In the 1960s, the six founding countries  of the European Economic Community (EEC) initiated a process for the harmonization of livestock trade and its products among Member States (MSs) and third countries. In those years, several major animal diseases  were widespread in Europe, with severe economic implications. To share a common strategy, the EEC promoted a harmonization process of the regulatory differences between the countries, with the aim of establishing one single market for live animals and their products.This process has been ongoing for the last 50 years, with continuous revision and updating of the wide body of rules on the legislation on animal health and food safety. This has gradually harmonized the legal framework in the European Union (EU), which currently includes 27 Member States and approximately 450 million citizens . This amIn 2016, a further ambitious step forward has been taken by means of Regulation EU 2016/429  , minimize border controls and bureaucratic procedures between EU MSs, and eliminate the crowd of bilateral agreements applied so far. Moreover, the new system must guarantee and accelerate the traceability and sharing of data on the identification and certification of the moved animals to be ready for early detection and rapid warning of disease risk.This policy facilitates animal movements by more stringent biosafety guarantees, which are required for those countries of dispatch. Furthermore, introduced innovations have over time attributed ever greater responsibilities to all relevant actors involved in all steps of the animal production chain.To better understand the evolution of this regulation, we went through and considered all major steps taken to date.The first European Directive concerning animal movement among MS (Council Directive 64/432/EEC dated 24 June 1964) , and theWith the strengthening of the Common European Market, further conditions for the movement of animals in the EU were introduced (Directive 90/425/EEC) . The MS With the issuance of Directive 64/432/EEC  added prHowever, only with the issuance of EC Regulation 1/2005 , a real The great part of the AHL  is mainlA novelty is a new way to consider the risks related to animal diseases: now each pathogen is included in a category according to the intensity of control measures to be applied. It is called “categorization” as regulated by Article 9. Each category includes groups of animal diseases that can affect various susceptible species, grouped by epidemiological characteristics. Therefore, all the 63 diseases listed in the CDR 2018/1629  are grouFor all these diseases, specific restrictions are provided , including the immediate notification to the competent authority and, according to an information system regulated by Articles 22 and 23, which will be established by the EC .Considering the CIR 2018/1882, with reference to Article 128 of Reg. 429/2016 , animal production operators will not be able to move animals destined to be culled in another MS if they are part of mandatory or voluntary eradication programs as provided by Article 31, for the diseases of categories referred to in letters a), b), and c) of Article 9. In relation to the diseases mentioned in Article 9 letter d), operators will be able to move livestock to another MS only if they fulfill all health requirements shared among MS with AHL enactment.via the TRAde Control and Export System (TRACES) system.Among the health requirements strengthened by AHL, biosecurity certainly represents the principal tool to prevent the risk of pathogen introduction into the food chain. Biosafety has become a strategic prerequisite for efficient health management of farms: farmers, operators, all professionals of the animal production sector must apply the necessary knowledge on biosecurity on the farm, to the means of transport, to assembly centers, to animal markets, and exhibitions. The application of biosecurity measures is under the responsibility of all operators in the animal production sector and is supervised by competent authorities. Consolidating the previous rules in the EU, all movements of terrestrial ungulates must be accompanied by a health certificate as reported in the AHL  and related CDR 2020/688, Chapter 8, section 1, Articles. 69–72 , Operators other than transporters are required to notify (Article 152) the competent authority of their MS of origin the expected movements of animals; the latter is required to notify the competent authority of the state of the movements (Article 153).The entry into the EU of live animals and their products from third countries is regulated by Articles 229–239, which provide that imports can only take place from countries and establishments that fulfill all necessary guarantees on the health status of their territory, as well as the capacity for surveillance and control of the listed and emerging diseases, considering epidemiological data on previous entries of animals and products at the EU entry points. Upon entry into the EU, animals coming from third Countries are subjected to official controls as stated by Reg. (EU) 2017/625, to ascertain compliance with the provisions on welfare (Article 21) and compliance with animal health legislation (Article 44).More “preparedness” has been introduced with the AHL: Article 6 clarifies the definition of “emerging diseases”: “a disease which results from the evolution or modification of an existing pathogen, which spreads to an area or to a new host species; identified for the first time in the EU or caused by an unrecognized or previously unrecognized pathogen.”Thanks to the work and mediation between the 27 Member States and the United Kingdom, the great step toward a European law on animal health has been made coherently with previous experience and current epidemiological risk evaluation approaches.With the introduction of Reg. 2016/429, some novelties can be remarked: a revised list of 63 diseases has been considered for the certification and traceability of the origin of susceptible species. Some diseases  are now managed with a different approach involving more pathogens (TB complex) of the genus and more species (multispecies diseases), whereas others (bluetongue) have been reconsidered, approving eradication plans only for those territories which voluntary require such a certification. Moreover, AHL will delete from the list of notifiable diseases, certain pathogens historically included, such as vesicular diseases of swine and horses and Teschen disease.In addition, much more coherence of AHL is applied between scientific knowledge and the most updated epidemiological achievements with a new, more realistic, approach for those “unpredictable outbreaks” where vectors or migratory species have a primary role in their occurrence. In these cases, the decision of the Commission is limited to implement and strengthen the risk assessment in the EU, avoiding expensive and often ineffective control measures against insects or worse, against viruses carried by migratory birds.Another new point is the introduction of disease management and surveillance of unusual “exotic” livestock species, such as cervids and camelids, which now require similar rules to those of domestic ungulates.With the new rules, an infected region, characterized by disease outbreaks in domestic or wild animals, can continue its commercial activity by guaranteeing (under the responsibility of the Veterinary Authority) proper biosafety measures sufficient to prevent the risk and to certify the movement of animals and their products.The other main advantage of the AHL is its flexibility: according to epidemiological evidence, it allows to issue new Delegated or Implementing Acts  to better adapt to the new epidemiological situation or to react to new emerging risks. All these changes, contribute in improving surveillance and control policies for animal health in the EU, modulating veterinary measures to the entity of the risk and to the sustainability of the actions.In conclusion, the main pillars on which AHL relies are: a renewed, central role of the veterinarians and their full responsibility in the prevention perspective; the requirement of training initiatives; the identification of priority diseases; an improvement of rapid and centralized, communication and information technologies; and the importance of biosecurity management of livestock settlements. Therefore, more professionality and training are required and vets represent the reference professionals who must bring this new EU sanitary policy into the local productive reality.GL and AL: conceptualization. GL and SM: writing—original draft preparation. GL, SM, CB, and AL: writing—review and editing. GL, GC, and AL: supervision. All authors have read and agreed to the published version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment—220 in private nursing homes and 227 in public nursing homes—participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies. On 31 December 2019, the first case of SARS-CoV-2 infection was reported in China and on 11 March 2020, taking into account the virus’s spread and the severity of cases, the WHO declared a pandemic. The rapid advance of the disease, coupled with scientific ignorance of the virus, led to a global paradigm shift that drastically and suddenly transformed lifestyles. Although the epidemiological behaviour of the virus was international in scope, its impact differed from one country to another.Scientific evidence shows that age is a risk factor associated with greater lethality of the virus ,2. AccorThe virus did not spread uniformly throughout the territory ; some enGeneral data indicate that more than half of people who are diagnosed with COVID-19 are over 60 years of age , a populThe intersection between studies on ageing, residential spaces and COVID-19 has prompted multiple research projects and reflections in the Spanish context, including studies on the virus’s consequences according to nursing home type , health This is partly because older adults have been scarcely acknowledged in modern society. They are generally considered a population group of minor social importance and are sometimes affected by ageist stereotypes, prejudice, and discrimination. This has impacted the social-health system in providing adequate treatment for their health, as evidenced during the pandemic  when addMultimorbidity conditions were compounded by institutional precariousness in caring for patients in nursing homes ,31, whicIn an attempt to control infection in nursing homes, prevention measures were imposed in many of them, including confinement within rooms without the possibility of using common residential spaces. During the first few months of the pandemic, research emerged in an attempt to document the possible consequences of this measure, both in the general population  and specDespite the initial idea that the older population was the most vulnerable and most likely to suffer the emotional consequences of lockdowns, such consequences seem to have had a greater impact and degree of affectation among the younger and female populations . Indeed,Some studies