The lockdown imposed following the COVID-19 pandemic of spring 2020 dramatically changed the daily lives and routines of millions of people worldwide. We analyze how such changes contributed to patterns of activity within the household using a novel survey of Italian, British, and American families in lockdown. A high percentage report disruptions in the patterns of family life, manifesting in new work patterns, chore allocations, and household tensions. Though men have taken an increased share of childcare and grocery shopping duties, reallocations are not nearly as stark as disruptions to work patterns might suggest, and families having to reallocate duties report greater tensions. Our results highlight tightened constraints budging up against stable and gendered patterns of intra-household cooperation norms. While the long-run consequences of the COVID-19 lockdown on family life cannot be assessed at this stage, we point toward the likely opportunities and challenges. At least that’s what I’ve been told my life long by parents, friends -male and female- superiors, underlings and even my daughter these days. They’ve been conspiring together to demoralize me, I know; they think that if they go on telling me I’m hopeless they’ll convince me there’s an element of truth to the story. But I hang back on the sidelines, waiting for an opportunity to make myself useful, to redeem myself. Now the plates are all caged up in their little carriage, round faces astonished to find themselves standing upright, curved backs waiting for the storm about to break over them down there at the bottom of the tunnel where they will be sent off in exile until the cycle of cloudbursts, waterspouts and steam jet is over. This is the moment for me to go into action.’’ Italo Calvino, ‘‘La Poubelle Agree’’ in The Road to San Giovanni, pp. 58/591Frantically trying to limit the spread of the COVID-19 pandemic, governments worldwide imposed severe lockdown policies that suddenly changed the daily lives and routines of millions of people. This lockdown artificially created a fusion between the work and family life of men and women, who had to come to terms with their relative contribution to childcare and household chores. Such unexpected changes to the domestic division of labor fueled tensions and exacerbated pre-existing gender and socio-economic inequalities, and might lead to long-term changes in gender norms.health consequences of COVID-19 suggests that men have fared much worse than women, the emerging evidence on labor markets indicates that the impact has been stronger on sectors with high female employment shares and that women are more likely to be working in jobs that can be done from home and more likely to lose their jobs  disutility from working from home, and the associated cost of sharing childcare and other household duties. Following the crisis, both partners might have updated their priors and re-bargained the division of household chores accordingly. As a result, we can expect: (1) an increase in household bargaining with its associated tension and stress; and (2) an increase in strategic behavior, with partners believing the situation to be temporary signaling a higher willingness to cooperate than would normally be the case but revealing their true colors by specializing at gendered tasks.The burden of extra home production has fallen unequally on women with the potential for long-term negative impacts on their wages and job prospects, as well as potentially creating tensions within households. More positively, new ways of working – and the fact that many fathers are also now doing more – has been hailed as having the potential to help change gender norms and lead to a more equal allocation in some households in the longer term.Although the expectation from the outset was that mothers would invest more of their own time and resources into home schooling, childcare, and domestic tasks than fathers  thus exa2 excess mortality during the pandemic3 and, according to OECD projections,4 in economic terms too.In April 2020 we ran an online survey on a total of 3,157 adults (18--83 years old) and 235 children (4--18 years old). The survey was administered in three countries: the United States, the United Kingdom and Italy over the period 11--19 April, when our respondents had been in lockdown for between 5--6 weeks in Italy, 2--3 in the United Kingdom, and 1--4 in the United States depending on the respondent’s specific location. Rather than being a cross-cultural comparison study, these countries were chosen as they were among the worst affected OECD countries by COVID-19  in both reported COVID-19 deaths per capita,5 which stratifies samples across age, sex, and ethnicity. The participants in Italy  were recruited primarily through social media and thus cannot be expected to constitute as representative a sample as those of the United States and United Kingdom.6 Of the 3,157 adult respondents, 2,526 indicated that they are cohabiting with either their partner or another adult during the quarantine period . This is the subset for which, when division of labor responses were provided, we measured and summarized the re-allocation of household tasks. Of these 2,526 cohabiting respondents, 893 indicated that they are also living with their children during the quarantine period .The participants in the United States (949 adults and 42 children) and the United Kingdom  were recruited using an online survey collection toolhttps://osf.io/upq5g/. Adults were asked 46 questions. For the purpose of this paper, we focus on the adults.All recruited participants were directed to a Google Forms survey which varied by country. The Italian participants completed a survey which was in Italian, and the United States and United Kingdom participants completed versions of the survey in English, with minor variations to account for language use and demographic questions which vary across the two countries. All versions of the full survey may be found at Our survey is a study of family life during the first lockdown, aimed at understanding how daily routine had been modified, how the division of labor within the household had changed, and how personal wellbeing, family tension, beliefs and aspirations, risk attitudes, and the willingness to cooperate within and outside of the household had been during this lockdown.Questions asked about participants’ demographics, family status and living situation, as well as the ways in which the pandemic affected them and their households personally. This encompassed their health, wellbeing, employment situation, the allocation of labor within the household, tensions between household members, and anti-COVID prophylactic behaviors. Furthermore, to measure cooperation within couples, respondents took part in an incentivized Prisoners Dilemma game .Most of our questions are adapted wholesale from two main validated sources: Understanding Society – and in particular the Understanding Society Coronavirus Study: March 2021 questionnaire – and the United Kingdom Labour Force Survey. Some questions particular to COVID-19 were not piloted, our intention was rather to get the surveys out as quickly as possible during the height of the first pandemic wave. The children’s survey was written following the model of the Youth Questionnaire by Understanding Society and is composed of 45 questions, among which we included one unincentivized risk elicitation question.Many of the family dynamics we were interested in might have changed suddenly at the start of lockdown, so we asked subjects to describe their current as well as pre-pandemic work status, chore allocation, and levels of tension. This allowed us to implement a “pseudo-panel” design, in which we can investigate changes in the outcome for a participant, even though both are measured at the same moment in time.7 , and low levels of happiness8 . Respondents clearly feel isolated, and most reported that one of the first things they would like to do once lockdown ends is to visit family and friends . 20% of respondents in Italy, 41% of respondents in the United Kingdom, and 47% of respondents in the United States reported that one of the first things they would like to do once lockdown ends is to go shopping.By April 2020, the impact of the virus was already sizable. We find that 17% of respondents in Italy, 11% of respondents in the United Kingdom, and 10% of respondents in the United States were directly affected by COVID-19 either because they were tested for it or knew someone who was infected. 