The BMI z-score was positively correlated with maternal BMI, paternal BMI, and maternal pregnancy weight gain, r = 0.24 p < 0.01; r = 0.16 p < 0.01; r = 0.12 p < 0.05, respectively. A decrease in overweight and obesity prevalence over the past decade and higher median values of BMI z-scores in the group of children with excessive weight in 2017 were observed. Birth weight, maternal BMI, paternal BMI, and maternal pregnancy weight gain all correlate positively with a child’s BMI z-score.The aim of this study was to assess ten-year differences in nutritional statuses and obesity prevalences between populations of preschool children from Katowice, Poland, examined in 2007 and 2017, and to determine factors associated with overweight and obesity in preschool children. A cross-sectional questionnaire was conducted among parents and legal guardians of 276 preschool children in 2007 and 259 preschool children in 2017. Basic anthropometric measurements were performed. Overall, the prevalence of overweight and obesity among our sample of Polish preschool children (median age 5.25 year) was 16.82%, whereas 4.49% of children were obese. No significant differences in the number of overweight and obese children were observed when comparing the years 2017 to 2007. Overall body mass index (BMI) z-score was significantly lower in this group of children from 2017. However, median values of the BMI z-score were higher in two of the weight categories (overweight and obesity) in 2017. The child’s BMI z-score was positively correlated with birth weight (r = 0.1,  According to World Health Organization (WHO), in the year 2019, approximately 38.2 million children below the age of five were overweight or obese [Obesity in children leads to a wide variety of comorbid conditions and complications. Childhood obesity is linked to various metabolic complications, including dyslipidemia, decreased insulin sensitivity, increased circulating insulin levels, glucose intolerance, type 2 diabetes mellitus, and metabolic syndrome . SeveralThere are various factors linked to the occurrence of childhood obesity; however, the role of some of them is still unclear. Although the vast majority of childhood obesity cases are exogenous, a small proportion may have endogenous causes  . ParentaA wide range of factors associated with childhood obesity were identified, including maternal, paternal, gestational, and postnatal factors  . Both maRecent studies suggest that in children with obesity, most of their excess weight is gained in their first 5 years of age . TherefoRegarding the rapid rise in prevalence of obesity in preschool children, its association with severe comorbidities, obesity in adulthood, and the lack of consistent data regarding factors leading to childhood obesity, further research on this topic is required. Regarding the lack of studies assessing 10-year differences in preschool children’s nutritional status, we have identified a research gap. The aim of this study was to assess the differences in nutritional status and obesity prevalence that occurred between populations of preschool children from Katowice, Poland, examined in 2007 and 2017, and to determine maternal, paternal, gestational, and infantile factors associated with overweight and obesity in preschool children.The study was conducted using data from a cross-sectional questionnaire conducted among parents and legal guardians of children attending preschool in Katowice, Poland, in the years 2007 (g-2007) and 2017 (g-2017). Basic anthropometric measurements were performed in both groups (g-2007 and g-2017).All of the preschools located in Katowice, Poland, in 2007 were invited to participate in our study. The management of 11 preschools in Katowice, Poland, agreed to take part in the study. Invitations regarding participation in the study were sent to all of the parents/legal guardians of children from 11 preschools. The questionnaire was handed over to the parents/legal guardians of the children who agreed to be involved in the study. Afterwards, written consent concerning anthropometric measurements was sent to all of the parents/legal guardians. Anthropometric measurements were performed after receiving informed consent from the parents/legal guardians. The same 11 preschools from Katowice, Poland, were included in our study in 2017. Therefore, the children who were recruited were from the same neighborhoods and had similar socioeconomic backgrounds.The questionnaire was divided into 10 parts concerning: general questions regarding children and parents; pregnancy and infancy; kindergarten; eating habits; physical activity and play; screen time; family habits of buying food; eating habits of the family; social life; and health. However, the aim of this study was to evaluate parts of the questionnaire regarding general questions, such as those about pregnancy, infancy, and kindergarten. The questionnaire was performed twice: in 2007 (g-2007) and in 2017 (g-2017). The study group consisted of 535 children: 276 (g-2007) and 259 (g-2017). The median age in the g-2007 was 5.25  years, and in the g-2017, it was 5.5  years.2). BMI was converted to age- and sex-specific z-scores using WHO AnthroPlus, which is the global application of the WHO Reference [Weight was measured in light clothes and without shoes to the nearest 0.1 kg with an electronic scale, and height was measured barefoot to the nearest 0.1 cm using a wall-mounted stadiometer. BMI was defined as weight divided by height squared . Furthermore, for every variable, the probability density function was estimated. It was carried out separately for the years 2007 and 2017.The analysis of relationships between qualitative variables was performed using the chi-square test. For verification of relationships between qualitative and quantitative variables, analysis of variance (ANOVA) was performed. Assumptions of ANOVA were verified with the use of Levene’s test (homogeneity of variances) and the Shapiro-Wilk test . If assumptions were fulfilled, then classical ANOVA analysis was conducted, and the Tukey Honest Significant Differences test was used for testing the significance of differences between average values of a quantitative variable calculated for groups corresponding to particular values of a qualitative variable. If the assumptions of ANOVA were not fulfilled, then the Kruskal-Wallis rank sum test was used for verification of the significance of the relationship between variables and Dunn’s test—for testing the significance of differences between average values of a given quantitative variable in every pair of groups. p value of <0.05 was considered statistically significant. The analysis was conducted with the use of Microsoft Excel and the R computing system. To compare the distribution of a quantitative variable across two groups, the Kolmogorov-Smirnov test was performed. Since the majority of data were not normally distributed, quantitative data were described as medians and interquartile ranges (IQR). A The study was conducted on a sample of 535 preschool children, of whom 49.72% were girls. The median age of the preschool child was 5.25  years. n = 90) of the study group was overweight or obese, of which 44.44% (n = 40) were girls. A statistically significant difference between groups from 2007 and 2017 in terms of BMI z-score was observed; BMI z-score was significantly lower in 2017 than in 2007  (see The number of children in each weight category was presented in ely) see .There were no significant differences in the number of overweight and obese children between 2017 and 2007. However, visible trends included a decrease in overweight and obesity prevalence over the past decade . The medp < 0.001). With regard to the normal weight group, values of the BMI z-score were significantly lower in 2017, indicating improvement in nutritional status in this weight category , median BMI z-score values were lower in 2017, but the difference was statistically significant only in the normal weight group , probably due to the low number of children in the excessive weight group. However, differences in parental education between children with normal weight and overweight/obese children were not statistically significant , 16.82% were overweight/obese, and 4.49% were obese. A significant difference in the median BMI z-score from 2007 to 2017 was observed. The median BMI z-score was significantly lower in 2017. The median values of the BMI z-score were higher in two of the weight categories (overweight and obesity) in 2017. The occurrence of extreme values of the BMI z-score in a group of children with obesity in 2017 was observed. In the normal weight category, median BMI z-score values were significantly lower in 2017. There were no significant differences in the number of overweight and obese children between 2017 and 2007. However, visible trends included a decrease in overweight and obesity prevalence. Differences in terms of parental age between populations examined in 2007 and 2017 were observed. The BMI z-score was positively correlated with maternal BMI, maternal pregnancy weight gain, paternal BMI, and birth weight. However, it must be noted that the correlations were weak.The prevalence of overweight and obesity in our study is consistent with previous studies regarding preschool children. In one study estimating the global prevalence of overweight and obesity among preschool children from 1990–2010 and projecting its prevalence in 2015 and 2020, in 2010, 11.7% of children from developed countries were overweight/obese, and the projected number of children with excessive weight in developed countries in 2015 and 2020 was 12.9% and 14.1%, respectively . In a crOverall, the BMI z-score was significantly lower in a group of children in 2017; however, among the children with overweight and obesity, the BMI z-scores were higher in 2017 than in 2007. Moreover, from the overview of In our study, the medians of maternal and paternal age among preschool children were significantly higher in 2017 than in 2007. The differences can be justified by the fact that in the developed world, the average age at which people have children is increasing rapidly .p < 0.05) to have excessive weight than children whose mother’s weight was stable or had gained weight [The results of our study regarding the association between child BMI z-score and birth weight match previous studies. In a study by Olson et al., infant birth weight was positively associated with a higher risk of obesity in children aged 4 . Accordid weight . The resd weight . This std weight ,38.Developmental factors predisposing to overweight and obesity at age 5 include the mother’s preconceptional BMI, mothers smoking 1–12 cigarettes/day during the 1st trimester, a smaller number of children at home, the child’s high birth weight, the female sex of the child, the pattern of early growth, and nutrition ,40. ObesThis study has several limitations that warrant consideration. First, the sample does not represent the entire population of Poland since it only includes respondents from one city. Second, there is a lack of data regarding response rate.Nevertheless, despite these limitations, this study provides data regarding ten-year differences in nutritional status and obesity prevalence between years 2007 and 2017 and results regarding risk factors for overweight/obesity in preschool-aged children. The results of our study might be useful for public health in terms of implementation of prevention and treatment programs among preschool children. Moreover, results could be used to identify vulnerable subgroups of children and implement prevention programs in order to avoid the occurrence of obesity and its comorbid conditions in children and therefore prevent adverse health outcomes associated with obesity in adulthood.Further studies regarding nutritional status among preschool children should be conducted in order to assess the COVID-19 pandemic’s impact on weight status.Among our samples of Polish preschool children, 16.82% were overweight/obese and 4.49% were obese. Overall, the BMI z-score was significantly lower in the group of children from 2017; however, among the children with overweight and obesity, the BMI z-scores were higher in 2017 than in 2007. The BMI z-score was positively correlated with maternal BMI, maternal pregnancy weight gain, paternal BMI, and birth weight.