suggest that the health conditions of older adults in nursing homes have worsened as a result of being isolated and, in many cases, having suffered from the disease . The cliThe pandemic has also highlighted certain pre-existing problems in the older institutionalised population, such as loneliness ,53,54. IGiven the radical changes older persons were subjected to in residential environments, the question arises as to how the pandemic affected residents’ quality of life. Results in this respect are by no means homogeneous, and a study conducted in Belgian nursing homes observed that the pandemic, and being confined in particular, triggered a loss of quality of and meaning in life for residents by depriving them “of freedom, social life, activities and autonomy”  (p. 14);Methods of coping with the pandemic are linked to value systems and collective imaginaries that are rooted in certain ages. Thus, narratives articulated about older people’s vulnerability, frailty and helplessness could have been reinforced during the pandemic by COVID-19 ,63, undeThese were the premises upon which research on homes for the elderly in the Region of Madrid was carried out between June and October 2021 through a survey divided into several thematic modules to be answered by residents. The research aimed to answer the question of how the pandemic affected the population in Madrid nursing homes. The impact of the pandemic is understood in a complex and integrated way in relation to various dimensions such as physical health, mental health, emotions about the pandemic, quality of life, the residential environment and the self-perception of ageing. This article discusses the planning, study design, methodology and logistics of the fieldwork and provides an overview of the results and characteristics of the population studied.The Project “Nursing homes and COVID-19. Environments of older people as protectors in health emergency situations” has used a methodology that combines quantitative and qualitative information. To gather quantitative data, a questionnaire was used to measure, quantify and systematise the experience of and effects on older persons living in nursing homes during the COVID-19 pandemic. The qualitative perspective, which will be developed later, will allow us to delve into meanings, motivations and experiences through a discursive and narrative analysis of social agents .The first stage involved conducting a sampling process in nursing homes and, in the second stage, older people were selected to participate. The sample stratification criteria were the nursing home’s ownership (public or private), its geographical location  and its size according to the number of places for residents. A total of 42 nursing homes  and 447 The initial sample size (600 surveys) was calculated with a maximum sampling error of ±5% for estimating percentages under the hypothesis of maximum variability (p = q = 0.5) and at a confidence level of 95%. The calculation assumed a design effect of 1.5 (the ratio between the variance of the estimator under the type of sampling used and the variance of simple random sampling). The sample had to be redesigned due to difficulties in completing the fieldwork see , maintaiThe nursing homes were selected in terms of probability proportional to their size , while participants were selected by simple random sampling (approximately 10 persons from each nursing home). Other inclusion criteria according to the information provided by the nursing home were male/female, being 60 years of age or older, not suffering cognitive impairment and having given consent to participate in the research. The fieldwork was submitted to the Bioethics Committee of the Spanish National Research Council (CSIC), which gave its approval in June 2020.Accessing the nursing homes involved great effort from the start of the fieldwork due to access restrictions put in place as the pandemic evolved during 2020 and the first half of 2021. Indeed, 95 nursing homes were contacted and details of only 42 homes were obtained. Data were collected at different paces as the number of contacts required to obtain data was lower in public nursing homes (2.1 contacts on average) than in private ones . SimilarThe nursing homes that decided not to participate were replaced by another 13 reserve nursing homes until the final number was reached. This process of contacting the nursing home/affirmative response/negative response and substitution, if applicable, took a relatively long time—more than two weeks for the private nursing homes and more than 10 days for the public nursing homes. Another factor was the need to make a high number of contacts (between three and four). Different reasons were given for not participating, ranging from not having enough older people without cognitive impairment, no specific reason, difficulties in organising the survey while the nursing home staff were working, managers having little time available, unexplained delays in the responses, etc., which might suggest that staff were overloaded with daily chores or a possible aversion to participating, given the difficult circumstances in which the research was carried out.A pilot sample was carried out in early May 2021 in two public nursing homes to test the feasibility of the questionnaire and other aspects to be considered in the fieldwork, and this led to two questionnaire questions being changed. The fieldwork was carried out between June and October 2021 by an opinions research company whose pre-trained interviewers had the questionnaire programmed into a computer application. The personal interviews lasted approximately 25 min on average. Once the information was collected, it was sent for review by a market research company manager before being added to the database.The interviewers went to the nursing homes properly identified. For this purpose, several project information documents were prepared: (1) approval of the Spanish Scientific Research Council Bioethics Committee (Ref. Nº. 114/2020), (2) official resolution adopted for the project by the Spanish Scientific Research Council (Ref. Nº. 202010E158), (3) information about the project’s objectives and (4) a general information sheet for participants .The questionnaire contained topics of interest for the project, which were drawn up and designed by a multidisciplinary expert committee. Finally, 20 questions of different types  were presented thematically: personal circumstances during the pandemic, health, feelings and methods of coping, residential environment and activities, quality of life, ageism, and attitude towards own ageing . AdditioThis block included questions that sought to paint a general overview of how the person had been affected by the pandemic , Health.Understanding residents’ health was one of the most important objectives of the research , Health.Perception of loneliness was measured by a unique question , adaptedHealth-related information was obtained with questions about satisfaction with the care provided by staff  and services in the nursing home .This set of questions responded to interest in understanding the emotional mechanisms and strategies for coping with COVID-19 , which was constructed from the response to items with a single positive valence . It has As this study examined older people living in nursing homes, their opinions on such settings during the health crisis were considered relevant on account of the difference with the family homes and because of the high incidence of the pandemic in nursing homes . The residential model in Spain, which is linked to stay and care costs, offers two possibilities: have one’s own room/shared with a partner/other family member or share a room with another resident. This was explored with a simple question to relate it to the advisability of staying in the room in order to avoid catching the virus. In addition, this restriction regarding the use of nursing homes’ common areas is linked to possible limitations in carrying out activities, whether these are “survival” activities  or leisure time ones.The specific scale on the Assessment of Aspects of the Residential Environment  measures various aspects of daily life in nursing homes by means of a 5-level Likert scale . The Factor Analysis  showed high communalities and identified four factors , which were interpersonal relationships in the nursing home, aspects of the nursing home , mobility  and intimate space (having a room available). With this information, four subscales were constructed  by grouping the scores of items for each one. So, higher values indicated a better assessment. Application of Cronbach’s Alpha coefficient showed values above 0.7 as a threshold for accepting the hypothesis of reliability of the internal consistency of the items with the subscales . Engaging in activities is an essential aspect to give meaning to daily life in a nursing home as a social space for the older population. In this research, we designed questions about eight activities drawn and adapted from previous studies ,92,93 anQuality of life is a scientific construct with a strong social value. It is used in a large number of studies and disciplines for various purposes and is a term that is used in everyday life. However, besides its usefulness, it is characterised by difficulties associated with its definition and measurement, precisely because of the diversity of possible applications. This study included a measure oriented by its objectives , adapted to the situation caused by COVID-19 and placing the older person’s perspective at the centre , Ageism.Likewise, the older residents’ perceptions of their own ageing were assessed, as recommended by Levy et al. , throughThis topic was covered by the basic objective variables  obtained from the documentation provided by the selected nursing homes and taken in parallel with the questionnaire .After the fieldwork, the data file was reviewed exhaustively using the SPSS-v28 pro-gramme for debugging purposes. The first step consisted of ensuring that the information in the database was consistent with the questionnaire and redefining the properties of the variables in terms of levels of measurement . In addition, a mnemonic name was assigned to the variables to allow their immediate identification at any time during the study, and the categories of the nominal and ordinal variables, their numerical codes and literal labels were revised. An essential part of this standardisation process consisted of examining the missing answers to some questions (“Don’t know/No answer”); in filtered ones these answers were not regarded as missing. In this same regard, we checked whether the criterion of inclusion of participants by age from 60 years onwards had been met. Furthermore, new variables were generated by recoding the categories of some questions  and counting others, such as, for example, the effects derived from having had COVID-19 or the diseases and medications listed in the direct information provided by each nursing home on the participants. Specific mention should be made of the scale analysis. Taking the scientific literature