Food insecurity is a critical issue that refers to a lack of access to adequate food to support a healthy and active lifestyle. This problem has wide-reaching effects and can negatively impact health, education, and overall well-being. Addressing food insecurity requires a multifaceted approach that involves the efforts of governments, organizations, and individuals to ensure access to a balanced and nutritious diet for all.per capita, and GDP growth rate among 14 Organisation for Economic Co-operation and Development (OECD) countries. We developed a modeling approach in three stages to compare food insecurity risk and discussed the reasons for the rankings of the countries based on the model results.The aim of this study is to shed light on macro-level models and evaluate food insecurity risk in international comparisons. We considered six criteria to evaluate food insecurity risk in terms of health expenditure, gross domestic product (GDP) According to our findings, the United States has the lowest food insecurity risk, while Colombia has the highest. The results suggest that economic factors, such as GDP per capita and GDP growth rate, play a significant role in food insecurity risk. The study highlights the importance of addressing economic disparities and promoting economic growth to reduce food insecurity.This study provides insights into the relationship between food insecurity and economic factors, indicating that addressing economic disparities and promoting economic growth can reduce food insecurity. Future research using similar models to link economic outcomes with important health components such as nutrition and physical activity could provide a foundation for policy development. Climate crisis, the COVID-19 pandemic, increasing inflation, fear of recession, and the ongoing war between Ukraine and Russia, two essential grain importers, the world is threatened once more with a not-so-foreign term, food insecurity.The definition of food security is agreed upon in World Food Summit 1996 as “When all people, at all times, have physical and economic access to sufficient safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” Thus, food insecurity refers to a lack of access to enough food to support a healthy and active lifestyle .The effects of food insecurity are wide-reaching and can have negative impacts on health, education, and overall well-being. For example, food insecurity can lead to malnutrition, which can have serious health consequences, particularly for children. Malnutrition can cause a range of health problems, including stunted growth, weakened immune systems, and increased susceptibility to illness. When children are not getting enough to eat, they may be less able to focus and learn in school. This can lead to reduced school attendance and lower educational achievement. Additionally, food insecurity can lead to increased stress and anxiety levels, which can negatively impact mental health . Food inOverall, food insecurity is a serious problem affecting millions of people worldwide and requires a multifaceted approach to address. Governments, organizations, and individuals need to work together to address the root causes of food insecurity and to ensure that everyone has access to enough food to support a healthy and active lifestyle.per capita , and quantities produced are shared , total  crop production (tons per 1 m people), producer protection , producer support (% of gross farm receipts), food inflation , household spending (% of GDP). Also, we determined GDP per capita, health spending, and GDP growth rate as three indirect variables; that interact with each other and the other criteria in terms of both long-term outcome and cause. We are using this data because it is the most recent data available for the year 2020 in the OECD database for all 14 countries in terms of the relevant variables for the study. These ensure our data is up-to-date and allow us to accurately analyze and compare the food insecurity dimensions across the 14 countries.We have used OECD data in this study to ensure that all the data comes from the same source. We have chosen six widely accepted indicators of food insecurity as our criteria for 14 OECD countries for the year 2020. These are total  meat consumption  and calculated it using the Euclidean distance method. We calculated the distance ratios of the six variables from Factor_1 and subtracted them from 1 for ranking the results of the ratio matrix from the lowest risk of food insecurity. Then, to determine the criterion weights, we compared them to the total score. These ratios formed the criterion weights.In the last step, we used the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method to determine the country with the lowest risk of food insecurity within a set of 6 variables and to rank them from lowest to highest risk. Another reason we used this method is that it considers variables that have positive and negative effects. In the model, we determined that total meat consumption, crop production, producer protection, and producer support are positive, while food inflation and household spending are negatively effective. The research model is shown in Food insecurity is affected by many interrelated economic data. In our research, we aimed to use as recent data as possible from the OECD, to compare as many OECD countries as possible, and to include as many criteria as possible that are believed to affect food insecurity and are logically related. Therefore, using data from 2020, including 14 OECD countries, and comparing them based on six criteria were the most significant limitations of the study.per capita, GDP annual rate, and health expenditure ($) were combined under a single factor. Then, the values of Factor_1 were determined for each country using regression outputs. The generalized method of moments (GMM) was used to obtain the regression outputs in a similar way as applied to cross-sectional data. However, the GMM method is a technique that allows the use of lagged levels of regressors (explanatory factors) as instruments to address the probable link between the lagged regress and the error term, as well as the endogeneity of explanatory factors , which is a multi-factor evaluation technique in cross-sectional data, was used . This meIn the final step, we compared the countries using the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method based on the criterion weights we determined. In the TOPSIS method, determining the decision option that is closest to the positive ideal solution and farthest from the negative ideal solution through matrices is targeted by a multicriteria approach . To makeper capita) and crop production (tons per 1 m people) and their subunits, population, producer protection , producer support (% of gross farm receipts), household spending (% of GDP), food inflation , health spending ($ per capita), growth rate , GDP per capita ($) for 14 OECD countries are present.In per capita, while the least was the GDP growth rate. As a result of the factor analysis with the regressional score method, we created the variable, Factor_1 . When we examined the variables in the space, it is seen that the total of the elements that make up the crop production is located at the farthest distance from Factor_1. The closest distance is occupied by producer protection . The disWhen we examined the distances of the variables according to Factor_1, we determined that the closest to the farthest is producer protection (0.018); food inflation (0.078), producer support (0.373), household spending (0.790), meat consumption (0.897), crop production 1.769; .To determine the weights of the criteria, the ratio of each distance value to the sum of the distance values was calculated to create a proportional matrix. Then, the determined values were subtracted from 1 to rank the criteria from most successful to least successful, and the criteria weights were determined by calculating the ratio again .We found the normalized decision matrix by normalizing the values in rows (i) and columns (j) for each observation (d) in the unweighted matrix , 6.After normalization, we determined the normalized matrix and found the values from before the weighted matrix . To findA*) and negative cost criterion values (A−) for each column were calculated through the maximum and minimum column values. Then, the positive ideal solution distances (S*) and negative ideal solution distances (S−) were found, and the analysis was completed by determining the Closeness Coefficient (C*) with the formula.After the determination of the vector, the positive benefit criterion values (A*) and cost values (A−). We determined that the country with the highest proximity coefficient in the solution matrix was the most successful in terms of the criteria and weights in the comparative analysis. We also ranked the countries by their success.We used the weighted matrix to calculate the benefit values  were mildly insecure and 299 (2.8%) were moderately/severely insecure  can be found in the article/supplementary material.SY and AG contributed to the idea, conception, and design of the study. SY organized the database, performed the statistical analysis, and wrote the background and discussion. AG wrote the first draft of the manuscript and the abstract and introduction. 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.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


