Parkinson’s disease (PD) is a common neurological disease affecting around 1% of people above sixty years old. It is characterised by both motor and non-motor symptoms including tremor, slow movement, unsteady gait, constipation and urinary incontinence. As the disease progresses, individuals living with the disease are likely to lose their independence and autonomy, subsequently affecting their quality of life. People with PD should be supported to live well within their communities but there has been limited research regarding what the public know about PD. This review aims to develop an understanding of how the public view people living with PD, which has the potential to aid the development of an educational resource for the future to improve public awareness and understanding of PD. The purpose of this scoping review is to review and synthesise the literature on the public perception and attitudes towards people living with PD and identify and describe key findings.This scoping review aims to explore public perceptions and awareness of Parkinson’s Disease among diverse populations, encompassing beliefs, knowledge, attitudes, and the broader societal context influencing these perceptions.A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for ScR (PRISMA-ScR). Four electronic databases were searched systematically . The Joanna Briggs Institute Critical Appraisal Tools (JBI) were used to assess the quality of primary studies, however, all relevant studies were considered regardless of their methodological quality. The ‘Population-Concept-Context’ framework was used in the screening process to identify eligible papers.A total of 23 studies were included in the review representing global research in quantitative (n = 12) and mixed methods approaches (n = 11). All 23 studies adopted some aspect of cross-sectional design. Three themes emerged from the studies, the first being public knowledge of symptoms, causes and treatment of PD and this highlighted a lack of understanding about the disease. Secondly, the review identified public attitudes towards PD, highlighting the social consequences of the disease, including the association between PD and depression, isolation and loss of independence. Finally, the third theme highlighted that there was a paucity of educational resources available to help increase public understanding of PD.Findings from this scoping review have indicated that public awareness of PD is a growing area of interest. To our knowledge, this is the first scoping review on this topic and review findings have indicated that public knowledge and attitudes towards PD vary internationally. The implications of this are that people with PD are more likely to be a marginalised group within their communities. Future research should focus on understanding the perception of the public from the perspective of people with PD, the development of interventions and awareness campaigns to promote public knowledge and attitude and further high-quality research to gauge public perceptions of PD. Parkinson’s Disease (PD) is the fastest growing neurological condition in the world and is the second most common neurological condition after dementia , 2. It iPD was first described as a ‘shaking palsy’ by Dr. James Parkinson in 1817 . DopaminGood medical care, including the use of medication, can help manage PD. Medications, such as Levodopa, are available for the management of PD symptoms. Timely access to medication is essential in PD to prevent exacerbation of symptoms , 20. OthWhile there have been positive outcomes associated with social interventions for people living with PD, implementation of these is inconsistent. One reason why this inconsistency exists is because the public may not be aware of the unique needs and capabilities of people living with PD. Public awareness and attitudes to disease are important as they have a direct influence on how people live within their communities. Attitudes and perceptions of disease can be both positive and negative but have the potential to affect the quality of life (QoL), as well as social, physical and psychosocial wellbeing for those living with the condition. People living with PD can experience negative perceptions or attitudes from the public due to the lack of awareness and misunderstanding of disease symptoms, which may exacerbate feelings of depression and social isolation and impacting QoL .There appears to be a lack of empirical investigation on the public understanding and awareness of PD, alongside an absence of reviews that synthesise the existing literature on this topic. With the increasing prevalence of PD and younger onset of diagnosis, it is important that the public are educated about the disease and how it affects those living with it. Without good awareness and knowledge of PD, the public are less likely to be able to effectively support people with PD in their local communities and plan or deliver meaningful social interventions. The aim of this review is therefore to synthesize international evidence to determine the current public perceptions and awareness of PD. This scoping review also aims to identify gaps in the research and inform the development for future research or educational resources for PD awareness.This scoping review (ScR) used a systematic approach, following guidelines from Joanna Briggs Institute (JBI) , Arksey th June 2022. A combination of search terms was used depending on MeSH terms and database selection including key search terms related to “Parkinson’s disease” or “public” or “perception” (see https://www.covidence.org/).The search strategy was developed with the review team including input from a subject librarian. To attain a greater understanding of the topic and scope existing literature, an initial search was completed via Google Scholar focusing on public awareness of PD. Four electronic databases were used to conduct the review, CINAHL Plus (EBSCOhost), Medline All (Ovid), PsycINFO (Ovid) and International Bibliography of the Social Sciences (ProQuest). These specific databases were chosen as their literature primarily focusses on nursing, medicine, psychology and social sciences. Databases were searched between 10-20The Population, Exposure and Outcome (PEO) framework was used to develop inclusion criteria as recommended by Bettany-Salttikov and McSherry . This reThe database results were exported to Covidence, and all abstracts were screened by two people independently (SC & GM). This step was repeated for full text screening of applicable papers. Conflicts throughout the screening process were resolved following discussion with another member of the team (PS).Data were extracted from the included papers in Covidence using JBI Template Source of Evidence Details . Data exThe chosen approach of data analysis for this review was narrative synthesis due to the ability to organise findings from all included studies. Firstly, studies were investigated for similarities and differences, relationships explored, and the strength of evidence and results were assessed. To enhance the ease of presenting a narrative synthesis, specific elements were grouped together into themes, allowing for a more organized and understandable presentation. Findings from the studies were then summarised in themes and explained using text and words , 43. As After the database search, a total of 2,008 papers were found. Twelve studies in this review used a quantitative approach, with the remaining eleven papers adopting a mixed methods approach. Details of study setting can be seen in Samples sizes range from 13 to 2609 participants, with a combined total of 3,701 participants in this review. Demographic information of participants can be seen in Questionnaires were used by 19 studies, using face-to-face, online or telephone methods , 57–67. The quality of papers was appraised using the JBI source of evidence details critical appraisal tool. Quality appraisal is not mandatory for scoping reviews ; neverthThis review has explored the public perceptions and awareness of Parkinson’s Disease. In total three themes emerged following narrative synthesis. To facilitate a narrative synthesis, findings were grouped into themes, resulting in a more organized and coherent presentation . This prThe first theme addresses the level of knowledge the public had about the main symptoms of PD including tremor and difficulties with communication, alongside causes, risk factors and available treatments for the disease. The second theme focusses on public attitudes towards PD, discussing its social consequences and its psychosocial impact including the association with depression, isolation and loss of independence. Lastly, the importance of raising awareness of PD is the third theme identified.Evidence from the papers in this review shows public knowledge of symptoms, causes and treatment of PD is adequate, however, most studies highlighted the benefits further research and education in this area would have for knowledge and awareness of PD. The level of knowledge of symptoms of PD was a key topic that was highlighted throughout the literature where participants commonly attributed symptoms of PD to ageing, as opposed to disease. Several studies highlighted that motor symptoms were significantly more known that non-motor symptoms –49. In pFindings from this review also indicate that the causes of PD are also poorly understood. One study  reportedA lack of awareness of treatment for PD was an aspect that came up frequently in the literature. Two studies , 54 reveOverall, this theme illustrates that the public have variable knowledge about Parkinson’s Disease. While many were aware of the condition, there was poor awareness about the non-motor symptoms and advanced/device-assisted medical treatments for PD.Attitudes towards disease, including PD, are essential as they contribute to determining the environment which the person lives and interacts. Poor attitudes towards PD could be a result of the lack of knowledge of the disease as identified in theme one. Findings relating to public attitudes included social consequences and perceptions about quality of life for people with PD with associations to depression, isolation and loss of independence.In this review, five studies identified areas of social consequences surrounding PD in the public. These took the form of being worried or fearful of developing PD , not wanSeveral studies reported that just over half of participants linked depression to PD , 57–64 FParticipants also claimed they were aware that people with PD often feel socially isolated , 48. TheOverall, this theme has highlighted public attitudes towards PD, particularly the psychosocial impact of living with the disease. Some studies have also demonstrated positive public attitudes towards those with PD, expressing feelings of supportiveness, compassion and sympathy.Findings of twenty-one studies included in this review acknowledged the benefits of raising awareness of PD , 52–67. Most studies within the review discussed the importance of implementing resources for the public to be educated on PD , 58–65. This scoping review aimed to summarize and present the current literature on public awareness and perceptions of PD, while also identifying gaps in the existing research. This review identified the level of public knowledge and significant misconceptions about PD including its symptoms, aetiology, and prognosis. This is more pertinent in developing and less developed countries , 53 compAccording to literature, the problem of poor awareness and lack of knowledge in general is associated with several factors. Poor health literacy may be a key factor impacting public knowledge of not only PD, but other health related issues. Health literacy refers to the ability individuals have to obtain, process and understand basic health information to make appropriate health decisions . Poor heData about attitudes towards PD were present in the reviewed literature in the form of analysis of social consequences and perceptions about quality of life in PD. Firstly, the link between PD and depression was apparent in the literature which has the potential to influence public attitudes towards people with PD. In addition to this, many studies within the review made links to PD and social isolation , 57–64. Social consideration and attitudes towards PD are essential since they contribute to determining the environment in which a person with PD lives and interacts . Better To shape active aging as a lifelong process and recognise the potential that older people represent in society, the World Health Organisation challenged communities worldwide to become more age friendly . BuildinAn interesting omission in the included studies worth noting was the link between PD and palliative care. Various studies over recent years have highlighted the lack of public knowledge and negative perceptions towards palliative care, particularly in those without family-related experiences –88. IncrA main strength is that, to our knowledge, this is the first time a scoping review aiming to explore public perceptions and awareness of PD has been conducted. Due to time and resource constraints, only four databases were chosen to complete the search. While this is common within scoping reviews, the use of a larger number of databases may have yielded a greater number of papers. However, the use of broad search terms with precise inclusion and exclusion criteria ensured we were able to capture as many papers as possible within these databases to answer our research question. A further limitation was we only included papers written in English and papers in other languages may have provided additional data.Findings from this review have indicated that public awareness of PD is a growing area of interest. Review findings suggest that public knowledge and attitudes vary across the globe. The implications of this are that people with PD are more likely to be a marginalised group within their communities, despite this being a common disease of older people. Future research should focus on understanding the perception of the public from the perspective of people with PD, the development of interventions to promote public knowledge and attitude and further high-quality research to gauge public perceptions of PD internationally.S1 File(DOCX)Click here for additional data file.S2 File(DOCX)Click here for additional data file.S1 Checklist(DOC)Click here for additional data file.