as a reference, various statistical techniques were used, such as Factor Analysis by principal components and the internal reliability test of the items—applying Cronbach’s Alpha or Kuder-Richardson KR-20—to determine some basic psychometric characteristics. This procedure was performed with the FCV-19S, PANAS, BRCS, EVAER, Activities, FU-MAT-24, Ageism and Self-perception of ageing scales.To obtain the basic results presented in this study, frequencies were calculated to check the consistency of the information and draw initial ideas about their distribution. As expected, they were not distributed evenly, and this may have been related to the respondents’ traits, which is why statistical relationships between variables had to be obtained by means of contingency tables and measures of association. Thus, use will be made of univariate and bivariate analysis techniques and other more complex, multivariate and statistical modelling techniques adapted to each specific data. The internal consistency of the ATOA subscale was run using the Kuder-Richardson KR20 reliability coefficient (for dichotomous items), following the Stata module by Caci  and adapThe sample consisted of 447 participants, representative of institutionalised older people in the Region of Madrid (Spain). In relation to the socio-demographic characteristics see , the popSlightly more than a third of the respondents reported having had the disease, but without effects, given the living conditions in the nursing homes, while 55% stated that they had not contracted it. Only one in 10 had experienced after-effects (sequelae), the most frequent symptoms being pain and neurological problems. However, just over a third (38%) were diagnosed with COVID-19 by a medical professional and, of these, two out of ten stated that they had been admitted to hospital for this reason . Faced with the health crisis generated by the pandemic, concern about COVID-19 among older residents was widespread (83%), and in fact, six out of ten were very worried. Concomitantly, fear of COVID-19 was not, in general, a very present feeling , although some of its components reached a relevant proportion, such as fear of death and of the SARS-CoV-2 virus itself. In contrast, more than half of respondents (53%) reported feeling as satisfied with their lives as before, compared to 43% who reported being less satisfied.The participants’ medical reports showed that six out of ten people had more than five diseases, with heart (83%) and bone (63%) diseases being the most common . PerceivDepression reached a mean score of 1.7  on the GDS-5 scale. More than five out of ten older people had no symptoms , the rest were suspected of having depression, with almost 20% scoring at a level indicating moderate or severe degrees of it.It was confirmed that positive effects prevailed over negative ones; thus, the balance between the two was positive. However, their scores  were below the expected mean for the scale (12). Feeling active and attentive were the most frequently reported positive emotions . In the nursing homes, 47% of people reported never or almost never feeling lonely. Among those who always or almost always felt lonely (13%), half communicated feeling lonelier than before the pandemic.More than 50% of respondents reported being fairly or very prepared for the COVID-19 situation and 40% believed they could take something positive from it, while 15% to 20% related feeling bad about themselves or being caught up in negative thoughts as a result of the pandemic. More than 60% of the residents agreed with developing attitudes of control regarding the pandemic situation.Most residents had a single room or shared a room with a spouse/partner/family member, while less than three out of ten shared a room with another resident. A high percentage of people (70%) stated that they were always in the room during the COVID-19 pandemic. Despite the movement limitation measures, the rest enjoyed some mobility outside the room, with 26% making limited use of the residential spaces, mainly for eating and walking in common areas and, to a lesser extent, for social gatherings .In general, the residential assessment was good in all the domains analysed, especially regarding safety and relationships with family members, in contrast to mobility in and out of the nursing home, which was less valued due to restrictions during the pandemic. A more detailed analysis of the residential assessment identified four subscales linked to people’s behaviours (their relationships and mobility) and other aspects related to living in a nursing home, such as their safety, privacy or how their way of life was managed. As a complement, another residential satisfaction-associated question sought to compare the situation during the pandemic with that prior to the spread of the disease. The results indicated that the pandemic had not altered their assessment of their stay, since six out of ten stated that it was the same and a quarter stated that it was better.On a daily basis, residents in the nursing home (more than 80%) engaged in simple activities  or activities of little physical relevance . Activities that required a certain degree of personal motivation  were practised daily by less than 50%, as were doing handicrafts, going to chapel or doing activities to support other people. The four clusters of people who engaged in activities responded to a bipolar profile in which many older people with low levels of activity, including those who engaged in religious practices, contrasted with somewhat smaller groups of people with more active behaviours who were interested in the use of electronic devices or who did activities for the benefit of others or volunteering. How did these habits change during the pandemic? Between 70% and 80% of the surveyed population maintained their activities during the pandemic . The incIn general, all domains of quality of life scored highly, with an overall average of almost 10 out of 12 . The domOlder adults in nursing homes are convinced that they are more responsible and competent than other population groups in following measures to cope with the virus (78%), making their own decisions freely (61%) and, in the event of a shortage of health care resources, obtaining the same access as other population groups (86%) . RegardiSince the outbreak of the pandemic, many social behaviours have changed in addition to many research procedures in terms of design, data management, analysis and diagnosis of situations. One indicator of this new reality is the exponential increase in studies assessing the multiple aspects and effects of COVID-19. In essence, urgent research was launched and processes and circumstances were diagnosed, and unconsolidated evidence and a diversity of scientific products of unequal value were published ,106,107.Older adults have been the subject of research due to the extraordinary and severe incidence of the pandemic among them. Multiple studies have approached this group from different perspectives—mostly considering the older population as part of the general population—by means of online surveys (on the Internet), which limits access to those who do not have the capacity to respond . In addition, few studies have focused on nursing homes for older persons and, when they have done so, the topics of interest were linked to the study of residential management during the pandemic, the design and application of regulations, or the impact on workers. However, residents’ previous situations and habits  and the possible changes that occurred due to the pandemic were not adequately examined in these studies.One of this project’s contributions is to have chosen older people living in nursing homes as the subject of study as this is not frequent and signals a methodological shift that enables direct access to this population’s opinions, perceptions and circumstances. In addition to its scientific interest and value, this calls for demanding fieldwork that sometimes involves limited access, the execution of which is conditioned by the bringing together and understanding of various agents, disciplines and interests. However, diagnosing the situation of older aged in nursing homes based on a consensus between scientific analysis and residential environment managers is essential to improving older people’s quality of life so that they can live their last stage of life in conditions of dignity and respect for their rights as persons. Researching institutionalised older adults and fairly inaccessible residential environments is a task that is not likely to be free of difficulties, thereby having a relative impact on the results obtained. Given the urgency of the decision-making process, selecting nursing homes in the Madrid Region is a limitation of this study. This was driven by the need to carry out fieldwork that was as controlled as possible during the pandemic. We are thus forced to assume that the situation in this geographical area can be extrapolated to the rest of Spain, which may not be true. However, the selection of nursing homes was conditioned by their distribution in terms of owners and managers, and this is true in Madrid, but may not be so in other Spanish regions. Some studies have revealed serious deficiencies in the Spanish nursing home system, such as a lack of material resources  and human resources . This is aggravated by the lack of inspections and the low level of fines for infractions ,38. ThisIn addition, and in accordance with the study’s purposes, the data collection had to be directly from the respondent, which necessarily involved selecting responsive residents, i.e., people without cognitive impairment or with only mild impairment, according to the information provided by the nursing homes. This decision left out all those people with worse mental health conditions. Therefore, the information obtained must be read with a qualified approach, taking into account that part of the resident population was excluded from participating. The experience both of relatives and of the nursing homes’ workers and managers was discarded in this quantitative phase to be explored qualitatively a posteriori.Perhaps this too is a limitation, but the fact that there were no previous or parallel studies to help the research team select the right content led us to identify the research topics in terms of social and health dimensions, in line with the project’s objectives. The result has certainly been satisfactory because the response rate was good, the quality of the data was high and the analyses carried out so far are highly consistent, reinforcing the interpretation and diagnosis of these situations. The questionnaire’s results will be contrasted with the opinions and experiences of residents, family members and workers in later phases.In short, and despite its limitations, this research, which focused on older nursing home residents and was designed with the urgency and need to assess their opinions and experiences during the pandemic will pave the way to reflect on decision-making concerning older people’s lifestyles during health crisis situations.


