayed content and data manifestation. Physical and semantic information could be easily accepted and understood by the public, while the customised content arises more curiosities. The more pedestrians are related to topic, the more concerns they show to the display. However, it may lead to the negative effect "Social awkwardness"-Since content is shared with local community or large audience, some potential participators are held back by the fear of submitting inappropriate data in front of public (14). Visualisation output stimulates perceptional changes by information capacity and temporality. In "My position" and "Reveal it!", the accumulated projection of personal information leads to comparison between participators, and to some extent, it also motivates spectators to join the competition (16). While for customised display, people are encouraged to crate identifiable content instead of setting up competition. Besides, the dynamic projection maintains sustainable attractions to spectators. According to the analysis, perceptional changes evoked by data-based features further encourage different behavioural changes. In "Reveal it!", accumulative projection of personal data causes differentiated understandings which leads to social comparison and discourse (15). While the curiosity for customised content has more chances to raise social talk or discussion, as shown in "Solstice LAMP" (4). Input technologies trigger curiosity and participation through exaggerative input actions or the real-time interactivity between user input and interfaces. Compared with mobile or distributed devices, Public interfaces or screens with interfaces embedded could acknowledge the public of interactivity easily. For display output, rich visual style of aggregated information incentivizes competition or collaboration, while real-time display attracts more curiosity and casual participation. --- Conclusion In this paper, we explored the role of data in the ambient display and its impact on social interactions. The results suggest, the addressed topic not only defines the main content of display, but also has a great influence on maintaining the spectator curiosities. due to its social relevance of topic. Input technology plays a significant role in supporting pedestrians' notice of display interactivity and further participation. For output, besides attracting attention, it also affects public understandings of display. Further studies need to be carried out in uncovering connections between data-supported experience and contextual factors. In particular, we want to know under different context, how data-related features influence social interaction.

This paper presents the early findings of studies in the role of data informing the interaction between the user, public and public display. It focuses on exploring how different strategies amplify and stimulate these datasupported interactions. Building on the work by Tomisch et al (13), we establish a taxonomy for databased features under the category of key elements in urban visualisations: 1) addressed topics, 2) input technologies, and 3) visualisation output. We analyse how these factors facilitate social interactions meaningfully through case studies of previous projects developed and implemented by Media Architecture research community. We suggest that data properties and manifestation play a significant role in 1) sustaining attraction to passers-by 2) enriching public understandings of display, and 3) encouraging diverse participation.

of a larger study on decision making about aging-in-place (R01AG058777), we are longitudinally following a cohort of older adults with surveys every 6 months. Subjects are asked to describe conflicts that have occurred regarding their living situation. Responses were coded using constant comparative analysis examining type, content, and whether statements were interests, rights, or power-based. We enrolled 293 subjects (mean age 73.5 yrs, SD 5 yrs, 40.4% non-White; 94.5% retention rate) and 124 conflicts were reported over 18 months. Thematic analysis revealed three types of conflicts: Interpersonal (subcategories: spouse, intergeneration, other), task, and value-based. Content was coded into 6 themes: Location change, home maintenance issues (e.g., My son insisted I put in a new lower tub, and I didn't want to), different ways of completing tasks (e.g., it is about my children and the way we do things), safety (e.g., Neighbor's boyfriend kicked in the door and destroyed our property), financial, and health-related. Most statements were either interests or rights-based. Older adults experience a range of conflicts involving aging-in-place decision making. Most often older adults experience interpersonal conflicts with supporters about moving from their home or maintaining/ adapting their home. Training in negotiation may help alleviate these conflicts between older adults and their care supporters. Abstract citation ID: igad104.2637 --- INDECISIVENESS ABOUT LONG-TERM CARE AMONG OLDER ADULTS Allie Schierer, Amber Miller-Winder, Raven Relerford, Charles Olvera, Vanessa Ramirez-Zohfeld, Alaine Murawski, and Lee A Lindquist, Northwestern University, Chicago, Illinois, United States As cognition and function worsen, older adults often make decisions about living in long term care (LTC) or accepting support in the home. We are longitudinally studying LTC decision-making among a cohort of older adults (65+), who have viewed PlanYourLifespan.org (PYL), a proveneffective LTC planning tool. Subjects were surveyed at baseline (BL), administered PYL, then followed with surveys every 6 months. Participants were asked about LTC decisions in the event of worsening cognition and to describe those decisions. Responses were analyzed using a mixed-methods approach with open-ended responses coded using constant comparative analysis. Of the 293 subjects, mean age was 73 years, 72.7% (213) female, 40.4% (118) under-represented minority. Between baseline-18 months, 66.5% of subjects changed their LTC plans (28.7% one change, 24.23% two changes, 9.2% three changes) At 1 and 6 mos., the proportion of respondents who changed their decision from their prior timepoint was 44%. By 12 mos., this proportion has declined to 39%, and by 18 mos., the proportion further decreased to 34%. Higher indecision (Yes-No-Yes-No) was seen with changes in family caregivers, timing around COVID-19, and personal health. Decision permanence increased at 12-and 18-month time points. LTC decision-making fluctuates; however, over time, the decision-making progresses from circling to more permanence. Understanding LTC decision making is longitudinally important to understand and should be revisited every 6-12 months in clinical practice.

who had a communal problem-solving style and where the wife perceived higher marital satisfaction were more likely to be concordant in their moving desires (i.e., agreeing to move or to stay), after controlling for other individual and family characteristics. Further, couples were more likely to agree to move-when they had discussion about life after retirement and shared individual stress between spouses. Our findings suggest the importance of marital dynamics in understanding concordance in spouses' desire to move after retirement.

Methods: Guided by Streiner et al.'s (2015) approach, we engaged experts-by-lived experience in content and face validity testing of an item pool matrix to determine relevance and coverage of domains and items. The matrix consisting of 3 domains, 14 categories, and 72 items was based on a literature review of home and community PREMs (32 PREMs with 550+ items) and interviews with healthcare leader experts (n=6). To conduct content and face validity testing we held three focus groups with home care recipients and family/friend caregivers (n=17) as well as individual interviews with health and social care providers working in home care (n=15). We analyzed transcripts line-by-line to generate themes related to face and content validity of each item. Results: Participants agreed that client experience of innovative home and community care is well captured by three domains: equity, continuity, and life care. They also agreed the corresponding 72 proposed items had face validity. Suggestions to improve content validity included that items be adapted to recognize the role of caregivers; the role of primary providers and/or coordinators in delivering well organized care; and shifting from a focus on self -management to having needed supports to stay in the home, and collaboratively developing care plans. Participants excluded several items due to being vague or not meaningful, such as asking, "my providers understood my needs". Based on feedback, 22 items were removed from the matrix. Learnings: Engaging experts-by-lived experience in development of PREMs helps ensure the data generated from PREMs will be meaningful and useful for guiding health system improvements that matter to clients. Relying on existing literature and traditional expert opinion alone did not guarantee relevance or coverage of items. --- Next steps: The feedback from participants will be used to further refine and scale the PREM items. Clients of home care and family/friend caregivers will then be re-engaged in cognitive testing to identify issues related to answering the questions on the scale. Once complete, the PREM will undergo psychometric testing.

Designing meaningful surveys: Engaging experts-by-lived experience in the development of a patient-reported experience measure (PREM) of integrated home and community care.

Introduction Menstruation is the natural process in which normal uterine bleeding occurs once every month [1]. Normal menstruation often disrupts women's physical, mental, social, and cultural well-being [2]. On the other hand, abnormal uterine bleeding (AUB) refers to continuous bleeding and its pattern, volume, and duration are longer and sometimes overlap the menstrual periods for long periods of time [3,4]. AUB affects the women's health-related quality of life, sexuality, intimate relationships, social life, and participation, mental health (including anxiety, stress, and depression), access to education and employment opportunities, stigma and shame, and economic burden [5][6][7]. Prevalence of AUB is significantly higher in adolescents, women of reproductive age, and premenopausal age than prepubertal and post-menopausal age [8]. A study showed that the prevalence of AUB was found to be 8.9% of total women visiting the gynecology department in tertiary care hospital [9]. A study conducted in Brazil found that 31.4% of women faced AUB [10] which is aligned with another study from Ethiopia [11] but another study from India reported 18.3% of women in premenstrual age faced the problems [12]. The incidence of AUB worldwide is estimated to be 3-30% and the majority of cases occurs at menarche or near menopause [13]. Findings from a systematic review revealed that the prevalence of AUB in developing countries was found to be 5-15% [14]. Vaginal bleeding is a shared characteristic of both menstruation and abnormal uterine bleeding. This similarity might lead patients to overlook the need for diagnosis, treatment, management, and other social and cultural consequences. Given the lack of nationwide data concerning AUB, its prevalence within the community can be linked to an iceberg -predominantly concealed from view. So, this mini review tries to appraise the social and cultural issues of menstruation and AUB in Nepal. Menstruation is the physiological process where vaginal bleeding occurs due to the shedding of the uterine mucosa. The length of the menstrual cycle varies among women, but the average duration is about 28 days from the start of the menstrual period to the next. Menstruation consists of four phases i) Menstrual phase (0-4 days) ii. Proliferative phase (0-14 days) iii. Ovulatory phase (14 th day) iv. Secretory phase (14-28 days). The menstrual cycle occurs due to a decrease in estrogen and progesterone which is followed by the proliferative phase that coincides with the follicular phase of the ovarian cycle where the endometrium regrows under the influence of estrogen from developing follicles. The ovulatory phase occurs on the 14 th day which coincides with ovulation from mature follicles in an ovarian cycle that occurs under the influence of the Luteinizing hormone. The secretory phase follows the ovulatory phase where the endometrium becomes highly vascularized and edematous due to estrogen and progesterone from the corpus luteum. Menstrual blood consists of arterial blood mainly with 25% venous blood. A normal woman's menstrual cycles typically last 3-5 days, although they can be as short as 1 day or as long as 8 days. Normal blood loss might range from a little spotting to 80 mL; the typical loss is 30 mL. An abnormal loss is one that exceeds 80 mL [16] . Irregularities in the menstrual cycle that involve frequency, regularity, duration, and volume of flow are together referred to as "abnormal uterine bleeding". The International Federation of Obstetrics and Gynecology (FIGO) has developed the helpful acronym PALM-COEIN to categorize the underlying causes of irregular uterine bleeding. Structural problems are described in the first section, PALM. Non-structural problems are described in the second section, COEI. One or more listed below causes AUB [17] and they are- --- Worldwide Scenario of Menstrual Practice and AUB Most world religions typically have negative views and impose prohibitions on menstruation and women experiencing it except Sikhism [18]. The woman with menstruation is untouchable and ritually unclean and may not have intercourse with her according to the book of Leviticus Hebrew Bible [19]. Menstrual-related hygiene and sanitation are important components of good menstrual practices. Globally 500 million women and girls lack facilities for menstrual hygiene [20]. Since there is no direct connection between menstrual hygiene and abnormal bleeding prolonged use of more than 6 hours of tampon may cause menstrual toxic shock syndrome [21]. The studies from various countries revealed different societal attributes. A study from France found that almost 81% of women and girls preferred disposable sanitary pads [22]. Another study found that 27.2% of women had experienced heavy uterine bleeding [23]. The study from India found that menstruating girls and women were treated as taboo and discriminated against in social as well as religious activities. Hindu, Muslim, and Orthodox Jews still abide by these taboos [24]. A similar study from Bangladesh found that, menstruating women and girls are impure and restricted in socio-cultural and religious activities. Almost 91% used old, unhygienic cloths as menstrual pads [25]. However, another study from Sri Lanka found that menstruation is treated as a physiological process and related problems to hormone levels and pathological conditions of the uterus [26]. This difference may be due to the high literacy rate in Sri Lanka. Menstruation is a natural physiological function of the female reproductive system, but it is enveloped by different myths, superstitions, religious and cultural traditions. Ancient cultural myths describe menstruation as sacred and magical, attributing it to divine gifts or punishments in the legends and prehistory of various societies. --- Cultural Issues of Menstruation and AUB in Nepal The cultural issues surrounding menstruation are complex and deeply ingrained in Nepal. They are influenced by cultural beliefs, religious practices, and societal norms. Menstruation and childbirth involve vaginal bleeding, which has been historically deemed ritually unclean, leading to be adaptation of restrictions in various religious, social, and cultural contexts 4 111 [18,27,28]. AUB creates confusion for the duration of restriction (usually 4-5 day) for menstruation and sometimes would be longer in this case. Regular bleeding creates problems of hygiene and restrictions on several activities. Most Nepali believe Hindu religion and believe that women and girls with vaginal bleeding are impure and are restricted and excluded from participation in daily, community, and religious activities. Those women and girls are prohibited from entering the prayer room/temple, kitchen, and touching male family members, sleeping on their own beds separately, and cannot even touch the beds of male members, and sometimes going to school. Menstruation is perceived as a stigma and taboo in the western hilly region of Nepal. Menstruating girls and women were unclean, and untouchable, and kept outside of their homes in a hut made from stone and mud without a lock, window and very small in height or in a cowshed called Chhaupadi [29]. At the time of menstruation, they are not only isolated from home and family but also restricted from drinking milk and dairy products and cannot touch men, water sources, plants in kitchen gardens, or visit public places [30]. A recent study revealed that most of 84% of adolescent girls were practicing these practices [31]. Cultural and sociodemographic factors contribute to inadequate personal hygiene, lack of information regarding normal and abnormal bleeding, safe water, and use of safe, clean toilets and protective absorbents [32]. The legal provision in Nepal prohibits exploitation in the name of customs, traditions, and behavior. The Supreme Court of Nepal directed the Nepal government to formulate a law to control such bad practices in May 2005 [30] but the implementation of the legal provision has not reached to affected community. --- Social Issues of Menstruation and Abnormal Bleeding There are several social issues of menstruation and abnormal bleeding. 1. Affect on quality of life: Heavy menstrual or uterine bleeding significantly affects the quality of life more than normal bleeding among women [33]. Several other studies also support these findings [6,34]. Excessive blood loss may interfere with the physical, emotional, social, and material quality of life of women [35]. 2. Social isolation: women with heavy uterine bleeding might feel socially isolated due to the fear of experiencing unexpected heavy bleeding in a public setting. A qualitative study revealed that a person with menstruating or heavy bleeding might be attributed to the perception that not adhering to the tradition of seclusion during menstruation could lead to potential religious consequences or curses [36]. --- 3. Loss in work productivity: Some study findings revealed that work productivity has been diminished due to AUB. 20% of women with menorrhagia reported they had missed work because of their disease [37]. Other studies suggested that 40% of women with bleeding due to fibroid took leave from their work for several days a month from their works [38]. Women who needed surgical treatment took more leave than women with medical conditions [39]. 4. Intimate relationship: AUB can affect intimate relationships due to physical discomfort, blood stains during coitus, unpredictable bleeding, and unclean vaginal canal, and also may lead to decreased sexual activities and communication challenges and strain on partnerships. 5. Social stigma and shame: Menstruation and AUB are subjected to various kinds of social stigma and shame. Because of social taboos, women, in rural areas of Nepal are unable to use disposable sanitary pads leads to staining, leaking, and being the source of infection of the reproductive tract [40]. --- Practice in Menstruation and AUB in Nepal The hygienic menstrual pad has an important role in maintaining menstrual hygiene. A study conducted among school girls reported only one-third use disposable sanitary pads [41]. A similar study conducted in the rural population of the mid-western region found that only 40.4% used sanitary pads [42]. The study results from the far-western province are more treacherous than other parts of Nepal, which showed that more than 70% of girls did not use disposable sanitary pads because of more expensive prices and only 44% used new clothes for their last menstruation [43]. Different factors such as education, family size, living with relatives [44], and other several sociocultural and religious factors are the major drivers behind it including illiteracy, superstitions, stigma, existing gender-based discrimination, cultural, traditional, and religious beliefs, and poor implementation of laws are major drivers behind it [30]. Nevertheless, ongoing interventions by various organizations, including education programs, income generation initiatives, local government efforts, and law enforcement, are underway, aiming to enhance and promote better practices, fostering anticipated improvements in menstrual hygiene. --- Conclusions All religions except Sikhism have negative views of good practice during menstruation. Nepali women from some parts of the country still follow unacceptable and unhealthy practices regarding menstruation and AUB. Restriction and prohibition of touching some food items, sleeping in the same house, and inadequate personal hygiene during menstruation are reported by many researchers as cultural issues. Healthrelated quality of life, sexuality and intimate relationships, social life and participation, mental health (including anxiety, stress, and depression), access to education and employment

Practice difficulties during menstruation and abnormal uterine bleeding (AUB) are major global concerns. So, this review will explore the issues of cultural and social for menstruation and AUB in Nepal. Nearly one-third of menstruating girls and women were facing abnormal menstruation and uterine bleeding worldwide. All religions have negative views and enforce prohibitions on menstruation and abnormal uterine bleeding except Sikhism. AUB impacts women's living quality, sexuality, social engagement and participation, mental well-being, access to education and employment prospects, experiences of stigma and shame, as well as economic challenges. Menstruation restrictions are a routed problem in some parts, some religions, and castes, and very few menstruating women use disposable sanitary pads in Nepal. Awareness programs, educational intervention programs, and education on menstrual health help to rule out the causes of AUB, and legal implementation of these should be applied to the effort to overcome the issues.

INTRODUCTION Some 12.6% of the total US population is immigrant. China, after Mexico, is the second largest sending country. 1 Asian Americans are the only major population group in the United States for whom the annual number of cancer deaths is greater than that for heart disease. 2 Much effort has focused on increasing access to screening for minority and underserved populations, including the Chinese population. 3,4 Several authors show that, after adjusting for diagnostic stage, substantial disparities in cancer survival remain among minority populations in general, indicating that other, post-diagnostic factors contribute to the mortality differentials. 3,[5][6][7] Low rates of cancer treatment appointment keeping, lower rates of receipt of adjuvant therapy, and early treatment termination have been described. 3,[8][9][10][11][12][13][14][15][16][17][18] However, these studies largely focus on black and Hispanic minority populations, with few authors examining disparities in treatment and survival among Asians. There are no studies assessing cancer treatment appointment keeping among Chinese immigrants. Minorities are confronted with considerable social and economic barriers to cancer treatment appointment keeping, including poor housing, employment limitations, limited access to health insurance, cost of treatment, lack of child care and transportation, and inadequate nutrition. 3 The Chinese population is subject to all of these barriers, plus language barriers, additional cultural factors, and other economic, personal, and family health priorities. 19 Socioeconomic factors can significantly impact access to cancer treatment and appointment keeping and have been shown to affect treatment to significantly impact survival in minorities. 8,20,21 Few studies have focused on assessing and addressing socioeconomic correlates of cancer treatment appointment keeping. This study was conducted to specifically determine social and economic correlates of cancer treatment appointment keeping among Chinese immigrants. --- METHODS The Immigrant Cancer Portal Project is a program funded by the New York Community Trust to provide assistance to largely low-income, immigrant, and minority patients in 11 New York City hospital cancer clinics where treatment appointment keeping had been noted to be problematic. Most patients at these sites prefer to communicate in languages other than English, most often in Chinese and Spanish. This study is a nested cohort of all Chinese patients participating in the Portal Project between 2008 and 2009, their areas of needed assistance, and appointment keeping for cancer treatment. Central to the Portal intervention is the trained, bilingual access facilitator who assesses needs and coordinates an individualized set of transdisciplinary services for each patient. Access facilitators operate in a breadth of areas, ranging from assessing and prioritizing needs; providing assistance with intake procedures to patients with low literacy and limited English proficiency; providing financial support, i.e., assisting with obtaining reimbursements and funding that may go towards doctor's visits, radiation therapy, chemotherapy, radiological scans, pain medications, medical supplies, and home care; addressing food insecurity; assisting with transportation; assisting with rent support and housing conditions; assisting with accessing programs that provide free medications; assisting with insurance and obtaining mandated hospital fee reductions; accessing free or low-cost legal resources for immigration, eviction, wills, and work discrimination concerns; assisting with referrals to social services, counseling, and cancer support groups; assisting with accessing child care for appointments; accessing and working with interpreters; and helping patients improve patient-provider communication. Eligible patients in the nested cohort included all English, Mandarin, Cantonese, and Fukianese-speaking immigrant adults with Chinese ancestry with a diagnosis of cancer who were undergoing treatment. Facilitators approached all patients in the waiting area prior to their medical visits. As part of the patients' care, access facilitators conducted a needs assessment survey in the patient's preferred language. The needs assessment included sociodemographic indicators; need for socioeconomic assistance (financial support, food, transportation, rent, medications, insurance issues, legal issues, social and psychosocial services, and child care); reports of missed oncology, radiation therapy, and/or chemotherapy appointments and the reason(s) why. Once patient needs were identified, facilitators provided immediate and ongoing assistance in those areas. We performed descriptive statistics to examine sociodemographic characteristics, areas of needed assistance, and missed appointments. --- RESULTS Six hundred eighty-nine patients with cancers of all sites were enrolled in the study between July 2008 and July 2009. One hundred ten Chinese immigrant patients were approached; 25% refused help, and 82 agreed to participate. All had immigrated from China, Hong Kong, or Taiwan; 52% had resided in the United States for 10 years or less. Forty percent had not completed high school, and nearly all preferred to speak Chinese in the health care setting. Twenty-seven (33%) had no health insurance, and 49 (60%) were insured (three responded "Don't know" and three responses were missing). Of the 49 patients who did have insurance, 27 (55%) had Medicaid and 13 (27%) had Emergency Medicaid. Only 23% reported working with a social worker (Table 1). Among all those enrolled, patients most commonly reported needing assistance in the following areas to help them attend appointments: financial support (87%), food support (18%), and transportation (18%). Nine percent reported needing assistance with health insurance issues. Twenty-two percent reported that they had missed appointments for oncology follow-up, radiation therapy, and/or chemotherapy. Among the 18 patients who had missed appointments, 94% reported they needed financial support. Among the 62 patients who had not missed appointments, 79% needed financial support. Two responses were missing for this question on missed appointments (Table 2). Additionally, stated reasons for missing appointments included misunderstanding of when the appointment was scheduled, conflicts with other appointments, and patients being too weak to attend appointments. There were no sociodemographic differences between those who had reported versus those who had not reported missing appointments. --- DISCUSSION In this nested cohort of 82 Chinese immigrant cancer patients, we found a high number of patients who reported missed appointments for follow-up care and treatment. Some of the reported reasons for missing appointments, such as misunderstanding of when the appointment was scheduled and conflicts with other appointments, could be addressed by ensuring available and accurate interpreting/translation services at the time of appointment scheduling or through the presence of bilingual staff and/or patient navigators. Patients most commonly reported needing financial support. Only 23% of patients had been working with a social worker at the time of study enrollment, indicating that patients were either not aware of, or not willing or able to (due to language barriers or resource scarcity), access available resources. Strategies such as provider reminders, patient education, and automated referrals to linguistically responsive social services could potentially address this. This study likely underestimated the missed appointment rate, as we performed a cross-sectional survey of patients who were present at the clinic for follow-up. Patients who missed more appointments were less likely to have been enrolled in the study. Additionally, as the study was based on self-report of missed appointments, accuracy may have been affected by poor patient recall. A larger, prospective study is needed that tracks patients from intake through treatment and assesses their reported concerns and objective measures of appointment keeping. Targeting social and economic correlates of cancer treatment appointment keeping in minority and underserved populations is an area that has received little attention, yet may be essential in improving the disparities in cancer outcomes seen in minority and underserved populations. Chinese immigrants are a particularly vulnerable and understudied group, with high rates of a variety of cancers and multiple barriers to care. Efforts to further address social and economic correlates in cancer care should be developed and implemented for this population. The socioeconomic barriers to cancer treatment described in this study have been reported in other minority populations. 20,22 Our Immigrant Cancer Portal Project begins to address these significant concerns and may potentially serve as a model for replication in other vulnerable communities.

Chinese immigrants have high rates of a variety of cancers and face numerous social and economic barriers to cancer treatment appointment keeping. This study is a nested cohort of 82 Chinese patients participating in the Immigrant Cancer Portal Project. Twenty-two percent reported having missed appointments for oncology follow-up, radiation therapy, and/or chemotherapy. Patients most commonly reported needing assistance with financial support to enable appointment keeping. Efforts to further address social and economic correlates in cancer care should be developed for this population.

United States,5. Faerge Drinker,Washington,District of Columbia,United States Lucid episodes (LE) in people living with late-stages of dementia (PLWD) have been reported anecdotally, but less is known about how this seemingly unexpected phenomenon is experienced by family members. This study aims to examine variability in family caregivers' experiences with LE, focusing on the two most common groups of informal caregivers, spouses and children-whether they may exhibit differential appraisals of and responses to LEs. Using a sample of former and current family caregivers from UsAgainstAlzheimer's A-LIST, we conducted an online survey to spouse and child caregivers (N = 387). Qualitative semi-structured interviews were also conducted with a subset of these caregivers who have witnessed an LE (n = 22). Survey results indicate that child caregivers were more likely to witness a LE. Among "former" caregivers who have witnessed a LE (n = 140), spouses were likely to appraise LEs more negatively and make changes in care decisions (i.e., end-of-life planning and financial decisions) after LE, compared to child caregivers. Among "current" caregivers who have witnessed a LE (n = 80), spouses were more likely to indicate no special circumstances prior to LE, whereas children were more likely to indicate LEs associated with visits from friends and family; there was no difference in positive and negative appraisals of LE between current spouse and child caregivers. Content analysis of qualitative interviews revealed that observed differences between spouses and children were related to their different caregiving contexts, such as relationship history, living arrangement, expectations/ motivation, and care resources. Abstract citation ID: igad104.3144 --- A NEW METHOD TO IDENTIFY MEDICARE CLAIMS-BASED FACTORS ASSOCIATED WITH POST-ACUTE RECOVERY IN OLDER ADULTS WITH ADRD Chixiang Chen 1 , Biyi Shen 2 , Jason Falvey 1 , Michelle Shardell 1 , and Haoyu Ren 3 , 1. University of Maryland School of Medicine,Baltimore,Maryland,United States,2. Regeneron,Ellicott City,Maryland,United States,3. University of Maryland,Baltimore County,Baltimore,Maryland,United States Nearly 300,000 older adults experience a hip fracture every year, the majority of which occur following a fall. Unfortunately, recovery from hip fracture is poor, where older adults diagnosed with Alzheimer's Disease and Related Dementia (ADRD) spend a particularly long time in hospitals or rehabilitation facilities during the post-operative recuperation period. Because older adults value functional recovery and spending time at home versus facilities as key outcomes after hospitalization, identifying factors that influence days spent at home after hospitalization is imperative. However, few rigorous analytical approaches are available to help overcome potential sources of analysis bias such as hospital-level unmeasured confounders, informative hospital size, and loss to follow-up due to death. To overcome these challenges, we developed a new data science approach equipped with unsupervised learning to simultaneously handle statistical complexities that are often encountered in research using large administrative claims databases. The proposed approach is

The latest research confirms the heterogeneity of Alzheimer's Disease Related Dementia (ADRD). This justifies a metaanalysis study on the association of novel plasma biomarkers with screening assessments for early detection of ADRD. The conceptual framework model will be analyzed from the 2020 edition of the GSA KAER Toolkit with updates. The purpose of the current study is two-fold. First, to determine the need of a universal protocol method for early assessment of ADRD by primary care teams. Second, implementation of Food and Drug Administration (FDA) approved novel plasma biomarkers testing as a follow-up protocol to a screening assessment. The two suggested protocols have recently established Medicare coverage. The study will conclude with an extensive review of the known novel plasma biomarkers that are available for testing, at present and a brief overview of available screening assessments for early detection of ADRD.

INTRODUCTION Dunia Fantasi or Dufan has been Indonesia's favorite amusement park since 1985. Thirty-six years and still going strong, Dufan has grown and developed many additional attractions. Currently, there are 17 outdoor attractions and 7 indoor attractions with 5 uniquely themed areas. This causes Dufan to be visited by both local and foreign tourists. On 2019, Dufan has reached an exhilarating 9,3 million visitors [1]. On their busy day, there won't be any area without tourists. Entrance, rides, food court, exit gate, all of them are packed with people. Dufan provides countless promo for its ticket and over one type of annual pass. The ticket marketing strategy brings more tourists to Dufan. The queue waiting time for one ride can reach up to 1 -2 hours on sunny days. When it's raining, the indoor attraction will get more attention with multiplied waiting times on each ride. But this didn't stop tourists from visiting and enjoying Dufan. There are complaints about the crowdedness but so far, nothing too serious [2]. For this, Dufan generated a way to mitigate lengthy queue lines by selling premium and fast track tickets which allow its buyer to 'cut' the line and have the first seat on the ride. Despite the premium and fast track ticket, Dufan doesn't actively prevent crowding. Every person who has seen and experienced Dufan will know that both the fast track and the regular queue are almost the same length, sometimes exceeding the queue area that has been provided. But this doesn't stop people from visiting the park. Even in the current pandemic, Dufan didn't see any shortage of tourists [3]. Without a doubt, Dufan is a go-to vacation destination for people of all ages. In today's 4.0 digital era, Dufan can benefit from using information systems to manage their attraction, queue line, navigation, and improve the tourist experience. The information system will feature queue line management that allows tourists to book an attraction, a notification feature to know which attractions are available or not, and a navigation system to explore the park with ease. The objective of the application is to benefit both the management and tourist of Dunia Fantasi by having the included function: 1. Allow tourist to navigate easily the various attractions on the amusement park by using the website's navigation feature. It will reduce the time the user will take in navigating the park, especially newcomer whom have not been familiar with the park area. 2. Allow tourist to book an attraction from anywhere around the park. The user doesn't need to wait long line in the heat anymore. They can do it whilst sitting in a restaurant or doing something else more useful than waiting. --- Provide the information tourist need to know about Dunia Fantasi attraction such as the attraction description, precautionary, and estimated waiting time. 4. Provide customer satisfaction to the tourist that will have a good impact on Dunia Fantasi's management. --- II. LITERATURE REVIEW Waiting has always been one of the biggest issue service provider attempt to tackle. According to research, waiting time has a detrimental influence on consumer perceptions of service quality and, as a result, on customer satisfaction [4], [5]. Knowing this, the service provider should try their best to provide solutions so customers get the best out of their time [6]. One of the service providers that struggles greatly because of the wait time is the amusement park service. This lead to amusement park's managements to employ many strategies with one of them being virtual queueing system. They either develop their own system, such as Disneyland with their Disney Virtual Queueing System [7] or buy a technology such as Dollywood with the Lo-Q device [8]. Until this day, Dunia Fantasi still use the traditional queueing which give the author the inspiration to develop Dufan Navigation and Queuing System. The following is the comparison overview with the related works. --- III. DESIGN ANALYS AND IMPLEMENTATION SYSTEM --- System Analysis The web-based queueing and navigation system should be easily accessed with any browser and the layouts are responsive to any device such as iPad and Smartphone. The system will be developed with Laravel framework which uses PHP, HTML, CSS, JavaScript, and MySQL database. The functional requirements for the application include the following. --- Register an account The system must allow user to register their account to store it to the application database --- Login to the application The system must allow user to log into their account on the application by entering their email and password. --- Edit User Profile The system must allow user to edit their account data on the application --- Navigation The system must allow the user to search for an attraction through the application's map --- Queueing to an attraction The system must allow Tourist to queue virtually in the attraction that they choose. --- Manage Queue The system must allow the Operator to manage the virtual queue line by confirming if a queue batch has finished. --- Manage Attraction The system must allow Admin to add, edit, delete, open, and close an attraction in the application. --- Manage Operator The system must allow the Admin to add Operator and assign an attraction to an Operator. --- View Attraction Report The system must allow the Admin to view the attraction's performance report. The following are the use case diagram which depicts the relationship between the tourist, operator, admin, and system. In Figure 3.1, there are three actors: the tourist, who will use the app to navigate through Dunia Fantasi and queue virtually for an attraction. Second, there's the admin, who's in charge of managing the attraction and the operator. Finally, there is the operator who is directly responsible for the queue. --- System Design The system design consists of researching and designing the UI/UX of the system as well as the database.The following is the mock-up of the main features of the application, the home page, navigation page, and queueing page created using Figma. --- System Implementation The system implementation phase consists of the building of the application and implementing the research and design done before. Figure 5.1, 5.2, and 5.3 display is the final result of the main features interface development. --- System Testing The system testing consists of testing the application to find bugs or errors that could be improved. Overall, the testing is successful considering all the features works accordingly. Table 3.1 shows the testing scenario for the tourist features, which are the main features of the application. As Expected T10 Cancel Queueing The system will delete the user data from the selected attraction. As Expected --- T11 Search the location of an attraction The system will show the attraction searched by the user. --- As Expected --- T12 --- Navigate to the attraction The system will show the route to the selected attraction. --- As Expected --- IV. CONCLUSION Dunia Fantasi has been Indonesia's favorite amusement park since 1985 and is visited by both local and foreign tourists. On a busy day, there won't be any area without tourists. Entrance, attractions, food courts, exit gate, all of them are packed with people. This cause crowding and long line especially in its attractions. On famous attractions, tourists need to queue for approximately 30-60 minutes to enjoy a 5 minutes' ride. Other than that, Dufan is huge, which causes new tourist to struggle to find their way around Dufan. The Dufan Queueing and Navigation System is developed with that problem in mind. With the application, Tourist can queue for any attraction without having to stand physically in line. They can search for any attraction and the navigation feature will display the route they need to take. It's also easier for the operator to queue line since the queue batch and the attraction capacity are displayed in the application. The Dufan management, the application admin, can easily manage the attractions. They can add, edit, or delete any attraction as well as opening and closing it. With the application, the author goal is to improve the tourist satisfaction and generate more revenue to Dunia Fantasi. It is hoped that Dunia Fantasi can keep striving as Indonesia's favorite amusement park for years to come.

Amusement Park is the perfect destination for all-ages with plenty of attractions for both families and thrillseekers. To accommodate the various attractions, the park built must be huge. Because of those, the tourist may struggle to select an attraction to ride, waiting hours in a long queue line, and getting overwhelmed by exploring the enormous park. Every amusement park all over the world is experiencing this issue, including Dunia Fantasi. This final project development aim to build an information system that amusement park tourists, in this case, Dunia Fantasi, could use while touring the park. The project presents a tourist information system with a navigation system and queue line management system to help tourist enjoy their experience in Dunia Fantasi to the fullest. In addition, the Dunia Fantasi management will also benefited from better customer satisfaction. The system will consist of attractions description, estimated waiting time, Dufan map, the number of capacity available, and which attraction are available to ride.

INTRODUCTION Adolescence is the period between childhood and adulthood. This transition process is the cause of change so that teenagers feel more stressed (WHO, 2019). In the process of adolescent development, many changes occur in development fine motor and gross motor skills related to maturity or puberty, cognitive, intellectual, social and emotional development (Sunaryo, 2014). Incompatibility with adolescent development tasks will cause problems that arise such as anti-social behavior in adolescents, drug abuse, being easily moved into destructive behavior, and falling into promiscuity such as smoking, drinking alcohol, brawls and sexual behavior (Budiman, 2019). One of the impacts of promiscuity is early marriage. Adolescents who are forced to marry or under certain conditions are under 18 years of age will be vulnerable to access to education, health conditions and have the potential to experience domestic violence (UNICEF, 2018). In Indonesia itself, nationally the trend of early marriage has increased due to the Covid-19 pandemic. According to the Ministry of National Development Planning/Bappenas, there were 400-500 girls aged between 10-17 years carrying out early marriages from 2019-2020 during Covid-19. The percentage of early marriages in 2019 reached 11.21% and in 2020 there were more than 64 thousand applications for marriage relief for underage children. This figure is still categorized as high (Bappenas, 2020) Source: (Primary Data 2023) Based on table 1 above, the research results showed that respondents' knowledge about early marriage at SMA N 1 Doro before being given intervention was mostly in the poor category, namely 71 (93.4%) respondents, and in the good category, namely 5 (6.6%) respondents. Knowledge after being given intervention was mostly in the good category, namely 73 (96.1%) respondents and a small part was in the poor category, namely 3 (3.9%) respondents. So, there was an increase in knowledge before the counseling was carried out and after the counseling was carried out by 89.5%. Based on table 3, it shows that the comparison of knowledge before and after being given the intervention there was a change, the average before being given the intervention was 12.9 and after being given the intervention the average was 28.3, while the standard deviation before the intervention was 3.24 and the standard deviation after the intervention was 28. ,3. The statistical test results obtained a p value of 0.000 (<0.05) so it was concluded that there was a significant influence before and after being given counseling using video media on knowledge about early marriage. 4, it shows that the comparison of attitudes before and after being given the intervention there was a change, the average before being given the intervention was 26.5 and after being given the intervention the average was 39.1, while the standard deviation before the intervention was 5.26 and the standard deviation after the intervention was 5.82. The statistical test results obtained a p value of 0.000 (<0.05) so it was concluded that there was a significant influence before and after being given counseling using video media on attitudes about early marriage. --- DISCUSSION Knowledge or cognitive is a very important domain for the formation of a person's actions. A person's knowledge about an object contains two aspects, namely positive aspects, and negative aspects (Wawan and Dewi, 2010). In this study, it was shown that the frequency value of the less category was 71 respondents. This is because there are several factors that influence knowledge, including education, mass media/information, social culture and economics, environment, experience, and age (Rahayu, 2017). The pretest results showed that knowledge was in the poor category as many as 71 (93.4%), 5 (6.6%) in the good category, after being given the intervention, 73 respondents had good knowledge. Where the average knowledge before and after the intervention increased by 15, 4%, which means that after being given counseling, knowledge increased from poor knowledge to good knowledge. This increase in knowledge was influenced by the answers to the questionnaire which experienced a lot of improvement before being given counseling, there were 96.1% of respondents. The results of the posttest which increased according to Martanegara (2018) revealed that knowledge and interesting media used in providing information can influence the increase in scores obtained from questionnaire questions. This is in line with research conducted by Fitriani (2020), that one of the successes of an extension can be influenced by mass media and presenters. According to Heriana (2020), good knowledge is obtained from the ease of obtaining information, thereby speeding up a person's increase in knowledge. This is also in accordance with research (Martilova, 2020), states that information is a source of a person's knowledge which will increase when they get a lot of information. Attitude is an assessment process carried out by an individual towards an object. The process of a person's assessment of an object can be in the form of positive and negative assessments. Manifestations of attitudes cannot be seen directly, but can only be interpreted first from closed behavior (Sulaiman, 2020). The pretest results showed that attitudes were in the negative category as many as 72 (94.7%), positive as many as 4 (5.3%), after being given health education using video media about early marriage, there was a significant increase, namely there were 12 (15.8%) respondents in the negative and positive categories were 64 (84.2%). Martilova ( 2020), states that a person's attitude is influenced by beliefs, emotions, thinking tendencies, beliefs, and emotions which play an important role in a person's attitude. Human attitudes are not formed through social processes that occur during their lives, where individuals gain information and experience. This process can take place within the family, school, or community. When a social process occurs, a reciprocal relationship occurs between individuals and their surroundings. These interactions and relationships then form patterns of individual attitudes towards those around them (Notoatmojo, 2018). Results of data analysis using the Wilcoxon test. For knowledge, pretest and posttest, a p-value of 0.000 (≤ 0.05) was obtained, so it is concluded that H0 is rejected, and Ha is accepted, which means there is a significant influence before and after being given video media counseling on knowledge about early marriage. This shows that counseling using video media can influence teenagers' knowledge about early marriage at SMA N 1 Doro, Pekalongan Regency. The results of this study are in accordance with research (Johari, 2020) regarding the effect of providing videos on the impact of early marriage in Yogyakarta, where a p-value of 0.000 (<0.05) was obtained, so it was concluded that there was a significant difference between the control group and the intervention group. Video media is an effective medium in conveying information on reproductive health education, counseling using video media increases teenagers' knowledge of early marriage. This is also in accordance with research (Johari, 2020), which states that educational videos can increase the average knowledge from 59.47 to 78.31. The increase in knowledge occurs because the sense of sight will channel knowledge of approximately 75-87%, 13% from the sense of hearing and 12% from other senses. Educational videos contain images and sound so that respondents are able to absorb around 88% of the information provided, while e-modules only contain writing and images so respondents are only able to absorb around 75% of the information provided (Tuzzahroh, 2019). Results of data analysis using the Wilcoxon test. For attitudes, pretest and posttest, a p-value of 0.000 (<0.05) was obtained, so it was concluded that H0 was rejected, and Ha was accepted, which means there was a significant influence before and after being given video media counseling on attitudes about early marriage. This shows that counseling using video media can influence teenagers' attitudes about early marriage at SMA N 1 Doro, Pekalongan Regency. Similar to research conducted by (Sari, 2019), before and after being given the intervention there was an increase of 25 respondents (100%), seen from the p-value of 0.00 (<0.05) which means there was a significant effect before and after being given counseling about early marriage. Factors that influence a person's attitude are personal experience, the influence of other people, culture, mass media, education, religion, and emotional factors. Attitude is a person's closed response to a stimulus or object and involves the relevant opinion and emotional factors (Azwar, 2018). Health education is an application of educational concepts that aims to change detrimental behavior towards beneficial behavior (Notoatmojo, 2018). The existence of health education for teenagers can gain better health insight and knowledge about early marriage. Videos are a substitute for the natural environment and can show objects normally, videos can describe a process accurately and can be remembered easily, so they can encourage and increase students' motivation to keep watching them (Fatimah et al., 2019). Providing counseling using video media is an effective medium because at the time of the intervention several respondents had high enthusiasm for seeing the contents of video media shows. Attitudes will be formed when someone has been exposed to repeated information so that a positive attitude will be formed (Fibriana L, 2016). The results of this research provide important information about the influence of counseling using video media on adolescent knowledge and attitudes. So that teenagers can prepare and understand the impact of marriage on themselves for their physical and psychological health. The results of research using the Wilcoxon test obtained a p-value = 0.000 ≤ 0.05, which means that there is an influence of video media counseling on knowledge and attitudes about early marriage at SMA N 1 Doro, Pekalongan Regency. The limitation in this research is that it uses direct counseling using video media, where the researcher must collect samples from the class. This is because the researcher had difficulty collecting samples because at the time of the research it coincided with the students' first day of school after the odd semester break, so with help from the teacher, more Specifically, it is the student affairs sector that collects samples so that researchers can carry out outreach. --- CONCLUSION Based on the results of this research, it can be concluded that the majority of 96.1% of respondents had good knowledge after being given counseling using video media. Most teenagers' attitudes about early marriage after being given counseling using video media were in the positive category as much as 84.1%. There is an influence of counseling using video media on knowledge about early marriage among teenagers at SMA N 1 Doro, Pekalongan Regency. There is an influence of counseling using video media on attitudes about early marriage among teenagers at SMA N 1 Doro, Pekalongan Regency. Suggestions for institutions: Can use video media to increase students' knowledge and attitudes about early marriage when providing education at school and/or counseling guidance.

Early marriage is a phenomenon that appears among teenagers. Cases of early marriage are caused by external factors, namely socio-cultural, environmental, inappropriate media sources and lack of exposure to information about early marriage. One way to increase teenagers' knowledge and attitudes about early marriage is by providing health education through video media. The purpose of this study is to determine the effect of video media counseling on teenagers' knowledge and attitudes about early marriage at SMA N 1 Doro, Pekalongan Regency. The type of research used is pre-experimental one group pre-test and post-test design. The sample for this research was 76 respondents from class. This research obtained an average knowledge before 12.9 and after 28.3. The results of increasing knowledge before and after were 15.4 while attitudes were 12.6. The results of the Wilcoxon test obtained p value = 0.000 < 0.05 which shows that there is an influence before and after being given counseling using video media about early marriage to teenagers at SMA N 1 Doro, Pekalongan Regency. Conclusion: It is hoped that related institutions, academics, and researchers can use video media as reference material in providing education about early marriage. To increase the knowledge and attitudes of teenagers to avoid getting married at an early age.

Social research is conducted on social phenomena that have occurred during a particular period regarded as the present or a certain point in the past. It can also deal with processes that last for a period of time, where only collected data directly record a change (e.g., rationalization [Weber 1922], Europeanization [Spohn et al. 2003], McDonalization [Ritzer 1993], globalization [Steger 2003], or nationalization [Tanaka 2013]), but also contain abundant information on such changes. For example, in questionnaire research, the collected data pertain to the facts that occurred at the time the survey conducted, that is different from the time the research was performed (even if the survey enquires about "the present"). In interview research, all the contents include retrospections of a time which is different from the time the interview was conducted. In document research, all documents refer to facts that occurred at a time different from the time the documents were created or analyzed. Further, the data and results of analyses are transformed immediately after the social research ends or even during the research because their meaning begins to change following the transformation of societies. Similar to young Rip Van Winkle-who tastes the liquor of odd-looking persons, falls asleep in the Kaatskill Mountains, awakens to find himself an old man with a long, grizzled beard, and that 20 years have already passed (Irving 2019)-all the elements of social research are haunted by the processes of various changes. These changes depend on the notions of time, which differ by societies and are deeply rooted in such societie's structures (Maki 1981). For example, the time is a line segment in some societies, while a circle in other societies (ibid.). Some scholars have proposed a process-oriented methodology (Baur and Ernst 2011;Onaka 2013), which theoretically emphasizes the notion of process and/or empirically stresses the significance of process-produced data. All social research projects employing this methodology must be sensitive to these processes. Thus, it is impossible for them to avoid improving themselves as process-oriented social research. In this special issue, the author would like to introduces several recent studies of this type; The first article deals with the change in values related to intimate partner violence against women in Europe and North Africa. Based on a data analysis of the sixth wave of the World Value Survey using the structural equation model (SEM) and analysis of moment structures (AMOS), the author demonstrates the value-shift in justifying violence, especially in Middle East/North Africa (MENA) countries, which is increased by sexual tolerance and the use of mobile phones. The second article discusses the change in the patronage process of exchange relations from pre-colonial to colonial Ibadan based on National Archive documents. The third article discusses the career development of female teachers in Japan in the 1970s and the 1980s based on case studies, especially focusing on women who were able to focus on their work by relying on a housewife in the neighborhood as a byproduct of the process of "housewifization." The fourth article discusses the act of nose-picking in Vietnam based on an analysis of a magazine, Thanh Nghi that publicized and advocated Western civilization in the 1940s. The author hypothesizes that this process introduced the act as the opposite of the processes in Western societies. The fifth article discusses the entrepreneurship of Thai female returning migrants through intensive interview research, and using the theory of entrepreneurial process; the authors accordingly clarify the merits and risks such women experience. These articles exemplify the importance and significance of process-oriented social research, while demonstrating the diverse notion of time included in the process. For example, the first, third, and fourth articles presuppose the time of a directed linear segment, while the second and fifth articles are based on a cyclical time.

Process-oriented social research is a type of social research which theoretically emphasizes the notion of time and/or empirically stresses the significance of process-produced data. Therefore, this type of research has to be especially conscious of time. This special issue introduces several recent studies.

Unsafe sex is the second most important risk factor for morbidity and mortality in low-income areas [1]. The World Health Organization estimates that there are .150 million new curable sexually transmitted infections in South and Southeast Asia each year [2]. But traditional medical and public health approaches to sustainably change sexual behavior have been wrought with failure. Moreover, the process of framing these public health issues has often been charged with assumptions about sex work, distancing sex workers from important resources and complicating effective research programs. Although there is international consensus about the importance of sex worker human immunodeficiency virus (HIV) and sexually transmitted infection (STI) medical programs, there are no best practices for social responses (legal, political, economic) on behalf of vulnerable sex workers, and not all sex workers are vulnerable to HIV infection. The social response of each Asian nation to its sex industry intimately depends on culture, normative structures, and legal boundaries. Implicit in these notions of sex work are value judgments and moral assessments that extend well beyond the traditional framework of biomedicine charged with organizing STI/HIV control measures. A broad spectrum of social responses to sex work has emerged in Asiadsome nations arrest or detain prostitutes in top-down mobilized state responses, connecting commercial sex to human trafficking and other transnational criminal activity. Other Asian nations foster grassroots NGO efforts to empower sex workers in client negotiations and reproductive health choices, using empowerment approaches. The consequences of sex worker regulation for the spread of HIV/STIs are unclear, but empirical data from our multidisciplinary working group helps to inform these critical policy positions. A better understanding of the social context shaping commercial sex policy in Asian states can facilitate implementation and roll-out of HIV/STI social policy and public health programs in Asia and beyond. This interdisciplinary workshop brought together specialists across various fields to examine the commercial sex enterprise in Asia. Emphasis was placed on a biosocial framework to integrate historical, social, political, legal, economic, biological, and public health perspectives. This is not a matter of simple translation across disciplines, but rather a serious consideration of the contribution of many different factors not as separate influences but as mutually constitutive and inherently intertwined parts of a complex whole event. In order to illuminate new aspects of sex work and the relationship to STIs, this conference addressed the following major conundrums: How can traditional dichotomous theoretical frameworks of sex work that rely on simplification of sex workers to either fully autonomous empowered individuals or nonautonomous victims be reframed? How have nongovernmental organizations (NGOs) and the spread of civil society in many parts of Asia changed the potential for sex workers to organize HIV/STI prevention? How does sex worker agency measured individually or collectively influence sexual risk taking? What are the implications of transnational sex trafficking and sex work for inter-Asian state relationships and collaborative medical and public health responses? The collection begins with a piece by Dr Joseph D. Tucker at the Harvard School of Medicine and Dean Astrid Tuminez at the National University of Singapore [3]. Their article highlights the importance of choosing an appropriate conceptual framework when analyzing sexual health. Much of the research on sex work in Asia has focused on using an empowerment approach, although there have been increasing efforts to use an abolitionist framework to understand commercial sex. A new behavioralstructural conceptual framework is described, with implications for clinicians, policymakers, and public health practitioners. They point out that using such a behavioral-structural framework can incorporate some elements of both prevailing conceptual frameworks, advancing our knowledge of how sex work becomes unsafe and what structural factors can be changed to attenuate sexual risk among sex workers in Asia and beyond. One example of how the social environment of sex workers increases sexual risk comes from India where violence and mesolevel environmental factors are critically linked. Annie George, Shagun Sabarwal, and P. Martin from the International Center for Research on Women (Hyderabad, India) investigate the organization of sex work on exposure to physical and sexual violence [4]. They report an alarmingly high prevalence of violence among all female sex workers, with a 3-fold increased risk of physical violence and a 2-fold increased risk of sexual violence among women engaged in contract work. This group's research reveals the connection between sex worker terms of working and risk of violence, with important policy implications. In their article, Jennifer T. Erausquin, Elizabeth Reed, and Kim Blankenship of Duke and American Universities investigate the relationship between self-reported sexual risk and interactions with police among 850 Indian female sex workers [5]. Although there has been much speculation regarding the effect of punitive police measures on sexual risk, this article provides an empirical analysis of this relationship in the context of Avahan, a Bill and Melinda Gates Foundation-supported AIDS initiative. They find that a number of dimensions of police maltreatment of sex workers are associated with increased sexual risk. Their findings highlight the importance of including police and others who implement local policy in the process of designing and sustaining effective sexual health programs. Continuing with the theme of violence among female sex workers, Jay Silverman and colleagues examine coercion among HIV-infected female sex workers in Mumbai, India [6]. Of their sample of 211 women, 41.7% were trafficked into sex work. Coercion into sex work is associated with increased exposure to violence, poor condom use, higher number of clients per day, and greater alcohol use. Coercion and agency play a key role in mediating sexual risk, with forced sex work playing a role in expanding STI/HIV transmission. Better understanding of the terms and context of sex work can help to promote sexual health interventions. In their article, Suiming Pan and Yingying Huang of the Institute of Sexuality and Gender at the People's University (Beijing, China) and William Parish of the University of Chicago examine the clients of female sex workers in China [7]. Drawing on a 2006 population-based representative sample of adult men, they find that 5.6% of urban men reported visiting a female sex worker in the past year. This percentage was similar to that found in 2000, suggesting that China's punitive anti-prostitution campaigns have not substantially transformed the STI epidemics. The bulk of self-reported STIs were associated with unprotected commercial sex, consistent with earlier populationrepresentative studies. Interestingly, they did not find that young, migrant men have an increased risk of unsafe sexual behaviors. Instead, higher-income businessmen report having more unprotected commercial sex. This analysis serves as a useful reminder of the importance of male determinants in promoting STI spread in the Chinese context. In her article, Joan Kaufman of Harvard and Brandeis Universities examines the influence of civil society on improving the effectiveness of STI prevention among sex workers [8]. Criminalization of sex work in several Asian contexts pushes marginalized female sex workers farther away from the government outreach workers officially charged with STI/HIV prevention. In many Asian states, a weak civil society and poorly coordinated NGOs stall comprehensive sexual health programs. She argues that a labor rights-based approach to community-based STI/HIV prevention is the most likely to succeed, highlighting the recent success of Sonagachi in India and other peer-organized NGOs that represent sex workers' interests and needs. Greater cooperation between government and NGOs and more NGO-led responses are key parts of effective STI/HIV responses. The goal of this supplement is to provide an evidence base to further our understanding of how sex worker and client health can be promoted in Asia. There are many challenges in designing sexual health programs focused on sustainably decreasing unsafe commercial sex. High rates of migration within and across borders, limited sex worker NGOs, and lack of agency among sex workers create structural barriers for STI/HIV prevention programs. While many innovative programs for sexual health have been implemented in Asia, few have been comprehensively evaluated. Further interdisciplinary research is needed to understand the context and outcomes of such programs. A broader evidence base could help inform programmatic and policy efforts focused on STI/HIV control in this critical region. --- Notes

hosted a symposium in October 2010 focused on sex work and sexually transmitted infections in Asia, engaging a biosocial approach to promote sexual health in this region. Asia has an estimated 151 million cases of curable sexually transmitted infections (STIs; eg, syphilis, gonorrhea, chlamydia) each year, with commercial sex interactions playing a large role in ongoing transmission. Substantial human movement and migration, gender inequalities, and incipient medical and legal systems in many states stymie effective STI control in Asia. The articles in this supplement provide theoretical and empirical pathways to improving the sexual health of those who sell and purchase commercial sex in Asia. The unintended health consequences of various forms of regulating commercial sex are also reviewed, emphasizing the need to carefully consider the medical and public health consequences of new and existing policies and laws.

Introduction Big Data is relevant to all organizations, including higher education institutions who produce large data sets and wish to benefit from the interpretation of these data. Through analysis of information flow, Big Data analytics looks for hidden threads, trends and patterns (Matteson, 2013). Influential examples of Big Data applications include Google Flu Trends, which provides predictions and estimates of influenza activity for more than 25 countries, through aggregation of Google search queries (Pervaiz, Pervaiz, Rehman & Saif, 2012); and the research of Aslam et al. (2014), which reported on influenza-like illness rates through the collection and analysis of 159,802 tweets. While Big Data analytics is having a wide impact on public health and businesses' commercialization and marketing, its application remains limited in the field of education. Even in the few emerging studies on Big Data and learning analytics, the majority are carried out in America (e.g. Picciano, 2012) and Canada (e.g. Ellaway, Pusic, Galbraith & Cameron, 2014). --- Figure 1. One model of educational data analytics (Ellaway et al., 2014) In the field of higher education, an increase in information flow can be seen through the wide adoption of web-based learning systems by educational institutions (e.g. MOOCs). These learning systems often feature a wide array of materials, which build on a large resource of publicly available data. These data may reveal hidden patterns to "predict student outcomes such as dropping out, needing extra help, or being capable of more demanding assignments" (West, 2012, p. 2). Therefore, mining information from web-based learning systems can lead to insights regarding student performance and teacher pedagogical approaches (see Figure 1). In this paper, we give the details of our project to harness this insight from electronic education data available through learning management systems using Big Data technologies. In particular, this research focuses on extracting insights in relation to student behaviour in learning a higher education course, and factors that can affect their learning. This paper introduces the preliminary findings from a small data set which we intend to further validate using large data sets from different courses at this university. --- Big Data Analysis for Australian Higher Education Big Data is a concept that emerged with the rapid growth of web-based technologies and computer and mobile devices. It indicates "large pools of data that can be captured, communicated, aggregated, stored, and analysed" (Manyika et al., 2011, p.4). Big Data in education is also gaining a growing attention from scholars (Eynon, 2013). Data that are produced by university learning systems can be seen as one type of Big Data. Learning analytics is a term researchers often refer to when discussing the use of Big Data in the field of education. Analysis results can be generated either from build-in analytics functionalities in learning management systems, or through analysis of data gathered using data mining techniques. Researches (Clow, 2013;Timms, 2015) summarize the differences between learning analytics and educational data mining that, educational data mining has a greater emphasis on technical challenges, in that educational data mining more often develops new methods and models for data analysis, and the later tends to apply existing models. This research examines university lecturers' pedagogical approaches and student engagement in online learning, through the use of Big Data and learning analytics, using one Australian university as a starting point. The study collects archived data from the web-based learning system used at this university, which is based on the Desire2Learn (Brightspace) platform. The objectives of the project were set to examine correlations between: • lecturers' pedagogical support and student engagement; • types of teaching materials and resources provided and student engagement; and • student evaluation and satisfaction and their level of engagement. --- Methodology The research was approved by the Social Science Human Research Ethics Committee (HREC) Tasmania Network (reference H0016064). This project is being conducted in the following three stages. Stage 1 of the project has been completed as a literature review. Relevant studies that have been conducted in higher education contexts using learning analytics have been reviewed and summarized. Stage 2 of the project is a pilot study which will be conducted on approximately eight units from the disciplines of computing and education. This stage of the project will involve the data extraction from this specific learning management system and data cleaning. Archived data of student online discussions, lecturers' feedback, news items, unit materials and resources, and student engagement statistics generated by this learning management system are extracted, for the three year period of 2013-2015. After the initial data collection, invalid data not serving the aims of the study are filtered and removed. Stage 3 involves the analysis of the collected data. To understand the students' interaction with learning materials, different features are identified. These features include: the number of times a student accesses a particular learning module, dates when the student visited the learning module, dates when the student submitted assignments, time when s/he accesses the assignment details, his/her achievement in terms of marks, and how frequently the student posted to the discussion board. To understand the teaching team's interaction, features were collected, such as: when teaching materials were uploaded, teaching strategies, number of assignments collected, and dates assignments are recorded. Data mining techniques such as clustering and classification are utilised to detect different patterns in the data. Big Data frameworks such as Hadoop will be utilised to analyse the data using machine learning techniques. Pearson's correlation coefficients for the association between student engagement and participation and other three variables: lecturers' pedagogical support and interactions; types of teaching materials and resources; and student evaluation and satisfaction, will be calculated in R Foundation for Statistical Computing. --- Preliminary Study and Results We conducted the preliminary study using Excel's statistical tool to guide what features we need to extract from future larger data sets and which factors we should study to generate insights. The small scale study consisted of two master level ICT units: UNIT1 (Web Development) and UNIT2 (Data Management Technology) offered at the chosen university. The enrolled cohorts in the two units overlap to a large extent. One of these units (UNIT1) is a lower level unit and the other (UNIT2) is the higher level unit. For the study, we used a set of 20 students in UNIT2, consisting of low achieving (PP = Pass), medium achieving (CR-DN = Credit or Distinction), and high achieving students (DN-HD = Distinction or High Distinction). The aim is to study the behaviour or study pattern of the students in these units, thus we chose three factors: 1) frequency of access to each learning component; 2) date of access; and 3) their achievements in the units. To summarise and further analyse the data, we evaluated the minimum number of accesses, maximum number of accesses, and average number of accesses, in all the learning contents. Figure 2 and Figure 3 shows a summary of data. It can be seen clearly from the data, the study pattern of the students is similar in both units. This may indicate a high level of similarities in the patterns of teaching activities. At the same time, it can be noticed that on average the students in UNIT1 accessed learning materials less than those in UNIT2. This may indicate that more advanced units requires more effort from the students to understand the contents than lower level units. This can be evidenced further by the marks comparison between the two units. The data reveal that UNIT1 students got overall higher marks than in UNIT2. It is also interesting to notice that there are some high achieving students who enrolled in both units and achieved similar marks in both units. A difference can be seen in some medium achieving students who enrolled in both units. There is a one grade point difference in their achievement in the two units. This may be a reflection of the fundamental difference in the nature of these units. Both units have a portion on programming; however, UNIT2 has more difficult programming contents than UNIT1. Among low achieving students there is no clear pattern, however, two of these students achieved almost 20% more marks in UNIT1. This may indicate that these students have specific interest in a particular area as included in UNIT1, due to which they were able to achieve significantly higher results. --- Concluding remarks This paper presents the methodology and some preliminary analysis results from a small data set. Archived data were harvested from the learning management system used at one chosen Australian university. The aim was to study the innovative ways in which data management and analytics can benefit and contributes to Australian higher education. The preliminary study conducted using two master's level ICT units at one Australian university. The analysis validates that features, such as the number of visits to learning modules and their achievements in the units, are important indicators of users' interaction and learning in the unit. There are two key findings that emerged from this preliminary analysis. First, student interaction pattern remains the same from one unit to another. Second, students would access the teaching material more often if the unit is difficult or of higher level. These findings will be further tested and validated with larger data sets. Other features that are relevant to lecturers' pedagogical support and student engagement will also be added in later stage of the research. These features will be examined, using Big Data analytics techniques and skills that to date remain an unexplored area in Australian higher education. Starting with one university, the study will demonstrate relevance and impact for higher education nation wide, with the potential to contribute to online education at an international level.

In the past two decades, with the globalisation of education, there has been a continuous increase in the diversity of students in Higher Education. This diversity form a basis for a culturally rich environment, although, the cultural and language differences and the diversity in teaching and learning styles also bring challenges. From a university's perspective, providing the maximum support to overcome these challenges and achieving maximised student engagement would be in its best interest. Recent advances in Big Data and increase in electronically available education data can help in achieving these aims. This paper reports the findings of a preliminary study which applies Big Data analysis methods to analyse education data gathered from learning management systems. The aims was to understand ways to improve student engagement and reduce student dropout. This paper documents the experience gained in this early exploration and preliminary analysis, and thereby provides background knowledge for reporting of data from the formal data collection stage which will be conducted at a later stage of research.

