The data was collected through an anonymous survey. Young people were asked about their body weight and height, the barriers to physical activity and the health-related motives to engaging in it. The IOTF  standard by T. J. Cole was used to categorise overweight and obesity, while the PCA − Principal Component Analysis − to assess the motivation for physical activity. Logistic regression was used in the analyses of the correlations among the body weight, the level of health-oriented motivation and the occurrence of accumulated barriers to physical activity.Overweight and obesity was found in 12.4% of the respondents; more often in boys (17.8%) than in girls (7.8%). The most frequently perceived barriers to undertaking physical activity among overweight adolescents include deficiencies in energy, time and support. Three barriers , as well as the perception of several barriers occurring simultaneously, were reported more frequently by overweight students in comparison with their peers with a normal weight. Among the health-oriented motivation for physical activity in the group of adolescents with overweight and obesity, the most important one was the need to improve health, while the least important the need to look good. The excess of body weight turn out to be an important predictor of the perception of cumulative barriers to physical activity only among adolescents with a weak motivation to undertake physical activity .Young people with overweight and obesity, but with a strong health-oriented motivation, perceive barriers to physical activity similarly to their peers with a normal weight. Thus, motivation is a key element shaping the physical activity of overweight and obese young people by changing their perception of the barriers. In overcoming the barriers to physical activity in obese adolescents, one should aim to comprehensively reduce body weight and to support health-oriented motivation. Both epidemiological studies and everyday observations of adolescent behaviours confirm the finding that adolescents with overweight and obesity are characterised by lower physical activity than their peers with normal weight. Moreover, overweight adolescents take part in PE classes and extracurricular sports less often , 2. UnfoIt is, therefore, important to investigate the reasons why overweight adolescents are less active than their peers with normal weight.The barriers perceived by young people probably have a potential influence on physical activity. Some barriers may have a stronger negative impact on engaging in physical activity than others; they may also be more specific for adolescents with excess body mass. These are primarily the so-called internal barriers resulting from low self-esteem and self-limitations, such as lack of skills and lack of energy. Overweight might have a negative impact on achieving the milestones in child development and shaping the basic motor skills in young people. It was demonstrated that obesity significantly hinders some motor activities, such as jumping, climbing or squatting. Research has also shown an inverse relationship between cardiorespiratory fitness and obesity level . In someMotivation plays a significant role in maintaining physical activity. Understanding its role in pursuing an active lifestyle is the key to tackling the problem of an insufficient amount of physical activity. This problem largely affects overweight and obese children and adolescents . Most ofAccording to Edmunds et al., more is needed to maintain an active lifestyle than just internal motivation; one alsoneeds external factors, such as peer support or trends . ExternaThe most important factors motivating overweight and obese adolescents to physical activity include mixed and external motives occurring under the influence of the social environment, such as the need to lose weight or to improve physical fitness. At the same time, for adolescents with normal weight, internal motives, such as pleasure and fun, are essential , 17, 18.The aim of the study was to analyse the barriers to engaging in physical activity that are reported by adolescents with excessive body mass, and determine whether they perceive those barriers similarly to their peers with normal weight? Moreover, the aim was to establish whether relationships exist among the perceived barriers and the health-oriented motivation to physical activity.1Analysis were conducted within the statutory activity of the Institute of Mother and Child, project No 510-20-65. The data was collected through an anonymous survey among students from 163 classes from 68 randomly selected schools. Questions about the barriers to physical activity and the motivation to undertake it were answered by adolescents aged 13-16 , N= 2,300 persons . The study was conducted in accordance with the Declaration of Helsinki, and were approved by the Bioethical Committee of the Institute of Mother and Child, Warsaw, Poland (No. 20/2013).The study was conducted in 2013 as part of the project funded by the Ministry of Sports and Tourism in Poland in 2013, on a representative sample of 3,346 students aged 10-16  Participants answered the questions about their weight and height. The data was used to calculate the BMI index. In the classification of overweight and obesity, the IOTF  standards, developed by T. J. Cole were used .The test Barriers to being active. What keeps you from being more active? was used to examine the barriers to undertaking physical activity. This tool is devised and distributed