Several research studies have demonstrated the potential of mobile health apps in supporting health management. However, the design and development process of these apps are rarely presented.We present the design and development of a smartphone-based lifestyle app integrating a wearable device for hypertension management.We used an intervention mapping approach for the development of theory- and evidence-based intervention in hypertension management. This consisted of six fundamental steps: needs assessment, matrices, theoretical methods and practical strategies, program design, adoption and implementation plan, and evaluation plan. To design the contents of the intervention, we performed a literature review to determine the preferences of people with hypertension (Step 1) and necessary objectives toward the promotion of self-management behaviors (Step 2). Based on these findings, we implemented theoretical and practical strategies in consultation with stakeholders and researchers (Steps 3), which was used to identify the functionality and develop an mHealth app (Step 4). The adoption (Step 5) and evaluation (Step 6) of the mHealth app will be conducted in a future study.Through the needs analysis, we identified that people with hypertension preferred having education, medication or treatment adherence, lifestyle modification, alcohol and smoking cessation and blood pressure monitoring support. We utilized MoSCoW analysis to consider four key elements, i.e., education, medication or treatment adherence, lifestyle modification and blood pressure support based on past experiences, and its potential benefits in hypertension management. Theoretical models such as (i) the information, motivation, and behavior skills model, and (ii) the patient health engagement model was implemented in the intervention development to ensure positive engagement and health behavior. Our app provides health education to people with hypertension related to their condition, while utilizing wearable devices to promote lifestyle modification and blood pressure management. The app also contains a clinician portal with rules and medication lists titrated by the clinician to ensure treatment adherence, with regular push notifications to prompt behavioral change. In addition, the app data can be reviewed by patients and clinicians as needed.This is the first study describing the design and development of an app that integrates a wearable blood pressure device and provides lifestyle support and hypertension management. Our theory-driven intervention for hypertension management is founded on the critical needs of people with hypertension to ensure treatment adherence and supports medication review and titration by clinicians. The intervention will be clinically evaluated in future studies to determine its effectiveness and usability. Hypertension or high blood pressure (BP) is a leading modifiable risk factor of cardiovascular disease (CVD) –3 affectEmerging technologies such as mobile health apps have been shown to improve the treatment of hypertension . Apps haWhile several studies have demonstrated the potential of mobile health  apps in supporting the hypertension management –16, veryWe used an intervention mapping approach , which iThe aim of phase-1 was to understand the self-management needs of people with hypertension. We conducted a literature review including qualitative and quantitative studies that described the opinions and preferences of people with hypertension. Studies were included, if they: (i) discussed self-management support for hypertension, (ii) discussed interventions that support self-management of hypertension, and (iii) were published in English. We excluded abstracts, protocols, viewpoints, and letters to the editor. Furthermore, reference lists of primary studies and related reviews were also screened, and articles that met the inclusion criteria were considered in this assessment. The data extracted from relevant studies were thematically synthesized  based onIn this phase, we identified the objectives of the intervention based on the target stakeholder's perspective. The matrices focused on promoting self-management behavior in people with hypertension, through a literature review based on the following questions: (i) What does the user aim to accomplish with the change in behavior?, (ii) What agent needs to be implemented to integrate the intervention in the daily environments of the user to promote a change in behavior?, (iii) Why would a user want to change their behavior? and (iv) Why would the user want to integrate the intervention in their activities?This phase involved brainstorming sessions with the authors to determine appropriate strategies for hypertension self-management. Theoretical models included in this development study were derived from empirical evidence that focuses on promoting behavior change. Furthermore, we linked the theoretical models and matrices identified in the previous phase to address the self-management needs of individuals with hypertension.In this phase, we designed a mHealth app to support the self-management of people with hypertension based on the needs, matrices and theoretical models identified in the previous stages. mHealth apps offer a useful platform to deliver behavior change interventions as they can be connected with a myriad of medical sensors and wearable devices to promote self-monitoring, personalized goal setting, social competition and comparison and physiological change management . The desThe content of the app was first represented in the form of a primitive wireframe, which included based schematics that represented the design and interactions. Over a month, the schematics were constantly iterated by the authors through multiple discussions to ensure smooth transitions between each screen. The wireframes were translated into an initial prototype using Adobe XD with the intention of understanding how the design was to be represented. The Adobe XD design was reiterated several times after discussion with the authors until a general agreement was achieved on the design and functionality of the app.After agreement on the design and functionality of the app, the app was coded by the primary author for smartphones using an IONIC cross-platform design framework connected to a remote server to retrieve and store information. The app was meant to collect and visualize data to gain user attention and engagement. Any information within the app was represented in a simple manner with limited medical jargon to ensure user comprehension. Moreover, the app implemented two forms of communication which were pre-coded into the app. The communication protocols were Generic ATTribute Profile (GATT) for data transmission between the app and the wearable device, and Hypertext Transfer Protocol (HTTP) for data transmission from the app to the remote server. Furthermore, the app consists of a notification prompt to trigger at the server end to promote behavior change based on abnormalities identified in the data collected.This phase is focused on the creation of adoption and implementation plan that considers understanding the user and integrating the intervention in their everyday lives incorporating the process, matrices, and determinants in phase 2.The final step involves the evaluation plan of the intervention in the everyday lives of the users, which would be achieved in a future study.We identified several self-management requirements from a literature review . EducatiThe overarching aim of the intervention is to promote self-management of hypertension, which is achieved from the identification of the resultant objectives. The outcomes and objectives pertaining to the identified aim were mapped to ensure knowledge gain, patient empowerment and self-efficacy, while also considering patient-centered outcomes and health status measures such as health-related quality of life, treatment adherence, and reduction in cardiovascular risk. To promote these outcomes and objectives within the intervention, a table with a detailed matrix was considered that defines the entire change objectives based on a broad conceptualization of all the activities involved in the self-management of hypertension .The information, motivation, and behavior skills (IMB) model served as a theoretical framework for the design of the intervention to improve health-related