Mixed results have been found regarding the relationship between media use degree and depressive symptoms. The purpose of this study is to explore the relationship between media use degree, big five personality and depressive symptoms with a mediation model.This was a cross-sectional study. With 9-item Patient Health Questionnaire (PHQ-9), 10-item Big Five Inventory (BFI-10) and self-designed media usage scale, 11,031 participants aged 12 and above in 120 cities in China were collected. Pearson correlation analysis and regression analysis were performed on the data. The Process plug-in was used to construct the mediation model and explore the relationship among media use degree, big five personality and depressive symptoms. The nonparametric percentile Bootstrap method was used to test the mediating effect of personality traits.r = 0.20, P < 0.001), and big five personality played a mediating role between the degree of media use and depressive symptoms. Among five traits, extroversion , conscientiousness , openness  and agreeableness  were negatively correlated with depressive symptoms, and neuroticism  were positively correlated with depressive symptoms. In addition, extraversion , conscientiousness , agreeableness  and neuroticism  in big five personality played a mediating role between media use and depressive symptoms.The degree of media use was positively correlated with depressive symptoms (The degree of media use positively predicted depressive symptoms, and excessive media use may bring risks to mental health. People with high neuroticism, low agreeableness, low conscientiousness and low extroversion are more likely to suffer from depressive symptoms. Depression is one of the most common mental disorders. Depression is a kind of emotion, which refers to the psychological state that individuals feel constrained and depressed. It is a typical negative emotional experience and can develop into depression in severe cases . DepressMany scholars have studied the risk factors of depression, such as low social support  and highMedia refers to the tools or carriers that people use to transmit and obtain information, including traditional media  and new media . The increase of media use function will lead to the decreased top-down attentional control associated with media multitasking  could diPersonality psychology points out that personality traits can distinguish stable differences among different individuals and predict behavior tendency. Personality can be characterized by a series of five dimensions, namely Big Five Personality Model . AccordiAccording to the cognitive affective personality system (CAPS) theory, the personality state changes . PersonaThe degree of media use has different effects on depression due to personality factors . Some scTo sum up, it is necessary to explore the mediating role of the five personality types of Big Five personality in the degree of media use and depression. This study puts forward the hypothesis H2: Big Five personality plays an intermediary role between the degree of media use and depression. H2a: Extroversion plays an intermediary role between the degree of media use and depression. H2b: Conscientiousness plays an intermediary role between the degree of media use and depression. H2c: Agreeableness plays an intermediary role between the degree of media use and depression. H2d: Openness plays an intermediary role between the degree of media use and depression. H2e: Neuroticism plays an intermediary role between the degree of media use and depression.Some studies have found that individuals of different genders have different possibilities of depression. In essence, women are more likely to suffer from depression, and they are also more susceptible to some significant social factors that induce or activate depression . Women hIndividuals are in the era of media, and ubiquitous media information contact plays an important role in influencing public depression. Depression is a process of complex interaction between individuals and many social factors, which is intertwined with media information ecology and personality traits. Therefore, this study takes 11,031 people in China as the research object, combines the hypothesis theory of media information ecology and personality traits, takes age, education level and family economic status as the control variables, explores the mechanism path that the degree of media use affects depression. By constructing an intermediary model , the investigators distributed online questionnaires to the public face to face and one to one in their respective regions, and the respondents answered them by clicking on the link. The informed consent of the subjects was obtained during the investigation, and the questionnaire number was input by the investigator. If the respondent has thinking ability but not enough action ability to answer the questionnaire, the investigator will conduct one-on-one inquiry and answer it instead.This survey was conducted by multistage sampling from July 10th, 2021 to September 15th, 2021. A total of 23 provinces, 5 autonomous regions and 4 municipalities  in China were included. Using the random number table method, 2–6 cities are selected from the non-provincial administrative regions of each province and autonomous region, totaling 120 cities. Next, openly recruit investigators or investigation teams (consisting of ≤ 10 people) in these cities. Based on the data of the “Results of the Seventh National Census in 2021”, 120 urban residents were sampled by quota , so that the gender, age and urban-rural distribution of the samples obtained basically conform to the demographic characteristics. Finally, with the help of the Internet Questionnaires Platform , and the total variance of the two factors was 52.38%, which indicates that the deeper the use of media, the easier it was to have depressive symptoms (Table This study showed that there was a significant positive correlation between the degree of media use and depressive symptoms, and the deeper the degree of media use, the easier it was to be depressed. Assume H1 holds, which was consistent with the existing research results . The useThrough literature review, Chen found that most studies in western countries support that media use leads to an increase in individual depression, but the study with China as the subjects confirms that media use has a significant negative predictive effect on depression . On the Although previous studies have shown that media use has an impact on depressed state, the effects of personality traits on media use and depressed state have not been fully studied . We studResearch showed that openness had no mediating effect, assuming that H2d was not established. In the past studies, it was often found that there was no significant correlation between openness and depression . OpennesThe analysis also showed that people’s age and family economic status were significantly related to media use and depression. The younger the age, the worse the family economic situation, the higher the degree of media use and depression. Chen surveyed 886 junior high school students in three full-time middle schools in Wuhan, and found that excessive use of social networking sites has a significant positive predictive effect on depression . Some stThrough the analysis of data collected nationwide, this study verified another factor that affects depression-the degree of media use, which has outstanding theoretical value and practical significance. It was found that the degree of media use has a positive effect on depression, and the more frequently media use, the greater the possibility of depression. At the same time, the degree of media use also has the mediating effect of Big Five personalities, and different personalities have different manifestations in the degree of media use and the possibility of depression.There are some limitations in this research. First of all, people’s media usage only measures the usage days of different media, but can’t fully present the content type and purpose of people’s specific media usage. Secondly, this is a cross-sectional study. Although it is suitable for our research hypothesis, it does not allow us to draw causal conclusions. In the future research, in terms of causal explanation, we can compare people with depression and people without depression through experimental control design, and explore the influence of media on depression. At the same time, this research uses self-report and this is a limit because it increases the risk for social desirability in the responses. Qualitative research methods such as in-depth interviews can be added to further explore the relationship among media, personality and depression, and enhance the persuasiveness of the results.This study investigated the relationship between the degree of media use, Big Five personality and depression. The results showed that the degree of media use aggravated people’s depression, and people with high neuroticism, low agreeableness, low conscientiousness and low extroversion were more likely to suffer from depression. The conscious use of media to protect mental health is an important topic in our society. Time spent in the media may pose a risk to a person’s mental health. In order to protect ourselves from the negative effects of media use, it is important to know our personality and how media use affects our mental health. Especially for people with neurotic personality characteristics, they are more likely to suffer from depression.