The marital tie represents one of the most influential and prevalent relationships in adulthood, with enormous implications for well-being. Better quality marriages (e.g., higher marital happiness) are associated with fewer psychological and physical health problems (Choi & Marks, 2008;Kiecolt-Glaser & Newton, 2001;Whisman, 2007). The life course of marriage and the context in which it occurs, as well as variations such as divorce and remarriage, require systematic study. Cross sectional studies have revealed that marital happiness follows a U-shaped curve (Glenn, 1990;Spanier & Lewis, 1980) in which happiness starts out high, declines in the middle years, and increases in later life. Surprisingly, we have little long-term data with longitudinal studies often only examining the early years of marriage (years 1 to 4). We know little about the transition from engaged to married or how marital quality changes longitudinally over time from young adulthood to old age. In addition, we know little about what happens after marriages dissolve in terms of the contexts of divorce and remarriage. Further, much of the work on marriage has focused predominately on White middle-class couples. Finally, little work has considered the complicated relationships of in-laws and stepfamilies. This special issue uses diverse samples, examines individuals in different marital situations (engaged, married, divorced, and remarried), and considers martial situations with regard to several contexts (e.g., in-law relationships, marital happiness, support, caregiving, well-being) across the life span. This issue includes four articles examining several marital situations among different age groups. Fingerman, Gilligan, VanderDrift, and Pitzer focus on the formation of marital ties in early adulthood. Engaged couples and their mothers-in-law completed interviews before and after the wedding, providing information about the in-law ties that may influence the marriage. Couples who had more positive in-law relationships and greater one-on-one contact with in-laws prior to marriage had better ties after marriage. Birditt, Hope, Brown, and Orbuch examined trajectories of marital happiness from the first year of marriage to the 16 th year. They found distinct trajectories of marital happiness, and those trajectories were associated with divorce and varied by sociodemographic characteristics. Brown, Birditt, Huff, and Edwards examined links between divorce and depressive symptoms in midlife and whether those links varied by race and relationship quality in the first year of marriage. Most importantly they found that relationship quality moderated the effects of marital status on depressive symptoms differently for Black and White women. Sherman assessed marriage later in life among middle-age and older women who had remarried and were caregiving for a spouse with dementia. Qualitative findings revealed variations in support and nonsupport by family, stepfamily, and others that contribute to caregivers' experiences of burden and well-being. Overall, these studies highlight the complexity and the diversity of experiences in marriage, divorce, and remarriage. These articles used a variety of approaches including qualitative and quantitative methods, cross sectional and longitudinal designs, and included participants ranging in age from young to older adulthood. These articles contribute to the literature in several important ways. We know little about the early years of marriage and the transformation of in-law relationships. We also know little about the developmental course of marriage beyond the early years or what marital characteristics predict better or worse divorce outcomes. Finally, this special issue seeks to provide insight about the remarried relationship, especially with regard to the stress of spousal caregiving. All of these issues are critical for many people who are experiencing increasingly complicated family structures due to increased longevity, divorce, and remarriage. In addition, there is great diversity in the marriage experience by gender, family context, socioeconomic status, and race, which is progressively more essential to consider as the U.S. population becomes increasingly diverse.

The marital tie is one of the most influential relationships in adulthood, with vast implications for well-being. This special issue uses diverse samples, examines individuals in different marital situations (engaged, married, divorced, and remarried), and considers martial situations with regard to several contexts (e.g., in-law relationships, marital happiness, support, caregiving, wellbeing) across the life span. This issue includes four articles examining several marital situations among different age groups. Articles examine formation of marital ties in early adulthood and implications for in-law relationships, the development of marital happiness over 16 years, the implications of marital quality for the divorce experience, and the caregiving experience among remarried caregivers. Overall, these studies highlight the complexity and the diversity of experiences in marriage, divorce, and remarriage which is especially critical given the increasingly complicated family structures individuals experience across the life span.

I. INTRODUCTION Social inequality is often measured by the Gini-index or Gini coefficient (g) [1][2][3][4][5][6] obtained from the area between the diagonal (equality line) and the Lorenz curve, given by the plot of cumulative fraction (w) of income or wealth (when ordered from lowest to highest income or wealth) against the corresponding cumulative fraction (n) of people sharing them in any society (at any particular time or year). In a similar way, we measure here the inequalities in the output of the various academic institutions and universities by determining g-values obtained from Lorenz curves of the institutions obtained by plotting the cumulative fraction of the citations of the papers (when ordered from lowest to highest citations) published in any year from that institution, against the corresponding cumulation fraction of papers sharing those citations (see Fig. 1). The Gini index or g-value is again given by twice the (normalized) area of the region (shaded in Fig. 1) between the equality line or diagonal through the origin and the Lorenz curve. We introduce then a new inequality measure, the k-index (k for Kolkata; in view of the extreme nature of social inequalities in Kolkata [7]) which is given by the coordinate value k in the n-axis in Fig. 1 of the cutting point of the Lorenz line with the diagonal orthogonal to the equality line. As one can see in the case of income inequality, it says the fraction (1 -k) of people earn more than that earned by fraction k of people in the country or society. In the case of an academic institution the k-value says that the fraction 1 -k of their papers published (in a year) from that institution have more citations than those earned by k fraction of papers. As is obvious from Fig. 1, g = 0 corresponds to complete equality (Lorenz curve merges with the diagonal) while g = 1 corresponds to extreme inequity. The corresponding values of the k-index are k = 1/2 for g = 0 for complete equality and k = 1 for g = 1 for limiting (extreme) value of inequality. In the income or wealth inequality context, Pareto had already observed [8] (see also [5]) that a tiny fraction (typically less than 20%) of (rich) people possess 80% of the total wealth of the nations. The k-index defined here gives a more quantitative measure of this inequality. Also in the context of academic institutions or universities, the k-index gives a (normalized) complementary measure of the h-index [9] equivalent for the respective institution for that year; h-index of a scientist gives the number h of his or her papers, each of which has at least h citations. Apart from k-index and g-index, we analyze these citation data for institutions and journals by measuring two other inequality indices introduced recently: Pietra index or p-index [10][11][12] and median index or m-index [6]. p-index is defined as the maximal vertical distance between the Lorenz curve and the line of perfect equality in Fig. 1. m-index is given by 2m ′ -1 where L(m ′ ) = 1/2 (L(x) denoting the Lorentz curve). Values for p-index and m-index both range from 0 to 1; the value 0 represents complete equality while value 1 represents extreme inequality in the society. In this article, we measure inequality in income, citations for papers published in institutions and journals as examples for inequality in society, by using some newly defined quantities. --- II. ANALYSIS AND RESULTS We give here a few estimated values of g and k indices of different countries in different years in table I for income inequalities across the countries of the world, with the data taken from refs. [13,14]. In tables II and III we give the estimates of the values of g, k, p and m indices for different institutions and universities across the world in different times (years). These estimates are made from the corresponding Lorenz curves drawn numerically from the respective data sets. For citations of the papers, the data are taken from ISI web of science [15] and are counted up to the year 2013, while the publications (corresponding to the institutions of origin or to the journal where published) are for the individual years of publication (see e.g., tables II-IV). Assuming that the Lorenz curve can be approximated by two discontinuous straight lines forming a triangle with vertex opposite to the equality line given by intersection point of the Lorenz curve and the diagonal perpendicular to the equality line, one gets g = 2k -1. However, this relation is very approximate and is often not satisfied for large values of g and k. It is also seen that the k-index value gives an upper limit for the range of fitting of power law (namely the Pareto law [7]): for n ≥ k, 1 -w ∼ (1 -n) α where we find α = 0.50 ± 0.10, giving n = 1 -const(1 -w) ν with ν = 2.0 ± 0.5. --- III. SUMMARY AND CONCLUSION Social inequality is traditionally measured by the Gini-index (g). Recently, a few more indices measuring social inequality have been introduced: p-index [10] and m-index [6] as discussed earlier. It may be noted that g, p and m take values within the range 0 (representing complete equality) and 1 (representing complete inequality). We introduced the k-index here, signifying that 1 -k fraction of people or papers earn more wealth or citations than the rest k fraction of people or papers. As such, the lowest value of k-index is 0.5 (complete equality) and the highest value is 1 (corresponding to complete inequality). k-index can be rescaled to unit interval via the transformation k ⇒ 2k -1, where 2k -1 gives the vertical distance at the point k, between the perfect equality line and the Lorentz curve. Most of the estimates of the income or wealth data indicate the g value to be the widely dispersed across the countries of the world: g values typically range from 0.30 to 0.75 at any particular time or year. We estimated similarly the Gini-index for the citations earned by the yearly publications of various academic institutions. The ISI web of science data suggests remarkably strong inequality and universality (g ≃ 0.70±0.05) across all the universities and institutions of the world (see also [16]). We also find that most of the p-index values for universities and institutions range from 0.40 to 0.60 and similarly for m-index it is ranges from 0.80 to 0.90. We define here a new inequality measure, namely the Kolkata-index or k-index and find that while the k-index value for income distributions ranges from 0.60 to 0.75 across the world, it has a value around 0.75 ± 0.05 for different universities and institutions across the world. As such, k-index is the social equivalent to the h-index for an individual researcher in science. Also we find that the value for k-index gives an estimate of the crossover point beyond which the growth of income (or citations) with the fraction of population (or publications) enters a power law (Pareto) region.

Social inequality is traditionally measured by the Gini-index (g). The g-index takes values from 0 to 1 where g = 0 represents complete equality and g = 1 represents complete inequality. Most of the estimates of the income or wealth data indicate the g value to be widely dispersed across the countries of the world: g values typically range from 0.30 to 0.65 at a particular time (year). We estimated similarly the Gini-index for the citations earned by the yearly publications of various academic institutions and the science journals. The ISI web of science data suggests remarkably strong inequality and universality (g = 0.70 ± 0.07) across all the universities and institutions of the world, while for the journals we find g = 0.65 ± 0.15 for any typical year. We define a new inequality measure, namely the k-index, saying that the cumulative income or citations of (1 -k) fraction of people or papers exceed those earned by the fraction (k) of the people or publications respectively. We find, while the k-index value for income ranges from 0.60 to 0.75 for income distributions across the world, it has a value around 0.75 ± 0.05 for different universities and institutions across the world and around 0.77 ± 0.10 for the science journals. Apart from above indices, we also analyze the same institution and journal citation data by measuring Pietra index and median index.

INTRODUCTION Health literacy can be defined as the capacity to acquire, understand and use information in ways that promote and maintain good health. [1] Health literacy plays a very crucial role in creating awareness about how to manage your health and use the healthcare system for accessing good health. It is associated with direct as well as indirect health outcomes. Understanding the level of health literacy existing in various socio-economic strata in India is vitally important to make the health system more robust and supportive to provide access to healthcare services to marginalized segments of the community. The success of public healthcare policies depends on building the health literacy of those for whom the policies are designed to make them aware of these policies and take benefit of the same. Health literacy represents the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health 1 . Low health literacy is often linked with poor socio-economic circumstances. [2] Research shows that there is a positive outcome between health literacy and health outcomes of the people. [3] It also leads to the active participation of people in having better control over their health. [4] Health literacy is also positively associated with preventive healthcare as it leads to better health habits and helps people to navigate the healthcare system more effectively. [5] It is also seen that higher health literacy leads to higher hospital visits and a higher level of vaccination. [6] Low health literacy may cause a higher disparity in health status and health outcomes which is prevailing due to racial, socioeconomic, and cultural barriers. [7] It may also lead to lower oral health [8] as well as unhealthy health behaviors. [9] It is seen that low health literacy among women affects their ability to navigate the healthcare system which gives them lower access to preventive healthcare leading to a lower ability to care for their children. [10] It is also observed that improvement in health literacy through educational programs such as the dissemination of information through booklets and videos improves the health behavior of patients with chronic diseases and leads to better health outcomes. [11] The research shows that critical health literacy required for navigating the health system is affected by socioeconomic status and demographic features. [12] It was found in asthma patients that racial and ethnic minority populations had a significantly lower level of health literacy which affected their disease control, quality of life, and emergency visits to the hospital in a negative way. [13] The relationship between formal education and health literacy is found to be positive. Educated people are more likely to make better use of healthcare services and effectively manage health emergencies. Education also has a long-term impact on increasing or reducing health inequities. [14] Health literacy is also associated with age. In Iran, it was found that the level of health literacy of elderly populations was lower which was reflected in their lower health status and lower utilization of healthcare services. [15] It can be seen that less educated, poor, minority, and elderly populations are likely to have low health literacy on various accounts such as less access to the internet, less access to communicate with healthcare professionals, lack of trust between the patients and healthcare professionals due to differences in socio-economic background, and higher frequency of change in healthcare providers. [16] Bridging the gap in health literacy requires strategic communication. It can be through integrated marketing communication, education, and building social capital [17] The existing research also suggests that health literacy should be incorporated in school, nursing, and medical education [10], and health literature should be made available in the easier-to-understand language. [16] Relatively very few studies are made on developing countries like India. Most of them measure technical or disease-related practices of the patients and most of them show a very low level of health literacy. [18] One study shows a very strong positive relationship between maternal health literacy and child nutritional status. [19] One study observes that the health literacy score is very low in India, and it is relatively higher among those who have family physicians to take care of day-to-day healthcare needs. The study also mentions that more than 50 percent of the sample studied of the patients attending tertiary care in hospitals in South India had below-average health literacy. [20] In another study, more than 60 percent of the sample population was found to have low dental literacy. [21] Existing research mentions that health literacy in India is still at a primary level of acquiring knowledge at the individual level and has not improved to a secondary or tertiary level of acquiring the skill to manage individual health and influencing others to adopt healthy behavior. [22] The existing research throws light on the importance of health literacy in bringing out better health results and a few of the antecedents which impact health literacy. Though there are a few similar studies made in other countries, there is no such study made in India. The Indian health system is unique in its vast scale and diversity. India is the second most populous country in the world. India spends 3.2% of its GDP on public healthcare. The health structure is overburdened due to the prevalence of high disease burden and scarcity of skilled manpower and other amenities. It has a mixed healthcare delivery system where public healthcare predominantly exists in rural India and caters for primary healthcare. Seventy percent of the market share of the hospital market is controlled by the private sector which prominently exists in urban areas. Along with health inequity in rural and urban India, there is also a high level of variation in health status across the states. Hence this type of study will be useful for academicians as well as for policymakers. --- OBJECTIVE: The purpose of this study is to find out the impact of socioeconomic and demographic factors on the level of health literacy in India. --- METHODS: It is a cross-sectional study of 380 respondents across --- RESULTS: DESCRIPTIVE ANALYSIS: Table 1 gives the demographic profile of the respondents. --- THE RESEARCH FINDINGS ARE AS FOLLOWS: 1. There is no statistical difference between the level of health literacy between males and females. 2. The statistical difference in educational categories is significant for all the nine parameters of health literacy. The mean is rising along with educational level on all the nine parameters. 3. The age-group has a unique relationship with health literacy. The statistical difference as per the age-group is significant for all the parameters except 'The ability to actively engage with healthcare workers'. The mean value is rising along with age groups for two parameters such as i) feeling understood and supported by healthcare workers and ii) social support for health. The mean value is declining with age groups for all the remaining six parameters where the statistical difference is significant. 4. The statistical difference as per income category is found to be significant in eight parameters except 'feeling understood and supported by healthcare providers'. --- DISCUSSION: The present study finds a positive relationship between educational level and health literacy. The finding is in concurrence with the existing literature. The study adds a new dimension related to age-group. It finds that aged population find the healthcare system more supportive and also perceive that they have social support in case of emergencies. On all other parameters such as seeking and appraising health information, navigating health system, etc. the younger population has a more positive perception. The study proves that with higher income, people are getting more resources to access health information, appraise it and navigate the health system in a better way. --- CONCLUSIONS: Health literacy plays an important role in building public health. The present study identifies the role of socioeconomic and demographic factors in building it. These factors need to be taken into consideration in planning and designing health policies. The study suggests that more focus on education and policy initiatives to assist elderly population in accessing the information and navigating the health system can bring out positive result. The study contributes to the literature by helping in --- RECOMMENDATIONS: The study has theoretical as well as managerial implications. As the existing research observes there is a very limited study made on health literacy in the Indian context. Hence it adds to the theory of understanding the level of health literacy in the Indian context. The Indian government is gearing up for providing Universal Health Access and making huge investments in public healthcare. It is meant to improve access to healthcare services for the weaker and marginalized sector and to improve the status of public health. Building health literacy through effective communication and awareness programs is the cornerstone for its success. It is recommended that policymakers should give enough attention to building the health literacy of marginalized sectors to make effective utilization of the health system. It can be done in various ways such as the creation and dissemination of health information in vernacular languages and with videos showcasing promoting healthy habits or helping people understand the early symptoms of any disease and encouraging them to avail health facilities; empowering ground-level health workers to undertake community level training programs to build health literacy, etc. to name a few. The future research scope will be on understanding how health literacy affects health behavior and identifying innovative ways to improve health literacy for the marginalized population having low educational levels.

The objective of the study is to assess the impact of socioeconomic status based on gender, age group, education, and income level of people on the level of health literacy.The study uses the primary data of 380 respondents belonging to various socio-economic classes. It is a cross-sectional study.The study shows that the level of health literacy is significantly affected by the educational and income level of the respondents. Health literacy is also uniquely affected by age groups. Few of the nine parameters of health literacy are affected positively in rising age groups and few are affected negatively by rising age-group. The study finds that health literacy is not affected by gender differences.Health literacy plays a vital role in building the health status of people and helping the effective utilization of healthcare services. It is found that level of health literacy is affected by the socio-economic status of the people. It is the need of the hour to build health literacy in the weaker section of society with the help of policy tools.

INTRODUCTION Depression signifies a chief public health dilemma that is described by feeling low, reduced attention and concentration, loss of sense of control and a personal experience of great suffering. Prevalence studies give very elevated figures of Depression worldwide. 1 It is third foremost contributor to the overall burden of disease. 2 Stigma associated with Mental Illness has been studied in many researches around the globe. In the West associated Stigma with Mental Illness is well acknowledged now. However in Developing Countries, the Discrimination and Stigma associated with mental illness is still uncovered to a greater extent. 3 Perceived Stigma is the conviction that the public have negative attitudes towards individuals with mental health issues and the apprehension that others will discriminate them, while Experienced Stigma identifies incidents of unjust treatment due to Mental Health Problem. 4 There is an evidence to suggest that people from different social classes and professions have negative ideas about psychological patients and disorders. 5 Loss of comfort and personal wellbeing are not caused completely by the etiologies, in-capabilities, and anxiety induced by their psychological disorder. Stigma and Discrimination associated with illness also hamper Quality of Life, Self Esteem and Personal Sense of Wellbeing. People with psychological problems embrace high level of Stigma in comparison to physical illnesses. 6 Perceived Stigma is linked with reduced life quality, 7 poor self-esteem 8 , decreased occupational functioning and increased hindrances for social and leisure activities. 7,9 It is also related with greater severity of Depression Level 9,10 and reduced Treatment Adherence. 9 A research was conducted on attitudes of teachers and students in a University of Lahore, Pakistan towards mental illness revealed that most of the participants had negative attitudes towards mental illnesses specifically towards Schizophrenia, Depression, and Substance Abuse. 11 Even 50 % of the medical students and doctors held negative attitudes towards Mental Illness. In Pakistan, a country of 175 million people there are only 800 Mental Health Practitioners and four Mental Hospitals. Patients from rural areas have no access to psychological services. In addition in Pakistan, people avoid seeking psychological help due to the Social Stigma faced by a person who visits a Psychologist or a Psychiatrist. 12 In Developing Countries, the Culture and Gender plays a complex role in shaping the Stigma associated with Mental Illnesses. In addition in developing countries, mental illnesses are also viewed as the impact of supernatural forces. Such faulty explanations also complicate the issue and become the roots of Stigmatization. 11 Gender Differences and associated Discrimination with Mental Illnesses has caught very little attention of the researchers. 13 This situation raises many questions like if Women experience more Discrimination and Stigma associated with Depression in comparison to the Depressive Men patients in the patriarchal culture of Pakistan? Study of Stigmatization in developing countries is very essential. This can serve as a baseline, as well as a first step in developing awareness in general public and the professionals about mental illnesses. --- METHOD --- Sample: The data used in this study is derived from an International Multisite Research 14 Subsequently on Subscales of ISMI, Women experienced more Internalized Stigma compared to Men. The significant difference was found among the two groups on subscales of Discrimination Experience t(34) = -1.58, p = 0.00 (Men: M = 11.71, SD = 2.02; Women: M = 13.42, SE = 4.22) and Social Withdrawal t(34) = -1.58, p = .04 (Men: M = 13.82, SE = 3.12) (Women: M = 15.84, SE = 4.47). --- DISCUSSION The results from this study have shown that Discrimination and Stigma is experienced by both Men and Women; however Stigma is more experienced by Women who were diagnosed with Depression. The mean score of Experienced and Anticipated Discrimination measured with Discrimination and Stigma Scale (DISC) was high in Women in comparison to Men but not to the level of statistical significance. The mean score of Internalized Stigma measured with Internalized Stigma of Mental Illness Inventory (ISMI) was high in Women in comparison to Men at significance level of .05. Among the five subscales of Internalized Stigma; the significant difference was found on Discrimination Experience and Social Withdrawal. The fear or anticipation of being stigmatized by the society cause avoidance in participation in particular life areas; hence lead individual towards segregation and social banishment. 17 These results were replicated in previous studies, a study reported association between Anticipated and Experienced Discrimination, in which 87% of participants experienced Discrimination in at least one area of life in their past year. 17,18 Moreover, Women anticipate and experienced more Discrimination than Men. 17 A Qualitative Analysis of INDIGO Study on patients diagnosed with Schizophrenia; highlighted the negative feelings experienced by the mentally ill individuals in their communities; resulting in Social Withdrawal. 19 Hence these Discrimination experience resulted in high prevalence of negative experiences leading individuals towards social banishment. 72% experienced Discrimination because of their mental illness; 50% reported that the negative stereotype and feeling of burdening others cause Social Withdrawal in them; 37% reported that they avoid getting close to those who are not mentally ill, to avoid rejection. 20 The same results were replicated by another study which highlight that Social Withdrawal is the reason of the Stigma associated with people having Mental Illness. 21 The perception of being Stigmatized and being treated discriminately was related to both Gender and Race. Hence studies report reluctance in such individuals to seek help due to Perceived and Experienced Stigma. 16 Nashi Khan et al. +The plausible explanation for these findings could be following; The Patriarchal Culture of Pakistan provides more tolerability to Men's problem in comparison to the Women. This societal trend engulfs all aspect of life like; illness, health, employments, responsibilities and decision making. Secondly, generally Women have greater level of psychological distress in comparison to the Men. So they are prone to experience greater level of Discrimination and Stigma then Men. 22 The present study is first of its kind that has examined the gender differences between the --- Declaration of interest: The authors declare that there is no conflict of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. --- Authors

Objective: This study aims to examine Gender Difference in the level of Discrimination and Stigma experienced by people diagnosed with Major Depressive Disorder in Pakistan. It was hypothesized that Women diagnosed with Depression are likely to be experiencing more Discrimination and Internalized Stigma in comparison to Men. Methods: This is a Cross Sectional Study. Thirty eight patients diagnosed with Major Depressive Disorder recruited from different Government Sector Hospitals of Lahore; were approached after obtaining informed consent. Discrimination and Stigma were measured through Discrimination and Stigma Scale and Internalized Stigma of Mental Illness Inventory respectively. Results: Both Men and Women experience considerably high level of associated Stigma and Discrimination due to their Mental Illness. However, Women in comparison to Men experience significantly greater level of Internalized Stigma especially in domains of Discrimination Experience and Social Withdrawal.The findings of this study highlight the fact that people with Depression can be more benefited with psychological treatment if dealing with Stigma and Discrimination is also addressed in Intervention Plans.

SOCIAL INTELLIGENCE TRAINING AND CUSTODIAL GRANDFAMILIES: A QUALITATIVE ANALYSIS OF RELATIONSHIPS Megan Dolbin-MacNab 1 , Gregory Smith 2 , Frank Infurna 3 , Britney Webster 4 , Saul Castro 3 , D. Max Crowley 5 , and Carol Musil 6 , 1. Virignia Tech,Blacksburg,Virginia,United States,2. Kent State University,Kent,Ohio,United States,3. Arizona State University,Tempe,Arizona,United States,4. Diebold Nixdorf,Louisville,Ohio,United States,5. Pennsylvania State University,State College,Pennsylvania,United States,6. Case Western Reserve University,Cleveland,Ohio,United States Custodial grandfamilies often experience relational challenges related to parenting and the grandparent-grandchild relationship that would benefit from intervention. Social intelligence training (SIT), which focuses on improving socio-emotional skills via online, self-guided modules, holds promise for helping grandfamilies address their relational challenges. The purpose of this qualitative study was to examine SIT skills that custodial grandmothers and grandchildren utilize in their interactions and the impact of SIT on their relationship. The sample consisted of 27 dyads of custodial grandmothers and adolescent (ages 11 to 18) grandchildren enrolled in an RCT examining the effectiveness of SIT. Dyads who completed the SIT were randomly selected and completed individual, open-ended interviews over the telephone, after post-test but prior to the 3-month follow-up. Results of a thematic analysis revealed several themes related to the SIT skills grandmothers and grandchildren were utilizing including taking and understanding the other's perspective, attending to the nonverbal communication, engaging in active listening, reflecting on their treatment of each other, and slowing down communication to think before speaking. Analyses further revealed that grandmothers and grandchildren noted SIT-related improvements in their relationship, with themes reflecting improvements in the quality of communication, the frequency and intensity of conflict, understanding of each other, and sense of emotional connectedness. Those dyads that did not report relational improvements had a strong relationship prior to completing the SIT or the grandchild did not fully engage in the SIT. Directions for research and family-based interventions with grandfamilies will be discussed. [Funded by the National Institute on Aging (R01AG054571)] Abstract citation ID: igad104.3070 --- THE 12 DS: AN UPDATE TO EDWARDS' AND RAY'S REASONS FOR NONPARENTAL CAREGIVING Acacia Lopez, and Danielle Nadorff, Mississippi State University, Mississippi State, Mississippi, United States This study examined the prevalence of the "Nine D's," a framework developed by Edwards and Ray for understanding the heterogeneity of reasons for which grandparents assume care of grandchildren (i.e., Death, Disease, Detention, Divorce, Departure, Drugs, Desertion, Delivery, Deployment) within a contemporary sample. Using a nationwide sample (N = 427) of custodial grandparents and foster parents, caregivers were asked their reason for assuming care of the grandchild or foster child within their care. The results of the study suggest that the Nine D's are a useful framework, but fail to capture many of the reasons for assuming care. Three new themes-Dollars, Duty, and Daily Grindwere identified and are applicable to both grandfamilies and foster families. These themes represent different motivations for assuming care and provide insight into the social structures which may act as barriers to family formation. This study provides a foundation for future research examining the impact of assumed care by non-parental attachment figures on the health and well-being of both grandchildren and foster children. Abstract citation ID: igad104.3071 --- THE EFFECTS OF GRANDPARENTAL CARE ON MENTAL HEALTH AMONG CHINESE GRANDPARENTS: A LIFE COURSE PERSPECTIVE Jiahui Lyu, University of Florida, Gainesville, Florida, United States As the population continues to age, grandparental care has become a more prevalent form of childcare, particularly in China. Limited research has investigated the effects of grandparental care on grandparents' mental health and the conclusions are ambiguous with both positive and negative outcomes being found. In this study, a life course perspective is adopted to examine the mechanisms of such effects. Using data from the China Health and Retirement Longitudinal Study (2011-2013), I conducted logistic regression models to examine the association between various stages of grandparental care and depressive symptoms among Chinese grandparents between the ages of 45 and 80 (N = 3946). Specifically, this study examines the impact of transitions into or out of grandparental care on depression and the potential moderating role of gender. Results show that grandparents who stop providing care for grandchildren are less likely to experience depression compared to those who provide no grandparental care (OR = 0.78). Additionally, grandmothers who provide ongoing grandparenting tend to have a higher risk of experiencing depression. The findings presented in this study offer valuable insights into the various mental health implications of grandparental care in the Chinese context, underscoring the significance of accounting for gender differences. This study also highlights the need for evidence-based policies and interventions that promote the well-being of older adults. Abstract citation ID: igad104.3072 --- THE GEOGRAPHY OF FAMILY CAREGIVING IN AN AGING SOCIETY: WHO MOVES CLOSER AND WHY Stipica Mudrazija 1 , Elizabeth Peters 2 , and Fernando Hernandez Lepe 2 , 1. University of Washington,Seattle,Washington,United States,2. Urban Institute,Washington,District of Columbia,United States An emerging literature examines the dynamic aspect of the link between parental health and parents-adult children geographic distance, yet who moves when a parent needs care-the parent or the child-and why remains unexplored. Using pooled 2004-2014 data from the Health and Retirement Study on respondents age 65 years or older and their adult children and detailed geographic information, we analyze who moves when parents and children move in together or move closer without coresiding, and who benefits from such moves. Preliminary results reveal that children are roughly four times more likely to move in with parents than parents move in with children, and moving primarily benefits those who move: 89.2 percent of parents who moved reported that either they were the sole beneficiary of the move or that both they and their children benefited, and the same was true of 92.8 percent of children movers. However, as parents' health declines, they increasingly benefit from the proximity-enhancing moves regardless of who moves. For example, about half of all children who move in with parents following the onset of parents' health decline reports doing was to benefit their parents, either exclusively of in conjunction with them. Next, we will fit regression models of who moves for newly coresident dyads and dyads moving closer, respectively, as well as models of who benefited from such moves. This research provides new policy-relevant insights because the caregiver supports needed could be different depending on whether it was the parent or the child that moved. The coronavirus disease 2019 (COVID-19) pandemic intensified the stressful and already difficult circumstances of communities of color. Yet, no current photovoice research has highlighted the lived experiences of low-income Black, Indigenous, and persons of color (BIPOC) older adults during the pandemic. This qualitative study used photovoice to visually portray the struggles of low-income BIPOC older adults and how they recovered from and adapted to the impact of the pandemic. The data analyzed were drawn from interviews, focus groups, photographs, and written stories exploring their experiences and how they found meaning. Results show that participants faced different challenges during the pandemic, such as the fear of COVID-19 exposure and death, struggles to adopt COVID-19 mitigation strategies, loneliness, and social isolation. Amid this crisis of suffering, isolation, and sadness, participants found meaning through a positive reappraisal of the negative situation and engaging in emotional, spiritual, social, and physical self-care practices. The findings have implications for clinical social workers, mental health counselors, faith communities, nurse managers and administrators, and policymakers. --- SESSION 7960 (POSTER) --- EXAMINING INEQUITIES AND INEQUALITIES IN AGING Abstract citation ID: igad104.3074 --- ARE INEQUALITIES IN HEART DISEASE CHARACTERIZED BY INTERGENERATIONAL EDUCATIONAL ATTAINMENT?

ambivalent, positive, and negative emotions. Older parents, N=263, Mage=75.06, SD=5.49, participated in an online survey. Participants' agreement with adult children's ideas and caregiving practice to support 10 life issues were assessed by five categories: 1=agree, 2=disagree, 3=it depends, 4=it is not my issue, and recorded into 0=agree, 1=fully/partially disagree/not my issue. Participants' information sharing on the same items was assessed by 1=openly share, 2=leave out critical points, 3=avoid talking about, 4=lie or making a story, 5=It is not my issue, and recoded to share 1=openly and 0=not openly share. The median dichotomized the mean scores of 10 items to create four patterns: disagree-do not disclose, disagree-disclose, agree-do not disclose, and agreedisclose. Positive, negative, and ambivalent emotions toward adult children have been assessed by the scales and formula used by Lendon et al. (2013). A series of one-way ANOVA, F(3, 260)=4.41, p=.005, η=.05, revealed that participants in agree-do not disclose the pattern, M=3.15, SD=.90, reported the highest level of ambivalence. A post hoc test showed it was significantly higher than that of participants in disagreedid not share, M=2.16, SD=1.10. Disagree-do not disclose group reported the lowest score in positive and negative emotions among groups. Frequency of contact predicted disclosure in auxiliary analysis. The need for within and between differences in older parents' agreement and disclosure patterns was discussed.

Introduction In this context of rapid economic development, cities are attracting a large number of rural laborers, so there is a lack of education for the next generation. In rural areas, the diagnosed rate of psychological disorders among primary and secondary school children is increasing, and data show that the average anxiety score of rural children is 6.4 with a standard deviation of 4.6. 74.3% of rural children have mild anxiety or less, 25.7% have moderate anxiety or more, and 25.2% have depressive tendencies [1]. This research attempts to study some causes of psychological problems among rural primary and secondary school children and their specific manifestations. Can inequality in educational resources lead to the development of psychological deficits in primary and secondary school students? What are the specific manifestations? This study reveals some rural educational resource inequalities that lead to the emergence of unhealthy psychological conditions in primary and secondary school students, and provides some references for future educational reforms. --- 2. Causes of Psychological Defects --- Inequality in Educational Resources Since the country's reform and opening up, economic development in China has varied by region. China has experienced the transition from a planned economy to a market economy. And, as a result of unequal economic development and the unequal importance of education, there is an unequal distribution of educational resources throughout the country, particularly a significant disparity in educational resources between urban and rural areas. Unequal distribution of educational resources will lead to serious polarization, students with good grades will only get better and better, and students with poor success will get worse and worse. These are very detrimental to the healthy growth of young people in rural areas, and rural primary and secondary school students will slowly become inferior, feeling that they do not deserve to go to school, not seeing their own advantages, and even feeling that they are inferior to others in every way [2]. Since primary and secondary school students are not yet mature, they are in a relatively innocent and naive period, and their perception of society has no clear direction, so they are easily brainwashed by incorrect ideas and go astray. Compared with urban primary and secondary schools, where teachers are better qualified, rural children receive relatively few teachers, which leads to deviations in the level of education of teachers. Due to the backwardness of the rural economy, the hardware facilities are far inferior to those in the cities, the teaching methods are not innovative, and there is a large gap between urban and rural teachers. These have seriously affected the educational equity and teaching quality of rural primary and secondary schools. At the same time, rural residents do not pay enough attention to education and lack the right attitude toward education, which will cause them to lack motivation and self-confidence to learn, and have no opportunity to learn to overcome difficulties. Many primary and secondary school students in urban and rural areas believe that everything in the city is out of reach, that they are unfamiliar with the city, and that they are afraid to contact them. --- Absence of Family Education In order to improve the living condition of their families, most of the parents in rural areas go out to work in the city, so their children are left to the care of their grandparents. The grandparents of the children have no awareness of this aspect of education, and they think that it is enough for the children to eat and drink, and they do not have too much control over their education [3]. Primary and secondary school students are in their adolescence, which is a relatively sensitive period, and will inevitably have growing troubles, but because their parents are always working, children in rural families lack a lot of parental care and attention. Parents do not have time to establish correct moral values or leave a channel where they can talk about their worries, so a series of problems arise in their values, which have a very negative impact on their growth and psychology [4]. The survey showed that 43. 91% of the completely left-behind children live with their grandparents and 21. 36% of them live with their siblings. In terms of the relative proportion of left-behind children in this age group, the highest percentage of children in grades 1 to 3 was 44.05%, followed by grades 4 to 6 with 40.26%, and the lowest in grades 7 to 9 with 37.96% [5]. In general, primary and secondary school students are currently the ones who need the most to grow up with their parents, and having a happy childhood is a very important factor for their later growth. --- 3. The Reflections of Mental Defects --- Low Self-esteem and Anxiety Most primary and secondary school students in rural areas are more prone to low self-esteem. Low self-esteem is a kind of disconfirmation of themselves and dissatisfaction with their own ability. Moreover, they feel that they do not deserve the respect of others. If they have excessively low selfesteem, frequently engage in self-denial and self-depreciation of themselves, and also deny their ability to solve problems, they will stop when they encounter problems; they will be easily agitated and anxious, and may even be depressed. Due to long-term low self-esteem, they lack motivation and are not as energetic as children in the city, they are silent when communicating with others, and they are cautious and afraid of making mistakes when doing things [6]. --- Isolated and Withdrawn If rural primary and secondary school students have the opportunity to go to school in the city, some of them may think they come from a poor family. Due to the constraints of economic conditions and different educational attitudes, the educational methods of rural parents are very different from those of urban parents. For parents in urban and rural areas, the education style is more rude and does not serve as a role model. Over time, children's thinking is also greatly affected. They will think that being of rural origin is shabby and will be looked down upon by others, and when compared with urban children, their emotions will be greatly affected. Not only that, children in the city may reject the children in the country because of this. This will also lead to the character of rural children gradually becoming withdrawn and unwilling to approach strangers [7]. --- Conclusion In conclusion, this paper has studied the causes as well as manifestations of psychological deficiencies in primary and secondary school students in rural areas, and the following conclusions can be drawn: this paper studies the causes and manifestations of the psychological deficiencies of primary and secondary school students in rural areas, and the following conclusions can be drawn: the uneven distribution of educational resources can lead to a scarcity of teaching resources in rural areas; the hardware facilities in rural areas are far inferior to those in cities due to the economic backwardness; rural parents work outside all the time and neglect their children's feelings, so that a series of problems arise in their values. These factors can lead to low self-esteem, anxiety, and even depression, and they are likely to be discriminated and isolated in interpersonal communication. However, this paper only studies the problem of educational inequality and its resulting manifestations in rural areas of this country, China, and the sample data are still insufficient. It is hoped that a larger range of data will be available in the future to provide a more accurate study.

In recent years, China has experienced rapid economic development, but the problem of the uneven distribution of educational resources between urban and rural areas has also emerged. This problem has caused the educational gap and cognitive ability gap between rural children and urban children to gradually become larger, and rural children may even develop psychological problems such as low self-esteem and anxiety. Therefore, the focus of this paper is to study the psychological deficiencies of rural primary and secondary school students due to the unequal distribution of educational resources and the lack of family education. Through literature reading and analysis, this paper draws the following conclusions: the inequality of educational resources and the lack of family education can easily lead to psychological disorders such as low self-esteem, anxiety, and withdrawn personalities in rural primary and secondary school students.

Introduction This research focuses on the labor market opportunities that arise from digitalization in the new normal. COVID-19 has significantly changed the working patterns in Europe and Serbia in favor of home-based and flexible jobs on the platform. The platform or gig economy via applications includes crowdsourcing and on-demand work. ILO has published several studies on non-standard employment, agency work, and temporary and dependent self-employment, with discussions on open issues of employment relationships and hidden employment relationships (McKinsey Global Institute, 2015; 2017; ILO, 2016; WEF, 2016a; 2016c; Bertrand, 2011;UN Women, 2005). Many studies of platform work assume that atypical employment relationships involving casual, daily, or seasonal contracts are not covered or are covered only to a limited extent by traditional employment protections (Nambisan, Wright, & Feldman, 2019; Nambisan, Siegel, & Kenney, 2018; Balsmeier& Woerter, 2019; Ahlstrom, 2020). Platform female workers are usually legally treated as self-employed, and many EU countries have modernized labor law and made the labor market more flexible by modifying common law (Leahy & Wilson, 2014; Radović-Marković, Kočović & Grozdanić, 2013; Radović-Marković, Grozdanić & Jevtić, 2017). The paper also respects the SDGs concerning sustainable employment of women and gender equality (Worthington, 2014), which are connected to: -Economic benefits of women, SDG 5 -Unemployment and wages of women, SDG In selecting digital job opportunities for women, the authors include the SDG pillars of sustainability, equality issues, and the increase of women's employment rates faster than men's by the end of the decade (Diesendorf, 2000;Dunphy, 2000; EU Treaty for Equality Promotion by 2030). Both traditional and modern industries can be considered the demand side of the labor market for female employment in the digital era ( The paper is structured through the introduction, the case study gap, the materials and methods with the main findings, the conclusions, and the references used in the study. --- Serbian Gap Analysis The number of employed persons in Serbia decreased to 2,888,700 in 2022 from 2,942,000 in 2021 (SORS, 2023) (Figure 1). The labor force participation rate in Serbia remained unchanged at 55.80 percent in 2022. Female unemployment in Serbia was reported at 11% in 2021, according to the World Bank development indicators (Figure 2). Although the youth unemployment rate in Serbia decreased from 25.40 percent in the third quarter of 2022 to 24.30 percent in the fourth quarter of 2022, it is still very high. The reason for taking this country for the gap study lay in the fact that Serbia is among the ten economies in the world by the number of freelancers in terms of population. About 100,000 freelancers were employed, mostly equally men and women, in 2021. According to SORS (2022), most freelancers work for foreign companies, and most of them did not sign any contract, and if they did, such a document is not recognized in the Serbian legal system as the platform company is not recognized as an employer. Furthermore, the research found the following insights: -More men are working in the technology sector than women. -Men are mostly better paid than women. -Women usually offer language courses, translation, textile design, writing, fashion, and similar services over online platforms (Vučeković et al., 2021). -The number of women joining the "gig" economy is growing, and the feedback is usually positive. -Freelancing is the main source of revenue for many women, as the gross value of such income is double the average gross wage in Serbia. In the time of the digital transformation of work in Serbia, legal structures were not changed and adapted to new circumstances of employment and new work patterns. Stronger labor and social protection regulatory rules have to be developed, and policymakers in Serbia would have to work to shape the transformation of regulations. Concerning the ICT sector in Serbia, its impact on economic and social influence on new business models is expanding, and it can be said that the industry opportunities are growing each year with more support from the national ecosystem (Špiler et -But in terms of labor market efficiency, Serbia is in the lower positions: the country's capacity to retain and attract talent is low, ranking 79th in women in the labor force in ratio to men, 68th in pay and productivity, with 46% of knowledge-intensive jobs in the workforce, and 80th out of 144 in hiring and firing practices. -65% of individuals using the Internet have digital skills (more men); 68% use virtual social networks; in the E-Participation Index, 78th position (WEF, 2022). --- Methods and Materials This research is part of a wider investigation by authors across Serbia about the success triggers of female employment opportunities and barriers in the age of new technologies. To answer the research question, an empirical analysis was conducted in Serbia in 2022, which included 224 unemployed female participants (T. 2). One main and two auxiliary hypotheses are defined in the hypothetical research model given in Figure 3. Two auxiliary hypotheses are also defined as follows: 𝐻𝐻 1 = A does not impact C. 𝐻𝐻 𝑟𝑟1 = A impacts C. 𝐻𝐻 2 = B does not impact C. --- 𝐻𝐻 𝑟𝑟2 =B impacts C. A mixed-methods research design was adopted, with the online quantitative data collected through 15 claims to identify the participants' attitudes and correlation and regression analysis realized in SAS JMP 17. The sample includes women and girls from all over the country. In terms of demographic characteristics, 33.93% of participants are between the ages of 18 and 24, and 29.91% are between the ages of 25 and 40, which makes up the majority of the sample (young people, 63.84% of the total number). Most have secondary and high education levels: 168 girls and women (65.00%). Employment status shows that 89 participants are temporally employed, 78 are not employed, and 43 lost their jobs because of being laid off (technological decline, job reduction, company closing), which makes 54.02% of women unemployed for both reasons. 6.25% of participants were employed on full-time contracts in various industries (Table 2). --- Research Findings The defined impact of 3 variables is analyzed through 15 further claims: Claims A. --- Claims C. Dependent variable, Labor market inclusion of women (abbr. WLMI) c11 Employment/reemployment (public enterprises and institutions) c12 Employment/reemployment in SMEs, businesses, ICT firms c13 Self-employment, technology entrepreneurship, Online Outsourcing c14 Working online over the platform, freelancing c15 Informal work, micro work The standard deviation and mean scores for the respondents' attitudes toward the stated claims within the variables are given in Tables 3 and4. --- Table 3: Factors and values for the (A, B & C) --- Variable (AC) Correlation analysis The hypothetical model of A & C is given in the further Figure. The coefficient of determination value is 0.548503. It showcases that the (C) variable can be described by 54.85% of the (A) variable. Also, 0.74061 is the coefficient of correlation between two variables, which means a strong relationship between them (Figure 5). 5). --- Figure 7: Theoretical system model (B & C) The coefficient of determination is 0.478716, and the variable (C) is 47.87% described by the (B) variable. 0.691893 is found as a value of the coefficient of correlation between the variables, showing a weaker relationship (Figure 8). 6. According to the findings, the main hypothesis cannot be confirmed (H0: A and B do not impact C), and the alternative one, Ha: A and B impact C, can be accepted. Figure 11 presents the non-standard contribution values set system model. A positive correlation between variables (A) and (B) was found. The 0.502397 is the variable (A) with the highest impact on (C). Variable (B) has a lower impact of 0.347089. The 0.686 is found as the mean value of the impact of the deviations of two variables (A) and (B) from their respective means. --- Figure 11: (A, B & C) System model A multiple regression equation is formulated, and it reads (3): 𝐶𝐶 = 1.0761355 + 0.4208663 • 𝐴𝐴 + 0.3385774 • 𝐵𝐵(3) The (A, B & C) multiple regression equation diagrams are given in (Figure 12). --- Figure 12: (A, B & C) variables multiple regression equation diagrams --- Conclusion The inclusion of women in the Serbian labor market depends on educational factors, digital capabilities, skills, and government support with labor laws and other regulations. The main hypothesis is supported by the correlation analysis provided in the paper. To support educational efforts in Serbia, investing in training and reskilling opportunities for women, mid-career, or those returning to the workplace is needed and recommended (Radović-Marković et al., 2022). It would mean that the country subsidized transition costs for selected occupations and sectors, increased transparency on labor demand trends, and launched informational campaigns targeting women (Grozdanić, Radović-Marković & Jevtić, 2013). To address labor mobility constraints, women need support in balancing family care and work obligations, and finally, they need help reducing stereotypes about gendered occupations. Positive movements are found with institutional support for nurturing changes in digital transformation, as they provide an open platform for the sustainability of women's employment in the global workforce. The research also showcased the levels of the digital divide and social inclusion issues (SDGs) in the "gig" economy. Furthermore, the paper's results contribute to the current literature regarding women's human and labor rights, education, flexible work patterns, and the digital transformation of work. --- According to the findings, the first hypothesis H1 = a does not impact C cannot be confirmed (the alternative one is accepted, Ha1: that A impacts C). 4.2830357 is the mean score for the A variable. The multiple regression equation reads (Formula 1): (A & C) diagram is presented in further Figure (6). --- Figure 6: Diagram for A & C variables (BC) variable correlations The hypothetical research model (BC), composed by one independent (B) variable, and (C) dependent one (Figure 7). --- (A, B & C) Variable Multiple Correlations The hypothetical research model (ABC) is shown in Figure 3. 0.612228 presents the determination indicator, meaning that with 61.22% (C), it can be closer defined by two variables, AB. By analyzing the variables ABC together, a strong correlation is found. Among A and C, the correlation is the highest, 0.7406. The largest variance size is 0.519, and it is the size of the A variable. The smallest variance of 0.382 is found for the dependent variable (C).

In this paper, women's social inclusion in the labor market as a long-lasting employment problem is researched under the new digitalization requirements. Furthermore, the importance of the factors is explored, including those connected to the digital knowledge and skills of women (WDKS) and the institutional support of digitalization (DIS), for women's inclusion in the labor market (WLMI) and employment in a digital age. Using the Likert scale instrument for 15 claims within the specified variables of the study conducted in Serbia in 2022, 224 women participated in the research and rated the influence. Findings showed that the knowledge, digital skills, and competencies of girls and women (WDKS) are strongly correlated with their social inclusion in the labor market (WLMI). The impact of the DIS, institutional measures, and policies as a set of digital infrastructure, networks, and low-level adjustments for the digitization process's development is also important as a part of national digital ecosystem development.

BACKGROUND Tobacco and its derivatives are still interesting to discuss even though the World Health Organization (WHO) has set as of May 31, 1988, to commemorate World Tobacco-Free Day. This is in line with reports related to the cause of death where every year more than 5 million people take their lives because of ironical tobacco in 2020 10 million of them from developing countries caused by diseases due to exposure to cigarette smoke so it is not surprising to be Volume 1 Issue 2, September 2023, pp 263-275 https://ebsina.or.id/journals/index.php/JRCNP eISSN 2986-7401, pISSN 2986-8424 -8424 264 The Relationship Between Family History and Smoking Behavior of Family Members the world's attention (Widiyaningsih and Rustiana, 2021). The smoking phenomenon is often found in various environments including the family environment, government institutions, educational environments, and even other public places, the impact of this behavior and phenomenon not only hits the perpetrators but also on people around who do not smoke (Attaqy et al, 2021). In the family sphere, interest in smoking is because other family members also smoke and there is no ban on smoking in the house. So that it is easier and greater the risk of someone becoming an active smoker. Family attachment acts as a protective factor for various kinds of risky health behaviors, one of which is smoking (Suryawati and Gani, 2022). In Smoking is a habit that has become part of the lifestyle among people in Indonesia men and women (Rahmatia et al, 2020). In women, this habit will also increase the risk of infertility, hampers problems, perinatal death, and miscarriage. The emergence of smoking habits in the form of social pressure, peer influence, and smoking habits among the family so that tobacco is considered a form of destructive addiction after a while which becomes a time bomb that will explode (Gupta & Raj, 2023). Health problems in the family are mutually continuous and affect each other between family members. The family itself is a group that can create, prevent, ignore, or even improve health problems within its scope. The family functions as health care through Clean and Healthy Living Behavior (PHBS). One indicator is not smoking at home because it can cause disease for smokers but also for people around (Andriaty, 2022). Various efforts or programs that have However, from these results, it was found that residents considered it only as a form of formality and tended to be less attractive. The prevalence of families who are not exposed to secondhand smoke is less than those who have been exposed to secondhand smoke. One of the factors is the habit pattern which is very difficult to change quickly (Widiastuty & Ekasari, 2022). From the explanation of the problems described above, as prospective nurses, researchers are interested in researching "The relationship between family medical history and smoking behavior of family members in the working area of the Kaliwates Health Center, Jember Regency". --- METHODS The Furthermore, inference analysis can determine the relationship between family medical history and smoking behavior, so the bivariate analysis used is Chi-Square with a confidence level of 95%. --- RESULTS --- Overview of Research Location of Kaliwates --- Health Center Area The working area of Kaliwates Health --- Family Medical History in Kaliwates Health --- Center Working Area In the study, family medical history data was obtained from a family medical history questionnaire with one question item consisting of existing answer options and no family medical history in the respondent's neighborhood. I handle and manipulate my cigarettes as part of smoking 3,00 (3,00-3,00) 0,540 <001 Putting or chewing something in your mouth to distract yourself from smoking 4,00 (4,00-4,00) 0,535 <001 Smoking after finishing something or work 4,00 (4,00-4,00) 0,539 <001 If you don't smoke, will it be difficult to do something 3,00 (3,00-3,00) 0,502 <001 Smoking is not allowed in certain places and will play packs of cigarettes or cigarettes 3,00 (3,00-3,00) 0,530 <001 In certain places or certain things that can trigger smoking, for example seats, sofas, rooms, or during work 4,00 (4,00-4,00) -<001 Light cigarettes regularly (without desire) 4,00 (4,00-4,00) -<001 Finding yourself putting things like cigarettes and other objects (stationery, toothpicks, chewing gum) into your mouth and smoking them to relieve stress, tension, anxiety 4,00 (4,00-4,00) -<001 The part that you enjoy the most when smoking and when lighting 1,00 (1,00-1,00) 0,536 <001 When alone in restaurants, bus terminals, etc. you will feel comfortable or confident if you hold a cigarette 2,00 (2,00-2,00) 0,501 <001 Note: MD = median, P = percentiles, Z = value of Kolmogorov Smirnov test coefficient, p-value = significance value of Onse sample Kolmogorov-Smirnov Test --- DISCUSSION --- Family health history From the results of the data analysis, it is known that in the working area of Kaliwates Health Center, more respondents do not have a family medical history. This is because the family's function toward family health is optimal. The family functions as an exchange of information among family members and the role of each family member functions well. Family functions can be optimal if the implementation of family functions is well-established between family members (Isnaini et al, 2020) From this description, it can be concluded that family medical history is not related to smoking behavior. --- Implications of Nursing The study showed that a family medical history of the behavior was not --- ACKNOWLEDGMENT We would like to thank the chairman of Kaliwates Health Center, and the respondents for their cooperation in this study. --- DATA AVAILABILITY STATEMENT The data are not publicly available due to privacy or ethical restrictions. --- AUTHOR CONTRIBUTIONS --- Substantial contributions to conception, data collection, analysis, and writing: Okky Oktaviyana Putri, Tantut Susanto, Latifa Aini Susumaningrum. Manuscript revisions: Okky Oktaviyana Putri. --- CONFLICT OF INTEREST The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Smoking is often found in various environments, especially in the family environment. Various efforts or programs that have been echoed and implemented to overcome these problems include the Healthy Indonesia Program with a Family Approach (PIS-PK). This study aimed to analyze the relationship between family health history and the smoking behavior of family members. The research design is correlational with a crosssectional approach. The population in this study were all families in the working area of the Kaliwates Health Center, Jember Regency, totaling 12,840 families, with a sample of 170 respondents. The sampling technique used was multistage sampling with the data collection tools, namely the family health history questionnaire and the GN-SBQ smoking behavior questionnaire. The results of this study indicate that the Chi-Square statistical test obtained a p-value of 0.615 (<0.05) where there is no relationship between family health history and the smoking behavior of family members in the working area of the Kaliwates Health Center. In this study, most family health history was in good health, as seen from the history data (65.9%). However, most of the families in the working area of the Kaliwates Health Center showed smoking behavior in the very severe category (60.6%). This study concludes that no significant relationship exists between family health history and smoking behavior. It is hoped that with this research, health workers can help improve counseling related to smoking behavior in the working area of the Kaliwates Health Center.

With the recent developments in information and communication technologies (ICTs), there is a significant change in our daily life. Most of us have become very much dependent on the technology -78.3% of the developed world's population and 32.4% of the developing world's population are the Internet users and, those figures are increasing every year (International Telecommunication Union; http://www.itu.int/en/ITU-D/ Statistics/Pages/default.aspx). Eventually, integrating ICTs into teaching and learning offers significant potentials for higher education institutions and opens new challenges for educators, through their capacity to facilitate new kind of education in the digital environments. Consequently, significant changes occurred in several professions' curricula such as design, business, medicine, and engineering. to facilitate new requirements, projections, processes, and possibilities provided by advance digital tools. Research in educational use of digital environments delivers convincing evidence of the potentials of the emerging digital platforms to assist more effective learning. One of the main advantages of digital education identified is that digital teaching platforms offer students data-rich, online, synthetic environments, enabled with media, information, and communication tools. In such platforms, students become virtual characters (avatars) who immersed into virtual reality to collaboratively work and learn. In order to enhance their learning capacity, students should be given opportunities for exploration and manipulation within the environment as well as opportunities for discourse between students (Dickey, 2007). Similarly, this new learning and teaching environment provides teachers possibilities to built constructive environments in which knowledge is obtained and learning is an active process. Teaching in digital environments can take many forms including didactic teaching, active learning, collaborative learning, gaming, simulations, etc. Working and articulating ideas in a group context, questioning and challenging each others' ideas, and engaging in total collaboration in the determination of design problems make learning most effective. Winn (1993) identifies the following approaches in digital education. The first approach is based on behavior theory that transforms the conventional approaches to the instructional design (Dick and Carey, 1985;Gagne et al., 1988): (1) forecasting students' behavior (Reigeluth, 1983); (2) decreasing essential knowledge and skills by operating proper analytical techniques (Landa, 1983); and (3) adapting a set of actions to confirm that without the additional help of the teachers or designers, the application would work successfully (Winn, 1993). Second, it is important the ways of information that are offered to students (Fleming and Levie, 1993). In this approach, processing information and the learning material have a greater impact rather than on task reduction and determination of instructional strategies on the basis of the content (Winn, 1993). Psychologists recognize that cognitive theories of learning and instruction require the foundations for instructional designers to determine assistance rather than behavioral theory (Winn, 1993). Cognitive theories are adapted as the third approach. The basic principle is that the ways of how the interaction between the students and instruction occurred has greater importance than the content or how information is presented (Winn, 1993). The cognitive theory (Anderson, 1976(Anderson, , 1983) ) formulated the basis of "intelligent" computer-based tutors as follows: • The objective structure of the problem space must be identified; • The guidance in the context of problem-solving must be provided; • The instant feedback on errors must be provided; • The load of the working memory must be minimized; • Modifying the "grain size" of instruction with learning to facilitate the knowledge gathering process; and • Empowering the student to reach the required skills by sequential estimation. The final one depends on determining the ways students interact with courseware. The approach is based on the assumption of knowledge construction that is built by the students themselves, not provided through the course material (Winn, 1993). According to this view, the knowledge is constructed, not transferred, and the students dynamically learn (Jonassen, 1999). Within this context, students are given opportunities to apply new knowledge and skills in a collective setting (Gül et al., 2007). Furthermore, the role of teachers is "to help and guide the student in the conceptual organization of certain areas of experience" (Glasersfeld, 1983). To support the intention of integration of digital environments in education, we have developed several collaborative virtual studios over the years: (1) designing virtual worlds and global teamwork (collaboration between The University of Sydney-Australia and Istanbul Technical University-Turkey in 2007 and 2008) (Gül et al., 2007(Gül et al., , 2008)), (2) NU Genesis (collaboration between the University of Newcastle-Australia and Rangsit University-Thailand) (Gu et al., 2009). As discussed earlier, we have adopted Winn's (1993) teaching approach that depends on the understanding of students' interaction with the course material considering the students as the active learners. In design teaching context, the main concern is to teach the theory and applications in designing of artifacts that accommodate human activities. Incorporating the digital environments into design education, the principle of teaching process is not changed but there are some additional concerns needed to be considered. For example, our teaching experience shows that in order to achieve the best outcome in the collaborative virtual design studio, constructing a shared goal, and an understanding of the given problems are essential for students. In addition, we have outlined several crucial factors in order to enhance students' learning: (1) focusing on active learning; (2) focusing on the learner through the relevance of the content; (3) developing clear objectives to provide direction to student learning; (4) articulating knowledge and learning experiences; (5) ensuring the application of effective feedback mechanisms; (6) employing effective "scaffolding" in the organization of the learning experiences; and (7) encouraging collaborative learning (Gül et al., 2012). Our digital teaching experience confirms that the virtual design studio and digital platforms provide an outstanding environment for learners. Particularly, digital education platforms support collaborative learning and co-design situations in which students develop a mutual understanding of the given design problem and a shared goal, and achieve this goal through working and learning together on the design artifact. This design artifact becomes the ground on which the collaboration, negotiation, conflicts, and critiques occurred (Gül et al., 2012). In order to enhance this fundamental subject, we pursue papers that provide theoretical or empirical contributions to the role of advanced digital technologies in education. Digital education specialty section of Frontiers in ICT will be devoted to original papers, concerned with the challenge of new emerging educational paradigms of emerging digital technologies. The principal aim of this special section on technologies for teaching is to provide further discussion at the intersection of theory and practice. Related topics to the application or reflection of digital technologies in education, which may include, but are not limited to, are welcome: • Frameworks for teaching with emerging technologies; • Curriculum development; • Assessment of knowledge and skills; • Collaborative learning in digital environments; • Facilitating learning utilizing digital spaces; • Ideation and virtuality; • Multi-disciplinary and multi-cultural collaboration in education; and • Supporting student learning in a media-rich environments. --- Conflict of Interest Statement: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

With the recent developments in information and communication technologies (ICTs), there is a significant change in our daily life. Eventually, integrating ICTs into teaching and learning offers significant potentials for higher education institutions and new challenges for educators, through their capacity to facilitate new kind of education in the digital environments. As a result, there have been significant changes in several professions' curricula such as design, business, medicine, and engineering., to accommodate new demands, opportunities, processes, and potentials provided by digital media and computational tools.

