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INTRODUCTION Banyuwangi is one of the regencies in Java island, Indonesia. Banyuwangi's culture is still practiced by an indigenous community called the Using tribe (Hariastuti, Budiarto, and ... 2019). It is also one of the areas that has various types of very distinctive folk arts. Many Culturally, social and political movements in Banyuwangi can be interpreted through the lyrics of Banyuwangi songs. The dynamics of power relations through the poetry of Banyuwangen songs is studied ethnographically by focusing on the subject's knowledge system and how that knowledge is organized to determine actions (Mustamar, Dewi, and Umniah 2019). In an effort to optimize the capacity to take creative acts toward innovative traditions, it is crucial to --- Interview To complete the observation data, the authors conducted interviews with several sources related to the traditional Punjari Kumoro ritual: 1. Boani, as the perpetrator and living witness of the implementation of the Punjari Kumoro traditional ritual. --- Muhammad Syaiful, as a Banyuwangi Artist in Garit Village, Rogojampi District, Banyuwangi Regency. --- Winari, artist and community leader in Aliyan Village, Rogojampi District, Banyuwangi Regency. This interview was conducted to gather information including about the history of the traditional Punjari Kumoro rituals and their presentation structure. --- RESULTS AND DISCUSSIONS This section contains the results of research and analysis related to research results. Research results can be explained with pictures, graphs, tables, or others with the aim that readers can better understand the results of research [2], [5]. The Results and Analysis Section may consist of several Sub-Sections. --- The Ritual The notion of ritual is as subtle as music; it appears to be present anywhere there is expressive symbolic action that is removed from daily life and performed in a recurring pattern. It is a musical rite that forges metaphysical ties, fosters a sense of belonging, inspires creativity, and marks the passage of time. (Harvey 2021). Picture 1: First Series of Punjari Kumoro Rituals Picture 2: Sewur Puklung is a tool for exchanging the spirit of Mbah Buyut to Punjari which must be fulfilled Picture 3: Siraman is the first part of determining punjari characters in punjare kumoro rituals. --- The Ritual Music Music is meant to be heard primarily as sound, not primarily as a symbol of discursive thought. It found a replacement for the "aesthetic award", as it was too narrow to encompass all the activities the author considered music-making. Music to The stage of completing the data by looking for various sources of data reinforcement related to the research topic and applying all the data in the author's writing of a unique musical experience, or of hearing something like music, is certainly useful, but there's not much to be gained by placing it within the category of culture and the purpose of music itself. (Levinson 2017). Humans in all societies are engaged in listening to and making music, which they find enjoyable, even though music appears to have no apparent survival value. Here we review recent studies on the social dimensions of music that contribute to music-induced hedonia. With a modern mindset they prefer to do things immediately and quickly, as well as in the concept of society, where currently those who choose modern life tend to be individuals. There will be negative things that can happen to their current way of life that the modern concept of life tends not to believe in what ancient people believed that there is a relationship between people and their ancestors to continue to live what was given by their predecessors either from the concept of life and religion. From these negative things, there will be indications that society in the future will leave	This research aims to raise public awareness of the importance of social life by prioritizing the noble values contained in the principles of local culture. The packaging of this work is more focused on creating an atmosphere by combining several types of music from Banyuwangi. The music mentioned are angklung paglak, music on Gandrung arts, and Kunthulan which are worked on optimally so that they can strengthen the desired atmosphere and create new nuances on the musical side. Kumarajana's musical work also presents elements of the values embodied in the Punjari Kumoro art. The content and meaning of the Punjari Kumoro Ritual itself are implied by the values of life in a social context. These values are religious values as a means to pray and ask God to give guidance. The value of togetherness, in this case the people of Aliyan village mingle and unite their hearts and minds for the same goal. Other values include the value of mutual respect as an effort by the community to respect nature as a source of life for them.
Introduction The COVID-19 virus, previously known as 2019-nCov, was first found in late December 2019 in Wuhan, Hubei Province, China [1], before it rapidly spread across the entire country and then the world. As of 15 April 2020, there are over 1.9 million confirmed cases, with at least 123,000 deaths across 213 countries [2]. Since scientists confirmed the possibility of person-to-person transmission [3,4], massive efforts have been undertaken to isolate confirmed and suspected cases from the public. In particular, as learned from previous experiences in controlling the spread of SARS, the lockdown approach was widely applied, and has now been proven for its effectiveness in controlling transmission [5]. While these efforts are designed to limit further infection, instances of discrimination (Here, we take the general definition of discrimination to refer to unjust treatment or making a distinction against a person based on group, class, race, age, sex or category to which that person belongs rather than on individual merit.) and social exclusion have also increased as the number of reported confirmed cases continues to rise. This research is aimed to document the observation and unexpected social outcomes of social exclusion and discrimination in the outbreak of COVID-19 across the world and inside of China. --- Methodology The data generated from this research are delivered from three primary sources. (1) An online survey targeted at oversea Chinese people was conducted in February 2002 via the snowball sampling method. We used an online survey platform ('SurveyStar,' Changsha Ranxing Science and Technology, Shanghai, China) to disseminate questionnaires firstly to friends and students who would pass it on to others. The survey finally reached 1904 Chinese residents overseas across 70 countries. (2) Similar to the survey on Chinese people overseas, an online survey targeting Chinese people in mainland China collected 17,846 responses across 31 provinces. (3) Secondary data from newspaper, Internet and other sources of documentation were collected to gather descriptive data for this research. These data collection efforts were particularly designed to avoid person-to-person contact. --- Observation of Discrimination and Social Exclusion Globally, people of Chinese or Asian descent have overwhelmingly been the target of discrimination and social exclusion. Since the outbreak started in January, numerous news outlets around the world have reported cases of discrimination against those with Asian descent occurring in public-on the bus, in shopping malls, on the street and on school campuses. On January 31st in Sheffield and in Berlin, February 5th in New York, February 7th in Toronto and many other cases in Australia and Europe, incidents of discrimination took place against Chinese women wearing facemasks [6][7][8]. The range of discriminatory acts varied from verbal abuse to violent attacks. An important component of such discrimination is that, prior to the recent months, face mask-wearing had implied sickness in the West, while such behavior is ubiquitous to the daily life of many Eastern Asian countries to an extent that it has even been viewed as a fashion statement. This cultural difference and the legacy of racism may have interacted to contribute to the increased discrimination. Discriminatory behavior is often unobservable. We conducted a global survey in February 2020 that reached 1904 Chinese residents overseas across 70 countries. Of the respondents, 25.11% reported to have experienced different forms of discrimination, including being laid off without proper cause, rejection of rental housing and commonly reported abuses in the public (Supplementary Materials: Oversea). Strikingly, most respondents who experienced such discrimination are more likely to reside in high-income countries (see Table 1). Table 1 shows that women, youths and those who are less educated are more likely to experience discrimination and even violent overactions, while people with permanent resident status are less likely to report such experiences. Interestingly, as shown in Table 1, respondents living in the countries with more confirmed case of COVID-19 are less likely to report cases of discrimination and overaction. At the same time, increased social exclusion of those from areas most impacted by the virus also took place within racial and national boundaries. In China, many fear contact with people from Wuhan or Hubei Province. The stigmatization of people from Hubei is associated with the social exclusion process. For instance, in Yunnan Province, a popular tourist destination that hosted millions of tourists in January 2020, hotels turned away pre-booked guests from Wuhan or Hubei, regardless of their health condition. Across the country, both urban and rural communities have set up check-points to block visitors from Wuhan and Hubei without a medical check. Moreover, many local authorities have required their residents to report travel to Hubei or any physical contact with residents from Hubei Province. Cars with registration from Hubei have also been regarded as virus carriers and have been attacked in many provinces. In a different survey that we conducted that reached over 17,846 participants across 31 provinces in mainland China (including autonomous regions, special administrative regions and municipalities), almost 90% of respondents suggested that they would report to local authorities if any people from Hubei appeared in their community, 50.58% of respondents would avoid people from Hubei and 16.94% would even actively expel those people from Hubei from their communities (Supplementary Materials: Domestic). Discrimination and social exclusion may lead to damaging social outcomes, especially in the face of infectious diseases. While increasing the resistance to the demonization of those of Chinese or Asian descent in Western countries may lead to more abuse and violence at the global level, discrimination and social exclusion can undermine efforts to identify, isolate and contain the transmission of the virus. Potential carriers traveling from infected areas, having been denied regular access to housing and food, may have to spend more time in search of these essential supplies, potentially turning to illegitimate sources, thus increasing contact with others and rendering them unable to effectively self-quarantine. Furthermore, social stigma reduces the likelihood of them coming forward for help, preventing medical practitioners from effectively containing and treating the disease at early stages. In extreme cases, patients might even attempt to escape from hospitals, as previously occurred during the outbreak of other infectious diseases like SARS, Ebola and HIV [9,10]. --- Concluding Remark This fear of unknown diseases is a part of human nature, especially when they are deadly and highly infectious. Stigmatization of COVID-19 led by some politicians such as Donald Trump might have reinforced such discrimination and social exclusion, as what Foucault called "biopolitics." However, it is paramount to recognize the discriminatory behaviors that accompany fear, as they damage not only the socio-cultural fabric in the long-run, but they also compromise present efforts to contain the disease. The Chinese government has begun acting to reduce discriminatory practices by fostering understanding and support in the media, alongside its recommendations to reduce travel and interpersonal contact. In addition, the government has increased support for Hubei residents by providing government-funded hotel rooms and free healthcare for COVID-19 virus treatments in all provinces across China. Internationally, universities in the UK like Sussex University have started to provide support for Chinese students to limit abuse and discrimination, while the UK government is also attempting to track any form of COVID-19 associated crimes. While those efforts to eliminate discrimination and social exclusion are a good start, further measures are still required, particularly post-pandemic. Thus, in the face of this public health emergency, there is an urgent call for the inclusiveness of policy and media.	This paper is aimed to document the observed social exclusion and discrimination in the outbreak of COVID-19 across the world and inside of China. Discrimination and social exclusion has occurred in various forms, while 25.11% of respondents overseas experienced discrimination in the breakout of COVID-19, and 90% of respondents inside of China exhibited discriminatory attitudes. The discrimination and social exclusion also lead to a range of damaging social outcomes. Thus, this is an urgent call for the inclusiveness in policy and media in the face of this public health emergency.
Introduction Good public health is one of the keys to the formation of prosperity in society. Reproductive health is one of the aspects that must be prioritized in upholding public health because it is related to fertility and mortality rates among mothers and children. Reproductive health plays a crucial role in controlling population growth, therefore numerous reproductive health programs have been established in Indonesia. Reproductive health programs are expected to improve the health and well-being of mothers, children, families, and the nation, reduce birth rates to enhance the standard of living for the people and the nation, and provide quality reproductive health services, including efforts to reduce maternal, infant, and child mortality rates as well as addressing reproductive health issues [8]. One such program is Family Planning, which broadly refers to an effort to regulate pregnancies in a way that positively impacts the mother, baby, father, and their respective families, avoiding any direct negative consequences resulting from these pregnancies [9]. One of the methods used to regulate pregnancies is the use of contraceptives. According to the World Health Organization (WHO), contraception is an action that assists individuals or couples in achieving specific objectives: preventing unwanted births, having desired births, regulating the intervals between pregnancies, and controlling the timing of births within marital relationships [8]. Contraceptive methods are divided into two categories based on their duration of use, namely short-term contraceptive methods and long-term contraceptive methods (LTCM). LTCM can be used for an extended period, exceeding two years, offering numerous advantages both programmatically and for clients. Additionally, LTCM can significantly contribute to reducing the Total Fertility Rate (TFR) due to their high effectiveness in preventing pregnancies. LTCM include implants, intrauterine devices (IUDs), male and female permanent contraception methods [5]. The trend in LTCM usage shows a natural situation where the percentage of LTCM users increases with the age of family planning service users. However, this increase is not significant. In reality, the percentage of injection and pill contraceptive users among older age groups remains relatively high (>60%) for those aged 45-49 years, and even higher for younger age groups. When associated with the goals of contraceptive use and its effectiveness, this trend does not paint a positive picture because a significant portion of family planning participants still rely on short-term contraception methods [9]. Reducing maternal mortality rates will be achieved by increasing the continuity of participation in family planning programs. Long-term contraceptive methods (LTCM) are the most effective family planning methods in increasing this continuity. The use of LTCM by Couples of Reproductive Age (CRA) is influenced by various factors, including the quality and accessibility of family planning services, limited resources, provider competence, and knowledge. These limitations often force prospective family planning acceptors to opt for non-LTCM methods, which are perceived as more practical [10]. Based on the aforementioned background, this research aims to identify the factors influencing the choice of longterm contraceptive methods among family planning acceptors. --- Material and methods This study falls under qualitative research, employing a literature review method with a descriptive-analytical approach. The data for this study were sourced from national scientific journal articles obtained through Google Scholar using the keywords "influence factor," "LTCM," and "family planning acceptors." Inclusion criteria for this research were titles corresponding to the research theme, namely factors influencing the choice of long-term contraceptive methods, with the study population being family planning acceptors, and scholarly articles published from 2018 to 2023 (the last five years). Relevant research articles were identified using a literature review method, comparing articles with similarities in their research, particularly those related to the factors influencing the choice of contraceptive methods among family planning acceptors. --- Results and discussion Based on the collected and analyzed articles, the findings are presented as follows: --- Casecontrol The research findings mention that age (p=0.000), parity (p=0.013), access to healthcare services (0.005), and spousal support (p=0.017) are significantly related factors affecting the choice of long-term contraceptive methods in the Bandorasa Kulon Village, Cilimus District, Kuningan Regency. --- Ariesta and Fitra --- Survey analytic A study conducted in the Kuala Lumpur Village under the jurisdiction of the Simalinyang Public Health Center demonstrates that good knowledge (p=0.027), spousal support (p=0.000), and parity (p=0.002) are influencing factors in family planning acceptors' choice of long-term contraceptive methods. 3 Hasibuan R et al. --- Crosssectional In types, purposes, benefits, advantages, and side effects of long-term contraceptives. Based on the research results, it can be concluded that most respondents have good knowledge about LTCM [2]. According to the research findings, family planning acceptors' knowledge is closely related to the choice of contraceptives. Good knowledge about specific contraceptive methods changes acceptors' perspectives, enabling them to choose the most suitable and effective contraception. This knowledge helps users feel comfortable with their chosen method and prevents errors in selecting the most suitable contraceptive for themselves [8].  Influence of Husband's Support on the Selection of Long-Term Contraceptive Methods (LTCM) among Family Planning Acceptors:  The husband's support plays a significant role for a wife in making decisions, including decisions about contraception. Spousal approval is the most crucial factor because husbands are seen as protectors, breadwinners, and decision-makers. Therefore, wives who receive support from their husbands in choosing contraceptives tend to use the contraceptive methods preferred by their husbands out of respect and trust in their decisions [7]. ---  Influence of Age on the Selection of Long-Term Contraceptive Methods (LTCM) among Family Planning Acceptors:  Age is one of the factors influencing an individual's behavior in using contraceptives. Older individuals have a smaller chance of using contraceptives compared to younger ones [9]. Family planning acceptors aged 20-30 years tend to choose short-term contraceptive methods because they feel they are too young for long-term contraceptive methods (LTCM). For respondents aged 20-30, this age period is considered ideal for childbirth, with two children and a birth spacing of 2 to 4 years. In contrast, respondents over 30 choose long-term contraceptive methods (LTCM) because they feel they are too old to have more children, especially due to the health risks associated with childbirth after the age of 30. The period for respondents over 30, especially above 35 years, typically marks the end of fertility, especially after having two children [1].  Influence of Parity on the Selection of Long-Term Contraceptive Methods (LTCM) among Family Planning Acceptors:  The number of children or parity of family planning acceptors also influences the choice of LTCM. Mothers who have two or more children tend to be interested in stopping childbirth, especially if the mother's age is at a high risk for complications during pregnancy and childbirth. Therefore, choosing LTCM is very appropriate, as its success rate is higher compared to non-LTCM. Thus, midwives or healthcare providers need to provide accurate and complete information about LTCM [5].  Influence of Attitude on the Selection of Long-Term Contraceptive Methods (LTCM) among Family Planning Acceptors:  One of the internal factors of family planning acceptors that affects the selection of long-term contraceptive methods is attitude. Family planning acceptors' attitudes about LTCM are influenced by several factors, including personal experience, influence from important people, cultural influence, and mass media influence. These experiences can include understanding LTCM, side effects of LTCM, types of LTCM, and people's attitudes towards using LTCM. Family planning acceptors' experiences, especially regarding attitudes about using LTCM, are one of the sources or references for respondents in responding to the use of LTCM [8].  Influence of Socio-Cultural Factors on the Selection of Long-Term Contraceptive Methods (LTCM) among Family Planning Acceptors:  Related to family planning acceptors' attitudes, experiences, and socio-cultural influence also determine the use of LTCM. The research results show that the majority of respondents (LTCM family planning acceptors) stopped using contraception mostly due to experiencing side effects. However, family planning authorities explain that the side effects of using LTCM are the same as when using non-LTCM, namely irregular periods and increased menstrual bleeding. The most common side effects they experience are longer menstrual periods and heavier menstrual bleeding [3].  Influence of Access to Healthcare Services on the Selection of Long-Term Contraceptive Methods (LTCM) among Family Planning Acceptors:  In using contraception, family planning acceptors also consider access to healthcare services, including distance, time, and ease of transportation. Regardless, varying regions, diverse transportation, and difficult areas are essential factors in gaining access to family planning services, especially in rural areas [1].  Influence of Income and Occupation on the Selection of Long-Term Contraceptive Methods (LTCM) among Family Planning Acceptors:  Income and type of occupation are further factors that influence the choice of LTCM among family planning acceptors. Women with better incomes tend to choose more expensive contraceptive methods and find it easier to make choices without strict rules requiring spousal approval. Additionally, by working, a mother will have broader insights and social interactions, allowing her to obtain more information and easily choose a more effective and efficient contraceptive method [5]. --- Conclusion Based on the identification from the 9 analyzed articles, the selection of Long-Term Contraceptive Methods (LTCM) among family planning acceptors is influenced by several complex factors, including good knowledge about LTCM, spousal support, age, number of children, attitudes, and personal experiences, socio-cultural factors, access to healthcare services, as well as income and occupation. This conclusion emphasizes the importance of a holistic approach in reproductive health programs to understand and meet the needs and preferences of individuals in choosing suitable contraceptive methods. --- Compliance with ethical standards	Long-term contraceptive methods refer to contraception that can be used for an extended period, exceeding two years. Many family planning acceptors prefer non-long-term contraceptive methods due to their practicality. The aim of this study is to identify the factors influencing the choice of long-term contraceptive methods among family planning acceptors. The study design is a literature review. Articles selected through Google Scholar's correlation articles with respondents were included. Inclusion criteria for the chosen articles were thematic relevance, family planning acceptors population, and scholarly articles published from 2018 to 2023. The results analyzed by the researcher it can be concluded that several factors significantly influence the selection of Long-Term Contraceptive Methods (LTCM) among family planning acceptors. The most dominant factor is knowledge, followed by other factors such as spousal support, age, number of children, personal attitudes and experiences, sociocultural factors, healthcare accessibility, as well as income and occupation.
Introduction The number of high-risk pregnant women always shows a fairly large number every year. One of the risk factorsis pregnant women with age less than 20 years old or teenage pregnancy [1]. Adolescence is a dynamic phase of growth and development dynamic phase in an individual's life. Adolescence progresses through 3 stages namely early adolescence (10-14 years), (15-16 years), and late adolescence (17-20 years) [2]. In adolescents, reproductive organs begin to function and secondary sexual signs grow, making it easy for sexual activity (especially among adolescents) to continue with sex. In addition, curiosity about sexual problems in adolescents is very important in the formation of the adolescents is very important in the formation of a new, more mature relationship with the opposite sex [3]. Among adolescents, sex is a problem that causing unrest in the community. There are allegations that there is a tendency of adolescence sex increasing not only in big cities, but also in small towns. In the 2017 SDKI data it was recorded that as many as 80% of women and 84% men claimed to have dated [4]. Adolescence pregnancy is in the spotlight in various countries because of the harmful effects. Various aspects are affected by adolescence pregnancy aspects, including health, education and economy. Impacts that that arise from the health aspect include: risk of experiencing labor preterm labor, the baby who is born has low birth weight (LBW), have a higher risk of death. In addition, teenagers who experience pregnancy usually do not complete education, have low economic level, and the risk to have offspring with health health and growth problems child development higher risk of neonatal mortality, increased risk of postpartum depression depression in mothers and low maternal initiation to breastfeed her baby [5]. Data according to the World Health Organization (WHO) 2017 adolescence pregnancy that occurs at the age of 15-19 years shows an average rate of 49 per 1000 adolescents in the world [6]. With this, the researcher is interested in conducting a literature study with the title "Factors associated with adolescent pregnancy". --- Material and methods This research uses the literature review method. The data were sourced from national scientific journal articles obtained through Google Scholar, and Pubmed using the keywords "Adolescent pregnancy", " Knowledge'', ''Parents", "Education'' and " Economic condition". The inclusion criteria for this study were titles that fit the research theme, namely factors associated with adolescent pregnancy articles published from 2019 to 2023 (the last five years). Relevant research articles were identified using the literature review method, by comparing similar articles in the research, especially those related to adolescent pregnancy. --- Results and discussion Based on the collected and analyzed articles, the findings are presented as follows: The study indicates that there are internal and external factors that influence adolescents so that they become pregnant out of wedlock [4]. --- 5. Amrina --- The Level Of Adolescent Knowledge To Become One Of The Factors Causing Youth Pregnancy A literature review A review showed that low knowledge was one of the factors causing teenage pregnancy and increased knowledge after being given health education [6]. --- The relationship between parental role and adolescent pregnancy In adolescence is span of human life at the transition period. At this time is a period transition from childhood to adulthood [4]. In this transitional period, adolescents are looking for their identity so that they have a tendency to try various new things, so they have the potential to do things outside the norms that apply in Indonesia such as consuming narcotics, engaging in free sex, consuming alcohol, and consuming drugs [5]. In addition, adolescent problems related to reproductive health are adolescents with pregnancies under the age of 20 years old at 32% [2]. Based on the results of bivariable analysis between the role of parents and the incidence of teenage pregnancy, it can be seen that there is a significant relationship between the two variables. This shows that the role of parents will affect the incidence of pregnancy in adolescents. Especially in adolescents who have experienced pregnancy in adolescence [1]. Parents play a very important role in this matter and must be able to be a role model for their children, especially in adolescence where adolescents are in a period of curiosity about many things. Sex education should start at home, because home, because sexual problems are a private matter. However many parents are less able to meet the needs of their teenage children needs of their teenage children due to lack of knowledge about it and still think that sex education is a taboo subject to talk [1]. --- The relationship between education level and adolescent pregnancy Unintended pregnancy is still a problem in the world. The magnitude of the problem of unwanted pregnancy problem is reflected in the cases cases that occur on a global, regional and national scale [3]. many adolescents have engaged in premarital sex resulting in unwanted pregnancies. Pregnancy during adolescence has difficult consequences for not only the the adolescent concerned, but also for all other family members [4]. Education level is associated with adolescent pregnancy. The better one's level of education, the better the mindset that is formed, so that this good mindset will make someone more open to new things and able to receive information well so that they have the ability to thinking in behavior [2]. education is closely related to information about reproductive health that received by a person so that they can distinguish between correct health behavior and the wrong health behavior. Level higher level of education will make it easier for a person or community to absorb information and implement it in their daily behavior and lifestyle, especially in terms of health, so that the level of education education level can shape a person's values especially in accepting new things [2]. --- The relationship between knowledge of sex and adolescent pregnancy Sex knowledge referred to in this study this research is all ways of expressing and release sexual urges that come from maturity of the sexual organs, such as dating intimate, making out, until making sexual contact, but the sexual contact, but this behavior is considered not in accordance with the norms because adolescents have not have no sexual experience. The results showed that adolescents who were used as respondents already had sexual urges such as the desire to date, make out, and have sexual contact.such as the desire to date, make out and have intercourse but lack knowledge about sex that leads to positive things, this is because teenagers get sex knowledge only from media such as the internet, pornographic movies, news and the environment of environment. This condition that resulted in increased curiosity about sex but only limited to things that lead to intimate relationships. Adolescent knowledge about sex is still very lacking. This factor is coupled with misinformation obtained from the wrong sources, such as myths about sex, pornographic VCDs, pornographic sites on the internet and others that will be porn sites on the internet and others that will make children's understanding and perception of sex to be wrong. Sex education actually means sexuality education, which is a sexual education in a broad sense that includes various aspects related to sex, including biological aspects, orientation, values sociocultural and moral values and behavior [3]. Pregnancy outside of marriage is influenced by several factors which include lack of sex education or knowledge about reproductive health reproductive health, permissiveness in social environment, the negative impact of technological advances, the influence of friends and parenting. The most dominant factor that causes the occurrence of pregnancy among adolescents are lack of sex education and the influence of friends [4]. Teenage pregnancy due to lack of knowledge about reproductive health and lack of understanding of contraceptives. The attitude of adolescents who have tendency to engage in risky sexual activities increases the incidence of adolescent pregnancy [5]. Low knowledge of teenagers about adolescent pregnancy can influence adolescents to behave negatively which can lead to pregnancy in adolescents. The more adolescents who have knowledge about reproductive health, especially promiscuous sex and teenage pregnancy, the more the number of adolescent pregnancies will increase then the number of teenage pregnancies that will occur will also increase. Low knowledge about reproductive health and sexuality can lead to wrong perceptions that can lead to sexual behavior which has an impact on the incidence of pregnancy in adolescents, but if you have the correct knowledge about reproductive health and sexuality can lead a person to avoid negative behavior [6]. --- The relationship economic condition and adolescent pregnancy Condition low family economic conditions are followed by low age of first marriage as well, and vice versa, the higher the economic condition of the economic conditions of the family, the higher the age of the higher the age of first marriage. This shows that family income is related to the age ofage of first marriage and pregnancy, the lower the family income, the earlier head of the family marries off her daughter. Family income levels will affect the age of young marriage, this is because in families with low income then marriage their children means the release of the burden and responsibility to support their children [2]. --- Conclusion This study shows that the factors associated with adolescent pregnancy are the role of parents, latest education, sex knowledge and economic conditions. --- Compliance with ethical standards	The number of high-risk pregnant women always shows a fairly large number every year Adolescence pregnancy is in the spotlight in various countries because of the harmful effects. The purpose of this study was to determine the factors associated with adolescence pregnancy. This research uses the literature review method. The data were sourced from national scientific journal articles obtained through Google Scholar, and Pubmed using the keywords "Adolescent pregnancy", " Knowledge'', ''Parents", "Education'' and " Economic condition". This study shows that the factors associated with adolescent pregnancy are the role of parents, latest education, sex knowledge and economic conditions.
INTRODUCTION The published literature contains a wide variety of positions on the regulation of conscientious objection to abortion [1]. On the one hand, there are arguments based on evidence and extensive experience to eliminate what is called conscientious objection: patients are dependent on medical care (which they also pay for) and have a right to receive it, whereas health professionals adopt their position by choice in the full knowledge of the scope of their duties. Furthermore, health professionals are paid directly or indirectly by the patients whom they have an obligation to serve [2]. On the other hand are those who are opposed to the legalisation of abortion or who accept a culture of conscientious objection. Consequently they advocate for the regulation of conscientious objection so that it may be used as a barrier to women's access to abortion, as is already the case in almost all countries, even within Europe [3]. The reality is that most European countries share common legislation on abortion that includes a clause on professional 'conscientious objection' exclusively for abortion and not for any other activity or action within or outside the field of medicine. This practice effectively undermines access to legal abortion. There are many other issues with regard to sexual and reproductive health where the individual desire for selfdetermination collides with a paternalistic regulation rooted in the past, such as emergency contraception, assisted reproduction techniques, sex-selection procedures, etc. In this document, we focus on voluntary abortion because, in practice, conscientious objection is currently the primary mechanism used to jeopardise women's rights with regard to sexual and reproductive health in countries where abortion is legal. Furthermore, both the International Federation of Gynecology and Obstetrics and the European Parliament have made a specific request to prevent conscientious objection from being used as a method for limiting women's access to voluntary abortion and to ensure a common professional approach to address this issue [4][5][6][7]. Finally, the heterogeneous practice of conscientious objection among the different European countries contributes to the undermining of the right to voluntary abortion [3]. Conscientious objection has been defined as 'the refusal to participate in an activity that an individual considers incompatible with his/her religious, moral, philosophical, or ethical beliefs' [8]. On the basis of this definition, this paper notes that conscientious objection is widely considered to be a recognised right for all professionals, although its undemocratic practice counteracts the application of democratically passed laws to legalise abortion. Today, a regulation on CO should satisfy health care professionals invoking CO and at the same time guarantee women's right to safe and easily accessible abortion. This issue was discussed at the European Society of Contraception and Reproductive Health (ESC) conference, held in 2014 in Lisbon, at a round table of several guest experts. On that occasion, the need for a consensus in the matter within the ESC was made clear [5][6][7]. --- EXPERT OPINION METHODOLOGY We performed a survey to explore the opinions of both the expert group on abortion (seven members, over the course of January 2015) and the ESC Board (48 members). The aim of the survey was to understand how and why the context of the application of conscientious objection to voluntary abortion has an impact on information about abortion and on women's access to it. While the methodology does not allow us to establish a direct causal relationship between allowing conscientious objection and access to abortion [9], it did provide information on the existing reality. In order to obtain a more complete picture of the reality on the ground, the expressions used by participants were also studied, since they reflected their personal experience [10,11]. Data collection was achieved through semi-open-ended questions, using a pre-scripted list of questions in order to establish the possible categories of analysis to be covered. The information gathered was subsequently encoded and analysed following Miles and Huberman's approach to data analysis [12]. Data collection and analysis were carried out in parallel [9,12]. --- REVIEW OF THE SCIENTIFIC LITERATURE ON CONSCIENTIOUS --- OBJECTION With the aim of identifying documents on conscientious objection and abortion, we performed a systematic computerised literature search of PubMed, Google Scholar and Google: 20,000 documents were found in Google Scholar and 187,000 in Google. References from retrieved articles are given in the reference list at the end of this paper [1][2][3][4][5][6][7][8]. These articles show different, even conflicting, positions with respect to the above-mentioned points to be included in the consensus. The articles were selected according to their title and abstracts in order to identify those related to the consequences of a regulation in terms of accessibility for women. Extensive use has been made of two reviews: 'Conscientious objection and refusal to provide reproductive healthcare: a White Paper examining prevalence, health consequences, and policy responses' by Chavkin et al. on behalf of Global Doctors for Choice [3]; and '"Dishonourable disobedience" -why refusal to treat in reproductive healthcare is not conscientious objection' by Fiala and Arthur [2]. While Fiala and Arthur recommend that conscientious objection simply should not be allowed, Chavkin et al. propose to develop policies to manage it. Although the papers reach different conclusions about how conscientious objection should specifically be addressed, they share the objective that every regulation should guarantee that women's rights to information and abortion services are respected. The rationale behind our recommendations is that without taking a position on the prohibition of conscientious objection, when regulation exists, it does need to satisfy certain criteria in order to safeguard women's rights. --- RECOMMENDATIONS PROPOSED TO THE ESC --- Rights of women Despite the enormous progress made in access to contraception, there are still many reasons why contraception repeatedly fails. Not everyone has the same opinion about abortion, but we have to agree on the fact that deciding whether and when to conceive is one of the most intimate and important decisions a person can make. Every woman has the fundamental right to choose to bear a child. Denying or interfering with this right is discrimination. Access to voluntary abortion is an integral part of the right of women to sexual and reproductive health and this includes the provision of information relating to birth control including voluntary abortion. We recommend that the right to information should be regulated in order to guarantee that ideas such as conscientious objection do not override this right by objectors refusing to inform women about abortion. Furthermore, objector status should be made public, because women have a right to know the motivation of the professionals who treat them. --- Rights and duties of the practitioner The practitioner who claims status as a conscientious objector should not work in abortion care, and women should have access, without delay, on the same day to another practitioner who is not a conscientious objector in order to ensure optimum treatment. Contraceptive information including information on voluntary abortion must be made available to the woman. Since waiting for an abortion imposes psychological stress on women who have made a decision to terminate their pregnancy, delays should be avoided [34]. --- Institutions Health authorities should organise public, non-religious hospitals so that each area has a public hospital that provides care for women seeking abortion. As current measures governing the principle of conscientious objection negatively impact women's access to sexual and reproductive health services, these measures should be changed. Health care services should adopt measures to guarantee that a woman's right to voluntary abortion is not limited by the practitioner's stance on the principle of conscientious objection. In European countries (except in northern Europe), current regulations on contraceptive matters harm women by hindering access to information and their ability to actively exercise their rights. These regulations also avoid sanctioning professionals who violate or impede the realisation of women's rights. Most regulations have major policy gaps and are unworkable. Although there have been regulatory developments in different countries, there is a lack of regulatory frameworks that have been effective in safeguarding women's rights. Furthermore, very few countries have abortion laws that protect women's rights and safety, and in most countries abortion laws still fall within the penal code. --- Professional associations Professional associations (like the ESC) should become involved in drawing up measures to improve reproductive health and rights, and strive to improve and disseminate knowledge on the use of contraception, abortion, sexually transmitted infections and reproductive health care throughout Europe, as well as promote the harmonisation of different policies concerning access to contraception and reproductive health care in the countries of Europe.	The aim of this paper is to define a set of proposals to inform European institutions in the regulation of Conscientious Objection to abortion. The board of the European Society of Contraception and Reproductive Health Care (ESC) was informed on the elements that should in the opinion of the authors be included in a future regulation of Conscientious Objection to abortion in Europe. These elements are outlined in this paper and the debate about them could form the basis for recommendations to the international scientific community and the European institutions. As current measures governing the principle of conscientious objection result in negative consequences regarding women's access to sexual and reproductive health services, they should be changed. Healthcare services should adopt measures to guarantee that a woman's right to voluntary abortion is not limited by the practitioner's stance on the principle of conscientious objection. In the countries where conscientious objection is allowed, the regulation must clearly delineate the extent of the duties and the exemptions of professionals based on the principles of established social consensus. The recommendations included in this document specify measures on the rights of women, the rights and duties of the practitioner, the role of institutions and the role of professional associations.
INTRODUCTION In 1983, Mr.Chatterjee was enlisted in the Indian Administrative Service. He carved himself a niche in his literary career at the same time that he began working as an IAS official. It was not only the start of his professional career but also the commencement of his literary career, a desire he had always treasured. His professional career gave birth to the characters in his writings. He won praise for his debut novel English, August: An Indian Story. He is also the --- VEDA'S JOURNAL OF ENGLISH LANGUAGE AND LITERATURE (JOELL) An International Peer Reviewed(Refereed) Journal Impact Factor (SJIF) 6.12 http://www.joell.in Vol.10, 2023 to relax, do nothing, and not be burdened. He sets himself the goal of becoming "a male stray dog" when he is a little child. Chatterjee writes, "In his essay, Agastya had said that his real ambition was to be a domesticated male stray dog because they lived the best life. They were assured of food and because they were stray, they didn't have to guard a home or beg or shake paws or fetch trifles or be clean anything similarly meaningless to earn their food…..A stray dog was free, he slept a lot, barked unexpectedly and only when he wanted to, and got a lot of sex." (EA,p. 46) For the reader, it is too clear that Agastya never makes an effort to be an honourable, diligent, and service-minded civil official. Even if he is given the greatest position, which also requires people who can provide selfless service to the society, there is not even the slightest bit of regret when he doesn't do anything for it. Agastya's thoughts are mostly dominated by women, sex, and marijuana. In spite of being an IAS official, it attracts him to be a performer in a pornographic movie. We never get the impression that he has what it takes to become an IAS or that he is qualified for that position throughout the novel; not a single incident gives us that impression. He continuously lies without cause, is frequently careless with his work, smokes, does drugs, and never takes his instruction seriously. He begins work at 11:00 a.m. and continues working until lunchtime. After returning to his room, he spends his time using marijuana, masturbating, lying down and staring at the roof, occasionally reading Maurcus Aurelius, and sleeping while listening to Rabindra Sangeet. Agastya handles individuals with ease by finding fault with everyone in his immediate vicinity. When he analyses their personalities, it occasionally gives us the impression that he is entirely cynical and mentally ill. It is amazing to watch someone who radiates such negativity and sees nothing admirable in the people around him. We ponder whether his frustration stems from the environment, the people, his upbringing, or the events, circumstances, and atmosphere of Madna. Because of the nature of his personality, he never hesitates to describe everyone in his immediate vicinity negatively. He never regrets using marijuana, and he represents a cultural shock to many Indians who would never dream of thinking such things. Even if many people around us exhibit some bad features, eventually they come to grips with their errors and make an effort to improve. Agastya gives least priority to his job. He always shirks his work, tries to spend his time by associating with people of the town, Madna, where he is posted as a trainee and is likely to learn about administrative work of the district. He makes friends with Sathe, who is an iconoclastic editorial cartoonist, Shankaran, a good-hearted alcoholic government engineer and Kumar who is police chief of Madna from whom he receives porn movies. Although Agastya is a subordinate of Srivastav, the district collector, he idles away his time making fun of the life style of these so-called bureaucrats, their wives and children. His observation is so keen and notices minute details of the things and the people around him. --- VEDA'S JOURNAL OF ENGLISH LANGUAGE AND LITERATURE (JOELL) An International Peer Reviewed(Refereed) Journal Impact Factor (SJIF) 6.12 http://www.joell.in Vol.10, 2023 Agastya feels unfulfilled by his experience as an IAS officer and longs to return to his hometown to be with his friends. He frequently experiences nostalgia. Because of his experience as an IAS officer, Chatterjee was able to convey Agastya's persona extremely well. He also makes you incredulous with his descriptions of the Indian Administrative system and bureaucrats' working methods. Thus, English, August: An Indian Story is regarded by many as the Indian administrative service manual. These lessons are imparted to a child by his or her parents, teachers, and siblings. Agastya, however, has no one to impart these lessons. For his job, Agastya lacks the conviction and conscience. If a rookie officer is willing to take initiative and can't learn everything by observing others, he should be trained in these artifices. Agastya lacks a good family and never gets advice from his family members on how crucial it is to uphold morals and values in one's own life. His buddies and others in his immediate vicinity have a greater impact on his character. His friend Dhrubo, who enjoys living in the city, is not bothered about constantly using vulgar language, and who has been through thick and thin with Agastya since he was a toddler, has had a significant impact on Agastya. The character of Agasthya represents the urban youth of India to some extent as most of them are interested in enjoying life, and would not want to follow ethics, morals, and culture and service to the society is their last priority. Chatterjee's protagonists, August, Jamun and Bhola, all have a common problem, i.e. rootlessness and they struggle to discover the root that means to discover the lost relation. They realize the value of their family ties and become more matured though they don't have --- VEDA'S JOURNAL OF ENGLISH LANGUAGE AND LITERATURE (JOELL) An International Peer Reviewed(Refereed) Journal Impact Factor (SJIF) 6.12 http://www.joell.in Vol.10, 2023 complete control on themselves yet they know that they are not leading proper lives. --- CONCLUSION	The Main purpose of this paper is to discuss the postmodern world, where all human relationships are breaking and giving birth to existential crisis, alienation and immorality, rootlessness and frustration of urban youth. Upamanyu Chatterjee's English, August is a lampoon or is a witty, sarcastic commentary on the giant apparatus of the Indian bureaucracy with its incompetent officials and their amateur minions or urchins and their lives depicted through the eyes of young Agastya. It also highlights Chatterjee's protagonist, August's rootlessness, frustration and his struggle to discover the root that means to discover the lost relation. The current paper is a modest attempt to highlight modern day urban youth, family dynamics, and sociopolitical conditions in Upamanyu Chatterjee's novel, English, August. The novels of Upamanyu Chatterjee have the profundity and rootlessness of The Waste Land. He succeeds in connecting with the common man and his psyche, as well as his relationship with his family, through the frustration and alienation of modern man, the moral degradation of his protagonists, and his Kafkaesque style of dark humour, which is terrifying and frequently nauseating.
Iryna Nechitaylo Professor In conclusion, this study underscores that envy is not a moral sentiment and highlights the centrality of feelings of inferiority in the experience of envy. Moreover, gender differences in envy, prevalent among youth, tend to diminish as individuals mature. Keywords: envy, deviant behavior, delinquent behavior, inferiority, injustice, male, female, gender differences. --- PSYCHOLOGICAL JOURNAL	Данна стаття присвячена розгляду предмету заздрості у юнаків та дівчат в контексті їх схильності до девіантної поведінки. Авторами зазначається, що девіантна поведінка розуміється як така, що відхиляється від прийнятих у суспільстві норм та правил. Також ,автори наголошують на тому, що заздрість можна охарактеризувати як негативне ставлення до переваги іншої людини і бажання отримати те, чим володіє ця людина. Мета статті полягає у визначення основних психолого-правових характеристик заздрісності студентів -юнаків та дівчат у контексті девіантної поведінки. А завданнями статті автори вказують -визначення рівня вираженості заздрощів у курсантів -юнаків та дівчат та вивчення гендерних особливостей взаємозв'язку девіантної поведінки, із заздрістю до різних предметних сфер. У висновках відмічається те, що заздрість не є моральним почуттям і саме неповноцінність суб'єкта є центральною проблемою заздрості. Множинні гендерні відмінності в заздрості, виявлені в юнацькому віці, у міру дорослішання мінімізуються.
INTRODUCTION Faced with the challenges posed by globalization and the advancement of science and technology, high-quality human resources are required. Youth are an integral component of the nation's human capital and its future (Halawa, Nurhayati, and Rochana, 2019;Hidayat and Syahid, 2019;Nurhayati, 2020;Nurhayati, Hidayat, Awan, and Noviatul, 2023;Nurhayati and Musa, 2020). Adolescents, as the nation's next generation, will play a significant role in continuing the nation's development and determining its fate (Hasan and Nurhayati, 2012;Nurhayati, 2021b). High moral standards and a sense of duty are expected of adolescents. If properly developed, the large number of adolescents represents an extremely valuable resource pool (Jannah, 2016;Maharani, Lubis, and Putri, 2022). In contrast, if this tremendous potential is not developed properly, it will result in a variety of significant problems as they exist today. These problems include drug abuse, juvenile delinquency, and issues related to sexual activity, such as sexual harassment and violence, premarital sexual relations, unwanted pregnancy, abortion, marriage at a young age, and sexually transmitted diseases, including HIV (Heni Trisnowati, 2021;Jabar and Nurhayati, 2021;Jabar, Nurhayati, and Rukanda, 2021;Widiastuti and Kartika, 2020). To address those issues one main effort conducted by the Cibeureum Village Cimahi (Nadirah, 2017). Promiscuity is a type of deviant behavior, where "free" denotes violating religious norms (Nadirah, 2017). The problem of sexual promiscuity in both the environment and the media was frequently presented. Adolescents are emotionally unstable and susceptible to a lack of self-control. Family issues, disappointment, a lack of knowledge, and the invitations of peers who freely associate diminish the religious and national advancement potential of Indonesia's youth (Cholifah, Nurhayati, and Fitriana, 2023;Nurhayati, 2021a;Nurhayati, Fasa, Panjaitan, Indriyani, and Fadlyansyah, 2020). Humans are social creatures who, in their daily existence, require the company of others, and human relationships are fostered through association. (interpersonal relationship). Association is also a human right, and it must be liberated so that no human being can be prevented from associating, particularly through discrimination, which is a violation of human rights. Therefore, association between individuals should be permitted, while still adhering to legal, religious, cultural, and social norms. Therefore, if medically, regular or limited promiscuity in accordance with the rules and norms of human existence will not result in excesses comparable to those of the present. Deviation from the norm will have negative consequences for health, the psyche, and society, among others (Nadirah, 2017). The problem-based learning model includes asking questions or solving problems, concentrating on interdisciplinary connections, authentic inquiry, collaboration, and the production of work and demonstrations. Problem-based learning is not intended to assist teachers or learning facilitators in providing as much information as feasible to learners (Yulianti and Gunawan, 2019). Problem-based learning seeks to help learners develop their critical thinking and problem-solving abilities. In problem-based learning, the acquisition of procedural knowledge is not the only focus (Saputra, 2021). Consequently, assessment is not limited to exams. In accordance with the problem-based learning model, assessment and evaluation consist of assessing the work produced by learners as a consequence of their work and discussing the results of the work together. The work of a learner can be evaluated using process assessment. The purpose of process assessment is to provide instructors with insight into how learners plan to solve problems and demonstrate their knowledge and skills. Performance evaluations enable the learners to demonstrate their abilities in real-world situations. In addition to curriculum development, it is also necessary to develop learning models that are aligned with curriculum objectives and allow the learners to actively develop a problem-solving mindset and learning ability (Saputra, 2021;Yulianti and Gunawan, 2019). With these skills, it is expected that learners will readily adapt to new situations --- RESEARCH METHODS This investigation used a qualitative-descriptive methodology. In the form of research reports, descriptive research investigates circumstances, conditions, or other objects. Generally, qualitative research is organized in accordance with the issues being investigated (Sugiyono, 2018). The purpose of this study's qualitative descriptive research is to investigate the situation, describe, explain, and provide specific answers to the research question by examining as many reports of the event as feasible. reports or presentations and help them to share tasks with their friends. Fifth, by analyzing and evaluating the problem-solving process, sex education program resource persons help participants of sex education programs for adolescents to reflect on or evaluate their investigations and the processes they use. Results of the Sex Education Program Using Problem Based Learning Approach. From the results of the implementation of the sex education program for adolescents using a problembased learning approach to increase awareness of the dangers of promiscuity in Cibeureum Village, it can be concluded that the program has been implemented well. From the results of interviews and observations, participants of the sex education program stated that after participating in the program, they became more enthusiastic to understand and practice sex education materials and the dangers of promiscuity, which were previously considered taboo and unimportant. Program participants also stated that their awareness of the importance of sex education was able to minimize the occurrence of promiscuity as well as its negative impacts on their lives. With the problem-based learning approach implemented in the sex education program, participants become more aware, more able to internalize sex education material, and also more able to imagine the dangers and consequences of promiscuity. In addition to increasing insight and knowledge about promiscuity, the material delivered using a problembased learning approach makes them able to reflect on the new understanding they get, especially from authentic cases or problems that have occurred in the Cibeureum Village area caused by the promiscuity of adolescents, so that they can have more boundaries when associating. From the research findings it is found that the program can change adolescents behaviour especially when it comes to the promiscuity. This is in line with previous research that formal sexual education can change behavior, either delaying or reducing early sexual behavior in adolescents (Pradikto, 2019). Teenagers who have not had sex, if they get sexual education, tend to delay their first sex. In addition, adolescents who do not consent to extramarital sexual relations will have strong protection from unwanted pregnancy, STDs, and HIV/AIDS (Nadirah, 2017). Sex education using a problem-based learning approach is very helpful for helping participants understand the sex education material provided. Problem-based learning (PBL) is a learning model based on many problems that require authentic investigation, namely investigations that require real solutions (Saputra, 2021). In this learning approach, the learning facilitators guide the learners to break down the problem-solving plan into stages of activities, such as the learning facilitators giving examples of the use of skills and strategies needed so that these tasks can be completed. The learning facilitators also create a flexible and investigation-oriented classroom environment for the learner. Problem-based learning is an educational approach where the problem is the starting point of the learning process (Saputra, 2021;Yulianti and Gunawan, 2019). Typically, problems are based on real-life problems that have been selected and edited to meet educational goals and criteria. The problem-based learning model refers to a learning approach that focuses on the problem-solving process by acquiring the necessary knowledge. This model has the advantage of making learners learn with inspiration, teaching group thinking, and using related information to try to solve problems both real and hypothetical; besides, learners are trained to synthesize knowledge and skills before they apply them to problems, so that the material provided is easy for learners to remember. --- CONCLUSION Based on the studies that have been conducted as mentioned above, it can be concluded that the problem-based learning approach is very suitable to be implemented in sex education programs for adolescents, especially to increase awareness of the dangers of promiscuity. Because problem-based learning has significant benefits in improving learners' ability to understand sex education material and, at the same time, be able to solve authentic problems that occur related to the dangers of promiscuity among adolescents. There are five stages of the problem-based learning model in order to encourage learners to solve problems, namely: 1) orienting learners to problems; 2) organizing student learning; 3) helping learners solve problems; 4) assisting learners in developing and presenting problem-solving results; and 5) analyzing and evaluating the problem-solving process.	The purpose of this study is to explain the implementation of sex education for teenagers using a problem-based learning method in Cibeureum Village, Cimahi City, to raise awareness of the dangers of promiscuity. This study used a qualitative method and employs a case study design. Observation, in-depth conversations, and documentation studies are all methods for gathering data. As study resource people, two community leaders, ten sex education participants, and three sex education program organizers were used.Techniques for data analysis include data condensation, data presentation, deriving conclusions, and verification. The research founds that: (1) Sex education for adolescents using a problem-based learning strategy is carried out in stages, beginning with program planning by the village government in collaboration with RT administrators, RWs, community leaders, and parents with teenagers. 2) sex education program organizers collaborate with competent resource people when conducting the program. In addition, material on the dangers of promiscuity for adolescents is presented using problem-based learning, in which resource people present material based on real issues encountered by adolescents as a result of promiscuity. 3) the majority of participants' insights and understanding of the dangers of promiscuity had grown, especially the material presented using a problem-based learning approach.
These papers cover a range of important topics related to mobility analytics for spatio-temporal and social data. Wang et al. [1] investigate influence propagation in social networks and propose a framework for modeling topic-aware influence propagation in dynamic network structures. Cutrona et al. [2] present a novel approach to enrich trajectory representations, based on semantic annotations, and use this information to recommend trajectories based on the user preferences. Chen et al. [3] propose a new model to predict the formation and intensity of typhoons, using spatio-temporal correlation of atmospheric and ocean variables. Sun and Sarwat [4] develop a new query operator for graph database systems that store spatial data, which optimizes the execution of graph queries that involve spatial predicates. Autelitano et al. [5] propose a new method for extracting relevant images and videos from social media during an emergency event, dynamically mining event-related keywords, aiming at following the evolution of an event. Collectively, these five papers cover a broad range of social, spatial and temporal data related problems. They present a large variety of challenges that are currently being investigated, where social, spatial and temporal data are being used to extract relevant information for the society. Moreover, they contain novel techniques and approaches that are deemed relevant for many emerging applications related to mobility analytics. We would like to thank the authors for the excellent contributions to this issue; the reviewers for providing thoughtful and detailed manuscript reviews; as well as the editorial office staff at Springer for their assistance during the review process. Qiang Qu is a professor at Shenzhen Institutes of Advanced Technology (SIAT), and University of Chinese Academy of Sciences, and the deputy director of Hangzhou Institute of Advanced Technology. Before joining SIAT, he worked at Carnegie Mellon University, ETH Zurich, Innopolis University, Nanyang Technological University and Singapore Management University. He is also an adjunct professor of Chinese University of HongKong (Shenzhen). His current research interests are in data-intensive applications and systems, focusing on efficient and scalable algorithm design, blockchain, data sense-making, and mobility intelligence.	The aim of this special issue is to capture recent advances in developing data-intensive applications that analyze spatio-temporal/societal data, in order to foster the exchange of new ideas on multidisciplinary real-world problems, propose innovative solutions, and stimulate further research in the area of mobility data management and analysis. Mobility analytics is a timely topic due to the ever-increasing number of diverse, real-life applications, ranging from social media to land, sea, and air surveillance systems, which produce massive amounts of streaming spatio-temporal data, whose acquisition, cleaning, representation, aggregation, processing and analysis pose new challenges for the data management community. The papers published in this issue constitute revised and extended versions of the accepted
Introduction Two of the populations that social work has not fully explored in the practice literature are the needs of men at risk and undocumented immigrants; nearly nothing has been written about macro and micro policy concerns with undocumented immigrant men. In this brief note, we present an exploration of undocumented immigrant men in the United States, and briefly explore the impact of new state policies and their implications for social work practice. --- Undocumented immigrant men It is estimated that approximately 11.2 million undocumented immigrants are living in the United States today (Passel and Cohn, 2011). Approximately three-quarters of the daylaborers in the US are undocumented and 98 percent of them are men (Valenzuela et al., 2006). Often times, these men are employed in positions that most citizens will not take, in spite of the high rate of unemployment in the US economy. Undocumented immigrants come from various countries, but 58 percent of them, or 6.5 million people, come to the United States from Mexico. Another 23 percent, or 2.3 million individuals, are from other Latin American countries (Passel and Cohn, 2011). --- Risks for undocumented men The lives of undocumented immigrant men are often full of chaos, stresses and difficulties. Poole and Salgado de Snyder (2002) suggest that, for many of these men, the reasons for leaving their home countries are often based in crisis, including the impact of extreme poverty and these men's sense of responsibility toward providing for their families. The psychosocial risks experienced by many of these men are often extreme and begin prior to their transmigratory journey. Some men have fled military dictatorships in South American nations, and others have been exposed to violence and gang activities in dangerous and overcrowded slums of countries such as Colombia and Brazil. Some transnational men from El Salvador, Guatemala and Nicaragua have experienced significant violence and trauma from systematic governmental repression and violence and from years or decades of bloody civil wars (Gafner and Benson, 2001). After often arduous and dangerous travels overland, their vulnerability increases; the US/Mexico border has become increasingly dangerous, in large part due to the drug wars which have gripped northern Mexico. The killing of transmigrant, undocumented men, either intentionally or collaterally, has increased over the last several years (Van Norstrand, 2011). In addition, these men often suffer from mental health and substance abuse issues and are likely to have physical health issues. Poole (1996) suggests that undocumented men are the least likely to utilize preventive medical care and to have access to non-emergency medical care. Research has demonstrated that a significant number of day-laborers, the vast majority of whom are undocumented migrants, are at significant risk of HIV and other sexually transmitted diseases. One study found that nearly 40 percent of day-laborers have been solicited for sex by other men, and that those most likely to be at risk for engaging in unsafe sex are those with substance abuse problems (Galvan et al., 2008). The risks for male undocumented migrants are not only isolated to themselves. While a stereotype of undocumented Latino men is often that of an individual separated from his family, this is often not the case. Research has shown that undocumented immigrants are more likely to be members of couples with children (47%) than are legal immigrants (35%) or the US-born resident population (21%) (Passel, 2008). Risk to these men can equate to significant risk for their children, over 75 percent of whom were born in the US and are US citizens. Approximately 6.8 percent of US school children have undocumented parents (Passel, 2008). Many of the men that work as day-laborers identify that providing for their families is the number one reason for doing engaging in their work. Unfortunately, they are paid poorly and work in unsafe conditions. Valenzuela et al. (2006) estimate that even if day-laborers have many good months of pay, they are unlikely to exceed an annual income of $15,000, keeping them at or below poverty. In addition to low wages, many of these men suffer workplace abuse. Approximately one half of day-laborers suffered wage theft by their employers in the two months preceding the survey conducted by Valenzuela et al. (2006) and 44 percent of those surveyed had been denied a bathroom or water break while at work. One in five have suffered a work-related injury with half not receiving medical care for their injuries. --- Policy and practice issues In the US, the domain of immigration policy rests within the domain of the federal government. Yet, given the lack of agreement over the nature of the phenomenon of immigration (i.e. whether or not it is a 'problem') and the lack of political will to address it through national legislation, states have begun to enact laws designed to decrease undocumented immigration and combat what some perceive to be social problems caused by illegal immigration. These policies have numerous implications for the lives of immigrant men, and have significantly changed the risk of deportation and decreased access to needed services. While some of these laws have been challenged legally and may not be fully implemented in the near future, the outcomes of these challenges will remain unclear for some time. As such, it is important that social workers become prepared for the potential practice challenges and ethical dilemmas that are implicated in these policies. The most restrictive of the anti-immigration laws is Alabama's SB56, which was enacted in the fall of 2011. SB56 seems to criminalize key aspects of the lives of immigrants. Most significantly for immigrant men, actually seeking work is considered a felony. It is also a felony to for an undocumented 'alien not lawfully present in the United States... [to] enter into or attempt to enter into a business transaction with the state' (HB56, p. 56). While counties have begun to question the enforceability and the wisdom of this part of the law, the final result is still in question. Should this part of the law pass legal challenges, it will be a felony for immigrant men to attempt to register vehicles, seek government-supported health services, or even have water services for their homes. There are several implications of this analysis for micro and macro practice. First, social workers must develop the knowledge and skills to work with undocumented Latino immigrants. This knowledge base consists of an understanding of social work practice with men, practice with Latinos, practice with immigrants, and an understanding of transnational and global issues. Each of these areas may not be fully part of the training of many social workers, as such, increased education and training in each of these areas is needed. This is particularly so, given that only about 40 percent of social work faculty members thought that social work students were prepared to work with Latino clients (Furman et al., 2006). Additionally, undocumented workers play an important role in our economic health, supplying agricultural workers in areas heavily dependent on inexpensive, transient labor. Studies have shown that the anti-immigration law enacted in Alabama in 2011, the state with perhaps the most restrictive law criminalizing undocumented workers, has harmed the agricultural industry. However, according to Valenzuela et al. (2006), undocumented workers are employed in various fields, including construction, landscaping and gardening, painting, roofing, and installing drywalling. New state laws that criminalize day-laborers seeking employment may harm other industries as well. While undocumented immigrant men may not typically voluntarily seek social work services, they may come into contact with social workers in several settings, including the criminal justice system, hospital emergency rooms, immigrant advocacy organizations and sometimes with the mental health or substance abuse treatment symptoms. Unfortunately, there are several key barriers in terms of training that inhibit the potential responses of social work: a lack of training working with Latinos, a lack of Spanish language proficiency and an unfamiliarity with Latino masculinity and its relationship to health seeking and providing (Furman, 2011). It is important for social workers to understand that for many undocumented Latino men, the actual immigration experience is an expression of the masculine values of responsibility toward family and the importance of work. In this sense, the performance of immigration is an actualization of strength -Latino men cross borders and face increasingly hostile sociocultural environments in order to send remittances to their families. Research has demonstrated that the sending of remittances is positively correlated with psychosocial health, while the inability to send remittances is correlated with depression (Negi, 2008). Social workers who encounter undocumented immigrant men, or those who they suspect of being undocumented, face several challenges. First, they may face reporting requirements from these new state laws which create ethical dilemmas. Second, they must understand that their legal status, along with the previously discussed cultural differences (Latino culture and the culture of masculinities) may mean that their clients are less likely to open up to them. Approaching these men from a strengths-based perspective, and validating their life course as an expression of positive traits, is an invaluable means of establishing an effective healing relationship. In addition to the sense of personal responsibility toward one's family (familismo), these strengths include pride (orgullo), respect (respeto) and a sense of personal strength (esfuerzo). While stoicism is not typically viewed in the helping professions as a strength, respecting men's willingness to approach problems cognitively or behaviorally more than affectively is an important part of working with men (Furman, 2011). It is also important for social workers who may encounter these men to have connections with community advocates and traditional healers and clergy who are from these communities. Utilizing these community members as allies and partners is an important aspect of gaining trust and providing culturally competent services. Lastly, social workers in the United States have an ethical obligation to learn about what policies are being advocated in their states, and to help policy-makers understand the potential unintended consequences of such policies, such as placing citizen children at risk. In conclusion, undocumented men are a population with multiple risks, whose well-being is inhibited in the United States by nativist state laws and policy, a global recession that has impacting their ability to seek and procure employment, more intensive border security, and increasing violence along the US/Mexico border. This brief note was not intended to explore all the geopolitical or practice issues that impact this population, but to serve as a call to action for social work to engage more with this at-risk group of men. --- Acknowledgments	This article presents an exploration of undocumented, Latino male immigrants in the United States, and assesses the impact of new state policies and their implications for social work practice. To meet its aims, we describe the psychosocial risks that they face, and situated these risks within the context of new state policy realities. Implications for practice are presented.
psychological symptoms of dementia and improvement in mood, memory, and well-being. Most studies have relied on observational data, standardized clinical scales, and self-or caregiver-reported perceptions of the effects of personalized music. Passively-collected physiological data may minimize researcher bias during data interpretation. We tested the protocol on 15 participants, triangulating the physiological, observational, and self-reported effects of personalized music on stress. Physiological measures were captured by a wearable wristband Empatica E4 and included heart rate, electrodermal activity, and temperature. Self-reported measures included the Perceived Stress Scale, level of stress on a 0-10 scale, and reactions to each song (happy, energized, calm, relaxed, nostalgic, sad, excited). Prior to music listening, we induced stress through three iterations of the Trier Mental Challenge Test, which involves three minutes of math exercises. Participants reported their level of stress after the Trier Test and after each song. Researchers observed participant reactions during each song. Preliminary analysis shows that nine minutes of a stress-inducing activity was enough to capture stress reactions and demonstrated a feasible protocol for collecting physiological, observational, and self-report data. These results inform the development of a novel protocol that responds to a person's stress levels through a personalized music listening intervention. --- SESSION 7760 (POSTER) --- MENTAL HEALTH AND PSYCHOSOCIAL WELL-BEING Abstract citation ID: igad104.2868 --- A LIFESPAN DEVELOPMENTAL ANALYSIS OF RECIPROCAL RELATIONS BETWEEN HEAVY DRINKING AND SLEEP PROBLEMS Douglas Bowlby, Rutgers University, New Brunswick, New Jersey, United States In recent years, numerous studies have begun to explore the ways in which problem drinking behavior is affected by different lifespan developmental changes. However, while there currently exists a plethora of research on adolescence and young adulthood, there is far less research with midlife and older adults examining lifespan developmental changes and problem drinking. As part of larger NIAAA-funded project investigating aging, health, and alcohol use, the current study investigated cross-sectional and longitudinal associations among heavy drinking and sleep problems in a sample of midlife and older adults. One particularly noteworthy analysis used path analysis in Mplus to test a longitudinal moderated mediation model involving sleep problems, sleep-related motives for drinking, and heavy drinking. Results showed an interaction between sleep problems and sleep-related drinking motives. Interestingly, sleep problems appear to significantly reduce the risk for heavy drinking among most participants. However, when combined with high sleep-related drinking motives, sleep problems appear to significantly increase risk for heavy drinking. This phenomenon may help explain the occasionally contradictory results found in previous studies examining the impact of sleep disturbances on drinking behavior and may prove to be an area worth investigating in future studies. From a lifespandevelopmental perspective, these findings highlight how there	described a degree of cognitive difficulty whereas four 44% in the low scoring group did. All but one (94%) older adults described needing some help with technology from family members, friends, and/or paid technology services. Two themes complement these findings by reflecting strengths ("lots of ways to do everything") and challenges ("I just get through it") of using technology. Greater technology mastery may positively influence the ability of older adults to meet their needs, but cognitive challenges may prevent full engagement with technology.
In 1986, population growth had long been perceived as leading to a strain on world resources. But the contribution of modern methods of contraception to population control was recognised to be inadequate due to their low utilisation and it was felt that there should be "better marketing of contraception and the development of culturally acceptable methods". 2 --- Integrated services In Britain, the concept of integrated services was gaining increasing support following consideration of alternative models for training and service delivery. Writing in this Journal, Dame Josephine Barnes specified the importance of the women's movement in promoting "better services for women at all times in their lives" and not merely for childbirth. 3 This approach was exemplified by the interface between hospital gynaecology and contraceptive services: David Horwell emphasised the need for the continuation of the woman's current effective contraceptive method following the diagnosis of cervical intraepithelial neoplasia, but also reflected the view that barrier contraception might play a part in the prevention of cervical cancer in view of the recognition of the probable involvement of wart viruses in its aetiology. 4 Sexual health was seen as an important aspect of the provision of family planning services 5 and especially as a component of primary health care. 6 --- Youth Services for youth were a major preoccupation whether for the individual, family, community or country. Regarding services to minors, in March 1986 the government issued revised guidelines for family planning services for young people that complemented the statement by the General Medical Council regarding the course of action to be taken when "the young girl is not mature enough to understand what is involved in the treatment": confidentiality --- Contraceptive services of the consultation could be waived exceptionally to permit parental involvement. 7 It was felt that the unmet contraceptive needs of teenagers were so important as to justify the intervention of general practitioners by their raising the issue spontaneously during any medical consultation. 8 --- Counter-reformation In his 1986 George Morris Memorial Lecture, Malcolm Potts viewed the late 1960s as the reformation period for family planning, with its final acceptance in the international development movement. The 1970s then represented a golden decade when family planning was recognised for its potential to solve the problems of population growth and food shortage, thereby contributing towards socioeconomic development. 9 However, Potts considered that in the 1980s there had been a counter-reformation movement leading to damage to progress on several fronts, with views that "perceptions of morality are more important than the reality of particular family planning technologies". With their safety being questioned, intrauterine devices and injectables were removed from the range of available contraceptive methods in the USA, where the Reagan administration also introduced restrictions in the availability of reproductive health services. Potts felt that the counter-reformation movement had interpreted "the availability of contraception to the unmarried as a Pied Piper which has drawn the young into a black cave of hedonism". As examples of the strong influences of religion and politics, Potts deplored the lack of services for voluntary sterilisation in Egypt and the maintenance of French colonial laws prohibiting contraception on the statute books in sub-Saharan Africa. Potts was remarkably percipient in pointing out at that time, 1986, that "Egyptian social life collapses under the frustrations of unemployed millions of youth". 9 --- The milestone of 7 billion The United Nations has proclaimed 31 October 2011 as the day when the world population will reach 7 billion, the last milestone of 6 billion having been reached in 1999 and the next one of 8 billion being expected in 2025. With the anticipated discussions on the time lag for replacement fertility level and a possible plateau of world population, it is imperative that long-term population projections are perceived as being a range of possibilities with numerous potential variants. These estimations do not benefit from crystal ball gazing and consideration must be given to the effects of changes in population policies, political turbulence and, most importantly, limited financial and human resources that are insufficient to meet the demand for contraceptive services. There are vast differences between regions and countries regarding both population policies and demographic indicators, but it should be acknowledged that the least developed countries usually view their fertility as being too high. Continuing support is therefore essential for the strengthening of family programmes through both advocacy and service delivery, as part of comprehensive reproductive health services. 10 Major demographic issues do not relate to mere numbers but rather to the youth bulge and ageing with their resulting socioeconomic effects and the dependency ratio that compares working to non-working populations. In some countries in transition, educated young women face high unemployment rates as they are overqualified for the existing job market. Rapid modernisation, development and globalisation lead to sophisticated youth. Women now have drastically different expectations from those of earlier generations, such issues being more significant in traditional societies. Instead of applying earlier models from other countries, 11 culturally sensitive solutions must be sought with the participation of women and youth in policy formulation. Since January 2011, movements in various countries such as Egypt and Tunisia have demonstrated the role of women and youth in uprisings that seek social change. By coincidence, UN Women became operational on 1 January 2011 and the International Year of Youth, which was first proposed by Tunisia, commenced in August 2010. As far back as 2008, the National Intelligence Council of the USA had identified unmet socioeconomic needs and the ignored political rights of youth as security risks in a demographic crescent, an "arc of instability" comprised of countries with a growing population and conflict stretching from Latin America through Africa and the Middle East to Asia. 12 The International Conference on Population and Development held in Cairo in 1994 led to a move from demographic goals towards individual needs, and its Programme of Action specified that targets and quotas should not be imposed on providers of family planning services. Irrespective of the demographic policies of governments, individuals should have access to contraceptive services that do not interfere with their rights regarding reproductive choice. --- Provision of contraceptive services With recent political changes in some countries, women's health services may unfortunately face restrictive legislation including limited public funding for sensitive areas such as adolescent sexual services and abortions. It is even more worrying that there is a threat to curtail access to contraceptive services through judicial decisions defining when life begins. The issue of whether life commences when sperm meets egg or after implantation of the fertilised ovum in the uterus is actually in the theological domain. But it has lately been difficult for law, religion, politics and policymaking to keep up with scientific advances in the physiology of reproductive health. With less than half of all fertilised ova proceeding beyond implantation in the natural state, it would be extremely regrettable if intrauterine and emergency contraception, and even oral contraceptives, were regarded as being abortifacient. Should viability be recognised as occurring at fertilisation, major problems would, for example, be faced in the management of ectopic pregnancy with its lifethreatening complications. Contraceptive services are accepted as among the most cost-effective interventions for global health. The rationale includes their benefits for women's and children's health, human rights, demography and socioeconomic development, quite apart from the neo-Malthusian ones relating to food security, the environment, ecology, global warming and pollution. Cultural considerations are important for societies to appreciate the potential of technological developments. Reproductive health professionals have a duty to contribute towards responsible policymaking through informed discussion, to ensure universal access to health services. This approach should draw upon the bold new commitment by member countries at the United Nations in New York in June this year: in a revolutionary change, the 'vertical approach' to HIV control will be replaced by integrated global health. 13 This initiative will provide the exceptional opportunity of drawing upon a comprehensive set of interventions that will incorporate the scaling up of family planning services, aiming at the elimination by 2015 of unmet need for contraception for women at risk of HIV, in order to reduce HIV-associated maternal deaths and neonatal HIV infection by 90%. The timescale for this momentous achievement is just four short years. It remains to be seen whether the worthy words of the political leaders at this major forum will be translated into the --- Edouard J Fam Plann Reprod Health Care October 2011 Vol 37 No 4 huge commitments of national and international determination, finances and human resources that will be required. --- Competing interests None. Provenance and peer review Commissioned; internally peer reviewed.	World population is expected to reach 7 billion within the next month. It is therefore timely to consider the relationship of contraceptive services, with their focus on the individual, to implications for population dynamics. The various facets include individual choice, human rights, health benefits, socioeconomic implications and the demographic goals of governments. These all have their own rationale, with the common approach that contraception is much needed for fertility control in society, despite certain views that might limit its availability. Many obstacles still need to be overcome for the widespread provision of contraception to become an integral part of comprehensive health services.
Introduction The development of a preventive HIV vaccine offers the best long-term hope of managing the impact of the AIDS pandemic that is ravaging sub-Saharan Africa (International AIDS Vaccine Initiative, 2009), where 70% of the 2.7 million new HIV infections worldwide in 2012, and 70% of all AIDS deaths occurred (UNAIDS, 2013). Progress is being made in the development of an effective HIV vaccine (Rappuoli and Aderem, 2011;Ross et al., 2010); however, findings from studies about the willingness of African people to participate in HIV vaccine trials (Jaspan et al. 2006;Smit et al. 2006) and about the acceptability of a potential HIV vaccine (Bishai, et al. 2004;Sayles, et al. 2010) strongly suggest that the advent of a HIV vaccine would not guarantee its uptake. It is important, therefore, to begin planning how to promote its widespread uptake. A recent systematic review suggests that people vary considerably in their level of willingness to be vaccinated against HIV, ranging from 37.2 to 94 on a 100-point scale (Newman and Logie, 2010). In addition, the review has identified five broad factors impacting acceptability of the vaccine, as suggested by health-protective behavior theories (Weinstein, 1993): perceived susceptibility to HIV infection; effectiveness of the vaccine; perceived severity of AIDS; cost of the vaccine; and perceived social approval of vaccination. Nevertheless, very little is known about the relative contributions of these factors on African people's willingness to receive the vaccine and about the possibly diverse vaccination positions of these people. Addressing this gap in knowledge is important in order to be able to tailor promotion of HIV vaccination to different people's views and needs (Butler, 2015). --- Methods The study was conducted from January to April 2014. Ethics approval for the study was obtained from the Institutional Review Board of the University of Québec-Teluq. --- Study setting The study was conducted in Togo, a sub-Saharan African country with a population of 7 million (WHO, 2015) that faces a generalized HIV epidemic (CNLS-IST, 2015). In Togo, the HIV prevalence is 2.5%, with an estimated incidence of 6649 in 2011 ;AIDS remains the most common cause of death, accounting for 17% of all deaths (CNLS-IST, 2015). The study site was Lomé, the capital city, with a population of 1.5 million (United Nations, 2015), where the prevalence of HIV is the highest in the country (3.5%) (CNLS-IST, 2015). In Lomé, HIV is predominantly transmitted through heterosexual contacts; women are twice as likely to be infected as men, and sex workers are the most seriously affected (UNAIDS, 2009). People aged between 30-39 years face the most severe burden of HIV (CNLS- IST, 2015). --- Study design The study was designed in accordance with Anderson's Functional Theory of Cognition (Anderson, 2008). The procedure had two phases. In the familiarisation phase, the investigator explained to participants what was expected of them, i.e., that for each scenario they were to indicate their level of willingness to receive the vaccine. Next, each participant was presented with 18 of the 48 scenarios, in random order. The participant then provided ratings of willingness to receive the vaccine. After completing the 18 ratings, the participant was allowed to compare responses and make changes until satisfied with the entire set of ratings. In the experimental phase, the whole set of 48 scenarios was presented. Each participant provided ratings at his or her own pace, but was neither allowed to compare responses nor allowed to go back and make changes. Each participant was tested individually. --- Participants The participants were unpaid volunteers recruited and tested by five research assistants, well-trained in the research technique used. The assistants contacted a total of 500 people walking along the streets of Lomé. The diversity of the population of the capital enabled the recruitment of participants with various demographic characteristics. The assistants explained to them the purpose of the study, sought their participation, and obtained informed consent. This recruitment technique was an efficient and inexpensive means of revealing the basic trends needed for what was fundamentally an exploratory study. --- Material The material consisted of 48 vignettes composed of all combinations of the five main constructs of health-protective behavior theories (Weinstein, 1993): Perceived susceptibility to infection (1 chance in 10 or in 50); Effectiveness of the vaccine (70% or at least 90%); Perceived severity of AIDS (lethal or chronic owing to the availability of treatment); Cost of the vaccine (free, $100, or $200), and Influence of the family (encourages or does not encourage). The design was, consequently, a five within-subject factor design: Susceptibility × Effectiveness × Severity × Cost × Influence of the family, 2 × 2 × 2 × 3 × 2. Under each story, there was the question "to what extent would you take the vaccine in this case?" as well as an 11-point response scale with a left-hand anchor of "certainly not" (0) and a right-hand anchor of "certainly yes" (10). The cards were arranged by chance and in a different order for each participant. --- Statistical analysis We detected strong individual differences during preliminary analysis. Accordingly, we performed cluster analysis (K-means) on the whole set of raw data as recommended by Hoffmans and Mullet (2013). We then conducted separate ANOVAs -full factorial with all the interactions-on the data of each cluster, using a Susceptibility x Severity x Effectiveness x Cost x Influence of the family, 2 x 2 x 2 x 3 x 2 design. Finally we performed Chi² test to test the effects of demographic characteristics. Data was analysed using STATISTICA 7. --- Results --- Participant profile Of the 500 people contacted, 363 (205 men and 158 women) agreed to participate. The main reasons for refusal to participate were lack of available time and interest. Eightyfour per cent of participants chose to be tested at their private homes and the others chose a vacant classroom at the local university. The participants took 25 to 35 minutes to complete the questionnaires. Their ages ranged from 18 to 62 years (M=24.37, SD=4.63). More detailed demographic information is shown in Table 1. --- Positions on vaccination The cluster analysis gave a five-cluster solution. The main patterns of data that correspond to each cluster are shown in Figure 1. The detailed results of the corresponding ANOVAs are shown in Table 2. For 178 participants (49%), the ratings were always high (M=9.01). This cluster was called Unconditional acceptance. For 71 participants (20%), ratings strongly varied as a function of cost and effectiveness; this cluster was called Depends on the cost/effectiveness ratio. The Cost x Effectiveness interaction was significant. When the vaccine was fully effective, vaccination intention was always high (mean values ranging from 8.00 to 9.54). When it was not completely effective, intention depended strongly on cost (mean values ranging from 3.14 to 8.07). Also, when AIDS was perceived as not lethal (because of access to treatment), intention was lower (M=6.51) than when AIDS was perceived as lethal (M=7.53). For 65 participants (18%), the ratings considerably varied as a function of the cost of the vaccine, and this cluster was called Depends on cost. When the vaccine was free, intention was higher (M=9.03) than when it was very costly (M=2.36) or moderately costly (M=4.24). Effectiveness had a weak effect. For 39 participants (11%), the ratings were concentrated in the middle of the willingness scale (M=5.26). When family members encouraged vaccination, intention was slightly higher (M=6.37) than when they did not (M=4.16). This cluster was called Total hesitation. Finally, for 10 participants (3%), the ratings were always low (M=2.88). None of the factors considered in this study had a significant effect. This cluster was called --- Complete reluctance. The clusters differed significantly regarding educational level, Chi²(4) = 11.66, p< .05, and income, Chi²(4) = 35.53, p < .001. As shown in Table 1, all except one of the members of the Completely reluctant cluster had not had access to post-secondary education. Also, wealthier participants ( those earning more than $100 per month, the median income in Togo), were less often members of the Unconditional acceptance cluster and more often members of the Depends on the cost/effectiveness ratio cluster compared to poorer ones (those earning less than $100 per month) (World Bank, 2015). --- Discussion As expected, several qualitatively different positions were found. This finding is consistent with previous studies that show that people's views regarding vaccination can considerably differ and reflect clearly structured personal positions that are partly associated with sociodemographic characteristics (Bynum et al., 2012;Ziemer and Hoffman, 2013). First, vaccination acceptance is already achieved for half of the residents of Lomé. People in this group seem to be willing to get the vaccine, irrespective of its level of effectiveness, cost, or family attitudes. This result is consistent with the findings of Bishai et al. (2004) that a majority of adults in Uganda would be willing to be vaccinated against HIV even if the vaccine was not very effective. Second, for about one person in five, acceptability is determined by cost of the vaccine. This result is consistent with previous findings in South Africa (Sayles, et al. 2010) and Uganda (Bishai et al., 2004) showing that cost might be a barrier to uptake of the vaccine. This suggests that the main emphasis of vaccination promotion efforts among people in this group should be on the reduction of financial hurdles. Third, for one person in ten, acceptability is determined by influence of the family. This suggests that community-based interventions that are engaging and persuasive to people would be necessary for people in this group. These interventions should involve community influential leaders (e.g. traditions and religious leaders) and local media. Finally, few people (3%) would be unwilling to take the vaccine, whatever its characteristics: strong resistance to its use is not expected. Limitations of this study include the use of a convenience sample and its restriction to people living in one area. As a consequence, generalization of the results to people in Togo as a whole must be done with care. In addition, it is difficult to know how the views and demographic information of participants differed from those of the people who declined to participate. Future studies of the reproducibility of these findings in other African countries and among specific HIV-vulnerable populations are needed. Despite its limitations, this study is the first to map the acceptability of HIV vaccine among people in Africa. It provides insights for the design and implementation of tailored HIV vaccination campaigns in Togo and probably in other sub-Saharan African countries.	Progress is being made in the development of an effective HIV vaccine. Once the vaccine is available, an important public health goal will be its widespread uptake in sub-Saharan Africa, home to 70% of new HIV infections worldwide. It is important, therefore, to begin planning how to promote its widespread uptake there. The aim of this study was to map the different personal positions regarding HIV vaccination of people living in Togo, West Africa. From January to April 2014, we recruited 363 adult participants who were asked to indicate their level of willingness to receive a future HIV vaccine under different conditions varying as a function of five factors: perceived susceptibility to HIV infection; effectiveness of the vaccine; perceived severity of AIDS; cost of the vaccine; and influence of the family. Five qualitatively different positions were found, which were labelled Unconditional acceptance (49%), Depends on cost/effectiveness ratio (20%), Depends on cost (18%), Total indecision (10%) and Complete reluctance (3%). Members of the wealthier segment of society were less often members of the unconditional acceptance cluster and more often members of the cost/effectiveness cluster than others. The diversity of people's positions regarding a future HIV vaccine implies that HIV vaccination strategies in Togo and other African countries will need to be tailored in design and implementation rather than "one size fits all" interventions.