In recent years, several studies have addressed the challenges and psychological issues that transgender individuals face. However, only a few studies have explored the experiences of this population in Iran. Life experiences are heavily influenced by the dominant religious and cultural conditions and common beliefs in a society. The present study aimed to investigate transgender individuals' lived experiences of facing life's challenges in Iran.This is a qualitative study with a descriptive and phenomenological design conducted from February to April 2022. Data were collected using semi-structured, in-depth interviews with 23 transgender individuals (13 AFAB and 10 AMAB). The collected data were analyzed using Colaizzi's method.Analysis of the qualitative data resulted in the emergence of three themes and 11 subthemes. The three main themes included mental health disparities , gender dysphoria (contradictory gender identity and contradictory behaviors), and stigma and insecurity .The findings of the study indicated that transgender people in Iran are exposed to considerable mental health disparities. In addition to disrepute, infamy, and stigma, transgender people face sexual abuse, social discrimination, and a lack of family social support. The results of the present study can help mental health experts and the healthcare system as a whole to adjust their mental and physical health programs according to the needs and experiences of transgender people and their families. It is recommended that future research address the problems and psychological challenges that transgender people's families have to confront. One of the most important aspects of an individual's human identity is their gender identity, which forms in the process of socialization in formal and informal institutions , 2. GendOccasionally, an individual may have the biological characteristics of a male or female but not have a mental sense of belonging to that gender. Such an individual is called a transgender person . In the The study of Nematollahi et al. showed that transgender women are at risk of depression, anxiety, and stress. These conditions are closely related to their quality of life. Moreover, transgender women suffer from high levels of sexual violence that affect their mental health. There is a strong requirement to promote the culture of preventing violence against women in Iranian society . AnotherThese studies indicated that more extensive studies should be conducted in Iran in this regard since sexual matters are sensitive in the Iranian culture and can pose a threat to an individual's dignity or the dignity of their family. Moreover, life experiences are deeply influenced by religious and cultural beliefs. Transgender people suffer from discrimination and face life challenges. Life challenges are problems and issues that make people's lives difficult and interfere with their ability to achieve their life goals. These psychosocial issues are beyond their control and deeply affect transgender people's lives. Thus, the present study aimed to investigate transgender individuals' lived experiences of facing life's challenges in Iran.This is a qualitative study with a descriptive and phenomenological design. The study was conducted from February to April 2022. Descriptive phenomenology is a philosophy and a scientific approach that investigates and describes individuals' lived experiences . The goaThe participants comprised 23 transgender individuals with a wide range of demographic characteristics regarding age, gender, work experience, and so on. Creswell and Creswell  claimed The inclusion criteria were as follows: identification as transgender, verification through medical records and diagnosis by the attending physician, willingness to participate in the study, Iranian nationality, proficiency in Farsi, and ability to effectively express and provide comprehensive and appropriate information. The first author contacted two welfare centers affiliated with a university of medical sciences in the west of Iran and acquired the phone numbers of all the transgender individuals registered there. Then, the corresponding author contacted these individuals, explained the study's objectives to them, and asked them to participate. In this study, 43 transgender people were introduced, but only 23 of them were willing to participate in the study and were willing to be interviewed. For participating in the study, each participant was given $10. The participants were selected via purposeful sampling. Purposeful sampling is a method used in a qualitative study to identify and select individuals or groups of individuals who are especially knowledgeable about or experienced in a particular phenomenon . MoreoveData were collected from 23 individual, semi-structured interviews. Four key questions were initially selected based on a review of the literature. To develop and test the questions, two interviews were conducted in the presence of all the research team members. Based on the outcome, an interview plan was developed. The participants were interviewed via video calls on WhatsApp, which were scheduled at mutually convenient times. The corresponding author conducted and analyzed all the interviews. Each interview began with a few general questions, including “Can you describe a typical day of your life?”, “What feelings have you experienced?”, “How has being a transgender person affected your life?”, and “How have you lived with this challenge so far?”. Subsequently, based on the respondents' initial answers, follow-up questions were asked to add to the clarity of the information; these questions included, “Can you explain further?”, “What do you mean by that?”, and “Can you give an example?”. The interviews centered on the main objective of the study. Each interview lasted between 30 and 40 min. Upon interview completion, each interview was repeatedly listened to by the first author and the corresponding author several times to develop a general understanding and deep insights.Then, the interviews were transcribed. After extracting the semantic units and classifying these semantic units for each interview, the two authors conducted a meeting in the room of the corresponding author and agreed on the semantic units, the titles assigned to the semantic units, and the classification and naming of the categories. The interview continued until the data were saturated and no new categories could be extracted. The data were organized using the MAXQDA software program. The collected data were analyzed using the Colaizzi's method, which consists of seven steps: (1) reading and re-reading every transcribed interview, (2) extracting important terms and phrases from the transcripts, (3) assigning meaning to the extracted units, (4) organizing and categorizing similar units, (5) providing comprehensive descriptions of the extracted categories, (6) creating a basic paradigm of the subject under study according to the extracted categories, and (7) confirming the basic paradigm by having the participants verify the themes and categories .Guba and Lincoln's criteria were used to evaluate the trustworthiness of the study . To enhaThe present study was conducted using the revised Declaration of Helsinki, a statement of ethical principles that directs physicians and other participants in medical research involving human subjects. All participants provided informed consent to participate in the study. The participants were assured of the anonymity and confidentiality of their information. Moreover, the local Ethics Committee approved the study at Hamadan University of Medical Sciences in the west of Iran .The participants consisted of 13 AFAB and 10 AMAB. The average age of the participants was 32.04±2.54 years. A total of eight participants (four AFAB and four AMAB) had started treatment under the supervision of a specialist doctor, two were candidates for surgery, and six were undergoing hormone therapy. According to the interviews with transgender people, the beginning of the treatment made them feel calm and reduced their depression, but they still faced the challenge of family and society's acceptance. The majority of them (86.95%) had a high school diploma. Additionally, most of them (91.30%) had an income of approximately $US 70 during the last 12 months. In addition, most of them (86.95%) lived independently and far from their families .Analysis of the qualitative data resulted in the emergence of three themes and 11 subthemes. The three main themes were mental health disparities, gender dysphoria, and stigma and insecurity.In total, 18 transgender people reported mental health disparities such as the fear of having their sexual identity revealed, non-acceptance by society, and a lack of emotional support, which severely affected their mental health. The theme of mental health disparities consisted of the fear of having one's secret revealed, depression and despair, suicidal thoughts, and secrecy in the family.Most participants reported that they feared their secret would be revealed and everyone would find out that