ABSTRAK Penelitian ini berfokus pada analisis film 3 Hati Dua Dunia Satu Cinta yang dirilis pada tahun 2010 di tengah fenomena sosial yang menunjukkan peningkatan intoleransi agama. Tujuan penelitian ini adalah menganalisis fenomena sosial dan disparitas dalam masyarakat perkotaan melalui narasi dan karakternya. Penelitian ini juga bertujuan untuk memahami dampak film tersebut terhadap heterogenitas masyarakat perkotaan dari perspektif politik ruang. Metode yang digunakan adalah penelitian kualitatif dengan pendekatan analisis naratif dan analisis diskursus menggunakan kerangka pikir antagonistik ala Laclau-Mouffe. Data dikumpulkan melalui penontonan dan analisis langsung film tersebut, serta melalui studi literatur yang relevan. Hasil penelitian menunjukkan bahwa film 3 Hati Dua Dunia Satu Cinta berhasil memanfaatkan fenomena sosial sebagai strategi pemasaran, merawat disparitas melalui narasi dan karakternya, menghasilkan dislokasi subjek menuju identitas hegemonik tertentu, dan mempengaruhi heterogenitas masyarakat perkotaan dari perspektif politik ruang. Kata kunci: Strategi, narasi, dislokasi, antagonis, dan politik ruang --- PENDAHULUAN Seperti halnya karya sastra, film juga berangkat dari suatu keberadaan dan bukan kekosongan. Seolah ingin mengambil momentum yang tepat sebagai strategi pemasaran film melalui fakta fenomena sosial (Setyawan, 2016) (Laclau, 1994). (Soja, 1996). Data dikumpulkan melalui dua metode utama. Pertama, penontonan dan analisis langsung terhadap film tersebut (Bordwell & Thompson, 2010). Ini melibatkan penontonan film secara detail dan pencatatan aspek-aspek penting yang relevan dengan tujuan penelitian. Kedua, studi literatur yang relevan (Fink, 2019) (Jørgensen & Phillips, 2002). --- PEMBAHASAN --- Memasarkan Dilema Cinta Beda --- Agama Logika pemasaran menuntut adanya kedekatan kultural atau dalam penyiaran dikenal sebagai 'parasocial interaction' atau 'intimacy at a distance' di mana ada kedekatan antara tokoh yang dimainkan dengan penonton yang mampu membekuk pengalaman keseharian seperti yang dikemukan sebagai intimasi. These terms were coined in an attempt to comprehend some of the peculiar social phenomena that were emerging around early television watching. Intrigued by how, or indeed why, some people could become fans of television personalities to such an extent that they would imaginarily involve their heroes in intimate aspects of their everyday lives such as, in extreme cases, sexual fantasies (Hutchby, 2006). --- Meruncingkan Narasi Identitas --- Hegemonik dan Keterbelahan --- Subjek Gramsci was well aware that, in spite of the extreme diversity of the social forces that had to enter into the construction of a hegemonic identity, no collective will and no sense of community could result from such a conception of negotiation and alliance (Laclau, 2006). Keberangkatan --- Dislokasi Rosyid dan Keberjarakan dengan Identitas Populis The subject is the distance between the undecidability of the structure and the decision…. according to which dislocation is the trace of contingency….. There is dislocation, as deconstructionists well k now, not as a result of an empirical imperfection but of something which is inscribed in the very logic of any structure (Laclau, 2006). We will call any articulation of practice establishing a relation among elements such as their identity is modified as a result of the articulatory practice. The structured totality from the articulatory practice, we will call discourse. The differential positions, in so far as they appear articulated within a discourse we will call moments. By contrast, we will call elements any difference that is not discursively articulated (Laclau & Mouffe, 2013). The unity of the class is not determined by an a priori consideration about the priority of either the political struggle or the economic struggle, but by the accumulated effects of the internal split of all partial mobilizations. In relation to our subject, her argument amounts to approximately the following: in a climate of extreme repression any mobilization for a partial objective will be perceived not only as related to the concrete demand or objectives of that struggle, but also as an act of opposition against the system (Laclau, 2006) The classic tradition of theatrum mundi equated society with theater, everyday action with acting. This tradition thus couched social life in aesthetic terms and treated all men as artists because all men can act (Sennett, 2003). Namun, hal ini justru tidak terjadi ketika dalam narasi film axis of power antara helper dan opponent tidak terjadi, yaitu tokoh Rosyid tidak mendapatkan tokoh penolong yang mampu mensukseskan kehendaknya. Secara naratif hilangnya helper tidak memungkinkan Rosyid untuk bertindak suksesif di mana the receipt of the helper which is the consequence of the qualifying test, we have already seen that it was the counterpart to the privation of heroic power (Greimas et al., 1984

One Love) amidst the social phenomenon indicating increased religious intolerance. Additionally, this study seek s to analyze social urban society's phenomenon and disparity through the film's narrative and characters. This research also seek s to understand the film's impact on urban society's heterogeneity from the spatial politics perspective. The study employed the qualitative method with narrative and discourse analysis approaches using Laclau-Mouffe's antagonistic framework . Data was collected by watching and directly analyzing the film and through relevant literature studies. The research results indicate that the film 3 Hati Dua Dunia Satu Cinta successfully utilized the social phenomenon as a mark eting strategy, maintained disparity through its narrative and characters, resulted in subject dislocation towards a certain hegemonic identity, and influenced the heterogeneity of urban society from the perspective of spatial politics.

Introduction Marriage can be interpreted as someone who has bound physically and mentally between a man and a woman as a married couple (husband and wife) carried out legally, both in the eyes of the law and the customs/beliefs of each individual. (Desiyanti, 2015). Marriage according to Law No. 16 of 2019 the minimum age for marriage for both men and women is 19 years. Meanwhile, according to UNICEF (2014, (Desiyanti, 2015)Early marriage is a marriage that is carried out at a relatively young age with an age range of 10-19 years in adolescents to form a new family. Several studies have shown that marriage under the age of 18 in various countries such as America is 90%, East Asia is 62%, and the Pacific is 53%. (Arthur & Earle, 2018), while in Indonesia itself related to early marriage, the proportion of married before the age of 18 years in 2020 in Indonesia is 10.35%, East Java with the age of women marrying before the age of 18 years in 2020 is 10.67%. In Jember Regency While in Jember Regency in 2020, there were 600 out of around 21,000 marriages that involved girls under 19 years old. In addition, 400 of them involved boys under 19. In Sumberjambe, the history of early marriage in 2020 is 19.8% of children aged <19 years old, marriage age 19-21 years is 14.4%, marriage age is 21-30 is 10.16%, marriage age is 30 years and over ie 9.5%(Central Bureau of Statistics, 2021). Marriage and pregnancy in adolescents contain several risks, including the following: first, with a long reproductive age range, pregnancy and childbirth for women under 20 years of age have a much higher risk of death compared to those aged 20 years and over. Marriage and teenage pregnancy prevent women from pursuing higher education. Fourth, because they are not yet fully mature and psychologically mature, the possibility of divorce in young marriages will be very high (Muntamah, Latifiani, and Arifin 2019). The age of marriage with its relation to pregnancy readiness for the mother needs an adjustment from this physical point of view to a body shape where sometimes pregnant women tend to be sensitive to changes in body shape during pregnancy. While the mother's psychological self can be in the form of the mother's experience, anxiety and emotional disorders, and family and husband support. Therefore, it is necessary to be prepared related to pregnancy with the support of the surrounding environment in the hope that the pregnancy will run by healthy conditions both during early pregnancy, childbirth, and the birth of a baby. (Sunarti, 2012). Wilujeng Dwiningtyas, Awatiful Azza, Diyan Indriyani Relationship of Marriage Age with Pregnancy Acceptance……… In essence, after marriage, a person needs to be prepared to live life. Likewise, related to the hope of the couple to have children as the successor to the descendants of the small family that was built after the marriage. Because this is influenced by decision-making in carrying out marriages in terms of the marriage age they choose for various reasons. Seeing this, readiness itself can be interpreted as a whole condition that makes it ready to respond or answer in a certain way to a situation (Slameto 2010). While pregnancy can be interpreted as a husband and wife relationship with the process of releasing an ovum for a woman with the transfer of spermatozoa to an egg cell which can lead to a seed, a normal pregnancy is around 40 weeks or commonly referred to as 9 months 10 days (Armini & Yunitasari, 2016). In the results of interviews with midwives at the Sumberjambe Health Center, it was found that there were still many histories of early marriage with various problem factors, from an economic and cultural perspective that still existed in various villages. Not only that, there are still many pregnant women with a history of early marriage and pregnancy, especially novice mothers who still need to be prepared both physically and psychologically. In the problems that have been described, it is necessary to do research with the title "The Relationship of Marriage Age with Readiness to Accept Pregnancy in Pregnant Women in the Work Area of Sumberjambe Health Center, Jember Regency. --- Method The research design in this research uses observational analytics with an approach cross sections namely the collection of data from the object of research measured at the same time between variables. This research was conducted in the work area of the Sumberjambe Health Center, Jember Regency. The time of research was carried out by the researchers from May to July 2022. In May, the researchers conducted a preliminary study to get an initial picture of the research location. Data collection was carried out by researchers from June 24 -July 11, 2022. The number of samples in this study amounted to 92 members who were taken randomly probability sampling by using a simple random sampling approach, namely how to take samples if the object under study is large. Data collection was carried out by researchers with the method of distributing observation sheets by looking at the age of marriage through the marriage certificate, while for pregnancy readiness using a questionnaire as many as 20 questionnaires. Instruments for pregnancy readiness include several things including physical readiness, psychological readiness, financial readiness, and cultural readiness. This research has gone through an ethical test with letter number 107/KEP/FIKES/VI/2022. Data analysis in research is an important part of data collection. This study uses univariate analysis, the results obtained with frequency distribution in the general data category, while the bivariate data analysis used in this study is the Chi-Square Test. 1. This shows that the distribution of data regarding the characteristics of respondents in this study differs between categories that have been determined. The age category of pregnant women shows the results of 92 respondents where most of the ages are in the range of 21-25. In the last education category, most of the mothers are in their last high school education. In the occupational category, the majority of the work is housewives as many as 72 people. In the category of respondents based on the mother's religion, all of them are Muslim. In the category of respondents based on ethnicity, most of the mothers have Javanese ethnicity. In the category of husband's monthly income, the largest choice for income is Rp. <1,500,000. in the category of respondents related to pregnancy information obtained by pregnant women, most of them received information from health workers. Table 2 shows that of the 92 respondents, most of the respondents married at the age of <19 years, higher than the age of married mothers >19 year. Table 3 shows that of the 92 respondents, most of the respondentsthat the readiness of the mother in accepting pregnancy is the highest with the first order being less than optimal readiness, while the second order is optimal readiness. continuity correction is .000 where the value is smaller than 0.05 (<0.05), it can be concluded that there is a relationship between the age of marriage and the readiness to accept pregnancy in pregnant women. --- Results --- Discussion The age of marriage is a benchmark in building a household by being said to have married legally and legally. The age of marriage according to the government is to have a minimum limit of 19 years, less than that age is called early marriage (Heryanti, 2021). Early marriage is a natural thing that happens in various countries, not in Indonesia, but in foreign countries, it can also happen. In essence, after marriage someone expects offspring. But the need to have readiness in making decisions, readiness itself can be interpreted as the whole condition that makes it ready to respond or answer in a certain way to a situation (Slamet, 2010). At the age of marriage, it is closely related to the readiness of pregnancy for the mother, which requires adjustments in terms of physical, psychological, financial, and cultural aspects. From a physical point of view, this refers more to changes in body shape, while psychologically it emphasizes the mental condition/readiness of the individual in dealing with pregnancy by preparing everything during the pregnancy process so that it runs smoothly until the time of delivery. from the economy, while this culture is a form that is needed in every step because it has become a habit of individuals with diverse cultures, each pregnant woman will be different between individuals (Sunarti, 2012). In the results of the study on 92 pregnant women respondents in the work area of the Sumberjambe Public Health Center, Jember Regency with the category of married age less than 19 years and married age more than 19 years with readiness shown in both the less than optimal and optimal readiness categories can be seen from the results of the use of the chi-square with the resulting Asym Sig value. (2-sized) Continuity Correction is .000 where the value is smaller than 0.05 (<0.05), it can be concluded that there is a relationship between the age of marriage and the readiness to accept pregnancy in pregnant women. While the research conducted by Komariah & Nugroho (2020) using the chi-square test, the results obtained a p-value: 0.003 <: 0.05, so Ho is rejected, that is, there is a relationship between age and readiness for pregnancy. Meita (2016) said that, if psychologically the mother-to-be has rejected her pregnancy, this can cause physical complications when the mother is pregnant or during childbirth. Underage pregnancy is also very likely to cause babies to be born with low body weight and not infrequently babies are also born immediately die of prematurity (not old enough). --- Conclusion Based on the results of the study and the description of the discussion of this study, it is found that the more the age of marriage is less than the minimum age of marriage, which is 19 years, the less readiness for pregnancy is also less than optimal. So it can be concluded in this study that the age of marriage will affect a person's readiness in preparing for pregnancy. Future researchers can be expected to be a reference source in making research based on the theme that will be taken by further researchers, related to maternal gestational age, differences are made between primigravida and multigravida. So that there is more variation between the age of marriage and pregnancy that occurs in pregnant women.

Introduction: Marriage can be interpreted as a married couple of men and women so commonly referred to as husband and wife. A person is said to be legally married in terms of the age of the two spouses. Law number 16 of 2019 concerning the minimum age limit for marriage for both men and women is the same as the minimum age limit for men, namely 19 years. Couples who are married <19 years are said to be early marriage Method: This study uses quantitative research with a cross-sectional approach. The population in this study were primigravida mothers with a total sample of 92 respondents. Using a simple random sampling technique. The collected data were analyzed by chi-square test. Results: in this study, the results of the analysis of the chi-square test with the results of p-value .000 (<0.005) said that there was a relationship between the age of marriage and the readiness of pregnant women.The age of marriage is closely related to the mother's readiness for pregnancy physically, psychologically, financially, and culturally. Married young teenage girls are still a phenomenon now, there needs to be a role from health workers in providing education in the form of information.

INTRODUCTION In December 2019 in the Chinese city of Wuhan, Hubei province, health systems reported patients affected by atypical pneumonia of unknown origin, the disease was identified as a new virus of the Coronaviridae family, called SARS-CoV-2. The associated clinical condition was named COVID-19. As mentioned by the Spanish Ministry of Health (1), it appeared suddenly, generating a deep crisis at a global level, with serious effects on economies and health systems. It is important to highlight that little has been done about the post-pandemic, especially the potential effects at a psychosocial level that in many countries are presented as effects on the mental health of their populations. In Mexico, for example Torres-Muñoz mentions: The National Institute for Excellence in Health and Care recommends maintaining active monitoring of health personnel, even when the crisis has been overcome, to ensure that those who present data of moral damage or some mental alteration are identified and helped to access evidence-based care (2) The World Health Organization-WHO (2020) estimated that half of the population exposed to COVID-19 could suffer some psychopathological symptoms. Therefore, it is important to investigate the potential negative effects on the mental health of health workers, related to stigma, fear and feelings of guilt that are expressed with greater intensity in extraordinary stages such as the pandemic we are experiencing. For example, Huarcaya (3) mentions that in a study carried out in Peru on 187 nurses during the MERS-CoV outbreak, it was found that stigma influenced or negatively affected the mental health of this professional group. Stigma towards health professionals must also be considered. While no studies have been found in the current pandemic, research conducted during other epidemics or pandemics showed that between 20% and 49% of health professional's experienced social stigma related to their work and community fear and relatives of being infected by them (3). --- MATERIEL AND METHODS Health workers around the world have had to reorganize their meanings of belonging, due to deep feelings of helplessness, when their work and all their professional training were not enough to save lives. How to understand the senses of belonging, anguish, pain, and guilt of a human being? This is what anthropologist Michael Jackson (4) calls the production of the senses of being. This researcher has dedicated himself to understanding human beings from existential anthropology. He states that we all need to create senses of belonging, integrate, which implies a daily struggle to live facing adversity and loss. It relates it to a result between certain dynamic circumstances, over which we have little control, and our ability to live that it was transformed into our experiences, our lifeworld. Along the same lines, another anthropologist, the Swedish Sverker Finnström(5), considers that the struggle for being crystallizes in certain environments that he calls bad surroundings or spaces where we experience negative or evil feelings, frustration and guilt. Spaces where we fight against a life without hope, to make life worthwhile and make sense of episodes as strong as death. This article presents testimonies converted into ethnographic stories about the experiences of human beings strongly marked by a feeling of stigma, fear and guilt. For the health workers interviewed, the hospital became bad surroundings, since they considered that their life in that place had no meaning or benefit, especially after the episodes of strong trauma experienced by their collapse, because of the COVID-19 pandemic. The life surrounded by negative spaces, appeared as a recurrent moral questioning, that caused anxiety, anguish, and lack of sleep, added to a feeling of stress, fear and guilt, since they could be potential carriers of the virus and contaminate their families with the disease (2-8-11). The collected testimonies were converted into ethnographic narratives that concentrated in the imaginaries of many doctors, nurses and other health workers, in the face of the pandemic and the health crisis, could not find the meaning of their lives, after helplessly observing the death of thousands of patients in hospitals collapsed by COVID-19. --- RESULTS AND DISCUSSIONS --- Near-Death Jobs, Feelings of Guilt, Anxiety and Poor Communication Feelings of guilt, stigma, frustration and fear are little-analyzed effects in the current health crisis; they take a backseat when priorities were seeing just from an economic perspective. For Torres Muñoz (2), it is necessary to take into account helping those who need it can be rewarding, but also difficult, since workers can experience fear, grief, frustration, guilt, insomnia and exhaustion. The COVID-19 crisis is exposing health personnel to intense suffering in the face of a death in isolation that has families heartbroken for not being able to accompany and help their loved ones. The lack of resources, the overload and the patients' own uncertain evolution sometimes mean that the professional is forced to make complex decisions in a short time, generating intense moral dilemmas and guilt. The appearance of this new virus has radically changed the way of life and the economy of practically everyone in a very short time, confronting humanity with a reality for which we are not prepared. In Ecuador, for example, a former health minister, in a public interview, blamed doctors for having been carriers of the virus and having infected patients in hospital environments, increasing the feeling of guilt, the poor information and communication of the government, increasing stigma towards health workers. The health personnel who were infected (with Covid-19) and who died are not because they were infected in the hospitals but in the social sphere, they were the ones who brought the disease to the hospitals, obviously without bad intentions, but with total ignorance what were the rules to protect themselves. Another problem that this pandemic highlighted was social inequality. ECLAC (6), in its latest study, highlights the problems of inequality in the American continent. It points out that, due to the direct and indirect effects of the pandemic, it is very likely that extreme poverty and poverty rates, as well as social inequality gaps, will increase even more in the short term, making a more complex world where few will accumulate much more wealth and power. --- Chaos and Death in Hospital Corridors On February 29, 2020, Ecuador announced the first case of the so-called coronavirus in the city of Guayaquil, along with the implementation of a mandatory quarantine and the stoppage of all work activities except essential ones, marked the beginning of a new reality in the country. Tropical diseases such as dengue, malaria, chikungunlla and zika; that have systematically and at different times collapsed the weak public health system for decades have hit Guayaquil, Ecuador's main port. According to data from the Ministry of Health ( 7), 2,051 health workers have been infected with the virus, including doctors, nurses, and assistants. The numbers of infected health professionals stopped being published at the beginning of June. According to the latest report, on June 11, there were 36,126 confirmed cases of COVID-19 nationwide, of which 1,851 were doctors and 34 had died. Next were nurses, nursing assistants, dentists, obstetricians, among others (7). The arrival of COVID-19 once again highlighted the problems in the city's hospitals, destroying them in a couple of weeks; however, the government and the media romantically called them heroes without capes. The media has placed us, health workers, at the level of heroes without capes, saviors, warriors who face the pandemic on the front lines; however, the reality is different and is reflected in precarious, bad jobs. Salaries and few bio-safety instruments for our protection, while the government calls us heroes, it has fired hundreds due to the cuts demanded by the International Monetary Fund (IMF). With the famous austerity, investment in health has decreased, which meant the dismissal of thousands of health workers, non-payment of salaries, increased work hours, extra shifts, that is, the precariousness of work (7). --- CONCLUSIONS Since March 14, 2020, Ecuador has been experiencing a state of alarm due to the health crisis. The pandemic has highlighted social inequality, precariousness of health workers, as well as the recurring feeling of frustration and guilt, when working and living in environments of death. Quarantine and social isolation have caused frustration, caused by the uncertainty of not knowing what will happen in the near future, also anxiety due to fear of contagion and sustained suffering due to the loss of loved ones, who cannot be said goodbye. For doctors, nurses, assistants, who worked in extraordinary situations, in an extraordinary moment like the one we expected as humanity, there were a feeling of guilt that generated moral questions and caused by the impotence of seeing first-hand death, to this are added episodes of social stigmatization that they have suffered, even hospitals have been blamed for being virus carriers. Mental health problems, such as depression, anxiety, distress and stress are some of the biggest causes of suffering; interestingly those who are most at risk are frontline healthcare workers. The United Nations (8) in its report "COVID-19 and the Need for Action on Mental Health" deepens the panorama of the mental health of the world population in the pandemic and warns of a probable increase in psychological suffering as well as an increase of suicide rates. Finally, for Wahed (9), mental health care becomes a fundamental element to face the crisis that currently being experienced. It is clear that the virus not only attacks our physical health; it also increases psychological suffering. Medeiros agrees with the above (10). The grief over the loss of loved ones, the shock caused by the loss of employment, isolation and restrictions on movement, the difficulties of family dynamics, uncertainty and fear of the future. COVID-19 has had unfortunate impacts and consequences on the Ecuadorian population. We are living in a difficult, extraordinary, conflictive stage where health professionals work and provide care in times of crisis, which is also the importance of understanding the potential mental health problems of all populations including caregivers and health workers. COVID-19 arrived at a time of fragility of the global economy, health systems, lack of employment, poverty and social inequality that have exposed an unfair model of development and social organization. The post-pandemic helps us reflect in the search for common sense, to balance what we want as a world and society, the priority of governments should be the common good and social justice (11).

In December 2019 in the Chinese city of Wuhan, Hubei province, health systems reported patients affected by atypical pneumonia of unknown origin, the disease was identified as SARS-CoV-2, a new virus of the Coronaviridae family, The COVID-19, and it appeared suddenly generating a global crisis, with serious effects on economies and health systems. To describe the feelings and perceptions of a group of health workers, whom in Ecuador, the government, using the media, romanticized, placing them at the level of heroes without a cape who faced the pandemic in the front line. This article presents testimonies that narrate the experiences of human beings strongly marked by closeness to death, the feeling of loss, powerlessness and guilt, since their effort, work, experience and training were not enough to save the lives of critically ill patients of COVID-19. Health workers were romanticized as heroes but at the same time precarious, they received little bio-security protection, which increased infections and deaths at the level of health personnel. The negative impact of COVID 19 at the psychosocial level and the effects on the mental health of health workers is a poorly studied issue; work should be done to better understand the perceptions of frustration, fear, stress and social stigma than many health workers did. They felt by being potential carriers of the virus and taking it to their close environments.

Introduction In online social networks (OSNs) users voluntarily provide information about their lives, especially about their current situation or exceptional events. Nowadays these so called social signals are ubiquitous and can not only be collected from OSNs (e.g. friendships, interests, trust-relevant metadata), but also from applications (e.g. messaging or call patterns) and sensors (e.g. location). Social awareness harvests these signals, extracts information (e.g. users' social relationships, activity patterns, and interests), and exploits them in order to improve a service. Recently in the field of traffic management in the Internet, works were conducted which utilize social information for example to avoid congestion, increase bandwidth, or reduce latency. In that context, social awareness links social signals and information such as social network structure, users' preferences and behaviours, etc. to network management mechanisms. This means that such mechanisms exploit the information in order to perform efficient network management, content placement, and traffic optimization to enhance the performance of an overlay application (e.g. video streaming, file sharing). As this promising research field has yet got little attention, this paper will provide an insight to this new topic. In this extended abstract we will only focus on the use case video streaming being the most prominent example of overlay applications, and present socially-aware caching solutions and algorithms. In the talk we show interdisciplinary efforts between communication networks and social network analysis. Specifically, we give an overview on existing use cases and solutions, but also raise discussions at the workshop on additional benefits from the integration of social information into traffic management. --- Example Use Case: Video Streaming Concerning video as a key application contributing largely to the overall IP traffic [Cis12], video and specifically user generated content (UGC) sharing (e.g. home-made videos) has evolved to a major trend in OSNs. We consider an OSN having users around the globe who upload UGC to an online video streaming platform such as YouTube and share the content (URLs) via the OSN where it can be viewed by their online friends and their friends of friends, etc. In order to meet the content demand by users of the video streaming platform, who are located worldwide, the video platform is operated on a geo-diverse system comprising multiple points-of-presence (PoPs) distributed globally. Each user is assigned and served out of their (geographically) nearest PoP, for all of his requests. Placing data close to the users is an approach followed by most content delivery networks to improve Quality of Experience for the end user and reduce costs for video platform providers. Therefore all content uploaded by a user A is first uploaded to the nearest respective P oP A . When content is requested by another user B, the nearest PoP to B, i.e. P oP B , is contacted and the request is served if the content is available. If the content is not available in P oP B , a request is made to P oP A and the content is brought to P oP B . The scenario considered in this section is inspired by the evaluation scenario described below in [THT + 12]. --- Existing Socially-Aware Caching Solutions for Video Streaming Socially-aware caching tries to predict future access to user generated content (e.g. videos) based on information from OSNs. Hints shall be generated for replica placement and/or cache replacement. In [SYC09] the classical approach of placing replicas based on access history is improved. Therefore social cascades are identified in an OSN, and declared affiliations of potential future users (i.e. OSN friends of previous users) are added. In [SMMC11] standard cache replacement strategies are augmented with geo-social information from OSNs. Again social cascades are analyzed to recognize locally popular content which should be kept longer in the cache. In [THT + 12], the authors propose Tailgate which addresses long-tailed content (photos, video) by deriving and using social information and meta-information from Twitter, such as social relationships, regularities in read access patterns, and time-zone differences so as to predict where and when the content will likely be consumed. The content is then pushed where-ever before it is needed. Traffic Management Algorithms Social awareness can be used in different ways to improve traffic management. To exploit the information of social networks it is important to understand how information is spread in social networks and how to identify important persons and relationships. In [BHMW11], the authors investigate the influence of posts by tracking the diffusion of URLs in Twitter and show that content that is connected with good feeling and interesting content is more likely to be propagated. They also find that the users that have most influence are also the most cost-effective. Hence, influential users post relative rarely, but if they do, the content is of high interest. In [RTT + 11], the authors collected data from five different sources and investigated the temporal growth and decay of topics in the network and the geographical and social spread of the topics. Besides identifying different classes of temporal growth patterns and time zone differences in popularity, they find that the social cohesion of users interested in specific content is greater for niche topics. Next, in [WPD + 10], the authors infered the network structure of Facebook from crawls, packet captures, and network measurements. Due to high locality of interests they state that service providers could profit a lot from locality to save traffic on intercontinental paths. Finally, in [WSWY12], the authors explore how patterns of video link propagation in a microblogging system are correlated with video popularity on the video sharing site, at different times and in different geographic regions. Then, they design neural networkbased learning frameworks to predict the number and geographic distribution of viewers, in order to deploy a proactive video sharing system. The evaluations show that their frameworks achieve better prediction accuracy compared to a classical approach that relies on historical numbers of views. --- Discussion The research field of socially-aware traffic management opens new perspectives for improved service delivery in the Internet, but also new interdisciplinary research challenges. From the network traffic management perspective, it is unclear how to realize socially-aware traffic management solutions. In particular, the design and implementation of socially-aware networking functionalities involves several stakeholders of the service delivery chain, like the OSN provider, Internet service providers, cloud providers offering video services, and finally the end user. Hence, there must be an incentive-compatible network management mechanism which satisfies the requirements of involved stakeholders (e.g. high Quality of Experience for end users, low traffic/congestion in Internet service providers' links, lower energy consumption in data centers where video servers run), and which is based on well-defined open protocols like IETF ALTO. Furthermore, a seamless integration of those socially-aware mechanisms into today's Internet applications and network management is desired. Such architectural and conceptual challenges are currently developed in the FP7 SmartenIT (Nov 2012 -Oct 2015) for a tighter integration of network management and service functionality to offer a large business potential for all players involved. From a social network analysis perspective, there are also some practical aspects addressed in order to obtain, maintain and update social signals from existing platforms due to the huge amount of existing data. There is a tradeoff between accuracy and costs of social information, which may be adjusted by appropriate (temporal and spatial) sampling methods. Further, the computational complexity of some algorithms, e.g. to identify relevant nodes in the network responsible for video cascades, has to be addressed. Additionally, a major challenge is privacy which has to be ensured and has to be integrated in the solution space. In our talk we want to deepen this topic, provide additional use-cases, and trigger discussions on current and future interdisciplinary efforts between communication networks and social network analysis to advance socially-aware traffic management in the Internet. --- Literatur [BHMW11] Eytan Bakshy, Jake M. Hofman, Winter A.

Socially-aware traffic management exploits social signals to optimize traffic management in the Internet in terms of traffic load, energy consumption, or end-user satisfaction. Several use cases can benefit from socially-aware traffic management and the performance of overlay applications can be enhanced. In the talk we show interdisciplinary efforts between communication networks and social network analysis. Specifically, we give an overview on existing use cases and solutions, but also raise discussions at the workshop on additional benefits from the integration of social information into traffic management.

Tujuan dari PkM Internasional di SIKL ini adalah untuk memberikan pelayanan dalam sosialisasi kerjasama internasional dalam MoU pendidikan Internasional. Pendidikan merupakan proses sosialisasi, yaitu mensosialisasikan nilai, pengetahuan, dan keterampilan dalam kehidupan. Pembelajaran merupakan produk dari warga itu sendiri, yaitu dapat hidup tanpa berubah menghadapi ancaman dan tantangan di masa depan (Mufida, 2018). Adapun SIKL sendiri memiliki pandangan bahwa kemajuan suatu negara tergantung pada pendidikan generasi mudanya dan mereka juga memiliki paradigma bahwa keberhasilan seorang siswa dipengaruhi oleh pendidik yang mengajar di sekolah. Sosialisasi dan pengenalan program disampaikan pada saat kegiatan berlangsung. Hasil dari kegiatan PkM ini memotivasi para siswa dan juga staf di manajemen SIKL dalam melaksanakan implementasi kerjasama internasional. --- Kata Kunci International; Community; Services; SIKL. --- | INTRODUCTION Education curriculum socialization is an Indonesian educational institution located in Kuala Lumpur, Malaysia, catering to Indonesian citizens residing in Malaysia. Considered the top foreign school, SIKL was the first to receive accreditation from the School/Madrasah Accreditation Board (BASM) in 2012, thanks to its innovative learning system [1]. SIKL education system is continuously evolving and adaptable to the changing times, enabling it to meet the standards set by BASM. The rapid advancements in science and technology greatly influence human life. The Education and Training Cooperation Sector at SIKL is responsible for developing education and training collaborations with international and national organizations [2]. They also provide guidance and supervision for Indonesian Schools Abroad and monitor the implementation of learning assignments. To fulfil these responsibilities, the sector performs various functions, including preparing assessments, implementing, and developing cooperation with international organizations, overseeing nondegree education, and training cooperation, guiding, and supervising Indonesian Schools Abroad, and monitoring learning assignment affairs. Several activities are organized under the Education and Training Cooperation Sector, including diplomatic training with international institutions, collaborative training programs to enhance the knowledge and skills of diplomats, and bilateral education and training development with partner countries [3]. The Ministry of Foreign Affairs' Centre for Education and Training plays a crucial role in fostering collaborations with diplomatic training institutions of friendly nations, international educational institutions, and domestic educational institutions, with the aim of enhancing the training provided by the Indonesian Ministry of Foreign Affairs. The Kuala Lumpur Indonesian School follows the national curriculum of Indonesia, but there are minor adjustments considering the geographical, natural resource, and infrastructure differences [4]. The education system in Malaysia is predominantly administered by the federal government and encompasses education from pre-school to tertiary institutions. The learning services provided at SIKL include early childhood education, kindergarten, elementary, and middle school education [5]. While both Malaysia and Indonesia have well-structured education systems, there are differences between the two countries at various levels of education. For example, Malaysia offers pre-primary education for students aged 4-6 years, and elementary school is mandatory for children aged 7-12 years. There are national schools for Tamil and Chinese students, as well as national-level schools for Malay students. The primary education curriculum focuses on foundational skills, such as reading, writing, and mathematics, while the later stages aim to strengthen and utilize these skills. To ensure alignment between the Indonesian curriculum and the curriculum at SIKL, it is essential to promote socialization of international collaboration. This facilitates the sharing of updated data and ensures that the Indonesian curriculum is effectively implemented at SIKL. The objective of this international community service is to address the specific needs of SIKL and support the successful implementation of the Indonesian curriculum. --- | METHOD The activity method is divided into 3 stages, namely the first concept/theory study, the second is field practice, and the third is reflection. The following is an explanation of each stage: 1) Initial Stage, this stage is carried out before the program is implemented including preparation and socialization. 2) Core Stage, this stage is the core of the training program implementation. 3) The final stage is mentoring, intensive assistance is carried out by students who live there for approximately 2 months which will be counted as field teaching activities (PPL). 4) Stages carried out after the implementation of the program are Evaluation and reflection. Evaluation of activities is carried out to assess the implementation of the training program. Activity evaluation aims to find out the obstacles faced, and to assess whether implementation is in accordance with the objectives that have been determined at the beginning of the activity. In addition, an evaluation was also carried out on the trainees to determine their abilities after attending the training. The theoretical study was carried out virtually by academics from the International Community Service Team, with the following material. Prior to the implementation of the training, pre-test and post-test were carried out to find the students' awareness of education. --- | RESULT AND DISCUSSION --- Results The implementation of actions in this service is in the form of program implementation as a problem-solving realization found in deep Sekolah Indonesia Kuala Lumpur the activities are divided into several stages according to the schedule with due regard time and main duties of teachers at Sekolah Indonesia Kuala Lumpur. Forms of activity include workshops and assistance. First, the workshop is filled with provision of theoretical insights and application of local potential-based Education curriculum socialization application training assistance in practice and the education system in schools was held on March 27, 2023, in the form of a discussion focused on material. Picture 2: The Presentation of PkM Materials. --- Discussion The discussion revolves around a non-profit project being implemented at Secora Indonesia Kuala Lumpur (SIKL) to address specific needs and support the successful implementation of the Indonesian Language Curriculum. SIKL is an Indonesian educational institution based in Kuala Lumpur, Malaysia serving Indonesian citizens living there. The school is regarded as the best foreign school and its innovative learning system is accredited by the Board of Accreditation of Schools/Madrasa (BASM). The socialization of international cooperation plays an important role in ensuring consistency between the Indonesian curriculum and the SIKL curriculum. This non-profit project follows his three-step methodology: Initial phase, core phase, final phase. The initial phase includes pre-program preparation and interaction. The core phase is the main implementation phase and consists of workshops and support. Workshops will cover topics such as the benefits of online media in learning and the design of curriculum socialization. The support provided focuses on the identification and preparation of the SIKL curriculum format. In the final stage, students will stay on-site for about two months as part of their instructional activities and will be given intensive instruction by the students. The implementation of the program includes activities planned according to the teacher's primary duties and time considerations at SIKL. The aim is to provide theoretical insight and practical application of educational curriculum socialization through workshops and support. The workshop discussed the basic concepts, properties, and advantages of online media as an alternative to learning at SIKL. We also considered the characteristics and types of online and offline training support for teaching, curriculum, socialization, and applied classes. This non-commercial project offers several solutions to solve partner problems. This includes the implementation of workshops and training, training support, review of training results, and follow-up support to promote socialization in the educational curriculum. The aim is to improve the quality of education at SIKL and support the proper implementation of the Indonesian language curriculum. Results of non-commercial projects. It emphasizes the importance of implementing the program in phases and conducting evaluations. The activities were carried out according to the schedule, considering the teachers' main duties and time constraints. By involving experts like PhD, Sri Yuliani and Julianto from the Department of English Language Teaching at FKIP Islamic University in Riau ensured that they provided theoretical knowledge and practical application. Overall, the discussion revolves around the successful implementation of non-profit projects, the importance of hilarious international cooperation, and the solutions offered to address partner issues. The aim is to improve the educational system of SIKL and ensure effective implementation of the Indonesian language curriculum. --- | CONCLUSION Based on this community service activity, two main conclusions can be drawn. Firstly, the knowledge and understanding of SIKL students regarding the socialization of international collaboration have significantly increased. This indicates that the students have gained valuable insights into the importance of collaboration and its impact on their education. Secondly, there is a notable increase in motivation among the students to acquire new models of the Indonesian curriculum to assist their learning process. This shows their enthusiasm and willingness to embrace innovative approaches in education. Considering the significant benefits derived from this community service activity, it is recommended to extend similar activities to other schools that would benefit from such devotion. By replicating these initiatives, other schools can also enhance their educational practices and benefit from international collaborations. Additionally, it is crucial to ensure continuity and monitoring of the program even after the community service activity concludes. This will guarantee that SIKL effectively implements the designed curriculum in their classrooms, enabling sustained improvements in the quality of education provided.

The purpose of this International Community services in SIKL was to give a service in socialization of international engagement in international education MoU. Education is a process of socialization, namely socializing values, knowledge, and skills in life. Learning is a product of the citizens themselves, that is, they can live without changing address future threats and challenges (Mufida, 2018). As for SIKL itself, they have the view that the progress of a country depends on the education of its young generation, and they also have the paradigm that the success of a student is influenced by educators who teach in schools. Socialization and introduction of the program was delivered during the activities of PkM. The result of this PkM activity was motivating the students and staffs in SIKL managements in executing the implementation of international collaboration.

Introduction The scientific community has been interested in Twitter due to the scope for extended information dissemination and promotion of research [1]. To enable discussions about research papers, academic journals use Twitter [2][3][4]. Furthermore, journals with social media accounts (e.g., Twitter) have been found to have higher research metrics [5]. The current exploratory study attempts to compliment two earlier Twitter studies conducted with tweets posted by academic journals. In the first study [6], the overall social media presence of academic journals was investigated, specifically for Twitter and Facebook platforms. In the second study [7], the Twitter usage of Arts & Humanities Citation Index (AHCI) and Social Science Citation Index (SSCI) journals was reported. This study reports the Twitter interaction dynamics of Science Citation Index (SCI) academic journals indexed in the Master Journal List (MJL). In the MJL, the journals are indexed in three main citation indices namely SCI, AHCI and SSCI. The following research questions are investigated in this study. 2 Methodology --- RQ1: Does the communication between journals in --- Base Dataset A subset of the dataset used in a previous study [6] was used for this current study. The dataset preparation is described as follows. Journal titles from SCI were extracted from the MJL. After manually identifying the Twitter accounts of the journals, the tweets were extracted using the Twitter API. The basic Twitter API permitted extraction of only 3,000 tweets for each Twitter account during the time of data collection. Out of the 8,827 SCI journals in MJL, 857 were found to have Twitter accounts and 953,253 tweets were extracted for these journals. --- Data Preparation The data for addressing the four research questions was prepared through the following process. In this paper's context, the term 'mention' refers to a Twitter account tagged in a tweet. The tweets that contained mentions were shortlisted for the next step. From these tweets, the parent Twitter account name (journal) and the mention(s) were extracted. A combination of Twitter account name and the mention is referred to as a 'conversation' in this paper. It is to be noted that a single tweet could contain multiple mentions hence there could be multiple conversations within a tweet. Using the conversations data from the previous step, a Twitter communication graph was built. Gephi [8] was used to build this graph. In the communication graph, the source node is always the journal Twitter account whereas the target node is the mention (a Twitter account which is not necessarily a journal). The nodes with a degree value of one were filtered out, for handling the issue of sparsity. After building the graph, the community detection algorithm ForeAtlas2 was used in Gephi to identify the different communities in the graph. In this algorithm, communities are identified based on the frequency of interactions between the source and target nodes of the graph. A sub-graph of a particular set of nodes that interact more with each other than with other nodes, is regarded collectively as a community. The top 20 nodes (Twitter accounts) with the highest indegree values and out-degree values in the communication graph were identified as a part of this step. The in-degree of a graph is the number of edges where the node is a target node while the out-degree of a node is the number of edges where the node is the source node. A node with a high in-degree value is referred to as an 'authority' while a node with a high out-degree value is referred to as a 'hub'. The nodes with the highest out-degrees (hubs) are the Twitter accounts managed by journals whereas the nodes with the highest in-degrees (authorities) could be any Twitter account. --- Results --- Twitter Conversations SCI journals' conversation stats are listed in Table 1. The number of conversations in SCI journals was high (n=509,062) corresponding to the high number of tweets (refer Section 2.1). This metric was nearly five times more than AHCI (n=103,181) and SSCI (n= 121,099) journals. To determine the interaction levels with other journals, we identified the mentions which were journal accounts (data listed in rows D, E, F of Table 1). SCI journals had the highest percentage of conversations at an intra-index level (18.16%). In [7], it was identified that HSS journals intra-index conversations had comparatively lower percentages (13.39% for AHCI, 13.25% for SSCI). --- Communication Graph The communication graph1 generated for the SCI journals is illustrated in Figure 2. The node color represents the parent community of a node. The size of the nodes was set according to the betweenness centrality values of the nodes. Representative labels have been added for each community based on the commonality of topics2 . Communities comprised of journal accounts belonging mainly to the disciplines of Chemistry, Bioscience, Ecology and Surgery. Technology & Engineering formed a very small community in this graph. Interestingly, there was one community which was entirely oriented towards journals from the Nature Publishing Group (NPG). The SCI graph structure resembles a "tight crowd" [9] mainly because of the central presence of Nature journals across many communities. This type of network has been observed in other related Twitter scholarly communication studies [10]. Unlike the SCI graph, the communities in the AHCI and SSCI graphs were represented by a greater number of topics [7]. Both these graphs were classified as a "community clusters" due to the presence of multiple communities and minimal interspersed nodes. --- Top Authorities and Hubs In Table 2, the top 20 authorities (based on in-degree values) from the SCI communication graph are listed, along with the account types which had been identified for these Twitter accounts. The major presence of news portals as top authorities was noticed (e.g., Nature News, The Guardian), with these accounts occupying 25% (n=5) of the top 20 authorities. Scientific organization was another authority type identified, which was as popular (n=5) as news portals. We used this account type as an umbrella term covering different organizations related to academia and scientific research. The next most popular authority type identified was journal. SCI had the most number of journals (n=4), whereas AHCI and SSCI had only one and two journals in the top 20 authorities list respectively in the earlier study [7]. Agencies were the next most popular authority type (n=3) identified. These Twitter accounts included government and global agencies (WHO, NIH & CDC). Magazine Twitter accounts (n=2) were not as popular as authorities for SCI journals, unlike HSS journals where this account type was quite prevalent (approximately 35% of the top 20) [7]. --- PLOSMedicine --- Conclusion In the current study's context, SCI journals were found to have a marginally better presence than HSS journals on Twitter. For RQ1, the conversation statistics revealed certain differences between the journals from SCI and HSS. In our earlier study [7], the structure of the communication graphs of both AHCI and SSCI journals largely resembled a 'community clusters' network where there were multiple communities with high intercommunication. In the current study, the bigger SCI graph resembled a 'tight crowd' network. We can conclude that there are differences at the conversational level in Twitter between hard (SCI) and non-hard (AHCI & SSCI) sciences for RQ1 and RQ2. The top authorities and hubs in the communication graph were identified for RQ3 and RQ4. News portals and scientific organizations were amongst the most authoritative Twitter accounts. Magazines such as the New Scientist and Scientific American were also present in this authorities list. Compared to HSS journals, SCI had more number of journals as authoritative accounts. With the participation of different account types such as news portals, scientific organizations, journals, magazines, and government agencies, the involvement of key players in the scholarly communication lifecycle of SCI journals is clearly perceived. This is in contrast to the HSS journals' top authorities lists which comprised mostly of news portals and magazines which cater to the general public [7]. Interestingly, three Twitter accounts were found to be present in the top 20 authority lists of both SCI and HSS journals. These accounts were Guardian, NY Times and YouTube. The Top 20 Twitter hubs list comprised almost entirely of natural sciences and medicine related journals. This finding highlights the prominent outreach activities of journals from these disciplines on Twitter. With regards to the question of ascertaining whether the top hubs in Twitter were also top journals in the citation network (represented by JCR rankings), data shows that SCI had mostly first quartile journals in the list, unlike SSCI journals where journals from all four quartiles were present in the list [7]. --- 3 , the top 20 hubs (based on out-degree values) from the SCI communication graph are listed. It is well-known that the JIF is measured and indexed along with the corresponding quartiles in the JCR [11] every year. We have included the JIF quartile data for the top 20 hubs in Table 4. The JIF quartile indicates the popularity of the journal within the citation network. For instance, if a journal belongs to the first quartile, it is considered to be among the top 25 percentile of journals for the respective research subject. Journals from the disciplines of medicine (n=3), biology (n=4) and chemistry (n=4) were prominent. It can be observed that most of the journals (n=14) in this list were from the first quartile of their respective research subjects. This finding indicates that the top journals in SCI seem to be most active in Twitter. Interestingly, engineering journal accounts were not present in this list.

This paper investigates the Twitter interaction patterns of journals from the Science Citation Index (SCI) of Master Journal List (MJL). A total of 953,253 tweets extracted from 857 journal accounts, were analyzed in this study. Findings indicate that SCI journals interacted more with each other but much less with journals from other citation indices. The network structure of the communication graph resembled a tight crowd network, with Nature journals playing a major part. Information sources such as news portals and scientific organizations were mentioned more in tweets, than academic journal Twitter accounts. Journals with high journal impact factors (JIFs) were found to be prominent hubs in the communication graph. Differences were found between the Twitter usage of SCI journals with Humanities and Social Sciences (HSS) journals.

have negative effect on their values because they think these channels play a negative role in their society, and this role may result in a negative impact on the youth's delinquency, and their traditional and social behavior. The study also shows to what extent the students are worried about their social values. The students' responses revealed evident worries that these channels may result in the dissemination of the social and religious values. Through the serials, programs and films that these channels broadcast. They also expressed their fear that these channels may eventually reflect negatively on their academic performance. --- ‫اﻟﻤﻘﺪﻣﺔ‬ --- ‫اﻟﻤﺠﺎل‬ ‫اﻟﻔﻘﺮات‬ ‫ﻋﺪد‬ ‫اﻟﻔﺎآﺮوﻧﺒﺎخ‬ ‫ﻗﻴﻤﺔ‬ ‫اﻟﻨﻔﺴﻲ‬ ١٠ ٠.٨٤٠ ‫اﻻﺟﺘﻤﺎﻋﻲ‬ ١٠ ٠.٧٩١ ‫اﻷآﺎدﻳﻤﻲ‬ ‫اﻟﺘﺤﺼﻴﻞ‬ ٩ ٠.٨٢٥ ‫اﻟﺜﻘﺎﻓﻲ‬ ٩ ٠.٧٨٧ ‫اﻟﺪﻳﻨﻲ‬ ٨ ٠.٧١٥ ‫اﻟﻜﻠﻲ‬ ٤٦ ٠.٨٣٩ ‫أﻋﻤﺮ‬ ‫وﻋﻠﻲ‬ ‫اﻟﺪﺑﻮﺑﻲ،‬ ‫اﷲ‬ ‫ﻋﺒﺪ‬ ‫ـــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ـ‬ ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ ٥٨١ ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ﻣﺠﻠﺔ‬ ‫ﺟﺎﻣﻌﺔ‬ ‫اﻟﻨﺠﺎح‬ ‫ﻟﻸﺑﺤﺎث‬ ) ‫اﻟﻌﻠﻮم‬ ‫اﻻﻧﺴﺎﻧﻴﺔ‬ ( ، ‫ﻣﺠﻠﺪ‬ ٢٥ ) ٣ ( ، ٢٠١١ ‫اﻟﺠﺪول‬ ‫ﻳﺒﻴﻦ‬ ) ١ ( ‫اﻟﺜﺒﺎت‬ --- ‫ﺪول‬ ‫ﺟ‬ --- ‫اﻟﻤﺠﺎل‬ ‫اﻟﺪراﺳﻲ‬ ‫اﻟﻤﺴﺘﻮى‬ ‫اﻟﺤﺴﺎﺑﻲ‬ ‫اﻟﻤﺘﻮﺳﻂ‬ ‫اﻟﻤﻌﻴﺎري‬ ‫اﻻﻧﺤﺮاف‬

This study aims to investigate the stances of students of the Applied Science Private University in Amman-Jordan, towards satellite channels. It aims to know their tendencies in addition to the impact of these channels on their personalities, views and their implications on them, both socially and psychologically .The subjects of the study are 341 Students selected randomly from the university students mentioned. The results of the study show that the students are worried that these channels ٥٧٦ ‫ـــــــــــ‬ ‫ــــــــ‬ ‫ــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ـــــــــــــــــــــ‬ " ‫اﻟ‬ ‫ﺟﺎﻣﻌﺔ‬ ‫ﻃﻠﺒﺔ‬ ‫اﺗﺠﺎهﺎت‬ ‫اﻟﺘﻄﺒﻴﻘﻴﺔ‬ ‫ﻌﻠﻮم‬ ‫ﻧﺤﻮ‬ ...... " ‫ﻣﺠﻠﺔ‬ ‫ﺟﺎﻣﻌﺔ‬ ‫اﻟﻨﺠﺎح‬ ‫ﻟﻸﺑﺤﺎث‬ ) ‫اﻟﻌﻠﻮم‬ ‫اﻻﻧﺴﺎﻧﻴﺔ‬ ( ، ‫ﻣﺠﻠﺪ‬ ٢٥ ) ٣ ( ، ٢٠١١ ‫ـ‬ ‫ــــــــــــــــــــ‬ ‫ــ‬ ‫ـــــــــ‬ ‫ـــــــــــــــــــــــــــــــــ‬ ‫أﻋﻤﺮ‬ ‫وﻋﻠﻲ‬ ‫اﻟﺪﺑﻮﺑﻲ،‬ ‫اﷲ‬ ‫ﻋﺒﺪ‬ ‫ـــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ـ‬ ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ ٥٧٧ ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ﻣﺠﻠﺔ‬ ‫ﺟﺎﻣﻌﺔ‬ ‫اﻟﻨﺠﺎح‬ ‫ﻟﻸﺑﺤﺎث‬ ) ‫اﻟﻌﻠﻮم‬ ‫اﻻﻧﺴﺎﻧﻴﺔ‬ ( ، ‫ﻣﺠﻠﺪ‬ ٢٥ ) ٣ ( ، ٢٠١١ ٥٧٨ ‫ـــــــــــ‬ ‫ــــــــ‬ ‫ــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ـــــــــــــــــــــ‬ " ‫اﻟ‬ ‫ﺟﺎﻣﻌﺔ‬ ‫ﻃﻠﺒﺔ‬ ‫اﺗﺠﺎهﺎت‬ ‫اﻟﺘﻄﺒﻴﻘﻴﺔ‬ ‫ﻌﻠﻮم‬ ‫ﻧﺤﻮ‬ ...... " ‫ﻣﺠﻠﺔ‬ ‫ﺟﺎﻣﻌﺔ‬ ‫اﻟﻨﺠﺎح‬ ‫ﻟﻸﺑﺤﺎث‬ ) ‫اﻟﻌﻠﻮم‬ ‫اﻻﻧﺴﺎﻧﻴﺔ‬ ( ، ‫ﻣﺠﻠﺪ‬ ٢٥ ) ٣ ( ، ٢٠١١ ‫ـ‬ ‫ــــــــــــــــــــ‬ ‫ــ‬ ‫ـــــــــ‬ ‫ـــــــــــــــــــــــــــــــــ‬

Introduction The new coronavirus SARS-CoV-2 has infected more than 14 million people worldwide so far (Worldometers 2020), the reason why the World Health Organization (WHO) has described the situation as a pandemic (WHO 2020). Up to date (July 17, 2020), there are 2,046,328 confirmed cases in all regions of Brazil (Brazil 2020), which is currently the second leading country in number of cases (Worldometers 2020). São Paulo state accounts for 20% of cumulative confirmed cases in Brazil, with 407,415 confirmed cases, being currently the most affected state worldwide (John Hopkins 2020), while São Paulo-SP is the city with most confirmed cases (163,624) in Brazil (SEADE 2020a). São Paulo is the largest city in Latin America, with a population of 12,252,023 people, and an expanded metropolitan area with 33,652,991 people (SEADE 2020b). On March 24, 2020, partial lockdown was ordered by São Paulo state government (São Paulo 2020a), being social isolation monitored since then (São Paulo 2020b). One recent review has addressed the role of climate change in the emergence and re-emergence of infectious diseases worldwide, indicating that temperature is an important environmental condition determining the success of infectious agents (El-Sayed and Kamel 2020). Furthermore, several studies have investigated the impact of weather on the COVID-19 transmission, with special attention to temperature and humidity (Harmooshi et al. 2020;Liu et al. 2020;Qi et al. 2020;Şahin 2020), indicating that temperature is inversely related to COVID-19 incidence. Moreover, each 1 °C increase in temperature has been associated with decreases in daily new cases at different extents (Prata et al. 2020;Wu et al. 2020). A few investigations have also considered social aspects potentially associated with the spread of COVID-19, such as population density, metropolitan population, intra-provincial traffic, and national lockdown, indicating that the social distancing measures have been successful in reducing new cases (Ahmadi et al. 2020;Hamidi et al. 2020;Tobías 2020). The aim of this study was to assess environmental and social factors influencing the spread of SARS-CoV-2 in the expanded metropolitan area of São Paulo, Brazil. --- Materials and methods Seeking to understand the mechanisms of SARS-CoV-2 spread in the most affected area of Brazil, COVID-19 infection rate from March 24, 2020, to July 06, 2020, were analyzed. The infection rate (Eq. 1) defined by Ahmadi et al. (2020) was used to assess the COVID-19 spread speed. Infection Rate ¼ Number of Infected People Days of Infectionð1Þ Firstly, a spatial analysis was conducted using the cumulative confirmed cases of COVID-19 to provide insights into the spread of COVID-19 within the expanded metropolitan area over time. Moreover, cities in the expanded metropolitan area of São Paulo with more than 500 confirmed cases of COVID-19 were selected for statistical analyses (Spearman correlation test and sensitivity analysis) of the following social indicators which possibly influence the incidence of COVID-19 (infection rates): population (people), population density (people•km -2 ), Municipal Human Development Index (MHDI), gross domestic product (R$ per capita), and average income (R$ per capita). Therefore, 59 cities were included in this analysis, accounting for a total of 29,389,922 people. Secondly, the following criteria were used for selecting cities for statistical analyses (Spearman correlation test and sensitivity analysis) of both meteorological conditions and social isolation rate: (i) cities with more than 2000 confirmed cases of COVID-19; (ii) within the expanded metropolitan area of São Paulo; and (iii) with available meteorological data. Thus, a total of 10 cities were analyzed considering the infection rates, corresponding to a population of 18,033,600 people (Table 1). Daily data made available by the São Paulo State Environmental Agency (CETESB 2020) were used to assess the meteorological conditions of temperature (T, °C), relative humidity (RH, %), wind speed (WS, m s -1 ), and ultraviolet radiation (UV, W m -2 ) from March 18, 2020, to July 06, 2020. Social isolation rates (SIR, %) published on a daily basis by the São Paulo State Social Isolation Intelligent Monitoring System (São Paulo 2020b) were used to analyze the effectiveness of a social distancing measure for reducing the transmission of COVID-19. For each city, the Spearman correlation test at 95% significance level (α = 0.05) was used to assess correlation between infection rate and meteorological parameters or social isolation rate. The partial correlation coefficient (PCC) method was applied to perform a sensitivity analysis using the infection rate as the dependent variable and meteorological conditions or social indicators as the independent variables. Data were normalized using the mean value and the standard deviation (Eq. 2), according to Zhu et al. (2020). The forward, stepwise, and backward procedures (Mollalo et al. 2020) were conducted to select the best linear regression model and to determine the regression coefficients and significant variables (p value < 0.15). --- X ¼ x-μ σ ð2Þ where X is the normalized value; x is the raw value; μ is the mean value; and σ is the standard deviation. --- Results and discussion The analysis of cumulative confirmed cases in a spatialdependent manner shows that initially (March 26, 2020), the COVID-19 transmission was mainly in the capital city São Paulo. Over the weeks, increasing transmission has been occurring in cities surrounded by highways, and by July 06, 2020, COVID-19 has spread all over the expanded metropolitan area of São Paulo (Fig. 1). Therefore, using spatial analysis, we have observed that the spread of COVID-19 from the capital city São Paulo-its epicenter in Brazil-is directly associated with the availability of highways within the expanded metropolitan area of São Paulo. Our findings are consistent with recent literature, as Hamidi et al. (2020) have reported metropolitan population as one of the most significant predictors of infection rates in the USA, due to shared transportation and interaction of people in metropolitan areas. Using the Spearman correlation test, significantly positive correlations were found between infection rate and population (people), cumulative COVID-19 confirmed cases, and population density (people•km -2 ) (Table 2). Similarly, Şahin (2020) reported high correlation between population and total cases in Turkey, and Ahmadi et al. (2020) found significant correlation between population density and total cases in Iran. Interestingly, Hamidi et al. (2020) have reported that at county level in the USA, population density is not significantly related to infection rate possibly because of adherence to social distancing. In low-and middle-income countries though, high population density is commonly associated with informal urban settlements, being social distancing impracticable (Wilkinson 2020). The sensitivity analysis indicated the importance of the average income and the gross domestic product within the expanded metropolitan area of São Paulo, Brazil (Table 3) possibly due to higher frequency of international traveling of population living in wealthier neighborhoods. As for a different social aspect, significantly negative correlations were found between COVID-19 infection rate and social isolation rate in all analyzed cities (Table 4), thus indicating that social distancing has been effective in reducing the COVID-19 transmission within the expanded metropolitan area of São Paulo. Furthermore, using graphical analysis, we have observed a consistent trend in all analyzed cities, with increases of confirmed new cases of COVID-19 associated with decreases in social isolation rates (Fig. 2). Our results corroborate data from recent literature, as Ahmadi et al. (2020) found a significant correlation between COVID-19 cases and intra-provincial traffic in Iran. Using the Spearman correlation test, significantly negative correlations were found between COVID-19 infection rate and UV radiation in all cities with available UV data (5 out of 9 analyzed cities) (Table 4); furthermore, the sensitivity analysis pointed out UV radiation as a significant variable (Table 5). These findings are consistent with recent literature; for example, Ahmadi et al. (2020) have found the lowest COVID-19 infection rates in provinces with high solar radiation. Furthermore, Schuit et al. (2020) have demonstrated that the influenza virus in aerosols decays more rapidly under simulated sunlight than under dark conditions, and concluded that their results are in accordance with epidemiological data reporting sunlight levels to be inversely correlated to influenza transmission. More importantly, Sagripanti and Lytle (2020) have recently predicted the inactivation of SARS-CoV-2 by solar UVB in densely populated cities in the world. The authors have estimated that during the winter season in the city of São Paulo, a 41-min exposure to sunlight around solar noon would be required to achieve 90% inactivation of SARS-CoV-2 virus, while a 13-min exposure to sunlight around solar noon could achieve 99% inactivation during the summer season. Therefore, recent literature corroborates our finding that the UV radiation provided by sunlight potentially reduces the infectivity of SARS-CoV-2. Significantly negative correlations were also found between COVID-19 infection rate and temperature of three, 7 or 14 days previous to case reports in all cities with available temperature data (9 out of 10 analyzed cities) (Table 4), thus suggesting that increases in temperature contribute to decreases in COVID-19 transmission in the expanded metropolitan area of São Paulo. Several studies in recent literature have also indicated that temperature is inversely related to COVID-19 incidence (Liu et al. 2020;Prata et al. 2020;Qi et al. 2020;Şahin 2020;Wu et al. 2020). More importantly, some authors have reported that the infection ability of SARS-CoV-2 decreases with temperature increases, and thus, COVID-19 prevention and control are expected to be more effective at warmer weather, being the molecular mechanism thoroughly described elsewhere (He et al. 2020). Significant negative correlations were also found between COVID-19 infection rate and wind speed 14 days before case reports in 7 out of 9 analyzed cities (Table 4), and the sensitivity analysis pointed out wind speed 14 days before case reports as a significant variable (Table 5). Likewise, Ahmadi et al. (2020) have reported significant inverse correlation between infection rate and wind speed in Iran. --- Conclusions Our results reveal that the spread of COVID-19 within the expanded metropolitan area of São Paulo, Brazil, is influenced by the availability of highways. As for social aspects, COVID-19 infection rate was found to be both positively correlated with population density (ρ = 0.46), and negatively correlated with social isolation rate (ρ varying from -0.39 to -0.86), hence, indicating that social distancing has been effective in reducing the COVID-19 transmission. Overall, our results show that the COVID-19 transmission within the expanded metropolitan area of São Paulo is inversely correlated with both temperature (ρ varying from -0.28 to -0.67) and UV radiation (ρ varying from -0.28 to -0.68). Together with recent literature, our study suggests that the UV radiation provided by sunlight potentially contributes to depletion of SARS-CoV-2 infectivity. --- Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The new coronavirus SARS-CoV-2 has infected more than 14 million people worldwide so far. Brazil is currently the second leading country in number of cases of COVID-19, while São Paulo state accounts for 20% of total confirmed cases in Brazil. The aim of this study was to assess environmental and social factors influencing the spread of SARS-CoV-2 in the expanded metropolitan area of São Paulo, Brazil. Firstly, a spatial analysis was conducted to provide insights into the spread of COVID-19 within the expanded metropolitan area. Moreover, Spearman correlation test and sensitivity analysis were performed to assess social indicators and environmental conditions which possibly influence the incidence of COVID-19. Our results reveal that the spread of COVID-19 from the capital city São Paulo-its epicenter in Brazil-is directly associated with the availability of highways within the expanded metropolitan area of São Paulo. As for social aspects, COVID-19 infection rate was found to be both positively correlated with population density, and negatively correlated with social isolation rate, hence indicating that social distancing has been effective in reducing the COVID-19 transmission. Finally, COVID-19 infection rate was found to be inversely correlated with both temperature and UV radiation. Together with recent literature our study suggests that the UV radiation provided by sunlight might contribute to depletion of SARS-CoV-2 infectivity.