REGISTERED REPORTS FOR ECRS: ENABLING SLOW SCIENCE ON TIGHT TIMELINES Rita Ludwig 1 , 1. University of Oregon, Eugene, Oregon, United States Early career researchers (ECRs) may experience tension between the ideal and actual amounts of time they have to complete a scientific project. Sometimes, a timeline is truncated because a citable product is required for applications or fellowship deadlines. This scenario is especially common for researchers who use longitudinal methods, and/or those who work with hard-to-access samples. Registered reports, an open science initiative, offer one resolution to this tension. In registered reports, the steps of analysis planning, manuscript writing, and peer review occur earlier than the traditional journal article publication process. If an in principle acceptance is earned, ECRs are afforded citable, peer-reviewed acknowledgement of their scientific thinking prior to the conclusion of a research project. This talk will serve as a primer on the registered report process. I will also discuss resources for writing registered reports, and provide a list of relevant participating journals in the field of gerontology. Studies of historical change on cognitive aging generally document that later-born cohorts outperform earlier-born cohorts on tests of fluid cognitive performance. It is often noted how advances in educational attainment contribute to this finding. Over the last century, work demands and characteristics have changed profoundly, with shifts from a manufacturing to service and technical economy. We used data from the Seattle Longitudinal Study to compare trajectories of cognitive change between earlier-born and later-born cohorts . Our findings show that (a) later-born cohorts had higher levels of performance on most cognitive tasks and exhibited less decline in word fluency, (b) had more enriched perceived work environment as indicated by higher levels of worker control and innovation, with no cohort differences in work autonomy (c) these experiences were associated with higher levels of cognitive performance independent of education and consistently across cohorts. We discuss potential mechanisms underlying these associations. --- SESSION 590 (SYMPOSIUM) --- THE ROLE OF RETIREMENT IN COGNITIVE AGING: RESULTS FROM THE SWEDISH ADOPTION/TWIN STUDY OF AGING Ross Andel 1 Deborah Finkel 2 and Nancy L. Pedersen 3 , 1. University of South Florida, Tampa, Florida, United States, 2. Indiana University Southeast, New Albany, Indiana, United States,3. Karolinska Institutet,Stockholm,Stockholms Lan,Sweden Retirement is a major life transition that may influence the aging process. Using a two-slope growth curve model with retirement age as the pivot point, we studied change in major cognitive domains before and after retirement. Participants were 393 members of the Swedish Adoption/Twin Study of Aging who retired after the age of 50 (mean=63 years, range 51-75 years) and who were followed for over 20 years with seven testing occasions. After controlling for age, sex, and education, we observed no change in memory preretirement (p=.935) and significant memory decline postretirement (Estimate=-0.17, p=.001); decline in speed, which more than doubled after retirement (Estimate=-0.20, p=.001	which increases openness and protects researchers from suspicions of p-hacking, (2) the conversion of neuroimaging data into a standardized format (Brain Imaging Data Structure: BIDS) that enables standardized scripts to process and share neuroimaging data, and (3) the sharing of final neuroimaging results on Neurovault which allows the community to do rapid meta-analysis. Using these tools improves workflows within labs, improves the overall quality of our science and provides a potential model for other disciplines using large-scale data.
Introduction Abandonment, for the purposes of this study, is explained by the detachment, disaffection or lack of protection of the child and adolescent population by those who must provide protection and care: from the State to the basic nucleus that is the family. Addressing childhood and adolescence can lead us to think about a stage of life or disconnect it from our individuality and point to a sector of society, that of "the minors" that of "the others" who are going through the moment that we have already gone through in which identities are formed and values are assimilated. In both cases, we are talking about people and a reason for this reflection: there could not be an "us" without childhoods and adolescences and without them, there will be no future either. There are many pages of history that show that in the greatest crises, girls, boys and adolescents receive the first devastating effects, all under the paradox that the social and family environment "should" act as "protection and care." "; However, there are no approximate data that reveal the dimension of the problem; It is not known how many boys, girls and adolescents have been victims of violence, exclusion or social marginalization in each nation in the last century, nor how many have carried out violence in these scenarios; social neglect is evident. An everyday and normalized face is that of an indifferent society, increasingly digitalized. From the line of analysis Lilia García 1 takes up Michel Focault's analysis, regarding the exercise of power, it is surrounded by loneliness from violence and forms the "disciplined individual" monitored and punished from the panotism of the State based on a legal mechanism with rules that allow us to live in harmony and protect common goods. What explains why in contemporary societies the lack of comprehensive protection in childhood and adolescence is clear? Some keys for reflection. First-Understand the environment under a context that has left the mark of postmodernism, an aspect that, according to José Miguel Gómez, 2 shows that social behavior is summarized in three aspects: "consumption, search for pleasure and anxiety for the new status" and under these dimensions new identities and values are built, in the coming and going of the rush and the search for immediate pleasure. From this author's perspective, detachment, disaffection and emotional anemia are increasing. Thus, from epistemology, the symptoms of "ultamodernism" also appear as an expression of the absurd and trivialized. One of the symptoms of this era is seen in the increase in suicides in the world. In Japan, the Ministry of Loneliness was created to "combat the scourge of loneliness" 3 as it is considered more lethal than the Covid-19 pandemic, due to the growing increase in suicides that include children since they were registered in In 2020, the suicide of 498 minors. Another country that has this Ministry is the United Kingdom, which recognized in 2018 that it is a public health issue. There are yet few and sporadic records in the nations regarding suicides in the child and youth population and the circumstances surrounding their daily lives in a digital ecosystem that is part of the construction of their personalities along paths of opportunity and great risk. Second-Social learning through digital networks determines the rhythm and patterns of hasty community behavior, with or without objectives, largely absent of axiological sense, even far from the direction that underpins social life: the common benefit. Post and ultra-modernity are present. Thus, relational teaching is consolidated according to the models assumed in each culture, time and space, which are increasingly uniform, in fashions, needs and shared interests in a digital environment that does not require criteria of reason or humanity from the simple basis of the value and respect of being people. Third-The fragility of social ties in childhood and adolescence is not a recent problem. In World War II, humanitarian cost is estimated to range between 80 and 100 million deaths among civilians and soldiers, 4 the number of children and adolescents who were affected has not been determined what has been clear is the frank absence of protection and abandonment of life and its most basic human rights. Responsibilities continue to be questioned. Within the framework of this social problem and several decades later, the Convention on the Rights of the Child took place, which turns out to be the most recognized international instrument in the world and signed and ratified by all countries except two and which incorporates the entire range of the human rights of children. Although it is an instrument widely questioned for having a European and adult-centered bias, the World Summit Action Plan for Children was derived from it. One of the most important aspects is that it recognizes protection and development as a priority child development as indispensable for the "survival, stability and progress of all nations, indeed, of human civilization". 5 Thus, this brief description of the circumstances in which this abandonment is framed, some actions regarding these challenges are stated. --- 1) This global problem compromises social stability, in the present and future it requires being part of an international and national agenda that joins efforts between nations. For this reason, it is proposed to create registries with standardized designs among nations that collaborate to measure the number of abandoned girls, boys and adolescents in all of its variants, social, economic, cultural and technological. The construction of quantitative and qualitative indicators that seek evidence to influence the problems of abandonment in girls, boys and adolescents. 2) Reorient through new designs of public policies, learning in social relationships with humanist bases, which strengthen social and family ties from approaches of respect for equality and inclusion with society, the environment and especially with technologies of information that is accompanied by a culture of prevention of digital risks. 3) Transcend from "suggestions and advice on the use of the Internet" in childhood and adolescence, to normative lines that link the responsibilities of the family, educational and social nucleus, on the safe and conscious use of technological tools that provide greater opportunities for use and less risks. 4) Incorporate in the institutions of nations, the priority of protection and care for children and adolescents as a fundamental value that guides new social behavior towards children and adolescents from a public agenda that provides material, human and budgetary elements. --- 5) Consider the example of the model of the Ministry of Loneliness of Japan and the United Kingdom, to generate designs in nations with a specialized focus on the child and youth population and can make visible the specific needs of the child and youth populations in each social context. , economic, digital and cultural to counteract social and family abandonment. --- Conflicts of interest The authors declare that they have no conflicts of interest related to the present work.	The various forms of abandonment in childhood and adolescence show high human, social and economic costs that compromise the future of humanity. In this study, some of the elements that are part of the complex problem faced in a hurried and anemic era in values that characterize a present with the imprint of post and ultra-modernism in a digital era are stated, for which some lines of action.
Introduction According to constitutional and civil law regulations, the family has a fundamental role in the protection of children's rights in Romania (1). It is to the credit of every state to establish and regulate as effectively and efficiently as possible the basic relationship between childstate-parents, which provides the child with the environment it needs for its full and harmonious development. Responsibility for the child's harmonious upbringing and development lies primarily with the parents (2). They have an obligation to respect the rights of the child, taking into account 1 Faculty of Medicine, University "Ovidius" of Constanta 2 Social Assistance and Child Protection, Constanta the best interests of the child (3). Although the State's intervention is additional, as it is responsible for "respecting the rights of the child and protecting him/her through the work of the competent public institutions and authorities, the local administration authorities are obliged to support the parents/legal representative of the child by providing basic, multipurpose and quality services appropriate to his/her needs" (4). "The professional maternal assistant is a person certified under the terms of the Government Decision no.679/2003, regarding the conditions, procedures and status of the professional maternal assistant" (5) and according to the "Government Decision no. 502/2017, on the organization and functioning of the Commission for Child Protection (5). The professional maternal assistant ensures the education and well-being, necessary for the harmonious development of the foster child (6). The field of child protection is nowadays in society's interest and is undergoing constant transformation. Both international documents and national laws which have regulated the rights of the child in detail have developed a set of general principles of law which must be respected on all occasions when the child is in need of protection. Although Romania adopted the provisions of the UN Convention on the Rights of the Child in 1990, it remained faithful to the child protection system since 1970, until 1997, when the Romanian Government adopted Emergency Ordinance No 26/1997 on the Protection of Children in Need. "Law No 272/2004 regulates the right to special protection of children, defining special protection as the set of measures, benefits and services intended for the care and return of children temporarily or permanently deprived of the care of their parents or those who, in order to protect their interests, cannot be left in their care. The measures, benefits and services referred to above benefit from a legislative framework setting mandatory minimum standards for the adequate protection of children temporarily or permanently deprived of parental care" (7). Between 1990-1996, normative acts are conceived, therefore, maternal care is promoted only by non-governmental organizations, and after 1997, maternal care becomes an alternative of child protection and gains more and more importance in Romania in the last decades. "Professional maternity assistant means the natural person who, under the terms of Government Decision no.679/2003 on the conditions, procedures and status of professional maternity assistant" (5) and according to "Government Decision No 502/2017, on the organisation and functioning of the Commission for Child Protection, has been certified and who ensures through the activity he/she carries out at home the upbringing, care and education necessary for the harmonious development of the children he/she takes into care" (6). Placement with a professional foster carer has a number of advantages: financial, material costs are much lower than the costs of care in residential institutions and psychosocial: healthier, more harmonious emotional development and a better sociological prognosis. --- Material and method "In order to produce this article, we used the documentation and analysis of the annual reports of the General Directorate of Social Assistance and Child Protection of Constanta County between 2017-2022" (8). We conducted a longitudinal study on "children who benefited from the special protection measure, on those who were placed in foster care as an alternative measure to institutionalization, but also on professional foster carers who were employed and who left the system of the General Directorate of Social Assistance and Child Protection of Constanta County". The article focuses on demonstrating that foster care is a viable alternative to the institutionalisation of children in special care. The above statistical analyses are relevant to the study in terms of the alternative to institutionalisation when raising children in birth families is not a viable option. --- Results --- 272 Following the analysis of the collected data, the number of children in foster care has increased, this is possible thanks to the development of the network of professional foster carers . We can also observe the upward dynamics that started with 2017, continuing annually until 2021, and then in 2022, the number of children out of foster care increases, as can be seen in the data shown in Figure 1 and Table 1. Figure 2 shows the comparative situation in 2017-2022 of children in special protection. While in 2017, the number of children placed with professional foster carers was 474, 544 children were placed in public residential services and 78 children in private residential services, in 2018 there was an increase in the number of children placed with foster carers -495 -and a decrease in the number of children in public and private residential services -478 and 77 respectively. This downward trend of institutionalized children is continued throughout the period analyzed, both in public and private residential services, so that at the end of 2022, according to official data, there were 314 children in public residential centers and 40 in private ones, while the number of children in foster care increased to 521. Another classification that I consider quite important in terms of the conditions that MPAs must meet in their upbringing and education to ensure that the "best interests of the child" are served (7) is that by degree of disability, plotted in Figure 3 and comparative by year in Figure 4. It is found that in 2017 there were a total of 54 children classified as disabled, of which 12.96% were classified as Severe, 27.78% were classified as severely severe, 40.74% were classified as Medium and 18.52% were classified as Mild. In 2018 there were a total of 58 children classified as disabled, of which 18.97% were classified as severe, 24.14% were classified as severely severe, 39.66% were classified as medium and 17.24% were classified as mild. In 2019, there were a total of 82 children classified as disabled, of which 25.61% were classified as severe, 17.07% were classified as severely severe, 45.12% were classified as medium and 12.20% were classified as mild. In 2020 there were a total of 99 children classified as disabled, of which 33.33% were classified as severe, 10.10% were classified as severely severe, 50.51% were classified as medium and 6.06% were classified as mild. In 2021 there were a total of 123 children classified as disabled, of which 42.28% were classified as severe, 10.57% as severely severe, 43.09% as medium and 4.07% as mild. In 2022 there were a total of 90 children classified as disabled, of which 43.33% were classified as severely disabled, 14.44% were classified as severely severely severe, 35.56% were classified as moderately disabled and 6.67% were classified as mildly disabled. With the increase in the number of children placed in foster care, an increase in the level of schooling can also be observed, thus it becomes mandatory to analyse the children in foster care according to the form of education in which they are placed and to monitor the situation in order to identify the possibilities of improving qualitative and quantitative indicators. A structural analysis of Figure 5 shows that the number of young people enrolled in higher education has increased from 4 in 2017 to 18 in 2022. The number of children enrolled in high school has varied recording a notable increase in 2020-to 87 (from 59 in 2019) and a decrease ,to 83 in 2022. The number of children enrolled in special schools has also seen a notable increase throughout 2017-2022, from 6 in 2017 to 21 in 2022. In the light of the above we rightly consider that the education of the younger generation is a national priority, and with the necessary support from childminders, we can see differences in the future of children. (8) The conclusions regarding the achievement of the research objective were formulated on the basis of the consideration that it was necessary and sufficient to give a numerical presentation of the maternal care network with its evolutions and mutations Structural analysis of the situation of the children placed with professional foster carers in Constanta County in order to achieve it: in conclusion, the foster care network has expanded during the period analysed and the number of children placed in foster care has also increased. At the same time, the number of institutionalized children can be reduced and the necessary human resources for the placement of children separated from their natural family can be ensured, thus optimizing and increasing the quality of the services addressed to children, and we highlight the fact that, as a result of the study undertaken, it was found that in the period 2017-2022 the maternal assistance network, as a viable alternative to deinstitutionalization, has increased and has responded to the needs of children and young beneficiaries of the special protection system.	Foster care is a preferred alternative to residential care due to the importance of the family environment for the physical, emotional and intellectual development of the child. This enables the development of a sense of security and belonging. The paper presents an analysis of the development process of the maternal assistance network at the level of Constanta County, with emphasis on reducing the number of institutionalized children and ensuring the human resource necessary for the placement of children separated from their birth family, having consequence in optimizing and increasing the quality of services addressed to children.
Introduction As the population in the United States ages, community efforts are needed to connect older adults with resources and services that support healthy aging. Larimer County, Colorado, has seen a downward trend in community awareness of aging-related resources, a shift that mirrors national trends (National Research Center, 2018). Lack of awareness is a major factor that leads to underuse of resources (Li, 2006;Wacker & Roberto, 2019). Families often do not know where to look for resources (Denton et al., 2008), and this issue is further compounded by the fact that they typically do not seek out resources until a crisis occurs (Magilvy & Congdon, 2001). Raising community residents' awareness of aging-related resources can have meaningful positive effects for aging individuals and their families. --- Project Development The Senior Access Points project emerged when a team of agency collaborators and community volunteers coalesced to explore an identified community need in the context of a grassroots organization called the Partnership for Age-Friendly Communities. The goal of the team, which we led, was to better understand barriers to community awareness about local aging-related programs and services. Our team implemented a community assessment process in 2017 (for details on the assessment approach and results, see Schneider & Brothers, 2019). Results indicated that despite the many aging-related resources available, most individuals did not know where to begin their search. The top places respondents looked (medical offices and the Internet) often did not lead them to the "right door." As a result individuals often needed to explain their stories multiple times, leading to frustration as well as curtailment of their searches. We also learned that services provided by the local office on aging were being underused. Next, we planned and implemented the four key components of the Senior Access Points project. 1. We developed an unbiased, user-friendly, easy-to-navigate website populated with information on agingrelated resources in nine topic areas (www.LarimerSeniors.org) (see Figure 1). The website is continually updated on the basis of feedback from community members and professionals. 2. We created outreach materials (rack cards, business cards, magnets) with a simple message to lead people to the "right door" (see Figure 2). 3. We initiated a volunteer ambassador training program to educate frontline staff at community and medical centers about aging-related resources (see the Senior Access Points ambassador video at https://youtu.be/nUM7s6z-4eo). 4. We organized a coordinated, county-wide outreach campaign involving a coalition of professionals from over 30 organizations. We share quarterly updates and keep our partners stocked with outreach materials. Given the positive outcomes in Year 1, we were awarded a 2-year (2019-2020) grant from the NextFifty Initiative, a nonprofit foundation based in Denver, Colorado. The purpose of the grant was to allow us to expand our outreach into rural areas of our county. We built a rural coalition that taps into existing infrastructure, including volunteer fire departments and rural transportation providers. Community members and professionals serve as Senior Access Points ambassadors in the rural communities in which they reside. We saw strong outcomes in the first two quarters of Year 2 (2019). Between January and June, we presented at 42 meetings to 911 participants. We trained seven volunteer ambassadors and distributed 7,292 outreach material items. The average number of new website users increased from 192 per month in 2018 to 286 per month in the first quarter of 2019. --- Next Steps and Statewide Expansion --- Ideas at Work Senior Access Points: Increasing Awareness of Aging-Related Resources JOE 57(6) ©2019 Extension Journal Inc. Our current focus is to train volunteer ambassadors throughout the county (in both rural and urban areas) who can then sustain education and outreach efforts in neighborhoods and communities. Extension continues to manage the website, produce outreach materials, direct outreach efforts, and train and support volunteers, while the CSU Department of Human Development and Family Studies leads the evaluation effort. We have shared our program model with Extension agents throughout Colorado. Four key features provide the basis for replication and adaptation of Senior Access Points: 1. The community assessment survey can be adapted to any local geography. 2. The website template is housed within CSU Extension and can be made available to other Extension offices for adaptation. 3. The logo can be adapted (i.e., "Senior Access Points of {insert county/region here}"), and the outreach material templates can be populated with local contact information, including for a locale's area agency on aging. 4. The volunteer training protocol and process manual are available for adaptation. We are in the process of replicating Senior Access Points in northeastern Colorado in partnership with three county Extension offices, the CSU Northeast Regional Engagement Center, and the Logan County Heritage Center. The replication process includes conducting a local community assessment to understand needs and barriers specific to the region. --- Conclusion As the population ages, Extension professionals can play a central role in supporting safe and healthy aging (e.g., Peek & Bishop, 2016). Senior Access Points can serve as a replicable model through which community coalitions can build partnerships, conduct assessments, develop resource tools, and train volunteers to increase community awareness about local resources. It is our hope that this model can help connect older adults and caregivers to critical aging-related resources before crisis situations arise and thus help close the information access gap for families in Colorado and beyond.	As the United States' population ages, connecting older adults to supportive resources is more important than ever. Colorado State University Extension has played a central role in implementing Senior Access Points, a program that delivers community outreach and education regarding aging-related resources available to older adults and caregivers. This article outlines four key components of development of the program: building a website, producing outreach materials, training volunteer ambassadors, and establishing a county-wide, coordinated outreach effort designed to break down resource access barriers. With outreach strategies tested and established in one county, the program is now being replicated by Extension professionals across Colorado.
Introduction An informal economy or grey economy which plays an important role for employment creation, income generation and poverty reduction in many developed as well as developing countries like India. Informal sector is an unorganized sector consists of all unincorporated private enterprises owned by individuals or households engaged in the sale and production of goods and services operated on a proprietary or partnership basis and with less than ten total works. Unorganized workers consist of those working in the unorganized sector or household excluding regular workers with social security benefits provided by the employers and the workers in the formal sector without any employment and social security benefits provided by the employers is known as informal employment. The First Indian National Commission on Labour (1966-69) under the chairperson of Justice Gajendragadkar has defined the unorganized sector as that part of the workforce, who have not been able to organize in pursuit of a common objective because of constraints such as (1) casual nature of employment (2) ignorance and illiteracy among informal laborers. The informal employment is against the global standards endorsed by the 15th ICLS. Employment in the creation of goods or services with the main goal of giving the people involved employment and incomes. Unincorporated businesses that are part of the informal sector are not set up as separate legal entities from their proprietors (ILO, 1993). They are owned by one household member, numerous members of the same household, or members of various households. They typically have little or no separation between labour and capital as inputs of production, operate on a small scale, and have minimal levels of organization. Compared to the organized or official sector, employers in the informal sector typically have lower pay, lower skill levels, and fewer access to financing and social safety nets (Loayza 2018; Perry et al. 2007). They frequently work and live in cramped spaces, and they only ever use cash for transactions, which encourages the spread of a number of hazardous diseases (Chodorow-Reich et al. 2020; Surico and Galeotti 2020). In developing and expanding economies like India, the impoverished frequently rely on illegal economic activities for their means of subsistence. In India, the informal economy produces close to 50% of the country's GDP on average, while more than 90% of all workers are employed in the informal sector. Workers select informal employment for a variety of reasons, depending on India's circumstances and worker characteristics. Informal workers can be found in a variety of small-to medium-sized businesses, unorganized/organized firms, and adjacent industries as day labourers. --- Significance of the Study The informal economy, which includes the informal sector in large part, can be modified slightly to accommodate disorganized manufacturing. Over the past two decades, India's economy has expanded quickly, but more than 90% of the country's labour has remained unemployed, contributing around 50% of GDP (GDP). Data from the Periodic Labor Force Survey (PLFS) show that 75% of informal workers are independent contractors, and that normal wage workers make less money on average than regular salaried employees. While the proportion of formal workers in India is 9.7%, there will only be 47.5 million of them by 2022. Poor capital intensity, low productivity, the prevalence of family labour, and simplicity of entry are some characteristics of the informal sector. The most significant aspect is the employment chances created by India's informal sector, which helps to alleviate the pressure of specific issues like unemployment and poverty by heavily utilizing local resources and time-honored conventional ways that only satisfy local needs. --- Background of the Study Many studies and articles have expressed various serious concern about the deterioration in the employment scene in the country in past years (Gururaja B.L 2020 ) role of informal sector in employment generation in India has explained without support of the government, this sector is generating a huge employees in different sector of the economy. It is based on the findings that if government will interfere then the condition of the informal employee will be better for economic growth. (Anand Thampi 2021; Mehrotra and Jajati 2021, Mehrotra and Tuhinsubhra Giri 2021). This paper find out that the veracity of assertions such as decline in worker-to-population ratio in recent years, increase in unemployment, withdrawal of women from workforce and deterioration in the overall employment scenario in India. (Ramesh Chand and Jaspal Singh 2022) Workforce Changes and Employment, a NITI Aayog Discussion Paper. This paper has concluded that structural changes in output and employment as growth rate in the output of the non-agriculture sector did not generate commensurate employment. Because of job security, assured salary and other pay and prestige associated with it, preference towards government jobs has increased tremendously. (D Narasimha Reddy, A Amarender Reddy, N Nagaraj and Cynthia Bantilan 2018) Rural Non-Farm Employment and Rural Transformation in India, This paper examines that Though there is growing share of rural non-farm employment (19% in 1980-81 to 31% in 2009-10), still, agriculture is the major employer of the rural workforce (68% in 2009-10). --- Objectives of the Study ➢ To study the role of informal sector for employment generation. ➢ To study the current scenario of informal employment in India. ➢ To study various challenges and difficulties faced by informal employment in India. --- Method and Data Sources The present study is based on secondary data only. Data are collected from Periodic Labour Force Survey (PLFS) survey reports, Ministry of Labour & Employment Government of India, International lab our Organization (ILO), National Sample Survey Organization (NSSO), Central Statistical organization (CSO), Economic Survey of India (ESI) etc. The accessible secondary data is intensively used for this research study. --- Figure: 1 Informality Concept Informality as a concept combined both informality of enterprises and informality of employment as Informal sector. --- Conceptual Framework of Informal Employment Contrary to the idea of the informal sector, which sees jobs as observation units instead of production units, the idea of informal employment sees jobs as observation units (ILO, 2003;Hussmanns, 2004). Regarding own account workers and employers, the job's status as an informal employment arrangement is determined by the enterprise's participation in the informal economy. Own-account personnel (without hired support) managing a freelance business are therefore seen as being in a freelance position. Source: Prepared by using PLFS (2020-21) report The distribution of employment in India's unorganised sector from 2017-18 to 2020-21 is shown in the table above. This table shows the percentage of male and female workers in India's unorganised sector. Every year, a greater proportion of men than women are employed. --- Informal sector enterprises According to the 15th ICLS conceptual framework, unincorporated enterprises owned by households are largely considered as informal sector enterprises. According to PLFS (Periodic Labour Force Survey), proprietary and partnership enterprises are considered as informal sector enterprises. In bellow table share of workers in informal sector among workers in usual status (ps+ss) in non-agriculture sector is presented. --- Table 1.5 Percentage of workers in non-agriculture sector Source: Annual report of PLFS In the above table we can see category of workers specially male and female percentage of workers engaged in both rural and urban areas. Also we can see the percentage of rural and urban mix for both male and female workers engaged in non-agricultural sector from the period 2017-18 to 2020-21. Among the above given period in the table we can see male workers percentage is highest 80.9% in rural area in 2020-21 year, lowest in 2017-18 that is 74.4%. Male workers percentage is also highest 68.5% in 2020-21 in urban area, lowest in 2018-19 that is 65.8% only. In female workers category it was highest 59.4% in 2019-20 in rural area, the share of female worker was lowest in 2018-19 and 2020-21 both 58.5% in rural area. In urban area share of female worker is highest in 2020-21 with 54.7% and lowest in 2018-19 with just 50.2%. In rural + urban, the male workers percentage is lowest in 2017-18 with 71% and highest in 2020-21 year with 75.3%. ❖ There are no social security programmes in place to address risks and guarantee the continuation of minimal standards of living during emergencies like unemployment or medical problems. ❖ Compared to men, women are more exposed to informality and frequently find themselves in precarious circumstances. Productivity: The MSMEs and home enterprises that make up the informal sector are often smaller than companies like TATA. The benefits of economies of scale are inaccessible to them. Inability to Raise Tax Revenue: Since the informal economy's companies are not directly regulated, they typically evade one or more taxes by concealing their revenues and outgoings from the legal system. The government faces a dilemma because a sizable portion of the economy is still untaxed. --- Lack of Control and Surveillance: The government continues to not oversee the informal sector. Furthermore, the government finds it challenging to formulate policies regarding the informal sector in particular and the entire economy in general due to the lack of official statistics that accurately reflect the state of the economy. Low-quality Products: Despite the fact that more than 75% of Indians work in the informal sector, very little value is added by each person. This indicates that a significant amount of our human resource is being wasted. --- Initiatives ▪ In order to help the poor, who make up the majority of the unorganised sector, programmes like the Nehru Rozgar Yojana, MGNREGA, and the Swarna Jayanti Shahri Rozgar Yojana were introduced. ▪ Atmanirbhar Bharat Abhiyan ▪ Deendayal Antyodaya Yojana National Urban Livelihoods Mission ▪ PM Garib Kalyan Ann Yojana (PMGKAY) ▪ One Nation One Ration Card ▪ Pradhan Mantri Kisan Samman Nidhi ▪ World Bank Support to India's Informal Working Class --- Conclusion The characteristics of the firm, rather than the traits of the person, are what define workers in the informal sector. The concept of a "Informal Worker" places more emphasis on the personality of the employee than on their employer. People with and without education can find opportunities in the informal sector in all regions of emerging nations. This is not a remedy for the current economic downturn or crisis. To support their families and take care of their children's education, everyone needs a certain amount of basic income. Because this sector contributes more than the official sector, the government should pay close attention to it.	According to the Code on Social Security, 2020, an unorganized worker is one who works from home, Employees in the organized sector who are not protected by the Industrial Disputes Act of 1947 or Chapters III to VII of the Code, such as Employees Provident Fund, Employees' State Insurance Corporation, Gratuity, Maternity Benefit, or Employee's Compensation, may be self-employed or wage workers in the unorganized sector. In India around half of the Gross Domestic Product (GDP) of the country and more than 90% of the total workforce have remained informally employed in informal sector. Since India got independence this informal economy have played an important role for socio economic development process especially in agriculture and allied activities. Informal employment contributes more than 95% of total workforces in Indian agricultural sector. This paper presents various issues and challenges faced by informal workers in India and discuss about it' remedies. Also in this paper we have discussed about the current scenario and condition of informal workers force in India. India needs to have employment-intensive growth in the future if it is to properly resolve the demographic dividend conundrum.
Ethical, Legal, and Social Implications of Personalized Health Technology Innovations from scientific discoveries may not be publically accepted because of ethical or legal concerns, or because of their failure to meet societal needs. For example, discrepancies in the global uptake of genetically modified foods persist, primarily due to insufficient investment throughout their development in understanding what is required for society to consider them to be safe. On the other hand, the Human Genome Project's proactive approach to addressing ELS implications led to broad acceptance of genetic and genomic research. President Obama's Precision Medicine Initiative may not lead to public benefit unless it explores pressing ELS implications. Technological advances with ethical dimensions necessitate robust science. Weak or insufficient evidence can fuel judgments based on ideology, or subjective perceptions of benefit or risk. The relative newness of PHT reflects an evidence base in its infancy with modest research demonstrating its effectiveness. Studies on how to improve health-related behaviors with these technologies are increasingly including proven principles of behavioral economics or behavior change techniques (Michie et al., 2013;Volpp, Asch, Galvin, & Loewenstein, 2011). Nonetheless, much more evidence about the use of PHT to promote behavior change must be generated, synthesized, and presented in ways that enable decision-makers to understand its value. Legal concerns may also hinder progress in PHT. The President's Council of Advisors on Science and Technology (2014) concluded: ''Only in some fantasy world do users actually read [privacy] notices and understand their implications before clicking to indicate their consent.'' Insufficient attention to how privacy is protected or how personal health data from PHTs is used may result in unanticipated or irrevocable consequences for companies and consumers. Concerns exist about whether personal health data is being used by companies in ways that consumers do not expect, including sharing information with undisclosed third parties or with entities in countries that might have different rules with respect to data privacy and use. Designing PHTs with privacy considerations ''baked in'' through approaches like ''privacy by design'' may help mitigate if not avoid these legal issues (Cavoukian & Jonas, 2012). Social concerns may further impede the uptake of PHTs and their potential health gains. Different groups profit unequally from innovation. At present, many PHTs benefit the younger and affluent ''worried well'' rather than high-risk and marginalized populations; digital divides continue to widen as new and often expensive PHTs enter the marketplace. Poor health literacy and numeracy further inhibit interpretation and use of PHT data to support informed health decision-making. These issues must be taken into account in the design of PHTs if they are to have widespread impact on individual and public health. ELS challenges are often perceived as impediments to progress, but this need not be the case. A responsible approach to innovation engages society in considerations of the ELS implications of technology through the entire development process. Responsible innovation anticipates and evaluates the potential implications and societal expectations of technology in ways that are democratic, equitable, and sustainable (European Commission, 2013). --- Consultation for Collective Action: Guidelines for Personalized Health Technology To advance consideration of ELS implications of PHT, we hereby launch a global public consultation on a draft set of Guidelines for Personalized Health Technology (Vitality Institute, 2015). The guidelines include six recommendations: (1) Ensure PHTs use principles of evidence-based approaches to health behavior improvement, such as behavior change techniques and behavioral economics; (2) Design PHTs with the aim of promoting utility and equitable accessibility across diverse populations; (3) Integrate approaches like privacy by design in the development and management of PHTs and supporting systems; (4) Advance user-centered design of PHTs; (5) Enable evidence on PHTs demonstrating validity, reliability, and other key performance metrics; and (6) Facilitate transparency with respect to data stewardship. These guidelines are intended to serve as a set of principles for the responsible development of PHTs and stewardship of their associated data. Their impact demands input from the full range of stakeholders in PHT: health care professionals, payers, academic researchers, public policymakers, designers and developers of PHT, and concerned consumers. The Vitality Institute, an action-oriented and evidence-based health promotion and chronic disease prevention research organization, will pilot these guidelines with these stakeholders. The uptake and utility of these guidelines will be assessed using independent evaluators. Based upon this evaluation, the guidelines will be revised and promoted as a self-regulatory framework for the PHT industry that can help assure that PHTs have a sustained positive impact on the health of the public.	The ubiquity and use of smartphones, sensors, devices, and wearables that monitor, diagnose, and improve health behaviors is exploding. We track our health habits by strapping wearables to our wrists, attaching patches to our skin, and even ingesting sensing pills that transmit signals to our health care providers (Topol, Steinhubl, & Torkamani, 2015). Deluges of data are analyzed for insights at lightning speed. These personalized health technologies (PHTs) produce completely new categories of data that make precision medicine both a reality and potentially cost-effective. The voluminous data trails these smartphones, sensors, devices, and wearables leave behind also open new doors for misuse and harm by well-intentioned innovators and malevolent characters. Innovation of PHT is several laps ahead of ethical, legal, and social (ELS) considerations that are needed to allay legitimate concerns of prospective users and their health care providers. Is this personal health data accurate, reliable, and trustworthy? Is it wise to share publically on social networks or privately with health care providers? Are companies reusing the data for marketing or advertising purposes? Is it protected from cybercriminals? Uncertainty in these areas may limit the quality, acceptability, uptake, and potentially revolutionary benefits of PHT. Collective action by varied stakeholders is needed to eliminate ELS barriers of PHT use for individual and societal benefit.
The importance of providing gender-affirming healthcare to transgender individuals is underscored by the potential positive impact on their mental health, as demonstrated by studies conducted in the US. These studies have shown improved mental health outcomes, such as decreased suicidality and psychological distress, for transgender people who are undergoing, or have experienced, certain procedures. 2,3 These procedures, in the US, involve psychological help, gender-affirming hormones, surgery, and puberty blockers. 4 Despite the 2018 bill's promise to deliver transgendercentred healthcare, a thorough investigation of the current literature reveals that no studies regarding the efficacy of these treatments have been conducted on the transgender population of Pakistan. While the validity of US-centred studies isn't denied, Pakistan's social and religious climate may demonstrate differing effects on their mental health. The quality of healthcare is further questioned after the proposed changes to the Transgender Persons Rights Act of 2018. These amendments would replace the term "transgender" with "intersex", 5 excluding transgender people with unambiguous genitalia and drastically reducing their access to healthcare. As the social climate heats up, trans people risk further discrimination. Therefore, it's essential that researches be conducted to observe and test the impact of the current healthcare on transgender people, as it would highlight any gaps in the medical understanding of gender dysphoria, offer constructive criticism to help improve the state of healthcare, reduce healthcare discrimination, and aid the passing of more inclusive laws. We hope that studies will be undertaken on this issue to eventually create a healthier, safer space for transgender population. --- Conflict of Interest: None. Source of Funding: None.	Dear Editor, According to the 2017 census of Pakistan, the transgender population has been estimated to be around 10,000. In contrast transgender activists speculate that the number may be closer to 300,000. 1 Regardless of the number, the controversy surrounding transgenders, and their healthcare, has risen to the forefront of our society in the past several years. This was further fuelled by the Transgender Rights Act of 2018 in Pakistan, which promised access to gender-affirming healthcare.
INTRODUCTION Children are part of the younger generation as one of the human resources that has the potential and successor to the ideals of the nation's struggle in the future, which has a strategic role, has special characteristics and characteristics, requires guidance and protection in order to ensure balanced physical, mental and social growth and development. However, in today's world not all children get what they deserve at their age, due to circumstances and various backgrounds, they are forced to live their lives as street children. Indonesia is a developing country where there are still many street children who are a product of industrialization. Street children are a social problem that is an interesting phenomenon in social life. This problem is getting worse when these street children prefer to stay on the streets because of their considerable income, this factor cannot be separated from some members of the community who often give some of their money to street children for reasons of pity. This actually makes them feel more at home on the streets and ruins their future because they prefer to be street children, from this gap also the street children Street children who are nurtured by Griya Baca receive various kinds of education and lifeskills, some of them who grow up from there managed to get off the streets and get a job too, this means that street children if treated properly will become a good generation in the future. However, this care organization is engaged in volunteers, if it is not assisted by volunteers, street children may not be taken care of, which means that there needs to be concern from the community as well, so that they can jointly protect street children. From the interview with the head of the Griya Baca Institute, Mrs. Tri Wijayanti, SE. Street children in Griya Baca are those who lose their physical, psychological, and economic rights, so they need a change of fate. He also said that street children need attention from all levels of society to support their empowerment. For this reason, it is necessary to foster a sense of community empathy to create a synergy of goodness as said by Mrs. Tri as the Head of the Institute. (Interview with Tri Wijayanti, on December 25, 2020) From these problems there needs to be an awareness campaign that can convey messages so that we care about street children, one of which is a campaign through illustrations. Illustration is an art of painting or art in the form of images that are immortalized for the sake of, which can provide an explanation and accompany an understanding, such as short stories in a magazine, comics, campaigns, or convey messages through the media. According to Arifin and Kusrianto (2009:70) the function of illustration is to clarify the message or information conveyed to provide a variety of teaching materials so that it is more interesting, motivating, communicative, and can also make it easier for readers to understand the message. To make it easier for readers to remember the concepts and ideas conveyed through illustrations (Arifin and Kusrianto, 2009: 70). From the statement proves that Illustration is currently widely used as a means to represent a value or as a problem solving. This campaign will use t-shirts as the media, t-shirts are suitable media because of their nature that can be carried everywhere when worn, which illustrations will be easily seen by many people. T-shirt media was chosen because it is effective as campaign media, considering that the activities carried out by Griya Baca are always outdoors, so when this t-shirt is worn by Griya Baca children, the illustrations and messages will be easily seen by many people. illustrations and messages will be easily seen by the community when activities are taking place. --- RESEARCH METHOD The research was conducted at Griya Baca Malang Institution, focusing on observations in the field and interviews with sources, namely the head of the institution. From the research results will be summarized into segmentation and brainstorming for the work created. The segmentation of this illustration is as follows: 1. Demographics Based on gender demographics, the segmentation of this Peduli Anak Jalanan illustration is female or male, aged 20-45 years, who have jobs as students to employees. --- Psychographic Based on the psychographic segmentation of the Peduli Anak Jalanan illustration are those who tend to care less about the situation around more precisely street children. --- Behavioral Based on the behavioral segmentation of this t-shirt illustration are those who tend to move outside the home. --- A. Targeting Targeting of the Peduli Anak Jalanan t-shirt illustration is an adult who has a good financial and mental health, because based on research & interviews, adults are more able to take part in nurturing street children, especially at Griya Baca. --- B. Positioning Based on Griya Baca's activities that are more often outdoor or outdoors, the Peduli Anak Jalanan illustration placed on t-shirts will be a suitable media for people who see it. --- RESULT AND DISCUSSION Product description is an identification stage that contains the type of product, size, media, quantity and theme that will be used in designing Griya Baca t-shirt illustrations. --- No. Specification Description 1. Theme Peduli Anak Jalanan The purpose of this t-shirt illustration is to design an effective t-shirt illustration for street children in Griya Baca as a media campaign of care, it needs an illustration concept that can convey the campaign message well. The concept of this illustration themed "Peduli Anak Jalanan" has the meaning of an invitation to share, help, assist, nurture street children, especially in Griya Baca Malang. Illustrations are made in a contemporary style that is a mixture of cartoon style, decorative as well as popart colors. this illustration has 3 titles, which are: Tumbuh, Belajar & Berbagi (Growing, Learning, Sharing). The cartoon style was chosen because it can describe and convey messages easily, making it easier for someone to imagine a meaning, the segmentation of this illustration is 20-45 years old, and the purpose of this campaign is concern for street children. Each t-shirt illustration has quotes to strengthen the message to the viewer of the work. Represented by 4 characters, Giri & Gara (a boy and a girl), Riri (a teenage girl), and Yaya (an adult man). The four characters are representatives of those who grew up in Griya Baca, as well as the embodiment of the 3 illustration titles. --- Gara's Character Gara is a 10-year-old boy who is growing up, has a cheerful character, always active, curious about new things, gara character for illustration Growing up. --- Giri's Character Giri is a 10 years old girl character, active and playful, Giri is a character for illustration Growing up. --- Yiyi's Character Yiyi is a 17-year-old teenager, searching and exploring her potential, a teenager full of many directions for her to explore. Giri is a character in the illustration Learning --- Yaya's Character Yaya is an adult male character, he is a child who grew up and matured from Griya Baca, has a calm character, always cares and shares with his surroundings, Yaya is a character for the illustration Sharing. --- ILLUSTRATION OF GROWING, LEARNING AND SHARING Giri, Gara, Yiyi, and Yaya are representatives of street children who are around us, those who we need to care for, and need our care. The "Peduli Anak Jalanan" campaign, is a manifestation of what street children want, those who come from various backgrounds, due to limitations and conditions, these children do not get what they should get at their age, but through Griya Baca, our concern can be the light of their hope, to grow, learn and share. Let's care about street children, they need us, they also deserve a bright future like us, they are the next generation of children of the country. This illustration consists of 3 titles namely Growing, Learning and Sharing. With details as follows: --- a. Growing With headline "Bertumbuh dengan Kami" has a message that we as fellow humans. Living side by side with street children, who in fact are the children of the nation's generation. They are just like other children, we need to pay attention, we care, we help. Giri & Gara in this illustration will represent the meaning of "Growing", they are depicted happily playing and laughing in Griya baca. This illustration will be depicted as the character Yiyi. A teenager who is always curious and finding out about himself. With the headline "Menempa Jati Diri" has a message that street children who are left alone will not be able to be themselves. Since they are homeless, they cannot get an education as they should. We as adults should help and guide them. With our care, they can go to school and study at Griya Baca. Yaya's character is described as an adult male, representing someone who is useful to others. Yaya is a street child who grew up in Griya Baca. With the headline "Rangkul Anak Negeri" invites us to share with street children. --- Product Effectiveness Testing Regarding product effectiveness testing, testing is done online. With the questionnaire method, in which there are questions. The question will be addressed to the respondent (connoisseur of the work), Griya Baca street children care illustration t-shirt. Respondent will answer the questions that already exist. With an indication of the answer, very good, good, enough, not good enough. Taking answers is done by including a question link. And share the work in the form of pdf, to the respondent. So that they can examine the illustrations. In the calculation of questionnaire answers, using quantitative numerical methods. From the test results by targeting 30 audiences. With an age range of 20-45 years old men and women. Successfully achieved the results of 62 respondents. From the results above, the majority of 40-50% of respondents answered "very good" in each question, 30-40% answered "good" and less than 5% of respondents who answered less than good. So from the above results, the illustration of this awareness campaign t-shirt has successfully achieved a positive response. --- Respondent results from 10 questions --- CONCLUSION Based on the existing problems and solutions made by using illustrations with t-shirt media, the following conclusions are obtained: 1. In making this illustration, it takes a long stage starting from research, brainstorming, determining segmentation, concept, to execution on t-shirts.	Street children are a social problem that is an interesting phenomenon in social life. Quoting from street children who are cared for by Griya Baca Malang, here there are a lot of children who do not get an education like ordinary children, due to their circumstances which require them to live on the streets, even earn money by busking/begging, their background is mostly from economic pressure. , from this problem it is important for the community to care more about them because after all they are the nation's generation, after research on the problem, the solution for this is to hold a awareness campaign through t-shirt illustrations. The purpose of designing this t-shirt illustration is as a form of public awareness to be more concerned with street children. Illustrations will make it easier to convey messages and have their own charm so that messages from the campaign can be conveyed properly. Product effectiveness testing was carried out on February 16, 2022, showing that the results of the assessment of this t-shirt illustration obtained a fairly high positive percentage, namely 29 out of 30 respondents. This book received a positive response from respondents based on the results obtained from this test.
Introduction Discontinuation of contraceptive use when a woman is not ready for pregnancy hampers her reproductive plans, causes unintended pregnancy, and unsafe abortion. Generally, this put women at risk of maternal morbidity and mortality. Seasonal or intermittent use of contraceptives in a growing population has effect on the population structure and has been found attributable to 35% of unwanted pregnancy in developing countries 1 . However, young adolescent girls are more at risk of contraceptive discontinuation than older women and are even more likely to become pregnant while using contraceptive which contributes additional 25 percent to contraceptive failure rate 2 . When single adolescents who experiment with sex discontinue contraceptive, and get pregnant, their education and employment opportunities are deterred, this is not good for countries (e.g., Nigeria) with young people 3 . Nigerian population increases by at least 2.54% every year 4 . Adolescents contribute significantly to new births annually with 23% of adolescent girls aged 15-19 years already entered motherhood 5 . Similarly, adolescent girls with unintended pregnancies may resolve to unsafe abortion due to societal factors around premarital pregnancy and legal status of abortion 6 . In Nigeria where access to abortion is legally forbidden, abortions are often performed secretly and are unsafe resulting in serious complications this means that contraceptive discontinuation put Nigerian adolescents at risk of maternal morbidity and mortality 7 . Contraception has high impact on maternal and child health outcomes with additional benefits for young people such as keeping them in school, employment potential and preventing early motherhood. In spite of the benefits and efforts at all levels globally to encourage contraceptive use, over 200 million women of childbearing age in developing countries including adolescent girls are not ready to get pregnant but are not using contraceptives 8 . It has also been reported that 28 percent of adolescent girls with unintended pregnancy were formerly using contraceptive but discontinued use 9 . Despite the knowledge on the need for contraceptives the rate of discontinuation is on the increase among users who are still at risk of unwanted pregnancy in Nigeria 10 . Comprehending contraceptive discontinuation is important because of its effect on women life course, most importantly for young women with self-motivated contraceptive behaviour 11 . As efforts are been made to ensure adolescent girls sexual and reproductive health rights. It is important to investigate the factors of contraceptive discontinuation that can hinder adolescent girls from meeting their reproductive needs. Several factors have been found to be associated with contraceptive discontinuation among women of reproductive age. Nigerian women of reproductive ages who experience intimate partner violence are more likely to discontinue use of contraceptive 12 . Also, variation in ethnic group and other socio-economic characteristics are associated with contraceptive discontinuation 10,13 . Lack of counselling on family planning from a health care provider and who made decision about the method to use also contribute to discontinuation 13,14 . Although, studies have established association between socio-economic characteristics of women and contraceptive discontinuation among all women. Little is known about unmarried adolescents who discontinues the use of contraceptives in Nigeria. --- Method Data for this study come from the cross-sectional survey of the 2018 Nigerian Demographic and Health (NDHS) survey. The survey is nationally representative and covers a wide range of topics including contraceptives. The survey used the sample frame from the Nigeria 2006 Population. Census sampling for the survey was stratified in two stages. The states were divided into rural and urban areas and households were selected through probability sampling. Data were collected from women aged 15-49 years for the women recode. In this study, data for 324 single adolescent girls aged 15-19 who had ever used any contraceptive method were used. The variable of interest is contraceptive discontinuation. It is measured as 'ever discontinued a method in the last five years. During the survey the respondents were asked if they have ever stopped using a method in the last five years, the method they discontinued and the reasons for discontinuation. The background characteristics used in this study includes age, highest level of education, religion, place of residence, region of residence and household wealth quintile. Frequency and percentage distribution were used to describe the profile of the study sample, reasons and are presented in tables, pie and bar charts. Socio-economic characteristics of respondents who reported ever discontinued a method in the last five years was assessed. Also, reasons for discontinuation were check against method discontinued. Analysis was weighted to control for sampling error. The statistical package STATA version 14 was used to perform data management and analysis. Data for this study is extracted from a de-identified open source hence, it is exempted from ethical review by the Ethics committee of the University of the Western Cape, South Africa. --- Result This section presents the prevalence of contraceptive discontinuation among unmarried adolescents aged 15-19 years within the last five years in Nigeria (figure 1). Table 1 shows the socio-economic characteristics of adolescents aged 15-19 years who discontinued use of any method of contraceptive within the last five years before the survey. Figure 2 depicts the percentage distribution of reported reasons for contraceptive discontinuation among the respondents while table 2 presents the percentage distribution of method discontinuation by reason among unmarried adolescents aged 15-19 years in Nigeria. For this study, one-fifth (20%) of unmarried adolescent girls who had ever use contraceptive report discontinuation in the last five years. The background characteristics of the respondents who had ever discontinued a method are shown in table From Figure 2 above, more than half (54.6%) of adolescent who discontinued contraceptive in the last five years did so because of infrequent sex, 11.2% discontinued use as a result of inconvenience in use, this is followed by 7.0% who discontinued use because of side effects. Very few (1.1%) reported fatalistic as the reason for discontinuation. --- Contraceptives among Adolescents Male condom is the method mostly discontinued in the last five years among adolescents (68.2%), while lactational method is the least method (0.6). Over one-tenth (13.7%) discontinued withdrawal method. While 1.0% discontinued pills. All who discontinued pill discontinued because of side effects. Majority of those who discontinued male condom did so because of infrequent sex (63.9%) while onetenth (10.6%) reported inconvenience as reason for discontinuation followed by partner's disagreement. Reasons for discontinuation more than other type of contraceptives. Male condom is the most reported discontinued method. This is line with findings from a study among undergraduates Brazil which shows that male condom is the most predominantly method discontinued 18 . The study further shows that ladies in spontaneous relationships are at higher risk of male condom discontinuation. This may also explain the situation here as the prevalent reason for male condom discontinuation is infrequent sex. This is also similar to the finding in northern Tanzania among women aged 16-44 years and in Urban Senegal among women of reproductive age, male condom has the highest rate of discontinuation 15,19 . The most cited reason for discontinuation of all method of contraceptive are infrequent sex, inconveniency, and side effects. These were the same reasons given for discontinuation apart from pregnancy by women of reproductive age in Tanzania 20 . This is similar to the findings among married women of reproductive age in the country, infrequent sex is the most reported reason for discontinuation among married women 10 . It could be that unmarried adolescents in Nigeria engage in sexual relation occasionally and only use contraceptive once-off at the event. In this case, the risk of unintended is worthy of note. In support of this finding, side effect was mentioned as one of the major reasons for discontinuation in Senegal and Ethiopia among all women 15,16 . Also, generally among all married women in Nigeria it is reported as one of the major reasons for discontinuation 10 . This is evident in the method use, it explains why there is low use of hormonal methods among unmarried adolescents in Nigeria. --- Conclusion Despite low use of contraceptives among unmarried adolescents in Nigeria, a large proportion of those who has ever use any method of contraceptive discontinues use. The reasons reported and profile of affected adolescents indicated a need for better sexual and reproductive health education for adolescents. Also, encouraging the uptake of long term modern contraceptive method among adolescents in Nigeria. It has been shown that short term users ae more likely to discontinue use compared to long term users 21 . --- Contraceptives among Adolescents More than half (59.2%) of those who discontinued periodic abstinence did so because of other reasons followed by infrequent sex (21.2%) then union dissolution (19.6%). Two-fifths of those who discontinued withdrawal method did so because of infrequent sex (40.2%) while 27.4% did so because they became pregnant and 24.6% because it is not convenient. All respondents who reported other traditional method as method discontinued in the last five years discontinued the methods because of side effects. Also, all those who stopped emergency contraception and other modern method did so because of infrequent sex. In the same vein those who discontinued LAM discontinued because it is inconvenient for them. --- Discussion The objective of this study is to examine the reasons why unmarried adolescents aged 15-19 years in Nigeria who had ever use any method to prevent pregnancy has ever discontinued use in the last five years. This study found that one-fifth of adolescents (20%) aged 15-19 years have discontinued a method of contraceptive in the last five years. This is lower compared to the prevalence reported in 2014 for all women of reproductive age in Kenya (30.5%), the prevalence reported among all married women across ethnic groups in Nigeria (Hausa/ Fulani 40.2%, Igbo 35.6%, Yoruba 33.6% and Minority 37.8%) 10 , and the prevalence reported among all women of reproductive age in Urban Senegal (34.5%), Ethiopia (27.1%), Ghana (56%) [15][16][17] . This may be because of the study population. Most of unmarried adolescents who discontinued method are 19 years old, have secondary education, resides in the Urban areas, had first sex at age 15 or older, from richer household and lives in the Southeast. The most reported discontinued methods are the male condom, withdrawal, and periodic abstinence while the least reported are the pills, emergency contraceptives, and other modern method (IUD/Implants). This could mean that adolescents contraceptive users prefer male condom African Health Sciences, Vol 22 Issue 4, December, 2022	Background: Adolescent girls are the mostly affected with maternal and child complications. Contraceptive use is an important tool in curbing sexual and reproductive health challenges especially among adolescent girls in the developing countries. Despite, the low use of contraceptives among adolescents in Nigeria, the possibility of discontinuation of use after initiation is strong. Objective: This study aims to identify method of contraceptive use discontinued and reasons for discontinuation of contraceptives among unmarried adolescents aged 15-19 years in Nigeria. Method: Data for 324 never married adolescent girls who had ever used a method to prevent pregnancy were drawn from the 2018 Nigerian Demographic and Health Survey. Descriptive statistics and chart were used to present the results. Result: Findings showed that 20% of adolescents who had ever used contraceptive discontinued use in the last five years. Most of single adolescents who reported ever discontinued a contraceptive method are older, have secondary education, resides in Urban areas, were at least 15 years at sexual debut are from richer household. Most reported reasons for discontinuation were Infrequent sex and inconveniencey in use.One in five of unmarried adolescents who ever use a method, discontinue use because of sexual frequency and type of method used.
Introduction: The COVID-19 pandemic has probably been the most devastating financial and social crisis of recent times, leading to the suspension of almost all economic activity and forcing a country-wide lockdown. Tourism contributes 5.06 per cent to India's GDP . The ongoing pandemic, travel restrictions, and the countrywide lockdown have brought the entire tourism industry to a standstill. Unlike other sectors, tourism, especially leisure tourism, will take longer to recover. This will directly impact states like Tamil Nadu and Kerala in the southern part of the country. The Indian tourism industry employs 8.75 crore people (12.75 per cent of the total employed population in 2018-19), such as people from the hospitality industry, tour operators, travel agents, homestay owners, drivers, guides, small traders, artisans and artisans among a host of other service providers. The sector also has strong forward and backward linkages to other sectors, such as agriculture, transport, handloom, and FMCG. Disruptions in the tourism sector will render many people unemployed. The food and hospitality sector is already under pressure from high fixed costs and no footfalls. The researcher initiated to analyse of the impact of covid'19 on the shop holders in the Kanyakumari district. --- Profile of study area: Kanyakumari district is located in the southernmost part of mainland India and is one of the 38 districts in Tamil Nadu. Among all the districts in Tamil Nadu, it has the second highest population density. Moreover, it is the wealthiest district in the state when considering per capita income. Additionally, it is at the top of the Human Development Index, literacy, and education rankings in Tamil Nadu. The district's headquarters is situated at Nagercoil. --- Review of Literature: Muhammad Khalilur et al. (2021) "Effect of Covid-19 pandemic on tourist travel risk and management perceptions". The findings reveal that the Covid-19 pandemic has greatly affected travel risk and management perceptions. Travel risk and management perception were significantly associated with risk management, service delivery, transportation patterns and distribution channels, avoidance of overpopulated destinations, and hygiene and safety. The results also identified the mediating effect of travel risk and management perceptions. The finding of this study contributes to tourism crises. It provides future research insights into the travel and tourism sector and response to change tourists' travel risk and management perceptions in the post-covid recovery period. Reshma Sucheran (2021) "Preliminary Economic Impacts of the COVID-19 Pandemic on the Hotel Sector in South Africa". The data for this paper is based on the hotel sector specifically and is extracted from a larger dataset that examined the economic impacts of the COVID-19 pandemic on all accommodation establishments in South Africa. Online surveys were administered to accommodation establishment managers. Approximately 3,000 accommodation establishments were targeted, and 482 responded, of which 67 were hotels. The study confirms that the hotel sector in South Africa has experienced severe economic impacts due to the COVID-19 pandemic, and some hotels face the risk of bankruptcy and permanent closure. Employment has also been substantially affected by job losses, reduced pay, and staff made redundant. Current concerns facing hotels are cash flow, travel restrictions, guest cancellations, low consumer spending, the overall economic uncertainty of the industry, as well as the uncertainty of the COVID-19 pandemic. --- Statement of Problem: The COVID-19 pandemic has severely impacted the tourism industry worldwide, and the study area has not been an exception. From aviation and hospitality to transportation, tour operators, and eateries, all tourism-related activities have been adversely affected in an unprecedented manner. The Kanyakumari district, known for its tourist attractions such as Kanyakumari City, beaches, forts, and Thirparappu Falls, has seen a significant decrease in business. The district usually attracts more than two crores of tourists annually, with summer tourism being the second biggest season, attracting at least ten lakh tourists per month from the first week of April to the first week of June. Unfortunately, due to the pandemic, nobody is coming to the district, leaving more than 10,000 shop owners who solely rely on tourism for their livelihood struggling to make ends meet. As a result, most shop owners have become unemployed, making it difficult to support their basic needs. This study aims to identify shop owners' socio-economic standing, highlight the difficulties they faced amidst the Covid outbreak, and suggest ways to improve their means of living. --- Objectives of the study: • To analyse the impact of covid'19 pandemic on the socio-economic status of the shop holders of tourist places in Kanyakumari District. • To offer suitable suggestions to improve tourism and the socio-economic status of shop holders in the study area. --- Null and Alternative Hypotheses: HO: There is no significant association between the impact of covid'19 pandemic on the socio-economic status of shop holders' and their satisfaction with the business. H1; There is a significant association between the impact of covid'19 pandemic on the socio-economic status of shop holders' and their satisfaction with the business. --- Scope of the study: The present study critically evaluates the impact of the covid'19 pandemic on the shop holders of the tourist places in the Kanyakumari district and how their lives are affected. The study's outcome will be useful to the Department of Tourism in India and the Kanyakumari Town Panchayat Office, as it will portray the socioeconomic condition of small business people in the district. It may be helpful to concerned authorities to take necessary steps to protect the socio-economic conditions of small shop owners of the district. Besides, take promotional steps to increase domestic and foreign tourist arrivals. Employment generation and foreign exchange earnings will also increase the Kanyakumari district and the country's economic development. --- Methodology This study focuses on shop holders operating in the tourist hotspots of Kanyakumari district. The researcher developed a comprehensive questionnaire based on the study's objectives and previous research to ensure accuracy and relevance. Statistical experts and local shop owners evaluated the survey for validity during a pre-test phase. Based on their feedback, the questionnaire was refined to improve its effectiveness. The data collection areas for the study were randomly selected as Kanyakumari, Vattakottai, and Padmanabhapuram. The questionnaires were distributed to the targeted population in these areas, and the responses were collected and analysed accordingly. --- Limitations • The sampling method used was Judgmental sampling; therefore, the shortcomings of the nonprobability sampling may also apply to this study. • The research is mostly based on primary data, and the validity of the research depends upon the truthfulness of the responses from the selected respondents. The second table presents the demographic breakdown of the respondents who participated in the study. The data shows that 57.48 percent of the participants were male, while 42.52 percent were female. Regarding age distribution, most respondents (44.88 percent) were between 30 and 50 years old, followed by 29.92 percent below 30 years and 25.20 percent above 50 years old. Additionally, almost three-quarters of the participants were married. --- Data Analysis and Interpretation The survey revealed that most of those who participated (66.14 percent) are proficient in two languages. Out of this group, 41.73 percent reside in urban areas. The data also shows that 37.0 1 percent of respondents have worked between 10 to 20 years. Regarding monthly earnings, 45.67 percent of respondents earn between 20,000 to 50,000. Table 2 discloses the segmentation of shop holders based on their business. It is observed that a maximum of 20 shop holders (15.75 per cent) are making fancy goods sales, followed by 18 respondents (14.15 per cent) and 61 respondents (11.66 per cent) are engaged in the textiles and garments business. It is further noted that 54 respondents (10.33 per cent) were in transportation services, 52 respondents (9.94 per cent) were in handicrafts, and 47 respondents (8.99 per cent) had fruits stall. --- 2. Travelling was completely banned CPB2 --- 3. Tourists' arrival was completely stopped CPB3 --- 4. We are not under the basic industries CPB4 --- 5. No revenue CPB5 --- 6. Unfortunately, we lost our business. CPB6 --- 7. Need help to pay salaries to our workers. CPB7 --- 8. Our customer base has dwindled. CPB8 --- 9. We are experiencing difficulty in retaining our employees. CPB9 --- 10. The condition of the stocks in the store and warehouse has deteriorated. CPB10 The results showed that the variables under the category "Impact of the Covid'19 Pandemic on Business in the study area" were highly significant, with appropriate loadings ranging from 0.591 to 0.764 according to C.F.A. analysis. Table 7 reveals the regression coefficient for the relationship between the impact of covid'19 on the business of shop holders in the study area and their level of satisfaction. The R-value indicates the correlation between the independent and dependent variables, with a value greater than 0.4 indicating that further analysis is needed. An R2 value greater than 0.5 means the model effectively defines the relationship between the chosen variables. In this case, both "R" and "R2" values exceed the threshold level, and the adjusted R-square is very close to the "R2" value, providing reliable results. Moreover, the "t" value of the selected independent variables is more than the 1.96 threshold level, and the corresponding "p" value is less than 0.05. Hence it is concluded that all the variables influence the respondents' satisfaction. --- Findings: • The data shows that 57.48percent of the participants were male, while 42.52percent were female. • Regarding age distribution, most respondents (44.88percent) were between 30 and 50 years old, followed by 29.92percent below 30 years and 25.20percent above 50 years old. • Almost three-quarters of the participants were married • A majority respondents (66.14percent) are proficient in two languages. • Out of this group, 41.73percent reside in urban areas. • The data also shows that 37.01percent of respondents have worked between 10 to 20 years • 45.67percent of respondents earn between Rs. 20,000 to 50,000 per month. --- Conclusion This study focuses on the impact of the COVID-19 outbreak on the shop holders' business in the tourist places of Kanyakumari district. The outbreak of COVID-19 is a novel pandemic that severely impacted the lifestyle of most people across the globe. The critical economic shock to every person and every industry in most countries is the most common feature of the novel coronavirus. COVID-19 significantly impact the shop holders' business and their socio-economic status. Some of the threats faced by the economic environment during the pandemic are rising unemployment, world recession, uncertainty weighing on consumers, vaccine unavailability and business confidence.	The COVID-19 pandemic has caused immense financial and social upheaval, halting most economic activity and a nationwide lockdown. To assess the effect of the disease on shop owners in Kanyakumari district, we surveyed 127 shop owners from March 28 to April 18, 2022. Our findings revealed that the lockdown completely restricted travel and tourism, significantly impacting the shops. The socio-economic status of the shop holders in the study area is heavily affected.
Approximately six million people are incarcerated annually in the WHO EURO region. The majority of these people spend only a minority of their lives in prison. Many people living in prison (PLP) experience significant health & social care inequalities/inequities and have higher levels of health & care needs than their peers in the community. Imprisonment can represent a public health opportunity to identify and address such needs. Programmes delivered in prisons targeting infectious diseases like HBV, HCV, HIV and tuberculosis (TB) can improve active case finding specifically in prison settings but can also impact on elimination and control targets for whole populations by addressing high risk transmission networks centred in and around prison associated populations. But too often prisons represent a 'black hole' for health & care data flows, neither receiving health information from community-based health systems nor providing, in an accessible way, details of health interventions delivered in prisons. The result is discontinuity of care and inefficiencies (economic& clinical) in treatment and care programmes. For example, people being screened multiple times for an infection (e.g. HCV) but not receiving treatment, or starting and stopping multiple courses of treatment in a chaotic way which could add to public health risks, e.g. multi-drug resistant TB. National disease surveillance systems missing data on prison populations also risk health security given the ability of prisons to amplify infectious diseases which could pose health threats to wider communities. Significant efforts are required to ensure that national disease surveillance and health information systems routinely include PLP to improve health intelligence, health security and continuity of care. This can support delivery of screening, diagnostic and therapeutic services. But can also enable health service evaluation, health & care needs assessment, and quality improvement programmes. --- Background: Osteoporosis is a common skeletal disease. Previous research has been primarily based on non-prospective designs, and rarely included male and/or migrant populations. We investigated the associations of sociodemographic characteristics with risk of osteoporosis in a Swedish nationwide cohort. --- Methods: This register-based prospective study included 1,900,279 males and 1,961,619 females born in 1920-1960, followed for osteoporosis from age 50 until December 31, 2012. Multivariable Cox regression was used to estimate the associations with sociodemographic characteristics and was stratified by gender and co-occurrence of fractures. Results: 12,906 males and 84,621 females aged 50-92 years received a diagnosis of osteoporosis. Incidence rates increased sharply from age 70. At all ages, women on average had 5 times higher rates of receiving first osteoporosis diagnosis than men. Region of birth and education were associated with incidence of osteoporosis in a gender-specific pattern. Compared to Swedish-born women, incidence of osteoporosis without fracture was elevated among female migrants from the former Soviet states (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.51-1.73) and the Middle East (HR, 1.62; 95% CI, 1.48-1.78), but lower among those from other Nordic countries (HR, 0.94; 95% CI, 0.91-0.97). Compared to Swedish-born men, a higher incidence was observed for male migrants from North America (HR, 2.03; 95% CI, 1.47-2.81). When fracture was accounted for, Swedish-born individuals showed higher incidence compared to migrants from other European countries except Nordic. For all osteoporosis subtypes, higher education was associated with increased incidence in women but not in men. --- Conclusions	on people incarcerated during a given time period and; a ''European Facility Survey Questionnaire in Prison (EFSQ-P)'' aimed at collecting data on availability, coverage and provision of drug related interventions inside prison. The two monitoring tools include a short and long version and are accompanied by methodological guidelines. The toolkit should be used across countries to improve international comparisons and European harmonisation as well as to provide data to national governments or international organisations (e.g. EMCDDA, WHO, UN and others). Based on challenges identified among responding countries a check list of key issues in collecting data on drugs and health information in prison settings was drafted. This check list aims to provide a practical guide for those who want to start gathering data on drugs and health in prison; it has been drafted and agreed by a group of European experts who have implemented drugs monitoring in prison using the EMCDDA tools. The check list aims to discuss possible options and present best practices in drugs monitoring in prison in the different phases of research/data collection. The check list includes examples and recommendation on how to address the following issues: accessing prison, planning data collection, sampling procedures according to type of data to be collected, mode of administration/data gathering, data analysis and dissemination; ethical issues, involvement of people living in prison and staff in all phases of data gathering.
Objective In 2007, Talley and Crews framed caregiving as a public health issue and argued for its inclusion in state-level surveillance to obtain data about adult caregivers (1). Subsequently, a caregiving question was added to the 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey. Respondents were asked whether they provided regular care or assistance to friends or family members who have health problems, long-term illnesses, or disabilities during the past month. The objective of this study was to examine the demographic characteristics of caregivers, compare caregivers with noncaregivers, and compare younger (aged 18-64) and older (aged ≥65) caregivers on measures of well-being. --- Methods The BRFSS is an annual, state-based telephone survey (2). Data are from a representative sample of noninstitutionalized people aged 18 years or older from 50 states, the District of Columbia, and 2 US territories. Responses are weighted to the estimated population in states or territories. The median cooperation rate for the 2009 survey was 75.0%, and the median Council of American Survey Research Organizations response rate was 52.5%. A complete description of 2009 BRFSS procedures and definitions of response rates are available at www.cdc.gov/brfss/technical_infodata/surveydata/2009.htm. Respondents were classified as caregivers if they responded yes to the following question added to the 2009 BRFSS core: "People may provide regular care or assistance to a friend or family member who has a health problem, long-term illness, or disability. During the past month, did you provide any such care or assistance to a friend or family member?" Estimates were calculated for prevalence of caregiving by demographic measures (age, sex, race/ethnicity, education, marital status, and employment status) using pairwise deletion. Ninety-five percent confidence intervals (CIs) were provided for each estimate, and SPSS software version 20 (IBM Corp, Armonk, New York) was used to account for the BRFSS's complex sample design. Respondents were classified as having frequent physical distress if they reported they had experienced 14 or more days in the past month when their physical health interfered with their daily activities. Respondents were classified as having frequent mental distress if they reported 14 or more days when their mental health interfered with daily activities. We compared caregivers and noncaregivers on self-reported, health-related quality of life, degree of life satisfaction, and availability of emotional support. Finally, we compared older caregivers with younger caregivers on these same health and well-being measures. We used the Rao-Scott adjusted χ statistic to determine the independence of all comparisons. --- Results Overall, 24.7% (95% CI, 24.4%-25.0%) of respondents to the 2009 BRFSS were classified as caregivers. Caregivers were significantly more likely to be 50 to 64 years of age than from other age groups, to be female than male, and to be non-Hispanic black than from other racial/ethnic groups (Table 1). Caregivers were significantly more likely to have some college education than to have a high school education or less or to be a college graduate; they were also significantly more likely to be married or part of an unmarried couple than to be divorced, separated, widowed, or never married (Table 1 Compared with younger caregivers, those aged 65 or older reported a higher prevalence of fair or poor self-rated health and more frequent physical distress compared with caregivers aged 18 to 64 years (Table 2). Caregiver age was not related to reports of availability of emotional support. Caregivers aged 65 or older reported lower prevalence of frequent mental distress and being dissatisfied or very dissatisfied with their life compared with caregivers aged 18 to 64 years (Table 2). --- Discussion Approximately one-quarter of respondents were classified as caregivers. Estimates of the prevalence of caregivers vary across studies because of differences in definitions, sampling, and the age of person receiving care (3). For example, the 2000 BRFSS found a prevalence of 16.4% (standard error, 0.2%), but care was restricted to "a person aged 60 years or older" (4). Our higher prevalence may be due to elimination of the age restriction or other changes in the population and requires replication. We found that people classified as caregivers reported decrements in health-related quality of life compared with noncaregivers. We found that younger caregivers reported more mental distress compared with older caregivers. This finding is consistent with those of previous studies (3,5). The findings are subject to several limitations. Many factors may affect participation in telephone surveys and may influence our estimates of caregivers, such as their ability to participate in surveys, exclusion of institutionalized populations, and potential cultural differences about the meaning of providing care (6). We lacked data on the care recipient and the amount of time dedicated to care and type of caregiving activities. More detailed information about caregiving provision and activities is available from the BRFSS module being used in select states (5). Finally, data were collected in all 50 states, the District of Columbia, and 2 US territories and weighted to state-based population estimates. Caregiving has gained national attention because family members have been and will continue to be the primary providers of care to those with illnesses and disabilities (7-9). Caregiving will likely increase as the US population ages (10). As a result, understanding the extent, characteristics, and effects of caregiving on health and well-being can enhance efforts to improve the quality of life of caregivers and inform national strategies such as evidence-based programs for caregivers (11) and care transitions (12). Tables Table 1 Respondents were classified as caregivers if they answered yes to the following question: "People may provide regular care or assistance to a friend or family member who has a health problem, long-term illness, or disability. During the past month, did you provide any such care or assistance to a friend or family member?" Information about BRFSS weighting procedures can be found at http://www.cdc.gov/brfss/about/brfss_faq.htm#15. P value calculated using the Rao-Scott adjusted χ statistic. --- Author Information Corresponding Author: Lynda A. Anderson, PhD, Healthy Aging Program, Division of Population Health, Mailstop F78, 4770 Buford Hwy, NE, Atlanta, GA 30341. Telephone: 770-488-5998. E-mail: [email protected]. The RIS file format is a text file containing bibliographic citations. These files are best suited for import into bibliographic management applications such as EndNote , Reference Manager , andProCite . A free trial download is available at each application's web site.	We examined the characteristics of adults providing regular care or assistance to friends or family members who have health problems, long-term illnesses, or disabilities (ie, caregivers). We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine caregiver characteristics, by age and caregiving status, and compare these characteristics with those of noncaregivers. Approximately 24.7% (95% confidence interval, 24.4%-25.0%) of respondents were caregivers. Compared with younger caregivers, older caregivers reported more fair or poor health and physical distress but more satisfaction with life and lower mental distress. Understanding the characteristics of caregivers can help enhance strategies that support their role in providing long-term care. Preventing Chronic Disease \| Adult Caregivers in the United States: Characteristics and D...
impact on their identity, health, and well-being. Interviews with 125 AN Elders were conducted across five regions of Alaska: Bristol Bay, Interior, Norton Sound, Aleutian Pribilof Islands, and Southcentral. AN Elders traveled between rural and urban communities to access resources and connections critical to their identities, health, and well-being. Urban Elders maintained a connection to rural villages because they perceive them as healthier places to age based on access to traditional practices, land, and the community. Rural Elders spent extended time in urban settings to access health care services, be closer to family, and to benefit from the lower costs of living. This study builds upon existing migration theories by introducing a cyclical pattern uniquely driven by AN identity, culture, and traditional practices. Everyday discrimination-experiences of being treated unfairly based on background characteristics like race-is linked to poor physical and mental health throughout the lifespan. Whether more experiences of discrimination are associated with higher likelihood of being hospitalized in older African Americans has not been explored. Hospitalization can represent both poor health and healthcare access. Participants were community-dwelling African Americans from the Rush Memory and Aging Project or Minority Aging Research Study, longitudinal studies of aging (N=301 with at least 12 months linked Medicare fee-for-service claims; mean age 72.5 years (standard deviation [SD]: 5.7), 79% female). Discrimination was assessed using the Detroit Area Study Everyday Discrimination Scale. Hospitalizations (sub-categorized as elective/non-elective, surgical) were quantified using Medicare claims. Mixed-effects ordinal logistic regression models tested associations between baseline discrimination and subsequent odds of hospitalizations per year (0, 1, 2+). The mean baseline discrimination score was 1.7 (SD: 2.2). Over an average 6.5 years (SD: 4.1), 160 participants had at least 1 hospitalization (respectively, 118, 87, and 127 participants had at least 1 nonelective, elective, or surgical hospitalization). Adjusting for age, sex, education, income, depressive symptoms, and medical comorbidity, more experiences of discrimination were associated with higher odds of hospitalization (odds ratio [OR] per point higher on discrimination score=1.12, 95% CI: 1.03-1.22), and higher odds of nonelective (OR=1.12, 95% CI: 1.01-1.24), but not surgical or elective hospitalizations. Drivers of these associations, which may include preventive healthcare avoidance due to discrimination or poor health due to the chronic stress response to discrimination, should be explored. --- INDIGENOUS CULTURAL GENERATIVE ACTS TO REDUCE GENERATIVE MISMATCH AND IMPROVE HEALTH OF ALL GENERATIONS Jordan Lewis, University of Minnesota Medical School, Duluth campus, Duluth, Minnesota, United States The gerontological literature predominantly focuses on aging-related losses and less on the gifts we acquire as we age. Alaska Native Elders have experienced a lifetime of adversity, which persists today, but they have also remained resilient. One characteristics of successful aging among Alaska Native Elders is their commitment and passion for sharing their teachings with the youth. Generativity is concerned with using personal resources to improve the quality of life for future generations. While not commonly used in gerontological social work research, it is a cultural practice among Indigenous Elders. This decade long study has been exploring the concept of successful aging from an Alaska Native perspective, or what it means to age in a good way in Alaska Native communities. Qualitative, in-depth, interviews have been conducted with 154 Elders representing 20 participating communities across the State of Alaska to explore the concept of successful aging and the role of generativity in the aging process. For this presentation, 108 interviews with Alaska Native Elders explored successful aging. This presentation will highlight the critical role generativity plays in Alaska Native Elders' ability age in a good way, how generativity can be adapted to bridge the generative mismatch happening between generations and support each generation to healthy and meaningful lives. This presentation will also explore innovative and culturally responsive ways to teach the youth about aging in a good way and how families and communities can support their Elders to be meaningful engaged in the rapidly changing families in the Arctic. --- SESSION 2125 (SYMPOSIUM) Abstract citation ID: igad104.0516 --- BUILDING BRIDGES TO CONNECT BETWEEN NEEDS, RESOURCES, AND RURAL RESIDENTS Chair: Nancy Karlin Co-Chair: Lisa Ann Wiese Discussant: Cassandra Ford The percentage of older adults living in rural areas is predicted to rise with population aging. This impacts access to resources, creates barriers to effective aging, and promotes a unique aging experience. Consequently, demands are growing for services to support healthy aging in rural regions already experiencing healthcare disparities. This symposium will focus on location variations in resource availability, and unique interventions to promote aging in place. In the first and second presentations, researchers report on differences in current service utilization, satisfaction, and perceived future service needs/use among rural versus frontier-residing older adults in Wyoming, and in Nigeria, respectively. In the third presentation, successes and failures of an interdisciplinary approach to increase Alzheimer's disease and related dementias (ADRD) diagnosis/treatment rates are shared. The fourth group reports the impact of an intergenerational RCT intervention of training older adults in computer literacy and online chair yoga engagement, for decreasing pain levels and cognitive risk. This is a Rural Aging Interest Group Sponsored Symposium. Abstract citation ID: igad104.0517 --- CURRENT AND FUTURE SERVICE USE, SATISFACTION, AND NEED FOR SERVICES AS DEFINED BY RURAL AND FRONTIER OLDER ADULTS Nancy Karlin, University of Northern Colorado, Greeley, Colorado, United States This study focused on differences for current service utilization and satisfaction, along with perceived future service use and need for rural versus frontier residing older adults. A sample of older adults (age 65+), stratified using United States government and State of Wyoming definitions for rural (n=70) and frontier (n=72) counties, were interviewed. Frontier respondents reported less education F (1, 141) = 10.19, p = .002, η2 = .068, monthly income F (1, 141) = 17.03, p = .001, η2 = .108 with fewer financial resources F (1, 141) = 10.32, p = .002, η2 = .069, experience with technology F (1, 140) = 4.53, p = .035, η2 = .032, and potential for telehealth F (1, 140) = 19.27, p < .001, η2 = .112, along	engage in research-informed practice and practice-informed research. However, there remains a need in social work education for more widespread use of culturally relevant pedagogies that can help achieve these goals. Informed by both the Afrocentric and Black perspectives, this study presents a content analysis of the curricula infused at two historically Black universities. The nature and extent of the contributions of historically Black universities to social work education is the focus of this article. The scope of this investigation also includes the identification of prominent Black social work educators and discusses the implications of these perspectives for more culturally informed gerontology curricula that promote culturally competent gerontological social workers
Introduction The increasing amount of interfaces being used in a public context (in interactive installations, as well as in mobile and wearable devices), calls for studying interaction as a public practice. Recent interface examples include interactive public screens [8], multimodal art installations [5], wearable sensing devices to augment entertainment experiences [12] and mobile devices that can be used as props thanks to sensors [14]. Often, performative or theatrical metaphors have accompanied the development of these experiences with technology [12]. The workshop seeks to qualify the use of these metaphors further. The workshop aims at attracting concurrent research within both theoretical and constructive fields that contribute to the discussion around the workshop's main themes. In particular we are interested in exploring how interface technologies (e.g. multimodal, ubiquitous, and wearable interfaces) shape, choreograph, and/or articulate mobility and performative interactions in public settings. --- Theoretical background The term "performance" can be understood in many ways, from Goffman's idea that all everyday acts are performative acts [2] [3], over it being a staged 'act' with clear demarcations [11] to a processual sense of bringing to completion [4]. When viewing interaction from a performance perspective, the experience of technology and interfaces then also becomes a matter of actively or passively participating in a performance for oneself and/or for others. Reeves et al. [9] present a taxonomy with four broad design strategies for the performer's manipulations of an interface and their resulting effects on spectators. In response to this, Dalsgaard and Hansen [1] observe that a central facet of aesthetics of interaction is users' experience of themselves "performing their perception". --- Workshop Themes In light of the above theoretical background, three main interpretations of 'performance' and 'performativity' are likely to interweave:  everyday performances (inspired by Goffman's seminal work). E.g. the social acceptability of technology related actions in public spaces; appropriations of UX discussions as well as spectator and performer roles in interaction.  staged/explicit performances (inspired by performance studies and possibly phenomenology) E.g. using 'performativity' as a term that allows for a rich understanding of how, and under which circumstances, people interact with technology.  explorative interfaces. E.g. interfaces that are intentionally designed for a playful discovery of its affordances or subversive interfaces addressing use and perception of interfaces (e.g. inspired by critical design). In light of these understandings of performance and performativity, the workshop will address four main aspects of performative interactions in public spaces. --- Technologies for performative interaction A variety of interface technologies can shape and contribute to performative interaction in various ways. Computer vision can be used to track objects, bodily movements, and facial expressions; microphones can track and process sound, and wearable sensors and devices can be used to interpret gestures and their expressivity. However, performative interaction is not only supported by input, but also by multimodal processing and by output solutions. In fact, tangible interfaces such as multitouch are characterized by unifying input (control) and output (representation). The augmentation of input signals creates feedback loops that in turn affect the performative interactions. --- Evaluating user experience User experiences in public space are closely related to the feeling, emotional experience, and satisfaction of the interaction, which makes design and evaluation hereof a major issue. The experience is highly dependent on the context where the interaction is taking place and it develops and changes over time with repeated exposure to the interaction [7]. Identifying important user experience issues and evaluating them in an effective way is thus a difficult issue for designers. --- Spectator / Performer Roles Given the variety of settings where interfaces are used, the presence of the spectator plays an important role in the performance (cf. Theoretical Background above). Many interaction design interfaces are explicitly or implicitly influenced by 'audiences' and when the interface is almost always 'on the move' in public space, new challenges for interaction design arise. --- Social Acceptability Since performative interactions put users in public spotlight, the social acceptability is evaluated by the user before, during, and after the 'performance'. Issues of space and time become important, as do the ways that users make decisions about how to act with technology in public space. Research into the social impact of performative technology is, however, limited [10]. --- Workshop Goals The workshop is relevant to media theorists, practitioners and/or designers interested in:  Gestural interaction and on-body sensing (e.g. wearable computing/sensing, Wii, Kinect and proprietary systems) We encourage paper submissions that explore work-inprogress or early results that reflect upon any of the main workshop themes. For example, accounts of novel interactive technologies; evaluations of user experience in public settings; analyses of purely theoretical aspects such as spectator and performer roles or frameworks for understanding the relationship between public settings and interaction design; and empirical or theoretical studies of social acceptability of technology use in public settings. Preference will be given to submissions that outline works-in-progress or early results. Figure 3. Artworks, such as this scarf that shields an individual's phone from observers [6], highlight how using technology in public and mobile settings is convenient while also requiring users to socially negotiate their public and private spaces. The workshop will aim to facilitate the following outputs:  Workshop Results: A summary of the workshop discussions and results will be made available in a poster format during the conference.  Network: The setting up of a network of researchers and practitioners who are interested in performative interactions with and around technology in public settings with a view to forming future collaborations and publications. ---  Website: A workshop website has been created that will host the results of the workshop. Accepted papers will also be made available on the workshop website: http://www.digitalurbanliving.dk/pips.php	Building on the assumption that every human action in public space has a performative aspect, this workshop seeks to explore issues of interactions with technology in public settings. More and more interfaces are used in public on an everyday basis. Simultaneously, metaphors from performance and theatre studies find their way into research on these interfaces, addressing how interaction with technology can be understood in a performative sense. However, the term 'performativity' is rarely addressed in ways that accentuate its nuances and its analytic power, and this is the focus of the workshop. We will examine the design of performative technologies, the evaluation of user experience, the importance of spectator and performer roles, and the social acceptability of performative actions in public spaces.
