Nowadays, accompanied with the rapid advances in industries and technology, many concerns about the implications of technological development are threatening human life. High application of pressure vessels and their high operational risks indicate the need to identify the hazards and causes assessment of possible incidents. This study was conducted to evaluation of the risk of boiler unit in a textile industry in Qom and in 2015.In this study, the operational hazards of a boiler unit were analyzed using Functional Hazard Analysis technique (FuHA). FuHA is one of the system risk analysis methods and is considered as a qualitative technique. This method identifies and analyzes the risks of the system. In fact, the purpose of this technique is to determine the system s risks through functional analysis.Based on the application of FuHA technique on the selected boiler unit, 26 cases of hazard and functional failure status were identified. From this identified failure 3 cases were unacceptable, 11 cases were undesirable, 10 cases were acceptable but needed revision and 2 cases were evaluated as negligible risk finally. In total, for identified hazards, 49 causative factors were identified and determined. Among the identified hazards, failure to perform or inaccurate operation of the boiler valve with a 2A risk index (unacceptable) was identified as the most critical risk in the studied system. This situation can lead to an increase in Boiler pressure, then blasting and financial losses or injuries to individuals and properties. The obtained results showed that the FuHA technique has a desirable capability to identify and analyze the system and subsystems systemic risk especially the software subsystems. Therefore, this method can be used as one of the strategies for assessing hazards in industrial environments.Safety, Boiler, Risk assessment, Functional hazard analysis, Textile industry


Drug-disease interactions negatively affect the benefit/risk ratio of drugs for specific populations. In these conditions drugs should be avoided, adjusted, or accompanied by extra monitoring. The motivation for many drug-disease interactions in the Summary of Product Characteristics (SmPC) is sometimes insufficiently supported by (accessible) evidence. As a consequence the translation of SmPC to clinical practice may lead to non-specific recommendations. For the translation of this information to the real world, it is necessary to evaluate the available knowledge about drug-disease interactions, and to formulate specific recommendations for prescribers and pharmacists. The aim of this paper is to describe a standardized method how to develop practice recommendations for drug-disease interactions by literature review and expert opinion.The development of recommendations for drug-disease interactions will follow a six-step plan involving a multidisciplinary expert panel (1). The scope of the drug-disease interaction will be specified by defining the disease and by describing relevant effects of this drug-disease interaction. Drugs possibly involved in this drug-disease interaction are selected by checking the official product information, literature, and expert opinion (2). Evidence will be collected from the official product information, guidelines, handbooks, and primary literature (3). Study characteristics and outcomes will be evaluated and presented in standardized reports, including preliminary conclusions on the clinical relevance and practice recommendations (4). The multidisciplinary expert panel will discuss the reports and will either adopt or adjust the conclusions (5). Practice recommendations will be integrated in clinical decision support systems and published (6). The results of the evaluated drug-disease interactions will remain up-to-date by screening new risk information, periodic literature review, and (re)assessments initiated by health care providers.The practice recommendations will result in advices for specific DDSI. The content and considerations of these DDSIs will be published and implemented in all Clinical Decision Support Systems in the Netherlands.The recommendations result in professional guidance in the context of individual patient care. The professional will be supported in the decision making in concerning pharmacotherapy for the treatment of a medical problem, and the clinical risks of the proposed medication in combination with specific diseases. Contra-indications are situations where a medical product must not be given for safety reasons  DependinThe official product label is an important source of information regarding DDSIs. The European Summary of Product Characteristics (SmPC) and the U.S. FDA label information describe , contra-indications  However,Patients with comorbidities are often excluded from clinical trials, which limits the generation of evidence regarding safety of drugs in specific patient groups . Even whSince the 80’s, alerts for DDSIs have been introduced in Clinical Decision Support systems in the Netherlands . The evaPractice recommendations of DDSIs will be assessed following a six step plan, forming a continuous circle of evaluation Figure 1The role of the expert panel will be (A) to determine the scope of the DDSI, and (B) to conclude about the clinical relevance and recommendations (see step 1 and step 4 for detailed information).For every DDSI, three aspects should be identified:Definition of Disease.Internationally accepted classification systems such as International Classification of Primary care (ICPC)  or InterDefinition of Clinically Relevant Potential Effects.A disease can worsen in various degrees. To maintain a clear line in the assessment process of all DDSIs regarding disease Y, the minimal level of worsening regarded as clinically relevant should be defined. This clinical relevance is the impact of the drug on the worsening of disease, and is specified by (1) the impact on clinical outcomes and/or the quality of life, and (2) the expected odds that the worsening will happen. A rise in systolic blood pressure of 1 mmHg is not regarded clinically relevant in patients with hypertension. However, any seizure in previously seizure-free epilepsy patients is generally regarded clinically relevant because of the impact on patients’ lives.Relevance of Treatment.It needs to be determined whether the risk of a DDSI persists after successful treatment (hypertension under control) or cure (mamma carcinoma).Drugs to be evaluated will be selected according to the following sources: (1) information in the official product information (SmPC), (2) published information in medical literature, and (3) handbooks and professional guidelines.SmPCs: All SmPCs from products marketed in the Netherlands will be explored. The sections “contraindications” (4.3) and “special warnings and special precautions for use” (4.4) will be searched for drugs to be selected. When a disease is named in one of these sections, the DDSI will be evaluated.Medical Literature: for each disease a literature search will be performed in electronic literature databases  to identify potential drugs that may be involved in a DDSI based on either evidence or pharmacological profile. Reviews about the pathophysiology and pharmacotherapy in specific diseases will be selected for this purpose.Handbooks and professional guidelines will be searched to identify potential drugs involved in DDSIs.The expert panel will evaluate the drugs found in step 1–3 and will add or remove potentially relevant drugs based on motivated expert opinion.In conclusion, at the end of step 1, the disease and the drugs to be evaluated will be defined. This will be the starting point of the evaluation of the specific drug-disease combinations.For each drug, evidence will be collected with respect to the risks of its use in the context of the disease Y. The evidence will be clustered together for drugs that are expected to cause similar worsening of the disease through shared pharmacological properties based on similarities in the chemical structure and receptor binding profile, a common pharmacological mechanism of action and side effects profile . Potential risks for the use of drug X in disease Y can be based on the findings presented in Information will be collected in the following sources:SmPC and Public Assessment Report (PAR): The following sections in the SmPC will be searched for relevant information about the DDSI: “Posology and method of administration” (4.2), “contraindications” (4.3), “special warnings and special precautions for use” (4.4), “side effects” (4.8), “pharmacodynamics properties” (5.1), and “pharmacokinetic properties” (5.2). Whenever available, the PAR will be searched for additional information. The registration holder will be contacted for more information if data in the SmPC or PAR are unclear.Guidelines and Handbooks: Handbooks and (inter)national guidelines about the specific disease will be searched for information regarding the DDSI.Electronic Databases: A literature search will be performed in electronic databases  using keywords for the following search items: disease, drug name/drug