Students with emotional behavioural disorders may exhibit extremely challenging behaviour that interferes with their academic achievement and social relationships. Failure at school frequently leads to a succession of poor life outcomes including increased rates of unemployment or underemployment. Increasing on-task behaviours and decreasing disruptive classroom behaviours is of crucial importance. If successful, this may promote positive experiences and outcomes in terms of effective learning, and, ultimately, greater opportunities in life. This study evaluated a high-tech approach to classroom management using an App* that offers elements of choice and predictability to students. Teachers were provided with two hours of training on how to upload lesson plans to their smartphone and how to broadcast onto screens in classrooms. A multiple-baseline design across four participants was used and the data suggested that the use of the App resulted in both increases in on-task behaviour and a reduction in disruptive classroom behaviour for all participants. Emotional and Behavioural Disorder (EBD) refers to emotional, behavioural or psychiatric disorders, including attention deficit hyperactivity disorder, depression, and mood or anxiety disorders ,2. TypicSchool-wide Positive Behavioural Support (SWPBS)  is impleDespite the evidence for the use of common multi-component classroom interventions, their effectiveness may be limited due to two primary considerations: the high costs involved, and the number of skills that teachers need to master for this endeavour within a short period of time relative to years of acquiring and practising other teaching skills . In a reBrady, Padden and McGill  explain Since 2007, mobile phones using Apple’s iOS or Google’s Android systems have taken over the mobile market. The latest figures show an increasing number of smartphone users year after year. In 2022, the number of global smartphone users is estimated at 6.6 billion marking a 4.9 percent annual increase . Such acThe research literature suggests that the elements of choice and predictability within the classroom promotes attentiveness and learning ,53,54,55The general concept for the development of an App for classroom management was to embed elements of choice at various points during a lesson, and to provide a visual representation of the progress of the lesson to make the lesson predictable, all of which was visible to students on a large flat screen within the classroom. The App was designed in such a way that teachers needed to embed two choice points during each lesson. Both the choices and the point at which they became available during the lesson were chosen by the teachers. For example, the second segment of a lesson might have been ‘focused work’, and the teachers would offer the students the choice between individual or group work. During the course of the lesson, students would see an image following a path  to indicate the point reached (and elapsed time) and remaining course of the lesson (and remaining time). The image continued to move throughout and in parallel with the course of the lesson with specific key markers reached along the way. Additionally, appropriate on-task behaviours, for example, raising a hand for help or engaging in quiet discussion were represented by appropriate icons which also appeared on the screen at the relevant point. Teachers prepared their lesson as they would normally and then used the App to upload the key elements of the lesson to their smartphone, a process that took approximately 90–120 s. In the classroom the teachers would then broadcast the visual representation of the lesson to the classroom’s flat screen. In the event of unforeseen circumstances or time-keeping issues, the teacher could quickly make changes via the App and update the screen. For example, they could shorten, or adjust, remaining sections to ensure that the lesson ended precisely on time and that the students were also aware of the new expectations. This study aimed to evaluate the use of the App in terms of both increasing on-task behaviour and reducing disruptive classroom behaviours in students with EBD using a multiple baseline across subjects design . The jusThis research consists of a specific case study of four students. Participants were selected based on teachers’ referral of students with high levels of disruptive behaviours and low levels of on-task classroom behaviours during regular classroom instruction. Four teachers in a small, public Special Education school for students with EBD were each asked to select one of their pupils for inclusion in the study, resulting in the selection of four male participants , aged between 11 and 12 years, one from each of four classes of ten students. All four participants were reported to be in the low-average range of intelligence. The four teachers who participated in this study had the minimum of a first degree, a teaching qualification, and were employed by the Ministry of Education in Israel and they had been teaching in the school for a minimum of six years. Teaching assistants who were blind to the purpose of the study collected data on participants’ on-task and disruptive behaviours and teachers’ social contact with the participants during the different phases of this study (one assistant for each participating student). All assistants had at least two years’ experience in data collection and the implementation of behavioural interventions. Information about the purpose of the study was provided to the participants, their families, their teachers and the Director of Special Education and consent was obtained from all in writing. In addition, the Director of Special Education found no conflict of inteterst, and all ethical issues were resolved. 2) Class schedules and lesson content, as planned by the teachers, remained constant across all phases of the study.The study was conducted in a small regional school for Special Education located in the north of Israel. All sessions were conducted during the first lesson of the day (0800-0840) and within the participants’ main standard-sized classrooms  it was energy efficient and did not drain the mobile phone battery, (b) it had error- and bug-detection capabilities, so that potential viruses would not slow or freeze the mobile phones, and (c) allowed only the content from the App to be broadcast on the screen. The screen also changed at regular intervals, showing different screens at different times. For the first five minutes of each lesson, the screen showed the entire layout of the lesson with its segments and alternative choices, their timing and expected on-task behaviours. Then the screen would zoom in to focus on the current segment or alternative, with its timing and targets. After two minutes, it would zoom out, to illustrate the entire layout of the lesson for 30 s. This cycle continued until five minutes before the end of the lesson. Then the screen showed the current and follow-up segments with all their components.Teacher training was conducted for precisely 120 min for each of the four teachers in seven steps. For the first step (approximately five minutes), the teachers were introduced to the App and its components on the researcher’s smartphone and the researcher explained each component. Step two  involved the researcher demonstrating how to upload a lesson using the App, and each of the teachers practised uploading a lesson using the researcher’s smartphone while the others watched. In step three the researcher provided positive or corrective feedback where necessary and answered any questions for approximately another ten minutes. In step four, the researcher provided the teachers a username and password, enabling them to download the App onto their own smartphone and practise in their own time. Step five occurred on the following morning before lessons began. The researcher provided each teacher ten minutes introduction explaining the procedures. The researcher monitored the teachers as they uploaded their lessons on to their respective smartphones, and broadcast to the screen in their respective classrooms. In step six, a few minutes before a lesson began, the participants were shown by the researcher the overall lesson plan on the screen, including the segments and choices, the time for each segment and the expected on-task behaviours. Participants were also shown by the researcher the progression of the lesson as it appeared on the screen and questions were answered. This step lasted approximately ten minutes per classroom. In the final step, the teachers were instructed and explained by the researcher to begin teaching the lesson they had planned and uploaded onto the App and the lesson was monitored to ensure synchronisation of the lesson with the screen content, with adjustments made to the content via the App accordingly. The lesson commenced as soon as the teacher clicked ‘Run’ to begin the clock progression on the screen.A multiple baseline experimental design across participants was used for this study. The target behaviours were various on-task and disruptive classroom behaviours. These were selected because they were those typically identified as targets for change with students with EBD  and they20-min observations of 45-min lessons were conducted in the participants’ classrooms five times each week commencing at a quasi-randomised time between 0805 and 0825. Although the lesson began at 0800, the earliest data collection could commence was 0805 to allow for punctuality and time-keeping issues. Data collection was restricted to 20 min to acknowledge that the assistants had other roles and responsiblities to perform and so needed to be attainable and able to be sustained for several weeks. To ensure that data collection period provided a cross-sectional representation of the entire lesson, the data collection start times were quasi-randomly determined by asking the assistants to select one of five slips of paper  from a box before the class commenced.Occurrences of on-task and disruptive classroom behavior were recorded using partial interval recording with 10-s intervals. If the participant exhibited any of the on-task or disruptive behaviours at any time within a ten-second interval, the interval was scored as an occurrence. The percentage of intervals with on-task or disruptive behaviours was calculated by adding up the scored intervals for each, dividing by the total number of possible intervals minus any missed observations, and multiplying by 100. +social) or social contact that appeared to be functionally punitive in nature to decrease behaviour .In addition, teachers’ social contact with the participants was also recorded. Differential social contact during the various phases of the study could likely influence the occurrence of the dependent variables and so was required to