N = 138) self-reporting diagnoses of various mental disorders with impairments in social functioning. Participants provided retrospective and current self-report measures about their PoGo use, life satisfaction, social functioning  and clinical symptom severity. Results showed higher self-reported social functioning and life satisfaction since playing PoGo compared to the time period before playing, which involved a shift from negative to positive ratings. The increases in self-reported life satisfaction and sociality  were more pronounced for the clinical compared to the non-clinical subsample. Results also showed the effect of the social ability change on the life satisfaction change was mediated by the sociality change and moderated by the number of daily in-person player interactions (including strangers). The findings here, using subjective judgements, show that PoGo motivates social interactions and increases life satisfaction, demonstrating that social mobile gaming provides an easy to implement tool to subjectively improve social functioning. This has important implications for populations with social difficulties and reduced social motivation.Pokemon Go (PoGo) is a social mobile game requiring both physical activity and social interaction, and previous research has reported positive effects of PoGo on physical health. However, little research has been conducted on the effects of PoGo on social functioning and life satisfaction, which are important factors for good mental health. The current study investigated the effects of PoGo on life satisfaction and social functioning in participants with and without self-reported diagnoses of mental disorders. Participants were 434 current PoGo players aged 18–69 of diverse genders and nationalities, with a subsample ( A sedentary lifestyle can have detrimental effects on physical health of adults and children .Pokemon Go (PoGo) is a commercialised App for smartphones see . These sis the social factor , the frequency of contact with friends and family as well as the quality of these social contacts, alongside social integration, and an active lifestyle are significant predictors of life satisfaction  was determined by the number of participants who filled out the survey within this time frame. Due to a continuous introduction of additional game features and thus gaming experience, the period of data collection was restricted. There were versions of the survey in Brazilian Portuguese, German, and English; 229, 208, and 66 individuals filled out the versions, respectively. Inclusion criteria were a minimum age of 18 years and actively playing PoGo (at any frequency). Sixty-nine participants were excluded as they stated an age lower than 18 years, not stated their date of birth, or entered impossible dates, e.g., such in the future. All participants were PoGo players the game at the time of filling out the survey. Thus, the sample size for statistical analyses was 434, composed of 204, 172, and 58 individuals from the Portuguese, English, and German version, respectively. The mean age of the sample was 31 years (SD = 9.5), ranging from 18 to 69 years, and consisted of 285 males and 144 females; additionally, 5 individuals self-identified as agender or non-binary.Recruitment took place on various online platforms and social media  from April to August 2019; the sample size  with n = 18 having reported outdoor hobbies and n = 42 having reported both types of hobbies. N = 90 participants self-reported a formal diagnosis of a mental disorder , since only submitted answers are stored on Google forms.Participants were provided with the opportunity to leave a comment; the text box allowed to let the researchers involved in the study know if anything was not asked for, they feel like should have been asked. After submitting the survey, the option was provided to type in an email address to be considered for a prize draw, which was a Play Store or iStore voucher allowing participants to purchase in-game currency. One voucher was given away per 100 participants for $10 in the currency of the winners. The prize draw was conducted using an online random number generator. However, Brazilian participants were excluded based on the country's regulations prohibiting research participant compensation.Response re-coding and categorisation are explained in the p-values  with a small positive association with the change score in life satisfaction . The mean playing days per week reported was 6.57 (SD = 1.04) with a mean of 2.78 h per day (SD = 1.89). These results combined suggest that excessive gameplay is unlikely necessary for experiencing the positive effects of playing PoGo. In fact, Ewell et al.  and the experience of positive emotions and friendship initiation and intensification . For both social and solitude players, the results regarding life satisfaction, social ability, and sociality were in line with the hypothesised positive effect of playing PoGo. Although the change in score was highest for the participants who reported to prefer to play in groups but to mainly play alone, there was an increase in perceived life satisfaction, social ability, and sociality from the pre-game period to since playing PoGo in oups see . The finoups see . These roups see .A preference of solitude can be tied to a person's personality. Research on early players of PoGo found many players to score high on introversion  had lower scores on the three factors  than those who did not report such a diagnosis. However, for the diagnosis group, the ratings from before playing PoGo were (descriptively) below the midpoint of the scale  whereas the ratings since playing the game were above the midpoint of the scale , the greater the increase in sociality. These two correlations were small but positive see . There wThat the current study found perceived social functioning and life satisfaction to be lower in the diagnosis group than the no-diagnosis group and sociality to be negatively associated with symptomatology is in line with the known effects mental disorders can have on people. The current study thus aligns with the definition of mental disorders  suggest that engaging in a leisure time activity such as PoGo can affect factors that can contribute to mental health . A recent qualitative study on the effects of video game play on mental health and behavioural problems in recovering veterans found that the effects were overall positive  and sex. Moreover, the current study postulated a model and found an increase in social ability to predict an increase in the quality and quantity of social interactions which, in turn, predicted an increase in life satisfaction while the amount of daily face-to-face social interactions with other players moderated the latter effect. This study suggests that PoGo players may improve their life satisfaction through social interactions, corroborating findings that life satisfaction increases with increasing expected or experienced positive social interactions . The patients/participants provided their written informed consent to participate in this study.TW and YZ conceptualised and designed the study. TW organised the database, performed the statistical analysis, and wrote the first draft of the manuscript. YZ revised the manuscript. Both authors read and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Significant reliabilities were found in closed eye conditions for smartphones and wearables. The smartphone and wearable devices had concurrent validity for the static balance evaluation and the smartphone had better validity results than the wearables for the static balance evaluation.Falls represent a public health issue around the world and prevention is an important part of the politics of many countries. The standard method of evaluating balance is posturography using a force platform, which has high financial costs. Other instruments, such as portable devices and smartphones, have been evaluated as low-cost alternatives to the screening of balance control. Although smartphones and wearables have different sizes, shapes, and weights, they have been systematically validated for static balance control tasks. Different studies have applied different experimental configurations to validate the inertial measurements obtained by these devices. We aim to evaluate the concurrent validity of a smartphone and a portable device for the evaluation of static balance control in the same group of participants. Twenty-six healthy and young subjects comprised the sample. The validity for static balance control evaluation of built-in accelerometers inside portable smartphone and wearable devices was tested considering force platform recordings as a gold standard for comparisons. A linear correlation (r) between the quantitative variables obtained from the inertial sensors and the force platform was used as an indicator of the concurrent validity. Reliability of the measures was calculated using Intraclass correlation in a subsample (n = 14). Smartphones had 11 out of 12 variables with significant moderate to very high correlation (r > 0.5,  Balance is the basic ability to perform any movement, as well as daily activities, maintaining the center of mass (COM) within the support basis without losing equilibrium . It is cCurrently, the most accurate instrument for objective quantification of static balance control evaluation is the force platform, which records the center of pressure displacements on the