OBJECTIVES/GOALS: During earlier periods of the pandemic, Black and Latinx populations in Michigan have suffered higher rates of infection, hospitalization, and deaths when compared to Whites. We conducted this study to understand how Black and Latinx residents perceived this disproportionate burden. METHODS/ STUDY POPULATION: In 2021, 40 semi-structured interviews were conducted virtually in English or Spanish with Black (n=24) and Latinx (n=16) residents in Michigan areas highly impacted by COVID-19: Genesee, Kent, Washtenaw, and Wayne counties. Using a Community-Based Participatory Research (CBPR) approach, we partnered with leaders from 15 community-based organizations and health and human service agencies to develop research questions, an interview protocol, and to interpret the data. We used the data analysis software Dedoose (ver 4.12) for inductive coding (IRR=0.81). This study is a part of the NIH Community Engagement Alliance (CEAL) Against COVID-19 initiative. RESULTS/ANTICIPATED RESULTS: Participants described the significant impact of the pandemic in terms of physical and mental health, job security, and the sheer number of deaths among loved ones. They attributed the impact to comorbidities and social determinants of health disparities exacerbated by the pandemic, including income, housing, access to healthcare, as well as systemic racism. They noted being overrepresented among frontline workers with higher exposure to COVID-19, limited or misinformation about the virus, language barriers, and difficulty with social distancing. Cultural norms that promote being in close proximity, such as intergenerational households, and loss of trusted community leaders were also noted. DISCUSSION/SIGNIFICANCE: Findings reflect the needs of Black and Latinx community members in Michigan and the discussions they feel are important to highlight. We must work strategically with partners and the community to provide transparency and effective leadership, and prioritize addressing systemic disparities in SDoH. OBJECTIVES/GOALS: Chronic stress has vast implications for health. Pathophysiological dysregulation, as evidenced by allostatic load, is associated with increased morbidity and mortality. Health disparities exist in both the incidence and outcomes of chronic stress. This study investigates the intersection of identity, allostatic load, and depression. METHODS/STUDY POPULATION: A nationally representative sample of pre-pandemic health data from the 2017-2020 cycle of the National Health and Nutrition Examination Survey (NHANES) was used to assess variation in depression and allostatic load by identity status. Datasets containing biomarker, mental health, and identity data were merged using Stata. An index of allostatic load was created by generating quartiles for nine biomarkers of cardiovascular (cholesterol, triglycerides, systolic and diastolic blood pressure), metabolic (glucose, body mass index, albumin, creatinine), and immune (c-reactive protein) functioning, and summing the total high risk biomarkers per person. Depression scores were averaged across nine items from the patient health questionnaire, and dichotomous identity variables (e.g., race) were generated. RESULTS/ANTICIPATED RESULTS: People identifying as female (t = 8.25, p < .001) or Black (t = 7.18, p < .001) have higher allostatic load scores, whereas people identifying as White (t = -2.64, p < .01) or Asian (t = -3.80, p < .001) have lower allostatic load scores. People identifying as female (t = 10.76, p < .001), White (t = 2.66, p < .01), or Another/Mixed race (t = 6.23, p < .001) have higher levels of depression, whereas people identifying as Asian (t = 9.17, p < .001) have lower levels of depression. Multiple regression analyses indicate a significant effect of depression on allostatic load when controlling for sociodemographic variables (B = 0.33, SE = 0.05, t = 7.02, p < .001). The identity*depression interaction increases allostatic load for females (B = 0.43, SE = 0.10, t = 4.21, p < .001) and racial/ethnic minority males (B = 0.25, SE = 0.10, t = 2.62, p < .01). DISCUSSION/ SIGNIFICANCE: This study highlights differences in the experience of allostatic load and depression based on identity. Depression exerts an independent and moderating effect on allostatic load. Findings have implications for health disparity research, and highlight the dynamic intersection of identity, mental, and physical health in the face of chronic stress.

firearm injuries are associated with county-level poverty, defined as the percentage of the population living below the federal poverty line. Rates will be calculated by determining county level population within subgroups using the National Historical Geographical Information System database. We will also conduct regression analyses to adjust for confounding variables selected based on evidence from prior research. Some of these variables include age, sex, race, urbanicity, and the social vulnerability index. RESULTS/ ANTICIPATED RESULTS: An abundance of prior research has demonstrated differences in firearm injury by age, sex, and race. Prior studies have also shown that poverty is associated with higher rates of firearm-related deaths among youth. Based on that foundational data, we anticipate that regression analyses will demonstrate that counties with higher poverty levels will have higher rates of fatal and non-fatal firearm injuries, even after controlling for other known risk factors. DISCUSSION/SIGNIFICANCE: Findings from this study will contribute to growing evidence on the role of poverty in the burden of firearm injuries and mortality. This will have policy implications regarding the allocation of public health resources and interventions aimed at reducing firearm-related injuries and deaths in Maryland.

Introduction The Semantic Web is an extension of the current web, which has a structure that enables to express the content of pages or documents so that computers can understand and process them, this fact facilitates interaction between computers and users [1]. To make this possible, we need knowledge models (ontologies), descriptions of resources; as well as management languages and knowledge representation techniques. In particular, ontologies can have different purposes, among which stand out: the publication of information according to a knowledge model, the exchange of information between applications, the disambiguation of concepts, the inference of knowledge and the description of vocabularies [2,3]. In recent years, multiple ontologies have emerged in different fields of knowledge ranging from Physics to Social Sciences [4]; however, the adaptation of ontologies in particular domains is a common task due to the need of covering specific domains, that means that although reutilization is recommendable, often only general concepts are maintained. This article presents the construction of two ontologies: an educational and a military ontology focused on the representation of knowledge in Mexican institutions. The Mexican context is represented by the structure of these institutions, their teaching modalities and considering the educational strategies to enable students to achieve good cognitive and formative levels. These ontologies are used by individuals of the Military Education System as training tools, they are also part of the MIIDAS prototype, which is a proposal for the integration of educational resources managed through semantic technologies [5]. The rest of the article is structured as follows: Section II presents some concepts about ontologies. Section III presents a review of the ontologies developed in the educational and military domain. Section IV explains the process of building both ontologies. Section V shows preliminary results of ontologies' evaluation. Finally, conclusions and future work are presented in Section VI. --- Theoretical and Explanatory Framework The theoretical perspective of this work involves the topic of ontologies, which we describe below. Ontologies can be conceived as an explicit and formal specification of a shared conceptualization [14]. From this definition, it can be said that the specification refers to the selection of a particular domain, the explicit refers to the concepts used in the ontology and the restrictions for its use that must be clearly defined, the formal describes the use of comprehensible syntax for computers, the conceptualization points to the representation of knowledge and shared refers to the consensus by domain experts [15]. According to [16], the main elements of ontology are: class (concepts), properties (relationships), and individuals (instances). Classes are real-world objects, which can be grouped with elements that have similar characteristics; these classes are the base element of ontology and describe the concepts of a specific domain. The properties are relationships and serve to describe relevant features of the entities; these can be of three types: object, data or annotation. Individuals are elements which belong to a specific class. OWL (Ontology Web Language) is the standard language of the Semantic Web to express and codify ontologies [17], this language is based on descriptive logics. OWL language is composed of three sublanguages with different levels of expressivity, these are: 1) OWL-Lite for those cases that need a hierarchical classification and simple restrictions, 2) OWL-DL for those cases that require great expressiveness and a computability guaranteed and 3) OWL-Full for those cases that require maximum expressiveness and complete syntactic freedom; but without guarantee of complete computability. OWL also uses special software modules, called reasoners, that can make inferences and to check logic consistency into the knowledge base of ontologies. --- Related Work In this section, we present some ontologies that have been developed for the educational and military domains, the purpose is to review the concepts that can be adopted by our own ontologies for knowledge reuse. An ontology that represents a knowledge model which establishes the relationships between the requirements of the labor markets and the content of the work plans is presented in [6], the ontology is studied during a given training program. In the article [7] describes domain and pedagogical ontologies which together help to enable the search, visualization and navigation of learning objects in Science of the Earth and Geography areas. Curriculum Ontology [8] is an ontology proposed by the UK public radio and television service, which aims to provide data models and vocabularies to describe national curricula in the same country. In the HERO ontology (Higher Education Reference Ontology) [9] several general aspects of the domain of a university are described, such as the organizational structure, personal (academic and administrative), roles (teaching and research) and even incomings. Regarding ontologies in the military domain, the following stand out: the C2 ontology [10], this exposes a knowledge model that specifies military command and control concepts of the Department of Defense of the United States. The military ontology Muninn [11] defines classes and properties of military history. The article [12] describes the implementation of an ontology as a basis for the intelligent information system of the tactical command of the army of Korea. The THOR ontology [13] provides a vocabulary to describe and request the content generated by the combatant. As summary, the related works shows diverse ontologies from different perspectives, however, they do not consider the features of the Mexican context. That represents the organization of educational institutions in Mexico, their educational approaches, the teaching modalities and strategies used to achieve cognitive and formative levels of individuals of the Mexican Military Education System. --- Building Ontologies For the building of the ontologies Methodology 101 [18] was used, proposed by Stanford University, which consists of 7 phases, these phases are: 1) Determine the domain and scope of the ontology, 2) Reuse existing ontologies, 3) List important terms for the ontology, 4) Define classes and their hierarchy, 5) Define the properties of the classes: slots, 6) Define the facets of the slots and 7) Create instances or individuals. --- Building Phases for the Educational and Military Ontology Before building the ontologies it is necessary to define the domain and the scope of these, in order to determine it, it is essential to ask the competency questions. Table 1 shows the different competency questions for each one of the ontologies. Once the competency questions have been formulated, the scope of the ontologies can be established. Table 2 shows its respective scope. After analyzing the scope of the ontologies it is necessary to list the important terms; as well as defining its hierarchy. For the educational ontology, we worked with experts in education and pedagogy that helped to obtain the significant terms. Ontology Scope --- Educational The ontology should describe several aspects of Mexican educational institutions, such as their structure, their teaching modalities, the educational strategies to achieve a cognitive and formative level in the students; as well as the evaluation instruments used. --- Military The ontology should describe the terminology used in the different subjects for the training of military personnel in the various curricula of the Military Education System. Regarding the Military domain ontology, the taxonomy of concepts and their definitions were obtained by reviewing documents that belong to the Military Educational System. Figure 1 shows the hierarchy of classes of both ontologies. --- Hierarchy classes Educational ontology Military ontology --- Ontologies Evaluation The quality of the built ontologies was estimated by considering three aspects: structural evaluation, functional evaluation and usability. These aspects were tested as follows. --- Structural Evaluation The structural evaluation consists of analyzing the logical structure of the ontology. Three different reasoners were used to verify the logical consistency as well as the redundancy of information, they were FaCT ++ [19], Pellet [20] and HermiT [21], all of them reported no inconsistencies or redundancies in the educational and military ontologies. --- Functional Evaluation Functional evaluation refers to the use of ontology; as well as the conceptualization of some domain. This evaluation includes aspects such as the agreement of domain experts, evaluation through competency questions and an estimation of user satisfaction. --- Domain Expert Evaluation. This evaluation is carried out by experts in the domain, which assess the compliance of the ontology in terms of concepts, hierarchy, standards and requirements [22]. The educational ontology was evaluated by experts in education, specifically in didactics and pedagogy, while the military ontology was evaluated by expert personnel in the military environment (captains and majors). In general, the suggestions of the experts were based on the classification and equivalence of concepts, inclusion of object and data properties; as well as reviewing annotations. Evaluation through Competency Questions. This test consists of translating the competency questions posed at the beginning of the construction of the ontologies to the SPARQL query language. Table 4 shows the queries made to the educational and military ontology in natural language, the respective queries in SPARQL as well as the result set. --- Usability Evaluation To evaluate the usability of the ontologies, a prototype called MIIDAS was made, which is a web application that makes use of these ontologies and allows users to interact with them by means of a graphical user interface. A usability rubric was used as an evaluation instrument to evaluate ontologies. This rubric was applied to 25 professors and 39 students of the Military School of Engineers, all of them are part of the Military Educational System. As an illustration, Figure 2 shows the average of qualification assigned for navigation and utility (the qualification is a number between zero to ten). According to the results presented on the evaluation criteria of the ontologies, these were favorable in terms of navigation and usefulness for the student and teaching population, as they reported favorable results for each of these criteria. --- Conclusions This article describes the process of building two ontologies, one in the educational and the other in the military domains; both ontologies were built by implementing Methodology 101 and considered the context of the Mexican Military Educational System. Ontologies presented in this work have been preliminary evaluated in three different aspects: structural, functional and usability, obtaining favorable results in each one. These ontologies can serve as a reference to develop multiple applications and as a point of reference to standardize a vocabulary within Mexican institutions. As future work, we have to research plans, the first is to extend the educational ontology to support training of teacher's evaluation established by the National Institute for the Evaluation of Education (INEE), and the second is to support the impact of the ontology when this is used to support individual's development.

This article presents a process to build ontologies for the educational and military domains focused on the representation of knowledge in Mexican institutions. The Mexican context is represented by the structure of these institutions, their teaching modalities and considering the educational strategies to enable students to achieve good cognitive and formative levels. The ontologies are used by individuals of the Military Education System as training tools. The article includes the description of some tests for ontology evaluation. The preliminary results show that these tools are acceptable for potential users.

familiar with your new model. Please explain briefly your conceptual point of departure and development over time. The Quadruple Helix contextualizes the TH by adding as the fourth helix ''civil society'' and the ''media-and culture-based public.'' This is the understanding that additional perspectives must be added to comprehend innovation in the unfolding twenty-first century. In fact, democracy frames and changes our conditions of innovation. The TH is not really sensitive enough for this democratic additionality, whereas the Quadruple Helix reflects on this. Furthermore, the Quintuple Helix embeds the Quadruple Helix by extending this architecture of innovation to the environment and social ecology. The Mode 3 Knowledge Production Systems concept, extends, expands and complements the Mode 1 and Mode 2 Knowledge Production concepts by emphasizing the presence and impact of higher order learning (learning, learning-to-learn and learning-to-learn how to learn (see multiple books, journal articles and publications by Carayannis et al. since 1993 to date with key one (Carayannis et al. 2001)). Q 2 The TH model of UIG relationships has been limited to a limited number of applications, including national and regional innovation systems. What limitations hinder the extension of the TH model outside innovation research? To what extent can the Quadruple Helix or N-Tuple model help address such limitations? The Quadruple Helix brings in aspects that are thus far not included in the TH. The TH can be said to describe core processes of the knowledge economy. The Quadruple Helix is sensitive for the knowledge society and democracy. The Quintuple Helix, finally, addresses social ecology and the need for having awareness of the environmental context of society and the economy. The Quadruple Helix and the Quintuple Helix emphasize and explain why democracy and the environment need to be integrated in the wider perspective of the architecture of innovation. Without this, our understanding of innovation is constrained and not really sufficient for fully comprehending innovation and associated challenges. In short, the TH focuses on top-down government, university and industry policies and practices whereas the Quadruple Helix focuses on BOTH top-down government, university and industry policies and practices as well as bottom-up and mid-level out civil society grass-roots initiatives and other actions that help better shape, fine-tune and make more effective and efficient the government, university and industry policies and practices. The Quintuple Helix adds to the Quadruple Helix the environmental dimension to ensure that said top-down, bottom-up and mid-level out policies, practices and initiatives are indeed as smart, sustainable and inclusive as possible and meet the triple bottom line (financial, social, and environmental) hurdles criterion. Q 3 Before the use of the TH model and its adoption by researchers became a worldwide phenomenon, empirical measurement tended to be a major issue in academia. In response to this concern, Professor Loet Leydesdorff developed the TH indicator using a Shannontype information formula for three dimensions and their combinations (Park 2013). Can we still apply this indicator to the N-Tuple model or do you suggest something new? We are indeed working on a number of potential metrics, including information-theoretic models using entropy as a performance measure, and this indicator may be extended to models such as the Quadruple or Quintuple Helix with the right adaptation, which may need to be nontrivial, particularly in terms of the assignment of variables and the related level of significance of each. Q 4 You have recently tended to emphasize the importance of social and natural components for the Quadruple Helix and the Quintuple Helix, respectively. How can these dimensions interact with the traditional TH, that is, UIG relations? For example, there are ''innovation cultures'' that influence the process of innovation within academia, markets, and political systems. Innovation cultures can be communicated by media, and innovation is carried by a diverse set of actors in civil society. All these aspects and considerations are well rooted in the Quadruple Helix. Implications of the environment and of environmental needs challenge society and the economy but also act as incentives for progressing innovation such that innovation engages knowledge production and knowledge in a new balance with our ecological environments. Moreover, and per the comments to your previous questions, the social and natural considerations act as the ''creative glue'' for promoting smarter, more sustainable and more inclusive growth opportunities in the Knowledge Economy and Society for both developed and perhaps even more so for transitioning and emerging economies where civil society and environmental structures, infra-structures and institutions are often lacking or under-developed allowing for the accumulation of substantial negative externalities (such as pollution) and other transactional costs of growth (such as corruption) as well as impeding or even suppressing market, knowledge and network spill-over effects (positive externalities). Q 5 Knowledge-based innovation systems may vary across countries (Kwon 2011). However, the TH model has not been extensively examined beyond Western countries (Khan and Park 2012). In what context can N-Tuple Helix relations become more important? In addition, how can we functionally and/or intellectually validate of the N-Tuple model for developing and transitional economies? Knowledge-based innovation may never be seen as a privilege of industrialized countries. This indeed would be a misleading approach. Knowledge-based innovations are just as valid for emerging economies and developing countries. In that sense, the Quadruple Helix and the Quintuple Helix are global und universal. The more appropriate question to ask would be what the specific implications and ramifications for knowledge-based innovation would be when applied in diverse political, economic, social, and technological contexts around the globe (Carayannis 1998a(Carayannis , b, 1999a(Carayannis , b, 2000(Carayannis , 2001(Carayannis , 2004(Carayannis , 2008;;Carayannis et al. 2000Carayannis et al. , 2006Carayannis et al. , 2011Carayannis et al. , 2012a, b;, b;Carayannis and Alexander 1999, 2000, 2002, 2004;Carayannis and Laget 2004;Carayannis and von Zedtwitz 2005;Carayannis 2009;Carayannis andCampbell 2009, 2012) and how it concerns developed democracies versus emerging autocracies. In particular, the Quadruple and Quintuple Innovation Helix constructs may well serve to reveal and promote ways and means to help advance growth in a manner that is becoming increasing aligned with the progress of democracy instead of having growth advancing in defiance of and for the suppression of democratic institutions. Over the medium to long term, our fundamental belief and premise is that true and transparent democracy constitutes a sine qua non for smart, sustainable and inclusive growth and this constitutes our main motivation and guide for our focus on ways and means that concepts such as the Quadruple and Quintuple Innovation Helix, can better serve architect a better tomorrow for the peoples of the world.

Given the widespread use of many digitalized communication channels, knowledge production activities have rapidly become interrelated. As the term ''network society'' implies, knowledge-based innovation systems have been built mainly on the mediated social infrastructure, which has lead to the emergence of the N-Tuple Helix model. I wish to contribute to this special issue by offering an interview with Prof. Dr. Elias G. Carayannis and Dr. David F. J. Campbell, the two co-authors and co-creators of the Quadruple (Government, University, Industry and Civil Society) and Quintuple (Quadruple Innovation Helix plus Environment) Innovation Helix concepts that extend, expand and complement the Triple Innovation Helix rubric. This article starts with brief background information on N-Tuple Helices and concludes with some implications for developing and transitional economies.

INTRODUCTION Globally, people who inject drugs (IDU) constitute 5-10% of individuals living with HIV. [1] IDU face an heightened risk of HIV infection, largely due to shared drug paraphernalia including syringes and crack pipes. [2,3] In Canada, an estimated 13.4% of those living with HIV are IDU. [2] Although earlier diagnosis of HIV through testing has been shown to improve health outcomes and survival of patients, [4] IDU often present to healthcare only after AIDS-related opportunistic infections have developed. [3] Further benefits of routine HIV voluntary counselling and testing (VCT) include reduced risk behaviours conducive to HIV transmission and increased uptake of antiretroviral therapy following diagnosis. [5,6] Many barriers to VCT among IDU have been identified; distrust of the healthcare system and primary care providers are leading concerns. [7,8] Peer-delivered VCT represents a unique opportunity to circumvent these barriers. In various studies, health services delivered by non-medical providers were shown to lower financial costs and result in equal or improved quality of care and service uptake, particularly among hard-to-reach populations. [8][9][10][11][12][13] Certain organizations in Vancouver's Downtown Eastside neighbourhood, such as the supervised injection facility Insite (at which IDU can inject pre-obtained illicit drugs under nurse supervision), and the community organization Vancouver Area Network of Drug Users (VANDU), incorporate peer-delivery into their programming. [14] However, little is known about the acceptability of peer-delivered VCT among the IDU population, as no such programs currently exist. Therefore, this research sought to characterize IDU's willingness to receive peer-delivered VCT in Vancouver, Canada. --- METHODS Data for this research were drawn from the Vancouver Injection Drug Users Study (VIDUS), a prospective cohort of HIV-negative IDU recruited through street outreach and self-referral since 1996. The study has been described in detail previously. [15] Participants complete baseline and semi-annual follow-up questionnaires that elicit a range of information, including demographic data, information on drug use and HIV risk behaviours, and experiences with healthcare. Blood samples are also collected for serologic testing. The VIDUS study has been approved by the University of British Columbia/Providence Healthcare Research Ethics Board. This study employs cross-sectional data from participants who completed a survey between December 2011 and May 2012 (n=600). Seven (1.2%) observations with missing data were excluded from analysis. During this follow-up period only, new survey questions asked respondents who they would want to administer HIV pre-test counselling, rapid HIV test, and HIV post-test results and counselling. For each question, possible responses included: doctor, nurse, outreach/community worker, peer from Insite, someone from VANDU, close friend, acquaintance, someone with street experience, social worker, HIV support worker, HIV specialist (doctor), anyone (it doesn't matter who), or other. Participants selected all that applied, thus categories were not mutually exclusive. Participants were considered willing to receive peer-delivered services if they selected at least one of: an Insite or VANDU peer, a close friend, acquaintance, someone with street experience, or anyone, as these categories are generally comprised of current or former members of the IDU community. The three distinct outcomes explored by this study are willingness to receive peer-delivered pretest counselling, peer-delivered rapid HIV testing and peer-delivered posttest counselling. Pearson's Chi-squared tests were conducted for bivariate analysis, except where 5 or fewer individuals existed in one or more cells. In this instance, Fischer's exact test was used. Odds ratios were calculated using simple logistic regression analyses. Three multivariate regression models were then constructed using the Akaike information criterion (AIC) and p-values. Each of the three models were initially constructed to include all variables where p<0.05 in bivariate analyses, then reduced by progressively removing the variable with the greatest p-value until no variables remained for inclusion. The model with the lowest AIC score was selected for reporting. All p-values were two-sided. --- RESULTS In total, 600 participants were included in this study. Seven (1.2%) observations were excluded from analysis due to missing data. 195 respondents (32.5%) were female, 301 (50.2%) were aged ≥48 years, 375 (62.5%) self-identified as Caucasian, and 153 (25.5%) self-identified as Aboriginal. 143 (23.8%) respondents were current members of VANDU, 450 (75.0%) had used Insite in the past, and 136 (22.7%) reported smoking crack cocaine daily. Overall, 309 individuals (51.5%) indicated willingness to receive peer-delivered pretest counselling, 244 (40.7%) to receive peer-delivered rapid HIV testing, and 257 (42.8%) indicated willingness to receive peer-delivered post-test counselling. In bivariate analyses, reported in Table 1, the following characteristics were significantly associated with willingness to receive peer-delivered pre-test counselling: drug dealing (Odds Ratio (OR) = 1.71, 95% confidence interval (CI): 1.10-2.65), daily crack smoking (OR = 1.59, 95%CI: 1.08-2.34), daily heroin injection (OR = 1.65, 95%CI: 1.05-2.61), injecting with others always or usually (OR = 1.66, 95%CI: 1.07-2.56), having used Insite (OR = 2.08, 95%CI: 1.42-3.03), and being a current member of VANDU (OR = 1.78, 95%CI: 0.54-2.07). Factors significantly associated with willingness to receive peerdelivered rapid HIV testing included drug dealing (OR = 1.70, 95%CI: 1.10-2.61), daily crack smoking (OR = 1.77, 95%CI: 1.20-2.60), daily heroin injection (OR = 1.65, 95%CI: 1.06-2.58), having used Insite (OR = 1.93, 95%CI: 1.30-2.87), and being a current member of VANDU (OR = 1.68, 95%CI: 1.15-2.45). Factors significantly associated with willingness to receive peer-delivered HIV test results and post-test counselling were daily crack smoking (OR = 1.63, 95%CI: 1.11-2.40), daily heroin injection (OR = 1.64, 95%CI: 1.05-2.57), injecting with others always or usually (OR = 1.64, 95%CI: 1.07-2.51), having used Insite (OR = 2.00, 95%CI: 1.35-2.96), and being a current member of VANDU (OR = 1.67, 95%CI: 1.14-2.43). As shown in Table 2, multivariate analyses identified the following factors to be significantly associated with willingness to receive peer-based pre-test counselling: having used Insite (Adjusted odds ratio (AOR) = 1.85, 95%CI: 1.25-2.72), and being a current member of VANDU (AOR = 1.55, 95%CI: 1.04-2.30). Daily crack smoking (AOR = 1.70, 95%CI: 1.15-2.51) and having used Insite (AOR = 1.73, 95%CI: 1.15-2.59) were significantly associated with willingness to receive peer-delivered rapid HIV testing. Willingness to receive peer-delivered post-test counselling was significantly associated with male gender (AOR = 1.46, 95%CI: 1.02-2.10), frequent crack smoking (AOR = 1.55, 95%CI: 1.04-2.31), having used Insite (AOR = 1.73, 95%CI: 1.15-2.60), and being a current member of VANDU (AOR = 1.47, 95%CI: 1.00-2.18). --- DISCUSSION Our study found moderately high levels of willingness to receive peer-delivered HIV VCT among IDU in Vancouver, Canada. Willingness was predicted by previous exposure to peerdelivered programming and markers of higher intensity drug use, specifically frequent crack smoking. These findings may reflect the potential for peer-based services to overcome various barriers to VCT associated with traditional VCT delivery. Specifically, peerdelivered VCT may help address issues such as lack of trust in the healthcare system, physicians' unfamiliarity with the social conditions surrounding IDU, and discomfort awaiting test results. [7,8] We found that more IDU were willing to receive peer-delivered pre-test counselling than testing and post-test counselling. A previous study from Thailand found similar results, which were later explained by concerns about confidentiality and peers' ability to correctly administer tests. [16] IDU in our sample who had used Insite, Vancouver's supervised injection facility which involves peer workers, or were members of the peer-run organization VANDU were more willing to engage in peer-delivered VCT. These results complement findings from a study in Thailand, which found that IDU who had engaged with a peer-run drop-in centre also expressed high willingness to receive peer-delivered VCT. [17] Given the potential importance of peer-delivery in the provision of HIV-related services, there may be value in implementing peer-delivered VCT within already established peer-run organizations to increase access to VCT within the community. High willingness for peer-delivered VCT among frequent crack cocaine users may be explained by previous research, which found that perceived risk exposure constituted a main reason to seek HIV testing. [7] Due to ongoing educational efforts in Vancouver's Downtown Eastside, it is likely that IDU acknowledge crack cocaine use as a risk factor for HIV infection. Vancouver Coastal Health Authority's crack pipe distribution program, which occurred between 2011 and 2012, represents one example of such efforts. [18] In Vancouver in 2011, a VCT pilot project delivered HIV counselling and testing to IDU through peers, in conjunction with nurses. An evaluation of the program found positive results, but no large-scale peer-delivered VCT was implemented. [19] Research in Melbourne, Australia, also investigated a program of peer-delivered hepatitis C counselling and testing among IDU and found improvement in risk behaviours and knowledge of hepatitis C. [20] The findings from the present study are consistent with these studies and provide evidence that IDU are willing to engage in peer-delivered VCT; these types of programs and services should therefore be brought to scale. Our study has limitations. First, our sample was built using snowball sampling methods and was not randomly selected; therefore, residual confounding may exist and results may not be generalizable. Second, we relied on self-reporting, which may subject our results to response bias. Lastly, our analysis is cross-sectional in nature and could be extended by future longitudinal and intervention research assessing how reported willingness compares to actual willingness to receive peer-delivered VCT. Overall, this study highlights the potential of supplementing traditional VCT strategies with peer-delivered approaches tailored to IDU. --- What is already known on this subject Peer-based approaches have been successful in delivering HIV-related interventions. This type of task-shifting from primary healthcare providers has been shown to increase quality of care and reduce costs of service delivery. --- What this study adds This study provides evidence that people who inject drugs (IDU) support the use of peerdelivered HIV voluntary counselling and testing (VCT). Associations between involvement with community services or peer-based networks indicate that these organizations may be key roll-out points for peer-based VCT services. Results also suggest that IDU who know they are participating in high-risk activities may be more likely to take advantage of low-barrier VCT opportunities.

Background-People who inject drugs (IDU) face unique systemic, social and individual barriers to conventional HIV voluntary counselling and testing (VCT) programs. Peer-delivered approaches represent a possible alternative to improve rates of testing among this population. Methods-Cross-sectional data from a prospective cohort of IDU in Vancouver, Canada were collected between December 2011 and May 2012. Bivariate statistics and multivariate logistic regression were used to identify the prevalence of and factors associated with willingness to receive peer-delivered VCT. Results-Of 600 individuals, 51.5% indicated willingness to receive peer-delivered pretest counselling, 40.7% to receive peer-delivered rapid HIV testing, and 42.8% to receive peerdelivered post-test counselling. Multivariate analyses found significant positive associations between willingness for pre-test counselling and having used Vancouver's supervised injection facility, Insite, or being a member of VANDU (a local drug user organization) (all p < 0.05). Daily crack smoking and having used Insite were positively associated with willingness to receive peerdelivered HIV testing (p < 0.05). Willingness to receive peer-delivered post-test counselling was positively associated with male gender, daily crack smoking, having used Insite, and being a member of VANDU (p<0.05).While not universally acceptable, peer-delivered VCT approaches may improve access to HIV testing among IDU.

INTRODUCTION Drug abuse has become a global phenomenon and its intensity varies depending on the country in question. World over, about 15.3 million individuals experience a minimum of one drug abused related disorder (1)(2)(3)(4). In the year 2012, the United Nations Office on Drugs and Crime (UNODC) estimated that about 183,000 drugrelated deaths occurred globally; with around 162-324 million people, aged between 15 and 64, reported using abusing drug at least once yearly (5, 6). There is an increased of about 26% in the burden of drug abuse among youth, compare to the past decade (7, 8). Drug abuse is considered as a pattern that is maladaptive due to sustained use, despite awareness of developing a repeated or persistent social, professional, psychological, or physical challenge as a result of recurrent use in circumstances that are physically harmful (9, 10). The term "abuse" is often used informally to mean any utilization of illicit drugs. Due to its double standard, the name is used strictly on non-dependence drugs case. Drug abuse during adolescence and early adulthood has become a serious public health problem with several consequential impacts on them (11,12). The Impact of drug abuse on the youth is a global phenomenon. Drug abuse contributes to the rise in youth violence, poverty, unemployment, and crime among others (12). Youth abused drugs for a variety of reasons, which includes fun, alertness, performance, satisfying hunger, and weight management among others, ignoring its consequential morbidity and mortality effects (13). In this regard, drug-related fatalities are estimated to be 187,100 people annually as of 2013, with an intolerable number of drug abusers dying before their time, with approximately 400, 000 deaths per year in the 2020s, worldwide (14). It is difficult to combat the impact of drug abuse without political commitment. The needed commitment demand putting in place a strategic drug abuse management technique, with particular attention on the youth. Against this, background, the review was conducted to identify the types and degree of drug abuse impact on the youth and suggest policy brief areas, which will direct the development of interventions that would reduce the impact of drug abuse on the youth and other illegal drug use. --- METHODOLOGY The study is a narrative review. It adopts a desktop search technique for literature and published reports. Desktop literature search enables a purposive selection of literature that best address the issues under discussion. The literature search was done through Google Scholar, non-academic, as well as industrybased websites with a stake in and drug abuse related issues. "Drugs" and "abuse" key words were used simultaneously to search for the published texts. Words like substance, addictions, and dependence without --- Social Impact Youth who abuse drugs experience a wide range of social life issues. The youth's social concerns in relation to drug abuse include disruptions in their social network, such as academic challenges, distorted career paths and avoidable contact with the juvenile justice system among others (24). The following explains some of the frequently encountered social issues faced by the youth in relation to drug abuse. • Academics: Drug abuse is linked to issues like declining grades, absence from school and other activities, and a high likelihood of dropping out of school, lack of dedication to study, increased truancy rates, causing cognitive and behavioral issues that can impact their academic performance as well as their peers' ability to learn (7, 25). This is not where it ends, more to it, the impact can frequently extend to their families, towns, and even the entire society. --- Drug Abuse Impact on Career Drug abuse has constituted a career risk to the youth's potential. The situation could follow the youth into their adult life stage, in addition to the physical challenges, it also presents physiological and psychological issues due to its ability to cloud judgment and promote hasty decisions. Specific issues with career distortion attributes include non-erasable criminal records, assaults, sexually transmitted infections, unintended pregnancies, career cut-off, family and friends' disconnections and missed opportunities to mend fences among others (23, 26). --- Social and Criminal Justice The connection between drug abuse and crime is • Peers. Youth who abuse drugs frequently feel isolated and stigmatized by their peers. Drug abusers frequently skip out school attendance and community events, robbing their peers and communities of the beneficial contributions they may have otherwise made (31). • Families. In addition to personal hardships, drug abuse by youth can put many elements of family life in danger and cause family crises, sometimes leading to disintegration. Drugs abuse by youth have a significant impact on both parents and siblings (32). The financial and emotional resources of a family can be deeply depleted by drug abusers (7). --- Recommendations To curtail the menace of drug abuse impact on the youth, there is a need. • To design a comprehensive prevention package in the contexts of health education, guidance, and counselling topic, to be implemented by the public, civil society, and private sectors with stake in drug abuse control. • To encourage political commitment by the public sector through the provision of sustainable funding mechanisms that would support the prevention economic, social and environmental impact of drug abuse on the affected youth. • To Create and develop parent/guardian orientation and sensitization programs, on effective parents-toward/child communication skills, to fortify family bonds, that will stop their kids from patronizing drugs. --- CONCLUSION The review has thus, identify four range of harmful impacts, thus health, economic, social, and environmental, resulting from drug abuse by the youth. The youth who abused drugs struggle in a variety of ways, which includes academic, physical, and mental health issues, and cordial relationship with their peers, among others. That being said, drug abused by the youth have consequential impact on their health, and behaviors in general, due to its influence on the brain growth during the teenage and early twenties. --- Bunu et al --- Impact of Drug Abuse on the

It appears that drug abused by the youth, seriously impact their lives in many forms, making it hard for them to cope with their expected life routine. The review aims to address these challenges, by identifying the types and degree of drug abuse impact on the youth, and also suggest policy brief areas, which will direct the development of interventions that could reduce it. The review adopts a desktop approach of literature search of published articles. The search was conducted through Google Scholar and other websites with stakes in drug abuse issues, using 'drug' and 'abuse' search words simultaneously. In all, 26 published records were selected and explored for the narrative. Four categories of drug abuse impact on the youth are identified, thus, health, economic, social, and environmental issues. The issues inhibit the youth's ability to strengthen and develop the needed skills for an ideal healthy lifestyle. Furthermore, the impact of drug use is difficult to quantified, as such, regional specific impact study should be conducted, for the development of a content specific drug abuse prevention program, grounded on principles of an all-inclusive approach irrespective of age, gender and cultural diversity.

INTRODUCTION Narcotics (Narcotics, Psychotropics, and other Dangerous Addictive Substances) are materials/substances/drugs which, when entered into the human body, will affect the body, especially the brain/central nervous system, causing physical, psychological, and social health problems due to habits, addiction (addiction) and dependence (dependency) to drugs (Anggraini, 2016). Sidenreng Rappang is the largest rice-producing area or rice barn in eastern Indonesia. This complimentary stigma shifted that Sidenreng Rappang is now better known as a drug producer or drug barn, one of the centers of drug trafficking in South Sulawesi Province. This research is qualitative research, which aims to determine the network pattern that allows an increase in network cases that are the center of network operations and network operation mode in catching drug abuse (Rahmat Pannyiwi, 2020). --- METHODOLOGY This study used a quantitative research type with a pre-experimental research design (pre-post test design with one group). The research design used one group, previously a pretest was carried out to measure youth's knowledge of the dangers of drugs and then a post test was carried out. According to Sugiyono (2017), population is a generalized area consisting of objects/subjects that have certain qualities and characteristics set by researchers to study and then draw conclusions. Another opinion was put forward by Arikunto (2013), which stated that the population is the entire research subject. If someone wants to examine all the elements in the research area, then the research is a population study or population study or census. --- RESULTS AND DISCUSSION The results showed that the age of the respondents was 15-18 years. Most of the respondents' average age was 16 and 17 years (35%). Most of the respondents (63%) were male and almost the majority (37%) were female. Almost half (46%) of their parents work as Civil Servants. The results of the knowledge data test using the Wilcoxon test obtained a p value = 0.000 <0.05 using a 95% confidence level, meaning that there was an effect of health education on knowledge in Makassar Vocational High School students. In Fitriani's research (2017) it was found that as many as 52.7% of teenagers at SMAN 24 Jakarta who were the object of research were male. Adolescents with male sex have a greater risk of abusing drugs (79.2%), compared to adolescents with female sex (30.2%). --- CONCLUSION Health education is needed to increase a person's knowledge and abilities through practical learning techniques or individual instruction to increase health awareness so that they consciously want to change their behavior to be healthy, an important step in health education is to create messages that are adapted to include media selection, here researchers use health counseling to convey information that can have a significant effect on increasing knowledge and attitudes. The same research was conducted by Cristin (2017) which stated that there was an effect of health education on the level of knowledge with a p value of 0.000. This research is in line with Hanif, M (2017) Researchers found that there was an influence of health education through audio-visual on attitudes towards preventing drug abuse in class VIII adolescents at SMP Ma'arif Gamping Yogyakarta.

Adolescents always try to understand themselves and manage their behavior and emotions as much as possible, they will develop a positive self-image, reasoning power and the ability to manage thoughts, emotions and behavior, always trying to overcome the problems or stress they experience. However, teenagers are also inseparable from the attitude and behavior of fad or trial and error and can be curious to know more. Adolescents and youth are the next generation of nation building. The future development of the nation is very dependent on the quality of youth in the future as Human Resources. The purpose of this study was to determine the dangers of drugs in Makassar Vocational High School. This study uses a type of quantitative research with a pre-experimental research design (pre-post test design with one group). The research design used one group, previously a pretest was carried out to measure adolescents' knowledge of the dangers of drugs and then a post test was carried out. This research was conducted at Makassar Vocational High School. The results of the study showed that the age of the respondents was at 15-18 years. Most of the respondents' average age was 16 and 17 years (35%). Most of the respondents (63%) were male and almost half (37%) were female and almost half (46%) their parents worked as civil servants.

Objective People with disability may be at risk of developing diseases due to physical inactivity (1)(2)(3). The US Department of Health and Human Services recommends that people with disability engage in regular physical activities (4-6). Evidence indicates an inherent benefit of moderate to vigorous physical activity on health outcomes (7,8). Social support from family and friends is positively related to regular physical activity (9). Research is needed to understand whether people with disability are disproportionately affected by lack of support (2). We hypothesized that living alone will more negatively affect engagement in physical activity among people with disability in Florida than among those without disability. --- Methods This cross-sectional study used 2009 Florida Behavioral Risk Factor Surveillance System (BRFSS) data. BRFSS is a random-digit-dial telephone household survey of adults aged 18 or older administered annually by state and territorial health agencies with support from the Centers for Disease Control and Prevention (CDC). BRFSS collects demographic and health-related data using core questions. In 2009, Florida added disability-related questions. Respondents were asked BRFSS questions used to define disability, as well as state-added questions (Box). The state-added questions were used to create a 4-level disability severity variable: no disability and 3 mutually exclusive classifications for activity limitations for 6 months or longer and needing assistance with 1) instrumental activities of daily living (IADL) only; 2) assistance with activities of daily living (ADL), with or without IADL assistance; and 3) neither IADL nor ADL assistance. ADL are the basic tasks of self-care (eg, feeding, toileting, grooming, bathing, walk-ing, putting on clothes oneself), and IADL are elaborate skills needed for successful independent living (ie, finance managing, handling transportation, shopping, preparing meals, using a telephone or other communication device, managing medications, doing housework, and doing basic maintenance). We constructed a dichotomous variable, with participants "living alone" if they had no adults and no children younger than 18 living in their household. Then we assessed CDC-defined physical activity including any, moderate, and vigorous activity for at least 10 minutes each time in a usual week (10). Box. Disability definition and state-added questions used to develop the categories of disability, Florida Behavioral Risk Factor Surveillance System (BRFSS), 2009. --- Questions used to define disability (BRFSS core questions) Are you limited in any way in any activities because of physical, mental, or emotional problems? Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone? Questions used to create the severity levels of disability (state-added questions) Because of any impairment or health problem, do you need the help of others in handling your routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes? Because of any impairment or health problem, do you need the help of other persons with your personal care needs, such as eating, bathing, dressing, or getting around the house? How long have your activities been limited due to this condition or impairment? The response rate for the 2009 Florida BRFSS was 51% and included 12,055 respondents with landline telephones. Of these, 346 did not respond to questions that ascertained disability status; another 807 who reported activity limitations lasting less than 6 months were deemed to have a short-term disability and were excluded, yielding an analytic sample of 10,902. We assessed demographic composition of the sample by age, sex, race, education, employment, income, marital status, and health behaviors (ie, smoking and drinking). Differences in physical activity measures for each disability classification were stratified by whether the respondent was living alone at the time of the survey and were assessed by using multivariate logistic regression analysis and considered significant at P < .05. Interactions between disability status and living alone were tested. To give model estimates meaningful interpretation, adjusted average predicted probabilities of physical activity for each disability classification were calculated and adjusted to the overall distribution of covariates. All analyses were conducted using Stata/IC12.1 for Windows (StataCorp, LP) by using weighting procedures to account for the complex sampling design of the BRFSS. --- Results Overall, 51% of respondents were female, 61% were white, 60% were married, and 56% were employed. Mean age of respondents was 49 years, and 64% reported an annual household income below $50,000; 18% of the sample reported living alone. In total, 8,335 (76%) respondents had no disability, and of the remaining 2,567 who reported having a disability, 235 (9%) had ADL assistance needs, 713 (28%) had IADL assistance needs, and 1,619 (63%) had no needs. Respondents with a disability tended to be older, unmarried, and unemployed and had lower incomes than those with no disability. We found a lower prevalence of participants engaging in each category of physical activity across all 3 levels of disability (Figure ): any (running, gardening, or walking during the past month), moderate (bicycling, vacuuming, gardening, for at least 10 minutes per session in a usual week), and vigorous (running or heavy yard work, for at least 10 minutes per session in a usual week). One exception was found among people with ADL needs: a higher proportion engaged in vigorous activity than did people with activity limitations and IADL needs. The adjusted average predicted probabilities indicated that respondents who lived alone were less likely to engage in all levels of physical activity than were respondents who did not live alone (Table ). Of respondents with activity limitations and ADL needs who did not live alone, the predicted probability of engaging in any physical activity was 52.3% (95% confidence interval [CI], 34.3-70.4), 52.8% (34.1-71.4) for moderate activity, and 23.8% (6.9-40.8) for vigorous activity. For the same subsample who lived alone, the probability of engaging in any physical activity was 47.2% (29.3-65.1), 41.6% (21.8-61.3) for moderate activity, and 15.0% (2.5-27.5) for vigorous activity. All comparisons were significant across regression models. --- PREVENTING CHRONIC DISEASE --- Discussion Our findings suggest that living alone is a predictor of engaging in physical activity, among people both with and without disability. Adjusted average predicted probabilities of engaging in physical activity showed a consistent low prevalence across disability levels, regardless of household composition. However, people who lived alone were less likely to engage in any type of physical activity than were those who did not live alone across disability levels, and this had a disproportional impact on people with disability. Thus, living alone was negatively associated with engaging in all levels of physical activity (any activity, moderate, or vigorous) for people with disability. Our finding that people with ADL needs reported engaging in more vigorous activity than did those with IADL needs is counterintuitive. We think these results reflect the more integral cognitive functions of people with disability with ADL needs, which allow them to seek sources of support. We believe this finding warrants further exploration. Social support is important for engaging in healthy behaviors, including physical activity (7,8). Although living alone does not equate to lack of social network or support (11), it is associated with early onset of disability and death (1). Our findings could be used to develop a set of health interventions to promote wellness and combat social isolation, among people both with and without disabilities. For example, online support sites and Internet-based communities increase social support and sense of community among this population. Interventions that use these technologies (eg, mHealth) might have positive results engaging people with disability in physical activity (12). Our study had limitations. We used data from a representative survey with a large sample size. Although results are generalizable to households with landlines in Florida, a steady decrease in the use of landlines among young people may have caused underrepresentation of this demographic group. Survey data were self-reported and are subject to recall and social desirability biases. Public health efforts should consider the role of household composition in increasing physical activity, among people both with and without disability. Moreover, efforts in improving physical activity among people with disability should take into account social support, specifically household composition. --- Author Information Corresponding

People with disability may be at risk of developing diseases due to physical inactivity; social support from family and friends is positively related to engaging in regular physical activity. We compared the association between living alone and engagement in physical activity among people with and without disability in Florida. We used multivariate logistical regression to analyze 2009 Florida Behavioral Risk Factor Surveillance System data (n = 10,902) to assess differences in physical activity in disability levels for respondents who lived alone versus those who did not. Respondents with a disability were less likely to engage in physical activity than were people without a disability, regardless of disability type, and the lowest rates of engaging in physical activity were found for people with disability who lived alone. Public health efforts should consider the role of household composition when targeting physical activity interventions among people with disability.

INTRODUCTION Over a billion children experience violence each year, with a disproportionate number of those in the Global South (1). Violence against children has been linked to a multitude of immediate and long-term negative health outcomes and substantial economic costs. It violates the UN Convention on the Rights of the Child, and ending "abuse, exploitation, trafficking and all forms of violence against and torture of children" and "all forms of violence against all women and girls in the public and private spheres" are specific targets of the 2030 Sustainable Development Goals (SDG 16.2 and SDG 5.2). There are a number of evidence-informed and promising interventions for preventing and reducing violence against children, such as those detailed in the World Health Organization-led INSPIRE framework (2)(3)(4)(5)(6)(7)(8). To achieve the SDGs, these interventions need to be scaled up and evaluated at the population level (9). However, the current evidence base on scaling up violence prevention strategies and evaluating their scale-up is limited, particularly in LMICs [see (10) --- on scaling social norm change interventions and (11) on scaling early childhood development]. There is a growing evidence base of research on parenting programs, including promising results in diverse LMIC settings [e.g., (12)] and studies on scaling parenting programs in highincome countries [e.g., (13)], but studies examining scaling parenting programs in LMICs are urgently needed to inform practice in the field. While randomized trials are important for understanding intervention effectiveness, they are often conducted under circumstances that do not fully reflect real-world delivery. For instance, the external validity of study results is limited when particularly competent and well-resourced organizations take part in research studies. Thus, initially effective interventions may face a high risk of failure when taken to scale (14). --- CHALLENGES OF SCALE-UP Successful scale-up encompasses expanding program coverage and quality to larger populations or areas and embedding program delivery into lasting systems (15). The successful scale-up of violence prevention programs is challenging for a variety of reasons. As violence against children is an issue that cuts across sectors such as health, social welfare, education, and justice, violence prevention programs often require multisectoral cooperation to fit within existing service delivery systems that face substantial resource constraints. In addition to the financial commitment and material resources necessary to sustain programs, implementing agencies also need the structures and technical capacity to deliver interventions with fidelity and quality. Although task-shifting through community or lay workers is often seen as a solution for rapid scale-up of lowcost service provision in LMICs, the training, supervision, and retention of such workers can be costly and requires effective organizational management (16). Moreover, frontline service providers are frequently overburdened and underpaid, resulting in high turnover or poor service delivery in low-resource settings where the need is greatest. We also have to accept that program implementers often resort to ad hoc and reactive adaptation-for example, to simplify or reduce costs of social interventions-thus deviating from the evidence established in randomized trials. Interventions may either mature and evolve to suit the cultural and organizational context better, or they may drift and include counterproductive changes. Substantial research has been conducted on cultural adaptation, and scholars have identified the importance of adapting interventions for implementation in routine settings. However, beyond the formal studies of adaptation, the vast majority of adaptations are ad hoc and not reported (17). There is also scarce evidence on the impact of these informal adaptations made during scaling up, highlighting a need to continue researching interventions as they are delivered more widely and within new systems. Furthermore, measuring violence is challenging, for instance due to stigma and related under-reporting (18,19), and reliable administrative data on the implementation and outcomes of services related to violence against children are rarely available. Thus, continuously improving and conducting research on violence prevention programs at a large scale or within scaled-up programs presents formidable challenges. --- SCALE-UP OF PARENTING EVALUATION RESEARCH STUDY A new collaboration between researchers and implementing agencies is the Parenting for Lifelong Health Scale-Up of Parenting Evaluation Research (SUPER) study (20). This crosssectoral collaboration is working to harness implementation science in order to study and maximize the scale-up and effectiveness of parenting interventions that reduce violence against children and improve child well-being. It focuses on the recent rapid dissemination of two Parenting for Lifelong Health (PLH) parenting programs throughout LMICs, PLH for Young Children (2-9 years), and PLH for Parents and Teens (10-17 years) (21). PLH is a suite of evidence-based parent training programs based on social learning theory and designed to reduce violence against children. Originally developed based on evidence of key parenting program components (3,22), and tested in South Africa, PLH programs have demonstrated positive impacts in randomized trials in reducing violence against children, improving child development and mental health, and increasing family economic well-being (23)(24)(25)(26). The PLH programs involve a series of weekly group meetings and/or home visits based on the structure provided by the intervention manuals. Since their initial testing, PLH for Young Children and PLH for Parents and Teens have been rapidly disseminated to over 25 LMICs at varying degrees of scale, with additional trials forthcoming in other countries. A range of government, non-governmental, and parastatal agencies deliver PLH, often within large-scale donor-driven initiatives in combination with other social services and implementation packages. For example, in several countries in Sub-Saharan Africa, PLH has been delivered within the DREAMS projects funded by PEPFAR-USAID focusing on adolescent girls and young women. In some settings, PLH programs have been integrated into existing government packages of services, such as the Philippines' government conditional cash transfer system and the Thailand public health promotion system (27)(28)(29). By the end of 2022, PLH programs are expected to reach approximately half a million families in Sub-Saharan Africa, Eastern Europe, South and Southeast Asia, and the Caribbean. In response to the COVID pandemic, in 2020 a set of parenting tips based on the PLH programs has been made freely available and accessed by estimated 136.1 million people through a global collaboration that includes international agencies, as well as governments and NGOs (30). The SUPER study represents an opportunity for researchers, policymakers, donors, implementing agencies, and community stakeholders from within and outside LMICs to collaborate in order to deepen our understanding of the scale-up of family-based interventions in low-resource settings (see Figure 1 for an overview). The study aims to examine processes for effectively adopting, implementing, adapting, monitoring, and disseminating PLH programs. Translational research is a particular focus of the SUPER study, investigating processes and mechanisms for successful delivery of evidence-informed interventions through existing service delivery structures. It also examines program transferability across cultures and contexts, and how variations in design, implementation approach, and participant engagement are associated with family and programlevel outcomes. Finally, it addresses questions around financial and human resources needed to sustain scale-up and identifies overall trends and factors related to successful scale-up. Analyses of program costs may also be used to assess and improve the performance of PLH programs to maximize child well-being. The SUPER study will use innovative research methods, drawing on ongoing service delivery data, as well as qualitative and quantitative research data collection that includes trial data, to generate quality evidence that will inform programming. The study will include data at the individual, familial, organizational, and national levels. It will focus on insights for action, andbeing mindful of the burden on service providers-aim to uphold the principle to "only collect data you can commit to use" [(31), p. 26]. Another major component of the study is mutual learning and ongoing program improvement, through which researchers gain insights about implementation at scale while implementing agencies gain skills in robust monitoring strategies and evidence generation. Collaborators will also work together to maximize the dissemination and utilization of research at community, national, and international levels. The SUPER study is thus offering a window of opportunity to close the gap between research and practice in the area of violence prevention and enhancement of child well-being through parenting support. --- DISCUSSION Achieving SDG targets 5.2 and 16.2 by ending violence against children will require researchers, technical experts, policymakers, governments, donors, implementing agencies, local program managers, and community stakeholders to work closely together to answer challenging questions regarding how programs can both be effective and sustained at scale. Through these collaborations, we may begin to learn how we can best prevent violence against children and support frontline violence prevention. As a global community, it is essential that we advance scientific knowledge on what works, for whom, and how, to improve the well-being of children and their families at scale; the PLH SUPER study aims to act on this agenda. --- DATA AVAILABILITY STATEMENT The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author. Study materials are available on the project Open Science Framework page: https:// osf.io/v597r/. --- AUTHOR CONTRIBUTIONS YS, LC, and JL have led the writing of the paper. All authors have contributed to conceptualizing the paper, reviewed the manuscript, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work. The remaining 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.

Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the implementation and impact of these programs in respect to their delivery at a large scale or within existing service systems, particularly in low-and middle-income countries (LMICs). We advocate for greater collaboration between researchers, policymakers, donors, governments, non-governmental organizations, and program managers and staff to study how violence prevention programs operate on a large scale. We describe a new initiative aiming to foster such collaborations in the field of family strengthening programs.

Introduction The digital divide is the gap between those who have access to and benefit from modern information technology and those who don't [1]. Originally, the focus was set to access, mainly to computers and an internet connection. Nowadays, this divide is understood as a gap in the ability to use and gain benefits from technology, not only limited by access [2]. There are many factors acting on this divide such as gender, socioeconomic level, education and age [3]. The elderly are a group particularly at risk, as they are "digital immigrants", not having the life-long exposure to technology as younger generations [4], as well as physical and cognitive disabilities [5]. The world's population is rapidly aging, primarily in developing countries. In 2019, there were 703 million people aged 65 years or older (9.1% of the global population), this number is projected to double to nearly 1.5 billion in 2050 [6]. The increasing proportion of older adults presses upwards pressure on overall healthcare spending, as the use of medical care services rises with age, as well as per capita costs of healthcare [7][8]. Personal health records (PHRs) may be a valuable tool for older adults to manage their personal health information and self-manage their health and conditions [9][10]. They have been shown to provide long-term positive net value for organizations [11]. Usings PHRs patients may view information like laboratory results and medication history, securely message their physicians, request prescription refills, and schedule appointments [12]. Factors influencing the digital divide in this population may hinder their possibilities to fully adopt PHRs and their benefits, this must be taken into account in design and implementation [5]. The goal of this study is to explore the digital divide as a barrier for the use of a PHR in older adults (> 69 years of age) and describe the use of a PHR in an elderly population in Argentina. --- Methods --- Setting Our study took place at Hospital Italiano de Buenos Aires (HIBA), a community-based tertiary care hospital located in Buenos Aires, Argentina. HIBA is a HIMSS Level 7+ organization with an in-house developed health information system [13]. An integrated PHR has been available since 2007. Its main functionalities include: appointment scheduling, test results visualization, patient-practitioner secure messaging, health information sharing, medication management, and different teleconsultation modalities. At present, it has approximately 400,000 registered users. HIBA has its own health insurance called Plan de Salud (PS) with over 150,000 affiliates. --- Design, participants and data collection We conducted a cross sectional study which included older adults who attended the Coronavirus vaccination campaign between March and April 2021. Eligible participants were included if they were older than 69 years old and affiliated to HIBA PS. Those physically or mentally unable to answer were excluded. Participants consented orally to participation. Data were collected through a survey designed by an interdisciplinary team of health informatics specialists, sociologists and psychologists. The survey encompassed demographic characteristics, educational level, internet connection, access to electronic devices, use of PHR, need of assistance to use the PHR and functionality usage. --- Ethical considerations The research project was approved by the institutional ethics committee (CEPI # 4501). The study was performed in full agreement with current national and international ethical regulations. --- Results A total of 128 participants agreed to complete the survey. The median age was 77 (IQR 6) years old and the female sex was predominant (61.71%). All surveyed had a HIBA PHR account but only 60.15% reported using it. Most non-users' PHRs were managed by someone else, usually a family member. We explored variables related to the digital divide as internet access and electronic devices. We found a statistically significant correlation of having a personal computer (p <0.001) and internet access (p = 0.003) with PHR use. Also evidenced with the variable education (p = 0.03). --- Discussion In this study, we attempted to explore the digital divide in elderly users and non-users of a PHR and describe its use with the objective of rethinking effective ways to engage this population in the adoption of personal health records. It is often assumed that the elderly population are non technology users [14], however our results showed that 88.28% had internet access, 71.87% had a personal computer and almost all the surveyed had smartphones. As the years go by this is a changing reality, the preconceptions about older adults from decades ago are no longer true today. They have a higher level of connectivity, use smart devices and connect to the internet to keep in touch, socialize, manage their finances and consume media [15]. There is pending work in the eHealth field to integrate these elders into current PHRs and help them enjoy their benefits. This area is also critical when considering the possibilities of AI in PHRs, enhancing patient's experience (such as study interpretation support and presenting relevant information), understanding their perspective and attitudes towards AI and technology is key for successful implementation and AIsupported PHR enhancements. When exploring the difference between PHR users and non-users, having a smartphone couldn't be correlated with PHR use, however having a personal computer was statistically significant (p <0.001) and may be related with regular internet usage and a higher skill level regarding information technology. Computer literacy has been described as a common barrier for PHR use in works such as Jabour et al [16]. Another determinant for use is education level, our results (p = 0.03) are consistent with similar findings reported in the literature. Educational level is a known determinant of health. A higher education gives people the tools they need to access the health system and effective self-care. Advanced education may be a proxy for higher socioeconomic status. Both factors have been described as determinants of the digital divide [17]. Almost half of the participants who used the PHR (45.45%) said they needed some kind of assistance. While they may be aware of its functionalities and willing to use it they couldn't manage it by themselves completely. This division in assistance needed shows that this is an heterogeneous population regarding their usability and accessibility needs. It should be a strong point to take into consideration when designing PHRs: both accessibility options for the elderly and taking into account that not only the patients themselves may be users, but also families and caregivers. Similar findings have been reported by Kim et al [18]. Although the elderly population represents a large portion of patients, there is not enough research done on their use experience using eHealth solutions. Not fully understanding their needs and usage patterns may cause PHRs design to "not fit" properly into their daily lives, homes and needs. It is necessary to study the elderly in their different contexts. Many are living in nursing or retirement homes, which may be simpler to approach for researchers, in contrast with adults who live in their own homes. It's easy to group them into a single label, hiding their true complexity. While there are many studies in the literature researching PHR use and the digital divide, most have a Northamerican or European setting. These could not adequately represent the population of developing countries such as Argentina, where the education and socioeconomic realities are different. Our research is relevant because it is the first to explore PHR use and the digital divide in an elderly population in our local context. This study has some limitations. This is a single-center study and sample size (n = 128) was limited for practical reasons, which impacts the generalizability of this work. The older adult participants may not be representative of the general older adult population affiliated to PS, nor the general elderly population of Argentina, as private medicine patients represent a wealthy strata. On another note, patients had to be physically able to travel to the hospital to receive the vaccine, these could be sources of bias in our sample. As a future line of work, we intend to explore more aspects of the digital divide, PHR user satisfaction and usability, expand our sample size and collaborate with other medical centers. This study is foundational to future work and research in the area. --- Conclusion The digital divide can hinder the ability of elderly patients to fully benefit from PHRs. The findings from this study revealed that many digital divide factors are related with PHR use among older adults, as has been reported in the literature. More research is necessary, applying a usability approach, to explore their needs and patterns of use, as well as their capabilities. In the future, more of our users will be older adults, it is necessary that health informatics professionals begin to take them into account as relevant eHealth consumers.

The digital divide can hinder the ability of elderly patients to fully benefit from PHRs. They are "digital immigrants", not having the life-long exposure to technology as younger generations, as well as physical and cognitive disabilities. The aim of this study was to explore the digital divide as a barrier for the use of a PHR in older adults (> 69 years of age) and describe the use of a PHR in an elderly population in Argentina. We conducted a cross sectional study which included older adults who attended the Coronavirus vaccination campaign in 2021. Data were collected through a survey encompassing digital divide factors and use of the PHR. A total of 128 participants agreed to complete the survey, 60.15% reported using the PHR. We found a statistically significant correlation of education level, having a personal computer and internet access with PHR use. Concerning PHR users, 45.45% reported needing assistance to use it. Although the elderly population represents a large portion of patients, there is not enough research done on their use experience using eHealth solutions. There is pending work in the eHealth field to integrate these elders into current PHRs and help them enjoy their benefits.

To live in the world is to adapt constantly. A year after COVID-19 pandemic has emerged, we have suddenly been forced to adapt to the 'new normal': work-from-home setting, parents home-schooling their children in a new blended learning setting, lockdown and quarantine, and the mandatory wearing of face mask and face shields in public. For many, 2020 has already been earmarked as 'the worst' year in the 21st century. 1 Ripples from the current situation have spread into the personal, social, economic and spiritual spheres. Is this new normal really new or is it a reiteration of the old? A recent correspondence published in this journal rightly pointed out the involvement of a 'supportive' government, 'creative' church and an 'adaptive' public in the so-called culture. 2 However, I argue that adapting to the 'new normal' can greatly affect the future. I would carefully suggest that we examine the context and the location of culture in which adaptations are needed. The term 'new normal' first appeared during the 2008 financial crisis to refer to the dramatic economic, cultural and social transformations that caused precariousness and social unrest, impacting collective perceptions and individual lifestyles. 3 This term has been used again during the COVID-19 pandemic to point out how it has transformed essential aspects of human life. Cultural theorists argue that there is an interplay between culture and both personal feelings (powerlessness) and information consumption (conspiracy theories) during times of crisis. 4 Nonetheless, it is up to us to adapt to the challenges of current pandemic and similar crises, and whether we respond positively or negatively can greatly affect our personal and social lives. Indeed, there are many lessons we can learn from this crisis that can be used in building a better society. How we open to change will depend our capacity to adapt, to manage resilience in the face of adversity, flexibility and creativity without forcing us to make changes. As long as the world has not found a safe and effective vaccine, we may have to adjust to a new normal as people get back to work, school and a more normal life. As such, 'we have reached the end of the beginning. New conventions, rituals, images and narratives will no doubt emerge, so there will be more work for cultural sociology before we get to the beginning of the end'. 5 Now, a year after COVID-19, we are starting to see a way to restore health, economies and societies together despite the new coronavirus strain. In the face of global crisis, we need to improvise, adapt and overcome. The new normal is still emerging, so I think that our immediate focus should be to tackle the complex problems that have emerged from the pandemic by highlighting resilience, recovery and restructuring (the new three Rs). The World Health Organization states that 'recognizing that the virus will be with us for a long time, governments should also use this opportunity to invest in health systems, which can benefit all populations beyond COVID-19, as well as prepare for future public health emergencies'. 6 There may be little to gain from the COVID-19 pandemic, but it is important that the public should keep in mind that no one is being left behind. When the COVID-19 pandemic is over, the best of our new normal will survive to enrich our lives and our work in the future.