further enable the assessment of behaviour change in participants and the potential of a transactional relationship caused by changes in social contact. Social contact was broadly defined as any contact initiated by a teacher towards a participant, whether physical, for example, a stroke or a pat on their shoulder, or verbal, for example, ‘well done’, ‘good work’ or a reprimand. Social contact was recorded as either social contact that appeared to have have the function of providing positive reinforcement to increase behaviour  had been reached with the researcher. To protect against observer drift, the researcher reviewed the operational definitions of the target behaviours and social contact with the assistants on a weekly basis. The researcher or another data collector independently observed 33–39% of all observation periods. Agreement was recorded when both observers recorded an occurrence or non-occurrence within a given interval. IOA scores for on-task, disruptive, and teacher social contact behaviours were then calculated on an interval-by-interval basis by dividing agreements by the total number of agreements plus disagreements, multiplied by 100 . All IOAFor the purpose of this study, the researcher modified a feedback questionnaire previously developed by Sasso, Reimers, Cooper, Wacker, Berg, Steege, Kelly and Allaire . ModifyiBaseline: Participants and teachers were observed and data recorded (as described above) during a typical first lesson at the school. The stability of the baseline data were used to determine the first participant to start the intervention.Intervention: The intervention was the introduction of the use of the App (applied first to Oscar as his baseline data appeared the most steady and stable). All students were instructed to attend as usual and to look at the screen periodically to be reminded of the lesson progress, segments, choices and appropriate behaviours. This was replicated for each participant based on the protocols of using a multiple baseline across subjects design.Follow-Up: The follow-up phase was identical to the intervention phase except that data were only collected very intermittently to see if the intervention was still having an effect with minimal input from the researcher.To ensure the integrity of the implementation of the intervention, each teaching assistant also monitored 25% of the intervention lessons using a simple check-list. Each lesson had to be a maximum of 45 min long, two segments had to include two alternatives, each segment of the lesson had to specify one or two on-task behaviours, the display had to show an image moving along a dotted line (to simulate the progression of the lesson), the teacher had to be synchronised with the content displayed on the screen. Treatment fidelity was 100%.Comparison of the levels during baseline and intervention observations for the participants shows a mean increase of 30% for on-task behaviour  and a decrease of 33% for disruptive classroom behaviours .M = 74% during follow-up) and decrease his disruptive classroom behaviours (M = 30% during follow-up).The data for Oscar suggest a steady, stable and modest intervention effect for on-task and disruptive classroom behaviours. The difference between the mean levels during baseline and intervention was +19% for on-task behaviour  and −16% for disruptive classroom behaviours . The steadily increasing trend in on-task behaviours seems to correspond with the declining trend in disruptive classroom behaviours. Oscar continued to increase his on-task behaviours and show decreases in his disruptive classroom behaviours during the final follow-up phase. Similarly, Simon’s data also suggest a moderate yet consistent effect of the intervention on both on-task and disruptive classroom behaviours. The difference between the mean levels during baseline and intervention was +15% for on-task behaviour  and −21% for disruptive classroom behaviours . The follow-up phase for both dependent variables suggested that Simon continued to increase his on-task behaviours consistently  and for disruptive classroom behaviours, the difference was −38% . The clear and sharp upward trend in on-task behaviours corresponds to a downward trend in disruptive classroom behaviours. The follow-up data suggest that Mark continued to increase his on-task behaviours and decrease his disruptive classroom behaviours during follow-up.The on-task and disruptive classroom behaviour results for Richard show relatively immediate and consistent intervention effects for both behaviours. The difference between the mean levels of on-task behaviours during baseline and during intervention was +51% (baseline level = 5.8%) and for disruptive classroom behaviours −60% (baseline level = 94%) with no overlap for either dependent variables. The sharp increase in on-task behaviours appears to correspond to an equally sharp decrease in disruptive classroom behaviours. This effect was maintained during follow-up. +social contact for all four teachers across all phases was low but highly stable. −Social contact was 71% at baseline and 40% during the intervention, a mean decrease of 31%, with a further decrease to 20.3% during follow-up.Teachers’ social contact, per session, is shown in The results from the feedback questionnaire from each of the participants, teachers, teacher assistants and parents (n = 16) are shown in A major training element of the study involved technology: making use of smartphones, screens and an App. The use of technology is contemporaneous with the current era, which has changed dramatically and quickly over recent years and for which, as a consequence, there is a paucity of research. However, some recent research has suggested that high-tech methods of teaching new skills are effective, economical and simple to apply and often result in positive outcomes ,47,49. TThe data collected at baseline for each participant’s on-task and disruptive behaviours were used to set specific outcome criteria for posthoc analysis of success ,73. For +social contacts which could have been an alternative explanation for the increase in on-task behaviour. Indeed, the clear decreasing trend for −social contacts suggest that the use of such contact was also reduced as a consequence of the intervention which led directly to decreased disruptive behaviour and so reduced the necessity for such contact.Visual analysis of the data recorded for three of the four participants reveals what appears to be only a gradual behaviour change from baseline to intervention phases for both on-task and disruptive classroom behaviours see  and may The research literature is replete with suggestions on how to enhance quality of life for students at all ages, including through empowerment with choice and a degree of control ,58,75. MSuch interventions are the future whether we like it or not, and they may be more effective than traditional teaching and teaching methods and have a significant impact on many learners worldwide, in a variety of age-groups, settings and subject areas, ultimately enhancing the quality of learning and life experience for many.


Opioid Overdose Network is an effort to generalize and adapt an existing research data network, the Accrual to Clinical Trials (ACT) Network, to support design of trials for survivors of opioid overdoses presenting to emergency departments (ED). Four institutions  worked to adapt the ACT network. The approach that was taken to enhance the ACT network focused on 4 activities: cloning and extending the ACT infrastructure, developing an e-phenotype and corresponding registry, developing portable natural language processing tools to enhance data capture, and developing automated documentation templates to enhance extended data capture. Overall, initial results suggest that tailoring of existing multipurpose federated research networks to specific tasks is feasible; however, substantial efforts are required for coordination of the subnetwork and development of new tools for extension of available data. The initial output of the project was a new approach to decision support for the prescription of naloxone for home use in the ED, which is under further study within the network. Opioid misuse and dependence continue to be a significant and growing cause of preventable morbidity and mortality in the United States.Patients presenting with OOD to EDs represent an extraordinarily high-risk group for mortality (up to a 24-fold risk ratio),Recognizing that accuracy and detail in preliminary data are essential when designing effective clinical and translational studies  through appropriate governance processes. Sites were required to clone and install a second ACT i2b2 instance and SHRINE node for this purpose. The design of the network is shown in The ICD-10 and laboratory data-based e-phenotyping team was led by an OUD researcher. The primary objective of this team is to develop precise OOD cohort entry descriptions for surveillance databases. This team’s approach was focused on the harmonization of prior literature on definitions of OOD published in the literature. This team conducted a scoping reviewTheir approach was focused on abstraction at the sentence level of medical facts about the case  documented response to OOD treatment  confirming the diagnosis of OD and (2) the “intentionality” of the OD. For example, “Was this a patient with chronic pain who accidentally used too much medication, an individual with OUD who unanticipatedly took a more concentrated aliquot of the drug, or was this a suicide attempt?” Such inferences would valuable information for clinical intervention development and trial planning.The primary goal of the NLP team is to enrich data in identified cases with critical concepts for OUD and OOD in the notes but which are unreliably coded. The NLP team was led by an experienced informatician and its objectives and work reflected that perspective. Our initial work evaluated several different approaches to concept identification that combined ML and NLP methods using the CLAMP platform.While we were optimistic about the potential role of NLP and other tools in enhancing available data from patients previously treated for OOD, we believed it was preferable for incident cases to improve provider documentation of the OOD during clinical care. To achieve this goal, we worked with physicians and OUD experts to develop an enhanced template for documentation of provider notes in the ED so the necessary data for trial planning would be captured. The team was led by an ED clinician with a research focus on OUD. The goal was to produce a clinically useful tool to enhance data capture for the OOD clinical context.,To make the additional documentation for the research database more palatable for providers, the OOD template or Opioid Smart Tool (OST) was designed to automatically produce a text note