class, and terms that identify risks associated with the combination . In case of diseases with very different clinical presentations, terms that will be used for identifying the population will be aligned with the expert panel at the end of step 1. Subheadings, Booleans, and title words will be used to refine the strategy. Additional publications will be added through citation tracking.When a drug is contraindicated for reasons of ineffectiveness or the availability of better treatment options, this will not be regarded as evidence supporting a DDSI. This will be motivated in the assessment report. Other exclusion criteria are studies that do not involve humans and publications lacking information on the key questions in The following criteria will be used to select the evidence:Contribution to answer the research question. Generally, few studies have been performed in the population with the disease in question. All available publications concerning the population at risk will be included. If not available, publications regarding drug X causing disease Y will be included. A specific type of papers are those describing the potential pharmacological mechanism. These papers might contribute to answering the research question, although they often do not include patient data.Level of evidence. We will include the publications of clinical information with the highest level of evidence . Other sources, such as case reports, will be included to underline the potential clinical relevance. The quality of the evidence concerning the population at risk was evaluated by grade 1 to 4 based on established criteria for drug-drug interactions that were used in previous studies , slightlThe exact search strategy and criteria for the selection of literature will be motivated in every DDSI report. For every DDSI assessment, summary tables will describe the following characteristics and results of the included information: study type, number of patients with and without disease Y, drug regimen, outcomes, and level of evidence of the study. The outcomes will describe the identified risks, including severity of the disease and statistics if present. Additional risk factors are presented quantitative whenever available.Summary tables will also present the relevant data originating from the SmPC and relevant data from handbooks and or guidelines.The data obtained in step 3 will be presented as an assessment report with motivated answers to the following questions: (a) is there a clinically relevant DDSI, and (b) is an alert required in clinical decision support systems.The data will be considered in the context of the patients at risk for a clinically relevant interaction between drug X and disease Y (Yes/No) using the criteria determined in the scope of the DDSI (see step 1). When evidence for specific formulations is lacking, pharmacokinetic data, and data on systemic effects will be reviewed and used to decide whether extrapolation is justifiable. In all the reports, the reviewers will evaluate if the additional risks can be attributed to the individual drug or the entire drug class. The evaluation will be based on literature and pharmacologic characteristics of the drug(s). A preliminary conclusion about the DDSI will be formulated.When sufficient evidence of a clinically relevant interaction between drug X and disease Y is available, another question will be answered: does the DDSI require an alert in the clinical decision support systems (Yes/No)?Alerts are often overridden which is partly caused by their appearance in situations without peril or not requiring action . Alerts When an alert is required, an alert message will be proposed with information about the clinical risk, risk factors and decision support. Risk factors are factors that are associated with a higher probability of the occurrence of the clinical risk. The decision support consists of four types of advice that will be composed for the specific DDSI Table 3.The expert panel is provided with all used information and decides on the literature selection criteria (step 2), summary, and conclusions of the literature, the proposed categorization and contents of the advice (step 3). The reports will be supplemented with expert opinions generated in the discussions. These may also involve evaluation of current handling of the (presumed) DDSI and practical implications of the proposed handling; every discipline should be able to practice the decision support advice. If there are different opinions within the expert panel, these will be included as comments in the assessment report. The expert panel will conclude by consensus. The conclusion will be included in the reports.The assessment reports will be published in Dutch guidelines for DDSIs . The advThree main pathways are identified for keeping the assessment reports, related advices, and background information up-to-date:New drugs and new risk information on existing drugs will be screened to identify eligible drugs to be submitted in step 1 of the assessment procedure. New risk information is defined as a news item from the regulatory authorities .Periodically, all DDSIs for disease Y will be reviewed from step 1. When the results of step 1 have changed, new assessment reports may have to be written. When the results of step 1 have remained the same, the existing reports will only be updated with new literature published after the previous search. In this case, step 3 and 4 are more focussed on whether the earlier made decisions are affected by new evidence or changes in medical practice . For every new drug a new assessment report will be written.Health care providers can also initiate a (re)assessment. This situation may particularly occur when medical practice has changed.As there were no patients nor data directly derived from patients involved in our methodology, this protocol was not evaluated by an ethics committee. Also, there were no privacy issues with respect to study data applicable.Not all drug-disease combinations will be associated with clinical questions about safety of medications and dose recommendations. To develop the relevant recommendations for DDSI, we will need input from clinical practice for drug-disease combinations they experience clinical problems. Moreover, a multidisciplinary expert panel needs to be initiated to develop recommendations. Finally, drug databases need to implement this knowledge in their database and be able to transfer this to Clinical Decision Support Systems in hospitals and primary care.We expect that the development of practice recommendations will result in advices for specific DDSI. The content and considerations of these DDSIs will be published in national guidelines, professional journals, and international scientific journals. To enhance the application in clinical practice, the DDSIs will be implemented in all Clinical Decision Support Systems in the Netherlands.A summary will be made to present the findings of all drugs evaluated in the context of a DDSI. This summary will consist of the description of the disease with in- and exclusion criteria, and the substance names of medications that have been evaluated for potentially clinical DDSI, with a conclusion and motivation if the DDSI is considered relevant see Table 5.Finally, the recommendations for clinical decision support will be implemented in the two National Drug Databases in the Netherlands (Pharmabase and G-Standaard). As information of these databases is used in all Health Care Information System in primary care and hospitals, this approach will guarantee a nationwide implementation of the developed DDSIs.We have developed a systematic method to develop practice recommendations for DDSIs. This method will provide standardized reports of combined evidence and expert opinions about DDSIs, that can be adapted to the specific demands and criteria that might differ between diseases. This protocol facilitates transparent communication about the scientific and clinical motivations of potential DDSIs, and their relevance for decision support in patient care.The strengths of this method are the combination of evidence and expert opinion, the multidisciplinary character of the advices and the integration in clinical decision support systems. First, there is often limited evidence available in DDSIs, which makes it more important to rely on expert opinions; the clinical and pharmacological experience complement the evidence. Second, the multidisciplinary character of the expert panel ensures that the proposed advices include the available knowledge and experience, and are applicable for all disciplines. Third, the specific actions suggested by alerts of decision support systems enforces implementation in daily practice. These advices are integrated in all Dutch clinical decision support systems for prescribers and pharmacists, in primary and secondary care. This can be regarded as a limitation, since international dissemination is desirable. To support international dissemination, we have published our study protocol and will publish the results of DDSI assessments in international scientific