A year after COVID-19 pandemic has emerged, we have suddenly been forced to adapt to the 'new normal': work-from-home setting, parents home-schooling their children in a new blended learning setting, lockdown and quarantine, and the mandatory wearing of face mask and face shields in public. For many, 2020 has already been earmarked as 'the worst' year in the 21st century. Ripples from the current situation have spread into the personal, social, economic and spiritual spheres. Is this new normal really new or is it a reiteration of the old? A recent correspondence published in this journal rightly pointed out the involvement of a 'supportive' government, 'creative' church and an 'adaptive' public in the so-called culture. However, I argue that adapting to the 'new normal' can greatly affect the future. I would carefully suggest that we examine the context and the location of culture in which adaptations are needed.

Outcome measures: 7-day average of weekly visits per clinician, both in-person and telehealth, tracking trends in the volume of care provided before and during the pandemic by patient race/ethnicity. We defined telehealth conversion ratio (TCR) as the number of telehealth visits during the pandemic divided by the total number of pre-pandemic visits. We calculated TCR and visit volume changes from March 15 through the end of 2020 relative to the same period in 2019. Results: During the pandemic we observed decreases of 12% and 22% in the average number of total and in-person visits, respectively, as well as a 10% TCR. Total visits reached a nadir in April 2020 with a 29% decrease from the same point in 2019. Telehealth visits peaked the following week with 23% of that week's total visits, and 139 times more than 2019. Total visits decreased and telehealth visits increased for patients of all races/ethnicities. The magnitude of these changes differed, with Black (5% decline, 15% in-person decline, 10% TCR) and Hispanic (9%, 24%, 15%) patients seeing less of a decrease in total visits than White (12%, 21%, 9%) and Asian (16%, 30%, 14%) patients. Conclusion: Declines in primary care visits during the pandemic were partially offset by an increase in telehealth use. Utilization in our sample suggests less decline in Black and Hispanic patient primary care utilization during the pandemic than expected, in contrast to Asian patients, who demonstrated the largest declines. This metric and these results are novel and foundational for ongoing & further study using other data sources.

Context: Early evidence suggests that many patients chose to forgo or delay necessary medical care during the COVID-19 pandemic. Existing and well-documented racial and ethnic disparities in access to care were exacerbated by the pandemic for many reasons, potentially including the additional barriers involved in a rapid shift to telehealth for certain groups of patients. Objectives: 1) Examine changes in primary care visit volume and telehealth during the COVID-19 pandemic. 2) Test for racial and ethnic differences in primary care in-person and telehealth visits during the pandemic relative to pre-pandemic levels. Study design: Longitudinal. Datasets: EHR data including patient visits, procedures, and demographics captured in the American Board of Family Medicine's PRIME Registry.

Introduction: Food allergy and atopic dermatitis are significant pediatric health problems in many developed countries. The prevalence of these conditions has been increasing over the past two decades in Western societies. However, there is a lack of epidemiological data for Bulgaria. --- Purpose: To study the frequency of different manifestations of doctordiagnosed allergies among families with atopy in Bulgaria. --- Materials and methods: A cross-sectional study was conducted among 2,408 families with mothers of childbearing age hospitalized between 2017 and 2019 in the Maternity Ward of St. Anna hospital -Varna, Bulgaria. A direct individual questionnaire was applied to obtain information on social-demographic characteristics and manifestations of various forms of allergies. Data was analyzed with SPSS v. 21.0. --- Results: The relative proportion of families with evidence of allergy on the side of the mother, father, or child was 11.63% (n = 280). The incidence of allergic diseases among mothers was 60.5% (n = 127), among fathers 38.6% (n = 8), and among children 57.8% (n = 63). Rhinconjunctivitis was the leading allergic manifestation in mothers (29.5%; n = 62) and fathers (24.8%; n = 52), and atopic dermatitis was the most common manifestation of allergy in their child (30.3%; n = 33). A significant relationship was established between atopic dermatitis in the family and the overall incidence of allergies in the child. --- Conclusions: The data resulting from our study may serve as a basis for further research so the mechanisms of atopy to be investigated better. Prevention strategies need to be developed to address the march of allergy, characterized by the initial manifestation of allergy in childhood with atopic dermatitis and moving to food and respiratory manifestations. --- Key messages: The incidence of allergies has been increasing in recent years both in the world and in Bulgaria. Rhe development of preventive measures to reduce the risk of allergic diseases could be of great importance for public health. --- Background: In some high-income contexts, the COVID-19 pandemic was associated with improved birth outcomes, which was hypothesised to be caused by a positive effect of the pandemic on maternal health. Conversely, an improvement in birth outcomes may have been driven by pandemic-induced compositional changes in parental characteristics, which are associated with health outcomes at birth. Research on this consequence of the COVID-19 pandemic is critical for understanding pandemic-induced changes in population health (inequalities) and planning of public service provision. --- Methods: We analysed population-wide data on birth outcomes and parental sociodemographic characteristics from Finland collected between January 2015 and December 2021 (n = 336,000). The total effect of pandemic-induced compositional changes on birth weight and preterm birth rate was estimated by segmented regression models using three conception cohorts: a) conceived prior to May 2019, b) conceived between June 2019 and February 2020 (to account for in-utero exposure to the pandemic), and c) conceived during the pandemic between March 2020 and February 2021 (to prevent selection bias). --- Preliminary Results: Adjusting for secular trends and seasonality, and accounting for in-utero exposure to the pandemic, the estimated effect of parental compositional change on average birth weight was 36.5 grams --- Background: The attitudes that underlie vaccine hesitancy are important for predicting individuals' vaccination behaviour but also for

infection, with fever and cough being the most prevalent. In addition, one parent was tested at the school and was also diagnosed with influenza B, indicating the spread of the virus within the community. Gaps were identified in the scope of public health, including the lack of outbreak response protocols and an effective communication network with schools. In order to address these shortcomings, it is intended to develop action protocols for outbreak scenarios in the school environment and establish a closer response between public health services, and the school community. The innovative approach of the Albufeira PHU can serve as a model for other settings and countries.Effective collaboration between healthcare providers and schools is essential to mitigate the impact of infectious disease outbreaks in the school environment. The development and implementation of outbreak response protocols is critical to ensure a coordinated response to infectious disease outbreaks.

Inequality of Access The first challenge is that Internet penetration is very heterogeneous (from 98% in Iceland to 2% in South Sudan) and reaches just 59% of the world population. 1 This mainly leaves out developing countries as well as poor people everywhere, creating an immediate wealth bias in Internet as a data source. Indeed, the penetration does not reach 40% in Africa while goes up to almost 95% in North America. In contrast, mobile phone penetration is larger than Internet penetration, specially in developing countries, reaching almost 67% of the Earth population. --- Social Media and Data Privacy Social media or online social networks (OSN) users are estimated in 3.8 billions, which represent almost 49% of the world population and 83% of the people with Internet access. In Table 1 we show the main online social networks, including implicit ones (chat apps) and excluding the ones focused in China (QQ, Qzone, Sina Weibo, and Kuaishou) with the exception of WeChat. These numbers must be considered as proxies to the real numbers as they come from different sources where not always there is consensus. As we can see in Table 1, in many cases data is not public, hence we need to assume that people that makes their data public is similar to the one the keeps their data private. This is a very strong assumption and there are no studies, to the best of our knowledge, showing this (can only be done by each OSN). In addition, in many cases we sample the data with an API provided by the OSN. Hence we need to also assume that this sample is random, but probably is not completely true as at least some filtering might be done (e.g., adult or hate content). --- Biases The first bias is activity bias [2]. That is, not all people are active all the time. Indeed, Nielsen proposed the 90-9-1 rule to convey participation inequality in Internet [5]. That is, in any segment of time, 90% of the people is passive (lurkers), 1% is heavily active and 9% react to that activity. For example, in Table 1 we show active monthly and daily users when available, but the overall number of users of each OSN is in many cases much higher (e.g., for LinkedIn is about 670 million). If we consider the percentage of active users that generate half the content, we have found 7% and 2%, for Facebook and Twitter, respectively [1]. These values are consistent with the 90-9-1 rule and imply that content per user is quite heterogeneous, not only in content, but also in volume. 1: Main online social networks (some are implicit) and their characteristics (age ranges are partial). (Sources: statista.com, hootsuite.com, dustinsout.com, khoros.com, wikipedia.org) Figure 1: Age bias in a Twitter user sample for Chile. The second bias is demographic. Gender, age, and other characteristics do not necessarily reflect the general population. As we can see in Table 1, some social media are dominated by women while others are dominated by men (the numbers represent an informed guess as in some cases there is no consensus among the different sources). Similarly, some OSNs are dominated by young people while others are dominated by adults over 35 years old. --- Discussion Demographic bias can be mitigated by segmenting the users by gender and age ranges. To do this we need to build classifiers for gender and age range prediction, using users that self-report those attributes as training data. Then, we must compare the percentage of users in each segment with the latest census of the country where we are doing the analysis, to know how to weight each segment so we get the real representation of it. We did this in an analysis of Twitter data during the legislation of a controversial abortion law in Chile and when compared to real surveys, we got representative results [4]. Figure 1 shows the differences in age segments for self-reported, predicted and overall population. In this same work we estimated that 43% of the users were women, much more than the world average, probably due to the topic under study. Hence, demographic biases can be very different from one country to another. Finally, when analyzing social media data, there is the tendency to look at the top-k influencers. For example, which percentage of them have a property (e.g., are foreign). However, this is completely bogus as the percentage depends on the value of k. In fact, we can choose k to maximize this percentage which will be much larger than the real percentage when all users are considered (a number much larger than k). We have seen this mistake in many studies, including some that are well publicized [3]. --- BIOGRAPHY

Social media data is often used to pulse the opinion of online communities, either by predicting sentiment or stances (e.g., political), to mention just two typical use cases. However, those analysis assume that the data samples really represent the underlying demographics of the overall community, both, in number and characteristics, which in most cases is not true. As a result, extrapolating these results to larger populations usually do not work. This happens because social media data is inherently biased, mainly due to two facts: (1) not all people is equally active in social media platforms and most of them are really passive; and (2) there are demographic biases in gender and age, among other attributes. Hence, the questions of how representative is the data and if is possible to make it representative are of crucial importance. We also discuss related issues such as using public samples of mostly private platforms as well as typical errors in the analysis of such data.• Networks → Social media networks; • Social and professional topics → User characteristics; • Computing methodologies → Machine learning.

Introduction Sexually transmitted infections (STIs) have been stigmatized since syphilis was associated with sin and moral laxity in 14 th century Europe. 1 Until modern times, STIs were known collectively as venereal diseases with undifferentiated stigma because many infections were unrecognized or poorly defined. 2 In the AIDS era, HIV stigma is widely considered to be distinct from and more severe than other STIs. 3 However, the stigma of non-HIV STIs still exists and is blamed for a host of problems, including delayed treatment and increased morbidity from common infections. 4 Differences between non-HIV and HIV stigma have yet to be examined fully, although work by Fortenberry et al. (2002; 2004) and others have begun to address this issue in clinical settings. 5,6 In their study of community-based stigma, Lichtenstein, Neal, and Brodsky (2008) identified higher levels of HIV stigma compared to other STIs, but found that these "lesser" infections attracted substantial stigma as well. 7 In that study, non-HIV STIs were all considered to be a sign of sexual immorality regardless of the perceived seriousness of the disease. This result is perhaps unexpected given that most STIs are curable or highly treatable and are among the most frequently reported diseases in the United States. 4 The present study examined differences in relation to stigma for HIV/AIDS and non-HIV STIs among a community sample in a southern U.S. state, the region with the highest HIV/STI rate in the U.S. 8 We used two stigma constructs from Goffman's (1963) theory on stigma: damage to social reputation (a social attribution, often based on group stigma) and attributions of moral weakness for afflicted individuals (an individual attribution for blame, broadly defined in terms of a deficient personal trait). 9 These theoretical constructs have been applied to numerous studies on disability, and on mental and physical illness including for STIs. 10,11,12 Clinical studies typically differentiate between group and individual stigma in describing barriers to partner notification and treatment for STIs. 5,6 In Lichtenstein, Hook, & Sharma's (2005) community survey, respondents were unlikely to notify their sexual partners if they feared being labeled as immoral or sexually deviant. 13 They were also likely to delay or avoid treatment for fear of being classified as members of a stigmatized group (e.g., STI clinic attendees). For the present study, the two constructs were operationalized in items about damaged reputation and moral weakness of character for seven infections ranging from least serious (pubic lice) to most serious (HIV/AIDS). We hypothesized that stigma differences would occur for the selected STIs based on perceived seriousness in social or clinical realms. --- Method --- Participants The respondents (n=537) were predominantly white (78%) and female (63%) with a mean age of 52.6 years. Forty-six percent of respondents were unemployed; the retired 30% of respondents were counted as unemployed. Fifty-eight percent of respondents were married, 85% had at least a high school education, and 69% lived in an urban area. Ninety-six percent of respondents reported a religious affiliation (79% self-identified as Protestant). Elderly persons, women, and whites were over-represented compared to the general population. This artifact is common in RDD surveys. 14 --- Procedure A random-digit-dialed (RDD) telephone survey asked adults in Alabama, USA, about stigma attributions for HIV and other STIs. The research was approved by the University of Alabama Institutional Review Board. The survey was embedded in a larger yearly omnibus survey of attitudes held among citizens who were representative of the state. The questions were asked by staff at the Institute of Social Science Research at the University of Alabama who were blind to the purposes of the study. After successful contact was made, respondents were informed that they would be asked three questions about sexually transmitted diseases. Thirtyfive respondents (6%) spontaneously objected to the topic and did not complete the survey. The respondents who agreed to participate were then asked to rank the stigma of seven types of infection: pubic lice, gonorrhea, syphilis, chlamydia, genital warts, genital herpes, and HIV/AIDS. Our response rate was 93.9% of surveys completed, which yielded 537 respondents for the final sample. The survey items were developed from the two stigma constructs: "damage to social reputation" and "weak moral character." The survey questions were posed as follows. 1. Respondents were asked to identify which STI would be most damaging to someone's social reputation by choosing one of eight items. Options were genital herpes, gonorrhea/clap, HIV/AIDS, genital warts, syphilis, pubic lice/crabs, chlamydia, don't know/ other. --- 2. The respondents were then asked which STI was the second most likely to damage social reputation by choosing one of the remaining seven options listed in question 1. --- 3. The third item took the form of a set of questions that asked respondents to rate each STI on a scale of 1 to 5 for the weak moral character construct, with 1 being "do not agree" and 5 being "strongly agree" for each STI. --- Results For the first question, 74.8% of respondents reported that HIV/AIDS would be the most damaging to somebody's reputation. This response was significantly higher than for any other choice, with genital herpes (3%) ranked a distant second. For the second question, 26.4% of respondents identified genital herpes as the next most stigmatizing infection. Again, this response was significantly higher than for any other choice, with syphilis (17.3%) ranked after genital herpes. For both the first and second choice options, the responses for chlamydia, genital warts, and pubic lice ranked well below the responses for HIV/AIDS (Table 1). - --- INSERT TABLE 1 ABOUT HERE - Results for the weak moral character sequence of stigma questions were analyzed through paired-samples t-tests. Agreement with the 5-point Likert-type scale is presented with means and standard deviations for each STI (Table 2). The options ranged from 1 ("strongly disagree that [STI] is a sign of a weak character") to 5 ("strongly agree"). As opposed to the results for items 1 and 2, responses to item 3 indicated that HIV/AIDS had the lowest mean score for any infection. Thus, acquiring HIV/AIDS was perceived to be less and HIV/AIDS. Nevertheless, the mean scores in this section ranged from a high of 3.72 for chlamydia to a low of 3.72 for HIV/AIDS, indicating moderately high stigma for all STIs in terms of blame for being infected (Table 2). - --- INSERT TABLE TWO ABOUT HERE - --- Discussion These results help to differentiate between STI and HIV stigma as perceived by a representative sample of residents in a southern US state. HIV/AIDS was rated significantly more likely to damage someone's social reputation than the other infections. However, HIV/AIDS attracted the least stigma for the weak moral character items compared to other STIs. This paradox illustrates how HIV/AIDS is understood differently from other STIs, and might be explained by social desirability bias. 15 In this bias, respondents correct for attitudes they know to be unpopular, or their responses reflect media influences that frame HIV-positive people as sympathetic victims 16 (e.g., in the case of "AIDS victims" in sub-Saharan Africa). The dichotomy identified here suggests that non HIV-STIs may be viewed as merely "nasty." By contrast, HIV stigma has eased over time, with fear-based punitiveness towards HIV-positive people declining substantially in recent years. 17 The finding that attributions of blame in the "weak moral character" section were moderately high for all STIs is meaningful because personally experienced stigma is a barrier to care-seeking. 6 This convergence suggests that stigma is relatively consistent for all STIs included in this study regardless of the seriousness of the infection. 7 Nevertheless, caution should be taken in interpreting the results. In the case of STI stigma, respondents may lack sufficient knowledge about the "lesser" infections to know how to rank each condition in terms of relative stigma. As noted in Table 1, 10.7% and 19.2% of respondents to items 1 and 2 answered "don't know" or "refused" for the stigma rankings. These non-responses indicate that some respondents may have been unable to distinguish between different STIs or found the ranking process to be unpleasant, itself a possible reflection of stigma attributions. If the sample refused to answer because of inability to distinguish between STIs, then this deficit raises the issue of the role of stigma in lack of knowledge about infections that range from the merely irritating (pubic lice) to lifethreatening (syphilis and HIV/AIDS). The results of this study have implications for prevention and treatment in the southern US. If common STIs are more likely than HIV/AIDS to attract stigma because of attributions of individual blame, then even minor infections might result in delays and non-treatment, which clearly has implications for prevention. The heightened stigma for minor STIs may be implicated in the high burden of STIs in the United States, especially if lack of awareness about different STIs results in widespread avoidance of screening and treatment. 4 Clinicians should be aware of this relatively undifferentiated stigma, at least in Alabama, USA, and of the possibility that patients will refuse to disclose symptoms for fear of stigma, even when the infection is minor or highly curable. Further research should determine whether these findings are applicable to other regions. If so, treatment and prevention efforts should be tailored accordingly. On a final note, our results suggest that prevention messages, particularly in the southern US, should target all STIs rather than target HIV risk alone. Such messages would take account of the knowledge that non-HIV STIs are substantially more prevalent than HIV/AIDS in the United States and other western nations, and that stigma is a relatively unitary construct as measured in Alabama that impedes the reduction of both HIV/AIDS and non-HIV STIs.

This study sought to identify stigma differences between HIV/AIDS and other sexually transmitted infections (STIs). Interviewees from Alabama, USA (n=537) rated two types of stigma (damage to social reputation and "moral weakness") for seven infections ranging from "nuisance" conditions (e.g., pubic lice) to life-threatening disease (e.g., HIV/AIDS). When asked which of the seven STIs would be most damaging to reputation, 74.8% of respondents chose HIV/AIDS. However, when asked to choose which STI represented moral weakness in infected persons, HIV/AIDS was rated as significantly lower than the other STIs, which suggests that HIV/AIDS is perceived differently than non-HIV STIs. This study addresses the possibility that advances in public awareness of HIV/AIDS have not necessarily been extrapolated into awareness of other STIs. Clinicians should be aware of these high levels of stigma as potential barriers to treatment for all STIs. Public health officials should consider the impact of undifferentiated stigma on STI prevention messages.

Introduction Queer theory along with Feminist studies has thus, provided us with lens to speculate the intersectionalities that exists in each paradigm of identity, and the necessity to recognize the same is important to deconstruct the stratified layers of marginalization, the intersectionality of the same to portray how the identity of a 'woman' is still the peripheral within Indian literary and socio-political framework. Feminism initially commenced with the middle-class white women's call for political rights including the Suffragettes, where the public and private binary was challenged with the powerful demand of re-claiming the spaces by Women, However, with the passage of time the famous historians Rebecca Walker and Maggie Humm, divided the History of Feminism into three waves, which eventually started including not just women but all oppressive 'bodies.' The immensely crucial and echoing slogan "Personal is Political" was introduced by Carol Hanisch that reflected the dimension ad growth of Second wave Feminism; the creation of Feminism(s); however, this aroused too few political complexities. This concept of Feminism(s) could broadly include-Radical Feminism; Cultural Feminism; while the Third wave very carefully focused on the deconstruction of the "inherent-link" between one's sex/gender/sexuality, stating them as choice/performances rather than an authentic ultimate, where one of the prominent personality was Judith Butler, and eventually Jacques Derrida's post-structuralist theory further envisaged our perceptions towards languagesign/signifier and signifies, which presented the fact, that the relation between them is arbitrary and deconstructed the very essentiality of truth/essence/main/centre, which with time and inclusion of queer theory organized Feminism into Queer-post-structuralist and intersectional political standpoint. --- Literature Review Gender is socially constructed as put forward by Simone De Beauvoir, but is this dimension just adhering to the binarized male/female quotations? Judith Butler regarded Gender is 'performative' and eventually deconstructed the intricately designed thread of inherent link of sex/gender/sexuality [1]. 'Gender is a choice to perform an identity', but it is curbed with policing and panopticon social structure. Gender studies portray and teach how Gender is a 'spectrum' and a floating concept where anyone can identify themselves as anybody at any juncture of experience [2]. This complex operation of Gender has decoded the Brahminical standard of power and authority of one anatomy over the 'othered' anatomies [3]. Rape culture is celebrated norm in India, because the object of 'rape' has been women's body which is further linked to the concept of shame/purity; however, men are also the object of rape, but our political framework has always portrayed them as the 'subject' of every shelter and oppression; hence portraying them as the object will no longer make 'a fate worse than death' (rape), an un-questionable category under 'power'; men as object of rape, would have been crushed. Keeping in mind what Butler regarded the subject 'women' as, we see that 'rape culture' in India is patriarchally popular which focuses on blaming the victim and not the criminal-Nirbhaya and Hathra's case; whereas feminists discard 'rape' because it is "against the autonomy and bodily integrity of a woman" [4]. The concept of 'consent' in 'rape' is omitted by patriarchy and hence our social structure veils 'marital rape', and tries to blame the woman as a subject of political representation the cause behind rape (by revealing her body-said by Chairperson of Karnataka Human Rights Commission) and not the man. Therefore, maintaining of 'rape culture' will instill a fear within the "cultural set-up", resulting in controlling of women's body; thus regulating their sexuality and identity, creating the 'ideal definition of what a women should be; how should she present herself-obedient daughter/wife/mother' of emerging and strong phalluses [5]. The area of literature has always been a reflective of any socio-cultural, ethico-ontological, cognitive and political dynamics of power, that webs and constructs certain 'norms' of presentation and re-presentation within the literary domain [6]; however, within which 'power' and 'deconstruction' functions simultaneously. As Gayatri C Spivak in introducing the Breast Stories wrote, "Power is nothing if not opposed to what it is not…make the latter's form of expression concretely possible" (Spivak, x). If the society did not present what 'just the breasts are not', then what the 'breasts are and can possible represent would not have an existence', and to amplify the relation between 'power and breast' [7] [8], I opt the story of Dopdi Mehjen from among the stories narrated in Breast Stories. While we delve our cognitive comprehension with Devi's first story-"Draupadi"; we can find a power is born as a result of some tension, which is emerging from the periphery and challenging the 'constructed center' [9]. Devi has presented 'breasts' as thet symbol, which beyond 'just an erotic attraction'; it represents the power that can suppress the 'oppressive institutional social barking', as well as, the stories of marginalized and subjugated bodies and identities-Women [8] [10]. If we look into 'breast' as that anatomical part which is considered the 'beauty, pleasurable, object' of a body, it is also depicted as a 'shame/weakness/inferior' concept; yet that feed mouths and penises alike with erotic touches [11]. This erotic re-presentation of breasts makes the identity of women as that suppressed/passive object of male subject, and this similar linkage is also presented in the character of Tilo (Mistress of Spices), Anju and Sudha (where her objectified physical beauty is the main plot) in Sister of My Heart and Vine of Desire, and quite vibrantly in "Rudali", where Women are clearly either wives or prostitutes, who during their old age turn into Rudalis (sells crying to earn during funerals) [12] [13]. The character of 'Dopdi' is crucial, (the plot mainly begins after her husband dies), in relation to the title of the story-Draupadi, as this was the name of that female character in Mahabharata who symbolizes the power of men in 'destructing and securing the "shame" of a women'; whereas, Dopdi symbolizes that destructive institutional device-'police', who not only 'raped' her 'breasts' but also tore her "shame" without the ability to 'dress' her again, yet Dopdi also represents how the power of patriarchally authoritative sacredness can also protect women (just like her husband)-"Dopdi is at once a palimpsest and a contradiction" [14] [15]. --- Methodology This study uses Judith Butler's Analysis which sees Gender and Caste as a lens to describe the narrative of marginalized women's identity. This exploratory study aims to determine the development of Indian society's perception of women. --- Finding and Discussion The character of 'Dopdi' is crucial, (the plot mainly begins after her husband dies), in relation to the title of the story-Draupadi, as this was the name of that female character in Mahabharata who symbolizes the power of men in 'destructing and securing the "shame" of a women'; whereas, Dopdi symbolizes that destructive institutional device-'police', who not only 'raped' her 'breasts' but also tore her "shame" without the ability to 'dress' her again, yet Dopdi also represents how the power of patriarchally authoritative sacredness can also protect women. It also shows how Dopdi refused to be the victim and not hoped to be rescued by men unlike Draupadi-"Dopdi is… what Draupadiwritten into the patriarchal and authoritative sacred text as proof of male power -could not be". The last scene of the story is remarkably reverberating, when 'Dopdi' undresses her body 'swept with thick blood and torn breasts', presenting herself as the "object of" their "search" and terrifyingly splitting her ululation "What's the use of clothes? You can strip me, but how can you clothe me again? Are you a man?" this scene demonstrates the power of an unarmed object and its ability to challenge both patriarchal institutions and political identities; the 'clothing of shame and identity for women' is terrifyingly discarded and created as the 'super-object' of that oppressive search. The character of 'Dopdi' is crucial, (the plot mainly begins after her husband dies), in relation to the title of the story-Draupadi, as this was the name of that female character in Mahabharata who symbolizes the power of men in 'destructing and securing the "shame" of a women'; whereas, Dopdi symbolizes that destructive institutional device-'police', who not only 'raped' her 'breasts' but also tore her "shame" without the ability to 'dress' her again, yet Dopdi also represents how the power of patriarchally authoritative sacredness can also protect women (just like her husband)-"Dopdi is at once a palimpsest and a contradiction" . The last scene of the story is remarkably reverberating, when 'Dopdi' undresses her body 'swept with thick blood and torn breasts', presenting herself as the "object of" their "search" and terrifyingly splitting her ululation "What's the use of clothes? You can strip me, but how can you clothe me again? Are you a man?"; this scene demonstrates the power of an unarmed object and its ability to challenge both patriarchal institutions and political identities; the 'clothing of shame and identity for women' is terrifyingly discarded and created as the 'super-object' of that oppressive search. It also shows how Dopdi refused to be the victim and not hoped to be rescued by men unlike Draupadi-"Dopdi is … what Draupadi -written into the patriarchal and authoritative sacred text as proof of male power -could not be" --- Conclusion It therefore becomes immensely necessary to adopt the lens of gender theory while studying and visualizing both literary and socio-political framework of any culture and important to apply the same in everyday life and not just limit to educational sphere, because then only we can sensitize people that gender is performance rather than essentialisation, and how within the mainstream literature application of Gender studies assists in understanding the 're-presentation' of the marginalized identities, where presentation just remains an illusion. Politically, Gender is molded as a device to regulate and control bodies/identities, to conveniently maintain the "nude-makeup" like social structure of our society. Both Diasporic and Dalit Literature has enhanced and elevated the presentation of heterogeneous cultures dwelling in Indian geographic dimension. In these stated literary domains, the subject 'women' has been juxtaposed with fragmented cultural subjugation threaded intricately with norms and regulations. Thus, we see how by the application of poststructuralist queer feminist theory, we adopt to our eyes, a lens, which assists us to discern the institutionally motivated familial and cultural practices that 'other's' selective identities, while mainstreaming 'one'; how the definition of what 'power' is not, has been conditioned as natural, where gender as a practice/performance/choice is hindered. Hence, both literally and socially, sensitizing our cognitive perceptions to scrutinize the 'representative identities' within Indian political framework must become an ululation of deconstruction.

As Elizabeth J. Meyer wrote in the book Queering Straight Teachers Discourse and Identity in Education is that, "Queer theory goes beyond exploring aspects of gay and lesbian identity and experience. It questions taken-for granted assumptions about relationships, identity, gender, and sexual orientation. It seeks to explode rigid normalizing categories into possibilities that exist beyond the binaries of man/woman, masculine/ feminine, student/teacher, and gay/straight" (Meyer, 1). Among these series of complexly designed network of marginalization, which is a branched and towered regime of oppression in Indian framework, so, I select Gender and Caste as that lens to depict the narratives of marginalized identity-women. The concept of "women" as Judith Butler defines in her famous work Gender Trouble 1990-"Women are the sex which is not "one". Within … a phallogocentric language, women constitute the unrepresentable … women represent the sex that cannot be thought, a linguistic absence and opacity" (Butler, 13). The identity of a woman gets trapped between some supposed and created links, which therefore my paper will try to discern, by the application of queer post-structuralist feminist theory, in both few selected literary texts-Mahasweta Devi's Rudali and Breast Stories, Chitra Banerjee Devakaruni's Mistress of Spices, Vine of Desire, and Sister of My Heart, and social context-women as subject of politics within the rape culture.

Introduction According to 2015 Taiwan Social Change Survey, there are 54.18% of Taiwanese voted for same-sex marriage comparing to only 11.37% in 1991. Besides, in a 2012 poll conducted by TVBS, more than 85% of respondents said they could be accepted as colleagues or friends with homosexuals. However, Taiwanese referendum on November 24th, 2018, failed to pass the proposal of same-sex marriage, meaning that there is remaining discrimination on homosexuality in Taiwan society. Meanwhile, a Pew Research Report (2013) shows that on a national level, attitudes toward same-sex marriage have changed significantly in the past decade, with only 32% of people favoring same-sex marriage in 2003, rising to 51% in 2013. As news coverage of issues of national importance often lead to further discussion on television and the Internet, and affects people's judgment on the issues and decisions in elections (Barnhurst, 2003;Tewksbury, 2006), it is of great importance to examine how the media described homosexuality and the relationship between the social image and media coverage that helped shape the news content. Taiwan China Times, which is comprehensive newspaper, providing the public with diversified opinions, offers a great chance to research on how media covered a controversial topic. This article is attempting to examine two questions: RQ1: How media frames homosexuality to the public during 14 years (2005-2018) ? RQ2: How these news coverages build up the image of homosexuality and relate to the Taiwan society? --- Method --- Sampling Design A content analysis was conducted in this study. Through Wiser, which is the world's largest Chinese data set, with over 470,000 sources ranging from print, to web, social media, and business databases and the archive of over 59 billion licensed and reliable items reaching back to 1979, select the population. By setting the keywords "homosexuality" and "China Times" to search for relevant reports from the year of 2005-2018 respectively [1][2]. The samples were selected by the constructed week sampling, through the random number generator, news coverage from Monday to Sunday are randomly drawn from different weeks in the population, and these samples constitute "one week" (constructed week), and two constructed weeks are drawn as ISSN 2706-6827 Vol. --- Coding Category The 196 samples constructed different homosexual images through different topics and descriptions. In order to be more objectively and comprehensively to investigate the construction of homosexual images in the news coverage, the main coding categories are listed in the following: Topics: the purpose of coding topics is to investigate what issues the media intentionally linked homosexuality with. The topics that were coded included: homosexual participation in politics、fight for homosexual rights、crimes、AIDS epidemic、chinese tradition and family values、cases of celebrity news、opinions about same-sex marriage、individual cases、education、drugs and others. Basic personal image: the purpose of coding basic personal image is to investigate how the image of homosexuals in the news coverage has changed over time. The basic personal image that were coded included: gender、age、occupation and region. Role attributes: the purpose of coding role attributes is to investigate whether the media's description of homosexual images is positive, negative or neutral. Referring expression: the purpose of coding referring expression is to investigate the evolution of the homosexuality language in the news coverage. Record the modifiers for homosexuality in each report, such like "LGBT", "LESBIAN", "0Hao", "1Hao", ect [3][4]. --- Results The results are divided into two parts, including media frames and the image of homosexuals from 2005 to 2018 to have further discussion of homosexual image in China Times. And the following analysis is based on the statistical table of research results. --- Media frames from 2005 to 2018 --- The changes of topics In general, China Times paid more attention to crimes and equal rights from 2005 to 2018. Among them, the crime issue has gradually declined, and in 2011 it dropped dramatically from the previous 36% to 7%. However, the reports focusing on fighting for homosexual rights showed a growing trend, from Hence, 2011 is a representative year that brings lots of changes in topics. In the amended provisions of the 2011 gender equality education act in Taiwan, "gender equality education" was implemented to ask for respect for diversity of gender. The aim of the act is to eliminate gender discrimination and promote substantive equality of gender status. At the same year, New York state passed the same-sex marriage equality act. In fact, these two events showed that not only in Taiwan, but the international world like America has also made great progress in fighting for homosexual rights. Under such circumstances, China Times covered more public issues instead of individual cases. Also, education and celebrity issues reached 29% and 14% respectively. The appearance of education and equal rights issues implied that social acceptance was increasing, which meant homosexual groups were getting more and more attention after 2011. Besides, after the introduction of Diversified family structures draft legislation in 2013, which refers to the draft law on amending the civil law involving marriage and family system to promote gender equality in Taiwan, the public's attitudes towards homosexuality tends to be more open-minded. In this case, some issues about homosexual exhibitions appeared to think about how homosexual is constructed through mass media. What's more, although AIDS epidemic issues were reported from 2005 to 2012, there has been no AIDS-related topics since 2013. --- The changes of figures At the beginning, most of the reports' figures were students or people without identifiable information. Then, some celebrity news came out, but most of them were related to gossip. However, the media started to cover some issues about homosexual participation in politics from 2009, which meant homosexuals came into power and were accepted by more people. Actually in 2009, homosexual condition in Taiwan changed a lot. In order to protect homosexual rights, a Taiwan Alliance to Promote Civil Partnership Rights was established in 2009. In the same year, a homosexual parade was held in Taiwan, which broke the participant record in recent years. The key focus of this parade was LGBT rights, particularly antidiscrimination laws and the recognition of same-sex unions. Thus, because of the change, the media tried to focus on other figures [5][6]. --- The changes of regions In the past 14 years, the media generally focused more on Taiwan, but since 2006, some foreign reports appeared. Moreover, the proportion of it has reached 50% in 2014 and 2015. During that time, the west spared no efforts to promote same-sex marriage, and finally the American achieved their goal to make same-sex marriage legalize. At that time, the media reported more actions from foreign countries. In addition, there were also some reports from Chinese mainland and Hong Kong, but not in large numbers. --- Image of homosexuals from 2005 to 2018 China Times focused more on young people, especially male homosexuals in Taiwan. And most of their image has become more positive and objective. --- The neutral referring expressions have dominated the same-sex coverage since 2013 During these 14 years, "Tong Xing Lian" and "Tong Zhi"were two referring expressions that appeared every year. But before 2013, most reports tended to use some negative expressions like "Niang Niang Qiang" or "Si Ren Yao", which showed disrespect for the homosexuals. Among them, there were still few expressions that were neutral, such as LGBT. Fortunately, after the adoption of diversified family structures draft legislation in 2013, the media used more and more positive expressions, such as"Tong Zhi" and "LGBT", which were more inclusive. --- Since 2009, the depiction of homosexuals in news coverage has become more inclusive and objective. Before 2009, most of reports were connected with theft, drugs, sexual promiscuity and sexual assault. However, heterosexuality is rarely reported. In fact, the media tried to exploit the homosexuals in an exaggerated way for sensational effect. For example, in a report of 2008, the media used "Fan Yun Fu Yu"which caught people's eyes to describe the homosexual love process. Also, in the same year, one report said that homosexuals were easier to be cheated, which showed the image of weakness. Published by Francis Academic Press, UK -64-more inclusive and objective. What's more, readers can find some politicians with higher social status in the reports. Moreover, after 2011, the media preferred to present a more objective image, revealing homosexuals' specific information rather than obscuring their personal information such as age and occupation, and using some detailed depictions in order to attract audience's attention. --- The image of homosexuals changes from the weak to the brave In the past reports, homosexuals were often portrayed the homosexuals as weak persons. It seemed that most of them were dangerous persons such as criminals and were even at the bottom of the society due to their unclear occupations or age. Luckily, some homosexual politicians appeared in the reports who had higher social status. Meanwhile, many entertainment stars became supporters of homosexuality and participated in the homosexual parade in 2013. Although there were some contradictions between church and homosexuality in 2014, things still got better. The appearance of entertainment stars, politicians and scientists showed that the image of homosexuals has changed from the weak to the brave. They had the courage to fight for their rights and have influence on the society. --- Conclusion This study analyzes the changes in the construction of homosexual image in China Times in the past 14 years. The modifier used in the discussion of homosexuality evolved from the slander and derogatory words such like "Niang Niang Qiang","1Hao","0Hao"to a more multifaceted language, like "LGBT", "same-sex marriage" ect. Another notable change is the significant reduction in news issues linking homosexuality to AIDS, crime, and violence, and the growing popularity of equal rights and homosexual education. The China Times' description of the homosexual image has also changed from a career vagueness, a low-educated criminal to a high-profile, powerful politician and entertainment star. This change shows that the homosexuality is gradually moving from a bottom-level topic to a mainstream topic. Besides, the China Times no longer only reports local homosexual gossipy and seek novelty news, but also reports more foreign discussions on homosexual topics, such as the fight for equal right and gender education. These topics also make the discussion of homosexual discourse more inclusive and diversify. What's more, changes in the social environment are also important factors in causing this change. In 2011, Taiwan amended the Gender Education Equality Act and began to implement Gender Equality Education, which aims to educate students to be respect for multi-gender. As a result, public issues on homosexuality coverage began to increase gradually from 2011, especially those on education. In 2013, Taiwan promulgated the Diversified family structures draft legislation, which further promoted the media to report homosexuality positively and objectively. In the Taiwanese referendum of 2018, the number of celebrity and education topics increased dramatically, which shows that the homosexual group is gaining wider support from the population and gradually popularizing to the whole society. All in all, across the 14-year time span, the image of homosexuality built by China Times has gradually turned from negative to positive, which is closely related to the change of social environment.

Taiwan has made tremendous efforts on the road of equal rights for the same sex through mass media, and the affirmative action since1990s. Although the Taiwanese referendum on November 24th, 2018, failed to pass the proposal of same-sex marriage, Taiwan is expected to become the first Asian region to legalize same-sex marriage in 2019. This article conducted Framing theory and Discourse Historical Approach to research on how news coverage changed when framing homosexuality during year 2005 to 2018 on Taiwan China Times, specifically in diversity of topics, referring expression, basic personal image and role attributes. And found that media's description of homosexual groups has gradually changed from negative to positive, and the media has a great role in building the social image of homosexual groups.

Introduction Globally, cassava has experienced consistent growth of above 3% annually and it is the fastest growing prominent stable food crop in cassava consuming countries while also rising consistently in industrial demand. Cassava is used for the making of fufu, gari, flour, tapioca, animal feed, ethanol, starch, gum, and glucose while the leaves are sources of vitamins, minerals, and proteins. The root of cassava can be eaten as food, fed to stock, or used in the manufacture of starch (Eguono, 2015). Cassava is cultivated all through the year, which makes it more desirable compared to periodic crops like yam, beans, or peas and it possesses the ability to adapt to climate change, with a tolerance to low soil fertility, resistance to drought conditions, pests' diseases and suitability to store its roots for long periods underground even they mature. African countries account for 64% of the global production of cassava and Nigeria is the largest producer of cassava in the world, representing 19.4% of the global production in Fig. 1. One-third of the total national output of cassava comes from the Niger delta region of Nigeria as many of the rural farmers depend on cassava as a main source of food and income. According to Daniels et al. (2011), the major cassava producing states in Nigeria are Benue, Kogi, cross river, Ondo, Imo, Akwa Ibom, and rivers states. In the region, the cassava industry is occupied by about 70% of women farmers who are entirely responsible for the processing and marketing of cassava and its by-products. Cassava plant prefers an annual rainfall of 1000 mm or more which implies that an average of 50 mm rainfall per month spreading over a period of 6 months is enough for a cassava plant to grow well (Hauser et al., 2014). The Cassava value chain describes the range of activities and set of actors that brings the product from production in the field to the final consumer's table, wherein at each stage value is added to the product. It entails a whole lot of activities from production, processing, distribution, and marketing of specific traded commodities (Fatunbi et al., 2015;Apata and Babalola, 2013). The actors in the value chain can be categorized into the producers (land clearing, tilling of land, mound making/ridges, stem cutting, planting, weeding/replanting), harvesters (harvesting and bagging of raw cassava), processors (peeling, washing, grinding and frying for garri, grinding and soaking for pap, soaking for fermentation for fufu, boiling for tapioca, cutting the peeled ones and sun drying for animal feed or cassava flour, bagging) and marketers (selling). The production of cassava and its products is characterized by small-scale producers who plant low yielding inputs and uses traditional production technologies which largely accounts for low output. The Nigerian government 2002 initiated a program in order to increase cassava production to meet both local and export markets (Omotayo and Oladejo, 2016). Despite this initiative, the demand for cassava roots and products is high and fast rising and the current supply cannot meet the need of the ever-increasing population (OPHI, 2017;FAOUN, 2019) in Fig. 2. This study, therefore, sought to examine where there is a gap for government/stakeholders to intervene in order to increase production that meets both the local and industrial demand. Therefore, the objectives of the study were; to examine the socio-economic characteristics of the respondents; examine the cassava value chain activities the respondents are involved in, and; determine the constraints faced by rural women involved in the cassava value chain. --- Materials Primary data was used for the analysis with the aid of a questionnaire where the respondents were interviewed. --- Methods --- Study Area Although cassava is grown in all agroecological zones of Nigeria, it thrives better in the rainforest and derived savannah areas. The highest cassava production is recorded in the North-central and South-South regions of Nigeria. Akwa Ibom state has located in South-South Nigeria the state lies between latitude 4°31 and 5°31 North and longitude 7°35 and 8°35 East; occupies a total land area of 7, 254, 935 km 2 . Akwa Ibom state occupies a total land area of 7, 254, 935 km 2 with a Tropical monsoon climate with an annual temperature of 28.47°C (83.25°F) and which is 0.99% lower than Nigeria's averages. Cassava grows best on light sandy loams or on loamy sands which are moist, fertile, and deep, but it also does well on soils ranging in texture from the sands to the clays and on soils of relatively low fertility. --- Sampling Procedures A multi-stage sampling technique was used. In stage one, two Local Government Areas (LGAs) in the State were purposively selected based on the high level of cassava production. In the second stage, five communities were selected from the LGAs. In the third stage, 25 female cassava farmers (producers, harvesters, processors, and marketers) were selected from each of the communities which made up 125 respondents. --- Data Collection and Analysis Data collection was done with the aid of administered questionnaires. Descriptive statistics involving the use of frequency counts and percentages were used to describe the socio-economic characteristics of the respondents and the type of cassava value chain involved. In objective 3, the likert scale was used to measure and present the results of the respondents' responses on the constraints to rural women's participation in the cassava value chain. The scale was graduated as follows; 1 = Strongly Disagree, 2 = Disagree, 3 Neutral, 4 = Agree, 5 = Strongly Agree. The mean constraints fall between 1.0-1.8 (Strongly Disagree), 1.81-2.60 (Disagree), 2.61-3.40 (Neutral), 3.41-4.20 (Agree), and 4.21-5.0 (Strongly Agree). --- Results and Discussion --- Distribution of the Respondent's Socio-Economic Characteristics Age The result in (Table 2) shows that 57.6% of the respondents were between the age of 41-50 years which indicated that most of the respondents were still young and active age. 28.0 and 14.4% of the respondents were between the age of 31-40 years and 20-30 years. The result corresponded with Akaninyene et al. (2022) that most rural farmers were made up of young people because of the vigor involved in agricultural activities. Besides this, young people get involved in agricultural activities as a means of livelihood. --- Marital Status The result in Table 2 shows that 66.4% of the respondents were married. 24.0 and 9.6% of the respondents were widowed and single. The married farming household is befitted from family labor as the cost of labor is used for other things. The result corresponded with Akaninyene et al. (2022) that most rural farmers are married. --- Household Size The result in Table 2 shows that the majority (58.4%) of the respondents had a household size of 5-10 persons. About 41.6% of the respondents had a household size of 1-4 persons. The large family size was an advantage to the rural farmers who employed household labor in the cassava value chain activities. The result also concorded with Akaninyene et al. (2022) that most of the rural farmers had a large family size. Table 1 describes the different stages of cassava value chain in the study area showing from the input/production where the raw materials are planted as the first stage. The second stage involved the harvest of the produce, the third stage involved the processing and the packaging stage while the last stage is the sales/distribution of the produce till it gets to the final consumer. --- Farming Experience Table 2 result shows that 58.4% had 21-30 years of experience which can be of help to the respondents to avert the risk involved in cassava enterprise. 27.2% Had 11-20 years of experience and 14.4% had 1-10 years of experience. The years of farming experience helped the farmers to employ a mechanism that averted high losses as a result of poor markets or the unavailability of storage facilities. The years of experience also helped the farmers to try out various technologies in order to maximize profit. The result corresponded with Akaninyene et al. (2022). --- Primary Occupation The result in Table 2 shows that the majority of the farmers (89.6%) were primarily in the cassava value chain business while 10.4% were combining other businesses/jobs with the cassava value chain business. The rural women involved in the cassava value chain as their primary occupation aided in the availability of the product on and off-season. --- Level of Education The result in Table 2 shows that most of the respondents (40.0%) had primary education, 28.8% had no formal education, 16.8% had secondary education and 14.4% had tertiary education. This was an advantage to the cassava value chain as most of the respondents were educated and as such could read and understand the use of new technologies for improved production. This also agreed with Akaninyene et al. (2022) that most of the rural farmers had formal education. --- Farmland Size The majority (65.6) of the respondent had <1 ha of farmland while 25.6 and 8.8% had 1-2 and 3-4 ha in Table 2. The result shows that the respondents were still farming on fragmented/rented farmland in order to increase their cassava production. The result confirmed by Akaninyene et al. (2022) that most of the rural farmers cultivated farmland that is less than 1ha. --- Distribution of Women According to Cassava Value Addition Activities The result in Table 3 shows that rural women were more active in the processing of cassava (34.4%) followed by marketing (31.2%), harvesting (20.8%), and planting (13.6). This was attributed to the fact that during the planting season, rural farmers who are married do the planting, harvesting, and marketing with their families while the men see the processing (peeling, washing) as solely the work of the women. Besides, after planting and harvesting the cassava, the men went to other farming work or business to support the family leaving the peeling and processing to the women who take pleasure in doing it since it's their primary occupation. --- Constraints Faced by Rural Women Involved in Cassava Value Chain From Table 4 the mean scores were within the 3.41-4.20 threshold, therefore the farmers agreed that low returns (profit), lack of access to credit, lack of farmland, theft, lack of facilities, and distance to the market were the major constraints they faced. The result corresponded with Akaninyene and Maurice (2022) that rural farmers faced many constraints in their farming activities some of which were poor returns, lack of farmland, and lack of access to institutional credit. --- Conclusion and Recommendation The value chain participation showed that rural women are mostly occupied in the processing and marketing of cassava as food and also a source of income. The findings from the study also showed that cassava as a staple food that most women in rural areas venture into is capable of creating more jobs for Nigeria's teaming population once the factors identified by the participants are made available and accessible to the farmers. Therefore, government and the key stakeholders in the cassava industry should pay attention to the identified constraints and put in efforts in ensuring that the rural women in the cassava value chain industry are supported adequately. --- Funding Information The authors have not received any financial support or funding to report. --- Author's Contributions Akaninyene Patrick Obot: Considerable contribution to conception and design and/or acquisition of data and/or analysis and interpretation of data; drifted the article of reviewed it critically for significant intellectual content; and author give final approval of the version to be submitted and any revised version. Obiekwe Ngozi and Anunobi Chizoba: Make considerable contributions to conception and design and/or acquisition of data. Obot Elizabeth and Udoh Mfon: Contribute in drafted the article or reviewed it critically for significant intellectual content. --- Ethics All the authors were cited and well acknowledge in the reference section.

Cassava is one of the fastest expanding staple food crops in cassava-consuming countries and has continued to gain prominence among farmers while the industrial demand is also rising consistently. The study was carried out with the intention of examining rural women's involvement in various cassava value chain activities and identifying the factors that hinder their active involvement in cassava value addition. The study employed descriptive statistics (frequency, percentage counts, mean, and likert scale) in the analysis. From the results obtained, more rural women were involved in the processing of cassava and marketing of the products while they really engaged families or hired labor in the planting and harvesting. The identified constraints facing the respondents were low returns (profit), lack of access to institutional credit, lack of farmland, theft, lack of storage facilities, and distance to market. The study recommended that government and the cassava industry stakeholders should support the rural women involved in the cassava value chain adequately as it would not only generate more profit for the women but also create more jobs for the youths and bring foreign exchange to the government.

E1651 is expressed as an isolated gesture and a stubborn disposition. It is like the lightning that cuts through the night sky. Comte-Sponville reminds us to not be mistaken: courage is not the absence of fear, but the ability to overcome it through a stronger and greater will. It has always been welcome, yet particularly scarce these days. Perhaps this helps explain why this edition of Brazilian Journalism Research is so unique and highly rated, after all, it is governed by the essential sign of courage. The ten articles that comprise the dossier "Militant, In our call to the scientific community, we stated that newsrooms often believe that journalists should not interfere in the events they report on; they should temporarily suspend their ideologies and feelings. This idea of non-interference helped shape several journalistic canons -exclusion and impartiality being two examples. The result of this collective effort is the creation of an artificial non-place for journalists, a place where they can observe life events and history without interfering, and interpret and narrate them without any filters, influence, or constraints. We highlighted these ideas in our call for papers, raising questions about the legitimacy of activism in journalism, the compatibility between reporting and taking sides in a story, and the technical and deontological challenges posed by these changes. Our goal was to collect submissions that could fertilize the punished (and troubled) soil of journalism, and we were not The dossier opens with a question posed by Barsotti and Vieira (2023) that cannot be postponed any longer: is activist journalism possible? They argue that the recent emergence of new journalistic arrangements over the last couple of decades has shaped an environment that has put a strain on the professional ethos: as many of these new media organizations become committed to causes, the pillars of neutrality begin to show some cracks. After interviewing nine professionals in these new arrangements, Barsotti and Vieira concluded that taking a stance or a position is no longer a deontological transgression and has now become a value to be pursued. We could say it is the courage to challenge one's code of ethics. The next article, by Moraes (2023), looks more towards the destabilization of the system. She poses the question: who are these activists and engaged people we are talking about? Her questioning makes us look outside independent or alternative media, which is usually labeled as activist. Moraes sheds light on the Brazilian mainstream media which also positions itself according to themes, interests, influences, and local conditions. She puts forth the idea that positioning can be influenced by politics in all types and sizes of newsrooms, and can even be concealed or not visibly declared. Reading her article might lead someone who is disconnected from the subject to ask: how much courage is there in secretly taking positions? Loureiro, Pereira, and Figueira (2023) address the themes of the dossier from an international point of view. They analyze journalistic coverage of the war in Ukraine, particularly from Bruno Amaral de Carvalho, a correspondent for CNN Portugal who reported on the conflict from the Russian side. Focusing on the period from March to October 2022, the authors identify two types of combat that the reporter had to face: misinformation and the symbolic degradation to which he was subjected by politicians and professional colleagues. The only journalist to report on the conflict from within Russia for the Portuguese audience, Bruno Amaral de Carvalho was the target of moral attacks and questions about his editorial independence while working in the trenches to fight against rumors, state propaganda, and counter-information. As brave as being on the front line. The next four articles in our dossier cover not only the daily conflicts of journalistic coverage but also the continual challenges to its professional self-affirmation. It is quite common for environmental journalism to be confused with ecological activism. Loose and Belmonte (2023) list four key moments that helped shape Brazilian environmental journalism as an engaged practice, at least since the last quarter of the 20th century. They highlight how the press' opposition to environmental injustices led to specialized coverage taking on causes, moving away from the expected objectivity and neutrality, which also generated some contempt in the sector. The article highlights a greater openness to defending the elements of nature, motivated by the increasing climate emergency and changes to journalism itself concerning the valorization of subjectivities, for example. Souza and Miguel (2023) focus on reports from the Amazônia Real portal to understand and problematize the proximity between environmental journalism and media activism. These authors use journalistic coverage analysis to highlight not only the premises of environmental journalism (contextualization, plurality of voices, assimilation of environmental knowledge) but also the discursive tactics of media activism -engagement and opinion. Gould (2023) looks at an independent media outlet from the Amazon region and its activism in specialized coverage. This particular media outlet is called the Sumaúma portal and it criticizes the Jair Bolsonaro government and its attempts to commit genocide of the Yanomami people (2019)(2020)(2021)(2022). With the interpretative contribution from the French discourse analysis, Gould's corpus is closer to a counter-hegemonic journalistic perspective based on subjectivity. Created by journalist Eliane Brum and the idea that the Amazon is the center of the world, its reality must be reported on by local media. The Sumaúma portal is also an example of courage included in the theme of this dossier. Creating a means of communication is already a challenging task, so founding a portal in the middle of the Amazon, far from metropolises and capital flows, seems both trivial and unrealistic. Eliane Brum's journalism is not limited to the Sumaúma portal. In the seventh article of this dossier, Javorski and Alencar For at least four decades environmental journalism has contradicted the rigid grammar of objectivism, yet more recently it is gender issues that have led to questions about the legitimacy and professional effectiveness of journalism. Social advances towards equity in the labor market and increased participation in decisionmaking processes have highlighted issues of justice between genders and increased coverage of specific issues facing the LGBTQIA+ populations. Along these same lines, this edition of BJR includes three articles that expand on the boundaries between engagement, journalism, activism, and the fight against inequalities. Rodrigues and Aguiar (2023) look at the mode of journalistic production "anchored in historically exclusive premises of objectivity and newsworthiness". To do this, they analyze the editorial principles and the profile of AzMina magazine, a publication that is engaged and specialized in feminist and intersectional causes. These authors conclude that the production, investigation, and writing routines of the aforementioned media outlet are legitimized by professional journalism, differing itself by how it selects its agendas and treats its information sources, which requires a high level of training and specialization for the journalists who cover these topics. Silva Júnior (2023) shows how the activist nature of the homosexual movement and the journalism of some agents in the 1970s and 1980s were fundamental to the emergence of a unique event in the history of Brazilian journalism: the gay press. The author compares events and themes covered by the Folha de S.Paulo (a generalist journalism outlet) and Lampião da Esquina (a newspaper for gay audiences). He concludes that the activist press was ground-breaking and that its focus on activism helped take some issues regarding the homosexual populations and bring them to the public sphere. As we anticipated, the ten texts in this dossier echo the idea of courage and bring militancy, engagement, and activism closer to the most celebrated, demanding, and noble of journalistic practices. In the pages to follow you will find people who dare to denounce and call things as they are, the courage to face the powers that be and to change the actual grammar, the courage to reveal and go against expectations, and the courage to take sides and not seek comfort in impartiality. All forms of journalism that are willing to combat obscurantism, disinformation, and denialism constantly have to manage fear. Some acts of courage involve personal sacrifices, detachment from personal benefits, and a commitment to collective needs. In these cases, this courage brings about remarkable moral legitimacy and widespread recognition and esteem. Having courage means calculating the risks, taking risks, and accepting the consequences. It requires a "firmness of soul", as the philosopher Baruch Spinoza said. All courage is made up of will, a small amount of reason, and a greater dose of passion. This idea of adopting sides and taking up causes is still being fought in newsrooms today. The texts we have collected in this edition can help shake these convictions. When facing extreme situations, we must choose between fighting or fleeing. Courage can be about confronting the threat, facing one's fear, or questioning established truths. An agenda can be a cause and courage is a quality just as necessary for journalism as curiosity is. Comte-Sponville's definition of courage included at the beginning of this text was so well elocuted, that we shall refer to it once again to finish off our conclusion. "Life teaches us that it takes courage to endure despair, and also that despair can sometimes give courage. When there is nothing left to hope, there is nothing left to fear: here is all the courage available, and against all hope, for a present fight, for a present suffering, for a present action!" (1999, p. 45).

For philosopher André Comte-Sponville, courage is the most universally admired virtue. In his book A Small Treatise on the Great Virtues, Comte-Sponville claims that cowardice is despised everywhere while bravery is praised. Each civilization has its fears, and also has its expressions of courage and strength. Courage is a character trait, a virtue, or a desired quality often attributed to heroes. It can also be attributed to every day, unknown individuals.