15% of respondents in Italy, 20% of respondents in the United Kingdom, and 17% of respondents in the United States lost their job or were furloughed. On a psychological level, respondents showed high levels of anxietyEven while struggling with the personal and social toll imposed by the pandemic, individuals sustain high levels of cooperation. In terms of cooperation with lockdown measures, most people adopt the recommended protective measures such as washing hands , avoiding shaking hands , keeping a safe distance from others , and avoiding crowded places . Mask-wearing habits vary greatly by country, 84% of respondents in Italy, 13% of respondents in the United Kingdom, and 58% of respondents in the United States reporting that they wear a mask in public, reflecting the lack of a general consensus amongst governments and intergovernmental organizations on mask effectiveness at the time of the survey. A majority of respondents also follow more restrictive lockdown measures like limiting supermarket visits as much as possible , refraining from visiting friends , refraining from visiting relatives , and staying home except in case of emergency .In terms of cooperation, 69% of respondents in Italy, 71% of respondents in the United Kingdom, and 75% of respondents in the United States are willing to cooperate with strangers who respect social distancing measures, whilst 21% of respondents in Italy, 14% of respondents in the United Kingdom, and 20% of respondents in the United States would cooperate also with strangers who do not respect measures. These results indicate a strong willingness to cooperate, but only with those who are deemed responsible and trustworthy. We furthermore tie households’ willingness to shift domestic labor allocations to cooperativeness. More cooperative households show propensity for a greater share of chores to be allocated toward the partner who experiences a relatively greater shift in time available to be spent at home – i.e., someone who has been furloughed when their partner has not. This indicates to us that the descriptive changes we see are not merely the utility-maximizing reallocations of a unitary household’s labor supply . Norms mshared childcare increased dramatically , and for most other tasks  sharing grew between 2 and 11 percentage points on average. The one exception is grocery shopping, which during lockdown became a more male-specialized task . Overall, the burden of household chores on women increased, which is problematic as there are significant reductions in lifetime earnings associated with performing these activities , and in the partner’s tasks, with men both in the United Kingdom and the United States samples reporting they do more  than what women say their partners do.time constraints faced by couples. Time constraints in our data are proxied by grouping individuals into three categories, according to their work status: working outside of the home (least time at home); working at home (moderate time at home); not working (most time available at home). Looking at the change in time constraints faced by respondents and their partners from before to during the lockdown, we can establish the potential for taking on more household work. We analyze the ‘‘shift in comparative advantage toward home production’’ by taking the difference between the respondents’ and their partners’ change in time constraints, in the spirit of a difference-in-differences9 approach . We focus on the perspective of individuals who saw an increase in time at home relative to their partners, for example people who started working from home during the lockdown while their partner kept on going to the office, or people who were laid off while the partner kept on working.10 As expected, those who lost their job report doing more now, while those who are still working report doing the same or less, especially in the case of women. The opposite is true for those whose partners lost their job, again especially for women. Similar results are found by To understand the reallocation of tasks within the household, and the ensuing tension, it is important to first understand the The left panel of 11For childcare, both men and women who saw a shift in comparative advantage toward home production take on more of this responsibility themselves compared to before. This same pattern, though slightly less pronounced, holds true across most other household work see . However12 We see that having relatively more time at home is always related to greater involvement in household chores (a negative coefficient), slightly more for men than women, although often the relationship is small. Specifically, men who experience relatively more time at home compared to their partners take on a greater share of childcare, as well as a greater share of grocery shopping, though this latter effect is smaller as we observe men taking on more grocery shopping duties regardless of their change in relative time at home. Only a few women are seen to take on a greater share of grocery shopping when they experience an increase in available time at home relative to their partners. Women also take on more cleaning duties when they experience an increase in relative time at home. Interestingly, whether respondents would be willing to cooperate with their partners in the Prisoner’s Dilemma game is also predictive of taking on more household responsibilities during lockdown, particularly men taking on more childcare and women doing more cleaning. Controlling for propensity to cooperate with one’s partner does not substantially change the estimated predictive power of experiencing a relative shift in time at home, suggesting independent contributions to the respondents’ willingness to reallocate household chores. Few movements in the allocation of cooking, laundry, or gardening duties are predicted. 13 Estimates are broadly similar whether or not we account for selection in the Italian sample.Additional evidence supporting the notion that shifting time availability is predictive of some – but not all – variation in household task reallocation is shown in So far, we have shown that the lockdown led to substantial reallocation of household chores, following not only changes in time constraints, but also individual propensity to cooperate with the partner and task-specific gender norms. Next we ask: is this reallocation of tasks conducive to more or less harmony within the couple? To investigate the potential consequences of an uneven reallocation of chores, we examine the respondent’s report on tensions about the division of household labor, quarrels before and during the lockdown, and the language used to discuss these issues.14 is reported by 28% of men and 43% of women amongst respondents in Italy, 28% of men and 37% of women amongst respondents in the United Kingdom, and 32% of both men and women amongst respondents in the United States. Child respondents report household tensions more frequently than adults, with 67% of children from the Italy sample and 64% of children from the United Kingdom and United States samples reporting significant household tension. In line with national surveys of wellbeing over the same period, most respondents report higher anxiety and lower instantaneous wellbeing relative to overall life satisfaction and sense of leading a worthwhile life, with women reporting consistently higher anxiety and lower wellbeing than men in both Italy and the United Kingdom, while the averages are closer for women and men in the United States sample. Average life satisfaction is 5% lower amongst women than men in the Italy sample, 1% lower in the United Kingdom sample, and less than 1% lower in the United States sample. Instantaneous anxiety, on average, is 19% higher among women than men in the Italy sample, and 12% higher among women relative to men in the United Kingdom and United States sample.15 These findings align with those in the United Kingdom and United States indicating that women, and mothers in particular, experienced a markedly larger decline in wellbeing than men during the pandemic  or who are working from home (while their partners kept on working outside of the house) are shouldering a greater share of household chores. The opposite is true for those whose partners lost jobs (but not them). Thus, asymmetric changes in job situations are strongly associated with a deviation from the The specialization pattern we find, with women doing more of everything and men doing more shopping, is corroborated by a range of studies carried out during the crisis. In the United States, We must also caution that while our United Kingdom and United States samples are representative on a few sociodemographic variables , we have obviously surveyed a segment of the population with stable access to the internet, as well as time availability to complete the survey. We are therefore unlikely to have sampled those families with the greatest tensions or sharpest time constraints. More work must be done to assess the needs of the most vulnerable families, especially since their wellbeing and health are most at risk from the COVID-19 crisis.As with much of the COVID-19 crisis, it is early days to speculate on the durability of these changes. However, there is some hope that more sharing of childcare and household work might be the silver lining on the cloud of adverse occupational effects that women are set to face: There is, as yet, no direct evidence on the impact of COVID-19 on gender norms. In many households, women are doing more childcare, and pre-existing norms may become entrenched. But some households, particularly those where men are not working, are now experiencing a more equal gender division and this may lead to longer-term positive changes, particularly if they are combined with new ways of working (more working from home). Even although the pandemic is forcing men to participate more in house work, many still do so by exercising