In 2020, coinciding with its 60th anniversary, the International Society of Nephrology (ISN) launched its Emerging Leaders Program (ELP), the first of its kind by a major nephrology society. The program was conceived with the intention to build a global cadre of nephrology leaders who would strive together for a future where all people would have an equitable access to sustainable and quality kidney health care, in alignment with the mission and vision of the ISN. This can be achieved by providing the opportunity to partake in ISN’s global capacity-building programs and workgroups, and work closely with international experts to develop skills in implementation science and research. The program also aims to enhance capacity at developing and implementing context-specific, resource-sensitive, evidence-based, multidisciplinary care to those with and at-risk of kidney diseases. In addition, the focus is on acquiring the necessary skills in the evaluation, development, and management of health systems along with principles of entrepreneurship, advocacy, and communication to ensure better equity and diversity. Finally, the program provides access to continuous professional development to take on leadership roles locally and globally.A call for expression of interest was sent to early career ISN members, defined as those who have been less than 10 years out of professional training. Candidates were asked to submit a portfolio detailing their professional, scholarly, and academic activities to date but most importantly to identify issues related to kidney health that they planned to address through collaborative studies within the program. Of the 71 applications representing all 10 ISN geographical regions, the ELP Steering Committee selected a total of 14 candidates from 12 countries (6 ISN regions). In terms of gender distribution and disciplines, 5 were women, 11 were adult nephrologists, 2 were pediatric nephrologists along with a non-physician entrepreneur, who had established a dialysis provider network in East Africa.Over the course of 12 months, we attended webinars, courses, and workshops aimed at nurturing our understanding of global nephrology challenges, building capacity in leadership and communication, and leveraging advocacy and partnership skills. We met with major ISN leaders who have forged the organization’s identity, and with major global health actors from the World Health Organization and the Noncommunicable Disease Alliance. In addition, we were invited to work with various ISN working groups. This provided us with deep insights into various ISN core programs such as the design of the ISN Academy; the coordination and design of networks of clinical trials; and the development of fellowship, mentorship, and advocacy programs and structures. To nurture further communication and advocacy skills, we were solicited to moderate topical networking sessions during the last 2 editions of World Congress of Nephrology, which centered around a variety of topics such as chronic kidney disease prevention, social justice, and kidney outcomes . In addiKidney International Reports, demonstrated poorer access to all essential kidney medicines in community settings compared with tertiary settings.A unique feature of the program was the opportunity to work on collaborative projects impacting the kidney health agenda worldwide. We were first invited to reflect on the access to essential medicines in nephrology. To that effect, we developed and disseminated an international survey evaluating barriers to accessing essential medicines in low-income and low-middle income countries for people with chronic kidney disease. Our results that were published in The ELP program has had an invaluable impact on our personal and professional developments as young leaders in nephrology. Many of us, for instance, were given the opportunity to play active roles in international projects such as the Global Kidney Health Atlas, the ISN/DOPPS collaborations with numerous publications,S1However, the most valuable impact was widening our individual perspectives. Working with a diverse group of like-minded professionals from all over the world not only exposed us to different healthcare systems, skillsets, cultural specificities, but also allowed us to realize that the barriers faced by patients and health care providers to achieve sustainable kidney care are often universal. We also learned to collaborate with people from different backgrounds and were able to appreciate different outlooks. Listening to and coordinating the views of 14 different leaders was at times challenging, and taught us to know when to assume leadership, and when to let go of it. Another important lesson learned was the necessity at times to redesign ambitious projects at a smaller scale to achieve more realistic goals with the available skills and resources. Indeed, when working at the national or international stages, many barriers can come from actors as large as major governmental organizations. This allowed us to cultivate determination and perseverance and prepared us to better deal with setbacks. Furthermore, the program empowered us to take more active leadership roles in our own organizations and health systems. Most importantly, the program catalyzed the establishment of a unique collaborative network, and of special friendships and sets of skills for many years to come in a distinguished collegial atmosphere and environment .Figure 112 members of the second ELP cohort began activities on collaborative leadership and problem-solving in global kidney health. Composed of a diverse cohort of nephrologists, pathologists, and researchers, their area of focus is the complex interplay of environmental factors and kidney health, and will be addressed through different angles and projects geared at increasing awareness and implementation of “Green Nephrology”.In May 2022, the The unique ELP of the ISN has provided us a unique experience with involvement that extends far beyond the official duration of the program . Members


Prevotella, Treponema, anaerobic bacteria) and a depletion of bacteria associated with periodontal health maintenance . More well-designed studies differentiating between pregnant women with good oral health and those with periodontitis are needed to ascertain which differences are due to GDM or periodontitis.Gestational diabetes mellitus (GDM) is one of the most frequent endocrine conditions during pregnancy. GDM is linked to adverse pregnancy outcomes and has implications for maternal health. Studies have demonstrated the link between pathogenic periodontal bacteria, glycemic control, and the risk of diabetes. The objective of the current study is to perform a mini-review of the available literature on the potential changes in the oral microbiota of women with GDM. The review was conducted by two independent reviewers (LLF and JDC). Indexed electronic databases  were searched, including articles published in English and Portuguese. A manual search was also performed to identify related articles. The oral microbial community of pregnant women with GDM is unique from that of healthy pregnant women. The majority of the alterations found in the oral microbiota of women with GDM point to a pro-inflammatory environment with high levels of bacteria associated with periodontitis ( One important change is increased insulin resistance, due to the changes in placental hormone secretion that result in a higher demand for insulin secretion. However, some pregnant women have a reduced ability to produce more insulin, which can cause blood sugar levels to rise and, ultimately, result in GDM , 2. ObesGDM is the most common pregnancy endocrine disorder, and its frequency varies greatly around the world, ranging from 1% to more than 30% .High levels of tumor necrosis factor (TNF), C-reactive protein (CRP), and interleukin 6 (IL-6) point to the involvement of infection and inflammation in the etiology of GDM. GDM has been linked to microbial changes in the maternal microbiome at various body locations . Other sThe present study aims to perform a review of the available literature on the possible changes in the oral microbiota of pregnant women with GDM and their associations with GDM pathology.2The review was conducted by two independent reviewers (JDC and GAF). Indexed electronic databases  were searched, including articles published in English and Portuguese. The terms used in the search were “gestational diabetes” and “oral microbiota.” A manual search was also performed to identify related articles.The inclusion criteria were epidemiological studies  analyzing the oral microbiota in women with GDM, including the presence of a control group of pregnant women without GDM. A total of 32 studies that evaluated intestinal microbiota, newborn microbiota, treatments, and literature reviews were excluded.3The literature search resulted in nine studies that looked at the oral microbiota of pregnant women with GDM. Data from each study and their main results are summarized in Proteobacteria and Neisseria  and a depletion of bacteria associated with the maintenance of periodontal health   , 16.Both pregnancy and diabetes are known to have effects on oral microbiota , 18. PreSimilarly, periodontal bacteria, particularly anaerobic bacteria, benefit greatly from hyperglycemia . The higThis increase in systemic