COMMENTARY The COVID-19 pandemic continues to threaten public health systems around the world, and the African continent is not spared. [1][2][3] The pandemic presents an unprecedented humanitarian crisis that has impacted health systems and disrupted the livelihood and overall well-being of people globally. 4,5 Although the number of COVID-19 cases in Africa is currently lower than that of other regions of the world, these numbers are increasing gradually. 1 As of November 14, 2020, 1,965,485 cases and 47,134 deaths have been reported in the African region. 6 The pandemic has made evident weaknesses in responding to public health emergencies such as COVID-19, on the continent. 1 Although African governments and other stakeholders continue to make efforts to contain the pandemic, there is more to be done to put the pandemic to an end. Nonetheless, the COVID-19 pandemic continues to impact human rights and exacerbates inequalities and disparities that are already in existence. Despite the efforts to address the COVID-19 pandemic on the continent, the marginalized and underrepresented groups have been reported to be left behind and discriminated against in the course of the COVID-19 responses. 7,8 Creating equitable access to mainstream healthcare services and ensuring inclusive health responses serve as a means of addressing health inequities and disparities. In this article, we argue on the need for inclusive health response to public health emergencies in Africa using COVID-19 as a case example. The concept of inclusive health focuses on good health and well-being for everyone; and this entails health services that are equitable, affordable, and efficacious. 9 This concept also resonates with a rights-based approach to health including political, social, economic, scientific, and cultural actions that are geared toward advancing the cause of good health and well-being for all. 9 With the emergence of the COVID-19 pandemic, it is increasingly important to ensure an inclusive health approach to health emergencies on the continent. It is now evident that it is not all about achieving "health for all" but an "inclusive approach" in meeting the health needs and responding to public health emergencies. 9 In the context of the COVID-19 pandemic and other public health emergencies, health responses need to be genuinely empowering so that vulnerable, underrepresented, and marginalized "voices" are included in social discourse, policy, and the health response. Although most health policy documents may refer to "all people," "for all," "all citizens," or "everybody," they often end up privileging "some" over "all." 9 Vulnerable and marginalized populations usually have greater healthcare needs than others and are therefore more vulnerable to the impact of low-quality, inaccessible healthcare services as well as noninclusive uniform public health responses than others. 8 In addressing public health issues, it is important to make it clear that no one is more important than the other, and the response efforts must not leave behind the most disadvantaged groups. The impact of public health response needs to be viewed from the lens of how it will affect the marginalized group and what can be done to prevent any form of inequity. Right to health is a human right, so the approach to responding to health emergencies needs to be able to ensure that right to equitable health is not infringed on and the outcome of the response should not weigh negatively on the vulnerable groups. It is also worthy to note that if public health responses exclude the marginalized "voices," there is a potential threat of reversal in any hardwon progress and efforts in addressing such public health crisis. 7,8 This highlights the need for African governments, national health authorities, and other stakeholders to lead the path in ensuring inclusive responses to public health emergencies. Sex workers in some African countries (e.g., Nigeria, Uganda, and Botswana) are excluded from the government's safety nets in response to COVID-19. 7 This forced some sex workers back to work amid the lockdown imposed by the national health authorities in the early days of the pandemic. Lockdown policies in many African countries and globally have significantly affected access to antiretroviral drugs and care services among people living with HIV. People living with disabilities have also been significantly affected by uniform response activities in many African countries. 10 According to a rapid virtual audit of pandemic-related press briefings and press conferences issued by governments and international organizations, only 54% of sub-Saharan African countries have a sign language interpreter present in COVID-19 press briefings and conferences. 11 COVID-19 has already caused interruptions in vaccination schedules in many African countries, further putting many children at risk of vaccine-preventable diseases. It has also weakened public health responses to ailments such as malaria and meningitis outbreaks and reduced access to maternal and reproductive health services, further discriminately affecting at-risk groups. COVID-19 also highlights the vulnerability of healthcare professionals to the impact of public health emergencies and how they can be discriminately affected. This vulnerability is compounded by limited access to protective equipment and stigmatization, which impacts on their mental health, as reported in some African countries. 5 Some researchers have also reported how people who use drugs are left out of the COVID-19 responses in some African countries, for example, Kenya and Nigeria, with the potential threat of affecting HIV response and access to healthcare services among this group. 8,12 COVID-19 has also been reported to exacerbate long-standing problems in Africa's prisons and how precautionary measures, such as handwashing and physical distancing to reduce disease transmission among the inmates, are challenging to observe because of poor infrastructure. 13 A report from Kenya, Tanzania, and Uganda, the regions with consistently high maternal and neonatal mortality rates, also revealed that the COVID-19 pandemic has grossly affected antenatal care services. 14 The disruption of these services, if not addressed, may affect the achievement of Sustainable Development Goal 3 Target 1, which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. The noted disruption in healthcare services in Africa is also affecting older adults with chronic diseases in the region. 15 Access to healthcare services among people living with chronic diseases, 16 people with lower socioeconomic status, homeless people, migrants, minorities, and other vulnerable groups is discriminately affected before the pandemic, and the urgent need to address the COVID-19 pandemic has exacerbated this challenge. Although some efforts have been made in Africa toward ensuring an inclusive response, more efforts still need to be carried out. For instance, Ethiopia is translating COVID-19 health information into local languages 17 and the country plans to make communication materials accessible to those with seeing, learning, and hearing difficulties, as well as people living with mental illness. 10 It has also been reported that South Africa has granted $10.6 million aid to assist small, medium, and microenterprises, with people living with disabilities and women prioritized. 10 In Nigeria, a faith-based organization is helping with sign language interpretation of COVID-19 health information. 10 Africa's response to public health emergencies needs to recognize that for every marginalized/vulnerable group, it is important that any health intervention designed to meet their needs must be carried out in a way that surmounts any barriers to accessing health care. For Africa's public health response to be more inclusive, there is a need to be more strategic and proactive in reaching out to specific groups to identify and address their peculiar needs (Table 1). An inclusive health approach needs action and not just mere inclusion in policy documents. The approach will not only foster solidarity, health equity, and effective community response to public health interventions and emergencies, it is also in line with the sixth element of the Universal Health Coverage movement-"Move Together"which involves setting up diverse multi-stakeholder strategies aimed at engaging and involving everyone without discrimination. The significance of an inclusive, dynamic, multistakeholder response remains critical in the context of COVID-19 and other public health emergencies. A commitment to an inclusive health response implies that response activities will be compassionate and sensitive to all. The aftermath of a noninclusive public health response is expensive. For instance, if marginalized or vulnerable groups with poor access to healthcare services experience COVID-19-related symptoms, they may delay or even forgo being tested and may consequently turn to medical care only in late stages, resulting in worse outcomes. This may put their families at risk, facilitating community spread of the virus. Furthermore, African governments need to start devising means and strategies to ensure inclusive access to COVID-19 vaccine when it becomes available. 18 --- CONCLUSION Africa's COVID-19 and other health emergencies response strategies must be inclusive of marginalized and vulnerable groups to ensure they maintain respect for dignity, human rights, and fundamental freedoms and avoid widening already existing health and social disparities. This reinforces the need to ensure full participation of the communities affected and relevant civil society organizations in preparedness and response planning, including maintaining the commitment to universal health coverage and ensuring that the most disadvantaged groups are not forgotten amid the urgent need to respond to any public health emergencies. Strengthening the healthcare systems of African countries through increased political will, increased funding to health care, collaboration and cooperation among stakeholders, and effective leadership remains essential in ensuring inclusive responses to health emergencies. Received November 18, 2020. Accepted for publication December 4, 2020. Published online December 15, 2020. --- COVID-19 AND INCLUSIVE HEALTH RESPONSE IN AFRICA

COVID-19 is a global public health emergency affecting many countries around the world. Although African governments and other stakeholders are making efforts to contain the pandemic, the outbreak continues to impact human rights and exacerbates inequalities and disparities that are already in existence. The concept of inclusive health focuses on good health and well-being for everyone, and this entails health services that are equitable, affordable, and efficacious. Creating equitable access to mainstream health and healthcare services and ensuring inclusive health responses remain a means of addressing health inequities and disparities. In this article, we argue on the need for inclusive responses to public health emergencies in Africa using COVID-19 as a case example. Africa's response to public health emergencies needs to recognize that for every marginalized/vulnerable group, it is important to strategize to address their particular needs in such a way to surmount any barrier to the right to health. For Africa's public health response to be more inclusive, we therefore need to be more strategic and proactive in reaching out to specific groups and to identify and address their needs. Strengthening the healthcare systems of African countries through increased political will, increased funding to health care, collaboration and cooperation among stakeholders, and effective leadership remains essential in ensuring inclusive responses to health emergencies.

Ijtimoiy-madaniy faoliyatda magistratura talabalarining tashkiliy-boshqaruv ko'nikmalari haqidagi zamonaviy g'oyalar --- INTRODUCTION The change in the socio-economic conditions taking place in the modern world has led to a change in the role of education in society, leading to the introduction of a multilevel system of education, the implementation of which is associated with the development of the institute of magistracy [1; 35]. Organizational and managerial activity in scientific research is presented as a problem associated with the formation of organizational and managerial abilities of students and this aspect is formulated based on understanding it as a complex of general and special abilities necessary to ensure the life of an institution [2; 173]; it is noted that organizational and managerial activity consists of a complex of activities (cognitive, projective, stimulating, educational), the specificity of which determines their qualitative certainty, and its content (organizational and managerial activity) comes from the process moments of the designated types of activity: taking into account the terms of the concept organizational and managerial activity researchers put managerial activity in the first place, which includes organizational aspects. --- LITERATURE REVIEW The formation of managerial competencies of a master's student is a complex and large-scale problem that has certain social, organizational, and pedagogical features. Such authors as G.P. Kornev, V.A. Slastenin, V.S. Serikova, V.I. Stolbov, and others devoted their research to the problem of training managerial personnel, considering it from the point of view of professional pedagogy. Later, O.V. Popova studied the formation of managerial competencies among university students in the process of extracurricular activities, in their studies, N.A. Ran and A.E. Shastina studied the features of the formation and problems of modeling managerial competencies among students of technical specialties. And today this problem is underdeveloped [3; 100-106]. --- RESEARCH METHODOLOGY In this aspect, management activity is a complex intellectual activity of a person, which requires special knowledge and experience and is one of the most important factors in the functioning and development of an organization in a market economy; at the same time, approaching the professional accents of managerial activity, a type of professional activity is considered, aimed at co-organizing the activities of other people in achieving goals [4]. RESULTS AND DISCUSSION R.G. Panteleev defines the organizational and managerial competence of a specialist as an integrative characteristic, which includes a set of acquired knowledge, skills, and professionally important qualities that determine his ability and motivational readiness to carry out organizational and managerial activities and manifests itself in the process of self-realization [5; 229]. In the structure of the professional competence of a master's student, as one of the key ones, many authors, including us, single out organizational and managerial competence. So, S.G. Markovchin and S.A. Kravtsov understand organizational and managerial competence as "... an individual, integral, dynamically changing, relatively stable characteristic of a person, which is the result of his continuous professional and personal development and manifests itself in an independent and responsible solution of the tasks of ensuring optimal relationships" [6; 321]. Researchers believe that when forming organizational and managerial competence, it is necessary to take into account the fact that "... to correspond to this image, an employee needs to understand what characteristics of his activity (results, actions, efforts) are most important. And taking into account this understanding, it is necessary to build activities by precisely these requirements, so that they are given priority ..." [7]. As V.A. Belikov notes, denoting the structure of organizational and managerial competencies formed among students, the structure "...should be clear and logical so that the future specialist, receiving theoretical knowledge at a university, could be able to solve problems based on this knowledge..." [8; 357]. The organizational and managerial competence of a master's student is understood by us as a systemic psychological and personal characteristic, including the following fundamental components: cognitive, motivational, activity, design-research, and personal, designed to provide him with the effective performance of organizational and managerial functions in the course of the implementation of high-tech production technologies [9; 193]. In modern conditions of the development of innovative technologies, the problem of uninterrupted and reliable control is of particular relevance. First of all, this requires the formation of organizational and managerial competence of undergraduates in the process of their professional training. In turn, the promotion of this competence is ensured by the creation of the necessary pedagogical conditions, which we outlined in the study [3; 100-106]. This complex of pedagogical conditions represents those conditions, the provision of which leads to the successful promotion of its structural components. For us, the most preferable analysis of the structure of the organizational and managerial competence of the student in the implementation of master's programs is proposed by E.V. Savenkova [10;212]. This structure includes a certain set of components: motivational-personal (motivational orientation), cognitive (experience recorded in knowledge), operationalactivity (skills and possession of methods of activity in standard and non-standard situations), and communicative, allowing, taking into account the existing experience students in solving problems of a certain type of professional activity, to successfully put into practice the knowledge, skills, and abilities acquired during the training. As a result, in the structure of the organizational and managerial competence of a master's student, we have identified cognitive, activity, professional and personal, motivational, communicative, and information and communication components (Fig. 1). --- Figure 1. The structure of the organizational and managerial competence of a master's student Thus, the integrity of the organizational and managerial competence of a master's student is made up of cognitive, activity, professional and personal, motivational, communicative, and information and communication components. First of all, the cognitive component identified in the structure of organizational and managerial competence allows, taking into account the experience of organizational and managerial activities of a master's student, to successfully implement in practice the knowledge gained in the learning process in a certain area of professional activity when solving problems of organizational and managerial types. The activity component includes a certain set of organizational and managerial skills that are professionally important for a master's student and acquired (developed) both in the process of professional activity and in the learning process, allowing them to consciously and independently make informed management decisions. The professional-personal component includes a set of certain professionally important qualities of a student that influence the qualitative characteristics of his future professional activity. Moreover, the professionally important qualities of a master's student are formed (developed) both in the process of carrying out his professional activities and in the course of professional education. Since one of the distinguishing features of the professional activity of a student with a master's degree in management is its indispensable connection with the implementation of organizational and managerial activities, in this regard, the structure of his professionally important qualities should provide the ability to manage subordinate units, as well as make informed management decisions in any situation [11; 28-34]. An analysis of scientific research conducted in this area made it possible to identify a certain set of psychological and physiological professionally important qualities of an undergraduate student, necessary for the implementation of his organizational and managerial activities. These, in our opinion, include purposefulness, determination, team leadership, sociability, non-standard thinking, the ability to make informed decisions in nonstandard situations, taking into account the limited time resource, as well as in the presence of incomplete (inaccurate) information, the ability to self-reflection, the ability to act in conditions of significant physical and mental stress, etc. --- CONCLUSIONS Based on the foregoing, we note that the process of professional training of a master's student at a university is targeted training in theoretical aspects, the formation of professional knowledge, skills, and their development, consolidation through practiceoriented classes that enrich the student with personal experience. The specificity of the master's program is that the student receives deep theoretical training, and acquires professional competence of a higher level. This program includes in-depth educational and research components, conducting research and scientific-pedagogical practices, and writing a dissertation. A large number of hours are given to the master for independent work, which is extremely relevant on the way to becoming a master in his professional activity. Thus, we note that university education should be based on motivating students to be true subjects of the educational process since only personal work will allow a student to turn into a competitive, highly qualified specialist. --- REFERENCES

In this article, organizational and managerial activity is considered as a problem associated with the formation of organizational and managerial abilities of students. It also highlights the cognitive, activity, professional and personal, motivational, communicative, and information and communication components of the organizational and management skills of a master's student.

Older adults who experience chronic pain (CP) face many challenges from their illness, which can affect their personal and healthcare relationships. Research indicates the importance of relationships on health and quality of life outcomes in older adults with CP. However, minimal research has explored their perspectives on the relationships they have with their healthcare providers, healthcare system, their CP, and family/friends/community. Objective: To understand how older adults' CP impacts their relationship with the healthcare system; and how older adults' CP impacts their personal relationships (i.e. self, family, community). Methods: Adults >50 years of age with pain were eligible to enroll in virtual focus groups and/or interviews. Audio recordings were transcribed, coded, and analyzed via a mixed inductive-deductive framework approach using ATLAS.ti. Microsoft. Descriptive statistics were performed using Stata 16. Results: Sixteen participants participated in a focus group (n=3) or an interview (n=13). Participants identified as White (n=12,75%), female (n=12,75%), and were between the ages of 55-64 years old (n=8,50%). Most participants held an associate's degree or higher (n=15,93%) and reported private medical insurance coverage (n=11,70%). Sessions lasted between 30-90 minutes. Participants described complex relationships that could have positive or negative impacts on their ability to manage their CP and their overall quality of life. Relationships explored included the healthcare system, clinician(s), family, other patients, and CP. Discussion: The relationships of older adults living with CP are multidimensional and can support or adversely affect pain management, mental health, and quality of life. Utilizing Geographic Information System (GIS) techniques and a composite index, this project delves into the intricate geographic patterns of property tax burdens in Pennsylvania, with a specific focus on older residents contemplating aging in place amidst limited financial resources. The study scrutinizes various factors, including property tax rates, home values, income, demographics, and other housing-related variables, to comprehensively grasp their effects on the financial feasibility of aging in place. Pennsylvania displays notable disparities in property taxes, averaging approximately 1.5% of home value, across counties due to distinct assessment systems and varying assessed-to-market ratios (CLRs). Tax rates are also influenced and specified by smaller administrative and geographic entities, including municipalities and school districts. Despite alternatives (e.g., assisted living), aging in place remains the preferred choice for most older Americans. This accentuates the significance of assessing property tax affordability that facilitates potential aging in place, particularly for financially constrained but "healthy" seniors who may not qualify for tax rebates or local freezes. Moreover, escalating housing prices and assessed values further emphasize the urgency. Cartographic and tabular findings from the study unveil challenging situations for seniors in specific county clusters of Pennsylvania, encompassing not only "expensive" urban but also "typically affordable" rural settings. Additionally, areas with the highest tax rates are not always the most financially burdensome (and vice versa) with all other factors taken into account. This study offers practical insights that have the potential to inform adjustments in housing and tax policies aimed at benefiting older adults in Pennsylvania. --- Florida, United States

ageism continues to impact healthcare professional's attitudes toward older adults. Older adults are often assumed to be frail, weak, or a burden on society. Addressing ageist attitudes and myths about ageing, which often lead to discrimination, can impact policy decisions. Knowledge of opportunities available to older adults to increase healthy ageing is vital in any healthcare training program. Recognizing the growing needs to prepare health professionals to work with the increasing numbers of diverse older adults, this research survey conducted for the college of health and human sciences (CHHS) to examine the students' attitudes and perceptions of ageing, interest in ageing careers, knowledge gaps in ageing, and ageing topics of interest. This survey resulted in 141 respondents who helped provide an informed baselines of CHHS student misconceptions about ageing, baseline of learning needs, and topics and practice opportunities of interest. This poster will share the unique results of this survey providing insight into students' attitudes and perceptions on ageing. Additionally, this poster will provide a brief picture of the college's response to the survey including curriculum development and systemic changes.

This is an insightful book, and the reader will learn much from it. The focus is on the participation of social enterprises in the formal process of procurement, rather than in the more informal process of having its goods or services purchased by government agencies or authorities. That is because social enterprises have a better track record of participation in the latter than in the former. It appears that the size of the social enterprises (measured by total revenues) and their self-rated capacity for preparing proposals matter. However, making connections and building relationships with purchasers can also be helpful. Knowing how to demonstrate an enterprise's social value and impact is also an asset. But in all cases, many obstacles will be faced, and the cost of participating in procurement can be considerable. There is much to be said about funding and increasing capacity building of social enterprises in harnessing the power of procurement and purchasing procedures. The potential for social enterprises is huge if governments truly consider social and environmental value or benefits when making purchasing decisions. But price and quality still dominate the decision process, social enterprises are hesitant and ill-equipped to prepare and submit bids, and there is a scale-up challenge in being able to fulfill a large successful order. However, breakthroughs are possible, sometimes by having several social enterprises bidding together as a supplier to meet the scale of the order. A lot could be achieved with closer links being established between social enterprises and organizational purchasers to demystify the process and educate the social economy bidders on how to respond to the tender. Social enterprise leaders and those responsible for purchasing and procurement decisions in the public or private sectors will gain much knowledge from reading this book about how to close the gaps that separate them still in establishing closer and tighter supply-chain relationships. Researchers and students interested in the social economy will also, by reading this book, deepen their understanding of how difficult it is to make the market economy work for organizations preoccupied by the conditions of citizens who are marginalized, disabled, or living in precarity. --- ABOUT THE AUTHOR / L'AUTEUR Luc Thériault is Professor of Sociology and Chair of the Economics Department at the University of New Brunswick (Fredericton). He specializes in social economy organizations, social policies, and housing and immigration issues. Email: luct@unb.ca

This book is the result of a three-year Canada-wide research project investigating the state of social procurement and social purchasing in 19 work integration social enterprises (WISEs) providing training and employment to marginalized individuals. Part 1 of the book provides an overview of the literature, federal government policies for procurement and purchase with social value, and the results of a unique survey showing surprisingly low participation by Canadian social enterprises in pursuing formal social procurement. Part 2 is based on the study of four social enterprises that have secured large contracts by investing in what the authors call relationship building. Part 3 details five cases where the role of a parent organization's support was key for social enterprises to bid on contracts. Part 4 focuses on the dilemma of five social enterprises regarding their decision to market or not to market the social value dimension of their work. Finally, Part 5 explores the challenges of five social enterprises in managing the concept of multiple bottom lines while pursuing social procurement opportunities. The conclusion discusses some future directions for the study of WISEs' participation in procurement and purchasing procedures.

INTRODUCTION After India gained independence, policymakers recognized the need for comprehensive rural development and focused on implementing various programs and initiatives to streamline agricultural development. The KVKs, initiated by the ICAR, are innovative schemes aimed at providing vocational training to practicing farmers, farm women, and young farmers. These KVKs act as primary links between farmers and the agricultural technologies being generated. They facilitate technology transfer by conducting on-farm testing, frontline demonstrations, and training programs to update farmers' knowledge and skills in improved agricultural practices. Currently, there are 731 KVKs operating across India, including seven KVKs in South Gujarat, dedicated to enhancing the livelihoods of farmers. One such KVK is located in Navsari district, where it directly engages with the farming community, transferring agricultural technologies and providing training programs to improve productivity and economic conditions. --- OBJECTIVES (1) Profile of the beneficiaries of KVK (2) Relationship between profile of beneficiaries and impact of activities organized by KVK Navsari --- METHODOLOGY An Ex-post-facto research design was used in the present investigation. The study was conducted in Navsari district of South Gujarat. Navsari district has six talukas. All six talukas were selected for the study. Two adopted villages were selected using the lottery methods. Ten beneficiaries were randomly selected from each village. In this way the sample size for the study comprised for 120 KVK beneficiaries. Twelve independent variables of the KVK beneficiaries were measured through respective scales with due modification. --- RESULTS AND DISCUSSION --- Profile of the beneficiaries of kvk It became clear from the data presented in table 1 that the more than half (54.17 %) of the KVK beneficiaries were in the middle age, followed by 25.00 and 20.83 per cent of KVK beneficiaries were found in old and young age group, respectively. Similar result was reported by Dobariya et al. (2017). More than one third (41.67 %) of the KVK beneficiaries had middle school level education, followed by 20.00 per cent had high school, 15.00 per cent had graduation level education. Whereas, very few 05.00 and 04.17 per cent were belonged to functionally literate and illiterate https://doi.org/10. 56572/gjoee.2023.36.1.0018 categories, respectively. This finding is in support to the findings revealed by Medhi et al. (2020). Slightly more than one third (35.83 %) of the KVK beneficiaries belong to semi medium category of land holding, followed by 31.67 per cent belong to small land holding category, 15.00 per cent belong to medium and 12.50 per cent belong to marginal category. Whereas, very few 05.00 per cent KVK beneficiaries had large size of land holding. The possible reason of this findings might be due to inherited deviation of land from generation to generation. This finding is partial support to the findings revealed by Patil et al. (2019). Less than two third (61.67 %) of the KVK beneficiaries belonged had medium level of farming experience, followed by 20.83 per cent had low level of farming experience and 17.50 per cent of KVK beneficiaries belonged to high farming experience category. This finding gets support from research reported by Nikhita et al. (2021). Less than half (43.33 %) of KVK beneficiaries were having annual income between ₹ 1,00,001 to ₹ 1,50,000, followed by 27.50 percent had ₹ 1,50,001 to ₹ 2,00,000, equal (11.67 %) had ₹ 50,001 to ₹ 1,00,000 & Up to ₹ 50,000 and 05.83 per cent KVK beneficiaries had Above ₹ 2,00,001 annual income. This finding is in partial support to the findings revealed by Kumar and Bairathi (2016). Less than half (48.33 %) of the KVK beneficiaries had medium level of extension contact, followed by 26.67 and 25.00 per cent had high and low extension contact, respectively. The result gets support from the research reported by Patil et al. (2019). More than half (53.33 %) of the KVK beneficiaries had medium level of risk orientation, followed by 25.00 and 21.67 per cent had high and low level of risk orientation, respectively. This finding is in accordance with the findings of Singh and Bose (2022). More than half (51.67 %) of the KVK beneficiaries had membership in more than one organization, followed by 29.17, 10.83 and 08.33 per cent had membership in one organization, holding position in organization and no membership in any organization, respectively. The finding has been partially supported by Dobariya et al. (2017). More than half (65.00 %) of the KVK beneficiaries had medium level, followed by 18.33 and 16.67 per cent had high and low achievement motivation, respectively. Similar results were reported by Nikhitha et al. (2021). More than half (66.67 %) of the KVK beneficiaries had medium level of scientific orientation, followed by 20.83 and 12.50 per cent had high and low level of scientific orientation, respectively. More than half (54.17 %) of the KVK beneficiaries belongs to nuclear types of family, followed by 45.83 per cent joint family. Similar results were reported by Kumar and Bairathi (2016). Less than two third (60.00%) of the KVK beneficiaries had medium level of innovativeness, followed by 20.83 and 19.17 per cent had low and high level of innovativeness, respectively. The results are similar with Vinaya et al. ( 2013), Nargawe and Mishra (2019), Dhananjaya et al. (2020) and Bhabhor et al. (2022). The table 1 revealed that education, farming experience, annual income, extension contact, risk orientation, social participation, achievement motivation, scientific orientation and innovativeness was found to be positive and significantly associated with impact of activities organized by KVK Navsari and land holding was found positive significantly related with impact of activities organized by KVK Navsari. Whereas, age and types of family was found negative non-significant relationship with impact of activities organized by KVK Navsari. --- Relationship between profile of beneficiaries and impact of activities organized by kvk navsari --- CONCLUSION In conclusion, the findings of this study reveal that the education, farming experience, annual income, extension contact, risk orientation, social participation, achievement motivation, scientific orientation, innovativeness were found positive and significant relationship with impact of activities organized by KVK Navsari. While, land holding had positive and significant relationship. Whereas, Age and Types of family were found negative and non-significant relationship with impact of activities organized by KVK Navsari. --- CONFLICT OF INTEREST All authors declare that they have no conflict of interest

The study was conducted in the Navsari district of South Gujarat. All six talukas were selected for the study. Two adopted villages were selected using the lottery methods and ten respondents from each village were selected following simple random sampling. Therefore, a total of 120 beneficiaries were selected for the study. The appropriate measuring techniques/scale for dependent and independent variables were also chosen, and a well-structured interview schedule was developed accordingly. The collected data were analyzed using statistical tools and methods for analysis. The finding of this study revealed that the variable like revealed that education, farming experience, annual income, extension contact, risk orientation, social participation, achievement motivation, scientific orientation, innovativeness was found to be positive and significant relationship with impact of activities organized by KVK Navsari and land holding was found positive significantly related. Whereas, age and types of family was found non-significant relationship with impact of activities organized by KVK Navsari.

Background: To tackle adolescent sexual health challenges, sexual health promotion must be versatile and originate from adolescents' needs. Social marketing, an audience-centered approach that aims at changing people's behavior, can be used in adolescent sexual health promotion. This scoping review researched the content and delivery methods of social marketing interventions in adolescent sexual health. To our knowledge, these objects have not been previously reviewed. Methods: Six databases were searched to capture the peer-reviewed quantitative, qualitative, and mixed methods articles without time restrictions that provided evidence of sexual healthrelated social marketing interventions targeting adolescents aged 11-25. An inductive-deductive content analysis was performed. Nineteen studies were included in the data. --- Results: The content of interventions included sexual risks, risk prevention, morals of sexual relationships, and changes in the body. Risks and risk prevention dominated the data, and they focused on sexually transmitted diseases, unwanted pregnancies, and sexual violence. Morals of sexual relationships included values such as fidelity toward one's partner, whereas changes in the body were observed from a reproductive perspective. Delivery of interventions occurred through various media channels, events, and activities. --- Conclusions: The interventions were mostly preventive and concentrated on the risks, whereas the delivery methods were diverse and creative, combining modern and already well-established channels. Sexuality should be seen comprehensively, and interventions should respond to the full range of adolescents' needs in a way that also positive aspects, such as love and relationships, respect, and equality are included. --- Key messages: The study improves public understanding of the phenomena by summarizing the existing knowledge. The results are beneficial in planning social marketing interventions and other sexual health programs. Abstract citation ID: ckad160.1441 A wellness intervention to address weight gain in people living with HIV

socioeconomically vulnerable, and 55.7% were involved in remote learning activities. The COVID-19 health emergency increased the non-compliance of the physical activity guidelines and the sedentary behaviour in childhood and adolescence. It is mandatory to design health promotion strategies to encourage active life styles during these stages, as they lay the foundations of healthy habits in the future, and this is a shared responsibility between educational institutions, families and policy-making institutions Key messages: The ActivityGram test assesses physical activity in children and adolescents. Analysis of physical activity and sedentary habits help to design health promotion policies in young people.

UNDERSTANDING PERSON-CENTERED CARE FOR OLDER PEOPLE IN SIX DEVELOPING COUNTRIES Jing Wang 1 , and Barbara Bowers 2 , 1. University of New Hampshire, Durham, New Hampshire, United States, 2. University of Wisconsin-madison, Madison, Wisconsin, United States Person-centered care (PCC) is a widely acknowledged and encouraged approach to quality care for older adults residing in residential care facilities. However, current understandings of PCC are mainly based on research and practice in western, first world nations. The lack of research on PCC in developing countries leads to uncertainty over whether and how current understandings of PCC apply to cultures and contexts in non-western, developing countries. To enhance care and outcomes for diverse populations, it is crucial to comprehend and culturally adapt PCC understandings and approaches. Therefore, we conducted interviews with researchers and practitioners from six countries in various stages of development to identify elements that form the core of high-quality care for older people and how they relate to Western notions of PCC. We gained valuable insights into how cultural differences, population health priorities, political conflict, and limited resources impact their understanding and implementation of PCC. In addition to variations in the language of PCC, some first world assumptions about PCC do not resonate well in developing countries. One example is the emphasis on individualism, a basic element of PCC. The role of the older person in decision making and focus on family and community priorities reflects both cultural and economic differences between first world, western nations and non-western, developing countries. The findings can serve as a valuable starting point for the development of a globally applicable measurement for the quality of care. Abstract citation ID: igad104.0970 --- ASSESSING CAREGIVING SUPPORT NETWORKS FOR PERSONS WITH DEMENTIA IN A LONG-TERM CARE CONTEXT IN CHINA AND THE US

the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. As part of the TRANS-SENIOR research network, rapid ethnographies were conducted across multiple sites (including interviews, observations and informal conversations), in long-term residential care homes in the UK, Switzerland and the Netherlands between October 2020 and December 2021. During analysis and interpretation of data, different themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed. We observed differences between the long-term care homes in as much as the setting could be considered, resident choice was implemented, residents were enabled, care was individualized in the communal setting and how much the person of the residents was known with their past and present. In the presentation we will discuss the possibility to provide person-centred care during mealtimes in view of differences between staff approaches, the overall environment (size of dining area, seating arrangements etc.), allocation of staff resources and country-specific rules and regulations. We see an interplay of factors in place for mealtimes to be moments of participatory choice, interaction, independence, and dignity.

When imagination is the method by which our research is conducted, we come to the realization that we are not just constructing research projects . . . research is the generation of life worlds that are nothing less than our contemporary and future society. (Sameshima et al., 2019, p. 22) n March 11, 2020, the World Health Organization (WHO) officially labelled coronavirus infections a pandemic (WHO, 2020). Coronovirus (COVID-19) was spreading rapidly around the world with no known vaccines or treatments at that time. On March 19, 2020, the Canadian Society for the Study of Education's (CSSE) board of directors, constituted by the CSSE executive and the association presidents, voted unanimously to cancel the 2020 conference. Throughout the deliberation processes, deep gratitude was felt for the tremendous amount of work already put into the planning and preparations for the conference by numerous volunteers. At the Canadian Association for Curriculum Studies (CACS), we deeply thank Drs. Sarah Davidson, Claire Ahn and David Scott for their tireless leadership as conference chairs. CSSE is an opportune time for scholars to connect with one another and to learn about new and ongoing research. We also recognize the disproportional impacts to graduate students and nontenured faculty of the cancellation of this national conference. Therefore, this special issue of conference presentation abstracts serves as refereed conference proceedings for those who chose to submit their abstracts. JCACS/RACÉC invited all accepted CACS submissions as well as those from CACS' special interest groups including the Arts Researchers and Teachers Society (ARTS), the Canadian Critical Pedagogy Association (CCPA), the Science Education Research Group (SERG), the Language and Literacy Researchers of Canada (LLRC) and the Regroupement pour l'étude de l'éducation francophone en milieu minoritaire (RÉÉFMM). This collection represents almost 80 abstracts of paper presentations, round tables, symposia and panel presentations. Despite the abstracts being already refereed, there was still considerable work to be done to process, edit, proof, layout and organize the presentations. For their work on this special issue, I particularly want to thank JCACS assistant editors, Rita Forte and Carol Lee and the JCACS production team of Paul Ema Faustin, Samidha Kalia, Mohamed Kharbach, Robert Pozeg and Adam Vincent. As well, none of this could have been accomplished without the perspicacious managing and associate editor, Holly Tsun Haggarty. I am also proud to present the new 28 member JCACS Team. In 2019, JCACS was successful in a proposal to the Social Sciences and Humanities Research Council Aid to Scholarly Journals' grant competition. JCACS was granted over $100,000 to implement a vision to expand the journal's I invite you to browse the abstracts and to reach out to colleagues in collaborative ventures. Wishing our curriculum community health, well-being, congratulations and loving-kindness.

This special issue contains select refereed conference proposal abstracts of presentations planned for the cancelled Canadian Society for the Study of Education (CSSE) conference at Western University May 30-June 4, 2020. The abstracts represent paper presentations, round tables, symposia and panel presentations from the Canadian Association for Curriculum Studies (CACS) and CACS' special interest groups including: the Arts Researchers and Teachers Society (ARTS), the Canadian Critical Pedagogy Association (CCPA), the Science Education Research Group (SERG), the Language and Literacy Researchers of Canada (LLRC), and the Regroupement pour l'étude de l'éducation francophone en milieu minoritaire (RÉÉFMM).

With an aging US population, more people than ever live with serious illnesses. Although palliative care (PC) can improve outcomes in serious illness, there are inequities in PC utilization. People with low socioeconomic status (SES), men, and Black and Hispanic people are less likely to receive and benefit from PC services. Despite these established demographic differences in PC utilization, there is a dearth of relevant survey research on preferences for PC in the general population. To address this gap, we surveyed a random sample of 1,500 NJ adults. Respondents were given a brief definition of PC and asked to indicate how likely they would be to schedule, attend, and routinely attend PC visit(s) if they were diagnosed with a serious illness. Predictors included in logistic regression modeling were SES indicators (income, educational attainment, insurance status, employment status), gender, and race/ethnicity. Data were weighted to be representative of the population of NJ. Modeling results revealed that lower income and lower educational attainment were associated with significantly lower odds of endorsing willingness to schedule, attend, and routinely attend PC visits in the event that one would become seriously ill. Unexpectedly, there were no gender or race/ethnicity differences in preferences for PC. These findings highlight the importance of public health education for what PC is and its benefits for an aging population, especially among those with lower SES. Future research efforts are needed to understand discrepancies in reported PC preferences versus real-world PC utilization for men and Black and Hispanic individuals. Abstract citation ID: igad104.1651 --- NO PENSION, NO HAPPINESS?-FINANCIAL SUPPORT EXPECTATION IN THE OLDEST-OLD AGE AND DEPRESSIVE SYMPTOMS Chengming Han, and Nan Zhou, Case Western Reserve University, Cleveland, Ohio, United States Objective. This paper aims to explore the effect of financial support expectation on depressive symptoms among the oldest-elderly. Method. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) 2018. The analytical sample included 10641 respondents who were older than 45. Financial support expectations refer to whom they would reply on when they cannot work, which includes four categories: children, themselves (savings or commercial life insurance), pensions, and others. Linear regression models were employed after controlling for pension, health insurance and urban-rural household registration (hukou). Results. More than half of the sample reported that they would rely on their children when they became too old to work. Those who reported that they would rely on themselves (b=-1.72, p=0.000) or pensions (b=-1.23, p=0.000) reported lower levels of depressive symptoms compared to those who would rely on their children. When pension and health insurance were controlled for, only those who would rely on themselves presented lower level of depressive symptoms. Pension and health insurance (except rural health insurance) mediated the association between the financial support expectation and depressive symptoms. However, the hukou status inhibited the mediating effect of pension and health insurance.

that 1.) between-person levels, not within-person fluctuations, matter, and 2.) between-person levels matter across all ages. Openness to Experience, Conscientiousness, and Extraversion predicted earning a higher yearly income; Neuroticism predicted earning a lower yearly income. Effects sizes for traits were comparable to that for parental education. Our results shed light on how people navigate social structures across the lifespan.

O ver 700 million people around the world are currently living in extreme poverty, surviving on an income of less than $2.15 a day -about the price of a tube of Pringles. For people trying to get by on such a small amount, life can become a real fight for survival. Extreme poverty is a global problem. Even in wealthy countries, millions of people live below the poverty line. In the US, for example, almost 40 million people are living in extreme poverty. How is it that America, the home of Hollywood, Wall Street and The American Dream, is also the home of so many people who are struggling to survive? The answer is not a simple one. The causes of extreme poverty, and extreme inequality, in the US are numerous, varied and complex, and many people have dedicated their careers to studying them. Even so, studying the causes of extreme poverty is just the first step on a long journey to eradicating the problem. The next step involves implementing schemes and programmes that can support people living in poverty and help them to achieve financial security. Dr Nathan Fiala, an agriculture and resource economist from the University of Connecticut, is leading a new programme in the region of New England, where his university is based. He hopes that this programme will help to encourage economic growth in the povertystricken communities of rural New England, so that the people who live there can attain a better quality of life. --- Life in New England "Extreme poverty is common across the US," says Nathan. "New England is no different." Poverty is particularly prevalent in rural communities in the north of the region. Big cities, like Boston in Massachusetts, tend to be the economic heartbeat of a region. In them, it can be much easier to find well-paying jobs, affordable housing and educational opportunities. In rural communities, on the other hand, access to these basic needs can be harder to come by. Rural communities are often cut off from much of the money that moves around in the big cities. As well as a lack of jobs, housing and education, these communities also tend to lack good quality infrastructure, such as roads and public transport, access to health care, and support from government programmes. Many such programmes are designed to tackle poverty in urban environments, and they are not always appropriate for these rural communities. TALK LIKE AN ... --- AGRICULTURE AND RESOURCE ECONOMIST Causality -the concept of cause and effect Extreme poverty -severe lack of access to basic human needs such as food, water, shelter, healthcare and education Poverty linethe minimum level of income a person needs to afford necessities (which will vary depending on country) Randomised control trial -a study in which an intervention is randomly assigned to people within a population. A control group is also randomly selected, and the two groups are studied over time to determine the effect of the intervention Rural communities -small villages or settlements that are located in the countryside Skills gap -a disparity between the skills that employers are searching for and the skills that potential employees have --- How is Nathan hoping to fight extreme poverty in rural communities? One of the biggest causes of poverty in rural New England is unemployment. Many people in rural communities have less access to quality education and there are fewer job opportunities in their local areas. On top of this, many of the jobs that are available require skills and expertise that many people in these communities do not have. This is known as a skills gap -an imbalance between the skills than an employer needs and the skills that potential employees have. Nathan's project involves trying to get a clearer picture of these skills gaps so that he can identify exactly which kinds of skills local employers are looking for, and which kinds of skills local people are lacking. Nathan hopes that by identifying and narrowing these skills gaps, he will be able to help these rural communities lift themselves out of poverty. --- How will Nathan identify these skills gaps? Nathan will work with local business groups and associations to understand which jobs they are struggling to fill and pinpoint which skills the applicants for these jobs are lacking. He will also work with these associations to determine what their employment needs will be in the future, and which skills their workforces will need to cultivate. Another way in which Nathan is collecting data for his project is via an online job postings website called Burning Glass. By analysing the job adverts on this site, Nathan will be able to understand which skills are needed in which places, and which skills are not being developed enough by local education and training programmes. --- How can the skills gaps be closed? Nathan will work to catalogue the existing training programmes within the region, at both high schools and higher education institutions like universities © bbernard/Shutterstock.com and colleges. There are also training opportunities within the business and industry communities themselves, so Nathan will talk members of these communities to get a full picture of all the training that is available to potential employees. Once these training opportunities have been identified, Nathan will be able to identify which sought after skills are not being supported by training programmes. He can then work with educational institutions and business groups to encourage them to develop the necessary training. Nathan will also communicate the findings of his projects to people in the local area who are unemployed or looking for new, higher-skilled jobs. He will be able to point these people in the right direction and help them find the training programmes that will help them gain the skills that they need. Nathan will also work with local high schools to help students understand which skills they might need to develop to begin their journey along their chosen career path. --- How will Nathan know whether the programme is working? Once Nathan has finished collecting data on the local skills gaps and training opportunities, he will share his findings with schools and young people in the local area. His plan is to conduct a randomised control trial to determine whether having access to this information will influence what types of further education young people pursue. A randomised control trial is a type of experiment that aims to evaluate the impact of a particular intervention. In this case, giving young people access to information about the skills gaps and training in their local area. The study group (those who are given access to the intervention) and a control group (those who are not) are chosen randomly from a wider population -in Nathan's investigation, young people in rural New England. The two groups are then studied over a period of time to understand the impact of the intervention on the study group. The feature that separates randomised control trials from other types of experiment is the random assignment of the study and control groups. This makes them particularly robust and allows them to provide powerful insights into questions of causality. Through these trials, researchers can confirm whether any changes to the study population are being caused by the intervention, as opposed to other variables. --- What will the long-term impacts of Nathan's programme be? Nathan hopes that his project will help to create sustainable economic growth by increasing access and availability to training, and by upskilling local people to fill employers' needs. In doing so, the project will help rural communities to climb out of the poverty that they are currently experiencing. Living in poverty can have an enormous impact on a person's health and well-being. Without a stable income, it can be hard to lead a healthy lifestyle, eat nutritious food and look after your mental health. If Nathan can help people in these rural communities find better jobs and escape poverty, he will also be helping them to live longer, healthier lives. --- RURAL COMMUNITIES ARE OFTEN CUT OFF FROM MUCH OF THE MONEY THAT MOVES AROUND IN THE BIG CITIES. I n its broadest sense, the field of agriculture and resource economics looks at how agricultural lands and natural resources are managed, and how this management can be improved. For example, a researcher in this field might investigate how farms can increase the amount of food they produce, whilst also minimising their contributions to climate change. Other researchers might study mining, energy production (including renewable energy) or water management. Much of Nathan's research has been focused on the social impacts of economics and resource management. He has worked with impoverished communities all over the world, investigating different ways of helping them lead healthier, more prosperous lives. For example, in Zambia, he conducted an experimental study that provided free bicycles to primary school girls. Two major challenges for young girls attending school in Zambia are the distances that they have to travel to get to school, and their safety as they make these journeys. Nathan found that providing these girls with bicycles made it much easier for them to attend school, leading to higher levels of aspiration and self-esteem. Other projects that Nathan is currently working on include studies looking at trust within homeless communities in Connecticut, how better cooking stoves can help communities in Rwanda, and the effect of private e-savings accounts on women in Tanzania. Nathan's research spans countries and includes a whole range of social resources and interventions. The common thread throughout all of Nathan's work is his desire to help people in poverty-stricken communities to lead better lives. • Work as an agriculture and resource economist can be highly varied. You might want to work in farming, fisheries, mining, forest management, renewable energy, water management or many other areas. Getting a degree in agriculture and resource economics can open the door to many career opportunities including: farm management, economic consultancy, policy analysis and loan officiating. • Nathan's work focuses on community action and the social aspects of growth and development. As an agriculture and resource economist, you will get the opportunity to meet and work with all kinds of people and communities. • There are many journals that are dedicated to research in agriculture and resource economics. --- What does your work as a consultant involve? Alongside my academic research, I also work as a consultant, supporting organisations to help them to understand the impact of the programming that they do. It is often hard to determine if the things that an organisation does have the positive effects on individuals they are aiming for. --- What do you enjoy about conducting research abroad? I enjoy trying to understand what types of programming are best to improve the lives of people living in poverty around the world. I have been lucky enough to conduct research all over the world in places like Uganda, Tanzania, Kenya, Zambia, Swaziland, Zimbabwe, Ghana, Myanmar, India and Paraguay. --- How do you decide which issues to work on? I go where the need is. For example, a team at Harvard University reached out to me about working in New York on housing evictions. Generally, organisations reach out to me to help them better understand the effects of what they're doing. What are your proudest career achievements so far? My work in Uganda, which has helped to show that people living in poverty can make good use of cash grants. There was concern that they would waste the money, but they do not. --- Q&A 1. It is important to get to know the people you are trying to help, so you can really understand them and their needs. 2. Working on your mathematics skills will set you up well for a career in advanced economics. 3. Data analysis skills are often in high demand, so working on these is a good idea. --- Nathan's top tips © Bits And Splits/Shutterstock.com

Extreme poverty is a global issue that affects hundreds of millions of people. Even in developed countries, many people struggle to make ends meet. In New England, a region in Northeastern USA, many rural communities face high levels of poverty. In large part, this is due to high unemployment rates and a lack of suitable education and training programmes. Dr Nathan Fiala from the University of Connecticut is working with these rural communities to help solve this problem and reduce poverty rates.

Introduction Scheduled tribes (STs) comprise 8.2% of India's population [1], and they mostly reside in forests and hilly terrains isolated from the other elite communities. In comparison with the wider community in India, this community has historically been subject to major social disadvantage and exclusion [2]. Recognizing their special needs, the Government of India has introduced several pro-ST policies and programmes; yet, the condition of the tribal community is far poorer than all of India, on average, in terms of most socioeconomic indicators. For instance, the National Family Health Survey-3 [3] reported that ST children have the poorest nutritional status in the nation. Malnutrition among children is considered as the key risk factor for adolescents' illness, and it is responsible for about one-third deaths of children globally [4]. It also affects physical and mental development, resulting in lower levels of educational attainment [5]. Moreover, children affected by severe or chronic malnutrition also go on to suffer from diminished functional and intellectual capacity as adults [6]. There have been several studies that have tried to understand child malnutrition and its proximate determinants in India [7][8][9]. But in aggregate studies, the specific issues of various small communities are not properly and adequately addressed, and this is so true for the STs. There is a second level of problem that is related to the fact that existing studies have based their findings on statistical regression analysis [7,8]. These models have their own assumptions and predefined underlying relationships between dependent and independent variables. If these assumptions are violated, such models lead to an erroneous estimation of parameters and a biased conclusion. Given this background, the present study seeks to identify the major factors associated with malnutrition among the tribal children in India using a non-parametric approach. --- Methods The investigation is based on secondary data compiled from the National Family Health Survey-3 [3], which is based on a nationally representative sample of 109 041 households and 124 385 women. Originally, the sample covers 99% of India's population living in all 29 states. However, for our purpose, we have considered 24 states because data on relevant variables are not available for other states. Definition of variables used in the present study are given in Appendix Table A1. A classification and regression tree (C&RT) model has been used to analyse data. C&RT is a nonparametric technique, and thus it is free from restrictive assumptions of conventional statistical methods. Here, the dependent variable is split into a series of left and right child nodes derived from the primary nodes. When the split is terminated, child nodes are determined as terminal nodes. In general, the development of a C&RT model consists of four basic steps: specifying the criteria for predictive accuracy, selecting splits, determining when to stop splitting and selecting the 'right-sized' tree. Please refer to [10] for more details regarding the modelbuilding process of C&RT. Statistical analysis was done using the statistical software package STATISTICA 10 for Windows. --- Results Prevalence of child malnutrition in India: spatial variation We observed significant spatial variation in malnutrition among tribal children (Fig. 1). The incidence of malnutrition has been found to be lowest in the northeastern region and highest in the central region. Among states, the highest incidence and the lowest incidence of malnutrition have been observed in Madhya Pradesh and Assam, respectively. Rajasthan, Gujarat, Meghalaya, Uttar Pradesh, Jharkhand and Madhya Pradesh have been identified as states where the incidence is higher than the national average. Factors affecting nutritional status of ST children Figure 2 describes the typical output of a tree model analysis. The analysis proceeds in a divisive way. On top of the figure, there is the root node of the tree model, which contains all the 24 available observations with a mean value of around 20%. At the outset, the malnutrition status is divided into two groups, according to the value of the wealth index (WI). Subsequently, node 2 is further split according to the variable 'antenatal care (AC)' and node 3 is separated according to the variable 'maternal malnutrition status (MM)'. In total there are five terminal nodes. These terminal nodes also called 'leaves' contain the main information conveyed by our tree model analysis. To determine which variables are the most important, each variable is ranked as to the order of its importance in Table 1. As provided in Table 1, breastfeeding practice (BF) turned out to be the most important variable, followed by WI and AC, in predicting incidence of child malnutrition in the ST community in India. The variable 'urban concentration of household' got the last place in the ranking. 'Importance' in Table 1 gives us an overall expression of the importance of a variable among all the splits in the tree. Note that the variable with the highest importance value (WI) is not necessarily the variable used for the first splits; rather, it draws its importance from its participation in many splits in the tree [11]. It may also be mentioned that unlike a linear regression model, a variable in a regression tree modelling can be considered highly important even if it never appears in the tree structure [12]. Thus, although decision-making autonomy of women, used as a proxy of women empowerment, and breastfeeding practice do not appear in the regression tree (Fig. 2), yet they turn out to be two important variables affecting child malnutrition in the tribal community. --- Discussion We observed a considerable variation in incidence of malnutrition among the tribal children across major regions and states in India. The highest incidence and lowest incidence have been observed in Madhya Pradesh and Assam, respectively. Our C&RT analysis shows that the most important factor that influences child malnutrition is BF. This result is supported by other empirical studies that have found that breastfeeding is crucial to improve the health status of children [13]. WI has been identified as the second important variable affecting child malnutrition, and it has a number of interactions with other variables. We found that in states where a relatively higher percentage (at least 26%) of mothers receive AC from a health professional, incidence of child malnutrition is less (node 5) even if those households do not belong to the highest wealth quintile. This clearly shows that if the medical support provided to women, especially during pregnancy, is improved, the risk of child malnutrition may be minimized even when the target group does not belong to a very affluent economic class. Consistent with our findings, there are studies that have found that inadequate AC during pregnancy is a significant predictor for delivery of a low-birth-weight neonate [14]. Maternal health and place of residence are the two other variables that interact with WI to determine child malnutrition. It has been observed that states where higher percentages (more than 47%) of women suffer from malnutrition, the incidence of child malnutrition is quite high (node 7) even if those states happen to be one where a relatively higher percentage of ST households belong to the highest wealth quintile. This indicates that if the economic status of the household is not conditioned by better maternal health, the risk of child malnutrition does not get reduced. In agreement with our findings, other scholars [5,6,14] also observed that maternal nutritional status and WI are positively associated with childhood nutrition. It may further be noted that states with a relatively better economic status of STs and lower incidence of maternal malnutrition exhibit lowest incidence of child malnutrition (8.5%), provided comparatively lower percentage of households reside in an urban location (node 8). But if a higher proportion of them reside in an urban location, the incidence of malnutrition increases to around 17% (node 9). This might seem little unusual, given the fact that urban locations generally have better disease prevention forces. But we have to remember that one has to have enough resources to purchase those comforts of urbanization. There are at least two reasons that may be put in favour of our findings. First, ST people who migrate to urban areas in search of work generally have lower purchasing power, and hence it becomes difficult for them to get better access to quality health care, improved water and sanitation systems and derive benefits from urbanization. Second, people living in rural locations, especially those who belong to a lower social class, do get some cost-free health facilities from the government and hence may fight malnutrition in a better manner. For instance, India has recently launched the National Rural Health Mission with the primary goal of improving the availability of and access to quality health care for people residing in rural areas. The present study suggests that malnutrition among the tribal children is the result of a nexus of multiple factors. Besides programmes that offer direct nutritional support, emphasis should also be given to improvement of BF, economic status, maternal nutrition and access to medical care especially during pregnancy. In contrast to the conventional thought, we found that the condition of tribal children is far more critical in urban locations, and hence, policymakers aimed at improving health of these children should not assume that people from urban locations require lesser attention, especially those who belong to a lower social class. --- Appendix

The purpose of this study is to identify the determinants of malnutrition among the tribal children in India. The investigation is based on secondary data compiled from the National Family Health Survey-3. We used a classification and regression tree model, a non-parametric approach, to address the objective. Our analysis shows that breastfeeding practice, economic status, antenatal care of mother and women's decision-making autonomy are negatively associated with malnutrition among tribal children. We identify maternal malnutrition and urban concentration of household as the two risk factors for child malnutrition. The identified associated factors may be used for designing and targeting preventive programmes for malnourished tribal children.

T eachers, pediatricians and pediatric psychiatrists agree on the fact that sustained intellectual exercise contributes to the brain growth and more sophisticated thinking, and thus brain must be challenged regularly. Communication and analytical thinking abilities of children develop if they regularly converse with their families and/or develop good reading habits. Families may unintentionally contribute to the mental deprivation and limited brain growth of their children by allowing unlimited use of media devices [1][2][3]. The social media network sites which have provided children with easy ways of establishing friendships, and satisfy their feelings of belonging and acceptance by others, have become more and more popular especially in developing countries [4]. However, there is no sufficient research/guideline on protecting chidren's safety in use of media devices in developing countries [5]. The results of the national school violence study in South Africa showed that 80.2% of secondary school learners have a mobile phone, while 54.3% have access to a computer or a tablet computer. About 70% of these children were reported to use social network sites and talk with strangers at least once a week [5]. Research findings in Vietnam have revealed that up to 25% of children in the urban areas and 20% of children in the rural areas had shared personal information such as their phone number or name of their school with strangers online. It was also reported that 49% of the urban children and 20% of the rural children in Vietnam were subjected to cyberbullying, or were threatened or embarrassed online. Unfortunately, only 1 in 10 of these victims informed a parent or an adult about this abuse [4,5]. Several studies have reported that victims of bullying are 2 to 9 times more likely to consider committing suicide [3][4][5]. Families should help their children realize the danger of cyberbullying by controlling their computer/tablet computer use. Watching television (TV) is the first-choice lesiure time activity of the families, especially in the urban areas of developing countries [6]. Burdette, et al. [7] reported that children in urban areas spent an avarage of 2.2 hours per day watching TV. Children's exposure to media violence plays an important role in the etiology of violent behaviors [7,8]. TV programs in US show 812 violent acts per hour, a typical American child would have followed 200,000 acts of violence, containing more than 16,000 murders, until the age of 18 years [8]. Furthermore, 15-20% of music videos and many of video games include violence [8]. Children tend to imitate the characters they watch on TV programs or on video games because they can not distinguish between fact and fantasy until 5 years of age. They may accept the violence as an ordinary means to solve problems over the time [8,9]. Therefore, physicians, especially pediatricians, should make parents and teachers media-literate meaning that they should comprehend the risks of exposure to violence, and teach their children how to interpret what they see on TV, in the movies, or in the cartoons. How does media affect weight in children? Watching television or playing with computer over 2 hours/day might result in obesity in children due to the lack of activity. Studies also suggest that 80% of obese children might become obese in adult life [9,10]. The incidence of childhood obesity -which may lead to hypertension, diabetes mellitus, coronary artery disease, cholecystitis, VOLUME 52 __ JUNE 15, 2015 AT KARAAGAC UNDESIRABLE EFFECTS OF MEDIA ON CHILDREN dyslipidemia, osteoarthritis or sleep apnea in adulthoodhas doubled in the last two decades in America in proportion to the increase in children's media use [11]. Moreover, American Academy of Pediatrics has declared that an average child watches 20,000 or more commercials every year, more than 60% of which promote junk foods related with obesity [12,13]. Costa, et al. [14] reported that 13.8% of 1369 commercials screened during 176 hours of TV programming in Brazil were related with foods as sugars, sweets (48.1%) and fats (29.1%). It has been suggested that the content and the timing of commercials should be carefully controlled because children under the age of 8 years are unable to differentiate the advertisements from the regular programs, and commercials have considerable influence on them [13]. Yousef, et al. reported a positive correlation between excessive TV watching (>2 h/d) and aggressive behaviors, attention problems, low self-esteem and internalizing and externalizing problems of children [15]. The use of electronic media devices beginning from the preschool age has been associated with 1.2-2 folds higher rate of emotional disorders like major depression, bipolar disorder or anxiety attacks. In addition, poorer family functioning has been reported with excessive TV watching or computer use [16]. Obesity and impaired glycemic control due to lack of exercise is one of the major risk factors for cardiovascular diseases [17]. If children's media use is not limited, they neglect regular activities as hiking, running, swimming and riding bicycle [14]. Therefore, it is important to encourage families to monitor their children's media use and to spend more time doing physical activities with their children to improve cardiovascular health in their adulthood. Children usually sit in unsuitable body postures for a long time in front of TV or computers. Drzal, et al. [18] demonstrated that prolonged sitting position resulted in decreased angle of inclination of the thoracolumbar spine, reduced thoracic kyphosis and lumbar lordosis, and pelvic asymmetry in children aged 11 years to 13 years in Poland. Posture education programs should be advocated for school children to avoid such advanced spine abnormalities. Melatonin is a very important antioxidant that protects nuclear DNA and cell membrane lipids from oxidative damage. It has been strongly suggested that prolonged exposure to magnetic fields might cause hematopoetic system cancers, especially in children, due to melatonin supression [19]. The most effective way of protecting children from the undesired effects of media is to provide the family control via media literacy education programs. The success of media literacy education of families depends on the power of communication between parents and children. One of the most important steps of this education is to set some rules about limiting the time their children spend watching TV or playing video games. Children's media use should be limited to 1-2 hours/day after they finish their homework and/or sport activities [20]. Parents should watch TV with their children to teach them how to interpret the media messages or content of commercials. Parental supervision during watching cartoons and movies enables the children to distinguish between reality and fantasy. Families should talk with their children about how violent scenes create false excitement, and how problems can be solved nonviolently [19,20]. Besides family relationships and willingness, several demographic factors such as age, educational status or income of the parents may affect the results of media literacy applications. Studies have shown that the educated parents can have a better control of children's media use and its content. On the other hand, two-thirds of 8-to 18-year-old children of the families with higher socioeconomic status have their own TV sets, computers or video game consoles, which makes family control difficult [20,21]. In conclusion, harmful effects of uncontrolled media use by children is a common problem shared by most of the countries throughout the world. It is impossible to forbid children's media use; however, physicians can promote healthy use through public education. Media organizations should also be trained to be more sensitive about the determination of program contents and timing. Pediatricians should play a key role in raising awareness of media literacy of families as well as encouraging politicians to create effective media-literacy education policies.

Pervasive media environment is a social problem shared by most of the countries around the world. Several studies have been performed to highlight the undesired effects of media on children. Some of these studies have focused on the time spent by children watching television, playing with computers or using mobile media devices while some others have tried to explain the associations between the obesity, postural abnormalities or psychological problems of children, and their media use. This article discusses the recent approaches to curb influence of media on children, and the importance of family media literacy education programs with particular relevance to developing countries.