they were transgender. People in this population have considerable fear and anxiety. They have to deal with the fear of being found out every day and going through serious psycho-emotional crises. One of the participants stated the following:My whole life is filled with fear and anxiety about what I should do if people find out about my gender dysphoria. I'm really worried that my friends and relatives might find out that I'm transgender people. Some of my close relatives have become suspicious of my physical appearance and unusual behaviors, but they don't know about my gender dysphoria yet. But, how long can I keep this a secret? They're going to find out sooner or later; the truth will (sic) out some day (Participant 6).All of the participants reported that transgender individuals experience high degrees of depression and despair, which could lead them to lose hope in life, isolate themselves, and avoid social contact. One of the participants stated the following sentiments:I'm really tired. My life feels meaningless. How long should I take antidepressant pills? They don't do me any good and every day I'm feeling worse. Would you call this living? How long do I have to live like this and be afraid of my own shadow? (Participant 5).Most of the participants said that the non-acceptance of transgender people by their families and society, as well as the negative views and inappropriate behavior of people around them and sometimes even inappropriate words and stigma surrounding them, causes severe depression and promotes suicidal behaviors. One of the participants said this:We haven't done anything wrong. We just have a problem and something must be done about it. Some of my friends who were transgender people became drug addicts or attempted suicide and died since their families and society did not support them and they felt rejected. Unfortunately, not many awareness campaigns have been set up to increase people's awareness of transgender people, and many see us as perverts and sexual deviants or social deviants. This attitude is (sic) a torture worse than death (Participant 9).Another participant expressed the following:I've wanted to commit suicide many times and free myself of all the disrespect and pain that I have to bear from people's unkind looks. How much am I supposed to tolerate this? (Participant 7).Another subtheme of mental health disparities was secrecy in the family. A total of 17 participants said that families hide their children's sexual desires from relatives and society. This subject caused psycho-emotional tension, anxiety, frustration, and diminished psychological security in transgender people and families, adversely affecting all aspects of their social lives. One of the participants stated the following:I've had a lot of arguments with my parents over why I should keep my sexual desires a secret; I've been scolded and even insulted. But how long can I hide this and lie to everyone? What have we done to have to hide our disorder? (Participant 3).Another theme extracted from the collected data was gender dysphoria. In total, 19 participants said that gender dysphoria was an inevitable crisis that affected all personal and social aspects of their lives. The theme of gender dysphoria is comprised of contradictory gender identities and contradictory behaviors.Most of the participants said that they do not like the gender that they were born with, and they tend to have the identity of the opposite sex, which is not accepted in Iranian society, since they experience contradictory gender identities. One of the participants said the following:I don't like the female gender; I have strong male tendencies. I've wanted to undergo surgery, leave this feminine body and look like a man several times. My family won't allow it. They say if I do it, they will disown me (Participant 10).The participants reported experiencing contradictory behaviors and interactions with their assigned gender at birth. A lack of compatibility between their gender identity and their assigned male or female body, engaging in activities such as wearing make-up and feminine clothing, experiencing hatred toward their genitals and female body parts, as well as adopting male clothing and behaviors were examples of contradictory behaviors associated with gender dysphoria.One of the participants stated that,Many times contradiction in my gender-related behaviors in my social and personal interactions has caused me mental and emotional shock. For example, one day, when I went shopping at a store, the other customers mocked me. One of them said, “Strange! Why does this guy look like a woman?' another said, “I don't think she was a woman. He seemed more like a man.”(Participant 16).Another theme extracted from the data in the present study was stigma and insecurity, as experienced by 20 participants. This theme comprises sexual abuse, social discrimination, disrupted occupational performance, a lack of support, and disrepute and disgrace.One of the psycho-emotional issues that threaten the security of transgender individuals is sexual abuse, as reported by 15 participants, nine AFAB and six AMAB. Moreover, this type of abuse is more prevalent in childhood and adolescence. One of the participants stated the following:A friend of mine who is transgender people once told me that when he was serving in the military, he was sexually assaulted and abused by some other soldiers who were his roommates (Participant 17).Most of the participants revealed that one of the greatest challenges in their lives was being rejected by society and experiencing social discrimination. The absence of social justice and lack of access to cultural/social/recreational/educational facilities were the major examples of social discrimination against them. According to one of the participants,It's like we are not part of this society. Because of our disorder, they deprive us of our right to welfare and social services. What's the difference between us and other people? Like everyone else in the society [sic], we are entitled to have social rights as citizens (Participant 15).All participants stated that they were experiencing considerable occupational stress and that their gender dysphoria threatened their job security. One of the participants expressed the following sentiments:Our job prospects are really unclear. When we are not accepted by the society [sic], how can we have job security? For instance, I passed the employment test of a bank, but when they found out about my gender dysphoria [transgender people], they refused to employ me. My other friends that I'm in touch with have the same problem: none of them has job security or can find a job at all (Participant 18).Lack of support was another subtheme of stigma and insecurity in the present study. Based on 17 participants' experiences and views, individuals with gender dysphoria are in urgent need of a family and social support system. Lack of support threatens their security and aggravates their psycho-emotional crises and personal, family, and social stress. One of the participants stated the following:Most of the time, I feel really lonely. I don't think anyone cares about me, and I feel worthless and frustrated. I don't know where to seek refuge or who to ask for help. I only have hope in God's help, and it's only this belief in God that's making it possible for me to continue my life (Participant 19).As another subtheme of disrepute and disgrace, disrepute and disgrace caused great concern to 17 of the participants and affected all personal and social aspects of their lives. One of the participants stated the following concerns:Fear of stigma and a bad reputation is eating me. I feel ashamed. I feel I've lost my social and human dignity, don't have any value in the society [sic], and have brought shame to my family (Participant 14).The findings of the present study indicated that the lived experiences of young transgender individuals could be categorized into three main themes: mental health disparities, gender dysphoria, and stigma and insecurity.The young transgender people in the present study experienced serious psycho-emotional issues that influenced their psychological security as well as their personal lives and social activities. The theme of mental health disparities consisted of the fear of having one's secret revealed, depression and despair, suicidal thoughts, and secrecy in the family. In a study by Kade , the revMoreover, Nematollahi et al.  stated tGender dysphoria was another theme extracted from the data in the present study. The gender dysphoria of the participants influenced all personal and social aspects of their lives. The theme of gender dysphoria consists of contradictory gender identities and contradictory behaviors. Afrasiabi et al.  stated tStigma and insecurity was another category of the experiences of young transgender people in the present study. This theme comprised sexual abuse, social discrimination, disrupted occupational performance, a lack of support, and disrepute and disgrace. In many studies involving transgender individuals, the study population mentioned being stigmatized in educational environments, workplaces, and other social venues, and many of them deemed it necessary to hide their