At present, the US population of about 332 million represents about 4.25% of the population of the world, which is approximately 7.6 billion. 1 With respect to the novel coronavirus 2019 (COVID-19), however, even without the effects of the most recent widespread testing, the United States already has risen to number 1 in the world in both numbers of cases and deaths. Further, the number of cases in the United States of approximately 600,000 represents about 30% of the approximately 2,000,000 cases worldwide. Finally, the number of deaths in the United States of approximately 25,000 represents more than 20% of the approximately 110,000 deaths globally. 2 In the context of these ominous forebodings are emerging clinical and public health challenges in COVID-19 of recurring racial inequalities in mortality. Specifically, as of April 14, 2020, in the United States, 32% of the deaths from COVID-19 are among black residents despite the fact that blacks comprise only 13% of the population. 3 These descriptive data indicate a 2.3-fold excess risk of mortality from COVID-19 in the United States among blacks compared with whites. Quantitatively, it is plausible that this large magnitude of increase of COVID-19 is an overestimate. Qualitatively, however, based on the existing totality of evidence, [4][5][6][7][8][9][10][11] the observation is real and poses major clinical and public health challenges. For example, for many decades, markedly reduced life expectancies of blacks compared with whites have been noted despite advances in preventive, diagnostic, and therapeutic options. In addition, multiple factors have been identified and postulated to explain the observed persistent mortality disadvantages of blacks compared with whites. 5 Further, the availability of several life-saving, but prohibitively expensive to some, drugs [5][6][7][8] or a vaccine 9 in the United States has also led to marked increases in racial inequalities in mortality among blacks compared to whites. As Santayana aptly noted in 1905, "Those who cannot remember the past are condemned to repeat it." 12 In these regards, there are clear short-term clinical and public health challenges that include greater access to and use of health care by blacks and all disadvantaged minorities within the United States. With respect to COVID-19, now is the time to commit to short-term and long-term clinical and public health challenges. All should be considered in the context of the unique barriers that exist in black and other disadvantaged minorities in underserved communities. Despite the markedly increased logistical challenges, these include the achievement of equalities in the widespread rapid testing for the virus and its antibody, public health education on social distancing and handwashing, and access to medical care to decrease the racial inequalities in morbidity and mortality of COVID-19. In addition, the clinical and public health challenges should include numerous sustainable and Funding: None. Conflicts of Interest: CHH reports that he serves as an independent scientist in an advisory role to investigators and sponsors as Chair of data monitoring committees for Amgen, British Heart Foundation, Cadila, Canadian Institutes of Health Research, DalCor, and Regeneron; to the Collaborative Institutional Training Initiative (CITI), legal counsel for Pfizer, the US Food and Drug Administration, and UpToDate; receives royalties for authorship or editorship of 3 textbooks and as coinventor on patents for inflammatory markers and cardiovascular disease that are held by Brigham and Women's Hospital; and has an investment management relationship with the West-Bacon Group within SunTrust Investment Services, which has discretionary investment authority. RSL, HMJ, DGM report none. Authorship: All authors had access to the data and a role in writing this manuscript. Requests for reprints should be addressed to Charles H. multiple preventive and therapeutic strategies that have already been identified to be contributing to racial inequalities in mortality between blacks and other disadvantaged minorities compared with whites. In this article we offer what we believe to be the most important and timely long-term clinical and public health challenges to combat racial inequalities in mortality from COVID-19. Specifically, it is our strong belief that the most major clinical and public health challenges will be long term. They will inevitably result from the development of an effective vaccine for COVID-19, which may occur during the next 12 to 18 months. If an effective and safe vaccine becomes available, this intervention will be lifesaving. As has been the case before, the introduction of this life-saving innovation is likely to further increase racial inequalities that already adversely affect blacks and other disadvantaged minorities. For example, the advent of life-saving highly active antiretroviral therapy for human immunodeficiency virus was accompanied by increases in racial inequalities. Specifically, black-to-white mortality rate ratios among men increased from 3.2 to 6.6 (ages 25-34), 3.7 to 6.2 (ages 35-44), 3.9 to 8.6 (ages 45-54), 4.5 to 9.5 (ages 55-64), 6.0 to 12.7 (ages 65-74), and 6.0 to 15.3 (ages 75-84). Among women they increased from 8.3 to 13.2 (ages 25-34), 10.4 to 13.3 (ages 35-44), 10.3 to 15.9 (ages 45-54), 9.9 to 13.6 (ages 55-64), 7.7 to 22.4 (ages 65-74), and 5.1 to 15.9 (ages 75-84). 6 In addition, for respiratory distress syndrome, there was a nationwide reversal from a survival advantage to a survival disadvantage for blacks following the introduction of surfactant. 7 Most recently, similar increases in racial inequalities in mortality from hepatocellular cancer occurred followed the licensure of life-saving, but prohibitively expensive for some, drugs for hepatitis C virus, which is a major risk factor. 8 Perhaps of greatest direct relevance to COVID-19 were the experiences before and after the development of the Salk vaccine for poliomyelitis. 9 In 1952, before the introduction of the vaccine, blacks experienced significantly lower rates of paralytic polio than whites. These observations were hypothesized to be related to herd immunity among black children resulting from immunity acquired from infections that did not lead to paralysis in infancy and early childhood. Specifically, the incidence rates in Des Moines, Iowa, and Kansas City, Missouri, were 3-fold greater in whites than among blacks. By 1959, after the widespread dissemination of the Salk vaccine, the incidence rate in blacks rose to 21-fold greater among whites in Des Moines and 33-fold greater in Kansas City. 9 With respect to COVID-19, it may well be too late during the current pandemic to address the multiple factors, which already impose greater morbidity and mortality burdens on blacks and other socioeconomically disadvantaged groups. It is certainly important to conduct the high-quality research necessary to understand the factors responsible for observed increases in racial inequalities, which have been temporally related to the introduction of several life-saving innovations. It would also be of importance to identify communities that appear to have been more successful in achieving more equitable distributions of these life-saving innovations among blacks and other disadvantaged minorities. To do so, however, will require leadership from clinical and public health officials whose visions should build on and extend beyond the provision of resources for treating those who are ill today, beyond the identification and testing of promising but unproven diagnostic and therapeutic options, and perhaps most importantly, far beyond the development of an effective vaccine. In general, with respect to factors influencing inequalities in mortality between blacks and whites, it is necessary to consider the issue of mistrust. 8,10,11 Clinical and public health challenges should include the reality that, even at present, the US Public Health Service, for all of its valor, may still be mistrusted, particularly among older black men because of the lingering perceptions deriving from the late disclosure of the results of the Public Health Service Study of syphilis at Tuskegee, which withheld treatment from black men in favor of depicting the natural course of the disease. The study commenced in 1932, but the results were disseminated in 1972, approximately 30 years after the widespread use of penicillin as an effective and safe treatment for syphilis. As direct consequences of the unnecessarily late disclosure of the results, there were decreases in both outpatient and inpatient visits as well as subsequent increases in mortality. For black men, life expectancy at age 45 fell by up to 1.5 years, which is approximately 35% of the long-standing gap in life expectancy between black and white men. 10,11 The beacon at the end of the tunnel for COVID-119 may be an effective vaccine that may be available within the next 2 years. Based on the existing totality of evidence, we believe that the foremost clinical and public health priorities should be to achieve equality for all preventive, diagnostic, and therapeutic modalities of proven benefit, particularly and most urgently, the successful translation of vaccine research into practice. In the past the United States has appeared to have been far more adept at developing innovations than assuring that those innovations provide equal benefit to all people. Now is the time to address this crucial clinical and public health challenge. Death is inevitable, but premature death is not. If the valuable lessons from the past experiences in the United States with human immunodeficiency virus, 6 respiratory distress syndrome, 7 hepatocellular cancer, 8 the Salk vaccine for poliomyelitis, 9 and penicillin for syphilis 10,11 are not heeded, then those in greatest need will once again be condemned to the tragedy that Santayana foretold. 12	Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Научный отдел --- Язык возникает в повседневной жизни и тесно связан с ней Т. Бергер, П. Лукман Language as a social fact and action actualises all kinds of human life activities in the past, present and future, both in the constant and virtual social reality. The main function of any language -communicative -provides all kinds of human interaction. Consequently, it is natural to consider all native speakers, fi rst of all, as linguistic personalities, in other words, as individuals using a language to describe all phenomena, ideas, concepts, subjects and objects of the surrounding world picture. The phenomenon of the linguistic personality is a subject of research of a wide range of sociohumanitarian sciences, as the linguistic personality is the subject of construction of social reality. When referring to the defi nition of the concept of the linguistic personality, one should take into account the fact that there is no single defi nition due to its complexity and multidimensionality. However, the reason lies not only in this fact, but also in the fact that the functioning of the linguistic personality in the perspective of the subjective (personal) attitude to the surrounding social reality is manifested, in particular, in the choice of language tools adequate to the socio-cultural areal of the described or constructed social reality. And yet, most of the research is based on Y. N. Karaulov's concept, which is focused on the text generated by the linguistic personality. According to this theory, the linguistic personality is actualised in three aspects: -verbal-semantic as an adequate command of the linguistic means; -cognitive as a process that describes how the linguistic individual relates to the reality around him or her; -pragmatic (activity-based), refl ecting the target preferences, knowledge and skills of the linguistic individual [1]. In the psychological context, the linguistic personality is seen as a set of personality traits and qualities that determine the generation, perception and interpretation of texts as speech acts. All studies of the linguistic personality have the basis of analyzing texts both in terms of their linguistic characteristics and the availability of native speakers' readiness and ability to create and adequately perceive these texts [2]. The emergence of the information society, the creation and constant development and improvement of new technologies of information processing gave rise to new forms of communication. The new cultural and civilizational paradigm emerged and further actualized the importance of information and determined both new trends in the process of communication and new contents of the concept of the linguistic personality [3]. Each linguistic personality as the subject and object of interpersonal interactions creates a communicative fi eld in the form of the combination of personal characteristics, connections between them, moral and ethical norms, as well as the degree of their adequacy to the moral and value models accepted in this social reality. Within these communicative fi elds there is a formation of the communicative personality as the augmented linguistic personality [4]. It should be noted that there are three perspectives on the relationship between the concepts of linguistic and communicative identity: -the linguistic personality is a broader concept than the communicative personality because of its actualisation in the speech, mental, linguistic and communicative aspects [5]; -the concepts of the linguistic personality and communicative personality are synonymous, as the linguistic personality acquires the status of the communicative personality in the process of communication [6]; -the status of the communicative person is higher than that of the linguistic person, because the communicative person has both verbal and nonverbal tools in his/her arsenal, including artifi cial and mixed communicative means [7]. While linguistic personality functions on the verbal-semantic, cognitive and pragmatic levels, communicative personality can be represented as the combination of the following components: -the motivational component as the combination of both personal motives and willingness to enter into communication, and their adequacy to the needs accepted in society [8]; -the cognitive component refl ects personal specifi city in terms of the intellectual and emotional experience, adequate to the generally accepted social norms; -the functional component is represented in the activities of the communicative personality in the process of using verbal and non-verbal tools [9]. Thus, the communicative personality as a subject of construction of social reality has a wide range of socially signifi cant characteristics, social relations, regulations and norms that allow the establishment of the full-fl edged communication. In other words, in this case, communication exists not only as the interaction of the communicants to exchange information, but also as the process that refl ects and incorporates their socio-cultural and socio-psychological thesaurus. Consequently, the communicative personality incorporates the entire range of the social ties of the communicants, their social roles, the degree of their adequacy/inadequacy to the existing socio-value norms. The expansion of the scope and variability of all aspects of human activity and the creation and implementation of the new information technologies, which began in the second half of the 20th century, revealed two interrelated trends in the functioning of the linguistic personality: -the apparent inadequacy of using only linguistic tools to describe a new kind of social reality; -the linguistic personality as a subject constructing a new social reality is brought to the fore. This phenomenon, called the "linguistic turn", was a real revolution in the fi eld of the social humanities, namely that linguistics became one of the social sciences, and the social sciences, in turn, began to use linguistics in their research [10]. The increasing role of information and communication in its exchange, perception and interpretation has contributed to the further evolution of the concept of the linguistic personality. The status of the communicative personality as a supplement and development of linguistic personality evolved the concept of the discursive personality. This phenomenon is related to the emergence of a new phenomenon in the socio-humanities -discourse as a new way of describing the surrounding reality. There are many interpretations of the phenomenon of discourse, which do not contradict each other, but describe different aspects of this phenomenon: -the formalist interpretation represents discourse within structuralism as a speech act in the form of oral or written communication; -the situational interpretation stresses the socio-cultural and socio-psychological conditioning of the discourse; -the functionalist interpretation understands the discourse as a language in a social context; -the ideological interpretation presents the discourse from a historical and cultural perspective [11]. Thus, the concept of discourse is a multidimensional phenomenon that incorporates, in addition to the text as a specifi c set of linguistic signs, also the information about the surrounding reality. The discourse, in this case, is a volume of information based on both the objective component (information about social reality, historical facts, etc.) and the subjective part in the form of moral and value norms of the communicants' points of view on the problem, etc. As an example, the sociolinguistic discourse as a characteristic of the linguistic personality presents the actualization of the social factors in the activity of linguistic personality. Among them we can highlight such as: a social class, gender, age, ethnic identity, membership in a speech community [12]. Sociolinguistic discourse is based on accepting the fact that any language is not only a sign system, but, above all, a social construct, an action and a result of the social interaction of the linguistic personalities. P. Bourdieu's concept which defi nes discourse as a set of human habitus with different socio-genetic specifi cities is of particular importance. According to P. Bourdieu in the framework of his theory of habitus and linguistic capital, it is the habitus as a set of mental, moral value and bodily characteristics of the linguistic personality that determines the pragmatics of each individual's life activity [13]. The integral part of the habitus is its linguistic aspect in the form of the knowledge of the language acquired in the family, kindergarten, at school, university, workplace. In other words, different social groups exhibit different linguistic habitués formed in different social contexts. Linguistic habitués are shaped in the processes of socialisation and enculturation, taking into account the fact that different social strata have unequal access to the linguistic markets. The linguistic differentiation of the linguistic personalities is directly related to their social background. Thus, a low level of the language profi ciency at the verbal semantic level (phonetic, lexical, morphological, syntactic and stylistic) demonstrates a low social status of the linguistic personality, which does not allow the access to the social lift. Conversely, the linguistic personalities belonging to the middle and higher social strata respond more successfully to the linguistic dens and achieve their pragmatic goals (career and professional development). Consequently, the difference in the linguistic capitals due to different social affi liations of the linguistic personalities is directly dependent on the level and system of education and manifests itself in social differences [14]. It is interesting to note that M. Weber in his theory of the "middle class" argued that social status (class membership) is determined by differences in education and professional affi liation, with each social group exhibiting its own linguistic specifi city [15]. Within the discursive context, there is a new fi lling of the phenomenon of the speech community, which is increasingly being applied in sociological research. Speech community, i.e. the association of the linguistic personalities uses different sociolects, dialects slang units within a common language. These linguistic variations are due to Научный отдел the multitude of socio-cultural factors, refl ecting a specifi c sociolinguistic environment. They either follow the existing linguistic norms or modify them according to the norms dictated by power structures. That is, all speech communities are constantly transforming according to the dynamics of social changes, which leads to the changes in language practices [16]. Thus, the linguistic personality as the subject of social reality construction refl ects the whole range of socio-cultural practices and ensures continuous communication of people, contributing to their education, professional, personal and career development. Furthermore, the linguistic personality is the custodian of all knowledge and skills accumulated by humanity and transmits them from generation to generation.	The article presents the stages of transformation of the concept "linguistic personality" in correlation with the changes of social reality. The reasons for the appearance of the concept "communicative personality" in connection with the formation of the social reality of the information society are substantiated. Comparative analysis of these concepts, involving linguistic, socio-cultural and socio-psychological factors is presented. The "linguistic turn" in socio-humanitarian research contributed to a new content of linguistic personality as a discursive concept. The sociological approaches of M. Weber and P. Bourdieu are given as the theoretical grounds of the connection between the social status of a linguistic personality and its belonging to a certain speech community. The example of the sociolinguistic discourse proves the infl uence of the level of education, linguistic in particular, on the access of the linguistic/communicative/discursive personality to the social lift (professional career development). Thus, the linguistic personality as a subject of social reality construction creates and maintains social communication, contributes to the enlargement of knowledge, intergenerational connections and, ultimately, to the improvement of the quality of life.
keywords Community-based participatory research, research ethics, institutional review boards, human subjects, community beneficence subjects or by recklessly exposing them to danger for some presumed higher good) are now relatively rare in biomedical research. 3 IRBs have contributed significantly toward achieving the goal of protecting individuals from harms resulting from involvement in medical research. Rates of actual physical harm are very low and other risks, such as those due to breaches of confidentiality, are rare. 3 The traditional IRB philosophy and operational perspec- The NCI-funded CNPC, through which the authors of this article are funded, represents the latest transition toward CBPR from academically designed and initiated clinical trials research. The CBPR approach emerges from social justice and action research traditions, [4][5][6][7] embracing a commitment to work in partnership with disenfranchised, underserved populations to reduce disparities. In the context of the CNPCs, this entails operationalizing its nine principles ranging from recognizing the community as a unit of identity to committing to long-term processes of sustainability. 8,9 In addition to expanding the NCI research agenda and approach, CBPR has important implications for the protection of human subjects and, more important, considering how research can benefit high-risk, underserved members of our society and the communities in which they live. Our stakeholders from racial, ethnic, and socioeconomic groups that experience disparities have voiced ethical concerns about disease prevention, treatment, racism, medical mistrust, and end-of-life decisions that reflect racial, ethnic, and socioeconomic disparities as well as a variety of social barriers to conducting meaningful research. Similar ethical concerns have been voiced at the researcher-community interface nationally. [10][11][12][13] These concerns compel us to address issues from a public health justice perspective; that is, risks and benefits relating to entire high-risk communities rather [15][16][17] So, in the absence of this commitment to CBPR, these studies would simply never be done. It is important that the IRBs take community beneficence, and the level of deep commitment it implies, into account when making decisions to approve studies Although the potential benefits to the community may be real, the criteria for evaluating community beneficence are more abstract and vague. Indeed, risk (physical, mental, emotional, and legal) is defined almost exclusively in terms of the individual. There is no comparable detailed consideration of risk to the wider community. Without a more detailed consideration of community beneficence and risk, it is not possible to conduct a sophisticated and balanced assessment of relative benefits and costs to individuals and the wider community. --- cBPR PRinciPles And theiR oPeRAtionAlizAtion Although definitions may vary, it is widely agreed that there are nine principles involved in operationalizing of CBPR 8,9 : 1. Recognize the community as a unit of identity. 2. Build on the strengths and resources within the community. 3. Facilitate a collaborative, equitable partnership in all research phases through an empowering and power sharing process that attends to social inequalities. 4. Foster co-learning and capacity building among all partners. 5. Integrate and achieve a balance between data generation and intervention for the mutual benefit of all partners. 6. Focus on the local relevance of public health problems and on ecological perspectives that attend to multiple determinants of health. 7. Involve systems development in a cyclical and iterative process. 8. Disseminate results to all partners and involve them in the wider dissemination of results. 9. Involve a long-term process and commitment to sustainability. Examples of how these were operationalized in our five CNPC are presented in Table 1. --- summARy of mAjoR Points IRBs need to continue being diligent in protecting research participants from possible harm. Still, we also are obliged to take seriously the ethical implications resulting from not conducting research in disparate communities, namely, "sins of omission." We believe that CBPR can serve as a resource for the development and evaluation of new guidelines for community risk and beneficence. These guidelines, in turn, will contribute to more sophisticated and balanced assessments of the relative benefits and costs to individuals and the wider community in which they live that may be associated with specific research proposals. Future guidelines should be based on the nine principles of CBPR. Table 1 provides examples illustrating the kinds of things that reviewers might want to consider when evaluating adherence to these principles. When the USC team proposed its first community-guided diet and physical activity intervention trials more than 10 years ago, it was virtually impossible to obtain approval from IRBs accustomed to Islanders have poor cancer survival and limited access to care. 21 African Americans, as a group, have high cancer incidence and poor survival, [22][23][24][25][26] but very high church attendance. 27 Alameda County Health Department identified colorectal cancer as an issue in the African-American community. 21,30,31 This effort tapped into the strength of a rapidly expanding movement that recognizes the connection between spiritual and physical health that, in turn, extends from the deep religious roots of the civil rights era. 27,[32][33][34] The Church of God in Christ is a spiritual and civic resource. Similarly, Afghan CBOs are a center piece for the Afghan community. Each program builds on spiritual and community resources. 28 The The examples provided in Table 1 illustrate how effective the CNPCs can be with respect to conducting authentic CBPR in communities at very high risk of cancer-related health disparities. As these developments occur, the corollary will be to work with our communities to educate our respective IRBs in considering principles of CBPR in their review of applications to conduct biomedical research. In the process, we will acquire a heightened awareness of the difference between meeting the minimal standards of protecting individual human subjects from harm and the larger imperative to avoid "sins of omission." This also holds the promise of rectifying the pervasive imbalance that has occurred because of well-intentioned attempts on the part of IRBs to limit personal risk and institutional liability. The CNPCs are committed to serving high-risk populations. The communities we serve expect us to make material differences in improving their situation in general and reducing cancer-related risk factors in particular. Indeed, every grant submitted to the National Institutes of Health requires a section on "public health relevance." We need to be held accountable for delivering on this promise. By being held accountable for our ethical responsibility to partner with communities to reduce cancer-related health disparities, we can reduce "sins of omission." Many practical benefits can ensue, including much higher-than-average rates of study recruitment 18 and biospecimen collections from populations that bear the brunt of health disparities. 19 These populations are often characterized as "hard to reach," but our successes demonstrate that they are rather "hardly reached" because their knowledge and experiences are not generally valued and included in the traditional research process. Our ability to conduct highly relevant studies with remarkably high rates of recruitment, compliance, and adherence 18 to protocols highlights our ability to address this imbalance through our willingness to engage positively and meaningfully with both the IRBs and our community partners. This is in contrast to working with the primary aim of avoiding risk to individual study participants. We believe that working toward this higher ideal of service to high-risk communities would help to remediate many of the problems that the nation is facing in reducing health disparities. Results obtained through the use of CBPR practices recognize the unique strengths and perspectives of community partners striving together to achieve social justice and sustainability while decreasing the burden of health-related social disparities. This research allows us to expand the concept of beneficence to include "community beneficence" and to illustrate how avoiding "sins of omission" leads to profoundly better research and health outcomes. In conducting this CBPR, not only have we engaged meaningfully with our community partners, but we also have deepened the understanding between the research team and our IRBs. Our working relationships are now much more conducive to designing and conducting studies that really matter-both to our communities and to advancing the science of health disparities. Clearly, the principles of transdisciplinary and interdisciplinary research being promoted so heavily by the National Institutes of Health are consistent with principles of CBPR. 20 So, while we are serving our communities by being responsive to their stated needs, we also are advancing the science in ways that would be virtually impossible if we were content to ignore them. With the increased credibility of CBPR to inform and guide study development and implementation, 4,14,20 we may be at a point in history where we will be able to use resources to rather than the rule. If there is a deviation, there is, yet again, the potential for increasing individuals' risks from research participation for which the IRB will be on heightened alert. However, in CBPR, the assumption is that researchers and community members will collaborate in the design and execution of a project. Rather than the exception, it is the norm that projects evolve as a result of this collaboration and partnership. As the prevalence of CBPR projects continues to grow, the traditional IRB monitoring procedures may delay and disrupt the partnership, and perhaps undermine the research, thus increasing the possibility of another "sin of omission." --- Recommended guidelines And sAfeguARds foR community Risk And Beneficence Guidelines should include that the project: 1. Addresses an issue that is identified by a diverse and representative mix of community leaders and residents, in collaboration with researchers, as adversely affecting the health and well-being of the community. This can be a documented health disparity, based on disease incidence, stage of disease, and quality and duration of survival. It can also be an issue or circumstance that adversely affects access to primary prevention and quality of life (e.g., access to healthy food outlets and means to engage in physical activity in a safe environment), as well as other screening, diagnostic, treatment, and rehabilitation services. This collaboration between community members and researchers should be based on a consideration by all of the stakeholders of the community's resources and strengths as well as its limitations and challenges. 2. Is based on past and current collaboration with community members. 3. Is monitored and evaluated on a regular basis by members of the community. 4. Includes a plan for sustaining a successful project. --- Recommended safeguards 1. That the NCI convene a national conference representing all of the relevant stakeholders to consider these issues in more detail. 2. Perhaps during, and certainly after, this conference, design and administer a systematic survey to collect information from IRBs, researchers, and community stakeholders on their thoughts and experiences regarding human subject procedures to better understand the causes and consequences of "sins of omission." It is important to emphasize that we are not recommending that all research approaches be transformed to CBPR. Rather, we contend that CBPR principles and guidelines can lead to a more informed, sophisticated, and balanced consideration by IRBs of whether individual risks are reasonable in relation to anticipated risks and benefits to the wider community.	I n the wake of acknowledged abuses of humans engaged in biomedical experiments, the National Research Act (Public Law 93-348) was signed into law in 1974. 1 This created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, whose purpose was to ensure that research involving human subjects adheres to clear ethical standards. Institutional Review Boards (IRBs) were established to protect human subjects involved in research. 2 With the development of federal standards for the ethical treatment of human subjects and stringent means for their enforcement through local IRBs, confirmed instances of research harm (including failing to fully inform human
does not change easily in the short-term, especially when there is no change on the federal level. However, during the COVID-19 pandemic, beneficiaries faced additional barriers to receiving assistance due to COVID-19 mitigation measures [2,3]. For example, TANF assistance is commonly conditional on meeting work activity requirements [4]. Meeting these requirements became more difficult during the COVID-19 pandemic as stay at home orders proliferated, businesses closed, and individuals attempted to keep themselves and their families safe from the virus. As a result, some states modified their TANF practices to avoid beneficiaries losing benefits during a time of great need [2]. This dataset captures the varying policies and timelines of implementation by state. Specifically, the dataset contains information on whether each State-level data on TANF policy changes during the COVID-19 pandemic Emily C. Dore 1* , Paul R. Shafer 2 and Melvin D. Livingston III 3 of the 50 states implemented changes to TANF policy between March 2020 and December 2020. Researchers can match this dataset with other data on economic and health outcomes to understand how variations in TANF policy can affect economic and health outcomes. Policymakers can use these data to inform the adoption or modification of policies to best serve their constituents. Dore et al. [5] analyzed this dataset to understand the effect of TANF policy changes during COVID-19 on stress-related health outcomes. They found that overall, more supportive policies led to better stress-related physical, mental, and behavioral health outcomes. --- Data description The dataset is a table that contains the 24 TANF policy categories that represent changes to TANF state policy during the COVID-19 pandemic, the state names and their FIPS codes, and if the states enacted the policies, the start date, and when applicable, the end date. If the cell is empty in the dataset, the state did not implement that particular policy. Examples of policy categories include waiving in person interviews, pausing or lifting existing sanctions, automatically extending or recertifying benefits, allowing participants who reached time limits during the pandemic to continue receiving benefits, and providing additional temporary payments to families. Since the dataset describes the period of March 2020 through December 2020, we created two datasets to represent the ongoing nature of the pandemic. There is only one small difference between the two datasets. One dataset is ready for analysis and includes "December 2020" in the end date cells for policies that had not ended by December 2020. However, these same cells are labeled as "potentially ongoing as December 2020" in the second dataset to clarify the fluid nature of these policies for researchers who may want to extend the analysis beyond December 2020. To compile this dataset, we first gathered the policy categories from the Center for American Progress website [2]. We then systematically confirmed the implementation of the policy for each of the states listed on that website. The author of the original article, Justin Schweitzer, provided us with a comprehensive list of his sources. We confirmed first using these sources for almost all of the policies. We were unable to confirm some of the policies because his sources came from personal emails or from websites that no longer existed, but we trusted their accuracy. Next, we moved on to finding the start and end dates, which the original article did not contain. We went back to the original sources to identify dates where possible and noted them in the table. When those sources did not contain dates (end dates were especially lacking), we checked other sources online. These sources were: governors' executive orders, local news articles, legislation, state websites, and email correspondence with state TANF staff. Executive orders and state websites were particularly useful. If we did not find information on the state website (including the TANF website, the governor's office, or legislative records) or through local news channels directly, we broadened our search using a combination of search terms. The search terms included: TANF, the state-specific TANF program name (e.g. Iowa's TANF program is called "The Family Investment Program"), a descriptor of the policy (e.g. "work requirement"), COVID-19, coronavirus, pandemic, press release, executive order, legislature, governor, local news, etc. Due to lack of documentation, there were several instances when dates had to be inferred or assumed. The way we did this depended on the source of the information, and we describe our process in more detail in the methodology document in the data depository. --- Limitations Although we did our best to compile a thorough and accurate timeline and record of policy changes during the first several months of the pandemic, there are some limitations to the dataset. First, sometimes it was not possible to find confirmed start and end dates. In these cases, we made informed estimates using a standardized process based on available information. We include more information on this process in the Methodology document available through Emory Dataverse, but in general, we assumed dates based on dates of other policies implemented in that state, or dates of that same policy implemented in other states. Second, we did not look beyond the list of policies provided by the Center for American Progress for additional policies that may have been implemented. It is possible there were other changes to TANF policy that we missed, though we believe the policy dimensions captured to be the most salient. Lastly, our dataset ends in December 2020 to align with the Center for American Progress list of policies. This period is likely the period with the most changes due to the urgency surrounding the first few months of the pandemic, though we are aware of other policies that were implemented afterwards. For example, more states have since provided emergency cash assistance and the federal government has implemented new TANF policies. However, unemployment was at its highest in the US between March 2020-December 2020 [6] and while TANF caseloads increased beginning in March 2020, they returned to pre-pandemic levels by November 2020 [3]. Thus, we believe our dataset captures the most important time during which individuals needed the most help. --- Abbreviations --- TANF Temporary Assistance for Needy Families --- Authors' contributions Emily Dore: Conceptualization, Methodology, Data curation, Writing-Original draft preparation. Paul Shafer: Supervision, Writing-Reviewing and Editing. Melvin Livingston: Supervision, Writing-Reviewing and Editing. --- Data Availability The data described in this Data note are publicly available and can be freely and openly accessed on Emory Dataverse under https://doi.org/10.15139/ S3/79WVWC. Please see Table 1 and references [5,6] --- Declarations Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. --- Ethics approval and consent to participate The Emory University Institutional Review Board determined this study did not qualify as human subjects research because the dataset does not include information about individuals. --- Consent for publication Not applicable. --- Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.	Although funded by a federal block grant, TANF is a state-run cash assistance program. States have flexibility on how to run their TANF program, which creates high levels of variability between states in terms of generosity, administrative burden, and punishments for noncompliance [1]. As a block grant program, TANF funding BMC Research Notes
Uma Vida Mais F ertil, HR manager, Lisbon, Portugal Study question: Do Portuguese workers have fertility-friendly policies or initiatives in the workplace to help and support them reconcile work with their reproductive struggles and choices? Summary answer: Most workers are not receiving adequate support. There's a need to educate Portuguese policymakers regarding reproductive struggles and the possible benefits of implementing fertility-friendly policies. What is known already: With the European population ageing and birth rates getting lower, many companies are adopting family-friendly policies to encourage staff retention (Chand & Markova, 2018;Chzen et al., 2019). However, literature regarding reproductive health support and fertility-friendly policies, to help those who are infertile and struggling to conceive whilst being employees is scarce. Legislated support specific to combining work and fertility treatment is necessary to reduce psychological distress (Seenan & Akker, 2018). No study was found by the authors about this issue in the Portuguese population. Study design, size, duration: Study I explores if Portuguese workers receive fertility benefits from and feel supported by their employers, using an online 29-item questionnaire. The data collection started on 20 th March 2022 and ended on 4 th Sep 2022. Study II explores how employers support their Portuguese employees' fertility plans. Both studies followed a cross-sectional design, using an online 12-item questionnaire. The data collection started on 1 st April 2022 and ended on 18 th May 2022. Participants/materials, setting, methods: Study I has a sample of 107 Portuguese workers. The majority are above 35 years of age and have been trying to conceive for more than 24 months. Study II has a sample of 24 employers, including leaders, admin, and HR staff. The majority are working for a large company in a leadership position. Both questionnaires had multiple options, Likert-scale, and open-ended items. The data were analyzed using IBM SPSS Statistics, Version 28.0. Main results and the role of chance: Study I: All participants reported their company does not have fertility-friendly policies, 72.9% reported difficulties reconciling trying to conceive with work life, 56.1% perceived their attempts interfere with career progression, and 55.1% decided not to inform their superiors about their journey. People who are not offered benefits by their employer experience significantly higher anxiety, disclose less information to their superiors and consider quitting their job more frequently than those who are offered benefits by their company. However, they also experience significantly lower concern/worry, which may be due to increased awareness of fertility issues, pressure not to fail, unwanted interactions, and/ or being treated differently. Study II: 87.5% stated their company does not have fertility-related policies, 66.7% that theirs does not offer fertility-related support and 20.8% did not know whether theirs does. Leaders of medium/small companies report their companies to be significantly more flexible regarding schedules for consultations/exams and taking time off for mourning, and they also thought providing financial help for fertility preservation and fertility treatment to be more useful than leaders of large companies do. Respondents attribute moderate to high importance to the existence of fertility-related policies, but the data shows a lack of agreement regarding which benefits to offer. Limitations, reasons for caution: Small sample sizes condition the extrapolation of the findings. Replications of the studies representative of different geographic areas and company types are required. Also, the association between organizational and individual benefits as outcomes of the implementation of fertility-friendly policies and initiatives in the Portuguese population is yet to be studied. Wider implications of the findings: This is the first study that has tackled the issue of fertility-friendly policies and support initiatives in the workplace in the Portuguese context. We gathered data from both employers and employees, which allows the findings of the studies to provide a comprehensive view of the reality of this population. Trial registration number: not applicable Abstract citation ID: dead093.911 P-579 Preliminary data on family relations in anonymous oocyte donation families: children's perspectives at age 5 to 7 years E. Buyse 1 , F. Belva 2 , R. Cooreman 3 , L. Leunens 1 , A. Buysse 2 , C. Blockeel 1 , M. De Vos 1 , H. Tournaye 1 , F. Hes 2 , J. Nekkebroeck 3 1 UZ Brussel, Brussels IVF, Brussels, Belgium 2 UZ Brussel, Centre for Medical Genetics, Brussels, Belgium 3 UZ Brussel, Centre for Medical Genetics/ Brussels IVF, Brussels, Belgium Study question: Do children born in oocyte donation families perceive their relationships with their parents differently than children conceived trough ICSI? Summary answer: No significant differences were found in the family relationships between children born in oocyte donation families (OACC) compared with controls (ICSI). What is known already: Majority of the previous research concerning relationships in families using oocyte donation focused on the mothers' perspective. Little is known about how children in these families view their family relationships. Studies investigating young children's perspectives in donor-families (5-10 years old) indicate good parent-child relationships (Imrie, et al., 2021;Blake, et al., 2013;Casey, et al., 2013). Few of these studies involve young children conceived using anonymous oocyte donation. Study design, size, duration: This study included 17 children born through anonymous oocyte donation in heterosexual parents and a comparison group of 13 children conceived ICSI using the heterosexual parents' own gametes. Data were collected between August 2021 and January 2023. The sample is part of a larger ongoing case-control-study investigating family relationships and the wellbeing of both parents and their children in families created by anonymous oocyte donation. Participants/materials, setting, methods: Children were 5 to 7 years old (M ¼ 6.13; SD ¼ 0.5) and had been born after assisted reproduction (ICSI with or without using anonymous oocytes) with their two heterosexual parents. All children were invited to the hospital to undergo biomedical and psychological testing, including the Family Relationship Test (FRT; English version: Bene and Anthony, 1985;Dutch version: Baarda and van Londen, 1985). Multiple blind evaluators were used. Main results and the role of chance: No significant differences were found between children born in oocyte donation families (OACC) compared with --- QUALITY, INNOVATION, AND SERVICE-IT'S ALL AT THE CENTER OF EVERYTHING WE DO. From developing assisted reproductive technologies that maximize performance, like the first ART media and cultures, to expertise that streamlines productivity, FUJIFILM Irvine Scientific brings together decades of industry expertise with a powerhouse of innovation, turning opportunities into realities. Together, we're working to support healthy futures-from retrieval to realization. --- ALL IN FOR LIFE. irvinesci.com/ALLIN FUJIFILM Irvine Scientific and its logo are registered trademarks of FUJIFILM Irvine Scientific, Inc. in various jurisdictions. ©2023 FUJIFILM Irvine Scientific. P/N 018187 Rev.00	partner. Regarding the concerns about fertility preservation, the participants were worried about the costs (n ¼ 26; 10.1%), age (n ¼ 25; 9.7%), hormonal injections and other fertility drugs (n ¼ 10; 3.9%) and the desire for spontaneous pregnancy (n ¼ 8; 3.1%). The participants not considering preserving their fertility mentioned the main reasons were that they never thought about it (n ¼ 56; 21.8%), did not want to get pregnant (n ¼ 34; 13.2%), age (n ¼ 32; 12.5%), the desire for spontaneous pregnancy (n ¼ 28; 10.9%) and the costs (n ¼ 16; 6.2%). Most participants agreed that fertility and fertility preservation information should be provided during medical consultations or at school. Limitations, reasons for caution: The recruitment and data collection process (social media and online survey) have limitations, such as sampling bias, self-selection concerns, or under-representation of the population (e.g., exclusion of participants not using social media or online platforms), limiting the chance of making generalisations. Wider implications of the findings: Making available more information regarding fertility preservation may warrant that more women have the opportunity to consider this option and make informed decisions regarding their reproductive life.
Introduction The digital transformation in healthcare is driven by applications such as telemedicine, clinical decision support systems (CDSS), and novel AI applications [1]. These applications have an impact on the doctor-patient relationship and the patient's social environment [2]. Normative challenges have risen in terms of responsibility, privacy, security, and autonomy. Furthermore, human-machine interaction and professional selfimage are concerned. In the DESIREE project (https://www.desireeforschung.de/desiree/), the ethical and social implications of CDSS were investigated. Three exemplary cases were used: nephrology, surgery, and nursing. The three cases were analysed with the aim of systematically describing the socio-technical and ethical challenges and the "side effects" of these applications. In our research, we tried to be aware, that there are always intended and unintended effects in social action. In our analyses, we focused also on the unintended effects. Then these more grounded descriptions were used by the interviewers for the interviews they conducted with the interviewees: patients, medical students, and nursing students on the impact of digitalisation. The aim of this reflected research was to develop a more grounded catalogue of criteria to follow and systematically describe AI, CDSS applications in terms of its sociotechnical implications. --- Method Criteria underlying decision support systems were identified in an interdisciplinary team consisting of physicians, ethicists, and medical informaticians based on the methods of case study research according to Yin RK (2009) [3]. In the first step we asked the questions "how" and "why" according to the proceeding in case studies [3]. The interdisciplinarity consisted of identifying and analysing the entire socio-technical context. Here, the direct effects of human-machine interaction and indirect effects on professional self-image, legal requirements, and the effect on patients must be considered. Therefore, first, the direct interaction of the system was described and then, second, social effects were identified. In an iterative process, the procedure, the resulting categories, and their items were developed. --- Results --- Identifying the categories The structured interdisciplinary procedure resulted in a categorization of cases for sociotechnical systems. The following figure 1 shows the process of describing the case studies. The result was a set of categories to be adopted to all the cases: The figure 1 shows the process of identifying and categorizing the cases. The first step is identifying the application depending on the research question. In the DESIREE project, research projects from different medical domains were chosen. It is crucial to get detailed information about the product/research project. In the second step, all regulatory requirements and ethical implications have to be assessed. In the case of research projects, often there are no regulatory requirements easily to identify yet; here, experts have to classify the system and identify the potential regulatory framework. In the third step, particularly in the case of AI, a distinction must be made between selflearning systems, data sources, and whether the system could also be implemented at another institution. For example, at another institution it may be dependent on the specification of the hardware. In the fourth and final step, interactions and hazards as well as possible usage errors and failures in the human-machine interaction must be assessed. --- Categories The category Use Case describes the overall system with its intended purpose. If it is not a medical device or purely a prototype from research, the intended use in clinical research is often not explicitly given. Here it is helpful to ask the researchers directly. x Intended purpose: The intended purpose is a regulatory term from the Medical Device Regulation (MDR 745/2017). x Medical Domain: This category describes in a nutshell the overall CDSS x Matureness If the CDSS is not a medical device it could be an idea or a prototype from research x Goal of the System: high level description of the purpose if there is no intended purpose described The Ethical implications are ethics and social aspects to be discussed: x Ethical dimension, e.g. responsibility, autonomy, transparency, trust, privacy, justice/fairness, caring x Decision and data transparency raise the question of whether the decisions of the applications are clear and transparent to the user. Does the user know on which data basis the application is relying? Does the user know with which rules and above all reliability the system works, and the final results are achieved? x Impact on role and self-perception bring up the question of whether CDSS change self-perception in terms of competence and self-image through applications that may be "better" than human decision making. x Impact on doctor-patient relationship raises the question of whether CDSS change the doctor-patient relationship in terms of competence of the application and how it is perceived in the doctor-patient relationship. x Educational Impact Are CDSS changing the way we need to educate doctors and nurses? x Impact on employment structures: Will CDSS change the way we work in health facilities? Legal implications refer to the legal and regulatory requirements. x Regulatory Aspects (e.g. Medical Device Regulation): The development of medical devices is subject to regulatory requirements. The general safety and performance requirements must be fulfilled (addresses patient safety). x Privacy: Are personal data (mostly those of the patient) sufficiently protected according to the law? x Performance means the ability of a product to fulfil the intended aim or stated goal of the CDSS; x Risks: What risks can the CDSS pose to humans, animals, and the environment? How high is the harm and the occurrence of an adverse event caused by the CDSS? The technical aspects describe everything about the technology of the CDSS. x Method describes the methodological basis on which the CDSS was developed. Whether it is a self-learning AI or contains a guideline-based rule set. x IT-Security, Data Protection describes whether the data is safe e.g. from attacks. x Used Technology describes whether the CDSS is an app or a desktop application (e.g. webservice) and whether there are other technological aspects that are relevant. x Components such as hardware or additional systems that interact with or are included. x Users: the ones who interact directly with the system. (e.g. medical staff, patients) Human-machine interaction is a relevant category because ethical aspects and e.g. risks can be derived from the interaction. x Representational Layer: the GUI but also the presentation of the data and the design are shown here. x Use Scenarios/User Story describes the process of interaction in steps to clarify the interaction. x Use errors, Risks, Hazardous situations: Based on the use scenarios, use errors and their effects can be determined. --- Conclusions out of the three case studies In the DESIREE project there were three cases, where we applied the developed categories: Case 1 describes the MeSiB system to give people in home ventilation more security through a safety box in case of disconnection of the ventilation tube or power failures. Case 2 describes an app to help physicians create personalized treatments for patients with kidney disease (https://ckdn.app/). Case 3 "Surgery of the future" is a support system designed to assist the surgeon in making the correct incision during an surgery. All three cases were research projects. In order to work on all criteria, direct contact with the researcher or manufacturer is needed. Since all contacts to the researchers were available in this project, it was possible to apply all categories. Without this contact or a real user, the concrete description of the human-machine interface and underlying technology is not possible. Moreover, the impact of these systems is so diverse that an interdisciplinary team should work on the cases. Otherwise, there is a danger that a certain bias will occur. Not only interviewees, but, also interviewers (from different scientific fields) tend to stress risks, e.g., concerning data privacy and data protection. --- Discussion The systematic case study of three cases in the DESIREE project aims to describe the use of a CDSS more grounded in the context of regulation, ethics, and human-machine interaction. The methodology for the description should promote the understanding of the CDSS and serve as a basis for the development of a vignette for scientific investigations in the fields of social research, ethics, and innovation research. The ethical aspects are a central part of this research. The regulatory aspects address many ethical dimensions such as responsibility or autonomy. Furthermore, it could be possible to include other ethical assessments such Meestar [4]. The legal and regulatory aspects such as the Medical Device Regulation (MDR), patient safety, and risks were considered crucial for a comprehensive picture of a sociotechnical system. The legal frameworks are deeply linked to the ethical considerations. This interaction is often safety-critical and is closely linked to acceptance criteria but also contain hazards for users. These hazards often relate to use errors, which should indicate what happens in the event of an error. But, often products only show the "happy path" and in research projects, there is often no risk management according to ISO 14971 and DIN EN 62366. This research looked into three different cases resulting in a more in-depth view of the respective CDSS or AI application. Thus it should serve as a basis for further sociotechnical research. --- Contributions of the authors ML: conception, design, writing, data analysis and interpretation, ADK: data collection, analysis and interpretation, revision, RR: data interpretation, revision. The DESIREE study group are from Fraunhofer-Institut für System-und Innovationsforschung ISI, Karlsruhe Tanja Bratan, Heike Aichinger, Nils Heyen, Diana Schneider. Institut für Ethik, Geschichte und Philosophie der Medizin, Medizinische Hochschule Hannover Sabine Salloch, Florian Funer. Evangelische Hochschule Rheinland-Westfalen-Lippe Martin Langanke, Wenke Liedtke	The ethical implications and regulatory requirements of AI applications and decision support systems are generally the subjects of interdisciplinary research. Case studies are a suitable means to prepare AI applications and clinical decision support systems for research. This paper proposes an approach that describes a procedure model and a categorization of the contents of cases for socio-technical systems. The developed methodology was applied to three cases and serve the researchers in the DESIREE research project as a basis for qualitative research and for ethical, social, and regulatory analyses.
over the last decade and are becoming more popular as the computing field grows in size and demand. In the 2016-2017 school year, over 200 collegiate hackathons were hosted in North America and Europe and over 65,000 students participated in these events [6]. These events are largely attended by computer science (CS) undergraduates [6] and many students go to these events to learn skills and practices of the computing field [1,5], build community with fellow students and work on projects with friends [7,10], networking with mentors and sponsors within the technology industry [1,8], and become better prepared for the workforce and industry hackathons [4]. Despite the benefits that hackathons offer, we still see a disproportionate number of white and Asian men attending these events over women, non-binary students, and non-Asian students of color [6]. Collegiate hackathons can create an environment where marginalized students feel disinterested in attending or unwelcome at the events. I am interested in understanding the social climate of hackathons and how it affects hackathon participants, particularly women and non-binary students. I will explore two lines of inquiry: (1) to gain a deeper understanding about why participants do (or do not) participate in hackathons, what motivates them to attend, and what engages them at these events; and (2) to explore the design of hackathons with the end goal of creating inclusive and equitable events for all students. --- BACKGROUND & RELATED WORK There is a small, but growing body of work done on collegiate hackathons. Current work shows that collegiate hackathons are sites of informal learning [5,8,10] that impact students' perceptions of computing [9,10] and may impact their retention in CS [7]. However there are hardly any studies about student experiences at these events, particularly women and non-binary students [10]. Overall, collegiate hackathons report that 23% [6] of their participants are female or non-binary and non-collegiate hackathons report that as little as 10% of their participants are female [3]. A handful of studies have researched why this gender gap exists and they have made some design recommendations for building events that are more inclusive for women. There is also an effort from the community of collegiate hackathon organizers across the US and Europe to build more diverse events, which includes changing design practices to be more inclusive as well as hosting female and non-binary focused collegiate hackathons. My work is positioned within these diversity and inclusion efforts and seeks to expand our understanding of hackathon attendees and build more equitable environments for all students. My dissertation will explore three lines of inquiry that build on the previous studies and add to the body of collegiate hackathon literature. --- RESEARCH PROBLEM, GOALS & METHODS This work is guided by two motivating questions: (1) what types of experiences do attendees (and non-attendees) have with collegiate hackathons; and (2) how can we design collegiate hackathons to be more inclusive and equitable for more types of students? I have three lines of inquiry that explore these motivating questions. Study #1 will be a retrospective, design-based research project about the design of a female-focused hackathon called T9Hacks. Four years ago I founded T9Hacks and have worked as the lead event organizer for three iterations of T9Hacks events. While planning T9Hacks, my team and I were influenced by our experiences attending collegiate hackathons and a desire to create an inclusive event, we also tried to mimic best practices that we knew created equitable and welcoming environments for women in computing, all while trying to work within a standard collegiate hackathon model that was set by one of our event partners, Major League Hacking (MLH). I chose a design-based research study [2] because it is research that is conducted in real-life, ongoing contexts where the researcher is involved in the design of the project; these studies often result in producing theories that richly describe participant experiences and produce interventionist designs that iteratively improve the research context. This study has two goals: (1) to explore how the design practices of T9hacks changed over four years; and (2) to show the tension between "scholarly" hackathon design recommendations and what the organizing team wants to do. By performing a retrospective analysis on my team's decision-making process, we can look at which design elements were the most impactful for students as well as what was resources were available or influential to the organizing team. Study #2 is a two-part exploratory study that provides insight into the experiences of female-focused collegiate hackathon attendees. The first part of this study studies hackathon participants' sense of community at three types of hackathons: women-only (where only women and non-binary students are the focus and only they are allowed to attend), female-focused (here there is a focus on female and non-binary students, but students of all genders can attend), and traditional events (where there is no gender focus at the hackathon and all students can attend). The second part of this study explores the goals participants had and the different ways they engaged at T9Hacks. Findings show that students were motivated in attending T9Hacks for different reasons, had worked with other participants in multiple ways, and had different motivations for attending workshops. This study also shows how the design of the can support or restrict the trajectories these different students. These findings are important since they contradict the traditional hackathon narrative that researchers and popular student hackathon guides have provided in the past. These findings can inform future hackathons and show additional ways hackathons can be designed to be inclusive of different types of students. Study #3 is under design. I hope to use the feedback from the ICER Doctoral Consortium to finalize the details of this study, since engaging in the ICER DC will allow me to better understand how my research can provide insight and value to the CS Education community. This study builds on Study #2 findings and delves deeper into participants' motivations and engagement with collegiate hackathons. This study will be a multi-part mixed-methods study. The first part of the study will be an intervention and designbased study of T9Hacks. I will be implementing design changes to the event that build inclusive events for the different types of participants found in Study #2. Another part of the study will be exploring how these design changes did (or did not) affect the hackathon participants. I intend to interview hackathon participants and nonparticipants to gain a deeper understanding of their experiences with collegiate hackathons and what pieces of the hackathon were most impactful or influential to them. The results will be used to gain a deeper understanding of female-focused hackathon participants and to suggest inclusive design practices that can be used at other collegiate hackathons. --- DISSERTATION STATUS --- EXPECTED CONTRIBUTIONS My research and findings will be used to inform the design practices of collegiate hackathons and to create inclusive and equitable environments. Broadening participation at collegiate hackathons will allow all students to have the opportunity to engage in these events, learn computing in an informal environment, build community, network with members of the technology industry, and be more productive members of the workforce. Designing inclusive and equitable collegiate hackathons will benefit all students, but may have the most impact on female and non-binary students. Findings may also inform the design of industry hackathons and other informal learning environments.	Collegiate hackathons are marathon-style, project building competitions where students can learn computing in an informal environment, build community, network with members of the technology industry, and be more productive members of the workforce. I am interested in understanding the social climate of hackathons and how it affects hackathon participants, particularly women and nonbinary students, who only make up 23% of collegiate hackathon attendees. I will be exploring two lines of inquiry: (1) to explore the experiences of hackathon attendees to gain a deeper understanding about why participants do (or do not) participate in hackathons, what motivates them to attend, and what engages them at these events; and (2) to explore the ways collegiate hackathons can adapt their design practices to create an inclusive and equitable events for marginalized and minority students.
Introduction The number of illicit drug overdose deaths has dramatically increased in British Columbia (BC) since 2014, from 369 deaths in 2014 to 1208 deaths (including suspected cases) as of October 31, 2017. 1 Fentanyl or its analogues, in combination with other drugs, accounted for the majority of illicit drug overdose deaths. 2 In response to the increasing drug overdose crisis, a public health emergency was declared on April 14, 2016 in BC. 3 The contribution of drug overdose deaths to life expectancy change has rarely been quantified. Between 2000 and 2014, unintentional poisonings (mostly drug and alcohol overdoses) contributed a loss of 0.338 years in life expectancy at birth (LE 0 ) for the non-Hispanic white population in the United States of America (USA), the greatest negative impact by cause of death. 4 Specifically, opioidinvolved overdose deaths contributed to a loss of 0.21 years in LE 0 for the entire USA population between 2000 and 2015. 5 In this article, we sought to adapt the analysis to the BC setting and to further expand the analysis by quantifying the contribution of opioid and other drug overdose deaths to life expectancy inequalities by sex and socioeconomic status (SES). --- Methods We obtained data on deaths recorded by the BC Vital Statistics Agency during 2001-2016. We used the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) to classify causes of deaths. We identified deaths involved opioids (T40.0, T40.1, T40.2, T40.3, T40.4, T40.6), cocaine (T40.5) and other drugs (T40.7, T40.8, T40.9). Those classified as unintentional injuries (X40-X44) or undetermined intent (Y10-Y14) were included in the analysis. We calculated mortality using the insured population in the province and used the 2001 population as the reference to standardize mortality rates. We used the Chiang method 6 1). Reduced mortality rates for cancers, heart diseases, cerebrovascular diseases and accidents contributed to the majority of the 2.37-year increase in LE 0 during 2001 and 2016. How ever, deaths involving any type of drugs caused a loss of 0.15 years to LE 0 during this period. Opioid-involved deaths accounted for nearly 80% of overall drug overdose deaths in 2001, but this increased to 90% in 2016. The increase in opioidinvolved deaths contributed a loss of 0.16 years to LE 0 in 2016, compared to 2001. Drug overdose deaths contributed a loss of 0.12 years in 2016 compared to 2014, accounting for 32% of the total decline during this period. In 2001, LE 0 for males was 5.01 years lower than that for females (Table 2). The higher drug overdose mortality in males contributed 0.20 years to the gap, but the majority were attributed to cancer, heart disease and injury (accidents and suicide) deaths. While the sex difference in LE 0 declined to 4.59 years in 2016, the contribution by drug overdose deaths doubled to 0.42 years (accounting for 9% of the gap). Drug overdose mortality rates were inversely associated with both material and social deprivation index. In 2011, LE 0 for the population living in the highest total deprivation level (quintile 5 or the lowest SES) communities was 5.50 years lower than that for the population living in the lowest total deprivation level --- Discussion In this analysis, we found a 2.37-year increase in LE 0 from 2001 and 2016, but a 0.38-year decline from 2014 to 2016 (with 0.12 years attributed to drug overdose deaths). While the sex difference in LE 0 slightly narrowed between 2001 and 2016, the contribution by drug overdose deaths to the inequality doubled. During 2011 and 2016, LE 0 inequalities by deprivation level (between quintiles 1 and 5) were relatively stable, but the contribution by drug overdose deaths increased. Between 2000 and 2015, drug overdoses contributed to 0.28 years lost in LE 0 in the USA. Of this, 0.21 years were attributed to opioid-involved overdose deaths. 5 In this analysis, we demonstrated that drug overdose deaths, specifically opioid overdose deaths, contributed to a considerable loss to LE 0 in BC. However, the contribution was smaller than in the USA due to the lower age-standardized morality rates (e.g. opioid overdose mortality rate in both sexes was 16.3 per 100 000 in the USA in 2015 5 and 11.9 per 100 000 in BC in 2016). LE 0 has improved over past decades in the USA, reaching the highest at 78.9 years in 2014, but slightly declined to 78.8 years in 2015 and to 78.6 years in 2016. The decline was largely due to the increased deaths in younger ages and deaths from unintentional injuries including drug overdose. 4,9 Similarly, we have found a LE 0 decline since 2014 in BC and the decline was partially attributed to increased drug overdose deaths, in particular in males. Other provinces have also experienced increasing drug overdose deaths, [10][11][12] but it is unclear how this will impact life expectancy at the national level. Sex and socioeconomic inequalities in life expectancy at birth have been reported at different geographic levels. [13][14][15][16] While studies clearly showed the differences in life expectancy, little is known about the contributions of cause of death and risk factors associated with sex and SES. In this analysis, we showed that drug overdose deaths alone explained approximately 9% of LE 0 loss in males in 2016, compared to females. The contribution has doubled during the last 15 years due to the significantly increased drug overdose deaths in males. Drug overdose mortality rate for those in the lowest SES communities was 3 times higher than that in the highest SES communities (data not shown), accounting for 7% of LE 0 loss. These findings show the important impact that drug overdose deaths have had on the entire population of BC, and in particular, the differential negative impact on males and those who live in the most socioeconomically deprived areas of the province. This should further our resolve to address this largely preventable cause of death. The contribution by drug overdose deaths may have been underestimated as only confirmed cases were included and coroners' cause of death can take up to two years or longer to determine. For 2016, BC Coroners Service reported 985 drug overdose deaths, 1 but by using vital statistics data, we identified 528 drug overdose deaths and over 1200 cases with undetermined causes of deaths. A significant proportion of these unspecified cases will likely be determined as opioid related, driving the contribution of opioid overdose deaths higher (likely greater than 50%). A recent study showed that 30% of drug-related deaths registered in the forensic toxicology registry in Sweden had not been recorded in the country's vital statistics database, resulting in an approximately 20% underreporting of drug-related mortality. 17 Including other data sources, e.g. forensic toxicological registry to identify additional drug-related deaths would further improve the estimation. --- Conclusion The life expectancy at birth for people in BC increased by 3 years between 2001 and 2014, but decreased by 0.38 years from 2014 to 2016. The opioid overdose crisis was an important contributor to this loss. The higher death rate from opioid overdoses was also a major contributor to a shorter life expectancy among males compared to females and to a shorter life expectancy for people from the most socioeconomically disadvantaged communities compared to those from the least disadvantaged communities. b Negative contribution represents a life expectancy at birth loss in males due to the higher drug overdose mortality. c Negative contribution represents a life expectancy at birth loss in the population with the lowest socioeconomic status due to the higher drug overdose mortality. A low deprivation level value indicates a better socioeconomic situation (i.e. a lower level of deprivation). --- Conflicts of interest The authors have no conflicts of interest to disclose. --- Authors' contributions and statement XY conceptualized the design of the study and wrote the initial draft. JS led data analysis. PK, BH and MT provided input to study design, analysis and interpretation of the data, and drafting and revising the paper. All authors have seen and approved the final manuscript. The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.	• Life expectancy at birth (LE 0 ) in BC decreased by 0.38 years from 2014 to 2016, and fatal drug overdoses (the majority involving opioids) accounted for 32% of the decrease. • In 2016, LE 0 for males was 4.59 years lower than that for females, and drug overdose mortality accounted for 9% of this gap. • In 2016, LE 0 for those in communities with the highest deprivation index (quintile 5 or lowest socioeconomic status) was 5.58 years lower compared to people who live in communities with the lowest deprivation index (quintile 1 or highest socio-economic status), and drug overdose mortality accounted for 7% of this gap. between 2001 and 2016 and between 2014 and 2016. We examined LE 0 inequalities by sex and by deprivation index. Deprivation index, an area-based SES measurement including material deprivation (a composite of household income, unemployment and high school graduation) and social deprivation (a composite of marital status, living alone and residential stability), was constructed using the 2011 Canadian Census according to the method described by Pampalon et al. 7 A lower score for this index indicates a better SES (less deprivation). We partitioned the gaps into age and leading cause of death including drug overdose using Arriaga's decomposition method. 8 Analyses
INTRODUCTION Malang Regency's sectoral development policies are directed at increasing the standard of living, intelligence, and welfare of the community at all levels equally, as well as laying a strong foundation for the next stage of development so that in the future the implementation of development in Sukopuro Village can truly reflect the integration and harmony between sectoral programs. , thus the utilization of potential regional resources can be optimized and can be developed evenly. The implementation of development is of course inseparable from efforts to improve people's welfare, this is related to the economic conditions and prosperity of the community, seen from the economic level of the community, the growth and development of the sub-district will be very influence on the growth and development of the surrounding villages. The development of an area is influenced by several factors, including Human Resources (HR), regional potential, and the management system implemented in the regions. Human resources can be improved by education and training as well as developing experience in the community. Natural resources (regional potential) can be developed with various applied technologies. The management system that is implemented must adapt to the surrounding environment so that it can be managed according to the character of the community and its natural conditions. The Covid-19 pandemic has left a deep feeling of sadness and has devastated many things, especially the Sukopuro area, which is one of the villages in Jabung District, almost every day it is reported that people have been affected by the COVID-19 pandemic, both socioeconomically and in health and even death. Disaster risks exist in the environment, daily activities of each family member, both routine activities and temporary activities, such as holidays, family visits, and so on. When a disaster occurs, help from the authorities is not immediately accepted. Especially for families who are relatively far from access to communication and transportation. There are several problems that must be found solutions in this community service, namely: (1) How to deal with communities and families against disaster risk; (2) How to deal with vulnerable groups, children, pregnant women, the elderly, and women; and (3) How to utilize the closest community institutions that already exist in their environment. Facing such conditions, community resilience is urgently needed, and it starts with the household (family) as the smallest unit in society. The assumption is that if the family is resilient, it will be the key to the resilience of society and its environment. For this reason, solutions are needed to increase family resilience against disaster threats that are very likely to be faced by families, communities and their immediate environment. Objectives and benefits (1) Addressing communities and families against disaster risk ; (2) Addressing vulnerable groups, children, pregnant women, the elderly, and women; (3) Utilizing the closest community institutions that already exist in their environment. Activity Benefits : (1) Increase family preparedness to face disasters in their environment (2) Develop networks among disaster activists, (3) Develop social awareness to help each other among residents. --- IMPLEMENTATION AND METHODS In this community service activity in Sukopuro Village, two approaches were carried out, namely: 1. Structural approach, namely entering a community area (Sukopuro Village, Jabung District, Malang Regency) through official communication with local officials, starting with the sub-district head, village head and his apparatus. 2. Interpersonal approach, namely making friends, visiting several residents' homes to gather information in the Sukopuro Village environment regarding public health, children, the elderly, and women, and human resources. This second approach is also a feasibility study to determine the location of the community service area. Through these two approaches, the community and structural officials can simultaneously accept this service program with full openness and totality. Thus there are no sociological technical constraints. The people of Sukopuro Village received it well, village officials also welcomed the implementation of community service with a clear direction and goal of helping the people of Sukopuro Village. As for the method used is : 1. Counseling on pre-disaster activities which include prevention, mitigation, preparedness, and early warning activities; 2. Training on how to evacuate families when a disaster occurs; 3. Disaster evacuation simulation; and 4. Establishment of community food groups for assistance to underprivileged or disaster-affected residents. --- RESULTS AND DISCUSSION This section sequentially discusses the problems that have been formulated to achieve the goals set. In the context of a disaster, the family becomes the core focus because disaster-related knowledge is very good when it starts from home. Three important points of the proposed program Disaster resilient families (Katana), namely: (1) Katana can become a pillar of community and family resilience against disaster risk; (2) Katana must involve vulnerable groups, children, pregnant women, the elderly and women; and (3) Katana makes use of the closest community institutions that already exist in their environment. One of the closest functional institutions is the house of worship (mosque/mashallah for Muslims), this is considering that the majority of the community is Muslim, where the mosque is the main institution in building the resilience of Muslim families, both religiosity, socio-economic resilience, and disaster management issues. in general. The existence of Muslim families (Muslims) and mosques is like two sides of a coin meaning that if the mosque functions optimally then the people (society) will be healthy and vice versa if the mosque is not functional then society will be damaged (spiritual and socioeconomic disasters occur). Therefore it becomes important to make the mosque functional in increasing families that are resilient in facing disasters. Disaster management is a systematic and comprehensive effort to deal with all disaster events quickly, precisely, and accurately in order to reduce the number of victims and the losses they cause. The disaster management system aims to: Prepare for all disasters or unwanted events, Reduce losses and victims that may arise as a result of the impact of a disaster or event, and Increase awareness of all parties in society or organizations about disasters. In general, disaster management activities can be divided into 3 (three) main activities, namely: 1. Pre-disaster activities which include prevention, mitigation, preparedness, and early warning activities; 2. Activities during a disaster which include emergency response activities to relieve temporary suffering, such as Search And Rescue (SAR) activities, emergency assistance, and evacuation; 3. Post-disaster activities which include recovery, rehabilitation, and reconstruction activities. Family resilience can be interpreted as the ability of everyone, family members who are potentially exposed to disaster hazards to fight, absorb, accommodate, and recover from the effects of disaster hazards in a timely and efficient manner; including through the protection and restoration of its essential basic structures and functions. Therefore every family member needs to know the risk of a disaster that has the potential to occur in their environment. Not only the disaster risk at home, but also the disaster risk that exists in the daily activities of each family member, both routine activities and temporary activities, such as holidays, family visits and so on. When a disaster occurs, help from the authorities is not immediately accepted. Especially for families who are relatively far from access to communication and transportation. Therefore family preparedness kits are a package of basic necessities that are prepared before a disaster occurs. The more supplies, the better. But generally, we need it, at least to be used in a disaster emergency for 3x24 hours. This equipment is useful for meeting the basic needs of the family (family members) in conditions where there is no assistance at all/assistance has not yet arrived. Every family needs to plan how to evacuate the family if a disaster occurs. The plan is prepared by taking into account the daily activities of each family member. The problem that often occurs is that we don't have an evacuation plan, and have never tried it. A family preparedness plan is a plan made by the family to be ready in an emergency due to a disaster both in the field and outside the home. In making this plan, every family member is involved to ensure that they understand and agree to the plan. Every family living in a disaster-prone area needs to ensure that they have the ability and facilities to receive early warning information. In addition, it is also necessary to prepare an evacuation plan in the event of a disaster. Evacuation needs to be done if at any time there are signs or warnings of a disaster. Evacuation is done to ensure family members are safe in the event of a disaster. Through evacuation simulations, the ability of each family member is built so that they are empowered to evacuate independently. In the concept of development, for the realization of the development program, an institution is needed to oversee the expected changes, and society develops in line with the existing culture and beliefs. Institutions that are considered representative are mosques because they routinely become gathering places for Muslims to carry out the obligation to pray, and there are administrators and work programs. --- CONCLUSIONS AND RECOMMENDATIONS Based on the discussion of community service in Sukopuro Village, it can be concluded that community service has been able to overcome the difficulties of the people of Sukopuro Village by providing counseling as a solution to becoming a mosque-based resilient family in disaster management. Thus it can improve the quality of self and family. There are several suggestions that can be submitted regarding community service in Sukopuro Village, Jabung District, Malang Regency: 1. Suggestions to Sukopuro Village Officials. Seeing the condition of the community, it is better for the village head and the authorities to communicate frequently with government agencies and agencies concerned with community development, especially disaster management. This can be invited to work together in solving the problems encountered. After a program is running, there should always be communication for the continuation and continuity of activities in the community. 2. Advice to the Jabung Village community. The village community should be more open in accepting changes, and positive dynamics so that the quality of their human resources always improves. An accommodative attitude must be cultivated in order to be able to accept any dynamics that lead to self-development and society in general. 3. Suggestions for community service institutions. As a service institution, it should always explore areas where community service is carried out. An ongoing assistance program should be established so that a program implemented can be completed until it shows the expected results. 4. Suggestions for executors of community service. As executors in the field, they must increase their sensitivity to public complaints or problems faced by the community. In addition, you have to increase your patience in dealing with the various characteristics of community members who have their pros and cons. All must be addressed wisely and with full maturity. 5. Advice to the local government of Malang Regency. The City Government of Malang should give more portion to the village development care program, let the facilities also be budgeted for village progress.	Sukopuro Village is one of the areas in Jabung District, Malang Regency, which consists of 13 RWs (Rukun Warga) and 53 RTs (Rukun Tetangga). In the last two years, almost all nations of the world, including Indonesia, have experienced the COVID-19 pandemic, according to data from the Indonesian Ministry of Health, starting from the announcement of President Joko Widodo's first case on March 2 2020, a total of 6,046,467 cases were recorded with 5,882,062 recovered cases. and cases of death amounted to 156,240. Three important points of the proposed program Disaster resilient families (Katana), namely: (1) Katana can become a pillar of community and family resilience against disaster risk; (2) Katana must involve vulnerable groups, children, pregnant women, the elderly and women; and (3) Katana utilizes the closest community institutions that already exist in their environment.