anteroposterior and mediolateral axes. However, due to the high cost and difficulty in handling this tool, it is mainly restricted to well-trained evaluators working in research centers . Thus, tThe use of smartphones or wearable devices with built-in inertial sensors is widespread, and several applications are being developed for the evaluation of static balance . Many ofUsually, the validity of the application is carried out in open and closed eyes conditions, with a standard placement of the device in the lumbar spine, specifically the L5 vertebra, because it is close to the body’s center of mass. However, there is significant variability in other parameters, such as a device with an inertial sensor  ,20,21, tIt is important to note that both smartphones and wearables represent a set of several instruments with differences in their physical features  and available software for data analysis. It is not clear whether these differences could lead to different outcomes in the static balance control assessment. No study has validated inertial recordings obtained using smartphones and wearables during static balance evaluation in the same subjects compared to data obtained from a force platform. Our hypothesis was that smartphones have a similar validity to wearable devices for evaluating static balance control.In the present investigation, our objective was to evaluate the concurrent validity of a homemade app, named Momentum, for smartphones and lightweight commercial wearables for static balance evaluation in the same subjects. The current validation includes three postural conditions , two inertial devices (wearable and smartphone) and a force platform, and four quantitative stabilometric parameters .Study designWe investigated the concurrent validity of a smartphone and a lightweight portable wearable device.Ethical considerationsThe procedures performed were approved by the Research Ethics Committee of the Tropical Medicine Center of the Federal University of Pará . All participants were informed about the investigation procedures and signed a consent form to participate in the study.SubjectsThe study was carried out in the Laboratory of Human Motricity Studies of the Institute of Health Sciences of the Federal University of Pará with 26 participants . No participants reported complaints or clinical alterations in balance. Static balance evaluationThree devices were implemented to assess static balance: a force platform, a smartphone device, and a commercial wearable sensor. All three trials were performed during the static balance task for 60 s. Participants remained standing on the force platform, barefoot, with feet parallel to 15 cm apart, head straight, and gaze fixed on a point marked on the wall 1 m away . In carr2, and a notebook with the Biomec program  received its readings with an acquisition rate of 100 Hz. A smartphone device  was also used. Samsung Galaxy A10 has emerged as one of the best-selling Android devices and its dimensions are in the range of user preferences of mobile sizes [The static balance was evaluated using a force platform as a gold-standard method  and two le sizes . We usedle sizes ,28 and iData analysisData were processed using computational routines developed in the MATLAB language . The temporal series from the force platform and the inertial devices (smartphones and wearable devices) underwent initial treatment of detrend with later off-line filtering using a Butterworth second-order filter between 0.1 and 20 Hz. After starting the recording on the three devices, the participant was asked to jump over the force platform, and the jump signal was used to trigger the recordings in the computational routines of analysis. Time series were quantified in the time domain through parameters commonly associated with deficits in the balance control ,30,31,32(i) RMS amplitude of the stabilograms in the mediolateral and anteroposterior axes (Equation (1)). For the force platform, this parameter was quantified in millimeters, and for the smartphone and the wearable device, this parameter was quantified in gravity units.(ii) The total deviation of the statokinesiogram represents the length of the trajectory of the center of pressure over the base of the support (Equation (2)). For the force platform, this parameter was quantified in millimeters, and for the smartphone and the wearable device, this parameter was quantified in gravity units.(iii) Statokinesiogram deviation area, which is also an indicator of the two-dimensional deviation of the center of pressure over the base of support (Equations (3) and (4)). For the force platform, this parameter was quantified in square millimeters, and for the smartphone and the wearable device, this parameter was quantified in square gravity units.No additional toolbox of MATLAB was needed to proceed the algorithms.Statisticsp-value lower than 0.05 were considered significant. In the significant correlations, we calculated the power analysis of the correlation. The test-retest reliability of the measurements from each device was quantified by two-way random-absolute agreement model of intraclass correlation (ICC) coefficient in a subsample of the present investigation (n = 14). Those correlations with p-value lower than 0.05 were considered as significant. SPSS software was used to perform the statistics.The validity of the smartphone and the wearable device was based on Pearson’s product-moment correlation (r) between the parameters quantified in their time series and the same parameters obtained from the force platform (gold-standard method). Strength correlation was interpreted using the Cohen and Holiday criterion : very hiFor the smartphone, it was observed that 11 of 12 quantitative parameters had a significant correlation with those of the force platform. Under open-eye conditions, there were three moderate and significant correlations and one high and significant correlation, while under closed-eye conditions, there were three moderate correlations and one low and non-significant correlation. In unipedal support with open eyes, there were two very high and significant correlations, one high and significant correlation, and one moderate and significant correlation.For the wearable device, it was observed that 8 of 12 parameters reached a significant correlation with those of the force platform. Of the parameters with significant correlations, there were three moderate correlations in the open eye condition; there was one moderate correlation in the closed eye condition; and there was a very high correlation, two high correlations and one moderate correlation for unipedal support.The present study investigated the validity of inertial sensors present in smartphones and wearable devices to evaluate static balance control by comparing a gold standard method, force plate-based posturography. We used four variables  in 3 static balance control conditions  to test the validity of the inertial sensors. In general, our main findings confirmed inertial sensors as valid tools for evaluating static balance control as an alternative for force platform measurement in a young adult population. The present investigation also added that smartphones had better validity outcomes than lightweight wearables for static balance control assessment and that the greater the disturbances during the balance task, the better the validity of the instrument.Several investigations have evaluated the validity of inertial sensors for static balance control, as shown in To the best of our knowledge, this is the first description to validate multiple inertial sensor devices in the same group of participants. All participants performed the same task and were evaluated by the same experimenter, and body displacement was recorded simultaneously by all instruments. The reason for the differences in validity obtained from each inertial instrument is not clear. One potential factor that could explain these differences is the different masses and sizes of the instruments. Wearable devices are lightweight instruments and may be more susceptible to responding to different forces, which adds more noise to their recordings. Smartphones have dimensions of several centimeters, and their size allows a broader zone of attachment to the body. In our experiments, we searched for the ability to fix both instruments to the body as tightly as possible, avoiding discomfort to the participant. Previously, weak to moderate correlations were also found between inertial sensor-built wearable devices and force platform recordings . It is cThe limitation of the present investigation is low sample size, transferability of the current findings to other populations including the elderly and/or patients. Future investigations can extend the number of subjects in validity and reliability quantification, as well as apply to other populations and clinical conditions.We conclude that smartphones and lightweight wearable devices had validity to evaluate static balance control under different experimental conditions. The validity of smartphones to evaluate static balance control candidates confirms them as a low-cost alternative to the force platform and encourages their use in routine clinical practice, in health services for low-income populations, and for screening purposes. This makes it possible to popularize a quantitative assessment of static balance control that can be fundamental in identifying functional losses in different populations.