their freedom to choose the more pleasant tasks, deciding how to contribute through gender-tinted lenses. The disaster literature suggests alternative scenarios for the short and the long run in terms of changes in the division of labor: A feature of the COVID-19 lockdown is that most of the work that was still happening, and all of the childcare, have moved into homes. This forced fusion of work and family life means that men at the very least witnessed, if not shared, the demand to be available for both work and family, typically experienced more acutely by working mothers. We do not yet know whether this will be sufficient to generate the changes in workplace and household culture necessary to create more balanced allocations of both paid and unpaid work , but theTwo things are distinctive about COVID-19 lockdowns. The first is the scale of the demand-side shock. The changes have been profound. The total amount of childcare being done at home is of a completely different order of magnitude higher than usual because of the closure of almost all formal childcare. The impact has been across the board, affecting all families, meaning that almost all men have increased the quantity of childcare they do.The second difference is that this is not a deliberate policy to promote a more equal distribution of childcare: changes in the division of labor are unintended consequences of measures to stop the virus from spreading. The changes in the division of household tasks that have been brought about may need to be recognized and reinforced to have longer-term effects.https://osf.io/upq5g/.The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: The studies involving human participants were reviewed and approved by University of Reading, School of Politics, Economics and International Relations Ethics Committee. Written informed consent to participate in this study was provided by the participants’ or their legal guardian/next of kin.SB, PB, and JV generated the Sankey diagrams of household task allocations. PB, JV, and MDG generated the household tension diagrams. SJ generated the word cluster diagrams. All authors contributed to the design of the study and to the writing of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.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.https://www.frontiersin.org/articles/10.3389/fpsyg.2021.687570/full#supplementary-materialThe Supplementary Material for this article can be found online at: Click here for additional data file.


Overdependence on the internet is a grave concern that has enveloped Malaysian youths which could lead to a variety of sequelae. This narrative review aims to determine the definition of internet overdependence and its associated factors, as well as the potential preventive and treatment strategies for internet overdependence. From the literature, internet overdependence is regarded as a 3-factor model encompassing salience, self-control failure, and serious consequences. Sociodemographic factors such as age, gender, and ethnicity, as well as psychosocial factors such as depression, anxiety, stress, and loneliness, were found to be associated with internet overdependence among Malaysian youths. A multimodal treatment approach is recommended by the implementation of various types of treatments, integrating disciplines such as pharmacology, psychotherapy, and family counseling. Despite various terminologies being used and unclear conceptualization of its nomenclature, overdependence on the internet is prevalent among youths in Malaysia. Future research should go toward establishing a clear definition of its terminology and attaining more robust evidence on treatment strategies. The good and the bad of the internet has been a continuous debate—it's penetration rate in youths is of particular concern. Malaysia recorded a notable increase in national internet usage from 76.9 to 88.7%, in a 4-year period, with 85.9% of them being individuals aged 44 and below . AlthougThere exists a rich collection of local internet addiction studies. Of these, a handful of internet overdependence studies targeting primary, secondary school students, college, and university students were reported –9. OftenTherefore, the aims of this review are to describe what constitutes internet overdependence and to examine its associated factors with reference to Malaysian youths. We conclude the review by suggesting strategies that could be implemented to curb overdependent usage of the internet among young people in Malaysia.internet addiction  and (repetitive) transcranial magnetic stimulation (rTMS). Past studies have investigated the efficacy of neuromodulation techniques and their effects on cognitive processes related to addiction –80. tDCSIn terms of psychotherapy, motivational interviewing, cognitive-behavioral therapy, reality therapy, as well as acceptance and commitment therapy were found to reduce internet overdependence , 85, 86.via the detoxification method. This may serve as an opportunity to subjects to engage in intensive psychological treatments and help them to build interpersonal relationships thanks to the therapeutic component of this approach.The residential treatment approach in internet use related disorder has been discussed in some literature but there is inadequate scientific evidence in its clinical utility. One study in Korea has reported the effectiveness of a 12-day residential program comprising education and alternative recreational activities  and founIn Malaysia, the 1998 Communication and Multimedia Act provides a legal mandate to defend a free and open internet. This mandate is overseen by government agencies such as Malaysia Communications and Multimedia Commission, and Cybersecurity Malaysia which were established to promote and regulate the development of communications and multimedia activities and to strengthen cybersecurity , 91. WitInternet overdependence has become an increasing public health concern but its evidence in preventive and treatment strategies is still lacking. Future internet overdependence research can focus on conducting a large-scale local prospective study integrating both preventive and treatment strategies. In addition, identification of neurobiological basis of internet overdependence would be a platform to design related biological treatment strategies for the condition. Subsequently, this will aid in the development of specific pharmacological treatment of internet overdependence.Despite various terminologies being used and unclear conceptualization of its nomenclature, overdependence on the internet is prevalent among youths in Malaysia. It is associated with certain modifiable risk and vulnerability factors. However, evidence on its preventive and treatment measures is lacking and inconclusive. Therefore, future research should go toward establishing a clear definition of its terminology and attaining more robust evidence on treatment strategies. In addition, the neurobiological etiology of this condition should be extensively studied in order to assist in the exploration of its therapeutic treatment modality in view of its nature, which differs from substance dependence.NRNJ and NI were involved in the conception and design of the review. All authors contributed to earlier drafts of the manuscript, which was finalized by NRNJ, NI, and K-AT. All authors did the literature searches and screened articles for inclusion and approved the final version of the article.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 2018, the World Health Assembly adopted a resolution on improving access to assistive technology (AT), and mandated the WHO to prepare a global report on assistive technology based on the best available evidence and international experience. As limited data on access to AT at country and global levels were available, there was a need to conduct representative population surveys in order to inform the development of the global report, national AT programs, and global initiatives. The objective of this protocol is to describe a multi-country study of access to assistive technology in six self-reported areas: use, source, payer, satisfaction, unmet need, and barriers. In collaboration with WHO Regional and Country offices, Member States, and other stakeholders, the Assistive Technology Access team in WHO coordinates the study. Data are collected through household surveys using the rapid Assistive Technology Assessment (rATA) questionnaire. Findings from the surveys will be published in the global report. Today, an estimated one billion people need assistive technology (AT) to lead productive, inclusive, and dignified lives, yet only 1 in 10 people globally are believed to have access to the AT they need. Access to AT is essential for many people to maintain and improve function, health, and wellbeing; and to participate in education, work, and social activities. Among people who commonly need AT are older people, people with disabilities, and people living with health conditions or with acute health conditions. As the world’s population lives longer, and the prevalence of noncommunicable diseases increases both in real terms and as a proportion of total health burden, the need for AT will increase and is expected to reach