Dirofilaria immitis.Tissue Doppler imaging is a useful echocardiographic technique to evaluate the systolic and diastolic function of the right ventricle and has been used as an estimator of pulmonary hypertension. The objective of this study was to evaluate the diagnostic value of tissue Doppler echocardiography to determine the presence of pulmonary hypertension in dogs with heartworm disease. A total of 116 heartworm-infected dogs and 33 healthy dogs were included in the study. Echocardiographic determinations were performed following established protocols to determine the presence of pulmonary hypertension in 47.4% of dogs infected with heartworm. Subsequently, a total of eight echocardiographic measurements were performed using tissue Doppler imaging to determine their usefulness in the diagnosis of pulmonary hypertension. Overall, the results showed significant differences with respect to the presence or absence of pulmonary hypertension. Furthermore, acceptable cut-off values were reported to estimate the presence of pulmonary hypertension in most echocardiographic measurements determined using tissue Doppler imaging. The measures analysed have demonstrated their usefulness as a complementary tool to determine pulmonary hypertension in dogs with Dirofilaria immitis is a nematode that produces proliferative pulmonary endarteritis in dogs due to direct contact of the adult parasites with the intima layer of the pulmonary arteries, leading to irreversible severe structural damage and sustained pulmonary hypertension (PH), which can produce severe cardiorespiratory disorders. The purpose of this study was to assess the diagnostic value of the echocardiography tissue Doppler imaging (TDI) in determining the presence of PH in dogs with heartworm disease. Methods: There were 116 heartworm-infected dogs with PH and 33 healthy dogs included in the study. Based on the right pulmonary artery distensibility index (RPADi) < 29.5%, PH was present in 47.4% of infected dogs. Additionally, the animals were evaluated using other standard alternative echocardiographic measures to estimate PH. Moreover, a total of eight echocardiographic measurements were analysed using the TDI to determine its usefulness in diagnosing PH . Results: The TDI measurements showed significant differences between dogs with and without PH, demonstrating a positive correlation with respect to the RPADi. In addition, cut-off values for the detection of PH with excellent sensitivity and specificity were found for E′:A′, global TDI, HRI-IVCT, HRI-IVRT and R-TEI. Conclusions: The TDI mode may be useful as an adjunct diagnostic method for the determination of PH in dogs with Dirofilaria immitis.Background:  Dirofilaria immitis , found worldwide and mainly affecting domestic and wild canids and felids. Heartworm disease produces severe cardiorespiratory disorders in dogs which require significant economic investment in endemic areas where regular prophylactic measures must be performed [D. immitis with the intimal layer of the pulmonary vessel causes proliferative endarteritis, inducing dilatation, loss of lumen and loss of elasticity. Obstruction of blood flow can also occur, raising the pressure in the pulmonary arteries due to increased pulmonary vascular resistance. This increase is known as precapillary pulmonary hypertension (PH) [D. immitis. Chronically, PH can cause hypertrophy and dilation of the right ventricle in its attempt to compensate for lung perfusion complications, leading to fatal right heart failure [Heartworm disease is a parasitic disease caused by s Leidy, 856, founion (PH) , respons failure .D. immitis, previous research has determined that the right pulmonary artery distensibility index (RPADi) is the most accurate non-invasive measure to estimate the presence of increased pulmonary artery pressure, especially when tricuspid regurgitation velocity and pulmonary regurgitation are not evaluable [Nowadays, echocardiography sets the best technique for the detection of PH in daily veterinary practice, due to its accuracy and convenience . To detevaluable ,5,6.Tissue Doppler imaging (TDI) is an echocardiographic method focused on the analysis of segmental myocardial movements in the systolic and diastolic phase. The degree of movement is determined by the cardiac contractility, the volume of the cardiac chambers and pressure differences, and allows for analysis of the systolic and diastolic functions . CurrentD. immitis.The haemodynamic changes that can be detected using TDI in the right heart chambers, caused by the presence of adult parasites, might be a useful tool for the evaluation of PH in canine heartworm disease. Thus, the aim of this study was to assess the utility of the measurements obtained via echocardiographic examination in TDI mode  to detect the presence of PH in dogs infected by D. immitis [This prospective study included 149 client-owned dogs that visited the Veterinary Teaching Hospital of the University of Las Palmas de Gran Canaria  between September 2021 and July 2022 and lived in a hyperendemic area of  immitis . A compl immitis , as wellD. immitis antigens, using a commercial kit . Dogs with a negative test were used as healthy control animals, based on history, physical examination, cardiovascular evaluation and echocardiographic exam. In all cases, dogs with evidence of cardiac conditions coexisting with heartworm disease or dogs that had previously received any cardiovascular medication were excluded from the study.The presence/absence of heartworm was diagnosed by the detection of circulating ®, General Electric, Boston, MA, USA). Electrocardiographic monitoring was performed in all patients. Dogs were placed in right and left lateral decubitus with the transducer placed in the third-fourth intercostal space according to the described and validated methods [Echocardiographic exams were performed with the animals conscious and restrained without the use of any sedation, using an ultrasound equipment with spectral and colour Doppler and multifrequency phased-array transducers  (REF). The RPADi and the tricuspid regurgitation systolic flow, among other measures taken routinely, were used as previously described ,4,20,21.Right TDI examinations were performed as previously described and validated ,10 Figu. LongituThe RR interval was established on the same 3 consecutive cardiac cycles due to the significance of heart rate in the measurements. Therefore, TDI time indices were indexed to the RR interval, defining heart-rate-indexed (HRI) time indices, as previously published ,10. MyocFinally, the presence or absence of worms in the pulmonary arteries and right heart chambers was evaluated, and the parasite burden was classified as low or high, according to the guidelines previously published .Based on the RPADi and clinical status, dogs were classified into 3 groups. Group A comprised healthy control animals, Group B included heartworm-infected dogs without PH and group C was formed of heartworm-infected dogs with PH.2 test and, only in the case of 2 × 2 tables, Fisher’s exact test was applied. For continuous variables, the differences in the parameters between groups were evaluated by means of Mann–Whitney/Kruskall–Wallis tests (non-parametric) or T-student/ANOVA (parametric) based on the normality of the variables to be evaluated by means of a Shapiro–Wilks test. To establish the correlation and explanatory capacity of the methods with the gold standard (RPADi), linear regression was applied and the non-standardised beta coefficients, their 95% CI, the R2 and the equation were shown. To determine the ability of the different echocardiographic measurements to classify the presence/absence of PH, the receiver operating characteristic (ROC) curve was used. All multiple comparisons were adjusted using the Bonferroni correction. All the contrasts were accompanied by the effect size estimator to complete the interpretation of the results. For categorical variables, it was Cramer’s V and, for continuous variables, it was Cohen’s d. The criteria for the classification of the magnitude of the effect were as follows: Cohen’s d: small (d = 0.2–0.4), medium (d = 0.5–0.8) and large (d = greater than 0.8). Cramer’s V: 0.00–0.09 as negligible, 0.10–0.29 as low, 0.30–0.49 as medium and from 0.50 as high. For all cases, the significance level used was 5% (α = 0.05).Frequencies and percentages were shown for categorical variables. The differences in parameters between groups were evaluated using Pearson’s non-parametric ChiAll owners were informed and gave their consent to participate in the study. Ethical approval was not required for this study, as it was a purely observational study with voluntary enrolment and did not involve additional invasive clinical diagnostic procedures. The evaluation of the study included ethical considerations and legal aspects regarding animal protection and welfare, and was conducted in accordance with the current Spanish and European legislation on animal protection.D. immitis . Group C included 55 dogs with heartworm and presence of PH.Presence of heartworm was diagnosed in 116 dogs (77.85%) while 33 (22.15%) dogs were used as healthy control animals. Based on the RPADi, all healthy dogs were normotensive , whilst PH was absent in 52.6% of dogs infected with The results of the descriptive analytical study of the clinical variables and the standard and TDI mode echocardiographic measurements in the studied dogs are shown in The parasite burden ranged from 1 to 4 ,26 in thp = 0.000), and no differences were found between groups A and B. The results of the additional standard echocardiographic measurements to estimate the