Polycystic ovary syndrome (PCOS) is one of the most common gynecological endocrine diseases for women of puberty and reproductive age. PCOS can affect women’s health for the rest of their lives since the incidence of coronary heart disease (CHD) may increase in the perimenopausal and senile periods among PCOS women compared with non-PCOS women.A literature retrieval based on the Science Citation Index Expanded (SCI-E) database. All obtained records results were downloaded in plain text format for subsequent analysis. VOSviewer v1.6.10, Citespace and Microsoft Excel 2010 software were utilized for analyzing the following terms: countries, institutions, authors, journals, references and keywords.There were 312 articles retrieved from January 1, 2000 to February 8, 2023, and the frequency of citations was 23,587. The United States, England, and Italy contributed the majority of the records. Harvard University, the University of Athens, and Monash University were the top 3 most productive institutions with publications on the relationship between PCOS and CHD. Journal of clinical endocrinology & metabolism ranked first with the highest publications (24 records), followed by Fertility and sterility (18 records). The keywords were divided into six clusters in the overlay keywords network: (1) the correlation between CHD risk factors and PCOS women; (2) the relationship between cardiovascular disease and female reproductive system hormone secretion; (3) the interaction between CHD and metabolic syndrome; (4) the relationship between c-reactive protein and endothelial function and oxidative stress in PCOS patients; (5) the potential positive effect of metformin on reducing CHD risk factors in PCOS patients; (6) the study of serum cholesterol and body-fat distribution in patients with CHD in PCOS. Oxidative stress, genome-wide association, obesity, primary prevention, and sex difference were main hotspots in this field in recent five years according to the keyword citation burst analysis.The article obtained the hotspots and trends and provided a reference for subsequent research on the association between PCOS and CHD. Moreover, it is hypothesized that oxidative stress and genome-wide association were frontier hotspots in studies that explore the relationship between PCOS and CHD, and prevention research may be valued in the future. Its cliHowever, after searching various major databases, we found considerable literature on the relationship between the risk of CHD and PCOS. Although some scholars have done literature review studies –12, the Bibliometric analysis is a method of analyzing, cleaning and mining the quantitative information of literature using mathematical and statistical functions, which explore structures, characteristics and laws of science and technology. The VOSviewer software developed by Van Eck of Netherlands University can intuitively display terms in different color clusters and clearly show the connections between clusters . CiteSpaScience Citation Index Expanded (SCI-E) database, as one of the three major databases in the core collection of Web of Science (WOS) databse, is an authoritative and high-impact citation index database of scientific journals. Therefore, this study intended to use VOSviewer and CiteSpace to visually analyze the literature related to the relationship between CHD and PCOS in the SCI-E database to explore the main research content and track the research hotspots. Based on the data analysis findings in the literature, we attempted to describe the significant impact of PCOS on the health integrity of patients in order to provide a reference for the further research direction of the relationship between PCOS and CHD and the preventive measures for PCOS patients with CHD.22.1http://www.webofscience.com/), the most common database for bibliometrics, was used to retrieve literature. The retrieval method was subject-term searching. Using keywords related to polycystic ovary syndrome, including “polycystic ovary syndrome”, “polycystic ovarian syndrome”, “PCOS”, and “Stein-Leventhal Syndrome”; and coronary heart disease-related keywords, including “coronary heart disease”, “CHD”, and “Coronary Diseases”, and operation method was “AND”. All obtained records results were downloaded in plain text format for subsequent analysis. We did all the searches and data exports on the same day  since metrics constantly changed over time.Our study referred to the general internationally accepted method of bibliometrics. The SCI-E database (2.2The inclusion and exclusion of studies were based on the filters of the WOS database. The studies that met the following criteria were included (1): articles published in the period from January 1, 2000 to February 8, 2023 (2), articles about PCOS and CHD, (3) original articles or reviews, and (4) published in English. Exclusion criteria were (1) repeated publications, (2) proceeding paper, editorial material, meeting abstract, book chapters, letters, early access, correction, reprint, and other types. Two researchers strictly screened the literature by detailed examining the abstract section according to the inclusion and exclusion criteria. The third researcher decided on the contents with differences and uncertainties.2.3The following basic information was collected for each article: countries, authors, institutions, journals, references and keywords. Keywords with the same meaning but in different styles were standardized: “syndrome pcos” was replaced by “polycystic ovary syndrome”, “coronary-artery disease” was replaced by “coronary heart disease”, “type 2 diabetes mellitus” was replaced by “type 2 diabetes”, “obese women” and “overweight” were replaced by “obesity”, “BMI” was replaced by “body mass index”.2.4http://www.vosviewer.com) is software for mapping scientific knowledge, which can construct and visualize the relationship between network data. It shows the structure, evolution and cooperation of the knowledge domain with its outstanding feature of the ability of graphic display and large-scale data analysis. Compared with VOSviewer, CiteSpace software has its certain advantages in visualizing burst words and revealing the dynamic development and change of research hotspots and discipline.The above plain text was imported into VOSviewer v.1.6.10  and Cite2.5In the knowledge map generated by the VOSviewer, research projects were presented, including countries, institutions, authors, co-cited references and keywords, et al. The research projects can be demonstrated as nodes, and links between nodes represent collaboration, co-occurrence or co-citations among them. The bibliographic co-citation analysis and keyword co-occurrence analysis networks were used to construct a knowledge map of studies on the association between PCOS and CHD. Reference co-citation cluster analysis can summarize the main topics in the research field. Keyword co-occurrence analysis can illustrate the theme of the literature. The distribution trend of obtained research was generated by Microsoft Excel 2010 software. The burst words were analyzed by CiteSpace.33.1There were a total of 312 records in the search results from January 1, 2000 to February 8, 2023 Figure 13.2According to the search results, 312 articles were from 46 countries, and the top 35 countries by the number of publications were presented in 3.3A total of 513 institutions were involved in these articles. 