inflammation and periodontal tissues may induce an imbalance in the oral microbiota because, as previously demonstrated, an inflammatory environment favors the growth of pathogenic bacteria associated with periodontitis . Thus, tThus, what seems to occur is a repetitive cycle that perpetuates the changes seen in GDM, in which increased levels of glucose and advanced glycation end-products lead to increased inflammation, which induces dysbiosis of the oral microbiota. Dysbiosis, in turn, leads to more periodontal inflammation, which has a systemic impact and consequently worsens diabetes Figure 1However, because GDM is multifactorial, it is important to analyze other risk factors in research. Maternal age and BMI can be confounding variables in GDM studies because both are considered risk factors for the development of this condition. According to some of the studies reviewed, women with GDM had a higher mean age than pregnant women without GDM , 6, whilMaternal oral health is closely associated with children’s oral health, including maternal relatedness and the vertical transmission of oral pathogens from mothers to infants. Studies have shown that when a mother has GDM, the microbiota of her newborns is altered, which is very similar to the change that occurs in the oral microbiota of mothers. Thus, it is hypothesized that the effects of GDM on the maternal microbiota can be vertically transmitted to the fetus during pregnancy , 27. TheOne limitation of this review is that the results of the studies differ and, in some cases, contradict each other. The difficulty in comparing results may be attributed to the complexity of GDM as a multifactorial disease, the genetic differences between study populations, differences in the methods used to identify bacteria, and the fact that some studies did not evaluate oral health prior to sampling. The sites collected in the studies differ in subgingival, supragingival, tongue, and saliva. The Human Microbiome Project has already demonstrated that there is a significant difference between these intraoral sites, which may affect the bacteria found in the studies . AnotherThe topic in this review is relatively new, with the majority of studies conducted since 2018, and interest in the possible link between oral microbiota and GDM has grown in recent years. Unfortunately, most works have not evaluated the microbiota of periodontitis or healthy periodontium separately. More well-designed studies separating pregnant women with good oral health from those with periodontitis are needed to ascertain which differences are due to GDM or periodontal conditions, as it is unclear whether the identified changes are primarily caused by periodontal inflammation or by hyperglycemia.Therefore, understanding the risk factors associated with GDM is critical to reducing the complications associated with this condition.5We can conclude from the results observed in this review that the oral microbiota of pregnant women with GDM is different from that of healthy pregnant women, and this discrepancy usually favors pathogenic bacteria, indicating a dysbiosis of the oral microbiota. Pregnant women with GDM should be carefully monitored by a multidisciplinary team led by a periodontist since high levels of periodontal pathogens during pregnancy have been linked to an increased risk of preterm delivery.JC: conceptualized the project, assisted with article search and wrote the text. GF and LF: conducted the search for articles, summarized the findings and assembled the results. All authors contributed to the article and approved the submitted version.


Ethnic and racial differences in life expectancy have been well established in different societies. However, even though an important part of the population of Latin America is Indigenous, there is little knowledge about them.Determine if there are ethnic differences in life expectancy at birth and at 60 years in Chile, and if the Mapuche (largest Indigenous ethnic group) have similar life expectancy to other Indigenous peoples.Life tables for the Mapuche and other Indigenous groups and non-Indigenous people were built using the 2017 census. Specifically, we used the questions of the number of live children born and the number of surviving children. With this information, using the indirect method of own children we determined infantile mortality. Then, using the relational logit model and the model life table (west), we estimated the survival function for all ages.Indigenous Chileans have seven years lower life expectancy at birth than the non-Indigenous population (76.2 vs. 83.2 years). The differential at age 60 is 6 years (20.3 vs. 26.4 years). We also found that Mapuche have an even greater disadvantage in survival than other ethnic groups. This is reflected in 2 years less life expectancy, both at birth and at 60 years.Our results ratify the existence of marked ethnic-racial inequality in the extension of life in Chile and demonstrate a greater disadvantage in terms of survival of the Mapuche compared to other Indigenous and non-Indigenous groups. It is thus of great relevance to design policies that would decrease the existing inequalities in lifespan. Prolonging the number of years of life is one of the greatest achievements of humans. However, although the population has benefited from the increase in life expectancy in the last decades in almost all regions, including Latin America, important differences have been detected in ethnic-racial health and longevity –7. StudiThe demographic changes associated with the transition of mortality and fertility in Chile have contributed to a considerable increase in life expectancy at birth in the last decades, which is currently 81.2 years . AdvanceSummarizing, a limited number of studies have explored some central elements related to the health and longevity of the Chilean population, focusing the study on ethnic differences. This may be explained in part by a lack of information, like not including ethnic origin in the vital statistics of the country , and by Thus, in Chile there is still little knowledge about ethnic differences in life expectancy. This study asks if there are ethnic differences in life expectancy at birth and at age 60 years in Chile, and if the Mapuche (largest ethnic group) have similar life expectancy to other Indigenous groups. Answering these questions would provide information that could be very useful in designing public health policy, as well as promoting the study of differences in longevity in the entire country and in different parts of it. We believe that the increase in life expectancy in Chile has not benefitted all its inhabitants equally, that is, they have not been distributed homogenously in the population. We expect to find greater life expectancy at birth in the non-Indigenous population.The data are from the Population and Housing Census of 2017 , which iTo generate life tables according to ethnic origin, we first estimated infant mortality by the method of Brass . This meIt must be noted that Chile does not currently incorporate ethnic origin in its vital statistics, which makes it impossible to obtain directly mortality rates by age according to ethnic origin. It is difficult to use other indirect mortality estimates such as the inter-census method, due to changes in the questions over time. In the previous valid census, of the year 2002, people were asked if they were members of an Indigenous groupThen we used a relational logit model with a model table (of the Princeton West family) to construct life tables for the Indigenous and non-Indigenous populations. Since we only had information for the indirect estimation of infant mortality and considering that population ageing is importantly due to decrease in mortality, especially in older age groups, in the process of constructing life tables using ethnic-racial self-identification we detected irregularities in older age groups (70 years and older).Although the 2017 Census presents good indicators of age reporting , it is likely that detected irregularities may be related to the existence of an age differential bias in ethnic self-identification. To correct the irregularities detected in older ages, we performed a smoothing process using the Heligman-Pollard formula as a tool for expanding an abridged life table proposed by Kostaki , and theFinally, since the census asked about the total number of children born alive and the total number of surviving children, not distinguishing by gender, our estimations refer to the life expectancy at birth for both sexes together.The results shown in It is important to note that the differences between Mapuche and the other Indigenous groups, and between Mapuche and non-Indigenous groups remain very similar during the whole life cycle. As the figure indicates, the difference only reduces at 80 years. Also, the other Indigenous groups have lower life span than non-Indigenous people. An Indigenous non-Mapuche has a life expectancy at birth 6.5 years less than non-Indigenous people, and 5.5 years less at age 60.Life expectancy at birth has been used frequently as an indicator of inequality; this study was designed to contribute to clarify the ethnic differences in life span in Chile. Using the 2017 Chilean census and indirect demographic methods, we show that Indigenous peoples have seven years lower life expectancy at birth