behaviors. The IMB model conceptualizes determinants to change behavior by providing a general framework that understands and promotes prevention activities across the populations with the behaviors of interest . This moAnother aspect considered in this study toward the development of the intervention was the concept of patient engagement. The concept of patient engagement combines patient activity  with the intervention to promote positive health behavior, including exercising and obtaining preventive care, while improving health outcomes, patient care and decreasing costs . To achivia the user's mobile device, (ii) the control layer which processes data based on the care plan defined by the researcher/medical professional, (iii) the security layer which allows for selective access to the remote server, (iv) the data linking layer which is responsible for the access, communication and storage of data collected and processed, and (v) the data storage layer which stores all the data collected with a timestamp to ensure data integrity.The mHealth intervention was developed based on the requirements identified in the previous phases. The technical model for the intervention is illustrated in The self-management practices , 3 identInitially, the design of the app included wireframes to determine the interactions for each screen within the app for each of the features identified . The goaReal-time BP monitoring: This feature considers BP data collected from a previously validated Bluetooth smart watch  a response type (t), (ii) an identifier assigned during registration (app_id), (iii) scope of requested permission (s), (iv) optional parameters to maintain request and response (p), and (v) redirection URI to which the authorization server would connect and redirect once the access is granted. Upon request of the Access Token, the authorization server would validate the request and present the app with its own local access and storage. Any invalid access would result in the disconnection of the protocol. Once the access is granted the user can authenticate themselves using their own credentials. The Authorization server validates the user credentials and upon confirmation requests the user to indicate the type of access required. Once the user confirms access the authentication server reviews the request and on approval redirects the URI along with the access token to the URI of the app. The app URI allows for the user to access the app services uninterrupted. The protocol flow for the OAuth2 access is shown in Gateway: The access and modification of information is managed using HTTP requests. Hence, it is necessary to ensure no unauthorized POST access is made to the server. To control this a Confluent Kafka REST proxy is implemented within the server to authenticate and authorize POST requests using the content validation techniques. This technique also validates the request based on the access token used and the privileges available to the user.Audit trail: The app is designed to log user data collected from a wearable sensor over set periods of time. These logs would be stored within the server along with the resource access date and time (or audit record). These audit records either new or old could be tracked by the system at any given time. Hence, any unauthorized activity that occurs outside the defined period would be considered invalid and would not hamper the normal operations of the system.Communication between the mHealth app and the database was achieved through a REST-based software architectural design pattern. REST is a practical approach used in web app development as the system requires easy means to interact with independent systems. It is based on a stateless and resource-oriented architecture that considers everything as a resource. Every request is independent and the server does not store the state of the request . The typFive groups of data are stored within a MySQL database, i.e., personal information, healthcare data, care plan, medications and notifications as shown in Adoption and implementation plan includes providing a validated wearable BP device to the user, instructions to download and use the app, training to individuals and healthcare providers to use the app and wearable device and interpretation of information. This includes written material with a comprehensive description of the implemented features and necessary activities to be conducted to improve self-management behavior.The mHealth app is currently available on Google Play Store and will soon be published in Apple App Store. In the next phase of this study, the app will undergo rigorous re-iterations involving people with hypertension to ensure it is usable in their daily self-management regimen. Further, the app would be evaluated in a pilot trial including different stakeholders, i.e., people with hypertension, clinicians, and researchers to ensure app effectiveness based on the health outcomes defined in We present the design and development of an mHealth app for self-management of hypertension for the first time using a wearable cuffless BP device and an Intervention Mapping Approach. The intervention mapping approach is a structured and systematic approach to intervention development, using theory-based development. Lifestyle intervention included education, along with behaviors such as medication or treatment adherence, lifestyle modifications, such as limited smoking, reduced alcohol consumption, proper diet and regular exercise, and BP monitoring. In addition, communication with clinicians and medication management as critical to improving health outcomes for people with hypertension. Hence, an mHealth app was developed to address these aspects, while considering theoretical models to promote behavior changes   and engamHealth or mobile health technology ensures that healthcare can be made more accessible and affordable to its users . MoreoveWhile there are several mHealth apps to support hypertension self-management, most of these apps have several limitations. A review of 186 hypertension apps identified from commercially available app stores such as Google Play Store and Apple App Store, demonstrated that most apps lacked a clear theoretical basis, and had absence of evidence related to their effectiveness and usability . MoreoveA strength of this study is the use of an intervention mapping approach in the development of the app. We used multiple theoretical frameworks in the design of the app, which is similar to the recommendations provided by the Medical Research Council for the development of complex interventions . In addiHowever, some limitations need to be addressed. First, the study draws perspectives on improving health outcomes of people with hypertension from the literature. While theoretical models can form a solid foundation in the design of novel interventions, it limits one's ability to determine the users' capabilities in using the system, especially in terms of structure, design and user interaction . Hence, Our mHealth app was developed to ensure future integration of wearable device data into electronic medical records and hospital systems, while also allowing for the app of artificial intelligence and machine learning to provide context-aware support to the person living with hypertension. However, these features would need to be explored in the future.This paper describes the development of an mHealth app using the intervention mapping approach. The intervention mapping approach was successfully used to translate the critical needs of people with hypertension into a theory-based intervention that can ensure treatment adherence and reduce cardiovascular risk. This was a comprehensive process and involved a multidisciplinary team to develop the theory-based intervention to deliver support for the target stakeholder. However, the app would need to be evaluated to determine its usability and feasibility, which will be performed in the next part of this study.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.SI, RM, and EL conceptualized the paper. EL designed and developed the programming for the app and platform. EL and SI wrote the first draft. CK, MA, JA, CC, YZ, MK, and RD provided data, developed models, reviewed results, provided guidance on methodology, or reviewed and contributed to the manuscript. All authors approved the final version of the manuscript.