3.4A total of 1,518 authors were involved in related publications, authors with a frequency ≥ 2 times were incorporated in the collaboration network analysis, and 111 authors were obtained. Dr. Wang, Ping, Dr. Glueck, Charles J, Dr. Wild, Robert A, Dr. Lambrinoudaki, Irene, Dr. Azziz, and Dr. Ricardo had the highest number of publications. They were distributed in different clusters, showing close cooperative relationships with other authors Figure 43.5A total of 170 journals were included in related research. The top 11 journals with more than five publications were shown in 3.6Of the 312 records, the top 10 publications ranked by citation were listed in 3.7Through the co-citation analysis of the cited documents of related research, the research foundation in this field can be effectively constructed. Of the 23,587 cited references, the minimum number of citations for a single document was set at 20. By analyzing the citation frequency of 23,587 documents, 42 documents reached the threshold Figure 53.8A total of 1,491 keywords were extracted from the retrieved records. The minimum number of keyword occurrences threshold is set to 5, and 115 reached the threshold. The network map of the 115 keywords was were showed in The keywords were divided into six categories in different colors: (1) the interaction between CHD risk factors and PCOS women; (2) the relationship between cardiovascular disease and female reproductive system hormone secretion; (3) the interaction between CHD and metabolic syndrome; (4) the relationship between c-reactive protein and endothelial function and oxidative stress in PCOS patients; (5) the potential positive effect of metformin on reducing CHD risk factors in PCOS patients; (6) the study of serum cholesterol and body-fat distribution in patients with CHD in PCOS.Burst words detection results revealed that popular keywords had undergone obvious annual changes Figure 84This study conducted a statistical analysis of the literature on the WOS database to retrieve studies on the association between PCOS and CHD and obtained a total of 312 pieces of literature, generally reflecting the trend and hot spot of related research. Its research fields mainly focused on endocrinology metabolism, obstetrics and gynecology, cardiovascular diseases, and reproductive medicine, et al., indicating that the research field was relatively popular. The distribution trend result showed that the literature was on the rise from 2002 to 2008. However, it appeared to be a steady trend in recent years, which reflected that the research on the relationship between CHD and PCOS had entered a relative bottleneck period.The publication quantity and citation frequency of literature are important indicators to evaluate the scientific research strength of a certain country, region or institution. The country with the most papers was the United States, and the institutions with the most papers were Harvard University, the University of Athens, and Monash University, which showed that the difference in scientific research levels in different countries and regions was considerably large. It was related to the earlier research start, stronger scientific research ability and economic strength in a handful of countries/regions and institutions. Moreover, there were still issues regarding more cooperation among research teams and cross-regional and cross-institutional communication. It is suggested to coordinate research resources from the level of relevant national departments to facilitate cooperation opportunities and further study of different research institutions.In terms of journals, the Journal of clinical endocrinology & metabolism, Fertility and sterility, and Human reproduction were the three most publishing journals with relevant articles. In addition, after a comprehensive analysis of the authors’ network, Dr. Wang, Ping, Dr. Glueck, Charles J, Dr. Wild, Robert A, Dr. Lambrinoudaki, Irene, and Dr. Azziz, Ricardo ranked in the top five based on the the amount of publications. The researchers and teams involved in relevant studies should pay attention to cooperation and communication with them in future research. The team of Dr. Wang, Ping and Dr. Glueck, Charles J proposed that metformin safely improved the risk factors of CHD and endocrine diseases and promoted the resumption of normal menstruation in the study of the metformin diet in women with PCOS . In addiA keyword is a high summary and refinement of the literature content, which reflects the core substance and value of the full article and responds to hot spots and research frontiers. Six categories were obtained by cluster analysis of keywords. The first cluster emphasized the association between CHD risk factors and PCOS. CHD risk factors include insulin resistance, diabetes and obesity et al. The incidence of cardiovascular disease (including hypertension and dyslipidemia) was higher in PCOS women than in non-PCOS women . Young wThe second cluster focused on the relationship between cardiovascular disease and female reproductive system hormone secretion. Testosterone promoted visceral fat accumulation and insulin resistance by inhibiting lipolysis and promoting adipogenesis . FurtherThe third and sixth clusters demonstrated the interaction between CHD and metabolic syndromes such as diabetes-mellitus and dyslipidemia et al. in PCOS patients. Both obese and non-obese PCOS patients had greater visceral fat than non-PCOS controls . Also, vThe fourth cluster illustrated the relationship between CRP, endothelial function, and oxidative stress in PCOS. As previously mentioned, PCOS patients had more visceral fat, its adipocyte hypertrophy triggered an inflammatory response, and hyperandrogenemia exacerbated the inflammatory response . Moreove2) who were randomly assigned to the metformin group, high-dose oral COC group, or low-dose COC plus spironolactone group. The results showed that abnormal coagulation events were observed in two COC groups but not in the metformin group. In addition, studies have shown that metformin had an advantage in reducing diastolic blood pressure and triglyceride, thereby predicting favorable metabolic and cardiovascular outcomes in women with PCOS. Moreover, metformin was more effective in reducing hyperandrogenemia indicators (As for the fifth cluster, we concluded the potential positive effect of metformin on reducing CHD risk factors in PCOS patients. A study by Velazquez et al.  includeddicators . Howeverdicators . Carotiddicators . More stThis study detected 25 burst words that appeared from 2000 to 2023. The burst words reflected the emerging trends and abrupt changes in current research hotspots. According to Similar to other bibliometrics studies, our research had some shortcomings that must be addressed. Our study’s limitations were as follows: This study only retrieved the most commonly used WOS database, lacking studies on other databases, resulting in some relevant articles may not have been covered. Also, we retrieved articles written in English; thus non-English studies with high quality were not included in our study. Moreover, part of the meta-analysis was recognized as the original article in the WOS database, which may cause discrepancies in the number of reviews and original articles.5This study explored the relationship between PCOS and CHD and displayed a deep insight into the status and trends of the research field with the bibliometric analysis method. In recent five years, the hotspots of the association between PCOS and CHD were oxidative stress, genome-wide association, obesity, primary prevention, and sex difference. Our study had a certain reference value for further research on the relationship between PCOS and CHD and future relevant research topics hunting.All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.XL and HH contributed equally to the research. XL, YW and HH retrieved articles. XL and HH wrote the first draft of the manuscript. HZ and LW performed the data collection. JY provided figures. JF and SF critically revised the paper. SF designed research. JF provided funding support. All authors contributed to the article and approved the submitted version.