gender identity. In a study by Bowling et al. , one of To avoid the negative attitude and criticism of their society, the families of some transgender people moved to other countries or larger cities or even made their children immigrate alone , 38. In One limitation of the present study was the small size of its study population, which may not represent all transgender people. Moreover, there is a lack of generalization of the findings due to the probability sampling method. Moreover, the lived experiences of transgender people who were not willing to speak to the researcher were not included, which may limit the transferability of the results. It is recommended that more studies need to be conducted to investigate the experiences of this population in different cultural contexts. Another limitation of the study was that, because of the COVID-19 pandemic, the participants were not interviewed face to face. However, the researchers used video calls to improve their interaction with the participants.The findings of the study suggest that participants in Iran are subject to considerable mental pressure. In addition to disrepute, infamy, and stigma, participants are faced with sexual abuse, social discrimination, unemployment, and a lack of family and social support. Moreover, concerns about the future, despair, and suicidal thoughts are other issues these people in Iran have to cope with. Raising public awareness, avoiding bias against transgender people, and not criticizing them or their families are essential to preserving their dignity. The results of the present study can help mental health experts and the healthcare system as a whole to adapt their mental and physical health programs according to the needs and experiences of these people and their families. It is recommended that further studies need to be conducted to investigate the experiences of this population across different cultural contexts.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.In the present study, individuals who met the inclusion criteria of the study were identified after the researchers had obtained permission from the Ethics Committee of the research department at the University of Medical Sciences in the west of Iran (IR.UMSHA.REC.1401.477). The patients/participants provided their written informed consent to participate in this study.FM, MB, and SZM were involved in the conception and organization of the study. SZM, FM, and KO were involved in the execution and data collection of the study. FM and BT participated in statistical analysis design and/or execution. All authors contributed to the preparation and critical review and approved the final version of the manuscript.


The study of the biological meaning of its song can provide a theoretical basis for understanding the adaptive evolution of the communication methods of burrowing rodents. So far, the acoustic signal and behavioral response analysis of the plateau pika have been carried out independently, and there is no comprehensive understanding of the biological significance of the calls of the plateau pika. In this study, based on previous studies on the call of plateau pikas, it is assumed that plateau pikas can use acoustic signals to transmit alert information. To test this, we first collected the alarm call of plateau pikas, and then used field playback experiments to verify the alarm call of plateau pikas. Finally, in order to determine the universality of the alarm call of plateau pikas, we conducted playback experiments in different regions. Our research results show that plateau pikas can transmit alert information through acoustic signals, and their alert calls are responded to differently in different regions.With the continuous progress in research technology, it is found that auditory signals are particularly important for social rodents. The plateau pika Ochotona curzoniae) is a call-producing mammal endemic to the Qinghai–Tibet plateau (QTP) and considered a keystone species owing to its multiple benefits in alpine rangeland ecosystems. Previous studies have shown that plateau pikas emit alarm calls as part of their daily activities. However, only field observations have been used to identify these alarm calls of the plateau pika, with no attempts at using playback experiments. Here, we report the alarm calling of plateau pikas through field observations as well as simulated predator and playback experiments in the Eastern QTP from 2021 to 2022. We found that both female and male adults emitted alarm calls, the signals of which comprised only one syllable, with a duration of 0.1–0.3 s. There were no differences in the characteristics between the observed alarm calls and those made in response to the simulated predator. The duration of the alarm call response varied with altitude, with plateau pikas living at higher altitudes responding at shorter durations than those at lower altitudes.Acoustic communication plays a vital role in passing or sharing information between individuals. Identifying the biological meaning of vocal signals is crucial in understanding the survival strategies of animals. However, there are many challenges in identifying the true meaning of such signals. The plateau pika ( Intra- and interspecific communications are important aspects in the daily activities of animals in the wild ,2 since (Ctenomys pearsoni) will frequently make a unique courtship sound in the initial stage of reproduction [(Rhombomys opimus) are frightened, they will emit a short whistle to alarm other individuals [Worldwide, rodents are the most diverse of the small mammals , and areoduction ; when geividuals ; and squividuals . Alarm cividuals . The individuals , which i(Ochotona curzoniae) is a rodent-like small mammal inhabiting the alpine rangeland ecosystem at an altitude of 3000–5100 m [Grassland rodents usually choose to live in groups to reduce the risk of predation and the consumption of energy through thermoregulation . This so0–5100 m . Pikas c0–5100 m . The str0–5100 m .The study of acoustic communication in the plateau pika started in 1986. To date, there have been four papers that have reported the types of calls and their meanings in plateau pikas. Smith et al.  firstly From the above studies, it is clear that the analysis of acoustic signals and behavioral responses in plateau pikas have thus far been independently conducted, and a comprehensive view of the biological meanings of pika calls is lacking. Therefore, the aim of this study was to identify the alarm calls of plateau pikas via an integrated approach that recorded short calls and their accompanying behavioral responses in the field and used a simulated predator to induce the alarm calls. Furthermore, playback experiments were conducted to verify the reliability of the biological meanings of alarm calls in plateau pikas. Kobresia humilis, Elymus nutans, Potentilla fragarioides, Potentilla anserina and Poa annua , Maai township  and Nima township , in Xiahe county, Luqu county and Maqu county, respectively, were employed in this study . All throa annua . The thrAt the Bola township study site, we recorded the pika calls and their accompanying behaviors as the pikas emitted the calls. We also used a simulated predator to induce the plateau pika into emitting alarm calls and conducted playback experiments. At the other two study sites, we also conducted the playback experiments to verify the reliability of the alarm calls obtained in the field. The complexity of the calls along with the researchers’ previous delimitation of the seven types of calls were too subjective to serve as a basis for classification. The plateau pika’s call is temporarily only divided into long and short calls based on the duration of the call. The calls of plateau pikas were classified into two types (long and short) according to the call duration. Long calls were more than 10 s and short calls less than 10 s. We adopted the definitions of vigilance behavior and call types in plateau pikas outlined by Smith  and Zhan®, Tokyo, Japan) connected to an SY-322 shotgun microphone  was used to record both the calls and the behavior of the marked individuals in their habitat. Recordings were made for four hours in the morning and four hours in the afternoon, for 10 days in each month, resulting in a total of 280 h of recordings in March and April 2021. The purpose of the recordings was to select the potential alarm calls from all the short calls emitted by plateau pikas.Plateau pikas are diurnal small mammals with a relatively greater seasonal activity in March and April than in early spring. Previous research has shown that only adult plateau pikas utter long and short calls in spring . Using tFor identifying the real alarm calls of plateau pikas, we built a weasel-like, remote-control piece of equipment that we used to simulate a predator to induce the marked pikas into producing alarm calls. All observers stood far out of sight of the marked pikas. One of the observers controlled the equipment to move forward toward the marked pikas, while the other observer recorded the alarm calls induced by the simulated predator and the pikas’ accompanying behavior. Adobe Premiere Pro 2020 software was used to select the alarm calls with obvious vigilance behavior and