journals as a first step to overcome this limitation. Another limitation of this method is, that it is more time consuming compared to individual opinions, or a single literature source such as the SmPC. However, this effort will result in DDSIs that are evidence and expert-opinion based, and hence we believe the recommendations will be better accepted in clinical care.However, these assessments cannot replace the information in the SmPC. Where the SmPC should provide information on all potential DDSI, a specific evaluation should reveal the clinical relevance of and conclude about the meaning for clinical practice. Integration of all possible risks regarding DDSIs in clinical decision support systems will lead to a drug alert overload. Important drug alerts may be accidentally overridden, a consequence that is known as “alert fatigue” . By discA previous study has shown that in one-third of patients one or more DDSI alerts were not generated due to missing data in pharmacy practice . PhysiciThe assessments resulting from our protocol will produce advices for health care providers, albeit patients should also be involved in the handling of DDSIs; DDSIs should always be considered in the context of the individual patient, and these kind of decisions should ideally be the result of shared decision making . PatientMethods have been designed for determining the clinical relevance of drugs risks, such as drug-drug interactions  and antiEvaluated DDSIs will lead to scientific publications about these DDSIs using this protocol, and knowledge integrated in decision support followed by interventions that will eventually improve drug management. Future research should focus on (a) closing the current knowledge gaps, (b) the degree of compliance and reasons to differ from the advices, and (c) the patient outcomes.In conclusion, the procedure of a structured evaluation of DDSIs is described. The advices will generate clinical decision support for healthcare professionals based on available evidence and expert opinion, which enables optimal patient care. Finally, this will also identify gaps in existing knowledge in DDSIs that will form a research agenda for future investigations.JT and SB drafted the manuscript. JT, SH-I, HS, RA, BB, LD, DH, AK, BK, ML, MO, TP, RV-R, KT, IW, MW, and SB contributed to the protocol design. JT, SH, HS, BB, LD, AK, MO, TP, IW, and SB critically revised the manuscript. All authors read and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


M. leprae has ceased in Spain, based upon the patterns and trends of notified cases.The aim of this study is to explore whether transmission of Data on new cases reported to the National Leprosy Registry between the years 2003–2018 were extracted. In absence of detailed travel history, cases were considered “autochthonous” or “imported” based on whether they were born within or outside of Spain. These data were analyzed by age, sex, clinical type, country of origin, and location of residence at time of notification.Data were available on 61 autochthonous and 199 imported cases since 2003. There were clear declines in incidence in both groups, and more imported than autochthonous cases every year since 2006. Autochthonous cases were more frequently multibacillary and had older age at diagnosis compared to imported cases. All the autochthonous cases had been born before 1985 and were more than 25 years old at diagnosis. Male-to-female ratio increased with time for autochthonous cases (except for the last time period). The imported cases originated from 25 countries, half of them from Brasil and Paraguay. Autochthonous cases were mainly distributed in the traditionally endemic regions, especially Andalucía and the eastern Mediterranean coast.M. leprae is likely to have now effectively stopped in Spain.Autochthonous and imported cases have different epidemiologic patterns in Spain. There was a clear decline in incidence rates of autochthonous disease, and patterns consistent with those reported from other regions where transmission has ceased. Autochthonous transmission of  M Leprae. In several European countries, as social and economic conditions have improved, leprosy rates have declined and transmission appears to have stopped. The epidemiology of leprosy is still not fully understood: the study of leprosy in countries with low incidence rates can give valuable information on its epidemiology that could inform eradication campaigns in other countries. Leprosy has been endemic in Spain for centuries and, despite very low incidence in the last decades, new autochthonous cases are diagnosed every year. In this study, we analyse the epidemiologic trends of autochthonous leprosy in Spain in recent years. Our data provide insights into the dramatic decline of leprosy in Spain since 1950, and, for the cases diagnosed after 2003, show a shift from a predominace of disease attributable to locally acquired infection to overwhelming predominance of disease attributable to infections acquired elsewhere. The comparison of patterns of disease between the autochthonous and imported cases shows important differences, suggesting that the most recent autochthonous cases were those with long incubation periods after infections which were acquired many years ago. The epidemiologic trends are similar to those found in other countries with declining incidence and suggest that transmission effectively stopped in Spain more than two decades ago.There is increasing interest in the potential for cessation of transmission of  Leprosy has been endemic in Spain for centuries, with four historical areas of high prevalence: the eastern Mediterranean coast , Andalucía in the south, Galicia in the northwest, and the Canary Islands . ThroughDuring the second half of the 20th century, incidence rates steadily declined in Spain, paralleling an increase in national gross domestic product. This deStudies in several countries with declining incidence rates of locally acquired leprosy have found consistent epidemiologic trends, such as changes in the geographic distribution ), as appropriate. Differences in proportions and means were assessed using χA total of 1900 leprosy cases were notified in Spain since 1950: the numbers of notified cases per year are shown in The low numbers recorded for 2003 may be due to underreporting when the registration system was changed. Patients with autochthonous leprosy were predominantly male (64% of the cases), and the male-to-female ratio increased with time for the first three time periods analysed and decreased in the last period, but the number of patients in the last two periods was low . There wThe proportion of MB patients in successive 4-year time periods is shown in The geographic distribution of autochthonous cases is shown in These data provide insights into the dramatic decline of leprosy in Spain since 1950. Similar to the pattern seen elsewhere in Europe and in many other high income countries, there was a shift from a predominance of disease attributable to locally acquired infection to overwhelming predominance of disease attributable to infections acquired elsewhere,24. The We appreciate several limitations to the data. First, there was no information on travel history for most patients, and therefore we cannot exclude that some of the cases born in Spain might have acquired the infection elsewhere and that some of the foreign-born cases could have acquired their infections in Spain. We note that this issue arises often in studies of leprosy, and is related to the fact that WHO has encouraged countries to report cases by whether born in the reporting country or elsewhere, since 2015. Second,Depite these caveats, the extraordinary decline in recent decades is convincing and consistent with patterns which occurred in northern Europe decades ago and more recently in high income countries such as Japan and Korea, as well as in northern Portugal,6,25. ThThe cases among individuals born in Spain are most relevant for assessing whether transmission has occurred in recent times in the country. The autochthonous cases had significantly older age at diagnosis than the imported ones, and their average age was appreciably older than the average age of the Spanish population for the same time period. Although the time span of our study was short, age at onset increased over successive time periods , and this trend was not found among imported cases. The average age at diagnosis for autochthonous cases was 65 years old, and there were no autochthonous cases younger than 25 years old. This pattern of increasing age at diagnosis has been described consistently in other regions with declining incidence rates,28,29, sThe male-to-female ratio increased with time among autochthonous cases , whereas it showed no clear trend among imported cases. An increasing male-to-female ratio has been described in other populations with declining leprosy incidence, and has been associated with an increasing proportion of MB forms ,8,31.The geographic location of the autochthonous cases largely reflects the regions where leprosy was traditionally endemic in Spain, predominantly the eastern Mediterranean coast and Andalucía. Several cases were diagnosed in the city of Madrid or its surrounding areas, which was not a traditionally endemic region, and we suspect these are attributable to migration to the capital city from other regions. Other studies have shown a shift towards lower latitudes as incidence declines,6,8, andth century. This could also explain the cluster of cases diagnosed in the area of Madrid.Although our study in the Valencia Region and otheM. leprae, or the failure of new infections to progress to clinical disease, is not entirely clear. Without a valid test for  M. leprae infection this crucial question of leprosy’s natural history will remain unanswered.The differences between cases born within and outside Spain are consistent with the hypothesis that they were infected locally versus elsewhere, respectively, and with transmission having effectively stopped in Spain more than two decades ago. The possibility of transmission from imported cases within Spain is not zero, but experience has shown it to be rare in high income countries (the last reported transmission from an imported case in the UK was in 1954). The ex