Sleep disorders, which are prominent problems among college students, may be associated with skipping breakfast. Therefore, we aimed to explore the role of sleep chronotypes and depressive symptoms as mediators in the relationship between breakfast frequency and sleep quality. A cross-sectional survey enrolling random samples of 712 college students was conducted by the Questionnaire Star online platform. Statistical description and correlation analysis were performed by SPSS 25.0, and a chain mediation test was performed by model 6 in PROCESS 3.5. The result of the article demonstrated that breakfast frequency can affect sleep quality through two mediating pathways: ① sleep chronotypes, with a mediating effect of 32%; and ② depressive symptoms, with a mediating effect of 52.4%. However, the chain mediating effects of sleep chronotypes and depressive symptoms was not significant, and neither was the direct effect of breakfast frequency on sleep quality. Breakfast frequency can indirectly affect sleep quality by adjusting sleep chronotypes and depressive symptoms. Regular breakfast can increase morning and intermediate sleep chronotypes, reduce depressive symptoms, and thus improve sleep quality. During the COVID-19 pandemic, in order to make up for the shortage of medical and health resources and better maintain public health and social order, many countries adopted quarantine, including studying online for college students. At home, without the supervision of the school and peer influence, college students are more likely to be influenced by self-control, such as sleeping early or late, eating breakfast or not, and so on. Furthermore, we found that during online classes at home, students’ diet and lifestyle habits changed dramatically, including the longer use of electronic devices, lesser breakfast frequency, and longer sleep duration . RelevanNumerous studies have linked breakfast to nutritional intake, weight control, cardio metabolic risk factors, and cognitive performance . FurtherThe circadian system regulates many aspects of eating behavior, including hunger rhythms, food intake timing, and so on. SC is a self-assessed description of circadian preferences that reflects the organization of the circadian system. Researchers generally distinguish three main SCs: morning (“larks”), intermediate, and evening (“owls”) . SCs andDepression, and its associated mood disorders, is a global health problem and was one of the most common psychiatric disorders during the COVID-19 pandemic . For adoBased on the above studies, we can speculate that there is a relationship between BF, DS, SC, and SQ. However, the impact mechanism of BF on SQ is not clear, so we aimed to investigate the relationship between the above four and to explore the multiple mediating roles of DS and SC between BF and SQ. We investigated the situation of college students in Chongqing Medical University’s online classes and fully explored the mechanism of BF affecting SQ, aiming to provide some guidance for college students to develop a healthy lifestyle and promote public health. Therefore, we proposed the following four hypotheses:Hypothesis 1 (H1). BF has an impact on SQ.Hypothesis 2 (H2). BF affects SQ through the separate mediating effect of SC.Hypothesis 3 (H3). BF affects SQ through the separate mediating effect of DS.Hypothesis 4 (H4). BF affects SQ through the chain mediating effect of SC and DS.This study used a cross-sectional survey method. From 19 September 2022 to 27 September 2022, 712 college students from Chongqing Medical University were recruited to participate in an online questionnaire survey using the convenient sampling method. The questionnaire included basic demographic variables, social support scale (PSSS), depression–anxiety–stress scale (DASS-21), the Pittsburgh Sleep Quality Index (PSQI) scale, and morning and evening questionnaire (MEQ-5). Before the survey, professional investigators introduced the survey content and purpose to obtain all participants’ informed consent. Questionnaire filling, data collection, and summary were all performed on the Questionnaire Star online platform; the inclusion criteria were sophomores and above, and having online class experience, and the exclusion criteria were no history of major diseases, chronic diseases, or trauma, and incomplete questionnaires. After removing missing and invalid data, the number of remaining samples was 660.We measured this through the question “How many days have you had breakfast in the past week?” to measure how often participants ate breakfast. Results ranged from 0 to 7, and the higher the value, the higher the frequency of breakfast.The morning and evening questionnaire (MEQ) is currently the internationally accepted classification tool for the natural trend of sleep–wake circadian rhythm, which belongs to the category of self-assessment of sleep behavior. We used the morning and evening scale (MEQ-5) to assess SC, and a simplified 19-item version of the classic 5-item MEQ to assess chronotypes, where the scores of the 5 items are added together, with higher scores representing earlier chronotypes. This questionnaire has validity and reliability to a certain extent, and is widely used in the assessment of sleep . FurtherDS was measured using the depression component of the depression–anxiety–stress scale (DASS-21). Brown et al. (1997) demonstrated that the DASS scale could be reliably categorized into depression (DASS-D), anxiety (DASS-A), and stress (DASS-S). The depression subscale assessed lack of incentive, low self-esteem, and dysphoria. Compared to the traditional DASS-42 scale, DASS-21 has a greater differential validity . The CroThe Pittsburgh Sleep Quality Index (PSQI) is a retrospective self-assessment questionnaire, mainly used to measure SQ in the previous month. The scale consists of 18 self-assessment items and 7 components. Component scores range from 0 (no difficulty) to 3 (severe difficulty), and each part is added together to produce a global score ranging from 0 to 21 . A globaTo minimize the bias in the results, we performed measures of basic demographic characteristics, including sex, age, grade, height, weight ), monthly family income, and home address.n (%)), continuous variables used mean and standard deviation (M ± SD). The normality test and homogeneity test of variance were conducted for the scores of BF, SC, DS, and SQ under different basic demographic characteristics, and the t test of two independent samples or homogeneity-of-variance were further conducted to determine whether there were differences in the mean values of BF, SC, DS, and SQ among different subgroups when all were satisfied. This study used SPSS 25.0 to process data and perform correlation analyses on BF, SC, DS, and SQ. The Harman univariate test was used for common bias test. Furthermore, the multiple mediation effect model was tested using model 6 in the PROCESS program developed by Hayes, and the significance of the mediation effect was tested by sampling 2000 times by bias-corrected percentile bootstrap. The significance level is 0.05.For frequency and percentage representation of categorical variables (p = 0.019). SC scores varied by gender, age, monthly family income, and home address . Finally, the mean of DS and SQ scores also differed significantly by gender .As shown in The specific method of testing is to employ exploratory factor analysis on all topics to see if the explanatory amount of the precipitated first common factor is below the critical value of 40.0%. This study precipitated a total of six common factors with feature values greater than 1. Among them, the amount of explanation of the first common factor is 22.80%, which is below the critical value, which means that the data are acceptable without significant common method deviation.p < 0.001), while BF and DS as well as BF and SQ were negatively correlated . SC and SQ were negatively correlated , and SC and DS were not correlated (r = −0.027). DS and SQ were positively correlated . The detailed results are shown in The results of Pearson correlation analysis showed that BF and SC were positively correlated , while BF and DS were negatively correlated . There was an inverse correlation between SC and SQ , and DS and SQ were positively correlated . BF was not significantly associated with SQ, and SC was not significantly associated with DS. Regression models incorporating BF, SC and DS as independent variables explained a total of 17.5% of the variance in sleep quality (R2 = 0.175).Based on the correlation of BF, SC, DS, and SQ, we used multiple mediation analysis to explore the mediating role of SC and DS in the college student population. With BF as the independent variable (X), SC and DS as mediating variables (M), and SQ as the dependent variable (Y), a chain mediation model was constructed. The analysis results in The mediation path model is shown in To test whether the mediation effects of SC and DS was significant, we designed an autonomous estimation procedure for the samples. The effect is the most when the pathway coefficient of the 95%CI does not include 0. Although there are many studies on the factors related to SQ and BF, the mechanism of how BF affects SQ has not been fully elucidated. In this study, we established a multiple intermediary model to show how the relationship between BF and SQ transmitted through DS and SC. We first described the demographic characteristics and found that there were some differences in BF, SC, DS, and SQ among different populations. Furthermore, we established three main pathways: DS as a separate mediator, SC as a separate mediator, and DS and SC as multiple mediators. The results show that the direct effect of BF on SQ is not significant, but the indirect effects tellingly show. The separate mediation effect of DS and SC is obvious, but the multiple mediation effects of DS and SC are not significant.We found body mass index (BMI) varies from different BFs. According to the results of other studies, BF may be related to eating habits, and people with an unhealthy diet have higher BMIs than those with healthy eating habits , which iIn previous studies, there was a correlation between BF and SQ. This is consistent with our assumptions. Sleep time is so crucial to breakfast intake that people with poor SQ will be more inclined to irregular eating habits ,30,31,32The study found that SC also played a mediating role in the relationship between BF and SQ, with a mediating effect of 32.0%. This is in agreement with previous studies: people who skip breakfast tend to sleep late and tend to sleep later in a lower sleep quality ,34,35. IThis study found that DS played a mediating role between BF and SQ, with a mediating effect of 52.4%, which is consistent with previous findings. People who skip breakfast are more likely to show higher symptoms of stress and depression than those who eat breakfast, and there is a significant positive correlation between skipping breakfast and the odds ratio of depression, stress, and psychological distress ,43,44,45Similarly, we also propose a chain multiple mediation model of SC with DS, and there is no significant chain between SC and DS from the model regression and correlation analysis. However, previous studies have proved the relationship of SC and DS and revealed the interaction of evening types and DS; evening types are more prone to be depressive and suicidal. Meanwhile, people experiencing DS and suicidality also show greater preference to being evening types, but the mechanism is still unclear ,49,50. OIn summary, regular diet and high-quality sleep are positively related to the physical and mental health as well as the healthy lifestyle formation of college students. We discussed the two influence pathways of BF on SQ via SC and DS, and we revealed that regular breakfast is a feasible and effective way for college students to keep fit.This study provides empirical evidence that BF has an indirect impact on SQ in the regulation of SC and DS, and the results of this study suggest that college students should develop a habit of regular breakfast, which is conducive to increasing morning and intermediate SC, reducing DS, improving SQ, and thus staying healthy rather than skipping breakfast to be vexed by sleep disorders.Our hypotheses are still partially unproven, and our study has some limitations. Firstly, the descriptive studies we cited were difficult to determine the causal and temporal relationship between BF and SQ from, and the sample survey was prone to selection bias and information bias. Therefore, cohort studies can be conducted on existing conclusions for further discussion on the causal and temporal relationship among the variables. Secondly, due to the COVID-19 quarantine, the generalizability of this study may be influenced by the uncertain changes on psychology and obtaining of food of college students, especially those living alone. In addition, during the COVID-19 period, in order to fulfill limited duties, the social activities of college students were restricted, which may have led to an increase in evening chronotype and result in some bias in the results. Thirdly, the main purpose of our study was to investigate the influencing mechanisms of BF on SQ, while the lack of covariates on sleep quality may lead to bias in the results. Finally, the experimental results may widely vary in college students from different regions and skin colors, while all participants in this study were only from Chongqing Medical University because of the COVID-19 lockdown. Hence, generalization of the study findings requires further validation using a larger, more representative sample study.