presence of PH showed significantly higher values for TRPG and PT:Ao in group C when compared with groups A and B (p = 0.000). There were also significantly lower values for the AT:ET ratio, TAPSE and PV:PA ratio in group C when compared with groups A and B (p = 0.000). However, no differences were observed in the echocardiographic parameters studied between groups A and B.The statistical study revealed significant differences in the RPADi between group C in comparison to groups A and B (p = 0.000) (p = 0.166).Similarly, ANOVA tests found significant differences between the values of the TDI parameters in the studied groups. The Bonferroni post hoc tests for multiple comparisons indicated that, for all the parameters, except for the A′ measurement, there were significant differences in dogs from group C when compared to groups A and B. The values of E′, S, E′:A′ and global TDI were significantly lower in dogs from group C, whilst the values of HRI-IVCT, HRI-IVRT and R-TEI were significantly higher in dogs from group C (= 0.000) . The res2 > 0.5 (2 close to 0.3. The result obtained for A′ showed that this measurement did not correlate with the RPADi (R2 < 0.1).Linear regression was carried out for each TDI parameter studied, showing that the parameters that best correlated with the RPADi were HRI-IVCT, HRI-IVRT and R-TEI, with R2 > 0.5 . The parThe results of the ROC curves for each of the TDI measurements to determine the presence or absence of PH and the cut-off points of the parameters that maximise sensitivity and specificity (using the Youden index) are collected in D. immitis and is responsible for multiple cardiorespiratory complications that characterise canine heartworm disease [The presence of PH is a severe hemodynamic condition that usually occurs in dogs parasitised by  disease ,4, inclu disease ,6. HowevD. immitis [In this study, the guidelines of the ACVIM for the diagnosis of PH have been used . Since s immitis ,22,23. T immitis ,6,21.The TDI echocardiographic mode is widely used in veterinary medicine and its effectiveness is particularly important in providing information on systolic and diastolic function triggered by cardiovascular diseases. Previously, the use of echocardiographic measurements using the TDI mode has shown its efficacy for the assessment of volume overload and its effects on left ventricular dysfunction in dogs with myxomatous mitral valve disease and dilated cardiomyopathy ,13,14,15D. immitis, by demonstrating excellent correlations between TDI measurements  and the presence and severity of PH, as well as high sensitivity and specificity values when establishing cut-off points for the detection of PH for most TDI measurements. Another study, unlike the present one, found significant differences in the value of A′ in dogs with PH [Regarding the detection of PH, the study of TDI mode has already demonstrated its usefulness in dogs, specifically in the diagnosis of PH in dogs mainly suffering from left heart pathologies ,8,9. The with PH , althougThe results observed agree with the cardiovascular alterations present in canine heartworm. In this sense, the presence of adult parasites in the lumen of the pulmonary arteries generates proliferative endarteritis that causes a decrease in the distension capacity during the cardiac cycle, an increase in pulmonary arterial pressure and therefore morphological changes with loss of myocardial functionality. When this event becomes chronic, tricuspid insufficiency occurs due to the increased pressure in the right ventricle. Finally, at the final stages, signs of atrial dilation and retrograde venous congestion are generated with a decrease in the speed of passive diastolic filling (E′) and also a decrease in systolic velocity (S) due to volume overload. However, the active diastolic filling rate (A′) remains unchanged because it does not depend on pressure differences in the cardiac chambers. Likewise, it is logical that the aforementioned pressure and volume overloads cause increases in the relaxation (HRI-IVRT) and contraction (HRI-IVCT) times adjacent to ventricular systole. Similarly, measures that adjust these haemodynamic changes to analyse them more precisely, such as the global TDI and the R-TEI using diastolic and systolic measurements in TDI mode, have shown satisfactory results in the present study.D. immitis infection does not show preferences regarding these epidemiological parameters, nor does the development of PH in the presence of this pathology [No significant differences were found according to age, sex, weight, breed or BCS between groups, coinciding with previous studies that determined that athology ,5,18,20.A higher parasite burden was reported in animals with heartworm suffering PH, although the statistical differences were not significant. The influence of the parasitic load on the development of PH is not clear. Some authors claim that the greatest influence on the development of endarteritis and PH corresponds to the chronicity of the disease, the intensity of exercise and the immune response of the host to the parasite ,5,26, whD. immitis.Most dogs with cardiorespiratory symptoms corresponded with those with PH; previous studies have demonstrated that approximately 50% of infected animals developed PH and, therefore, associated symptoms ,5,6,21. D. immitis, although further studies are indicated with the aim of obtaining standardised protocols and exact reference values to satisfactorily establish the diagnosis and estimate the severity of PH in dogs with heartworm disease.The results showed that the TDI measurements of E′, S, E′:A′, HRI-IVRT, HRI-IVCT, global TDI and R-TEI differentiated between normotensive dogs and those with PH (RPADi < 29.5%). Therefore, they can be a helpful alternative for evaluating patients with heartworm via transthoracic echocardiography. Similarly, the A′ measure proved to be an inadequate indicator for estimating PH in dogs with heartworm disease. The HRI-IVCT, HRI-IVRT and R-TEI showed higher levels of efficiency in the detection of PH in dogs parasitised by


Addiction to online video game streaming has become one of the most appealing ways to occupy leisure time and is one of the most popular activities. The satisfaction it provides and the time invested in it are two of the main reasons why it is preferred. However, despite the clear benefits that this activity offers, in some cases, excessive use can lead to personal and/or family problems or abuse.M = 22.87, SD = 5.02). The Streaming Dependence Scale (SDS) was developed based on a literature review, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted.The objective of the study was to develop and validate a scale to measure potential traits of dependence on online game streaming. The participants were 423 Peruvian adults aged between 18 and 47 years .The scale showed adequate internal consistency . Confirmatory analysis confirmed the one-dimensional structure (χThe brief SDS is a valid and reliable measure that can be used as a useful tool to identify and evaluate streaming dependence. In the age of digital transformation, traditional leisure patterns have undergone a profound metamorphosis. Video games and streaming platforms have become central players in this transformed landscape, altering youth interaction and socialization . This teHowever, video game addiction is an emerging phenomenon that has become increasingly worrisome, given its effects extend to individual aspects disrupting family and social dynamics . Video gVideo game addiction has given rise to an even more worrying phenomenon: the addiction to video game streaming. The popularization of platforms like Twitch, which hosts an average daily audience of 26.5 million viewers, has shown a concerning increase in addiction to these streaming services . In thisVideo game and streaming addiction is not a uniform experience and can vary enormously from one place to another. An example of this is found in Peru, where the use of the internet and video games has risen in recent years, particularly among the youth . DespiteHowever, it is essential to note that although video game and streaming addiction present significant risks, it does not entirely discredit the potential benefits these services can offer. Streaming services can provide significant benefits in terms of learning, skill development, and social support . NeverthTherefore, the aim of this study is to develop and evaluate the psychometric properties of a scale for live-streamed online gaming addiction in adults.M = 22.87, SD = 5.02). The study’s inclusion criteria stipulated that participant had to be over 18 years old, living in Peru, and have regular access to video game streaming platforms. We excluded individuals who did not meet the age and residency criteria, as well as those who did not have regular access to streaming platforms. The majority of participants  was created based on a rigorous literature analysis. This analysis took into account the established diagnostic criteria present in the Diagnostic and Statistical Manual of Mental Disorders, fourth , and fifTo assess anxiety, the Spanish version of the Generalized Anxiety Disorder Scale, GAD-2 , was empThis study faithfully adhered to the principles of integrity, transparency, and respect for human dignity, ensuring the fidelity and accuracy of the findings. The Ethics Committee of a Peruvian university (reference 2181-2022/UPEU-FCS-CF) meticulously examined and approved our research protocol. Each participant was fully and clearly informed about the nature of our study. Informed consent met legal requirements and reflected our conviction in respecting the individual’s autonomy