than the non-Indigenous population. Indirect methods have been used widely to estimate mortality in data-deficient societies and populations and to estimate ethnic-racial differences in mortality , 39–41.Our results demonstrate that Indigenous people in Chile, one of the most developed countries in the region, on average live seven fewer years than non-Indigenous people. Most of the evidence that shows shorter life spans for Indigenous peoples come from industrialized countries. For example, Dankovchik et al.  found thAn important number of studies have documented large differences in life expectancy at birth between Indigenous and non-Indigenous people in Australia and New Zealand, from 13 to 20 years, depending on the methodology used , 44, 45.In Latin America, Robles  used theThere are several factors that may explain these differences. A structural mechanism may be involved; in different societies (including Chile) low socioeconomic status is associated with worse health results and greater mortality , 48. TabPsychosocial and lifestyle factors  and the access to and use of health services also play an important role in explaining ethnic differences in longevity  that would allow a direct comparison of Indigenous to non-Indigenous people, it is hard to know exactly the size of the gap in survival and longevity. In the future, data recording in Chile should include the ethnic origin variable in the vital statistics, as Sandoval and Alvear  suggesteA second limitation, related to the above, is that the life tables of the Indigenous—including the Mapuche—and non-Indigenous people were elaborated using only one parameter, in this case infant mortality. It is probable that a single parameter would not fit well to the calendar of mortality by age of a population. However, we feel that our results are a first advance towards the study of ethnic differences in longevity in Chile. Using indirect demographic methods, designed specifically for contexts with lacking information, we found a difference of 7 years in the life expectancy of birth between Indigenous and non-Indigenous people.The results obtained in this study are of ethnic differences in life expectancy for both sexes together. Unfortunately, the census did not include questions about the sex of children born alive and survivors, thus it was impossible to make estimations separately for males and females. Future studies must find a way to examine gender and ethnic origin differences in life expectancy.This study ratifies the existence of marked ethnic-racial differences in life span in Chile. The country has made significant advances in recognizing the multi-cultural character of its population, for example the program for recovery and revitalizing Indigenous languages begun in 2006 , the proFinally, it is probable that the ethnic-racial differences in life expectancy in Chile are even greater, as has been detected in societies in which relatively good-quality data on ethnic-racial origin and mortality have been recorded for many years. Thus, it is relevant for future studies to continue exploring variations in longevity according to ethnicity, to determine if these are maintained, increase, or decrease, and to advance in the study of the factors associated with these differences.https://www.ine.gob.cl/estadisticas/sociales/censos-de-poblacion-y-vivienda.Publicly available datasets were analyzed in this study. This data can be found here: Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.MS and MA: study design, conceptual interpretation, data analysis, interpretation, and manuscript drafting and reviewing. CA: drafting and manuscript reviewing. All authors contributed to the article and approved the submitted version.


Problematic Internet use (PIU) can have detrimental effects on physical, emotional, psychological, and social functioning. Besides well-described PIU correlations in psychological domains such as personality traits, or life satisfaction, and self-assessment, the social aspect of PIU risk also appeared to be important. This study aimed to investigate the association between PIU and attitudes towards persons with disabilities.A total of 595 Polish students aged 18–29 participated in this research by completing the Internet Addiction Test, Multidimensional Attitudes Scale Towards Persons With Disabilities, and personal information form.The findings revealed that 30.6% of the respondents were at high risk for PIU. Moreover, heightened levels of PIU were more prevalent among male participants and students in technical fields of study than in those in medical and social fields of study. Increased PIU was also associated with more negative attitudes towards persons with disabilities in general and in the domains of emotions and behaviours. Additionally, prior personal contact with individuals with disabilities was related to both PIU rates and attitudes towards persons with disabilities in the domain of emotions and beliefs.This study highlights the prevalence of PIU among Polish students and emphasizes the need for preventive measures, particularly targeting male students and those in technical fields of study. The results indicate a relationship between PIU and attitudes towards individuals with disabilities. Further research is required to determine the direction of the relationship. It is recommended that educational programs provide opportunities for interaction with individuals with disabilities to promote understanding and acceptance. The modern world requires using the Internet daily, in many aspects of our everyday life: working, studying, shopping, banking matters, making an appointment with a doctor, and many other situations. The Internet has become a tool that makes one’s life easier and, as it turned out during the COVID-19 pandemic, a tool that currently makes work and contact with the outside world possible, for instance, while in quarantine. However, the benefits of the Internet also pose threats: cybercrimes, cyberviolence, as well as, problematic Internet use (PIU). This notion implies using the Internet in a risky, excessive, or compulsive manner .This article aimed at verifying whether problematic internet use co-occurs with negative attitudes towards persons with disabilities. Research conducted so far has indicated that people with PIU have worse interpersonal relationships more frequently –5 and loAn attitude is a favourable or unfavourable response to someone or something, expressed in a belief, feeling, or intended behaviour. The cognitive component of an attitude is mainly manifested in categorising and stereotyping people. The affective component is an emotional way of interpreting the environment and leads to the realisation of the behavioural component, e.g. positive emotions can lead to altruism, and negative emotions can lead to prejudice and discrimination , 22. AttThe social learning theory proposed by Albert Bandura , later kThe widespread use of the Internet has exposed young people to a variety of role models, some of whom may exhibit undesirable behaviour. As a result, socially negative attitudes may be reinforced by excessive exposure to peer-selected content. Problematic Internet use can be explained within the framework of social cognitive theory as a deficit in self-regulation skills. This deficit hinders the individual's ability to recognise the purpose of attitudes and to conform to socially acceptable norms. The social cognitive theory also addresses the development of pathological behaviours. Bandura claims that modelling and vicarious conditioning can reinforce pathological and undesirable behaviours, thereby perpetuating negative attitudes in society . IndividIn today's society, the advent of the Internet has dramatically changed the availability of role models and sources of information. Young people in particular now have unprecedented access to a wide range of online role models, not all of whom demonstrate positive behaviours. The prevalence of peer-selected content, combined with the power of modelling and vicarious conditioning, can lead to the perpetuation of more socially negative attitudes . In the In view of the multiple causes and consequences of PIU outlined above, its relationship with social attitudes can undoubtedly be anticipated. In particular, disturbances in interpersonal difficulties and limited social skills may lead to the reproduction of stereotypes  and even prejudices  , which mModulating these attitudes is difficult and continues to take place in various areas, including social advertising, the integration of persons with disabilities into society in education, work, and other fields, and the education of selected social groups. Raising the awareness of the whole society about persons with disabilities is one of the measures to ensure the protection of their rights and dignity by the Convention on the Rights of Persons with Disabilities of 13 December 2006 (Article 18) . AccordiAttitudes towards people with disabilities are rooted in the social environment . This enIt should be mentioned that research on PIU and attitudes towards persons with disabilities is particularly crucial in the COVID-19 pandemic among young people, especially those who intend to work with the sick. The pandemic forced such people to learn remotely and reduce their interpersonal relations, whereas poor relations with teachers and students were