Also, after 12 months, there was an improvement of ≥50% in four SMAP criteria (p < 0.05) and in the mean average of all SMAP criteria (p = 0.021) compared with baseline in the intervention group, in which intra- and inter-group improvements for desserts in traffic light ratings, nutrients, and allergens were observed (p < 0.05). Therefore, the intervention showed beneficial effects, improving the quality of menus toward the Mediterranean diet pattern and gluten and food allergy/intolerance management.The consumption of out-of-home meals is increasing. This study is aimed at assessing the effect of an intervention on healthy offerings and the management of food allergies and intolerances. Ten (control group) and eight restaurants (intervention group) were randomized in a 12-month parallel controlled trial. The outcomes were changes regarding adherence to the Mediterranean diet (AMed) and gluten management (SMAP) criteria, the traffic light rating category, nutrients, and gluten- and allergen-free content of dishes. After 12 months, and compared with baseline, there was an improvement of ≥25% in four items of the AMed criteria in the intervention group, whereas an increase in the offer of dairy desserts without added sugar, and a decrease in the first course offerings of vegetables and/or legumes were observed in the control group ( The consumption of out-of-home meals has increased in recent decades , with woThe implementation of healthier meal offerings in restaurants is a great opportunity to improve consumers’ dietary choices and promote healthy dietary habits. Additionally, in restaurants, changing to healthier offerings can increase customer satisfaction. In a cohort of restaurant consumers from ten countries worldwide, only 18% of them were satisfied with the healthy options available on menus . CustomeA systematic review of 25 studies on community-based restaurant interventions to promote healthy eating concluded that evidence is limited, and further studies with robust designs and standardized evaluation methods are needed . PreviouIn this scenario, a health intervention in restaurants is essential for improving both the food environment and individual eating behavior. A systematic review and meta-analysis on interventions promoting healthy meals in full-service restaurants and canteens was recently carried out . The reshttps://clinicaltrials.gov/ct2/about-site/background, accessed on 21 February 2019) with the project identification code NCT03826576. All restaurant owners gave their informed consent for participation in this study. This study was conducted in accordance with the Consolidated Standards of Reporting Trials 2010 extension for randomized trials [A parallel, randomized controlled trial  was performed in restaurants in Tarragona (Spain). The trial was aimed at improving the nutritional quality of the menus offered and the availability of allergen-free dishes or those catering to specific food needs . The intervention period lasted 12 months. This study was part of a European-funded project called PECT-TurisTIC en Familia  led by the Rovira and Virgili University . This study was conducted in accordance with the Declaration of Helsinki , and theFrom September 2019 to March 2021, a total of 61 restaurants offering traditional and Mediterranean cuisine were recruited, and 44 of them were randomized as previously described [A virtual/face-to-face training for the kitchen and room staff on Mediterranean diet menu offers and food allergen management.A web-app to help chefs to improve their recipes concerning nutrition and allergen-free issues. Chefs can introduce each recipe of the menu in the app and be aware of the principal macronutrients (using a traffic light system) and the food allergens involved.Personalized recommendations for each restaurant based on key points for improving the Mediterranean diet profile and food allergen management.A marketing campaign about weak points to be improved in the restaurants concerning the two previously referred items.The multicomponent intervention included several actions:The outcomes were directed at assessing changes from before to after the intervention.AMed criteria are a list of items created by the Public Health Agency of Catalonia, Spain. AMed criteria are the basis for a certification to be provided to restaurants and food service establishments in order to guarantee the offer of a Mediterranean diet-based menu . AMed itThe Malabsorption Syndrome Parents Association (SMAP) of the Catalan Celiac Association (Spain) has developed an SMAP certification . SMAP coFrom the nutritional information, a traffic light rating system for every dish was obtained, in agreement with the cut-offs provided by the UK Food Standards Agency . The eneThe offered dishes were classified as starters, main dishes, and desserts. The information collected for each dish was energy  and grams of protein, total carbohydrates, sugar, total and saturated fat, fiber, and sodium. The food composition database was extracted from the nutritional information of commercial food products and data from different public databases ,27,28,29The 14 most common food allergens that should be declared, according to the European Regulation 1169/2011 , were idThe typification of a vegetarian or vegan dish was made according to the ingredients used. The plant-based meals not containing animal products were labeled as vegetarian and the meals not containing animal products or their derivates were identified as vegan .2 tests. Wilcoxon and Mann–Whitney tests were used for intra- and inter-group comparisons, respectively, for categorical variables, and the X2 test was used for multiple comparisons. Student’s t-test was used for intra- and inter-group comparisons between related and unrelated samples, respectively, for continuous variables. Statistical significance was defined as a p-value ≤ 0.050 for a 2-sided test. Analyses were performed using SPSS for Windows, version 26 . Before data collection, hypotheses and the analytic plan were specified, and any data-driven analyses were clearly identified and discussed appropriately.Data are presented as mean ± standard deviation (SD) for continuous variables and as a percentage (number) for categorical variables. Differences in baseline characteristics between groups were assessed using Mann–Whitney or XOf the 44 randomized restaurants, only 18 remained at the end of this study, 10 in the control group and 8 in the intervention group . Reasonsp = 0.016).p < 0.05). In the intervention group, when considering both mandatory and optional criteria, increases of 37.5% were observed in “olive oil for dressing, and olive oil or high oleic sunflower for cooking” and “prioritize side dishes of vegetables and legumes”, but they did not reach significance (p = 0.083). In this group, a 25% increase was observed in the “offer of dairy desserts without added sugar” (p = 0.317) and “offer options with no added salt” (p = 0.157). No significant changes were observed in the other analyzed items or between treatments. When the average AMed criteria were compared, even though increases were observed after intervention in the AMed mandatory or in the sum of all AMed , neither intra nor inter-treatment significant differences were observed.p = 0.057). In both groups, there was a 50% increase in “to place on the tables bottles of oil, vinegar, sauces, and baskets for exclusive use, or single-dose portions” (p = 0.046). In the intervention group, increases in “to provide a clean apron when working with flours or products that may leave gluten traces on the clothes”  and in “do not use kitchen cloths and wooden tools, which are materials that can retain traces of gluten”  were observed. The increase observed in “to dispose of closed saltshakers and spice boxes or use a teaspoon to pick up the salt, as long as hands will be not placed inside” reached borderline significance . Additionally, in the intervention group, but not in the control group, the average of all SMAP criteria