Introduction The world population is rapidly aging, especially in Japan, where 28.9% of the total population in 2021 was aged 65 or older [1]. The current society deems the active participation of older adults as important and meaningful. Social participation refers to people performing activities evaluate the finding that older adults with frailty have lower social participation is replicated in Japan. Meanwhile, many older adults participate in social activities on a daily basis even with frailty. The difference between these frail adults and other older adults is a striking question. As one of the characteristics of such older adults, we focused on subjective health (comprehensive and self-rated health measures defined by a wide range of factors, including physical and mental health, income, and living environment) [9]. The subjective health of older adults has received increasing attention in the academic field of public health [10]. Indeed, older adults with higher subjective health have higher social participation [11,12], as well as higher quality of life [13] and life satisfaction [14]. It should be noted that while subjective health and objective health-related indicators generally have a positive correlation [15], it is reported that frail older adults with low depressive tendencies maintain the same level of subjective health as the general older population [16]. Therefore, we exploratively examine the possibility of frail older adults having higher subjective health and participating in the society similarly as the general older population. We hereby evaluate the following hypotheses by conducting an online survey for older adults aged 65 years and more. Specifically, we examine whether older adults with frailty have lower social participation than robust older adults in Japan (Hypothesis 1) and whether older adults with frailty having higher subjective health participate in society similarly as the general older population (Hypothesis 2). --- Main text --- Methods Participants. This study included 1,082 Japanese aged 65 years and older (548 males and 534 females). Participants were registered respondents of Intage Inc., a major Japanese research company. This survey was conducted online in June 2022. Older adults certified as requiring long-term care (N = 18) were excluded from the study. Finally, 1,064 participants were included in the study (542 males and 522 females), with a mean age of 70.59 years (SD = 4.68). Participants' demographic information and the results of the study related to the certification of requiring long-term care are presented in the Open Science Framework (OSF) repository (https://osf.io/xycsk/). Ethical approval was obtained from the authors' institution and all methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all participants in the form of checking a box in the online survey. A power analysis was conducted for conducting a onefactor analysis of variance (k group = 3 (frailty, pre-frailty, robust), f = 0.25 (medium effect [17]), α = 0.05, β = 0.80). Thus, the required sample size in each group was 53. The sample size of each group in this study met this criterion (for the exact sample size in each group, see below). The survey was developed for this study and all items included in the survey were posted on the OSF. Measurements and procedure. Participants completed an online survey and responded to each of the following items. Social participation was measured using 14 items (five-point Likert scale) [18]. The mean was calculated (α = 0.92), with higher scores indicating higher social participation. The specific content of social participation (e.g., volunteer groups, sports groups) was also measured, and the results were posted on the OSF. Frailty was measured using five items (two-point Likert scale) of the Frailty Screening Index [19]. The total is the frailty score, with higher scores indicating a higher degree of frailty. Scores ≥ 3 were considered to indicate frailty (N = 164); 1-2, pre-frailty (N = 675); and 0, robust (N = 225). Subjective health was measured using five items (four-point Likert scale) of the S-WHO-5-J [20]. The mean was calculated (α = 0.86), with higher scores indicating higher subjective health. Demographic items, including participants' subjective wealth, cohabitation, work status, age, and gender, were evaluated. Histograms of each indicator were posted on the OSF. --- Results The summary statistics of each group are illustrated in Table 1. The results were similar when data from all the participants without screening were analyzed (for details, see OSF). When comparing social participation among the three groups (frailty, pre-frailty, and robust); controlling the participants' subjective health, subjective wealth, cohabitation, work status, age, and gender, the main effect of group was significant (F(2, 1055) = 46.19, p < .001, η 2 = 0.09). Multiple comparisons using Tukey's test revealed that participants in the robust group had higher social participation than those in the frailty (t(1055) = 3.58, p = .001, d = 0.83) and pre-frailty groups (t(1055) = 2.79, p = .01, d = 0.35), supporting Hypothesis 1. The same results were obtained without considering control variables (see OSF). To investigate the interaction between subjective health and frailty score, a multiple regression analysis was performed with social participation as the dependent variable and subjective health, frailty score, the interaction between them, subjective wealth, cohabitation, work status, age, and gender as the independent variables (Table 2). As a result, the interaction between subjective health and frailty score on social participation was not significant (β = 0.01, 95%CI = [-0.04, 0.06], p = .70). Meanwhile, frail participants who had higher subjective health had higher social participation scores than many robust participants. Specifically, the estimated social participation score of participants with higher subjective health (+ 1SD; 2.92) in the frailty group was 3.06, and 87 (38.67%) robust participants scored below this value. The estimated social participation score of the participants with higher subjective health (+ 1SD; 3.24) in the pre-frailty group was 3.35, and 131 (58.22%) robust participants were below this value (for details, see OSF). In summary, Hypothesis 2 is supported by the fact that older adults with frailty and higher subjective health participate in society to the same extent as robust older adults. In other words, even if a person is frailty (or prefrailty), if his/her subjective health is high, he/she can participate in society as well as robust people. --- Discussion We focused on frailty as a factor that influences older adults' social participation. We conducted an online survey with Japanese older adults and found that frail older adults have lower social participation than robust older adults. Meanwhile, we showed that older adults with frailty and higher subjective health participate in social activities to the same extent as the general older population. The results suggest that even older people with low physical health may be able to participate well in society if their subjective health is high enough. In previous studies [11,12], older adults with higher subjective health had higher social participation. However, this association is only a correlation, and it is unclear whether enhancing the subjective health of older adults will increase the degree of social participation. Additionally, strategies to enhance their subjective health should be investigated. Some aspects of physical health will be maintained in each older adult while others will not, such as vision, hearing, and other physical functions. Therefore, one of the effective strategies to increase older adults' subjective health would be having them focus on their healthier aspects. Academic researchers in public health should continue to examine the subjective health of older adults in detail. --- Limitations Despite these findings, this study has three major limitations. First, the participants were limited to older adults who were able to participate in an online survey. In the future, to cover a broader sample, a mail survey should be conducted among older adults throughout Japan. Meanwhile, the number of participants in the pre-frailty group was 4.12 times that of the robust group; thus, the sample was not biased toward healthy participants. Rather, a higher percentage of participants was frailty or pre-frailty. This may be related to the fact that the survey was conducted during the COVID-19 epidemic. There may have been a temporary increase in the number of participants answering "yes" to the frailty questionnaire items on "Do you go for a walk for your health at least once a week?" and "In the last 2 weeks have you felt tired without a reason?" Therefore, we do not believe that our sample was biased. Second, frailty was measured using the five items of the Frailty Screening Index [19]. This scale is frequently used with the Japanese older adults and is less burdensome for the participants. However, several measures of frailty have been developed [21] and the robustness of this study should be re-examined while taking a more multifaceted view of frailty. Third, items on subjective health do not include ones regarding the comparison of the health between the self and other older adults around the participants [22]. A longitudinal study has shown that older adults who consider themselves healthier than other older adults have lower subsequent mortality rates [23]. Accordingly, we should also examine the effect of feeling healthier than other older citizens on social participation. The subjective health of older adults should be measured extensively and investigated in more detail. We exploratively focused on subjective health as a characteristic of older adults participating in social activities even with frailty. It is crucial to prevent frailty in promoting social participation. However, the decline in physical function of older adults varies greatly with each person, and some older adults acquire frail at a relatively young age [19]. Based on this study, it may be effective to improve subjective health, even with frailty, by focusing on the positive aspects of one's health status. The relationship between subjective health, frailty, and social participation is primitive, and further studies are needed. --- Data Availability The data and materials underlying this article are available in the Open Science Framework (OSF) repository (https://osf.io/xycsk/). --- Supplementary Information The online version contains supplementary material available at https://doi. org/10.1186/s13104-023-06407-x. --- Supplementary Material 1 Authors' contributions YS investigated the previous studies, analyzed and interpreted the participants' data, and wrote the original draft of this paper. MS, YH, and TS investigated the previous studies, checked the original draft, and revised it. All authors have read and approved the final manuscript. --- Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ethics Committee of the University of Tokyo (UTSP-21044) and all methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all participants in the form of checking a box in the online survey. --- Consent for publication Not applicable. --- Competing interests The authors declare no competing interests. --- Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

in their daily lives and taking on social roles [2], which contributes to the promotion of well-being in older adults [3] and reduction of depressive tendencies [4]. The social participation of older adults is crucial to compensate for the decline in the working-age population, which is serious in many developed countries including Japan. Thus, we should investigate how to promote social participation of older adults. Frailty was our primary focus, as it prevents their social participation (increased vulnerability to health problems due to various age-related functional changes) [5]. Since social participation requires a certain degree of cognitive function and physical activity [6, 7], older adults with frailty are likely to have lower social participation. Indeed, previous studies of older adults in China and Taiwan suggested higher social participation with higher cognitive and physical function [3,8]. In this study, we

and the undeniable underrepresentation of women and people of color in Silicon Valley is a complicating factor in the skewed narrative that digital media presents. "Filling the pipeline and holding 'future' Black women programmers responsible for solving the problems of racist exclusion and misrepresentation in Silicon Valley or in biased product development is not the answer." Given the ubiquity of "search" many people have the illusion that search engines return accurate, unbiased information. Google, Noble reminds us, is a commercial enterprise, not "an information resource that is working in the public domain, much like a library." Not that libraries have an unblemished record in this regard. Information organization is never neutral but derives from "sociopolitical and historical processes that serve particular interests." Noble illustrates the biases of Library of Congress Subject Headings and writes about the work of radical librarian Sanford Berman, who "led the field in calling for anti-racist interventions into library catalogs in the 1970s." Yet it took a two-year organizing effort (2014)(2015)(2016) for the Library of Congress to "replace the term 'illegal aliens' with 'noncitizens' and 'unauthorized immigrants' in its subject headings." As discouraging as it is to learn that the Library of Congress once classified Asian Americans as the "Yellow Peril," at least library classification schemas are visible and correctible. Algorithms and machine learning are not. The evidence that Noble uncovers shows how unchallenged these algorithms are. She asserts, "The problems of big data go deeper than misrepresentation, for sure. They include decision-making protocols that favor corporate elites and the powerful, and they are implicated in global economic and social inequality. Deep machine learning, which is using algorithms to replicate human thinking, is predicated on specific values from specific kinds of people -namely, the most powerful institutions in society and those who control them." (This issue is addressed convincingly, and in great depth, in Cathy O'Neil's important 2016 book Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy.) Since Google derives much of its income from advertising, the ranking of search engine results is explicitly skewed to favor advertisers and not consumers. Many users have difficulty distinguishing between paid advertising and organic search results. "Search happens in a highly commercial environment, and a variety of processes shape what can be found; these results are then normalized as believable and often presented as factual." That Google returns results in an order that favors its own financial interests is problematic, but a much more serious problem is the proliferation of hate speech. Noble offers the case of Dylan Roof, the young man who murdered nine worshippers at the Mother Emmanuel AME Church in 2015. Trying to make sense of the Trayvon Martin case, Roof researched "black on White crime." The results he saw were from the white nationalist Council of Conservative Christians, not the U.S. Department of Justice or the FBI. She writes, "It is critical that we think about the implications of people who are attempting to vet information in the news media about race and race relations and who are led to fascist, conservative, anti-Black, anti-Jewish, and/or White supremacist websites." Noble argues that the harmful effects of digital media in real life necessitate an increase in government regulation. "Attempts to regulate decency vis-a-vis racists, sexist, and homophobic harm have largely been unaddressed by the FCC, which places the onus for proving harm on the individual. I am trying to make the case …that unregulated digital platforms cause serious harm. Trolling is directly linked to harassment offline, to bullying and suicide, to threats and attacks. The entire experiment of the Internet is now with us, yet we do not have enough intense scrutiny at the level of public policy on its psychological and social impact on the public." Regulation also impacts the consumer's right to privacy, what Noble calls the "value of social forgetfulness." "These rights to become anonymous include our rights to become who we want to be, with a sense of future, rather than to be locked into the traces and totalizing effect of a personal history that dictates, through the record, a matter of truth about who we are and potentially can become." Algorithms of Oppression is, ultimately, a call to activism. "My hope is that the public will reclaim its in-stitutions and direct our resources in service of a multiracial democracy. …we must fight to suspend the circulation of racist and sexist material that is used to erode our civil and human rights." Unfortunately, Noble's use of highly politicized language -hegemonic control, neoliberalism, persistent racialized oppression, gendered identities, etc. -is wearisome and ultimately detracts from the strength of her argument. Still, Noble's perspective as a black feminist information professional is an important voice to listen to in this necessary and growing conversation. --- Reviewer Information Rachelle Linner, a freelance writer, has an M.S. L.I.S. from Simmons College, School of Library and Information Science. She has worked at search-related software companies for over twenty years. She can be reached at linner02128@yahoo.com

lgorithms of Oppression is a wellresearched analysis of what Noble (Assist a nt P rofe s sor of Information Studies at UCLA) rightly names "technological redlining." She describes, and illustrates, how discrimination is "embedded in computer code and, increasingly, in artificial intelligence technologies that we are reliant on, by choice or not." The book's publication is particularly timely, given recent focused attention on the societal impact of technology companies, including related to election hacking, consumer privacy, and the psychological effect of social networks. Noble's book is well-illustrated with screenshots from searches that reveal the embedded racism of the Internet. (Noble's examples run from 2010 to 2016, and she acknowledges that Google has changed its algorithm to some degree, as can be seen in some of the latter screenshots.) "Although I focus mainly on the example of Black girls to talk about search bias and stereotyping, Black girls are not the only girls and women marginalized in search." Searches for black, Asian, Latino, Hispanic, African-American and Asian Indian girls return sickening images of pornography. As she notes, "…gender and race are socially constructed"

Background British-based Journal readers may recall, in the autumn of 2008, a sudden explosion of shock-horror headlines in the press about a new television series. Channel 4's The Sex Education Show was apparently being just too upfront and personal about all kinds of sexual issues and, even more appallingly, was aimed at teens as well as adults and was scheduled before the watershed of 9.00pm. Personally, and professionally, I thought it a brave and useful project. But I was fascinated to peep behind the scenes and see what the programme-makers really intended, and whether my family-planning-informed enthusiasm was well justified. I approached the relevant production company, Endemol, with some trepidation. Given the aforementioned press negativity, I was prepared for not only refusal to be interviewed but also defensiveness if the interview did take place. In the event, neither fear was realised. What I got was absolute co-operation -even to the point of offering to let me see the complaints the series received. The press office was accommodating, the production team willing, and a few weeks later I found myself posing my questions to producer, Adeline Ramage Rooney. --- Agenda To begin with, I asked what had the programme-makers' agenda been? Adeline's answer: "to get people talking". But by this the intention was not to cause controversy and hit the tabloid headlines; instead their mission was get their adolescent viewers talking to each other ('the school playground water cooler moment') and then get them talking to the adult viewers. "We hoped that a teen would watch it in the bedroom while their Mum watched it in the front room -and that maybe some time over the next 24 hours the two would discuss [sex] without embarrassment." Encouragingly, that entire agenda came from the teenagers themselves, who told the programme-makers: "We are still children and we need to learn, but our parents think we know it all and won't talk about it to us". In our sexualised society, what the press and public perhaps don't realise is that there is not only a need to give young people knowledge, values and guidance, but also a need to help parents understand that whatever their seeming recalcitrance, teens need those things and want trusted adults to deliver. "Television ... makes knowledge more credible per se -it also makes guidance more acceptable, less state-dictated." The project agenda was firmed up -and has been continuously updated over the course of the first, second and now upcoming third series -not only with focus groups but also via a YouGov Survey of 1300 teenagers, and via roadshow work in schools that invited the programme-makers in. Also involved were experts from a No to anything that suggested all teenagers are "at it". And double No to anything that could approach sleaze. Then, add on an accompanying website to continue the support after the show was aired. As to programme format and 'shape', it soon became clear that there were no precedents. The team didn't even spend much time looking at previous sex education videos ("it's a completely different market") or sexual pleasure DVDs ("our job is not to show people how to have sex"). In addition, it proved impossible to set a standardised format, à la Wife Swap or Come Dine with Me, because that would have alienated the impossibly diverse audience. "We needed a magazine format, which appealed to everyone, covered all the bases, but still maintained the same core messages." The 'cast' of the show were ordinary schoolchildren from a variety of backgrounds, carefully briefed and with full parental consent, plus a raft of specialist experts. The presenter, with a pivotal role, needed to be someone at ease with sensitive and sometimes embarrassing material, someone who could ask challenging questions, but also someone who could wear their heart on their sleeve and be prepared, for example, to have an STI test live on camera! The programme-makers decided on Anna Richardson, an established TV personality -a decision not always welcomed by critics, who felt that a sexual health specialist would have been a more appropriate choice. Adeline says: "We didn't go that route in case it gave a preachy feel or in case an expert felt they had to be so formal in their dealings that it took the heart out of the series. In the end we made the right choice. Anna has not only been great on camera, off-camera she's also been great; for example, in one programme she ended up comforting a girl who'd had an abortion." --- Critical reception Decisions confirmed, experts consulted, scripts written, team hired, filming went ahead and the first series was aired in September 2008. As mentioned, reception was mixed. The Daily Mail ran a half page of scathing accusations including the words "Channel 4 has been accused of peddling obscenity". One sexual health one site found. "What we always wanted was to create an arena where Jessie from Milton Keynes could say 'I occasionally get this fishy smell downstairs after having sex, though I'm really clean ', and get [good] advice. It's all about people sharing their experience." --- Next steps How has the concept changed since its controversial launch? The first series covered a multitude of topics, from period pains to penis size, STIs to fertility testing. But by the time the project was recommissioned for 2009, the focus had become tighter; the second series homed in on the pornification of society and how it affects teens. Slid over and past the watershed to allow more graphic content and screened on consecutive nights over the course of a week, that series made hardly a stir in the press, attracted few complaints (which Ofcom deemed it irrelevant to even investigate) and not only created 'school water cooler' and teen-parent conversations à la the programme-makers' original brief, but also gathered a dedicated fan base across a wider age range. What of the future? Surely a continuing website. Surely more schools using the DVDs. Hopefully -there is already evidence of this in other TV channels' commissioning strategies -a society-wide impact on the whole field of responsible but accessible sex education. And, certainly, a third series. Though sworn to secrecy on the details, your intrepid correspondent can reveal that a third series will air in Summer 2010 and address diversity of sexuality. "We want to give a voice to the sexually invisible -the disabled, the older. We want to cover stories of people who have overcome incredible prejudice to claim their right to a sex life, but once again we want to put that across not in a sensationalised way but with an underlying message that sex is good and fun, but you need to look after yourself." --- And finally I was left, following my research and my interviews, with any doubts assuaged, feeling positive not only about the focus of The Sex Education Show, but also about the intentions and capabilities of its makers. And I leave you with the very encouraging thought that when I asked Adeline whether the project had affected those who worked on it, the answer was a resounding Yes. "Absolutely. Every single member of the team has learned a lot and had their eyes opened. We've now made a pact with ourselves that if we have younger friends, cousins, nieces or daughters who are approaching puberty and [having wobbles about sexuality], we won't fall into the trap of thinking that it's not our place to say anything. Instead, we'll sit down with them, talk it through, and make sure they're happy." Whatever the tabloids shriek, as a personal and professional philosophy, surely you can't say fairer than that? Statements on funding and competing interests Funding None identified. Competing interests None identified. --- Author's note A third series of The Sex Education Show will air on Channel 4 in Summer 2010. organisation -tactfully the Endemol spokesperson refused to say which one -was very critical and withdrew support. Reportedly 152 viewers rang in to complain, particularly about the use of real-life models. There were many who argued that The Sex Education Show quite simply went too far. Ofcom was called in to investigate. The programme-makers were unfazed. Yes, they had expected, albeit not courted, press wobbles. Yes, they were saddened by individual and organisational objections "some people seemed to think we didn't care about the teenagers, but we do, very much". Yes, they acknowledged, and later rectified, an initial heterosexual bias and certain difficulties with spanning such a wide viewer market aged 13+ years to adult. But they were confident that they had acted thoughtfully and responsibly, with an army of advisors and lawyers checking "every image, every script, every voiceover". As to the tabloid-outraging real models issue, this approach was "actually suggested by the sexual health organisations, which wanted us to dispel harmful myths about body image and sexual performance that are rife on the Internet". And when Ofcom did investigate, looking at every single complaint, it totally cleared the series, stating that it not only fulfilled its brief to "examine sex and sexual health in an accessible way that would engage viewers" but that it also responsibly gave clear warning of explicit content pre-transmission, at the start of each programme and throughout it. The regulator, in fact, strongly backed the whole project, saying that it was "of paramount importance" that such issues were covered in the media and that it would be a "an inappropriate and a disproportionate limitation on the freedom of speech" to prohibit programmes of this nature, even before the watershed. --- Positive reception Adeline and her colleagues had further reasons to be cheerful. A resounding 99% of the feedback was positive. "[The very day after the first programme was aired] we started to get [messages] coming in from people saying how much they loved it." Parents wrote in to express their gratitude, saying things like "Thank you so much, I've now got a genuine reason to start a conversation about contraception rather than trying to shoehorn it into everyday life". Sex and relationship educators constantly asked for the series DVD. Much press coverage was supportive and grateful. "The UK could do with a bit of sex education", commented The Independent. And -scoop of the year -Cameron Diaz (some Journal readers may need me to point out that she's a film star) when interviewed for Cosmopolitan magazine, stated that she watched the programme, loved it, and thought it was just what America needed. Dear reader, what further endorsement does one need? Most importantly of all, surely, was the positive response from teenagers. E-mail after e-mail congratulated the show. In schools visited by the programme-makers, class after class learned and loved learning. The show's website (http://www.sexperienceuk.channel4.com) -by the time I spoke to Adeline -generated over 22 million hits and that figure has no doubt risen since. Indeed, at one point if you Googled™ the word 'sex', the show was the number " " I've now got a genuine reason to start a conversation about contraception. --- " " We want to say that sex is good and fun, but you need to look after yourself.

No to scaremongering. No to position of the week. No to sleaze.

INTRODUCTION Marketing communication has undergone a change from conventional marketing to digital marketing, the development of the internet which is starting to be accessible via cellular phones and the term smart phone (smartphone) appears with various various facilities, ranging from Email, Browsing, and other social media facilities. The government continues to encourage the use of digital technology to increase the productivity and added value of SMEs (Ministry of Communication and Informatics, Republic of Indonesia, 2020). As many as 59.2 million MSME actors, 8 percent (3.79 million) have used online platforms to market their products (Kurniawan, 2021). The use of social media for micro, small and medium enterprise (MSMEs) marketing has become increasingly popular and useful in recent years. Social media platforms provide a cost-effective and accessible way for MSMEs to reach their target audience, build brand awareness and drive sales. As technology advances, trends in marketing will make advertising easier for users. Traditional marketing strategies have been defeated and are starting to be abandoned. Businesses need efficiency and cost-effectiveness, which are goals that social media marketing successfully achieves. By optimizing their social media presence, MSMEs can effectively engage with their target audience, increase brand visibility and drive customer acquisition. Social media platforms such as Facebook, Instagram, Tiktok are the most used social media by people in Indonesia. Each social media has different characteristics and the audience is also different, so that there are opportunities that can be utilized by MSMEs in marketing the goods and services they produce. Product/service marketing through social media has become the best way to expand markets or customers. This is because social media has more roles and functions than conventional media, namely (a) simpler, (b) building relationships, (c) global reach, and (d) measurable (Prasetyo, 2018). The selection of marketing communication media is based on the type of product to be marketed, the target audience, the time to send the message and marketing costs. Consideration is needed in choosing an effective marketing communication media. Thus, UKM actors must carefully consider choosing the right media in marketing their products so that they can be accepted by the community (Pasaribu, 2020). With various features in marketing through social media that are static and dynamic which make it easier for SMEs to market various products and activities in the form of activities (Siswanto, 2013). Social media is the target of business actors, especially MSMEs because this media can reach targets broadly and even personally. Not to mention that several platforms such as social media are the first and superior media for MSMEs because the costs are relatively cheap and easy to apply. It's just that social media is the right choice considering that millions of people are present in this world and make the digital world hectic, jammed and congested. As a result, for consumers who want to find information, although it is facilitated, they are also confused by the variety of information received. Therefore, for business actors, especially MSMEs, they need to know the necessary ways so that the use of social media as a marketing medium is optimal, not just posting information, but can generate audience interest which in turn can trigger sales of MSME products. the purpose of this community service activity. --- IMPLEMENTATION METHODS There are several activities with different methods in efforts to develop social mediabased businesses for MSMEs in Banyuasin District through digital marketing training. Broadly speaking, there are two main activities, namely identifying the use of social media in MSME marketing in the Banyuasin District, and training activities on the use of social media in marketing MSME products in the Banyuasin District. --- Identification of the use of social media for marketing to MSMEs in Banyuasin District The activity of identifying the use of marketing media in MSMEs in the Banyuasin District was carried out to find out the current condition of business actors in utilizing information and communication technology in running their businesses. The method used in identifying the use of social media marketing for MSMEs in Banyuasin District is: a. Observation This observation activity was carried out on several MSMEs in Banyuasin District, carried out to find out how these MSMEs do business, along with knowing the various problems faced by MSMEs in doing business. b. Interview and distribution of questionnaires. Interviews were conducted with several business actors in Banyuasin District. Through interviews, qualitative information was obtained which was not obtained through questionnaires. The interview technique used was an in-depth interview. Information obtained from interviews and distributing questionnaires is regarding: the use of technology and information in doing business, technological infrastructure owned in running a business, social media or marketplaces that have been used, marketing methods that are more widely used, strategies for business actors to utilize information technology in doing business, the readiness of human resources in doing business online, and the obstacles faced in doing business --- Social media use training Based on the identification in the previous stage, the authors conducted training activities on the use of social media in an effort to develop technology-based businesses in Banyuasin District SMEs. The method used is the lecture and training method. a. The lecture method is carried out on the basic material of entrepreneurship, namely doing business online. This aims to increase business actors' insight into entrepreneurship, especially doing business online. In addition to increasing insight, this material is also carried out to provide encouragement and motivation to business people in Banyuasin District. b. The training method is carried out by practicing registering a business on social media such as Instagram, Facebook and Tiktok. This material was carried out in accordance with the initial identification together with business actors and also community leaders in Banyuasin District --- RESULTS AND DISCUSSION The main activity (after identification) of this digital marketing training starts at 10.00 WIB. The first session is a presentation of material or a theoretical explanation of digital marketing. The participants were invited to understand various simple ways to market their products on social media. The presenter also explained how to make attractive photos, clear product descriptions, then the presenter also conveyed the importance of consumer testimonials in marketing strategy. In this session, the presenter also explained tips for choosing the right promotional sentences, tips for creating ad hashtags and strategies for creating effective and efficient advertisements through social media. In this session, participants gained additional knowledge about sharing experiences and the ins and outs of managing a digital business. The presentation of the material lasted for 60 minutes until 11.00 WIB. The second session is a question and answer session and discussion. Session two was held starting at 11.10. Training participants are given the opportunity to ask a number of questions related to the material that has been presented and followed by a discussion of the problems faced by participants in managing the online shop. The presenters explained and answered well the problems faced by the participants and were also given motivations in entrepreneurship. This discussion session went smoothly, the participants received a lot of input regarding the procedures for advertising and managing their online shop. --- DISCUSSION In the current digital era, MSMEs must be able to carry out guerrilla marketing. Social media, with all its advantages and features, is proven to be able to provide facilities that are no less attractive than other media that require high costs to use. It is not impossible, if social media can be used optimally then it can foster a positive image for the wider community. In order to be able to keep abreast of technology and information developments, MSME actors must increase their understanding and capacity in the field of technology and information. For example through training, workshops, seminars on technology and information. According to Jannatin et al. (2020) in the current era it is very important for MSMEs to be able to use the internet to market their products digitally. Digital marketing training is really needed by MSMEs and has been proven to increase MSMEs' understanding of marketing techniques on the internet (Wahyudi et al., 2019). Isnaini et al. (2019) stated that digital marketing training was able to increase MSMEs' knowledge of strengthening digital brands and businesses. Anggoro et al. (2020) stated that during the Covid-19 pandemic, online marketing and sales were one of the solutions to keep MSMEs afloat under various limitations. The results of this training activity are expected to be able to answer partner problems related to the management of online shops owned by participants. Increasing the knowledge of young online shop owners about digital business marketing techniques is expected to be able to improve the ability to manage online shops and can increase the promotion of their products and services. --- CONCLUSION MSMEs must develop into businesses that have high competitiveness. This must be built consistently starting from technological innovation and information. Therefore, MSMEs must make the most of technology. From the simplest technology to technology capable of producing products with high added value. This activity provides many benefits for the trainees. The use of media becomes more optimal as a marketing strategy. Participants become more aware of the use of digital media to present better promotions. Participants' confidence in the resulting product is getting better because it looks attractive compared to before. The result of this activity is that the participants have increased skills in terms of knowledge about digital marketing starting from theory to how to create content, product descriptions, how to take photos and the ins and outs of doing business using social media, so that participants individually are able to create content and caption of items sold on their respective social media accounts.

Social media has become an important tool for businesses to market their brands and reach a wider audience. Social media optimization is the process of improving social media strategies to achieve better results, such as faster follower growth and increased interaction with potential consumers. In this community service activity, the author discusses and conveys the importance of optimizing the use of social media for marketing and provides several tips for achieving this to MSME entrepreneurs in the Banyuasin sub-district. This community service activity was attended by 35 entrepreneurs in the culinary, accessories and fashion fields in the Banyuasin sub-district. This activity lasted 2.5 hours, starting with a presentation by each author, then presenting examples of the application of marketing on social media, and ending with a discussion session that very much aroused the enthusiasm of the participants about optimizing social media in MSME operations. Community service like this must continue to be carried out to increase public awareness that digitization can increase efficiency in business and can increase MSME sales.

Introduction --- I n recent decades, overweight has been considered an important public health burden in the child, adolescent and adult populations. 1,2 In many western countries, an inverse social gradient in overweight exists in the adult population 3 and it is a challenge to identify the mechanisms that cause this social pattern. According to the Adolescent Pathway Model by Due et al., 4 two potential explanations are the tracking of social patterns already present in adolescence and socially differentiated tracking of overweight. Socially differentiated tracking of overweight implies that the risk of remaining overweight is higher among adolescents from lower than higher socio-economic groups. Substantial tracking of overweight from childhood into adulthood has been demonstrated. 5,6 However, the modifying effect of socio-economic position (SEP) on the tracking patterns of overweight has not been studied extensively. A Danish study by Kristensen et al. 7 showed no social patterns of tracking of overweight from childhood (age 8-10 years) into adolescence (age 14-16 years), while another Danish study found that the inverse social relationship between SEP and overweight becomes steeper from a mean age of 14.8 to 21.3 among girls, and also emerges among boys. 8 The aim of the present study was to analyse whether the tracking of overweight from age 15 to 19 years and from age 19 to 27 years differed between adolescents from higher and lower socio-economic groups. Tracking patterns were studied by prediction analyses. --- Methods We used data from the Danish Longitudinal Health Behaviour Study. The baseline survey was conducted in 1990 at the age of 15 years, the first follow-up was in 1994 at the age of 19 years and the second follow-up in 2002 at the age of 27 years. The study population was a random sample of the Danish population selected from the National Civic Registration System. Data was collected by anonymous postal questionnaires. Of all the adolescents invited (n = 1100), 9% were left out due to lack of parental consent, leaving 996 participants in the sample. The response rates were 85% in 1990, 87% in 1994 and 81% in 2002. Only participants completing questionnaires in all three surveys were included in the present analyses (n = 561, males = 215, females = 346). Body mass index (BMI, kg/m 2 ) was calculated from self-reported heights and weights. At the age of 19 and 27 years, overweight was defined by a BMI of !25. For 15-year old participants, age-and sex-specific BMI cut-points proposed by Cole et al. 9 were applied. Sex and SEP were included in analyses as modifiers. SEP in adolescence was measured when the participants were 15-years old and again by retrospective data at the age of 27 years by two items about the father and mother's occupations. We used the retrospective data that were most complete and coded the information according to the standards of the Danish National Institute of Social Research into SEP I (high) to V (low) and VI (living on social welfare benefits). Participants were categorized according to the highest-ranking parent into two groups: high SEP (I, II) and low SEP (III-V). SEP VI only included a very few individuals (n = 2) and was left out of the interaction analyses. In analyses of loss to follow-up, we used data on parental occupation collected by students' reports at the age of 15 years. --- Statistical analyses We used logistic regression analyses with odds ratio (OR) estimates (and 95% confidence limits) to assess the predictive power of early overweight for later overweight between the ages of 15 and 19 years, 19 and 27 years and 15 and 27 years. Modifications by sex and SEP were tested by interaction terms in the logistic regression models. Finally, analyses stratified by SEP were conducted. Analyses of loss to follow-up from baseline to second follow-up were conducted with regard to sex, weight and SEP using chi-square tests. --- Results The prevalence of overweight among males and females was 5.2 and 3.6% at the age of 15 years, 12.2 and 10.1% at the age of 19 years and 38.0 and 24.4% at the age of 27 years, respectively. The prevalence of overweight in high-and low SEP was 3.9 and 4.2% at the age of 15 years, 6.7 and 13.0% at the age of 19 years and 21.6 and 33.5% at the age of 27 years. Among females, inverse associations between SEP and overweight were observed cross-sectionally in all three surveys [age 15 years: OR = 2.32 (0.50-10.77), age 19 years: OR = 2.21 (0.88-5.52), age 27 years: OR = 3.41 (1.76-6.62)]. Among males, cross-sectional data showed that social gradients were less evident [age 15 years: OR = 0.70 (0.21-2.38), age 19 years: OR = 2.04 (0.78-5.37), age 27 years: OR = 1.18 (0.66-2.10)]. Analyses of tracking of overweight showed strong and significant prediction patterns from age 15 to 19 years, from 19 to 27 years, and also over the full study period from the age of 15 to 27 years (table 1). Analyses of interaction terms with sex and SEP revealed no significant effects. This is reflected in analyses stratified by SEP, also presented in table 1. Analyses of loss to follow-up from baseline to second follow-up showed that dropouts were characterized by being male (P < 0.0001) and obese (males: P = 0.0365, female: P = 0.0260). Loss to follow-up was not associated with SEP. However, a selected uptake of individuals into the study at baseline had occurred as almost no individuals receiving social benefits chose to participate (full distributions not shown). --- Discussion In line with the existing literature, 5,6 the present study identifies strong tracking patterns of overweight from childhood into early adulthood. In accordance with the study by Kristensen et al., 7 who covered the years from the age of 8-10 to 14-16, our findings indicate that subsequent tracking of overweight from mid-adolescence into late adolescence and from late adolescence into early adulthood are consistent patterns independent of socio-economic background. We did not identify a modifying effect of SEP as found in the previous Danish study of 14.8 to 21.3 year olds. 8 Therefore, our results do not support the relevance of socially differentiated tracking as a contributing pathway to inequalities in overweight among adults. Rather, they support other studies indicating that overweight is socially patterned already in early life 4 and that these social distributions are forwarded into later life through strong and general patterns of tracking. This pattern supports the second pathway outlined in the Adolescent Pathway Model 4 stating that adult health inequalities may be created through general tracking of socially patterned health determinants from early life into later life. The randomly sampled population, the long period of follow-up and the inclusion of two follow-up data collections are important merits of the study. Still, a number of limitations should be considered. Analyses of loss to follow-up revealed that dropouts were more often male than female and more dropouts were overweight. Attrition was not associated with SEP. However, a selected uptake of individuals into the study at baseline had occurred as almost no individuals receiving social benefits chose to participate. The conclusions of the present study can, therefore, be considered only for children with economically active parents. Finally, weight status is based on self-reports of height and weight and some overweight individuals may be misclassified as being normal weight. 10 To strengthen the evidence in this area of research, analyses based on larger, more complex and less selective data sets should be emphasized. The present study indicates that social inequality in adult overweight is not due to socially differentiated tracking but rather due to patterns of social inequality in overweight created during childhood that are forwarded into adulthood through strong and general patterns of tracking. Besides adding to our understanding of the mechanisms that cause inequalities in overweight in adulthood, the presented findings also highlight the importance of designing targeted and focused interventions to be implemented during childhood and adolescence. a: BMI cut-point of 23.94 valid for girls is applied. This is 0.65 higher than the cut-point valid for boys of the age of 15 years. Some overweight boys may thereby be misclassified as being normal weight. b: Adjusted by sex c: Adjusted by SEP d: The samples in each stratum by SEP do not summarize to the full population. This is due to the fact that participants living on social benefits (e.g. students) and missing values were left out of the stratified analyses CI: confidence interval. --- Introduction T he body-mass index (BMI) has been widely used to stratify the risk of metabolic and cardiovascular disease because of its simplicity and strong association with body fat. In adults, a BMI of 25 kg/m 2 originally discriminated the normal corpulence from overweight, which has been associated with increased risk for non-communicable diseases like diabetes mellitus. However, the World Health Organization has pointed out that the risk corresponding to overweight varies from 22 to 25 kg/m 2 in Asian populations. 1 Abdominal fat has been implicated in the development of insulin resistance. Then, an increased amount of fat is expected in populations with high diabetes prevalence. This has indeed been observed in Asians 2 in Asia and after migrations. Whether this pattern occurs early in life has not been clearly demonstrated. The body fat distribution of adolescents of Indian origins has not been extensively studied, but the BMI cut-off points published on adolescents from India suggest that the question is relevant. 3 Our aim was thus to define the nature of the relationship between body composition and body size in India-originating Guadeloupians (IOG), as a subgroup with increased diabetes risk, and Guadeloupians of other origins, as the control group. The main hypothesis was that part of the normal range of BMI would be associated with a higher quantity of body fat, in particular abdominal fat, in IOG. --- Methods The participants were 178 IOG adolescents and 481 Guadeloupians adolescents of other origins (mainly African and mixed African and European descents) from five schools in Guadeloupe, French West Indies. They were 13.3 AE 1.4 years of age (mean AE SD). They agreed to participate in the experiment running from September 2006 to January 2008. More information was provided in an earlier publication. 4 Subjects were lightly clothed for their stature (cm) and body mass (kg) measurements, used to calculate the BMI (kg/m 2 ) and BMI for age z-scores (BMIZ) from the Centers for Disease Control and Prevention age-and sex-specific references. Waist and hip circumferences (measured in centimetres with tape) and bicipital, tricipital, subscapular and iliac thicknesses (measured in millimetre with Harpenden skinfold caliper) were measured twice. The latter values were added to give the sum of four skinfold thicknesses (S4ST). --- Conflicts of interest: None declared. --- Key points Analyses of a Danish cohort show a continuously increasing prevalence of overweight from the ages of 15 to 19 years and from the ages of 19 to 27 years among both men and women. Strong patterns of tracking are observed between the age of 15 and 19 years, 19 and 27 years and for the full period from the age of 15-27 years. Tracking of overweight from mid-adolescence into late adolescence and from late adolescence into early adulthood is a consistent pattern independent of sex and SEP.

Socially differentiated tracking of health and health behaviours may contribute to health inequalities in adulthood. The modifying effect of socio-economic position on the tracking of overweight from mid-adolescence (age 15 years) into adulthood (age 27 years) was assessed in a randomly sampled Danish cohort (n = 561). The tracking was studied by prediction analyses conducted by logistic regression analyses. Strong tracking patterns were found to be independent of socio-economic background.

Introduction Gender-based violence (GBV) is described as "any harmful act that is perpetrated against a person's will and is based on socially recognised difference between males and females" (1). It mainly impacts women and girls, has serious consequences for health and wellbeing, and incurs a high national cost for treatment and rehabilitation (2). GBV includes physical, sexual, emotional, and economic violence. Physical violence may include assault, battery, burns and other injuries; sexual violence refers to sexual activity involving violence or coercion; emotional violence could include abusive language or manipulative behaviour that controls and instils fear in another; and economic violence refers to deprivation of financial means and the bare necessities of life (2)(3). The World Health Organization indicates that 1 in 3 women worldwide are subjected to either physical and/ or sexual violence in their lifetime (2). In South Asia, the prevalence of intimate partner violence against women ranges from 20 to 72%. (4). According to the Sri Lanka Demographic and Health Survey 2016, the prevalence of domestic violence among married women (15-49 years) was estimated to be 16.6%, with a higher proportion reported from urban areas (19.8%) (5). The GBV Help Desk at Teaching Hospital -Jaffna functions as a one-stop centre for GBV survivors in Northern Sri Lanka. It provides services to both inpatient and out-patient help seekers or clients. Although the centre has been functioning for seven years, studies on its clientele and service provision have not been undertaken. This study describes the socio-demographic characteristics of clients and their alleged perpetrators, types of violence and outcomes reported, and the services provided by the GBV Help Desk at Teaching Hospital, Jaffna, during a two-year period (2019 & 2020). --- Methods Data were collected retrospectively from the records of all clients who received services at the GBV Help Desk at Teaching Hospital, Jaffna between January 1, 2019 and December 31, 2020. The data extraction sheet covered socio-demographic characteristics of clients and alleged perpetrators, types of violence, the relationship between client and alleged perpetrator, referral point and service provision. Data were analysed using the Statistical Package of Social Sciences (SPSS version 21). Frequencies and percentages were used to describe socio-demographic characteristics, referral modes, types of violence and outcomes reported, and service provision. Chi squared test was used to describe the association between selected categorical variables. Ethics approval was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Jaffna. --- Results A total of 883 clients received services from the GBV Help Desk from January 1, 2019 to December 31, 2020. Sociodemographic characteristics of the clients are described in Table 1. The mean age of clients was 30.5±10.7yrs. The mean age of the alleged perpetrators was 33.2 (SD 10.1) years. When considering the alleged perpetrator's relationship to the client, in the majority (65.5 %, n=578) of cases, the husband was the alleged perpetrator; less than 5% were non-family members. Physical, economic, emotional and sexual violence were experienced by 68.5%, 48.2%, 40% and 29.4% of clients, respectively. Around one third (33.6%, n=297) experienced more than one type of violence. We assessed the association between marital status and the type of violence experienced. Physical violence was more likely among married legally married women (84.3%) compared to legally not married women (34.5%) (p<0.001; Table 3). Sexual violence was more likely in legally not married women (70.5%) compared to legally married women (10.3%) (p<0.001; Table 4). Majority of the clients (94.6%) were referred from the wards to the GBV Help Desk. Among clients referred as inpatients, physical violence was most common (64.9%, n=542), followed by sexual (23%, n=192), economic (7.3%, n=61) and emotional violence (4.8%, n=40) (Table 5). In terms of reported outcomes, physical injuries (45%, n=397) and financial constraints (44.8%, n=396) were common among clients. While feeling depressed was reported by 25.6% (n=226), separation of family and suicidal tendencies were reported by 11.5% (n=102) and 7.3% (n=64), respectively. With respect to mode of referral, the vast majority of clients were referred from the wards (94.6%, n=835), including the psychiatry unit (17.1%, n=151). The rest were referred from the outpatient department (5.2%, n=46) and police (0.22%, n=2). Table 6 shows the services provided by the GBV help desk. All the clients who attended the centre were befriended. In addition, counselling was arranged for 27.8% (n=245) of the clients. A total of 577 (65.3%) clients were referred for services outside the hospital. Table 6 shows the services provided by the help desk. --- Discussion GBV was mostly reported by female clients (91.3%). Three hospital-based studies on GBV carried out in Batticaloa, Colombo and Kandy districts report similar results (6)(7)(8). While GBV is experienced more commonly by women due to gendered power differentials (1-3), it should be noted that clients in the present study were mostly inpatients referred to the GBV help desk by healthcare providers, who may exercise more vigilance regarding GBV among women. Over two-thirds (69.4%) of the clients were married, suggesting that GBV may be more common among this demographic (9) or that help seeking may be less among others. Notably, 90.3% of alleged perpetrators were men, and majority of them were intimate partners (87.9%). --- While consistent with studies carried out in Kandy and Colombo where 90% and 94.4% of clients reported violence by intimate partners (8,7), a substantial proportion in our study experienced violence by other family members (7.5%). Apart from reflecting cultural and community norms on gender, these patterns of violence may also reflect the socioeconomic dependence of women on their male partners as over 80% of clients were unemployed, despite the majority having secondary level education (8). Although three-fourths (78.3%,) of alleged perpetrators were employed, over 95% did not have a permanent job, likely representing the low-income category. Nearly two-thirds (65%) of alleged perpetrators had a history of alcohol usage. Unemployment, low socioeconomic status, and alcohol use are known to be associated with GBV (9-10). In the present study, two-thirds (68.5%) of the clients experienced physical violence. Economic, emotional and sexual violence were reported by 48.2%, 40% and 29.4% of clients, respectively. A similar pattern of violence has been reported in other parts of Sri Lanka (11,7) and India (10). Physical violence was also more common (89.3%, n=542) in those referred from the wards; all male clients among ward referrals had physical injuries. The external appearance of physical injuries may enable health staff to suspect GBV, while this may not be the case for emotional, sexual and other forms of violence (12). Two studies carried out in Sri Lanka (8,13) and another in Turkey (14) reported high rates of physical violence among referred clients. It is noteworthy that the second most reported type of violence is economic violence, perhaps reflecting the socioeconomic status of the community served by Teaching Hospital Jaffna. The pattern of violence would be surely influenced by the fact that this is a hospital sample and social norms discourage the reporting of GBV (7,15). GBV has wide-ranging implications for individuals, families and the society more broadly. In terms of outcomes, clients mostly reported physical injuries (45%) and financial constraints (44.8%) resulting from GBV. A substantial proportion reported depression (25%) and suicidal thoughts (7%), while 11% of the clients had separated from their spouses. In contrast to our study, a hospital-based study of clients accessing services at two GBV help desks in Colombo revealed that 93% of GBV survivors were depressed and 20% had suicidal ideas (7). Almost 95% of those who receive services at the GBV Helpdesk at Teaching Hospital Jaffna are referred patients, either from the wards, psychiatry unit or police. In other words, few GBV survivors present on their own to the GBV Helpdesk, indicating that there may be barriers to accessing services. In other settings, community norms that treat GBV as a private matter, fear of reprisal, social stigma and dissatisfaction with services are known to impede access to care (). Most clients received psychosocial support at the GBV Help Desk of Teaching Hospital -Jaffna. All were befriended and a fourth (27.8%) were provided counselling. Only a minority were referred for legal service (17.9%), suggesting that most GBV survivors do not seek legal redress. This means that most perpetrators of GBV are not held accountable by the criminal justice system, which, in turn, may perpetuate the cycle of violence and abuse and its social and economic consequences (1)(2)(3)(4). This study has a few limitations. As it focused on clients who received services from the GBV Help Desk, Teaching Hospital Jaffna, the results do not reflect patterns of GBV at the community level. The study was based on secondary data and we are uncertain as to whether a standard method was used to categorise the types of violence reported by clients. Furthermore, as the interviews on which the data are based were conducted in a hospital setting, the likelihood of under reporting is likely to be high. --- Conclusion The GBV Help Desk at the Teaching Hospital Jaffna provides services mostly to women, with a large proportion comprising referrals from within the hospital. A large majority of clients experienced violence in the family, including from intimate partners. Physical violence was most commonly reported, with a quarter experiencing sexual violence.

Gender-based violence (GBV) is a serious health and social problem in South Asian countries, including Sri Lanka. This study describes the socio-demographic characteristics of clients and their alleged perpetrators, types of violence and outcomes reported, and the services provided by the GBV Help Desk at Teaching Hospital -Jaffna. Data were collected retrospectively from records of all 883 clients who sought help and who were referred to the GBV Help Desk of Teaching Hospital -Jaffna during a 2-year period (January 1, 2019 to December 31, 2020) using a data extraction sheet. The clients of the GBV Help Desk were mostly female (91.3%; n=806). Physical, economic, emotional and sexual violence were experienced by 68.5%, 48.2%, 40% and 29.4% of clients, respectively. In 87.9% (n=776) of cases the husband, lover or partner was the alleged perpetrator. Around two thirds of alleged perpetrators (65%, n=518) had a history of alcohol use. Physical violence was more likely among legally married women (84.3%) compared to legally unmarried women (35.4%) (p<0.001) whereas sexual violence was more likely in legally unmarried women (70.5%) compared to legally married women (10.3%) (p<0.001). Suicidal inclinations were reported by 7.3% (n=64). All clients were befriended; further counselling was arranged for 27.8% (n=245). In conclusion the GBV Help Desk mainly provides services to women following intimate partner violence.

Introduction: Complex problems regarding child development and parenting require integrated services and efforts of all those involved: parents, children and professionals from different organisations (both youth and adult services). In this session, we present results and bundle insights from three practice-oriented studies on integrated services. Based on an analysis of similarities in our studies, we focus on the collaboration among professionals and between clients (families/parents, children) and professionals. --- Why a workshop? We are practice researchers in the Netherlands, who organized themselves in a network in order to exchange experiences and knowledge. in this workshop, we aim to create a joint learning process with the participants of the session, by inviting them to reflect on their own practice, based on the joint lessons from the various research projects. For who? The target group of this workshop are researchers, policy makers, managers, practitioners. Our studies focuses on services for youth and families. --- Session: The workshop starts with a short presentation of 1) a literature review and 2) pitches from the three research projects. The three projects focus on integrated services, each with a specific target group (serious and long-term problems in families; domestic violence; children aged 18-27 years not in education, employment, or training. The first study discusses a qualitative action research into an integral specialist working method for families with multiple and complex problems. The study followed five integrated care teams, by observing their multidisciplinary care meetings and by conducting interviews with various stakeholders. The second study discusses a participatory action research into the collaboration in domestic violence cases in which a network organisation is involved that supports integrated services in very complex situations. Participants in this study developed a discussion tool for multidisciplinary case meetings, which will be presented in the workshop. The third study focuses on the outcomes of a intervention for uneducated and unemployed young adults (aged 18 to 27) who avoid care. After intervention, 85% of the participants completed their education, went back to school, or got (volunteer) work. Frequent and persistent contact and renewed confidence in one's own capacities are crucial for intervention success. Although the focus differs in terms of target group, research design and outcomes, each of the projects shows the importance of collaboration with clients and among professionals. Then we will discuss in small groups three topics with the participants: 1.How can we encourage shared decision-making with clients in multidisciplinary case meetings? 2.How can professionals keep learning and improving integrated care? 3.How can integrated services be financed sustainable? The workshop participants will be divided into three groups. Participants will discuss challenges and successes they face. --- Program: 1.Introduction (5 min.) 2.Presentation of all three studies (25 min.) 3.Two rounds: Discussion of the three topics in small groups (40 min.) 4.Brief reaction on the results from the small groups (10 min.) 5.Take home message (5 min.) How to summarize the take home messages? We end up with lessons learned and sum these up in take home messages.

Integrated care with families with multiple and complex problems. An indepth view

This kind of question can quickly cut through the scientific shell of medicine's most difficult decisions. I was instantly transformed from an intensive care consultant into a dad. If I were to take on this role-if I were in fact this patient's father and not her doctor-it would make the decision easy for me: choose the operation, choose the possibility of life, at all costs. In intensive care we have to continually think about how our patients will be affected by the treatment and care we provide, to consider what their life will be like in the aftermath. Yet stepping into the shoes of a relative, rather than the patient, changes the fit of a decision in important ways. This kind of bias could cloud my interpretation of the data and may result in a loss of impartiality. There's a reason why someone's mum or dad cannot, or should not, be their doctor. Sometimes difficult decisions need measured objectivity-but discussed through a prism of humanity. --- Rationality and impartiality I've heard the same question asked in other contexts. On one occasion it was asked not by a relative but by a researcher at a meeting, who was presenting the results of a trial on the use of vitamin C in sepsis. Despite the trial showing no outcome benefits the researcher argued that this intervention should nevertheless be used, asking the audience, "If it were your daughter, would you want her to have the treatment?" Many people raised their hands in affirmation, although the objective data were clearly set out on a slide in the background. But, when phrased like that, who could blame them? The blame should surely lie in the question's construction. "Will you still give patients the treatment?" would have been better, and I suspect that it might have yielded a very different answer. And so, I answer: "If it were my daughter I would think about what she would say, what she would want. I would imagine her sitting in the room with us right now, listening to this tough conversation. What would she say?" I am rational as a doctor but irrational as a parent. Shared decision making remains essential. We need to share the discussion and the scientific data, but we must also maintain some impartiality when interpreting them. --- Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests. Provenance and peer review: Commissioned; not externally peer reviewed. Matt Morgan is an honorary senior research fellow at Cardiff University, a consultant in intensive care medicine, research and development lead in critical care at University Hospital of Wales, and an editor of BMJ OnExamination.

The family room hangs in silence. I've explained the science, the medicine, and the human costs. It was a near impossible decision to make, with no right or wrong answer. An operation will probably kill her. Without an operation, she's likely to die. Then came the familiar question relatives often ask: "If it were your daughter, what would you do?" 1

Introduction Increasing digitization is changing many areas and industries and, in addition to politics, public administration, medicine and retail, is also affecting education [1]- [4]. This is especially true for smartphones: as early as 2011, researchers predicted for the United States of America that mobile learning devices would soon be used permanently and by every student [5]. Mobile apps, which are also one of the most important functions of smartphones in other areas such as retail or medicine, play a special role here and allow a wide range of application possibilities [6]- [9]. Parents in particular have a strong interest in making mobile technologies available to their children for learning, also because they can better participate in their children's learning process this way [10], [11]. Numerous studies show that smartphones are used primarily as a communication tool (i.e., for chatting) among children and young people, but also among students [12]- [14]. Thus, chat groups on WhatsApp can not only serve communication, but also strengthen the community and collaboration [14]. Also, research describes the use of apps and especially chat apps for language learning [15], [16]. Gamification approaches can be used to learn mathematics [17]. It should be emphasized that smartphone use is changing the leisure activities of children and young people [18], [19, p. 44]. The "KIM Study" of around 1,200 children and young people between the ages of 6 and 13 from all over Germany shows that smartphones and the Internet are now the most important interest after friends and sports. In particular, mobile devices are used for messaging and telephoning, followed by the Internet and games. Despite the high level of interest in smartphones and the Internet: Watching TV, meeting friends, learning, playing indoors and outdoors, own family and sports are still more relevant as leisure activities [18]. The aim of this case study is to provide insights into the smartphone usage behavior of elementary school students and thus supplement existing knowledge. To this end, a total of 33 students in the third and fourth grades of an elementary school in a rural area in northern Germany are surveyed about how they use smartphones -both in their leisure and for school purposes -and they do in their leisure. First, the material and methodology are discussed. For the most part, the survey results are presented descriptively. Subsequently, the results are discussed against the background of existing findings from the field of education in the broadest sense. --- Material & Methods The case study is based on a survey conducted at an elementary school in a rural region in Schleswig-Holstein in northern Germany. Students in grades 3 and 4 were surveyed. In addition to sociodemographic data, the questionnaire asks about two topics: smartphone use, especially in school contexts, and leisure time activities. With regard to smartphone use, the questionnaire asks about frequency of use (De-viceUse), ownership of a smartphone (OwnDevice), use cases (DeviceUsePlay, De-viceUseChat, ...) and enjoyment of device use (DeviceLikeUse). For use in a school context, frequency of use (DeviceUseSchool) and app use (Ap-pUseLearn, AppUseCalc, ...) are asked. Related to leisure time activities, the questionnaire asks about leisure time activities (DoSports, DoMusic, ...). A pre-test of the questionnaire with a small group of students reveals that the previously proposed scales (Likert scale from 1 to 5) are often perceived as too complicated. The students state that they are partly overwhelmed by distinctions such as "frequently" and "very frequently". Therefore, especially the questions about use cases and leisure activities are changed to binary scales (0 = rather rarely, 1 = rather often). Table 1 shows the scales of the queried items. The questionnaire is completed jointly with the students of two classes (grades 3 and 4), each in a large group, generating 33 usable responses. --- Results The survey yields responses from 17 girls and 16 boys. The majority of the students are nine years old at the time of the survey (cf. tbl. 2). In the third grade, 15 responses are collected, and in the fourth grade, 18. Of the students surveyed, 22 (67%) already own their own mobile device. --- Fig. 1. Distribution of usage frequency Fig. 1 shows that the majority of students use smartphones rather frequently, i.e., according to their own statements, in some cases for several hours a day. No student states that they never use a smartphone. It is striking that the frequency of use differs between students who own a smartphone (M = 5.04, SD = 1.13) and those who do not own a smartphone (M = 3.27, SD = 1.10); t(31) = -4.27, p = .0002. If a student owns a smartphone, the frequency of use increases significantly (β = 1.77, t = 4.27, p = .000). --- Fig. 2. Distribution of enjoying usage Despite the high prevalence of smartphones among students, students do not seem to experience explicit great pleasure in using smartphones (cf. fig. 2). In terms of use cases, the survey data show that smartphones are used by elementary school students in particular for playing games and consuming media (videos and music). Device use for chatting and especially for learning appears to be of little relevance among young students (cf. fig. 3). --- Fig. 4. Activities in leisure In terms of leisure activities (away from the smartphone), most respondents said they played sports and met friends. Playing a musical instrument seems to be the least relevant among students (cf. fig. 4). If a student owns his or her own smartphone, this has hardly any impact on leisure activities (compared to not owning a smartphone) (cf. tbl. 3). Playing a musical instrument is an exception. Here, owning one's own smartphone has a significant negative effect (β = -.363, t = -2.24, p = .033). --- Fig. 5. Distribution of device usage for school With regard to school use, the survey data show that most students tend not to use their smartphones for school (cf. fig. 5). There is no significant difference between the groups "own device" (M = 1.95, SD = 2.10) and "no own device" (M = 1.54, SD = 1.92); t(31) = -0.54, p = .5919. Learning apps (e.g., vocabulary or knowledge quizzes) or the calculator are most likely to be used for school on the smartphone (cf. fig. 6). --- Fig. 6. Usage of school-related apps --- Summary and Conclusion The aim of this case study was to provide insights into the smartphone usage behavior of elementary school students using the example of a rural region in northern Germany. To this end, an explorative survey was conducted on how the surveyed students use the smartphone in general and in the school context in particular, and how they spend their free time. The data collected was processed descriptively and related to existing findings. In summary, the results show that even children of primary school age use smartphones intensively. This use is particularly favored by owning their own device. At 67 percent, children in the relatively small sample presented here are significantly more likely to own their own device compared to the Germany-wide KIM study from 2018 (51 percent) [18]. When it comes to smartphone use, the results of the survey correspond to those of the KIM study. Smartphones are mainly used for games, music and videos [18]. Frequent use for gaming opens up opportunities for learning with gamification approaches for elementary school students as well [17]. Less relevant to elementary school students is the use of chatting, which is the main use case for university students in Korea, for example [11], [13]. For the use of smartphones as a (supportive) learning tool in elementary school, this means that chatting is probably less suitable as a learning method [15], [16]. In terms of leisure activities, the results of the present case study fit with previous findings that (despite high smartphone use) sports and friends are still of highest relevance for the children [18], [20]. However, owning a smartphone is negatively associated with playing a musical instrument. The fears of some educators seem to be confirmed here [21]. However, due to the small sample, a larger scale study should be undertaken in this regard to test the statement. With regard to school use, some researchers had predicted that smartphones would become an integral part of everyday educational school life. At least for the sample presented here from a rural region in the north of Germany, this has not yet occurred [5]. So far, elementary school students have used smartphones only sporadically, especially with learning and calculator apps. Overall, the survey shows a high relevance of the smartphone for elementary school students in their leisure time activities, without "analog" activities such as meeting friends or playing sports seeming to take a back seat. Nevertheless, the proportion of smartphone use at school plays only a secondary role among the respondents.

With digitization and the spread of smartphones in many areas of life, mobile devices have also become increasingly relevant in education. While comprehensive research exists especially for smartphone use among teenagers and students, the findings for elementary school students are limited. Based on a survey, this case study provides exploratory insights into the smartphone usage behavior of elementary school students in a rural region in northern Germany. The responses of 33 students in grades 3 and 4 (ages 8 to 10) show that many students already own a smartphone at this age and use it daily, sometimes for several hours, especially for gaming and media consumption. The influence of owning an own smartphone on usage and leisure activities is reviewed. School use is of little relevance among the elementary school students surveyed.

Introduction In February 2013, the United States Post Office made a historic announcement: Saturday delivery will cease by August [1]. This follows a downward trend in mail so sharp that some speculate that paper mail be obsolete in the future. We look to the mailbox: the symbol of residential communication for two centuries, and ask a simple question: how can a mailbox be used to support communication between neighbors and strengthen community? The answer lies in new media technology, the very technology often blamed for the breakdown of community in the 21st century neighborhood. "As the Internet further reduces the burden of distance, it may further degrade the role of the parochial realm; ties across the street may become increasingly rare as ties at a distance become ever more accessible" [2]. Digital technologies, while uniting people across distances, can also be used to reinforce place-based communities. Urban planning and digital media practitioners have joined forces in the past several years to recast public spaces with tools and technologies to promote information sharing, community pride and play [3]. Examples of experimentation abound. Consider Mouna Andraos and Melissa Mongiat's "21 Swings", an urban installation in Montreal, Canada, where swinging generates a melody, but one that is best experienced communally, when many swings are engaged [4]. Imagine how many dreary bus stops could be improved with a musical swing installation: where people aren't shutting out the world by listening to music from their ipods and earbuds, but making music together, by moving their bodies. Another whimsical application of digitally augmented public space is the Piano Staircase in Berlin, Germany, by Volkswagon. The stairs are painted like a piano and music sounds as they are stepped on. The designers of this installation had more than music in mind. They wanted to create an incentive for people to use the stairs, instead of the escalator, by making the stairs more fun. They were able to increase stair usage by 66% [5]. While the bulk of urban digital projects have focused on public places, some have concentrated on the domain of the neighborhood. Digital devices join a long line of technology blamed for the breakdown of community, including the air conditioner and television. Now smart phones and social media fulfill our communication needs without real time interaction or geographic proximity. Can digital experiences draw people back outside and into communication patterns with their neighbors? This is the goal of The Smart Mailbox. Can the mailbox become its owners face and voice in a faceless community? Apostol et al. in "From Face-Block to Facebook or the Other Way Around," provide more fodder for our discussion: "We wish to employ the technology developed for such online communities to bring communities back to the "barn-raising"-type of collective action that could encourage participation, increase the feelings of solidarity and social capital, and lead to building community identity" [6]. As electronic mailboxes continue to innovate at rapid pace, physical mailboxes have changed little in the last century. Sensors implanted into everyday objects are changing the way we interact with our homes, transforming them into smart communicators [7]. Why should the mailbox be left behind? We are not the first to ask this question. Denzil Ferraira, a computer science student at the University of Oulu in Finland created SmartMail: a digital physical mail. Using an ArduinoDuemilanove and a photosensitive sensor, he developed an electronic notification reporting "you've got mail" for physical mail [8]. --- Prototype Design Description and Implementation This section describes the design process of the UCF Smart Mailbox, including the implemented algorithms, the hardware architecture and the prototype implementation. The UCF Smart Mailbox system is able to play a Personal Message that the owner wants to share with the community and also to record a message from the neighbors. If a message is recorded, the system notifies the owner for the recorded message. More specifically, a Twitter notification is sent to the owner via email. Twitter notifications about the outdoor environment's temperature and receiving a new mail are sent as well. Software. Several algorithms were developed, such as for playing an audio file and recording a message. The mailbox plays an audio message if a person is detected near the mailbox (distance less than 1m). Another algorithm waits for input in order to allow the message recording. While the user presses the recording button, a message is being recorded. An LED turns on to indicate that a recording takes place. When the button is released, a Twitter notification is sent to the owner and the LED turns off to indicate that the recording is over. Algorithms for providing information about the temperature and the changes in light conditions were also implemented. The overall behavior of the UCF Smart Mailbox system is described using a UML diagram. The UML use case diagram (Fig. 1) illustrates the events that occur in order for the UCF Smart Mailbox owner to leave and/or receive messages from the neighbors. --- Fig. 1. UML Diagram for the UCF Smart Mailbox System Hardware Architecture. The configuration of the hardware consists of a Rugged audio shield mounted on the Arduino board. A speaker and a microphone are connected on the Rugged Audio Shield for playing and recording a message, respectively. An XBee shield is placed on top of the Rugged Audio Shield. A proximity sensor and a force sensitive sensor are connected to the Xbee shield as inputs. Two XBees were used to send and receive signals for all the Twitter notifications. An LED is used to indicate that the message is recorded. A temperature sensor and a photocell provide information about the temperature and the changes in light conditions. The architecture diagram (Fig. 2) illustrates an internal view of the system architecture in order to understand the different components of the UCF Smart Mailbox's components and how they interact. Prototype. The UCF Smart Mailbox prototype has been developed to give neighbors a geography-based tool for communication and interaction. The Mailbox exhibits the following functionalities: • Proximity-triggered message broadcast • Push button-triggered recording device for leaving a message • Notification to owner via digital social network Twitter that a message has been delivered • Notification to owner via digital social network Twitter that physical mail has been delivered • Notification to owner of temperature at mailbox Fig. 2. UCF Smart Mailbox Architecture Fig. 3 illustrates the different components and the implemented prototype. Except from the visual components, the prototype includes a Twitter-python script for sending the Twitter notifications and storing information in a database for future data manipulation. --- Fig. 3. UCF Smart Mailbox Components & Prototype Representation --- Pilot Testing and Results The Smart Mailbox prototype was initially tested with 12 Central Florida community members. The participant population was all between the ages of 18-35 and included an equal number of males and females. Quantitative and qualitative data was collected in the form surveys. The experimenters also took notes during user-mailbox interaction to document usability issues. The experimental process consisted of three steps: • Step One (Baseline Survey): Participants were asked to fill out a pre-demo survey about their residential status and communication patterns with neighbors. • Step Two (Exposure to Mailbox): Participants were given verbal instructions from the experimenters about the Smart Mailbox. They were instructed to approach the mailbox, listen to the broadcast and leave a message for the mailbox owner. --- • Step Three (After Expo asked to complete the s preference on the part o Smart Mailbox may influ After the collection and analyze the data. More spec mean, median, mode, and deviations, computing prop charts. --- Mailbox Impact on Meet improve the likelihood of m likelihood of meeting new resulting in an average rati likely to rate the Smart M Females averaged 3 (a few Users also predict they w Mailboxes (Fig. 4). the cleaning of the raw data, we applied basic statistic cifically, the analysis included descriptive statistics such d min/max, computing means (averages) and stand portions and percentages, and drawing histograms or ting New People. Users predict the Smart Mailbox w meeting new people in the next month. We compared w people with and without using the Smart Mailb ing of 4.36 vs. 2.80 on a scale of 1-5. Males were m Mailbox's potential to improve relationships, than fema w times a month), males averaged 4 (a few times a wee will walk around the neighborhood more if it had Sm ut likelihood of walking around the neighborhood more ty to leave a message, hear a message and be notified w ved equal average rating of 2.2 on a scale of 1-5 (1 be useful). Ability to receive a temperature reading was ceived a rating of 3.4. was not a focus of our study, we did collect demograp gender. Males and Females rated most questions the sa mart Mailbox significantly easier to use than females. O fficult) males averaged 4.333 and females averaged 2.6 ee if this is repeated with a larger sample size. Type of Housing. We predicted that the type of housin nce their baseline level of sociability as well as th Smart Mailbox would influence their sociability. ng a heir did ome dwellers are more likely to know their neighbors and communicate with them than dorm and apartment dwellers. This may be explained by the temporary status of apartment and dorm living vs. the more permanent or 'settled' nature of single-family home dwellers. We did not ask whether single-family home dwellers owned their homes. That may be a question for a future survey. Perhaps owners are more likely to invest time and energy in getting to know their neighbors. --- Conclusions and Future Work A larger phase experiment could be conducted in the future to see if networked interactive mailboxes improve a community's sense of cohesiveness. We could track inter-community interactions and relationships before and after the installation to understand how the mailbox facilitates neighborliness. In the future, the UCF Smart mailbox system will integrate an identification and tracking module that will allow interaction with the users only if they carry an RFID tag. Future work may include transforming the recorded WAV messages to byte array, transmitting them to the receiver XBee, converting the byte array to WAV file and saving them in the database in order for the user to listen to them on a computer or a portable device. Future plans may also include the implementation of a blog/website to display and analyze the interactions that occur in the community. Data from different neighborhoods in the world could be displayed and compared. Moreover, we could identify and display which neighborhoods have "stronger" interactions. The content and number of "Personal Messages" as well as the number of recorded messages could be used for evaluating the activity network and drawing conclusions about the behavior of the neighborhood mailbox network.