and the right to decide about their participation in the research. Data collection was conducted in person, underscoring to each participant that their involvement in the study was entirely voluntary and anonymous.We began our analysis with a total sample of participants divided into two groups to facilitate robust cross-validation. Sample 1, with 162 participants, served as the basis for developing the model in the exploratory factor analysis (EFA), while Sample 2, made up of 261 participants, was used to validate the model through confirmatory factor analysis (CFA) . A descrTo examine the factorial structure of the SDS, an EFA was performed using unweighted least squares with oblique rotation (promax). Parallel analysis allowed us to determine the optimal number of factors. We verified the suitability of the data with Bartlett’s test of sphericity and the Kaiser-Meyer-Olkin (KMO) coefficient .2), the Confirmatory Fit Index and Tucker-Lewis index (CFI and TLI ≥ 0.95)  , and the ≥ 0.95) . Additio ≥ 0.95) . We evalFinally, we evaluated internal consistency using Cronbach’s alpha coefficient, composite reliability (CR), McDonald’s omega coefficient , and the1All statistical analysis was performed using R software 4.1.1 .M = 1.65), while item 2 had the lowest mean (M = 1.44). In terms of dispersion, it was found that item 6 (SD = 0.65) had a higher dispersion compared to the other items. Skewness (g1) and kurtosis (g2) fluctuated within the acceptable values of ± 1.5 for all items, suggesting a multivariate normal distribution. In addition, it was found that the scale had item-total correlations greater than 0.30, indicating high homogeneity. Finally, an acceptable internal consistency was obtained for each item by calculating the Cronbach’s alpha, with values greater than 0.70 (>0.70).In p < 0.001). Parallel analysis and the scree plot suggested the extraction of a single factor  was carried out on the unidimensional scale to determine the underlying structure of the items. The results indicated an adequate fit of the data through the KMO coefficient (0.83) and the Bartlett’s test of sphericity , SRMR = 0.05] did not reach the standards, indicating that this model might not be the optimal representation of our data structure. In addition, the factor loadings (λ) of items 6 and 8 were below the threshold (>0.50), suggesting that these items might not be strongly associated with the underlying factor. In light of these observations, a second model was developed, taking into account the preliminary evidence provided by the EFA. This analytical step indicated that the goodness-of-fit indices were adequate , thus providing a more robust argument for the validity of our model. Furthermore, factor loadings exhibited satisfactory magnitudes (λ > 0.50), reinforcing our confidence in the role of each item in representing the underlying construct  allowed for the development of the confirmatory factor analysis (CFA) to assess the factor structure . Initialonstruct .In relation to internal consistency  in Model2 = 24.16, df = 13; p = 0.03; CFI = 0.98, TLI = 0.96, RMSEA = 0.06 (90% CI: 0.02–0.09), SRMR = 0.04 (p < 0.001).To evaluate the relationship between the AFC and other constructs, a SEM model was proposed with two latent variables: streaming dependence and anxiety. This model showed a good fit: χR = 0.04 . AdditioThe digital world presents a universe of possibilities and opportunities, but also a vast field of challenges and threats to our physical and mental wellbeing. The use of online games, particularly those streamed live, has witnessed an unprecedented increase, raising concerns related to fatigue, insomnia, anxiety, and depression. The giants of this digital era, such as Twitch and YouTube, have experienced significant growth in their traffic, becoming the primary means of consuming online gaming content. This growing dependence on live-streamed online games on streaming platforms has become an enigma that oscillates between fascination with virtual immersion and fear of digital addiction. However, psychometric evidence supporting the existence of dependence on live-streamed online games, especially in regions like Peru and Latin America, remains scarce and insufficient. In the face of this challenge, the present study aimed to develop and evaluate a new psychometric assessment tool, the Streaming Dependence Scale (SDS).The SDS was designed to capture the nuances of dependence on live-streamed online games in adults. Drawing inspiration from the video game dependence criteria of the The findings of the Exploratory Factor Analysis (EFA) supported a one-dimensional structure, explaining 22.6% of the variance of the construct. However, the low communalities (h2 < 0.30) of items 4, 6, and 8 suggested their removal to improve the model’s robustness .The Confirmatory Factor Analysis (CFA) supported the proposed one-dimensional structure, highlighting the model’s robustness. Although the first model did not show satisfactory fit indices  , the secThe Streaming Dependence Scale (SDS) demonstrated high internal consistency, with McDonald’s Omega (ω) and coefficient H values exceeding 0.70 . This inConvergent validity of the Streaming Dependence Scale (SDS) was also evaluated through the positive correlation between its items and other indicators of the same variable. Average Variance Extracted (AVE) was used as a measure to determine whether the factors explain a significant portion of the indicators’ variance, with an acceptable threshold of AVE greater than 0.5 . In the The findings from our study on the Streaming Dependency Scale (SDS) have implications in several areas. First, from a professional practice perspective, the SDS emerges as an essential tool for mental health professionals. Specifically, when dealing with youth and young adults, the SDS offers an effective means to identify and assess dependency levels, paving the way for timely and effective interventions. Therefore, therapists, psychologists, and other healthcare professionals can use the SDS as a primary assessment tool, enabling them to design appropriate interventions and provide better guidance to their patients. Second, given the rising use of platforms such as Twitch and YouTube, streaming dependency is becoming an emerging public health issue. It is imperative that regulators and lawmakers collaborate with these platforms to formulate preventive policies. These policies can include awareness campaigns, limitations on consecutive streaming hours, and education about the risks associated with excessive use. Third, while theories on digital addiction have previously focused on video games and the Internet, the SDS introduces an additional dimension addressing streaming. This gives us a foundation to theorize about the unique characteristics of streaming, its distinct appeal, and how these factors can contribute to the development of a dependency. Fourth, in the realm of educational practice, the SDS could serve as a valuable resource for educators and school counselors. With the increasing integration of digital resources in the classroom, understanding the potential dependency on streaming can inform instructional design. For instance, educators might be cautious when incorporating streaming platforms as part of their curriculum, being aware of the potential for increased dependency.Moreover, it is crucial to research the applicability of the SDS across different cultural and geographical contexts to ensure its universality. Additional factors, such as real-time social interactions and the relationship between personality, academic performance, social relations, and mental health, should be considered.This study also presents certain limitations that need to be acknowledged. One primary limitation lies in the sample size, especially when advanced analytical techniques are incorporated, which heavily depends on the magnitude of the sample. Various guidelines, such as those proposed by The Streaming Dependence Scale (SDS) offers a valid and reliable tool within the current landscape of digital mental health research. Not only does the SDS allow for a rigorous evaluation of streaming dependence, but it also lays the groundwork for a deeper understanding of how the intrinsic features of live streaming, such as its real-time interactivity and the formation of virtual communities, can influence the onset of addictive behaviors. This understanding, in turn, is crucial for drawing parallels and distinctions between streaming dependence and other recognized forms of digital addiction, like video game addiction or social media addiction. Consequently, it’s imperative to continue research in this direction, not just to assess the prevalence and severity of streaming dependence across various populations and cultural contexts but also to identify associated risk and protective factors. Furthermore, it’s vital to develop, implement, and evaluate evidence-based intervention programs that address both the prevention and treatment of this emerging form of dependence.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The study was carried out by the Ethics Committee of the Universidad Peruana Unión (reference 2181-2022/UPEU-FCS-CF). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.LS-S, AC-V, and WM-G participated in the conceptualization of the idea. LS-S and WM-G were in charge of the methodology and software and commissioned the data curation, and resources. All authors contributed the validation, formal analysis, and research, carried out the writing of the first draft, review and editing, visualization, and supervision and have read and approved the final version of the manuscript.