increased from the beginning to the end of this study . No inter-treatment differences were observed.p = 0.054), from the beginning to the end of this study in the intervention group; the decrease reached significance compared with the changes observed in the control group (p = 0.017). A similar decreasing pattern in the intra-treatment changes for the intervention group was observed for carbohydrates (p = 0.030) and sugar (p = 0.016)  . Neitherp = 0.045), carbohydrates (p = 0.033), and sugar (p = 0.023), with the decrease in sodium values reaching borderline significance (p = 0.058). Despite considerable reductions in proteins or total fat after the intervention period, no significant differences were observed. No differences were observed in saturated fat or fiber values either. No inter-treatment differences were observed.When assessing the nutrient content of the restaurants’ dishes, neither intra- nor inter-treatment differences were observed for starters and main dishes  with thep = 0.040), with the increase being significant compared with the changes in the control group (p = 0.027)  .In this study, and after a 12-month intervention, improvements similar to or higher than 25% in four items of the AMed criteria in the intervention group were observed. In the control group, there was an increase from baseline data in the offerings of dairy desserts without added sugar (40%), with a decrease (40%) in the first course offerings as vegetables and/or legumes. Improvements of ≥40% in several SMAP criteria, as well as in the average of all SMAP criteria, were observed in the intervention group but not in the control group. Additionally, in the intervention group, but not in the control group, improvements in traffic light ratings, nutrients, and allergens were observed for desserts. Between-group differences were observed in energy reduction and allergen-free parameters in the intervention group desserts versus the control desserts. Thus, overall, the intervention showed beneficial effects that improved the quality of the menus.In the intervention group, the main increases for AMed criteria were observed in relation to two items. The first item was “olive oil for dressing, and olive oil or high oleic sunflower for cooking”. A large body of knowledge exists on the advantages of olive oil consumption compared with other types of fats ,32. The Concerning SMAP criteria, the item “place on the tables bottles of oil, vinegar, sauces and baskets for exclusive use, or single-dose portions” significantly increased in both groups. This item was one of the mandatory conditions established for the partial reopening of restaurants in Spain in May 2020 after the COVID-19 pandemic lockdown . SeveralIt is interesting that improvements in traffic light ratings, nutrients, and allergens occurred only in desserts in the intervention group, without changes in starters or main dishes. Despite having a small sample size, we were able to detect differences between groups for dessert energy regarding traffic light and allergen-free parameters. Regarding the traffic light ratings, there was an increase in green, a moderate decrease in orange, and a decrease in red for both energy and carbohydrates in the intervention group. Concerning sugar, however, the improvement in the intervention group was related to changes from red to orange, without modifications toward the green. Desserts are among the top five sources of fats and sugar . Due to Strengths and LimitationsThe present study has several strengths. First of all, this study’s design is robust enough to increase the available high-quality information on the effectiveness of this type of intervention. Additionally, focusing on the poor Mediterranean offerings on restaurant menus and difficulties preparing dishes without food allergens or with controlled food allergens is an original approach, considering the training of the restaurant staff and the provision of tools. This helps to increase their autonomy in improving the nutritional quality of the menu and food allergen detection, instead of teaching consumers about their selection when they visit restaurants.One particular limitation of this study must be highlighted to explain the moderate success of the intervention and the timing of the intervention: from September 2019 to March 2021, the COVID-19 pandemic was particularly prevalent in Spain , with seAfter a 12-month intervention, improvements were obtained in the intervention group for some AMed and SMAP criteria, as well as in traffic light ratings, nutrients, and allergens in desserts. The moderate rates of changes could be explained by the fact that this study was conducted in the context of the most severe COVID-19 pandemic period in Spain. Our results highlight the need for further interventions to enhance the nutritional quality and safety of menus offered in Spanish restaurants.


Objectives: This study aimed to examine the levels of trust in information provided by public authorities 2 years after the COVID-19 outbreak and to examine factors associated with trust.Methods: Using a cross-national approach, online survey data was collected from four Western countries—Australia, Norway, the United Kingdom, and the United States of America. Differences in reports of very low or low levels of trust were examined by age, gender, area of residence, and the highest level of education in the four countries.Results: Levels of trust in the public authorities’ information were highest among Norwegian respondents and lowest among U.K. respondents. Lower levels of trust in public authorities were found among males, individuals living in rural or remote areas, and those with lower levels of education.Conclusion: The outcomes contribute to knowledge regarding differences between socio-demographic groups and countries regarding the levels of trust people have in public authorities’ information concerning a crisis, such as COVID-19. Strategies to promote trust in societies in different countries could consider these socio-demographic differences. The coronavirus COVID-19) was declared a global pandemic on 11 March 2020, as media outlets shared information about a virus spreading rapidly and having fatal outcomes. Following the acknowledgment of a public health crisis, questions and concerns about the potential responses of public authorities to protect public health and safety surfaced across various forms of media 9 was dec.As public authorities across the globe began to respond to the emerging pandemic, disparities among approaches were observed . Each coTrust in government officials is developed and maintained by delivering accurate information, having consistency in responses, transparency in challenges and decision-making, and producing positive outcomes for citizens by providing valuable resources to address identified needs , 7, 8. TTrust is needed to incorporate self-efficacy in the most effective and efficient ways during any stressful situation , 12. PeoStudies examining trust in public authorities during COVID-19 have provided information about ongoing connections between trust and outcomes. Goldfinch et al. (2021) found that levels of trust in public authorities were associated with how the government responded to the pandemic. If the responses of the government were viewed to be effective in reducing the spread and lethality of the coronavirus, trust levels were increased, and the adverse impacts of COVID-19 were less than in areas where rates of trust were lower , 17, 22.Researchers note that the U.S. and the U. K. had higher levels of infection and fatalities and citizens were more likely to report distrust in the responsiveness of public authorities to COVID-19 , 26. A fAs COVID-19 continues to be a leading cause of death globally, with 6,897,025 deaths as of 11 April 2023, ongoing interventions are critical . Coronavirus has highlighted disparities between confidence and trust in public authorities. The inconsistencies require ongoing knowledge contribution to examine