Although online health communities are popular in supporting mental health, factors leading to the helpfulness of mental health information are still under-investigated. Based on the elaboration likelihood model and motivation theory, we incorporate two types of health information-related constructs, i.e., information quality  and responders’ effort , and adopt reputation as an extrinsic motivation to build our model. We crawl data from a Chinese online mental health community and extract 11 key variables, and then analyze the model with negative binomial regression. The empirical results indicate that the effect of the length of health information on its helpfulness votes is positively significant, while the effect of readability of health information on its helpfulness votes is relatively negative. In terms of responders’ effort, both the timelines of the response and interactive feedback have a significant positive impact on helpfulness of health information votes, while these effects are negatively moderated by the online reputation of responders. This study contributes to the literature on information evaluation mechanisms in online health communities. Patientslikeme and Haodf.com, are virtual community for health and medical information generation and transmission, which allow online communication, emotional support and mutual assistance, with doctors, nurses, patients, and their families as the main service objects (Powered by the rapid development of emerging information and communication technologies (ICTs) and the enhancement of public health awareness during the COVID-19 pandemic, massive online data and information concerning healthcare are growing at an exponential rate . For ins objects . Some on objects . The par objects , so as t objects .Although the popularity of OMHCs provides a convenient channel for patients to access services, the complexity of mental illness and treatment methods, people’s low level of mental health literacy, the inherent expertise of health information and knowledge make the information asymmetry , resultsIn the existing literature, scholars have explored the influential factors affecting online information helpfulness using various lenses and have mainly utilized two perspectives : informaHow do information quality and responders’ effort influence the helpfulness votes of health information in OMHCs?Accordingly, we formulate two research questions from the two following knowledge gaps. Firstly, the majority of studies explore the helpfulness of information from the perspectives of information content and information sources, and rarely pay attention to the responders’ efforts during the interactions between information help-seekers and help-providers . In OMHCHow do responders’ online reputation affect the relationship between responders’ effort and the helpfulness votes of health information in OMHCs?Secondly, In OMHCs, the efforts made by responders could be seen as prosocial behavior driven by intrinsic motivation like altruism or self-actualization. However, the affordance of online reputation ranking, as one kind of most-adopted extrinsic motivation, can avoid the potential risks brought on by false information and even regulate the voluntary contribution behavior of community users. Most studies aim to explain the relationship between reputation and continuous knowledge sharing behavior, and there is limited literature on the impact of reputation on the knowledge seeker’s helpfulness voting. The rewards of the reputation system act as extrinsic motivation, but only affect the quantity of information shared and not the quality. However, those health professionals or experienced users with a high level of reputations have pressure to keep their positive profiles and choose to share knowledge through answering normal users’ questions , which iIn order to answer the above questions, we take an online mental health service platform in China as example, and construct variables affecting helpfulness of information by collecting Q&A data from the platform for 3 months. Based on the motivation theory and Elaboration Likelihood Model (ELM), we integrated text mining and a negative binomial regression model to explore how the central route  and peripheral route (the efforts of responders) affect the helpfulness votes of health information in OMHCs. It is expected that our findings will enrich the existing theoretical research on information helpfulness, provide insight into the information evaluation mechanism of information searchers, and provide feasible suggestions for the sustainable development of the OMHCs.Motivation theory holds that individual behaviors are normally driven by intrinsic and extrinsic motivation . IntrinsOnline health community, a special virtual community which shared health knowledge in professional , has beeAs for extrinsic motivation, reciprocity will positively affect knowledge sharing intention , requirevia two pathways, namely the central route and the peripheral route. The former refers to the process by which users change their attitude or put forward a certain point of view by consciously refining the obtained core arguments. On the contrary, the peripheral route emerges when one has poor information-processing ability and relies primarily on external environmental factors to make a certain judgment :H3: The accuracy of the response in the context of the question positively impacts users’ votes on information helpfulness in OMHCs.If a comment is published earlier, it obtains a first-mover advantage and has a much higher probability that it will be read by potential consumers than other comments . In addiH4: The timeliness of responses positively affects the helpfulness votes given by users’ in OMHCs.Online interactions and discussions affect the quality of ideas based on the degree of facilitator interaction, which is also called feedback integration . RelevanH5: Interactive feedback positively affects users’ helpfulness votes for information in OMHCs.Online reputation is the overall evaluation of users by the community , which iResearch have showed that reputation, as the extrinsic motivation of health knowledge sharing behavior, can significantly and positively affect doctors’ continuous contribution of health information . Users wPrevious studies have proven that external motivation plays a negative regulatory role in the impact of internal motivation on information-sharing intentions . As an eH6a: Online reputation of responders negatively moderates the relationship between the timeliness of responses and information helpfulness votes by users in OMHCs.H6b: Online reputation of responders negatively moderates the relationship between interactive feedback and information helpfulness votes by users in OMHCs.The research model of this study is summarized in YiXinLi.YiXinLi in Jun 2019 and was allowed to obtain some public Q&A data from this website.The data used in this paper has been obtained from a well-known online mental health service website in China called YiXinLi in August, September and October, 2019, and thus integrated a 3-month cross-sectional dataset . YiXinLi Q&A forum.The data collection process includes three parts. Firstly, we chose the “recommended answer” of Q&A forumA total of 11 variables were extracted from the abovementioned dataset. All variables and their descriptions are detailed in Based on the research of  and otheResponders’ effort is measured from the perspective of response timeliness and interactive feedback. The timeliness of the reply refers to the enthusiasm and promptness of the responder’s active reply to the user’s questions; interactive feedback refers to the behavior of the user who actively maintains a continuous interaction and channel of communication with the questioner. Users’ online reputation is measured by users’ reputation rating in the community. In addition, we consider the variables that may affect the evaluation of information helpfulness, such as the number of replies, the number of followers of the question, and the number of views of the question as the control variables . The speThe descriptive statistical results for the different variables are shown in Since the dependent variable  is a positive integer greater than 0, and the mean value of variables is inconsistent with the standard deviation, it is likely to produce over dispersion, therefore negative binomial regression model is more suitable for the data in this study. In addition, we use the variance inflation factor (VIF) value to test for multi-collinearity of the variables used in the regression model. It is found that the VIF value of all regression models is less than 5, indicating that multi-collinearity is relatively low.p < 0.001), thus supporting H1. The RHI has a significant negative impact on the helpfulness of health information votes, and H2 is not supported . The impact of RC on HHI votes is also not significant, and H3 is also not verified.The regression results, which can be seen in p < 0.001; β = 0.068, p < 0.001); therefore, both H4 and H5 are supported. Additionally, in the moderation effect test, both the interaction between RT and ORR, and the relationship between IF and ORR have a significant negative effect on HHI votes ; thus, H6a and H6b are both supported.In terms of the efforts of responders, the TR and IF have a significant positive effect on the HHI votes  indicated that except the RHI is not significant compared with the original model, other effects of independent and moderated variables are consistent with the Model 3. In addition, given the abnormal distribution of the dependent variable HHI, a log transformation of the variable value and ordinary least squares (OLS) are used as the third robustness testing method. The significance of main variables in that results (M6) are consistent with the model 5 (M5), and we will make a summary and some possible explanations next.The results are summarized as follows. Among these, all our hypotheses are supported apart from H2 and H3. For H2, low readability has a significant negative impact on information helpfulness. This result may be related to the specific situation of OMHCs. In addition to seeking emotional support in mental condition, inquirers may desire to obtain more professional information  in the process of searching for information. In such a scenario, if users feel that the content they read is relatively simple, understandable and familiar, they may reduce their votes on the helpfulness of the information content. For H3, the impact of question response consistency on the helpfulness of health information is not significant. The reason may be that this article is in an OMHC with mental health as the theme. The content of the response may not be limited to the specific questions of the inquirer, but might carry out in-depth analysis, put forward suggestions and express encouragement according to the content of the question. Therefore, the degree of accuracy of the responses to questions may not necessarily have a direct impact on information helpfulness.Based on the responses to questions in OMHCs, this paper discusses the impact of helpfulness of health information votes from an ELM perspective. Here, the information quality is regarded as the central route, and the responder efforts are the peripheral route. Based on the statement above, the empirical results show that: (1) in the central route, the length of health information has a significant positive impact on the users’ information helpfulness votes in OMHCs, and the readability of health information has a significant negative impact on the users’ information helpfulness votes, and (2) in the peripheral route, it can be seen that both the timeliness of users’ replies and interactive feedback have a significant positive impact on the users’ information helpfulness votes, while these positive effects are negatively moderated by the online reputation of responders.Zhihu and Baidu zhidao, while a limited number of studies focus on the emerging nature of OMHCs. In this study, we discuss the helpfulness of information in combination with the inherent