for the clinician by selecting from alternatives or filling in specific blanks. The OST is shown in As specified in the grant application, the evaluation of the impact of the network was to be based on the network’s value in generating viable research processes for ED-based OOD mitigation research. This was proposed to be studied in a series of annual retreats which combined discussions of developments in opioid abuse treatment in emergency settings with results from the network, to generate hypotheses and proposals for studies. Discussions were recorded and qualitative analytical methods were to be used to assess the impact of network data on hypothesis generation. The first evaluation conference was held  in November of 2021.a priori case definitions for each category and associated ICD-10 codes resulting are presented in The proposed Tools combining AI and NLP approaches proved robust at identification and/or inference of targeted clinical concepts. NER+ Rules identified 1513 candidate opioid-related OD content sentences from a random 20% sample of 2.47 million clinical notes. The results demonstrated that the DL approach, BERT, with postprocessing rules achieved the best performance at inference with a precision of 0.97 and recall of 0.90 (F Score 0.94). NLP tools were then modified for installation using Docker and distributed to other sites in the consortium. Future work will examine the portability of these methods.n = 81) using postdischarge coded data during the test period at MUSC Charleston. The MUSC hospital system had recently acquired 4 regional community hospitals, and we were surprised to see that ED providers at the newly acquired regional hospitals were also using the OST, despite not having received any training. In a subset of cases seen in these facilities (n = 130), the rate of the template used in high-probability cases was 14%. Among respondents (n-12), the overall SUS score was 72.5% and the NPS score was 74.2%.As shown in P < .0001, Fisher’s exact test). At community hospitals, the use of the template was concomitant with naloxone prescription in 44% of cases, versus in 16% of cases when the template was not used .While not a primary goal of this study, we noted that the OST was highly effective in changing provider behavior. In cases where the template was used, the prescription of naloxone for home use was much higher than when it was not used. At MUSC, when the template was used, home naloxone was prescribed 66% of cases versus 16% when it was not used  e-phenotype definition and harmonization of coding, (2) enrichment of extent data with NLP of clinical notes, and (3) enhancement of prospective capture of data with informatics-based tools. Each of these areas posed unique challenges.,Persistent challenges include variability in codingThe question of whether a general-purpose federated research network such as ACT can be easily extended, at a low cost, to address targeted and emergent problems remains an open one. At the minimum, long-term support for a network needs to be assured, which is not the case for the ACT network at this time. NCATS has prioritized the centralization of data resources through its work on COVID-19 over federated networks.There are many challenges in adapting a federated network to a new task, and, as often is true in informatics, the technical challenges are the least significant ones. However, it is clear no single technology in isolation  can solve all the data issues necessary for a research network. Improved primary data collection, while difficult, through tools such as the OST, may be the only viable option at times. Furthermore, even with the completion of a network, its use for the acceleration of research is hard to ensure. In this case, a fortuitous finding related to the use of the OST, amplified by an informed interdisciplinary discussion led to a viable hypothesis for implementation research. The process of how new data triggers research hypotheses deserves further study. In the movement from hypothesis to study, a federated network may have certain advantages. A federated model respects each sites unique clinical processes and equips each site with resources that allows replication of early findings, as is being done with the OST from this study, potentially accelerating translation.Our initial work suggests it is feasible and valuable to extend the ACT network infrastructure, with its real-time query capabilities, to begin addressing the challenges of responding to the opioid pandemic in a federated model.This publication [or project] was supported, in part, by the National Center for Advancing Translational Sciences of the National Institutes of Health under Grant Numbers U01TR002628, UL1TR001450, UL1TR001998, UL1TR001442, and UL1TR001086. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Study design: LAL, VZ, LJ, JLM, JSO, SH, MH, and JCT. Acquisition, analysis, and interpretation of data: VZ, LJ, JSO, RW, LAM, PS, and DRH. Drafting of the manuscript and revision of content: all authors. Final approval of the manuscript and agreement to be accountable for all aspects of the work and resolution of all questions related to accuracy or integrity of the manuscript: all authors.ooac055_Supplementary_DataClick here for additional data file.


Background: Unhealthy sexual behaviors, such as unprotected sexual intercourse and lack of using screening services increase cyclical transmission of sexually transmitted infections including Human Immunodeficiency Virus (HIV), especially among young adults. Hence health promotion programs can contribute to reduce the consequences, by changing (determinants of) these behaviors. Such interventions need to embrace a comprehensive approach and apply theory-and evidence-based methods. This article describes the protocol for a process and effect evaluation study of a sexually transmitted infection prevention program among university students in Beira city, central Mozambique.Methods: The on-going program at Universidade Católica de Moçambique is described following the six steps of Intervention Mapping (IM), with a focus on the evaluation plan . The details regarding previous steps in the protocol are briefly described as well, as they lay the foundation for the final step. The overall study will apply a hybrid type 1 approach by assessing the effectiveness of the intervention while gettering implementation. The process evaluation will apply qualitative and quantitative methods to gain insight in the context, reach, dose delivered, dose received and recruitment. Interviews with closed and open-ended questions will be conducted with program implementers and users. A quasi-experimental non-equivalent control group design is used to evaluate the effectiveness. A cohort of university students will be followed for 6 months. Self-administrated questionnaires will be used to collect data every 3 months.Discussion: A combination of process and effect evaluation is proposed. This is a useful and fruitful procedure, since concurrent process evaluation can allow researchers to better interpret findings from the effect evaluation and understand how the intervention might replicate in similar contexts. We decided to follow the IM approach since, it is a theory-and evidence-based, systematic and detailed guide regarding what to do at every steps. A quasi-experimental non-equivalent control group design was chosen to fit the context of the study and generate outcomes with high external validity.Study Registration: 004/CIBS/2020. Unhealthy sexual behavior leads to sexual transmitted infections (STIs). Global estimation reported about 357 million new cases of the main four curable STIs, namely, chlamydia, gonorrhea, syphilis and Trichomoniase, occurred in people aged 15–49 years in 2012  and their partners, assume that young people are facing challenges, such as low self-esteem, lack of control of their own sexuality, unintended pregnancies, acquiring STIs including HIV and sexual abuse safe sexual health behavior and the use of STI/HIV screening services among university students in Beira city after exposure to the intervention; and to describe the implementation process. The studies will lead to recommendations for possible improvements in the current and future programs in this region.Universidade Católica de Moçambique (UCM) and the Universidade Licungo (UniLicungo) Beira extension . We have followed the intervention mapping (IM) approach to describe the evaluation of the STI/HIV prevention program among university students that is ongoing at the UCM in the Beira city. IM is an approach to systematically develop, implement and evaluate theory- and evidence-based interventions.The research is planned to take place in Beira city, Sofala province, which is in the central region of Mozambique. The two study settings are the IM consists of six steps: (1) the assessment of the problem; (2) the definition of expected behavioral and environmental outcomes, specifically performance objectives (POs) underlying these outcomes, and matrices of change objectives (CO) resulting from crossing performance objectives with underlying determinants; (3) the definition of the theme, components, sequences, selection of the theory-and evidence-based change methods and the designing of the practical applications delivering these methods; (4) the definition, pretesting and production of messages, materials and protocols; (5) the development of an adoption and implementation plan: finally, (6) the development of an evaluation plan. More details on the IM are available elsewhere . AlthougThe overall study will apply a hybrid type 1 approach. Hence, the study is to assess effectiveness of the STI/HIV prevention intervention among university students and concurrently collect data on the implementation process to better explain findings and enable the research to answer questions regarding context and fidelity when interpreting the effect results. The process evaluation part concerns a combination of qualitative and quantitative methods. This part is planned to be conducted immediately after setting up the cohort. The main aim is to gain insight in the program implementation process and provide information regarding context, reach, dose delivered and received as well as recruitment to the stakeholders. This information can be helpful in strengthening, improving and disseminating the program to similar settings. The effect evaluation part will apply a quasi-experimental non-equivalent control group design aiming to assess changes in selected (determinants of) behavior(s) and STI/HIV cyclical transmission over time for 6 months.The program that is being implemented at UCM is described in line with IM to provide insight into the rationale behind the program and how this is used in the evaluation plan.The problem was assessed through epidemiological data