population responses in countries with similar social-political contexts . As citiTo contribute to the scientific knowledge, examining trust in public authorities can provide information for public authorities to engage citizens unwilling or hesitant to adhere to policy, procedure, and practice recommendations to reduce the spread and lethality of COVID-19 at various time intervals of an international health crisis. The primary source of information specific to COVID-19 often relies on information provided by public authorities . IncreasTo expand on existing knowledge, this study examines the levels of trust in information provided by public authorities two years after the COVID-19 outbreak in four Western countries—Australia, Norway, the United Kingdom, and the United States—to examine factors associated with trust.This study reports from the third cross-sectional survey disseminated openly in four countries  during the COVID-19 pandemic. Participants were recruited from the countries where the researchers were based. The current survey was available for the general public’s participation between November 2021 and January 2022. A public landing site for the web-based survey was established and shared through personal and professional networks using electronic mail communication and various social media platforms . The initiator of the project was AØG from OsloMet. Due to ethical considerations and permissions, each country had its own project lead. The survey was simultaneously co-developed by the researchers in two languages—Norwegian and English. It was based on previous surveys conducted by the research group in the early phase (April 2020) and mid-point (November 2020) of the pandemic outbreak , 29–32. To be included in the study, participants had to be 18 years or older, understand Norwegian or English, live in Norway, USA, U.K., or Australia, and have access to an electronic device and internet.The sociodemographic variables include age group , gender identity , place of residence , and highest completed education level .The primary outcome variable—trust in communications issued by authorities—was constructed from the following question: “What is your level of trust in the information provided to the public by government and public authorities about the COVID-19 pandemic?” Participants were asked to respond using a 5-point scale with options of very low, low, moderate, high, or very high.p-values. First, a regression was conducted, testing for all main effects. Second, the regression analysis was repeated, including interaction terms of each socio-demographic variable by country, to test for the robustness of effects by country. For following up significant country interactions, stratified regression analyses  were conducted, and odds ratios of the socio-demographic variables on trust that had a significant by-country interaction were presented. There was no missing data.Descriptive statistics were examined for each variable by country, and chi-square tests were conducted to examine differences. Responses to the level of trust were analyzed as (1) very low or low, and (2) moderate, high, or very high. Proportions of participants reporting very low or low trust were cross-tabulated by the socio-demographic variables with chi-squared tests to examine the bi-variate associations. Multivariate logistic regression was conducted with all socio-demographic variables included on low or very low levels of trust as the outcome . Odds ratios with 95% confidence intervals (CI) were presented with The data collected in this study was anonymous. The researchers adhered to all relevant regulations in their respective countries concerning ethics and data protection.The total number of participants was 1,649, with 242 (14.7%) from Norway, 255 (15.15%) from the U.K., 915 (55.5%) from the U.S., and 237 (14.4%) from Australia see . The agep < 0.001.In our overall sample, 27% reported very low or low trust. The U.K. had the highest proportion reporting very low or low trust (32%), followed by the USA (29%), Australia (25%), and Norway with the lowest proportion (16%), Significant group differences in the level of trust in information from public authorities are shown in p < 0.001); the odds of reporting very low or low trust were about two times higher in the U.K., USA, and Australia, compared to Norway. In the unadjusted analysis, the 40–49 age group had higher odds of reporting very low or low trust than the 70+ group. Still, it was not statistically significant after controlling for all other variables examined. After adjustment for all variables, males and those who selected “other” or “preferred not to say” had 2.75 [2.11–3.60] and 3.39 [2.02–5.68] higher odds of reporting very low or low trust (p < 0.001) than females, respectively. Area of residence was associated with trust, with those living in rural or remote areas and those living in towns or suburbs more likely to report low or very low trust than those living in city or metropolitan areas. A dose-response trend was observed with education, such that the lower the level of education, the higher odds of reporting very low or low trust.Factors associated with trust in public authorities’ information are shown in p < 0.001). For the Norway participants, only the lowest education group had higher odds of very low or low trust compared to the highest education group (p = 0.003).Significant interactions were observed for gender*country and education*country. Stratified regression analyses by country show that the dose-response trend of lower education with lower trust was only observed in the USA see . In the p = 0.860). Males consistently had higher odds of having low trust in the other countries , which did not reach the sample size required for analysis. Thus, we have a limited understanding of the experience of non-binary respondents. Trust was measured in relation to the COVID-19 pandemic. Since we did not ask about trust in general, we do not have information to compare general levels of trust in the community. There are pre-existing differences in the general levels of trust of the general population between the countries in our study, which may have increased or decreased due to how the government and authorities have responded to the pandemic , 42. RacThis study examined trust in public authorities held by the general population two years after COVID-19 was declared a global pandemic. We find significant differences in levels of trust between countries and between sociodemographic groups observed.This study provides input for public authorities on the need to identify and target groups based on their trust level, which may impact their willingness to obtain a vaccine and utilize other prevention strategies, especially regarding the information provided by public officials. It is critical that public authorities use engagement strategies that promote trust in information and policies. Specific consideration to populations that have lower rates of trust should be made along with an understanding of the historical context that impacts engagement.Practices that increase levels of trust in public authorities implemented by some countries should be expanded to mitigate the ongoing negative impacts of COVID-19 across the globe. Future research needs to continue to measure change over time and focus on shifts in trust in public authorities after the COVID-19 pandemic to consider additional behavioral trends.Professionals responsible for social welfare, policy development, and program administration should be aware of the differences in the general public’s likelihood to trust information and financial support offerings when developing programs that target diverse population groups. Trust among citizens may be a vital component when seeking to increase the effectiveness of interventions used to support community safety and wellness. Increasing trust may foster higher levels of public health compliance to reduce the spread of COVID-19 and other public health concerns.