turn them into .wav format. Then, we used Adobe Audit 2020 software to reduce the noise and analyze the available acoustic signals to obtain the sound duration, sound frequency and number and interval of syllables [A Bluetooth speaker  placed in the center of the pikas’ habitat was used to play the alarm calls processed by the software in the field. The loudness of the alarm call playback was 88 dB. A Sony A7R3 video camera was positioned alongside the speaker on the ground. The observers remained inactive in the field for 15 min prior to the start of the playback experiment and, after the pikas had adapted to the presence of the observers ,28, we rThe video recordings were imported from the video camera in .mp4 format into a notebook computer. First, we used Adobe Premiere Pro 2020 software to select sound clips with obvious vigilance behavior and turn them into the required .wav audio format. Then, we used Adobe Audit 2020 software to reduce the noise and intercept the audio files that needed to be analyzed to obtain the sound duration, sound frequency and the duration and intervals of syllables in the sound. Open Adobe Audit 2020 software was used to import the target audio and obtain the waveform diagram and spectrum diagram of the target audio. Frequency analysis was selected in the configuration menu window option, in which the higher the FFT size, the larger the analysis resolution. Higher FFT sizes report frequency data more accurately, but they require longer processing time. Hamming and Blackman options that can accurately reflect the center frequency were considered, and the number of syllables in each sentence were counted via the language map of Adobe Audit 2020. The measurement parameters included sentence duration, syllable duration and syllable interval. The gene frequency and frequency range of each song were counted using the frequency spectrum. All data were recorded in Excel 2019, and the mean square deviation of the duration of different vocal segments and syllable intervals were calculated in SPSS19.0 software.During the experiment at the Bola township site in April 2021, a total of 201 effective calls were recorded, including 157 long calls and 44 short calls. These long calls were emitted by male pikas; however, the short calls were emitted by both male and female pikas . The durThrough field video observation, it was found that plateau pikas produced no obvious response to the arrival of cattle and sheep on the grassland, and remained in whatever their previous state was at the time. However, if their companions emitted a very short chirp, the observed plateau pikas would immediately show behaviors such as sitting on the grass with their necks stretched out, stopping their feeding, standing and watching, quickly escaping to the burrow entrance, or entering the burrow . These bIn the field, the remote-control model was used to simulate a nearby disturbance from a predator. It was found that plateau pikas would make a very short call when faced with an approach of the remote-control model, and the other pikas would quickly enter an alert state. When the sound was emitted, the animal that made the sound would shake their body with the sound, and then the other animals would stop eating, stand and watch, quickly escape, or enter their burrow. This kind of chirp was the same as the short chirp alert issued by plateau pikas in a natural and non-interfered environment. It is a short, single-tone chirp with only one simple syllable. The sound parameters of the two chirps are shown in After recording and observing the vigilance behavior of wild plateau pikas, the alarm calls of individuals that showed obvious vigilance behavior were recorded and extracted after noise reduction. Four temporary alarm calls in 2021 were selected, and five in 2022, resulting in a total of nine sounds. Each sound was verified by field playback experiments, five times at random. The results showed that plateau pikas respond vigilantly to the alarm calls played in the field , but theHe et al.  proposed [(Ailuropoda melanoleuca), the interactive behavior of the mother was observed, which determined the sound function of the cubs [Animal acoustic communication research methods combined with functional anatomy can help gauge the functional relationships between animals’ vocal organs, signal-receiving organs, acoustic parameters and individual differences. For example, it was found that the structure of the cochlea in plateau pikas is highly adapted to receiving high-frequency acoustic signals, as compared to the same structure in the subterranean plateau zokor anierii) , althougthe cubs . In ordeDuring the present study, it was observed that plateau pikas produced no obvious response to the arrival of cattle and sheep on the grassland, but would immediately respond with vigilance to an unknown presence, such as that simulated by our remote-control model. It is likely that, as part of the long-term survival process, pikas have learned that livestock pose little to no threat, and hence show no obvious vigilance behavior in their presence. The remote-control model was a strange and unknown presence to the plateau pika, meaning that the perceived risk would be high and they would immediately enter an alert state to ensure their safety once the model appeared. Note that we chose to use a ground-based remote-control model instead of an unmanned aerial vehicle (UAV) because the former is easy to camouflage, is relatively quiet, and is easier to operate and control. Conversely, with UAVs, which are noisy, it is impossible to distinguish whether the plateau pika’s vigilance behavior derives from the threat of a perceived predator or simply from the considerable noise that the UAV produces. The use of UAVs for simulating an airborne natural enemy is not yet mature, because these types of predators in the sky will not make a loud noise when hunting.During the playback experiments, it was observed that plateau pikas would respond with vigilance to the playback of alarm calls at different times and that the alarm calls could also elicit vigilance responses in different areas. This supports our observation that alarm calls are common in plateau pika populations, rather than a special behavioral adjustment or response between specific individuals at a specific time or geographical location. During the study, plateau pikas responded differently to different alarm calls, which may be because there was too much background noise in the field during the sound processing, and the pursuit of low noise in the noise reduction process would distort some of the audio, resulting in differences in the results of the playback experiments. In the field playback experiments, windless and sunny weather was selected as much as possible to eliminate the interference of wind speed and direction on sound transmission, but the existence of natural wind is still inevitable. Therefore, the behavioral response of plateau pikas to different alarm calls may be affected by wind speed and direction, resulting in observed differences when playing back the sound .Heterocephalus glaber), it was also found that unique group dialects could be detected, and it was shown via audio playback that individuals gave priority to their original group dialect [It was found that plateau pikas in different regions produced vigilance behavior when facing the same alarm call, but the duration of the vigilance behavior differed. This may be because plateau pikas in different places have “dialects” when they chirp, which makes their voices different. When the recorded alarm calls were played back in the sound acquisition areas, plateau pikas responded with long-term vigilance behavior. In a study of the naked mole ( dialect . The abi dialect . One pos dialect . The greThe ability of plateau pikas to survive relies on the timely discovery of the existence of risk, making quick and effective strategies, and regulating the time and energy allocation of different behaviors. The plateau pika has become an important part of the alpine meadow grassland ecosystem on the QTP because of its fast reproduction and strong adaptability , which hDue to time limitations, the present work can only be considered to be a preliminary study on alarm calls among plateau pikas. Owing to the complexity and variability of other sounds, it is difficult to determine their biological meaning in such a short period. Moreover, when the biological meaning of the emitted sound is uncertain, it is difficult for verification experiments to achieve meaningful results, and so more time is needed to collect a larger number of calls for analysis.Plateau pikas can use acoustic signals to transmit information, and different calls have different acoustic characteristics and represent different biological meanings. The alarm call of plateau pikas is a very short call. In the face of an alarm call issued by different individuals at different times, vigilance behavior can be elicited in other individuals as a response. Plateau pikas in different regions still respond with vigilance behavior in response to the same alarm call, but their alarm call may have dialect differences, and individuals will give priority to the dialect unique to their original location.