considered to be a risk of developing PIU even before the pandemic . TherefoMany researchers have attempted to determine which groups are most at risk of developing PIU. Previous research from Turkey , Norway The risk of PIU mainly affects young people. One of the most commonly studied groups is young adults, especially students , 54–57.Studies show that taking into account the field of study, the group least exposed to PIUs are students of medical faculties and the group most exposed are students of technical faculties , 58. HowPrevious studies of attitudes with the MAS scale mostly involved students and showed that women had more positive attitudes in the cognitive and behavioural components, but more negative attitudes in the emotional component than men e.g. , 71). In. In71]).Other studies using different scales, in particular, different versions of the Attitudes Toward Disabled Persons (ATDP) questionnaire by Yuker et al.  measuredThe research focused on the level of problematic Internet use and negative attitudes towards persons with disabilities among Polish students. The gender of the participants, their fields of study, self-assessment of their health and financial situation, and whether they had previous personal contact with persons with disabilities were also taken into account as possible determinants of PIU and negative attitudes towards persons with disabilities.As in most other PIU studies to date, the self-report questionnaire tool Internet Addiction Test (IAT) was used to assess it. The choice of the IAT instrument should provide an opportunity to directly compare the results of our research with studies using the IAT around the world, for example in the UK , USA, ChHaving regard to the above, we distinguished the following research objectives: 1) to check the prevalence of PIU among Polish students; 2) to determine whether there is a relationship between PIU in students and their attitudes towards persons with disabilities; 3) to examine whether there are relationships between PIU and the attitudes towards persons with disabilities with gender, filed of study, knowing to disable person and self-assessment of financial and health situation.The Internet Addiction Test (IAT) scores are associated with attitudes towards persons with disabilities.Both genders differ in scores on the IAT and attitudes towards persons with disabilities.Students having previous personal contact with persons with disabilities differ in scores on the IAT and attitudes towards persons with disabilities compared to students with no previous contact with persons with disabilities.Subjects with various fields of study differ in scores on the IAT and attitudes towards persons with disabilities.Self-assessment of one’s health is associated with scores on the IAT and attitudes towards persons with disabilities.Self-assessment of one’s financial standing is associated with scores on the IAT and attitudes towards persons with disabilities.Given the purpose and focus of the research as well as the theoretical premises presented, the following hypotheses were formulated:The cross-sectional self-report online survey was conducted between December 2021 and the end of April 2022. The following criterion had to be met to participate in the survey: a Polish student, aged 18–29 with no disabilities. Students from all over Poland could complete a survey at panelariadna.pl or via Microsoft Forms. The targeted selection of respondents in the sample was used to guarantee a similar number of students representing various groups of fields of study: 1) natural science and engineering technology; 2) social science and humanities; 3) medical and health sciences; 4) law, economics, and management (Table n = 4), respondents not being students (n = 7), respondents not being Polish citizens (n = 7), and respondents who declared having disabilities (n = 56) were excluded from the initial database.The survey was completed by 669 subjects. By controlling for responses to the questions on age, student status, nationality, and disability, the final data analysis covered 595 respondents. Respondents above 29 years of age (Polish adaptation of the Internet Addiction Test (IAT) by Kimberly Young , which wIt is a Polish adaptation of the Multidimensional Attitudes Scale Towards Persons With Disabilities by Findler et al. , which wStudents were also asked questions on socio-demographic data , the self-assessment of their financial situation, rated on a scale from 1 (very bad) to 5 (very good), self-assessment of their health situation, rated on a scale from 1 (very bad) to 5 (very good), and if the participant knew a person with disability personally and if the participant themselves were a person with a disability. All data obtained, including gender information, were data declared by students.Spearman's rank-order correlation was used to assess the relationships between raw scores on the Internet Addiction Test and attitudes towards persons with disabilities. The Mann–Whitney U-test with the rank-biserial correlation as a measure of the effect size was used to examine the gender differences in raw scores on the Internet Addiction Test and in negative attitudes towards persons with disabilities. The differences in raw scores on the Internet Addiction Test and negative attitudes towards persons with disabilities between subjects with or without previous personal contact with persons with disabilities were also tested using the Mann-Whitne U-test with the rank-biserial correlation as a measure of the effect size. The Kruskal–Wallis H test followed by Dunn’s test with p-value adjusted using Holm’s correction for multiple comparisons was used to examine differences in raw scores on the Internet Addiction Test and negative attitudes towards persons with disabilities and problematic Internet use persons with disabilities between students subjects in various fields of study. Statistical analyses were computed using the free and open-source statistical platform JASP , based oM = 22.42; SD = 2.69). As can be seen in Table The analysed sample consisted of 172 males (28.91%) and 423 females (71.09%). The students subject to analysis were aged 18–29 . Similarly, high scores were achieved by university students in Japan (38.2% of participants were classified as PIU) , and youThe present study has indicated that heightened PIU was related to more negative attitudes towards persons with disabilities in general and in the domain of emotions and behaviours. Beliefs were the only domain of attitudes that were not correlated with problematic Internet use. Therefore, the hypothesis on the relationship between PIU and attitudes towards persons with disabilities among Polish students regarding emotions and behaviours has been confirmed. Due to the cross-sectional nature of the research, it is impossible to answer the question about the direction of this relationship. On the one hand, negative attitudes towards persons with disabilities may reflect difficulties in social life caused by PIU. On the other hand, individuals with negative attitudes may be more exposed to the development of PIU. So far, other authors have not conducted research in this respect. Nevertheless, further research is required. Of particular interest may be the results of future research into the relationship between PIU and attitudes towards people with disabilities and the role of empathy and social skills in this relationship.The present study has confirmed the hypothesis that students of different genders differ as to PIU. Men scored considerably higher on the IAT score than women. This is in line with the results of research conducted by other authors , 101. ThThe study has also confirmed that men and women did not differ significantly in attitudes towards persons with disabilities as well as the emotional area of their attitudes. Men had slightly more negative attitudes than women only in the domains of beliefs and behaviours. This corresponds to numerous results of research conducted by other authors , 71–73. As hypothesised, prior contact with persons with disabilities was significantly related to the areas subject . HoweverThe results have confirmed the hypothesis that students in various fields of study have different PIUs and different attitudes towards persons with disabilities. In all areas subject to research, students in medical fields of study achieved more desirable results. Natural sciences, engineering, and technology students achieved significantly higher PIU rates than students in social and medical fields of study. Law and economics students, in turn, achieved higher rates of Internet use than students in medical fields of study. In the research in question, medical and health science students had significantly more positive attitudes towards persons with disabilities in the domains of emotions and behaviours than natural sciences, engineering and technology, social and law, and economics sciences students. For the domain of beliefs, the attitudes of medical and natural sciences, engineering, and technology students were more positive than law and economics fields of study students. A recent study conducted on a Polish sample has failed to determine that the level of attitudes differs depending on the field of study . PreviouIn the systematic review of 2021, Wang et al.  identifiThe results have also confirmed the hypothesised