Many athletes complain of anterior knee pain (AKP) which is the most common clinical problem, with a prevalence of 15% – 45%, posing a threat to their quality of life. Owing to a lack of consensus among clinicians and researchers, the causes and management of AKP remain controversial.The aim of this study was to map the range of non-surgical and non-pharmaceutical rehabilitation approaches to AKP among runners.A scoping review was conducted in five stages: (1) defining the research question, (2) identifying relevant studies, (3) selecting a topic, (4) charting and collecting data and (5) summarising and reporting the results. Included in the study were English original articles on AKP rehabilitation strategies for runners prior to November 2019. Six electronic databases were searched: EBSCOHOST, CINAHL, SPORTDISCUS, PUBMED, COCHRANE and SCOPUS.Thirteen out of 1334 articles met the inclusion criteria. Two reviewers independently participated in the screening and extraction of articles. The identified articles included four randomised controlled trials, one systematic review, four observational studies, one cohort study, two case studies and one quasi-experimental study. The following rehabilitation strategies were found to be useful: education, gait re-education, exercise, foot orthoses and multimodal rehabilitation.This study provided a range of rehabilitation strategies that were found useful in the rehabilitation of AKP. More comprehensive intervention studies are needed to address all physical and non-physical features of AKP.The outcomes of this study make explicit the usefulness of the identified rehabilitation strategies among runners with AKP. These will guide clinicians in the development of rehabilitation programmes for runners. Anterior knee pain (AKP) is felt at the front, centre and around the patellofemoral joint  and the vastus lateralis oblique (VLO), are the main forces that control the movement of the patella during knee action , and by correcting the patellar alignment by applying strapping and knee guards , bracing  and patellar taping are also considered as part of the treatment for AKP  and CINAHL. It was then followed by an analysis of the text words in both the titles and abstracts of each of the selected articles. The index terms for each article were also analysed at this stage. The MESH terms that were used initially included ‘patellofemoral pain syndrome’ OR ‘anterior knee pain’ AND runner. Step 2: this step included a search that was conducted on the basis of the keywords and index terms in the following six databases: EBSCOHOST, CINAHL, SPORTDISCUS, PUBMED, COCHRANE and SCOPUS.Step 3: this step included a search for additional studies that were based on the use of the reference lists of the articles that had already been identified.This review included original research articles that had initially been peer-reviewed prior to November 2019. Only human subjects (runners) were considered, but all of the studies looking at strategies for the rehabilitation of runners with AKP  were accepted as relevant to the study. Articles written in languages other than English were excluded.The selection of relevant studies was then followed by a process involving the extraction and charting of the data. The references to the electronic articles were downloaded onto the EndNote programme. All duplicates and articles that did not meet the inclusion criteria were removed. To avoid bias, the first author and his assistant then screened the identified articles independently of one another. The full-text versions of the articles that were relevant were then downloaded for further evaluation. The following were evaluated from the extracted articles: the name of the authors, publication year, study location, study design, aims/purpose of the study, study population and sample size, study methods, outcome of the study and limitations, if any.Experts reviewed the extracted information to confirm whether all of the aspects had been executed accurately. Lastly, summaries were made of our findings in the form of a table.This article followed all ethical standards for research without direct contact with human or animal subjects.The initial search process yielded 1334 articles . Five huDetails of the 13 articles included for final analysis and discussion are shown in These studies were conducted in various places, most of them in the United States  to AKP among runners. Only 13 published articles were reviewed. Five themes emerged from the reviewed articles: education, gait re-education, exercise, foot orthosis and multimodal rehabilitation. Most studies that were included were conducted in developed countries; no studies that had been conducted in Africa or South Africa could be found.In their previous studies, Kunene et al.  and KuneEducation is one of the key strategies that are used in the general rehabilitation of patients. This strategy should be considered to empower runners with the relevant knowledge and skills to prevent or rehabilitate runners with AKP. As suggested by Esculier et al. , runnersKunene et al. (2019) found that training load is one of the external risk factors among runners in communities with limited resources. Both overtraining and undertraining could contribute to AKP. Therefore, load of training is a critical factor that should be considered when designing prevention and rehabilitation programmes for runners with AKP. According to Esculier et al. , runnersgluteus medius and maximus muscles. Therefore, proximal strengthing of the lower limb muscles is necessary to improve hip control . Further studies are required to provide more evidence on the effectiveness of exercise programmes on these other risk factors.Exercises also play a role in addressing other problems that may lead to AKP  should be carried out.Kunene et al.  recommenCollins et al.  are in sTherefore, a combination of rehabilitation modalities is a strategy that can be considered to address the diverse AKP problems among runners. Clinicians should carefully select modalities that address the specific needs of the runners according to their clients’ assessment/screening outcomes. Runners need to be screened on a regular basis in order for their clinicians to come up with relevant prevention and rehabilitation programmes for AKP. It is crucial that runners be educated about AKP, it being the most common overuse injury. If runners are empowered, they would be more likely to take ownership of their training load management and adhere to their prevention and rehabilitation programmes without seeking the services of a health care provider (e.g. a physiotherapist).The goals of a rehabilitation programme for AKP should include three phases that would be based on the progress of the patient Werner . The earAnterior knee pain is a challenge to many runners. It is a condition whereby muscle factors require a multidimensional, yet individualised management approach. This study has identified a range of rehabilitation strategies that have been found to be useful in attempting to prevent this problem and to rehabilitate runners. Such strategies include the education of the patient, gait retraining, exercises, the use of foot orthotics and multimodal rehabilitation. These strategies are good, but they may need to be modified to suit various contexts. Some communities, especially low socio-economic communities, have limited resources that can make it difficult to access and afford some of the rehabilitation services.Considering the diversity of AKP among runners, this study could not provide comprehensive rehabilitation strategies that address all of the needs, both physical and non-physical, of runners with AKP. Therefore, further interventional studies should be undertaken to address the other needs that runners with AKP have and that they might face as they enter the rehabilitatory phase of their journey back towards a pain-free and mobile life.