The red palm weevil poses a significant threat to palm species, resulting in substantial economic losses. While multiple methods have been developed to control its infestations, there is an urgent need for eco-friendly insecticides that selectively target its critical systems or pathways. One such target is its digestive system, which is essential for its survival. This review highlights the potential of using the digestive system of the red palm weevil to manage its infestations. Proteomic and transcriptomic data analyses on the weevils have provided a better understanding of the protein and gene compositions in its digestive system. With technological advancements, a more comprehensive approach can be taken to explore the opportunities in manipulating the data on the digestive system of red palm weevil, leading to improved management methods.Rhynchophorus ferrugineus, commonly known as red palm weevil (RPW), is a high-risk insect pest that has become a threat to many important palm species. There are several dominant factors that lead to the successful infestation of RPW, including its stealthy lifestyle, highly chitinized mouthpart, and high fecundity rate. Due to that, millions of dollars of losses have been suffered by many countries invaded by RPW. Several methods have been designed to control its invasion, including the usage of insecticides, but many cause resistance and environmental pollution. Therefore, an environmentally friendly insecticide that targets specific systems or pathways in RPW is urgently needed. One of the potential targets is the digestive system of RPW, as it is the major interface between the insect and its plant host. The related knowledge of RPW’s digestive system, such as the anatomy, microflora, transcriptomic analysis, and proteomic analysis, is important to understand its effects on RPW’s survival. Several data from different omics regarding the digestive systems of RPW have been published in separate reports. Some of the potential targets have been reported to be inhibited by certain potential insecticides, while other targets have not yet been tested with any inhibitors. Hence, this review may lead to a better understanding on managing infestations of RPW using the system biology approach for its digestive system. Rhynchophorus ferrugineus (Coleoptera: Curculionidae), commonly known as the red palm weevil (RPW) (Olivier 1790), is a Coleopteran insect that has been classified as a significantly serious pest on the A2 list , according to the European and Mediterranean Plant Protection Organization (EPPO) . Th. Th84]. nhibitor .Anthonomus grandis) using RNAi recombinant transgenic cotton resulted in malformed first and third instar larvae. The report suggested that the knockdown of chitin synthase led to the obstruction of nutrient uptake in the gut [On the other hand, chitin synthase EC: 2.4.1.16) catalyzes the polymerization of the chitin polymer , a major.16 catal the gut .In another study, the expression profiling of RPW’s gut showed the identification of key enzymes in the digestion of plant cell walls , namely Myzus persicae, resulting in a high mortality rate. This study also highlighted that the insecticide tested was not harmful towards beneficial insect Chrysoperla carnea [Other than that, potentially targeted genes encoded for neuropeptide precursors and their receptors  were foua carnea .Hence, the gut transcriptome analysis of RPW shows that it can offer valuable insights into cellular processes that occur in the gut. The identification of those genes and neuropeptides is necessary for the development of potential insecticides to effectively manage and prevent the invasion of RPW in palm trees ,88,92.Having a comprehensive knowledge regarding the potential targets in the digestive system of RPW is helpful in developing and discovering new potential strategies in managing the RPW pest.Although certain potential targets have been found to be responsive to insecticides or inhibitors , severalAccording to Zulkifli et al. , among tCalotropis latex extract PIs were effective in inhibiting and reducing the activity of digestive protease enzymes in the gut of RPW by 39% and 18%, respectively, resulting in a decrease in the survival rate of the insect. This suggests that PIs obtained from plant extracts can serve as a valuable bioactive source for the development of biopesticides, essential for maintaining an ecological balance in the management of RPW insect pest infestations.The discoveries of selective inhibitors, such as specific inhibitors targeting the trypsin and peptidase enzymes, which are crucial components of insecticides, can result in the disruption of digestion in the target insect. Consequently, this can impede the insect’s growth and eventually lead to the mortality of the pest weevil. This corresponds with the findings by Mohamed et al. , who empAnother way of controlling RPW is by targeting the specific biosynthesis pathway involved in the digestive system of RPW. One of the potential target pathways for pest control in RPW is the chitin biosynthesis pathway . As mentStudying RPW’s digestive systems is crucial in agriculture, especially because of the detrimental impact of RPW as insect pests. With the advent of high-throughput analysis in metagenomics, proteomics and transcriptomics, the investigation of insects’ digestive systems has progressed to the systems’ biology level, encompassing the whole system rather than individual components. This approach offers insights into the dynamic nature of the digestive system and creates opportunities for further exploration .The ability of phytophagous insects to survive is largely dependent on their capacity to effectively consume their respective host plant. As for RPW, its ability to consume and digest the host plant was reported to be aided by its insect-associated microbial communities in the gut ,36. IdenAdditionally, gaining knowledge on the digestive enzymes that RPW produces when it infests different host plants can provide a way to learn how the insect picks a specific type of plant . This knAs part of RPW’s digestive system is lined with chitin, targeting the chitin biosynthesis pathway is also an opportunity for controlling and managing the pest . ChlorflThe review showed that there are many opportunities to explore and study the digestive system of RPW as a means for managing and controlling the infestation and spread of RPW as an insect pest. Metagenomic, proteomic and transcriptomic data were shown to be suitable approaches to further understanding the protein and gene constituents of RPW. However, with the advancement of technologies, the detection limit, the data generated and the tools for analysis no longer limit deeper exploration at the systemic level, opening the doors for gaining more knowledge on the digestive system of RPW. Hence, a more holistic approach could be used to produce a better way to manage RPW.


The results were related to the analyzed dimensions of emotion regulation in healthy subjects.The reports of the conducted studies were compiled for a total of 310 people, including 120 patients diagnosed with a somatic disease , as well as 96 patients diagnosed with depressive disorders and 30 patients with anxiety disorders. The control group consisted of healthy subjects . To assess the psychological variables analyzed, the subjects completed the Emotion Regulation Questionnaire developed by J. Brzeziński.The study showed that the patients suffering from a chronic somatic symptom disorder, similarly to those treated for depression and anxiety disorders, differed from the healthy individuals in most aspects of emotional control. The patients with dermatological and gastrointestinal diseases differed statistically significantly from the patients with depression and the patients with anxiety disorders in relation to three dimensions of emotional control. Patients with a somatic disease are characterized by higher emotional and rational motivation, lower emotional resilience and lower emotional arousal.A chronic disease co-occurs with the emotional sphere of a person’s daily functioning. Regardless of the diagnosis in terms of somatic disorders and mental illnesses, the way in which emotional states are controlled can be an important factor in the onset of the disease, coping with it as well as the treatment process. Each person is characterized by a tendency to react emotionally in a certain way, which is typical and fairly independent of the situation. This tendency involves three components of emotions, i.e., the individual’s subjective feelings, physiological changes, and the expression of emotion as presented in the person’s behavior. The ability to control behavior subject to emotion is inherent in these components. Emotional control is the process by which people can influence what emotions they experience, when the emotions are exacerbated, and how they evaluate and expresses them. Emotional control is an indicator of emotional maturity and the ability to constructively express one’s emotional states depending on the situational context , 2.Emotional and affect control is a component of emotion regulation, which is a broader term—although it is sometimes used interchangeably with emotional control, and includes the processes responsible for initiating, modeling, and maintaining the experience as well as expression of emotions. Emotion regulation refers to the processes of self-control and to correcting the ways in which emotions are expressed, changing their content and intensity, modulating emotion-related behaviors, and serving to undertake adaptive and goal-oriented action strategies. Emotional control is responsible for strengthening, weakening or changing an emotional response. A person with properly developed emotional control is able to inhibit their emotions in some situations and freely reveal them in others –6.Although emotional responses are usually appropriate to the demands of the environment and allow for an effective action, there are times when a person’s experienced emotions lead to behavior that is contrary to their needs and goals. Features of dysfunctional experience and regulation of emotions are usually observed and analyzed in people suffering from mental illnesses, such as affective disorders, anxiety disorders or personality disorders, fitting into the clinical picture of these disorders. It has been shown that such people reveal problems in understanding emotions and their control and, as a result, may have periodic or long-term difficulties in forming close emotional ties, or their ties are characterized by ambivalence, conflicts or overdependence on others , 7. Of tRecently, emotion regulation processes have also been considered in the context of chronic somatic diseases, not only as a reflection of the negative consequences of the disease, such as its inconvenience and chronic nature, but also as a risk factor involved in their formation. The emotional sphere of the personality, including mainly tension and negative emotions and difficulties in regulating them properly, in conjunction with difficult and stressful situations, co-occur with a decrease in the body’s immunity , 11. TheThe regulation of emotions takes place through three brain regions working together. The brainstem structures are responsible for the most elementary, innate and unconscious drive reactions . The limbic system, including mainly the amygdala and hippocampus, modifies emotional responses