available, literature review, review of existing program materials, and six meetings that were held with relevant stakeholders (program implementers and managers of the study settings). Cyclical transmission of STIs including HIV and high prevalence of STI/HIV are public health problems affecting university students, with undesirable consequences such as: increased costs for medical care, reduced life expectancy, infertility and low productivity.We have selected two behaviors at the individual level  namely: engagement in unprotected sexual practices and unregular seek and use of STI/HIV screening services. These are behaviors that are targeted by the current program and can be changed using theory-and evidence-based methods.The expected BOs at the individual level are (a) University students engage in protected sex practices for example consistently and correctly use of condoms; (b) university students regularly seek STI/HIV screening services. Several determinants underlie these behaviors, such as knowledge, risk perception, attitude, self-efficacy, skills and subjective norms. COs specify what needs to be changed (at determinant level) to result in the performance objectives (POs) to be achieved. POs are sub-behaviors resulting in behavioral or environmental outcomes that will lead to better health and improve quality of life of university students. The program consist of three components: (a) trained teachers provide 16 classroom curriculum lessons regarding STI/HIV within the life skills subject for all first year university students at the UCM; (b) volunteer students (activists) engage in sensitizing activities (4 sessions) to increase the use of STI/HIV screening services, and the use of condoms correctly and consistently among university students; and (c) health advisors offer STI/HIV counseling and testing services at all faculties. Methods depicted in Bartholomew Eldredge et al.  were useThe overarching theme of the program is, Listen, which was translated to the title: “Take the opportunity to listen and to be listened to.” The evaluation will address the three components of the program: (a) trained teachers provide sixteen classroom curriculum lessons regarding STI/HIV within the life skills subject for all first year university students at the UCM; (b) volunteer students engage in sensitizing activities (four sessions) to increase the use of STI/HIV screening services, and the use of condoms correctly and consistently among students, through regular campaign; and (c) health advisors offer STI/HIV counseling and testing services at the faculties.The program has already been developed and activities are planned at the department of Sexual and Reproductive Health, Gender and HIV/AIDS, at the rectory of the UCM (highest administrative level of the university). The implementers' team at Faculty of Health Science consists of one health advisor, three teachers and sixteen volunteer students. At the Faculty of Economy and Management, there is one health advisor, three teachers and sixteen volunteer students. All are committed to deliver the program activities in a collaborative way with the faculty authorities.The life skills classes follow a classical method of teaching, through a student-centered learning approach. A teachers' handbook and an equivalent students' handbook are the basic didactic materials. The subject consists of 64 h, of which 34 are devoted to lectures and 30 to practical sessions. Among the 64 h, about 50% are dedicated to SRH contents of which 16 h are committed to address STIs and HIV issues. Yet, the PO and CO defined for the research propose are addressed in sixteen lessons of about 2 h, twice a week, targeting first year graduation students in the first semester at each academic year. The structure and sequence of lessons is guided by the lesson topic translated into specific lesson content see . For theThe volunteer students perform their activities using pamphlets, handbooks, films, posters and flip paper. They also use methods such as interactive lectures, theater followed by a discussion session, and chatting sessions in classrooms. At each session they focus on one issue, for instance, control of their own sexuality and prevention of STIs including HIV. During the evaluation research, volunteer students will provide four sessions of awareness activities following the structure and sequence guided by the lesson topic translated into specific lesson content.Health advisors offer counseling and testing for STI/HIV services in a private room at each faculty at the UCM; the same will be ensured at the UniLicungo, 3 days per week, from 8:00 to 16:00. The services are delivered according to the national guideline  tests (Abbott biokit) will be performed, to screen Syphilis infection for the study purpose. Furthermore, questions will be asked to screen for general symptoms of STIs. The STI diagnosis will be made in accordance with the national guideline. In case of a positive test result or identification of symptoms, the client is referred to the health center for treatment and follow-up if needed.The adoption and implementation plan are presented following the same tasks as in the step 2 to 4; hence, outcomes and objectives (PO and CO) for adoption, implementation and continuation are expressed; methods and practical applications are selected; and an intervention to foster the program adoption, implementation and continuation is developed.The faculties' managers (program adopters) have decided to adopt the program and the evaluation research by signing the letters of authorization. Thus, the performance objectives for faculties managers are to review the evaluation research materials; provide the program implementers to deliver the lessons, sensitizing activities and screening services; guarantee support from the stakeholders' ; and communicate with the implementers about practice changes in their activities due to the research.The expected implementation outcomes are (1) Adoption of the program evaluation research “Take the opportunity to listen and to be listened to,” including provision of curricular lessons at UCM, sensitizing activities and screening for STI/HIV at both study settings, and (2) The implementers collaborate in the implementation of the program evaluation research, while are providing intervention activities.The framework to guide the evaluation plan was based on program components , 18–21. The process evaluation including its indicators are summarized in Qualitative and quantitative approaches will be combined for the process evaluation, combining documents and records review, as well as interviews with the program implementers and users, shortly after setting up the effect evaluation cohort, and during the study period. Additionally, focus group interviews are planned, aiming to explore experiences, barriers that students encounter to perform recommended sexual health behaviors and to contextualize the findings of the effect evaluation part.All teachers involved in teaching life skills are included, health advisors and a sample of activists will be invited to take part in the study. Additionally, A sample of first year students from the Faculty of Health Sciences and the Faculty of Economy and Management, both at the UCM, will be systematically selected through a stratified random sampling procedure strategy from the cohort's participants list within faculty and gender groups, as well as consideration of a number of interviews to achieve saturation, which is expected to range between 6 and 12 per gender and per faculty –25. The Inclusion criteria:ActivistsAttending second to fourth year for all courses, and second to sixth year for medicine at the UCM.Actively engaged in sensitizing activities.Health advisorsHolding a valid fulltime working contract at the UCM.Formally assigned to offer STIs screening, counseling and testing services at the UCM.TeachersHolding a valid fulltime working contract at the UCM.Assigned to teach the life skills discipline in the current academic year.Program usersFirst year university students from UCM.Being aged 16 to 25 years old.The process evaluation research will use different techniques and instruments of data collection see . SummariObservations and checklists will also be used to assess provision of curricular lessons and delivery of awareness activities. Tracking of program materials, training records, lessons, awareness activities and screening records will be used to capture data regarding reach, dose delivered and dose received, including fidelity and recruitment. Moreover, face-to-face structured interviews  and focuThe first interview will be done to assess how activists engage in sensitization activities, what they think about the usefulness of the program for themselves and for other students, and what they think about improvement of the intervention. The interview will be conducted face-to-face using a structured guide .The second interview is designed for teachers of the life skills subject, to learn more about the area of their training, how they were selected to teach the subject, how long they have been working as university lecturers, what their experience with SRH contents is (including number of trainings relative to the field), how they evaluate the attendance and participation of students to lessons of this subject. The interview will be guided by a structured form .The last interview among the implementers will be done among the health advisors; open-ended questions  will be All implementers will be asked to fill in a checklist and record sheets, in order to evaluate the reach, dose delivered and received, recruitment and fidelity of the program implementation. During the interview process, the conversations will be recorded and subsequently transcribed to limit possible bias and ensure natural information provided by the participant; also the interviewers will take notes during the interaction.Additionally, a selected sample of program users will be asked to attend a face-to-face interview. The interview will be administered using a structured interview guide . At the Focus group interviews will enable to access person's experiences, beliefs, opinions, values and desires. The sampling procedure will follow the same design as described above. Hence, from the list of participants studying at the Faculty of Health Sciences and Faculty of Economy and Management at the UCM, subjects will be randomly selected within gender groups and asked to take part of the group interview, until the sample size is completed (four groups of 6–12 participants) and saturation is achieved.Participants will receive written and oral information about the group interview details , includiWritten informed consent process will be conducted with all participants before the interview. Confidentiality and anonymity will be ensured to the participant, thus, the