by the Centers for Disease Control and Prevention (CDC) . It is cThe evaluation of barriers to physical activity was done by summarizing the responses of participants who answered very likely and somewhat likely to each statement as presence of barrier, and the remaining two answers  as lack of barrier. The accumulated occurrence of the barriers to undertaking physical activity was also estimated. It was assumed that the indicator represents young people’s perception of two or more out of the five possible barriers.A full, three-dimensional scale of the motives for undertaking physical activity was adapted for the Polish version in the 2005/2006 round of the HBSC survey; a detailed description can be found in a separate publication . This pa2 test for frequency, nonparametric tests for means Mann-Whitney (M-W)The statistical analysis entailed descriptive statistics including: percentages, mean values and standard deviations of the variables analysed. Differences between groups were calculated using the chiIn the analysis of the motives for undertaking physical activity, the PCA  was used. The new variable − “health-oriented motivation” was subsequently divided on the basis of tertiles, as follows: weak, average, strong motivation to physical activity.In the analyses of the relationships between body weight, the level of health-oriented motivation and the occurrence of accumulated (2 or more) barriers to physical activity, adjusted for gender and age, logistic regression was used; for all of the analyses p<0.05 was adopted as the sufficient significance level. The software used was SPSS v. 19.0.The characteristics of participants are shown in The factors most frequently perceived as barriers to undertaking physical activity by adolescents with excessive body mass were: lack of energy, time and social support (reported by 40-51% of the respondents) .Three out of five of the analysed barriers were, indeed, more often reported by adolescents with excessive body mass in comparison to their normal weight peers. The greatest differences were noted in the barrier “lack of skills” . No statistically important differences were found in the occurrence of the barrier “lack of social support”  and “lack of time” . Greater differences were noted in the perception of the barriers in overweight and obese boys in comparison with their normal weight peers (4 out of 5 barriers) than in girls (significant differences for 2 out of 5 barriers). The analysis conducted showed that young people with excessive body weight did indeed perceive several barriers to physical activity simultaneously (accumulated barriers). It was found that over half of the boys and 70% of the girls in that group perceived at least two out of five of the investigated barriers.In the general sample of adolescents with overweight and obesity, the most important reason for engaging in health-oriented physical activity, was the need to improve one’s health, while the least important one was the need to look good .In gender analysis, it was noted that in girls with excessive body mass the need to look good was the strongest motive to physical activity. The most important motive among adolescents with normal weight was to be good at sport, while to control my weight proved to be the least important one. In comparison with peers with normal weight, adolescents with overweight and obesity were characterised by lower motivation to get in good shape (p=0.003) and to be fit (p=0.009). However, they had stronger motivation to control my weight, though a statistically important correlation was found only in boys (p=0.003).No statistically significant differences were found regarding health-oriented motivation among young people with normal weight and their peers with overweight and obesity. Attention should be drawn to the tendency occurring in girls with excessive body weight: there was a greater percentage of persons with weak motivation for health in comparison with their peers with normal weight (39.5% vs. 30.5%) and analogically a lower percentage of those with strong motivation (36.1% vs. 41.2%) . Such a The assessed model of logistic regression showed that a greater risk of perceiving accumulated barriers to physical activity occurred in girls, in older adolescents and in people with excessive body weight . It was In the analyses conducted separately in groups of young people with different levels of motivation for undertaking health-oriented physical activity, it was demonstrated that the excess of body weight turn out to be an important predictor of the perception of a multitude of barriers to physical activity only in adolescents with weak motivation. In case of young people with strong and average health-oriented motivation, the excess of body weight ceased to be significant for the perception of accumulated barriers to health-oriented physical activity .Numerous psychological factors which can be potential predictors of insufficient physical activity in adolescents were examined in the last two decades on the basis of the social learning theory , 22. TheThe first objective of this paper was to identify barriers to physical activity in adolescents aged 13-16 with different BMI status. It was found that three out of five of the investigated barriers were indeed more often listed by overweight and obese adolescents than by their peers with normal weight. These barriers were among the so-called internal barriers. They resulted from the self-limitations of adolescents, relating