depending on incoming external stimuli—the environment. The prefrontal cortex, on the other hand, is responsible for feelings (conscious emotions) and control over emotions , 15. ThePsychoneuroimmunology is the study of the interactions among behavioral, neural, and endocrine, and immune processes. The brain communicates with the immune system through autonomic nervous system and neuroendocrine activity. Both pathways generate signals that are perceived by the immune system via receptors on the surface of lymphocytes and other immune cells. An activated immune system, in turn, generates cytokines that are perceived by the nervous system. Thus, bidirectional connection between the brain and the immune system reinforces the hypothesis that immune changes could mediate some of the effects of psychological factors on health and disease .Immunological disorders and chronic inflammation, which can consequently cause similar abnormal psychological reactions and disorders as in mental illnesses, can also occur in the course of some chronic somatic symptom disorders , 18.The aim of the study was to analyze emotional control variables in several somatic diseases  compared to patients with selected mental illnesses (depression and anxiety disorders), against healthy subjects.Surveys among patients with somatic disease and mental illness were conducted in dermatology and gastroenterology departments, as well as in the psychiatric ward of university hospitals in Lodz, Poland. The somatic disease group included patients with psoriasis (30 patients), rosacea (30 patients), irritable bowel syndrome (IBS) (30 patients), and gastroesophageal reflux disease (GERD) (30 patients). The mean age of all individuals surveyed in this group was M = 38.91 years, standard deviation (SD) = 11.74, minimum age = 18 years, maximum = 55 years.The patients with depressive disorders, including diagnoses of depressive episode (F 32 according to ICD-10 criteria) and recurrent depressive disorder (F 33) − 96 patients, and patients with anxiety disorders (30 patients) in the form of phobias (F 40) and other anxiety disorders (F 41), were under hospital treatment. The mean age of all the people surveyed in this group was M = 44.59 years, standard deviation (SD) = 11.97, minimum age = 18 years, maximum = 61 years.Patients with mental comorbidity, somatic disease other than the disease entities selected for the study, including neurological, inflammatory and oncological, were excluded from the study. The authors did not interfere with the diagnosis and treatment process at any stage of the study. The research was performed individually by the authors using the research methods described below. Medical data on the course of the disease were obtained directly from the patients and from attending physicians (with the patients’ consent).The comparison group (64 people) included those who did not meet the criteria for a diagnosis of mental disorders and somatic diseases. The mean age of all the people surveyed in this group was M = 32.77 years, SD = 10.56, minimum age = 20 years, maximum age = 61 years.Detailed sociodemographic data describing all the subjects invited to the study, including patients with somatic disease and mental illness, and the control group of healthy subjects, are provided in Tables The selection of participants for the study group was random. Each subject gave written informed consent to participate in the study. Each study was conducted in accordance with the rules of the Data Protection Act, and its design was approved by the Bioethics Committee of the Medical University of Lodz under the following applications: RNN/882/11/KB and RNN/383/11/KB.Emotion Regulation Questionnaire developer by J. Brzeziński  was usedexpressivity control (KE)—measures an individual’s ability to control the outward manifestations of experienced emotions . A high score indicates excessive expressivity control, a low score shows underdeveloped expressivity control.emotional and rational motivation (MER) - indicates the type of motivation of the individual, i.e., the type of control of one’s own behavior, which on the one hand can be emotional (impulsive) and on the other rational (controlled and thoughtful). A high score indicates controlled and thoughtful behavior, and a low score shows impulsive behavior.emotional resilience (OE)—measures the ability of the subject to prevent behavioral disorganization under the influence of experienced positive and negative emotions, as well as the ability to influence the source of emotions, allowing to suppress the current emotional process. A high score indicates resilience to emotions and excessive control over one’s own behavior; a low score signifies non-resilience to emotions and an inability to control the behavior associated with them.situation control (KS)—indicates the individual’s ability to control emotogenic (emotion-triggering) situations, to perceive and interpret them appropriately, taking into account whether the individual easily enters or avoids emotion-triggering situations. A high score indicates excessive control of the situation manifested mainly in the form of anxiety, and resulting from defensively oriented perception and interpretation. A low score means that the individual enters into various emotion-triggering situations too easily, without thinking about the consequences of doing so.emotional arousal (PE)—measures the threshold of general emotional arousal and illustrates the degree to which it is easy to enter an emotional state after being exposed to emotion-triggering stimuli. The lower the score on this scale, the more difficult it is for the individual to enter an emotional state, i.e., the less emotionally excitable they are [they are .The subjects provided other sociodemographic variables, like gender, age, duration of disease, by filling out a short questionnaire prepared by the study authors.STATISTICA 13.3 PL software was used for statistical analysis of the results obtained. A two-sided critical area was assumed during the statistical verification of the hypotheses. In order to choose the type of measurement, an analysis of the variables under study was conducted, which showed that the hypothesis of conformity to normal distribution should be rejected. In order to demonstrate the statistical significance of the association of the analyzed variables among the patients treated for somatic, affective and anxiety disorders and among the healthy individuals, a statistical analysis was performed based on non-parametric tests, including the Mann-Whitney U test and the Spearman’s rank correlation coefficient. The significance level of p < 0.05 was adopted in all statistical methods used.The study groups of patients with somatic symptom disorders were dominated by those with chronic disease—more than 10 years and 3 to 5 years. Among the patients with mental illness, those affected for 3 to 5 years and patients with illness for 1 to 2 years were the largest group , lower emotional resilience (OE) and lower emotional arousal (PE) Table .Table The patients with mental disorders—compared to healthy subjects—recorded the highest number of statistically significant differences in the analyzed dimensions of emotional control. They have higher levels of expressivity control (KE), situation control (KS) and emotional arousal (PE) than the healthy subjects. The dimension of emotional and rational motivation (MER) scored significantly lower compared to the healthy people. The results described are shown in Table A graphical presentation of the obtained results of the differences between the average values in each group is shown in Figs. All subgroups of somatic symptom disorders and mental illnesses were compared with the healthy subjects. Tables and figures include selected results of the statistical analysis without breakdown by patient group.On the situation control (KS) subscale that measures an individual’s ability to control emotion-triggering situations as well as their correct perception and interpretation, most of the subjects with somatic disease and mental illness scored higher than the healthy subjects. This indicates a defensive attitude and a tendency to control the situation in the form of anxiety. In the group of patients with anxiety disorders  and patients with psoriasis , these scores were slightly lower compared to the others. Those with irritable bowel syndrome  and rosacea  recorded similar results to the patients with depression .The dimension of emotional arousal (PE), which refers to the ease of entering an emotional state under the influence of emotion-triggering stimuli, was dominant in the group of patients with mental illness. On the other hand, expressivity control (KE) (controlling the outward manifestations of experienced emotions) and emotional resilience (OE)  in terms of the mean scores obtained were most similar in all the patients studied compared to the control subjects.Interestingly, in the emotional and rational motivation (MER) subscale, higher scores—compared to those with depressive and anxiety disorders, and even compared to the healthy people—were obtained by those with somatic diseases, i.e., psoriasis , rosacea , gastroesophageal reflux , irritable bowel syndrome . A higher score on this scale indicates motivation to engage in more rational and less emotional behavior in emotion-triggering situations.age from those with mental illness and from those in the control group. After a detailed statistical analysis, the group of patients with anxiety disorders was not statistically significantly different from those with somatic disease  and from the healthy subjects, as can be seen in Tables Subjects with a diagnosis of chronic somatic symptom disorders were statistically significantly different in age of the subjects co-varied statistically significantly with a small number of the emotional control variables discussed. In the patients with psoriasis, a positive correlation was for emotional and rational motivation  and situation control . A negative correlation for expressivity control  was confirmed among the patients with gastroesophageal reflux. Age did not correlate statistically significantly with the variables analyzed in the group of patients with rosacea and irritable bowel syndrome as well as among patients with anxiety disorders. In contrast, among those with depressive disorders, a significant positive correlation extended only to situation control . Age co-occurred statistically significantly with expressivity control  and emotional and rational motivation  among the healthy subjects.Among those with somatic diseases, the Duration of illness did not correlate statistically significantly in the anxiety disorder, psoriasis and irritable bowel syndrome groups. In the group of patients suffering from depression, a significant negative correlation was for emotional resilience . A significant negative correlation was also confirmed for emotional arousal  among the patients with rosacea. The patients suffering from gastroesophageal reflux had a significant negative correlation in situation control  and emotional arousal . In all the cases described, longer duration of illness co-occurred with lower intensity of the listed dimensions of emotional control.Gender differentiated the subjects  in a statistically significant way with reference to only two dimensions concerning emotional control, namely situation control  and emotional arousal , which had higher levels among women. The