interview contents will be labeled using codes, and it will take place in an area free from distractions and at the times and location that are considered suitable by the participants, for instance, at the faculty in a closed classroom. The focus group interview may last 1.5–2 h and will be carried out within gender and faculty specific groups. Hence, four focus group interviews are expected to be held: each gender group within each of the two faculties.All interview sessions will be recorded and transcribed afterward. Two researchers will be present, one as a moderator and another one as observer. The observer will not be allowed to contribute with any idea, his/her task will be to take notes and record the sessions in as much detail as possible. The participants will be explained the procedure before the interview starts. All focus group interview participants will be compensated for transport, and snacks will be shared at the end of the interview.Quantitative data will be processed and analyzed using SPSS version 25 ; descriptive statistics and proportions will be reported.” Qualitative data will be managed and analyzed using the NVivo software. A combination of thematic method and narrative analysis –31 will On the other hand, the narrative approach will consist of understanding the content and structure of the transcribed stories through reading and re-reading the transcriptions, identify crucial constructs , writing a summary addressing the main elements such as beginning, middle and the end of the narrative. The transition between themes will be captured and thematic connection of ideas will be developed based on the content of the story, finally comparison among different views of participants regarding the intervention will be presented.The effect evaluation including its indicators and methods are summarized in A cohort study applying a quasi-experimental non-equivalent control group design with pre-post approach will be used since the intervention is ongoing and by its nature, the use of a full experimental design is unjustifiable. Students registered for the first year, willing to take part in this study, will fill in the questionnaire at enrollment, post intervention and at follow up. The participants will be encouraged to visit a health advisor to undergo an STIs screening through clinical and testing examination. Considering that the prevalence of STI in general is high among young adults, and the primary outcome of the intervention is (determinants of) behavior change, all students, no matter their STI/HIV state, will be enrolled in the cohort and followed-up for 6 months. Students enrolled at UCM will be exposed to the full program, and students from UniLicungo will only receive information from research team and teachers to visit STI counseling and testing office.The main aims of the cohort are: To analyze changes in behavior and individual-level determinants that in turn influence unprotected sex behavior and use of STI/HIV screening services among university students in Beira city after exposure to the intervention, as well as to monitor cyclical transmission of STIs including HIV among first year university students in Beira at 3 and 6 months after setting up the cohort. During the follow-up period there will be regular consultations, every 3 months for STIs/HIV screening and questionnaire self-filling. Treatment will be offered at the health center to students that are diagnosed with an STI, and the participant will not be withdrawn from the cohort.At baseline, clustered and random sampling will be applied. University students will be enrolled consecutively from randomly selected classes (clusters) at the UCM and UniLicungo. Considering that the baseline survey will serve as identification and enrolment point of participants to the cohort, and the main purpose is to look for differences on determinants and behavior changes between groups (students exposed to the full program and those not exposed); based on a 95% confidence interval, desired confidence interval half-width of 0.15 and Cohen's d of 0.2, a total of 687 participants are needed . AssuminInclusion criteriaFirst year university students studying at one of the two universities in faculties located in Beira city.Being aged 16–25 years old.Having residency in Beira city for the entire academic year.Data collection will be performed by three data collectors after being trained in a 2-day session. The training will focus on study aims, how to obtain informed consent, how to approach the participants and how to distribute and collect the questionnaires. The data will be collected through a self-administered structured questionnaire see  with cloInformed consent will be obtained collectively before questionnaire distribution to the class though each candidate will freely decide and sign the consent form. The data collection process will take place in classrooms. The same questionnaire will be administrated to the study participants three times . At the time one and two, participants will be asked to respond only to questions regarding intersexual relationship (section 2) and questions addressing behavioral outcome 1 and 2 .During the time of filling in questionnaires, students will not be allowed to chat or to look at classmates' answers. Thus, in case of doubt, students will be advised to ask the data collector for clarification. After a given time for completing, the data collector will recollect the questionnaires, give a study participant identification card, and recommend her/him to visit the health advisor office for STIs counseling and screening within the following days.The health advisor will offer services according to the national guideline . He/she All quantitative data will be processed and analyzed using SPSS , descriptive statistics and proportions will be reported. The baseline data will be compared using t- tests and Chi-square tests. After intervention, data from different universities will be compared using multilevel regression models considering the baseline values and nesting of students within classes. Multilevel regression model analysis has been referred to be an eligible method to analyze data from research with a hierarchical structure, and variables measured at different levels and time-points –38. ThisEvaluation of health promotion programs is seen as an important step in intervention development, because it enables to learn about the effects of interventions and how they are established , indeed The result of this study will inform and guide the development of optimal sexual and reproductive health behavior promotion programs targeting university students, using a systematic approach. Having assessed the natural conditions under which intervention targeting STI/HIV prevention issues among university students works, the findings will support public health decision makers to expand the program to other universities (if deemed appropriate) and make adaptions (where needed).There are many approaches that can be applied to develop, implement and evaluate health promotion interventions, from the narrow one to the most comprehensive such as the Behavior Change Wheel and Intervention Mapping. O'Cathain end colleagues describe eight categories: 1. Partnership approaches; 2. Target population-centered; 3. Theory and evidence-based, 4. Implementation-based, 5. Efficacy based; 6. Stepped based; 7. Intervention-specific and 8. Combination . Our stuWe decided to follow the IM since it is a theory-and evidence-based, systematic and detailed guide regarding what to do, especially on how to perform specific needed activities to achieve intervention transparency , 41, 42.The program described in this manuscript, which we aim to evaluate, is already in its full implementation, meaning that it might be an unjustifiable and unfeasible procedure to apply a full experimental study design with random allocation to intervention and control group, which would imply excluding some classes or students from the intervention at UCM, while they share the same environment and policies. Hence to have a comparison group, similar in age and level of education, a quasi-experimental design assigning students from another university as comparison group is a rational and acceptable approach to evaluate the effect of the intervention aiming to change (determinants of) behavior with limited biases.Traditionally, randomized controlled trials have been seen as gold standard for generating casual evidence in health sciences field, especially when it comes to warrant inclusion criteria in systematic reviews and meta-analysis , 46. HowAlthough quasi-experimental studies have some advantages compared to other designs, it is recognized that they will only result in acceptable or valid inferences when conducted in a way that meet certain assumptions . They arThe studies involving human participants were reviewed and approved by Interinstitutional Committee on Bioethics of Health - CIBS Sofala. IRB00002657. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.AZ and RC developed and conceived the research protocol manuscript. NV contributed to the study design and reviewed the first draft of the paper. All authors contributed to the article and approved the submitted version.AZ is supported by the Nuffic, NICHE Program grant number: 30606015N, led by the Maastricht University as scholarship for her PhD trajectory. Obtaining this scholarship did not include peer-review of the study protocol.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.