Animal movements represent a major risk for the spread of infectious diseases in the domestic swine population. In this study, we adopted methods from social network analysis to explore pig trades in Austria. We used a dataset of daily records of swine movements covering the period 2015–2021. We analyzed the topology of the network and its structural changes over time, including seasonal and long-term variations in the pig production activities. Finally, we studied the temporal dynamics of the network community structure. Our findings show that the Austrian pig production was dominated by small-sized farms while spatial farm density was heterogeneous. The network exhibited a scale-free topology but was very sparse, suggesting a moderate impact of infectious disease outbreaks. However, two regions (Upper Austria and Styria) may present a higher structural vulnerability. The network also showed very high assortativity between holdings from the same federal state. Dynamic community detection revealed a stable behavior of the clusters. Yet trade communities did not correspond to sub-national administrative divisions and may be an alternative zoning approach to managing infectious diseases. Knowledge about the topology, contact patterns, and temporal dynamics of the pig trade network can support optimized risk-based disease control and surveillance strategies. Social network analysis (SNA) is the process of investigating social structures through the use of graph theory, which provides vocabulary and mathematical operations to study the properties of social networks4. Livestock movement patterns  can be studied through network-based approaches. A livestock trade network consists of nodes or vertices  and edges that connect pairs of nodes and represent the nature  and direction of the relationship between the connected nodes. Moreover, edges can have weights, i.e. values that characterize the connection between a pair of nodes, e.g. number of animals or frequency of exchanges6.Social networks provide a conceptual framework for representing relations between elements of a complex system9 and foot-and-mouth disease (FMD) in the UK in 200112, several EU countries have developed livestock registration and movement databases that facilitate tracing of animals and response to outbreaks14. More recently, the Animal Health Law  2016/429) sets out requirements for its member states regarding the electronic identification and registration of animals and certain animal products as well as rules for notifying and recording their movements within the EU15. Broader availability and enhanced quality of livestock movement data in the EU, together with more accessible computing power and analytical software, have encouraged the study of real-world complex networks in veterinary epidemiology, enabling new insights into the complexity of livestock trade and dynamics of infectious animal disease transmission17. The analysis of livestock movement data based on graph theory, e.g. in the UK19, Denmark21, Germany22, Spain23, France25, Italy26, Brazil27, and Ireland28 proved to be a valuable tool to explore the dynamics of trade patterns between livestock operations, quantitatively characterize the topology of animal trade networks, and understand the role each animal holding plays in the network29. In epidemiology, network approaches revealed also very powerful, e.g. to model patterns of infectious disease spread, risk of infectious disease introduction, estimate outbreak sizes35, develop and evaluate disease surveillance and mitigation strategies37, or facilitate policy development38.Leveraging lessons learned from the epidemics of bovine spongiform encephalopathy (BSE) in Europe in the 1990s18, which oversimplifies the reality and presents major limitations for the understanding of disease dynamics41. Similarly, when applied to animal trade networks, community detection, also known as graph partitioning or clustering, have generally not exploited the temporal features of the network45. The purpose of community detection algorithms is to unveil subgroups of highly connected nodes within the network that share specific properties46. Community detection is a relatively recent field of research47 and there is a lack of agreement on the optimal detection method49, which may explain why it is often ignored in the analysis of animal trade networks. However, taking into account the temporal dynamics of the community structure in livestock networks could reveal temporal variations in the strength of the connections between a group of holdings as well as changes in the trade preferences over time (e.g. number and size of communities)48.However, many studies propose a static representation of the livestock trade network, neglecting the temporal component of it50. The same year, the pork consumption reached 34.2 kg per capita, making pork the most consumed meat in the country52. However, the Austrian pig value chain is threatened by major exotic infectious diseases such as African swine fever (ASF), classical swine fever (CSF), and FMD, which can be introduced, for example, through live animal trade or importation of pork products53. Furthermore, endemic infectious pathogens, e.g. the porcine reproductive and respiratory syndrome (PRRS) virus54, Mycoplasma hyopneumoniae55, porcine circovirus type 2 (PCV2)56, Streptococcus suis57, and Actinobacillus pleuropneumoniae58 often lead to a reduction in the performance of infected animals and induce an important, yet often underestimated, burden on production as well as on animal health and welfare59. Despite these risks and potential impact on the pig sector, to date, data on pig movements in Austria has not been analyzed for scientific purposes. It is essential to understand the intrinsic structure of the Austrian pig movement network and translate mathematical results into information that could support evidence-informed surveillance systems for early detection of outbreaks as well as efficient, timely response to infectious disease outbreaks60.In 2021, Austria exhibited 103% of self-sufficiency in pork meat productionDescribe the Austrian pig trade network topology and trends over a seven-year period;Apply a community detection algorithm to uncover hidden relationships among nodes (holdings) in the network and investigate community temporal dynamics;Generate meaningful information that could be concretely used, e.g. in risk analysis or disease surveillance and control planning.In this study, we aimed to evaluate the structural characteristics and dynamic patterns of the Austrian pig movement network and discuss their potential applications in veterinary epidemiology. More specifically, we intended to:Consumer Health Information System, an electronic database of the Austrian Federal Ministry of Social Affairs, Health, Care and Consumer Protection (BMSGPK) and operated by Statistics Austria61. Data used in this study covers the period January 2015 to December 2021 and consists of (1) data on registered pig-related holdings and (2) daily records of pig movements within Austria as well as to and from other countries .In Austria, data on animals, livestock movements, and holdings  are recorded in the Verbrauchergesundheits Information System (VIS) or For each animal holding, the data includes a unique anonymized identification number (ID), the randomized 5 km-radius geo-coordinates, information on the type of activities of the holding, and the number of pigs per production stage for each year the holding was operating, as reported yearly on a mandatory basis by the animal owner. There are four major pig production stages, themselves subdivided on the basis of the animal sex and weight: (1) breeding animals weighting > 50 kilograms (kg): gilts, sows, and boars; (2) piglets: up to 8 kg, 8–20 kg, and 20–32 kg; (3) young pigs weighting 32–50 kg; and (4) fattening pigs: 50–80 kg, 80–110 kg, and > 110 kg.Regarding pig holding activities, the following labels (and sub-labels) are registered in the database: (1) farm ; (2) private pet owner; (3) processing plant (including meat and by-product processing), (4) boar station; (5) trade and logistics , (6) collection point or animal gathering; and (7) slaughterhouse. One holding (identified by an ID) can be registered with one or more labels.Each record of pig movement contains information on the source (ID of the holding of origin) and target (ID of the receiving holding), date of the event, number of pigs moved , and type of movement (see below).Before using the VIS data for the analyzes, it underwent a cleaning process. For each pig batch movement, a double notification system is in place. This means that each movement is reported twice, from the holding of origin and from the receiving one. Therefore, each duplicate has been reduced to a single data row.domestic, i.e. movement of live pigs between holdings within Austria, (2) slaughter, i.e. movement of pigs that are intended for slaughter, (3) abroad, i.e. import or export of live pigs, and (4) abroad-slaughter, i.e. import of live pigs that are intended for slaughter.Each reporting holding indicates whether the movement of pigs is outgoing, ingoing, or intended for slaughter and, in the case of a foreign movement, the ISO code of the country is provided. This results in four types of movement, (1) Our final data included 40,951 pig holdings and 1,917,584 movement records over the period 2015–2021. The data showed animal trades between Austria and 18 EU/EEA and seven non-EU/EEA countries.Since the study focused on revealing the structural properties of the Austrian pig trade network, movements to and from abroad were removed from the dataset. Similarly, establishments such as boar stations and processing plants were ignored. Ultimately, only “active” holdings, i.e. counting at least one trade event over the considered study period, were included in the analysis.63, slaughter-type movements were not included in the main analysis. After removing abroad-  and slaughter- (59%) type of movements, therefore keeping domestic movements only, the final network included 38,888 nodes  and 783,460 edges (40.8%). In the network, each node represents a holding, regardless of its activity or label.Our analysis assumed that the data accurately reflected the actual pig movements and that each of them corresponded to a direct transport of pigs, e.g. farm-to-farm or farm-to-slaughterhouse. Therefore, because measures applied to slaughterhouses have a very limited impact on infectious disease spread in the network64 using the geo-coordinates data. We then extracted for each holding the administrative divisions, i.e. federal state and district, using shapefiles of the Austrian administrative boundaries65 . Next, we displayed the yearly farm density by counting the number of farm-labeled holdings with recorded movements within 5-km hexagonal grids for each year.We plotted the spatial distribution of the holdings in QGIS softwareV represents a set of nodes (pig holdings) and E represents a set of directed edges (movements). Each edge is characterized by i (source) to a specific node j (target) at time t. The presence of The pig trade network was represented as a temporal directed graph, We used a static representation of the directed network, where edges were aggregated over seven years, to study the intra- and inter-state trade frequency.G over the period 2015–2021, we computed a time-ordered sequence of yearly snapshots, 1. Each layer is a directed multigraph, where more than one edge may exist between a pair of nodes3 . Each multigraph was converted into a digraph by collapsing the multiple edges into single-weighted ones, with edge weight corresponding to the trading frequency between pairs of nodes. We characterized the yearly networks using the metrics listed in Table 3, from the centrality scores of the nodes. For each snapshot, we described its degree distribution, P(k), that a node chosen at random will have degree k1. Additionally, for each snapshot, we searched for the presence of cycles, i.e. paths that start and end at the same node3.To study major changes in the structure of the pig trade network On average, there were 24,393 66 was used to analyze the trend in the number of nodes that recorded movements, edges, and volume of traded pigs.We computed a time series of monthly directed networks by aggregating the daily networks over each month, in which edge weight corresponded to trading frequency between pairs of animal holdings. The method of classical time series decomposition with two-sided moving averages (MA)We additionally explored the weekly patterns (Monday to Sunday) of the pig trade network using a daily aggregation of the number of nodes, edges, and volume of traded pigs. We then performed ANOVA , taking into account the interaction 67 to each yearly snapshot sequentially, i.e. from the earliest to the latest one. The algorithm decomposes the network into modules by mapping the probability flows induced by the network structure through a large number of random “surfing” processes that consider the weight and direction of the network edges. A random “surfer” differs from a random “walker” by the introduction of a teleportation probability in the random walk, which represents a positive probability that the process jumps randomly to any other node in the network. The algorithm does not allow overlap between community, i.e. a district can belong to one community only67.Using the yearly snapshots of the network, T were with those at T+n68. More