primarily to lack of skills, energy and willpower. This is important information, because such barriers are the proof of low internal motivation for engaging in physical activity among young people with overweight and obesity . Body weAnother objective of the study was to investigate the extent to which the perception of the barriers to physical activity changes in a group of adolescents depending on body weight and differences in the level of health-oriented motivation to engage in physical activity.In comparison to adolescents with a healthy body weight, young people with overweight and obesity were not motivated to physical activity by the need to get in good shape and to be good at sport; stronger motivation was the need to control weight, though a statistically significant correlation occurred only in boys.It can be presumed that among girls dietary efforts play a greater role in controlling body weight than physical activity . Polish The results of the multilevel logistic regression model applied in our study showed a significant influence of health-oriented motivation on the perception of barriers to physical activity by overweight and obese adolescents. In the model oriented on different levels of motivation for physical activity, it was concluded that the excess body weight as a predictor of the perception of accumulated barriers to physical activity remained in the model only in cases of weak health-oriented motivation. In adolescents with strong and average motivation for physical activity, the excess body mass ceased to be significant for the perception of accumulated barriers to physical activity. According to Korean authors, the BMI alone explained only 17% of the variability of physical activity in adolescents with overweight and obesity, however, after adding a component compliant with the self-determination theory motivation for physical activity, the percentage rose to 49% .It can be concluded that young people with excessive body weight and strong health-oriented motivation perceived barriers to physical activity similarly to their peers with normal weight. Thus, motivation was a key element, shaping overweight and obese young people’s physical activity by changing their perception of the barriers to physical activity.Both in comprehensive preventive measures and in the treatment of obesity in adolescents, physical education (PE) teachers have a special role to play alongside parents. We might still be far away from a situation where students have an opportunity to participate in a mandatory PE lesson tailored to their individual needs, abilities and expectations. However, teachers’ help might prove to be important as a breakthrough in increasing their motivation, especially if it is health-oriented, to undertake and maintain an appropriate level of physical activity , 29.Recognising the barriers to physical activity in overweight and obese adolescents might facilitate adopting an individual approach in PE classes, as well as devising effective intervention programmes aimed at ones with excessive body weight.In overcoming the barriers to physical activity in overweight and obese adolescents, one should aim to comprehensively reduce body weight and support health-oriented motivation for physical activity.The greatest chances of success are envisaged for the forms of assistance which include working with overweight young people and are oriented both towards the individual and the environment, supporting health-oriented motivation for physical activity.


Scientific research plays a fundamental role in current medical practice and it is of great importance that medical students relate to it from the beginning of their professional career, since it generates multiple benefits that will be reflected during the course of their careers as university students and future professionals. However, getting involved in research during the undergraduate years is not always easy, as there are different obstacles and challenges that result in a reduced number of research students. Because of this, it is necessary to adopt appropriate strategies and measures to help facilitate this process, in order to foster the early development of essential skills that will facilitate responsible clinical practice. Knowing the evidence on this issue is fundamental to propose educational solutions depending on each context. •Undergraduate research is the best way to promote the curriculum.•Undergraduate research increases the likelihood of publishing articles of higher quality.•Undergraduate research increases the likelihood of publishing more articles. Ensuring the attainment of knowledge and skills of the student and general practitioner is the most important task to maintain quality standards and reduce malpractice errors. It has been shown that participation in research and scientific publication from undergraduate level, specifically in the training of data analysis, problem-posing questions, critical reading of the literature and scientific writing, contribute substantially to the development of the minimum necessary skills ,2.But the importance of scientific research for physicians goes beyond the evolution of their scientific skills. Those students who do research are more likely to republish scientific articles, publish articles of better quality, have professional satisfaction, and have better economic and academic stability . In thisDespite the overwhelming importance of medical research for society, there is a marked difference in