differences between men and women were greatest among patients with depression. They addressed the following dimensions of emotional control: expressivity control, situation control and emotional arousal, with higher results for women in all the dimensions mentioned.Measuring emotional control takes on particular importance in the context of scientific reports that prove the existence of a relationship between the way emotions are expressed and the occurrence of mental, somatic and psychosomatic diseases .There are few reports in scientific studies comparing patients with chronic somatic disease to patients with psychiatric disorders in terms of control of emotional states. Most reports in the literature refer to common factors that link somatic diseases to depression or the co-occurrence of psychiatric disorders with chronic physical illness, mainly in a biological context , 21, 22.The association of somatic diseases with depression and anxiety is grounded in the presence of biological factors common to these diseases. Both depression and anxiety disorders, as well as a number of diseases of civilization , share a common immunological background. An increase in immune system activity and the adverse metabolic changes described above can be seen in each of the aforementioned diseases . The samThe reason for the co-occurrence of anxiety disorders with somatic diseases as with depression may be related to common biological and behavioral processes involved in the development of these types of diseases. There are also similarities in the pathophysiology of anxiety and selected somatic diseases or somatization tendencies , 27.The accepted models of disease formation primarily take into account biological factors relating to the genetic background, biological dysregulation conditions involving the activities of individual systems and organs of the body, which the authors of the presented paper did not directly address. It is pointed out that psychological and environmental factors—in addition to biological factors—play a significant role in the development of diseases, which in their theoretical assumptions emphasize the importance of personality traits , early human experience and adaptation to environmental demands, or the way of cognitive elaboration of one’s own experiences and evaluation of oneself. Certain personality traits can promote illness, while at the same time, changes in selected personality traits can be a consequence of the disease process .Deficits in the regulation of emotional control can include and simultaneously co-occur with the phenomenon of alexithymia, which is described as a disorder of cognitive and affective processes that limits a person’s access to his own mental states and awareness of his own emotions. Alexithymia is treated as a stable personality trait of patients, which, along with other personality factors, predisposes to the occurrence of various somatic and mental illnesses. The limited ability of a person with alexithymia to become aware of and process his own emotions using cognitive processes leads to both a focus on somatic sensations accompanying emotional arousal and a compulsive, poorly controlled response to negative stimulation .In the analysis of the study variables presented in this publication, the patients with skin diseases and the patients with gastrointestinal disorders differed statistically significantly from those with psychiatric disorders and from the healthy subjects on three dimensions of emotional control. People with somatic disease are characterized by higher emotional and rational motivation, lower emotional resilience and lower emotional arousal than those with mental illness. Compared to the healthy individuals, the patients treated for dermatological and gastrointestinal diseases have statistically significantly higher levels of emotional and rational motivation, situation control and emotional arousal. The patients with mental disorders—compared to the healthy subjects—recorded the highest number of statistically significant differences in the analyzed dimensions of emotional control. They have higher levels of expressivity control, situation control and emotional arousal than the healthy subjects. They scored lower on the dimension of emotional and rational motivation compared to the healthy people. The results described for the people with mental illness remain consistent with many other studies addressing this topic. In addition, regardless of statistical significance, there was similarity in the individual factors comprising emotional control on the dimensions that differentiate people with somatic disease and mental illness from healthy individuals.The literature on this issue indicates that emotion regulation disorders are important in the development and course of many mental illnesses such as depressive disorders, bipolar affective disorder, borderline personality disorder, generalized anxiety disorder, and eating disorders . NumerouIt has been repeatedly shown that emotion suppression is related to the level of depressive symptoms and leads to an increase in negative emotions. Studies evaluating the relationship between the ability to control emotions and the severity of symptoms of depressive and anxiety disorders have shown that the more people control, suppress and devalue their emotions, the higher their levels of anxiety and depression symptoms. Conversely, the more accepting they are of their emotions—both negative and positive—the less severe the symptoms of depression and anxiety . The resDermatological and gastroenterological diseases are among those with complex etiologies in which a significant role is played by both biological and psychological factors. In most cases, these diseases cause bothersome symptoms that impede daily functioning and may even result in unsightly changes in appearance, affecting the patient’s body image and self-esteem, and to a large extent determine the patient’s social relations , 38–40.In our own studies from 2008 to 2010 , 42 the Also in reports from 2009 , in whicAtroszko et al.  studied The relationship between emotional functioning and somatic diseases has been a topic of scientific research for several decades. The mechanism of this relationship is explained on the basis of various models that describe the relationship between emotions and physiological responses, mediated by other psychological factors such as stress and personality traits. Individual susceptibility to reacting with negative emotions and emotional control processes is of interest from this perspective , 45. MeaIn our study, we showed the existence of heterogeneous relationships between age and various dimensions of emotional control across groups. Age differentiated the subjects, but did not co-occur in a statistically significant way with a large number of emotional control variables. In the vast majority of them, selected dimensions of emotional control increased with age.Other studies addressing this topic also indicate that the ability to control emotions increases with age, as the ability to understand and name one’s own emotions associated with the development of social interactions rises. One study found that factors such as emotional suppression and aggression control, indicating a tendency toward less emotional expression, are highest in the group of people over 55. This phenomenon is explained by the fact that older adults may be better able to understand and accept their inner subjective experiences, condense them, and do not feel such a strong need to express their emotions. In addition, perhaps older people suppress the expression of negative emotions more, or experience fewer negative emotional reactions compared to younger people . The morIn our own research and considering all the groups studied, we have shown that women enter a state of emotional arousal with greater ease and at the same time show a greater ability to control expressivity. In contrast, in the group of depressive patients, women were characterized by greater emotional arousal, with stronger expressivity control and situation control. In the literature we find data indicating that women score higher on emotional expressivity than men in a group of patients suffering from various types of chronic diseases. The results also support the view that emotions are culturally constructed and context dependent. Cultural changes and social consequences that affect age and gender roles can have a direct impact on the ways in which emotions are experienced and expressed .Duration of disease did not correlate in a statistically significant way in the group of patients with anxiety disorders, psoriasis and irritable bowel syndrome. In the group of patients with depression, rosacea, gastroesophageal reflux, it was shown that longer duration of disease co-occurred with lower intensity of selected dimensions of emotional control. In the case of patients with depression, emotional resilience decreased with longer duration of disease, while in the case of patients with somatic disease, emotional arousal diminished mainly. This may suggest a tendency toward better emotional functioning with the duration of the disease in the case of a somatic condition, but not a mental one, which is understandable given the nature of mental disorders. A study by Kossakowska et al.  showed tThe heterogeneity of the comparison groups of subjects, in terms of the number of subjects studied and demographic variables, may be considered a limitation of the presented project. They varied significantly in terms of age, which is related to the prevalence of specific disease entities in the age range and the availability of healthy individuals who consented to the study. The study results should be treated with caution. Further research in this area should continue on larger group sizes in specific disease entities.A somatic disease and mental disorder of a chronic nature entails a fundamental and usually inauspicious change in a person’s life in the form of persistent ailments that cause suffering and restrictions on the performance of important social roles—both family- and work-related. Both categories of disease entities are closely related to the function of the nervous system and to the human mental sphere. Emotional processes, which have a significant impact on the way of thinking, behavior and physiological reactions, are a factor that determines the overall functioning, as well as the quality of life of an individual.Comparing patients with somatic disease to patients with mental illness in terms of controlling emotional reactions raises new possibilities for covering the described groups with similar therapeutic interventions that pay attention to the patient’s emotional sphere. The importance of various disease factors should be studied and taken into account in the treatment process, with the aim of selecting the most optimal therapeutic tasks.Control of emotional reactions, which is the variable analyzed in the current study, is one of the established personality traits, as we described in the discussion of the work. Other well-established personality traits and their contribution to somatic and psychiatric disorders will become the subject of our upcoming studies. In the given study, the authors also did not address the therapeutic side of the described phenomenon, and due to the significant number of patients affected by this problem, it requires much more research attention in the future.