This article aims to analyse the relationship between the bullying aggressor and bullying victim profile related to practising or not practising sport in adolescents living in southern Spain. The research includes male and female participants aged between 12 and 16 years in different secondary schools in the provinces of Andalusia, Ceuta and Melilla in the period between February 2022 and June 2022. The study aims to extend the existing scientific, theoretical and empirical knowledge on the influence of playing sport or not on disruptive bullying attitudes in adolescents. To this end, two initial hypotheses were designed; the first hypothesises that bullying victim behaviours are associated with future bullying aggressor behaviours when practising sport; and the second states that victim behaviours are associated with future bullying aggressor behaviours when not practising sport. To verify them, SPSS software was used for the preliminary analysis of the scale and sociodemographic profile. Additionally, the study is based on structural equation modelling methodology and variance-based methods employing SmartPLS v3.3 software. The results show the importance of sport or physical activity to reduce the chances of carrying out bullying actions on other peers and/or classmates. Therefore, it is considered necessary to prevent bullying in the classroom by implementing sports intervention programmes in educational centres. School climate and safety are at the forefront of current educational issues. Bullying is a fragment of the school climate and safety puzzle. Bullying, either as a victim or as an aggressor, can have a lasting impact on students . Such a As is reflected by , bullyinFor this reason, researchers and education professionals must understand and comprehend the prevalence of school bullying to become agents of change within their school systems . AuthorsThe main concern shown by experts studying school bullying, such as education professionals, is the myriad of possible effects it can have on the victim and the aggressor . Some reHowever, some prevention programmes have considered the physical education factor in the role against violence in schools due to its valuable effects by favouring the externalisation of emotions and social skills improvement . In thisInstead, other studies highlight the need and relevance of the proactive and, therefore, the non-reactive role of physical education teachers in dealing with bullying , thus hiTherefore, this research aims to analyse the relationship between the bullying aggressor (BAgres) and bullying victim (BVic) profile related to practising or not practising sport in adolescents. The study aims to extend the existing scientific, theoretical and empirical knowledge on the influence of playing sport or not on disruptive bullying attitudes in people aged between 12 and 16 years.As a result of the above, the following hypotheses are presented  behaviours are associated with future bullying aggressor (BAgres) behaviours when playing sport.H1b. bullying victim (BVic) behaviours are associated with future bullying aggressor (BAgres) behaviours when not playing sport.n = 944,570) from the southern and northern African Spanish centres of secondary education. This gives a confidence level of 95% and a maximum estimation error of 5% [Non-probability purposive sampling is used. The number of participants analysed (N = 1454) in the research is considered eligible. The number obtained is representative of the total number of adolescents stipulated  ,44, the The adapted instrument is designed for adolescents between 12 and 16 years old and is structured with 52 items that evaluate three blocks . Following theoretical indications , the elaTo carry out the proposed analysis, different software is employed. First, the SPSS programme is used for data preparation and to carry out the preliminary analysis of the scale and sociodemographic profile. To test the reliability of the scale used, a Cronbach’s alpha test value of 0.959 is obtained. The last is clearly above the minimum required value of 0.7, as indicated by reference authors in the field .On the other hand, the study was based on structural equation modelling (SEM) methodology, specifically on variance-based methods (V-SEM), employing SmartPLS v3.3, a tool widely used in the field of social sciences ,51,52. TThe mean sociodemographic profile of the sample selected corresponds to a female who is physically active, aged 13/14 years, whose religion is Christianity and of Castilian ethnicity and white race. The measurement evaluation of the model is carried out through an individual analysis, where factor loadings are addressed and, at the level of internal consistency, through the Dijkstra-Henseler composite reliability, convergent validity through the Average Variance Extracted (AVE) and discriminant validity through the Heterotrait-Monotrait ratio (HT-MT ratio). For the existence of individual validity, factor loadings must be greater than 0.70 , althougp-value, as well as the confidence intervals, thus carrying out hypothesis testing from a parametric and non-parametric perspective. Based on The results obtained show differences in bullying behaviours when they have been previously bullied. Thus, the first hypothesis (H1a), which stated that victim bullying behaviours are associated with future aggressor bullying behaviours when practising sport, has not been supported, indicating that if a sport is practised, this behaviour is not repeated. The results are associated with those obtained in previous studies  in whichSports practice becomes an excellent means for the transmission of values  and a prA study applied in schools with a high prevalence of bullying , showed On the other hand, the second hypothesis (H1b), the one that hypothesised that victim behaviours are associated with future bullying aggressor behaviours when not practising sport has been supported, indicating that when not practising sport or physical activity, there is a tendency to carry out future bullying aggressor behaviours when having been a victim of aggression in the past . As reflEvidence suggests that when a child or adolescent spends a significant amount of time in sedentary behaviours or activities, it is associated with poorer health and attitudinal outcomes . AccordiThe conclusions obtained highlight and confirm the two initial hypotheses put forward in the study, indicating the importance of sport or physical activity not only in terms of a better physical situation for the individual but also, as verified in the results of the study, in reducing the possibilities of bullying other classmates and/or fellows. Therefore, it is considered necessary, as a means of preventing this type of bullying, for schools to implement sports intervention programmes for this purpose in the classroom. In the present study, it seemed to be effective in reducing victimisation in school bullying and, as in many cases, in cyberbullying, as well as aggression in bullying, although with a more cautious interpretation. Teachers could apply this type of intervention, together with specialist teachers and programmes adapted to PE content, to reduce levels of bullying while working on aspects related to students’ socio-emotional skills.Thus, it is considered fundamental for educational institutions to raise these educational intervention programmes from the different contents of the curriculum to include training in values and prosocial aspects of learning through sport, which will encourage empathy, autonomy and help among the peer group. In this sense, pedagogical models already proven in the scientific literature could be a solution, as with, for example, Cooperative Learning, the Personal and Social Responsibility Model or interventions based on dialogical learning in schools that are transformed into learning communities. These models or their combination could reduce the negative behaviours of schoolchildren in the adolescent stage, such as aggression and the effects of victimisation, contributing to solving coexistence problems and developing a positive climate for the personal development of adolescents.As limitations of the study, it is necessary to consider with caution the data obtained in the research, since they do not constitute a sample of the total Spanish educational context—which is only characteristic of a Southern Spain context—, nor can they be extrapolated to European contexts. Despite these limitations, the sample is considered distinctive for the south of the country, which provides a solid approach to the phenomenon of bullying and how sports practice influences this phenomenon. Moreover, this research used a quantitative methodology, which may provide limited information about the construct. For this reason, it is recommended to extend the study to research that accumulates qualitative data to provide complementary information to the current findings and to contract them.Despite all these limitations, the results obtained in the research process are worthy and accurate for the existing scientific vacuum of research carried out in Spain on this type of bullying and how the practice of sport helps to reduce this type of disruptive behaviour in adolescents, as bullying is on the rise, specifically in educational environments, especially in those with a large cultural influx.As a result of these limitations, it is suggested that future research related to this study replicates the analysis of the model presented with other larger samples, using longitudinal designs, measuring at two or three different moments that would provide us with more accurate data on the analysed construct. On the other hand, another type of analysis is also proposed for future studies that address this aspect from the aforementioned methodological approaches. Therefore, it is recommended that future research ad-dresses all these limitations and study similar models with experimental, qualitative or mixed methodologies, also considering other theoretical perspectives based on modern human sciences and beyond educational theories to easily interpret some of the considerable empirical research carried out recently in many countries.


Digital health applications have been shown to be an accepted means to provide mental health information and advice in various high- and middle-income countries. Started in 2015, ehealth.sr was the first website to offer preventive information, self-tests, and unguided digital self-help for depression, anxiety symptoms, and problematic alcohol use in Suriname, an upper middle-income country in South America.This study aimed to assess the general demographics and behavioral patterns of the visitors of ehealth.sr, as well as to evaluate different promotional channels to attract the target audience to the website.Data collection for this study took place between August 2015 and December 2020. Conventional promotion channels such as newspaper and radio advertisements as well as social media advertisements were used to attract users to the website. The number of visits and activity on the website was registered using Google analytics and the website’s internal activity log.On average, about 115 unique visitors accessed the website per month. The average number of visits to the website increased notably when social media advertisement campaigns were conducted (266 per month in 2018) compared to when traditional advertisements campaigns through papers, radio, and television were used (34 per month in 2019). Of the 1908 new visitors, 1418 (74.32%) were female. On average, visitors accessed 2 (SD 0.3) pages of the website and a session lasted 2.6 (SD 0.9) minutes. The most popular pages for intervention on the website were those for the mood or anxiety screening  as opposed to those for alcohol screening . People aged <45 years  made more use of the website than people aged ≥45 years .Promotion via social media led to more visitors to the website than newspaper or radio advertisements. Younger age groups and females visited the website more often. The pages on preventive information and brief self-tests were visited more frequently than the self-help modules. In general, user adherence