information quality and responders’ efforts from the perspective of motivation theory and employ ELM in OMHCs, and the research conclusion enriches the existing literature on users’ information behavior on other medical and health platforms.Previous studies focused primarily on e-commerce platforms such as Amazon and Taobao, or general socialized Q&A communities such as Firstly, the current study identifies two persuasive routes underlying helpfulness of mental health votes: health information quality and responders’ effort. The empirical results show that although the information quality is the more obvious central evidence, the responders’ effort as distinct peripheral route have a more consistent and significant impact on information helpfulness voting. We expand the theory of ELM in OMHCs by figuring out that, for health-related information, it is normally difficult for common users to identify some high-quality information, but the usefulness of information can be determined by observing the efforts that information senders have invested. Additionally, compared with prior research on the helpfulness of online comments, this study came to some inconsistent conclusions. Many studies have shown that the readability and response consistency of information content have a positive effect on the helpfulness, but if the health information provided exceeds the scope of the problem description itself, the user helpfulness votes will decline.Secondly, we have proven that the online reputation of help-provider in OMHCs, as an extrinsic motivation, could undermine the impact of prosocial behavior such as responder’s effort on information usefulness. Different from previous studies that have found the behavior characteristics of opinion leaders with a high reputation in the virtual community following the “Matthew Effect” , our study found that in the context of OMHCs, the sense of trustworthiness developed by high-profile users would directly lead to the high information acceptance by other users without much evaluation of helpfulness. For users with a high reputation, their prosocial behaviors are more likely to be taken for granted by other users and received less helpful votes. On the contrary, the responders’ efforts of users with a low reputation are often more likely to elicit praise and recognition from other users in the community.On the one hand, from the perspective of users in OMHCs, publishing more comprehensive health information as replies may get more useful votes, but at the same time, attention must also be paid to the professionalism and preciseness of the health content. Although overly short and casual replies can result in a better reading experience, they may result in “already familiar,” “low credibility” and other cognitive biases on the part of other users. This would reduce the perceived helpfulness of the information. Due to lack of sufficient professional knowledge, common users may rely more on the speed of response and extra efforts of response to judge the usefulness of information. Therefore, prompt responses to the latest replies and continuous interactive feedback with the questioner can also improve their evaluation of helpfulness, which is beneficial for building their personal profiles. Particularly, for novice users who are unfamiliar to the platform and with low online reputation, their efforts to respond are more likely to gain the attention and recognition of others, which plays a positive role in building personal community reputation.On the other hand, from the perspective of platform governance, there exist inconsistent incentives for users with different reputation levels in helpfulness voting. Generally, high-profile opinion leaders are the main source of community knowledge contribution, so their knowledge contribution may cause other users to “take it for granted,” and their efforts to reply may be recognized by users without making a much higher helpfulness evaluation. Therefore, in the IT affordances such as evaluation of information helpfulness, the platform should provide insight into the possible impact of the voting scoring mechanism. Given the negative impact of reputation on users’ efforts and helpfulness voting, the platform needs to establish a personalized growth system to meet the needs of users at different ranks. Different incentive mechanisms or information adoption mechanisms can be set according to the reputation level of users in the community, so as to fully reflect the information feedback of knowledge inquirers and encourage continuous responses from various users in the community.Firstly, due to the availability of data, this study only analyzes a single online health community with 3 months data, we could not analyze the possible platform-related and time effect so that the generalization of the research conclusion may be limited. Further research can integrate and mine sample data from multiple health communities. Secondly, we do not distinguish the different types of inquiry in the question post which might affect different audiences. The follow-up research can identify and discuss different types of counseling by combining machine learning and other available methods. Thirdly, this paper uses cosine similarity based on semantic matching to measure the question response consistency variable, and there may be some biases in the results. Future research can extend this and use methods based on a combination of literal matching and semantic matching to obtain more accurate results.https://www.xinli001.com.Publicly available datasets were analyzed in this study. This data can be found at: GW and XG: introduction, results, and draft writing. GW, XG, and SH: theoretical background and hypotheses development. GW and CG: method. GW: robustness test, conclusion, discussion, limitations, and future directions. CG: first draft review, project administration, and funding acquisition. GW, XG, CG, and SH: article modification. All authors contributed to the article and approved the submitted version.This research was funded by the Doctoral Research Startup Fund of Panzhihua University, and the Open Funding of Sichuan Industrial Development Research Center for Vanadium & Titanium Materials: the theme tourism research driven by the sustainable vanadium-titanium source in Panzhihua City under the Healthcare-based Industrial Model (035300593).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.


Br J Nutr 19, 511–522’ has been cited 656 times according to Web of Science and continues to be cited with increasing frequency to the present day. The analysis described in the paper, or meta-analysis as it would be known now, is of methane production from cattle and sheep based on forty-eight trials using closed-circuit respiration chambers, all carried out at the Hannah Research Institute, Ayr, UK, between 1955 and 1965. Methane emissions per unit of diet fed were shown to vary depending on diet, level of feeding and individual animal. As such, previous notions that methane emissions were essentially proportional to energy intake were set aside. The main reasons for the paper’s continuing citation are the set of equations that can be used to predict methane emissions from ruminants when the technically demanding respiration chambers are unavailable, and that it was the first definitive study to describe the complexities of methane emissions with respect to animals and diets. The paper thus provided abundant insights of the relations between ruminant methane emissions and nutritional biology, and rumen microbiology, in particular, that have informed countless research projects in the intervening half-century. Given the importance of methane as a greenhouse gas in the climate change scenario, these insights are at least as relevant today as they were in 1965.The paper by K. L. Blaxter and J. L. Clapperton (1965) ‘Prediction of the amount of methane produced by ruminants.  In contrast to those rather niche interests, present-day interest stems from the realisation that the well-being of humanity depends in part on lowering greenhouse gas emissions, of which ruminant livestock contribute very significantly. Consequently, the emphasis of current research efforts is to lower methane emissions, whether by chemical, genetic or other means–6.Methane emission from ruminant livestock is a topic that has interested scientists for many decades. At the time of the Blaxter and Clapperton (1965) paper, the emphasis was on completing inventories of energy intake and expenditures of farm livestock by making the challenging measurements of methane production by individual animals and relating those to feed intake. Microbiologists were also fascinated by the methanogenic ‘bacteria’. Fibrous plant materials are broken down by microbial activity to SCFA, principally acetate, propionate and butyrate, that are absorbed from the gut and used by the host animal for energy and growth,9. Methane is a consequence of the anaerobic nature of the rumen fermentation, as it is in other anaerobic habitats. A complete account of the nutritional energetics of ruminants could not be achieved without the precise quantitation of methane emissions.Ruminant animals, including cattle, sheep and goats, are among the most efficient herbivores on earth, by virtue of their gut anatomy and high microbial activity in the foregut compartment – the reticulorumen, or rumen for shortThe Summary  describe.‘Metabolisable energy is defined as the heat of combustion of a feed less the heat of combustion of the faeces, urine and gases which are produced when it is eaten. The losses of energy in faeces and urine can be determined easily in sheep and cattle kept in metabolism cages, but to determine the energy they lose as combustible gas, that is as methane, involves quantitative measurement of the gaseous exchange and the use of much more complex and expensive equipment’. Regarding the latter, it is instructive to note that the authors regarded a thermal conductivity method following combustion of methane in samples as state of the art, in contrast to the simple method of choice today, GCThe conclusions of the paper are wrapped in metabolic equations, but the main impact on the reader derives from the figures, in which the effects of diet type, feeding level and apparent digestibility are clearly illustrated. The results showed clear and sustained inter-animal and dietary differences that had been suspected before but were now demonstrated with commanding clarity.According to Web of Science, the paper has received 656 citations, of which 405 were categorised as Agriculture, Dairy and Animal Science, 52 were Environmental Sciences, 25 Ecology, 24 Nutrition and Dietetics and 59 Food Science Technology . Thus, t) or if other more fundamental observations were being replicated. Twenty-one papers were identified by Web of Science, of which seventeen were open access (Papers published in 2018 were scanned for the Blaxter and Clapperton (1965) citation to investigate whether the authors were citing a single technical property of the paper (e.g. as in the classical Lowry method of protein assayn access . The mosKenneth Blaxter moved from the Hannah Research Institute in 1965 to become Director of the Rowett Research Institute in Bucksburn, just outside Aberdeen. There he constructed similar respiration chambers to those at the Hannah, and thus, he continued his work on the energy metabolism of ruminants. Under his Directorship, the Rowett gained international renown for research on the nutrition of farm livestock, including red deer. He was made FRS in 1967 and was knighted for his contribution to science in 1977. Kenneth Blaxter was Director of the Rowett when I was appointed in 1976. Blaxter was an inspirational man; he had a fierce intellect, loving to draw together information and data to tell a coherent story. I well remember entering his office sometime in the late 70s to find him doodling about the impact of forestry on the global carbon economy – amazingly prescient given today’s climate crisis. The featured paper with John Clapperton exemplifies his legacy to nutritional science.