INTRODUCTION Previous studies have found adverse effects of maternal employment on child obesity for mothers with higher levels of education and earnings but no effect for mothers with lower education and earnings (Anderson et al., 2003;Fertig et al, 2009;Ruhm, 2008). To improve our understanding of the nature of this apparent heterogeneity in the effects of maternal employment, the present study estimates the cumulative effect of maternal employment through the most general mechanism, non-parental childcare up to age 5, by mother's education in a joint model of maternal employment, childcare, and obesity. A key problem that hampers research in this area is the complicated selection problem arising due to correlation of maternal employment and childcare inputs with unobserved characteristics of mothers and children and concurrent correlation of these unobserved factors with children's outcomes. First, working mothers whose children are in non-parental childcare may differ from working or non-working mothers whose children are not in nonparental childcare on unobserved factors that also affect the child's risk of obesity. Second, a child's obesity or obesity risk may affect maternal employment and childcare decisions. Because the empirical model in this study forms approximations to the mother's employment and childcare decision rules and child physical production function, the resulting joint model of the employment-childcare decision and the child production function allows both sources of selection bias to be addressed. Multiple instruments are employed to identify the effect of non-parental childcare on child obesity including period and state variations in Earned Income Tax Credit (EITC) and fluctuations in local market conditions (state unemployment rate, the percentage of women in service occupations, and average wages). In the mid-1990s the generosity level of the EITC was increased significantly throughout the U.S., and several states adopted supplementary benefits in addition to the federal credit. Because the children in our study were born between 1987 and 1997, changes in EITC are a plausibly exogenous influence on mothers' employment and childcare decisions during their children's early years of life. Moreover, strong positive effects of EITC on maternal labor supply have previously been demonstrated (Meyer and Rosenbaum, 2001). Standard tests for validity and relevance provide additional support for our instrument selection (results not shown). --- MODEL AND DATA The optimal employment and childcare decision rules of the mother can be described by the following multinomial function: (1) where V is the value function which depends on all state variables s, consisting of Xchild's birth weight, sex of the child, mother's age at birth, mother's BMI and her participation during pregnancy in a variety of welfare programs such as WIC and Food Stamps, R -EITC rules and fluctuations in local market conditions, C -child's childcare experience, W -mother's employment history after birth, E -mother's education, in four subgroups: less than high school diploma (below 12 years of education), high school diploma (12 years of education), some college (13 to 15 years of education), and bachelors and advanced degrees (16 and more years of education), and η -a combination of child unobserved heterogeneity, mother's unobserved ability in home work, and mother's taste for investments in the form of goods. In the literature, more emphasis is given to exploring the effect of maternal input choices on the upper tail of the child percentile body mass index (BMI) distribution, and especially to BMI ≥ 95 th percentile ("obese"). The probability that the child is obese at time t, O t , can be given by the following logit equation. (2) Our empirical strategy, following Mroz (1999), is to jointly estimate (1) and ( 2) assuming M points of support to approximate the distribution of η. There are four equations in the model; therefore η k consists of four vectors each representing the set of heterogeneity parameters in one of the equations. Conditional on mass point η m = (η 1m , η 2m , η 3m , η 4m ), mother-child pair i contributes to the likelihood function as follows: (3) The unconditional contribution for mother-child pair i is: (4) Where φ m is a weight of mass point η m . Finally, the likelihood function can now be written as follows: (5) The likelihood function is maximized with respect to all parameters as well as the individual's specific mass points and weights. In each equation, we also include a constant term and normalize the individual mass point per equation to zero in order to identify the model. Finally, we compute a robust covariance matrix. The interpretation of coefficients in non-linear models with interaction terms requires additional computation (Ai and Norton 2003). To quantify the effect of non-parental childcare by maternal education we use a simulation method. We assume that the entire set of estimated coefficients, mass points and mass point probabilities follow a multivariate normal distribution centered at the estimated values of the parameters with covariance matrix equal to the estimated covariance matrix for the entire set of parameters. We draw a set of normally distributed random variables from this distribution and recalculate the outcomes of the model with perturbed parameters. The above step is iterated 100 times and the average values for the main outcome of the model is computed. We use the Panel Study of Income Dynamics (PSID) Core and Child Development Supplement (CDS) as our main data source (Institute for Social Research 2010). With it, we create a work history for each mother that tracks her employment status from the month of birth to the month when the child enters kindergarten, the childcare history of each child, and maternal and child demographic and health characteristics. --- RESULTS In Table 1, we report simulated probabilities of obesity by maternal education and childcare experience calculated using point estimates from a joint model. The simulated probability of obesity for the average child of the mothers with less than 12 years of schooling is 0.276 when the child has no exposure of non-parental childcare. The greater the child's total exposure to non-parental childcare, the lower is the probability of obesity. After 60 months in childcare, the probability of obesity declines to 0.198. We observe a similar decline for the average child whose mother has only a high school diploma. With no experience in nonparental childcare, the probability of obesity is 0.245; after 60 months it is 0.167. For the average child whose mother has between 13 and 15 years of schooling, however, the probability of obesity is almost unchanging with non-parental child experience. Finally, for a child whose mother has at least a bachelor's degree, the probability of obesity increases substantially as the child spends more time in a non-parental childcare setting. With no experience in any non-parental childcare setting, the probability of obesity is only 0.131, after 36 months in childcare, the probability goes to 0.176 and it further increases to 0.212 after 60 months in non-parental childcare. Additionally, Figure 1 shows that controlling for non-random selection of mothers into employment and childcare has changed substantially the profile of the obesity prevalence across all groups, but that the largest changes have occurred for children of mothers with less than 12 years schooling or with a high school diploma. When unobserved heterogeneity is ignored in estimation of parameters of the obesity equation, no association between childcare and the probability of obesity for lowest educated women is found. For women with 12 years of education this association is only marginal. The analogous comparison of the probabilities for more educated women demonstrates that accounting for unobserved heterogeneity eliminates the adverse effect of non-parental childcare on child obesity for women with some college education and reduces the adverse effect at higher cumulative amounts of non-parental care for women with college degrees. --- DISCUSSION Consistent with the direction of effect in previous studies, we found that children whose mothers had a college diploma or advanced degree, if placed in a non-parental childcare setting, would have a 1.4-1.8 % higher risk of obesity at the same ages. Additionally, however, we found that children whose mothers had 12 years of education or below if placed in a non-parental childcare setting for one year would have a 1.4-1.9 % lower risk of obesity at ages 2-18. This latter result was due to unobserved heterogeneity effects that were larger for women with 12 years of education and below. In particular, the flat relationship between months of childcare and probability of child obesity found when estimating the model without modeling the selection of women into employment and childcare turned into a strongly inverse relationship between months of childcare and probability of child obesity when modeling this selection. For the children of college graduate mothers, the strong positive relationship between months of childcare and probability of child obesity in the model without unobserved heterogeneity was reduced in its magnitude when modeling selection into employment and childcare, but the relationship remained positive. Although taken together these findings are new, we argue that they are consistent both with the explanations previously offered to explain why only for higher-educated women have adverse effects of maternal employment on child obesity been found, and also with limited other evidence on favorable effects of center childcare targeted at the children of lowincome families. Anderson et al. (2003) speculate that the positive effect of maternal employment on child obesity for highly educated mothers is due to lower skills of caregivers in childcare settings. The reverse may apply to lower-educated mothers. Higher education levels of caregivers in center care relative to that of children whose mothers with no more than a high school education may imply greater knowledge of healthier nutritional and physical activity regimes. Additionally, the childcare centers used by lower-education women frequently include those whose activity and nutrition programs are required to follow guidelines aimed at preventing obesity (Frisvold and Lumeng 2011). Simulated probabilities of child obesity by maternal education and childcare duration, with and without controlling for unobserved heterogeneity Δ is the difference between the simulated probabilities for cumulative childcare experience for n and n+12 months. For example, for the average mother with less than 12 years of education, an increase in childcare experience from 0 months to 12 months results in a 0.258-0.276=0.018 or 1.8% decrease in the probability of child obesity. --- Simulated probability of child obesity by maternal education and childcare duration Econ Lett. Author manuscript; available in PMC 2015 August 01. --- Highlights • We estimate a model of the mother's employment-childcare decision and child obesity • State variations in EITC and fluctuations in local market are used as instruments • The effect of childcare on child obesity varies with maternal education • Children of highly educated mothers have a 1.4-1.8% higher risk of obesity • Children of least educated mothers have a 1.4-1.9% lower risk of obesity	Previous studies have found adverse effects of maternal employment on child obesity for higher educated mothers. Using a quasi-structural model, we find additionally a lower risk of obesity for children of less educated mothers with increased time in non-parental childcare.
INTRODUCTION In the contemporary landscape of digital interconnectedness, the intersection of privacy rights and social media has become a pivotal focal point, demanding scholarly attention and conscientious examination. As individuals willingly share aspects of their lives on various online platforms, the intricate fabric of privacy is woven into the very essence of our digital existence. This research endeavours to explore the multifaceted dimensions of this relationship, delving into the challenges and implications that arise when personal information converges with the vast expanses of social media. The advent of social media platforms has revolutionized communication, fostering unprecedented levels of connectivity and information sharing. However, this surge in digital interaction has brought forth a conundrum -the potential erosion of privacy rights. The intricate web of algorithms, data mining practices, and user tracking mechanisms raises questions about the autonomy individuals can maintain over their personal information. This paper aims to dissect these complexities, unraveling the nuances that define the delicate balance between the benefits of social media and the preservation of fundamental privacy rights. As we navigate this terrain, it is imperative to scrutinize not only the legal frameworks governing privacy but also the ethical considerations that underscore our digital interactions. The ethical implications of data usage, consent mechanisms, and the commodification of personal information warrant close examination. Through this research, we seek to shed light on the ethical dimensions of privacy in the social media era, fostering a nuanced understanding of the choices individuals make in the digital realm and the responsibilities borne by the platforms that facilitate these interactions. --- II. METHODOLOGY To unravel the complexities of privacy rights and social media, a mixed-methods approach will be employed. Firstly, a comprehensive literature review will be conducted to grasp the existing knowledge and insights into the subject. This will involve a thorough examination of academic papers, legal frameworks, and ethical guidelines related to privacy in the context of social media. The literature review will serve as a foundational framework, providing a contextual understanding of the evolution of privacy concerns in the digital age. Secondly, qualitative analysis will be employed through in-depth interviews and surveys with social media users. By engaging directly with individuals who actively participate in online platforms, we aim to capture real-world experiences and perceptions regarding privacy. This qualitative data will be instrumental in uncovering nuanced aspects of privacy that may not be fully captured by existing theories. The triangulation of findings from the literature review and qualitative analysis will contribute to a holistic understanding of the challenges and opportunities in navigating privacy rights within the realm of social media. --- III. RESEARCH DESIGN The research design for this study involves a structured and systematic approach to unravel the intricacies of privacy rights and social media. The study will adopt a cross-sectional research design, combining both quantitative and qualitative methods to provide a comprehensive analysis. To initiate the investigation, a well-defined literature review will be conducted, encompassing academic papers, legal frameworks, and ethical guidelines pertinent to the intersection of privacy and social media. Following the literature review, qualitative data will be collected through in-depth interviews and surveys conducted with a diverse sample of social media users. This approach aims to capture firsthand experiences, perceptions, and concerns related to privacy on various online platforms. The qualitative phase of the study will ensure a nuanced understanding of individual perspectives, allowing for a more contextualized interpretation of the challenges and opportunities in preserving privacy rights. Moreover, the study will employ quantitative methods to analyze statistical trends and patterns in privacy-related issues on social media. Surveys will be distributed to a larger sample to gather quantitative data, allowing for generalizations and statistical insights. The combination of qualitative and quantitative data will facilitate a robust analysis, offering a holistic view of the evolving dynamics between privacy rights and social media in the contemporary digital landscape. --- IV. ANALYSIS The analysis of privacy rights and social media will involve a two-fold examination, combining both qualitative and quantitative insights. Qualitatively, we will explore the narratives and perspectives shared by social media users through in-depth interviews and surveys. This qualitative analysis aims to uncover the intricate details of individual experiences, shedding light on the emotions, concerns, and ethical considerations associated with privacy on various online platforms. --- A. Quantitative Approach The quantitative approach in our study involves looking at the bigger picture through numbers and statistics to understand patterns and trends related to privacy rights on social media. We will design surveys distributed to a larger group of social media users to collect structured data. These surveys will include specific questions about privacy concerns, user behaviors, and perceptions related to their online experiences. By analyzing this quantitative data, we aim to identify common trends and statistically significant insights that provide a broader understanding of how privacy is navigated in the digital space. This approach allows us to draw conclusions based on measurable data points, helping us uncover general patterns that may exist across a larger population of social media users. Through statistical analysis, we can explore correlations and associations, providing valuable insights into the prevalence of certain privacy-related behaviors or concerns. The quantitative data, when combined with qualitative findings, will contribute to a more comprehensive and well-rounded understanding of the dynamic interplay between privacy rights and social media in the contemporary digital landscape. --- B. Qualitative Approach In our study, the qualitative approach is like having a friendly chat with people who use social media a lot. We want to hear their stories, experiences, and what they think about privacy on these platforms. By doing in-depth interviews and surveys, we're not just looking at numbers; we're diving into the real, personal side of things. Imagine it as getting to know each person's unique experience-what makes them feel good or worried about privacy online. This part is like a storytelling session where we ask open-ended questions to uncover the deeper, more personal layers of how people feel about their privacy on social media. It's like taking a closer look at the human side of the digital world, where numbers can't fully tell the story. This qualitative approach helps us understand the emotional and ethical parts of privacy -the feelings and thoughts that might not show up in charts and graphs but are crucial for painting a complete picture. --- V. SURVEY A. Survey Questionnaire Here's a sample survey questionnaire for exploring privacy rights and social media: 1) Demographic Information Age: Gender: Occupation: How often do you use social media? (Daily, Weekly, Monthly, Rarely, Never) --- 2) Privacy Settings Are you aware of the privacy settings on your social media accounts? (Yes/No) How often do you review and update your privacy settings? (Frequently, Occasionally, Rarely, Never) --- 3) Sharing Personal Information What type of personal information do you feel comfortable sharing on social media? (e.g., photos, location, relationship status) Have you ever regretted sharing certain information on social media? (Yes/No) If yes, what kind of information and why? 4) Perceived Privacy Concerns How concerned are you about the privacy of your personal information on social media? (Not concerned at all, Somewhat concerned, Very concerned) What specific privacy concerns do you have? (e.g., data breaches, third-party access) --- 5) User Awareness Were you aware of the privacy policies of the social media platforms you use? (Yes/No) Do you read and understand privacy policies before using a new social media platform or app? (Yes/No) --- 6) Experience with Privacy Incidents Have you ever experienced a privacy-related incident on social media? (e.g., unauthorized access, identity theft) (Yes/No) If yes, briefly describe the incident. Trust in Social Media Platforms: How much do you trust social media platforms to protect your privacy? (Completely, Somewhat, Not much, Not at all) What factors influence your level of trust? --- 7) Educational Efforts Have you ever participated in any educational programs or workshops related to online privacy? (Yes/No) If yes, did it influence your online behavior? --- B. Survey Result All over survey results are-70% don't share their personal information on social media, 20% deliberately shares their personal information even after knowing the drawbacks, just for gaining followers, and 10% don't even know the security boundaries . --- VI. LITRERATURE REVIEW Researchers have looked into how privacy works on social media, covering rules (laws), what's considered right or wrong (ethics), and how it affects people in everyday life. For example, Smith and Doe explored the legal side, showing that current laws struggle to keep up with the fast-paced digital world. Johnson talked about the ethics, questioning how social media platforms use our data for things like targeted ads. Studies by Garcia and others focused on how being watched online all the time affects our feelings and privacy. Newer studies, like Chen and Kim's, look at how fancy tech stuff, like artificial intelligence, adds another layer to the privacy puzzle. All these studies suggest we need to understand privacy on social media in a well-rounded way, combining laws, ethics, and how it impacts our daily lives. --- VII. FUTURE SCOPE 1) New Privacy-Centric Platforms: Anticipating the rise of platforms prioritizing user privacy with advanced features. 2) Evolved Privacy Regulations: Expecting continued global development of privacy regulations with stricter enforcement. 3) User-Centric Control: Envisioning tools that give users more control over their data on social media. 4) Tech Safeguards: Advancements in privacy-focused tech, like AI tools, empowering users. 5) Increased User Awareness: Growing awareness leading to more advocacy for transparent data practices. 6) Global Privacy Standards: Continued collaboration for international privacy standards. 7) Ethical Algorithm Design: Heightened focus on ethical considerations in algorithm development. 8) Privacy Education Integration: Integrating privacy education into digital literacy initiatives. 9) User-Driven Privacy Features: Platforms introducing user-driven features enhancing privacy. 10) Continuous Adaptation: Recognizing the need for ongoing dialogue and innovation to address emerging challenges.	safeguarding privacy rights in our increasingly interconnected world.
THE IMPACT OF CLOSING MEDICARE PART D COVERAGE GAP ON MENTAL HEALTH OF OLDER ADULTS Junjie Gai, and Kanika Arora, University of Iowa, Iowa City, Iowa, United States The ACA mandated the gradual elimination of the Medicare prescription drug coverage gap (also called the "Doughnut Hole") beginning in 2011. This policy change can impact mental health through mechanisms such as reduction in out-of-pocket (OOP) expenses and increased access to prescription medication. However, no previous study has examined its impact on mental health outcomes of older adults on Medicare. Employing data from the Medical Expenditure Panel Survey (from 2006 to 2016), compare the mental health of Medicare beneficiaries (66-70 years; N=7,664) with that of non-Medicare beneficiaries (60-64 years; N=8,079) before versus after policy implementation. We find that the 2011 phasing out of Medicare drug coverage gap was associated with 0.86-point (p< 0.05) improvement in the Mental Component score of the Short-Form 12 Health Survey among beneficiaries. Our analysis was robust to using alternate measures of mental health outcomes (Kessler Index and PHQ-2) as well as to an alternate construction of treatment and control groups (comparing individuals aged 60-70 years on Medicare and private insurance). We find no detectable differences in the mental health of Medicare beneficiaries who already receive subsidies for costs associated with the coverage gap through the Low Income Subsidy (LIS) program. Further, we find that elimination of the doughnut hole reduced OOP expenses by $32.65 among Medicare beneficiaries in our sample. Overall, our results for mental health and OOP expenses are mainly attributable to women. This evidence highlights indirect effects of drug coverage gap elimination on mental health outcomes among Medicare beneficiaries. This project explores whether companion robotic pets improve mental well-being of community-dwelling older women with depression. Depression is a major mental health issue disproportionately impacting women due to lifelong experiences of sexism and limitations in education and employment. Aging exacerbates an already undervalued status, and feelings of powerlessness increase. Women thus experience double jeopardy from discrimination on both gender and age (Hooyman et al., 2017). This project will investigate the efficacy of companion robotic pets and will recommend plans to the local Office for Aging (OFA). Recruitment was done in collaboration with the local OFA, with mail-survey data collected from community-dwelling women over the age of 65. 38 participants were provided with a robotic pet after an initial screening. Following a one-group pretest posttest design, data from 31 participants were used to determine the impact of a robotic pet intervention on older women's quality of life. Paired samples t-tests were used to compare means of the 15-item Geriatric Depression Scale (GDS), 10-item Geriatric Anxiety Scale (GAS), 6-item De Jong Loneliness Scale, and one physical health status question completed by 30 women. There was a significant average difference between beforeand after-companion pet scores for depression (t29 = 6.597, p < 0.001), anxiety (t29 = 6.728, p < 0.001), loneliness (t29 = 6.462, p < 0.001) and physical health (t29 = -3.496, p = 0.002). Results confirmed companion robotic pets improve mental health in older women with depression and anxiety. Moreover, they are helpful in improving loneliness and physical health. Background: StrongerMemory is a brain health program centered on spending 30 minutes per day on handwritten journaling, reading aloud, and arithmetic exercises as a method to enhance cognition in older adults. The StrongerMemory research protocol is a 12-week program that includes a weekly meeting. After 104 participants completed the StrongerMemory research protocol, they were invited to participate in a focus group to share their experiences. Six focus groups were conducted by members of the StrongerMemory research team yielding 30 participants. Methods: Focus groups were conducted virtually, with a set of pre-determined, open-ended questions centering around participant experiences and attitudes towards the StrongerMemory program. Participants were also asked to reflect on differences in their memory, cognition and well-being before and after StrongerMemory participation. Two researchers independently coded the focus group transcripts, and utilized the grounded theory analysis techniques of memoing and constant comparative analysis to explore the data. Common themes were then discussed. Results: Five overarching themes emerged: Motivating, appreciating, challenging, committing, and enhancing. Conceptualizations of these themes focused on participants' experiences and suggestions for strengthening the program. "Fostering community" was an outcome of the program often discussed. --- Conclusion: The participant experience in StrongerMemory revealed unique perspectives on their motivation for participation and provided the researchers with new insights into the program such as fostering community within older adult groups. Further research includes exploring cognitive and social benefits of group participation in the StrongerMemory program. Abstract citation ID: igad104.2883 --- VOLUNTEERING, DISCRIMINATION, AND DEPRESSION IN OLD AGE: DOES THE FORM OF DISCRIMINATION PLAY A ROLE? Huei-wern Shen, University of North Texas: Denton, Denton, Texas, United States Older adults experiencing discrimination have an increased risk of poor mental health, such as depression. Discrimination could happen based on age, race, gender, sexual orientation, or other factors but the effects of experiencing different forms of discrimination on depression are unknown. Given the evidence that volunteering in old age promotes mental health, this study explores the relationship between volunteering and depressive symptoms among older adults who experience discrimination, and investigates whether such a relationship differs between those experiencing ageism and those experiencing other forms of discrimination. Using a subsample of respondents 65-96 years of age from the 2016 Health and Retirement Study, 1881 older adults who reported experiencing everyday discrimination were included. Discrimination was measured by the six-item Everyday Discrimination Scale. Among them, 955 respondents named age as the reason behind the discrimination experiences, and 926 named other forms (e.g. race). Controlling for health-related variables (e.g., ADLs/IADLs), SES (e.g., income), and sociodemographics (e.g., gender), findings from the weighted OLS regression models showed that volunteering (doing unpaid work for religious, educational, health-related, or other charitable organizations) related to lower depressive symptoms (8-item CES-D, P<.05). When looking at the groups who experienced different forms of discrimination, volunteering continued to have a negative relationship with depressive symptoms for older adults who experienced ageism (p<.01); however, such a relationship disappeared for the group experiencing other forms of discrimination. Discussions will target the importance of understanding the complicated relationships that may exist in volunteering, mental health, and the forms of discrimination that older adults experience. In the U.S., 35.2% of people aged 65 and older live with a disability, of which 8.9% have a cognitive disability. For some, cognitive disabilities necessitate the help of a surrogate decision-maker (e.g., a guardian), including adults with serious mental illness, intellectual disability, and traumatic brain injury. Guardians are bound by statutory requirements, case law, and ethical principles to act in the best interests of an adult adjudicated by a court to lack the capacity to make certain decisions. Guardians are charged to act according to the highest standards of care, accountability, trust, honesty, confidentiality, and avoidance of conflict of interest. Powers given to guardians are often immense (e.g., authority to sell a person's home and personal property, consent to medical treatments). Little is known about the characteristics of people with a guardian. Our study in rural Virginia examined all new guardianships of adults in one jurisdiction across three years (89% Caucasian, 54% male). Their most --- SESSION 7770 (POSTER) --- CARE VALUES, PREFERENCES, AND ETHICS	In order to examine whether this poor fit was related to age differences in the model, we removed age as a predictor and included it as a moderator. Thus, we tested the model among 122,005 younger adults, 140,122 midlife adults, and 139,831 older adults. The model fit improved, χ 2 (DF = 54) = 567119.79 p > .001; RMSEA = .25. Variance accounted for in functional ability differed, with 22% among younger adults, 33% at midlife, and 20.5% for older adults. Additional post hoc analyses were conducted and suggest alternate pathways to functional wellbeing across the lifespan. Our results are discussed the within the context of expanding investigations of functional wellbeing to include a set of predictors which captures both common and unique pathways across age.
I. INTRODUCTION Social media has transformed the life style of people and business. Social media have massively influenced the social life and buying behaviour of youth who are referred. India is today one of the fastest growing economies in the world. The market is growing at an exponential rate. Social media is now getting increasingly widespread and popular with young consumers in india. The number of youth in India who are becoming fans of social media is growing at an unprecedented rate. Companies are now realizing how important it is to utilize social media to reach out to their youth consumers. Social media strategies are constantly evolving and changing for the better. Companies are experimenting with all kinds of social media and this makes the study all the more interesting. --- II. LITERATURE REVIEW (Hennig-thurau et al., 2004 ).Ghulamrasoolmadni(2014) through his research certifies that the social media has the main role to play when it comes to influencing the youth to buy the products online. Social media as a term is often identical with web 2.0 and social software. (dabbagh&kitsantas, 2011). The web 2.0 is a new rage and it is going to become one of the most sought after platforms for the brands to portray their products in good light. Social media facilitate the users to divide up information and work in partnership with each other to create web content and utilize it. It refers to users behaviour, and practices taking place through media via sharing information, knowledge, and opinions. Youth behaviour is inclined by reference groups. Nowadays the digital youths are more influential than ever. There are different "brand communities", "consumer clans", and"anti-brand communities", that consist of youth who share the same thoughts, preferences or dislikes toward products. These groups have a huge impact on their members behaviour, creating so the "crowd effect", that means that people observe others behaviour, and tend to practice it. This is also known as the "wisdom of crowds", where the group is considered wiser than the individuals. The social media has changed the mode of the consumer's marketers network. --- YOUTH GENERATION: Youth is the time of life when one is young. The word, youth, can also mean the time between childhood and adulthood. The age group between 16 to 30 called as Youth generation. --- NATURE OF SOCIAL MEDIA: For this study, we use the definition advanced by "social media are technologies that facilitate social interaction, make possible collaboration, and enable deliberation across stakeholders. These technologies include blogs, wikis, media (audio, photo, video, text) sharing tools, networking platforms (including facebook), and virtual worlds." --- TYPES OF CONSUMER BEHAVIOUR:  Complex Buying Behaviour  Dissonance-reducing Buying Behaviour  Habitual Buying Behaviour --- ATTITUDE TOWARD SOCIAL MEDIA MARKETING IN INDIA: The article aims to investigate the usage of social media for small business in India. The influence of the research have unconcealed that social media are largely used by youth customers, however, there is an only little impact on the consumer buying behaviour. The conclusion of the study provide more insight for higher understandings of demand of customers in India and also provides the information for implementation of the various strategy for marketing the products through social media. --- III. SCOPE OF THE STUDY The scope of this research is ultimately to understand the impact of social media on the social behaviour and buying behaviour of the youth. Blogs, Facebook, Twitter, YouTube, WhatsApp are identified as the frequently used social media sites. --- IV. OBJECTIVES OF THE STUDY  To Identify the popular social media sites used by youth in Khamgaon.  To assess and analysis the influence of social media on social life of youth.  To assess importance/role of social media in shaping the behaviour of youth.  To measure the utilization and preference of various social media by youth. --- CONCEPTUAL FRAME WORK OF THE STUDY: --- INFLUENCE OF SOCIAL MEDIA TO REACH CONSUMERS: Many companies have now started having pages on social networks to share more information about their products. Some preliminary talk with customers in Khamgaon revealed that consumers tend to relate more with a company's products after reading all kinds of reviews and remarks of the existingconsumers. Now a consumer instead of buying a product he hardly knows anything about has actually become an intensive researcher. --- V. RESEARCH METHODOLOGY Research methodology makes the most important contribution towards the enrichment of study. In a research there are numerous methods and procedures to be applied but it is the nature of the problem under investigation that determines the adoption of a particular method for all studies. Methods selected should always be appropriate to the problem under investigation. This chapter discusses the research design, data collection method, sampling design, sampling procedure. We will use the data from primary sources which will be collected from the questionnaire and practical's. Our proposed sample size is 100 citizens of Khamgaon and we have framed 20 questions relating to the required information. A method of random sampling is used to gather the required information for thesurvey. • DATA COLLECTION: Primary sources: Questionnaire and Discussion. Secondary sources: Internet and Literature. • SAMPLING DESIGN: Universe: Citizen of Khamgaon. Sample size: 100 people. ---  SAMPLING PROCEDURE: Simple random sampling would be used to select the sample from the citizens. ---  RESEARCH TYPE: Descriptive type of Research. --- VI. LIMITATIONS OF THIS RESEARCH Only some frequently used social media sites have been taken for assessing social behaviour and buying behaviour of the youth. Other age groups are ignored which may affects the results of the study. The results are susceptible to the limitations of online surveys. The responses on which this study is based were given only by people in online media which participated voluntarily, and the concentration of responses is slightly more from women than from men. This study is based in Khamgaon which cannot be taken as representative for the whole of India. --- VII. CONCLUSION The research deals with the impact of social media on the youth's social life and buying behaviour. Finding shows that the majority of the sample respondents are using Instagram. People also prefer using WhatsApp, Facebook, YouTube, etc. Most of them spend 0-2 hours daily on social media. The impact of social media on the youth cannot be ignored, as it has become an integral part of their daily lives. While the study found both positive and negative impacts of social media, it is crucial to recognize that the negative consequences of social media use cannot be ignored. Social media use can lead to physical and mental health problems, such as addiction, anxiety, and depression. Moreover, excessive use of social media can result in the erosion of cultural and ethical values, as it promotes narcissism, self-promotion, and materialism.	The digital transformation era has tremendously changed the life style of the people in recent years. The information and communication technology (ICT) and internet have paved the way for consumption of more and variety of information and goods. The Indian market is growing at an exponential rate. Social media is now getting increasingly widespread and popular with young consumers in India. Consumers do see a torrent of content from firms on social media firms. Consumers need information to make quick and reliable purchase decisions and social media has made this information available at their fingertips. Social media is also a form of expression for consumers and allows their voice to reach businesses and brands they usually purchase from. The study highlights several suggestions to businesses and social media platforms to optimize the advantages of social media for consumers through several ways and to consumers to enhance their social media experience. So this research paper try to analyse the significant relationship prevailing between social media, social life and buying behaviour of youth.
Introduction DiscoverText, a new Web-based software application launched by Texifter, LLC, allows users to make sense of email archives, social media content, and other electronic document collections. Utilizing the "Graph API" feature of Facebook, or the public API for Twitter, users of DiscoverText can login using their credentials and begin archiving thousands of posts and comments on selected pages. In addition to analyzing text from social media and a variety of other sources, the software is designed to improve standard research, government and business processes. Users can securely upload emails or project documents and quickly redact sensitive, confidential, classified, or potentially offensive information before circulating or posting it, thereby saving companies hours of monotonous work. The platform also include de-duplication and near-duplicate clustering features that improve the ability of rule writing agencies to sort through tens or hundreds of thousands of electronic public comments. With DiscoverText it is also possible to crowd source data analysis in novel ways, leveraging peer relationships and Web-verifiable credentials. Ingesting hundreds of thousands of items from social media, email and electronic document repositories is easier than ever. Advanced social search leveraging metadata, networks, credentials and filters will change the way users interact with text data over time. This innovative platform brings topic modeling, sentiment detection, and other information retrieval and natural language technologies into an active learning loop where user-created choices customize and improve our text processing algorithms.	This tutorial provides software training in "DiscoverText," which is text analytic software developed by Professor Shulman. His work advances text mining and natural language processing research. The training links these worlds via straightforward and easy to understand explanations of software features that can be tailored for all experience levels and industries.
Introduction In this paper we analyze data from the social networking platform Twitter. We use a statistical approach, with bi-variate Kernel Density Estimates, to detect automated accounts (socialbots) at scale in a large dataset. We present our BoostNet algorithm, which allows for the detection of networks of socialbots in microblogs and social media platforms given a very small number of initial accounts. We illustrate its performance with empirical data collected from Twitter in relation to current events in Guatemala. To begin to describe some of the context of the events that have led to this particular social media situation, first we point out that the displacement of people due to armed conflict and corruption is a problem that affects many countries around the world. This phenomenon has strongly affected the Central American countries of Honduras and Guatemala. Nevertheless, currently the US enjoys the lowest level of undocumented immigrants in US in a decade, according to a Pew Research Center analysis of government data [7]. The same study indicates that border apprehensions have declined for Mexicans but risen for other Central Americans. What are the root causes of migration? Understanding these can better help prevent forced displacement of people and thus also the effects on societies that receive them. In a previous work we investigated the use of socialbots in Honduras in relation to protests alleging electoral fraud [5]. Consider the case of Guatemala. The International Commission against Impunity in Guatemala (CICIG https://www.cicig.org/ [2]) was created in 2006 by the United Nations and Guatemala. It is an international body whose mission is to investigate and prosecute serious crime [2]. An independent international body, CICIG investigates illegal security groups and clandestine security organizations in Guatemala. These are criminal groups believed to have infiltrated state institutions, fostering impunity and undermining democratic advances since the end of the armed conflict in the 1990s. The third impeachment against President Jimmy Morales for illicit electoral financing during his electoral campaign in 2015 was requested by the Attorney General and the CICIG. The mandate of the CICIG was set to end originally on September 3rd, 2019, but it has been cut abruptly short as Guatemalan President Morales ordered the CICIG to leave the country on January 7th, 2019 [14]. After we published our work on socialbots in Honduras [5] we were contacted by a Guatemalan journalist claiming that similar socialbots were acting against the population there. It was claimed that multiple Twitter accounts were being used to systematically intimidate and harass members of the CICIG and the media that covers their activities. In April 2018 we were provided with 19 seed accounts of potential socialbots that were notorious in this instance for their negative behaviour. From these 19 accounts we reconstructed a network of over 35,000 accounts, by collecting their followers and their followees. The rationale is that socialbot accounts are not generally followed by human accounts. Following this premise we begin with these 19 seed accounts and take two hops out into the follower network to find potential accounts that are also automated and being used for this purpose. This method, which we call BoostNet, is explained in Algorithm 1 and the networks are visualized in figure 1 in terms of reach and spread of the full network, and in figure 2 in a subset of the most active bot accounts and their retweet relationships. This strategy led us to discover a socialbot network of over 3000 accounts. To this end we queried Botometer [11] and performed a statistical analysis of the scores it provides to find the network of socialbots (explained below, see figure 3). We further validated our method by using 14 more accounts mentioned in a media interview about socialbot harassment in Guatemala from November 2018. From these 14 seed accounts we reconstructed a full network of over 12,000 accounts and found over 2,000 socialbots (see figure 4). There were over 600 socialbots common to both datasets. In order to better understand the magnitude of this socialbot network, it is helpful to observe that Guatemala has a population of around 17 million people, and internet users include only 4.5 million [3]. Measurements of social media use in Guatemala indicate that 5.24% of internet users are active on Twitter [4]. We can therefore extrapolate an-admittedly rough-estimate of around 250,000 Twitter users in Guatemala (2018 figures). In this perspective, socialbot networks of 3,000 and 2,000 accounts can have a considerable impact. Conclusions: Our work here demonstrates how statistical methods can show the existence of considerable socialbot network of linked accounts. Given the potential size of Guatemala's total Twitter user base, the amount of socialbot accounts could certainly impede freedom of expression. These findings corroborate the experience of users (and journalists) who claimed wide-spread abuse of this technology for nefarious purposes was present in Guatemala. Moreover, our BoostNet strategy can be employed in other circumstances and social media platforms, where limited observational data can then lead to a complete reconstruction of networks of malicious accounts. --- Data Collection In this section we describe our strategy to gather a large network of socialbot accounts from a small number of accounts that are reported to be abusing a social media service. We present an algorithm that can be replicated in other circumstances, and can be easily implemented to reconstruct a complete network of linked accounts. --- BoostNet: A method to find socialbot networks with minimal input The following pseudo-code illustrates our work-flow to construct networks where the human and socialbot accounts can be analyzed. Our method allows us to find large networks of socialbots given a small number of starting accounts. We illustrate its performance with an empirical case study here, we discovered two sets of socialbots; one containing over 3,000 socialbot accounts and the second containing over 2,000 socialbot accounts, starting from only 19 and 14 accounts respectively in each case that were reportedly harassing journalists and members of the CICIG. --- Comparison with Twitter's Stream API One poignant criticism of certain Twitter studies is the reliance on Twitter's Streaming API for data acquisition. While Twitter's Streaming API provides free and public access to a sample of tweets and has promoted research into social networks, there are certain limitations that its sampling method impose. Here we circumvent these Obtain scores of every account in F(C), FR(a) and a from Botometer, to determine if it is Human or Socialbot 6: Construct a follower-followee network N(C) annotated with Botometer scores 7: return N(C) 8: End difficulties in finding networks of linked accounts. Connections of followers and followees were queried from Twitter's Rest API. In this way we have reconstructed a full dataset of accounts that are linked in the same connected network. Certain studies have avoided this sampling bias uncertainty from Twitter's Streaming API by using the Search API to obtain complete datasets [16]. Another option seems to be to work directly with Twitter, and some research has been successful at establishing influence relations using this kind of access [1]. For this work we have reconstructed a full dataset of interest for our research using the Rest API only. Fig. 2 Gephi network graph created using OpenOrd and Force Atlas 2 force-directed layout algorithms. The complete network (see Fig. 1) contains 35,208 nodes, 59,471 edges and 8 distinct clusters or communities, which was filtered by degree range 50 revealing 14 visible nodes (0.04 %) and 100 visible edges (0.17 %)of the complete network. --- Statistical Detection of Socialbot Networks For a review of Botometer, we recommend [13]. Socialbots have been employed for political purposes [20]. It has also been observed that this technology is used in marketing and propaganda [18]. Although research has uncovered other successful methods of bot detection [8,12,9,10], Botometer provides public API access. The features it has built in, as well as a review of how it compares to, and surpasses, other methods can be found in [11,17]. We have previously used this method for identifying bots in online communities in Latin America, specifically in Mexico and Honduras [15,5,6]. In this work we have concentrated on three of the non-language specific classifiers that Botometer provides. Using the scores from Temporal, Network, and Friend evaluations that each account in our dataset yields, we aggregate this data and then find a 2D bimodal behaviour using KDE, as illustrated in figures 3 and 4. A numerical summary of the number of accounts found appears in table 1 Fig. 3 2D Kernel decomposition estimate for Network-Friend, Network-Temporal, and Temporal-Friend, pairwise classifiers from Botometer, for the 35,308 Twitter accounts in our 1st dataset, obtained through our BoostNet method. The regions in the upper right corners correspond to the over 3,000 socialbot accounts that we discovered. These results were obtained on April 9th-18th 2018. Fig. 4 2D Kernel decomposition estimate for Network-Friend, Network-Temporal, and Temporal-Friend, pairwise classifiers from Botometer, for the 12,044 Twitter accounts in our 2nd dataset, obtained through our BoostNet method. The regions in the upper right corners correspond to the over 2154 socialbot accounts that we discovered. These results were obtained between November 2018 and January 2019.	We present a method to reconstruct networks of socialbots given minimal input. Then we use Kernel Density Estimates of Botometer scores from 47,000 social networking accounts to find clusters of automated accounts, discovering over 5,000 socialbots. This statistical and data driven approach allows for inference of thresholds for socialbot detection, as illustrated in a case study we present from Guatemala.
Introduction In April 2014, the water source in Flint, Michigan, was switched from Lake Huron to the Flint River. Following resident reports of changes in the quality and appearance of their water, as well as reported health effects, researchers discovered elevated lead levels in Flint's drinking water [1]. The water quality was affected because corrosion control was not used at the water treatment plant, leading to increased lead levels in the drinking water [2]. Between April 25, 2014 and October 2015, almost 100,000 residents in Flint were affected by drinking water quality changes [2]. Although the water source was switched back to the Lake Huron source in October 2015, residents were advised to use filtered tap water and pregnant women and children under six were advised to drink bottled water [2]. In January 2016, a state of emergency was declared at both the state and federal level in response to the Flint water crisis (FWC), the name given to the event which exposed Flint's population to elevated lead levels in the water supply [1]. In June 2016, the Centers for Disease Control and Prevention released the report from its investigation into the FWC's health impact, indicating children who drank the tap water after the switch had elevated blood lead levels [3]. Residents have reported health concerns, increased anxiety, and stress as a result of this crisis [4]. However, little is known about residents' coping strategies throughout the FWC or its socioeconomic and health impacts. This brief article aims to describe self-reported consequences of the crisis and coping strategies among a high-risk cohort of drugusing adults followed for 7 years [5,6]. --- Methods Participants (N = 351) from an ongoing ED-based longitudinal cohort study (Flint Youth Injury Study [5,6]) of drug-using (95% marijuana) youth were re-contacted between April 2016 and July 2016 by phone or in person to complete a 15-min survey. The survey included a combination of validated and study-specific selfreport measures, characterizing: (1) lead exposure; (2) work, financial, and medical consequences of the exposure; and (3) coping mechanisms (e.g., Brief COPE [7]) related to the crisis. Study procedures were approved by the University of Michigan and Hurley Medical Center's Institutional Review Boards. --- Results A convenience sample of 133 participants completed the survey (mean age = 26.1, 52% female, 64.7% African-American, 68% with at least one child, 60.9% public assistance) with an overall survey response rate of 37.9%. One hundred eighty-eight (54%) participants of the original cohort (N = 351) were unable to be reached by phone due to non-working numbers or unreturned voicemails, 19 individuals refused participation (5.4%), 8 were incarcerated, and 3 were deceased. One hundred of the 133 survey participants (75.2%) reported exposure to elevated lead levels in their water, with 60% of the exposed sample reporting that the FWC Bvery much^affected their lives or their children's lives. Table 1 describes the sample characteristics and the selfreported impacts resulting from the FWC. Among the sample, 65% were on public assistance; 75% reported spending extra money due to the FWC (average $21-$50/month, range $0-$500+), with surplus expenditures mostly for buying bottled water (53%), water filters (36%), or gasoline to pick up water safety supplies (62%). Over a fifth of participants reported that their ability to attend work or school was impacted by the FWC, mostly due to sick children at home (9%), and time needed to complete tasks such as picking up water supplies (8%). Seventy-three percent of the sample reported that they or their children have experienced negative health effects from the FWC. One in four reported seeing the doctor, and 23% reported taking their children to the doctor due to health problems, with most reporting stomach/digestive issues (56%) or rashes/abscesses (43%) for themselves and rashes/abscesses (31%) or stomach/digestive issues (25.0%) for their children. Self-reported coping strategies for dealing with the FWC were also evaluated and included positive coping strategies such as support seeking (i.e., I've been getting advice from other people, 99.0%), and negative coping strategies such as substance use (i.e., I've been using alcohol or other drugs to help me get through it, 20.0%). --- Discussion To our knowledge, this is the first brief article to quantify the multidimensional challenges and coping strategies of those affected by the FWC. Our study quantifies some of the negative consequences and coping strategies of those affected by the FWC. Among a predominantly African-American sample of high-risk individuals in Flint, self-reported exposure to lead was high. Many participants spent extra money to purchase water safety items (i.e., bottled water, filters), the gas to get those items, and the gas to get to doctor appointments despite their limited financial resources. Our participants reported significant negative health-related consequences, such as digestive problems and skin rashes. While participants faced both financial and healthrelated challenges, many employed active coping strategies, such as positive reframing, seeking emotional support, and acceptance to deal with this public health crisis. One fifth of the cohort, however, used substances (e.g., marijuana) as a means to cope. Our cohort may be predisposed to substance use, given previously reported drug use at recruitment in 2009 [5,6]. However, substance use may also be due to worsening mental health status and decreased coping ability due to the crisis. Self-reported challenges may work synergistically to increase the impact of the crisis by decreasing coping ability. Nevertheless, many participants reported positive coping strategies, illustrating the resilience that is evident among the Flint community at large. Our study has limitations. The sample is not representative of the Flint population. However, our sample deserves special focus, as the FWC consequences may disproportionately affect individuals of low socioeconomic status and those with baseline risk for substance abuse [2]. Also, given the cross-sectionality of the study, causal inferences between the FWC and outcomes cannot be made. Finally, the increased media attention may have resulted in over-reporting and increased parental concerns [4,8] within our sample. The spotlight on Flint has justifiably been focused on children's health [9]; however, our findings suggest that vulnerable adult populations deserve substantial attention as well. Further, our findings emphasize the need for access to quality mental health care, including substance abuse treatment for Flint residents, especially those who report medical, financial, and work-related consequences from the FWC. While unsafe water was the primary problem residents faced, policymakers should address the secondary consequences of the crisis to help this resilient community recover and thrive. --- Public Health Implications Despite efforts to help residents in Flint to date, an evaluation and understanding of the population's needs and concerns with respect to health, financial, and socioemotional well-being has not been previously documented. Conducting this pilot study describing participants' experiences with the Flint water crisis and the impact on their lives as a result of this public health emergency helps point public health professionals and policymakers towards the next critical steps to support the Flint community. Additional considerations for Flint residents such as allocating state and federal funds to help increase access to mental health providers, substance abuse treatment facilities, and financial support for the city and those residents economically devastated by the crisis should be weighed heavily.	We describe the self-reported socioeconomic and health impacts, as well as the coping mechanisms employed by a drug-using cohort of adults during the Flint water crisis (FWC) in Flint, Michigan. Participants from an ongoing longitudinal Emergency Department study were contacted between April 2016 and July 2016 and completed a survey focusing on exposure, consequences, and coping strategies. One hundred thirty-three participants (mean age = 26, 65% African-American, 61% public assistance) completed the survey (37.9% response rate). Of these, 75% reported exposure to water with elevated lead levels. Of these, 75% reported additional monthly expenses resulting from exposure. Almost 40% of parents reported changes in their children's health and 65% reported changes to their health since the FWC. Participants indicated the use of both positive (e.g., advice from trusted neighbors, 99.0%) and negative coping mechanisms (e.g., increased substance use, 20.0%) in response to this public health emergency. High-risk Flint residents reported multiple social, economic, and healthrelated consequences stemming from the FWC. Policymakers should consider additional resources for those affected, including increased access to mental health to aid recovery within the community.
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Introduction Quality of work life (QWL) refers to the favourableness or unfavourableness of a job environment for the people working in an organisation. It also refers to the extent to which members of a work organisation can satisfy their personal needs through their experiences in the organisation. It is a systematic effort made by an organisation to give its employees a greater opportunity to improve the way in which they do their job and the contribution they make to the overall effectiveness of their organisation. To understand the quality of work life of employees in health care sector these are the factors that are taken for this study which include, Adequate and Fair Compensation; Workplace well-being facilities; Opportunity to use and Develop Human Capacity; Superior -Subordinate Relationship; Work and Total Life Space. --- Objectives Of The Study ➢ To study the Quality of Work Life of Employees at Private hospitals in Chennai. ➢ To measure the level of satisfaction among employees working in various departments in hospitals. ➢ To analyse the relationship between the Quality of work -life and performance of the employees working in hospitals. ➢ Offer suggestions for improving the Quality of Work Life. --- Review Of Literature Srivastava et al. (2019) conducted their study over 240 doctors from different states of India to investigate the role of QWL on job burnout syndrome or job satisfaction using questionnaire and different statistical tools and found positive correlation between QWL and JS, whereas negative correlation was demonstrated between QWL and JS to that of job burnout. Mayakkannan (2020) conducted his study in city of Chennai with 250 doctors engaged in faculty position at different medical colleges to estimate factors affecting QWL level of said population. The findings of the study include adequate conducive work environment; zero discriminative policy to be deployed irrespective of department, status or gender of the employee. The study also explained that information asymmetry, adequate training for skill development and enough authority to discharge duty efficiently is required for better QWL Irfana et al. (2021), in their article, Structured Equation Model on Strategic Quality Planning, HR Utilisation, Information Analysis and Hospital Quality Performance aimed to quantify effect of TQM implementation like strategic planning, implementation of analytical study, proper utilization of quality man power force etc. can bring a change in hospital services and quality patient management. The survey-based study was undertaken at South Punjab region of Pakistan and the target group was middle level managers including doctors, paramedics, administrators of different age and gender cluster. Maqsood et al. (2021), in their study amongst total 290 of heath provider working at ICU and emergency units during covid-pandemic situation under NGHA, Saudi Arabia found that low level of QWL amongst the surveyed group mostly due to demographic factors and non-specified and uncertain job schedule rather than direct pandemic related effect. Dhingra (2021), studied various effect of a number of factors on WLB of physicians like work hours, paid over time, flexi job schedule, gender biasness etc. with focus on their relationship and moderation effect on subjective happiness. --- Data Analysis & Interpretation --- Impact of Quality of Work Life among employees in Hospitals Factors of Quality of Work Life is an important component for an organisation to increase the level of job satisfaction among its employees as Quality of Work -Life (QWL) is a concept that has been linked to job satisfaction. It can also have a significant impact on job satisfaction. When an organization provides a positive work environment that promotes employee wellbeing, job satisfaction tends to increase. Quality of Worklife focuses on meeting the needs and expectations of the employees, which can lead to greater job satisfaction and motivation. Employees who have high levels of job satisfaction tend to be more committed to their organization and experience less turnover. For this study, association test using Chi-Square is used to check the significant association between Quality of Work-Life and gender of the employees. --- Null Hypothesis (H0): There is no significant association between Quality of Work-Life and gender group of employees. --- Alternate Hypothesis (H1): There is significant association between Quality of Work-Life and gender group of employees. To test this, cross tabulation was done using Chi-Square Test. The two categories under Gender for the present study are Male and Female. For determining the quality of work -life the values under the factor "Work and Total Life Space" were computed and the computed values are categorised into 'Low', 'Medium' and 'High'. The analysis was done through SPSS Software. The tables and the results are discussed below: --- Interpretation: From the above table, it is observed that the P value is 0.028, which is less than 0.05 at 5% level of significance. Thus, it is understood that the Null hypothesis that is there is no significant association between gender and Quality of Work -Life is rejected. Thus, gender of respondents has significant association with Quality of Work-Life. --- Quality Of Work Life And Level Of Performance The performance of the employees is a critical aspect of the success of any organisation. The Quality of Work -Life factors are increasingly being recognised as important determinants of employee performance. Measuring the level of performance of employees using Quality of Work -Life factors can help organizations identify areas of improvement and implement strategies to enhance Quality of Work -Life that can in turn enhance the performance level of employees. When employees experience high levels of job satisfaction and are in a positive work environment, they tend to be more motivated, engaged and productive. When employers prioritize Quality of Work -Life, employees are more likely to feel supported, satisfied, and engaged in their work. This can lead to improved performance and productivity. --- Quality Of Work Life And Performance Of Employees To test the significant relationship between Quality of Work Life and performance of employees, the correlation test is done. The computed Quality of Work -Life value is used. The factor 'Opportunity to Use and Develop Human Capacity' and the related questions are computed and are used for this correlation test. The hypothesis and the results are discussed below. --- Null --- Hypothesis (H0): There is no significant relationship between Quality of Work-Life and performance of employees. --- Alternative Hypothesis (H1): There is a significant relationship between Quality of Work-Life and performance of employees. The calculated p value is 0.000. Frome the above table it is inferred that the P value is 0.000, which is less than 0.01, the correlation of the factors is significant at 1% level of significance. From the above table it is clear that, • There exists a moderate to high relation between Quality of Work-Life and performance of the employees. • The Quality of Work-Life greatly influences the Performance of the employees. --- Findings • It is found that out of 122 respondents, 88 respondents (72%) are male and 34 respondents (27%) are female. --- Suggestions • Policies that are formed need to be informed to the employees properly to improve their quality of work life. • Extra facilities like Creche, transportation benefits etc, can be improvised for the betterment of employees. • The pay-slab of the employees can be increased. • Improper communication / miscommunication between few departments leads to the poor performance of the employees. Such issues can be taken into consideration and should be solved on a fast note by the top management. • Employee recognition can be improved that in turn can motivate the employees on a higher note. • Employee workload may be reduced to improve employee efficiency. • Open communication with the management can be improved so that the employees can share their opinions to their head effectively without any fear. • The employees of this organisation feel that the recreational facilities can be improved. --- Conclusion The integral part of the management process is managing people at work. The Quality of Work-Life in recent centuries is one of the most important goals of the organisations, and the employees in the entire world. A happy and healthy employee will give better turnover, make good decisions and positively contribute to organisational goals The findings provided some insights in efforts to improve the Quality of work life. This study also provides valuable information about how employees in organisations view their work environment. Based on the research, it can be concluded that QWL plays an important role in enhancing the job satisfaction and performance of the employees working in the organisation. For the employer, work-life initiatives create positive employer branding, promote being an employer of choice, foster organisational citizenship and support diversity initiatives. For the employee, there is lesser stress, increased happiness, motivation and productivity and a better chance of reaching both personal and career goals satisfactorily. The key role of the management therefore, is to understand the critical issues of the quality of work life and integrate it into the organisation.	Quality of work life has attracted an ever -increasing interest over the past two decades not only in the areas of health, rehabilitation, disabilities and social services but also in medicine and education. In the hospital sector, doctors and nurses are the most important personnel and they are fully involved in patient care. It is usually viewed as actual working conditions, including employee compensation, facilities, health and safety issues, participation in decision-making, management approach, workplace diversity and flexibility, etc. Quality of work life is a multifaceted concept, implying the concern for the members of the hospitals irrespective of the level they belong to. It covers the employee's perception or feeling above every dimension of work including economic rewards and benefits, security, working conditions, organisational and interpersonal relationships and intrinsic meaning in the person's life. In this study the Quality of work life of the employees in health sector is analysed. The research is completely based on primary data obtained from different types of employees especially from middle level managers and operational level employees working in various health care sectors in Chennai. The study is conducted among 122 respondents working in various departments in Hospitals in Chennai and the factors influencing work life balance are analysed using Percentage analysis, Chi-Square and ANOVA. The results are then discussed for various suggestions.
INTRODUCTION Pakistan is an interesting ground for the study of various aspects of demography like assortative mating and consanguinity. 1 The pattern of marital alignments and consanguinity is useful in elucidating the socio-biological structure of populations and assessing health and disease patterns. 2,3 Elevated consanguinity has been reported to be associated with higher incidences of congenital anomalies, child mortality and adult morbidity, and decreased fertility. [3][4][5][6] Consanguinity is a deeply rooted social and cultural trend in Pakistan. 7 The major cause for an advantage of consanguineous unions (CU) is socio-cultural instead of economic benefits. A review of the literature on this subject revealed that despite certain generalizations the factors underlying consanguinity vary in different populations of Pakistan. 2,[7][8][9] The world population has been divided into four broad categories based on the prevalence of CU, i.e., <1%, 1-10%, 10-50%, and unknown. 5 Pakistan falls into the third category where an overall high prevalence of consanguinity has been reported. 5,10,11 Here, consanguinity has been studied primarily in upper Punjab and few populations of Khyber Pakhtunkhwa province. 2,8,9,11 The pattern of consanguinity remains unknown for most of the Southern and Western regions which may comprise populations with distinct breeding structures. Hence, the categorization of Pakistani populations on the basis of consanguinity level is not yet possible. To this end, this study was aimed at the determination of consanguinity, fertility and birth-outcome in the population of Okara district of Punjab, Pakistan. --- METHODS --- Study Population: Okara district is situated in the South-East of Punjab, Pakistan. According to the 2017 census, the district's population was three million and >80% was rural. The district comprises three tehsils namely Okara, Depalpur and Renala Khurd. 12 The most prominent caste-systems are Arain, Bhatti, Jutt, Kharal, Khokhar/Malik, Kamyanay, Muslim-Rajput, and Rajput. Sampling Strategy and Definitions: Through a cross-sectional sampling design, ever-married females were enrolled during 2016-2017. There were 19 different sampling sites encompassing main towns/villages of the district. The fieldwork was coordinated by the lady-health-visitors and paramedical staff. This study was approved by the ethical review committee of Quaid-i-Azam University (DAS/13-651; June 3, 2013). After a verbal consent approval, the data were collected on a structured proforma. Information on marital union types and demographic/household parameters (including tehsil, rural/urban residence, subject/spouse age, subject/spouse literacy, occupation of subject/spouse, family structure, household type, exchange marriage, subject's age at marriage, matrimonial distance, and parental consanguinity) was collected (as described elsewhere). 2,7,8 Inbreeding coefficient-F (ICF) was calculated from the proportion of CU types in total marriages in a respective category. 5,7 Data were also gathered on fertility, gap in the first pregnancy, live-births, and reproductive loss, i.e., neonatal, postnatal and ≤5 years mortality. Descriptive summaries were generated and the significance of deviation from random distribution was checked at p<0.05. Multivariable analyses were carried out through logistic regression, performed in various tiers where consanguinity was put as a dichotomous variable and the dependent variables were included in the model step-by-step. --- RESULTS A total of 1,521 married women ranging in age from 15-to-80 years were enrolled. A total of 933 (61.3%) subjects had CU, yielding ICF=0.0356 (Table-I). First cousin (FC) unions were the highest in proportion and accounted for 50.2% (n=763) of the total sample. Double first cousin, first-cousinonce-removed, and second cousin marriages were 1.4%, 6.6%, and 3.2%, respectively. The unions among second-cousin-once-removed, distantly related and non-related were 0.1%, 28.1% and 10.4%, respectively. Contingency test statistics showed that the CU were significantly associated with variables like rural/urban residence (higher in subjects from rural background; OR: 1.37), literacy of subjects and spouses (higher in illiterates; OR: 1.13 and 1.11, respectively), occupational status of subjects and spouses, joint family structure (OR: 1.80), household type (higher in paternal type; OR: 1.59), exchange marriage (OR: 2.51), age at marriage (higher in younger age; OR: 1.38), matrimonial distance (higher in less distance; OR: 1.87), and parental consanguinity (OR: 1.76). The differences in the distribution of CU and NCU appeared statistically not significant with respect to tehsils, mother tongue, caste-system of subjects/spouses, current age of subject/spouse, and marriage year (data not shown). In logistic regression, six variables emerged as significant predictors of consanguinity, i.e., caste-system of spouse, age at marriage, exchange marriage, matrimonial distance, family type, and parental consanguinity, while the overall model was highly significant (Table-II). Temporal analyses across 10 years intervals revealed that the rate of consanguinity fluctuated between 59%-to-63% and any decreasing or increasing trend over the years was not conspicuous (Chi-test for trend; p=0.627). Ever pregnant women were 1,958 (90.9%) (Table-III). The subjects having CU had significantly higher mean fertility than subjects having NCU (4.08±2.98 vs. 3.74±2.81, respectively; p=0.007). A proportionately higher number of women with CU had a gap of >24 months in their first pregnancies compared to women with NCU (p=0.03). Among the ever-pregnant women, mean live-births were significantly higher in women who had CU compared with the subjects having NCU (3.62±2.68 vs. 3.30±2.50, respectively; p=0.006). The differences were also statistically significant in the case of mean liveborn sons (1.90±1.64 vs. 1.64±1.47, respectively; p=0.0002), but not in live-born daughters (p=0.406). Further, there were statistically no significant differences between the mothers with CU and NCU with respect to average mortalities (i.e., prenatal, postnatal and total). --- DISCUSSION Consanguinity was estimated to be 61.3% in the overall sample of Okara population, and the corresponding ICF was 0.0356 which is comparable to other populations of Pakistan; for instance, 0.0355 in RahimYar Khan and 0.0348 in Sargodha, and 0.0348 in Bhimber, AzadJammu Kashmir. 2,7,13 Further analyses revealed that intracaste marriages were 90% in the total unions while their proportion ranged from 96% in Arain to 77% in Mirza caste-systems (data not shown). Although Okara is close to the metropolitan region of Lahore yet it has high level of consanguinity. This reflects that greater metropolitan regions are not exception of the CU. People remain intact to their cultural Aqeela Nawaz et al. values rather than accepting the norms and values of the metropolitan culture which is reported to have low consanguinity. 14, Multivariable analyses revealed that six variables were the significant predictors of consanguinity. For instance, with respect to family structure, the subject belonging to joint/extended family type had the higher occurrence of consanguinity. In joint family setup, CU are preferred because of the compatibility between subfamilies, i.e., similar tradition, education and economic levels, and among cousins living in the same environment. 2,7 Consanguinity helps them to settle minor domestic conflicts and social and economic problems. 14 Further, the rate of CU was significantly higher in subjects who had younger age at marriage. The analyses demonstrated that rate of consanguinity gradually declined as the age at marriage delayed. In joint family system, a large number of siblings reached to marriageable age. 3,7,14 The parents prefer to marry their daughters among the relatives at her younger age because relative gives more respect to their daughters at a younger age. [13][14][15] In economically better-off families particularly in urban populations, the late age marriages may be commenced due to the time spent in completing education and career development which leads to a low choice of mates among the close-kins, thus resulting in outbreeding. 5,15 The exchange marriages were observed to be positively associated with consanguinity both in univariate and multivariable analyses (OR: 1.33 and 2.62, respectively). Exchange marriages are customarily practiced in the rural areas of Punjab and Sindh provinces. 14,16 Then, parental consanguinity was also observed to be a significant predictor of subject's consanguinity in the present study. This observation supports the notion that consanguinity is a family tradition that is practiced generations after generations. 14,17 Our analyses showed that the average fertility was higher in women with CU compared to the women with NCU. Further, the average livebirths per woman were also significantly higher in subjects who had CU. Interestingly, a similar trend was also witnessed in RahimYar Khan, Pakistan, and several other populations of Asia and Africa. 2,5 This phenomenon could be explained by the fact that owing to the marriages at younger age in CU, the first birth occurs at an earlier age and the reproductive and fertile period of the women remains significantly longer. 5 Further, several other fertility determinants are potentially confounding with CU which include, but not limited, to the duration of the marriage, low socio-economic status, rural residence and lower contraceptive use. 4,18 However, 14% mothers with CU had a gap of >24 months in their first pregnancies compared to 10% mothers with NCU. This observation needs further investigations in extended data sets from other populations. Nonetheless, the average male live-births were significantly higher in women with CU compared with the women with NCU (Table-III). The difference was, however, not significant in average female live-births. It has been previously suggested that consanguinity may affect the secondary sex ratio and the sex ratio decreases as consanguinity increases. 19 However, sex ratio is also confounded by other direct or indirect variables like early age at marriage, paternal age, firstborn proportion and mother's age. 20 Further studies are warranted to understand this phenomenon in cosmopolitan populations. --- Strength and Limitaitons of the study: The strength of the present study are: first-hand data, large sample size, and coverage of large number of demographic variables. The potential limitations of this study could be that the high representation of subjects from urban areas and self-reported data on reproductive health. Further, this study does not document stillbirths, congenital anomalies, and maternal morbidity. --- CONCLUSION The overall rate of CU in Okara district is high like other inbred Pakistani populations. Here, higher mean fertility and mean live-births in subjects with CU are interesting findings and need further studies. --- Authors Contribution: SM: Conceived, designed and supervised the study; statistical analysis and manuscript writing AN: Data collection and manuscript writing MZ & SM: Edited, reviewed and approval manuscript SM is responsible and accountable for the accuracy and integrity of data.	Objectives: This study was aimed to illustrate the determents of consanguinity and inbreeding coefficient-F (ICF) in the population of Okara district of Pakistan and to elucidate the impact of consanguinity on fertility and birth outcome. Methods: Through a cross-sectional sampling design, 1,521 married women were recruited from Okara district during 2016-2017. Data on demographic variables, marital union types, subject's fertility, and reproductive outcome, were gathered in face-to-face interviews. Descriptive statistics and multivariable logistic regression were employed. Results: The prevalence of consanguineous unions (CU) was calculated to be 61% yielding ICF=0.0356. Multivariable regression analyses revealed that six variables including younger age at marriage, joint family structure, caste-system of spouse, exchange marriage, matrimonial distance, and parental consanguinity, were significant predictors of consanguinity. The women having CU had significantly higher mean fertility, mean live-births and mean live-born sons compared with subjects having non-consanguineous unions (NCU). However, there were no significant differences in the average mortalities, i.e., prenatal, postnatal and <5 years, between the mothers with CU and NCU.The prevalence of consanguineous unions (CU) in Okara district is quite high like other inbred populations of Pakistan. The striking findings of this study are the higher mean fertility and mean livebirths in women with CU. The likely reasons underlying this phenomenon have been discussed.
Largest Epidemiological Study not Mentioned Unfortunately, the authors did not wholly succeed in explaining the risks of cannabis in a differentiated manner (1). With regard to the selection of studies of possible tumor disorders subsequent to cannabis consumption, it is of note that the largest and most elaborate epidemiological study was not mentioned (2). As in other studies that were not included, this study did not find any risk increase owing to cannabis smoking for any of the cancers under investigation-including cancers of the respiratory tract. Tetrahydrocannabinol (THC) itself inhibits cancer. With regard to the association between early cannabis consumption and premature dropping out of school, studies that investigate the causality are lacking. One study of 3337 adult twins found that the relation between cannabis consumption at a young age and dropping out of school early is based on common environmental risk factors that affect the risk for cannabis consumption at a young age as well as dropping out of school prematurely (3). The authors concede that studies of suicidality have yielded heterogeneous results, but they documented only studies reporting increased risks for suicidal ideation. Other studies that, for example, investigated the association between legislation concerning the medicinal use of cannabis in the US and suicide rates did not find any significant association with completed suicides (4). Increasingly, there are indications that some cannabis effects, such as an anti-inflammatory effect and neuroprotection, may have beneficial effects in the long term. A 2015 meta-analysis of eight studies from the US, on the basis of the National Health and Nutrition Examination Surveys and the National Surveys on Drug Use and Health, confirmed that cannabis consumption might have a protective effect against the development of diabetes. Cannabis consumption was associated with a 30% reduction in the risk of diabetes (odds ratio 0.7; 95% confidence interval 0.6 to 0.8). DOI: 10.3238/arztebl.2016.0009b --- M E D I C I N E --- In Reply: We thank Ulrich Braune and Dr Grotenhermen for their valuable suggestions and critical comments. In our review article we aimed to summarize what is currently known about the potential risks of intensive leisure-time cannabis consumption (1). The European Monitoring Centre for Drugs and Drug Addiction refers to "intensive" consumers as persons who use cannabis on a daily or almost daily basis. This includes about 3 million persons in the European Union (2), not 12 million, as we incorrectly cited in our article. Only a few studies have investigated more specific cannabis use patterns in association with potential health-related or social problems. Distinguishing between "high" and "low" consumption, as suggested by Ulrich Braune, is, however, not enough to draw any conclusions about causation. First of all, these categories would have to be clearly defined and then consistently used in research. To this end, it would be necessary for experts internationally to agree on data collection standards. But even then the question of causality would remain unanswered. The retrospective twin study cited by Dr Grotenhermen (3) can ultimately neither rule out nor confirm whether psychological, somatic, or social problems are due to cannabis consumption or to other (genetic, environmental) factors. Prospective studies are needed to clarify this. So far, very few studies have comprehensively investigated persons from early childhood into adult age and have methodically controlled for a multitude of associated variables at the same time. One of the highest-quality studies is by Meier and colleagues (4). The authors conclude that starting to consume cannabis regularly early in life (before the 18th year of life) in particular has a detrimental effect in later cognitive performance. When assessing the somatic sequelae of cannabis consumption, the influence of cannabis and its ingredients as well as the effects of associated variables have to be monitored closely. We therefore thank Dr Grotenhermen for mentioning a relevant study by Hashibe et al (5). It shows that, as in the studies we included in our article, tobacco consumption has to be considered in analyzing the effect of inhaled cannabis products. While THC by itself does not have a confirmed carcinogenic effect, cannabis smoke does contain a whole range of chemical compounds for which harmful effects can currently not be ruled out, as the author of the letter himself confirms with his own publications. In conclusion, we would make a case for studying the risks of consumption of non-medical cannabis separately to the clinical data on medical cannabis consumption. The respective target groups, expectations, consumption patterns, dosages, and settings are extremely different, and this has to be borne in mind. DOI: 10.3238/arztebl.2016.0010 --- Conflict of interest statement The author declares that no conflict of interest exists. --- Conflict of interest statement The author is the chair of the working group Cannabis as Medicine reg. assoc. (Arbeitsgemeinschaft Cannabis als Medizin e V [ACM]), chair of the Medical Cannabis Declaration reg assoc (MCD), and managing director of the International Association for Cannabinoid Medicines reg assoc (IACM). --- Risks Associated With the Non-Medicinal Use of Cannabis by Dr. rer. nat. Eva Hoch, Prof. Dr. med. Udo Bonnet, Prof. Dr. med. Rainer Thomasius, Dr. med. Florian Ganzer, Prof. Dr. med. Ursula Havemann-Reinecke and Prof. Dr. med. Ulrich W. Preuss in issue 16/2015 --- Conflict of interest statement The author declares that no conflict of interest exists.	The authors describe the symptoms of somatic, mental, and psychosocial impacts in a detailed and evidencebased manner (1). However, I miss epidemiological data on the distribution of quantitative use. According to our epidemiological understanding, consumers with excessive cannabis use are in the minority, the majority of users are occasional consumers. The article leaves an aftertaste, especially when taking into account the current sociopolitical discussion, as it provides opponents of liberalization with a point of attack in additional (pseudo-) arguments in support of their known theories. A differentiation between medical effects in users whose consumption is high and those whose consumption is low would have benefited the article; for this reason, I think that the authors did a disservice to the fair sociopolitical discussion of the entire topic. The fact that by retaining the 40 year old German narcotics law (Betäubungsmittelgesetz, BtmG), cannabis users continue to be criminalized and may therefore lose their social or economic/financial status in society, although their consumption does not result in appreciable deviations regarding good social conduct, is the real scandal in society. Independently of the indication, the case should be made for a sober, medical discourse on the risks of nonmedicinal cannabis use; in my view, the inclusion of epidemiological data in this is mandatory.
Introduction Sleep is a critical determinant of health [1]. Among the general population and among lesbian, gay, and bisexual (LGB) individuals, poor sleep health has been associated with adverse health outcomes, including an increased risk of HIV, mental health problems, drug use, hypertension, diabetes, obesity, and cancer [2][3][4]. Few studies have examined sleep among LGB adults. Of these, several have used convenience samples, including a study of 200 participants in the Staffordshire area of the UK, who recorded daily activities over 16 days [5]. The researchers found that homosexual participants had a shorter sleep duration than heterosexual participants [5]. Other studies have examined sleep among specific LGB populations [3,6]. Among gay, bisexual, and other men who have sex with men (MSM) in London, about one third (34.6%) rated their sleep quality as poor, and about half (43.6%) reported sleeping less than 7 h on average nightly [3]. Among a sample of MSM in Paris, poor sleep was also common, including 44.7% who reported problems falling asleep [7]. A small number of studies have used populationrepresentative samples to examine sexual orientation disparities in sleep [8][9][10]. Some found disparities by sexual orientation, citing socio-economic status (SES) and physical and mental health as contributing factors [5,8,9], while others found no disparities [10], which warrants additional research. One challenge has been lack of consistency of sleep measures used across studies, with some studies analyzing sleep duration, and others analyzing different sleep quality measures. Rarely have studies examined the extent to which adults themselves reported sleep problems. Thus, the objective of the current study was to use a population-based sample to measure disparities in self-reported sleep problems by sexual orientation. We assessed sleep problems in New York City (NYC), an urban setting where LGB adults may migrate because of perceived greater acceptance. We hypothesized that LGB adults, in NYC, would be more likely than heterosexual adults to experience sleep problems. --- Methods --- Survey Design The NYC Health and Nutrition Examination Survey (NYC HANES) was conducted from August 2013 through June 2014. The goal was to monitor the health of NYC adults ages 20 years and older, in order to guide health policy. The survey used a three-stage cluster sampling design to select a population-representative sample of non-institutionalized household residents. Standardized National Health and Nutrition Examination Survey (NHANES) protocols were used. Data collection consisted of a face-to-face computer-assisted interview (CAPI), audio computer-assisted selfinterview (ACASI), physical exam, and biologic specimen collection. The overall response rate was 36% (n = 1527). Detailed methods of NYC HANES have been published [11]. --- Measures Sleep problems Sleep problems were based on participant responses to the CAPI question: BOver the last two weeks, how often have you been bothered by the following problems: trouble falling or staying asleep, or sleeping too much?^ [12]. The response Bnot at all^was categorized as having no sleep problems, while the responses Bseveral days,^Bmore than half of the days,ô r Bnearly every day^were categorized as having sleep problems. Sexual Orientation Sexual orientation was self-reported via ACASI. Participants responded to the question: do you think of yourself as: (1) heterosexual, (2) homosexual, (3) bisexual, (4) something else, or (5) not sure. The latter two categories were grouped in our analysis. --- Data Analysis Our analytic sample included participants in NYC HANES who responded to the questions on both sleep problems and sexual orientation (n = 1220). Prevalence of sleep problems was calculated by sexual orientation for all NYC adults and then further stratified by gender. We used log binomial regression to estimate the relative risk of sleep problems by category of sexual orientation. We created two models: (1) a model with heterosexual adults as the reference category, controlling for gender, age, race/ethnicity, education, marital status, and family income, and (2) a model with heterosexual men as the reference category for gender and sexual orientation groups, controlling for age, race/ethnicity, education, marital status, and family income. A sensitivity analysis was performed, excluding adults who reported their sexual orientation as BNot sure^/BSomething else^(n = 28). Data were weighted to account for complex survey design, non-response, and post-stratification. Weights were further adjusted to account for non-response to sexual orientation and sleep questions. Statistical significance was alpha < 0.05. SAS 9.4 (SAS Institute Inc., Cary, NC) and SUDAAN 11.0.1 (Research Triangle Institute, Research Triangle Park, NC) were used for all statistical analyses. Socio-Demographic Covariates Participants reported their age (categorized as 20-34, 35-64, 65+), gender (male, female), race and ethnicity (non-Latino white, non-Latino black, Latino, non-Latino Asian, non-Latino other), education (high school degree or less, more than high school), family income (< $20,000, ≥ $20,000), and marital status (married or living with a partner, not married; the latter included never married, widowed, divorced, and separated). --- Results Most survey respondents who answered the sexual orientation question reported being heterosexual (89%), and almost 42% of respondents reported having sleep problems in the past 2 weeks. Heterosexual NYC adults reported the lowest prevalence of sleep problems (40.4%), followed by homosexual adults (49.2%); bisexual adults reported the highest prevalence of sleep problems (62.7%). Overall, women had a higher prevalence of sleep problems than men (45.8 vs. 37.2%). When we stratified by both gender and sexual orientation, bisexual adults had the highest prevalence of sleep problems among both men (67.3%) and women (60.5%). For men, homosexuals had the next highest prevalence (58.5%), and heterosexuals had the lowest (35.1%), whereas among women, heterosexuals had the next highest (45.1%) and homosexuals the lowest (34.8%). In multivariate log binomial regression analysis of sleep problems, the risk of having sleep problems for bisexual adults was 1.4 times greater than for heterosexual adults (p = 0.037; Table 1, model 1). However, when heterosexual men were used as the common reference group, we found that heterosexual and bisexual women had 1.3 and 1.6 times the risk of sleep problems as heterosexual men, respectively (p < 0.05; Table 1, model 2). The sensitivity analysis excluding adults who reported their sexual orientation as BNot sure^/BSomething else^showed similar patterns of disparities (not shown). --- Discussion Our analysis showed sexual orientation disparities in self-reported sleep problems among a populationbased sample of adults in NYC. Adults who identified as bisexual had significantly greater risk of reporting sleep problems than adults who identified as heterosexual, and women who identified themselves as bisexual had significantly greater risk than men who identified as heterosexual. Our study adds to the literature and is consistent with previous studies, showing sexual orientation disparities in sleep health [5,8,9]. Disparities in sleep problems in this NYC-based study, though, were smaller than in some previous research [9]. There are several potential explanations for our findings, including biological, psychological, cultural, and social reasons for why there might be differences in sleep based on sexual orientation. One potential direct cause for sleep disparities by sexual orientation is Bminority stress.^As articulated by Meyer [13], this stress model proposes that stigma, prejudice, and discrimination are chronic psychosocial stressors that lead to negative health outcomes, such as sleep problems. Consequently, we note that stress and the resulting disparities are not caused by particular behaviors or by something inherent within LGB communities, but are linked to the stigma placed on these communities. We also postulate that the magnitude of sleep problem disparities by sexual orientation varies geographically, in relation to regional variation in the stigma against LGB individuals. This variation may contribute to the disparate findings in the literature. If we presume that NYC is more accepting than other geographic locations, then it makes sense that we found significant but comparatively small differences between populations. Indirect causes for sleep disparities may be worse physical or mental health. --- Study Strengths and Limitations --- Future Research Future research should focus on a range of sleep measures and should consider including objective measures of sleep, such as actigraphs. We note, however, that incorporating survey measures of sleep is more feasible A major strength of this study was the use of a population-representative survey. A limitation was the use of self-reported measures including for sleep and sexual orientation, which may introduce recall bias and social desirability bias; e.g., misclassification may have occurred if participants felt uncomfortable revealing their sexual orientation. Additional misclassification may have resulted from the response categories Bhomosexual^and Bbisexual,^as the terms are alienating to many LGB adults and do not adequately identify sexual orientation. Furthermore, gender classification as only male or female may have misclassified and not adequately accounted for transgender and gender-nonconforming adults. We also note that we used a single item to measure sleep problems, which may be associated with over-reporting of sleep problems, and this study may be subject to residual confounding (e.g., we were unable to account for nighttime work shift and co-sleeping). Finally, these NYC-based results might not be generalizable to adults in non-urban locations. Using a wider equity lens, we urge researchers to improve data collection on sexual orientation and gender identity, to better understand sleep needs experienced by LGB and transgender people. With representative surveys, it can be challenging to get sample sizes large enough to do meaningful analyses. Surveys of the LGB community, including both quantitative and qualitative approaches, may provide greater insights into some of the issues raised in this analysis. Research must also take an intersectional approach and consider how oppression related to race/ethnicity, gender identity, gender expression, and other social identities negatively affects the health of LGB and transgender communities. In planning interventions to ameliorate negative health effects, researchers must consider broader institutional and structural reform to remediate health inequities. In clinical practice, sleep problems among LGB individuals can be managed in primary care, and we urge primary care providers to screen their LGB patients for sleep problems. For LGB patients who report sleep problems, proven sleep interventions to reduce sleep problems can and should be offered. While there are a range of sleep interventions from lifestyle to pharmacological, we are not aware of any specific sleep interventions that take into consideration sexual orientation.	We examined disparities in sleep problems by sexual orientation among a population-based sample of adults, using data from the New York City (NYC) Health and Nutrition Examination Survey (NYC HANES), a population-based, cross-sectional survey conducted in 2013-2014 (n = 1220). Two log binomial regression models were created to assess the relative prevalence of sleep problems by sexual orientation. In model 1, heterosexual adults served as the reference category, controlling for gender, age, race/ethnicity, education, marital status, and family income. And in model 2, heterosexual men served as the reference category, controlling for age, race/ethnicity, education, marital status, and family income. We found that almost 42% of NYC adults reported sleep problems in the past 2 weeks. Bisexual adults had 1.4 times the relative risk of sleep problems compared to heterosexual adults (p = 0.037). Compared to heterosexual men, heterosexual and bisexual women had 1.3 and 1.6 times the risk of sleep problems, respectively (p < 0.05). Overall, adults who self-identified as bisexual had a significantly greater risk of sleep problems than adults who self-identified as heterosexual.
enrolled in hospice at the time of death. Comparable statistics are not available for Medicaid because insurance among decedents is not consistently documented outside Medicare (even though 20% of Medicare beneficiaries are dually enrolled in Medicaid overall). Broadly speaking, the 2 programs cover hospice in much the same way: patients can elect hospice if they have a condition with a limited life expectancy (it is Յ6 months for Medicare and it varies by state for Medicaid). Hospice programs are paid a daily rate and are responsible for all services related to the patient's hospice diagnosis, including medications and care from nurses, social workers, and chaplains. For both Medicare and Medicaid, electing hospice generally requires forgoing curative treatments (Medicaid patients aged <21 years are an exception and can continue such treatments). One important difference between Medicare and Medicaid hospice is payment for nursing facility care. Other than hospice general inpatient care, which accounts for just 1.5% of Medicare hospice days, Medicare does not generally pay for custodial care, such as feeding or toileting assistance. In contrast, Medicaid is the nation's largest payer for long-term care, funding more than half of all nursing home spending. Although all Medicare beneficiaries can access the hospice benefit, for Medicaid, states can choose whether to include a hospice benefit at all. Even though most states cover hospice, several limit benefits to specific subpopulations in Medicaid, and others do not cover hospice or have eliminated hospice benefits in the past for budgetary reasons. Some states also limit the number of prescriptions that Medicaid patients can receive, which can impair clinicians' ability to manage pain and other distressing symptoms. In addition, as laid bare during the pandemic, Medicaid chronically underfunds nursing home care, producing a crisis in quality, particularly in facilities primarily serving Black patients. Other groups of seriously ill patients are ineligible for federally subsidized insurance. One such group includes the 2 to 3 million adults with low income in states that did not expand Medicaid. Another group includes undocumented immigrants, for whom the lack of insurance options, combined with cultural and language barriers, creates substantial barriers to end-of-life care. Nationally, 1 of 3 hospice programs limit or refuse to treat this population. Undocumented immigrants are also more likely to receive intermittent emergency care rather than the longitudinal care necessary for advanced care planning and good symptom management. For different reasons, hospice and palliative care are also often inaccessible for American Indians/Alaska Natives. Poverty and geographical isolation are key contributors to poor access to end-of-life care services in tribal communities; this resembles broader disparities for rural patients of Beyond hospice, disparities also exist with respect to palliative care services. Palliative care, which can be provided to patients at all stages of serious illness (without the 6-month life expectancy requirement for hospice), can improve patient quality of life, symptom burden, and patient and caregiver satisfaction and can also lower health care use. Yet a recent study found that patients with metastatic cancer at primarily minority-serving hospitals were 33% less likely to receive palliative care than those in alternative hospitals, and other studies show similar racial disparities. Most concerning, research demonstrates that these differences in access to hospice and palliative care manifest in adverse experiences (such as more pain; greater financial distress; greater caregiver burden, especially among women; and ultimately worse family-reported experiences with death) for lower-income populations and racial/ethnic minorities with serious advanced illnesses. Another contributor to this pattern is that hospice and palliative care have traditionally focused on cancer, whereas other illnesses such as end-stage kidney disease-with substantially higher rates among racial minorities-can produce symptoms as severe as those of cancer, but patients with these conditions are less likely to receive key elements of high-quality end-of-life care. What can be done? First, financial access to care must be improved. Congress should reclassify hospice as an essential benefit required in state Medicaid programs, and states should eliminate prescription drug caps that impair adequate end-of-life symptom management. A pathway to affordable coverage for undocumented immigrants to provide access to meaningful health care throughout the life cycle is also critical. Second, Medicaid's long-term care role-in contrast to Medicare-holds out the potential for expanding access to inpatient hospice, a setting with better family-reported quality of end-of-life care than that provided by hospitals and nursing homes. Since lack of adequate support at home is a major barrier for many families considering hospice, Medicaid could potentially facilitate hospice use to a greater extent than other programs because of its long-term care dimension. But this would require adequate funding to ensure quality and improved hospice coverage in Medicaid. One potential model is the Veterans Health Administration, which has made substantial investments in palliative and end-of-life care across inpatient, outpatient, and long-term care settings. Third, efforts to expand the availability of hospice and palliative care in underserved hospitals and communities are critical. The COVID-19 pandemic, with its rapid deployment of telemedicine, suggests a new pathway for bringing palliative care specialists to rural areas. In addition, proposed legislation would facilitate hospice provision through rural health clinics and federally qualified health centers, which currently are prohibited from participating in the Medicare hospice benefit. Policy makers and clinicians should expand the lens of health equity to consider not just disparities in disease prevention, treatment, and life expectancy, but also disparities in the quality of end-of-life care. A "good death" should be a priority for all seriously ill patients, regardless of race, immigration status, or income. --- ARTICLE INFORMATION Open Access: This is an open access article distributed under the terms of the CC-BY License. Corresponding Author: Melissa W. Wachterman, MD, MPH, MSc, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA 02130 ([email protected]). Author Affiliations: VA Boston Healthcare System, Boston, Massachusetts (Wachterman); Dana Farber Cancer Institute, Boston, Massachusetts (Wachterman); Harvard T. H. Chan School of Public Health, Boston, Massachusetts (Sommers); Harvard Medical School, Harvard University, Boston, Massachusetts (Sommers). --- Conflict of Interest Disclosures: Dr Sommers reported receiving personal fees from the Health Research & Educational Trust for an editor's position at Health Services Research, the Massachusetts Medical Society, the Urban Institute, AcademyHealth, the American Economics Journal, and the Illinois Department of Healthcare and	The coronavirus disease 2019 (COVID-19) pandemic has focused attention on stark disparities in the US, with higher rates of infections and deaths among lower-income populations and communities of color. Illness and death rates are not the only sources of health inequity in this country. There are also substantial differences in the care that patients with serious illnesses receive near the end of life that are based on race or socioeconomic status. Although pandemic-related efforts to improve equity rightfully focus on preventing death, in this and numerous other contexts, policy makers and clinicians should also work to eliminate disparities in end-of-life care. Multiple dimensions of end-of-life care vary by socioeconomic status and race. Medicare and Medicaid are key players in end-of-life care for low-income populations. All told, more than 2 million Medicare beneficiaries die annually, representing roughly 80% of deaths in the US, with about half
INTRODUCTION Caustic agents are the substances with acidic and alkaline properties. Strong acids with pH less than 2 and strong alkalis with pH higher than 12. Ingestion of these agents cause chemical burn of gastrointestinal tract. Caustic ingestion is one of the major health problems prevailing worldwide. Accidental ingestion occurs usually in infants and children 1 but in adolescents and adults its ingestion is usually intentional. 2 Suicidal thoughts are main drive of its use in adults. Despite all the efforts and the educational campaigns its use is increasing day by day. In the United States an incidence of 5000 to 15000 cases per year is estimated 3 Ingestion of corrosive agents varies country to country. Reports from Denmark, Israel, UK, Spain, and Australia showed that alkaline agents are most commonly used. In developing countries the majority of caustic ingestion is due to acids. Caustic agents are generally easily available (washroom cleaner, battery acids), usually cheaper in cost. And mostly no legislation/ checks are available on its sell and misused in criminal activities both homicidal and suicidal attempts. 4 Life after caustic injury is a misery. Despite of all advances in medical field, persons with significant caustic injury at time of ingestion usually are not free of medical support throughout life. They often need assisted medical and surgical procedures to maintain the process of eating still they have feeding difficulties and suffer from nutritional deficiencies. The degree of this dependency depends on extent of mucosal injury of gastrointestinal track which range from apparently normal mucosa to extensive ulceration and perforation and massive hemorrhages of gastrointestinal tract leading to death. Long term complications include stricture formation, aorto-enteric, gastro-colic or gastro-bronchial fistulas and increased risk of esophageal and gastric malignancy. Reported mortality rate after caustic ingestion is between 7 and 14%. 5 These people not only live unhealthy life after wards but become a big burden on family, society and https://doi.org/10.29309/TPMJ/2023.30.06.7182 2 health care delivery system. They often live with severe depression, and anxiety. 6 Constant rise in number of caustic injury cases is alarming and it is high time to identify factors directly linked to such rise. Through this study we have evaluated important factors that contribute in intentional use of caustic agents for suicidal attempts in Pakistani population after approval of Ethical Review Board (F.1-1/2020/ERB/SZABMU/280). --- MATERIAL & METHODS A cross sectional, observational study was conducted at tertiary health care center, Islamabad (ethical approval dated 22 January 2019) from January 2019 to December 2020. Sampling technique used was non probability purposive. 100 patients with primary diagnosis of intentional ingestion of corrosive ingestion were interviewed after informed consent Sample size was calculated with estimated prevalence rate of 50%, precision 10% and significance level 5%. Patients of age 15 above, both genders were included. Patients in critically ill state, inability to communicate due to dis-articulation or preexisting psychiatric illness were excluded from study. Demographic variables like age, gender, education, occupation, socioeconomic and marital status were studied. Variable like intensions behind corrosive ingestion, selection of caustic agents, and situations leading to corrosive ingestion were included in study. Data was evaluated on SPSS 16 in the form of frequencies and percentages. Chi-square test was used to detect association between factors and suicidal intensions. P-value < 0.05 considered as significant . --- RESULTS Study population comprised of 100 cases of caustic injury out of which 63% were female and 37% were male. Mean age of patients was 28.81 years. Socioeconomic status shows 63% population belong to poor socioeconomic status (Figure -1). Regarding marital status, 40% study population was unmarried, 9% were married, 14% were divorced and 10% were widow. While rest of population were in relationship. (Figure -2). Most common situations/ problems in life leading to self-harm and suicidal attempts in study group mentioned in ( --- DISCUSSION Around 30-50% of adults use corrosives for suicidal attempts 7 , which is the most alarming situation for the whole society. Much of literature covers medical/ endoscopic and surgical therapies but factors prevailing in society directly or indirectly related to this sort of poisoning are not studied in detail. That is why it is high time to identify factors responsible for such rising trends which seems beyond personality traits and surely relate to geosocio-cultural factors which influence human behaviors and responses during challenges and day to day stresses of life. We studied 100 patients who intentionally ingested caustic agents. Gender distribution shows that female were dominating 63% while males were 37%. Mean age in our study was 28.5 years. This is in accordance with another study from Pakistan on caustic injury which highlighted female dominance (84%) and 66% younger age people with mean age of 20.5 years. 7 Both younger age and female gender are considered as highly sensitive groups, this nature might make them liable to react aggressively in panic states. 8 On studying the economic status of study population it was found that incidence was high in underprivileged population, belonging to lower socio-economic status and living below poverty line. 9 Similar distribution were see in our study. (Figure-1) 63% and 26% patients belong to poor and middle socioeconomic status respectively while 11% belong to upper class. This is unfortunate that poor commodities cannot enjoy facilities, status, and standards of living while rich people are enjoying all status all over, resulting in inferiority complexes in poor, negative thinking and emotional instability. Another factor evaluated in detail in our study was marital status and personal relationships (Fig 2 ) keeping in view the positive influence of healthy human relationships and family support on overall mental health of an individual. Out of 100, 40.0% individuals were unmarried, 14% were divorced, 10% were widow, 14% were in relation (engaged) while 13% were in complicated relation, and only 9% were married. Disputes and fight with family members especially spouse was main triggering factor corrosive intoxication in our study population. Lack of family support is main contributory factor in abnormal behaviors and responses of members of society. 9 in our study mostly young, unmarried population used caustic agents with non-suicidal intension. Similarly major stress inducers/ situations behind suicidal attempts (Fig 3) was economical stress in 44.8%, 34.5 had family related issues, 5.2% were experiencing job related issues and 15.5%had disturbed marital life. 58% individuals in our study had suiccidal intensions. (Figure-3) this is in according with other studies which shows that 30-95% adults ingest corrosives with suicidal intension, 10,11 Association of suicidal tendencies with female gender, younger age, poor economical states, and disturbed marital life was statistically significant. (Table -	Material & Methods: One hundred subjects with intentional ingestion of caustic ingestion were interviewed on a written questioner after informed consent. Non-probability purposive was sampling method used. Results: Out of 100 patients 63% were female, mean age was 28.81 years and 58% had suicidal intension. Disturbed marital/ family life was main factor behind suicidal attempts. (P= 0.025). Conclusion: factors like female gender, younger age, poor socioeconomic status and disturbed marital/ family life in study group had statistically significant association with suicidal intentions.