Commonplace objects are being redesigned with digital functionality. Near invisible networks of radio frequency identification tags (RFID) are being deployed on almost every type of consumer product, and the "Ambient intelligence" promises to form a global network of physical objects as ubiquitous as the worldwide web itself. This diverse global network, "the internet of things" (IoT), provides digital connectivity on top of existing infrastructure and items. Nascent "smart object" developments like the presented "UCF Smart Mailbox," not only reformulate our relationship with the objects themselves, but they can also support social relationships that contribute to the sustainability of the society.

INTRODUCTION BACKGROUND OF THE STUDY Information technology is considered as the study of telecommunications and computers which makes an individual capable of retrieving, sending, storing and transmitting data (Muchran and Ahmar, 2019). The use of "information technology" in different factors has improved our lifestyle. There is a meaningful connection between IT and women empowerment which is discussed in this article. Information technology" has been playing a crucial role in changing social norms and attitudes which has influenced women's rights.1 --- AIM AND OBJECTIVES: The study aims to elaborate the connection between "information technology" and women rights in India. Specific goals and objectives of this article are: 1 .To identify the factors that has been influencing women empowerment and women rights in India. 2. To demonstrate the role of "information technology" in social change in India. 3. To examine in the contribution of "information technology" in establishing women empowerment throughout these centuries. 4. To understand the crucial role of "information technology "in the enhancement of women employment in India.2 --- LITERATURE REVIEW FACTORS THAT INFLUENCING WOMEN EMPOWERMENT AND WOMEN RIGHTS Women empowerment refers to the establishment of women in society as equal as men and women rights are a part of women empowerment. There are different factors that has been influencing women empowerment in India such as education, women development programmes, employment, eliminating gender discrimination and social norms (Kokane and Shinde,2020). In the history of India women were not allowed to be educated but now there are different programmes and policies for supporting women education. The women literacy rate is lower than men literacy rate in India but a huge development in women education is identified throughout these centuries which have been positively influencing women empowerment in the country. Considering these potential actions are taken by the Indian Government and women were given several rights to be equal as men. Along with education employment was also not allowed for women in history but the percentage of women employment has also increased in India. Due to the enhancement of women's education they became able to be employed and that has a positive influence towards that increase of women employment in India (Samad and Zhang, 2019). Apart from that gender discrimination is one of the crucial social norms that had a negative impact on women empowerment. There are different policies in programs against gender discrimination but this social norm is not completely eliminated from the society of India and that is influencing women empowerment. --- ROLE OF "INFORMATION TECHNOLOGY" IN SOCIAL CHANGE "Information technology" is a significant factor that contributes to social change in different ways. A great influence of IT in changing the perspective and attitude of society towards women is identified. Use of ""Information technology" helps to create a psychological comfort for women as it enhances additional skills and knowledge for them. These skills and knowledge build psychological empowerment among women which is important for social change. This psychological empowerment includes personal empowerment, social empowerment and organisational empowerment (Samosir et al.2020). In the history of India, it is identified that lack of education knowledge and skills have been the barriers in social changes regarding women empowerment. Different information technologies such a as mobile phones, television, internet, radio , computers and others are providing different information about real incidence across the world which enhances skills for tackling situations. On the other hand, different shows through television and radio that talk about women empowerment and its importance for social development have a great influence towards the changes of social norms. In short, "information technology" has been establishing a great communication between women and society which is contributing to social change in a positive way. Along with that, IT has improved the education system for women which is another factor that is contributing to social change (Mackey and Petrucka,2021). It is identified in the history of India that women were believed in different superstitions and due to that they used to avoid education. Hence, time changed and along with that the state of women in society has changed in which IT has a great contribution. Women's education has enhanced due to IT and that is making changes in the attitude and norms of society. --- ROLE OF NGO'S Smile (Savitri Marketing Institution For Ladies Empowerment) organizes IT seminars in collaboration with IT companies. NIIT has launched SWIFT JYYOTI programme for IT education for women. The programme is designed to provide computer literacy to females from six years to sixty years. It provides functional literacy on the one hand and benefits women in seeking and receiving information useful in their daily life. The duration of SWIFTT JYOTI programme is 18 hours. SEWA (Self Employed Women's Association) has launched IT programme to increase efficiency of rural micro enterprises. Ujjas Innovation: It is an initiative to empower women by bringing out their own newsletter called "ujjas". The newsletter went on air in All India Radio Bhuj Station in Gujarat. The newsletter provides a medium to express views against female infanticide, dowry and other relevant issues. --- CONTRIBUTION OF "INFORMATION TECHNOLOGY" IN WOMEN EMPOWERMENT IT has an effective impact on all the factors that influence women empowerment in Indian society. Education is one of the first factors that influence women empowerment and use of IT has changed the way of education for women. They do not need any proper class for education now, women can get different information about anything through information technologies such as mobiles, internet and others. Literacy rate among women has enhanced in India through theses years. In 2010 about 80.35% women in India were educated whereas about 91.96% women were educated in 2021 which is a noticeable growth. Women can learn from anywhere anytime and enhance their knowledge and skills by the use of "information technology". On the other hand, it has impacted employment of women in India as well. Due to the enhancement in farms. Labour force participation rate of women was 20.53% in 2018 which changed to 21.18% in 2019. Along with that "information technology" is helpful to reduce gender discrimination from the society. Different programs through "information technology" is such as television social media and others regarding the negative impacts of gender discrimination can change the perspective of individuals. Thus, in this way IT is contributing in women empowerment and women rights which is important for social development. --- WOMEN'S EDUCATION HAS IMPROVED DUE TO THE SPREAD OF INFORMATION "Women's education has improved due to the spread of information technology was the statement for getting responses from the respondents. Over 80% of the responses were positive as 34% of the women agreed3 and 52% of women "strongly agreed" with the statement. Besides 6% among the respondents have disagreed and 4% of the respondents have "strongly disagreed" with the same statement as well as about 4% women among all respondents did not provide any specific opinion on the statemen 4 t. A large percentage of positive opinion indicates that "information technology" has been contributing in the improvement of women's education. --- Conclusion: It can be concluded that "information technology" is playing a remarkable character in the establishment of women rights in India. Several factors are identified which has been influencing women empowerment such as education, gender discrimination, employment and others. All of these factors are developing day by day in which "information technology" has a great contribution and that is empowering women and their rights in society. It can be stated that there is a meaningful and great connection between "information technology" and women rights. In regard to, these primary sources are used for gathering relevant data for use in this article and due to that a serving was conducted among some women. Their opinions were also positive regarding the influence of "information technology" in empowering women in Indian society.

The women of the modern world are able to move to their preferences namely the "domestic and the public world". It is very natural that human beings are born with equal social and living rights but the social system and mental narrowness have made women' rights restricted and bound by male dominance activities. In this modern era, high technologies enable us to connect each other from "education of employment, politics to creativity". It has been noticed that a "global technology revolution" has taken place and in this situation, if women are not being a part of it based on their rights, the future of women's rights also will be desolated. Thus the government has launched several laws and acts for stabilizing the women's rights that has been not implemented properly. Information technology has become one of the vital parts of the world to run every day technological devices. Accompanied by the development of internet access, the acts and laws against women's rights can be unlocked for all. Different methods are used for gaining knowledge about the concepts of information technology and women's rights. The information and data collected from reviewed articles are evaluated in literature review. The significant role of information technology in making the future of women's human rights is discussed in this article.

related to food insecurity, poor dietary habits, physical inactivity, obesity, and limited access to healthcare. 2,3 Socioeconomic and health disparities experienced by Native Hawaiians have long-range consequences. Native Hawaiians have the shortest life expectancy of the state's five largest ethnic groups, 74 years, compared with 79 years for Caucasians and 83 years for Japanese. 4 The literature demonstrates a strong interrelationship among education, income level, and health outcomes, especially for minorities. [5][6][7][8] The World Health Organization identi- fied low educational attainment, illiteracy, and unemployment or underemployment as key risk factors for chronic disease. 9 However, interventions targeting social determinants tend to focus on one problem at a time (health, education, or employment), rather than helping people to advance their standard of living. 10,11 When disadvantaged students access college, it usually is junior college, with graduation rates below 50%. 12 Barriers include lifelong exposure to racism and low socioeconomic status, which can limit development of study skills, success in primary and secondary schools, and opportunities for higher education. [13][14][15] People designing interventions, however, often base them on their own values, and sometimes these interventions do not fit or are not embraced by the target population. 16 An important traditional Hawaiian value is lōkahi, a holistic balance or well-being, inclusive of emotional, social, cultural, physical, cognitive, spiritual, environmental, and economic domains. 17 Another is kuleana, which refers to individual and collective responsibility for the functioning and advancement of society. The gift of education is not free, but requires the recipient to mature into the new role and give back to society by performing well and graciously in it. Finally, Native Hawaiians, like other indigenous groups, want to be engaged collaboratively with researchers (or better yet, as researchers) in the development and testing of holistic interventions that fit their culture. [18][19][20][21] Inclusivity empowers marginalized groups to improve life conditions and increases leadership skills and work readiness. 22 This paper describes steps taken by an academic-community partnership to develop a holistic intervention that --- Methods The partnership included underserved students, community college officials, community members/partners, and workforce leaders, and employed a culturally based action research approach to build a program to help students escape poverty and lead healthier lives. Action research involves part-ners in problem-solving cycles of exploration, planning, and evaluation. 23 A tenet of action research is equitable involvement of stakeholders, regardless of their backgrounds and titles. This is compatible with Native Hawaiian approaches of engaging community in problem solving, as reflected in this saying, E malama i ke kanaka nui, i ke kanaka iki (Take care of the big man and the little man alike). 24 The program's Advisory Panel (AP) included 18 members. 2). Of the 135, 77 (57%) transitioned to higher education, and 79% transitioned to jobs that offered health insurance (20% were in both groups). Of the 77 entering higher education, 33 (43%) aimed for a degree Our experience shows that Pathway students increase their skills and confidence when made responsible for the program and all its participants, as well as for their own learning. We found, however, that funding such interventions can be challenging. Most national funding resources are singlefocused, for example on a specific disease (e.g., cancer) or a specific solution (e.g., education). The AP had more success securing funds from entities that shared our mission to improve the well-being of Native Hawaiians than from research funders. Next steps are to strengthen the evaluation system to better capture changes in healthy-living knowledge, health outcomes, and cultural pride. We also will follow students over time to examine long-term changes in their employment, income, and health status. It is our hope that the individuals who complete the Pathway and become RNs will experience multiple benefits and continue as partners in support of this program.

ith colonization, Native Hawaiians lost land and language. 1 Key elements of their collectivist lifestyle were devalued, including indigenous approaches to self-sustenance and health promotion. 2 About 25% of Hawai'i residents identify as Native Hawaiian; many have lost touch with their traditional culture but do not fully embrace or benefit from westernization. The resulting marginalization of Native Hawaiians is evidenced by the high prevalence of poverty related to poor educational attainment and low-wage jobs and the high prevalence of chronic diseases

the magnitude of the association between early-life (aged 0-17) SEP and later-life (aged 50+) cognitive functioning. After systematically searching PsycINFO, Scopus, and ScienceDirect, 30 studies representing 39 samples and 223,381 participants met the inclusion criteria. Extracted data included participant and study design characteristics, construct operationalization and measures, and effect sizes. The results of the meta-analysis revealed a significant correlation between childhood SEP and later-life cognitive functioning, whether measured as an overall effect size (r = .179, 95% CI = [.156, .201]), global performance (r = .206, 95% CI = [.157, .255]), verbal episodic memory (r = .160, 95% CI = [.132, .188]), verbal fluency (r = .203, 95% CI = [.168, .237]), or processing speed (r = .146 (95% CI = .108, .184]), but not inhibition (r = .146, 95% CI = [-.150, .418]). Subgroup analyses revealed that, in some domains, the correlation was weaker with an older mean sample age. Correlations did not vary by study design (i.e., prospective or retrospective) or journal impact factor. These results provide important evidence for the promotion of policies that buffer children from economic hardship, as one's cognitive performance in later life begins far earlier than older adulthood. Abstract citation ID: igad104.0873 Incarceration is a risk factor for adverse health and disproportionately affects Black Americans. Little is known about its implications for later life functioning. This study investigated the associations between incarceration and social isolation and cognition among older Black Americans. Sample included African American and Caribbean Black respondents aged 50+ from the National Survey of American Life, 2001Life, -2003 (N=1,561; (N=1,561;12.6% with incarceration history). Lifetime incarceration history (yes/no) was defined as having been in jail, prison, or juvenile detention. Continuous cognitive score was measured using the WHO Disability Assessment Schedule-II, with higher scores indicating higher cognitive difficulty. Binary isolation was assessed by combining two indicators of frequency of contact and feelings of closeness, for friends and family, using a 4-point Likert scale. Multivariable weighted linear and logistic regressions were fit for the associations between cognitive score and social isolation, respectively. All models adjusted for age, sex, ethnicity, poverty, education, marital status, and drug use; model for cognition further adjusted for mental health and traumatic experiences and models for isolation further adjusted for discrimination. Moderation by nativity (U.S. versus foreign born) was assessed using interaction. History of incarceration was associated with worse cognition (β = 0.09, 95% CI: -1.48, 1.66) and higher odds of social isolation for frequency (AOR: 1.48 95% CI: 0.89, 2.46) and closeness (AOR: 1.05, 95% CI: 0.52, 2.15). Results not moderated by nativity. Findings --- INCARCERATION HISTORY AND ITS ASSOCIATION WITH COGNITION AND ISOLATION AMONG OLDER BLACK AMERICANS

latency and sleep maintenance) are explored. Examining sleep quality-cognition associations across micro-level timescales are salient to discern whether and how effects accumulate and contribute to performance differences over larger timescales in individuals approaching midlife.

Introduction: According to Article 5 of the Maria da Penha Law, domestic and family violence against women constitutes any action or omission based on gender that causes her death, injury, physical, sexual or psychological suffering, and moral or patrimonial damage, within the scope of the domestic unit, the family or any intimate relationship of affection. In isolation, domestic violence is already considered by the WHO a public health problem. In the context of a pandemic, as was the case with COVID-19, the issue had the severity increase. Objectives: To investigate the rates of domestic and family violence against women in the city of São João Batista, State of Santa Catarina, Brazil, between January 1, 2019, andDecember 31, 2020, relating the data to the COVID-19 pandemic. Methods: Descriptive cross-sectional study, operationalized by the technique of bibliographic and documentary research. Results: There was a reduction in the total number of crimes involving domestic and family violence against women in the city of São João Batista/SC, Brazil. While in 2019 there was a notification of 116 crimes, in 2020 the number dropped to 65. (Graph 1) The most frequent crimes in both years were: threat and bodily injury. Together they accounted for 83% of cases in 2020. (Graph 2) The apparent decrease in the number of notifications does not necessarily represent a decrease in cases of domestic violence, but rather, it may mean fear of leaving the residence to formalize the complaint, difficulty in carrying it out, or even the worsening of factors that increase the risk in these situations, such as reduction or total loss of income and support network. --- Introduction: The ongoing pandemic due to coronavirus disease (COVID-19) is not only causing casualties amongst patients but is also putting an enormous strain on healthcare workers worldwide, especially those in frontline of the COVID-19. Objectives: This study examined the influence of pandemic fatigue on physicians' mental health, with resilience as a mediator. Methods: This was a descriptive, cross-sectional study involving frontline young doctors at two university hospitals of Sfax, Tunisia. The Pandemic Fatigue Questionnaire, Brief resilience scale, Maslach Burnout Inventory and Satisfaction on call duty scale were used to collect data through an online survey. The survey was carried out through an anonymous questionnaire using Google Forms. Collected data was treated on SPSS program to make all the statistical analysis. The level of statistical significance was set at p<0.05. Results: A total of 261 young doctors responded to the online survey. The mean pandemic fatigue score was 25.09 (out of 50). Terminal years of residency experience (β=0.171, p=0.005), being vaccinated (β=0.129, p=0.032) and staff inadequacy (β=0.205, p=0.001) were associated with elevated score of pandemic fatigue. Resilience partially mediated the relationships between (a) pandemic fatigue and different dimensions of burnout (emotional exhaustion (β=0.337, p<0.0001), depersonalization (β=0.311, p<0.0001) and personal accomplishment (β= =0.185, p=0.004) and (b) pandemic fatigue and satisfaction on call duty (β=-0.137, p=0.03). Conclusions: Resilience reduces the effects of pandemic fatigue on young doctors' mental health. Implementing resilience-promoting measures is essential to support physicians' mental health and foster their well-being therefore improves the quality of care provided. Introduction: The COVID-19 pandemic has raised multiple psychological challenges among most healthcare workers, from anxiety to depression, burnout, sleep disorders, and substance use disorders. Thus, the burden caused by this prolonged medical crisis has inevitably drastically lowered the quality of life of the medical staff. In order to mitigate the negative effects of the pandemic, healthcare workers resorted to various coping strategies, with better or worse outcomes. Objectives: The present study aims to identify Romanian physicians' main coping mechanisms and evaluate the role of positive and negative stress-reducing strategies on quality of life. Methods: A cross-sectional national survey was conducted using a web-based questionnaire among physicians practicing in Romania (n=265). In addition to socio-demographic and professional information, the questionnaire addressed participants' coping mechanisms using the COPE inventory and quality of life with the WHOQOL-Brief scale. Descriptive statistics, Pearson correlations, and multiple linear regressions were used in the statistical analysis. Results: In total, 265 physicians consented to their participation in the survey. Of those who responded, 84.5% identified as female, 92.1% had a permanent residence in a urban setting, 63.8% were married and 55.1% attained a master's degree, a PhD diploma or equivalent level of education. The results showed that optimism was higher in male professionals, while avoidance coping was higher in female health professionals. The mean values of QoL subscales were: 74.7AE 18.3 for the general quality of life, 70.8AE 20.7 for health satisfaction, 64.0AE 14.2 for the physical area, 61.7AE 16.2 for the psychological area, 61.2AE 20.3 for the social relationships area and 64.7AE 12.7 for the environment area. Specific coping mechanisms (emotional venting, behavioral and mental disengagement) were associated with lower quality of life. In contrast, emotion-focused (positive reinterpretation and acceptance), problem-focused strategies (planning, active coping, suppression of competing activities) and humor were associated positively with most QoL subscales scores. Conclusions: Our data points to specific protective characteristics and some detrimental factors on physicians' quality of life during the pandemic, with the implication that these factors may be important considerations for mitigating distress and psychiatric disorders for healthcare workers during times of high stress. Concerted initiatives to improve wellness in healthcare workers ought to develop targeted programs to ensure adequate psychological support. --- Disclosure of --- Disclosure of

We suggest that patients with depression or suicidal behaviour avoided admission, for fear of contagion in hospitals. Also, greater family support could prevent self-injurious behaviours. By contrast, other disorders continued to require the same admission rate, since the social consequences derived from confinement could lead to the genesis or worsening of symptoms, such as adjustment disorders.

Objective: A growing body of research demonstrates that social determinants of health (SDOH) are important predictors of neurocognitive and psychological outcomes in survivors of pediatric brain tumor (PBT). Existing research has focused primarily on individual level SDOH (e.g., family income, education, insurance status). Thus, more information is needed to understand community level factors which may contribute to health inequities in PBT survivors. This study aimed to examine the effects of specific aspects of neighborhood opportunity on cognitive and emotional/behavioral outcomes among PBT survivors. --- Participants and Methods: The sample included clinically-referred PBT survivors who completed a neuropsychological evaluation (N=199, Mage=11.63, SD= 4.63, 56.8% male, 71.8% White). Data included an age-appropriate Wechsler Scale and parent-report questionnaires (Behavior Rating Inventory of Executive Function, Child Behavior Checklist). Nationally-normed Child Opportunity Index (COI) scores were extracted for each participant from electronic medical records based on home address using Census tract geocoding. The COI measures neighborhood-level quality of environmental and social conditions that contribute to positive health. It includes three component scores assessing distinct aspects of opportunity, which include educational opportunity (e.g., educational quality, resources, and outcomes), health/environmental opportunity (e.g., access to healthy food, healthcare, and greenspace) and social/economic opportunity (e.g., income, employment, poverty). Stepwise linear regression models were examined to identify significant predictors of cognitive/psychological outcomes associated with PBT; the three COI indices were entered as predictors and retained in the model if they significantly contribute to variance in the outcome. Results: Lower educational opportunity was associated with lower processing speed performance (Wechsler Processing Speed Index: t = 2.47, p = 0.02) and increased parentreported executive functioning problems (BRIEF GEC: t = -2.25, p = 0.03; BRIEF Working Memory: t = -2.45, p = 0.02) and externalizing problems (CBCL Externalizing: t = -2.19, p = 0.03). Lower social/economic opportunity was associated with lower working memory performance (Wechsler Working Memory Index: t = 2.63, p < 0.01) and increased parentreported internalizing problems (CBCL Internalizing: t = -2.38, p = 0.02). Health/environmental opportunity did not emerge as a primary predictor of any of the examined cognitive/psychological outcomes. Exploratory analyses examining the impact of age on associations between COI and cognitive/psychological outcomes found a significant moderation effect of age on the relationship between educational opportunity and processing speed (t = 2.35, p = 0.02) such that this association was stronger at older ages. There were no other moderation effects by age. Conclusions: Consistent with a growing body of literature demonstrating the impact of social and environmental contexts to health outcomes, these results show inequities in neurocognitive and psychosocial outcomes in PBT survivors related to neighborhood-level SDOH. Examination of specific neighborhood factors highlight educational and social/economic factors as particularly important contributors to Objective: Pediatric cancer and cancer-related treatments may disrupt brain development and place survivors at risk for long term problems with cognitive functions. Processing efficiency has been operationalized as a nuanced cognitive skill that reflects both processing speed (PS) and working memory (WM) abilities and is sensitive to neurobiological disruption. Pediatric cancer survivors are at risk for processing efficiency deficits; however, a thorough characterization of processing efficiency skills across pediatric primary central nervous system (CNS) tumor and non-CNS cancer survivors has not yet been reported. Participants and Methods: Participants were selected from a mixed retrospective clinical database of pediatric cancer survivors (Total n=160; primary CNS tumor n=33; Non-CNS n=127). Univariate analyses were conducted to examine differences in processing efficiency mean scores (t-tests) and percent impairment (scores >1 SD below mean; chi-squared tests) between the total sample and normative sample, and across groups (CNS vs. Non-CNS). Multiple linear regressions were utilized to evaluate the relationships between additional risk factors, including biological sex, age at diagnosis, time since treatment, and socioeconomic status, and processing efficiency outcomes. Results: The total sample obtained lower scores on WM (M=90.83, SD=13.35) and PS (M=88.86, SD=14.38) measures than normative samples (M=100, SD=15), p < 0.001. Greater percentage of pediatric cancer survivors demonstrated impairment across all processing efficiency measures (24.8-38.1%) than normative samples (15.9%), p < 0.001. Regarding group differences, the CNS group obtained lower mean WM (M=84.85, SD =11.77) and PS (M=80, SD=14.18) scores than the Non-CNS group (WM M=92.39,SD=13.32;PS M=91.16,SD=13.56), p < 0.001. Rates of impairment between groups only differed for PS scores, with 63.6% of the CNS group and 31.5% of the non-CNS group demonstrating impairment, p < 0.001. Primary CNS tumor cancer type and male biological sex emerged as the only significant risk factors that predicted processing efficiency skills, with male sex predicting lower scores on PS (B=8.91 p<.001) and semantic fluency (B=7.59, p=.007). Conclusions: These findings indicate that both pediatric primary CNS tumor and non-CNS cancer survivors exhibit substantial weaknesses in processing efficiency skills after treatment. While both groups demonstrated deficits compared to normative samples, the CNS group was more susceptible to PS impairments than non-CNS group. A basic initial study of the relationships between risk factors and processing efficiency skills revealed that primary CNS cancer was a predictor of lower performance on working memory and processing speed measures, while male biological sex was a significant risk factor for worse performance on processing speed and semantic fluency measures. Continued focus on the construct of processing efficiency in pediatric cancer survivors is warranted. Applying a standardized approach to assessing and communicating this nuanced cognitive skill could contribute to advancing both clinical practice and outcomes research of pediatric cancer survivors.

To the best of our knowledge, this is the first report documenting detailed neuropsychological data on this rare disease. The case study documents widespread cognitive deficits with greater difficulty with visually based abilities than verbal abilities. Specifically, patients with ECD may present with cognitive difficulties in visual learning and memory, processing speed, visuospatial processing, select areas of executive/frontal systems, letter and semantic verbal fluency, and fine motor dexterity.

are economic, sociocultural, geographical and gender barriers that hinder access to services that must be eliminated. (2). The universal health strategy is the foundation for improving the health and well-being of all people; strengthening health systems; increase their resilience and responsiveness to current and future challenges; and promote intersectoral initiatives to address the social, economic and environmental determinants of health. This strategy rests on the foundation of the right to health, which is fundamental to our human rights and to our understanding of life lived with dignity. (2). Poverty and social exclusion are two indicators of socioeconomic position commonly used in Latin America. Poverty imposes restrictions on the material conditions of daily life, limiting access to fundamental pillars of health, such as adequate housing, good nutrition and the opportunity to maintain optimal personal hygiene. (3). Social exclusion prevents people from participating in education or training and accessing citizenship services and activities. Being excluded from society and being treated as less than equal leads to poorer health and higher risks of premature death. (4). There is a large number of people getting affected by untreated dental caries. In addition, severe periodontitis and edentulism diseases amount to 3,500 million in the world (6). Globally, the highest prevalence (7.4%) and incidence (5.9 million new cases) of total tooth loss is observed in Tropical Latin America. The highest prevalence of caries in permanent teeth was observed in Andean Latin America (54.9%), while severe chronic periodontitis (10.5%) was more prevalent in western sub-Saharan Africa. Of note, Tropical Latin America was the only region with a significantly higher prevalence and incidence of untreated caries in permanent teeth, severe periodontal disease and total tooth loss, compared to global averages in 2015 versus previous studies. (6). According to Kassebaum et al. (6), a more than 100% increase in the rate of disability-adjusted life years due to oral conditions was observed in 4 regions of Africa and 3 regions of South America between 1990 and 2015. However, it should be emphasized that this significant increase may be due to an increase in data recording and not necessarily reflect reality to the same extent. The objective of this review was to determine the risk of developing carious lesions as a function of socioeconomic position in Latin America. --- Materials And Methods --- A Protocol: The protocol was designed according to Cochrane standards for systematic reviews. The search criteria met the guidelines Preferred Reporting Items for Systematic reviews and Meta-Analysis Protocols (PRISMA) (8). Inclusion and exclusion criteria: The inclusion criteria were: studies published in the last 5 years, studies conducted on adults or children with permanent or deciduous teeth, studies conducted in Latin America, studies conducted in Spanish, English or Portuguese, studies addressing risk factors for dental caries, studies reporting on socioeconomic factors or indicators, studies reporting on CAOD/ceo-d. The exclusion criteria were: studies older than 5 years, conducted on animals, studies without statistical analysis, studies in a language other than Spanish, English or Portuguese, analytical studies that did not associate dental caries rates with socioeconomic indicators and studies conducted in geographical regions other than Latin America. --- Search strategy: We searched the following databases from 2016 to 26 October 2021: 1) MEDLINE via PubMed, 2) LILACS and 3) Elsevier via ScienceDirect. The search strategy used was: (caries OR decay) AND (socioeconomic position OR socioeconomic status) AND (Latin America or South America). Study Eligibility and Data Extraction: Full texts of potentially relevant studies were screened to answer the research question. A matrix was generated for data extraction from selected studies. https://jazindia.com Available online at: -11 - The matrix had the following fields: authors, year of publication, country, mean age, prevalence of CAOD/ceo-d>0, mean CAOD/ceo-d and type of socioeconomic indicators used. --- Analyzed result Studies investigating the association between educational or occupational background or parental or personal income and the prevalence, experience, or incidence of dental caries. The selected studies must have analysed the clinical parameters of dental caries. It was not predetermined how caries needed to be assessed (e.g., assessment of only dentin lesions or both enamel and dentin, clinically or radiographically determined caries, etc.), as different valid methods are currently used (9). The association between socioeconomic position (educational background, own or household income, own or parental occupation) and caries was analyzed. Estimates of dental caries were classified as follows: -Prevalence of caries (percentage of a population with untreated caries lesions, e.g. "C" component of the CPOD> 0) -Presence of any caries experience (percentage of a population with some caries experience, i.e. with POCD> 0) -Incidence of caries (increase in caries lesions or number of active lesions). --- Results and Discussion A total of 152 articles were reviewed, 129 studies were excluded based on the title, 9 based on the information found in the abstract and 5 after reading the articles in full text. Finally, 9 studies were included in the review. The diagram flow can be seen in Figure 1. The main results of this review can be found in Table 11) They also found statistically significant differences between the parents' level of education with the presence of caries. The risk of untreated caries was 1.9 times higher when the parents' maximum educational level was primary school compared to children whose parents completed secondary education. In addition, significant associations were found between social class, the presence of untreated caries, and the number of decayed teeth or teeth that required extraction. ( 13). The socioeconomic position not only influences the dental pathology present, but also significant differences were found between children with different socioeconomic position in terms of the number of visits to the dentist and the dental anxiety they presented. A child with a worse socioeconomic position was more likely to have never visited the dentist and to have dental anxiety compared to a child with a better socioeconomic position (13). In addition, a higher rate of caries was associated with female sex, non-white ethnicity and the presence of gingival bleeding (14). According to the analysis carried out by Pilecco et al. (15), sex, skin color, age, parental education, number of visits to the dentist, were associated with the number of filled teeth (15). Neves et al. (16), observed that there was a higher prevalence of caries if the last dental consultation was in public services rather than in private services. A higher prevalence of caries was also found the greater the number of residents in the home, the lower the knowledge about this pathology and when the patient belonged to a dysfunctional family nucleus. (16). There are other variables that are associated with a higher rate of caries such as the percentage of homes with non-potable water, percentage of families living on up to a minimum wage and the teething stage. The results indicate a 6% increase in the odds of experiencing caries at the community level for each additional percentage of homes with unsafe water. In addition, there was a 3% increase in the odds of having cavities for each additional percentage of families living on up to minimum wage. (17,18). This review found several factors that will increase the risk of caries at some point in life: socioeconomic status, educational level of parents, social class, family income, number of visits to the dentist, female sex, non-white ethnicity and access to drinking water (10)(11)(12)(13)(14)(15)(16). In addition, low-income families may encounter financial constraints regarding improving their oral health by purchasing preventative materials, such as toothbrushes and fluoride toothpaste. This review was not intentionally directed towards the paediatric population, however there were no studies conducted in adults that met the inclusion criteria. This in itself throws us a question: with caries being one of the most prevalent preventable diseases in the population of Latin America, how can it be that there are no more studies? https://jazindia.com Available online at: -13 -Other studies yielded information regarding the education received on caries prevention and low knowledge about oral health was associated with higher prevalence among patients from lower and lower-middle social classes. In addition, the use of dental services for emergencies and/or dental pain was associated with low knowledge about oral health, as well as toothbrushing less than twice a day, higher prevalence of severe impact on quality of life and presence of untreated caries (19). The objective and priorities pursued by European countries establish that at least 80% of children aged 5 to 6 years should be free of caries. None of the studies in this review reported a caries index that met this condition. However, it should be considered that global targets in terms of absolute values are limited and, instead, health management and planning at local and national levels should formulate realistic goals for the oral health of each community. (17). The prevalence of children with caries in this sample was higher than that stipulated by the World Health Organization -WHO for the year 2000 in Latin America, whose objective was that 50% of children between 5 and 6 years old were free of caries. The behavioral/cultural explanation should also be taken into account, which emphasizes behavioral and lifestyle choices and suggests that people of low socioeconomic status are more likely to engage in poor health behaviors, such as high sugar intake, infrequent dental visits, and poor oral hygiene practices. (20). In a study conducted by Piva et al., they observed that despite having access to free dental care, children from families of a low socioeconomic status do not always seek care and free access to a dentist does not necessarily improve the oral health status of the population. ( 21 --- ) --- Conclusion There is a direct association between socioeconomic status, parents' educational level, family income, and patients' oral health education and caries experience. It is necessary, in addition to guaranteeing access to health, to create education and prevention programs for dental pathologies. In addition, this review highlights the lack of research in Latin America on oral health at the community level and the lack of policies based on scientific evidence to try to reduce the rate of caries in pediatric and adult populations. ://jazindia.com https e online at: ilabl Ava -14 -

People who are in a bad socioeconomic position usually experience bad health outcomes. Moreover, higher mortality rates are linked to deteriorating socioeconomic status. This trend can also be observed in oral health. Worldwide, the highest prevalence of disease caries in permanent teeth was observed in Andean Latin America. The aim of this review was to determine the risk of caries based on the socioeconomic position in Latin America. The protocol was designed in accordance with the Cochrane standards for systematic reviews. The search criteria met the Preferred Reporting Items for Systematic reviews and Meta-Analysis Protocols (PRISMA) guidelines. A total of 152 articles were reviewed. Finally, 9 studies were included in the review. There is a direct association between socioeconomic status, parents' educational level, family income, and oral health education and patients' caries experience. Furthermore, this review highlights the lack of research in Latin America on oral health and the lack of policies based on scientific evidence to try to reduce the caries rate in the pediatric and adult population.

Progress in Community Health Partnerships: Research, Education, and Action Fall 2016 • vol 10.3 virus infection and cancer, lower rates of preventative screening, and poor access to care. [6][7][8][9][10][11][12] Undocumented immigrants are particularly vulnerable to mental health conditions such as trauma, depression, and anxiety, and face even greater limits on access to mental health care. [13][14][15][16] Much of the data on the health of undocumented immigrants focuses on older adults or children. There is a dearth of research on the health and health care access of the population of 14-to 31-year-olds who are eligible for DACA, often referred to as DREAMers because they were the target population for the 2011 Development, Relief, and Education for Alien Minors Act. 17 It is important to study this population specifically because policy changes such as DACA are likely to improve their access to health care and impact their health outcomes. In the first published study of the health and health care access of those eligible for DACA, our team identified highly limited access to primary care, mental health care, and specialty care, compounded by poor health care literacy. 15 Participants also reported histories of trauma, depression, and anxiety. 15 Despite these needs, DREAMers are explicitly excluded from accessing public or private health insurance through the Affordable Care Act. 18 By 2016, 62% of undocumented adults are expected to remain uninsured, making it critical to engage with DACA-eligibles to understand their health concerns and how they are accessing care. 19 Research engagement with immigrants is quite challenging owing to mistrust of medical professionals, power differentials between researchers and participants, difficulty penetrating isolated communities, language barriers, and small available sample sizes. 15,20,21 Research recruitment of undocumented populations is even more challenging given fears related to engagement with government and health care organizations, concerns about disclosing documentation status, discrimination, and competing economic and social demands for their time. 15,16,[22][23][24] Community-based recruitment has been successful in some studies with broader Latino samples and is likely to be critical to research with subsets of immigrant populations such as those without documentation. 9,20,21,25,26 As a difficult-to-reach and understudied population, it is also important to elucidate how to engage them, not only in available health care programming, but also in research that contributes to the development of policies that improve their health care access. This paper details the participant engagement strategies and research challenges of a research team studying DACA-eligible Latinos. --- METHODS Drawing on principles of community-based participatory research, we recognized the unique identity, strengths, and challenges faced by the undocumented community and sought to engage community stakeholders and DREAMers in a collaborative partnership in this study's design, participant recruitment, and validation of findings. 27,28 This approach allowed us to gain an understanding of the community's health concerns and health care access (published elsewhere 15 ), while also co-learning with DREAMers and community advocates about how to most effectively engage this population in research. 17 --- LESSONS LEARNED Recruitment Challenges The above methods culminated in the recruitment of 119 DACA-eligible immigrants, with 61 participants taking part in one of nine focus groups, representing a 55% retention rate (Table 2). Recruitment strategies were similar between those who attended and those who were lost to follow up. Among the "no-show" participants, frequently reported reasons for missing the focus group included competing demands for their time (work, school, and family obligations) and transportation issues. Two participants arrived for the focus group, but were unable to participate owing to lack of childcare. Given that participants cited family obligations as one of the most common reasons that they were unable to attend, onsite childcare would have likely improved our retention of some participants. --- Successful Recruitment Strategies With 42% of participants recruited through social media, pants often heard about the study through multiple recruitment channels, which contributed to the study's legitimacy and helped to create a sense of credibility and trust. Table 3 summarizes these data. Gender of participants did not vary by recruitment strategy. Unsurprisingly, participants who were more engaged in activism were more likely to hear about the study through peer or online activist communities. --- Proposed Engagement Strategies with Undocumented Populations The focus group discussions included an opportunity for participants to suggest strategies for engaging the undocumented community in health programming. Many of their suggestions also have relevance for engaging the undocumented community in research. As noted, focus group participants suggested partnering with CBOs, including immigrant advocates, specific national and local advocacy groups, local clinics, churches, schools, and English as a second language programs (Table 4). One participant explained that information "has to come from a source that you trust because, otherwise it [is a] community that may be scared." Participants suggested media outreach strategies targeted at different ages of undocumented community members. --- They proposed advertising during telenovelas and local Spanish language news programs to target older generations of immigrants. In contrast, they suggested using Facebook, Twitter, and Instagram to target adolescents and young adults. Although participants expressed wariness about disclosing their documentation status to health care or government officials, they identified government web sites as trusted sources of health information. Participants emphasized that one successful recruitment strategy would be to target family members of the intended audience. "Our parents are always on the lookout for anything that can benefit us," one participant explained. --- The Community's Call for Additional Research --- DISCUSSION This paper is the first to describe successful research engagement strategies with DACA-eligible immigrants. Although prior research, including our findings from these focus groups, suggest that undocumented populations are hesitant to disclose their status to government agencies and health care providers owing to fear of deportation, 15,16,23,24,29 participants in this study expressed enthusiasm about engagement in research as undocumented immigrants. This support likely reflects both the politically engaged nature of DREAMers as well as the research team's substantial efforts to engage the community in creating a comfortable and nonthreatening research experience. These efforts included not requiring participants to verify their current immigration status, eliminating the requirement for written consent, reassuring participants of confidentiality, and informing participants that their stories might help others who are in their same position. Multiple reinforcing recruitment strategies also built a sense of trust in the community, particularly as peer referrals played an important role in establishing credibility. Despite misconceptions that minorities are unwilling to enroll in research, these findings support previous work that demonstrates that minority populations are willing to engage in research under appropriate circumstances and with assurance of confidentiality. 30 Participants in this study indicated that their comfort engaging in research and health programming was largely dependent on the type of outreach strategy used. Supporting the limited research with other particularly vulnerable Latino populations including undocumented women, drug users, patients with human immunodeficiency virus, and children, 9,20,21,25,31 participants confirmed that they preferred engagement through trusted advocacy groups and CBOs. They emphasized building on their close-knit social networks and using participant-driven recruitment. 32 Participants also identified contact with family members within the undocumented community as a possible outreach strategy, suggesting age-appropriate Spanish-language media channels to reach adult family members who might refer other family members to research participation or health care. Although this is similar to social marketing techniques used with other vulnerable populations, 32 participants in this study specifically suggested the greater use of social media web sites to reach undocumented young people. This strategy supports a growing body of literature on using social media for recruitment of vulnerable populations. [33][34][35][36] In addition, participants in this study were successfully recruited using interactive engagement with technology through social media, email, and texting, suggesting that the previous technological divide between Latino populations and the general public may be rapidly changing within undocumented communities. 37 Overall, this study demonstrated that it is possible to partner with CBOs and undocumented community members to successfully conduct research to learn about their health concerns and health care access. Our experience in this study highlights the importance of community partnership and the interest of the undocumented community in using research to give voice to their health concerns. --- LIMITATIONS This paper focuses on the recruitment and engagement of DACA-eligible youth, a subgroup of the undocumented community, which is by definition relatively young and educated. This study focused on Latino participants, most of whom emigrated from Mexico. Although this is consistent with national trends, it may limit the study's generalizability to immigrants from other countries. In addition, the majority of the research participants also self-identified as engaged in immigrantrelated activism. This is likely related to our recruitment strategy of partnering with advocacy organizations, but it may also be related to increased political and community engagement emerging because of DACA and immigration reform efforts. --- Progress in

T he population of immigrants in the United States is an estimated 41.7 million, 11.7 million of whom are undocumented. 1 Undocumented immigrants have received increased media and public policy attention over the past several years as Congress debated immigration reform and the presidential programs for DACA and Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) were introduced. 2 These programs allow beneficiaries to live and work temporarily, without threat of deportation. 2 The DACA program, implemented in 2012, specifically targets young people who immigrated as children, have been living otherwise lawfully, and have attained certain educational goals (Table 1). 3 Efforts to implement DAPA and expand the

Introduction Human beings have constantly tried to create an identity for themselves, and with the world becoming increasingly progressive, they have more freedom of choice in many spheres of life, including gender expressions and sexuality. (Cederved et al., 2021) However, the understanding of these concepts continues to gradually evolve, and despite various major social advancements in the last few years, LGBTQIA+ people face discrimination on the grounds of sexual orientation and gender identity. Although social media has provided this minority with a platform to express themselves by sharing their experiences and build a strong, healthy community, there has been an increasing amount of general toxicity on the internet (Craig and McInroy, 2014). There has also been a spread of transphobic and homophobic comments through these online forums, due to the easy access to anonymity they provide, which ensures that these violators are never held accountable (McInroy and Craig, 2015) (Gámez-Guadix and Incera, 2021). The need for the detection and filtering of such acerbic content in user-created online content is thus at an all-time high. However, the manual detection and flagging of certain words might be time-consuming and ineffective in the long run. The tendency of Tamil speakers to use code-mixed transliterated text also poses a challenge to the task. In this paper, we examine various approaches for the classification of Tamil code-mixed comments into three categories, namely, Homophobic, Transphobic and Non-anti-LGBT+ content as a part of the shared task Homophobia/Transphobia Detection @ LT-EDI-ACL2022 (Chakravarthi et al., 2022a). After tackling the data imbalance using sampling techniques, feature extraction using count vectorizer and tf-idf was done along with various classifiers. Another approach involved the usage of transformer models to classify the text. The same has also been analysed for English and Tamil datasets. The remainder of the paper is organized as follows. Section 2 discusses related works according to this task. Section 3 analyses the given datasets. Section 4 outlines the methodology followed for the task. The results are presented in Section 5 and finally, a conclusion is delivered. --- Related Work The first formal defense of homosexuality was published in 1908published in (Edsall, 1908)). The 20th century witnessed many ups and downs in the progress of social acceptance of sexual minorities. Various studies on the existence of different sexualities have been conducted such as (Ventriglio and Bhugra, 2019), (Francis et al., 2019), (Trinh, 2022) and (Kiesling, 2019), and it has been observed that there has been a positive shift in the attitude of the general public towards homosexuality (Cheng et al., 2016) (Mathews et al., 1986). More recently, the LGBTQ+ movement has picked up and has gained many followers through social media. Several people have worked on the task of using machine learning to identify and filter out hurtful comments, thus aiding in the battle against homophobic/transphobic sentiments. Some of the early works in this field include (Mandl et al., 2020) and (Díaz-Torres et al., 2020), in which offensive language is identified in multiple Indian languages as well as some foreign languages. In (Pereira, 2018), homophobia was predicted in Portuguese tweets using supervised machine learning and sentiment analysis techniques. A wide range of techniques was utilised in this study, some of which include Naive Bayes, Random Forest and Support Vector Machines. The models were combined using voting and stacking, with the best results being obtained through voting using 10 models. (Chakravarthi et al., 2021) presents an expertlabelled dataset and various machine learning models for the identification and classification of Homophobia and Transphobia in multilingual YouTube Comments. In (Chakravarthi et al., 2022b), sentiment analysis and offensive language detection were performed for Dravidian languages in codemixed text, which are super-sets of the Homophobia/Transphobia detection task. In this paper, an experimentation of a number of machine learning algorithms such as SVM, MNB, KNN, Decision Tree, Random Forest and some BERT-based transformers, was done. In our work, we have put forward a comparison of some of the most popular models for this area of research and estimated the top three models for each language in the datasets given for this task. The three datasets given for this Homophobia/Transphobia Detection task are sets of comments from social media platforms, primarily YouTube, with the data given in the languages English, Tamil and Tamil-English code-mixed. The comments in these datasets are classified into one of these three categories -Homophobic, Transphobic and Non-anti-LGBT+ content. Table 1 outlines the data distribution of each training dataset. Most of the comments in these datasets do not extend beyond a single sentence and the average number of sentences in each comment is close to 1. All three datasets are highly imbalanced with respect to the categorisation classes. Considering this imbalance in the data distribution, it is expected that training a model on these datasets would give rise to a bias in the predictions towards the dominant category class in each dataset. Figure 1 illustrates the highly disproportionate distribution of data in each of the given datasets. The given raw datasets may contain inconsistencies in their data or may contain unnecessary data. Before feeding the data to the required algorithm, it is therefore important to clean the datasets. This cleansing of the datasets is carried out by removing punctuation, special characters and excess words that semantically contribute nothing to the overall mood of each comment. --- Methodology As part of our experimental setup, various classifier models were applied to the processed data after extracting the necessary features from it. For each dataset, three models that worked best for the language under consideration were chosen to predict the classification results for comments collected in that language. For reference, the models under consideration for the English dataset have been listed in Table 6 and Table 7 along with their performance on the development data. Similarly, the performance of the models for the Tamil dataset has been tabulated in Table 8 andTable 9, and their performance on the Tamil-English dataset has been illustrated in --- Embedding Embedding is used to encode the meaning of words in a text by transforming them into real-valued vectors. After successful embedding, words with similar meanings are found to be grouped together. For this task, we experimented using some BERTbased sentence transformer models and word embeddings. --- Feature extraction A feature is a unique property of a text by which it can be measured or quantified. Feature extraction helps to reduce the complexity of dataset on which a model is to be trained. Numeric encoding of the text is done as a part of this process. --- Feature extraction using Count vectorizer The Count Vectorizer is used to tokenize a set of texts by converting the collection of texts to a vector of token counts. The strategies of tokenization, counting and normalization are together called as the n-gram representation. --- Feature extraction using TF-IDF TF-IDF, which stands for term frequency-inverse document frequency, is a method of quantifying a sentence based on the words in it. Each row is vectorized using a technique in which a score is computed for each word to signify their importance in the text. The score for commonly used words is decreased while the score for rare words is increased. --- Models applied Some models that we experimented on for this task include Classifiers such as SVM, NLP, random forest and K-nearest neighbours, and some simple transformers like LaBSE, tamillion and In-dicBERT. These experiments were conducted for English, Tamil and Tamil-English code-mixed data. The best models observed were selected to generate the performance scores for the data sets. --- Observations It was found that certain models or combinations of models outperform others for each dataset under scrutiny. The performance results for each chosen model are presented in the tables given below. This task is evaluated on the macro averages of three performance metrics -Precision, Recall and F1-score. The scores achieved for this Homophobia Detection task are tabulated below in Table 5. --- English dataset After the required features were extracted, they were trained with different machine learning models. The models were then evaluated using the development data. The performance of the chosen models on the development data of the English dataset is depicted in Table 2. Our submission secured the 11th rank in Task B, i.e., Homophobia/Transphobia Detection on an English dataset. Our model procured a macro F1-Score of 0.37 and a weighted F-score of 0.93. --- Tamil dataset After the required features were extracted, they were trained with different machine learning models. The models were then evaluated using the development data. The performance of the chosen models on the development data of the Tamil dataset is depicted in Table 3 Tamil dataset. Our model procured a macro F1-Score of 0.50 and a weighted F-score of 0.75. --- Tamil-English dataset After the required features were extracted, they were trained with different machine learning models. The models were then evaluated using the development data. The performance of the chosen models on the development data of the Tamil-English code-mixed dataset is depicted in Table 4. Our submission secured the 9th rank in Task B, i.e., Homophobia/Transphobia Detection on a Tamil-English code-mixed dataset. Our model procured a macro F1-Score of 0.47 and a weighted F-score of 0.87. --- Inferences It is observed that each of the datasets is not very large and therefore, the number of training samples is limited. Almost all the classifier and transformer models used made highly accurate predictions on the English dataset. For the Tamil and Tamil-English code-mixed datasets, there is a significant variation in the performances of the different models used. It is evident that the SVM and MLP classifier models have similar good accuracy rates after performing some feature extraction, with SVM having a slight edge over MLP. The overall performance of the TF-IDF model is found to be slightly higher than that of the count vectorizer model. For the datasets with Tamil text, sentence transformers pre-trained for multilingual texts performed well. The LaBSE model was found to work particularly well for Tamil text. In summary, the SVM classifier model and the LaBSE transformer model yielded the best results for this classification task. --- Conclusion In this study, we have presented a comparison of different models for the LT-EDI-ACL 2022 shared task on homophobia detection. It was observed that average word embeddings along with the SVM Classifier worked the best for English text and that a combination of the tf-idf vectorizer and the SVM Classifier performed well on Tamil text. A language agnostic model called LaBSE worked best for Tamil-English code-mixed text. These results can further be improved by using suitable embeddings for each model and employing better preprocessing techniques.

Over the years, there has been a slow but steady change in the attitude of society towards different kinds of sexuality. However, on social media platforms, where people have the license to be anonymous, toxic comments targeted at homosexuals, transgenders and the LGBTQ+ community are not uncommon. Detection of homophobic comments on social media can be useful in making the internet a safer place for everyone. For this task, we used a combination of word embeddings and SVM Classifiers as well as some BERT-based transformers. We achieved a weighted F1-score of 0.93 on the English dataset, 0.75 on the Tamil dataset and 0.87 on the Tamil-English Code-Mixed dataset.

INTRODUCTION Population development policies in the context of national and regional development need to be strengthened, both in concept and implementation. At the policy level, population development must be able to integrate national and regional population issues so as to give birth to the concept of population-oriented development (Stokes & Seto, 2019). The synergy of population-oriented policies with the quality of human resources requires the quality of the population as a systemic vehicle in producing people who have life skills, personal skills that include self-awareness and thinking skills, as well as social skills, academic skills, and vocational skills (Murni et al., 2022). The main problem is the high population growth and the unbalanced distribution and age structure (O'Sullivan, 2018). At the implementation level, the population development policy is expected to be able to raise the standard of living of the population so that they become more advanced, independent, happy, and prosperous (Muhamad Khair et al., 2020); (Leal Filho et al., 2019). Where Population Development must really be able to take advantage of demographic bonus opportunities to trigger economic growth and improve people's welfare (Wandita et al., 2022); (Sampedro-Piquero et al., 2018). n (Wu et al., 2020). For this reason, this research is expected to provide a scientific foothold on the facts of the ongoing population phenomenon as well as to bridge it in the handling of this phenomenon through a population policy that is more pro-society. --- METHODS The type of research used is normative juridical research in the form of regulatory research that focuses on the study of theoretical aspects in the form of principles, norms, or policy regulation rules. While the method used is 1). Observation; 2). Documentation; 3). FGD. The analysis that will be used is secondary data analysis and document review. Residents are people/residents who live in an area and settle or intend to stay longer (Mahan et al., 2018) policies. These five aspects are known as the 5 pillars of population development (Cleland et al., 2019). In 2019, the contribution of women's income in the Boalemo district could reach 29.21 percent, even higher than the average income contribution of women in the province of Gorontalo. --- RESULTS AND DISCUSSION --- A. Research Results --- Boalemo

Population development policies related to national and regional development need to be strengthened both conceptually and practically. At the policy level, population development must be able to integrate national and regional population issues to create the concept of population-oriented development. The purpose of this study is to describe population development policies in Boalemo Regency related to policy implementation; policy concept; and the situation and conditions of population development. The method used is Observation; Documentation; and FGD, with the support of secondary data analysis and document review. The results of the study indicate that generally the implementation of population development policies in the Boalemo district has been carried out optimally, but still needs to be improved, especially in:

Background The European Union (EU) is the heaviest drinking region of the world, drinking 11 litres of pure alcohol per adult each year [1]. More than 1 in 4 deaths among men (aged 15-29 years) and 1 in every 10 deaths among young women in the EU is alcohol related [2]. Young people (aged 15-24 years) are responsible for a high proportion of this burden, with over 25% of youth male mortality and approximately 10% of young female mortality being due to alcohol [1]. Sparse information exists on the extent of social harm in young people, despite the fact that a third of a million (6%) 15-16 year old school students in the EU report engaging in fights, and 200,000 (4%) report unprotected sex, due to their own drinking [1]. Alcohol and other drug use increases markedly between the ages of 11 and 15 years amongst young people in Poland. Between the ages of 11 and 15 the proportion of those who have ever smoked increases from 12% to 59%. At age 11, 10% of 11-year-olds report that they have ever been drunk, and this increases to 53% amongst 15year-olds. Moreover, 18% of Polish youth report lifetime cannabis use [3]. Early alcohol and other drug use is associated with a range of subsequent adverse health and social outcomes [4][5][6][7][8][9][10][11]. The Strengthening Families Program 10-14 (SFP10-14) is a US-developed family-based intervention for preventing alcohol and other drug use and problems amongst young people. It has been evaluated in two large-scale randomized controlled trials in Iowa, USA [12][13][14][15][16] and has informed the development of a family-based intervention for African American families evaluated in a large randomized controlled trial in rural Georgia, USA [17][18][19]. Several systematic reviews have highlighted the promising results from these trials but also note the question of whether this US-developed intervention will be applicable in other countries and settings [20][21][22][23][24][25]. --- Aims of the project The aim of the trial is to assess the effectiveness of the Polish version of the SFP10-14 ("Program Wzmacniania Rodziny") when compared with a control group, in a large randomized controlled trial in Poland. The objectives of this trial are: To examine the effectiveness of the SFP10-14 in promoting positive parenting practices in parents of 10-14 year-olds in Poland To examine the effectiveness of the SFP10-14 in promoting positive parent-child relations amongst families with 10-14 year-olds in Poland To examine the effectiveness of the SFP10-14 in reducing problem behaviour amongst 10-14 year-olds in Poland To examine the effectiveness of the SFP10-14 in preventing alcohol and drug use and misuse amongst 10-14 years-olds in Poland --- Methods/Design Design A parallel group cluster randomized controlled trial where communities will be randomly assigned, with concealed allocation, to one of two groups, with a 1:1 allocation ratio. Communities in the intervention arm will participate in SFP10-14 group sessions; communities in the control arm of the trial will receive information leaflets for families. All families recruited into the trial will be assessed at baseline and at 12 and 24 months follow-up. Two years after baseline data collection, families from control communities will be offered the opportunity to participate in SFP10-14. --- Ethics Research undertaken in Poland funded by the National Bureau for Drug Prevention is reviewed by independent experts, and this independent review process covers scientific and any ethical issues that are identified by the independent reviewers. Ethics Committee approval for data collection was obtained from "Komisji Bioetycznej przy Instytut Psychiatrii I Neurologii W Warszawa" (Ethics Committee of the Warsaw Institute for Psychiatry and Neurology). Each family recruited into the trial receives an information sheet describing the trial and data collection procedures before giving their written and signed consent to participate. Consent was obtained from parent(s) and, separately, from children. --- Setting and participants Eligible participants are families with 10-14 year-old children from community settings across Poland. In all families at least one parent should agree to participate. If two children from the same family are involved in the intervention group then both parents will be asked to participate in SFP10-14 group sessions. --- Recruitment Communities who have expressed an interest in the SFP10-14 will be approached in 2010 to participate in the trial. Information about the SFP10-14 has been disseminated throughout Poland via conferences, journal articles, information bulletins and personal contact. Within communities, families will be recruited by community workers. Family recruitment will take place through community agencies, schools and via information leaflets and personal contact. --- Randomization Randomization occurs after communities have consented to participate in the trial. Simple randomization of community to intervention or control arm will be undertaken by the lead investigator drawing names out of a hat in a concealed allocation format. --- Intervention The SFP10-14 is a video based programme delivered by trained facilitators that includes parents/guardians and children learning together [26][27][28][29]. The 7-week program is delivered over 7-sessions, with 4 optional booster sessions available several months later. The weekly sessions last two to three hours: in the first hour parallel groups of children and parents from up to 15 families develop their understanding and skills, led by parent and child group facilitators; in the second hour, parents and children come together in family units to practice the principles they have learned. The remaining time is spent in logistics, meals and enjoyable family activities. The programme is highly structured with detailed manuals, videos and activities whilst at the same time being highly interactive [26][27][28][29]. --- Outcome measures Alongside demographic questions (including family size and structure, parental education, work status, disposable income) we have carefully selected validated instrument measures/scales: --- Primary outcomes Alcohol, cigarette and other drugs: age of first use, lifetime prevalence, 30-days (not other drugs) and 12-month prevalence Alcohol use without parent permission Drunkenness/binge drinking in past 30 days --- Secondary outcomes General Child Management [30][31][32] Parent -Child Affective Quality [30,32] Aggressive and Hostile Behaviors in Interactions [30,32] Intervention-targeted Parenting Behavior scale [32,33] Index of Aggressive and Destructive Conduct [34,35] Family aggressiveness [36] Family togetherness [36] Maternal support [36] Parental monitoring [36] Time spent with Mother/Father [36] Family Rituals Family Life Questionnaire [37] Truancy School behavior grades Grade Point Average Strengths and Difficulties Questionnaire [38,39] Parental alcohol and cigarette use --- Data collection Data are collected at baseline, 12 and 24 months. Interview-based questionnaires will be completed by parents and independently by children in separate rooms. In the control group one parent (or both if they express an interest) will complete the questionnaire, and if there are two children in the target age range (10)(11)(12)(13)(14) only the youngest will be asked to complete the questionnaire. --- Blinding Due to the nature of the intervention blinding of participants, SFP10-14 facilitators and data collectors is not possible. --- Sample size calculation No formal sample size calculation was undertaken but funding was requested for a sample size (N = 600 families) which was similar to that reported in other trials of the SFP10-14 [12][13][14][15][16]. These other trials have reported SFP10-14 effectiveness for reducing a number of risky behaviours amongst young people, including alcohol and drug use and misuse and other behavioural problems. --- Analyses Clustering at the community and family level will be taken account of in multi-level data analysis. Statistical tests of difference in proportions or mean difference tests (or non-parametric equivalents) will be used to examine differences between intervention and control groups. Based on pilot study results [40], data will be analyzed for the whole sample and by several sub-group analyses: child age group (10-12; 13-14); family problems (violence, chronic illness, substance use problems, financial problems etc.; low vs high severity); child behaviour and emotional problems (low vs high severity). All analyses will be on an intent-to-treat basis, and both completed case analysis and multiple imputation analysis will be undertaken. --- Discussion Social and cultural differences between the United States and European countries mean that positive results from US prevention trials may not translate to other countries. The Strengthening Families Programme 10-14 (SFP10-14) has been evaluated in several randomized controlled trials in rural Iowa in the United States and shown to be effective for delaying alcohol and drug initiation, but the extent that these results are applicable to other settings is not known. The long-term goal of the SFP10-14 is reduced substance misuse and behaviour problems during adolescence. This is achieved through improved parental nurturing and limit setting skills, improved communication skills for both parents and young people and development of young people's pro-social skills. These parenting skills and relationship factors are culturally universal so, in principle, the intervention should be applicable to other settings. This cluster randomized controlled trial of the SFP10-14 is one of the first trials to test this intervention outside of the United States. As such, this is an important replication that will examine the transferability and applicability of this intervention in an international context. Evidence about the effectiveness of the SFP10-14 in a European setting might lead to better family-based prevention programmes across Europe or, conversely, will provide much needed insight into the applicability of US programmes to other countries. --- Abbreviations SFP10-14: Strengthening Families Programme for Young People aged 10-14 and their Parents/Carers; US: United States; USA: United States of America. --- Competing interests Foxcroft declares that Oxford Brookes University has a training consultancy service for the SFP10-14. Okulicz-Kozaryn declares that she has received payment for training SFP10-14 facilitators. Author details 1 Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland. 2 Oxford Brookes University, Oxford, OX3 0FL, UK. --- Authors' contributions All authors have contributed to the development of this protocol. KO-K led on methodological development and analytical strategy and consulted DF on these aspects. KO-K and DF wrote the first draft together and all authors have approved this manuscript.

Background: Alcohol and other drug use and misuse is a significant problem amongst Polish youth. The SFP10-14 is a family-based prevention intervention that has positive results in US trials, but questions remain about the generalizability of these results to other countries and settings. Methods/Design: A cluster randomized controlled trial in community settings across Poland. Communities will be randomized to a SFP10-14 trial arm or to a control arm. Recruitment and consent of families, and delivery of the SFP10-14, will be undertaken by community workers. The primary outcomes are alcohol and other drug use and misuse. Secondary (or intermediate) outcomes include parenting practices, parent-child relations, and child problem behaviour. Interview-based questionnaires will be administered at baseline, 12 and 24 months. Discussion: The trial will provide information about the effectiveness of the SFP10-14 in Poland.