specifically, we defined C and T and T+n, respectively, and computed a matching value  are presented in We acknowledge that there might be movements or events that were not captured by the data, e.g. movements involving truck sharing, where pigs from different farms are collected and delivered to one or several farms or to the slaughterhouse, which represents a risk of disease spread via fomites70 (v.4.1.3) using RStudio71 (v.2022.07.1). The network analysis was conducted using the ’igraph’ package and the package ’TSstudio’ was used for trend analysis. Map visualization was performed in QGIS64 (v.3.26.3-Buenos Aires) and network visualization was executed in Gephi72 (v.0.9.7).Analyses for this study were performed with R programing softwareWe observed that the spatial distribution of the Austrian pig farms remained stable over the study period 2015–2021  were more frequent than inter-state movements . The majority of the intra- and inter-state movements (41.7%) originated from Upper Austria, followed by Lower Austria 25.1%), Styria (17.8%), and Carinthia (8.0%). These four federal states exhibited the highest relative contribution to the total number of intra-state movements, representing 42.4%, 24.8%, 17.8%, and 8.3% of them, respectively  of the yearly networks remained stable with a slight negative value over the seven years  was highly skewed with 1% of all holdings showing betweenness scores 5.The edge density displayed very low values (close to zero), which indicates the sparsity of connections between nodes in the networkhubs in the network. Among them, 35.7% (29.5–47.6%) were also identified as nodes with high betweenness. The typical topology of the Austrian pig trade network  is illustrated for Upper Austria (2021) in Supplementary Fig. The yearly in-degree, out-degree, and total degree distributions were right skewed, heavy-tailed and could be approximated by a power law distribution with an average exponent of 2.79 For each year, the largest strongly connected component (LSCC) contained a very small fraction of the nodes  Table  whereas 22 in the Austrian pig trade network are displayed in Supplementary Fig. Computed from the yearly network snapshots, the node rangesNo cycle was detected in the network.The monthly time series of the number of nodes and edges showed a steadily decreasing trend from 2015 until the second semester 2019 followed by a slight uptrend until winter 2020, before both trends decreased again Fig. a,b. SimiThe monthly number of edges and nodes showed marked and correlated seasonal bimodal patterns over the period 2015–2021, with a first peak in May and a second one in October, whereas January-February and July–August exhibited the lowest node and edge activities. On the contrary, the volume of traded pigs showed little monthly variations except a seasonal sharp decrease in February Fig. . Furtherp-value = 0.33, 0.25, 0.86, respectively)nor slaughter-type movements .The average daily number of nodes, edges, and volume of traded pigs did not show any significant difference between months neither for domestic .The number of trade communities in the Austrian pig movement network showed little variations among the yearly snapshots, with 10–13 communities detected annually Fig. . The medAs observed in Fig. This study aimed to explore, for the first time, the network of pig movements in Austria using methods derived from social network analysis and reveal its dynamic structure. Below, we provide an epidemiological perspective on this network, which suggests alternative, network-based applications to the monitoring and management of infectious diseases.73. Typically, the risk of farm-to-farm transmission increases with the farm density (independently of livestock movements) whereas farms with higher animal density are more susceptible to outbreaks75. Additionally, our findings showed that the Austrian pig production was shifting toward fewer holdings and trades, while the volume of animals produced did not exhibit a correlated decrease, which indicates that the farm and batch size are becoming larger. Although this information looks trivial, knowing precisely the spatial distribution of farms and animals is necessary to assess the potential impact of interventions and plan resource allocation for surveillance and control of infectious diseases76. It is also important to understand how shifting production patterns toward intensification (i.e. fewer but larger farms) may influence disease risk on a long term.We evidenced that the spatial distribution of the pig farms in Austria was heterogeneous, with two federal states, Upper Austria and Styria, accounting for almost half (46%) of all farms with trading activity in the country, whereas the pig farming system was largely dominated by small-sized farms of four pigs or less. Spatial heterogeneity influences the size and duration of an infectious disease outbreak20, France24, and the United States62. Furthermore, we proved that holdings showed a strong tendency for tradings with other holdings located in the same federal state whereas a smaller proportion of movements covered long-distances.The topology of the pig trade network, unfolded in the yearly aggregated snapshots, suggested sparse connectivity, along with a great proportion of nodes exhibiting either an in- or out-degree equal to zero, and the absence of cycle. The topology also revealed the small size of the yearly LSCC. These findings reflect the typical pyramidal pig farming system in Austria, with its tree-like, hierarchical structure and unidirectional animal flow, where batches of pigs move sequentially from a compartment (i.e. production stage) to the next one, till the end of the production chain (i.e. from farrowing to finishing and then to slaughterhouse). The pyramidal pig farming system can also be found in other countries, e.g. in Denmarkhubs). Holdings with a high out-degree and/or high betweenness can act as super-spreaders and should be targeted with priority i) in disease surveillance programs (farm sentinels) in order to achieve cost-effective and efficient early disease detection, and ii) in control interventions 80. From an epidemiological perspective, the in-degree and betweenness of a holding indicate its vulnerability to infection (from another holding) and pig holdings showing a high in-degree can be considered as super-receivers. On the other hand, the out-degree of a node reflects its capacity to spread pathogens. Enhancing biosecurity in highly connected premises (hubs), that act as “gatekeepers”, would greatly reduce the structural risk and favor timely detection of pathogens (early warning)81. These findings would certainly need further empirical verification through field testing, especially to assess their practical applicability and real-world implications.The yearly patterns of pig movements in Austria showed the topology of a scale-free network, with a large heterogeneity in the node degrees (i.e. number of connections for each pig holding), unveiling the presence of few highly connected nodes  and longer node ranges. We demonstrated that the LSCC, which is a standard proxy to assess the lower bound of an outbreak final size82 and supports the hypothesis that, at national scale, the size of an infectious disease outbreak in the Austrian pork production chain would be limited83. This statement is supported by the relatively small size of the LSCC and the relatively high diameter of the network .Overall, the absence of small-world like structure, the low average degree of the nodes, and the rare long-range movements favor the network resilience to epidemics84. Temperatures play a role on animal health in general, as well as on the maintenance, seasonal pattern, and transmission of infectious pathogens, especially respiratory pathogens86, within livestock trade networks87. Seasonal patterns in the network activities, linked with the swine breeding and production cycle, consumer demand as well as climatic conditions should be considered when planning surveillance activities and responding to an outbreak.The analysis of seven successive years of pig movement data underlined recurrent patterns and seasonal behaviors in trade activities. Especially, our results confirmed a greater activity in spring (during the Easter holidays) and autumn (before Christmas) whereas the lowest activity occurred in winter, consistent with other European countries88 and represents a useful epidemiological tool to delineate compartments or zones that could be used in preventive veterinary medicine, e.g. to design geographically-targeted surveillance strategies as well as control and eradication programs89. The implementation of a community-based approach to disease control (i.e. not based on administrative boundaries) would preserve commercial exchanges, have a lower impact on the pig production chain, and therefore would probably be cost-effective. We argue that disease management at sub-national level can be relevant, yet this compartmentalization approach should be further investigated. Indeed, the InfoMap algorithm generates disjoint communities, i.e. in our case, a district belongs to one and only one community67. Yet in real-world networks, communities have important overlapping and may present nested structures91. Detecting overlapping districts may unveil “bridges” between pig trade communities, which may be crucial for both epizootic and endemic disease control efforts.The trade communities covered geographic areas of various sizes and their limits did not correspond to the federal state administrative boundaries. Trade communities reflect connection preferences between pig holdings, i.e. pig production zones. Community structure greatly influences disease dynamics22. Nonetheless, estimation of the outbreak size requires a time-resolved analysis, where the time window for data aggregation largely depends on the dynamics of the network  and characteristics of the disease . The network stability and specific tree-like structure present also a major advantage for planning a simple, network-based targeted surveillance strategy, e.g. by using a static network analysis approach93, while contextualizing our results within a European framework. Surprisingly, the Austrian pig movement network did not exhibit a small-world effect, which is usually observed in livestock networks presenting a lot of large commercial farms, such as in Germany, France, or Denmark, which also exhibit a denser network and, on average, higher degree centrality93. In contrast, the Austrian pig trade network showed similarities with the North Macedonian, Georgian, and Bulgarian pig movement networks, which are similarly weakly connected and involve a majority of small-scale holdings95. Also, the proportion of nodes included in the LSCC of the Austrian pig trade network was comparable to the one reported for the North Macedonian network (1.03–4.08%)95, but larger than the proportion reported for Bulgaria (0.15%), France (0.60%), Italy (0.14%), and Spain (0.18%)93. However, its density was closer to the density reported for the French network , unless very strict biosecurity measures at farm gate are enforced69. Transport itinerary data is not available in the database of the Veterinary Authorities and is therefore not used for epidemic management and control. For this reason, we believe our analysis reflects the best possible outcome that could be achieved with the available data. Certainly, the additional use of transportation itinerary data (i.e. truck movements) could improved or refined the analysis of this network and would advance our understanding of the risk of disease spread via direct (direct trade) and indirect (truck sharing) contact between holdings.Our analysis has several limitations. First, the geo-coordinates of the holdings were randomized within a 5 km radius, which could have resulted in erroneous assignment of holdings located near administrative boundaries to a nearby federal state or district during the state/district attribution process in QGIS. However, we believe this had a very limited impact on our results as the number of affected holdings is small. Second, because the reporting is mandatory, we assumed that there was no missing data. Therefore, holdings found with no movement record during the entire study period or part of it may be small farms producing pigs for self-consumption or holdings which activity status in the system is outdated (this type of error cannot be tracked). Third, we found that pig movements in Austria were dominated ( 60%) by movements intended for slaughter, which we did not include in the main analysis because we considered that they have a limited impact on infectious disease spreadOverall, this study advances our understanding of the complex structure of the pig trade network in Austria and provides useful epidemiological information to designing cost-effective infectious disease control plans. Our findings highlight that when designing epidemiological surveillance activities and implementing disease control measures in the pig trade network in Austria, several components should be considered: the presence of high-farm density and highly-connected pig holdings, the seasonality of the network, and the presence of communities.Supplementary Information 1.Supplementary Information 2.Supplementary Information 3.Supplementary Information 4.Supplementary Information 5.Supplementary Information 6.Supplementary Information 7.Supplementary Information 8.Supplementary Information 9.