two billion by 2030 [In 2018, a resolution on improving access to assistive technology was adopted at the 71st World Health Assembly (WHA71.8). It requests WHO to prepare a Global Report on Assistive Technology (GReAT) by 2021 . As signDespite the urgency and the global imperative on improving access to AT, little country-level population data have been collected systematically to demonstrate the access to AT ,5. GReATIn 2018, the WHO Assistive Technology Access (ATA) team proposed the first draft rapid Assistive Technology Assessment (rATA) questionnaire to collect data on self-reported access to AT . Self-reIn January 2020, WHO launched a global initiative, and called for contributions to data collection on access to AT at the population level, inviting Member States and other AT stakeholders across the world to conduct surveys with the support of WHO. The goals of this multi-country study were to obtain data and evidence on access to AT; to advocate and raise awareness to governments and civil society about the importance of AT; to advance research and development in AT; and to support the design, planning, and prioritization of AT programs or interventions at country and global levels. The study is expected to provide essential data for the development of GReAT, and to understand efforts required to uphold the rights described in the CRPD and other international laws and conventions. The objective of this manuscript is to describe this multi-country study of access to AT.Using the rATA questionnaire, the multi-country study will collect self-reported data in representative population surveys in multiple countries across the world. Wherever possible, national household surveys representing the general population are to be conducted. Surveys representing the general population in one or more specific areas in a country will be conducted where national surveys are not feasible due to financial or logistic constraints.Two-stage cluster sampling is applied in each survey. The first stage is a random selection of geographical units (primary sampling units or enumeration areas), and the second stage is a random selection of households within each chosen geographical unit.The survey sample size is estimated based on the following formula:The survey targets the general population of all ages in the country or specific areas within the country. Given the purpose of the survey, all members of sampled households are eligible for inclusion. However, only people who consented, or whose guardian consented, are included.Adult members of the household will be interviewed directly unless they cannot answer the questions on their own . In case of absence, the household will be revisited up to three times to complete the survey. A proxy within the household will be interviewed when individuals are unable to answer. All children under the age of 15 will be interviewed by proxy, normally by the primary caregiver. Children between 12–15 years of age can be present and participate during the interview with the proxy. Children between 15 and 18 years of age can be interviewed on their own, provided that the parents or primary caregiver consents. However, local customs, laws, and organizational policies concerning child protection, in particular, might affect the survey plan in each context.A standard, adaptable pro-forma information sheet and consent form is provided to survey teams to use in the data collection see . The sur(1)Self-reported use of and unmet need for assistive products;(2)Sources of, payers for and barriers to accessing assistive products and related services;(3)Satisfaction with assistive products and related services;(4)Self-reported functional difficulties; and(5)Basic demographic information, such as age and gender.The rATA questionnaire collects data on:The questionnaire can be administered by trained interviewers. A manual was developed to provide explanation of the rationale and instruction for administration for the questionnaire . Two thrThe questionnaire has been translated into Arabic, Chinese, French, Portuguese, Russian, and Spanish by AT experts who were involved in the development, testing, or consultation of rATA. Translation, back-translation into English, and resolution of discrepancies by multiple experts were applied. The questionnaire will be translated into additional local languages if required in the surveyed population.A mobile application was developed by the WHO using the ERSI/ArcGIS software to support field data collection. Other data collection tools can also be used as long as the data collection process follows the standard procedure described in the manual and training workshops. The mobile application facilitates efficient, standardized data input. The application will store collected data on the device , and upload to the secured backend server located in the WHO headquarters when the mobile device is connected to internet. WHO will support each local survey team to validate the mobile application through standardized test cases prior to the enumerator training.Enumerator training is to be carried out by the local survey team lead based on the guide provided in the manual and the train-the-trainer workshop. Following the training, enumerators will be guided through field testing to practice the data collection process.To protect participants’ privacy, the survey will only collect de-identified data. Collected data are anonymized at input, as well as in the server with the coded participants’ ID, which will not allow the identification of the participants’ household location or personal identity. Administrative information that may directly or indirectly identify individuals will be re-coded before the survey commences. For example, village and household number will be coded ‘village—A, ‘village—B’, ‘HH—A’, ‘HH—B’. Only authorized local survey team members  will have access to the codebook. The specific address  is not recorded. To facilitate survey fidelity checks and basic geospatial analysis, a low-resolution GPS coordinate is stored. The coordinate is accurate to a 100 m radius, ensuring specific household location cannot be determined from stored data.Data cleaning and analysis will be conducted by the WHO in collaboration with local survey teams.The primary outcomes of the study include the following indicators for each surveyed country or specific surveyed areas in the country.(1)Prevalence of use of AT, which is the proportion of a population using assistive products.(2)Prevalence of need for AT, which is the sum of the prevalence of met need and the prevalence of unmet need. Prevalence of met need is the proportion of a population using assistive products that do not need new or additional assistive products. Prevalence of unmet need is the proportion of a population that needs new or additional assistive products regardless of whether they are already using assistive products or not.(3)Met need as proportion of need, which is the ratio of the prevalence of met need to the prevalence of need.Associations between the above indicators and the Human Development Index (HDI) of the surveyed country or specific surveyed areas in the country will be analyzed. HDI is a summary measure of average achievement in human development in three key dimensions: health, education, and standard of living .(4)Rank of assistive products in use, in need and with unmet need.(5)Rank of barriers to accessing needed assistive products.(6)Distribution of payers for and source of assistive product (including travel distance to source).(7)Level of satisfaction with the assistive products (including suitability for different environments and activities) and related services .Secondary analyses will determine:In the tertiary analyses, primary indicators will be stratified by age, gender, and living context. Additionally, functional profiles between respondents who self-report a need for AT, and those who report no need for AT will be compared to determine and address potential underestimation of population needs. Finally, further analyses will explore the predictive performance of HDI, and its individual dimensions for the primary indicators, namely, the prevalence of use and need, and the met need as the proportion of need for AT.According to the study goals, the data collection will support the country in developing or improving programs or interventions of access to AT. Countries participating in the surveys will be prepared to provide a follow-up consultation or services to address unmet need for AT identified through the survey. These will be at the individual level, national level, and global level.At the individual level, the enumerators will be able to provide information on local services for participants who are identified with any potential need for assistive products or services. The information will be delivered to the participants, for example, in a booklet with service and contact details. In countries, where little or no established local service is available, information about assistive products and their benefits will be provided to the participants.At the national level, the survey outcomes will be first discussed within the country with local AT stakeholders and relevant ministries to develop actional