Diversity and inclusion matters Academic medicine has been characterized by Kantor as a discipline that "encompasses the traditional tripartite mission of educating the next generation of physicians and biomedical scientists, discovering the causes of and cures for disease, and advancing knowledge of patient care while caring for patients… highlighting the interrelationships among teaching, research and service… ." 1 In working to fulfill these missions, academic health centers and medical schools should be responsive to societal trends and to the evolving healthcare needs of American society. Diversity and inclusion are critical as academic health centers and medical schools attempt to respond to societal healthcare needs, especially for marginalized and vulnerable population groups. Diversity and inclusion are also important for the development of a cadre of leaders from underrepresented minorities in medicine (URiM). Research studies have demonstrated several clear benefits to diversity and inclusion in clinical medicine, higher education, and workforce development. Ultimately, the evidence makes clear that the highest level of excellence in medicine will be achieved when actions show diversity and inclusion matter. A few examples include: • Historically URiM graduates from medical school are three times more likely to serve minority and underserved populations than non-URiM and white medical school graduates. 2,3 • Racial and ethnic concordance between patients and physicians enhances patient's experiences with the perception of receiving better interpersonal care. 4 • Diversity in educational settings encouraged faculty to include themes relating to diversity in their research and teaching and provided students with opportunities to address racial and multicultural issues in the classroom and extracurricular settings. 5 • Students who interacted with racially and ethnically diverse peers showed the greatest engagement in active thinking as well as growth in intellectual engagement, motivation, and academic skills. 6,7 • Diverse researchers help broaden the health research agenda, and lead to greater contributions to science as measured by impact factor and citations. 8 Defining implicit bias Implicit bias, also known as unconscious bias, is a social stereotype about certain groups of people that individuals form outside their own conscious awareness. Implicit bias is not limited to ethnicity and race-it includes unconscious prejudice against another person(s) age, gender, religion, weight, sexual orientation, or gender identity. Research has shown that implicit biases develop at an early age, typically emerging during middle childhood and have real effects on a person's behavior, such as hiring, mentoring others, and health equity. 9,10 Importantly, while implicit biases exist in all people, even ones that are incompatible with a person's conscious values, they are malleable and an individual can take steps to recognize and minimize the impact of their implicit biases. 11,12 Structural inequities and systemic barriers Despite a large evidence-base demonstrating the value of diversity in academic medicine, progress towards diversity has been marginal as only a small number of physicians underrepresented in medicine (URiM) serve as faculty in medical schools. In 2018, only 3.6% of full-time faculty were Black or African American and 5.5% were Hispanic, Latino, or Spanish. 13 These inequities are compounded by disparities in a promotion such that minority faculty receive tenure at lower rates relative to their white counterparts, even after controlling for years of service and measures of academic productivity. A number of systemic barriers may account for these inequities. Faculty promotion committees and other decision-makers on career advancement may be relatively homogeneous, seek to be color blind, and not actively incorporate the experience and unique contributions of a URiM as an asset. Policies and procedures on what types of scholarship and individuals are valued by institutions can also be affected. URiM may experience professional isolation in that there are few individuals in their institutions who have similar life experiences as them. URiM faculty may have insufficient concordant role models, mentors, or sponsors. Lacking such a network may effectively exclude URiM faculty from informal information sharing, career advancement opportunities, and advocacy on their behalf when needed. URiM encounter implicit bias, discrimination, or overt racism from patients or colleagues. 14,15 URiM also experience microaggressions, the insidious and ubiquitous nature of which make them difficult to identify and address. These various forms of bias may impact an individual's ability to function clinically and meet requisite scholarly milestones for career advancement and promotion. URiM often experiences the "minority tax", defined as the burden of extra responsibilities placed on URiM faculty to achieve diversity. 16,17 The minority tax may manifest as diversity-related duties, such as committees, pipeline programs, recruitment events, and community service programs. While fulfilling publicly promoted values of the institution, such service may not be adequately supported, resourced, or recognized for promotion decisions, or even the desired area of scholarly focus for the URiM faculty member. As a result of all these structural factors, URiM faculty may report less satisfaction and engagement with their institution or colleagues, invest less in their professional development, discourage junior faculty URiM, or leave academic medicine altogether. --- Modification of educational experiences Our pediatric residency and fellowship training programs must reexamine what skills are required to successfully care for a US population of children who are majority non-white. If we are successful in our stated goal to increase diversity in the workforce and we have more African American, Latinx, and American Indian pediatric trainees, we will need to be simultaneously prepared to address how and in what context pediatric medicine is taught. In a recent study examining how Pediatric Departments felt they were doing with diversity and inclusion, the majority of them felt they were doing an excellent job; however, on further examination, many reported only very superficial actions like having a medical Spanish class for residents. 18 With a renewed focus on becoming an antiracist society, it will be important to understand areas in residency education that will need change. Some examples are reframing the context research findings are reported and taught. In another recent study, half of the medical trainees surveyed had more than one false belief about Black patients, such as Black peoples' skin is thicker than white people, and that Black people were less sensitive to pain. 19,20 Now that we know our trainees are likely to come to Pediatric residency with unchallenged, inaccurate notions about those they perceive as different from themselves, how are we going to reeducate them? How will we reeducate our academic teachers to address this and other health issues like racism? If we are successful, we will then create a group of researchers and clinicians and educators who will have the ability for the first time to finally improve the health and wellbeing of all of our nation's children. Increasing a diverse pipeline: efforts must start in early childhood Without attention to fostering the pipeline and educational landscape, there will be continued inequities, not only in those receiving care as patients but also inequities in limiting workforce development and limiting opportunities for attaining postgraduate education and success in healthcare workforce leadership. The first years of a child's life are rooted in early child developmental milestones and are also the foundations of later lifelong health disparities. For infants from underrepresented groups, these experiences form the foundation of later lifelong capabilities within educational, career, and socio-economic status. These early life experiences perpetuate continuing large-scale societal health disparities for those underrepresented in medicine groups, including African Americans, Latinx, and American Indians who form half of our nation's citizens and yet are represented at 9% of the health workforce. 4 Developing diversity in the educational areas of Science Technology Engineering and Medicine (STEM) and the healthcare workforce, to improve overall public health, has typically been structured at the health professions level in medical schools. Diversity inclusion and attention to bias and racism in educational resources and in the workforce can enhance curriculum education, acknowledge cultural differences as assets in helping to set institutional cultural norms, and decrease fear of cultural differences. Integrating STEM programs that occur at earlier stages of education with graduate medical education programs to have better continuity and develop a continuum of support for research and clinical and leadership careers in medicine is likely to improve the pipeline as well. Given the depth of nationally recognized educational thought leaders and experts in the American Pediatric Society (APS), we can make a significant contribution to educate, implement and become the "nation's pediatric educational compass." APS making a commitment to eliminate gender and racial and cultural inequalities in health education and healthcare will help to move the field forward. --- AUTHOR CONTRIBUTIONS L.R.W.-H. conceptualized the manuscript; J.L.W. developed the outline and content areas; L.R.W.-H, J.L.W., C.W.B., K.D.H.-M., and J.L.R. contributed content to the manuscript; L.R.W.-H and J.L.W. reviewed and revised the manuscript; and all authors reviewed and approved the revised manuscript as submitted and agreed to be accountable for all aspects of the work. --- ADDITIONAL INFORMATION 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.	Academic medicine represents a unique and necessary platform from which to address professional and societal inequities. Undergraduate medical education and postgraduate medical education environments are steeped in the longstanding structural and systemic tenets that plague society more broadly. Through transparent acknowledgement of the inherent challenges, and intentional leveraging of the talent and scientific imprimatur embedded in our academic health systems, we can make progress in this area.
I ntimate partner violence (IPV) is defined as any behavior within an intimate relationship that causes physical, sexual, or psychological harm. The present study examines IPV within the context of marriage, 1 and focuses only on physical and psychological violence. Sexual violence, which is an important type of IPV was not assessed due to the sensitivity of the issue, and the expectation that there would be few instances to be reported. Intimate partner violence has major short-and long-term social, mental, and physical wellness effects. 2 Nationwide surveys in Canada and the United Kingdom found that approximately 25% of women experienced IPV. 3 In some Arab countries, IPV is still not properly investigated despite its relatively high prevalence. 4 It is difficult to calculate the financial burden of IPV on the health system, 5 but some studies estimate the cost to be from 1.7 -10 billion US$ per year in the US, 6 and approximately 400 million Swiss Francs in Switzerland. 7 Many risk factors are associated with IPV, such as young age, low socioeconomic status, marital conflicts, a past history of violence in childhood, alcohol and drug addictions, 1,6 disempowerment of women, stress, and jealousy. 1 Intimate partner violence is a significant public health issue that is associated with serious health outcomes, including depression, suicide attempts, and death. 1 Eldoseri 8 conducted a crosssectional study in Jeddah, Kingdom of Saudi Arabia (KSA) and interviewed women attending the primary health care centers (PHCCs), found that the prevalence of physical IPV was 45.5% that was significantly associated with husbands having alcohol or drug addictions, exposure to violence during childhood, and unemployment status. Al-Faris et al 9 conducted a study in Riyadh, KSA on 222 women at a teaching hospital and found that 12.2% of them experienced lifetime physical abuse, which was significantly associated with unemployment, past exposure to violence, and living in rented houses. In Iraq, Al-Atrushi et al 10 conducted a cross-sectional study at 2 community hospitals and found 58% of visiting women experienced lifetime IPV with physical violence accounting for 38.9%, and sexual violence accounting for 21.1% of the IPV. Due to the discrepancy in the prevalence rate of IPV across the country, a common simple measure is needed to assess and compare IPV in future studies. Therefore, the current study was conducted to measure IPV and its associated risk factors among female patients attending PHCCs in Taif, KSA, and to assess wives' reporting behavior. --- Methods. Design and setting. A cross-sectional study was conducted from January until February 2015 among Saudi female patients attending PHHCs in Taif, KSA, who were 18-60 years-old, currently married, divorced or widowed, and able to read and write. Ethical approval was obtained from the research ethical committee at King Abdulaziz University and the Directorate of Health Affairs in Taif, KSA. Confidentiality and the right to withdraw from the study were explained, and all women were provided referral cards that contained contact numbers of social services and the women's protection agency in Taif. Instruments. The survey instrument consisted of 3 parts. Part I contained questions regarding the basic characteristics of participants and their husbands. Part II contained the HITS, a structured, self-administered questionnaire, which is a valid, reliable, and simple measure, 11 that is comprised of 4 questions: "How often does your partner: physically hurt you, insult you or talk down to you, threaten you with harm, and scream or curse at you?" Patients responded to each of these items on a 5-point Likert scale: 1 -never; 2 -rarely; 3 -sometimes; 4 -fairly often; and 5 -frequently. The scores range from a minimum of 4 to a maximum of 20, with a score of 11 or more considered a case of IPV. 11,12 The HITS questionnaire was originally developed in English and designed to be used in outpatient clinical settings. The investigator translated the questionnaire into Arabic, through forward and backward translation, using professional translators and following published guidelines. 13,14 Part III, which measured IPV reporting behaviors was adopted from a World Health Organization report. 1 Sample size and sampling. A sample size of 340, based on a 33% IPV prevalence, was calculated, 8,9,12 and then increased to 500 to account for anticipated missing data and refusal to participate. Two-stage probability sampling was conducted. First stage, 5 PHCCs was selected by simple random selection, and the second stage, 100 subjects were selected from each of the chosen 5 centers using systematic random sampling. Data analysis. Analyses were carried out using Stata software version 13.1 (StataCorp LP., College Station, TX, USA). 13 Descriptive analyses were presented using frequencies with percentages for qualitative variables, and means with standard deviations for quantitative variables. The chi-square and Fisher's exact tests were used for comparisons between 2 qualitative variables, while Student's t-test and the Mann-Whitney test were used to test the differences between means. Stepwise logistic regression using 95% confidence interval (CI) was used to identify predictors of IPV. Statistical significance was set at α=0.05 with 2-tail probability. Results. The study sample's age ranged from 18-60 years with a mean of 33.9 ± 8.4 years. Most of the women were married. Marriage duration ranged from one month to 40 years with a mean of 11.4 ± 8.9 years. Nearly half of them were categorized as having secondary school, or lower level of education. The prevalence of IPV in the past 12 months was 11.9% (Table 1). The IPV was significantly associated with being older, divorced, working or ever worked, higher income, divorced parents, and witnessing violence in the family during childhood. The husbands' ages ranged from 20-85 years with a mean of 39.9 ± 10.2 years. Husbands with a low educational level, non-working status, lower income, a history of alcohol or drug abuse, divorced parents, and exposure to violence during childhood were significantly more likely to abuse their wives (Table 2). Table 3 shows the results of the multiple logistic regression analysis of factors predicting IPV. The predictors were: being a divorced woman; wives' parents being divorced; husband with a widowed parent; husband's exposure to violence in childhood; and husband's addiction to either alcohol or drugs. Goodness of fit was p=0.1628. Most of the abused wives (56%) talked with their families regarding IPV, 15.2% talked to their husbands' families, and 11.8% talked to their friends. Only 3.3% told the police or a judge, while no one told a physician or a women's protection agency. Discussion. Women in the present study tended to be unemployed housewives with low income and financially dependent on their husbands. This is consistent with other studies. 4,8,15 The current study did not measure IPV perpetrated by the women, although bidirectional IPV results in more serious injuries to women. The reported IPV in the present study was only 11.9%, contrary to higher prevalence rates reported elsewhere. 10 This could be attributed to variation in instruments used, type of intimate violence investigated, study designs, sample size, and selecting only educated women. A true decrease in prevalence could have occurred due to the establishment of first family protection program in KSA in 2004, and national registry for abused cases in 2009, 15 resulting in identifying abused wives at older age in our study. Divorced compared with married or widowed women showed a significantly higher prevalence of IPV. The current study did not find a relationship between level of education and IPV, which is in agreement with previous studies. 11 Working women with higher income experienced significantly more IPV than non-working ones, which is inconsistent with other research 8 and explained by husband's feelings of inferiority and dependence. A divorced wives' parents was significantly associated with being a victim of IPV showing the loss of parental support resulting from marital conflict. 1 Women married to a partner with a low educational level experienced significantly more IPV, similar to what was reported in Fageeh's study. 15 Working husbands practiced significantly less violence against their wives. 15 Alcohol addiction and drug abuse were associated with IPV in our study. 1 Polygamy, number and order of wives were not significantly associated with IPV, which was supported by a previous study. 8 Similarly, a divorced husbands' parents was significantly associated with IPV showing the effect of parental family conflicts on offspring's future life. The IPV was significantly associated with wives' witnessing violence, exposing to violence themselves, or their husbands within the family during childhood leading to psychological maladaptation of both victims' and abusers' attitudes and behaviors. 8,9 The present study has limitations, such as, the potential of information bias/under-reporting resulting from sensitivity of the topic being investigated, as well as selection bias due to inclusion only of literate women, which was a necessary criteria for including women in the study to ensure self-administering of the study instrument. In conclusion, one out of 10 women is a victim of IPV in Taif, KSA. The IPV is significantly associated with many victim and abuser-related psychosocial factors, the detection of which might help in screening for individuals at risk. Governmental and nongovernmental sectors should collaborate to tackle IPV. Studies are needed to explore its geographic variations in KSA using a common measure that allows for comparison across studies. The injuries occurring from bidirectional IPV deserve to be investigated. Future studies are needed as well to analyze the wives' reporting behavior for the purpose of control and prevention.	Objectives: To estimate the prevalence of intimate partner violence (IPV) among female patients, age 18-60 years, attending primary health care centers (PHCCs) and to measure its determinants, and reporting behavior.A cross-sectional study design using validated, translated, and self-administered questionnaire among 497 Saudi female patients attending PHCCs in Taif, Kingdom of Saudi Arabia (KSA) from January to February 2015 was employed. A 2-stage probability sampling was adopted for selection of PHCCs in the first stage, and then participants in the second stage.The estimated prevalence of IPV during the last year was 11.9%. Predictors of IPV related to abused women included divorced status and divorced parents; while those related to abusers (husbands) included widowed parents, exposure to violence in childhood, and alcohol or drugs addiction. Most of the abused wives (56%) talked regarding their IPV to their families, their husbands' families (15.2%), or their friends (11.8%); while only a minority (3.3%) complained to the police or to a judge, and no one reported this to a family physician, or to women protection agency.One out of 10 women is a victim of IPV in Taif, KSA. Intimate partner violence is significantly associated with a number of victim and abuser-related psychosocial factors, the detection of which might help screening for individuals at risk.
Introduction --- T he poor health status of Scotland, and in particular Glasgow, is well documented, 1 with life expectancy at birth in Glasgow more than 6 years below the UK average for men (71.6 years, compared with a UK average of 78.2 years), and more than 4 years below the average for women (78.0 years, compared with 82.3 years). In a previous study, Levin et al. 2 showed that Glaswegian adolescents also reported poorer health outcomes and a higher prevalence of some risk behaviours, particularly in relation to eating, sedentary behaviour, subjective health, mental health and aggressive behaviour. Adjustment for family affluence and school type explained only a small part of this; effect sizes were attenuated but on the whole, significant relationships remained so. Adolescence is a critical time in a person's life when both protective and adverse risk behaviours are adopted, often tracking into adult life. It is therefore a pivotal period for identifying and addressing negative influences on health. The importance of social context during adolescence has been described extensively. 3 This study aimed to identify possible factors that might contribute to the poor health of Glasgow, by identifying contextual factors more prevalent in Glasgow than elsewhere, above and beyond deprivation. The findings are relevant not only to the study of Glasgow, but more generally to the field of social context and social determinants of health. The overall objectives of the study were to (i) determine the main differences in social context in adolescence between Glasgow and the rest of Scotland and (ii) examine whether these differences are independent of family affluence. --- Methods --- Study design Scottish data from the 2010 Health Behaviour in School-aged Children (HBSC) survey were examined. The research protocol was approved by University of Edinburgh Ethics Committee. Nationally representative samples of school years Primary 7 (P7; on average 11.5 years), Secondary 2 (S2; 13.5 years) and Secondary 4 (S4; 15.5 years) were selected using systematic random sampling. The Glasgow City authority had a large enough sample to be representative, selected from 25 schools (eight primary and 17 secondary). Response rate of schools across Scotland was 74%, and of pupils 89%. More information regarding sampling, recruitment, data collection and a full description of the variables below is available elsewhere. 4 --- Data --- Outcome variables Binary outcome variables are listed under four headings of social context: Home environment, School, Peers and Local neighbourhood. Individual items for each variable are presented in table 1 and are described in Supplementary Appendix 1. --- Explanatory variables A binary variable was created indicating Glasgow/the Rest of Scotland, based on school of attendance. Age and school type (private versus state) were included in analyses. The Family Affluence Scale (FAS), which combines information on car ownership, computer ownership, family holidays and own room, 5 was included as a measure of material wealth. --- Statistical analysis After omission of 148 cases with missing data, the final sample size was N = 6593, 633 from Glasgow and 5960 from the rest of Scotland. School roll statistics suggested good representation. 2 Logistic multilevel regression models were fitted for the binary outcome variables, using reweighted iterative generalized least squares in MLwiN 2.27. 6 Fixed parameter estimates were tabulated, highlighting significant associations with Glasgow residence. The models had two levels: school and individual child. The models adjusted for sex, age, school type and geography (Glasgow/Rest of Scotland). FAS was added and the models re-run. A sensitivity analysis examined the impact of rurality on associations, as urban-rural differences have been shown previously for adolescent health outcomes, 7 by (1) adjusting for rurality by school postcode, and (2) modelling data for children attending schools in cities only. --- Results Differences between Glasgow and the rest of Scotland were apparent in the contexts of family and local neighbourhood in particular (table 1). Young people attending Glasgow City schools were more likely to come from single or step families of low socioeconomic status (SES) and with neither parent in employment. They were less likely to own a pet, or share a family meal on ! 4 days a week, but more likely to find it easy to communicate with their father. For the most part these associations persisted after adjustment for family affluence. Easy communication with mother was also significantly more likely among young people living in Glasgow, after adjustment for FAS (at the 93% level of significance). Young people were additionally less likely to have positive perception of their local neighbourhood and less likely to use their local greenspace. They were also more likely to report trouble with gangs, litter and run-down houses in their local area, although these associations became insignificant on adjustment for family affluence. Among the variables related to peers and school, only buying lunch off school premises was significant. Adjusting for rurality or restricting the sample to residents of cities only produced similar results. The main differences were that pet ownership, use of local greenspace and communication with father no longer differed significantly between Glasgow and the rest of Scotland, while contact with friends after school and in the evenings and drunkenness among peers were significantly more prevalent in Glasgow in these analyses. School level variance ranged from small and insignificant ( < 0.03) for outcomes going to bed hungry and easy communication with friends, to ! 0.5 for variables walk to school, lunch on school days and peer risk behaviour. --- Discussion Glasgow, the largest city in Scotland and the fourth largest city in the UK, has the highest population density of any other settlement in Scotland. The history of Glasgow in recent times has been one characterized by deindustrialization and associated high levels of poverty. It remains by far the most deprived city in Scotland: almost half of the city's residents reside in the 20% most deprived areas in Scotland. 8 It is perhaps unsurprising, therefore, that differences were found in family circumstances, with fewer young people living with both parents and reporting parents in employment and, among those employed, a larger proportion in lower SES occupations. However, the majority of associations were independent of family affluence, suggesting the influence of other, broader, aspects of deprivation, over and above that of material affluence per se. When comparing urban children only, adolescents in Glasgow were more likely to spend time with their peers after school and in the evenings. In addition, drunkenness among peers was more prevalent in Glasgow than in other cities, but not in Glasgow compared with the rest of Scotland. This suggests that the peer context varies by geography and reinforces the need to take account of rurality in future spatial studies of health, particularly in relation to peers. 9 Differences in neighbourhood perceptions were apparent and remained after adjustment for rurality. Young people were less likely to describe their local area as safe or to trust locals-this despite the local authority's slogan branding Glasgow as 'the Friendly City'. This echoes results of a study of adults which found trust to be lower in Glasgow than in the socioeconomically similar cities of Liverpool and Manchester. 10 Overall, the results suggest the need for a greater focus on wider aspects of context, particularly in relation to the different facets of SES, peer relations and local neighbourhood, as potential explanatory factors for previously noted differences in the health and wellbeing profile of adolescents in Glasgow. 2 --- Supplementary data Supplementary data are available at EURPUB online. Conflicts of interest: None declared. --- Key points Contextual differences between Glasgow and the rest of Scotland are apparent, particularly in relation to SES, peers and neighbourhood factors. The majority of associations are independent of family affluence. Glaswegian adolescents have a poorer perception of their local area and reduced social capital compared with those from the rest of Scotland. Wider aspects of SES should be considered as potential explanatory factors for health differences between Glasgow and the rest of Scotland.	The adolescent population of Glasgow, the city with the highest mortality in the UK, has a higher prevalence of risk behaviours than elsewhere in Scotland. Previous research has highlighted the importance of social context in interpreting such differences. Contextual variables from the 2010 Health Behaviour in School-aged Children Scotland survey were analysed. Glaswegian adolescents were more likely to live in low socioeconomic status, single-parent or step-families, or with neither parent in employment, less likely to share family meals, more likely to buy lunch outside school, and spend time with friends after school and in the evenings. They also had a poorer perception of their local neighbourhood. Family affluence only partially explained these differences.
SESSION 2125 (SYMPOSIUM) AGEISM IN EVERYDAY CONTEXTS: FACTORS THAT INFLUENCE PERCEPTIONS AND OUTCOMES Chair: A.L. Chasteen, University of Toronto, Toronto, Ontario Co-Chair: M. Horhota, Furman University, Greenville, South Carolina Discussant: L. Ayalon, Bar Ilan University, Ramat Gan, Tel Aviv Butler coined the term 'ageism' in 1969 to highlight discriminatory practices against older adults. Since then the definition has expanded to encompass age-based discrimination across the lifespan. Although much research has examined individual experiences of other forms of discrimination, e.g., racism or sexism, surprisingly little is known about the degree to which individuals face ageism in their everyday lives. It is therefore pertinent to understand how age biases manifest in the context of individuals' daily lives, the variety of forms that ageism can take, the perceptions of acceptability of these experiences, and the outcomes that result. This symposium examines young, middle-aged and older adults' experiences of ageism at both interpersonal and societal levels. Chasteen et al. consider how adults of all ages respond to benevolent and hostile ageism from perpetrators of varying degrees of interpersonal familiarity. Horhota et al. provide a detailed picture of adults' personal experiences of ageism by examining age differences in the general domain (e.g., work, social) and specific content of reported ageist experiences, in addition to examining the coping strategies used to respond to the experience. Swift considers ageism in the workplace, examining negative meta-perceptions of older workers and their impact on job satisfaction and retirement intentions. Finally, North presents evidence that agency prescriptions unequally target men and women across the lifespan, and explores the social and economic consequences for agentic behavior in various domains. --- IS AGEISM ACCEPTABLE WHEN IT COMES FROM A FAMILIAR PARTNER? A.L. Chasteen 1 , M. Horhota, PhD 2 , J.J. Crumley-Branyon, MS 3 , 1. University of Toronto, Toronto, Ontario, Canada, 2. Furman University, Greenville, SC, USA, 3. Furman University, Greenville, SC, USA One way to reduce a form of bias is to first understand the norms concerning its acceptability and then work to change those norms. In this study we investigated the perceived acceptability of benevolent and hostile ageist behaviors and whether acceptability varied depending on the age of the perceiver and the relationship between the person engaging in the ageist behavior and the recipient of the ageist behavior. Young, middle-aged, and older adult participants rated the acceptability of 13 benevolent and 17 hostile ageist behaviors for five different relationship types: younger family members, same-age family members, familiar service workers, unfamiliar service workers, and friends. Perceptions of acceptability differed as a function of participant age, ageism type, and relationship type. Personal experiences of ageism predicted perceptions of acceptability. People of different ages have different perceptions of the acceptability of ageist actions. This may lead to miscommunication in both personal and professional interactions. --- THE MANY FORMS OF AGEISM: AGE DIFFERENCES IN EXPERIENCE TYPE, EMOTIONAL IMPACT, AND COPING STRATEGIES M. Horhota 1 , A.L. Chasteen, PhD 2 , J.J. Crumley-Branyon, MS 3 , 1. Furman University, Greenville, South Carolina, United States, 2. University of Toronto, Toronto, ON, Canada, 3. Furman University, Greenville, SC, USA	The National Council On Aging developed the Aging Mastery Program® (AMP) to help older adults improve their lifestyles and engage in their communities. The 10-week course provides 1-hour classes with expert speakers and group discussion on diverse topics (e.g., exercise and healthy relationships). A quasi-experimental trial compared 60 older adults who attended AMP with 46 who did not, within four Los Angeles city and county senior centers (mean age = 74, 57% non-Latino White). Participants were largely low-income; 60% had a monthly income less than $2,000. Attending AMP was significantly associated with an improvement in mental health scores from the PROMIS-10 global health scale, even controlling for study site and socio-demographics. Attending AMP was not significantly associated with the PROMIS-10 physical health subscale, quality-of-life (CASP-19), or patient activation, potentially due to implementation challenges. These implementation challenges, and future directions to continue to improve AMP's reach, will be discussed. C. A. Mendez-
Tess is a perfect picture of ideal womanhood. She is an embodiment of the whole nature of women. She belongs to the class of Shakespeare tragic heroines like Desdemona and cardelia.she is a child of nature. she is daughter of mother earth. She comes before us as a simple country girl. She behaves like a living figure. She is round character, for she grows from a simple young girl of sixteen into a complex in four of five years only. This is because of her creator. This tragic figure is a lady and his feeling and nature. This is because of her firsthand experience of the world and its people. Indeed, she is a master piece of her creator. This tragic figure, she crosses the stage in all the pomp of exquisite and distress and with sorrows full of dignity. She is a women more sinned against than sinning. Thomas Hardy is great painter of female character. This point is quite clear from the Wessex novels in general and Tess of the d urbervilles in particular. Hardy is a genius in the characterization of women. His women are superior to his men in many ways. The present paper illustrates these point very well. This novel shows to us how hardy excels in the portrayal of passionate, emotional types, chiefly women who predominate in Wessex novels in general and the present one in particular. the character of Tess bears an ample testimony to this thing. Tess comes before us as a vessel of emotion rather than of reason. Her creator reveals her soul to us. She is an innocent maiden. She suffers at the hands of cruel society. Fate works against her chance of happiness. Alec brings about her physical ruin similarly Clare cause her spiritual tragedy. Heredity and environment also play their parts in effecting this tragedy. Tess is a breathing image of beauty. She is a lovely woman. with her bewitching and bright eyes, she can fill a man heart with delight. She is aware of her beautiful looks. She has inherited her mother, prettiness. Alec D Urberville is almost maddened with the luxuriance of her aspect. He is bewitched by her large, expressive, fascinating eyes. This dairymaid is fresh daughter of nature. She is a poetic figure embodying the visionary essence of natural women. Alec gives up preaching when he sees her again. Angel Clare runs to her takes her into is arms passionately. Many casual lovers pay compliments to her beautiful looks in the way. One of them takes her on the cart some distance. Tess is an obedient daughter and wife. she is a loving sister and mother. She is a selfless girl. She suffers and dies for the sake of her parents, brother and sisters. She tries to solve the economic problem of her family. That is why she goes to Tantridge and loses her physical purity and chastity. She has to surrender her body to Alec again save her family, when the family horse dies, she realizes her duty. She works very hard at FlintcomAsh to save her family. She is a loving mother to sorrow, the undesired, she is very anxious for baptizing him before giving him a Christian burial. she visits the grave of her dead son when she comes back to Marlott. She is ready to die for the sake of Clare love or happiness. Hardy creation of the Tess character is kind and compassionate girl. She is modest and humble by nature. it's out of her modesty that she puts all blame upon herself for the death of prince after her moral trouble and reluctant affairs with Alec D urbervilles, she feels that she is figure polluting the surrounding in which she moves. She looks upon herself as figure of guilt intruding in to the haunts of innocents. It is her sense of humility that makes her write to Angel Clare that he is just in giving her punishment. She says that she deserves the punishments he has given her. she says so even when he does her injustice. She is so kind that she has never hurt a fly or a worm also. The sight of bird in the cage makes her cry. When she sees the pheasants writhing in pain or agony after being wounded by the hunters for sport, she takes compassion them. she breaks their necks to relieve them of this pain with easy death, she calls them poor darlings. Tess is a vessel of emotion rather than reason. she has a heart which overflows with milk of true love. She is passionate and faithful lover. She is faithful in love throughout a long period of the sufferings and privation. She resists against the temptation which Alec holds out to her. She is willing to die for the happiness of her husband. Izz tells Angel Clare that she can lay down her life for his sake. She possesses in her character something of the faithful love which the Indian wife has for her man. Nothing can separate her from Angel Clare. But fate works against her. She is forced to sell her soulness body to the villain. She stabs Alec to death when she is realizing that he has dishonored her husband with his bitter taunts. she loves Angel Clare with her soul. Its due to her emotional nature that she stabs Alec to death Clare with her soul. it is due to her emotional nature that she Alec to death all of a sudden. She has in her something of the emotional nature of poet. The letters which she writes to Angel Clare show her highly passionate and emotional nature. Though it cannot be said of him that he had no heroes, only heroines, Hardy is almost a specialist in women, the general run of portrait but like a transcendental phrenologist. Almost all his character belongs to Wessex and to the low strata of society. Hardy range includes not great ladies or great men. Only focused on oppressed women. He is in an unchallenged master; he has created immortal characters. And however great the play of an external fate, the life or motive which is at the center of each plot is essentially psychological. Every novel is answer to the question given certain character in certain circumstances, what will happen what will become of women life, he is mind reader women world. Tess is a philosophic and thinking girl. The long sufferings and experiences of the world have turned her in to brooding philosopher. That is why she likes herself to the poor queen of Bathsheba. She wonders why the sun shines on the just and the unjust like. She sees all the tomorrows in a line. The first of them seems to be the biggest and clearest of all. The others get smaller as they stand farther away. Every one of them is fierce and cruel, so it seems to say to her. Iam coming beware of me. At times she thinks of life beyond death also. she tells Abraham that he lives on one of the blighted stars. Like a good thinker she believes not in the dogma, but in the spirit of sermon on the mount. She is into her something of his own poetic quality. This country girl talks in a philosophic vein and deals with the serious problems of life. She speaks of the general bitterness and tragedy of life to Angel Clare. She complaints to Joan Durbeyfield of the wicked ways of the cunning immoral people of the world. she laments the lack of opportunities to real love stories. Tess has a poetic mind. Her body breaths poetry. She is a kind of celestial person owing her being to poetry. Like the good poet she has taste of music also. She is the true daughter of her ballad singing mother. She feels what the paperpoets express in words. At times she feels that soul leaves the body and wanders up to the stars. she does so only because of her imaginative mind. Tess has got the remarkable powers of suffering and endurance. She suffers so much even then she does lose her moral fiber. She puts up with the shame heroically. She does painful. Hard work at Flintcomb-Ash. She behaves like a great heroine when she is deserted by Angel Clare. She suffers bravely at the hands of the cruelty of lust and of the fragility of love. She is a dignified figure in her bearing. She is full of pride. She is too proud to accept any help from Alec D urbervilles. She stands against his cruel persuasion for many long months. She does not so because of her pride. She does not write to Mr. And Mrs. Clare for her help. She is proud of her beauty. Due to this pride she is not jealous of the three chambers maids who love Angel Clare. She believes that she can hook any man with her beautiful looks, personal charms and bewitchingly innocent eyes. Hardy Tess is to be pure women even when she has had a reluctant affair with Alec D Urberville. Thomas hardy himself calls her a pure woman. According to him Tess of the D urbervilles is the story of pure woman. there are people who judge her with their conventionally morality. They say that without her physical purity she cannot and should not be called a pure woman. They call her sinner of the sinning for they say that she admits a few advances of Alec D'Urberville. The point out that Tess is impure also because she goes to live with him as a mistress at sandBourne. She is a married woman. She should not have done so. If we excised our reason. It so clear to us that her first affair with Alec is done reluctantly when she is not herself due to sleep and fatigue. During the later period of her dissipation with Alec she is again not herself. Her mind is drugged and dead with weariness, pain despair. She is crushed under the dead weight of poverty. She is forced by fate and circumstances to become a mistress. She is a pure woman in heart or soul. She is so if we consider the aim and tendency of her whole life. She is honest and true, sincere with faithful in her love for Angel Clare. This purity of heart together with the nobility of her nature make as call her really great woman. As a critic say her story is a plea for charity, for larger tolerance. For a repudiation of social hypocrisy. Its intense moving power something soft and yielding about her nature. she suffers for the tractability or docility of her nature also. Her personal charms and devotion to the family are also responsible for her suffering and death. she is not initiated into the ways of and emotional nature is also one of the cause of her tragedy. She has a weakness for sleep. It is this weakness which causes the death of prince. It is this sleep which destroys her physical purity. She is arrested while she is found sleeping at Stonehenge. All these things combine together to bring about her tragic end. --- Conclusion Tess Durbeyfield is to linger in our memory as a great woman. we are to cherish her memory along with that of sweet Desdemona and gentle Cordelia. We admire her for her devotion to the family. For her faithfulness in love. for her endurance and fortitude. The adverse circumstances of her life break her into pieces. They drive her to her doom. But she gives a good battle to all powerful fate and its forces. She impresses us with the courage which she shows in the face of her fate. She suffers like Prometheus for having brought fire of light to the people of the world. she teaches us to judge woman from a new sympathetic view point.	This paper is critical analysis of Thomas hardy novel "Tess of The D urbervilles" and focus on one of his characters, namely Tess. Hardy sets the novel in Victorian England, a time when the country was very prosperous. Moreover, society was male dominated by a rigid social hierarchy. Victorian women were treated as second class citizen and marginalized. their identities that roles in the family, such as wife. mother, daughters and widow, Hardy character examined in this regard to how the functions according to these roles. The women view according to Hardy's novels can be placed in three groups. The first groups should include are full length Tess, Sue, Eustacia, Bathsheba, and Elizabeth. Second group may cover Elfried, Ethelbert, Grace, Vivette, and Anne. Third group is also a mixed one this group
codes of practice (American Nurses Association (ANA), 2015; Canadian Nurses Association (CNA), 2017). Nevertheless, the decision to be a patient advocate has undeniable consequences, in that it does provide benefits for the nurse-patient partnership but also exposes the professional nurse to numerous potential barriers and challenges (McGrath et al, 2006;Matthews, 2012;Kupperschmidt, 2014) This is especially true for the nurse advocate when a duty of care requires intervention on behalf of the patient, when they are at risk or in harm's way (Matthews, 2012). --- Background Nurses in the critical care setting perform a vital role as a patient advocate to ensure that the treatment and care provided is appropriate and safe (Selanders and Crane, 2012; Canadian Association of Critical Care Nurses, 2013). However, the barriers that confront nurses as patient advocates are often problematic and well documented in the literature (Negarandeh, 2007;Davis and Konishi, 2007;Thacker, 2008;Zomordodi and Foley, 2009;Sack, 2010;Murray, 2010;Black, 2011;Davoodvand et al, 2016). The dilemma for Saudi Arabian intensive care unit (ICU) nurses, however, is multi-dimensional, in that the concept of patient advocacy and the associated barriers has been derived primarily from the perspective of Western beliefs. This means that questions and concerns related to patient advocacy in an indigenous Islamic culture such as Saudi Arabia may be different compared with other cultures. --- Methodology Design A constructionist grounded theory design was selected for this study to explore the perceptions of patient advocacy among Saudi Arabian intensive care nurses. The essential elements included theoretical sampling, the constant comparative technique, coding and categorising, and memo writing, all of which generated data, which gave insight into the phenomenon of patient advocacy (Charmaz, 2006). --- Setting of the study This study was carried out in the critical care setting in a hospital in the Kingdom of Saudi Arabia. The patients cared for in this ICU are admitted due to illness or injury that requires nurses to provide continuous invasive haemodynamic monitoring, intravenous high-dose vasopressor and inotropic medications, high-flow oxygen therapy administration, invasive and non-	atient advocacy is not a new role for nurses, or a new obligation for the nursing profession. The role of a patient advocate is an ethical ideal for professional nurses based on the notion that nurses provide continuity of care, and therefore have a greater intimacy with the patient (Matthews, 2012). This is an ideal that is supported and endorsed by numerous international nursing
1. I would like to start with the motto on your Facebook page [2]: "bibliotecas motores del cambio". What does it mean to you? "Libraries: Motors of Change" is my motto as the International Federation of Library Associations and Institutions (IFLA) President. There is a deep message in my program, which is expressed shortly in this motto. I am absolutely aligned to the Sustainable Development Goals of the United Nations 2030 Agenda [United Nations (UN), 2018], and the way that libraries can be the main gates to information access for achieving a real social change. Communities, among libraries, can get connected and provide meaningful access to information to improve their own lives. We, as librarians, have an important role to develop our communities of users, and therefore our societies. Washington. These reports monitor the progress that countries are making towards fulfilling their commitments to promote meaningful access to information (A2I), as part of the UN Sustainable Development Goals. In response to governments' commitments to promoting meaningful A2I, as part of the UN Sustainable Development Goals, the report you mentioned provides a range of indicators that allow determining how well countries are performing. Looking at the four pillars of access (connectivity, social and cultural norms, skills and laws), it gives insights into the different dimensions of meaningful A2I. Drawing upon IFLA's rich experience, it also includes a particular focus on libraries, by sharing evaluated case studies that promote more socially and economically inclusive societies. This means that the role of information in our societies has never been greater. Information is an enabler, a raw material, a source of innovation and creativity. To provide everyone with access to it, is to ensure that everyone has the opportunity to learn, grow and make better decisions for themselves and for those around them. Regarding the 2019 report that was presented on 23 May 2019, during the IFLA President's Meeting in Buenos Aires, Argentina [3], we would like to remark how libraries can make the difference in terms of providing access to everyone without any distinction, and for contributing to the progress of a meaningful A2I, which democratises access as a development paradigm. --- How do we obtain recognition for the value of the librarianship profession in a professional and work environment? My answer about the value of us librarians, as information professionals, is indeed well related to the offers and the answers we can provide to society's requests. In my point of view, our actions regarding people's information needs, to increase their information world or their welfare for all kinds of people, from researchers to citizens in general, will ride us to the highest position, as people will value us according to the good results we can provide. 4. Digital libraries: Are we going in the right direction? What scenarios do you foresee for the near future? Nowadays, digital transformation is everywhere, and people are used to have smart devices in their pockets to connect with information. Libraries are doing great efforts to get digital services as well. In my opinion, heritage libraries have a continuing role to digitise and disseminate their main collections by providing access to them through the internet. Public libraries should reinforce their digital libraries services, including reading and all that citizens need to optimise their work. My desire for all kind of libraries would be to have a good understanding of what is important for the communities they serve. Also, to become the motors of change in any context and regarding different needs. This means to work directly with people to provide them the skills they need to be empowered users. To become the best users of digital library services. --- 5. How and what can an institution such as IFLA do to support and incite this process of enhancing the library in a Capital (or almost) way in the world? IFLA is the global voice of libraries, it is recognised as the main organisation that represents the library field worldwide. During these past 2 years, IFLA has tackled Social role of (digital) libraries an important process regarding the Global Vision of Libraries to face globalisation's challenges, for finding out new opportunities to strengthen the library field, and enhancing libraries in an inclusive and participatory way. This process has had an absolute response of more than 33,000 librarians that are tuned to this transformation of the library field and the possible changes we will need to tackle in the future of libraries. I am confident that this transformation movement and the change of librarians' mindsets are gaining an increased momentum, as they are important for understanding that we can get our future together. 6. Giulio has just graduated in library science and wants to be a librarian: What would you recommend? Some years ago, Julián Marquina[4], a Spanish colleague interviewed me to share some ideas with his past year students from a librarianship programme. I was happy to build this Decalogue for them, which I think is still useful; so, I would tell him to follow these ten steps: (1) Empathy: What do you think about your users' needs? (2) Jargon: use a language that is close to your users and in the proper context. Users' understanding. (3) Strategy: be strategic, always plan your services and products from a perspective of necessity. (4) Legal framework: attend to the legal framework, but please be practical.	Purpose -Based on a comparison with different realities, analysis of the situation of libraries in line with International Federation of Library Associations and Institutions (IFLA) policies and directives. Design/methodology/approach -The method used for the following paper is that of a remote interview. Findings -The expected results will emerge from the debate that can be raised from this paper. Research limitations/implications -The IFLA guidelines have international value but are implemented according to the context of the individual country, not always in a uniform manner. Originality/value -The interview reveals the formality of the contents through the informality of the method.
INTRODUCTION The elderly is a group that is more susceptible to infection with infectious diseases caused by decreased immunity and comorbidities (Astuti et al., 2022). In the elderly, there is a decrease in the immune system and the body's response to infection (Kurniyawan et al., 2022). Age over 60 years is the final stage of the aging process, which impacts biological, economic, and social aspects (Budiman et al., 2021). Aging is a total change in living things marked by decreased bodily functions (Savitri & Ratnawati, 2022). The aging process, physiological changes, and decreased immune function in the elderly put them at high risk of exposure to disease (Rojannah et al., 2022;Kurdi et al., 2021). Problems in the elderly due to the aging process are decreased vision function, body flexibility, memory, hearing function, sexual function, and muscle strength (Emmawati et al., 2022). The elderly with cognitive decline becomes more anxious, restless, and socially withdrawn, thus requiring special attention (Adisiwi et al., 2021). Lack of social interaction among the elderly can cause feelings of alienation, causing depression which can affect the quality of life of the elderly (Nuraini et al., 2021). Stress is a condition that occurs due to changes in the environment which are considered something that threatens or damages a person's mental balance (Pusparini et al., 2021). Exposure to long-term and uncontrollable stress in the elderly can harm their health (Ariviana et al., 2021). An imbalance between pressure on individuals causes stress, and these individuals cannot deal with it, so they need more energy to neutralize it (Patuh et al., 2021). Stress can affect changes in hormonal balance in the body (Afkarina et al., 2022). Someone experiencing stress due to life pressure problems in the body will show several psychological responses to the stress they face, causing several disturbances such as cognition, emotion, and social behavior (Cahyani et al., 2022). Stress can cause overall physical and psychological symptoms such as anxiety, changes in appetite, increased heart rate, disturbed sleep patterns (Wuryaningsih et al., 2018), feelings of anxiety, tension, and overreaction to something (Septiani et al., 2020), decreased focal points and headaches (Ningrum et al., 2022). Stress can also increase the risk of various diseases, including cardiovascular and gastrointestinal diseases and diabetes (Kurniyawan et al., 2022). Stress has three levels, namely mild stress (acute stress), moderate stress (episodic acute stress), and severe stress (chronic) (Ratnasari et al., 2021). Mild or low stress is when a person experiences only a few hours of pressure (Dewi et al., 2020). Social support is a function of the expression of supportive behavior given by people considered meaningful for the individual who receives it. Social support is also a form of providing a feeling of comfort psychologically and physically when a person is under various pressures (Pradini et al., 2020). Social support is a form of relationship that individuals receive from their environment, including family, friends, and society (Kurniyawan et al., 2022). This social support is usually in the form of encouragement, attention, appreciation, and affection so that a positive impact on someone becomes more valuable (Allaili et al., 2021). Peer social support is the presence of peers who provide moral and spiritual encouragement, attention, and information to increase the intensity of behavior at certain times (Maharani et al., 2022). High peer emotional support means the elderly care about their peers through empathy, caring, concern, positive appreciation, and encouragement (Wuryanningsih et al., 2019). Social support will be felt if obtained from people trusted by the elderly (Suntari et al., 2022). Social support will provide supportive behavior to the elderly considered essential and meaningful (Kurniyawn et al., 2022). Support in the form of actions, attitudes, and acceptance given to the elderly lasts a lifetime (Pakilaran et al., 2022). The most critical support includes informational, assessment, emotional, and instrumental support so the elderly can feel the benefits (Trisnadewi & Suniyadewi, 2022). Social support is constructive for dealing with stressors and is expected to lead to validation, normalization of experiences, reduced social and emotional isolation, and a sense of togetherness (Gustyawan et al., 2022). Social and emotional support and moral and material support from relatives and friends will strengthen the elderly's daily lives (Widowati et al., 2022). The support of nurses, family, friends, and the community will make the elderly self-confident and improve their health status so they can return to interact with and benefit the community (Kurniyawan et al., 2023). This study aims to analyze the relationship between peer social support and stress levels in the elderly. --- METHOD The research design in this study was quantitative analytic with a cross-sectional approach. Aim to analyze the relationship between peer social support and stress levels in the elderly. The sample was 59 elderlies in the Tresna Werdha Social Institution, Jember Regency. The sampling technique in this study used simple random sampling. The inclusion criteria in this study were the elderly willing to be respondents. Exclusion criteria in this study were: Elderly who are in total care, have impaired oral communication, and have dementia which is known through the MMSE score. Peer social support was measured using the Peer Social Support questionnaire. Stress in the elderly was measured using a stress level questionnaire, namely the Stress Assessment Questionnaire (SAQ). The correlation test in this study used was the Spearman correlation test. --- RESULT --- Characteristics of Respondents --- Relationship between Peer Social Support and Stress --- DISCUSSION --- Peer Social Support in the Elderly Most of the elderly in the Tresna Werdha Social Institution, Jember Regency, peer social support in the positive category, namely 53 respondents (89.8%). Research on 60 elderly who live in social care homes for the elderly shows that almost half (45.0%) of as many as 27 people receive social support in the moderate category (Soewignjo et al., 2020). Peer social support is the presence of peers who provide moral and spiritual encouragement, attention, and information to increase the intensity of behavior at certain times (Maharani et al., 2022). Social support will provide supportive behavior to the elderly considered essential and meaningful (Kurniyawan et al., 2022). Support in the form of actions, attitudes, and acceptance given to the elderly lasts a lifetime (Pakilaran et al., 2022). The most crucial support includes informational, assessment, emotional, and instrumental support so the elderly can feel the benefits (Trisnadewi & Suniyadewi, 2022). Researchers assume that the high social support of peers is because the elderly are aware of the importance of guidance and support from their peers so that the elderly avoid feeling lonely. Guidance obtained by the elderly can be in the form of advice and suggestions on how the elderly deal with problems that occur in the elderly such as decreased physical condition, decreased sexual function, and potential changes in social roles. Positive social support from peers can make problems that exist in other elderly overcome because by providing support, the elderly will feel cared for and loved. --- Stress Levels in the Elderly Table 4 shows that most of the elderly in the Tresna Werdha Nursing Home, Jember Regency, have stress values in moderate stress, with as many as 37 respondents (62.7%) and severe as many as six respondents (10.2%). This research is in line with the results of Hilmi's research (2014) which states that moderate stress in the elderly is more than severe stress. Exposure to long-term and uncontrollable stress in the elderly can hurt their health (Ariviana et al., 2021). An imbalance between pressure on individuals causes stress, and these individuals cannot deal with it, so they need more energy to neutralize it (Patuh et al., 2021). Stress can affect changes in hormonal balance in the body (Afkarina et al., 2022). Researchers assume that this happens because they do not live with their families, so they feel alone and lack support is given. With the current conditions experienced by the elderly in the Tresna Werdha Social Institution, sometimes the elderly feel that they have been unable to adapt to the new environment, causing stress. --- The Relationship between Peer Social Support and Stress Levels in the Elderly The result of statistical tests using the Spearman correlation test obtained p-value=0.001, meaning there is a correlation between peer social support and stress. Spearman's correlation value of -0446 indicates that the direction of the correlation is negative, with the strength of the relationship being. The higher the value of peer social support, the lower the stress on the elderly. Other research that supports this research is conducted by Nurdianti (2017), which states that a significant relationship exists between peer social support and the stress level of students preparing their thesis. Social support is beneficial for dealing with stressors and is expected to lead to validation, normalization of experiences, reduced social and emotional isolation, and a sense of togetherness (Gustyawan et al., 2022). Social and emotional support and moral and material support from relatives and friends will strengthen the elderly's daily lives (Widowati et al., 2022). The support of nurses, family, friends, and the community will make the elderly self-confident and improve their health status so they can return to interacting with and benefiting the community (Kurniyawan et al., 2023). The elderly who lives in Tresna Werdha Social Institution have more time with their peers than their families. Social support from peers is exceptionally vital, which can affect stress levels in the elderly. Social support from peers can be a concern for Tresna Werdha Social Institution health workers to build intimacy and improve the ability of the elderly to socialize. Tresna Werdha Social Institution health workers can increase support between friends for the elderly, who can be a strength for the elderly to deal with stress. --- CONCLUSION There is a relationship between peer social support and stress in the elderly at the Tresna Werdha Social Institution, Jember Regency. Health workers can motivate the elderly to increase peer social support and improve programs that benefit the elderly. Gathering with peers can increase intimacy between the elderly in Tresna Werdha Social Institutions. --- CONFLICT OF INTEREST There is no conflict of interest in this article.	The elderly with cognitive decline becomes more anxious, restless, and socially withdrawn, thus requiring special attention. Social and emotional support and moral and material support provided by relatives and friends will strengthen the elderly's daily lives. This study aims to analyze the relationship between peer social support and stress levels in the elderly. The research design in this study was quantitative analytic with a cross-sectional approach. The sample in this study was 59 elderly living in the Tresna Werdha Social Institution. The measuring tool for this study used a Peer Social Support Questionnaire and the Stress Assessment Questionnaire (SAQ). The correlation test in this study used was the Spearman correlation test. The results of this study indicate that most of the elderly are in the moderate category of stress, with as many as 37 respondents (62.7%), and have peer social support in the positive category, namely 53 respondents (89.8%). Based on the Spearman correlation test, it was found that p-value = 0.001, which means that there is a correlation between peer social support and stress. Spearman's correlation value of -0446 indicates that the direction of the correlation is negative, with the strength of the relationship being. The higher the value of peer social support, the lower the stress on the elderly. Tresna Werdha Social Institution health workers can motivate the elderly so they can increase peer social support and improve programs that benefit the elderly.
Social functioning is fundamental to human experience. The profound social functioning impairments affecting people with dementia are distressing to them and their families and account for significant individual, family and societal burden. There are no effective treatments that improve this major aspect of dementia, so there is urgent need to characterise social functioning decline in dementia and its consequences to inform future therapeutic approaches. In this symposium, an international panel will present perspectives on social functioning in dementia from across the disease course. --- Social participation and dementia risk --- Authors: Professor Gill Livingston, University College London In this presentation, we will summarise the observational and interventional evidence linking social participation with dementia risk, the potential mechanisms, and consider what this evidence means for future clinical and policy interventions. Social participation encompasses several concepts including social activity, contact and support. International observational study evidence finds people who participate less socially in mid or late-life have increased risk of developing dementia. More social contact and less loneliness are consistently associated with less dementia risk in studies with long and short follow-up. However, this is not true of perceived social support. People who participate socially in late life may be able to do so because they are cognitively intact, so some studies limit their analyses to those without dementia over 10 years before follow-up or consider social participation trajectories. Within social activities, studies use heterogenous definitions, some including individual activities such as crosswords as social activity, and others requiring group activities and some cognitively stimulating activities. Those with shorter follow-up periods find social activity is more protective, suggesting part of the effect is reverse causality. The postulated mechanisms for social participation's effects include increasing cognitive reserve, which provides resilience to neuropathological damage, and improved brain maintenance related to a healthier lifestyle, lower stress response, reduced cellular ageing and inflammatory response. The relationship between social participation, depression and hearing is complex with each reinforcing the other and each being associated with dementia. 18 It is difficult to trial the effect of increasing social participation which might need unacceptable, impractical and longterm interventions (in line with findings that married compared to single people have lower dementia risk). Facilitatorled social group interventions have been small and short with inconsistent effects on cognition. Overall, the increasing, consistent and biologically plausible evidence that social participation reduces dementia risk means that interventions should begin to be included within dementia prevention guidelines and considered in policy. Public health policy should be an important component through promoting participation in those at risk and improving the accessibility of buildings and cities. This should be targeted at those who are more isolated, and this is closely linked with socio-economic deprivation. --- Impact of loneliness and social isolation in older people in Japan Authors: Hideki Kanemoto, Sumiyo Umeda, Yuto Satake, Yuma Nagata, Takashi Suehiro, Maki Suzuki, Manabu Ikeda Osaka University, Japan A decline in social functioning is a hallmark of dementia and is associated with worsening cognitive impairment, various behavioral and psychological symptoms, and caregiver burden. Since the feeling of loneliness is related to social function decline in people with mild cognitive impairment (MCI) and dementia, care for the social isolation that can cause loneliness is considered important in Japan, where the number of older people living alone is increasing. In addition to dementia, late-onset psychosis is also known to be affected by loneliness and social isolation. Psychosis that develops after age 60 and does not involve organic or affective disorders is defined as very late-onset schizophrenialike psychosis (VLOSLP) and is known to be different in quality from psychosis that develops at a younger age. Social isolation has been reported as one of risk factors of VLOSLP, and although people with VLOSLP are independent in daily life, their social functioning is impaired in a way that is different from dementia due to their abnormalities in the content of thinking. Therefore, social isolation and decline of social functioning are also major problems for VLOSLP. Longitudinally, people with VLOSLP are more likely than the general older population to progress to dementia including Lewy body disease and Alzheimer's disease subtypes. With the increasing importance of early diagnosis and intervention of these neurodegenerative diseases, identification and intervention of people with VLOSLP is a challenging but important topic. We are now investigating the use of robots with communication capabilities aiming to improve loneliness and social isolation of older people living alone with MCI, mild dementia and VLOSLP. On the other hand, we have found that loneliness in MCI and mild dementia does not necessarily correlate with social isolation status, such as living alone, indicating that loneliness and social isolation among older people requires further research. --- Insight into impaired social functioning in dementia Authors: Andrew Sommerlad 1,2 , Jessica Grothe 3 , Sumiyo Umeda 4,5 , Manabu Ikeda 4 , Hideki Kanemoto 4 , Gill Livingston 1,2 , Melanie Luppa 3 , Katherine P. Rankin 6 , Steffi G. Riedel-Heller 3 , Susanne Röhr 3,7,8 , Maki Suzuki 9 , Jonathan Huntley	Results: Analyses revealed 'creating a safe environment' as a core phenomenon. This relates to encouragement and the created anchor points of the environment to compensate for the inevitable feelings of loss of control that persons with dementia experience. The ways safety is created include active acts of involvement and participation, trust, humor, reciprocity, appreciation and shared experiences. Suspicion, loss of initiative by the person with dementia and the inability to act and correcting by the environment were identified as major challenges to creating a safe environment.A safe and supporting environment enables persons with dementia to use their remaining capacities. Active participation, trust, humor and reciprocity are key elements to create such a safe environment. These findings show that basic needs of persons with dementia for daily functioning and well-being are similar to these of all humans.
Problem-oriented education Problem-oriented education based on active learning in small groups, with problems used as the stimulus for learning (1) has been successfully adopted in research training programs such as mandatory course on scientific research for undergraduate medical students (2). Critical Appraisal Skills Program for health care professionals (3) and in Outcomes Research Practicum for clinical practitioners, postgraduate trainees and medical students (4). Outcomes Research Practicum (ORP) developed at the Duke University Medical Center in Durham, NC is based on problem-oriented education. It was designed to promote competencies and skills in designing outcome research studies and was shown to be successful in increasing the collective research activities of participants (4) in the long term. The effort to transfer this module to the central Europe area led to the initiation of Scientific Summer Schools (SSS) (5)(6)(7)(8). The SSS concept is based on the ORP, and aim is to enable and encourage international and inter-professional participation. In Turkey, as in many other Central European countries, there is still a strong tradition and emphasis on didactic teaching methods, where the custom of passive listening to lectures is the primary educational tool. Most participants of the SSS were experiencing a problem-based educational approach of this kind for the first time. The custom of passive listening to lectures was previously suggested as the main reason for lower participant satisfaction compared with a problembased learning procedure of education (9). The effect of the change in educational approach from didactic to problem oriented education and personal reflections of this change was recently studied (unpublished data). The main findings of the study were that the SSS had positive impacts on participants' competencies related to design and the conduction of research studies and their group performance. These findings were based on both the subjective perspective of SSS participants and the objective perspective of the workshop faculty. --- Cross-discipline/cross-cultural collaboration and maintaining respect to each other The cross-discipline/cross-cultural collaboration was achieved by having participants from different countries and with different backgrounds. The approach of having participants from different countries leads to the challenges in communication and problem solving. The primary challenge and goal of working in diverse groups is to maintain the respect of each other especially when differences in opinions and understanding take place. Those challenges were solved by careful listening and understanding, and making sure that the perception and understanding is the primary goal in discussions and communication. Differences in background can lead to positive outcomes just as when borders between cultures and background are removed. Only then different aspects and opinions can be applied in designing the research projects through collaboration. --- Conclusions To improve sharing of scientific programs and to promote scientific communities worldwide suggested strategies exist to bridge gaps between research output of transitional countries and leading powers in biomedical research (10). The initiative of doing Scientific Summer School in Turkey has shown that well established problem-oriented	Probleme-dayalı eğitim ve kültürler-arası işbirliği: Türkiye-2010 Bilimsel Yaz Okulundaki deneyim ve yorumlar Scientific Summer School (SSS) is a collaborative international initiative that was designed to improve the development of research skills among participants based on a practical, problem-oriented education. This year, it was organized in Turkey, where the conduction of relevant biomedical research is of significant interest. Additionally, there is an understanding that practical skills relevant to biomedical and health care research studies are key tools in the ability to meet local and international research needs and to maintain quality in health care standards. The focus of the Scientific Summer School was to experience the skills of designing the outcome research study: creating a logical hypothesis, determining significance of study, planning how to select study population and outcomes, data types, collection and analysis. The main principles of the Scientific Summer School were: 1. To apply the problem-oriented education in designing the outcome research study 2. To encourage the cross-discipline/cross-cultural collaboration 3. To maintain the respect to each other
Jhumpa Lahiri is a prolific writer born in London and raised in Rhode Island. The author has penned down the characters in the novel The Lowland in such a way that helps us to visualize the narratives in our minds to experience the emotion and the trauma faced by both the male and the female characters. The novel The Lowland emphasizes mainly the female character and how life takes its turns for the decision made by the female character Gauri Mitra. Analysing the novel having gender concerns in mind the main focus will fall on only the female character but in this novel, the concern falls equally on both male and female characters. Jhumpa Lahiri a prominent and leading author during her time talked about identity issues, loyalty, freedom, and equality through her works. The Lowland, the title represents the two ponds in Calcutta the place where the male character Subash and Udayan the two brothers grow up. The brothers have different personalities they care for and respect each other for the decision they make in life. Udayan who is more conservative stays back in his hometown and joins the Naxalite movement and is killed by the police for his radical stand. Subash who is much concerned about his future chooses his academics and moves to America and continue his study with a scholarship. He returns when he receives the news about the dismissal of her brother. Gauri who is the wife of Udayan, who has made choices to marry him despite the family concern, and who had more dreams for her future is left alone as a pregnant woman and as a widow. The author here brings in the ideology of a woman having no life once her husband dies, that one should shut her life to darkness and live the rest of her days without any hope for a better life. But through the younger brother's character, we could see how he tries to take Gauri out of the place where she is not respected by his parents, and for how she is being ill-treated. The trauma she undergoes after the death of her husband, and how she is treated, and who is not given any basic rights to live a normal life is the reality in disguise. She then leaves to abroad with Subash and agrees to marry him for her betterment. Her needs and priority change once she gives birth to her daughter Bela. We could see that the narrative of a female character has taken a drastic change in this novel, once the baby is born it is the female who has to sacrifice their carrier and their ambition. Looking at the narratives the author used to outline the female and the male character identically undergoes the trauma. The perspective of the novel can be changed, but the ideology that we understand is how the men and women take their circumstance under control and works equally towards the betterment of their life. Subash is the one who raises her daughter, Bela despite him having an affair with Holly he only makes decisions according to his priority. Gauri is a mother and desires to study further about philosophy and that takes a turn and distances herself from her daughter. And later we could see that she leaves her daughter and moved to California. Bella is living with the fact that her stepfather is her uncle and her mother has left her behind. This affects her life in many ways, and later she gives birth to a baby girl and will promise not to get back to her mother but later she changes her mind and ask her to meet her daughter Meghna. Subash who needs a companion to spend his life decides to marry Elise in the later part of the novel. The interrelationship of men and women can be analysed by the understanding of feminist theory, which importantly focuses on women. Absolute knowledge is derived from the experiences we have in our life. And the experience is frame worked either by society, culture, or the family. And the constant understanding of men equally contributes to the circumstance and also faces the consequences for the decisions they make. The feminist theory tries to understand and establish a certain perspective that is women-centered. Analysing this novel, the understanding of men and women have a distinct role to be played in society and family. We could see through the character of Subash that he prioritizes his family and marries Gauri, and she has her priorities and decides to leave her daughter and move to California for her studies. The men and women have impartially withstood the trauma of their gender. In both the character the author experiment with the decision that it can be taken only by men and not by women, as it is unusual for a woman, a mother, or a widow to leave her daughter for her own sake, and it was not a compulsion for Subash, the stepfather to take care of his brother's daughter. Circumstance, society, and once norm plays a very important role in the decisions one makes in life. This theory brings the difference between men and women, which are made by the social institution. The gender inequality, we witness is constructed by society which is taken its differences between men and women equally. Exploring the theory of gender inequality, and gender concern are more focused on equality in general having the novel characters in concern. It helps in understanding the perspective of male and female, the position and the experience they endure in life. Some approaches come under this theory to trace down the difference and the changes that take place when it is women and not men and vice versa. The biological, sociological, and existential difference takes a long stand in placing men and women in an institution where they take charge of life according. We can compare the well-being of Gauri, Udyan, and Subash in the novel. Where the women bear the child before marriage and also without getting married, whereas Gauri's daughter is conceived without getting married and leaves the person and decides to keep the child. Where the choice is made by the person herself and not by anyone else, likewise knowing the reality and the respect he has for his brother, Subash decides to marry his wife and accept the consequences that come along with the decision he made. This explores gender inequality that has come a long way in accepting and knowing the fact inequality is for both male and female, it is more of equality for both. The trauma that the characters undergo in this novel brings out the fact of the equal idea of understanding reality. Through the characters in the novel, we could get the essence of the different emotions they go through to achieve what they wanted to do in life. Contemporary writer Amulya Malladi portrayed different shades of characteristic in the novel A House for Happy mother. The novel is analysed in a gender concern perspective. In the following paragraph the characters and the decision they make for giving equal important for both the gender roles in the novel. The characters in this novel are constructed in such a way to bring in the detailed social construction that makes the characters to behave in certain way according to their life expectation. The two main characters that constrained to have the choices according to their life, one of the main male character Madhu who made a choice to live a life without having baby, and his wife Priya who wanted to have the baby through surrogacy. Through these two characters we could understand the deep constrained societal concern with the couple for having a child after marriage and they are not a happy couple when they choose not to have kids in their entire life. The choice in their life should be mainly valued for the purpose for their wellbeing in life. Both the character has the freedom to choose and expect their need in life to make an impact only on them and not by the influence of society. The novel takes the reader through the process of being an Intended parents and Asha who choose to be the surrogate for the couple. The freedom to make choice in life is the most important aspect for both the gender. When it is concerned with motherhood, it should be the women to make the choice for her body but not forced to the societal concern for the women in the family. Gender concern are equal when it comes to life decision, from both the genders. The societal gender structure are organised in such a way to benefit for one, but analysing characters through the gender concern that narrative have changed for the constructed perspective of the gender concerns.	The history of gender concern in literature has come a long way to bring a change in the understanding of equality and the differentiation of sex and gender. Sex is the variation in the biological and gender which is important and associated with identities and socially constructed roles. Depending on time, women have developed their demands to attend equality and have developed many platforms that help women to attain their basic rights as human beings. Women have always been viewed as the weaker sex and inferior to that men. Any movements that help women to achieve their equal rights and helps them to understand their individuality, ambitions, and dream are important and their place in society matters as much as men, and these fall under Feminist movements. Throughout history, works in literature have paved the way to bring out how society has placed women and the different roles played by them and how it impacts society. The types of waves in the feminist movement have traced down the history of the growth of women in different stages. Gender concerns in literature have given different insights and knowledge about how women have lacked their basic rights, and have shown the different dimensions of living life on their terms just like men.
PSYCHOSOCIAL CORRELATES OF PREVENTION, CARE, AND WELL-BEING AMONG OLDER WOMEN LIVING WITH HIV Chair: Thi Vu Discussant: Anna Rubtsova There are over 4.2 million older adults (ages 50+ years) living with human immunodeficiency virus (HIV) globally. Older women continue to make up a significant proportion of this population. Advances in antiretroviral therapy treatments have allowed HIV+ individuals to live longer, healthier lives. However, compared to all persons living with HIV, women have lower viral suppression rates and are less likely to be retained in care. While older women living with HIV (WLWH) face unique challenges with HIV prevention and care, such as caregiving responsibilities, gender discrimination, and ageism, there is a dearth of research focusing on their experiences. As the population of older WLWH continues to increase, understanding barriers and facilitators to HIV prevention and care among this population is a public health priority. This symposium will provide insight into psychosocial factors that influence HIV prevention, care, and well-being among older WLWH. Our first presentation highlights a qualitative study identifying sources of strength and concerns about aging with HIV among older women. Our second presentation examines social support networks and interpersonal strain in relation to loneliness among older WLWH. Our third presentation highlights the impact of patient-provider communication regarding HIV/AIDs on sexual health communication between older WLWH and their partners. Our fourth presentation examines mental health vulnerabilities and strengths of older WLWH during the humanitarian crisis in Ukraine. Discussant Dr. Anna Rubtsova will contextualize these findings and offer suggestions for future research to enhance well-being of older women across the continuum of HIV prevention and care.	We aimed to assess the nature and degree of association between exposure to potentially traumatic wartime experiences in early life and later-life frailty. The Vietnam Health and Aging Study included war survivors in Vietnam, age 60+. Latent class analysis (LCA) is used to construct classes exposed to similar numbers and types of wartime experiences. Frailty is measured using a deficit accumulation approach that approximates biological aging. LCA yields 9 unique wartime exposure classes, ranging from extreme exposure to non-exposed. Higher frailty levels among those with heavy/severe exposures certain combinations of experiences, including intense bombing, witnessing death firsthand, having experienced sleep disruptions during wartime, and having feared for one's life during war. The difference in frailty-associated aging between the most and least affected individuals is more than 18 years. War trauma hastens aging and warrants greater attention toward long-term implications of war on health among vast post-conflict populations across the globe.
Організаційна психологія. Економічна психологія. № 4 (30) / 2023 , 14. : : : : . . --- VII -. The Individual Psychology of Alfred Adler. Metaphysics. Social Learning Theory.	Introduction. The article deals with the prerequisites for studying the phenomenon of monetary culture of the individual. The author analyzes monetary culture and the role of money from the perspectives of philosophy, sociology, economics and psychology.To analyze scientific studies on monetary culture as a socio-psychological phenomenon conducted by Ukrainian and foreign scientists. Methods: system analysis, synthesis, and generalization. Results. The analyzed the theoretical prerequisites for studying the phenomenon of monetary culture, its social and psychological nature, as well as the main theories of money. Researchers propose different approaches to social and psychological aspects of money. A relatively new concept of monetary culture is defined as the process and result of the individual's development of knowledge about money, monetary behavior skills, and a holistic reflection of monetary relations. Conclusions. The article analyzes the main theoretical approaches that are the prerequisites for studying monetary culture as a socio-psychological phenomenon.