scientific productivity between high-income and low- and middle-income countries, based on the low investment in research by the governments of each country; according to 2010 statistics, the U.S. had 3867 researchers per million people, as opposed to Colombia and Venezuela, which have 193 and 200 researchers per million people, respectively . But theIn general terms, surveys have found that medical students have a very positive outlook on scientific research, but they face multiple barriers that limit their participation in the approach and development of scientific projects, so they do not conceive of ever assisting in a scientific study ,7. Howev1.1curriculum, which is fundamental when it comes to gaining entry into competitive residencies and other types of graduate programs , . In addiFor their part, medical students themselves demonstrate a positive attitude and perception of the importance of early medical research as a tool of great value when applying for specialized training and also consider it very useful for becoming more comprehensive and skilled future professionals . A study2.1Research in undergraduate students is essential to achieve great advances in clinical medicine, since by increasing their early training in research areas, favorable results are obtained in the context of their health practice, thus allowing them to generate answers to global health problems in a safer and more effective way ,47. Beca2.2As evidenced throughout the literature review, participation in research areas offers important skills in a number of spheres . TherefoThe change in the curriculum of medical schools with the incorporation of the research component would have a much greater impact than expected from the simple production of the medical student alone . As the 3Research and publication of scientific projects during undergraduate studies is a fundamental pillar that all medical students should learn to develop from the beginning of their careers, since beyond the enrichment of their resumes as future physicians. This training provides the development of substantial skills and competencies that allow them to respond in the most effective way to the needs of global health. Considering that those students who research and publish during their undergraduate studies tend to publish more and better quality articles after graduation, it is necessary to reinforce this interest in order to encourage a culture of high quality research.It is not necessaryNone.All authors equally contributed to the analysis and writing of the manuscript.1. Name of the registry: Not applicable.2. Unique Identifying number or registration ID: Not applicable.3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable.sabrinaemz25@gmail.comSabrina Rahman. Independent University, Dhaka, Bangladesh. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


The Republic of Kazakhstan has one of the world’s highest suicide rates. A detailed study of the risk factors for suicide in that country is therefore important. We investigated country-wide statistics related to labor, financial, and economic factors and whether any of these factors contribute to the risk of suicide in Kazakhstan. Using the 20 year period from 2000 to 2019, we examined the annual suicide rates overall  and for males and females in Kazakhstan, annual unemployment rates, annual rates of increase in the country’s consumer price index, annual total exports, and annual total imports. We then calculated the correlations between the suicide rates and these four items. We also performed a multiple regression analysis of the relationship between the suicide rate and those four items. The results of these analyses indicated that the unemployment rate was the correlation coefficient most highly correlated with the suicide rate; unemployment was significantly related to suicide and should be targeted as a risk factor in suicide prevention interventions in Kazakhstan. With this in mind, organizations, government agencies, and professionals in relevant fields need to devise and implement suicide prevention measures. The Republic of Kazakhstan is one of the republics of the former Soviet Union . KazakhsThe conclusion of an investigation that took place over a six-year period in one area of Kazakhstan suggested a linear relationship between apparent temperatures (temperatures that people perceive) and daily suicide counts across the whole spectrum of temperatures . JumagelEconomic factors certainly play important roles in societal trends in suicide. Motohashi reported that the suicide rate in Japan was significantly correlated with the country’s unemployment rate , noting We reported that the suicide rate in Japan was significantly associated with the number of staff in department stores . This nuThere have been few studies on factors related to suicide in Kazakhstan. Therefore, discussions of the influence on suicide of labor, financial, and economic factors in Kazakhstan can only be based on surmised, not actual, data. There have also been few international academic reports across various fields in Kazakhstan until relatively recently. Based on opinions from several countries and the WHO, we hypothesized that labor, financial, and economic factors play roles in Kazakhstan’s high suicide rate. Hence, our present study focused on suicide and several available datasets reflecting labor, financial, and economic factors in the country, and we analyzed their relative importance.We obtained the annual suicide rate  for the