plans for improving access. Further analysis based on the survey data can be conducted to support developing such action plans according to country’s specific context, priority, and available resources.When the national surveys are completed, a rATA global data collection workshop will be organized by the WHO where all participating countries, as well as WHO regional and country offices, will be invited to share their experiences and action plans. This workshop aims to encourage knowledge exchange, as well as international and regional collaboration for joint development to address the challenges of access to AT.There are limitations in the study that need to be acknowledged. First, potential inconsistency in the survey translation and interpretation in multiple countries may limit data comparability. Language and culture differences may lead to various interpretations of the same question by participants from different countries. This limitation can be minimized by ensuring the survey methodology follows similar multi-country surveys used for other purposes. This includes following the standard translation process and field conduct process for enumerators, as detailed in the rATA manual. Adaptation to the methodology due to constraints in the local context, e.g., sampling design, should be kept to the minimum. Second, the standardized survey questions may limit country-specific barriers to be captured. To mitigate this, open-ended questions are optional to some topics where country-specific barriers can be captured. Third, self-reported need for AT may not be comparable to clinically collected data.Supporting governments to respond to the World Health Assembly resolution on improving access to assistive technology.Making reliable population-level data on the use of and need for AT available to stakeholders, including ministerial bodies, international development agencies, civil society organizations, and researchers, which will improve advocacy on AT, and support global cooperation on improving access to AT.Informing stakeholders and the general public about the need for and importance of AT for both individual and community development.Providing stakeholders with baseline data on the need and unmet need for, and current access to, AT in populations, offering them a possibility to compare design, planning, or prioritization of AT programs and interventions. It will also enable governments to monitor development in AT use and need in the population over time as an outcome measure of policy interventions.Providing an option for standardized data collection about population access to AT.The study is expected to contribute to the global AT development through:


Environment International. According to the report, 488 million people worldwide have long working hours, and more than 745 000 people died in 2016 from heart disease and stroke related to working more than 55 hours per week. These figures make long working hours one of the biggest occupational health hazards.On May 17, 2021, WHO and the International Labour Organization (ILO) released the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), published in the journal The health consequences of long working hours vary depending on factors such as the length of the working hours, job characteristics, socioeconomic status, and the individual's health condition. Overworking increases the risk of cardiovascular diseases and stroke, as well as affecting mental health. Physical and mental strain of the overworked people can start from acute physiological responses such as fatigue, stress, impaired sleep, and unhealthy lifestyle changes in response to the stress. In addition, overworking reduces work performance and results in productivity loss due to illness and occupational injuries.karoshi, which means death by overwork, to describe the cause of death. The 2018 report on World Employment and Social Outlook released by the ILO showed that people in low-income and middle-income countries were inclined to work longer than those in high-income countries; thus, it is unsurprising that the overworked phenomenon is even more common in the region's lower-income countries.Since the ILO put the 8-hour workday into international law in 1919, the average working time has decreased in most countries globally, but the number of people who overwork has been increasing since 2000 according to the WHO/ILO Joint Estimates. The uptrend is more frequently observed in people living in the Western Pacific and southeast Asia regions. Many countries in these regions have the longest working hours compared with the rest of the world. For example, in South Korea, 25·2& of employees work at least 50 hours per week, compared with the average of 11& in member countries of the Organisation for Economic Cooperation and Development. Overworking is so common in Japan that there is a legal term, Long working hours have been praised for contributing to fast economic growth in the Asia-Pacific countries. By contrast, the side-effects of overworking have been discussed but have not received sufficient attention. Unlike other working conditions, which might involve exposures that are difficult to avoid due to the nature of the job, working time can be modified through legal amendments; however, the reality is much more complex. Despite years of labour reforms to reduce the length of the working day, overworking remains a serious social issue in many countries in the Western Pacific region. Other than social and cultural factors, capitalism's demand for profit as well as financial concerns and fears over job insecurity from the perspective of the workforce drive people to work more. The rise of the so-called gig economy and telework was supposed to enable reconciliation between work and daily life, but rather than the convenience and flexibility it has provided, the new work model has been criticised for blurring work and life boundaries and raising demands and expectations from employers. The COVID-19 pandemic is likely to be worsening the situation. A study of 3·1 million employees from North America, Europe, and the Middle East in 2020 suggested that the average working hours had increased by 48·5 minutes. For health workers and other essential workers, the growing demands for their services to maintain daily life has made them work for a prolonged period during the pandemic.Long working hours have been on the rise for decades, resulting in an increasing number of people developing health consequences related to work pressure. The WHO/ILO Joint Estimate is a wake-up call regarding this unhealthy yet under-recognised practice and highlights the urgent need to address this health crisis. The solution is likely to involve change and collaboration between employers and employees, and more importantly, fundamental adjustments at governmental and legislative levels to adopt and enforce labour standards on working hours. After all, prevention is a more cost-effective option to resolve this social and health issue.The Lancet Regional Health – Western Pacific


Background: There is a steadily growing number of different reconstructive surgical procedures for hypospadias that were tested on animal models prior to their human application. However, the clinical translatability and reproducibility of the results encountered in preclinical urethral reconstruction experiments is considered poor, with significant factors contributing to the poor design and reporting of animal experiments. Our objective was to evaluate the quality of the design and reporting in published articles of urethral reconstructive preclinical studies.Methods: Both PubMed and EMBASE databases were searched for animal urethral repair experiments between January 2014 and September 2019. Internal quality (bias) was evaluated through several signaling questions arising from the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE), while the quality of reporting was assessed by the Animal Research: Reporting of In vivo Experiments (ARRIVE) guidelines by scoring of a 20-item checklist.Results: A total of 638 articles were initially screened after the literature search. Employing the inclusion and exclusion criteria, 30 studies were chosen for full-text screening and 21 studies were considered eligible for the quality assessment. The mean score of the checklist was 66%. The elements that accomplished the highest grades included the number of animals utilized, the number in each investigational and control group, and the delineation of investigational conclusions. The items that were least commonly stated comprised information about the experimental method, housing and husbandry, rationalization of the number of animals, and reporting of adverse events. No paper stated the sample size estimation.Conclusion: We found that several critical experiment design principles were poorly reported, which hinders a rigorous appraisal of the scientific quality and reproducibility of the experiments. A comprehensive implementation of the ARRIVE guidelines in animal studies exploring urethral repair is necessary to facilitate the effective translation of preclinical research findings into clinical therapies. Hypospadias is considered a common birth defect with an incidence