to the website in terms of the average session duration and number of viewed pages per session is low and is a key point of concern for the successful implementation of digital mental health websites. In recent years, mental health has attracted the attention of digital technology  since itThe application of information and communication technologies to support national health care services is rapidly expanding and has become increasingly important globally . ConsequThe implementation of eHealth promises a number of potential benefits to the health system, including, but not limited to, increased efficiency in health care, improvement in quality, the reduction of the cost of care, and the improvement of health system governance . With thDue to the wide availability of information and communication technologies, LMIC have developed eHealth strategies to prevent and treat mental health disorders and substance use disorders. For instance, HDep (Help for Depression or Ayuda para depresión [ADep] in Spanish) is an open-access and free web-based, psychoeducational, and cognitive-behavioral mental health program created in Mexico with a single goal—to help recognize and prevent depression . HDep haAs a low-income country, Bangladesh received special attention in 2013 for its innovative use of eHealth, especially in a mental health setting . A detaiThe advent of eHealth could thus be a powerful strategy for the delivery of mental health services, especially in LMIC. In this paper, we focus on web-based mental health care in Suriname, an upper middle-income country. In Suriname, eHealth is made possible through the website  designedThe aim of this study was to assess the general demographics and behavioral patterns of visitors on a mental health website offering psychoeducational information, self-tests, and unguided self-help interventions developed in LMIC. In addition, we also investigated the best way we can attract the target audience to a mental health website for LMIC such as Suriname.Suriname is a middle-income, Caribbean, and South American country with approximately 575,990 inhabitants. Web-based mental health for the Surinamese community is made possible through the eHealth.sr website  hosted bThe eHealth.sr website contains modules with psychoeducational information, self-screening tests, and structured self-help for problematic alcohol use, depression, and anxiety. The website is offered in the main language of Suriname, which is Dutch. Most inhabitants of Suriname have at least a basic understanding and reading ability in Dutch.The psychoeducational information module on alcohol addresses the short- and long-term risks of drinking, including the risk of developing alcohol use disorder and what can be done to mitigate these risks.The self-test module is a questionnaire with feedback and includes a 7-day timeline follow-back to assess alcohol use in the past week, the Alcohol Use Disorder Identification Test, an alcohol-problems screening instrument developed by the WHO , and theAfter completing the questionnaires, the participants will receive automated personalized normative feedback. The self-help module contains a fully automated digital alcohol self-help program, originally developed by Jellinek  and not In this self-help intervention, various options that enable the person seeking help to determine the advantages and disadvantages of both the use as well as quitting of alcohol are offered. The participant can also set targets for themselves, visit the forum, and keep a diary. The module is an MI-based program and provides help-seeking tips and an overview of the results achieved in the self-help program. The part for problematic alcohol use has a time limit of 6 weeks, and eventually, the program fidelity and its achieved goals are displayed . The modThe psychoeducational information module on depression and anxiety addresses the common symptoms of depression, stress, anxiety, and suicidal tendencies, as well as the prevention and treatment measures that can be taken to mitigate these symptoms.The self-test module is a questionnaire with feedback and includes the Center for Epidemiologic Studies Depression (CES-D) scale  and the The self-help module contains a fully automated digital alcohol self-help program based on problem-solving therapy (PST) and MI. It was inspired by the PST-MI Exercises of the Substance Use and Trauma Intervention (eSTRIVE) . The finOur self-help program offers PST-MI in 4 sessions. The participant will learn to recognize and handle problems as either unimportant or irrelevant, important but not resolvable, or important and resolvable. The goal for them is to regain control of their life, discover what is important to them, and learn how to conquer problems like nervousness, depression, or anxiety.The website  was launAt various occasions, promotion efforts were made to attract the target audience to the website by handing out eHealth flyers at regional health care centers and through the Facebook page and newspaper advertisements. The 2015-2016 population survey in Nickerie and Paramaribo took place from July 23 to August 17, 2016, during which all respondents were informed and handed a folder about the website . During Page views and visitors’ behavior were recorded anonymously using Google Analytics. The responses of the participants in the self-test were also recorded anonymously to give them automated normative feedback. “Users” refers to the number of unique visitors to the site, whereas “sessions” refers to the total number of visits to the site, which includes both new and repeat visits . Data inAs no data were prospectively collected solely for the purpose of this study and no participants were subjected to research procedures, this study was deemed exempt from medical ethics approval. The website is a result of a larger study that was approved by the Ministry of Health of Suriname (CMWO201504). Due to the anonymity of the persons entering their data on the site, consent was not required. In addition, consent was not obtained to guarantee the anonymity of the participants, thus they were prevented from entering personal data on any occasion.The average number of monthly visits to the eHealth website from 2015 to 2020 were 202 per month in 2015, 94 per month in 2016, 39 per month in 2017, 266 per month in 2018, 34 per month in 2019, and 59 per month in 2020. On average, about 115 unique visitors accessed the website per month. The value for 2015 represents only 5 months because the program started in August. We saw a relatively high monthly number of visits in 2015 and 2016 and then again in 2018, with a small peak in 2020. The high number of visits of 2015 and 2016 were probably due to the introduction of the website to individuals during the survey. In 2018, there was an active advertisement through the Facebook page of the institute. A systematic review recommended this type of advertising as being extremely successful . The numThis study aimed to describe the general demographics and behavioral patterns of the visitors of an eHealth website provided by the PCS and the impact of the different forms of promotion on this site. We found that younger age groups were more likely to use the site for diagnostic and intervention purposes. There were more female than male visitors to the website. Furthermore, we observed that the eHealth module parts that were less intensive got more visitors than those that were more intensive since the launch in 2015. The number of visitors of the eSTRIVE module for depression were also higher than the module for problematic alcohol use. Another important finding is that whenever there was an active or intensive campaign in person or through social media, the number of visitors increased. Regular advertisement in newspapers and other nondigital media did not result in the same number of visits. Additionally, there was a small peak in 2020, which is probably ascribable to the measures taken with COVID-19, where clinics were closed and only used for emergency cases.The decline of internet use for eHealth with age that we observed is very consistent with findings in high-income countries. A population-based survey from 2005-2007 in several European countries showed that the use of internet modules for general health was highest among people aged 18-25 years (70% to 80%) and declined progressively to under 20% among people aged >65 years . AnotherComparable studies in LMIC are not available. To our knowledge, this study is the first one analyzing these data in LMIC. The study shows that with proper advertisement it is possible to apply eHealth modules for mental disorders in LMIC. This is favorable since recent surveys have shown a significantly high treatment gap for alcohol abuse disorders  and deprFinally, we found that personal promotion and advertisements through social media resulted in the largest increase of visitors to the website. Traditional promotion through advertisements in the local newspapers and conventional media like radio and television did not contribute to a higher number of visits to the site. In general, peers and facilitators may increase the success rate of remote health programs , and thiA limitation of the program is that the promotion was initially in only 2 regions of the country, which could bias the number of visits to the website. However, more than 75% of the population resides in the capital, which minimizes the amount of expected bias. Another limitation is that the module is offered only in Dutch, thereby excluding those who do not use the language. Furthermore, the requirement of decent internet to complete the survey and then enter a possible treatment module limits the availability for the entire population. Due to the anonymous nature of the website, we were unable to assess the real-world impact of these limitations.In summary, we found that younger age groups and females visited the website more often. Furthermore, there was a success rate of at least 25% for both the alcohol abuse and depression or anxiety modules. Finally, we found that advertising through Facebook had the best effect on the use of these modules. We recommend that the use of an eHealth mental health intervention module is feasible to bridge part of the treatment gap in LMIC such as Suriname, if it is promoted adequately. Furthermore, to increase the use of the facility, it would be necessary to promote this kind of intervention among the older adults and men. We also recommend that the best way for promotion is through the personal involvement of doctors, nurses, and students. Advertisement through social media seems to work the best in these settings. Since the use of smartphones nowadays is more acceptable and widespread than desktop and laptop devices, it is recommended that future research develop a user-friendly app for smartphones.