Low back pain is one of the most common musculoskeletal disorders and the most common cause of activity restriction in people younger than 45 years. Nurses have a high incidence and prevalence of low back pain in terms of physical and emotional factors among healthcare workers. This study aimed to evaluate the prevalence and clinical characteristics of low back pain.This cross-sectional study was performed on 385 operating room personnel of the hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences. The data were collected via a research-made developed questionnaire. The questionnaire consisted of two parts, including the demographic information and prevalence and dimensions of low back pain.p < 0.05).The results showed that the prevalence of low back pain was 74% among operating room personnel. There was a significant relationship among low back pain, education level, and marital status (Hospital managers should reduce the prevalence of this disorder among operating room staff by teaching preventative patient handling techniques via training courses. Low back pain (LBP) is one of the most common types of work-related musculoskeletal disorders (MSDs) , 2. LBP The peak of LBP is in the third decade of life, and its incidence increases to 60–65 years and then gradually decreases , 9. NearThe purpose of this research was to determine the frequency of LBP and clinical features among operating room staff at Shiraz University of Medical Sciences. The findings of this research will be presented to hospital administrators and operating room directors, who will be able to design suitable initiatives to prevent, control and reduce the recurrence of low back pain in operating room staff.This is a cross-sectional study performed in 2019 on operating room personnel working in hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences, including Faghihi, Namazi, Khalili, Rajaii, Chamran, and Amiralmomenin hospitals.A total of 385 operating room personnel were sampled, similar to prior research by Choobineh et al. , the samThe total number of operating room personnel in each hospital was first determined, and then, the personnel were recruited and selected for participation based on stratified random sampling. To this end, we referred to investigators who administered surveys in hospitals during different shifts after obtaining permission from the Ethics Committee, and the sampling was carried out based on the inclusion criteria mentioned in different shifts after obtaining informed and written consent from the personnel. The questionnaires were distributed among the personnel and collected at the end of the office time on the same day.Participants’ inclusion criteria included a willingness to participate in the study and 2 years of work experience. Exclusion criteria were osteoporosis, acquired spinal diseases, and corticosteroid consumption.p < 0.05). The reliability and internal consistency of the instrument, determined by test–retest and Cronbach’s alpha coefficient, were found to be 0.77 and 0.60, respectively. The questionnaire consisted of two sections: “Demographic information and prevalence and dimensions of LBP.” This questionnaire assessed the prevalence and dimensions of LBP using 11 multiple-choice questions (18).Research-made developed questionnaire was used to evaluate and gather data on the prevalence and presence of LBP and its related dimensions. The validity and reliability of the questionnaire had already been examined. During the psychometric phase of instrument development, qualitative and quantitative methods were used to determine the face validity and content and construct validity evaluation. The face validity of qualitative data was checked by interviews with 20 professors and experts in this field, resulting in a modification of three items and the addition of two items. During the quantitative face validity phase, which assessed the importance of each item by using the item impact formula, all tool items received the least impact score. This was done by filling out the initial questionnaire by 20 operating room personnel. The content validity of the qualitative section was determined by the experts’ correction; three items were corrected, and one item was merged with the other items. Quantitative evaluation of the content validity was done using two indices of the content validity ratio and content validity index, by 14 and 10 professors and experts in this field, respectively. In this phase, two items failed to achieve the required score and were eliminated. The construct validity assessment was completed via the convergent and divergent validity, respectively, using the chronic pain questionnaire and General Health Questionnaire distributed among 30 operating room personnel. The correlation of the mentioned instruments was investigated with the research instrument. The relationship between the research instrument with the chronic pain questionnaire as a convergent tool and the General Health Questionnaire as a divergent instrument was 0.70 and −0.37, respectively, which was statistically significant  available link:All participants agreed to participate in the study and signed informed consent. The participants were assured that their information would remain confidential.A total of 385 operating room personnel working in six hospitals affiliated with Shiraz University of Medical Sciences were studied. The prevalence of LBP was reported at 75%. Therefore, it was found that the prevalence of LBP in hospitals varied, and the highest prevalence (84.2%) was in the hospital of burn and plastic . Also, tp-value = 0.023) and marital status  had a significant relationship with pain area  in operating room personnel. LBP is one of the most common work-related MSDs , which hLBP had a high prevalence among participants. In a study conducted by Choobineh et al. to investigate the prevalence of MSDs in the Shiraz operating room nurses, it was found that more than half of the participants had LBP during the past year, which was the most prevalent among other MSDs . High prThe other additional results of this study revealed differentiated pain duration. Consistent with this finding, 167 patients had acute LBP and a few suffered from chronic LBP. In the study by La Torre et al., LBP was identified as the most important musculoskeletal disorder among operating room nurses in Rome, and acute LBP was the most prevalent . The higOther results of this study indicated the absence of work in one-third of the affected people. Moreover, about two-thirds of patients did not see a doctor. Among those who were referred to a physician, most people underwent diagnostic or therapeutic measures. Drug therapy and X-rays were the most prevalent diagnostic modality among these measures. In a similar study, Bejia et al. reported the prevalence of LBP in more than half of Monastir Tunisian hospital staff. About one-quarter of patients in this study suffered from chronic low back pain. Thus, it was found that most patients needed medical care, and about half of them needed radiologic diagnoses. Hence, in a significant number of participants, LBP led to absence from work . RegardiAnother notable result of this study was determining the severity of LBP and its impact on participants’ daily life activities. The results showed that more than half of the patients had transient and permanent mild pain, about two-fifths of them had moderate pain that prevented heavy physical activity or heavy work, and only a few suffered severe pain that prevented them from doing their daily activities. In a study conducted by Awosan et al. to investigate the prevalence of LBP among healthcare workers in Sokoto, Nigeria, most participants experienced LBP after work. Among the patients, about half had mild pain, a significant number had moderate pain, and a small number had severe pain . By compThe limitations of this study include no evaluation of students and operating room personnel of private hospitals. Therefore, evaluating other risk factors such as mental status and occupational stress can provide better results among operating room personnel. Besides, it is recommended that other studies should evaluate students and private hospitals. The self-reported surveys were completed by the study subjects and are subject to recall and response bias. Subjects may not have recalled events or characteristics accurately or may have been reluctant to report the truth. This is because of the fact that some people believe that one with LBP lacks a normal life, leading to their decreased self-confidence. This can be due to factors such as old age, high BMI, low education level, and so on, which are related to LBP.The present study showed a high prevalence of low back pain among the operating room personnel. By examining the different factors and characteristics of participants, there was a significant relationship among LBP, education level, and marital status. Therefore, more attention is needed to these cases, and the increase in awareness among operating room staff via taking classes and courses has partly reduced the prevalence of the disorder.