of about 1 in 300 live births and has significant clinical and social impacts . It is cSeveral animal models have been utilized to evaluate several hypospadias repair techniques, with rabbits being the most frequently used , 10, 11.In vivo Experiments (ARRIVE) guidelines . Articles have been excluded, including 12 duplicates . For each of the selected studies, a score was calculated, which represents the percentage of positively reported items. The score was calculated using the following formula:As shown in The frequencies of the options “yes,” “no,” and “n/a” of the selected studies according to the ARRIVE checklist are shown in The background of the studies was described adequately, including the rationale and the context in all the experiments. The elements that accomplished the highest grades comprised the number of animals utilized, the number in each investigational and control group, and the delineation of investigational conclusions. The items that were least commonly stated comprised information about the experimental method, housing and husbandry, rationalization of the number of animals, and reporting of adverse events.P = 0.701).No tendency or steady pattern in the grade of the scores could be recognized over the studied duration (2014–2019) as the Kendall's rank correlation coefficient (tau) was unfolded to be very low at 0.055  about study processes. Recording of randomization scored 62%. None of the 21 studies reported sample size estimation. The least frequently reported items (reported in ≤ 20% of the studies) were items 18c (interpretation), 10b and 10c (sample size), 7d , and 17b (adverse events). As is evident from This systematic review unfolded that the reporting quality of some crucial pieces was commonly poor in preclinical studies of hypospadias repair, which did not seem to progress over the years. Preclinical studies play an important role in scientific progress and the discovery of new and potentially successful surgical procedures, provided that they are designed, conducted, assessed, and sufficiently reported according to internationally agreed guidelines. Several principal parts of the study design are frequently missed, which significantly adds to failure of reproducibility following these experiments, and urethral reconstructive studies seem not to be an exception. Fundamental experimental design components are often overlooked in scientific papers, which contributes to the irreproducibility of the experiments , and preThis study revealed that there is still room for methodological improvements of experiments on animals in the urethral reconstruction and hypospadiology fields. Most domains were judged to have an unclear risk of bias, and therefore, it is not possible to determine the degree of bias of the described treatment effects. Note that the risk of bias and the quality of reporting should be considered distinct from each other. Although, the former relates to the internal efficacy of a trial, the latter points to how researchers report their conclusions. Although, personal communication with the authors of the study might be an attempt at clarifying dubious or lack of information, this does not warrant the correctness of the information rendered .Strikingly, particulars to safeguard the reproducibility of such experiments, like animal housing, husbandry, and anesthetics, were seldom communicated, which might meaningfully disturb the study conclusions . Prager None of the included experiments reported sample size calculation similar to the previous signal that displays scarcity of reporting concerning sample size calculation in animal studies . AdditioOnly a few of the included studies have deliberated the “why and how” regarding the type of animal model employed and its applicability to human pathology. We consider that arguments are of noteworthy significance in all surgical reconstructive experiments because of the substantial variations between the genital anatomy of humans and animals. We found that blinding was not steadily described. However, it might be impractical to blind the investigator performing different urethroplasty procedures. Therefore, we did not attempt to analyze blinding within the included studies.An implementation approach to increasing compliance of reporting quality would be stringent polices by the editorial committees of the journals . HoweverThe limitations of this review include the potential subjectivity of the assessment by the evaluators. Yet, the pronounced inter-observer consensus established that the assessors had a rather similar approach to applying these guidelines. Additionally, the rather small number of studies involved restricted a broad appraisal of the conditions persuading reporting. Calculating a summary score for each study using the SYRCLE was not done as a summary score inevitably involves assigning “weights” to specific domains in the tool, and it is difficult to justify the weights assigned. Also, these weights might differ per outcome and review. Using the existing animal experimental literature is also challenging because the current reporting quality of animal studies is low; several details regarding the housing conditions or timing outcome assessment are often unreported. Users also indicated that they had to judge many entries as having an “unclear risk of bias.”This review exposed that the experiments testing urethral reconstructive procedures suffer from significant internal (design/bias) limitations and significant reporting shortages. We encourage the usage of the ARRIVE procedures in all animal experiments to benefit the production of manuscripts that deliver defined conclusions of scientific value.The original contributions presented in the study are included in the article/TA conceived the article, planned, and prepared its structure. TA performed the bibliographical search along with AP, AE, AK, and AA. AE, TA, AK, and AP analyzed the results. TA wrote the manuscript draft. TA, AK, AP, MA, AA, and AE edited sections of the manuscript and contributed to the critical revision of the final draft.AA is employed by Hamad Medical Corporation. The remaining 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.


On 13 March 2020 the Hungarian Government announced the immediate closure of all schools throughout the country to prevent the spread of COVID-19 forcing several hundred thousand children to learn from home, and teachers to ensure their education. The Hungarian Educational Authority hurried to issue recommendations on the use of digital education tools. During the COVID-19 pandemic and the special legal order consequently introduced by the Hungarian Government, Hungary has seen the emergence of such non-binding measures adopted by public entities, complementing governmental action against the pandemic, with the aim of providing guidance to bodies exercising a public service function (“addressees”). These protective measures adopted under the special legal order are deemed to be successful and are largely followed by the addressees. Since soft law has hitherto been neglected by both Hungarian administrative governance and the legal literature, the recent burgeoning of non-binding measures deserves scholarly attention. In this article, we set out to map the specific context of the emergence of domestic soft law and the conditions for its adoption and reception, relying on our case study conducted in respect of the National Educational Authority’s recommendations. I.Countries around the world followed different approaches in managing their response to the COVID-19 pandemic. In Hungary, the government decided to declare a state of danger on 11 March 2020, a form of special legal order under the Fundamental Law.Our article focuses on the emergence of such “external” non-binding measuresIn what follows, we first describe the stance towards soft law followed by the Hungarian courts, authorities and domestic legal scholarship in general. Next, we elaborate on the constitutional backdrop of the state of danger, and in particular, the specific social and public health context of the emergence of domestic external soft law during the pandemic. To provide insight into the adoption and implementation of these non-binding measures, we discuss a case study, focusing on the recommendations of the Hungarian Educational Authority issued to assist educational institutions in fulfilling their tasks under the lockdown and their reception by schools.Looking at the specific recommendations issued by the National Educational Authority, we conclude that, while they had been adopted with considerable delay and schools were forced to develop alternative solutions to meet the challenge of online education, addressees remain open to such guidance. The example of the National Educational Authority’s recommendations also shows that, while the driver of recent soft law regulation is the government, based on the experiences with the recent emergence of domestic soft law, non-binding external measures exhibit hitherto untapped potential in Hungarian administrative governance.II.Although legal scholarship pays increasing attention to international and EU soft law,Non-binding measures such as ministerial circulars, ethical codes for public servants or