The Coronavirus disease 2019 (Covid-19) scourge has challenged the world’s health systems and presented multiple socio-economic and public health challenges to the states it has affected. Zimbabwe has been affected by the pandemic, and in response, the government has set up an array of measures, including a national lockdown, to curb transmission. While it is critical to maintain such vigorous containment measures, socio-economic pressures in Zimbabwe will challenge the sustainability of the lockdown. Given the potential for lift of the lockdown before the Covid-19 pandemic ends, we discuss the Covid-19 pandemic situation in Zimbabwe and viewpoints on important considerations and strategies for lifting the lockdown. Coronavirus disease 2019 (Covid-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus  and as aThe COVID-19 situation in Zimbabwe: the government of Zimbabwe declared Covid-19 a national disaster on 17 March 2020 [rch 2020 . This alrch 2020 . The firThe decision to lift the lockdown: China was the first country to lift the lockdown after almost 100 days of lockdown in Wuhan. The decision was largely influenced by the successes of strict social distancing, massive testing, and contact tracing that helped reduce transmission and the numbers of new cases [ew cases . The WHOew cases . With reew cases . ZimbabwAwareness and education: the global spread of the Covid-19 pandemic means that it will be a long time before the pandemic can be eliminated, and the fear of resurgences is a reality. With no vaccine or effective antiviral drug likely to be available soon [ble soon , Zimbabwble soon , communible soon .Laboratory capacity: a notable weakness in Zimbabwe´s response to the Covid-19 pandemic has been the low number of tests carried out on the population. Among the WHO criteria that countries need to consider before lifting lockdowns is the ability of health systems to quickly detect, test, isolate, and treat new cases, as well as to trace close contacts. The Ministry of Health and Child Care (MoHCC) has targeted an ambitious 33,000 tests per month, but as at 20 April, the government had conducted a total of 3308 tests [08 tests . The govCurrently, the only positive cases have been reported in 4 of the country´s 10 provinces . As the Social distancing: without satisfying the WHO criteria for lifting lockdowns, Zimbabwe will have to move out of confinement and recover from economic losses, as well as mend social aspects of the population brought to a halt by the Covid-19-induced lockdown. One criterion is to make sure that transmission rates have reduced. Zimbabwe is not able to determine this due to the low number of tests conducted so far. Before the lockdown is lifted, the government will need to come up with measures of preventing the spread and importation of Covid-19. Zimbabwe, like other low- and middle-income countries, faces the risk of a surge in Covid-19 infections and deaths as unrestricted movement starts to take place. The country can perhaps adopt to some extent the Chinese model of lifting the lockdown: China continued to enforce strict social distancing coupled with testing and screening in Wuhan, even after lockdown was lifted, to avoid a resurgence of infections [fections . Unlike Our proposal to the government is to lift the lockdown in phases whilst carefully monitoring the behavior and responses of the population. The essential services like transport, the food industry, healthcare, and security forces have to be screened first to minimize local spread. This is particularly important for healthcare workers to avoid future outbreaks of nosocomial Covid-19 infections in hospital wards. Considering that people already have underlying conditions on admission to hospitals, fatalities may occur. New infection control policies specifically addressing Covid-19 should be a requirement for every company wanting to reopen after the lockdown. Employers will have to provide disinfection materials, masks, and temperature screening at single entry points. Employers will need to have small subcommittees for reporting suspected cases amongst their employees. The government will have to restrict unnecessary travel by mounting roadblocks on major highways. To prevent intercity spread of infection, it may be necessary to have travelers apply for a travelers´ pass from the responsible government unit or department. Perhaps a worrying issue is whether schools should reopen. In our view, schools can reopen on the condition that there are infection control measures put in place in schools. If schools are going to open, each school needs to have a committee responsible for the awareness and reporting of any suspected cases of Covid-19. As we approach winter, which is generally a common season for upper respiratory infections, extreme care has to be taken to mimimize spread. The teaching staff would have to be screened before schools reopen. Coming now to social gatherings, we suggest that the government delay lifting the ban on church gatherings and sporting events, while funerals may continue under the current lockdown framework of not having more than 50 people at one funeral. The wearing of masks when people are out of their homes should be enforced. Surveillance and screening must be enforced at borders and airports around the whole country to avoid importation of the virus.Welfare of vulnerable groups: going into the recently extended lockdown, there have been growing calls for the government to address the plight of many Zimbabweans who risk dying of malnutrition and starvation instead of Covid-19. The lockdown has deprived many urban dwellers of their source of livelihood, which is mostly in the informal sector. To worsen things, the prices of basic commodities have increased over the lockdown period, further eroding the buying power of the majority of Zimbabweans. The government has to come up with stimulation packages and incentives for suppliers so that they can continue supplying goods and services without hiking prices. Currently, the government is implementing a programme of cushioning 450,000 people through a 90 million RTGS Dollars facility. It is a good start, but divided equally, it means that each person will get 200 RTGS dollars, which is worth six loaves of bread at current pricing. In a country of approximately 16 million people, the state has to expand the programme to benefit more deserving people. Zimbabwe´s health sector was already overburdened before the Covid-19 pandemic by communicable and noncommunicable diseases like tuberculosis (TB), HIV, and diabetes and the current active malaria outbreak in Uzumba district. The government has to cater for these patients and ensure the availability of medical care and treatment. A plan for managing these deficits should be put in place as the country heads into the post-lockdown period. The government has to be sensitive to the need to reestablish social organization, while at the same time ensuring the safety and health of its citizens. Funerals, memorial services, marriage ceremonies, and weddings would need to be regulated but supported through the various arms of the government to prevent the spread of Covid-19 at these functions. It cannot be argued that many families, health workers, and security personnel might need psychological support. This pandemic has caused so much anxiety and stress in a lot of people; social services need to facilitate education and awareness through availing hotlines which affected people can use to reach out, with provisions in place to protect their identity and dignity.The authors declare no competing interests.


Implantology, prosthodontics, and orthodontics in all their variants, are medical and rehabilitative medical fields that have greatly benefited from bioengineering devices of investigation to improve the predictability of clinical rehabilitations. The finite element method involves the simulation of mechanical forces from an environment with infinite elements, to a simulation with finite elements. This editorial aims to point out all the progress made in the field of bioengineering and medicine. Instrumental investigations, such as finite element method (FEM), are an excellent tool that allows the evaluation of anatomical structures and any facilities for rehabilitation before moving on to experimentation on animals, so as to have mechanical characteristics and satisfactory load cycle testing. FEM analysis contributes substantially to the development of new technologies and new materials in the biomedical field. Thanks to the 3D technology and to the reconstructions of both the anatomical structures and eventually the alloplastic structures used in the rehabilitations it is possible to consider all the mechanical characteristics, so that they could be analyzed in detail and improved where necessary. Finite element method represents a possibility of recreating real condition simulating the stress of static device placed in a dynamic body or structure  issued on September 2016 stated how “Computational modeling and simulation studies, together with bench, nonclinical tructure  [1,2,3,4Parametric analysis is exploited in different fields of dentistry. In some studies, FEA analysis is used to evaluate orthognathic surgery healing phases and results. It shows the impact of maxillofacial surgery in 3D. This type of analysis could be easily performed before treatment or surgery for stress and strain distribution or for load evaluation ,22,23. FHaving a high-resolution CT radiology examination, 3D geometry of a specific implant, and 3D reconstruction of the patient-specific anatomy of the implant site, it is possible, for example, to calculate the peri-implant stress during the loads induced by mastication . It is pWe are proud that this topic has been largely treated in this Special Issue (SI). The topic widely treated in this SI aims to evaluate the survival and success rates of dental implant-supported prosthesis. The clinical success depends on several factors, including physical and chemical properties of implant materials, such as microstructure, its surface composition and characteristics, as well as design factors. For this reason, the interaction between the medical and engineering fields is a fundamental step in order to produce predictable devices, tried in vitro and then applied in vivo on patients. https://www.mdpi.com/journal/materials/special_issues/dental_implants_materials.At this moment the seven papers have been published in the special issue and it is possible to find them at the following link: The published papers covered different aspects about chemical and physical features of dental implants as well as the effectiveness of new tools for guide surgery in dental implants positioning, while also treating the clinical aspects related to the bone response and the aesthetic value of the oral surgery related to this kind of treatment.Due to the high impact factor of “Materials MDPI” we encourage further submission of new manuscripts covering the SI theme. The published researches will have great visibility and rapid diffusion related to high value of the Journal in the International Research Committee.