overall population and for males and females in Kazakhstan during the 20 year period from 2000 to 2019 from the WHO . The annWe calculated the correlation coefficients between the suicide rate and (a) the unemployment rate, (b) the rate of increase in the CPI, (c) total exports, and (d) total imports throughout the study period. We also performed multiple regression analysis between the suicide rate and these four factors using Excel.Based on the results of the statistical analysis, certain labor, financial and economic items that are risk factors for suicide in Kazakhstan were revealed, and new population-wide indicators for suicide risk were identified. We discuss specific prevention measures and planning for these risk factors.During the 20 year study period, the annual suicide rate  in the overall population of Kazakhstan varied from a minimum of 17.6 to a maximum of 39.7; the rate for males was 29.0–69.2 and that for females was 6.8–12.4 a,b. The The results of the multiple regression analysis of the relationship between the suicide rate and the four factors, i.e., (a) the unemployment rate, (b) the rate of increase in the CPI, (c) total exports, and (d) total imports, during the study period are indicated in Based on the results presented above regarding the suicide rate and the four datasets  representing labor, financial, and economic factors, unemployment was the only significant risk factor for suicide in the overall population and among males and females in Kazakhstan. Our literature search yielded several studies conducted in developed countries that obtained similar results ,20,22,34In Kazakhstan, which is still a developing country, unemployment causes hardships and intense mental and physical anguish that can lead to suicide, as in developed countries.Japan had a large, abrupt increase in suicides about 20 years ago . The couIn Kazakhstan, preventive measures addressing labor, financial, and economic issues, such as economic and life problems, are needed; medical support for the mental and physical states that result from those problems must be provided, and a government response to those mental and physical states is important. A network of close collaborations among personnel in these areas is needed, and a practical response manual could be created and followed to provide suicide prevention guidelines. Like Japan, Kazakhstan needs a country-specific approach to preventing suicides due to economic and subsequent life problems. Measures and programs that have been effective in other countries can be studied and imitated when appropriate. Actions that draw upon Kazakhstani culture should be devised, and the advantages of collaboration among professionals in multiple fields could be utilized. Unemployment is clearly a particular risk for suicide in many countries, but not in others; it would be interesting to consider what factors distinguish the two categories. It is possible that specific measures that have been effective in preventing suicide due to unemployment in other countries would work in Kazakhstan. Systems of collaboration to prevent suicide are also needed.At present, COVID-19 is a major problem around the world, including in Kazakhstan. Worsening mental states  due to COVID-19, mental issues due to the economic impacts of the pandemic, and pessimism brought about by the disease have garnered attention as COVID-19 continues to spread around the world ,38. AmonThere are some limitations to this study. The results were based on the relationships between the suicide rate and four factors and did not define causality. Furthermore, the present study was a discussion about economic-based risk factors for suicide based on statistical analysis of only numerical data without individual information. Analyses of case-based studies of suicide would be important from the viewpoint of clinical and societal interventions. The study did not examine differences between Soviet-era and post-Soviet suicide rates, so it cannot shed light on the effect of a command economy vs. a market economy on suicide. The study did not probe the stark difference between male and female suicide rates in Kazakhstan or compare them to those of other countries and cultures where masculinity may be defined differently. The study did not examine differences between conditions in countries like Japan and the U.S., where unemployment is related to suicide risk, and in Taiwan and Sweden, where it is not. It did not elaborate on what types of prevention programs have worked or examine the data for clues to whether those methods might be applicable to Kazakhstan. However, it is a timely exploration given the current economic conditions worldwide and it opens up these issues as opportunities for further study among researchers in a variety of academic fields.Our analyses revealed that, among several labor, financial, and economic factors, unemployment is a major risk factor for suicide in the overall population and for males and females in Kazakhstan. As prevention measures, it is important for labor, financial, and economic divisions of government at both the local and national level to collaborate in planning for economic downturns and to provide stabilizing supports such as jobs programs or organized volunteerism to maintain individuals’ sense of self and purpose. In addition, extra efforts to implement suicide awareness and prevention programs at schools, community centers, and places of worship during times of economic hardship are called for.