relationships between a subjective self-assessment of one’s health and financial situation and PIU and the attitudes towards persons with disabilities among Polish students. The higher the result of self-assessment of one’s health and financial situation, the lower the PIU rate. Access to the Internet is becoming easier and wider for students and does not require large financial expenditure . Furthermore, undertaking studies implies achieving large freedom of decision-making related to entering an adult life  . As a coSignificant relationships between the attitudes towards persons with disabilities and health situation and financial situation, respectively, have also been noted. In the detailed domains of attitudes, beliefs were significantly correlated with the declared health situation, while emotions and behaviours were significantly correlated with the declared financial situation. The higher the results of self-assessment of one’s health and financial situation, the more positive the attitudes towards persons with disabilities. No research has been conducted by other authors in this respect to date.However, it should be noted that the self-assessment of one’s health and financial situation explained a maximum of 2% of differences in negative attitudes towards persons with disabilities as well as PIU.Problematic Internet use constitutes a serious problem among Polish students since it refers to nearly one-third of the respondents. A higher risk of PIU was observed in men than in women and among students of technical fields of study than those of medical and social fields of study. Moreover, the existence of relationships between PIU and attitudes towards persons with disabilities among Polish students regarding emotions and behaviours has been confirmed. Further research is required to determine the direction of this relationship. Previous personal contact with persons with disabilities was significantly associated with lower PIU rates. In addition, respondents who had previous personal contact with a person with a disability achieved significantly more positive attitudes towards persons with disabilities (in the domain of emotions and beliefs). However, both relationships were weak.The conclusions of this study point to the need to implement some practical solutions. Firstly, due to the large number of people with PIU symptoms, an initiative aimed at preventing Internet addiction should be created for local health policy makers. Since our results revealed that men studying technical fields are more likely to demonstrate symptoms of PIU, further research is needed to determine which preventive methods are most effective in this group. The research to date suggests that this should include education about the risks associated with excessive use of the Internet, as well as the development of communication and social skills, taking into account the needs of people with disabilities, e.g. in the form of workshops during studies. Our research shows that ensuring contact with people with disabilities can help both to shape more positive attitudes and to reduce levels of PIU.It appears that education about the risk of PIU as well as promoting and facilitating spending free time through contacts in a non-virtual world should become an essential element of education in all fields of study, particularly natural science, and engineering technology fields of study dominated by men. Encouraging women to choose technical fields of study may guarantee the interaction between both genders and contribute to decreasing tendencies towards PIU.Activities to increase disability awareness and contact with persons with disabilities in different types of studies should be a key task. In particular, it should be made possible for persons with disabilities to participate in inclusive studies and activities in every field of study. Awareness-raising should include not only knowledge about disability and the problems of persons with disabilities but also the positive effects of contact with persons with disabilities . A variety of elective courses should also be introduced into the programme to enable students to come into contact with persons with different types of disabilities through internships and student placements. The tutors of such courses should actively help to establish positive relationships with persons with disabilities. It seems necessary to survey students' attitudes before and after the course on disability or contact with people with disabilities—consider modifying the course framework if the goal of improving attitudes is not achieved.This study has confirmed significant relationships between the subjective self-assessment of one’s health and financial situation and PIU together with attitudes towards persons with disabilities. Having regard to the low clinical significance of the results of the present study, further analyses and research in this area are necessary. However, it appears that it may be crucial to provide students with financial support, particularly those in a difficult financial situation and gifted ones, through a scholarship and social aid system, which should be developed on an ongoing basis and enriched with offers of various fields of study.


The European Medicines Agency (EMA) fosters access to innovative medicines through accelerated procedures and flexibility in the authorization requirements for diseases with unmet medical needs, such as many rare diseases as well as oncological diseases. However, the resulting increase of medicines being marketed with conditional authorizations and in exceptional circumstances has lead to higher clinical uncertainty about their efficacy and safety than when the standard authorizations are applied. This uncertainty has significant implications for clinical practice and the negotiation of pricing and reimbursement, particularly as high prices are based on assumptions of high value, supported by regulatory prioritization. The burden of clinical development is often shifted towards public healthcare systems, resulting in increased spending budgets and opportunity costs. Effective management of uncertainty, through appropriate testing and evaluation, and fair reflection of costs and risks in prices, is crucial. However, it is important not to sacrifice essential elements of evidence-based healthcare for the sake of access to new treatments. Balancing sensitive and rational access to new treatments, ensuring their safety, efficacy, and affordability to healthcare systems requires thoughtful decision-making. Ultimately, a responsible approach to timely access to innovative medicines that balances the needs of patients with healthcare systems’ concerns is necessary. This approach emphasizes the importance of evidence-based decision-making and fair pricing and reimbursement. In recent years, there have been significant technological advances in biomedical research that have been quickly translated into clinical practice . The phaThe European Medicines Agency (EMA) plays a significant role in evaluating pharmacological innovations and issuing opinion for their commercialization in the European Union (EU) countries . The EurThere is a demand that the process of access to innovative medicines should be faster, and patients should have timely access to new and innovative medicines . For lifThe EMA has acknowledged the existence of unmet medical needs and have established laws and regulations aimed at expediting the development and approval of drugs to address these specific diseases . A groupIn this article we will delves into the complex subject of medications authorized with limited clinical evidence. There are several reasons for granting access to medicines with limited evidence . We aim Medicine regulation by the EMA aims to ensure that only medicines with a favorable balance of benefits and risks are authorized for marketing. This requires the assessment of three criteria: quality, efficacy, and safety . HoweverThe European Union incentivizes the development of medicines that are intended to treat small patient populations, assuming that the development of these types of medicines may not be financially viable under normal market conditions. The EMA’s Committee for Orphan Medicinal Products (COMP) grants orphan designation to medicines that treat life-threatening diseases with a low prevalence in the EU and offer significant benefits over existing treatments or fill a gap where no satisfactory treatments exist. Orphan drug designation recognizes that the drug is addressing a relevant unmet need, and offers several incentives, including reduced or waived fees, protocol assistance (scientific advice specific to orphan drugs), and 10 years market exclusivity in the EU . Orphan Accelerated review processes have been developed to reduce the time required by the EMA to review a marketing authorization application for medicines that are considered important therapeutic innovations and are of great public health interest. This expedited review process reduces the review procedure time from 210 days to 150 days, if the applicant provides good cause for an expedited review .The PRIME (PRIority MEdicines) program is an initiative developed by the EMA to improve and accelerate the evaluation and approval process of medicinal products aimed to treat serious and life-threatening conditions with unmet medical needs. The