Research indicates a similar effect of Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for borderline personality disorder (BPD). However, there is a paucity in studies investigating the change narrative received from and developed in these treatments. The aim of the present study is to investigate similarities and differences in the change narratives provided by MBT and DBT, and how these narratives reflect the rationale, explanations, and procedures of the provided treatment.The study is a qualitative analysis of seven interviews conducted by the authors. Three of the participants had received MBT, and four of the participants had received DBT. This study presents an Interpretative Phenomenological Analysis (IPA) of the change narratives received in two specialized treatments for BPD.The main findings from the IPA were that the change narratives described by the participants reflected the treatment they received. The DBT participants highlighted explicit learning of tools and techniques, with predictable and safe therapists. In contrast, the MBT participants emphasized a long-lasting process of exploring to create procedural learning with therapists who followed their lead.The participants’ stories of change shed light on how a change narrative was developed, and therefore how the rationale, explanations and procedures were conveyed differently by MBT and DBT. Alice’s Adventures in Wonderland , Frank and Frank proposed four effective features shared by most healing rituals across cultures and across time. One of these was “a rationale, conceptual scheme, or myth, that provides a plausible explanation for the patient’s symptoms and prescribes a ritual or procedure for resolving them” The aim of the study was to openly investigate how patients who have received MBT or DBT experienced change in the treatments they received. When we looked closer at what the participants spoke about in the interviews, we became more and more interested in the systematically different change narratives they received from MBT and DBT, respectively. Furthermore, we wished to investigate how the similarities and differences in change narratives could be understood in light of the treatments’ rationales, explanations, and procedures.Interpretative Phenomenological Analysis (IPA) has been used as the fundamental method throughout the study. IPA is a qualitative method particularly suitable when seeking to understand an individual’s experience of their own lived experiences, and the meaning they relate to those experiences . The devBoth the phenomenological and the hermeneutic perspective is essential in IPA, as well as insights from the combination of these two. IPA is phenomenological because it is concerned with exploring a person’s experience in its own terms. Using IPA, the researcher strives to make sense of what the participant is trying to make sense of, namely what has happened, or is happening, to them . HermeneThe Norwegian Regional Committees for Medical and Health Research Ethics (reference number: 280677) and National Center for Research Data (reference number: 424892) have approved the study. The participants received written and oral information from the authors about the project and its purposes. All participants signed a letter of consent before the interviews were conducted.The sample consisted of seven participants. Four participants had received DBT and three had received MBT. Six of the participants were female, and one of them male. The participants’ age ranged from the mid-twenties to the mid-forties. According to themselves, all the participants met the inclusion criteria for the project. Inclusion criteria included that they at some point had met the criteria for F60.3 Emotional unstable personality disorder according to ICD-10, they had gone to either DBT or MBT, they ended their course of treatment at least 3 years ago and that they felt they could speak freely of their experience of receiving MBT or DBT. Two of the MBT participants received the regular MBT program, with 3 years in MBT-G and MBT-I, while one of them received a 16 weeklong MBT group, as well as receiving individual therapy. All the DBT participants received the regular DBT program.Five of the participants were recruited through two different Facebook groups where the invitation letter was posted, and two were recruited by a communications advisor at National Advisory Unit on Personality Psychiatry. Potential participants then contacted one of the authors by e-mail or SMS. This enabled the authors to contact the potential participants by telephone, and further information about the project was given. After the telephone contact, the participants were sent a digital letter of consent they could sign by using an electronic identification system. Five of the interviews were conducted via Zoom, and two were conducted in the premises of the Psychology department of University of Oslo.before therapy, during therapy, and after therapy. The interview guide was later modified to better suit the IPA framework as it is presented by Smith et al.  to a following (MBT) strategy, and from a held (DBT) to a more fluid (MBT) format. This could be understood considering the two therapeutic traditions that DBT and MBT springs out of, namely cognitive behavioral therapy and psychodynamic therapy , patients have the right to receive treatment befitting for their characteristics, culture and preferences . This miAdditionally, a lack of pluralism could potentially limit the field of psychotherapy’s progress in research. This is because favoring one evidence-based treatment over another could hinder equal chances of funding . A pluraThe original contributions presented in the study are included in the article/The Norwegian Regional Committees for Medical and Health Research Ethics, National Center for Research Data and The Science Ombud at University of Oslo have approved the study. The participants received written and oral information about the project and its purposes. The participants signed a letter of consent before the interviews were conducted. They were free to end participation if desired. During the length of the project, careful consideration of the BPD patient group in general, and the participants in particular, has been important. Patients with BPD often experience stigma in psychiatric and somatic health care, and in society in general. Attending to the participants’ well-being as well as maintaining respect have been at the forefront of our consciousness at all times. The potential benefits of the study have been compared to potential costs. Measures have been taken to minimize risk throughout the whole project, but especially in the making of the interview guide and in carrying out the interviews.TS and AHT conducted the study and wrote the manuscript. ES and EF contributed with concept, design, conceptual issues, analysis, and edited the manuscript. All authors contributed to the article and approved the submitted version.