Background and objectiveThere is a dearth of studies on the knowledge and awareness among mothers on childhood development in the United Arab Emirates (UAE). Maternal knowledge of childhood development is a critical determinant of children's development and behavior. In light of this, we conducted this study to determine the level of maternal knowledge about childhood development.MethodologyWe employed a cross-sectional study design involving 200 mothers of all ages recruited using stratified random sampling. After obtaining informed consent, the participants were required to complete a questionnaire adapted from the "Ages and Stages" questionnaire, which covered demographics and items on developmental milestones. The questionnaire was validated and checked for reliability by using a focus group. Inferential statistics were used, and the association between the variables was analyzed using the Chi-squared test.ResultsOur findings indicated that the knowledge among mothers regarding child development is relatively low in the UAE. Two-thirds of the respondents were knowledgeable about gross motor skills (62% of the mothers knew the age at which a child could lift his/her head). Less than half of the mothers were well-informed about fine motor skills such as writing and drawing (44% of the mothers were aware of the age at which a child should be able to scribble on paper). The respondents demonstrated a lack of knowledge regarding children's speech and language skills. Regarding social skills, only 8% of the mothers were aware of the correct age at which a child should start to dress by himself/herself.ConclusionAlthough mothers in the UAE were knowledgeable about certain aspects of childhood development such as gross motor development, they were less knowledgeable regarding other aspects such as social and language skills. The gaps identified in our study highlight the need to implement effective health education programs so that mothers are better informed to help improve child development outcomes in the community. It is well-known that awareness among mothers regarding early childhood development can contribute to a broad range of positive developmental effects . SeveralParenting is a multifaceted endeavor and requires a systematic response to children's various needs. Parents should develop both depth and breadth of knowledge, ranging from being aware of developmental milestones and norms that help in keeping children safe and healthy to understanding the role of professionals  and social systems  that interact with families and support parenting. One focus of many initiatives to support parenting is on the significance of parents' understanding of child development. The need for policy and program initiatives to promote parenting knowledge is emphasized by evidence-based recommendations made by the American Psychological Association Task Force on Evidence-Based Practice with Children and Adolescents (2008), the Centers for Disease Control and Prevention (CDC) (2015), and the World Health Organization (WHO) (2009). Based on these guidelines, parents require a basic awareness of baby and child developmental milestones and norms as well as the kinds of parenting techniques that encourage children to attain these milestones to optimize their growth .Studies conducted in developed countries have found that mothers' being knowledgeable about their children's developmental stages correlates positively with their ability to help them develop better . StudiesThe WHO Department of Child and Adolescent Health and Development and the United Nations Children's Fund (UNICEF) have jointly created the Care for Development Intervention (CDI) to assess the disparity between developed countries and third-world nations regarding the knowledge available for caregivers on how to support their child's development . CDI impThis was a cross-sectional study conducted at a tertiary care center in Al Ain, the eastern region of the UAE. The questionnaire was framed by adopting questions from the "Ages and Stages" questionnaire 3rd edition  and inclData were collected by distributing the questionnaire to the participants living in different areas of the UAE, irrespective of age, by adopting the stratified random sampling method. An online survey through SurveyMonkey was sent anonymously to participants through emails and mobile applications, which included an explanation of the study and its purpose, with informed consent required before participation and completion of the questionnaire. The Institutional Review Board of Tawam Hospital approved the study protocol (MF2058-2020-759). Data were analyzed using IBM SPSS Statistics . A p-value <0.05, was considered statistically significant. A Chi-squared test was performed to check the correlation between different variables.The questionnaire was distributed to 240 mothers in various parts of the UAE, irrespective of their age. The response rate was 80% (200/240). The participants did not report any difficulty with understanding the survey items and the survey layout. The participant demographics are presented in Table Table No statistically significant associations were found regarding mothers' knowledge about child development in terms of age, marital status, education, employment status, source of information, and husband's age, education, and career.The study addresses the key issues related to major milestones in the development journey of children. Additionally, the study assessed the level of knowledge among mothers in the UAE about developmental milestones and examined its relationships with several factors, including parental age, educational level, employment status, parity, the age of the youngest child, source of information, nationality, and the use of childcare assistance. To the best of our knowledge, this is the first study to address mothers' knowledge about early developmental milestones in children in the UAE.It is interesting to note that knowledge about gross motor development was adequate among parents. Typically, the advice that mothers receive from healthcare professionals is confined to the physical health of the child, with scant to no attention paid to the intellectual and psychological factors and parent-infant engagement abilities. Primary healthcare facilities naturally concentrate on monitoring a child's growth indicators, immunizations, and basic health-related issues such as eating, constipation, and nutritional disorders, and often fail to educate parents about anticipatory guidance, normal developmental milestones, and the red flags that should alert them of developmental delay. Our study indicated that the mothers possessed a fairly high level of knowledge regarding many of the physical aspects. This is consistent with a similar study from the Middle East, which demonstrated that mothers were more knowledgeable about physical and safety skills but less knowledgeable about cognitive, emotional, and parent-infant interaction skills .In the present study, the mothers scored the least in the area of milestones for social skills, exemplified by the fact that only 8% of the mothers surveyed in our study correctly identified the age at which the infant or child could dress by himself/herself. This finding reflects the mothers' lack of knowledge regarding the social aspect of developmental milestones, which is in line with a previous regional study by Ibrahim HA in 2010. Similar to the findings reported by Rikhy et al., the knowledge of other domains, such as fine motor, language, and social competence, was comparatively poor among mothers . The momThe present study has some limitations. Firstly, given the nature of the study design, no causation can be attributed to the observations. Additionally, the relatively small sample size means that the findings may not be representative of the general population. This also underlines the challenges faced in recruiting mothers willing to participate in the study. Regardless, the strengths of the study include the fact that this is the first study from the UAE to address the knowledge of mothers about their child's developmental milestones.Our study has illustrated significant gaps in the knowledge of mothers about their child's developmental milestones, especially in the social domain. The lack of parenting skills demonstrated may be partially attributed to the inadequacies in the engagement and interactions between healthcare professionals/caregivers and mothers. Nevertheless, nurses and physicians are mostly the first sources of knowledge about parenting for mothers. It is anticipated that the results of our study will be a stepping stone for researchers in countries with similar practices around the region. Further research that involves the participation of fathers and childcare providers should be conducted to attain a more comprehensive picture of factors affecting child developmental milestones in the UAE.


Recently, cardiovascular disease has become the leading cause of death worldwide. Abnormal heart rate signals are an important indicator of cardiovascular disease. At present, the ECG signal acquisition instruments on the market are not portable and manual analysis is applied in data processing, which cannot address the above problems. To solve these problems, this study proposes an ECG acquisition and analysis system based on machine learning. The ECG analysis system responsible for ECG signal classification includes two parts: data preprocessing and machine learning models. Multiple types of models were built for overall classification, and model fusion was conducted. Firstly, traditional models such as logistic regression, support vector machines, and XGBoost were employed, along with feature engineering that primarily included morphological features and wavelet coefficient features. Subsequently, deep learning models, including convolutional neural networks and long short-term memory networks, were introduced and utilized for model fusion classification. The system’s classification accuracy for ECG signals reached 99.13%. Future work will focus on optimizing the model and developing a more portable instrument that can be utilized in the field. According to the World Health Organization’s statistical report, the mortality rate for cardiovascular disease is significantly higher than that of any other disease globally. In 2012, this condition caused nearly 17.5 million deaths worldwide, representing approximately one-third of all fatalities. The China Cardiovascular Disease Report of 2018 reveals that regardless of whether individuals reside in urban or rural areas, they exhibit higher mortality rates related to cardiovascular disease than with other illnesses  represents the combined vector of the output value ht−1 from the previous unit and the input xt of the current sequence [The core of LSTM is the status of the cell, as represented in sequence .