program offers ongoing assistance for the advancement of qualified medications, which have been chosen based on their potential to provide substantial therapeutic benefits compared to current treatments or to benefit patients who lack treatment options altogether. The primary objective is to streamline the medicine development process and expedite access to these innovative treatments . The PRIA comprehensive review of the PRIME scheme’s experience since inception and up to June 2021 has been carried out . The monThe impact of the regulatory procedures mentioned above has been a progressive increase in the authorization of medicines with orphan and advanced therapies designations  Table 2Table 2. It must be emphasized that currently the European Commission is proposing a review of European Union pharmaceutical legislation, consisting of a new Directive and a Regulation to simplify and replace the previous legislation. The new legislation will promote innovation in the development of new medicines by speeding up the authorization process with simplified procedures, offering tailored scientific support and advice for innovative products, and providing special incentives for rare diseases. The reform aims to provide all patients in the EU with timely and equitable access to safe and effective medicines, and offering incentives for the development of innovative medicines addressing unmet medical needs .However, rapid access to new medicines from the regulatory side means that in most cases, more uncertainty is accepted at the time of approval, and there is still debate about the optimal balance between speed and evidence for developing new medicines. A review of oncology medicines approved by the EMA from 2015 to 2020 found that most medicines were approved for marketing based on surrogate outcomes, without evidence of improved overall survival (OS) or quality of life benefits .Moreover, there is concern on the actual magnitude and relevance of the clinical benefit, and balance with added toxicities of newly authorized products. An analysis of OS data of new cancer medicines approved by the US Food and Drug Administration (FDA) and the EMA between 2003 and 2013 found that only 43% of the drugs showed an increase of at least 3 months, 11% showed less than 3 months, and 30% showed no improvement in OS. The average increase in OS was of 3.4 months, and the majority of the new cancer medicines were also associated with increased toxicity . The anaTo note, clinical trials are increasingly adopting methodologies that allow early interruption led by interim analysis, if supporting positive results. However, early trial interruption may led to overestimation of effects, especially if decisions are not taken blinded to treatment groups, or are based on uncontrolled designs . Often, On top of that, the evidence on new drugs that are addressed to small populations, such as OMPs and ATPMs, may also be flawed by the use of weak methodological approaches. A review of the European Public Assessment Reports (EPARs) of 125 OMPs approved by the EMA between 1999 and 2014 found that one third of the trials did not include a control arm, one third did not use randomization, half of the trials were open-label, and 75% used intermediate or surrogate outcomes as the primary endpoint. The size of the population exposed at the time of OMPs approval was smaller than needed to classify adverse reactions as clinically relevant, and 10% of the OMPs were approved despite the results of the pivotal trials being negative . This suCurrently, some ATMPs have already been commercialized. A review of pivotal clinical trials (CTs) supporting the approval of ATMPs by EMA found that their approval was mainly based on small CTs, single-arm, no control group, compared to historical controls, and using surrogate outcomes as the primary endpoint . AdditioFrom 2009 to 2013, the EMA approved the use of 48 anticancer medicines for 68 indications. In 12% of the indications pivot trials had a unique arm study, in 35%, OS data were not available, and in those that were available, the median overall survival benefit was 2.7 months (range 1–5.8 months). Quality of life data only were available in 10% of cases. In post-marketing follow-up data only 3 of 44 indications that initially had no overall survival data showed an overall survival gain or benefit in post-marketing outcomes. Median follow-up after authorization was 5.4 years . Of the 23 drugs with an ESMO score, 12 (52%) had a score indicating non-significant improvement. For about half  the post-marketing benefit was still uncertain. Therefore, about 50% of medicines authorized for licensed oncology indications remained uncertain after an average of 5.4 years after approval .Conditional marketing authorizations should be reversible if benefit assumptions are not met, but in clinical practice, they barely are. For instance, in the case of ataluren, the conditional marketing authorization by EMA was issued without conclusive evidence on efficacy in pivotal clinical trials, but based on contextual reasons and a reasonably safety profile . SubsequPricing and reimbursement (P&R) decisions for innovative medicines are a complex and challenging task for health systems, as they balance the need to provide access to new treatments with the need to control costs and ensure long-term sustainability. The P&R process involves evaluation of the clinical and economic value of new medicines, considering factors such as clinical efficacy, safety, cost-effectiveness, and budget impact. It also requires taking into account the perspectives of various stakeholders, including patients, pharmaceutical companies, healthcare providers, payers, and policymakers. When there is a great unmet medical need and no therapeutic alternatives available, the decision making process becomes even more challenging. The perception of high value for accelerated, conditional, or exceptional authorizations can lead to high expectations, associated with high prices, from agents of interest and social pressure for hard bargaining. In these cases, there are no competitors, and therefore no comparative data to go on.Companies are unwilling to set low prices for their products, tend to overestimate the cost-effectiveness of their therapies, and claim theoretical prices that are expected to return costs of manufacturing, R&D investments and reward value of innovation . HoweverAccess to innovative medicines for patients with rare diseases and unmet medical needs is crucial. However, the uncertainties inherent in developing those medicines with a limited evidence pose significant challenges to traditional health technology assessment, and P&R processes.Firstly and foremost, it is vital to enhance the scientific evidence of those medications. Classic confirmatory clinical trial designs with randomization and control groups, with the best available treatment option, should be the best option, as longas it is feasible . This apSecondly, payers may have doubts about the effectiveness, safety, and therapeutic value of a treatment that has not been fully confirmed because they need accurate information to decide P&R of these innovative medicines . There iThe regulatory approval process has undergone meticulous review and adaptation to facilitate access of innovative medicines. Similarly, there seems to be a need to revisit the P&R system, through a transparent and evidence-based approach, as well as an effective price regulation, that is able to manage the greater amount of uncertainty resulting from regulatory measures to accelerate access of innovation .Fixing a price on a population level, as well as a spending cap per patient, in an uncertain setting should not result in premium prices based on expectations, but on prices that are proportional to its value at the time of P&R, considering the magnitude of benefit but also the strength and different levels of the evidence supporting it. If the evidence for a medicine’s efficacy and safety is weak, the price should also be lower, regardless of other factors, at least until the expectations can be robustly confirmed.A strategy often applied to manage clinical uncertainty of expensive medicines aimed to small populations are risk-sharing agreements or managed access agreements (MAA) . Thus, wCuriously, the introduction of a medical product to the market with substantial uncertainty, does not inherently lead to the implementation of performance-based agreements. Between 2006 and 2016, managed entry agreements based on clinical outcomes were not commonly used for products that had a conditional marketing authorization or those that were authorized under exceptional circumstances. Of the 48 products that received marketing authorization under exceptional or conditional circumstances in recent years, only a few were found to have managed entry agreements involving the collection of additional data. The complexity of collecting outcomes data in clinical practice led stakeholders to refrain from utilizing MAA approaches . BesidesCollaboration and early dialogue between stakeholders, including patients, is also crucial to manage expectations and to ensure that access mechanisms are transparent and appropriate . The newThe Oslo Medicines Initiative (OMI) is a collaborative effort between the WHO Regional Office for Europe, the Norwegian Ministry of Health and Care