In the CCP, women were significantly more likely to receive midwife assistance in infant care (90%) than women in the traditional care model (60%) (p < 0.001). Significantly more CCP patients want to return to the same hospital for their subsequent childbirth (74%) than women in the traditional model of care (43%) (p < 0.001). In patients’ opinion, the new CCP model is superior in meeting their needs and providing higher-quality services. However, educating women that an obstetrician-gynecologist and a midwife can manage their pregnancy is still necessary. In addition to the CCP program, special attention should be paid to available pain management during childbirth since the use of analgesia is still insufficient in Polish hospitals.Care for a pregnant woman can take various organizational forms. The World Health Organization (WHO) recommends leaders increase research into health systems. The aim of this is to manage the healthcare system in such a way as to provide beneficiaries with access to high-quality services with limited financial resources. The study presented in this paper was conducted using a diagnostic survey on a group of 1697 Polish women in the traditional model of care (TM) and 3216 women in the Coordinated Care for Pregnant Women Program (CCP). Two research tools were used in this study. The first is a survey prepared by the National Health Fund, the second is an author’s survey. The results indicate that most women (85%) receiving care under the CCP received effective pain management, compared to 67% under the traditional care model ( One of the goals set out by the UN Human Rights Council is to improve the quality of perinatal care in the world. This assumption is also confirmed in declarations relating to international politics ,2. The gIn Poland, every pregnant woman can choose one of two models of pregnancy care. In the first model , a woman makes separate choices of a doctor, a midwife, and a hospital where she will give birth. Each medical professional can work in a different healthcare facility, and they are not likely to contact each other ,9. The s-Assessment of the health of the pregnant woman, fetus, and newborn.-Detection and elimination of pathology risk factors.-Control of the patient’s test results, including blood group determination.-Conducting childbirth with a focus on natural childbirth.-Taking care of the pregnant woman, midwife, and newborn.-In the event of indications, providing the woman with specialist care.-Support for the mother and her relatives during childbirth and the postpartum period.-If necessary, ensure a faster termination of pregnancy.The main tasks of a person taking care of a pregnant woman include, in particular :-AssessmWhen pathological symptoms appear, when a midwife takes care of a pregnant woman, she must immediately be under the care of an obstetrician.According to applicable recommendations in Poland, pregnant women should have eight check-ups with a physician or midwife. If a midwife provides care during pregnancy, a physician should be consulted three times: up to week 10, between 24 and 26 weeks, and between 38 and 39 weeks. The remaining five visits can be scheduled with the midwife. A pregnant woman should have eight follow-up visits with a doctor or midwife. Even when the care of a pregnant woman is provided by a midwife, medical consultation should take place three times: up to the 10th week of pregnancy, between the 24th and 26th week of pregnancy, and between the 38th and 39th week of pregnancy. The remaining five visits can be made by a midwife. The doctor performs the first- and second-trimester morphological ultrasound and the screening for aneuploidy. In the case of physiological pregnancy, the patient should be followed up at least every 3–4 weeks. Physicians monitor 99% of pregnancies in Poland. Within the framework of perinatal care, the midwife is in charge of antenatal education, which can be carried out individually or in groups. Individual antenatal education is also the task of the obstetrician-gynecologist (OB/GYN). Education covers the period of pregnancy, childbirth, and the postpartum period. In Poland, patients usually only see the midwife before an appointment with their OB/GYN. Significantly, between weeks 21 and 31, a pregnant patient can visit the midwife once a week, and as of week 32, until labor—twice a week within the framework of the National Health System. During these visits, the midwife conducts perinatal education instead of birthing school, and the women do not use that solution ,13.Nursing care for the baby and the mother is the midwife’s responsibility. The midwife should mark the newborn, cut the umbilical cord, and assess the newborn on the Apgar scale; if possible, this assessment should take place on the mother’s belly .Before the mother and child are discharged from the hospital, external medical documentation of the newborn should be prepared, which will include, among other things, recommendations on the child’s nutrition, instructions on how to latch the child to the breast, and information on the need to choose a primary care midwife who will perform patronage visits .Breastfeeding information should be consistent and up-to-date, and instruction should be given on proper latching on and a variety of feeding positions.The midwife’s tasks during patronage visits specifically include: assessment of the general condition of the patient, the condition of the uterine muscles, perineal wounds, and the condition of the mammary glands and nipples. The midwife should also assess lactation, body hygiene, and the woman’s mental state. The midwife’s tasks also include checking the general condition of the newborn, the condition of its skin, reflexes, nutrition, eyes, the condition of the umbilical cord stump, how to care for body hygiene, and the hygiene and safety of the room in which the newborn is staying. They should also pay attention to family relationships and care possibilities of the family, encourage natural feeding, inform about the need to take the child for vaccinations, and inform about the need to visit an obstetrician in the eighth week after delivery .In both groups, the tasks of the midwife before and after childbirth are the same. Patients decide whether they want to be part of the CCP or TM at the first visit to the doctor or midwife. The medic presents the patients with both options.This study aims to compare the quality parameters of two models of care for pregnant women in Poland: the CCP and TM models. The study compared qualitative parameters related to childbirth, such as labor pain relief, help provided by midwives with the baby after birth, and privacy respect.A schematic of the carried out works to collect data required for the purpose of the research can be found in The study design was cross-sectional. In the first half of 2019, all 27 hospitals implementing the CCP were asked to provide data based on patient surveys evaluating this model. Eight hospitals (33%) located throughout Poland agreed to share completed surveys. Hospitals provided data for over 1000 women for each of the years between 2017 and 2019. Received questionnaires were rewritten into MS Excel, for comparison. In the second half of 2019, further data were collected directly from hospitals. Data were collected from 3216 patients in total. Patients provide informed consent to complete the postpartum survey by joining the program. In the next step, we created a proprietary research tool based on an earlier survey developed by the National Health Fund . Private healthcare was available to women in both groups, while only public healthcare was considered in the study. The author’s questionnaire also contained sections on outpatient care, perinatal care, and postpartum care. In addition, the first part of the survey included the metric part, which was missing in the survey prepared by the National Health Fund. The survey did not require translation. This tool was shared online on sites related to perinatal care. The survey was only in electronic form. The link was available for two months, and filling in the survey was voluntary. The survey was available online for 2 months. It was impossible to complete the survey without completing all the questions, thanks to which all the obtained surveys were complete. When one of the respondents interrupted the survey in the middle, the survey was not saved on the disk. The study involved 1697 women in traditional care. The inclusion criterion was childbirth within six months of the study. If a woman was pregnant more than once, only the last pregnancy was taken into account. The exclusion criteria included childbirth more than six months prior to the study and pregnancy management under the CCP. If there was a non-response error, the survey was not taken into account. In the case of online surveys, this was not possible.The questionnaire used for CCP patients consisted of three