PD is a progressive neurodegenerative disorder that affects, according to the ICF, body systems , and functions —all which impact driving performance, an instrumental activity of daily living in the domain of “Activity” and “Participation” according to the ICF. Although there is strong evidence of impaired driving performance in PD, few studies have explored the real-world benefits of in-vehicle automation technologies, such as in-vehicle information systems (IVIS) and advanced driver assistance systems (ADAS), for drivers with PD. These technologies hold potential to alleviate driving impairments, reduce errors, and improve overall performance, allowing individuals with PD to maintain their mobility and independence more safely and for longer periods. This preliminary study aimed to fill the gap in the literature by examining the impact of IVIS and ADAS on driving safety, as indicated by the number of driving errors made by people with PD in an on-road study.Forty-five adults with diagnosed PD drove a 2019 Toyota Camry equipped with IVIS and ADAS features (Toyota Safety Sense 2.0) on a route containing highway and suburban roads. Participants drove half of the route with the IVIS and ADAS systems activated and the other half with the systems deactivated.The results suggest that systems that assume control of the driving task, such as adaptive cruise control, were most effective in reducing driving errors. Furthermore, individual differences in cognitive abilities, particularly memory, were significantly correlated with the total number of driving errors when the systems were deactivated, but no significant correlations were present when the systems were activated. Physical capability factors, such as rigidity and bradykinesia, were not significantly correlated with driving error.Taken together, these results show that in-vehicle driver automation systems can benefit drivers with PD and diminish the impact of individual differences in driver cognitive ability. PD affeN = 5,410; PD = 1,955, Healthy Controls (HC) = 3,455], the odds of on-the-road test failure were 6.16  times higher; and the odds of simulator crashes 2.63 (95% CI 1.64–4.22) times higher, for people with PD (p = 0.38)  , even afIn developed regions and communities, driving is a fundamental ADL activity and an important determinant of independence, community participation, and quality of life , 30. Of People with PD may not be able to compensate for the progressive loss of functional visual, cognitive, motor, and other sensory abilities. The current rehabilitation interventions are less than optimal to ensure continued driving , 34–36; Although highly autonomous vehicles have the potential to enhance people with PD’s mobility and greatly prevent crashes, they may not be available for use for some decades , 38. HowThese in-vehicle automation technologies, including in-vehicle information systems  and advanced driver assistance systems , hold plausible opportunities for people with PD. In-vehicle information systems, e.g., lane departure warning, provide warnings to drivers about surrounding road conditions but do not assume tactical or operational functions of the driving task —an actioHypotheses: Drivers with PD will demonstrate fewer total number of driving errors (primary outcome) and fewer speeding, lane exceedances and signaling errors, when driving with autonomous in-vehicle technology in an on-road test vehicle. Rationale: Our work . Specifically, in this inquiry, we examined an initial sample of 45 adults with diagnosed PD and compared the number of errors made during an on-road driving course. Errors were identified during the drive by a certified DRS and compared across different segments of the drive (highway and suburban) under conditions where the driving assistance system was activated or deactivated. In addition, we examined the relationship between individual difference factors, such as demographics and cognitive and physical ability, and the number of driving errors made.The overarching objective of the study is to quantify the effect of IVIS and ADAS on driving safety as indexed by the number of driving errors made by people with PD as indicators of improved driving performance in an on-road test vehicle. Our work  and thatOur work , 43–45 hOur work  and on-rOur work , 23, 25,2.2.1.ageM = 67.53 years, SD = 9.15 years) completed the study in this preliminary analysis. The inclusion criteria were: (1) a diagnosis by a neurologist/movement disorder specialist with clinically probable PD by Movement Disorders Society (MDS) criteria; (2) a mild or moderate disease severity, based on the MDS-Unified Parkinson’s Disease Rating Scale for motor symptoms; (3) between 35 and 85 years of age; (4) currently driving with a valid driver’s license and meets the Florida state requirement for visual acuity of at least 20/50 in one eye, if one eye is blind or 20/200 or worse the other eye must be 20/40 or better (20/40 in at least one eye), minimum acceptable field of vision is 130 degrees; (5) lives independently in the community; (6) are proficient in reading/speaking English; (7) and a Montreal Cognitive Assessment (MoCA) score of 20 or higher  direct referrals from our team of neurologists affiliated with the UF Fixel Institute for Neurological Disease, and (2) referrals from outside physicians recruited through interactions with local PD patient support groups, mailing lists, and outreach events. All outside referrals were verified by our team of UF neurologists. Each participant was then screened using the inclusion and exclusion criteria listed above. If participants met the telephone inclusion criteria, they were enrolled in the study and scheduled for the experiment. On the day of the experiment, subjects were evaluated using the MoCA, and if they scored below 20, they were excluded from the study , 47. FurThis project was approved by the UF Institutional Review Board (IRB#: 202002321) and each participant consented to participate in this study by signing an IRB approved informed consent form. Drivers with PD was reimbursed $30.00 for completion of the study.2.2.The experiment used a within-subjects design where the main experimental variable was the status of the automation systems (activated vs. deactivated). The order of presentation of the system on vs. system off conditions were randomly allocated to participants during recruitment. The IVIS and ADAS systems used was the Toyota Safety Sense 2.0 system found in the 2019 Toyota Camry. This included adaptive cruise control (ACC), lane keeping assist (LKA), lane departure warnings (LDW), and blind spot monitoring (BSM). These systems represent common safety and driver assistance systems found in modern consumer vehicles. Participants drove on both local suburban two-lane and four-lane roadways and a divided highway . The mai2.3.A Toyota Camry XLE 2019 model  featuring the Toyota Safety Sense 2.0 IVIS and ADAS system was used in this study. The IVIS systems include Lane Departure Warnings (LDW), which alerts the driver when the vehicle drifts out of the lane through visual and auditory alerts , left, a2.4.After providing informed consent, the participants underwent a battery of clinical assessments to ensure they met the inclusion criteria outlined above [MoCA, Snellen chart , 49, OptTo control for order and learning effects, two congruent drives were used, which formed one continuous route . Half thDuring the drive, the DRS provided instructions and navigation guidance to the drivers, monitored the drive for safety, and setup the IVIS and ADAS systems when needed. The DRS was also responsible for recording driving errors that occurred during the experiment. The DRS logged the number of errors for each road segment in a standardized paper data recording form that can be seen in the 2.5.Data are displayed descriptively with counts for nominal and ordinal data; and sample means and standard deviations for numerical data. Additionally, boxplots are presented to show the quantiles, median, mean, and individual observations. Error data, aggregated and within each error category, was broken down by system condition (activated vs. deactivated) and driving environment. Driving environment was divided between suburban and highway segments due to the different ADAS and IVIS systems that were active in each road segment. Due to the lower speeds in the suburban section, ACC was not active in the automation activated condition. However, ACC was active in the highway portion of the automation activated drive.Spearman correlations were used to understand the effects of individual differences within the sample  on the number of driving errors when the IVIS and ADAS systems were activated and deactivated. Finally, for each individual difference factor that was significantly correlated with the number of errors, descriptive data and boxplots are provided to show how errors differed across different levels of severity of the factor.During the experiments, the total scores of both the MoCA and the MDS-UPDRS Part 3 were obtained and computed. The present manuscript provides detailed information on the subtest scores of MoCA and MDS-UPDRS Part 3. Specifically, the MoCA subtests include Visuospatial/Executive and Memory Index Score (MIS), whereas the UPDRS Part 3 subtests include Rigidity, Bradykinesia, and Tremor. The MoCA-MIS, which has a total score of 15 points, was calculated based on the participant’s ability to recall the five words from the memory test after 5 min. Three points were awarded if the participant was able to recall one word without any cues, two points if a category cue was needed, and one point if a multi-choice cue was required. The MDS-UPDRS 3-Rigidity was determined by the summation of subcategories 3.3, while the MDS-UPDRS 3-Bradykinesia was computed by adding up subcategories 3.4–3.8. The MDS-UPDRS 3-Tremor score was calculated by summing up subcategories 3.15–3.18.Data were captured using the university’s Research Electronic Data Capture (REDCap) system. REDCap is a secure, Health Insurance Portability and Accountability Act compliant web-based application, designed to support data capture for research studies. REDCap provides: (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages such as Microsoft Excel, SAS, Stata, R, or SPSS; and (4) procedures for importing data from external sources. To access the system, all