The issue of welfare is a widespread issue that any country in the world would love to achieve. However, in Ethiopia, many societies are living in poverty because of high food prices emanating from fragile agricultural productivity and exchange rate devaluation. The aim of this study is to investigate the effects of agricultural factors productivity, food prices, and exchange rates on household welfare in Ethiopia. Based on the stochastic process of the variables, the autoregressive distributed lag model has been employed. The result of the model revealed that agricultural land productivity in the introduction episode depresses welfare and, latterly, it optimistically improves welfare. Nevertheless, labor productivity in agriculture has a negative impact on welfare. Furthermore, exchange rate depreciation and food price increases in Ethiopia endanger welfare by eroding purchasers' purchasing power and amplifying the divergence of demand and supply in the economy. To improve the welfare of society, the government and society should increase the productive capacity of domestic firms and the agriculture sector to the extent that offsets the exchange rate effects on welfare. Welfare; Agriculture productivity; Food price; ARDL and Ethiopia. It accounts for about 25 percent of the world’s malnourished population. In 2015, 20.8 percent of the population was hungry, a figure that has risen dramatically to 22.7 percent in 2016 .Agriculture in Ethiopia contributes 27.5 billion dollars, or 34.1% of GDP, employs 79% of the workforce, accounts for 79% of foreign earnings, and is the primary source of raw materials and capital for investment and market .There are two conflicting results about the impact of agricultural factors productivity, food prices, and exchange rates on societal welfare. Food security is a dynamic interaction of food environments, food acquisition and preparation preferences, and inspired agency . It confMoreover, the acquisition of large-scale agricultural land has a substantial welfare implication for the affected rural population . Crop pr2The issue of exchange rates is the translation of the currency of one country into the currency of another country. Exchange rate volatility understood as a computation of wavering can affect disparity through its impact on different economic variables, which in turn manipulate disparity. As a result, it has a variety of effects on the well-being of domestic citizens, in addition to serving as a standard for demonstrating the competitiveness of domestic industries in the global market .Depending on preferences and the monetary-policy rules followed by each system, either exchange-rate system can be superior in terms of trade and welfare . It is iUrban households are less deprived than rural households. Poverty and welfare derivation are correlated and have been inversely determined by a household's education level, which enables them to look for new modes of income-generating activities. It has long been established that investing in rural dwellers' education and economic conditions is the primary tool for alleviating household poverty . There iAgricultural technology adoption positively affects the welfare of households in Ethiopia. Technologies could directly affect farm output, which translates into consumption at a household level. This also implies that the opportunity for enhancing the role of adoption of agricultural technologies is larger than what contributes to poverty reduction .It is concluded that the recurrent episodes of spikes in food prices raised poverty significantly, especially in urban areas of food-importing countries. High prices can also contribute to political unrest, and recent episodes have prompted many countries to enact protectionist policies . Policy According to 3In this study, the time series data from (1980220) has been used. The data is sourced from worldwide open data sources, mainly obtained from Penn World Data Source  and the World Development Indicator . It is crucial that a fitting methodology for the time series be applied, through which one can verify unbiased and reliable estimates. A method of selection for time series analysis is undertaken based on the stationery test results. If all the variables are stationary I(0), ordinary least square (OLS) or vector autoregressive (VAR) models can provide unbiased estimates.If all the variables are non-stationary, ARDL is appropriate to analyze the relationship .To select the optimal lag length included in the model, Akaike and Schwarz's criteria were important to identify the right model that leads to accurate prediction and guarantees a sustainable production system . In prac the model specification is given in According to k is the ARDL model maximum lag order and chosen by the user. The selected ARDL (k) As per From xs  are the explanatory or the long run forcing variables, k is the number of optimum lag order. In the above k lag length ARDL model, if there is co-integration or long run relationships between variables’, the error correction model has been specified (From the above pecified .(4)ECT=εECT shows how much of the disequilibrium is being corrected, that is, the extent to which any disequilibrium in the preceding period is being adjusted in yt. A positive coefficient indicates a departure, while a negative coefficient indicates convergence . In order to select the appropriate model for the long-run underlying equation, it is necessary to determine the optimum lag length(k) by using proper model order selection criteria such as the Akaike Information Criterion (AIC), Schwarz Bayesian Criterion (SBC), or Hannan-Quinn Criterion (HQC) . AccordiUsing ordinary least squares or other similar methods for non-stationary time series may produce spurious results. Hence, Engle and Granger (1987) developed a co-integration test method to analyze the relationships among non-stationary variables . Co inteThe welfare of a society is the maximum consumption of output retrieved from the optimum employment of factors of production. The ARDL model result from In this study, agriculture productivity is represented by land and labor. Agricultural land productivity is premeditated by total agriculture output per total arable land. In the model, the two previous land productivity data sets are included under analysis. All these are statistically significant. The current land productivity is positively allied with the welfare of society in Ethiopia. But in the previous year, land productivity in Ethiopia had a negative and significant impact on the welfare of households. The justification that exists behind this empirical result is that most of the time, an increase in agricultural land productivity persuaded societies to reinvest the total output rather than consumption until their income reached its climax. Households in developing countries were not liberated from risk and uncertainty, and the intensity of production at the primary stage of the production period was most probably low. This led them to be net investors and net savers rather than more purchasers. Due to this fact, the preceding land yield is harmfully linked to welfare, and welfare turns out to be amplified subsequently to the uninterrupted enlargement in land productivity. On the other hand, agriculture productivity is denoted by the total agricultural output per hour of total employed labor in agriculture. The results showed that agriculture labor productivity in the current and preceding years was statistically significant at the 5% and 10% levels of significance, respectively. The current year's labor productivity in Ethiopia is depressingly linked to welfare, while the preceding agricultural labor productivity is optimistically related to the welfare of the society. It is noticeable that, with regular technology, the marginal productivity of labor in the agriculture sector is zero. Therefore, an increase in the total number of laborers on a fixed area of arable land has not contributed to increasing the total agricultural output. Even if successive employment of labor in agriculture becomes a cause for the predicament of disguised unemployment, perhaps it will augment agricultural productivity. Following this authentic circumstance, which most likely exists in agriculture, the untimely period of labor productivity has a constructive effect on welfare since the number of laborers in the preceding year is comparatively smaller than the amount of labor employed in agriculture. i.e., as the amount of labor employed in agriculture is relatively lower, its average productivity becomes high and it has a positive contribution to household welfare.The empirical findings confirmed that increases in food prices have a variety of effects on household welfare in Ethiopia. The size of reimbursement payments depends on a number of factors, including the size of reimbursement payments, productivity spillovers on smallholders, employment opportunities for disposed farmers, and changes in food prices . Indeed,According to 5Welfare is the augmentation of society’s harvest consumption that has been derived from the efficient exploitation of factors of production. Scholars confirmed that welfare is constrained by both economic and institutional restraints like production, innovation, social programs, and allotment of products and resources. The issue of welfare is a static economic phenomenon that highlights the mounting total output consumption. To achieve the welfare of society in Ethiopia, the dynamic economic aspect (GDP) growth rate needs to be first capitalized. Agriculture productivity is an indispensable apparatus to boosting the national output in Ethiopia by adopting modern technology like innovation in improved seeds, fertilizer, and livestock reproduction, agriculture services, and constructing market links between agriculture and industry. Results of this study convey that agriculture productivity is a pathway to enhance the welfare of society in Ethiopia by escalating labor productivity with the adoption of complementary inputs like improved seed extension services etc. Due to this fact, the marginal productivity of labor in the agriculture sector is negative throughout time. If agriculture operated under constant technology, its implications for the welfare of society would be negative. Land productivity is positively interconnected with the welfare of society, which means that when land productivity increases through the adoption of modern technology and the formulation of good agricultural institutions, it can improve the welfare of society in Ethiopia. Furthermore, the problem of food price increases and exchange rates in Ethiopia over the last 40 years has had a negative impact on consumption levels by increasing the disparities between food demand and supply and decreasing consumer purchasing power. Hence, the study recommended that the government of Ethiopia should reduce food prices and exchange rate volatility. Also, governments ought to be increasing the market share between industry and agriculture by establishing agricultural processing industries in order to increase food supply. The exchange rate should be evaluated by considering the net benefit of foreign investors investing in the industrial sector rather than agriculture investments.Ferede Mengistie Alemu: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Data associated with this study has been deposited at World Bank data source and Penn World Database under the accession number 5028.The authors declare no conflict of interest.No additional information is available for this paper.


Three days after delivering food to her father, she jumped to her death. It started when a storm of public opinion erupted after she gave the delivery man $30.76 for his kindness. This real case occurred during the COVID-19 pandemic in Shanghai in April 2022. The girl, who had a happy family and was physically and mentally healthy, shared her heartwarming story on her Micro-blog, thanking the delivery man for his selfless act. However, this “small” incident cost her life.Previous studies have shown a significantly rise in suicide rates during the COVID-19 pandemic . In addiCyber violence is toxic to society. It refers to the illegal and criminal behavior by which individuals or groups intentionally spread illegal information through the Internet to repeatedly and continuously infringe on specific individuals or groups, which will lower the social evaluation of the attacked individuals, infringe on the right of personality and information, and even threaten the rights of person and property . The perIn the early days of the COVID-19 pandemic, The Lancet Psychiatry Commission predicted an increase in suicide rates worldwide . MoreoveThe United Nations has identified violence against women (VAW) as a shadow pandemic created in the midst of the COVID-19 pandemic. Previous literature indicated that the incidence of cyber violence against female victims was significantly higher than that against males , and cybA review that included reports from 53 WHO European member states found that the most common measure to prevent or respond to VAW was to use social media to raise awareness of violence among female victims and to provide services to them through online platforms, followed by measures to expand or maintain helpline services for female victims of violence . Some peIn this case, the suicide occurred just 2 days after the outbreak of cyber violence. It can be seen that the intervention of suicidal behavior lacks timeliness. During the COVID-19 pandemic, the incidence of cyber violence and suicide has increased, respectively , 18. It The issue of cyber violence during the pandemic is extremely important and cannot be ignored. Relevant departments need to formulate rigorous and effective measures to reduce the suicide caused by it.HL originally designed the study and have been responsible for obtaining funding. All authors contributed to this study, read the manuscript, approved the final manuscript, interpretation of data, and the approval of the final report.This paper was supported by Anhui Institute of Translational Medicine Research Fund (No. 2017zhyx17) and the Anhui Provincial Key R&D Program (202004j07020030).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.