There is growing empirical evidence regarding the relationship and sexuality experiences and needs of children, young people and adults with intellectual disabilities. A total of twelve papers met the inclusion criteria regarding relationship and sexuality education (RSE) programmes specific to the needs of this population. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed and quality appraisal undertaken. The four themes identified were principles informing RSE programme development, design and content of RSE programmes, delivery of RSE programmes and evaluation of RSE programmes. The discussion presents areas that need to be addressed to ensure that people with intellectual disabilities, their families, carers and professionals are fully involved in the design and delivery of RSE programmes. Further research is required to identify the impact of the programmes and the sustained outcomes achieved. Recommendations are made regarding the activities required to enable the development of evidence-based and person-centred approaches to relationship and sexuality programmes. Sexual expression takes many forms and contributes significantly to an individual’s health and wellbeing. The World Health Organization (WHO) highlighted in 2015 that the expression of sexuality is a fundamental human right and is multifaceted. The expression of sexuality includes safe and pleasurable sexual experiences free from discrimination, violence and coercion . Health An intellectual disability (ID) describes limitations in intellectual functioning which occurs before, during or shortly after birth and is life-long. An ID affects intellectual functioning and is referred to as a spectrum condition involving mild, moderate, severe and profound cognitive impairment. Intellectual functioning such as learning, problem-solving and judgement can be impaired as well as limitations in adaptive functioning in areas such as self-care and communication . From a RSE programmes have been developed to address the distinct needs of people with ID. From the available evidence, these programmes appear to include issues such as capacity and consent, anatomy and biology, contraception and sexual behaviours . It is uto identify who is involved in the design and development of RSE programmes for people with intellectual disabilities,to establish the content of the RSE programmes,to identify who delivers the RSE programmes andto identify if evaluations have been undertaken of the RSE programmes.The objectives of the review were:Prior to commencing the systematic review, the PROSPERO and Cochrane databases were checked to identify if a similar review had previously been untaken. No such reviews were identified. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) process was followed .The study is a systematic review of published research evidence therefore ethical approval was not required. An expert subject Librarian assisted with the literature searching. The databases searched were PsycINFO, CINAHL, MEDLINE, and ERIC. The key terms included (i) intellectual disabilities (ii) sexuality (iii) relationships (iv) education and training. To establish if additional relevant studies existed, we hand searched reference lists and also checked Google Scholar to identify any additional papers.focused on the design, content, delivery or evaluation of RSE programmes specific to people with ID,utilized an empirical research design,were published in the English language.were published from inception to August 2020.Quantitative, qualitative and mixed methods studies were all eligible for inclusion in the review. Studies were included that: did not focus exclusively on RSE programmes for people with ID,did not address the design, content, delivery or evaluation of RSE programmes specific to people with ID,were not empirical research,were not published in English andwere grey literature and theses.Studies were excluded that:Following the search of the databases, studies were screened against the inclusion and exclusion criteria. Two reviewers screened the title and abstracts using the study inclusion criteria following the removal of duplicate papers. The reviewers retrieved and independently screened the full text papers. The reviewers then independently appraised the full text and completed an inclusion and exclusion checklist. Final agreement of the included papers was reached by consensus.Data were extracted on country, study aim, design, sample characteristics, study method, key findings and recommendations. The synthesis of the mixed methods research literature was conducted as part of the systematic review process . The datThe appraisal process involved two reviewers. The mixed-methods appraisal tool (MMAT) was used in the assessment of the quality of the included studies . To deteThe three quantitative studies set out in The study selection process is set out in n = 3) and Sweden (n = 3). The others were undertaken in Australia (n = 2), Canada (n = 1), the Netherlands (n = 1), the United Kingdom (n = 1) and the United States (n = 1). The sample sizes ranged from 11 to 600 participants.The 12 papers that met the aim of the review are set out in Following the systematic analysis of the studies, four themes were identified: (i) principles informing RSE programme development; (ii) design and content of RSE programmes; (iii) delivery of RSE programmes; and (iv) evaluation of RSE programmes.Arising from the current literature review is the need to ensure that RSE programmes for people with ID are informed by underpinning principles and relevant theoretical and behaviour-change models. The principles include parity of access to RSE programmes in keeping with those provided for typically developing children and young people ,42. AcceTo be effective, RSE programmes require careful design to ensure that content is reflective of the needs and concerns of people with ID. Programmes should be designed around a structured evidence-based education framework and education delivery model and be adapted, where necessary at the point of delivery, to meet the needs of individual students ,48. ContSome studies in this review detailed or recommended content for programmes based on the specific views of people with ID and of families and professionals. The suggested programme content varied depending on the concerns and priorities identified by the different groups. A total of five studies specifically referred to programme content from the perspective of people with ID ,42,45,48From the perspective of parents of young people with ID, they expressed concerns about addressing the risk of sexual abuse and potential harm within programmes . ContrasFrom this review of the literature, no professional group emerged as the ‘natural’ one to deliver RSE programmes. People with ID have been identified as peer educators in the co-delivery of RSE programmes, however, further research is required on the effectiveness of this approach and the outcomes achieved ,39,48. TTo evidence their effectiveness, RSE programmes need to incorporate clear outcome measures and include formal evaluation, an integral element of delivery to identify impact and whether the intended outcomes have been achieved ,42,43. IThe twelve studies included in this systematic review were predominantly undertaken within the past ten years. One study was undertaken in Sweden and Japan in 1990 . The resAn important finding from the current systematic review relates to the evolving RSE programme research that identifies the design, delivery and outcomes achieved and their impact on behaviours over time. It is also evident that there is an absence of evidence-based RSE programmes that address the specific needs and concerns of people with ID across the lifespan, notably after the transition into adulthood. What is also required to be established is the evidence and processes utilised in the development of RSE programmes and who has the relevant knowledge, skills and confidence to effectively deliver such programmes. It is also yet to be established what the long-term benefits and outcomes are as a result of the existing programmes. This therefore indicates the pressing need for a policy focus, practice development and education initiatives to advance this agenda.With the growing need to ensure that RSE programmes are available and accessible to all children, including those with disabilities or special needs, the UK Government have embedded RSE programmes into the school curriculum for all pupils in primary and secondary schools from autumn 2020 ,50. WhilTo date, and as evidenced in the current review, RSE programmes vary in content, with no ‘natural’ professional or parent emerging as best placed to deliver them. Rather, it is apparent that RSE programme design and delivery needs to be a collaborative approach in which young people and adults with ID, their parents and professionals all play crucial roles. The content of RSE programmes can be a contentious issue for some parents and professionals. However, it is important to note that concerns including consent, same-sex relationships and online presence such as sexting, pornography and cyberbullying feature in the recommended UK RSE programme content ,50. TherFrom a practice perspective, this review