In addition, social awareness (p = 0.001) increased in all patients. Statistically significant differences resulted in four sub-scales of Youth Self-Report Scale: withdrawn/depressed (p = 0.007), social problems (p = 0.003), thought problems (p < 0.001), and rule-breaking behaviour (p = 0.03); these results showed a decrease in emotional and behavioural problems. This study is an innovative therapeutic and educational approach based on the filmmaking art. This research can offer an empirical basis for the effectiveness of alternative therapeutic tools in child and adolescent psychiatric disorders. At the same time, it can be replicated in broader contexts  to promote children’s psychological well-being.Evidence suggests that adolescents respond positively to simple, early interventions, including psychosocial support and educational interventions, even when offered in non-clinical settings. Cinematherapy can help manage life challenges, develop new skills, increase awareness, and offer new ways of thinking about specific problems. This pilot trial was conducted in Italy, aiming to investigate the effects of a six-week filmmaking course on the psychological well-being of adolescents (N = 52) with emotional/behavioural problems and neurodevelopmental disorders. At the end of the project, most participants showed improvements mostly in social skills, such as social cognition ( Over the past 30 years, a large increase in the number of children and adolescents suffering from anxiety and major depressive disorders or behavioural and conduct disorders has been described. Worldwide, 8.8% of the paediatric population has been diagnosed with several mental illnesses, accounting for a heavy disease burden . CurrentThis represents a challenge for the mental health care system, with a growing need for new therapeutic and preventive interventions, such as those based on music, theatre, and film therapy. It is urgent to focus not only on diagnostic and therapeutic procedures but also on creating opportunities for personal growth and empowering positive experiences with people dealing with the same obstacles. Evidence suggests that adolescents respond positively to early interventions, including psychosocial support and educational interventions, when offered in non-clinical settings . Psychosocial interventions include art and creative therapies. A small body of literature supports using art therapy to empower youth . RegardiAlthough video-based intervention and filmmaking have been previously studied in adult psychotherapy , their eDifferently from other figurative arts, cinema allows for different psychological benefits, such as the identification with the character’s feelings and emotions, the cathartic effect (learning through the character’s experiences), and the improvement in social abilities through sharing emotions and experiences with other participants. There is clinical evidence that through the use of movies and follow-up sessions, pre-adolescent children whose parents were going through a divorce improved their capacity to identify and express their feelings and developed coping skills ,15. A moCreativity should be an essential element of the education process of people with disabilities and mental disorders . Indeed,This study shows how a film-based intervention, with typical structural and practical phases of the filmmaking process, can actively involve children and adolescents with mental health problems. This study has several objectives. The first objective was therapeutic and psycho-educational. It intended to represent an educational and growth experience for children and adolescents with neurodevelopmental/psychiatric disorders to make them capable of putting their skills to the test by experimenting with the various roles that cinema caters to . At the same time, it wanted to stimulate them to live out highly creative and cooperative work experiences. In this way, the higher-order cognitive functions (executive functions) and the energetic, motivational, and empathic aspects (warm executive functions) have been strongly stimulated and trained. The constant presence of child neuropsychiatrists and psychologists, who supported the film director, ensured the achievement of these objectives. The second objective was to offer a theoretical and practical introduction to the key principles of filmmaking. The participants attended a series of structured lessons on the skills necessary to use the cinematographic language (from brainstorming and storyboarding to camera use or video editing) with the purpose of creating a professional audiovisual product. All participants and professionals were members of the technical and artistic cast, working under the guidance of a qualified movie director and cinema teacher. The students also received a training certificate. Finally, the current study explores whether, and to what extent, involvement in a filmmaking program could promote the psychological well-being of children and adolescents with emotive/behavioural problems. The hypothesis is that this highly creative and cooperative group experience could both enhance participants’ self-esteem and reduce the severity of their emotional/behavioural problems.Therefore, the research project included a quantitative assessment through standardized measures of the participants’ emotional, social, and behavioural profiles. In addition, the benefits of the filmmaking course have been estimated on the extent of changes in the study measures  through a before–after comparison. Furthermore, to support the outcomes of the filmmaking intervention, the evaluation of improvements observed by the caregivers was implemented.The study involved 52 participants aged between 9 and 17 years: 24 girls  and 28 boys , all with a diagnosis of neurodevelopmental/psychiatric conditions. The project was developed in two consecutive courses of 6 weeks each. A first group of participants (N = 18) was selected among patients from an outpatient service at the Child and Adolescent Neuropsychiatry Unit, “A. Cao” Hospital—“G. Brotzu” Hospital Trust, Cagliari. A second group (n = 34) was chosen at Rehabilitation and Education Center “Dismed Onlus-Centro Studi per Le Disabilita’ del Mediterraneo”, Messina, Italy.Inclusion criteria were: (i) clinical diagnosis of neurodevelopmental/psychiatric conditions, (ii) aged under 17 years old.Information regarding personal data , personal history , and family history (psychiatric conditions) was collected.The several diagnoses in the total sample were, in descending order: anxiety disorder (n = 19), ADHD (n = 15), depressive disorder (n = 14), dyslexia (n = 13), adjustment disorder or PTSD (n = 12), autism spectrum disorder (n = 11), OCD (n = 7), bipolar disorder (n = 6), psychotic disorder (n = 5), Tourette syndrome (n = 5). Most of the enrolled adolescents received more than one diagnosis. The exclusion criteria were Total IQ (TIQ) < 70, assessed using the Wechsler scale (WISC-IV). This study explores if a therapeutic approach based on a six-week filmmaking course would help adolescents with emotional/behavioural problems and neurodevelopmental disorders. We hypothesized that an intensive training course aimed to actualize an artistic and creative product, such as a film, could lead to improving emotional and social abilities of a group of adolescents. We questioned if the peer interaction and the cooperative work on a film set could represent an effective tool for promoting adolescents’ psychological well-being, as reported in most of the scientific literature ,18. Different professionals  supervised all the project phases to provide appropriate support during the entire project. An experienced movie director  coordinaFirst, the invitation to participate in the project was proposed to parents through the two clinical/rehabilitation centres. The interested parents were invited for a meeting during which they obtained all details and scope of the project and provided written consent for their child’s participation. Subsequently, children participated in a meeting to receive information about the filmmaking project and to obtain their assent for voluntary involvement.Then, participants started a daily course of 5–6 h per day, lasting in total three weeks. During the first two days, all project members attended theory-based lessons in filmmaking history and techniques. This phase also focused on building trust relationships among the participants. From the third day onward, the three main stages of the film production process were structured. First of all, a pre-production workshop took place. In this phase, the participants, divided into groups, ideated and wrote many screenplays. Participants were assigned different filmmaking roles according to their interests and attitudes: scriptwriting, direction, photography, sound, costume design, make-up artistry, production organization, and digital editing. Some subjects also held more than one role. During the pre-production workshop, the participants were also engaged in storyboarding, spaces were selected, and equipment for sets was provided. A day-by-day film production timeline was also created. Additionally, following the creative  and technical phases , the filmmaking process took place in natural locations or public areas  that were chosen by the participants. Participants were expected to produce a few short films (lasting about 15 min), but they outperformed expectations and ultimately produced 13 short films in total (6 in the first edition and 7 in the second edition of the course). The script themes were largely inspired by the main adolescents’ issues and concerns, such as unintentional injuries, violence, mental health, suicide, self-cutting, alcohol and drug use, gender dysphoria, sense of unease, etc. In addition, some scripts were inspired by social and political issues, such as the Russia–Ukraine war and the fear of the apocalypse. Only a few themes contain hopeful messages that aim to promote the power of friendship and