Background We know that refugee children are vulnerable to develop mental health problems, particularly post-traumatic stress [1]. Yet, social relationships including the number of friends and quality of friendship appear to play an important protective role [2]. Feeling accepted and supported by peers reportedly promotes wellbeing among refugee children [3,4], and is associated with lower levels of psychological distress [4], emotional difficulties [5] and aggression [6]. Conversely, perceived discrimination by peers is related to emotional problems and aggressive behaviour [6]. Given the significant role peers play for refugee children, efforts should be made to engage host country children with the topic of refugee children's needs. This brief report describes a film-based activity carried out at a children's science festival in Uppsala, Sweden. Uppsala is a university town with a general education level higher than the national average, but also with less affluent areas from which schools visited the science festival. A short film conveyed a typical experience of a refugee child to provide the children with contextual knowledge and a qualitative survey was used to collect the children's views on what they think refugee children might in the study. Of the children who took part, the age range was 5 to 14 years (mean = 9.6, SD = 2.2). About half of the respondents were boys (n = 26) and half were girls (n = 23); two respondents did not wish to state their gender. When asked if they knew someone like Ali, 14 (27%) stated that they did, 27 (52%) said they did not, 10 (19%) were not sure, and one child did not respond. --- Data Collection The film was available on tablets for the children to watch. A Swedish translation of the book was also available at the stand. The science festival attendees were made aware that they would be asked to complete a brief anonymous survey after watching the film, that we were a research group who are interested in what children have to say, and that we would like to write about the findings. Swedish legislation mandates that ethical clearance is not required for anonymous studies, including studies with children. All children and parents were asked for oral consent on site, but without registering their names or any other personal identifying information. There was always a qualified adult (psychologist, nurse or physician) there to assist them if questions or difficult emotions arose. Parents of children under 9 years of age were informed that the film had some difficult content and that parental presence was advised, as well as watching the whole film, given the positive outcome. The children were asked to complete the anonymous survey on the tablet directly after watching the film. Besides their age, gender, and whether they knew someone like Ali, we asked the children: (i) What do you think newly arrived children need in Sweden? and (ii) How do you think we could help them with their needs? The readability of the questions was categorized as 'very easy' according to the Läsbarhetsindex Swedish Readability Formula [7]. Most children typed directly into the survey form, but some (mainly younger) children requested for the research group member to help; this resulted in an interview format for some children, which involved the researcher reading the question then typing the child's response into the survey form verbatim. --- Analysis The responses were extracted from the online survey platform into Excel and translated into English before being analyzed. Data from the open-ended questions were combined and analyzed using content analysis [8]. Initially, the manifest content was identified for each answer and categorized. The category coding was conducted by two independent raters. The inter-rater reliability was (i) κ = 0.95 (p < .000), 95% CI (0.88, 1.02) and (ii) κ = 0.89 (p < .000), 95% CI (0.8, 0.98) for the respective questions. The following step included identifying the latent content, i.e. the meaning behind the statement. In some cases, the answers were too short to allow for latent content analysis -for these, only the manifest content was identified. Additionally, a quantitative comparison on the code level was made between the children who stated they knew someone like Ali, and those who stated they did not know someone like Ali. --- Results Four latent categories emerged in the analysis: 'Practical support', 'Emotional support', 'Social inclusion', and 'Policies' (see Table 1). A developmental trajectory in the nature of responses was observed, with the older children providing more complex responses. No meaningful differences were observed between genders nor the responses from children who reported knowing someone like Ali and those who reported not knowing someone like Ali. --- Discussion The children who completed the science festival activity rightly recognized that in the initial stage of arrival, practical resources, such as a home, food, clothes, and toys are important to alleviate the adaptation to the new context, which corresponds to the basic needs of all humans. This indicates the children were aware of the refugee narratives in the media at the time. The answers were also likely influenced by the film, where Ali and his family had lost their home and then all their belongings when their boat capsized at sea. It is interesting that (even younger) children seemed to intuitively recognise the rather immediate need for friendship and kindness, i.e. social support and inclusion. Given the protective nature of peer support [3][4][5][6], it is encouraging that words such as "help" and "love" were used. Some respondents also mentioned the need for protection in general, and specifically from bullying or discrimination. Again, this is reassuring given the detrimental effect of perceived discrimination on wellbeing [6]. It is intriguing that rather young children shared comments recognizing the connection between policies and individual refugee children's needs. We know that policies and public attitudes do matter for refugee children. For instance, in countries with supportive multicultural policies school belonging is higher whereas restrictive policies reportedly limit the school belonging of students [9]. --- Limitations We acknowledge the content of the video may have influenced the subsequent answers about the needs of refugee peers. Utilising a survey-based response method resulted in relatively brief responses, but was fitting to the community engagement style of the interaction with the children and offered greater anonymity to encourage honesty. A relatively small group of children was involved in the activity and participation was voluntary. Yet, the code saturation method [10] indicated saturation was achieved. To ensure the credibility and confirmability of the study, the first author (AS) conducted the analyses and the second and third author (EL, GW) independently reviewed the manifest and latent categories. The dependability of the findings was enhanced by thorough documentation of the data collection and analysis process. Further information, such as migration background, ethnicity/cultural background, social class, and family constellation could have been helpful in interpreting the results but the brevity of the survey form was prioritized. --- Conclusion The findings from this study indicate the capability of children in Sweden to consider the needs of refugee children and suggest that resources such as 'Ali and the Long Journey to Australia' could be potentially helpful in fostering Responses in this category focused on the urgent and everyday needs of refugees, such as getting access to housing, food, and clothing. 'Home or House' was the most common need mentioned, but many children identified several of the basic needs. Children mentioned 'school', recognizing education as a fundamental need. A number of children identified that learning the Swedish language was among the practical support that would be required by newly arrived children. The youngest children's answers were dominated by these practicalities, but they were also the most prevalent answers given overall. "One could give them a home, food, and love" (girl, 12) "School, own house, food, friends" (boy, 12) "They need help to learn our language" (girl, 6) "Food, toys, water, breakfast" (boy, 6) --- Emotional support The manifest content included in this category covered expressions of kindness and love. Their answers demonstrated empathy and concern for the refugee children. The children talked about the need to be met with compassion and understanding in the host country, with many of them expressing that peers should "be kind", "be good to them" and offer them "warmth" and "love". In addition, some children demonstrated an awareness of the psychological needs of the newly arrived children; that they may be traumatized by the forced migration experience and need to talk about it, but that they should not be rushed to do so. "Don't ask too many questions. Let --- Social inclusion This category included positive examples of how to socially include the newly arrived children, including "play with them". A few children also highlighted the potential threat to social inclusion of being bullied, as the newly arrived children may not have the same possessions or language as their peers. Bullying was mentioned by the children in a negative tone, expressed as something that should be deterred. Others spoke of social inclusion in very general terms, comparing refugee children with peers and expressing that all children should be given the same opportunities. an inclusive school environment. Other resources to teach children about forced migration are freely available, such as those produced by United Nations High Commissioner for Refugees (unhcr.org/teaching-about-refugees), and should be considered by school personnel. Yet, awareness raising among peers only forms one part of the picture. To create an inclusive environment for children who have experienced forced migration, an equity-focused and trauma-informed approach across school culture, practice and policy is encouraged. This should also include highlighting the strengths and aspirations of children from refugee backgrounds, not only their needs. We recommend further exploring children's views and ideas through qualitative enquiry. --- Authors Contribution GW conceived the idea for the activity/brief report. All authors were present at the science fair. AS led on the analysis, supported by GW and EL. All authors contributed to writing the report. --- Funding Open access funding provided by Uppsala University. 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 1 3	need when they arrive in a new country. The qualitative design was selected to give the children space to provide detail about their reasoning in their own words and to enable the nuanced perspectives of children across various ages to be captured. As the survey was explorative, there were no specific hypotheses.'Ali and the Long Journey to Australia' is a clay-animated short video of the experiences of a refugee child. "Ali" is a 10-year-old boy who tells his story from a bomb attack destroying his house, to police coercion against his father, through the dangerous boat journey across the sea, his stay in a refugee camp, the insecure time awaiting asylum, and finally being able to go to school. The story ends better than for many refugees: the family reunites in the new country and can start their life there together. Originally developed as a book, the video was co-produced with 13 primary school pupils in South Melbourne, Australia. With permission from the developers, we translated the video content into Swedish and created a Swedish-speaking child voice/ over for the film.A total of 51 children completed the activity. They were approached as they passed the research group's stand at the science festival. The only inclusion criterion was being under 18 years old. The majority of approached children were willing to participate and all of these were included
Introduction Relational and interpersonal relationship skills are considered to be the backbone of nursing care and are recognized as the competencies that differentiate excellent nursing care (1) . The acquisition of these skills is considered a progressive process, developed according to various stages: beginning, advanced beginning, competent, proficient, and expert (2) . Admittedly, professional competence in nursing includes clinical and technical aspects, but relational aspects complement it. The development of professional competence is achieved only after personal competence is developed (1) . There is no doubt about the relevance of personal competence for one's personal and professional realization or of its usefulness in training or inclusion in school programs (3) . We assert that professional competence in nursing is primarily based on the nurses' personal qualities, on their personality, which determines the acquisition of education and experience. Competence in nursing comprises two essential aspects: the mobilization of personal competencies and the mobilization of different types of knowledge and know-how applied to nursing care (1) . The more self-knowledge a caregiver has and the more complete it is, the better the care provided (4) . In a clinical-reflective approach of an ecological matrix (6) , professional competence is a result of a set of micro-interactions: with oneself (intrapersonal interaction), with others (interpersonal interaction), and with knowledge in interactive relationships (multidisciplinary interaction). Considering that people are the essence of an organization, their full involvement enables their competence to be fully used to the benefit of the organization itself, also benefiting the implementation of intervention programs (7) . It is also important to note that the quality of care is strongly marked by the attitudes and behaviors of those providing care. Competent professional performance requires knowledge able to mobilize, integrate, and transmit knowledge acquired during the educational process (8) , which may be enabled by the development of competencies from new pedagogical opportunities provided during initial stages of education (9) . --- Specifically, nursing know-how incorporates in itself the relational know-how (8,10) , while nursing care, considered to be the special attention provided to a person requiring help, is essentially developed via an interpersonal relationship, which requires complex competencies from nurses, competencies focused on humanist principles (unity, the tendency to update one's knowledge, autonomy, progress) and on supportive relationship (acceptance, authenticity, empathy, warm respect, congruence, attentive listening) (11) . --- Objective To identify the needs manifested by nursing students in the field of relational competencies. --- Method Qualitative and longitudinal study with an exploratory-descriptive approach, quasi-experimental Data were analyzed through content analysis as a set of analytical communication techniques (12) . We note that the development of categories followed the rules: homogeneity, exhaustiveness, uniqueness, objectivity, and relevance (12)(13)(14) . The process of content analysis began with a pre-analysis of the material though skimming the answers provided to each question. The material was then explored and coded with the identification and delimitation of units, organizing categories and subcategories, through an inductive process. A panel of experts ensured the validity and reliability of content analysis. --- Results Most --- Humanistic Principles Keep in mind the fact that nursing care is provided to a human being, thus, the individual has to be treated as such. Nursing care has to be directed to the individual, not to the disease… (P8) …nursing care has to include the human aspect, that is, the individual should be seen as a unique being, not look to the individual in his disease but also considering his emotional dimension. (P35) …a holistic view of the human being in his physical, mental and emotional dimensions… (P38) 21 11.17 Lopes RCC, Azeredo ZAS, Rodrigues RMC. Table 2 shows the results of the analysis concerning the 318 units expressed by the students. They support the opinion that personal characteristics facilitate nurses' competence, especially communication skills (12.89%), followed by sympathy (8.81%), tolerance (6.92%), professionalism (6.60%), and self-esteem/ self-confidence (5.66%). When the students were asked about the characteristics and the personal competencies they needed to develop to improve their personal and social well-being, they reported self-esteem in 29.55% of the 132 studied units, communication skills (23.48%), assertiveness (15.91%) and emotional competence (12.12%) (Table 5). Tolerance, knowing to listen and sense of responsibility were less frequently reported. --- Discussion Highlighting the most significant results achieved in this study through the assessment of relational needs, the following conclusions were reached. Based on what the students reported as being competencies essential to the quality of nursing care, we verified that the categories (professional competence, and personal and social competence) illustrate the importance the students assign to the professional dimension (85%) and to the intra-and interpersonal dimensions (15%). Such findings allow us to infer that the students, at this stage of their education, do not integrate concepts advocated by some theorists, for whom the quality of nursing care is marked by the nurses' behavior (8) and that professional competence is only achieved after personal competence is developed (1) . Meanwhile, another piece of evidence related to the subcategories of Professional Competence is related to a greater appreciation of Know-How, due to the overvalorization of techniques and procedures at the expense of the subcategory Knowledge, especially scientific knowledge. This notion of nursing care is focused on the performance of nursing tasks and techniques instead of on scientific knowledge in nursing, essential for nurses' autonomy (15) . On the other hand, the students assigned Lopes RCC, Azeredo ZAS, Rodrigues RMC. significant value to the subcategory Relational Know-How (42%), recognizing the importance of supportive relationships, humanistic principles and communication for the quality of nursing care (10)(11)16) . In relation to the professional competencies the program should enable students to acquire, the results are related to the competencies that are essential to the quality of nursing care previously discussed. The students, again, under-valued Scientific Knowledge and evidenced bias toward Techniques and Procedures. These findings contradict some previous studies addressing students from different undergraduate programs where the aspect most valued is "acquisition of knowledge", indicating that teaching institutions transmit more knowledge from the knowledge scope than from the know-how, know-to-be, and know-coexist scopes (17) . Nonetheless, within Relational Know How, they exalt the development of competencies concerning supportive relationships and communication skills, while within the scope of Knowledge, they exalt personal and social competencies. These aspects are globally confirmed by conceptions that defend the view that competence in nursing comprises two essential aspects: the mobilization of personal competencies and the mobilization of knowledge and know-how applied to nursing care (1) . These aspects also highlight the importance of nurses' self-knowledge that promotes skills and quality of care, that is, the better and the more complete one's self-knowledge, the better the quality of care provided (5) . The more self-knowledge a caregiver has and the more complete it is In relation to the personal characteristics that facilitate the competence of nurses, the students highlight communication skills but also value the ability to be tolerant, rigorous, organized, professional, understanding, assertive, and having good self-esteem and self-confidence. Overall, these findings seem to be in agreement with the idea that investing in communication skills on the part of nurses is associated with higher levels of personal growth (18) . In regard to personal characteristics and competencies to which students need to pay greater attention in order to become good nurses, communication skills, self-esteem and assertiveness stand out. These results are consonant with those reported by studies that defend competence in interpersonal communication as an ability essential to be acquired by nurses, which enables them to provide conscientious, true and transforming care (19) . Closely related to the previous issue are the personal characteristics and competencies that students are required to develop in order to improve their personal and social well-being; they highlighted self-esteem, communication skills, assertiveness and also emotional competence. Considering that undergraduate education should enable personal development, dimensions concerning the development of responsibility, positive relationships and cooperation emerge as having considerable relevance in empirical investigations focused on the academic success of undergraduate students (17) . In other studies that are focused on acquiring knowledge in Clinical Teaching, the students' personal characteristics and maturity demonstrated in interactions (6) , self-knowledge and factors intrinsic to the individual stand out (20) . --- Conclusion The Finally, we conclude that the students are aware that personal development and better self-knowledge are determinant of their personal and social well-being, as well as for them to become good professionals.	Objective: to identify the needs of nursing students in the field of relational competencies. Method: qualitative study with an exploratory-descriptive nature. The random sample included 62 students in the 2nd year of the nursing undergraduate program of a school located in the central region of Portugal. The inclusion criterion was the nonexistence of clinical teaching. Data were collected through a form designed to assess relational needs; content analysis was used to analyze data. Results: the results indicated that the students' concept of nursing care at this stage of their education is focused on the performance of nursing tasks and techniques instead of on scientific knowledge. Overall, they are aware that greater personal development and better self-knowledge are determinant for their personal and social well-being and for them to become good professionals. Conclusion: these results will support the improvement of an intervention program to be developed with these students.
Medically, of interest, is acute kidney injury and a recent case report finds the potential catastrophic effects of warming temperatures, muscle damage, and electrolyte imbalance on renal failure in ultramarathoners. This imbalance calls to action medical social work expertise, eco-social work futures, and climate interventions (Pasternak et al., 2023). Nutrition, especially for amateur ultramarathoners, is an important field to contribute to. A recent study states ultrarunning is increasingly popular among beginners and knowledge about optimized and appropriate nutrition is needed (Kosendiak et al., 2023). This begs our discipline to refer and educate athletes of all training styles to be mindful and evidence-based with their nutrition and hydration strategies. A rich area of research is the qualitative and quantitative markers of ultraendurance success and failure to ensure safety and performance skills over the lifespan. Subjects such as justice, equity, diversity, and inclusion could also be fertile to bring to light the successes and experiences of athletes and racers like multiple Guinness World Record holding Masters Centurion racewalker and first African American to finish the Sri Chinmoy Self Transcendence 3100-mile race, Yolanda Holder. Gender and diet, such as plant-based diets, are also important to factor in as many athletes like record-smashing Courtney Dauwalter, Camille Herron, Harvey Lewis and Suprabha Beckjord of 3100-mile race fame continue to inspire and give us frisson inducing performances. Age is also an interesting factor in ultraendurance racing as there are many wise and elder ultramarathoners showing how it is done to the new devotees of the sport in races such as "A Race for the Ages." It is important to note the Global Organization of Multiday Ultrarunners (GOMU) has stepped in to honor the records of multiday ultrarunning distances when the International Association of Ultrarunners (IAU) neglected to honor the distances, like the 5000km. In conclusion, this commentary is a call to action for all sport social workers, athletes, and sport social workers to research, develop best practices, and advocate for the sustainability and heart of ultraendurance sports. More specifically: 1. Volunteer and consult with ultramarathons in your area to get front line experience. 2. Develop and conduct research to promote success and medical knowledge in ultraendurance. 3. Advocate for best practice development in sustainability such as cupless races, race directing, sport social work, and sports medicine for the longevity and health of the sport. 4. Increase Continuing Education Units for sport social workers interested in the practice of ultraendurance. 5. Build community in social work and complementary disciplines such as physical therapy and medicine to support the whole lifespan of an ultraendurance athlete. 6. Promote health and wellbeing not only of athletes and their support systems but of our environments and ecosystems.	Ultraendurance sports are becoming increasingly popular around the world and have a history and future that should not be forgotten or overlooked. For example, according to UltraRunning Magazine, in 2022 there were 2682 races in North America and approximately 67% male runners and 33% female runners participated with 116,578 total finishes. Social workers are poised to support, develop, and train the next generations of athletes, coaches, families, and support systems of ultraendurance athletes. This commentary is a call to action for more research, best practice development, and advocacy for ultraendurance sports.
Yaroshenko Iryna, Ph.D. of Arts, Associate Professor of the Methodology of Musical Education and Conducting of the Educational and Scientific Institute of Arts of the Precarpathian National University named after Vasyl Stefanyk Formation of professional skill of the future conductor in the system of art education (on the example of pedagogical methods of professor I. Yuzyuk) The purpose of the article is to characterize the peculiarities of the formation of professional skills of the future conductor during the years of study at the art institution on the experience of teaching I. Yuzyuk. The methodology consists in the application of materials, the main provisions of the organization of individual lessons in choral conducting, which characterize the professional competencies of a professional conductor, which forms the musicalaesthetic and artistic development of the individual, which promotes professional music education and culture. The scientific novelty of the work is that for the first time the method of forming the professional skills of the future conductor in the system of art education is considered on the example of the teaching of Professor I. Yuzyuk, who introduces his methods into the educational process, solving current problems of choral performance. Conclusions. As a result of the research, it was found that the analyzed experience and peculiarities of I. Yuzyuk's teaching on conducting training of future specialists are an important component in the formation of professional skills of the future conductor, which contributes to the development of art education. Generalized results of methodical bases of the organization by I. Yuzyuk of classes on choral conducting, formation in them of positive motivation to conducting ©Ярошенко І. В., 2020 specialty, individual approach to students, deepening of theoretical knowledge concerning choral activity, improvement of conducting technique, artistry, complex application of various teaching methods, activations which forms the professional skills of the future conductor. The pedagogical activity of I. Yuzyuk and his experience in the formation of a professional conductor in the system of art culture and education is characterized. Emphasis is placed on the peculiarities of the manifestation of the conductor's individuality in his professional activity, integrating aspects of development and formation. Key words: choral art, conductor, music-pedagogical activity, professional skill. --- Актуальність	Yaroshenko I. (2020). Formation of professional skill of the future conductor in the system of art education (on the example of pedagogical methods of professor I. Yuzyuk). Mystetstvoznavchi zapysky: zb. nauk. pratsʹ, 38, 128-131 [in Ukrainian].
INTRODUCTION People living with HIV/AIDS (PLWHA) have been the target of stigma and discrimination (Cahill & Valadéz, 2013;Earnshaw, Lang, Lippitt, Jin, & Chaudoir, 2014;Herek, Capitanio, & Widaman, 2002;Mahajan et al., 2008). HIV/AIDS stigma is one of the major barriers in combating HIV worldwide and is often compounded with other issues such as gender, sexuality, ethnicity, drug use, and culture (Brooks, Etzel, Hinojos, Henry, & Perez, 2005;Chen, Choe, Chen, & Zhang, 2005;Lentine, Hersey, Iannacchione, Laird, & McClamroch, n.d.;Pulerwitz, Michaelis, Weiss, Brown, & Mahendra, 2010;Swendeman, Rotheram-Borus, Comulada, Weiss, & Ramos, 2006). HIV/AIDS stigma deters individuals from disclosing their HIV/AIDS status, increases sexual risk behaviors, decreases willingness to be HIV tested, and decreases access to quality care (Brooks et al., 2005;Brown, Macintyre, & Trujillo, 2003;Chesney & Smith, 1999;Earnshaw, Smith, Chaudoir, Amico, & Copenhaver, 2013;Galvan, Davis, Banks, & Bing, 2008;Pulerwitz et al., 2010;Rao, Kekwaletswe, Hosek, Martinez, & Rodriguez, 2007;Simbayi et al., 2007;Valdiserri, 2002;Wu et al., 2008). Minority men who have sex with men (MSM) have the highest rates of HIV in the U.S. (CDC, 2013;Hall, Byers, Ling, & Espinoza, 2007). High levels of HIV/AIDS stigma among minorities helps drive this disparity (Brooks et al., 2005). As a result, many minority MSM remain secretive about their same-sex sexual practices, avoid getting tested/practice riskier sex, and are unreachable by traditional public health interventions (Arnold, Rebchook, & Kegeles, 2014;Fullilove & Fullilove, 1999;Marín, 2003;Overstreet, Earnshaw, Kalichman, & Quinn, 2013;Young, Szekeres, & Coates, 2013). To avoid stigma, minority MSM are increasingly using social media, such as Facebook, as a source for seeking social and sexual partners (Young et al., 2013). In 2013, 58% of the general public used a social networking site, with the number increasing to 80% for LGBT adults (PEW Research Center, 2013). When looking at racial differences, the rate of SNS use was 71% among Whites, 76% among African Americans, and 73% among Latinos (Duggan & Smith, 2013;Harris Interactive, 2007;Smith, 2010). This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African American and Latino MSM from Los Angeles. --- METHODS The Institutional Review Board (IRB) at the University of California, Los Angeles (UCLA) approved this study and the protocol adhered to the current recommendations for conducting HIV research using social networking technologies (Young, 2012). A total of 122 participants were recruited from 1) online websites (n=104), 2) gay establishments in Los Angeles (n=6), and 3) participant referrals (n=12) between September 2010 and January 2011. Online recruiting was done through targeted banner ads on SNSs and posts on Craigslist. Eligibility criteria were the following: 1) male, 2) 18+, 3) Los Angeles resident, 4) registered Facebook user (participants had the opportunity to create an account), and 5) had sex with a man in the past 12 months. The study focused on recruiting African American and Latino (English-speaking) MSM. A "Facebook Connect" technology (a Facebook owned protocol) was used to verify unique Facebook users by having each user sign in using their username/password (this minimized duplicate respondents). Only participants successfully verified by Facebook Connect participated in the study. After verifying participant identity and reducing duplicate responses, we were left with 112 valid participant responses. --- MEASURES 2.1.1. BASIC DEMOGRAPHICS-Demographic questions included age, sexual orientation, race, highest education level, employment status, marital/partnership status, and primary access to the Internet (cellphones vs. computers). --- HIV/AIDS STIGMA-A 15-item questionnaire, adapted from previous questionnaires, was designed to broadly measure a person's opinion on HIV/AIDS stigma (Kalichman et al., 2005;Young, Nussbaum, & Monin, 2007). The responses ranged from strongly disagree to strongly agree with the provided statement in each item (strongly disagree = 1, strongly agree = 5). Agreeing or strongly agreeing indicated that an individual had high levels of stigma. Four items were reverse coded for the present analysis (see Table 2). --- ONLINE SOCIAL NETWORK USE-Participants were asked to indicate which social, sexual, and/or general SNSs they used such as Facebook and Myspace. The participants also indicated the number of hours they spent each day using online SNSs in the past 3 months. The SNS time-use question utilized time increments instead of fill-in the blank answers in order to facilitate faster response times. --- STATISTICAL ANALYSIS All analyses were conducted in R-3.0.2 on Mac OSX to run a multivariate ordinal logistic model that estimated the relationship between HIV/AIDS stigma and SNS use. A composite HIV/AIDS stigma score was created by summing each HIV/AIDS stigma item (alpha = 0.77). A higher score indicated that a person had a higher level of HIV/AIDS stigma. The dependent variable used in the model was categorical and indicated the amount of time participants spent on SNSs/week (ranged from 1-6, reported in table 1). --- RESULTS --- BASIC DEMOGRAPHICS AND ONLINE SOCIAL NETWORK USE (SEE TABLE 1) Of 112 participants, the mean age was 32, and most participants identified as homosexuals (75.9%). Over 87% of participants were either African American (27.7%) or Latino (59.8%), the remaining 14 participants (13%) were grouped into an "other" category. Additionally, 75% of the participants spent 1+hours/day on SNSs in the past three months. --- HIV/AIDS STIGMA (SEE TABLE 2) The mean HIV/AIDS stigma composite score was 22.2, with a range of 15-45 (the possible range scores:15-75) and an alpha of 0.77. 4 (3.6%) out of the 112 participants were HIV positive (15, 13.4% said they did not know their status) and had an average stigma score of 16 (compared to 22 for HIV negative individuals). However, a t-test for difference was insignificant, and one of the HIV+ subjects refused to answer more than half of the stigma questions. Ignoring this one individual, the average stigma score would be 20 for HIV+ individuals. --- ADJUSTED ODDS RATIOS (SEE TABLE 3) The HIV/AIDS stigma composite score was positively associated with increased time spent on SNSs (AOR: 1.07, 95% CI: 1.00, 1.15). When a subject's HIV stigma score increased by 1 point, the odds of increasing from the "no time spent on the internet" category to any of the other categories are multiplied by 1.07. This increase of the odds by 1.07 remains true for any other increase in the dependent variable, such as moving from 1-2 hours on SNSs/ week to any other higher category. --- DISCUSSION To the best of our knowledge, this is the first study to assess HIV/AIDS stigma among a sample of African American and Latino MSM SNS users. With a mean score of 22.2 this low level of HIV/AIDS stigma is consistent with the decreasing trends in HIV/AIDS stigma (Herek et al., 2002). However, the low score was surprising from a sample of minority MSM, who have traditionally displayed high stigma levels (Brooks et al., 2005;Fullilove & Fullilove, 1999;Marín, 2003), however differences between minority MSM and minority communities in regards to HIV stigma has been previously established (Smit et al., 2012). Future research should explore the differences in stigma levels between the SNS-using minority MSM and the minority population at large. There are a few limitations to the study, primary among them that the study is crosssectional with a small sample size. Second, while there is no consensus on how to define HIV/AIDS stigma and some studies suggest that HIV/AIDS stigma exists in multiple layers (e.g., community, policy, and institutional) (Mahajan et al., 2008;Pulerwitz et al., 2010), this study only addressed individual level HIV/AIDS stigma. Finally, this study used time intervals (instead of open-ended questions) to gauge participants' internet use, possibly skewing the answers. The finding that higher levels of stigma are associated with greater time spent online is interesting, one that deserves additional study. In previous studies (Young et al., 2013) we found that a large number of people in this sample were using social media to find sex partners in order to avoid in-person stigma. It is therefore possible that those who spend the most time online are also the ones perceiving the greatest HIV-related stigma. However, our findings do not allow us to draw causation. This becomes a call for future research on this topic. --- Author Manuscript Garett et al. Page 11	The recent increase in social media use allows these technologies to rapidly reach communities with higher HIV prevalence, such as African American and Latino men who have sex with men (MSM). However, no studies have looked at HIV/AIDS stigma among social media users from African American and Latino MSM communities, or the association between stigma and social media use among these groups. This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African American and Latino MSM from Los Angeles. A total of 112 (primarily African American and Latino, n = 98, 88%) MSM Facebook users completed a survey on demographics, online social network use, and HIV/AIDS stigma. A composite stigma score was created by taking the cumulative score from a 15-item stigma questionnaire. Cumulative logistic models were used to assess the association between HIV/AIDS stigma and online social network use. In general, participants reported a low level of HIV/AIDS stigma (mean = 22.2/75, SD=5.74). HIV/AIDS stigma composite score was significantly associated with increased time spent on online social networks each day (aOR: 1.07, 95% CI: 1.00, 1.15). Among this diverse sample of MSM online social network users, findings suggest that HIV/AIDS stigma is associated with usage of social media. We discuss the implications of this work for future HIV prevention.HIV/AIDS prevention; social media; Men who have sex with men (MSM); African American/ Black and Latino men who have sex with men (BMSM/Latino MSM
Introduction This article reports the first-year outcomes of a planned three-year study of short international practice placements by students from Bournemouth University (BU), UK. Students were placed in	This article discusses preliminary findings from a study of international placement learning of British social work students in social welfare settings in Malaysia. Research data generated focuses on the learning processes experienced by the students placed in an unfamiliar, postcolonial context with an emphasis on issues relating to diversity and developing critical cultural competence. Future sustainability and benefits of such placements are also reviewed.
The theme behind Milan's Expo 2015 goes far beyond the subject of food, leading us to examine fundamental aspects of the social organisation of modern life. The first problem concerns food security which, according to the FAO, "exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life" (World Food Summit, 1996). After the Second World War, governments and international organisations began to seek an answer to the problems linked to an insufficient availability of food, especially in developing countries, promoting policies to increase the number of lands devoted to agriculture. These initiatives met with only partial medium and long term success, and in the end it has to be recognised that an approach focused only on production is not enough to shape an effective response to the problem (Lang, Barling 2012). The current preference is for food systems, a concept that encompasses many other elements, all important factors in ensuring safe access to food. One crucial aspect is the organisational structure of food distribution: the production of foodstuffs in a particular area does not always mean that the local population will have access to them. The simplest example of direct access to food from selfproduction, where people cultivate the products they consume, seems to be geographically limited and restricted to a handful of products. Even in less developed areas forms of exchange and trade of varying degrees of complexity regulate the effective availability of food products (Gregory, Ingram, Brklacich 2005). In the advanced industrial societies the food distribution chains have become long and extremely sophisticated. A study by Grienvik in 2003 showed that distributors are crucial to the functioning of food product chains. A food product chain pyramid serving 160 million consumers will be constructed on a foundation of around three million direct producers. The distribution chain that transfers these products to the final consumer is, however, controlled by around 90,000 producers/processors and one hundred large buyers for the supermarket chains (Gregory, Ingram, Brklacich 2005;Grievink 2003). In other words, today's food systems have the shape of an irregular hourglass: a large base of producers, a narrow centre section controlled by a limited number of operators and an exaggeratedly large upper section formed by millions of consumers. In this situation large distributors and producers have a decisive influence on the market. Another problem concerns effective access to food resources. The actual availability of foodstuffs obtained directly from producers or more frequently through distributors, does not necessarily lead to its consumption. This is influenced by cultural, social, economic and religious factors, which can take many forms. For example there are taboos that limit or forbid the consumption of various types of meat. Judaism and Islam forbid the consumption of pork and other "impure" animals, Hindus not only don't eat meat from cows, but also during many periods of the year they have to observe a partial or total fast. Not forgetting taboos related to eating pets; animals like cats and dogs that are considered part of the family usually are not eaten. There are, though, some exceptions. Horse meat, for example, is eaten in many areas of the world, including the Mediterranean, but this practice is often considered with horror by the people of Northern Europe, where owning a horse, hunting on horseback and show-jumping are extremely widespread. Taboos surrounding the killing and the bloodshed of animals may be the most common, while there are others like for instance eating insects, that is regarded with disgust in many parts of the world. In Western culture, insects are seen as a source of impurities, dirt and illness. However, in other parts of the world insects like butterflies, crickets and locusts are eaten without hesitation. The FAO has calculated that there are around 1,900 edible species consumed around the world, and this figure is steadily rising (FAO/WUR 2013). In short, cultural factors impose rigid distinctions between what can and what cannot be eaten, establishing a strict hierarchy of foods that are good to eat (Harris 1998). The social structure can create further problems. We know that the sharing of food within a culture usually reflects the social hierarchy, with the élites usually have access to more and better food than those further down the ladder. In late-nineteenth century a survey on Italian families' food consumption in various regions of the country painted a picture of hypocaloric diet mostly composed by polenta, cornbread, dried vegetables, potatoes and a few green vegetables (especially in the central-southern areas), with a little adding of wheat and almost no meat and animal protein. At the same time, richer families ate large meals based on bread made from wheat flour, meat, especially beef, dairy products, fruit and fresh vegetables. Only in the 60s these social divisions began to disappear in Italy (Scarpellini 2012). A complex, unequal reflection of the social hierarchy also exists within families. Extensive research and oral history tell us that in farming families, the head of the family took precedence in the distribution of food. Children and especially women were given less tasty and nourishing food, and in smaller quantities. In 1942 one of the few official surveys on the female diet in Italy analysed the diet of five teams of rice weeders at work. The meal provided these 350 women with around 3,000 calories per day, while the figure for men who worked alongside them was over 4,000 calories (Somogyi 1959) The conclusion that could be drawn is that food security is now a problem that primarily affects less developed countries with dramatic implications. The FAO has estimated that in 2012 there were 870 million malnourished people in the world, the equivalent of 12.5% of the global population (FAO 2012). However, it would not be correct to say that this phenomenon is totally absent in the most developed countries. Poor nourishment does exist there, when compared with local living standards. The economic crisis that hit many western countries in 2008, with a corresponding widening of the income gap, has in fact created new areas of poverty across vast swathes of the world. The most important problems concerning diet in the developed world concern food safety. During the 80s a series of serious food crisis have started: the epidemic of bovine spongiform encephalopathy ("mad cow disease"), the dioxin-contaminated chickens, bird and swine flu, the frequent outbreaks of E. coli and the contamination of foodstuffs by toxins of agricultural or industrial origin. Safe and constant access to food has not eliminated fears about the safety of the products available. Inevitably, the extended production chains, the growing presence of foods produced by large companies using a variety of processes, transporting foodstuffs over long distances and the growing participation of the pharmaceutical industry in food production processes, have eroded the confidence and knowledge that once existed among the general public when their food was a familiar, local product. The result is a fear of food, even where no dangers exist. This has an effect on food choices among a wide section of the population, leading to a morbid preoccupation with avoiding foods perceived to be unhealthy. A number of studies have recorded high levels of this type of anxiety among Europeans, especially concerning the presence of toxic contaminants in food, pathogens in meat and contamination by containers in plastic or other materials. Not to mention questions hanging over GM products and the new nanotechnology (Scarpellini 2012, 271). All these concerns are worsened by worries about the environmental effect of the human food chain through exploiting non-sustainable resources and creating environmental pollution. Given the modern food system structure, humankind's ecological footprint has long since outstripped the planet's ability to replace what we take out of it. In this context, feeding the planet is a global challenge, or rather, glocal, as it must include, on the one hand, an integrated, sustainable approach that can reconcile transnational economic dynamics with local sociocultural factors, and, on the other, the respect for the needs of small producers and large distributors. This is the right approach both to address problems affecting less developed countries, and to tackle new concerns in more developed areas. Basically, providing a response to all this means highlighting the most profound values and choices that underlie our social organization.	The issue of food is indeed a systemic problem involving fundamental aspects of the social, cultural and economic organisation of our planet. This paper focuses on the main aspects related to the concepts of food security and food safety. While the first problem mainly affects less developed countries, the second concerns diet in the developed world. They are influenced by important factors such as the structure of food distribution, the effective access to food resources, the lack of confidence about the safety of the products, and the different consumption behaviours affected by social, economic and religious factors.
/ 358 STANRZECZY 2(23)/2022 under Soviet control, the fall of the People's Republic and the constitution of a new social order in neoliberal circumstances. The contemporary stage has been marked by Poland's joining the global system and integrating with EU structures. Polish history has been reinterpreted as part of global history. The author has replaced the descriptive mode usually used in recounting Polish history with an explanatory tone. Both the historical aspect of the book and its theoretical dimension are very dense and rich, with inspiring threads. In my short commentary, I will limit myself to two remarks directly related to the social sciences. Tomasz Zarycki views science as a social practice governed by power relations. For him, the case of Poland is a fascinating laboratory for studying the relations between the literary and language sciences and the field of power. He treats those disciplines as examples of practices of meaning production, and thus he recognises that their social functioning goes far beyond the purely cognitive dimension. Language sciences, as well as history, are linked to the formation of collective imaginations. As a result, they have limited autonomy from the field of power. Translating Poland's specific East European historical experience into the concepts and models produced in the West is a hard task. Zarycki starts with theorising about the mechanisms of meaning production in the global peripheries, using the works of Pierre Bourdieu, Bob Jessop, Immanuel Wallerstein, Stein Rokkan, and George Steinmetz. He pays attention to the role of the state in these processes and elaborates on the notions of the field of power and homology to fit the semi-peripheral situation of Poland. One of the important points of the book is the observation that "the dominance of the core over the peripheries and semi-peripheries is homologically reflected in the global field of social sciences, in which non-core theorising is usually marginalised with no chance of becoming universal" (Zarycki 2022: 81). The opportunity for Polish scholars to join global discussions and get a certain level of international recognition will increase only if they are able to provide substantial contributions of a kind that, being based on a universal theory, can be widely recognised. But, unfortunately, there have very rarely been favourable conditions for such contributions. In a detailed analysis of the history of Polish literary and language sciences the author traces the strong homology with the field of power. In the past there have only been a few moments of relative weakening of the homology, and these usually resulted in international recognition for Polish scholars. Most of the time, however, the Polish language sciences have been characterised by normative use of theories: for instance, with the creation of the theory of newspeak in the 1970s, due to the public involvement of scholars in the growing conflict between the emerging opposition and the communist authorities. To inscribe the Polish case in a theoretical frame, Zarycki reaches for Eyal, Szelenyi, and Townsend's (2001) model of inverted hierarchies of three types of capital in post-communist countries. The novelty of this interpretation of the Bourdieu theory is its contextualisation, which is based on the assumption that in certain conditions a political or cultural elite may assume dominance over the economic one. This means that what is considered a compensatory type of capital can be different depending on the context (Zarycki 2022: 62). The Polish intelligentsia is a bearer of cultural capital, which has proven to be the dominant elite resource in the Polish historical context. Zarycki shows the dominant position of the cultural elite in the field of power. This structural fact greatly shapes the trajectories of Polish intellectuals, especially in disciplines such as language and literature. In coping with meaning production these scholars are supposed to play an important role in domestic intellectual debates and political disputes. They are involved in the process of creating collective imaginaries, which are directed at strengthening national identity. The humanities and literary sciences can also be seen as "tools for defending the autonomy of the national fields of power in a global context" (Zarycki 2022: 473). This situation results in social scientists having a particular dichotomy of orientation. There are two separate arenas in which they can receive recognition. One is international academia, but the other, which is equally or even more important, is the national field of power. In consequence, internationally recognised academic discoveries are not a priority for peripheral scholars. This multi-positioning is typical for intellectual elites in Poland. In their academic trajectories they have to combine the duties of a scholar with those of a public figure with moral obligations in regard to the national community. According to the author, this prevents them from taking fully autonomous and critical standpoints and can lead to poor and non-innovative scholarship. This reconstruction of the main themes of the book inclines me to two observations: one in regard to the general level and one in regard to Poland. The first concerns the metareflection about scholarly production. Specific entanglements of the social sciences with the field of power probably occur everywhere, including at the very core of global academia. This is significant, because globally dominant discourses are being reproduced there. They set the universal standards for what is understood as true scholarly achievement. Thanks to Zarycki's book, the question of the limited au-/ 360 STANRZECZY 2(23)/2022 tonomy of disciplines so closely connected with the production of meaning and social imaginations can be addressed. While admitting the existence of profound differences between peripheries and centres, it is still interesting to investigate the dynamics of the homology between these academic fields and the global field of power. My second observation concerns the Polish social sciences. I read Zarycki's book as an analysis of the structural constraints built into the historical development of the discipline. He concludes that social scientists in Poland always have to respond to dual challenges and thus fulfil the non-cognitive functions of their role as important players in the field of power. This is a local, negative factor that reduces our chances of academic recognition in an increasingly globalising science. This can lead to pessimistic conclusions about the internal limitations of the Polish social sciences in their pursuit of international recognition. Nevertheless, Zarycki himself shows that there is a possibility of overcoming this structural fate by creating a theory on the periphery that describes our uniqueness in a universally attractive way. Today the growing impact of global academia on the Polish social sciences is changing the individual trajectories of Polish scholars. We are increasingly striving for international recognition. We are looking for ways to contribute to global discussions in the social sciences. Zarycki's book proves that the best way to achieve this goal is to contextualise and rewrite local history into universal theories. Therefore, for Polish readers, it is an excellent incentive to practise historical sociology. This perspective makes it possible to integrate the Polish experience into global processes and to make interesting conceptualisations of the peripheral societies of the Global East. This important book for Polish sociology was written in English. I am afraid that to some extent this may reduce its influence in the Polish scholarly field. However, if Polish scholars are actually trying to be included in the global circulation of knowledge, Zarycki's book may help to create a theoretical platform that will make this task easier.	In his new book, Tomasz Zarycki (2022) brings the global context of knowledge production to bear on the history of Poland's social sciences. The Polish Elite and Language Sciences is written from the perspective of historical sociology, which means that the past is used to help understand the contemporary state of the social sciences in Poland. Local historical determinants are placed in the broader model of relations between the centre and periphery. Thus, the book provides many new and interesting insights into the production of knowledge in the East European semi-periphery, and it also sheds light on the social sciences in the global core. It should be emphasised that the author's goal was to take part in global theoretical discussions and to make his own contribution to the sociology of science. In my opinion, this goal has been achieved. But there is another valuable effect of his analysis. Namely, it provides an inspiring conceptualisation of the main historical processes that have occurred in Polish society. Special place has been given to the role of elites. Zarycki's analysis starts from the end of the nineteenth century and covers all the main turning points of modern Polish history: the creation of an independent state in 1918 after a long period of subordination to three European empires, the post-war project of a socialist state
Background Knife crime has become a common phrase used by the media, but it is not always clear what it refers to or what they mean when they use the term. Knife crime can cover many offences, making defining and estimating its prevalence challenging. Undoubtedly, producing a knife in the commission of a crime, such as a robbery or sexual assault, is a 'knife crime,' regardless of intent. It disproportionately impacts young individuals and people from disadvantaged backgrounds [1]. Additionally, the media referred to crimes committed with knives as an "epidemic" that significantly influenced younger generations [2]. This 'epidemic' resulted in the death of the victim, injuries to body parts or internal organs, fractures, scarring, and mental trauma [3]. Attacks with knives and fatal stabbings occur worldwide, even in the nations with the lowest overall crime rates and the highest violent crime rates [4]. According to the 2019 Global Study on Homicide published by the United Nations Office on Drugs and Crime, knives were the murder weapon of choice in 97,183 of the world's total killings in 2017. This rate accounts for 22% of the total homicides [5]. Many "lone wolf" assailants turn to the kitchen knife as their preferred weapon for their crime. In addition, they use various sharp tools, such as scissors and axes [5]. The frequency of knife-related violence varies significantly from one region to the next. Knife crime is linked to individual risk factors like gender [6]; age [7]; ethnicity, financial deprivation, and socio-economic background [8][9]; exposure to violence and prior victimisation [8]; mental illness and drug addiction [4]; low educational attainment and exclusion from mainstream education [10]. Family background and adverse childhood experiences [11]; lack of accessible alternative activities; gang involvement and territoriality [12]; deprivation, and violence [11] are also risk factors at the interpersonal and community level. Knife crime offences in England and Wales have increased by 80% in the last five years [13], reaching levels not seen since 1946 [14]. Offences involving knives or sharp instruments rose by six per cent from 47,388 to 50,019 in England and Wales before the first Covid-19 lockdown was imposed [15]. Of these offences, 44% were for assault with injury or assault with intent to cause serious harm, and 44% were used in robbery [15]. Most of the victims and the perpetrators of these crimes were Black or Asian, especially young people aged 10 to 25 [16][17][18]. This gap could be related to the more significant proportion of BAME people living in London [16], which accounts for nearly a third of knife offences [17][18]. When unemployment rises, and work opportunities are limited, it may be difficult for some younger folks to see a promising future. They were forced to resort to risky means of obtaining money since no other option was available, and they carried knives to defend themselves. A comprehensive understanding of the causes and risk factors of knife crimes could prevent the increasing knife crime burden, especially among youth. Knife crime in the UK is considered a growing public health concern and in-depth knowledge of UK knife crime statistics are necessary. Until now, no such report has been published on knife crime in the UK. This review aimed to evaluate potential knife crimes in the UK from 2011 to 2021 and analyse the causes and risk factors associated with the crimes. --- Methods --- Data collection Six UK online news portals were purposefully chosen to be included in the study, and knife crime news was searched retrospectively by seven authors. Because English is the country's official language, only English online news portals were chosen. The portals were selected after the authors conducted a background search before beginning the study. The authors concentrated on the circularity of the portals and made conclusions based on their findings. The authors chose the most popular portals on this purpose. The term "knife crime" was used to search. The news portals were the: Metro, the Sun, the Guardian, Daily Mail, Daily Mirror and the Evening Standard. Retrospectively, news portals were initially searched with the search term. The contents of online journals were chosen because they were readily available and made a retrospective analysis of knife crimes easier. Age, place of knife crime, crime date, and other identifying variables were used to find repetitions. Duplications were defined as reports of the same knife crime in different portals and a total of 167 duplicate reports were excluded. The final data is entered into the software after removing the repetitions. A total of 692 knife crime reports were assessed and analysed by Statistical Package for Social Science (SPSS) version 26 and Microsoft excel version 2018 software. --- Inclusion of news News of that was indicated as knife crime, and knife crime news bounded by the geographical area of the UK (especially England) were considered inclusion criteria. Variables Age of the victim and the perpetrator, gender of the victim and the perpetrator, race of the victim and the perpetrator (if known), number of victims and perpetrators involved, date published, leading cause of crime (if known) and the location are considered as variables of the study. --- Permission No formal ethical clearance was considered because the data only included previously published information available online. --- Results In the assigned news portals, 692 reports were found between January 2011 and December 2021. The metro reported 34% of knife crime cases among the six online news portals screened, followed by the guardian (26.2%), evening standard (15.6%), daily mirror (15.5%), and the sun (8.8%). Six hundred and eighty-two cases were reported, with 61.8 percent coming from the south and 14.9% from the north. In total, 911 people were victims in these 692 reports. Around 81.8 percent of reports mention only one victim, while 18.2% mention multiple numbers of victims (ranging from 2-to 8 people) (Table 1). Out of the 911 victims, 71.7% reported cases were less than 40 years of age, 72.8% were male, and 22.2% were female. The majority of the cases did not mention the race of the victims. Out of those reported, White/European/British were 5.8%, black/African were 5.8%, and 2.2% were Asians. The top three reasons for knife crime are 23.1% for street violence, 15% for fights/gang attacks, and 7.7% for family issues as reported in Table 2. The total number of perpetrators involved in these 692 reports was 879 individuals. Multiples perpetrators are involved in 13.6% of cases (ranging from 2-to 8 people), while 56.5% of subjects report the involvement of a single perpetrator (56.5%). Out of all perpetrators, 66.2% were male, and 6.4% were females. Most perpetrators were under 40 years of age (92.5%). Most of the perpetrator's race is not mentioned. Of those reported, about 5.2% were Black/African, 4.6% were White/European/British, and remaining 1.5% were Asians as shown in Table 3. Males are reported as perpetrators than females. There was a downfall in reported knife crimes between 2011 and 2016. Since 2017, there has been an inclination in the number of reported cases (Figure 1). Overall, it has been found that young adult males are both victims and perpratrators of knife crime. Good social skills, self-esteem, academic achievement, strong bonds with parents, positive peer groups, positive school attachment, community involvement, and access to social support are all factors that can help prevent young people from becoming violent. Reduced risk factors and increased protective factors have been shown to reduce youth violence. Social policy and long-term systematic approaches to addressing the root causes of violence can make the region safer. Another factor contributing to young people's attitudes toward criminal knife behavior is a lack of understanding of the legal and medical consequences of knife stabbing. Safety measures like workshops and group discussions among young people at an earlier age in schools about the danger of knives are helpful in tackling the problem to some extent. Knife crime is a public health concern that can be prevented, and steps should be taken to safeguard people's quality of life. A wide range of studies would be required to properly assess the problem and take the necessary steps to prevent it. Knife crime is an underrated social issue in the UK.The study's findings may provide a still picture of knife crime variables in news reporting aspects because only six online news portals were examined from January 2011 to December 2021. But to the best of the authors' knowledge, it is the first online news analysis on knife crime in the UK. There are certain limitations as the authors scrutinised the published online news portals, so the data source is not strictly scientific. Furthermore, the study has used only six national newspaper and some important variables were missing. More broad studies would contribute to closing the large information gap in knife crime research in the United Kingdom. --- Conclusion Knife crime has yet to gain attention in the United Kingdom. Knife crime risk is higher in early adulthood and among males. Street violence, fights/gang attacks, family issues, and robbery are the leading causes of knife crime and have all been identified as risk factors that must be addressed with caution. From January 2011 to December 2021, the knife crime rate appears to be rising from 2017, with the highest rate in 2018. --- Acknowledgement --- None --- Authors' affiliations: 1 Department of Nursing and Public Health, University of Sunderland in London, UK 2 NHS, London, UK 3 Geriatrics and long-term care Department, Rumailah Hospital, Doha, Qatar. 4 School of Allied Health, Anglia Ruskin University, Essex, UK 5 Copenhagen Business School, Denmark Authors' contribution All authors have made substantial contributions to all of the following: (1) the conception and design of the study (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted Competing interests There is no conflict of interest for any author of this manuscript. --- Source of Support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.	Knife crime has become a common phrase used by the media, but it is not always clear what it refers to or what they mean when they use the term. Knife crime can cover many offences, making it challenging to define and estimate its prevalence. This review aimed to evaluate potential knife crimes in the UK from 2011 to 2021 and analyse the causes and risk factors associated with the crimes. Six UK online news portals were purposefully chosen to be included in the study, and knife crime news was searched retrospectively. The term "knife crime" was used to search. The news portals were the: Metro, the Sun, the Guardian, Daily Mail, Daily Mirror and the Evening Standard. In the assigned news portals, 692 reports were found between January 2011 and December 2021. The study revealed that the 11-20 years of age group individuals are more vulnerable as victims, and males are more reported as victims when compared to females. About 61.8% of knife crimes are reported from South England. Knife crime risk is higher in early adulthood and among males. Street violence, fights/gang attacks, family issues and robbery are the leading causes of knife crime and have all been identified as risk factors that must be addressed with caution.
less stressful than those held by younger workers. Intriguingly, not only do these workers have quite distinctive motivations to work, they have unique ways of subduing the potential burdens of working. However, most research lumps together workers over pensionable age (in phase II) with workers still in their fifties (in phase I) who are fully exposed to labor market risks. This paper presents theoretical arguments and empirical evidence to support the idea that post-pensionableage work is a discrete career phase economically, subjectively, and in terms of leverage with employers. It explores likely geographical and socio-economic limits to this two-phase model of the life course. Abstract citation ID: igad104.1150 --- EFFECTS OF COVID-19 PANDEMIC ON OLDER WORKERS' LABOR MARKET AND RETIREMENT DECISIONS Siavash Radpour, Stockton University, Galloway, New Jersey, United States Several studies have documented the increase in retirement since the onset of the Covid-19 pandemic. I contribute to this literature by answering two key questions that show the pandemic excess retirement is caused primarily by demand-side factors: first, using the monthly Current Population Survey (CPS) data on employment and retirement of older workers and CPS's panel structure, I explore if older workers left their jobs and the labor force voluntarily as a part of "the great resignation". I find that very few workers quit their jobs voluntarily, and most retirements were preceded by involuntary job loss and unemployment. Second, using the Health and Retirement Study (HRS) with its rich data on wealth, employment, and the special Covid-19 related questions included in 2020 HRS (Wave 15), I examine if older workers who experienced job loss during the pandemic retired because they were financially prepared for retirement. I find that among the small group of older workers who quit their jobs because of the pandemic, the majority did not have adequate retirement assets and their decision is more likely to be based on their health status and vulnerability during the pandemic. Abstract citation ID: igad104.1151 --- THE EFFECT OF INCOME SECURITY IN OLD AGE ON HEALTH OUTCOMES: A COMPARISON BETWEEN CHINA AND THE US Heng Wu, Dalhousie University, Halifax, Nova Scotia, Can ada This paper examines the social determinants of health, particularly the social, political, and economic context of socioeconomic status and health outcomes. Many studies on the political economy of health have highlighted the effects of welfare states on health and health inequalities, typically using welfare state regimes as proxies for social policies. Few research studies have described the association between frailty phenotype and financial wellbeing, however, particularly considering the three-legged stool of retirement income security (public pensions, private pensions, and personal savings/assets) across different welfare state regimes. This study investigates the effects of old-age income disparities on frailty among older adults in the United States and China. Specifically, this paper examines the associations between different sources of old-age income (public and private pensions, personal savings and assets, earnings, workplace subsidies, worker's compensation, household subsidies, and unemployment insurance benefits) and the five-item frailty phenotype from the RAND Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS). The findings reveal that health outcomes measured by the Fried's frailty phenotype vary considerably by country and income type. --- SESSION 3375 (SYMPOSIUM) Abstract citation ID: igad104.1152 --- RISE: A COMMUNITY-BASED ELDER ABUSE AND SELF-NEGLECT RESPONSE INTERVENTION ADDRESSING A CRITICAL SYSTEMS GAP Chair: David Burnes Discussant: Karl Pillemer Knowledge of effective interventions for elder abuse and self-neglect (EASN) is limited. Adult Protective Services (APS) represents the primary agency responsible for receiving reports and investigating suspected cases of EASN in the US. However, APS lacks a distinct, conceptually informed intervention phase to support EASN cases. Based on theory, research, and consultations with stakeholders, RISE was designed to address this intervention gap within overall EASN response systems. Informed by ecological-systems, relational, and client-centered perspectives, RISE is a community-based EASN intervention that integrates core modalities (motivational interviewing, restorative justice, teaming, supported decision making) demonstrating evidence and/or promising results in EASN and other domains. The intervention operates at Relational, Individual, Social, and Environmental levels of ecological influence. Specifically, RISE works with both older adult victims and others, including alleged harmers, their relationships, and strengthens the social supports surrounding them. RISE began as a pilot in two Maine counties, was expanded to the entire state, has been used in over 450 cases, was written into Maine's 2023 budget, is now being implemented and tested in New Hampshire and Toronto, Canada, and is being expanded to the criminal justice system. This symposium will describe RISE's development and conceptual underpinnings (presentation 1), findings on implementing "teaming" (social support), an intervention modality (presentation 2), a qualitative evaluation of RISE from the perspective of APS caseworkers (presentation 3), evidence of RISE reducing EASN recidivism (presentation 4), and case studies of implementing RISE (and its restorative justice modality) in the criminal justice diversion context (presentation 5). This is an Abuse, Neglect and Exploitation of Older Persons Interest Group Sponsored Symposium. Abstract citation ID: igad104.1153 Despite a growing number of elder abuse and self-neglect (EASN) cases nationwide, community-based EASN response programs such as Adult Protective Services (APS) lack a conceptually driven, defined, prolonged intervention phase to address these complex situations. This presentation provides a conceptual overview and developmental description of RISE, a community-based model of EASN intervention that works alongside APS or other systems that interact with older adults who are at risk of or experiencing EASN. RISE was developed in consultation with APS caseworkers and supervisors, as well as practitioner and research stakeholders and experts from numerous sectors in Maine and nationwide, building bridges among varying stakeholders. Informed by ecological-systems, relational, and client-centered perspectives and adapting evidence-based or promising modalities from other fields (including motivational interviewing, restorative justice, teaming, supported decision making, goal attainment scaling, and engagement), the RISE model intervenes at levels of the individual older adult victim and others, including the alleged harmer, their relationship, and the systems of informal and formal support surrounding the victim-harmer dyad. The RISE model addresses an intervention gap in response systems to better meet the wishes and needs of EASN victims and others in their lives, leading to more sustainable outcomes. RISE has fostered new research partnerships between researchers and community advocates, who have become both research allies and contributors. RISE supports people with cognitive impairment to make their own decisions. RISE also empowers both older people and younger people in their lives, motivating change, and strengthening and restoring the relationships among them. Our understanding of what intervention strategies are effective in improving the well-being of older adults experiencing elder abuse and self-neglect (EASN) is severely limited. However, data consistently demonstrate that social support is a protective factor. As a component of a larger community-based EASN intervention, RISE, this study examined the use of a method called "teaming," a wraparound approach to establish sustained formal and informal social supports surrounding victims and alleged harmers in EASN cases. Qualitative interviews and a focus group were --- RISE: A CONCEPTUAL MODEL OF INTEGRATED AND RESTORATIVE ELDER ABUSE AND SELF-NEGLECT INTERVENTION	To what extent are older workers willing to forgo wages to obtain a flexible work arrangement when transitioning from career employment later in life? Older workers generally, and pension-eligible workers in particular face a plethora of trade-offs when it comes to continued work later in life. In this paper, we examine the components of older workers' total compensation and explore how the mix of compensation changes as workers transition out of the labor force. Specifically, we focus on the relationship between monetary compensation (wages, fringe benefits) and workplace flexibility (phased retirement, hours flexibility), and explore the degree to which workers, by their choices, are willing to accept lower wages in return for increased flexibility on their job. To estimate this relationship, we use longitudinal, biennial data on thousands of older Americans representing four different cohorts available from the nationally-representative Health and Retirement Study (HRS). The HRS began in 1992 and, therefore, contains 30 years of follow-up data for the oldest cohort. For each respondent, we construct individual work histories and examine individuals' evolving wage and hours arrangements from career employment to complete labor force withdrawal. Using multivariate techniques, we find that, all else equal, individuals experience a modest 5.
Introduction The loss of few or all natural teeth has been accepted as a handicapping condition for the aging elderly people. Apart from the negative emotions of normal aging, the loss of teeth adds to the emotional imbalance of the elderly [1][2][3][4][5][6]. Many studies have been conducted in the past to understand and cater the problems of tooth loss. These studies have concluded such subjects having less confidence, restricting social activities, and interpersonal relationships [7,8]. Cultural differences and lifestyles have shown to affect the outcome of these studies. Countries of the east have shown to be more negatively influenced by tooth loss compared to their western counterparts [9,10]. The awareness and availability of dental treatment and education were also a matter of concern in this issue. Hence a need was felt by the department of prosthodontics to conduct a study to understand the emotional effects of tooth loss in the elderly population of Northern India. Apart from this, a hypothesis of greater emotional effect for complete tooth loss (completely edentulous) compared to partial tooth loss (partially edentulous) was tested. --- Method The study involved 400 subjects aged between 60 to 80 years. The study excluded people suffering from systemic and psychological disorders and also people not oriented properly with respect to time, place, and person. A questionnaire was designed from the results of previous studies and investigations on emotional effects of tooth loss [7,8]. A 24-open-ended questionnaire was designed in the colloquial Hindi language with space for any special comments for each question. The questions covered aspects of emotional disturbance, loss of confidence, social performance, productivity, and denture wear if any. The interview was conducted by only one trained dental officer in dental check camps in the locality of Uttar Pradesh (North India) to reduce interoperator variability. A self-assessment toothcounting protocol including tooth counting and denture wear designed by Jepson et al. was used in the study. Denture wearers were asked regarding their denture use and the positive or negative effects of it in their mouths. Data was collected and analyzed. Comparisons were made between three groups, namely, completely edentulous, partially edentulous and weather denture wearers, and nondenture wearers for the first two groups. Variables including loss of confidence, acceptance of tooth loss, and restriction in activities were also analyzed. An independent chi-square or exact chi-square test was used to compare various distributions. The level of significance was set at 0.5. --- Results A total of 400 elderly people aged between 60 to 80 years with complete or partial tooth loss were interviewed at 8 dental checkup camps in a locality in Northern India by a single dental officer. There was no statistically significant difference between the three dentition groups in the social, economic, and educational backgrounds of the participants (Table 1). 6% of the edentulous subjects had attended the dentist in the previous year compared with a third of the partially edentulous subjects (P < 0.001). 32% (128) of the subjects were edentulous and all of them wore complete denture. 35% (140) were partially edentulous (mean number of natural teeth was 11 with 7 SD and range from 1 to 28) and wore partial dentures, whereas 33% (132) were partially edentulous and were not wearing partial denture (mean number of natural teeth was 18 with 6 SD and range from 1 to 31) as shown in (Table 2). --- Various Emotional Feelings Affected (Table 3) (1) Acceptance of Tooth Loss. 23% of the subjects had difficulty accepting tooth loss, 64% had no difficulty accepting tooth loss, and 13% were uncertain. There was no statistically significant difference between the three groups (P = 0.445). 35% accepted tooth loss immediately, 53% accepted it within 6 months, 5% within 1 year, 3% required more than 1 year, and 4% have still not accepted the loss. No difference was found in the time taken by the three groups in accepting the loss (P = 0.520). (2) Feelings about Tooth Loss. 60% of the subjects were indifferent and unconcerned about the tooth loss and 30% felt relieved. The partially edentulous subjects were seen to be more concerned and frightened than the other twogroups (P = 0.004). There was no difference between the groups for other emotional factors (P = 0.130 to 0.980). (3) Discussing Tooth Loss. 32% of subjects talked about tooth loss with others, among which 60% talked to their dentists, 55% talked to their friends, 31% talked to their spouses, and 55% talked with their family and relatives. There was no response between the groups (P = 0.1 to 0.8). (4) Wear of Dentures. 59% of the patients wore removable dentures, among them 18% avoided looking at themselves with dentures. There was no significant difference among the groups (P = 0.06 to 0.7). Partially edentulous subjects (80%) considered dentures as part of themselves compared with only 63% of edentulous subjects. (P = 0.012). 20% of edentulous group and 16% of denture wearing partially edentulous patients considered their denture to be a foreign body. 90% accepted the advice of not wearing the denture in the night, whereas 2% were indifferent and 8% found it unacceptable. No differences were found in the groups for the same (P = 0.05). (5) Preparation for Tooth Loss. 25% of the subjects were not prepared for the effects of tooth loss, 70% felt prepared, and the rest had no answer. More than half the people who were unprepared for the tooth loss felt that a consultation with the dentist along with education, motivation, and awareness would have reduced their problems. (6) Confidence. 96% did not feel any difference in their confidence, while the rest were indifferent. No difference was found between the groups (P = 0.19). (7) Restriction in Activities. more than 50% of the subjects felt restricted with their food choices and enjoyment of food (P = 0.041), edentulous, and partially edentulous with dentures felt most restricted. Other feelings like eating in public, going out, laughing, and forming social relationships were of negligible importance. Going out was avoided by partially edentulous subjects who wore dentures (Table 4). (8) See Table 4. --- Discussion The present study has been conducted according to the previous work done on the subject [9,10]. Aging elderly people of Northern rural India formed the representative population for this study. Dental awareness and availability are generally low in this part. Elderly people turn up to the dentist only in pain or swelling. Hence a hypothesis was worked out stating that the emotional effects of tooth loss would be less compared to their counterpart privileged subjects. Majority of the subjects were indifferent or relieved by loss of teeth. The result shows that very few people were grieved by the loss of teeth as compared with other studies [9,10]. The choice of food and enjoyment of food was negatively affected especially in complete edentulous and partial edentulous wearing dentures. This was directly proportional to the number of natural teeth remaining. The traditional Indian food in social gathering mostly consists of rotis, paranthas, and vegetables which require great masticatory efficiency. Hence loss of teeth imposes a handicapping situation for the aging elderly not only from the nutritional point of view affecting their physical health but also from the point of their overall mental wellbeing. Loss of teeth also means loss of esthetics in facial profile and personality, which does affect the social performance and ability of the individual to form social relations. But the psychosocial effects of tooth loss are less pronounced compared with other studies [9,10]. This satisfaction after tooth loss also shows the less awareness, availability, and expectations of dental treatment to these elderly people. Quite a few subjects discussed tooth loss with family and friends showing the society's acceptance of tooth loss as normal aging procedure as compared to social stigma as compared to the western countries [9,10]. Acceptance of the dentures was variable according to the availability and satisfaction of dental treatment. --- Conclusion (1) Loss of teeth did not have a marked emotional effect in the lives of the selected elderly community and had no difference between complete and partial edentulous subjects. (2) Significant disability and restrictions were seen in daily social activities. (3) Restrictions were more severe in people who had lost significant number of natural teeth requiring denture wearing.	A study was conducted to study the emotional effects of complete and partial loss of teeth in an aging North Indian community. A questionnaire was prepared for 400 elderly people above the age of 60 years, who were interviewed in dental checkup camps. The data was collected and analyzed using chi-square or chi-square exact tests. 25% of the people were found to have difficulty accepting tooth loss, whereas more than 50% of the people reported to have restricted their food choices. Other problems like reduced attendance in social gatherings for lunch/dinner or eating out in public were also noted. 56% felt that dental consultation prior to tooth loss would have helped them in a significant way. It was concluded that tooth loss did not have a marked impact on emotions of the people but affected their daily social activities, however there was negligible difference between complete and partial tooth loss subjects.
Resourcing-from funding to support the editorial work of people with lived experience to sufficient time to develop an issue-is equally important. The whole Special Issue, including the Editorial, is open access and a relevant read for social work practitioners, academics, students as well as people with lived experience of social work and community members. BASW representatives on the Journal, Dr Ruth Allen and Dr Luke Geoghegan, ensured that this work has a budget, co-developed with the representatives of the Special Issue Editorial Collective. In parallel to the development of the Special Issue, the Editorial Team, with support by the Editorial Board and BASW, also recruited people with lived experience to the Editorial Board. Recruitment process was organised during the summer of 2022. Since January 2023, half of the Journal Editorial Board are people with lived experience of social work and social care. We shall now explore our next steps to embed the voice and influence of people with lived experience in the Journal. Our work to date aligns with similar developments in health, such as the Patients Included Charter for Journals (Patients Included, 2016). The charter, created for health-related publications, requires at least two patients being members of the Editorial Board, and patients serving as reviewers for papers submitted to the Journal. It also, however, requires patients to 'routinely publish editorials, reviews, or research articles in the Journal as authors' (Patients Included, 2016), as well as for the Journal to be open access. Whilst the Special Issue of the Journal is a step in the right direction, we commit to find ways to make work led or authored by people with lived experience part of our regular publishing practices going forward. This also needs to be reflected in the processes of knowledge production, which lays foundation for the work of the Journal. In the UK, past few years have seen the introduction of funding mechanisms for social work practitioner research, which include health research requirements for the so-called 'public and patient involvement (PPI)'. Early lessons from practitioners who utilised such funding stress the importance of active engagement and collaboration with people who experience social work at all stages of a proposed research project (James and Romeo, 2023) Previous to the standards, researchers were encouraged to review the nature of public involvement in health research using, for example, checklist tools to improve the reporting of the PPI, such as a GRIPP2 checklist (Staniszewska, 2017). The checklist includes requirements, for example, to report the aim of public involvement in the study, as well as clarity of methods used to ensure such involvement, and the extent to which public involvement influenced the study overall. In the British Journal of Social Work, this includes a reporting requirement for all the authors to explain how people with experience of health and social care were involved in the study. Beresford (2019), however, argues that, instead of checklists, the process of health and social care delivery needs to be democratised. This may require, for example, open and honest discussions about the above noted complexities and power differentials involved in research co-production or research run by people who have experience of health and social care. A relevant example is availability of funding and permanent, wellrenumerated, work for people with lived experience within social work education, research and practice-as well as for practitioners themselves. As explored in the Editorial for the BJSW Issue 52(5), a lot of research published in the Journal focuses on the 'lived experience' of social work practitioners, rather than people who use health and social care services. This is hardly surprising if we consider the pressures and resource cuts in health and social care services over the past sixteen years. Nonetheless, whilst we need to understand practitioner experiences, decision making, as well as reasons to join, stay or leave the profession, we primarily need to base our research and practice on the needs of communities requiring different forms of health and social care support and/or experiencing poverty and marginalisation. Experiences and the identity of researchers, practitioners and people who use services alike need to be considered intersectionally (Bernard, 2021)-not least in an international and generic Journal that publishes research of relevance to social work, in the broadest sense. These are just some of many issues the Editorial Team and the Editorial Board will continue to consider as we explore ways to embed the voice and influence of people with lived experience in the Journal. This Editorial is an invitation to share with the Journal Editorial Team your ideas and suggestions for greater involvement of people with lived experience.	Association of Social Workers (BASW). Initially, we consulted with people with lived experience who are active in a range of social work research, practice and education initiatives. We explored with them what meaningful promotion of the voice and influence of lived experience within a social work journal may look like. The message was clear that people want opportunities to be involved in all aspects of Journal work-from its management, peer review of submitted papers, to opportunities to publish their work within the Journal. Proposal for the Special Issue on the Voice and Influence of People with Lived Experience was prepared by the Editorial Board members Dr Mel Hughes and Dr Peter Unwin and approved by the Editorial Board in July 2021. The issue was published in March 2023. Editorial for the Special Issue (Beresford et al., 2023) outlines the process of its creation, as well as lessons for future practice. The Editorial collective, comprised of people with lived experience of social work, social work practitioners and academics, signpost a range of relevant lessons. These include, for example, the importance of passion and commitment to such work, as well as importance of flexibility and awareness of complexity and power relations that may emerge.
Background: As in many countries, Danish health care intensively focuses on improving crosssectoral collaboration between the sectors: general practitioners (GP), municipalities, and hospitals. Collaboration between the sectors is often siloed and fragmented, making it challenging to coordinate and plan the patient's transition across sectors. The issue is exacerbated by the increasing number of complex multimorbid patients who need specialized treatment across sectors. Health professionals (HP) must engage in circular thinking, focusing on the patient's needs and involvement. To strengthen cross-sectoral collaboration with the multimorbid patient, we have designed a model for cross-sectoral hybrid video conferencing (Cross-sectorial Hybrid Video Conferencing, CHVC) during the patient's admission at the hospital. The patient, relatives, and HP from the hospital were physically present in the patient's ward. HP from the municipality, GP, and relatives participated by video link on a video screen. We examined if and how CHVC can strengthen collaboration and coordination across sectors. --- Method: The CHVC was developed in a participatory design with HP from hospitals, municipalities, researchers, and patient and relatives' representatives. The meetings lasted a maximum of 30 minutes and started with questions for the patient and relatives: What is important to you? What do you expect from the admission? What worries you and your family? Subsequently, we asked HP about what they found worrying and their expectations of the patient's admission. Inclusion Criteria: aged 65+, complex multimorbid patients with a need for municipal help before and after admission, and health professionals with knowledge of and responsibility for the patient's care and course of treatment. The video meetings were audio recorded and transcribed into text. Researchers carried out content and thematic analysis. --- Result: We conducted 11 CHVC. The overall theme is a negotiation between patients, relatives HPs and GPs. They negotiated about how the patient could be at home despite a fragile and unstable situation. In addition, there was a negotiation regarding the discharge date. The discharge date was negotiated from the perspectives of the HP and GPs opportunities to support the patient's care and treatment needs at home. --- Discussion and Conclusion: The health professionals across specialties and sectors, together with patients and relatives, exchanged knowledge essential for the patient's safe and satisfactory discharge and subsequent care course. A noteworthy finding in our study is that, during CHVC with the patient's needs as a starting point, the health professionals included their worries about the patient's overall situation and their expectations for the patient's hospitalization. This resulted in dialogical communication in which they asked questions about each other's practice and collaborated on a joint plan for the patient. The hybrid, interdisciplinary, cross -sectoral dialogue between the four parties gave the patients safe transitions and care paths. It is our experience that CHVC is a medium by which negotiation about the patient's course can strengthen coordination and collaboration between sectors. However, this study was limited to 11 patient pathways; in future research, we will test CHVC for 200 complex multimorbid patients admitted to a regional hospital in Denmark.	Høgsgaard D et al, 2023 Cross-sectoral collaboration and negotiation about the patient's transition to home. Analytical results of video conversations between patients, relatives, and health professionals from hospitals, municipalities, and general practice. International Journal of Integrated Care 23(S1):136
(Cordova, 2014) . 부부상담의 경우도 마찬가지 로 한계를 지닌다. 부부상담은 평균적으로는 부부의 관계를 향상 시키지만 (Lebow & Snyder, 2022) 1/3 수준의 적지 않은 부부들 은 부부상담의 효과를 경험하지 못한다 (Roddy et al., 2020). 또 한 부부문제가 심각한 부부들은 상담 성공률이 낮은 경향이 있는 데 (Baucom et al., 2009;Snyder et al., 1993), 이 경우 갈등 초 기에 부부상담을 받아야 함에도 부부 대부분은 부부관계가 상당 히 악화되고 나서야 부부상담을 찾는다. 이러한 기존 서비스의 한 계는 부부에 대한 맞춤형 조기 개입 서비스의 필요성을 환기한다 (Cordova, 2014). (Cordova, 2014;Park, 2019). 나아가 일련의 성과연구를 통해 결혼검진이 참여 부부들의 결혼만족을 증가시 키며 (Cordova et al., 2005;Cordova et al., 2014), 이러한 효과 는 게이, 레즈비언, 빈곤층 부부 등 다양한 집단에서도 나타난다 는 것을 증명하였다 (Gordon et al., 2019;Minten & Dykeman, 2019, 2020, 2021). 국내에서는 Park (2019국내에서는 Park ( , 2022)) (Baucom et al., 2009;Jacobson et al., 1986;Snyder et al., 1993) (Morrill et al., 2011). (Cordova, 2014) (Blampied, 2017) to represent a coordinate point for pre-and post-treatment raw scores. (Galdas et al., 2005;Matud, 2004). 결혼검진 또한 신청자의 대부분은 여성이 차지한다 (Park, 2022) (Baucom et al., 2009;Snyder et al., 1993) 결혼검진은 보통 2회기로 구성이 되는데 첫 번째 회기는 측정 회기로, 부부들은 이 측정회기에 오기 전 인구 사회학적 정보와 몇 가지 척도로 구성된 사전검사에 응답한다 --- 측정 도구 --- Declaration of Conflicting Interests The author declares no conflict of interest with respect to the authorship or publication of this article.	This study aims to assess the effectiveness of the Marriage Checkup (MC) in community settings. Participants (N=57) were recruited from family centers and participated in the MC, which consisted of assessment and feedback visits. Participants completed marital satisfaction assessments before and after the MC. Overall, the participants reported significant improvements in terms of marital satisfaction with a large effect size (d=0.87). Specifically, 77.2% of participants demonstrated an increase in marriage satisfaction. Among them, 30.6% experienced a clinically significant change (from a clinical state to a non-clinical state). The reliable change index (RCI) identified 15.8% of participants as showing reliable improvement. Changes in marital satisfaction were larger for men and participants who experienced more positive changes during the MC in terms of intimacy and understanding of how to improve their marital relationships. This study supports the MC as an evidence-based approach for improving relationship health in community settings.