highlights the need for professionals to develop the necessary skills and knowledge to deliver RSE programmes with confidence to young people with ID . The preThe current review highlights the importance of formally evaluating the outcomes achieved following RSE programme delivery . EvaluatRSE programmes for young people with ID should be fully integrated within the school curriculum, be built upon education frameworks and effective teaching models and use evidence-based interventions to aid professionals in their delivery . School Health professionals require psychoeducation to develop their understanding of the importance of RSE for children, young people and adults with ID and recognise how the provision of RSE can help in reducing and preventing health and psychological problems across the lifespan . In addiA strength of the current systematic review is the identification of important issues regarding the design and development of RSE programmes relevant to the needs of children, young people and adults with ID. Attempts have been made to address the relationship and sexuality concerns of young people with ID, however, there has been a limited focus on extending these education initiatives and developments as they move into adulthood. Any RSE programme needs to be underpinned by relevant theoretical models to enable and sustain behaviour change. There is a need to evaluate outcomes and their long-term impact in influencing the relationship and sexuality experiences of people with ID across the lifespan. There is a lack of transcultural perspectives that needs to be recognised and responded to in RSE programme development. There were no multi-centre international research studies identified. The researchers sought to be rigorous in approach while conducting the review and acknowledge the potential for bias.Existing RSE programmes for both young people and adults with ID lack a theoretical basis . TherefoIt has become increasingly apparent through this systematic review of the research evidence that people with ID have distinct needs regarding their relationship and sexuality concerns. There is an evolving research evidence base regarding the design and delivery of RSE programmes to address their specific issues. While these developments are positive, it is important to recognise the limitations that exist regarding the RSE programmes currently available. It is apparent that any future RSE programmes must be designed around a recognised and evidence-based theoretical model that is effective in enabling and sustaining behaviour change. RSE programme content may be an area of contention and potential conflict, due to the potentially differing views of people with learning disabilities and their families. It is recommended that to be acceptable, people with learning disabilities, their families and professionals must all work collaboratively on the programme content design, which should also be informed by the research evidence base. It is necessary that all stakeholders are fully involved to ensure that the range of issues and concerns are fully reflected within the RSE programme. Failure to consider these important issues may result in poor uptake. The two key professional groups that emerged as those most commonly involved in the delivery of RSE programmes are school teachers and registered nurses. Some were of the view that they did not possess the necessary knowledge and skills to confidently deliver RSE programmes to people with ID. Therefore, to address these needs it is necessary to provide access to education and practice development initiatives that build their knowledge, skills and confidence. While it is apparent that there are RSE programmes being provided to some people with ID, it is yet to be established what their impact is in effecting long-term behaviour change. Arising from this, there is a pressing need to integrate clear outcome measures within all RSE programmes to enable the outcomes achieved to be identified. Additionally, there are no longitudinal studies in existence that identify the outcomes achieved regarding the development of positive and healthy relationships, intimacy and the expression of sexuality by people with ID. These are aims of RSE programmes and are therefore areas requiring further research attention.


The COVID-19 pandemic has been instrumental in creating a dramatic shift from people's need to live in mutual association toward a desire to stigmatize distinctive others. Pandemic seems to be causing othering. Stated simply, stigmatization is a social process set to exclude those who are perceived to be a potential source of disease and may pose threat to the effective social living in the society. Based on the secondary evidence collected from news published online or in print, the present article delves into stigma associated with the COVID-19 pandemic among different social groups in the Indian society and the mounting cases of prejudice based on race, class, and religion. It also presents insights into the varied manifestations, and the deleterious consequences of COVID-19 inspired othering brought to its potential targets in India. Humanity today is facing one of the biggest challenges of the century. The novel coronavirus is spreading rapidly to the extent of being declared as a pandemic across the world. The spread of the COVID-19 pandemic has raised concerns of everyone across the globe. People are in dismay for what is happening with them and at the same time are disturbed to see the conditions of others, particularly the marginalized. There is a sudden shift in people's daily routines. Apart from the fears, anxiety, and sadness, people's sense of irritability has started piling up. Amid such a deranged spread of COVID-19, one of the important concerns that is even more deleterious than all the above highlighted negative impacts and needs to be urgently attended to is stigmatization associated with the pandemic.People have been witnessed to undergo a dramatic shift from their willingness to live in mutual association to an urge to practice stigmatization  of indivThe present article takes a look at the increasing cases of “othering” that are characterizing the societal response at large. The focus will be on different social groups that are the targets of prejudice and discrimination so rampant during the COVID-19 crisis in India. It includes prejudice based on religion, occupation, race, and economic class.stigma was first introduced by Goffman   and H5N1Although the stigma associated with pandemic has been a well-established phenomenon The present ongoing situation of COVID-19 pandemic and its impact not only on the physical and psychological health but also on the way people are interacting with others are compelling enough to initiate analytical examination of stigma and discrimination related with COVID-19. This seems essential for the effective control of the disease, and the negative consequences of stigma aligned with being infected with coronavirus are extremely pernicious, the same way those were evident during SARS At this backdrop, using an analytical perspective, the present article delves into examining the way COVID-19–related stigmatization has unfolded itself against the specific sections of the Indian society and to gain a holistic understanding of the experiences of stigmatization as experienced by the people after the outbreak COVID-19 pandemic. An understanding of these would help us understand the way in which a crisis situation may lead to the segmented organization of the society in terms of strengthening of already existing categorizations, as well as emergence of new categorization. In addition, such an understanding is expected to supplement the government about the potential impediments that stigma is assumed to be creating in withholding the people's tendency of cause a delay in getting themselves tested or share their medical condition of being infected with coronavirus because of the fear of being stigmatized.The present review is based on a careful review of literature on stigma during a pandemic and/or medical emergency and on the thematic analysis of news reports published online and/or in print editions since the outbreak of this pandemic in India. While the literature served as a vantage point to evaluate the social reactions of the current pandemic, the newspaper reports were treated as the sources of data related to the experience of stigma during COVID-19 pandemic. The news reports presenting negative reactions and/or experiences and the stigmatized treatments directed against people during the COVID-19 pandemic were thematically analyzed, and anecdotes were extracted to describe the stigma related to the dejection, derogation, devaluation, exclusion, discrimination, etc., associated with COVID-19.From the careful analysis of the content extracted through the newspaper reports, several themes emerged indicating the stigmatic expressions and behaviors during the pandemic. The following section discusses these emergent themes in the light of the available literature explaining stigmatization.Since the outbreak of the pandemic in India, there existed a negative perception toward those infected with the disease. The COVID-19 patients are accused of being