judges, notices of the Competition Authority or opinions and resolutions of the Curia (the Supreme Court of Hungary) are, however, routinely issued in Hungary. Yet these are typically self-binding acts,In her pioneering work on “pseudo norms” (as she refers to soft law issued by Hungarian public entities), Géczi underlines that, while constitutionallycontra legem application of domestic soft law.To gauge the perception and application of domestic soft law, we traced the relevant judicial practice by conducting keyword searches in the electronic database operated by the National Office for the Judiciary.Based on the above, domestic soft law regulation remains an uncharted territory of Hungarian legal scholarship, while regulators also seem disinclined to resort to this type of rule-making. As far as the courts are concerned, soft law is used merely to bolster existing legal arguments, and is consistently deemed non-binding where it runs counter to “hard” law.III.In what follows, we set the scene for the recent emergence of domestic soft law issued by authorities, agencies and bodies. We briefly describe the broader context of the incremental centralisation of the Hungarian administrative system as the backdrop for all administrative-regulatory activity. Then we move on to the immediate constitutional context of the special legal order under the state of danger introduced by the government in response to the COVID-19 threat. Finally, we provide a short overview and typology of regulatory efforts undertaken with the aim of meeting the challenges posed by the pandemic, highlighting the role of “external” soft law within the regulatory framework.1.In the past decade, the Hungarian administrative system underwent considerable transformation under the governmental strategy of building a “good state”.Magyary Program) launched after 2010 is on the belief that a public administration with stronger ties to the central government has a greater professional competence and/or stronger loyalties to politicians than public servants working in decentralised organisations .the systemic reforms outlined in the (…) Hungarian administrative reform program  were integrated under the government and district office system. This transformation of the Hungarian administrative system led to a more centralised, hierarchical administrative structure.2.Recognising the public health threat posed by the COVID-19 disease, the Hungarian government took various actions to prevent its transmission and to prepare for a possible epidemic, as well as to meet the economic, educational and administrative challenges posed by the ensuing lockdown. In light of the rapidly spreading virus, the government established the Operational Corps responsible for the containment of the COVID-19 infection,(i)In the event of a natural disaster or industrial accident endangering life and property, or in order to mitigate the consequences thereof, the Government shall declare a state of danger, and may introduce extraordinary measures laid down in a cardinal Act.(ii) In a state of danger the Government may adopt decrees by means of which it may, as provided for by a cardinal Act, suspend the application of certain Acts, derogate from the provisions of Acts and take other extraordinary measures.(iii) The decrees of the Government referred to in Paragraph (2) shall remain in force for 15 days, unless the Government, on the basis of authorisation by the National Assembly, extends those decrees.(iv) Upon the termination of the state of danger, such decrees of the Government shall cease to have effect.In light of the spreading of COVID-19 in Europe, the government took the decision based on Article 53 of the Fundamental Law to declare the so-called “state of danger” on 11 March 2020.Kerngehalt) of such rights. According to the Hungarian Fundamental Law, such governmental decrees are to remain in force for only 15 days.The state of danger is a form of special legal order established under the Fundamental Law  voluntarily installed by those who had been put under quarantine with police supervision. With the help of the app, authorities gain access to the user’s profile, movements and health data, processing it for a maximum of 60 days following the lapse of the individual’s quarantine.The government adopted various binding decrees and decisions geared towards ensuring the safety of the population  on the introduction of a new work schedule in public education and vocational training institutions due to COVID-19. According to this Government Decision, out-of-classroom education was to be organised in schools accompanied by the digital monitoring and support of the learning process. Article 1(c) established the legal basis for the external soft law measures analysed in this study. Without naming the responsible institution, the Government Decision set forth “a methodological recommendation is issued to implement [the out-of-classroom education]”. It was the National Education Authority that finally adopted these methodological recommendations on 9 April 2020, comprising the following instruments: the “Methodological recommendation for out-of-class digital work schedule”;The recommendations are addressed to nursery schools, elementary and secondary schools and other teaching facilities and institutions. That is, these recommendations are addressed to institutions outside the organisation of the National Educational Authority. These measures do not bear the formal characteristics of legal acts: they have no title number, sections or numbered paragraphs. While their titles include the word “recommendation”, which clearly indicates their non-binding nature as far as their wording is concerned, strongly exhortative phrasing such as “we ask teachers to”, “should prepare for”, “provide students with”, etc2.Since there is no information in formal law or on the website of the National Educational Authority describing the legal basis, process and adoption of the recommendations, we decided to contact the Authority. In order to gain insight into the circumstances surrounding the elaboration of the analysed recommendations, in particular into the transparency and participation-related aspects of the adoption process, we conducted an interview with the Vice President of the National Educational Authority on 31 July 2020.In the interview, the Vice President of the National Educational Authority confirmed that the Authority had not issued external soft law before the state of danger. The closure of schools during the COVID-19 lockdown, however, was a unique situation that made the adoption of guidance addressed to educational institutions necessary. Schools were obliged to ensure ongoing teaching based on the National Core Curriculum and to prepare students for final secondary school examinations. The challenge was that out-of-classroom teaching had to be organised through online means and to be determined and implemented individually by the schools themselves. The online tool developed and made available previously by the state was the so-called KRÉTA platform, which could be used for recording students’ grades, publishing homework, assignments and conducting teacher-to-student/parent correspondence. Schools were free to choose the online tools available, including KRÉTA but also other platforms, such as Zoom, MSN Teams, Google Classroom, EduBase, etc. It was in respect of the online teaching activity that the National Educational wished to provide support with its recommendations.The recommendations were issued on the basis of Article 1(c) of Government Decision No 1102/2020 (III. 14), with the “permission and approval” of the Ministry of Human Capacities, meaning that the task of elaborating the recommendations was delegated to the National Educational Authority and internally signed off on by the Ministry. Apart from calling on the competent ministry to prepare the methodological recommendation, the Government Decision did not set forth any substantive points on what these recommendations should contain. The recommendations were elaborated with input from the competent ministry, public education institutions and the bodies operating public schools, as well as pedagogical services. Following their adoption, the recommendations were published in mid-April on the National Educational Authority’s website where they are freely accessible. As of yet, the National Educational Authority has not modified the recommendations, nor has it monitored their implementation or requested feedback on the same.ex proprio motu, but were based on the legal basis contained in Government Decision No 1102/2020 (III. 14). Moreover, they were issued with the permission and approval of the competent ministry. Therefore, no legal or constitutional limits have been overstepped in the adoption of these recommendations and as far as the transparency and participation aspects of the measures are concerned, the National Educational Authority informed us that they relied on expert knowledge, such as public education institutions and pedagogical services.Based on our interview, we conclude that the recommendations analysed for this article were not adopted by the National Educational Authority 3.To gauge the reception of the National Educational