σ refers to the sigmoid activation function [it is the retaining parameter, Ĉt is the value of input gate. Wi and Wc are the weight and bi and bc are the biases [The forget gate selectively maintains information by retaining or discarding it based on the combination of these inputs. function . The inpfunction .it = σ  , supportThe experimental results of LR, the SVM, and XGBoost were analyzed . The oveT-wave direction and QRS complex direction. Furthermore, the discriminatory power of QRS duration is insufficient, which is reflected in the relatively low feature importance obtained from the XGBoost classifier. Therefore, it is necessary to complement the model using deep learning techniques [However, there was a lower classification accuracy for ventricular premature beats. The core features of ventricular premature beats include a relatively wide and deformed QRS complex, ST segment, as well as a T-wave direction opposite to the QRS complex. The QRS duration is greater than or equal to 0.12 s . Analysis revealed that the main reason for the lower accuracy was that manual feature engineering fails to effectively capture the distinctive features of ventricular premature beats, especially the differentiation between ST segment and chniques .Learning_rate (eta): This represents the learning rate or step size for the iteration of decision trees. A smaller value leads to a slower iteration, whereas a larger value may result in lower accuracy.Max_depth: This parameter determines the maximum depth of each decision tree. It is generally set between 5 and 10. Setting it too high can lead to overfitting.Random seed: The random seed can be adjusted using cross-validation to ensure reproducibility and control randomness.colsample_bytree and colsample_bylevel: These parameters control the proportion of randomly sampled rows and columns, respectively. They are used to mitigate overfitting by introducing randomness into the sampling process.To select the best parameters, it is recommended to perform testing and cross-validation. The parameter settings of CNN are shown in XGBoost has several parameters to adjust, as shown in An analysis was conducted on the experimental results of CNN and LSTM, revealing an improvement of approximately 1.4% compared with traditional models and feature engineering . FurtherTo validate the accuracy of the overall model’s predictive results in practical measurements, two sets of data were collected comprising five left bundle branch block heartbeats and five right bundle branch block heartbeats. The actual prediction accuracy was found to be 100%. It is evident that the accuracy of the model’s predictions in practical scenarios is exceptionally high.The classification of V (ventricular premature beats) is relatively challenging compared with other symptoms in the overall context. The main reason for this difficulty lies in the inadequate depiction of distinguishing features related to the ST segment, T wave direction, and QRS wave direction. Consequently, the model fails to recognize these features effectively, indicating a need for special design considerations in characterizing the features and model structure for ventricular premature beats. Meanwhile, it is observed that deep models outperform traditional models in general, suggesting that the wavelet coefficients and morphological features do not sufficiently allow the model to learn the differences between ventricular premature beats and other states. Thus, more effective features in this regard should be explored.Furthermore, within the overall context, except for the CNN’s superior performance in classifying R (right bundle branch block), the accuracy of the fused models is better for the remaining cases. This highlights that fusion of models with low correlation indeed enhance the final predictive results effectively.Lastly, the accuracy of the model in predicting the normal state is nearly similar. This implies that the manually constructed feature set can effectively depict the heart rate during the normal state, resulting in the highest overall accuracy in normal state classification.In order to ensure the standardization of the research, it is necessary to adjust the classification criteria according to the AAMI  standards. AAMI and MIT-BIH fundamentally represent two different classification methods in clinical practice.Therefore, in order to meet the standards set by AAMI, the classification approach of the AAMI was employed to transform the problem into a five-class classification task. However, due to limited training data for the Q category in the MIT-BIH dataset, this category was excluded, resulting in a four-class classification problem for practical application. To expedite the training process, an improved CNN model was utilized for prediction, as depicted in Weighted processing—where different weights are assigned to different samples in the final loss function;Oversampling—which involves artificially increasing the number of samples by applying a sampling multiplier to the minority class;Undersampling—which reduces the number of samples in the majority class .The analysis of the final results leads to the following conclusions. It can be observed that there is an issue of sample imbalance in the S, V, and F classes within the MIT-BIH dataset. Therefore, in the initial phase of the study, these classes were intentionally avoided, and only the N class was used for classification. This approach indeed helped to address the problem of sample imbalance to a certain extent. To tackle sample imbalance, three common strategies are generally employed:In practice, all three methods were attempted. However, due to the scarcity of samples in certain categories, for example, the F class only had 800 samples in the training set, undersampling was not deemed suitable in some cases, whereas oversampling did not effectively improve the training performance . TherefoThe majority of the training data for this study is sourced from the MIT-BIH database. Due to the limited volume of data collected by the embedded system, only a small sample test could be conducted. Therefore, the accuracy achieved does not fully represent the accuracy of this classification system in handling real-time heart rate data. As a result, further in-depth research is required to investigate the real-time performance of the system .This chapter focuses on the software component of the entire ECG analysis system. Whereas the hardware component is responsible for signal acquisition, the software part is responsible for signal analysis and classification. Firstly, the overall machine learning classification process is defined, including data preprocessing, dataset partitioning, feature engineering, model selection, performance testing, and model fusion. In the data preprocessing phase, attention is given to addressing certain issues in heart rate signals by applying wavelet transformation for denoising purposes. Due to the specific nature of heart rate signals and to facilitate feature engineering, a QRS wave detection algorithm was designed. Subsequently, the dataset was partitioned and three partitioning methods were proposed and selected based on theoretical and practical considerations. Feature engineering was constructed from two perspectives: morphological features and frequency domain features. For model selection, traditional models such as LR, SVMs, and XGBOOST were initially tried in combination with manual feature engineering. However, considering the limitations of traditional models and the strong fitting capabilities and non-requirement of manual feature engineering in deep learning models, LSTM and CNN classic models were adopted for classification. Additionally, traditional models were used for model fusion to prevent overfitting . FinallyThe main research content of this paper is the study of an ECG signal acquisition and analysis system based on machine learning, and the main achievement is a system that can collect ECG signals and transmit them to the terminal for classification. The overall framework of the system is mainly an ECG signal acquisition system and an ECG analysis system. The signal acquisition system is responsible for collecting ECG data from the human body and sending it to the terminal. The analysis system mainly includes data preprocessing and machine learning models. Software modules are written on the terminal for data reception. The data is preprocessed and then a machine learning model is constructed to classify and set evaluation indicators to evaluate the model results, which mainly improves the convenience of the ECG acquisition system and realizes a system for detecting whether the human heart rate signal is normal. The final experimental results and conclusions are as follows:(1) Use self-made PCB to realize the design of ECG acquisition system and improve the portability of the system. The overall hardware design mainly includes signal transmission and processing. The main structure of the acquisition system is to first collect ECG signals through commercial electrodes and three-lead methods (the main reason for using three-leads is that three-leads are more accurate than single-leads and are simpler and more portable than twelve-leads). Then, use AD8232 as the acquisition front-end chip. The built-in circuit of the AD8232 chip has the functions of primary and secondary amplification and high-pass and low-pass filtering. Then, use STM32F103 as the main control chip to collect the analog signal obtained by AD8232 through the ADC module after the signal is digitally filtered. Finally, the converted digital signal is sent to the terminal. Finally, it is concluded that a circuit with AD8232 and STM32F103 as the core can accurately collect most types of heart rate signals .(2) Design a machine learning model to analyze the collected ECG signals and combine the embedded system to realize a complete system for ECG collection and artificial intelligence analysis. The overall scheme design of the analysis system mainly includes the preprocessing of the ECG signal and the idea of model construction. Collect the data through the terminal and then use the wavelet transform denoising method to filter the data; after the filtering is completed, use the QRS extraction method to achieve the extraction of the heartbeat. The core idea is to use the dual-slope algorithm to extract the position of the QRS wave. The position of the QRS wave divides the data points forward and backward to realize the heartbeat segmentation. The length of the data points is generally in the range of 200–300. In this article, we use 100 points forward and 150 points backward, totaling the division of 250 points that are used as the heartbeat length. We then build different types of models for an overall classification and model fusion. First use traditional models  and feature engineering for classification, feature engineering mainly includes morphology features and wavelet coefficient features, then use deep learning models  for classification. Finally, all models are fused to obtain the final result, and the final accuracy of the model is 99.13%.To deploy the proposed system for real-time monitoring of ECG signals and analysis of potential heart diseases, there are different approaches for implementation in hospitals or at home:Hospitals: In a hospital setting, the system can be integrated into the existing infrastructure for cardiac monitoring. The ECG monitoring device can be connected to a central monitoring station through wired or wireless connections. The ECG signals can be transmitted in real-time to a dedicated server, where the AL machine learning algorithms are deployed for analysis. The results can be displayed on a monitoring dashboard accessible to healthcare professionals, allowing them to make timely diagnoses and decisions.Home use: For deployment in a home setting, a portable ECG monitoring device can be developed. This device should be user-friendly, compact, and able to wirelessly transmit the ECG signals to a mobile app or a cloud-based platform. The app or platform can then apply the AL machine learning algorithms to analyze the signals and provide feedback on potential heart diseases. Users can securely access their ECG data and analysis results through the app and, if necessary, share them with healthcare professionals for remote monitoring and consultation.In both scenarios, it is important to ensure the system’s accuracy, reliability, and data security. Compliance with the relevant regulatory standards and obtaining the necessary approvals may also be required before deploying the system, especially in a medical context.