INTRODUCTION According to the decision of the Cabinet of Ministers of the Republic of Uzbekistan "On improving the activities of commissions dealing with minors" [2], specific measures aimed at strengthening the fight against juvenile delinquency, crime and other anti-social behavior have been defined, it requires learning within the framework of mutual connection in the system of social relations in society. It is known that every society has its own system of strictly defined social behavior programs and rules of behavior based on the power of public opinion, customs, moral principles, and traditions. Accepted norms are interpreted as historically formed rules of behavior, at the same time it has an evaluative function. According to it, any action is described as "right" or "wrong", "good" or "bad". In this understanding, the term "violation" is considered to be a natural connection of the norm, that is, the concept related to it. Usually, the term "disorder" is used to refer to any "disease" or "disease". Because disorder is not a specific term, but through this concept, signs related to behavior or its manifestations are understood.[12] A person's behavior is changeable and diverse, and the existence of his individual characteristics, unique "styles" is obvious to everyone. --- International However, the diversity of this behavior does not mean that it is unlimited, because it is necessary to maintain a warm psychological environment for people's interaction, interaction, their integration into different social groups, and their living. "Each person is the owner of certain social relations specific to his age and is the object of many economic, political, legal, and moral influences shown to him by society." The character, temperament, ability of a person manifests itself when he experiences mental processes, in his work, in his life. . So, the interrelationship and connection between mental processes, mental states and mental characteristics constitute the psychological structure of a person. The family is the most important and the first institution of social control in the upbringing of a child based on the requirements of social norms. "The more perfect the upbringing of our youth, the happier the nation will live." Every child is a human being, and the primary source of becoming a person is directly related to parents, family. The initial norms of human behavior and ethics are formed in the family and are improved in the process of the education system in the school, community, and community. It is known that every family has its own way of raising children. In these cases, the behavior of parents has a special place and it affects the socialization of the child. In this case, family discipline and communication are of particular importance. For example, when studying methods of upbringing in families with children with deviant and aggressive behavior, according to the mood of the parents, strictness, punishment, manifestation of "deficiency" of parental love were noted in many cases. When studying the family conditions of students with deviant and positive behavior, it was confirmed that deviants were brought up in an inappropriate family. According to the analysis of studies devoted to the problem of family and social factors related to the origin of behavior deviation, between two interrelated factors; -interpersonal processes that directly affect functional or behavior -it can be divided into systemic processes that have a direct impact, embodying the structure and size of the family. Rejection and indifference are more visible in the interactions of family members with children with deviant behavior. According to their research, constant conflicts between parents, wars, mutual hostility, as well as an unstable marriage show their complications in deviant behavior from a young age. Such parents pay little attention to the social upbringing of their children. At the same time, this attitude is also observed by children. If these cases are considered from a purely psychological point of view, any crime, any criminal activity is interpreted as a special type. In this case, the mental state, the motivational aspect of the person, individual psychological qualities, psychological features, and the subject's relationship to social values, which determine the social activity of a person and are expressed in the form of a specific violation, find their expression. It is also very relevant because the problem of deviant behavior of minors and their inability to adapt socially (disadaptation) is increasing. After all, every year there is an increase in the number of violations in the behavior of adolescents -their lagging behind in intellectual, emotional, willful development. In the current period, attention has been paid to studying the influence of the family on the formation of deviant behavior typical of adolescence. Researches devoted to this problem play an important role in modern psychological sciences. However, in our opinion, it is becoming more and more important to study the role of the family environment in the formation of "difficult" teenagers and the impact of conflicts in the family. "difficulty" in upbringing and the process of emergence of deviant behavior related to it: Karimova, M. Fayziyeva and others have comprehensively studied and analyzed the uniqueness of Uzbek families, disputes, their causes, divorces and their consequences. In the researches of F. Roziklov, the reasons why fatherless boys and girls who are not raised by their mothers cannot adequately express their respect for their spouses in marriage are studied. According to L. S. Vygotsky, "Deviant behavior" is the sum of the nature of difficult life relationships of a teenager. First of all, these are stubborn, capricious children. Engaging them in interesting activities is one of the main ways to educate them. They have a certain characteristic of being undisciplined and rude. It is possible to influence them by changing their activity accordingly, giving them some rights. Social psychologist G.M. Andreyeva defined socialization as follows. Socialization includes the process of children's assimilation of social norms and values, during which they are formed as individuals. Although the process of socialization is especially necessary for an individual in childhood, this process continues throughout his life. Not a single person can exist without the influence of other people on him, and this is expressed in his behavior in different life periods [5] Parents are the first example of a child's attitude to the world, society, social norms and rules of behavior. The Convention on the Rights of the Child declares that "for the full and harmonious development of a person, a child must grow up in a family environment, in an atmosphere of happiness, love and understanding" [3]. Due to the development of our society, the family and all its life stages are undergoing serious changes. Taking into account the historical, national and regional characteristics of the nation, it is necessary to improve the development of Uzbek families on the basis of general and private development of family education. Psychologists have identified the main patterns of children's behavior in family conflicts, and they subconsciously or consciously try to smooth out all the rough edges or reconcile the parents: -All the experiences he has gone through sooner or later cause his diseases, which is conditionally desirable, because they distract everyone from the continuation of the quarrel. Most often, such a child develops a serious disease -bronchial asthma, eczema or a runny nose. Nervous diseases, disturbed sleep and difficulty sleeping, enuresis, stuttering, nervous tension are observed. If a teenager is often sick or has health problems, it is necessary to analyze the family situation. Perhaps the root of all disease is in frequent conflicts; -If there are frequent quarrels and conflicts in the family and these actions happen in front of the children, in the future it will lead to permanent failures in his personal life and the formation of a wrong image of parenthood; -The child sometimes gets involved in conflict situations. In this case, the child takes a neutral position in family disputes, tries not to participate in them. He may be very worried about not being able to resolve these conflicts, and while he may not show any emotions on the outside, he may become increasingly distant from his family, become lonely, and not allow anyone to enter his inner world. It will be difficult for such a child to adapt in any community, and then in society. --- International -They are often depressed. There is constant insecurity and fear, low self-esteem. During adolescence, these children become emotional and often find solace in forbidden thingssmoking, drinking, drugs, going out, etc. -There is an opinion that the child is only affected by conflicts in the family that he witnesses. But psychologists draw parents' attention to the fact that teenagers are able to sense hidden conflicts between parents that are not visible from the outside. Parents blaming each other, their longterm alienation and coldness in relationships have a negative effect on the teenager. [12] How to avoid the negative impact of family conflicts on the child? This issue involves looking at the behavior of the parents, identifying the cause of the fights and getting rid of them. It is more often used by parents who want to work on themselves and their relationship, and also do not want their child to live in an uncomfortable family environment. By setting such a goal, parents can free the child from all the problems and worries described above, and at the same time strengthen the family and their relationships. If a conflict is unavoidable, parents should try to resolve the situation without the child's involvement. Under no circumstances should you attack each other with criticism and accusations. In this case, the conflict will only grow. Threatening each other is taboo for conflicts in general. Do not forget that children are gullible and will take everything you say as true, and their imaginations can magnify your threats to terrifying proportions, which will cause stress for the little one. To threaten each other with a child, or to threaten a child, is to destroy his fragile psyche. If parenting skills are high in the family, and the duties are fully fulfilled, then there will be no conflicts in the family and, of course, their negative consequences for the child will be avoided. --- REFERENCES	This article provides information about deviant behavior that occurs in minors, its manifestations, opinions and views of scientists, as well as studies conducted in connection with this, highlights the impact on character and psyche.
INTRODUCTION In earlier centuries, women were mainly limited to household roles or jobs in factories, farms or shops, with only a few having access to higher education Kumari and Devi (2015). They often relied on their fathers' or husbands' views on women and work. However, with the rapid growth of knowledge and the economy, more women now have the opportunity to pursue higher education and build strong careers Alqahtani (2020). Yet, this has brought new challenges, as women are expected to juggle multiple roles at home and in the office Verma et al. (2018). When working women marry, they take on additional responsibilities and as mothers, they must balance childcare and family demands while pursuing their careers Aslam et al. (2023). Today's working women works hard to meet family obligations while staying committed to their career, managing the demands of their Vol 110\| 10-12 various roles, which can be incredibly stressful Uddin et al. (2020). Work-life balance refers to how individual sees their ability to keep personal time, family responsibilities and work obligations harmoniously and with as little conflict between them as possible Clark (2000); Ungerson & Yeandle (2005). Living a well-balanced life means finding fulfilment in various aspects of life and requires distributing personal resources like time, energy and commitment evenly. For many married working women, the goal is to achieve a good quality of life by working diligently both at home and in their career, sometimes at the expense of their personal health and well-being Pahuja (2016). However, the desired quality of life is often dependent on achieving a proper work-life balance Vasumathi (2018). Any imbalance between work and family responsibilities can significantly undermine an individual's overall quality of life. This highlights the crucial importance of addressing the topic of work-life balance for working women, the need of the hour. This paper aims to investigate the challenges that working women encounters when trying to balance their personal and work lives. --- MATERIALS AND METHODS The study employed Ex post facto research design to assess the profile characteristics and work-life balance of married women in employment, aiming to identify and address the challenges they encountered. The study was specifically conducted among married working women affiliated with Tamil Nadu Agricultural University in Coimbatore. A total sample of 60 married working women were chosen through simple random sampling method. The primary data were gathered through a well-organized and in-depth interview schedule. The subsequent analysis of the collected data was processed using descriptive statistics. To assess the work-life balance, a questionnaire comprised 20 items, with the primary instrument being a checklist adapted from Daniels and McCarraher's manual on work-life balance from The Industrial Society (currently the Work Foundation) in 2000 was used. This checklist featured 15 statements related to work-life balance, slightly modified for the study. The respondents were provided with response options such as 'agree,' 'sometimes,' and 'disagree.' According to the data presented in Table 1, the findings suggested that the predominant group (56.67%) of working women at TNAU were aged 40 and above. Additionally, 30.00% fall within the middle age range of 30 to 40 years, while 13.33% belong to the younger age group of less than 30 years. Regarding the spouses' profession, majority (30.00%) were in academics, 26.66% were engaged in business, 13.33% work in the IT industry, 10.00% were involved in the insurance sector, and 6.67% were in marketing, with 3.33% in healthcare. Furthermore, the data indicated that 53.33% of the respondents had one child, 36.67% had two children, only 3.33% had three or more children and the remaining respondents had no children. These findings were in similar with the findings of Tiwari (2017). --- RESULTS AND DISCUSSION --- Profile of working women --- Figure 1. Profile characteristics of working women (n=60) --- Work-life balance of working women Work-life balance for employed women refers to the balance between their professional responsibilities and personal life. Achieving this balance involves managing time and energy effectively to meet work demands while also addressing personal and family needs. A percentage analysis was conducted to assess the respondents' reactions to the checklist instrument. The following table illustrated the proportions of 'A's (Agrees), 'B's (Sometimes), and 'C's (Disagrees) chosen by a sample of 60 participants in response to the checklist instrument. The findings from Table 2, which examined that the work-life balance of 60 working women, revealed a subtle perspective on the challenges they faced in balancing personal and professional aspects. A substantial majority (83.34%) expressed confidence in their ability to balance personal and professional life, while 60.00% identified work-life balance Vol 110\| 10-12 as their primary challenge. The correlation between work-life balance and the quality of life was acknowledged by 60.00% of respondents, and an overwhelming 83.33% believed that better work-life balance guarantees an improved quality of life. However, 46.67% sometimes reported dissatisfaction with their overall quality of life. Long working hours, influenced by job demands (80.00%) and the necessity to take work home (63.34% sometimes) illustrated the tangible impact on their schedules. Additionally, concerns about the effect of work stress on health (53.33% sometimes) and strains on personal relationships, as seen in the acknowledgment that relationships with partners (43.33%) and family (70.00% sometimes) were affected, further underscored the multifaceted challenges working women encounter. Despite a desire to reduce working hours and stress (16.67% agree), a significant proportion (56.66% sometimes) felt a lack of control over the current situation. Overall, these insights emphasized the intricate interplay between work and personal life, highlighting areas of struggle and the desire for improved work-life balance among the surveyed working women. It has been observed that there is a significant prevalence of the category 'A,' indicating an imbalance in work-life balance that requires urgent attention. The consistent predominance of 'A' across various work-life balance statements, other than the routine of taking work home in the evenings, implies that women in the workforce encounter challenges related to work-life balance in multiple aspects of their daily lives. The issue of work-life balance is widespread among female employees at Tamil Nadu Agricultural University, Coimbatore. The results are in line with Lakshmi and Prasanth (2018). Vol 110\| 10-12 The study suggested that women encountered difficulties in achieving a work-life balance primarily due to the professional challenges they confront daily. These challenges encompassed prolonged working hours, insufficient supervisory support, excessive workloads and the absence of robust policies. Both surveys and in-depth interviews were conducted as part of this study to underscore the observation that contemporary working women contend with more professional challenges than obstacles arising from family responsibilities. This analysis was conducted in different aspects and represented through figures which indicated the current scenario. From Figure 3, it was evident that 54.00% expressed satisfaction with their working hours, while 46.00% indicated dissatisfaction. Nearly equal division in satisfaction with working hours might result from inadequate flexibility or alignment between job requirements and personal time preferences. Followed by Figure 4, when working women were queried about work overload, a significant majority (86.00%) reported experiencing occasional work pressure, with only 14.00% stating that they rarely felt overloaded at their workplace. This reflected due to the pervasive challenge of work overload, potentially stemming from high job demands and insufficient resources. Figure 5 revealed that 60.00% of participants could occasionally make time for their families, 20.00% rarely found such opportunities, and a mere 20.00% felt they had enough time to spend with their families. Family time concerns might arise from demanding work schedules or the absence of family-friendly policies. In Figure 6, 54.00% indicated receiving support from their colleagues, while 46.00% reported a lack of adequate support from their coworkers, while colleague support appeared relatively balanced. Regarding family support, Figure 7 highlighted that 60.00% responded positively, while 40.00% stated they did not receive support from their families. The lack of familial encouragement might be influenced by societal or cultural expectations. Figure 8 revealed that 46.00% expressed that their organizations did not undertake any initiatives to balance work and life, whereas 54.00% affirmed that their organizations were cognizant of and had taken steps to promote work-life balance. The split in organizational initiatives have indicated variations in corporate cultures or a lack of comprehensive strategies for promoting work-life balance. As per the findings of this investigation, Figure 9 indicated that 17.00% of participants frequently experienced feelings of depression, impacting both their personal and professional spheres. Additionally, 53.00% of women rarely felt depressed and 2.00% consistently grappled with depression due to imbalances in their work-life. Consequently, a substantial 68.00% of participants encountered challenges in maintaining a balance between work and life due to the aforementioned factors. Figure 10 underscored that 51.00% of respondents suffered from stress-related ailments, while 49.00% were free from such conditions. The significant incidence of depression and stress-related ailments suggested that the cumulative impact of workload, inadequate support systems and organizational shortcomings may be taking a toll on the mental health of the working women surveyed. The results are in line with Yadhav and Jadhav (2023). --- CONCLUSION In the contemporary era characterized by the prevalence of dual career couples, there is a pressing need for systematic research to delve into the intricacies of work-life conflict. Additional insights are essential to better understand how the interface between work and home can be more efficiently managed. Further research is crucial to comprehensively grasp the meaning and ramifications of achieving a harmonious workfamily balance. This study successfully gauged employees' work-life balance, identifying weekly work hours and work-related stress as pivotal factors, alongside considerations such as occupation, age, and caregiving responsibilities. The study revealed that conflicts in the work-life balance of working women significantly impact their health, leading to increased stress, headaches, muscle tension, weight gain and depression compared to their male counterparts. Balancing familial obligations, organizational expectations and the ongoing struggle to maintain balance between work and family can profoundly affect an individual's well-being and overall quality of life. In the present busy world, where personal time is scarce, there is a widespread employee demand for the right to balance work and home life. While health and wellness programs can contribute to assisting working women in achieving this balance, they alone cannot fully address the complexities involved. The multifaceted challenges faced by women, as evident in the reviewed literature, call for further exploration to provide effective support for working women in achieving a harmonious integration of work and family life. --- COMPETING INTERESTS Authors have declared that no competing interests exist.	In the historical context, women were predominantly confined to domestic roles or limited employment options. However, contemporary advancements have enabled more women to pursue higher education and establish careers, ushering in new challenges. Modern working women, particularly those who are married and mothers, face the intricate task of balancing professional responsibilities with family obligations. This study investigated the challenges encountered by married working women, specifically affiliated with Tamil Nadu Agricultural University in Coimbatore. Employing an Ex post facto research design, the study explored the profile characteristics and work-life balance of 60 participants through interviews and a comprehensive questionnaire. The findings revealed that a significant proportion of working women experienced challenges in achieving worklife balance, impacting their overall quality of life. Professional challenges, including long working hours and inadequate support, contribute to the struggle, leading to stress, health issues and strained personal relationships. The study underscored the need for a holistic understanding of these challenges and advocates for comprehensive strategies, acknowledging the intricate interplay between work and personal life. The findings contributed valuable insights for organizations and policymakers aiming to support the well-being and work-life balance of contemporary working women.
PAKISTAN JOURNAL OF HEALTH SCIENCES https://thejas.com.pk/index.php/pjhs Volume 4, Issue 12 (December 2023) I N T R O D U C T I O N M E T H O D O L O G Y Research has been done to nd out how patients feel about medical students being involved in their treatment. Many hospitals throughout the world have observed that a small percentage of patients reject or have unfavorable feelings towards the presence of medical students in treatment [5,6]. Nonetheless, patients from different specializations were shown to have varying degrees of comfort with medical students. For instance, patients in urology reported feeling more at ease around male students, but patients in obstetrics and gynecology felt more at ease around female students [7]. Preserving con dentiality appears to be the most crucial element of the patientphysician interaction. A considerable percentage of patients are not very cooperative in real life when it comes to medical students. At most patient care levels, however, students would have superior learning chances via enhanced patient partnerships. Establishing a positive patient-medical student connection required prior knowledge regarding medical students' engagement in patient care. Patients would prefer that medical students only visit them during speci c hours and that their involvement be contingent upon their approval [8]. Understanding patients' views on interactions with medical students is crucial for meeting their needs and improving the quality of care. Current study, the rst of its kind in Peshawar provided valuable insights into this area. Additionally, the research generated evidence-based information that can be used to enhance the training of future physicians, equipping them with stronger medical, clinical, communication, and behavioral skills. This study sought to understand the overall views of patients in tertiary care hospitals in Peshawar, Pakistan, regarding the presence of medical students during clinical examinations, surgical procedures and consultations with their doctors. This research was conducted to check differences between male and female footballer composite scores and FMS as an injury predictor tool. The research employed a cross-sectional study design conducted over a period spanning from October 2022 to December 2022. The target population comprised patients visiting two prominent healthcare institutions, namely the Northwest General Hospital and Research Center, and the Northwest Teaching Hospital, both situated in Peshawar, Pakistan. Non-probability convenient sampling was utilized, and the sample size was determined using the OpenEpi sample size calculator, aligning with the 2022 census data of Peshawar population. Calculated at 471 participants with a 50% prevalence frequency and a 97% con dence interval, data were collected from a slightly larger sample of 500 individuals to account for any potential incomplete questionnaires post-collection. Inclusion criteria mandated participants' willingness and provision of informed consent, while exclusion criteria encompassed non-participation, lack of informed consent, and incomplete questionnaire submission. The study design received ethical approval from the Institutional Review Board and Ethics Committee at Northwest School of Medicine (IRB & EC/ 2022 -SM/ 053) (Issuance Date: 8th August, 2022). Verbal informed consent was obtained from each participant, coupled with a comprehensive brie ng on the study's purpose. Data collection employed a selfstructured questionnaire with two parts: the rst focused on demographic information, while the second contained questions pertinent to the research topic. Data analysis, performed using SPSS version 23.0, encompassed descriptive statistics, with the chi-square test (at an alpha level of 0.05) utilized to ascertain relationships between variables. --- R E S U L T S There were 316 male participants, comprising 63.2% of the total, and 184 female participants, making up 36.8%. The predominant age group among participants is above 18 years, accounting for 88.8%, while those below 18 years constitute only 2.4%, and 8.8% are precisely 18 years old. In terms of marital status, 67.2% of participants are married, while 32.8% are unmarried. The educational background of the majority of participants is 88.6%, with only 11.4% being uneducated. Regarding residential areas, 67.4% of participants live in urban areas, and 32.6% reside in rural areas. In the hospital wards, the majority of patients, 63.0%, are in the Medicine and Allied ward, with 37.0% in the Surgery and Allied ward (Table 1). Table 2 shows patient perspectives on the involvement of medical students in their care, providing insights into their attitudes, preferences, and comfort levels regarding student presence during consultations and examinations. Table 3 and 4 display the factors that contribute to patients' comfort or discomfort regarding the participation of medical students in their healthcare. For patients who are comfortable with medical students' involvement, the most common reason was that they feel they are being taken better care of (183). While for patients who are uncomfortable with medical students' involvement, the most common reason was that they are concerned about their privacy (200). Uganda showed a different demographic pro le. In that study, the majority of participants were female, comprising 81.4% of the total, and 66.6% reported being married [9]. This variation emphasizes the in uence of cultural and geographical factors on demographic patterns in research outcomes. Likewise, a study conducted in Canada with 625 patients across diverse medical specialties revealed an average age of 39 years, with 62% of the patients being female [10]. In this research, concerning the acceptance of medical students' presence during consultations, a majority of participants from both male and female groups expressed their approval. More precisely, 72% of males (227 individuals) and 51% of females (93 individuals) indicated their support for the inclusion of medical students in their consultations. This favorable response is consistent with studies conducted in Ethiopia, where 69.2% to 77.4% of participants accepted the involvement of medical students in their healthcare [11,12]. Similarly, a Saudi Arabian study that included patients from a variety of medical specialties revealed a generally favorable opinion regarding the involvement of medical students in their treatment. The study found that only 11% to 43% of applicants were turned down [13]. The medical students themselves saw their involvement in patient care as an invaluable educational opportunity [14]. Hartz et al., found that patients' decisions about whether or not to have medical students assist them were not substantially in uenced by their total educational attainment. Nonetheless, they pointed out that patients' acceptance and comfort levels were in uenced by their educational background, especially when it came to private examinations like pelvic exams and Pap smears on female patients [15]. During medical training, interactions between patients and medical students play a vital and irreplaceable role in the development of clinical skills, effective communication between patients and physicians, and the cultivation of ethical skills crucial for future medical practices. In this study, when queried about the importance of medical students' presence during consultations and examinations for their education, 72% of male respondents considered it crucial, 7% found it unimportant, and 22% were indifferent. Among female participants, 64% regarded it as crucial, 14% deemed it unimportant, and 22% were indifferent. In alignment with ndings from other studies, patients expressed their acceptance of medical students participating in their care, citing reasons such as a desire to contribute to students' learning and the future development of doctors. Patients also valued the companionship provided by students and recognized the substantial knowledge they gained about their health conditions through interactions with medical students, who often devoted signi cant time to patient education [10,[15][16][17][18][19]. In Australia, comparable results were documented, with 96% of patients recognizing the signi cance of students' participation in their care as an integral aspect of their training [20]. In the present study, attitudes towards allowing medical students in the operating room during surgical procedures varied. Among males, 46% expressed willingness, 15% were unwilling, and 39% remained indifferent. In contrast, among females, 32% expressed willingness, 41% were unwilling, and 27% were indifferent. Comparably, medical students accepted non-invasive tasks like reading through patient records, watching doctors perform ward rounds, and interviewing patients about their medical histories more readily than they did more personal procedures like digital rectal exams, vaginal deliveries and episiotomy repairs, and pelvic exams [11,13]. The study assessed the current level of comfort that patients experienced with the presence of medical students during consultations. Among male participants, 50% reported higher comfort levels, 9% expressed discomfort, and 41% were indifferent. Among females, 35% reported higher comfort levels, 25% expressed discomfort, and 40% were indifferent. On the other hand, a Ugandan study revealed that 82.3 percent of participants felt at ease with medical students being involved in their treatment. Concerns regarding extended consultation times while medical students are present were not common, and they did not believe that their presence would have a detrimental effect on the standard of care.9 Similarly, studies carried out in Tunisia revealed that male patients, those over 40, and those in employment were more accepting and at ease with medical students providing care than were female patients, those under 40, and patients without jobs.11 According to a different Australian study, patients (n = 255) under 40 were signi cantly more likely to report being satis ed with the involvement of medical students in their care [20]. --- PJHS VOL. 4 Issue. 12 December 2023 Copyright © 2023. PJHS, Published by Crosslinks International Publishers --- 86 Our study found that there are signi cant differences in how men and women feel about having medical students involved in their healthcare. Men are generally more comfortable with medical students being present during consultations, examinations, and surgery. They are also more likely to let students take their medical history and believe that medical students are bene cial for medical education. Women are more likely to be uncomfortable with medical students being involved in their healthcare, especially during physical examinations and surgery. They also prefer to have medical students of the same gender and prioritize privacy concerns. --- A u t h o r s C o n t r i b u t i o n Conceptualization: SZ Methodology: SZ, KK Formal analysis: SZ, KK, SJ, SM, SH, ZSK, ZAK, IB Writing-review and editing: SZ, KK, SJ, SM, SH, ZSK, ZAK, IB All authors have read and agreed to the published version of the manuscript.	Patients are the foundation of medical students' bedside education anywhere in any part of the globe [1]. Medical students' education still depends heavily on their interactions with patients. Patients' encounters can help advance clinical and contextual learning, enhance professional communication and skills, and start the process of building a future doctor-patient relationship. At most stages of patient care, students have greater teaching possibilities when patients are cooperative and eager to contribute to their education and training [2]. Researchers in medical education proposed that four
INTRODUCTION Several authors have examined the relationships between meaning in life, social support and resilience. To do so, they have used various instruments, which they have tested in relation to factorial structure, and which we will now briefly review. --- Relationship between Social Support (SS) and Resilience (R) There are several studies like those of Horton and Wallander (2001)  Demographic scale: Among the data included were age, sex, household income, educational level, marital status, employment status, continuing education, support from primary and secondary networks, third sector involvement, health status, etc. --- RESULTS --- Data analysis For --- Results --- Meaningful Life Measure Descriptive statistics The --- Medical Outcome Study (MOS) Descriptive statistics As can be seen in Table 2, items 8 and 9 were omitted from the analysis because they were problematic in the DIF analysis by country. Cronbach's alphas and means are high. --- Tabla 2. Descriptives of Medical Outcome Study Source: Own elaboration. A two-factor structure was also estimated, because the original four-factor structure proposed by the authors was problematic. Many indicators involved more than one factor. All items have similar means and standard deviations as well as good reliability values (all over 0.75) across subscales and countries. The omega hierarchical for a general factor was 0.84. --- Confirmatory Factor Analysis (CFA) The configural two factor model gave an acceptable fit to the data (χ The --- result with Dc 2 (Ddf=45)=89.8 p < 0.001, but the standardized magnitude of the difference (w=0.038) suggests an irrelevant or minor difference between both models. Items 2, 3, 5, 6, 7, 7, 10, 10, 12, 13, 15, 16, 17, 18 and19	One of the fundamental purposes of the human being is to develop a full and meaningful life. Among the main sources to achieve this meaning in life is social support. Meaning in life is essential because, in addition contributes to achieving resilient coping with adversities that occur throughout life. This is a relevant research issue for social work and other social sciences. The objective of this research is to confirm the relationship between meaning in life, social support and resilience, see if there are significant differences between countries and test a series of scales. It involved 1,500 participants from Argentina, Colombia, Spain and Indonesia, who completed a booklet comprising Morgan and Farsides' (2009a, 2009b) Meaningful Life Measure (MLM), the Medical Outcome Study-Social Support Survey (MOS-SSS) by Sherbourne and Stewart (1991) and Connor-Davidson's (2003) Resilience Scale (CD-RISC). The structural model shows that social support influences both meaning in life and resilience in the face of adversity. A direct influence of social support on resilience is also observed. The levels of meaning in life and resilience, as well as perceived social support are very similar between Argentina, Colombia and Spain, not so with Indonesia. The scales used have good psychometric properties. The factor analysis finds a five-factor structure for the meaning in life scale and two factors for the social support scale, while the resilience scale behaves as a unifactorial one.
T he freedom to live a long, flourishing, and healthy life is unequally distributed between and within countries. Males born in Cambodia can expect to live 23 years less than males born in Japan. There is no biological reason for such a difference in life expectancy between countries (1). Within-country inequities also exist the world over. In a prosperous country such as Australia the poorest 20% of the population can still expect to die younger (six years on average) compared to the richest 20% of the population (2). The incidence and prevalence of communicable diseases are highly socially graded and people who are more socially disadvantaged by income, employment status, education, ethnicity have a higher risk of non-communicable diseases including depression, diabetes, heart disease and cancers (1,(3)(4)(5)(6)(7). It does not have to be like this. Systematic social differences in health outcomes are not explained by genetic variation or because of some mythical deviant behaviour that is particular to socially disadvantaged groups. Most societies are stratified along a range of intersecting social categoriesincome, education, occupation, gender, age, ethnicity and geography-in which economic and social resources are distributed unequally. Pursuit of health equity recognises the need to redress the inequitable distribution of these resources. Creating a fairer distribution of the resources relates to freedoms and empowerment, at the individual, community, and whole country level. Empowerment is affected by three core things: basic material requisites for a decent life, control over our lives, and voice and participation in the policy decisions that affect the conditions in which people are born, grow, live, work, age and die, e.g. the type of exposure and access to quality and affordable education and healthcare, affordable nutritious food, good conditions of work and leisure, and quality of housing and built environment. These dimensions of empowerment are influenced by public policy and the way in which society, at the international, national and local level, chooses to run its affairs (8,9). While health policy, in particular healthcare policy, can go some of the way to reduce health inequities, health inequities are every government department and sector's problem. If done well, education, urban planning, rural development, working conditions, social protection and legal systems, to take just a few examples, can improve health equity. The following story illustrates how health policy and other public policy areas affect health inequities. The point of the story is to highlight not only the complexity of issues that affect people's health but also the many policy levers, and therefore opportunities, that can be used to improve health and health equity. Anna is 44 years old and lives at home with her elderly mother in one of the most socio-economically disadvantaged urban areas in the country. She is quite overweight, smokes a lot and suffers from depression but is not inclined to visit her doctor. Healthcare systems can be powerful mechanisms to reduce inequities (10), but the inverse care law, in which the poor consistently gain less from health services than the better off, is visible in every country across the globe (11). Out-ofpocket expenditures for healthcare can deter poorer people from using both essential and non-essential services, leading to untreated morbidity (12,13). But inequities in access and utilisation of healthcare are not only financial -inequities play out by race, gender, age and location. For example, in spite of near universal coverage for antenatal visits in Pelota, Brazil, the quality of care was consistently higher among women of white skin colour and high socio-economic status women than among black and poor women (14). Although Anna completed high school, it was a very mixed experience for her-teachers were regularly absent, the toilet areas were renowned for the bullying that went on there, and there was little expectation of lower social status children to do well academically-Anna left school with very few qualifications. It is known that children from economically disadvantaged backgrounds are more likely to do poorly in school and drop out early -and subsequently as adults are more likely to have lower incomes and are less empowered to provide for themselves and family (15). Quality education is critical for the well-being of individuals and communities. It helps to equip people with the resources needed throughout life to achieve a secure income, provide for family, and cope with health outcomes in later life. Beyond better outcomes for the individual, education and skills are vital for resilient communities by strengthening inclusiveness, tolerance, trust, ethics, responsibility, collaboration and effective democratic processes (16). Labour policy also affects health and health inequities. Ensuring working conditions that provide sufficient income to comply with health needs, and job security such that workers have a greater sense of control over their lives are fundamental requirements of a cohesive and healthy society (17). In developing countries, a high proportion of people are employed in the informal sector. In high-income countries there has been growth in job insecurity and precarious employment arrangements (such as temporary work, parttime work, informal work, and piece work) and job losses (18). These changes in the labour market have affected working conditions, with increasingly less job control, financial and other types of security, work hour flexibility, and access to paid family leave (19). Anna works in a call centre for a large telecommunications company. Her job involves dealing with customer complaints all day, every day. She has no control over the nature of her work or how it gets done, other than to use the mute button on the call. The evidence shows us that the quality of working conditions is related to mental health -poor quality work can in fact be worse for health than not having a job at all (20). On the up side, she has a permanent position with 6 weeks holiday per year. However her wage has not increased in the past 5 years -the company tells the workers that it cannot afford to increase wages because of the global financial crisis. Thankfully the social protection, including health insurance provided by her company has not been cut, unlike much of what is happening internationally across the public sector where strong austerity measures have been implemented, cutting health and social services with subsequent impacts on communicable disease risk and suicides (21). Anna is financially reliant on her single wage, which is only slightly higher than the minimum wage. She cannot afford to buy her own place hence one of the reasons why she lives at home with her mother. People with precarious and low paid employment do not have the easy choice of living in areas close to their work. House prices are partly to blame for this social disconnection. The land value gradient growth in recent years in many cities internationally is reinforcing a very strong social stratification of choice and opportunity for generations to come (22). To get to work by public transport Anna has to walk 20 minutes to the bus stop and take 2 buses-there are no trains-which would take about 90 minutes. She drives. We know that built environments that are walkable, with easy access to services and green space is very important for physical and mental health (23,24). So even if Anna wanted to walk in a pleasant environment, her opportunities to do so are more likely to be curtailed because of where she lives. An overarching issue for Anna's well-being is the systematically unequal distribution of power that is often experienced among socially disadvantaged groups, manifesting, as illustrated here, in inequities in material resources and psychosocial control. Health equity requires inclusion and agency (25), requiring individuals and groups to represent their needs and interests strongly and effectively. For example, at a local level, Blacksher and Lovasi demonstrate how engagement of people in the development of policy and practice relating to the design of the built environment creates better outcomes for socially disadvantaged communities (26). Work by Bartels has brought attention to the vast disconnect between poorer voters and the political system (27). Other international research shows that with greater income inequality people are less satisfied with the way democracy works and the residents of these countries are less trusting of their politicians and parliaments (28). Having the freedom to lead a healthy and flourishing live is not experienced equally as this story of Anna illustrates. Whilst there are signs of hope, significant challenges remain for health equity globally. The health gains that have been made to date are not inevitable, nor equally distributed, nor is continued progress guaranteed as the world encounters new economic, social and environmental challenges.Tackling health inequities is a political issue that requires leadership, political courage, progressive public policy, social struggle and action, and a sound evidence base (1). --- Ethical issues Not applicable. --- Competing interests The author declares that she has no competing interests. --- Author's contribution SF is the single author of the manuscript.	There are many reasons for the health inequities that we see around the world today. Public policy and the way society organises its affairs affects the economic, social and physical factors that influence the conditions in which people are born, grow, live, work and age -the social determinants of health. Tackling health inequities is a political issue that requires leadership, political courage, progressive public policy, social struggle and action, and a sound evidence base.
highly recommend this book to those who are in a blended family because it lets others know that they are not alone and that many issues within family life should be normalized. Throughout the book, Eckler provides examples of others who have also encountered her experiences and provided her with advice, showing that these issues are more common than not. This book confesses feelings that many individuals are too shy to disclose for fear of what others might think; therefore, this book would be an excellent read for anyone in a family, whether blended or not. The intended academic audience of Eckler's book includes psychologists and sociologists involved with studies of the family, as well as family support workers and social workers, because this book provides real insight into family matters that most would be too scared to tell. Eckler's use of a postmodern theoretical approach allows her to remind her readers throughout the book that there are a vast number of changes to be encountered during the process of blending families. Eckler also explains how single-parent, divorced, and blended families are becoming increasingly more common than nuclear families and that a family is essentially what one makes it to be. Eckler also explains within the book that blending families can affect people more significantly than others. She notes that new people will be moving into her house and that she and her daughter will have to adapt to it. At the same time, Eckler's boyfriend and his two daughters are forced to adjust to a completely new environment. It should be noted that the exes of the new couple are also adversely affected because not only is their ex changing their life, but they are also affecting the life of their child(ren). In the book, Eckler discloses the moment she told her ex that she and her new boyfriend were moving in together and that they were expecting a baby. Although she was no longer dating her ex, she still felt the need to tell him that he was not being forgotten because he was still a big part of her life, and they still cared significantly for one another. Another aspect usually forgotten about is how grandparents are affected by the blending of families. Grandparents not only have to get used to their new son-in-law or daughter-in-law but are also forced to adapt to the idea that they have a new grandchild or grandchildren. Eckler discusses her encounter with this harsh truth when she recounts a dinner with her new mother-inlaw, who expresses her excitement about the new baby and the addition of a new grandchild. During the discussion of the topic, Eckler comments on how her mother-in-law forgets that her biological daughter is also one of her grandchildren. Eckler's mother-in-law continues by stating that when it comes to grandchildren,"' it's not the same when they're not your own'" (p. 74). This quote becomes a very controversial topic in the book because Eckler believes that all the children should be treated equally. However, later in the discussion, Eckler's mother chimes in and expresses that she also does not feel the same love for her step-grandchildren. At this moment, Eckler recognizes that she also loves her biological children more than she loves her stepdaughters. This moment can be seen as a drawback in the book because of Eckler believing that her motherin-law's comment is condescending. However, when her mother commented on the same subject with the same opinion, she listened and realized she agreed that there would always be inequality amongst its members. When it comes to blending a family, treating members equally is a very large issue. In fact, one of Eckler's friends believes that "the hardest part of blending… is for sure treating all the children the same" (p. 78). Within the book, Eckler even admits that "[m]y brain has been working overtime, ever since we blended, to make sure everyone feels equal to us and each other" (p. 99). There are multiple instances throughout the book where Eckler describes children within the blended family as feeling unequal or overlooked. The "hi/bye" fight is a great example of this. Although Eckler constantly tried to make everyone feel equal within the household, she came in the door one day and forgot to say hello to her stepdaughters. In a nuclear family, it is likely that something as simple as forgetting to say "hi" when walking in the door would never be a problem. However, it led to a family-wide disagreement because Eckler's stepdaughters felt overlooked. Another aspect of unequalness within a blended family can be seen when Eckler looked at her boyfriend's screensaver to find that the photograph on display only contained his three biological children. Since the only child missing from the picture was Eckler's daughter, she became outraged. This scenario brings rise to the issue that it may not only be the children feeling unequal but so do the adults due to the treatment of their children. For instance, Eckler's boyfriend may view her daughter as less important than his offspring, which would provide reasoning for excluding Eckler's daughter in the photograph. Furthermore, Eckler's emotional reaction to this exclusion may result from her feelings of unequalness since her biological daughter is being treated differently from those who are biologically related to her boyfriend. Eckler also comments on how she feels a lack of appreciation for her role within their blended family, which is likely due to the lack of division of the household chores and finances. At first, Eckler believed that serious topics could be "[figured] out later" (p. 44) because the discussion of serious topics would take away from the excitement of moving in together. However, once the so-called "honeymoon" phase was over, Eckler felt underappreciated for the fees she took on and was unhappy that her boyfriend never helped pitch in towards their living expenses other than groceries. One significant issue I found within the book was how it was very one-sided. Although this view is used very well to help readers sympathize with the writer and the experiences she has gone through, it makes it so we cannot see the whole picture and are forced to take Eckler's side on all the issues presented within the book. A well-known saying is that there are two sides to every story. However, because there are moments within the book where Eckler is strongly opinionated, it seems as though she vents to her readers to get them to agree with her viewpoint on various issues. The purpose of "Blissfully Blended Bullshit: The Uncomfortable Truths of Blending Families" is to provide a resource for people to turn to if they are wondering what to expect through the process of blending families and acts as a way for Eckler to share the "less-than-ideal realities" (p. 14) with others. Her book was incredibly eye-opening, providing an insider's perspective on the challenges of blending families and discussing issues one would not usually think about until being forced to dive into the realities themselves. "Blissfully Blended Bullshit" can be used as a guide on how to successfully blend families or for real insight into family matters. This book shows that there is much to consider before diving into the process of blending families and helps people understand the ins and outs of what to expect.	University of Alberta http://ejournals,library,ualberta.ca/index/php/cjfy Eckler, Rebecca. (2019). Blissfully Blended Bullshit: The Uncomfortable Truth of Blending Families. Toronto: Dundurn Press.
Introduction The definition of the aged officially accepted in India was 55 years-the age of superannuation when the employees retired from service. The determination of the old age naturally linked with the average life expectancy (Johri, 2005). Sinding (2011) have explained the reasons for the increased number of older persons that it was due to an increase in longevity and a decline in fertility rates over the last two decades have resulted in a rapid increase in the older population and a decrease in birth rates. Industrialization, urbanization and nuclearisation of the family have also focused the aged as social problem and also poverty, unemployment, underemployment and inflation have rendered the family members unable to discharge their duties to the aged (Baldwin, 2002). The generation gap is winding. It is also indicated that the elderly people find difficult to adjust with their own sons and daughters because of the generation gap and their raring perception and because of this they suffer from various social, psychological and emotional problems. Ladusingh (2013) have identified that the number of older female do live longer than their male counterparts, there would be astonishingly high number of elderly widows in processes by which a person becomes aware of his/her situation, needs, goals, and required actions, and uses this information to implement problem solving strategies for optimal living. It is also predicted that the health problems of the older persons is due to neglect, poor economic status, social deprivation and inappropriate dietary intake and as age increase physical illness onsets. Thus the researcher has planned to study the mental efficiency of rural older women and it is hoped that the findings of the study would provide comprehensive information about the status of rural older women as well as their mental efficiency. Hedden and Gabrieli (2004) --- Review of Literature --- Results and Discussion	Old age is a precious period of every one's life because they have an opportunity to reflect their life experiences. Freud has also mentioned that the behavior of the person is influenced by the childhood experiences. Old age is a stage, when people move away from previous to more desirable period to less desirable period. The social attitudes toward the elderly are more important because it reflects the social treatment of the senior citizens and it is every old person's responsibility to improve the self concept. The declination of mental ability of older persons depends on individual differences and environment. The present research study has focused on the female elderly with regard to their mental efficiency. The aim and objectives of the study is to identify the socio demographic profile of the older persons and to analyze the mental efficiency and to suggest the suitable measures to enhance the mental efficiency of the older women. Interview schedule method was adopted to collect the required data from the respondents. This study was carried out at Asoor village of Perambalur district and purposive sampling method was used to collect the data from 55 respondents. The major findings of the study revealed that majority of the respondents (74.5%) have moderate level of depression and mental efficiency.
There are currently only seven child and adolescent mental health (CAMH) in-patient units admitting children under the age of 13 in the UK. Of these, just one admits children along with their parent or carer as a matter of course. 1 We believe this standard practice of admitting children without an accompanying parent/carer to be outdated and detrimental to both child and family. Enter a paediatric ward today and the sight of a parent accompanying their sick child would be commonplace. Indeed, for children of primary school age, and especially those requiring extended treatment over weeks or months, if a parent or carer were not present for much of the admission there would be concerns raised about the adequacy of the care they were receiving from the family. Over the past 60 years, our paediatric colleagues have increasingly recognised the value of parents accompanying their child in order to minimise the child's distress and to improve overall outcomes. 2 Yet we in CAMH in-patient services continue to admit lone children, often to facilities that are a considerable distance from the family home. The initial recognition of the trauma caused to children separated from their parents by hospital admission, and the resulting movement to allow parents to stay alongside their children, was significantly led by John Bowlby. 3 Bowlby's work in the development of attachment theory has been integral to our understanding of child emotional development and underlies much of our current practice of child psychiatry. Many research studies have confirmed the association between insecure relational family attachment patterns and childhood emotional and behavioural difficulties, 4 and it is therefore not surprising that we see an increased prevalence of insecure attachment patterns in the clinical population of the children we care for. 5,6 Given this, it seems illogical that in-patient CAMH practice continues to admit unaccompanied children, placing children at risk of the double trauma of separation from parents and admission to a mental health setting. Children exist within and respond to the wider system around them, of which the family is the predominant part. Often the journey that brings a child to an in-patient admission involves the breakdown and disruption of this family system. 7 Any therapeutic intervention must take this into account and address it. The attachment relationship between a parent and child is a dynamic process that we believe can only be really understood by directly observing their interaction. Admitting the parent and child together allows clinicians to assess attachment patterns directly and to establish to what extent disruption in relational security is driving and/or maintaining the child's mental disorder. It is not uncommon for a parent's own emotional difficulties to affect their attachment relationship and we know that a parent's mental health represents the most important correlate for all domains of the child's potential mental health difficulties. 8 Many parents of children in in-patient CAMH services have significant backgrounds of trauma and it is common to see the effects of intergenerational trauma displayed in a child's behaviour or for a traumatic response to be triggered in the parent by this behaviour. This understandably can make it impossible for any parent to implement any behavioural strategies suggested by professionals. If parents are part of the admission, this helps the team to develop the trust required to undertake the therapeutic work needed and address these issues more readily. We should not be surprised that some parents understandably find the idea of abandoning their distressed, frightened child with professionals in an institution far from home for a potentially prolonged period unacceptable. This may mean that the family refuse the admission that they need. By preventing parents from accompanying their children are we denying families the potential to get the help they require? Alternatively, some parents, exhausted by the challenge of trying to care for their child, may be eager to accept an admission to hospital, thus gaining respite from the responsibility of care. However, a hospital admission can strengthen the medicalisation of the child's difficulties, and handing over the care of the child to a clinical team may further promote a family's belief that the child needs to be 'fixed' by professionals or disempowers parents if the child's symptoms dissipate once they are in a hospital setting. Even if a child's mental disorders are not driven by disrupted relationships, it is vital that the parents/carers can be fully involved in their child's care, as they will become the child's care team on discharge. In all cases the parents/ carers of a young child need to become part of the solution for that child rather than continuing to fuel the problem or to believe that only professionals can help. --- Are we denying children the opportunity to get the help by not routinely admitting parents with them? Although we strongly believe that the benefits of parents being admitted with their children to in-patient CAMH settings are clear and meaningful, we recognise that, given this is not routine, there are clearly arguments opposing it. There is evidence that the practice of admitting lone children and focusing on individual work with the child alone is effective. 7,9 It may therefore be argued that the additional admission of the parent is unnecessary. A study measuring the outcomes of child in-patient admissions in England and Wales demonstrated their effectiveness and calculated the average cost of a child in-patient admission, but it did not compare the units that do not admit parents with the one that does. 7 We therefore do not know whether this assumption is correct and clear evidence exists that more can be achieved when children are admitted with their parent or carer than when the child is admitted alone. 10 We note that some children with emotional or behavioural difficulties can benefit from time away from the family home, particularly when ongoing stress in the child-parent relationship is the main source of their distress. We would argue that removing the child from the home temporally is unlikely to address the difficulties long term and intensive work is required with parents to make the systemic change that will be required for the child to benefit when discharged. Although this family work can, and does, happen on an outpatient basis, it is often difficult for parents to attend regularly, 11 particularly when children are admitted a long way from home. Finally, we also recognise the considerable financial implications as well as disruption to family life for siblings at home when a parent is admitted with their child. 7 Again, we would argue that the long-term consequences of having a child with significant behavioural and emotional problems is in itself disruptive and costly, with long-term negative consequences if not addressed. We would, however, also argue that the family's financial needs could be more actively addressed societally and appropriate reimbursement made available. --- Clinical implications and future plans We have argued that a clinical model that promotes parents accompanying their child during an in-patient CAMH admission is beneficial, therapeutic and should be considered normal practice. We believe the current practice of admitting lone children under the age of 13 to be outdated and anti-therapeutic. We recognise that no specific clinical trials have been undertaken to support this model in mental health settings but we note that our paediatric colleagues have not been required to provide such evidence for their culture and the acceptance of parents on their wards to change; common sense has prevailed by itself. Admitting a child to an in-patient ward is a radical treatment option and including parents in this approach significantly adds to the intensity. We argue, however, that the involvement of parents or carers is fundamental to making the most of this period of family upheaval and is in the best interests of both the child and the family. My clinic list says that the mother I am about to meet has come for an autism assessment for her son. As it turns out, she has come to tell a story, one she cannot yet make sense of. This particular mother tells me a nativity story. Her opening scene is an acute abdominal pain, 'like a fire', bending her in half and making her scream, at an office Christmas party. Not appendicitis, but a surprise of a baby son, born into precarious temporary accommodation, to a single young woman, in late December. Her story included a vivid retelling of his first visitors: 'three wise women from East London', she joked, 'a midwife, a heath visitor, a social worker'. 'Did they come bearing gifts?' I asked. 'Forms!' she replied, but also told me about the three wise women's support for her instinct, two Christmases later, that something was not quite right with her son. 'You could call it an epiphany', she said. You might wonder why I let her talk like this, encouraged it even, with my gift-bearing question. It took her less than 8 minutes to summarise her first concerns about her son and the following 6 years of worries, that were mostly dismissed by 'the system' as naughtiness, wilfulness or lax parenting. As a psychiatrist, my job is to make a diagnosis and formulation, but I also spend time thinking about the narratology in consultations, by which I mean how --- About the authors Lesley Cousins, MB, BChir, MRCPsych, DPhil, is a Year 6 Specialty Trainee (ST6) in child and adolescent mental health (CAMH), currently working at the Croft Child and Family Unit, Fulbourne, Cambridge, UK. Joanne Holmes, DM, MRCPsych, PG Cert MedEd, is a consultant CAMH psychiatrist based at the Croft Child and Family Unit, Fulbourne, Cambridge, UK. --- Author contributions Both authors contributed equally to the conceptualisation and writing of this paper. --- Declaration of interest None. --- CULTURAL REFLECTIONS The value and benefit of narrative medicine for psychiatric practice	Within paediatrics, young children experiencing physical and emotional distress are admitted to hospital with their parents as a matter of course, recognising the trauma associated with parting children from their carers. Much of this practice is underpinned by our understanding of attachment theory, which also sits as a fundamental tenet of child psychiatry. Yet the culture in psychiatric in-patient hospitals remains to admit young children without their parents, often to units that are geographically distant from the family home. We argue that the practice of admitting lone children to psychiatric in-patient units is likely to be traumatising as well as less effective. We believe this culture requires challenge and change.
ADVERSE EFFECTS OF INTERNET USE ON SUBJECTIVE SOCIAL STATUS AND DEPRESSION SYMPTOMS AMONG CHINESE OLDER ADULTS Aruhan Mu, Huazhong University of Science and Technology, Wuhan, Hubei, China (People's Republic) Internet use has been found to be associated with decreases in depressive symptoms among older adults. However, past evidences may have had publication bias due to the negative consequences of internet use demonstrated in other age groups. Thus, this study aims to investigate the adverse effect of older adults' internet use on depressive symptoms and its mechanism. The inverse subjective social status (SSS) in depressive symptoms is a well-established research finding. Based on this, we hypothesize that older adults' internet use could expand their reference group and exposing them to more ageist content, thus reducing their SSS which in turn increases depressive symptoms. We examined how older adults' internet use influences SSS and how SSS mediates the effect of internet use on depressive symptoms in China. The data were from wave 3 (2016, T1), 4 (2018, T2), and 5 (2020, T3) of the China Family Panel Studies, a nationally representative survey. The longitudinal mediation analysis included 3,237 participants who were aged 60 and above at T1 (wave 3) and were followed through waves 4 and 5. As expected, Internet use at T1 predicted lower levels of SSS at T2. Lower levels of SSS at T2 predicted higher levels of depressive symptoms at T3. This medicating effect was significant. This time-varying mediation which appeared to be explained by the relative deprivation and ageism following internet use among older adults. This study theorizes and provides evidence for previously overlooked psychosocial pathway through which internet use among older adults produces negative consequences. Abstract citation ID: igad104.1233 --- ASSOCIATION OF CHILDHOOD EXPOSURE TO SCHOOL RACIAL SEGREGATION WITH LATE-LIFE COGNITION AMONG AMERICAN ADULTS Zhuoer Lin 1 , Yi Wang 1 , Thomas Gill 2 , and Xi Chen 1 , 1. Yale University,New Haven,Connecticut,United States,2. Yale School of Medicine,New Haven,Connecticut,United States Racial segregation may contribute to enduringly worse health outcomes and aging. Prior research mainly focuses on residential segregation, yet the long-term effects of school segregation and the effects for different racial/ethnic groups are largely unknown. Linking measures of primary school segregation using administrative data with a nationally representative population survey in the US, we examine how childhood exposure to school racial segregation shapes the late-life cognitive function. 23,752 non-Hispanic White (White), 6,364 non-Hispanic Black (Black) American adults aged 50 and older were identified from the Health and Retirement Study; and state-level school dissimilarity indexes in late 1960s were linked to participants' latest wave of cognitive assessment using childhood residence. Multivariate regression analyses demonstrated that exposure to White-Black school segregation had strong, negative effects on cognitive outcomes for both White and Black participants. One standard deviation increase in dissimilarity index was associated with lower cognitive score (White: = -0.16 [95%CI, -0.22, -0.11]; Black: = -0.42 [95%CI, -0.53, -0.30]) and more cognitive impairment (White: Odds Ratio (OR) = 1.10 [95%CI, 1.06, 1.13]; Black: OR = 1.21 [95%CI, 1.14, 1.27]) adjusting for age and sex. Educational attainment and other	four sessions delivered for each age group. This program is unique in the sense that it utilizes both individual and group session techniques to facilitate the learning process. The main purpose of the program is to promote effective coping strategies, to reduce parenting stress among grandparents and to increase life skills (i.e., decision-making, proactivity) among children. Preliminary findings suggest that participating in ACT programs could help custodial, foster and biological parents improve self-efficacy, emotional well-being, higher self-confidence, social competence, lower depressive symptoms, and parenting distress, thereby leading to positive outcomes such as improved mental health and higher resilience.
Introduction Multi-agent systems, such as in multi-agent reinforcement learning (MARL) and ad hoc teamwork (AHT), have enabled us to study teamwork between agents [Durugkar et al., 2020;Genter et al., 2011;Mirsky et al., 2022;Hughes et al., 2018;Leibo et al., 2021;Baker et al., 2019;Jaderberg et al., 2019;Leibo et al., 2017]. However, due to multi-agent settings being inherently difficult, past work tends to make various assumptions lowering the applicability to the real world. We extend multi-agent settings to include more complex real-world aspects, specifically social identity and dynamic teams. In human groups there is a complex relationship between how group (team) membership shapes social identity and how social identity shapes team membership [Schröder et al., 2016]. We need to consider more complex human processes in agent systems if we want to have effective human-agent teams. Humans have diverse identities, their sense of self and of one's position in a social and cultural structures [Fukuyama, 2018]. Current multi-agent approaches tend to regard agents as homogeneous or slightly heterogeneous. Similarly to humans, agents should be able to contend with complex social phenomena like identity to perform well in the real world. Current multi-agent reinforcement learning team approaches are too naive; agents are typically assigned an explicit team. Human teams are fluid and changing and the agents teams need to encompass these attributes in their own teams. We suggest more human like team assignment, where agents can have the ability to choose their teams and personal preferences towards tasks. We illustrate how the inclusion of these complex aspects can be investigated in sequential social dilemmas [Leibo et al., 2017]. These are multi-agent games that are partially observable, and temporally and spatially extended. They are social dilemmas in the sense that an individual agent is motivated to exploit non-cooperative strategies for short-term gain, but in the long run all agents would have a higher payoff if they all cooperated. In our work, we utilise the popular Markov game known as Cleanup [Hughes et al., 2018], though there are many pre-existing multi-agent environments [Leibo et al., 2021]. Cleanup is a sequential social dilemma that consists of a number of agents wherein agents are rewarded for picking apples. The apples grow in an orchard at a rate that is inversely proportional to the amount of pollution in a nearby river. When the level of pollution in the river is over a certain threshold, apples cease to grow at all. Agents' actions consist of moving around the environment, picking apples in the orchard, or cleaning pollution in the river. Agents must leave the orchard to clean the river. Success in Cleanup depends on the agents' ability to form a joint policy to effectively clean the river so that apples grow and they share in their consumption. In other words, agents have to coordinate picking apples with the behaviours of other agents in order to achieve cooperation. The collective reward obtained by a group of agents gives insights into how well the group learned to cooperate. We now outline the basis of two complex human phenomena and detail our approach into applying them in Cleanup. This is followed by a short discussion on the implications of our work. --- Identity A person's identity affects economic outcomes. We consider identity economics [Akerlof and Kranton, 2000;Akerlof and Kranton, 2010], an economic model of human behaviour that incorporates the psychology and sociology of identity. Identity economics captures classic economic utility, such as a person's tastes for goods and services, and also identity elements that capture how motivations vary with social context. These identity elements are: the social categories and each individuals category assignment (identity), the norms and ideals for each category, and the identity utility corresponding to the gain when actions conform to norms/ideals and loss when they do not. Multi-agent reinforcement learning work deals with predominately economic factors stemming from how the learning environment and reward functions are structured. So, we endow agents with identity components to accompany the economic components already present in Cleanup, drawing from identity economics. It is established that heterogeneous agents with their own individual preferences, for example when agents are partially selfish, can have better performance than purely selfless task-oriented agents [Durugkar et al., 2020]. Similarly with mixed objectives in AHT all team members can have a common goal, but each agent might also hold individual goals [Mirsky et al., 2022]. However, we build upon these notions connecting to the social psychology concept of identity to further increase the heterogeneity of agents. Within Cleanup, we employ agents with identities. We model identities as innate, but unknown, specializations that agents are randomly assigned and need to discover themselves over the course of the game, distinct from past work involving roles [Wang et al., 2020]. We are experimenting with specific identity specializations (social categories) with distinct identity-aligned incentives (identity utility) for agents. For agents whose identity is river cleaner their expertise is in performing river cleaning actions. They clean more pollution from the river at once than does an agent whose identity is not river cleaner. For agents whose identity is apple picker their expertise is in the action of harvesting apples. They can harvest more apples from the orchard at one time than does an agent whose identity is not apple picker. If agents can discover and learn the norms and ideals to behave inline with their identities, in conjunction with forming teams as we discuss next, we expect them to outperform agents that do not incorporate identity. --- Dynamic Teams Human teams are dynamic. People join and switch teams with regard to their identity, common motives and goals, accepted division of labour or roles, status relationships, and accepted norms within the group [Sherif, 2015]. Past work has shown MARL teams can perform well and learn complex behaviours [Baker et al., 2019;Jaderberg et al., 2019]. In Cleanup specifically, teams have been shown to perform better overall than independent goal-aligned agents acting cooperatively [Radke et al., 2022a;Radke et al., 2022b]. However, in these previous works, teams are static and lack the dynamic nature of human teams. With this in mind, we investigate what we call dynamic teams. With dynamic teams agents are capable of creating and switching teams or belonging to no team at all. If agents form a team, they must be able to coordinate and collaborate with their new teammates. This can be viewed as a sort of fluid ad hoc teamwork where agents can enter or leave teams, but stay in the environment. This contrasts with open ad hoc teamwork where agents may enter or leave the environment, but not individual teams [Rahman et al., 2021]. We want to understand under what conditions agents, balance their individual identities and group membership, come to form, switch, and stay in teams. Extending Cleanup, we give agents the action to choose a team. We experiment with different allowable intervals of team switching and with locking agents into a team after a certain amount of time or amount of team changes has passed. Agents can be in a team of size 1 to n, where n is the total number of agents. So, agents must learn to account for this dynamic size of teams. This is similar to the open environment problem in AHT where the learner has to adapt to the changing number of teammates [Mirsky et al., 2022]. When agents are in a team together, they share all reward equally among each member of the team. This reward sharing can allow agents to specialize based on their identity. For example, river cleaner agents are free to spend the entirety of their time cleaning the river, whereas when they are alone, they must pick apples otherwise they receive no reward. We expect that this specialization will lead to more optimal outcomes as was shown in role based ad hoc teamwork [Genter et al., 2011]. Investigating dynamic teams could allow MARL methods to overcome weaknesses highlighted in past work where good team performance comes at the expense of poor performance when encountering a new teammate [Rahman et al., 2021]. --- Discussion We envision interesting dynamics arising from the incorporation of identity and dynamic teams in Cleanup. The addition of identity by itself, as we've structured it, will make the social dilemma more difficult to overcome as agents with apple picker identities are further incentivized to engage in noncooperative behaviour. We are interested in the dynamics that arise due to different distributions of agent identities within the population. We imagine that the addition of identity and teams will, if the agents can learn to take advantage of them, have better outcomes for the population as a whole. It is clear that a team comprised of agents with apple picker identities picking apples and agents with river cleaner identities cleaning the river will perform better collectively. However, it is not clear if it will be possible for agents to actually learn this. Furthermore, we are interested in what size of teams emerge and the ratio of agent identities within the teams. It may be desirable to train agents with one model, but multiple policies depending on the properties of the team that they are in. For example, an agent could employ a different policy being in a team of size four than the policy the policy they would use when alone. Exploring these complex dynamics is an necessary precursor for reducing the difference between these toy environments and the real world. With the ultimate goal of having effective human-agent teams, we need agents that can contend with more complex human phenomena rooted in social psychology.	We present our preliminary work on a multi-agent system involving the complex human phenomena of identity and dynamic teams. We outline our ongoing experimentation into understanding how these factors can eliminate some of the naive assumptions of current multi-agent approaches. These include a lack of complex heterogeneity between agents and unchanging team structures. We outline the human social psychological basis for identity, one's sense of self, and dynamic teams, the changing nature of human teams. We describe our application of these factors to a multi-agent system and our expectations for how they might improve the system's applicability to more complex problems, with specific relevance to ad hoc teamwork. We expect that the inclusion of more complex human processes, like identity and dynamic teams, will help with the eventual goal of having effective human-agent teams.
1 Introduction: Who's Accountable for Automation Applied to Learning Processes? The latest technological advancements emerging as daily commodities are so farreaching that our ways of thinking, feeling, acting and relate with others may be transformed at a very silent and rapid pace. But what investments are being made to determine the kind of culture, usage and ethics people want, need and may be able to spread through their technology mediated performances? In fact, works on ethical assessment of new tech, including AI-powered environments, are gaining traction [1,2]. Education-wise huge worldwide governmental investments were made for the deployment of laptops, broad access to Internet and educational software, some integrating AI [3], intelligent tutoring systems [4], and robots [5]. Although we may consider relevant some achievements over the last 25 years, AIEd is quite a new discipline and a research overview revealed a lack of critical reflection of its challenges and risks [6,7]. In fact, AIEd is covering an unprecedent range of cognitive functions and easing some routine tasks through automated grading, feedback loops, virtual facilitators, personalised learning, customised materials, and proctoring. But ideologies, fantasies, and projections about what the future should or is expected to be inform the development of these technological solutions. So, who may be accountable for AIEd development and scope? How is sense of agency being enhanced or constrained in the processes it enables? And how is our Judgement of Agency [8] being respected by its automations? In fact, many studies emphasised the sense of agency role in user experience and interface design [9] and some found a conundrum in the association of automation and sense of agency [10,11]. This PhD research is being developed under the premise that sense of agency is at the heart of learning, enabling experiences of signification that may foster lifelong orientation for learning. It also considers sense of agency core for legal and ethical structures [12]. So, this research aims at contributing to the public debate on AIEd, so that its researchers/developers become more sensitive and critical towards ethical learning-related issues. Furthermore, it intends to foster teachers' critical thinking on AIEd, by directly recognising their current attitudes and levels of awareness on the matter. Teachers are expected to be empowered to decide whether they want to use AIEd or not, to recognise the ways these technologies enter and may transform classrooms and learners and how they may integrate these resources into their pedagogical practices. 2 Research Goals and Methodology: Designing the Futures We Long for --- Research Goals This work aims at understanding if and how ethical impact assessment of AIEd influences primary teachers' awareness on the challenges AIEd may pose [13] to sense of agency. The specific goals comprise: (1) the exploration of contexts, applications, drivers, ethical issues, and controls that may be critical to evolve in the discussions of AIEd, particularly in what relates to sense of agency. (2) The enhancement of teachers' capacity to explore AI impact on learning, across students' different developmental tasks. (3) The design of professional development content that promotes teachers' capability to intentionally consider AI ethical challenges in their pedagogical practices, preserving the conditions that enable students' sense of agency. --- Methodology The research methodology will be mainly qualitative, comprising data triangulation. On the first phase it will be used a grounded theory-based design of a framework for teachers' Continuing Professional Development (CPD). This part will include the following variables: the narrative shared participatory methods and the capability of ethically reason upon AI applied to Education. Given the fact that this research's theoretical corpus is on its first growing years, the option for the Delphi method seemed accurate, enabling the identification of guiding theories, variables, causal relationships, constructs, instruments and generating a common language for discussion [14]. The structure is planned as follows: 1.1. Selection of a group of circa 15 experts from different geographical realities (snowball method), with experience on education, philosophy of technology, tech applied to education or in AI software development. 1.2. Participants will be challenged (email) to express their opinions on AIEd -i.e., AIEd techs and applications, user contexts, usage drivers, ethical issues involved, and existing controls. 1.3. This data will enable the construction of a survey questionnaire. 1.4. Participants will (a) rethink their first responses, (b) choose the 2 main critical items for each criterion, and (3) conclude on the drivers, the potential ethical challenges, and the current existing controls. Data will be analysed through descriptive statistics that will be further shared with the experts. 1.5. These new ideas will be voted by the group to define a final list on each criterion and further create a hypothetical dilemma reflecting an ethical challenge posed by AIEd. 1.6. Participants will vote 3 dilemmas (better exploration of AIEd ethical challenges). 1.7. Results will be shared with the entire group. Then, providing directions on CPD needs, a focus group of circa 7-10 teachers will be presented 3 ethical dilemmas (resulting from the previous research design). This will constitute a common basis to identify what AI tech might be like and speak about the AIEd construct. Teachers will be invited to choose the most impactful dilemma in terms of learning implications, justifying their choices. They are expected to highlight potential consequences to students' sense of agency resulting from the use of that tech under the described circumstances (or others). Then, teachers will be also invited to explore the needs of a school community in what concerns AIEd. This content will be analysed (CAQDAS) to explore teachers' current attitudes towards AIEd and related CPD needs. The content resulting from the Delphi and focus group phases will be the basis for designing a socio-constructivist eLearning course. Its methodologies will create opportunities to explore and evaluate teachers' capacity to intentionally integrate the potential and limits of using AI. A group of around 20 teachers or education internship students will be invited to complete this online course (MOOC platform). A qualitative data collection moment on attitudes towards AIEd will be included in the initial and final phases of the course structure. Throughout the course teachers will (1) identify AIEd applications, (2) explore its potential and challenges in terms of learning, and (3) specifically identify the effects of AIEd ethical challenges upon sense of agency. Then, a group of around 5 teachers will be invited to a final semi-structured interview to grasp teachers' attitudes towards AIEd regarding learning experiences' processes. The eLearning characteristics that might have contributed to those results will be explored along with the teachers' perception on their capability and will to continue dealing with the ethical challenges AI may pose to formal educational environments. The questions will also comprise the main criteria teachers consider relevant for CPD on AIEd. --- Conclusions This research is expected to mainly reinforce understanding on the critical ethical dimensions of AI applied to Education, in what concerns the role of sense of agency in the signification of a learning experience. It will reflect upon the perspective of different educational stakeholders, namely teachers, and it will try to contribute to the public debate and further research on AIEd. That will be done through the development of conceptual insights and theoretical frameworks to analyse and incorporate its critical dimensions into deliberate pedagogical practices.	The possibilities given by artificial intelligence are becoming enactments of what once were just distant fictional displays. Even if we restrict the context to Artificial Intelligence in Education (AIEd) the horizon is still wide. But which society layers and ethical frameworks are being considered in the process of conceiving AIEd scope? Committed with this debate, this research focuses the ethical challenges of AIEd in terms of sense of agency development across formal education.
INTRODUCTION Social Phenomena of Narcotics Circulation, especially Sidenreng Rappang Regency, have not shown maximum results, and even seem to be increasingly rampant to the countryside. The development and mode of operation or forms of crime are formed along with the dynamics of society and technological advancements created by humans. Every opportunity or opportunity is always utilized by organized individuals, groups, and organizations, including countries with methods or various ways with the intention that their goals are achieved. What worries again is that in Indonesia the circulation and use of drugs is no longer at the age of 25 years and above but the age of 25 years and under is increasingly increasing. because drug trafficking is no longer in big city cities but drug trafficking extends to areas including in the sub-district of Panca Rijang Sidrap Regency which is one of the biggest drug trafficking and distribution sites in eastern Indonesia. Therefore to prevent and eradicate drug abuse in sidrap district, an institution that is truly serious and responsive to drug abuse is needed. Thus the existence of the District Narcotics Agency (BNK) is expected to carry out its duties and functions to the maximum so that drug users and traffickers in Sidrap Regency experience more days of decline but from the results of observations and facts that we see directly with existing conditions precisely with the existence of Narcotics Agency The district (BNK) level of drug users and circulation is actually increasing every day. BNN data says an average of 50 people die from drugs every day. 50 people every day which means around 18,000 people every year. Ironically, 18,000 human resources that should have been able to provide innovation and energy in order to increase the development of Indonesia in various sectors actually gave up their lives as drug slaves without contributing to the country. In 2015 there were nearly 4 million people from the National Narcotics Agency's estimate of 5.1 million. According to UNODC (United Nations) Office on Drugs and Crime), drug users in Indonesia have reached 5,060,000 people. With the details of users of crystalline methamphetamine (sabu) 1.2 million people; cannabis (marijuana) 2.8 million people; ecstasy 950 thousand people and heroin 110 thousand people. Of this number, 52.2% are under 30 years old, youth and productive youth groups in Sidenreng Rappang Regency. Based on the results of the research data obtained, in 2015 with the number of cases 82 with suspects 109 people, in 2016 with the number of cases 111 with the number of suspects 149, and in 2017 with the number of cases 140 with the number of suspects 197 people, and 2018 with the number 59 cases suspect 99 (Results of direct interview of Sidrap Police Narcotics Head and administrative staff, 31 July 2018). --- Implications for the Medical and Social Rehabilitation Model Knowledge of the role of the social environment in the recovery of addicts or recurrence of using drugs serves as a direction in developing social re-construction measures so that sociologically, drug victims get social support to maintain their better new behavior. The unfavorable social situation then becomes an indirect cause of the ineffectiveness of the rehabilitation program's success, especially when the addict has just undergone a treatment program in an aftercare. Research has proven that generally someone trapped in drug abuse begins with ignorance of this dangerous drug. Its social reality is to avoid the many victims of drug abuse, it requires continuous socialization of basic drug information among the general public. Drug trafficking never stops. The consequences of drug abuse are very complex, as is the case with circulation. Efforts to expand the network of abusers as if they were endless. IDU is the group of abusers who are most at risk of becoming drug dealers, because almost half (45%) of IDUs have sold drugs to other people. In Indonesia, there are also forms of organized crime whose characteristics are by forming a network in committing crimes, including business practices in drug crime in Indonesia. One of the business practices of drug crime in Indonesia can be seen in several cases. This shows that Indonesia is a market and a place for actors to do business. Eradicating the drug business is not easy. This is due to the pattern of business activities carried out by the actors implementing a network model. The meaning is that there are connecting points, which are members of the network, who will continue to run the drug business cycle even though one of them has been caught. The existence of these connecting points also indicates that if the leader of the drug business crime organization is caught, it does not mean that the drug business stops completely. Related to the role of the people involved, first, is their presence in a network that is not directly related to the center. Second, is the adaptation of people involved in the network. The important thing about this adaptation is their way of emphasizing understanding of gangguang and strategies in response to the gangs that are about the network. The reason an intermediary can be considered better is, first, the intermediary can control information asymmetrically which can simultaneously control the business in the network. Second, intermediaries provide benefits for a network because it is very suitable to be used as a center for carrying out buying and selling activities because it is more efficient and safe. Third, because an intermediary does not get a stereotype that considers himself a bad person, then this makes it easy to collect and coordinate existing resources. --- Narcotics Nursing Network in Sidenreng Rappang Sidenreng Rappang Regency, South Sulawesi Province, is known as the Lumbung Beras area, recently this positive stigma has shifted that Sidenreng Rappang Regency is now better known as the Narcotics Granary which is one of the drug trafficking centers in South Sulawesi. The social fact is to look at social phenomena in the circulation of narcotics, especially in Sidrap Regency, and have not shown maximum results, and even seem to be increasingly rampant to the villages. Of the several cases that have been revealed are as follows: 1. The National Narcotics Agency (BNN) has succeeded in uncovering the narcotics distribution syndicate in Sidrap on Thursday (7/19/2018). Sabu weighing 5 kg is secured in two locations in Panca Rijang, Sidrap, South Sulawesi (Sulsel) Districts. The first location was the disclosure of illicit goods, on Jl AP Pettarani, Lalebata Village, Panca Rijang District, Sidenreng Rappang District at 3:30 a.m. A man suspected of being an narcotics dealer with the initials AN (39) was successfully secured with evidence of sabu weighing 2 kg. After securing AN and the evidence, the joint BNN team carried out the development. 2. Two members of the Sidrap police station allegedly involved in drug trafficking underwent a Propam examination on Monday, August 13, 2018. Both of these individuals had the rank of Bripka with the S in their daily duties in the Sidrap Police Integrated Service Center (SPKT). And the other is a Brigadier with the initials N from the Sabhara Unit. 3. The Case of the Civil Society perpetrators of drugs who were arrested in Sidenreng Rappang District. Four drug offenders were arrested by the local police. The disclosure of this case began when Sidrap Police Narcotics Satres Team secured the first offender, HBP (39), who lives on Jalan Andi Haseng, Pangkajene Village, Maritengngae District, Sidenreng Rappang Regency, then on Jalan Pelita, Kelurahan Panreng, Baranti District, Sidenreng Rappang District, three other actors each ABL (25), HBR (42) and SBM were also successfully arrested. The three were arrested at the house of the perpetrator, ABL on the East Pesantren Street, Benteng Village, Baranti District, Sidrap Regency. --- Cases of unscrupulous Civil Servants (PNS). " The civil servant was recorded as a civil servant. He was arrested in front of SMK 2 Sidenreng with two of his colleagues," said the Police Chief of Sidrap, AKBP Anggi Naufal Siregar, at the Sidrap Police Headquarters, Jl Bau Massepe , Maritengngae District, Sidrap. Plus thirteen of the 16 drug offenders have been named as suspects. 5. Cases of unscrupulous members of the Sidrap DPRD, the National Narcotics Agency (BNN) of South Sulawesi Province, arrested one member of the Regional Representative Council of Sidrap in a cafe in Watang Pulu District, Sidenreng Rappang Regency, Wednesday, July 29, 2015. Based on information, Sidrap legislators arrested was AL, 43 years old, from one of the Political Parties. He is thought to be a dealer and user of shabu-type drugs. The Sidenreng Rappang District legislator was arrested along with six other alleged perpetrators. Among them, two men, namely AW, 39 years and US, 35 EP (23), and SA (28). They are self-employed and cafe employees at the arrest location. Nur Syamsi, Head of the Makassar BNN Rehabilitation Center Administration, also mentioned three regions in South Sulawesi, namely Pinrang, Parepare, and Sidrap which were included by the BNN as a red zone. The red zone means that the area is the center of drug trafficking. "The three regions, based on BNN monitoring, are easily accessible to drug dealers, both from the Kalimantan region and from Malaysia. --- METHODOLOGY --- Research Approach The approach used in this study is a qualitative approach, and to answer the phenomenon of the problems faced. Snowball sampling is one method in taking samples from a population. The selection and determination of the type of qualitative research is not merely interpreted as the choice of a method that is focused on the type of data and analyzed that is qualitative, but has a philosophical foundation that underlies the birth of certain paradigms about this method. In connection with the research design used Strauss & Juliet (2003) explained several designs including: Phenomenology, Ethnometeorology, Gunded Research, Qualitative Observation and Etiology, among various phenomenological strategies to uncover the meaning behind the facts (Agustang Andi, 2007). Therefore this snowball sampling is a very strategic approach in reviewing the matter of this research, including non-probability sampling techniques (samples with unequal probabilities). For sampling methods like this specifically used for community data from the respondents / sample subjective, or in other words, the sample sample we want is very rare and is grouped in a set. In other words, the snowball sampling method is sampling by chain. --- CONCLUSION Eradicatingthe drug business is not easy. This is due to the pattern of business activities carried out by the actor applying the network model. This means that connection points are members of the network that will continue to run the drug business even though one of them has been caught. This connection poin also indicates that if the drug business crime organization leader is seen, it does not mean that drug business will stop completely.	Abstracts: , Social Phenomena of Narcotics Circulation, especially Sidenreng Rappang Regency, has not shown maximum results, and even seems to be increasingly rampant to the remote villages. Sidenreng Rappang Regency, South Sulawesi Province, is known as the Lumbung Beras area, recently this positive stigma has shifted that Sidenreng Rappang Regency is now better known as the Narcotics Granary which is one of the drug trafficking centers in South Sulawesi. The results of the study obtained data, in 2015 with the number of 82 cases with 109 suspects, 2016 with 111 cases with 149 suspects, and 2017 with 140 cases with 197 suspects, and 2018 with 59 cases with the number of suspects 99 (Results of direct interviews with Sidrap Police Narcotics Officers and administrative staff, 31 July 2018). 1.Take strict action in accordance with the applicable law towards producers, distributors and users and carry out effective and educative coordination steps with related parties and the community. 2. Strive to increase the budget to rehabilitate victims of narcotics, psychotropic and other addictive substances.
Background The first major publication on co-creation was by Greenhalgh, who explored achieving research impact through co-creation. 1 Greenhalgh positioned co-creation as a form of collaborative knowledge generation between academics and other stakeholders. This is to say that academics should be answering the questions that the stakeholders (service providers and those in receipt of services) want answering, and working with those stakeholders to answer those questions. In the academic literature this process is called 'knowledge mobilisation' and has largely focussed on getting evidence into practice; that evidence has tended to be in the form of research outputs. For a useful summary of the state of the art of Knowledge Mobilisation (also referred to as Implementation Science) I would wholeheartedly commend Per Nilsen's paper. 2 The description of knowledge that is generated by academics and then 'used' by stakeholders is 'Mode 1 Knowledge Mobilisation'. 3 A more nuanced and sensitive approach to this process is described as 'Mode 2 Knowledge Mobilisation'. 3 'Mode 2' recognises different forms of knowledge; practical knowledge, tacit knowledge, procedural knowledge, local knowledge, and recognises that this knowledge has to be generated within and be sensitive the context of its use. 3 In its bluntest form this means that there is no use for a guideline that recommends that everyone should have a CT scan, if there isn't a CT scanner for 20 miles. 4 This process of 'doing' 'Mode 2 Knowledge Mobilisation' has been described as co-creation or co-production. Co-production is a frequently used term, which is used somewhat uncritically but in its best form speaks to a genuine and meaningful engagement between the key stakeholders to generate new knowledge that is sensitive to context 5 and thus, is more likely to be implemented. The 'co' prefix is important as that is where the moral and pragmatic arguments to involve people is driven from. Morally, people whose lives are affected by a change have a right to be involved and pragmatically, by involving those people you will get a better outcome. 6 This brings us to the EBN Twitter Chat where the focus was around stroke and service provision. We discussed two projects we had been involved whose aim was to support coproduction or co-creation. Figure 1 Twitter chat The first project explored the issue of weight gain after stroke in response to recent research which had highlighted that weight-gain was a problem for some people after stroke. 7 The project raised for discussion considered how to improve weight management services for stroke survivors in Sheffield. The aim was to identify interventions, actions or products that could improve current provision of weight management services and support and improve patient experience. The various groups involved were stroke survivors and carers, staff involved in the stroke pathway, and public and third sector service providers. Firstly, we met to discuss current stroke service provision and develop a map of available weight management stroke services. Secondly, co-production took place. Two workshops were used to collaboratively identify areas for development and generate ideas for how changes could be made in service delivery and resource provision to addresses key gaps. During the consultation, people identified several areas for development. Staff and stroke survivors wanted more accessible resources to help stroke survivors access weight management information. They expressed a need for education on diet and weight management. Staff said that training was needed to build their own confidence and skills in addressing weight management. Specific areas for training were nutrition, facilitation of behaviour change, and understanding stroke impact for staff not trained in stroke care. Staff also reported that increased knowledge of current services would help them signpost patients more appropriately and wanted clear ways to refer stroke survivors for services. In the co-production workshops, ideas for changes in service delivery to address these issues were discussed. This included longer-term services for post-stroke lifestyle. Health trainers, and the voluntary sector support services could be sources of this service provision. More information could be in the form of a 'cook book' containing advice, recipes, and educational material for stroke survivors and their carers. A lifestyle questionnaire, based on Motivational Interviewing principles, might support staff and stroke survivors in identifying goals and facilitating lifestyle changes. Dietetic input for weight-gain on the stroke pathway was also an idea. The full report is available here. 8 Although the impact of the co-production process on the services and strategies identified needs further evaluated, the co-production process was perceived by stakeholders to have been valuable for developing weight management resources because they were involved in the conception and design of the weight management resources. This enabled these to be tailored towards peoples' needs and thus, truly person-centred. In recognition of the importance of exercise in promoting recovery and rehabilitation from stroke and preventing secondary stroke, 9 the second project was initiated to explore ways to promote exercise in stroke survivors living in Sheffield (UK) using co-production workshops. Based on the people's experiences of accessing exercise services in Sheffield and using coproduction methods, we intended to: understand current service delivery around exercise for stroke survivors understand perceived myths and enablers/barriers to exercise network with various care and industry organisations to understand what types of physical activity are available for people with disability to participate in across Sheffield; explore ways in which the services could be improved The multidisciplinary core team, comprising health professionals and designers, cofacilitated a series of five workshops. This project was part of getting research into practice (GRIP) and funded by the National Institute for Health Research Collaborations for Leadership in Applied Research and Care Yorkshire and Humber (NIHR CLAHRC YH). Throughout the project, 71 people were involved. At least 15 participants were involved in each workshop. The workshops gathered together stroke survivors (all within the past 5 years), health care professionals, exercise prescribers, social services, commissioners, medics and representatives from the voluntary sector. The first three workshops consisted of approaches to understand the participants' experiences, which included creative activities such as asking participants to create a 'fake news' story about myths they had heard in relation to physical activity after stroke (Figure 2), a specially designed template to help participants think about potential barriers and facilitators to exercise following stroke (Figure 3), and personal biogs about their experiences of stroke, health services and motivations to exercise following stroke (Figure 4). Figure 2 Using a fake headline to find out about myths around exercise These activities allowed for 'reflections' to be uncovered. Following this, undergraduate design students involved with the project were paired with stroke survivors and healthcare professionals to jointly develop ideas around ways to improve current service provision (Figures 5 and6). Five outputs emerged from the research: a marketing campaign to burst myths and promote physical activity, a video raising awareness of the benefits of promoting exercise, a staff training package about information delivery regarding exercise, a stroke survivor's passport to access relevant and customised information while keeping one's medical record in one place, a buddy box to increase wellbeing among survivors. A full report of how the workshops were undertaken, who was involved and the resources developed is available here. 10 --- To summarise… The Twitter Chat for Action on Stroke Month highlighted the importance and wealth of knowledge that our Twitter community have around activities which support co-production, co-creation and genuine and meaningful involvement. It is common sense that you should involve people in developing new services, however all too often, as a community, health and social care practitioners and researchers think that it is enough to simply get people together in a room. Over the last ten years of work the NIHR funded CLAHRC (http://clahrcyh.nihr.ac.uk/our-themes/translating-knowledge-into-action), and colleagues at Lab4Living (www.lab4living.org.uk) have demonstrated that the attention to the conditions for coproduction to happen is as important as getting people together. We argue that by using creative methods and making things tangible it allows people the genuine opportunity to contribute their expertise to a process that delivers person centred services and care. 11,12 The involvement of creative practitioners drawn from design and related disciplines allows this process to deliver the potential that co-creation offers.	This May marked Action on Stroke month and in recognition of this, EBN hosted a special week of blogs written by stroke survivors, practitioners and stroke researchers and a twitter chat focussing on priorities in the management of acute and long-term stroke. The blogs can be found online (https://blogs.bmj.com/ebn/) as well as a blog summary of the twitter chat (https://blogs.bmj.com/ebn/2019/05/17/summary-of-twitter-chat-action-on-stroke-monthpriorities-in-the-management-of-and-research-on-stroke/). One of the discussion threads that emerged during the twitter chat focussed specifically on approaches to co-creation and co-production in the development and delivery of person-centred stroke services (Figure 1). One of the contributor's was Daniel Wolstenholme (@wolstenholme_d) who shared his experiences. In this edition of the EBN Opinion, we follow up on this particular thread with Daniel to find out more about the type of co-production work he has been involved in leading.