Services, and the Norwegian Medicines Agency. The OMI aims to provide a neutral platform for the public and the private sectors to jointly outline a vision for equitable and sustainable access to and affordability of effective, novel and high-priced medicines, OMI in a technical report summarizes existing policy options for payers that support innovation and access to medicines in the WHO European Region. It identifies various tools, such as early assessment schemes, managed entry agreements, and innovation funds in 48 countries. The report describes methods for generating evidence and manage access to innovation, such as value-based pricing, pooled procurement, and subscription fee-based procurement. It also acknowledges potential limitations of the identified policies, such as financial sustainability of healthcare systems and trade-offs between incentivizing innovation and principles of evidence generation, transparency, and budget impact .The health and economic impact of making decisions on access to innovative medicines with limited evidence are significant, and it is essential communicating these issues more effectively to the public. Medicines regulation is designed to protect public health, and the requirement of robust evidence is an ethical obligation to ensure that new treatments are safe and effective. The decision-making process on the price and financing of these innovative medicines must be transparent and based on efficacy, efficiency and affordability, to ensure best use of resources and health system sustainability. Both are safety measures aimed to improve the good for the most, acting as filters rather than barriers, and it would be desirable to ensure that this is perceived as such by the public. Filters are a necessary step to ensure that innovative medicines are safe and effective and that they provide value for money, rather than being bureaucratic obstacles to access. A better communication can help to build a more informed and engaged society, trusting and empowering bodies in charge of veiling for public interests, and ultimately improve public health outcomes.In summary, while the EU regulatory process for access to medicines with limited evidence demonstrates flexibility in addressing rare diseases and unmet medical needs, it also introduces substantial clinical uncertainty for public system payers regarding the efficacy and safety of marketed medicines. The consequence of this is uncertainty about the therapeutic place of these drugs in clinical practice, difficulties in making decisions about the price and financing of medicines, and increased budgets for spending on drugs with little evidence.Based on the above concepts, it is recommended to ensure a balance between flexibility in order to facilitate access to medicines for rare diseases and unmet medical needs, and the need for rigorous clinical research to provide evidence of safety and efficacy at reasonable and affordable prices in order to make the health system sustainable. This could involve implementing well designed clinical trial and gathering post-marketing real world data for innovative medicines granted accelerated authorization, as well as the implementation of a balanced P&R system, through a transparent price regulation, evidence-based approach withprices proportional to the strength and level of evidence and value-based pricing or managed access agreements.Lastly, it is crucial to communicate the reasoning behind regulatory and financing decisions in a balanced manner. Presently, when regulatory and financing entities seek substantial evidence to guarantee the efficacy, safety, and efficiency of new innovative treatments, the messaging conveyed by media to healthcare professionals and the broader society often frames it as “barriers to innovation”. While there is always area for improvement in procedural efficiency, it is important to visualize the role of public administration bodies in pursuing the best interest for the most. An excessive simplification of messages may push political decisions on access in absence of guarantees on efficacy and safety of those innovative medicines that eventually could be against the general interest. New treatments must be made available to patients as soon as possible, but in a safe, efficient and responsible way. Being fast should not mean rushing but being more responsive. In the fast-paced world of modern medicine, it is easy to get caught up in the race for speed and efficiency. However, true progress lies in balancing speed with accuracy, and we must strive to move forward quickly without sacrificing the essential elements of patient care.


Summarizing categories, such as migration background or history of migration, do not reflect the diversity and heterogeneity of the population living in Germany and their health.A differentiated description of the health situation of people with a history of migration should consider migration-related, social, and structural determinants of health as well as their interactions.The findings obtained in the ‘Improving Health Monitoring in Migrant Populations (IMIRA)’ projects will help to improve the inclusion of people with a history of migration in future studies as well as in the RKI panel. This will enable an adequate description of the health situation of people with a history of migration and therefore of the general population in Germany.In future studies, the health status of people who have not been well included in health surveys so far, such as people who are not listed at the registration office, should be monitored. For this purpose, continuous development of sampling and survey methods is necessary. Germany is a country of immigration and has a long history of different migration movements, such as labour migration since the 1950’s or according to the European Union (EU) Freedom of Movement Act, and refugee migration in the context of wars and political conflicts. People with a history of migration represent a large proportion of the population living in Germany. In 2021, 27% were attributed a statistically defined migration background. Moreover, 17% of all people living in Germany were migrants themselves, and 13% had a citizenship other than German [One’s own or a familial history of migration alone does not make one healthier or sicker. However, there are various factors before, during, and after migration that can affect one’s health status . People Since 2016, the Robert Koch Institute (RKI) has been working on the IMIRA  and IMIRA II projects to expand public health monitoring in a diversity-oriented way. This entails the improved inclusion of people with a history of migration in studies in order to describe their health status in a more differentiated way within the context of public health reporting. Within IMIRA (2016–2019), feasibility studies were conducted to evaluate how to improve the inclusion of people with a history of migration in health surveys . New conThe main objective of the IMIRA II project (2019–2023) is to describe the current health status of people with a history of migration in a differentiated manner. Findings on the improved inclusion in health surveys obtained in IMIRA were implemented here, and the health interview survey GEDA Fokus was conducted among people with five selected citizenships . For GEDHealth of people with selected citizenships: results of the study GEDA Fokus’, some of the core indicators identified in IMIRA, such as self-assessed health or the prevalence of depressive symptoms, are analysed according to various migration-related and social determinants of health. The results show associations between the sense of belonging to the society in Germany and self-reported experiences of discrimination in the healthcare sector and various health outcomes. The article ‘COVID-19 vaccination status among people with selected citizenships: results of the study GEDA Fokus’ shows an educational and age gradient associated with the utilisation of COVID-19 vaccination. Both articles demonstrate that, depending on the health outcome, different migration-related, social, and structural determinants are relevant for explaining differences in health outcomes. The results thus underline that a differentiated, more in-depth consideration of various influencing factors is essential.The first results of GEDA Fokus are presented in the two original articles in this issue. In the article ‘Recommendations for collecting and analysing migration-related determinants in public health research’ addresses this issue. In addition to the recommendation of a minimum set of indicators to describe the migration status, suggestions are made for further relevant explanatory factors that should be considered in future data collection and analysis. Additionally, the article recommends refraining from using broad summarising categories, such as migration background. Instead, it encourages applying individual indicators that are relevant to answering the research question at hand. Therefore, besides considering one’s own or familial migration experience, it is essential to focus on specific migration-related determinants as well as on social and structural factors affecting health.The article ‘We hope that the results presented in this issue can be of use for further advancements towards a diversity-oriented public health research. Thank you for your interest.