ignorant and negligent, thereby being held responsible for having contracted the virus . The COVThere exists sufficient literature that highlights stigmatizing reactions of society against the infected during pandemics such as SARS outbreak The evolutionary perspective  of stigmThe notion of double stigmatization was also seen in some cases. A deaf-mute, for example, was deserted by his own family after they suspected him to be coronavirus positive that was later confirmed as not bearing the virus . SimilarThe easternmost part of India, comprising eight states—Assam, Sikkim, Arunachal Pradesh, Manipur, Nagaland, Meghalaya, Mizoram, and Tripura—is known as Northeast India. The residents from the Northeast India have been the targets of racism from the mainlanders in India for a long time as they have typical mongoloid features, which are similar to the features of Chinese individuals . The peoLiterature reports racism to be an important factor leading to an undue spread of disease in the minority community  even leaDuring this COVID-19 crisis worldwide, every country is trying to the best of its abilities and resources, to curb the spread of the pandemic. Individuals, groups, and communities are coming together and are presenting ultimate examples of prosocial behavior by helping those in need. Among them, there are doctors, nurses, other health care workers, police officers, and municipal workers who are risking their lives to serve their nation. India is no exception to this.However, the doctors who are making arduous efforts to save the lives of the patients , 88 and People at the forefront of the war against the pandemic  are becoming ostracized by their neighbors, landlords, taxi drivers, and even their own family members. Having left with no other option, doctors and nurses have had to sleep in the staff rooms and even in the washrooms of hospitals. Taxi drivers have also refused to serve them . The nurSuch ongoing stigmatized treatments directed against doctors, other health care workers, police officers, and municipal workers present classic representation of stigma by association , 101. SoThe social stigma of COVID-19 has not even shown mercy to the dead bodies of the patients. There have been violent disruptions or prohibitions of funeral ceremonies  and buriPeople's stigmatizing reactions for the dead family member indicate the strong and deep-seated embeddedness of irrational fear and threat that the virus has brought with itself. Several families in India denied claiming the dead body of their own kin members . Some haUnder such disturbing circumstances, many non-governmental organizations have taken the initiative of performing the last rites of the abandoned deceased. Abdul Bhai's Ekta Trust, for example, was accorded with the responsibility by the Surat Municipal Corporation, for the cremation and burial of COVID-19–infected bodies as per their respective religion .Sunnis-an Islamic subgroup), from all over the world at the Nizamuddin Markaz (Center) in Delhi. Later it was found that majority of these members were coronavirus-positive, and before they could be tested and contained, they returned back to their respective places all over India. The fear of the spread of the virus among general public was at the peak during that time, and the entire Muslim community at that time was stigmatized as the spreaders of the virus. The stigmatization of the whole Muslim community has been at the forefront of Indian public's reaction to COVID-19. Some political leaders were witnessed calling the Jamaat event as “corona terrorism”  was held constituting of members of Tablighi Jamaat, an Islamic missionary and reformist organization  committed suicide on facing social boycott even after being tested negative for coronavirus.The director of All India Institute of Medical Sciences, Delhi, warned about the perceived dread of being stigmatized among the people leading them to refrain from getting tested , 135. ThA recent survey  revealedOther stressful concerns of people include witnessing the difficulties of the underprivileged and facing the economic crisis, increased frustration with other people, disordered regime, unpredictable future and the virus itself , maintaiTaking serious consideration of the entrenched stigma associated with the disease in Indian society, the Government of India has been taking active and cognizant measures to curb it. Particularly important is the launch of a caller tune, a public health communication strategy, and appealing to the general public to fight the coronavirus disease, not the diseased. The government has also tried to boost the self-esteem of the doctors, health care professionals, police, and hygiene staff by calling them “corona warriors” and encouraging the general public to pay tribute to the health care professionals. The entire country got together in clapping for the coronavirus warriors from their houses' balconies, they lit up candles outside their houses, and Indian fighter jets showered flowers on the hospitals housing COVID-19 patients. These measures played an important role in reducing stigma and fostering togetherness.By the end of March, within 15 days of announcing the nationwide lockdown, the Indian Finance Minister, N. Sitharaman, announced INR 1.7 trillion relief package labeled the Pradhan Mantri Garib Kalyan Yojana. It was projected that under the scheme, 800 million Indians would receive 5 kg of wheat and rice for 3 months . One kilogram of the preferred pulse was added to this distribution. Furthermore, 60 million farmers registered under the PM-KISAN scheme  were given the first installment upfront for the fiscal year starting April 2020. MNREGA workers' wages were increased from INR 182/— to INR 202/—. The government also provided relief for other marginalized groups, allocating INR 1,000 each for 30 million senior citizens, widows, and disabled Indians and INR 500 per month for 3 months to the 200 million women who were Jan Dhan account holders. Furthermore, women covered under the Ujwala scheme (83 million families) were allocated free LPG cylinders for 3 months. Over 2 crore construction workers received financial support totaling Rs 3,066 crore under the Building and Construction Workers' Fund.All these actions were aimed at retroactively easing the crisis that was hurled at the Indian working class. At the fore of promising proactive measures to protect these workers is the effort spearheaded by the UP government. They have set up a Migration Commission for the employment of laborers in the state to ensure their social–legal–monetary rights. Any effort toward rehiring workers post lockdown would now require states to seek UP government's permission and follow protective procedures that the commission would outline.Apart from schemes aimed at helping the working class, the government also delayed the tax filing deadline under “Vivaad Se Vishwas Scheme” from March 31 to June 30, 2020, and expedited the income-tax refunds process, to release all refunds up to INR 0.5 million.The above exposition clearly establishes the deep fissures that underlie the collective, which manifest in times of crises, such as a pandemic. It is rightly said that epidemics reveal who and what is genuinely valued in a society. The power hierarchies come to the fore. This article highlighted stigma associated with being an infected patient, or a close contact of someone infected, along with belonging to a particular race, religion, and social class. It is important to note that stigma reduces health-, help-, and treatment-seeking behavior and needs to be mitigated, apart from the focus on COVID-19 treatment and prevention. Global Health communication plays an important role in the construction of diseases, their social perception, and resulting psychological issues. Thus, all relevant stakeholders, including the government, media and local administrative bodies, as well as hospitals, ought to mitigate stigma through a multipronged approach. Logie and Turan  suggest Nature has made us all equal. It is us who create divisions in society for our own benefit. Stigmatization serves this purpose. But what it also does is create boundaries at the interpersonal, intergroup, and international levels that are often impossible to undo. There are those who actually commit crimes, and there are also several others who only reap the consequences of being associated with the negative, whether it be in terms of the nature of their work, shared social identity—family, religion—or as simple as being a scapegoat to the injustices that projected their way by the society. What is important to learn from all this is that it reflects a sheer loss of human ability to distinguish between the bad and good and the basic human essence of being kind and helpful toward others. And if this would continue, it is not going to serve any fruitful purpose in the long run for we all are humans first, and the association that we share with our family, religion, profession, socioeconomic status, and many more comes later.DB, TS, SV, and SS conceptualized and collected materials. DB prepared the initial draft. TS and SV reviewed and improved the draft. SS made final revisions. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.