participants were assigned a unique participant ID number and all data from the paper questionnaires and on-road error form were entered and stored by the corresponding participant ID number. Data containing HIPAA identifiers were only accessible to the project team members who have been approved by the IRB.3.3.1.3.2.The total errors, summed across the five error categories , were compared across the system’s activated and de-activated conditions. The errors were further broken down into the highway portion of the drive, where all automation systems were active  in the automation activated condition, and the suburban portion of the drive, where the ACC system was not activated but the remaining systems  were present.The descriptive results showed that , for the3.3.To better understand the relationship between the IVIS and ADAS and the number of driving errors made by participants, errors were examined across the five error categories .Overall, there were fewer signaling errors during the drive than the other error types, and little variation occurred regardless of the activation status of the system or the road segment conditions. Both types of speeding errors , and both types of lane departure errors  had more occurrences during the suburban than highway drive segments. Furthermore, there were very few overspeeding errors that occurred in the highway road segments.3.4.Demographic and individual difference factors, such as age, cognitive, and motor ability, may influence driving errors , 19, 21.As can be seen in n = 19) and a higher score group . MoCA scores of 26 or greater have typically been used as a cut-off for normal function, with scores between 18 and 25 indicating possible mild cognitive impairment (n = 11), near perfect scores of 14 (n = 10), and scores below 14 (n = 24). The MoCA-MIS was calculated by adding the number of words remembered in free delayed recall, category-cued recall, and multiple choice-cue recall multiplied by 3, 2, and 1, respectively, with a score ranging from 0 to 15 . Specifically, we investigated an initial sample of 45 adults with diagnosed PD and compared the number of errors made during an on-road driving course.The objective of this study was to examine the impact of IVIS and ADAS on driving errors in participants with PD, via a preliminary The study reveals interesting findings in that IVIS and ADAS are more effective in reducing driving errors during the highway vs. the suburban section drives. Two important facts need to be considered when discussing the total number of driving errors: First, the ACC, only used for the highway section, might have accounted for most of the reduction in driving errors, and as such further investigation will be necessary to account for the contribution of the ACC in the overall variance of error reduction. Second, these findings are descriptive in nature and reflect an interim analysis—and as such no conclusion can yet be made about the effectiveness of the IVIS or ADAS systems for either the highway or the suburban drive. However, these findings are partly supporting our hypothesis, that is, drivers with PD will make fewer errors when ADAS is activated—as demonstrated in the highway section.From the signaling data, we posit that the blind spot detection may not necessarily change the number of signaling errors made, in either the activated or deactivated condition of the IVIS, and this finding holds true regardless of the road section. We are not certain why this finding manifests but may pose that signaling is a proxy variable for executing divided and/or selective attention . TherefoBased on the descriptive data, underspeeding errors were lower when the ACC system was active in the highway segments, while no differences were present between the system activated and deactivated conditions in the suburban drive. Whereas, in the suburban conditions, more wide lane departure errors and overspeeding errors occurred when the driver assistance system was activated than when it was deactivated. We render caution in interpreting this finding, as it is possible that automation complacency  may have led to more lane departures, but the data are currently inadequate to justify this assertion. Moreover, it is also possible that the differences are not significant, as the SDs are currently all relatively large. But taken together, these results suggest that systems that directly takes over a portion of the driving task  can result in reductions in the corresponding driving error . However, when the driving support is only a warning  or only partial support , errors may still occur.The negative correlations between the total MoCA score and the Memory Index Score (MIS) of the MoCA with the total number of driving errors, suggest that the number of driving errors increased as cognitive ability and delayed recall ability, in particular, decreased. This is not a surprising finding, but rather a confirmation of our clinical expectations , 55, 56.The nonsignificant correlations between the UPDRS rigidity and bradykinesia scores and total number of driving errors suggest that without driver assistance systems, cognitive ability had the largest effect on total number of driving errors, particularly memory ability as measured through the MIS. However, when these systems were activated, differences between individuals were not as impactful, suggesting that driver assistance systems may help compensate for the negative effects of individual decrements in cognitive ability. Noteworthy to mention, and consistent with the prevailing literature, we observed that all participants in the study completed the drive with their medication in an “on” state, which may explain the lack of differences due to the motor control factors , 21, 22.tactical driving skill impairments  has completed their on-road exposure.Our early reasoning pertaining to the MIS and driving error data is that these results are consistent with our earlier findings that cognitive impairment are the primary individual difference factor influencing driving errors in our sample, with memory impairment potentially having the greatest impact. Moreover, the benefits of the driving automation are the strongest when the system takes over a driving task, such as with ACC in the highway driving segments. Although too preliminary to make any inferences, this is an exciting finding. Specifically, we know that people with PD have airments , such thairments , 34, 57. demands , 34, 57,4.1.Study limitations include self-selection bias, convenience sampling resulting from focusing on a major PD treatment clinic in the city, participants’ apprehension about completing on-road interventions, and demographic factors that restrict the generalizability of the findings. Furthermore, there were a number of confounding factors that may have impacted the data collection and analysis. Firstly, driving errors were identified by the onboard experimenter, who was a trained DRS. While DRS’s identify on-road driving errors as part of their role, there may be variability in what individual DRS’s include in their error counts. Second, there were natural variations in traffic density and weather conditions during the experimental drives that may have impacted the participant’s driving error. Third, this current study examined the effects of the IVIS and ADAS technologies when they were active during the experiment, but we did not examine the participant’s proficiencies in activating the systems or their ability to decide when they should engage the systems. Finally, our current analysis focused on driving errors, but did not explicitly measure the specific activity limitations related to driver tasks and how those were impacted by the ADAS and IVIS technologies. While our results provide support for the possible benefits of these technologies for individuals with PD, further work could highlight the specific driver activities  that are being supported by driver assistance systems.4.2.The best evidence to ensure drivers with PD can continue to drive is sparse at best, and best practices are deficient in overcoming the PD-related functional declines necessary to drive safer and longer. Technology-based intervention to extend driver fitness, modify driver behavior , 43, 44,5.Although, we cannot make conclusive decisions for people with PD who drive with in-vehicle technology, our findings point to exciting opportunities that particularly ADAS, already available in vehicles, can be applied to help offset driving deficits, especially on the highways, for drivers with PD, while potentially also enhancing their driving safety. Our results found that speeding errors may particularly benefit from current in-vehicle technologies, but our findings are only descriptive and need to be interpreted as such. Furthermore, individual differences in cognitive ability appeared to be more impactful on driver error than differences in physical ability. However, ADAS and IVIS technologies appear to mitigate the effects of lower cognitive ability. These results lay the foundation for future research to build upon and further investigate the effectiveness of in-vehicle technologies in enhancing the driving performance of individuals with PD.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving humans were approved by University of Florida Gainesville Health Science Center Institutional Review Board (IRB-01). 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.WG: conceptualization, methodology, data collection, investigation, writing–draft preparation, and writing–reviewing and editing. HZ: data collection, data processing, data visualization, writing–draft preparation, and writing–reviewing and editing. BG: data collection and writing–reviewing and editing. BP: participant recruitment, data collection, and writing–reviewing and editing. AR-Z: participant recruitment, data collection, investigation, and writing–reviewing and editing. SW: data collection, writing–draft preparation, and supervision. MJ: participant recruitment and enrollment, data collection, and writing–reviewing and editing. YL: data collection, participant recruitment and enrollment, and writing–draft preparation. SC: conceptualization, methodology, participant recruitment, writing–draft preparation, writing–reviewing and editing, and supervision. All authors contributed to the article and approved the submitted version.