parts: A, S, and P. The first (A) concerned outpatient care and consisted of eight single-choice questions. The second part (S) focused on care in the hospital, which contained thirteen single-choice questions, and the third part (P) assessed care during the puerperium, which consisted of four single-choice questions.As researchers comparing both models, we had no influence on the research tool for the study of women in the CCP model , which did not include respondents’ demographic and social data. We present patient data only from the traditional model because we studied them with our proprietary tool, which included additional questions.The study was conducted with ethical principles. The Bioethics Committee of the Medical University of Gdansk approved the study. The study was conducted under the Declaration of Helsinki. The collected data were stored on a password-protected online drive with two-step verification, to which only the first researcher had access. Before participating in the study, each participant had to consent to take part, and the study was voluntary.cV) was used for larger tables . These measures take values in the range of 0 to 1, where 0 means no relationship and 1 signifies a full relationship between the variables. In this range, the significance level is α = 0.05, obtained from the chi-square test.Statistical analysis was performed in IBM SPSS Statistics 28. Chi-square independence tests were calculated to assess the relationships between categorical qualitative variables. The factor Phi was used to measure the relationship in the 2 × 2 tables.  Cramer’s V  with higher education (80%) living in cities with populations over 50 thousand (53%). The second most numerous group comprised women aged 31–35 years (28%) with higher education (90%) living in cities with populations over 50 thousand (63%). The least numerous group was women over 40 years of age (0.5%) with higher education (75%) living in the countryside (38%) and cities with populations up to 50 thousand (38%). Further analyses concern both groups. As shown in A chi-square independence test was performed to analyze the differences in the choice of healthcare professional between CCP and TM patients. The results are shown in The analysis revealed significant differences in the availability of the choice of the pregnancy caregiver between CCP and TM patients. Therefore, to understand this relationship, additional post hoc analyses were performed to further explore the issue  and patients under the traditional model of care (TM). Therefore, additional post hoc analyses were performed to further explore this issue . The next question concerned the willingness to return to the same hospital for subsequent childbirth. According to the data presented in Then, an independent chi-square test was performed to analyze the differences in the willingness to return to the same maternity facility between CCP and TM patients.There were significant differences in the willingness to choose the same maternity facility between CCP and TM patients. Additional post hoc analyses were performed to further explore this issue  could choose who would manage their pregnancy (physician or midwife) more often (92%) than patients receiving care from the traditional model of care (TM), where only 26% of women could make such a decision. This indicates that the traditional model (TM) is less likely than the CCP to provide pregnant women with the choice of their caregiver. In his speech, the Ombudsman in Poland drew particular attention to the issue of availability of choice in selecting the obstetrician provider according to the patient’s gender preference. For some women, receiving care from a woman or a man is essential. Women should be given a choice, especially if they have experienced sexual violence . A studyMuch of the research in this review confirms that the concept of woman-centered care is the foundation of good midwifery practice for midwives to act as anchoring companions, listening to the woman, allowing her to participate in her care, and building trusting relationships.Another vital element of perinatal care is the availability of anesthesia during labor. One of the most common fears of women associated with pregnancy and childbirth is pain during labor . There aThe regulation of the Minister of Health of 16 August 2018 on the organizational standard of perinatal care clearly states that a woman should receive education on breastfeeding, lactation support, and solving lactation problems in the framework of antenatal education. During childbirth, she should receive instruction on latching and support in breastfeeding. The midwife should also supervise the first breastfeeding session and provide the mother with consistent and up-to-date information [A woman giving birth should be treated with respect and should be allowed to make decisions about herself and her newborn. The hospital staff should pay attention to the speech, both verbal and non-verbal, tone of voice, words, body posture, and eye contact. Personnel should ask the mother about her needs and expectations and, if possible, realize them. Each person caring for the mother should introduce themselves and explain their role in caring for her. Staff should have a calm and trustworthy attitude. Privacy and the feeling of giving birth should be respected. Persons taking care of a woman in labor should familiarize themselves with her birth plan and, if possible, implement it, presenting the woman with the possibilities of pain relief, the use of physical activity, and optimal positions during childbirth, and call for help. The patient has the right to relieve labor pain, including using non-pharmacological methods such as physical activity, taking appropriate positions with available equipment, breathing techniques, massages, water immersion or acupressure, and pharmacological treatments ,29.Western governments are paying increasingly more attention to the quality of non-clinical services when monitoring the performance of the healthcare system ,31. In AAlso, the study conducted at the Mayo Clinic indicated the importance of interactions with clinical staff and their impact on the treatment process. The observations indicate that the staff members who contact patients directly should be thoroughly screened during the recruitment process to ensure that their behavior and the values they represent are consistent with the values of the medical institution. Staff should participate in ongoing training to enhance interpersonal skills, such as creativity, productivity, empathy, and extra effort in non-clinical support services that can influence and shape patients’ and their families’ perception of the overall quality of services .In its latest guidelines, “Intrapartum care for a positive childbirth experience”, The World Health Organization (WHO) pays special attention to providing respectful maternity care that reduces maternal morbidity and mortality. An individual approach to each patient and effective communication were considered very important. Positive childbirth experiences were considered the most important aspect . Future The patients’ opinions indicate that the new Coordinated Care for Pregnant Women program (CCP) protects their needs to a greater extent, allows for greater opportunity to make independent decisions, and provides services of a higher quality.It is necessary to continue to promote pregnancy management not only among OB/GYNs but also midwives.In addition to the CCP program, special attention should be paid to available pain management in labor since the use of analgesia is still insufficient in Polish hospitals.The CCP program was considered more satisfactory by patients—women received effective pain treatment more often, they could rely on help from midwives more often after childbirth, and most of them would choose the same hospital again for childbirth.There were no data regarding women’s marital status or place of living to provide additional information and check if there is any relationship between choosing each model. From interviews, we found that ladies chose their model out of curiosity, recommendation, or could not decide and chose one randomly.A limitation of the work was the use of retrospective data and the inability to obtain demographic data from patients receiving care in the CCP, as we used a secondary source.Another limitation was the inability to compare our results with other results of patients using the CCP because no one has conducted such studies in Poland yet, and the models of foreign care differ from those available in Poland. There is therefore a need for more research.The next limitation was access to the questionnaires. They were only available online, so women who did not use the Internet were not able to fill out the questionnaire.There were no data regarding women’s marital status or place of living to provide additional data and check dependence.