love. However, every script and film told a good story with an exciting plot that promoted reflection on sensitive topics. Finally, during the last two days of the programme, the video-editing crew worked with the movie director for the post-production phase: firstly, they drafted a rough cut of the film; then, they began to review and edit the footage making additions such as visual effects, background music, and sound design.0) and at the end (T1) of the course ; You; You22])Firstly, children and adolescents completed the Rosenberg Self Esteem Scale, which is a 10-item questionnaire that assesses global self-esteem. All items have a 4-point Likert scale . Higher scores indicate a higher sense of self-esteem and scores below 15 suggest low self-esteem. The Italian questionnaire has shown good internal validity (Cronbach’s α = 0.84) and test–retest reliability .Secondly, they filled out the Youth Self-Report Scale, which measures the severity of emotional and behavioural problems based on a sense of self-estimated evaluation. The YSR is recognized as having good psychometric characteristics, with α values ranging from 0.71 to 0.95. The questionnaire (112 items) is an instrument of the ASEBA  and inc0 and T1. Finally, all primary family caregivers were asked to complete Social Responsiveness Scale (SRS) and the Revised Conners’ Parent Rating Scale (CPRS-R) at points TThe Social Responsiveness Scale (SRS) measures the severity of social impairments in children affected by autism spectrum disorder or children from the general population. This questionnaire has excellent psychometric characteristics, and it has also been proven to be a useful tool for verifying changes in the severity of social impairment following intervention . The 65-item questionnaire includes five subscales: social awareness, social cognition, social communication, social motivation, and autistic mannerisms. Caregivers respond by estimating to what extent the item describes a child’s observed behaviour on a 4-point Likert scale . Higher scores indicate higher severity of social deficits in that area. The Revised Conners’ Parent Rating Scale  at the two assessment points (T0 vs. T1) from both children and caregivers were available for the statistical analysis.Statistical procedures were performed using IBM SPSS 19.0 data analysis software. All participants recruited at Tp< 0.05. Therefore, Wilcoxon signed-rank tests were performed to estimate pairwise differences between the measures. These tests were employed as a non-parametric alternative to the paired t-test, as it does not rely on the assumption of normality. Specifically, they were utilized to identify significant differences (p < 0.05) between the YSR, SRS, and CPRS-R measures (T scores) at two different time points (T0 vs. T1). Results are reported in Firstly, descriptive statistics for dependent variables were calculated see . The ass0 with low vs. normal/high self-esteem was 16 (30.8%) and 36 (69.2%), respectively; at T1, the percentage of participants with low self-esteem was halved , and 44 participants (84.6%) reported normal/high self-esteem levels. Then, the number/percentages of participants with high vs. low RSE were tested for the independence of distributions at T0 and T1 using the chi-square test (χ2). However, the test showed no significant association between self-esteem levels and phases: χ2 (1) = 1.56, p = 0.21.Primarily, an increase in self-esteem scores (RSE) can be observed see , even th0 to T1. A significant decrease in YSR scores from T0 to T1 resulted in four sub-scales: withdrawn/depressed (p = 0.005), social problems (p = 0.007), thought problems (p < 0.001), and rule-breaking behaviour (p = 0.04)  see .0 and T1, with the only exception being autistic mannerisms. Most importantly, the parameters that reached the widest statistically significant improvement were the social awareness subscale (p = 0.001) and social motivation subscale (p = 0.03). Social awareness increased in all patients. Moreover, in the Social Responsiveness Scale see , all par0 vs. T1) did not reach statistical significance. This finding was highly predictable since the programme was too short to change core aspects of a disorder, such as hyperactivity or oppositional behaviour. Finally, while a decrease in CPRS-R scores was observed , the differences . This project was beautiful (Arianna’s thread). From this experience, I understood that each of us has skills. Participating in a movie set with all the other kids was an incredible adventure. I hope more similar things are done. Anyone who has yet to experience it cannot understand.” , which are mental control processes needed to carry out goal-directed behaviours and are fundamental to successful daily functioning across the lifespan . Efs refLack of executive functioning was also detected in externalizing disorders  and some mood disorders . However, there are some variations in effect sizes. Apart from the classical “cold” EF, other mechanisms, including the so-called “hot” EF, i.e., motivational dysfunction, delay aversion, sensitivity to reward and punishment, and emotional processing, could be involved.Creating a film involves many stages, from writing the script to planning the shots, filming, and editing. These stages require using a range of cognitive skills, including all the critical components of executive functioning. Planning and organization are fundamental, from writing the script to scheduling the shoot and arranging locations and equipment. Filmmakers need to remember many details, such as camera angles, lighting, and sound while filming. It requires working memory, which is remembering information while using it to complete a task. Additionally, filming requires sustained attention to detail and the ability to switch focus between different aspects of the production. On the other hand, during the production schedule, it could be common to deal with unexpected changes, such as finding creative solutions to technical issues. It could help to improve the executive function of problem solving, which is the ability to identify and solve problems creatively and efficiently. Moreover, making decisions throughout the production process, such as selecting the location, choosing camera angles, and deciding on the best takes to use in the final edit, could enhance the decision-making steps.During their work, participants had to be flexible and adapt to the changes in the group and the environment, maintain concentration by reducing external interference and distractions, and tolerate denials, frustrations, and routine changes. In conclusion, participants could learn how to analyse situations, identify potential problems, and develop creative solutions. Consequently, this suggests that filmmaking, in the same way as other psychosocial interventions, could positively affect some executive functions. In the case of ADHD subjects, this can lead to the reduction in hyperactivity and inattention. This was not recorded in our work, due to the short time of the project and to the lack of psychometric assessments specifically for cognitive functions. We could hypothesize that more prolonged work might improve these outcomes.Last but not least, thanks to this experience, which requires technology and media tools, participants could learn how to use cameras, edit software, and use other tools to create a final digital product. Some of the participants were inspired by the project to work in the cinema field in the future. This is another important result for adolescents having difficulty in designing their personal, social, and educational development.The study had some potential limitations, represented by the small size of the sample and the absence of a control group, that limit the generalizability of the findings. In addition, it was conducted with limited time and resources, which can reduce the ability to collect detailed data. However, on the other hand, pre- and post-test comparisons were tested, and different statistically significant results were found. The group encompassed subjects with different and multiple diagnoses, and most participants affected by neurodevelopmental disorders show co-occurring psychiatric symptoms. However, the group was rather homogeneous since the participants shared neuropsychological and affective profiles and developmental trajectories. Additional research is needed in order to explore the effect of this kind of intervention on separate groups. Considering that the sample was not so wide, this was a denotative result, and with a larger sample, more significant results would emerge. More extensive studies will be necessary to test and refine research methods, procedures, and instruments. Larger patient samples and a systematic collection of standardized outcome measures are also needed. As more research is conducted in this area, we will better understand the benefits and limitations of this project as a therapeutic intervention.This is a pilot study, but the preliminary results demonstrate that a filmmaking programme can result in measurable changes in emotional, behavioural, and social domains in children and adolescents with psychiatric or neurodevelopmental disorders. The projects that involve movies or videos could help develop new skills, increase awareness, and offer new ways of thinking about specific problems in various patient populations. Projects like this may also encourage children and adolescents with psychiatric disorders to develop skills in their personal and academic lives, explore their passions, and engage with the world around them.Findings from this research project can offer an empirical basis for the effectiveness of a structured filmmaking method to be replicated in broader contexts  in promoting children’s psychological well-being.In conclusion, the filmmaking programme proved to be a valid and complete psychosocial intervention to promote mental well-being in general and to strengthen specific weaknesses in young patients suffering from a psychiatric disorder.