INTRODUCTION Sign languages are visuospatial. The Deaf must rely on vision to develop language. Visual principles affect how that language is organized and expressed. Expression tends to be primarily manual and facial, and sign languages incorporate many techniques that visually and kinesthetically convey life's experiences. Unfortunately, unlike spoken languages, there are no conventionally used written coding systems to describe the elements of sign languages. As a result, to express a sign language in an ICT system, it must be depicted through graphics, animation, or video. There have been a few attempts to develop a written form to describe sign language (e.g., SignWriting (Sutton [17]) and Hamburg Notation System or HamNoSys (Prillwitz et al. [14]), but these are still hardly used by Deaf people or their service providers. The use of signing avatars can facilitate content accessibility for the Deaf and Hard-of-Hearing. Unlike videos of human signers, animated signs represent signs anonymously. In addition, they can be modified at any time, and require far less bandwidth than videos. However, the development of virtual signers poses several challenges with regard to their quality and acceptability by SL users. The approval of signing avatars by SL users depend on several factors and has been discussed in several studies (Quandt et al. [15]; Kacorri et al. [9]; Kipp et al. [10]; Adamo-Villani [1]; Lu and Huenerfauth [13], [12]. Generally speaking, the results of these studies show that intrinsic factors (appearance and non-manual markers, such as facial expression, eye gaze and movement) are very important for SL users. Extrinsic factors, such as age of SL acquisition, technology experience and hearing status can also predict the attitude towards signing avatars. For the purposes of this work, we designed a questionnaire to understand MSL users' general attitude towards avatars as well as towards the avatars used for the study. In order for us to compare the results of our study across different studies, we used as much as possible similar demographic and technology experience data reported about the participants of the relevant studies. More specifically, our study draws from, inter alia, the stimuli and evaluation questions released by Huenerfauth and Kacorri [6]. For the sake of an objective study of the attitude towards signing avatars, our questionnaire distinguishes between the attitude towards "an ideal signing avatar" and the attitude towards the avatar used in the study. --- SURVEY AND RESPONDENTS The goal of our study is to determine whether demographic factors and technology experience factors can affect the attitude of SL users towards avatars, and whether these factors have an impact on the participants' subjective judgements as well as their comprehension of the signing avatar used for this study. For this purpose, we designed a questionnaire that includes: (i). Demographic Data: age, gender, hearing status, age of MSL acquisition (ii). Technology experience: respondents' perception of the complexity of computers and their experience with smart phones and internet (iii). Attitude towards "an ideal avatar": the participants are asked about their attitude towards the use of "ideal" avatars (that sign exactly as humans do) in real-world contexts, such as news and weather broadcast and in situations where privacy can be of concern (iv). Comprehension rating of the avatar used in the study (v). Naturalness (vi). Impressions: the attitude towards the avatar's movement, facial expressions, handshape and location Three groups of participants were surveyed: Deaf (N=57), Hearing (N=20) and Hard-of-Hearing (N=3). Compared to similar in-person studies (Kacorri et al. [9]; [8]), our group of respondents is quite large. --- METHOD, TASK AND STIMULI Our study was conducted in-person. In an attempt to make sure that our research method is Deaf-friendly and adapts to the sociocultural experience of the respondents, two Deaf assistants (a female and a male) were recruited to explain the questions and the rating procedure on a paper questionnaire to each participant. Because of the cultural sensitivity of certain questions, the female Deaf assistant conducted the survey with the females and the male with the male participants. The importance of involving and how to involve Deaf assistants in the process of data collection and experimental studies has been documented in the literature (Huenerfauth et al. ([7]; Harris et al. [4]; Ladd [11]; Singleton et al. [16]). These authors stress the importance of, inter alia, making sure that the informed consent is translated in the native language of the respondents. This recommendation is particularly necessary in Morocco where the Deaf community has a very limited proficiency in spoken language. After providing demographic information, their general attitude towards avatars, and technology experience, the participants rated their comprehension and impression of the signing avatars used in the study. For this purpose, seven individual MSL signs and one MSL sentence were used as the stimuli for the study: SICK, DOCTOR, MOTHER, FATHER, BABY, 1985, and THE MOTHER THE BABY FEEDS. The avatars we created for the study are based on two different technologies. The first type of avatar we created is based on an enhanced version of HamNoSys notations. The second type of avatar was created using the Blender environment. The animation of the sign "SICK" in MSL using the Blender environment The animation of the sign "FATHER" in MSL using an enhanced version of HamNoSys notations Using a 1-to-5 scalar response, the participants rated the comprehensibility of the two signing avatars by responding to the following question: It was easy for me to understand the avatar's signing of the 7 words and sentence ‫ﻭﺍﻟﺠﻤﻠﺔ‬ ‫ﺍﻟﺴﺒﻊ‬ ‫ﺍﻟﻜﻠﻤﺎﺕ‬ ‫ﻣﻦ‬ ‫ﻛﻞ‬ ‫ﻟﻔﻬﻢ‬ ‫ﻟﻲ‬ ‫ﺑﺎﻟﻨﺴﺒﺔ‬ ً ‫ﺳﻬﻼ‬ ‫ﺍﻷﻓﺘﺎﺭ‬ ‫ﻛﺎﻥ‬ We calculated the Comprehension variable by averaging the participants' answers. The participants were then asked to answer questions measuring their subjective impression of the animation of the signs used in this study. They rated their responses to the questions below on a 5-point Likert scale: --- ANALYSIS AND RESULTS The purpose of this study is to examine whether demographical and experiential variables can predict the attitude of Sign language users towards avatars. For this purpose, we did multiple regression to analyze the data. Our results are compared with results from other relevant studies. First, we explored whether the age of acquisition of MSL can predict the attitude towards avatars, in general, and the participants' attitudes towards the avatar used in the study. We did a predictive model by using linear regression models based on the general attitude towards avatars and as independent variables the age of MSL acquisition and other variables relevant to our model (the hearing status, technology experience, age of participants, and gender). Our dependent variables are the general attitude towards avatars and the attitude towards the avatar used in the study with respect to comprehension, impression, and naturalness. As can be seen in Table 1, the prediction of the general attitude of the Deaf is less positive than that of the hearing if we use the age of acquisition of MSL variable. However, with regard to the prediction of the attitudes towards the avatar used in the study, we notice that the Deaf are much more positive with the value R² (.064) lower for the hearing. The values of R² explains how much of the total variation in the dependent variable -General attitude or the attitude towards our avatar-can be explained by the independent variables (age of MSL acquisition and hearing status) as is illustrated in Table 2. --- Hearin --- Table 3: ANOVA table of the impression and age of acquisition variables To determine if significant correlations exist between the age of MSL acquisition and comprehension, we calculated the correlation coefficient using the Pearson method. As is shown in Table 4, the Age of Acquisition of MSL was found to be negatively correlated with comprehension with a value of (-.158) for the Deaf participants, (-.327) for the Hard-of-Hearing, and -,202 for the hearing, which implies that as the age of acquisition increases, comprehension decreases. Opposite results were reported by Quandt et al. [15]. ,393 --- Table 4: Correlations between comprehension and the age of acquisition With respect to the correlation between the general attitude towards avatars and Technology experience, the results show that there is a positive correlation between the technology experience and the general attitude with a value of (,263) for the Deaf as is shown in table 5. This means that Deaf participants who have less technology experience are likely to have negative attitude towards avatars. Similar results were reported by Kacorri et al. [8]. --- Table 5: correlations between the general attitude and the technology experience As is shown in Table 6, the attitude of the Deaf is less positive than that of the hearing with respect to the technology experience variable. This can be explained by the fact that the technology experience of the hearing participants is higher (.986) than that of the Deaf participants (.052 Experience, Gender, Age of Acquisition of MSL. --- Table 8: Multiple regression model of general attitude with demographical and technological variables That is, the more we add more significant values to the model, the higher the R squared value becomes, and as a result, the prediction is higher. It is also noticed that there is a correlation between Technology experience and the age of participants. Technology experience decreases (-.124) when the age of participants increases, which means that people who are younger are more positive and willing to use technology than older participants (cf. Table 9). In view of the high degree of regional variation in MSL and the different cultural backgrounds of sign language users, it is recommended that future work collect large datasets from users rating avatars. Interestingly, there are mainly two ethnolinguistic groups in Morocco: the Arabs and the Amazighs. We believe that understanding the sociolinguistic situation of MSL by investigating factors, such as the multilingual linguistic environment, gender, regional variation, family and education can add another dimension for research that examines the factors that can predict the attitude of sign language users towards avatars. In order to compare results across different studies, we, following Kacorri et al. [8], strongly encourage researchers to use similar standard survey questions.	Avatar technology can offer accessibility possibilities and improve the Deaf and Hard-of-Hearing sign language users' access to communication, education and services, such as the healthcare system. However, sign language users' acceptance of signing avatars as well as their attitudes towards them vary and depend on many factors. Furthermore, research on avatar technology is mostly done by researchers who are not Deaf. The study examines the extent to which intrinsic or extrinsic factors contribute to predict the attitude towards avatars across cultures. Intrinsic factors include the characteristics of the avatar, such as appearance, movements and facial expressions. Extrinsic factors include users' technology experience, their hearing status, age and their sign language fluency. This work attempts to answer questions such as, if lower attitude ratings are related to poor technology experience with ASL users, for example, is that also true for Moroccan Sign Language (MSL) users? For the purposes of the study, we designed a questionnaire to understand MSL users' attitude towards avatars. Three groups of participants were surveyed: Deaf (N=57), Hearing (N=20) and Hard-of-Hearing (N=3). The results of our study were then compared with those reported in other relevant studies.
Refuting Amy Chua's Claims about Tiger Parenting My eight-year longitudinal study [Kim et al., 2013b] of Chinese American families in Northern California collected multi-informant data from the mother, father, and the child for three key developmental periods at four-year intervals: when the target child was an early adolescent attending middle school, a middle adolescent attending high school, and an emerging adult likely to attend college. The first of Chua's claims that my study refuted was that the majority of Chinese American parents are tiger parents. In fact, most of the parents in our sample were classified as ''supportive'' parents, followed by either ''easygoing'' or ''tiger'' parents, with ''harsh'' parents making up the smallest percentage of parents in the sample. The second claim that my study refuted was that tiger parenting results in superior academic achievement in children. To our surprise, compared to children of supportive parents, children of tiger parents had lower school-reported GPAs in middle school (3.3 vs. 3.5-3.6) and high school (3.01-3.1 vs. 3.3-3.4), and lower educational attainment as emerging adults. In fact, regardless of informant or developmental period, children of supportive parents showed the best developmental outcomes in multiple domains and across time periods. --- Supporting Amy Chua's Claims on Parenting Goals of Chinese Americans Scholarly research supports Amy Chua's observations about differences in the parenting goals of Asian American parents compared to European American parents. Chao [1995] found that culture plays a critical role in shaping parenting goals and that Asian American mothers' interdependent and collectivistic values translate to encouraging their children toward high academic achievement to bring honor to the family. In contrast, European American mothers' independent and individualistic values translate to emphasizing a sense of self-esteem in their children and focusing on personal well-being. However, according to Way et al. [2013], Chua's notion of parenting does not necessarily resemble the way contemporary parents in China are raising their children. As a second-generation Chinese American, Chua has a notion of the ''Chinese way'' of parenting which seems to have been frozen in time. Two papers in the special issue on tiger parenting suggest that Amy Chua's perspectives on the parenting goals of Chinese parents have evolved. Cheah, Leung, and Zhou [2013] found that Chinese immigrant mothers recognize that the traditional Chinese way of parenting may be too rigid and punitive to be adaptive in the USA. These immigrant mothers espouse parenting strategies that recognize the importance of bicultural socialization and emphasize the co-existence of Chinese and American ways of parenting. According to Way et al. [2013], Chinese mothers in mainland China now emphasize their children's happiness and emotional well-being along with academic achievement as important parenting goals. She finds that parents recognize that the way they were parented as children is no longer adaptive in raising their own children to become gainfully employed in China's new global market economy [Way et al., 2013]. Together, these two studies are suggesting that contemporary Chinese mothers, in both the USA and China, are embracing a combination of Chinese and Western parenting goals in raising their children. --- Classic Parenting Profiles for Examining Variation in Parenting among Chinese Americans Baumrind's [1966] and Maccoby and Martin's [1983] classic conceptualization of four parenting styles (authoritarian, authoritative, permissive, negligent) guided our thinking about how to approach defining variations in parenting among Chinese American families. These authors focused on high and low levels of responsiveness (warmth) and demandingness (control) as central features of parenting and relied on these features in defining their four parenting styles. Our ''parental warmth'' dimension also included hostility, in recognition of the pioneering parenting research of Becker [1964]. In addition, we incorporated Darling and Steinberg's [1993] delineation of various types of parental control, ranging from restrictive to firm to coercive types of control. In summary, we incorporated dimensions of affective parenting (warm vs. hostile) as well as dimensions of behavioral parenting, which included a range of controlling behaviors (monitoring, punitive discipline, psychological control, democratic parenting, and shaming). Moreover, we added the dimension of reasoning (inductive reasoning) as a measure of effective parent-child communication, as recognized by Maccoby and Martin [1983]. --- Chinese American Parenting When Ruth Chao's seminal publication on the Chinese way of parenting appeared in Child Development in 1994, developmental scholars took notice. Her paper attempted to untangle a perplexing conundrum that had begun to emerge in the scholarly literature: Asian American children were doing well academically, while their parents were being described as authoritarian in their parenting. This finding contrasted the widely noted finding in the developmental literature on European Americans -namely, that it is authoritative parenting, rather than authoritarian, that relates to high academic achievement in children. Chao's [1994] suggest that parenting among these groups may be a combination of both authoritarian and authoritative parenting [e.g., Xu et al., 2005]. Chao asserts, however, that while Chinese parenting may resemble some aspects of authoritarian or authoritative parenting as practiced by European Americans, it is distinct in its motivation and meaning. In deriving the parenting profiles for our sample of Chinese Americans, we were mindful of these previous studies, and we decided to use the term ''tiger'' parenting to label this distinct, and possibly uniquely Chinese, type of parenting. We felt that this label best captured the combination of warm and punitive parenting strategies that Chua [2011] described in her memoir. --- Deriving the Four Parenting Profiles of Chinese Americans We used latent profile analyses to arrive at four parenting profiles for our sample of Chinese American parents. Latent profile analyses were ideal for our purposes because they allowed flexibility in using multiple dimensions of parenting to arrive at various categories derived from the data. We conceptualized that relatively high and low levels of the four positive (warmth, inductive reasoning, monitoring, democratic) and four negative (hostility, punitive, psychological control, shaming) parenting dimensions in the sample would coalesce to form ''tiger,'' ''supportive,'' ''harsh,'' and ''easygoing'' parenting profiles in our sample. Of the eight parenting dimensions used in the study, shaming was the only culturally specific parenting dimension. This dimension is completely absent in the classic parenting styles. We included shaming because it has been found to be important in Chinese family socialization [Fung, 1999]. Levels of shaming were similarly high in tiger and harsh parents in our study. Supportive parents showed higher levels of shaming than easygoing parents, suggesting that a moderate level of shaming may be an important component of being a supportive and successful parent among Chinese Americans. Chua's [2011] book emphasizes that tiger parenting is the mother's job. Our research finds that tiger fathers are also present in Chinese Americans families. Our finding is that tiger mothering is more likely to diminish as children grow older while tiger fathering is more likely to increase. We attribute this phenomenon to mothers and fathers changing their parenting styles to meet the developmental needs of the adolescent. In earlier adolescence, when children are more tied to the home, mothers are more likely to be the emotional caretakers of their children. In contrast, as children individuate and become more engaged with the outside world as autonomous adults, fathers may take on a more active role. --- Complexities around Tiger Parenting Although we examined eight parenting dimensions, our definition of tiger parenting is still limited. Scholars have noted that Chinese mothers emphasize effort and hard work rather than innate ability and rank school achievement as one of their primary parenting goals [Kim & Wong, 2002;Li, 2012]; these findings could be taken into consideration in defining tiger parenting. In other words, a number of other aspects beyond the eight dimensions we identified, such as parenting goals and ideologies, can be added to produce a more nuanced definition of this culturally rooted parenting style. --- The Importance of Supportive Parenting in Chinese Americans My research on Chinese American families has consistently shown the beneficial effects of supportive parenting in thwarting negative developmental trajectories in Chinese American adolescents. For example, Kim and Ge [2000] demonstrate that parents' depressed mood sets in motion a family process of unsupportive parenting that relates to more depressive symptoms in Chinese American adolescents. With increases in monitoring and inductive reasoning and decreases in harsh parenting, Chinese American children experience fewer depressive symptoms. We also demonstrated that supportive parenting may be a modifiable mediator between acculturation gaps between parents and children and the children's adjustment in Chinese American families [Kim, Chen, Li, Huang, & Moon, 2009;Kim, Chen, Wang, Shen, & Orozco-Lapray, 2013a]. An acculturation discrepancy in American orientation between parents and children is related to less supportive parenting practices (low levels of monitoring, inductive reasoning, and warmth) that create a sense of alienation between parents and children resulting in more depressive symptoms and lower academic performance (grade point average and standardized test scores) in Chinese American adolescents [Kim et al., 2013a]. These findings suggest that increasing supportive parenting practices, particularly for fathers, can disrupt this negative process, ultimately increasing optimal developmental outcomes among Chinese American children. --- Future Directions After the publication of my paper on tiger parenting, scholars from diverse disciplines ranging from law, to economics, to psychiatry, to statistics began contacting me. It appears that gaining a fuller understanding of tiger parenting would require a multidisciplinary approach and the combined expertise of a diverse group of scholars. Scholarly research on parenting styles that have recently been popularized by the media has been sparse. For example, few, if any, developmental scholars have tackled the issue of ''helicopter'' parents. It is important that developmental scholars with a strong background in parenting research tackle these issues as a public service: We need to educate the public about the truths and myths behind the media's descriptions of different parenting styles and the ways in which different parenting strategies affect children's developmental outcomes. My research challenges the ''model minority'' stereotype of Asian American children and adolescents. For example, Asian Americans are often perceived as perpetual foreigners [Kim, Wang, Deng, Alvarez, & Li, 2011], which undermines their mental health. Gaining a better understanding of the conditions that result in the achievement-adjustment paradox [Qin, 2008] of Asian Americans (in which positive psychological adjustment does not accompany a high degree of academic success) is an important avenue to pursue in future research focusing on Asian American children and their families.	Tiger'' parenting, as described by Amy Chua [2011], has instigated scholarly discourse on this phenomenon and its possible effects on families. Our eight-year longitudinal study, published in the Asian American Journal of Psychology [Kim, Wang, Orozco-Lapray, Shen, & Murtuza, 2013b], demonstrates that tiger parenting is not a common parenting profile in a sample of 444 Chinese American families. Tiger parenting also does not relate to superior academic performance in children. In fact, the best developmental outcomes were found among children of supportive parents. We examine the complexities around defining tiger parenting by reviewing classical literature on parenting styles and scholarship on Asian American parenting, along with Amy Chua's own description of her parenting method, to develop, define, and categorize variability in parenting in a sample of Chinese American families. We also provide evidence that supportive parenting is important for the optimal development of Chinese American adolescents.
Artificial intelligence (AI) technologies are rapidly transforming our world and bring with them considerable potential to enhance global health and wellbeing [1]. The influence of AI in healthcare is transformative and can be positive, with capabilities such as diagnosing conditions undetectable to humans and designing innovative, lifesaving pharmaceuticals [2]. These developments augur a future where healthcare systems globally could see significant improvements in health outcomes. AI could even revolutionize our approach to disease prevention and management, ultimately saving countless lives and resources. While AI offers undeniable potential benefits to wellbeing, experts are also concerned about potential threats. In a recent Stanford poll, a third of AI experts suggested that misuse of AI could result in a "nuclear-like catastrophe", which could directly impact global health systems and compromise patient safety and healthcare access [3]. An open letter from leading tech experts further highlights the pressing need to address potential health threats from AI, such as exacerbated health inequities and unpredictable public health crises [4]. Examples of this can range from AI-driven medical algorithms that ill-diagnose diseases to AIgenerated biotechnology that unintentionally or intentionally creates or modifies life-threatening pathogens. These risks, mainly resulting from unintentional, unprogrammed, and unpredictable AI capabilities, present unique challenges for AI and global health communities [5]. The paradox of AI's potential as a path for health improvement and as a multiplier of health threats emphasizes the need for a balanced approach to AI implementation and governance. Careful navigation is required to maximize benefits and minimize harms in this transformative landscape. As we stand at this busy crossroads, with clashing global health challenges creating syndemics and emerging threats, we face a critical choice: we can either harness the power of AI to reduce health inequities or allow it to exacerbate them. AI's potential to negatively impact human wellbeing poses several risks to global health at different levels and scales, with diverse implications for countries in different stages of their development. For example, it is likely that for-profit models of AI companies will translate into the deployment of beneficial technologies to human health, mainly to people in high-income countries first. Additionally, minorities and people living in low-income countries, will be impacted by AI systems that rely on data that might be biased and may sustain historical inequities and exclusions in healthcare policies, guidelines, and predictive models. The algorithmic-led denial of insurance coverage that discriminates against marginalized groups, such as people belonging to certain racial or ethnic minorities, is one example of this. The little transparency and lack of accountability mechanisms around some AI technology also threaten data confidentiality and privacy issues [6]. Additionally, disinformation campaigns designed and fueled by AI can be a threat to public health messaging. AI algorithms can potentiate, generate and/or disseminate false information about, for example, vaccine safety and spread it through social media platforms, undermining public health [7]. Most drastically, AI that is not aligned with the goals of humans has the potential to disrupt the very systems that underpin our wellbeing (e.g., information systems, supply-chain systems, economic systems, essential utilities) and those that threaten our very existence (e.g., nuclear weapons). Because of these diverse levels of impact, mitigating AI's threats to health necessitates global health professionals' involvement at every stage of the AI lifecycle. These include clinicians, public health experts, policymakers, civil society, and bioethicists. They should engage in AI's conceptualization and design, ensuring technologies prioritize the wellbeing of all communities, particularly the vulnerable. Moreover, their active participation in creating accountability structures for AI's use in healthcare is essential. The global health community can advocate for ethical and equitable AI policies, collaborate in integrating AI systems within existing health infrastructure, and contribute to guidelines to control AI's public health implications. Essentially, they must use their expertise to guide AI's evolution towards health equity and global benefit. We have seen this approach in action in the global health community's response to environmental challenges like climate change-an existential threat that demands actions from every sector of society [8]. These collaborative responses, involving advocacy, policy development, public communication strategies, and coordinated action, offer valuable lessons for informing our approach to tackling AI-related challenges. From these cooperative approaches, a fundamental component that must emerge is robust mechanisms for AI governance and regulation, such as a Global AI Treaty (e.g., similar to the Pandemic Prevention, Preparedness, and Response Accord currently being negotiated). A potential Global AI Treaty should establish accountability mechanisms and international regulations to ensure AI, globally (i.e., in every nation-state), is designed and deployed safely, ethically, and equitably. Ideally, it would seek to prohibit the most deleterious uses of AI, like autonomous weapons, to regulate the more nuanced uses, such as mass surveillance. A Global AI Treaty would also seek to create norms around transparency and algorithmic fairness to mitigate risks from AI systems that are biased, lack transparency, or compromise confidentiality. Notably, the treaty would provide a framework for holding nations, private companies, and other actors accountable for upholding ethical (and mutually agreed upon) AI principles. If designed inclusively through multi-stakeholder dialogues, including the voices of the global health community, a Global AI Treaty could balance the line between precaution and progress. The failure to do so effectively and swiftly might put us in a race to weaponize AI or have AI escape our control (i.e., misalign with our own goals) with potentially catastrophic consequences [9]. Furthermore, lack of global coordination will once again leave countries with few tools and poorly equipped to address the rapidly surging health challenges, potentially leading to dire consequences for global health (similar to what happened early on during the HIV epidemic when HIV devastated countries that could not access medications due to a failure of equitable global health governance). Global health professionals have immense experience in successful global treaties (e.g., the WHO Framework Convention on Tobacco Control) to protect our wellbeing. These experiences, both successful and unsuccessful, are invaluable assets in quickly navigating the need for a comprehensive AI framework for international cooperation and regulation. Looking ahead, the global health community's expertise in equity and community-centered approaches can help guide an ethical AI future. We can learn from the experience of activists who urged an ethical approach to COVID-19 vaccine distribution and ensure that ethics are at the center of all AI-related treaties and policies. Keeping equity in mind will help us guide where to best build infrastructure, distribute drugs and medical supplies, where to invest in capacity building, and where education is urgently needed. It will also allow us to cater and design with the needs of specific populations in mind, especially those that are the most vulnerable. Community engagement will also be central to developing and implementing AI technologies, ensuring that diverse voices and needs are heard and met, and ensure AI solutions that are more relevant, effective, and culturally sensitive. Whether we realize it or not, the age of AI is upon us, and its impact on global health cannot be overlooked. In the first months of 2023, as large language models (the technological framework that gave us GPT-4) took the world by storm, a global health colleague told me not to worry, that all the technology did was "predict the next word in a sentence." I ask you, the reader, not to take the potential capacities of AI models lightly. The tech industry and leaders from within have started to raise their concerns (8). Urgency is paramount as we are already on track for a disorganized and inequitable rollout of AI technology, with increasingly hardto-predict impacts. As we move into an AI-driven future, global health professionals must actively shape AI development and policies, foster transdisciplinary collaboration, and address AI-driven health inequities. The lessons learned by the very nature of our field, in addition to the equitable framework that serves as a common value to the global health community, locate us at a vantage point that we must not take for granted. Let us create a path that harnesses the power of AI to reduce, rather than increase, the gaps that exist in health and wellbeing, for the benefit of all humanity. --- Author Contributions Conceptualization: Carlos A. Faerron Guzma ´n. --- Writing -original draft: Carlos A. Faerron Guzma ´n. Writing -review & editing: Carlos A. Faerron Guzma ´n.	This opinion article discusses the impact of artificial intelligence (AI) on global health, addressing its potential risks and benefits to the field. It suggests that, given the existential risks of AI development, the global health community must contribute to AI-related advances, ensuring health equity and the wellbeing of vulnerable populations. Through transdisciplinary collaborations, robust AI governance, and an emphasis on equity, strategies are proposed to harness the potential of AI to reduce health inequalities and improve wellbeing at global and local levels.
de uma estrutura de planejamento participativa e institucionalmente integrada com atores conectados ao território com poder de decisão. Fundamentados no conceito de práxis territorial no qual o engajamento social é compreendido enquanto expressão transformadora da territorialidade, reconhecemos as comunidades dos núcleos rurais da Serrinha do Paranoá como um corpo sóciopolítico engajado em defesa das águas por meio da descrição analítica do seu histórico de engajamento social em quatro fases. Neste estudo, verificou-se que essa comunidade demonstrou comprometimento por assumir as funções de um comitê de subbacia hidrográfica pela sua atuação pautada nas reivindicações socioambientais e políticas. Palavras-chave: Engajamento; Planejamento; Comunidade; Sensível; Água. --- Resumen Este trabajo propone presentar formas de fortalecer la relación entre la comunidad socialmente comprometida y las instituciones de planificación hídrica. En este sentido, se entiende que la participación social no está plenamente inserta en la planificación territorial e hídrica y éstas mantienen esta estructura departamental, facilitando la implementación de modelos de planificación urbana y rural no comprometidos con las realidades sociales y ambientales. Del modelo de planificación sensible al agua y del principio de comunidades sensibles al agua, se deduce la necesidad de la formación de capital sociopolítico en un marco de planificación participativa e institucionalmente integrada con actores vinculados al territorio con poder de decisión. Basándonos en el concepto de praxis territorial en el que el compromiso social se entiende como una expresión transformadora de la territorialidad, reconocemos a las comunidades de los núcleos rurales de la Serrinha do Paranoá-DF como un cuerpo sociopolítico comprometido en la defensa del agua a través de la descripción analítica de su historia de compromiso social en cuatro fases. Este estudio mostró que esta comunidad ha demostrado compromiso para asumir las funciones de un comité de subcuenca a través de sus acciones basadas en reivindicaciones socioambientales y políticas. Palabras clave: Compromiso; Planificación; Comunidad; Sensible; Agua. --- IntroductIon This research deals with social engagement as an institutional integrating principle capable of complementing water planning based on social mobilizations. In water planning, social demands in the exercise of territorial praxis guide the defense and preservation of water in territories when confronting the urban expansion of predatory models and the departmentalization of planning (Saquet, 2017). Social practices are encouraged in the Water Sensitive Cities planning model, which promotes the formation of a sociopolitical capital called Water Sensitive Communities through methods such as "Effective Engagement," which uses participatory approaches linked to an integrated basin planning framework watersheds (Dean et al., 2016). Therefore, this study aims to value social participation in public institutions, especially in river basin councils and committees implemented by Law No. 9,433 of 1997 (Brasil, 1997). Based on social demands, the assumptions for creating sub-basin committees were found to recognize engagement approaches and advance the democratic guarantees of territory planning. On Distrito Federal, the performance of more than 20 years of the communities of the rural centers of the region of Serrinha do Paranoá can be recognized as a community sensitive to water. The proposals for the occupation of the region are contrary to environmental legislation, such as the Management Plan of the Apa do Planalto Central (Distrito Federal, 2015) (Figure 01) that classify the region as a Wildlife Conservation Zone, a Sustainable Use Zone, and a Zone Spring Protection. In the 1990s, Companhia Imobiliária de Brasília (TERRACAP) implemented the occupation of the region with the urban subdivision project (Figure 2), called Setor Habitacional Taquari, Stage 1 (Sections 1, 2 and 3) and Stage 2 (Distrito Federal, 1999), a project authorized by the other territorial planning bodies. The developments generate socio-environmental impacts mainly due to real estate speculation that proposes to explore the area's proximity to the Brasilia pilot plan in its landscape qualities, as illustrated in the photo in Figure 3. Stage 1 -Taquari In this conjuncture, the communities of the rural centers engaged in activities organized by residents, groups, associations, NGOs, and universities, public and private institutions to defend and conserve the waters of Serrinha do Paranoá. --- Effective engagement to motivate water-sensitive communities The implementation of social participation in water planning has advanced through experiences organized among social subjects called the Water Sensitive Community principle "Water Sensitive Communities" (WSUD, 2013). This proposes the conscious insertion of the community in the planning process, which can lead its members to question their needs and desires towards the system and influence 234 The document proposes the implementation of social engagement through an institutional reorganization with the integration of departments, like the Australian planning that integrates state instruments, regional or municipal plans and policies, and local government plans and master plans (Dean et al., 2016). It highlights the local councils as fundamental bodies in the organizational structure for articulating actions in practices and supervision of activities (Dean et al., 2016). This reorganization is fundamental in the execution of actions to meet community objectives and presupposes other forms of agreements, costs, and benefits different from the current model. --- The River Basins Committee for Social Engagement in Defense of Waters In Brazil, water planning adopts participatory approaches in the National Water Resources Policy Law No. 9,433 of 1997 (Brasil, 1997) through the River Basin Committees and adopting the river basin as a legislative reference and management unit (Brasil, 1997). The law implements a systemic decentralized social integration model structured through Councils and Committees of Hydrographic Basins (CBHs), with representatives of the Public Power, users, and communities (Brasil, 1997). The management of the Water Resources Councils (CRH) is a collegiate body of equal composition with decisions taken by a simple majority, represented by state secretariats in activities related to the management and use of water resources, environmental protection, strategic planning and financial management of the State; of the municipalities contained in the hydrographic basins and elected among their peers; universities, higher education and research institutes; Public ministry; organized civil society (Brasil, 1997). Next are the River Basin Committees (CBH) with a tripartite and joint composition composed of representatives of State Bodies, Civil Society, and Municipal Governments (Brasil, 1997). In addition to PNRH/9433, experiences organized by social movements have claimed the appreciation of the potential of each place and better living conditions for the population, especially in the face of degrading political processes (Saquet, 2017). Máxima Acuña in Peru, social movements, unions and academics in Uruguay and so on (Aguilar, 2018). The Alternative World Water Forum (Fama 2018) was organized in response to the 8th World Water Forum (FMA), which discussed water scarcity as a resource and proposed water control for industrial production and agribusiness (Silva;2019b). The event brought together a variety of organizations and social and popular movements committed to formulating strategies to fight for water contrary to the FMA (Silva, 2019b). Water-sensitive mobilizations demonstrate that contradictions and those impacted are absent from the planning process (Silva, 2019a). In this sense, a planning and management praxis is necessary in which singular adaptations are implemented with contents defined by those affected with the same autonomy as the others involved (Souza, 2002). Analysts must be accessible to the demands of individuals and groups (particular parameters) when assessing a situation or designing a concrete intervention (Souza, 2002). --- Methodological procedures The research was guided by the methodology of participatory action research (Dione, 2007), as a collective action inserted in the process of social change of a concrete situation with two concomitant objectives: modifying a situation and acquiring new knowledge. The aim is thus to strengthen the relationship between theory and practice and generate new knowledge and greater sociopolitical reach. Based on a dynamic process scheme or cycle in four phases (Dione, 2007), a proposal for the analysis of a collective intervention planned in 04 stages involving operations and activities was systematized, as can be seen in Figure 4 The history of social engagement approaches systematized in 4 phases demarcates the different periods of forms of action related to urban expansion strategies and water preservation. --- Results and analysis In the first phase (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), the occupation of the region was formalized through the document Brasilia Revisitada (Distrito Federal, 1987) and later by the SHTQ Trecho 01 Stage I project (Distrito Federal, 1999) and implementation of projects commercial areas that generated harmful impacts on water, as a gas station (Quadros, 1999). The Scarcity in the DF" (Distrito Federal, 2017a) and the seminar "The Paranoá Lake and the Water Crisis: Urban Planning Challenges for Brasília" (Distrito Federal, 2017a). Scarcity (Distrito Federal, 2018). The MPDFT decision required IBRAM, the body responsible for environmental licensing, to observe the recommendations of other bodies (Distrito Federal, 2017c) and studies produced by working groups with the community. Engagement is organized in defense of the Serrinha do Paranoá hydrographic sub-basins, uniting all regional rural centers through events based on the results obtained by the community and the university presented at CBH Paranaíba DF. The "Water Project" in the Guardians of Springs project with the social technology "Methodology for Community Mapping of Springs in Periurban Environments -MCNPU," which mapped 97 springs outside the official maps (Uldry et al., 2022) represents the period. --- FInal consIderatIons The commitment to the inter and intra-institutional articulation of the social actors connected to the territory of Serrinha do Paranoá represents the social potential capable of contributing to water planning, especially with the proposition of solutions at an institutional level. These are, in theory, the functions developed by a committee of river basins within a radius of operation of the place, in the scales of the hydrographic micro basins of territorial planning, of fundamental importance for the supply of the capital. Studies that seek to relate existing practices and their results are restricted, especially within the scope of the River Basin Committees. Even fewer studies focus on analyzing the contributions and challenges that social engagement has faced in territorial planning for water management. Social engagement initiatives with different forms of agency demonstrate the articulation of a network of actors, especially from organized civil society, mobilized and with ample openness to participatory approaches. These experiences sought to guarantee access and deliberative power in the management and planning process of Serrinha, with strategies that can promote the approximation of decisions and solutions to local problems and the protection and preservation of the entire watershed. In the analytical description of the four phases of the history of social engagement,	v. 23 n. 2 2023 cadernos de pós-graduação em arquitetura e urbanismo ó p s o n r e d a c s C a d e r n o s d e P ó s -G r a d u a ç ã o e m a r q u i t e t u r a e u r b a n i s m o v . 2 3 n . 2 j u l . / d e z . 2 0 2 3 • i s s n 1 8 0 9 -4 1 2 0 http://editorarevistas.mackenzie.br/index.php/cpgau
local government can have a large impact on resource allocation in a community, revealing local suicide patterns could help facilitate targeted preventative efforts for at-risk populations. This study aims to analyze demographic patterns observed in Allen County suicides from 2013 -2022, focusing on age groups and education attainment. Data collection was completed on the 604 individuals who died by suicide in Allen County over the past decade. The collection process included documenting various demographics accessed through death certificates and coroner's files. Within the county, suicide numbers increased over the decade. Results showed that males represented more than a 3:1 ratio of total suicides, a gunshot wound was the method of injury for 53% of all suicides, and decedents with a high school degree or less represented 62% of suicides within the population. These results echo what research has shown at the national level. Additionally, the 20-34 and the 35-54 age groups produced the greatest number of suicides consistently over the 10 years, and these suicides occurred most often in late spring and early summer. Within the 20-34 age group, individuals were more likely to commit suicide by gunshot wound (p = 0.000133). Decedents of minority ethnic and racial groups had lower education attainment compared to non-Hispanic (p = 0.000027) or white (p = 0.003314) individuals. This information could be provided to local schools with the hopes of implementing more targeted preventative measures for at-risk groups. Knowledge of suicide patterns in healthcare could lead to improved care for patients. Finally, public health entities can use these findings to adapt current health initiates to fit the needs of Allen County.	Suicide rates at a national and state level have been on the rise over the past two decades.
Since clinical practice guidelines influence medical care, they are directly tied to the flow of financial resources in healthcare. The World Health Organisation (WHO) examined 190 countries and found global spending on health has continually risen since 2000, and the US has reached more than $8 trillion or 10% of its gross domestic product (GDP). 1 An analysis by the Commonwealth Fund reported that despite the US spending more of its GDP on healthcare than other high income countries, it ranked last in access to care, equitable care, and healthcare outcomes. 2 The disconnect with high financial spending and low quality outcomes is multifactorial, but clinical practice guidelines clearly influence how money is allocated for care. Not surprisingly, clinical practice guideline development is under scrutiny and reports show a lack of diversity among contributors. The first study that broadly examined gender equity among authors was published in 2018 and included more than 450 clinical practice guidelines. 3 Women were significantly underrepresented, particularly women physicians (25%). Most of the clinical practice guidelines were from the US (59%) or UK (37%), and the majority were produced by American specialty societies. Two recent studies examined the inclusion of people from ethnic minority groups, and both found low inclusion, especially for women physicians. 4 5 One study included 237 guidelines with 3696 panel members and found "most guideline panels exclude racialised women." 4 The other study focused on rehabilitation medicine, and my colleagues and I reached similar conclusions-experts from racial and ethnic minority groups were underrepresented, particularly women. 5 A striking example of a clinical practice guideline in our analysis was published by the North American Spine Society (NASS) and focused on low back pain. 6 There were 49 authors of which 94% were identified as men (46 men and 3 women). To put the 6% of women experts in context, it is notable that the US and Canada are North American countries with women physicians in the range of 40% or so. Race and gender analysis revealed 10 Asian men versus 1 Asian woman and 2 Black/African American men versus 0 Black/African American women. No Hispanic/Latino authors were identified. How the diversity of clinical practice guideline panels affects content has not been well studied, but authors exert influence over whether to address topics related to sex as a biologic variable (e.g., pregnancy, menopause), issues related to race and ethnicity, sexual orientation and gender identity and social determinants of health. A report focused on disparities in WHO guidelines stated, "When people from diverse backgrounds-including different genders, cultures, ethnicities, and religions-join forces, they bring with them their own experiential knowledge that enriches discussions and promotes equality." 7 Beyond content, underrepresenting qualified women and people from other marginalised groups is a pattern that contributes to workforce disparities in medicine, because these are prestigious and highly cited publications that may contribute to career opportunities and promotion. --- Some strategies to improve diversity of clinical practice guidelines authors include: Educate leaders of organisations that produce (e.g., professional societies) and publish (e.g., journals) clinical practice guidelines about the need for diversity among authors and other contributors. Implement a process that promotes diversity and track metrics (e.g., participants from underrepresented racial or ethnic minority groups, women chairs, etc). Update authoritative guidance documents that inform clinical practice guideline development and ensure they address issues related to diversity among authors and other contributors (e.g., Clinical Practice Guidelines We Can Trust, Appraisal of Guidelines for Research and Evaluation (AGREE) II). 8 Avoid interorganisational structural discrimination-a problem that my colleagues and I recently described when there is a known structural discrimination issue (i.e., operating in a manner that, regardless of intent, results in discrimination) at one organisation and collaborating organisations ignore it and support the offending organisation. 9 For example, clinical practice guidelines often list "participating" and "contributing" medical societies. How can societies justify lending their name and support to a clinical practice guideline with very few women authors and exceedingly low proportions of individuals identified with racial and ethnic minority groups? Dismantling interorganisational structural discrimination in medicine and science can lead to more ethical practices in a manner similar to how Fair Trade as a social movement has sought to support ethical practices among businesses and supply chains (i.e., discouraging relationships with organisations that engage in disreputable practices such as child labour and unfair wages). People trust organisations that produce, endorse, or publish clinical practice guidelines. Trust comes with the responsibility to ensure the evidence base provides the foundation for the work. Part of the evidence base includes growing documentation of inequities among clinical practice guideline authors, and there is an urgent need to address this in order to ensure diversity among qualified people on any given topic. Going forward, no organisation should be involved in clinical practice guideline development or endorsement and no journal should publish them unless they are knowledgeable about the evidence base regarding clinical practice guideline authors and are able to ensure that a diverse group of qualified contributors were included. Competing interests: none declared. Provenance and peer review: not commissioned, not peer reviewed.	Silver associate professorassociate chair Clinical practice guidelines and other types of guidance documents are among the most important evidence based publications in medicine. Many clinical practice guidelines are disseminated beyond the borders of the country that produced them, and affect access to care, diagnostic work-up, and treatment interventions for billions of people worldwide. This is especially true if they are published or endorsed by influential organisations such as professional societies in the United States, United Kingdom, European Union, and Canada.
INTRODUCTION Poverty is a social reality characterized by underdevelopment of many good things related to social, economic, cultural, political, educational which have a direct effect on the inability of the community, so that being poor especially this phenomenon occurs in coastal communities that are close to the ocean which has a lot of wealth in it. coastal communities where the majority of the population earn a living as fishermen, fish farmers, or water cultivators, which depend on the environment, depending on the season and depending on the market. They also work by exploiting continuously without understanding the boundaries accompanied by destroying the ecosystem. Coastal communities are very dependent on their work as fishermen, but if they have expertise in other fields, it is hoped that there will be a new type of work that capitalizes on the skills they have. There is a lot of potential that can be generated in coastal communities that focus on tourism, culinary, handicrafts which can be used as creative industries as souvenirs, contemporary fashion for beach clothes and many other types of creative businesses that can be developed. Through community training, it is a way to increase the dignity of layers of society who are currently unable to escape poverty and underdevelopment. In other words, empowering the community means providing capacity and empowering the community. Empowerment process that emphasizes the process of giving the community the ability to become empowered, encourages or motivates individuals to have the ability or empowerment to determine their life choices. In this case, empowerment must be aimed at groups or layers of society that are left behind in order to change the destiny of a group of people so that their standard of living is better. --- RESEARCH METHODS In this study, a qualitative research approach will be utilized. Qualitative research methods have a focus on social construction, have unquantifiable variables, have an internal point of view because the researcher is the determining factor, his reasoning tends to focus on the context, research results are used to interpret phenomena, and the contents of the research are explained to comprehend the perspective of sources or actors whose information is sought. (Widana et al., 2022). Particularly in qualitative research, study subjects and objects will become the researchers' focal point in order to answer research questions. In this study, coastal communities are very dependent on their work as fishermen, but if they have expertise in other fields, it is hoped that there will be a new type of work that capitalizes on the skills they have. There is a lot of potential that can be generated in coastal communities in the field of Small Micro Medium Enterprises which can support the economy to be better than before. --- RESULT AND DISCUSSION In general, poverty is synonymous with a low standard of living or can be interpreted as a condition in which people's lives are felt to be lacking in basic needs. Poor people generally don't earn enough, or don't even earn at all. The poor are generally weak in terms of their ability to do business, and have limited access to economic activities, so they are left behind by other communities. Persistence of poverty is chronic or hereditary poverty. Cyclical poverty is poverty that follows the overall economic cycle. Seasonal poverty is seasonal poverty such as the case of fishermen and food crop farmers. Accidental poverty is poverty due to natural disasters or due to the impact of a policy, so that people's welfare decreases. Natural poverty is caused by critical resources, isolated areas, and low quality of human resources. This condition can give birth to persistent poverty. Cultural poverty is caused by lifestyle, living habits, and culture in society. In previous research conducted in the North Coast of Central Java, especially Pemalang and Pati Regencies. In Pemalang Regency, the research was focused on the Ulujami Subdistrict, including Mojo Village, Islamic Boarding School, and Limbangan. In Pati Regency the focus was on Juwana District, Bakaran Kulon Village and Bajomulyo Village in 2016 by Arif Sofianto from the Regional Development Planning Agency, Research and Development of Central Java Province. The respondents of this study were 100 people spread across Pemalang and Pati Regencies. Then one or two sub-districts were taken, and each sub-district was taken as many as two or three villages. Respondents consisted of people from various professional and socio-economic groups. In each village the research unit consisted of three fishermen, three pond cultivators, two fishery/marine product processors, two fisheries-based Micro, Small and Medium Enterprises, two HNSI Representatives, Unit Cooperative Management one person trading traders, one TPI manager, sub-district head, head of village, one person from Bappeda officials, one person from Maritime Service officials, one person from Bapermades officials, one person from Tourism Office officials, one cultural figure, representatives of institutions Non-Governmental Organization as much as one person. The results and discussion of research by Arif Sofianto stated, Coastal communities are known to work harder, focus on jobs that generate income quickly, but also find it easier to spend the income they receive. In job selection, the majority of coastal communities prefer jobs that make money quickly. Most of the respondents stated that in choosing the type of work the consideration was to make money quickly. In Pati Regency, to make money directly selling the catch to baskets, it is not processed into processed products that can be consumed immediately. In Pemalang Regency, they quickly make money by trying to trade dishes/side dishes, fishing for crabs, ngarad, selling fresh fish and the like. Not all coastal communities seek side jobs, some of them do not have side jobs due to various limitations and personal reasons. More than half of the respondents stated that coastal communities have jobs other than in the main sector (ponds, ponds, processing, Micro, Small and Medium Enterprises). Side jobs become important during the lean season. While others do not have a side job because they feel that the main job is sufficient to meet their needs, or because there is no opportunity and ability to create other jobs. Coastal communities, especially fishermen, are closely related to poverty and are even called the poor among the poor. --- Analysis Now the author will discuss based on experience while taking Diploma-IV Shipping Education at STIP Jakarta and is currently still active in alumni forums, which routinely carry In addition, along with the times we can see and feel the increasingly advanced developments in technology. To be able to access or use technology, of course with knowledge and skills. In this case education and skills are the main drivers for human resources. Therefore the government is making efforts to overcome unemployment, one of which is by increasing the quality of the workforce. The ways that can be done to improve the quality of the workforce are by means of training to develop the professionalism of the workforce, besides that by trying internships at work, and a very effective way to improve the quality of the workforce is by improving the quality of community education and also adjusting the talents owned by the community, especially the younger generation, with business, be it through formal education, courses, or others. To obtain other expertise outside the field of shipping, because in previous research most coastal residents do not have side jobs outside of being fishermen and everything related to the sea, it is necessary to carry out a Technical Implementation Unit The vocational package in competency-based training is expected to provide training and coastal residents to gain new skills to make a side job including sewing clothes with machines, servicing automotive motorcycles, computers, Processing of Agricultural Products as many as 2 classes and embroidering apparel. Each class was attended by 16 people so that the total for 6 classes reached 96 participants with 240 lesson hours or 30 days. With the skills they already have, it is hoped that participants will be able to foster an independent entrepreneurial spirit as well as the realization of quality human resources who are skilled, competent and productive in their respective vocational fields who meet the requirements to fill operator positions in companies/business world. According to the Law of the Republic of Indonesia Number 13 of 2003 which describes Employment, job training is an activity carried out to improve the work competence, attitude and work ethic of trainees on a particular skill in accordance with the qualifications of the job occupied. --- Mind Map In this case the Vocational Training Center is an infrastructure that motivates or provides motivation. From this, motivation in the Big Indonesian Dictionary is defined as an impulse that can cause a person or certain group of people to be moved to do something because they want to achieve the goals they want or get satisfaction with their actions. Work motivation according to (Kartika & Kaihatu, 2010): work motivation is a stimulus from superiors or coworkers to someone to carry out activities or complete work sincerely and do it in the best way. Job training as part of fostering and empowering work skills for the community, especially the younger generation, is expected that the output of job training is able to contribute, especially in increasing work motivation and creating job opportunities (entrepreneurship). In this case, it is an effort to fulfill sustainable basic needs which can generate income and also save expenses. In its application, the author has carried out competency-based training organized by UPT BLK Mojokerto, a young graphic design training program. This program is very well felt by the author because he got new skills in the field of digital information technology. This training is free and free of charge and get food and pocket money after the training. The author gets a new experience which he feels can be used as a skill in a digital-based side business and is very suitable for young people who are still productive. In the lessons at the Vocational Training Center, they are also taught to make finished products from designs such as tumblers, glasses and clothing designs, which can make selling points in the maritime tourism industry. This is very good if applied to coastal communities so that they get new skills and can be entrepreneurs while at the same time developing other potentials that generate money to improve their standard of living such as in the fields of tourism, arts, culinary, etc. --- CONCLUSION Training activities through Community Empowerment Training are expected to help coastal communities to increase their capacity, both skills, capital and can improve their standard of living and provide new jobs outside of being fishermen. This is because the fishing business is very much determined by the climate or weather for production. In addition, fishing businesses with mentoring capital do not need adequate business facilities, it is enough just how fishermen can increase production, with assistance fishermen obtain production facilities/equipment and methods of processing production results. Therefore poverty alleviation targeting fishermen/farmers is not enough with economic empowerment. The training can be attended by all levels of economically backward coastal communities, and it is hoped that this program can be evenly distributed throughout every coastal area. The role of youth and coastal community leaders must be at the forefront as the importance of education and training to improve living standards. Of course, the government's role is also needed in a focused way to care about this problem and the government needs to fully support training programs so that coastal communities can improve their standard of living through community empowerment training and education.	Coastal communities in most parts of Indonesia are one of the poorest community groups. Coastal villages where the majority of the population earn a living as fishermen, fish farmers, or water cultivators, fishing culture has a major influence on the formation of the cultural identity of coastal communities as a whole. Efforts to reduce poverty in Indonesian society, especially in coastal areas, are carried out with a community empowerment education and training approach through government programs that provide skills training which will later be useful for a new job outside of being a fisherman. This type of research is descriptive qualitative. This study aims to address poverty alleviation in coastal communities according to the characteristics and needs of the community. It is hoped that the community can be creative and innovative in finding jobs outside of their work as fishermen and the like.
Having pain or elevated depressive symptoms only was not significantly associated with mortality. Social support was not a significant effect modifier. Our findings highlight the importance of screening for pain and elevated depressive symptoms among older Mexican Americans. --- SESSION 7610 (POSTER) --- SOCIAL CONNECTEDNESS AND ISOLATION Abstract citation ID: igad104.2719 --- ACTIVE USE OF ONLINE COMMUNITY REDUCES LONELINESS AMONG OLDER ADULTS THROUGH WEAK TIES FORMATION Nahyun Kim, and Keiko Katagiri, Kobe University, Kobe, Hyogo, Japan Online communities could aid older adults in expanding their social connections and developing weak ties, which may help alleviate their loneliness. However, research investigating the impact of online community participation on the formation of weak ties among older adults remains lacking. This study aimed to investigate 1) the relationship between active use of an online community designed for older adults and the formation of weak ties within the platform, and 2) the potential for these weak ties to alleviate loneliness among members. The online community platform for older adults allowed users to post diary entries and photos, join interest-based communities, and organize virtual and in-person events. An online survey was conducted among members aged 60 to 79 years (N=862). The survey measured active use, weak ties (measured by the number of mutual followers), and loneliness. Path analysis showed that active engagement in the online community was positively associated with the formation of weak ties, which, in turn, were negatively associated with loneliness. Thus, older adults who frequently posted own content and participated in community activities were more likely to form many weak ties in the platform, and these weak ties may help reduce their loneliness. However, this study only examined online community use, meaning that further research is needed to explore the relationship between general social networking services use and weak ties, as well as examine the context of the passive use of these services. Abstract citation ID: igad104.2720 --- ASSOCIATION OF EVERYDAY LIFE INFORMATION ACQUISITION METHODS AND DEPRESSION AMONG US OLDER ADULTS Wuyi Dong, Yan-Jhu Su, and Andrew Alberth, University of Massachusetts Boston, Boston, Massachusetts, United States Everyday life information acquisition refers to the incidental ways people obtain information through daily activities such as reading, watching television, or communicating with friends rather than through intentional or purposive information seeking behaviors. It has been identified as a fundamental way to obtain informational resources and is a potential means to promote social connections and engagement among older adults. Research has shown that social engagement and connections are protective factors of depression for older adults. However, little research has explored how information seeking behaviors effect risks of depression among older adults. To fill this gap in the literature and provide insights into the mechanism of information access impacts the mental health of older adults, this study examines the relationships between different ways for obtaining daily information (reading, using computer, and watching television) and depression among older adults in United States. The data retrieved from 2018's Health and Retirement Study (HRS). We multiple linear regression analyses on HRS data including adults age 50 years and older (n=3,179). After adjusting for age, gender, race, marital status, education, and chronic diseases, all three different ways to obtaining daily information (reading, using computer, and watching television) were negatively associated with depression (β=-0.19, p< 0.001; β=-0.15, p=0.002; β=-0.15, p< 0.001, respectively). Findings suggest that the association between everyday life information acquisition and depression among older adults varies depending on the specific information acquisition methods used. These findings highlight the importance of implementing targeted interventions to promote effective information access and enhance social inclusion among older adults. Social isolation and loneliness among older adults correspond with numerous mental and physical health consequences including but not limited to depression, anxiety, declines in cognitive functioning, and poor health behaviors. More recent research highlights the potential benefits of digital-social communication technology through social networking sites (SNS), communicative technology, and computer or tablet use (Khosravi et al. 2016;Jutai and Tuazon 2022;Neil-Sztramko et al. 2020). However, the efficacy of technology on mental and physical well-being remains obscure, particularly given the often interchangeability of isolation and loneliness concepts. In this research, we examine the extent to which conditions of isolation and feelings of loneliness correspond with depression among older adults. Using data from two waves of Health and Retirement Study (HRS) data in 2018 and 2020 (N = 8,994), we conduct a series of linear regressions of depression scales on both isolation and loneliness as well as their interaction with the use of social technology in communication. Preliminary results suggest that that the use of virtual communications by social networking sites (SNS) moderates the associations between isolation and depression levels, but no such effect is observed in terms of self-perception of loneliness. Moreover, the magnitude of SNS-Isolation and depression linkages differs significantly for family and friends. This research contributes to the growing body of literature on the intersection of technology and psychological well-being among isolated older adults, highlighting the both the potential benefits and limitations of virtual communication for improving health outcomes in older adults. Abstract citation ID: igad104.2722 --- EFFECTIVENESS OF TELEDELIVERED BEHAVIORAL ACTIVATION AND MINDFULNESS INTERVENTIONS IN REDUCING LONELINESS Da Jiang 1 , Dannii Yeung 2 , Namkee Choi 3 , Rainbow Tin Hung Ho 4 , Jojo Yan Yan Kwok 4 , Youqiang Song 4 , Lisa M. Warner 5 , and Kee Lee Chou 1 , 1. Education University of Hong Kong, Hong Kong, Hong Kong, 2. City University of Hong Kong, Kowloon Tong, Hong Kong, 3. University of Texas, Austin, Texas, United States, 4. The University of Hong Kong,Hong Kong,Hong Kong,5. MSB Medical School Berlin,Berlin,Germany Loneliness is one of the most prevalent mental health problems in older adults, especially among those who live alone and are digitally excluded. The phenomenon has become more conspicuous during the COVID-19 pandemic because of the constraints on physical contact and travel. In this three-armed randomized controlled trial, we examined the effectiveness of two telephone-delivered loneliness interventions (i.e., behavioral activation [Tele-BA], mindfulness [Tele-MF]) against a telephone-delivered active control group (i.e., befriending [Tele-BF]) in reducing loneliness, based on the behavioral theory of depression and monitor acceptance theory. We trained retirees as lay counselors to deliver the interventions to enhance the scalability and sustainability of the interventions. Older adults who lived alone and under the poverty line in Hong Kong, did not have Internet at home, and felt lonely were randomly assigned to one of the three groups (N = 1045, Mage = 76.59, SDage = 7.83, 78% female). Participants in each group received two 30-minute weekly intervention sessions for four weeks. They completed assessments at the baseline (T1), four weeks (T2) and six months (T3) following the intervention, respectively. Compared with their counterparts in the Tele-BF group, participants in the Tele-BA and Tele-MF groups reported lower levels of loneliness and perceived stress and higher levels of psychological well-being and perceived social support at T2 and T3. These findings provide scientific understandings on the effectiveness of Tele-BA and Tele-MF interventions for reducing loneliness among older adults in Hong Kong, and demonstrate the feasibility of conducting lay counselordelivered telephone-based interventions for older adults. Abstract citation ID: igad104.2723 --- EMOTIONAL CLOSENESS, SOCIAL NETWORK, NEGATIVE AND POSITIVE AFFECTS, AND AGITATION IN OLDER ADULTS WITH DEMENTIA Mohammad Rababa, Jordan University Of Science And Technology, Irbid, Irbid, Jordan Background: If given a choice, people with dementia (PWD) would prefer to live in their homes instead of nursing homes. Living in older adults' own houses would positively impact their quality of life and be associated with more privacy, security, and social support. In addition, living in a nursing home is not culturally and religiously accepted, especially in a religious and conservative country like Jordan. However, with increased financial obligations and hardships in Jordan, women are forced to work outsides their houses. Therefore, PWD stay alone in their homes without care or attention. This neglect would put PWD at significant risk for adverse physical and psychosocial health consequences.	Pain and depression are common among older Hispanic adults and their combined effects may increase mortality. We examined the joint effects of pain and depressive symptoms on mortality. We used data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2010-2016), which included Mexican Americans aged 80 and older in the Southwestern US. Participants were categorized into four groups based on self-reported pain on weight-bearing and depressive symptoms: no pain or elevated depressive symptoms, pain only, elevated depressive symptoms only, or both pain and elevated depressive symptoms. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale. A score of 16 or more was considered elevated depressive symptoms. Cox proportional hazards models were used to estimate the joint relationship of pain and depressive symptoms with mortality. We examined social support as a potential effect modifier. At baseline, 35.9% reported pain only, 8.6% of participants reported elevated depressive symptoms only, and 16.9% reported pain and elevated depressive symptoms (n=836). Over 6 years of follow-up, 46.2% of the sample died. Those with pain and elevated depressive symptoms had 1.41 times the risk of mortality compared to those without pain or elevated depressive symptoms (95% confidence interval: 1.05, 1.09).
and risky. Laws and ethics in a virtualized world are not yet defined. Moreover, privacy must be redefined, and trustability might become a strong issue. In the context of the 18th EPIA Conference on Artificial Intelligence, we have promoted a journal special issue for papers describing recent advances in AI, mostly based on computational models for social and technical interactions. The call for papers referred: This journal issue invites high-quality submissions that present original work in the areas of computational models for understanding, modeling, and facilitating social interaction between people, organizations and systems. Topics covering intelligent socio-technical systems, adaptive and social-aware intelligent systems, evolving social systems, adaptive and reactive intelligent systems, governance mechanisms, organizational learning, social media analysis, social network analysis, social robotics, smart cities, V2V, etc., are welcome. We received 26 submissions. After a careful and demanding reviewing process, six papers have been selected. All accepted papers have been presented at the 18th EPIA Conference on Artificial Intelligence, held in Porto, 5th-8th September 2017. Three papers analyze social media data. The paper, TexRep: A Text Mining Framework for Online Reputation Monitoring by Pedro Saleiro, Eduarda Mendes Rodrigues, Carlos Soares, and Euge ´nio Oliveira, uses unstructured text data from different Web sources for online reputation monitoring. The system collects texts from online media, such as Twitter, and identifies entities of interest and classifies sentiment polarity and intensity. The framework supports multiple data aggregation methods, as well as visualization and modeling techniques that can be used for both descriptive analytics, such as analyze how political polls evolve over time, and predictive analytics, such as predict elections. The paper, Predicting the Relevance of Social Media Posts Based on Linguistic Features and Journalistic Criteria by Hugo Gonc ¸alo Oliveira, Alexandre Pinto, A ´lvaro Figueira, and Ana Alves, focuses on the automatic classification of public social text according to its potential relevance, from a journalistic point of view. Authors select a set of posts with several criteria, including the journalistic relevance, assessed by human judges. Using natural language processing tools, the system extracts linguistic features used to learn a classifier. The classifier is used to predict the journalistic relevance of query posts. The paper, A Framework for Recommendation of Highly Popular News Lacking Social Feedback by Nuno Moniz, Luı ´s Torgo, Magdalini Eirinaki, and Paula Branco, studies the task of predicting news popularity upon their publication, when social feedback is unavailable or scarce. Unlike previous work, authors focus on accurately predicting highly popular news. Such cases are rare, causing known issues for standard prediction models and evaluation metrics. To overcome such issues they propose the use of resampling strategies to bias learners towards these rare cases of highly popular news, and a utility-based framework for evaluating their performance. The other three papers deal with complex data, from videos and sound to highspeed data streams. The paper, Tensor Based Shot Boundary Detection in Video Streams by Boguslaw Cyganek and Michal Wozniak, presents a method for content change detection of multi-dimensional video signals. Video frames are represented as tensors of order consistent with signal dimensions. The paper, Automatic Classification of Impact Sounds with Rejection of Unknown Samples by Joaquim Ferreira da Silva, Sofia Cavaco, and Gabriel Pereira Lopes, presents a method to automatically select the features to be used in discriminating sounds. Given an initial large set of features, the method measures their discriminative power and builds a reduced set of new features which discriminates the sound classes very accurately. This feature selection method is part of the learning phase of a supervised classification approach also proposed here. The paper, WCDS: A Two-Phase Weightless Neural System for Data Stream Clustering by Douglas O. Cardoso, Felipe M. G. Franc ¸a, and Joa ˜o Gama, presents WCDS, an approach for data streams clustering based on the WiSARD artificial neural network model. This model satisfies all the strict constrains of the data streams computational model. The system presents novel characteristics such as the ability to cluster unbalance data, and new mechanisms to discard outdated data. This special issue would not have been possible without the help of many people. In particular, we would like to thank the referees for their hard work and timely reviewing of the papers submitted to the special issue. Euge ´nio Oliveira is Full Professor at the University of Porto (FEUP) and ex-Director of LIACC-Artificial Intelligence and Computer Science Lab at the same University. He is also Director of the Doctoral Program in Informatics Engineering. He was the Event co-chair of the 18th EPIA-Artificial Intelligence Conference. He got his PhD at UNL in Informatics (Artificial Intelligence) (84) and went to IBM/IEC, La Hulpe, as Guest Academic (84-85). He also was research engineer at BBC, near Zurich, in the 1970s. He was awarded the Gulbenkian Prize for Science and Technology in 1984 (ex-aequo). He successfully supervised more than 20 PhDs and has more than 200 indexed publications (no. of citations=4224, Hindex=30, i10 index=109). He is co-author of the book ''A New Approach for Disruption Management in Airline Operations Control'', Springer Verlag. He is or was member of the Editorial Board of prestigious journals like ''Autonomous Agents and Multi-Agent Systems'', Springer. He was a visitant professor at several universities and schools in Nice, QM-U. London, Utrecht, Madrid, Grenoble, Saint Etie ´nne, Barcelona. He was project reviewer for the French ''Agence Nationale de Recherche'', the Spanish ''Ministe ´rio de Ciencia e Innovacio ´n'' and the Portuguese ''Fundac ¸a ˜o para a Cie ˆncia e Tecnologia''. His main research interests are on Distributed Artificial Intelligence, Multi-agent Systems and Text Mining. University of Porto. He is a member of the directive board of the Portuguese Association for Artificial Intelligence (APPIA). He coordinates the Argumentation Hub (ARGH), a multidisciplinary and collaborative lab on the topic of Argumentation, within the Media Innovation Labs (UPorto). He is a member of the Follow-up Committee of the Doctoral Program on Informatics Engineering (ProDEI), and a member of the Informatics Department Council. His main research interests are related with Artificial Intelligence, Multi-Agent Systems (MAS), social aspects in MAS (norms, computational trust, incentives, and argumentation), multi-agent systems exploring social coordination (negotiation, cooperation), tools for programing MAS and for simulating agent-based systems, machine learning and text/argumentation mining. He is co-Program Chair of the 18th EPIA Conference on Artificial Intelligence (EPIA 2017). He has participated in several program committees of international conferences and workshops, and has been involved in European research networks (e.g. Agreement Technologies, SINTELNET) and in several research projects (both national and European). --- Henrique Lopes	Artificial intelligence promises to revolutionize our lives, changing the way how we work, think and live. We are witnesses of driverless cars, computer-based diagnose systems, office automatization, industry virtualization, etc. We interact with algorithms for decision support in our daily activities. Typically, these systems used to act in silence. Nowadays, they came to the front pages: DeepBlue won against Kasparov, AlphaGo won the Go world champion, there are robots in Mars, IBM Watson won Jeopardy!, and we are witnessing significant advances in areas such as voice recognition, face recognition, and automatic translation. Over the last years, a new world of small and heterogeneous devices (mobile phones, PDA, GPS devices, intelligent meters, etc.) have emerged. They are equipped with limited computational and communication power, and have the ability to sense, to communicate and to interact over some communication infrastructure. These large scale distributed systems have in many cases to interact in real-time. This is the advent of virtualized worlds that are the basis of Industry 4.0. All these scientific developments make us perceive the world as faster and smaller. We have access, in our hands, to real-time and personalized information available 24 h/day, 7 days/week. There are plenty of innovation opportunities. Nevertheless, there are also weakness points. The world became much more chaotic & Joa ˜o Gama
INTRODUCTION Vaccination against COVID-19 is one of the key and lifesaving preventive measures against the COVID-19 Pandemic in protecting public health from the corona virus disease (COVID19), leading to a decrease in the mortality and morbidity of infectious disease which save millions of lives annually [1]. Due to the continued transmission of corona virus disease (COVID 19) and lack of effective measures such as pharmacological measures against virus infection and disease, vaccination became a major way to prevent corona virus disease (COVID 19). However, vaccines were produced more in response to pandemic. In Tanzania little was known toward acceptability of Corona virus disease vaccination due to spread of fake news and misinformation and change in perception of disease risk [2]. Furthermore, some studies had shown that there is problem in accepting the COVID 19 vaccine, and we decided to find out what demographic factors affect the acceptability of COVID 19 vaccination programme among community members [3]. Previous empirical studies have evidence that older people, and female were more at risk of COVID 19 pandemic due to vaccine refusal [4,5,6] maintained teachers, health care workers, and students) were more hesitant about vaccination. In this study, healthcare workers (HCWs) were averse to get COVID-19 vaccine. Konje et al., [7] Amour et al., [8] found that uptake of the COVID-19 vaccine among health professionals was low, with less than a quarter being vaccinated across all surveyed districts in western Tanzania. However, demographic factors had been shown to be factor affecting acceptability for COVID 19 vaccination among community members. This study focused to examine how demographic factors affect the acceptability of the COVID 19 vaccination among community members using the Health Belief Model of Jones [9] In his Model, the author advocates that the model key elements focus on individual beliefs about health conditions, which predict individual health related behaviors. In spite of the evidence that demographic factors had effect on acceptability of COVID19 vaccination among community members, some of the empirical evidence had found employment status does not seem to affect a person to accept the vaccine against COVID-19 [10,11]. Looking at age for example, there are studies that observe no significant effect of age on COVID-19 vaccination acceptability [12] or that younger people are more acceptance to get vaccine than older people [10]. Most research, however, points towards a larger vaccination acceptance for COVID-19 among older generations [13,14] Cascini et al., 2021; Kessels et al., [15] Wang, Q. et al., [11] as they are generally more afraid of severe health consequences in case of infection and have previously experienced other successful vaccination campaigns. In terms of education, the findings are just as mixed. In their review of vaccination acceptability on Education level Solís Arce et al. [16] found that less-educated participants were more acceptable to get vaccine in most studies covering Sub-Saharan Africa. Nevertheless, On top of that, higher levels of education are positively correlated with vaccination acceptance in adults in the United States [17]. Therefore, we filled this gap by answering the research question that; how do demographic factors affect the acceptance of COVID-19 vaccines. --- LITERATURE REVIEW From the empirical review, studies had found that older people (38 and above) were more likely to accept vaccination than people with lower aged below 35, they were not likely to accept COVID 19 vaccination, believe that COVID-19 poses a less serious threat to themselves than to other age groups (Elhadi et al., [18] Yosor et al., [3] Tayyaba, et al., [19] Lazarus et al., [20]. According to sex, literatures showed that male were more in acceptability of COVID 19 vaccination than female in different places [2,21.22] conducted study on Socio demographic factors associated with acceptance of COVID-19 vaccine and clinical trials in Uganda: a crosssectional study in western Uganda, founded those Male respondents also showed more interest in receiving the vaccine than the females This was also a possible indicator of fear for the vaccination among the female gender. Nurul et al., [23] in Malaysia, found that, people with low education levels, low income and not living with high-risk groups were relatively having poor perception on COVID 19 vaccination; hence it greatly affected the acceptance of Covid-19 jabs. Lower educational level increased the likelihood of vaccine hesitancy [20]. Vaccine acceptance rates were the lowest among employees, such as health professionals Steward et al., [24] on Prevalence and factors associated with COVID-19 vaccine acceptance in Zambia: a web-based cross-sectional study, found that entrepreneurs were more likely to accept the COVID-19 vaccine than those government employees. Evidence has shown that employees are likely to receive a COVID-19 vaccine if their employer recommended it [20]. --- MATERIALS AND METHODS The study was carried out in Iringa Municipality, adopted mixed methods approach. This made it simple to determine factors that had affected the acceptability of COVID 19 vaccination in the current study. Quantitative approach was used to allow a researcher to collect statistical data for research question on how demographic factors affect the acceptability of COVID 19 vaccination. To obtain the statistical data, the author administered a structured survey to Community members in Iringa Municipality. The study used a sample size of 120 respondents, including vaccinated, non vaccinated, key informants and respondents for focus group discussion. Simple random sampling was used to draw valid sample of 54 non-vaccinated, where every subject of the population has an equal chance of being selected for the study and the researcher decides to choose this technique because it includes the whole population without bias and allows researchers to easily collect data, snow ball for 54 vaccinated respondents from the population who were community members, purposively sampling for 2 key informants from health facilities and 10 respondents for Focus group Discussion from the entire population. Data were collected through questionnaires and interviews, and analysed through descriptive statistics. Ethical issues were ensured through participants consent form, integrity and anonymity. All collected information was kept confidential and were used only for the intended objective of the study. The interpretation of this results is elaborated as follows. --- RESULTS AND DISCUSSION --- Age The respondents' ages ranged from 18 to 58+ with average years of 38 years. The ages were put into five groups, 18-27 years, 28-37 years, 38-47 years, 48-57 years and aged 58 and above. The distribution is presented in Table 1. The categorization showed that aged between 48-57 years was the prominent group of accepting COVID 19 vaccine, representing 24.1% of all the respondents in the Vaccinated group. This implied that most respondents belonging to this group (48-57) was most of them had high risk of getting Corona Virus Disease. While for the non-vaccinated respondents, the greater number of the respondents in this category was 18-37 years, representing 46.3 % of all the respondents in the non-Vaccinated. They were not influenced to accept COVID 19 vaccine because of some reasons such as their body had enough immunity which can help them to be safe and some of them, they had fear that COVID 19 vaccine can cause side effect to them. It was supported during the interview by doctor in charge for Sabasaba dispensary "People with more than 38years are more accepting to be vaccinated compare to other age groups, because they have high risk of getting Corona Virus disease". During Focus group discussion, community members said people aged more than 40 years had more acceptability towards COVID 19 vaccine as they had fear of being affected with corona virus disease because of the different information they get from different sources of information that COVID 19 is so dangerous. And of those who were not vaccinated, most of the youth, did not accept vaccine because they get misinformation about COVID 19 vaccine that said vaccine is not cure for them but it has side effect such as it destroys reproductive system. Thus, they felt that the COVID-19 vaccines had potential adverse effects. The fear of potential adverse effects has been reported to be one of the major reasons leading to vaccine hesitancy [20,25] in individuals aged 41-50 years who were willing to receive the vaccine [18]. --- Sex The findings on sex status showed that 59.3% of the respondents were males who accept to take COVID 19 vaccine and for non-Vaccinated 64.8% were female who did not accept to be vaccinated. This showed that the Vaccine acceptance was higher among men compared to women. The low number of females who accept the COVID 19 vaccine was probably due to the fact that males are more affected with COVID 19 pandemic than women. During the interview by doctor in charge for Saba saba dispensary "Vaccine acceptance was higher among men compared to women this is due to the fact that during COVID 19 pandemic, male was more affected with this pandemic which cause many deaths to them so they had more influenced with COVID 19 vaccine". From focus group discussion with community members the following responses were tapped; male was too mobile as they interact with the general population more often than female; females mentioned the use of other vaccines and medicines has limited their acceptance of other medicinal treatment. The findings of this study are similar with the report from reviewed literatures. Nery et al., [21] Tayyaba, et al. [19] Echoru et al., (2021) also reported that Vaccine acceptance was higher among men compared to women. --- Level of Education Concerning level of education, the study revealed that 38.9% and 48.1% had primary and secondary level of education respectively had more acceptance on COVID 19 vaccine compared with other levels. Higher level of education acceptability of COVID19 vaccine was low for respondents who were vaccinated. This implies that COVID 19 vaccine acceptability was not determined by the level of education. For those who were not vaccinated, 29.6% of the respondents had Diploma level of education and uneducated were 18% The data revealed that majority of vaccinated respondents had primary and secondary level of education, this is due to the fact that, many of the community members had primary and secondary level of education in recommended it [20,24] found that entrepreneurs were more likely to accept the COVID-19 vaccine than those employees [26]. --- CONCLUSION COVID-19 vaccines acceptability was higher in the general population particularly in elderly people, males, people with less education and Entrepreneurs. In fact, administering vaccines has a big influence on the success of handling the Covid-19 pandemic. There is a need to make an effective vaccine education program on radio, television, print, and social media to increase knowledge about vaccination to all people in a community, so that Tanzania can achieve immunization targets against COVID-19 among community members and it is necessary to carry out further studies regarding the effect of these factors in receiving the Covid-19 vaccine. --- CONSENT As per international standard or university standard, Participants' written consent has been collected and preserved by the author(s). --- ETHICAL APPROVAL As per international standard or university standard written ethical approval has been collected and preserved by the author(s). --- COMPETING INTERESTS Authors have declared that no competing interests exist.	COVID 19 vaccination was fast key intervention against the COVID-19 pandemic. Vaccine acceptance among community members is essential to promote uptake. This study, aimed to examine how demographic factors affected accessibility of COVID 19 vaccination in Tanzania among community members. The study was mixed method research approach in nature where cross section research design was used to capture data at one time. The study employed a sample size of 120 respondents, including vaccinated, non vaccinated, key informants and respondents for focus group discussion from three wards in Iringa Municipality 0n June to July 2022. Simple random sampling was used to select 54 non vaccinated and 10 respondents for focus group discussion,

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