Authority’s recommendations, we prepared a survey, which we sent out to the principals of a dozen schools and nursery schools in July and August 2020. To ensure that our findings reflect the institutional diversity in Hungary, we sent out the survey to public, private and church-run schools and nursery schools headed by principals among our personal contacts and among contacts who were recommended to us. Unfortunately, no nursery schools responded; however, we received responses from public (one), private (two) and church-run schools (one), amounting to four responses in total. As such, the responses received are relevant only to the recommendations addressed to schools and we have no information related to the reception of “Methodological recommendations for kindergarten, arts and other special education situations”.Did you as a school principal seek assistance from the National Educational Authority that they provide guidance on the adjustment to the new situation? Do you perhaps know any school principals who had requested such guidance, assistance?Were you, as school principal involved in any way in the elaboration of the recommendations (eg electronic consultation)?Did you receive a separate notification about the publication of the recommendations or were you only informed about them on the National Educational Authority’s website?Our first group of questions related to procedural aspects of the adoption of the recommendations, mainly, the aspects of transparency and participation:While all of the school principals answered that they had not sought guidance from the National Educational Authority, they had been informed about other schools that had turned to the Authority for help. Since the closure of schools was announced on a Friday and teaching had to continue uninterrupted on the following Monday, schools had to determine the relevant “digital” teaching methods within an extremely short window of time. As the principal of the respondent public school noted, “there was no chance of asking for help over the weekend anyway”.The principals unanimously noted that they had not been involved in the elaboration of the recommendations, with one respondent heading a private school noting that they would have been open to providing input. As far as receiving specific information on the fact that the National Educational Authority had published these non-binding measures, the respondents noted that they were made aware only through Authority’s website, although the principal of the church-run school subsequently also received an email pointing them towards the recommendations.Did you implement these recommendations?or because they were issued by the National Educational Authority and as such, should be followed, or because they contained such general suggestions that all institutions would have been implemented anyway or other (explain)?If so, was it because you found them convincing, or because they are not applicable to your specific institution or other (explain)?If not, was it because the recommendations are non-binding and as such do not have to be taken into account, Did you find these recommendations useful?Do you agree that the National Educational Authority should provide professional support to educational institutions through non-binding measures in the future?Would you like to provide professional input into the National Educational Authority’s recommendations?Next, we explored the legitimacy and effectiveness of the Authority’s recommendations, to understand whether these soft law measures were considered by the addressees to be useful and acceptable guidance. To this end, we posed the following questions in our survey:As to the implementation of the recommendations, all principals answered that they had not implemented them, partly because they were issued too late into the lockdown and partly because they were not applicable to the systems already put in place. Since the schools were bound to transition to digital teaching mid-March, the recommendations issued mid-April were no longer considered relevant by the respondent schools. As the principal of the respondent public school noted, “the recommendations came with considerable delay and contained very general advice”,Finally, we asked our respondents if they had been contacted to assess whether they had implemented the recommendations of the National Educational Authority. The principals unanimously answered that no one had requested information on the implementation of these measures in their schools. This means that without a systematic evaluation of the implementation of the recommendations, the National Educational Authority has no feedback on the regulatory performance and the level of implementation of its measures.V.During the special legal order introduced to prepare for, and combat, the COVID-19 pandemic, statutes of Parliament, as well as government decrees and decisions, were complemented by a novel regulatory solution: “external” domestic soft law. These types of non-binding measures have to date hardly ever featured in the Hungarian administrative-regulatory toolbox, yet the unique challenges posed by the pandemic and the ensuing lockdown meant that there was a need to provide guidance to businesses, bodies carrying out public service functions and schools on how to adjust their operation to deliver ongoing services both safely and effectively. In view of the recent burgeoning of domestic soft law in Hungary, our article represents a first step in mapping the regulatory context, adoption and reception of these non-binding measures.As far as the regulatory context is concerned, the Hungarian administrative system underwent considerable centralisation during the past decade, and the ensuing strict hierarchical structure was exacerbated by the requirements of the special legal order. Accordingly, the external soft law emerging in this period was not the result of regulatory experimenting, but much rather a flexible response to a regulatory obligation set forth in a government decision. As far as the recommendations analysed in our case study are concerned, their non-binding character notwithstanding, these soft norms were issued by the National Educational Authority with the approval of the competent ministry. This may be explained by the fact that the government decree specifically prescribed the adoption of these measures, for which the competent ministry was responsible. Based on our interview with the Vice President of the National Educational Authority, the recommendations were elaborated in consultation with professional bodies ensuring the necessary expertise; however, important stakeholders, such as schools or nursery schools, were not involved in developing the substance of these norms. These findings show that, at least under the special legal order (implemented because of the declared state of danger linked to COVID-19), there is a clear intention to move towards more flexible, novel regulatory solutions to emerging technical challenges, without however upsetting the strict hierarchical framework of the domestic administrative system.Although the findings of the case study show that in the concrete case the recommendations were issued with considerable delay and with an overly general substance, respondents to our survey were unanimous in noting that such non-binding measures of the competent administrative body would be welcomed in the future. Respondents further stressed that, owing to the very different endowments and circumstances of Hungarian schools and students, future non-binding measures should be framed with a view to accommodating this diversity and providing concrete guidance to specific situations, preferably involving and building on the expertise of the affected schools themselves. While our mini-survey may in no way be considered representative in nature, it clearly indicates an openness of external addressees towards receiving guidance from professional public bodies and a willingness to participate in their elaboration, both to share best practices and to develop detailed recommendations specific to the different circumstances of the addressee institutions.67 Developing external domestic soft law also outside the period of the special legal order would be a welcome addition to the existing regulatory toolbox of domestic decision-makers, in particular, if stakeholders were involved in developing their substance. On this basis, external soft law has the potential to become an important regulatory instrument in Hungarian administrative governance, ensuring useful professional guidance to domestic stakeholders.As a general conclusion, we suggest that, while the example of the National Educational Authority’s recommendations shows that the driver of recent soft law regulation was the government, based on experiences with the recent emergence of domestic soft law, non-binding external measures still exhibit hitherto untapped potential in Hungarian administrative governance. Beyond their flexibility in time-sensitive situations, the appeal of such non-binding norms may be that within the framework of the highly centralised Hungarian administrative system, external soft law can exert a strong compliance-pull towards addressees.