Zika virus remains endemic and opportunistic of high transmission in the tropical region of Africa, and the repeated cases of the Zika virus in Africa made it public health emergency in 2016. Amidst the COVID-19 pandemic, the catastrophic cases of unknown and unreported deaths overwhelming the region of Africa could not give health attention to respond to other endemic diseases. Here, we present the possible complication and challenges associated with the Zika virus in Africa and COVID-19 predominance, shifting the attention from the Zika virus surveillance. This paper determines to enlighten the reader about the situation, the efforts to curb the transmission of both the Zika virus and the COVID-19 pandemic. Therefore, the report recommends sustainable solutions that can lessen the threat to public health. Zika virus was identified first in 1947 in Entebbe Uganda Forest, which was found in an isolated Aedes mosquito . In 1952The Zika virus originated from Africa transmitted infection that outreached Brazil in 2015, and the virus prevalence still causes problems in Brazil amidst COVID-19 in Brazil . This reHowever, the growth of the Zika virus in Africa has spread to different parts of African countries through other routes, and it is possible due to common diseases surveillance. It has become more challenging for most African countries to track down those infected, resulting in undiagnosed death rates in Africa. Therefore, this situation could be a looming case to deal with, especially during the COVID-19 pandemic .Moreover, while African countries are working towards overcoming the arbovirus infection, the global pandemic took a catastrophic turn to the current challenges. According to the WHO, the first peak wave of the COVID-19 pandemic in Africa was reported in July 2020, with a contemporary approximation of more than 120,000 cases . FollowiThe WHO has labeled the "worst pandemic week ever" at the end of July 4, 2021, as the cases have exponentially risen to 251,000 in Africa. The mortality rate due to the COVID-19 pandemic in Africa is 2.6%, which is higher than 2.2% of globally affected countries, thus increasing the vulnerability of the African population [According to the World Health Organization, on 14 July 2021, 30,154 new COVID-19 cases and 443,472 active cases have been reported in Africa following 104,924 increasing deaths and 683 new cases of mortality in the region [The coalition in the clinical picture of the Zika virus and COVID-19 pandemic may increase the probability of misdiagnosis of the diseases. The over-rising in the cases of COVID-19 leads to the low diagnosis of the Zika virus. This situation may cause a delay in the correct diagnosis and worsen the symptoms as the delay in the initiation of treatment predispose. There are some clinical similarities and relationships between the Zika virus and the COVID-19 pandemic; these are explained in detail in Table Ae albopictus generally prefers humans and can be found feeding indoors [Ae. albopictus succeeded in colonizing temperate zones such as the United States and Europe. They invaded African countries where it now acts as the primary vector of Dengue virus and chikungunya virus (CHIKV) in urban and rural settings [On the other hand,  indoors . Ae. albsettings , 8. Amonsettings .Zika virus diagnosis with a reverse transcription-polymerase chain reaction (RT-PCR) has the low technical expertise to operate it, especially during COVID-19 due to shortage of medical staff to interpret with caution based on the sample used an interval of symptoms onset and date of specimen collection . AnotherInterestingly, now no medications or vaccines are available since Zika presents asymptomatically or with mild symptoms; symptoms may be controlled with bed rest, intravenous fluids, and acetaminophen, making it hard to control and given priority during the COVID-19 pandemic . The majAbout 56% of Africa's urban population is overcrowded, and only 34% of the continent has access to proper hand-washing facilities , 11. In Poor road infrastructure and lack of transport facilities make it difficult for people to travel to testing sites. There is a possibility that the number of positive cases is under-reported in the African continent. These drawbacks are amplified when it comes to administering COVID-19 vaccines and giving priority to the Zika virus. Africa has always been a hotspot for different viral diseases, mainly due to poverty, lack of proper medical facilities, untrained health workers, and overpopulation.Moreover, the existence of the Zika virus in the region with new strains of emerging COVID-19 pandemic cases is not only a burden to health facilities. Still, it is a reason for the increase in mortality in the region. Most of the viruses share similar clinical manifestations, which is a possible cause of ineffective and proper treatment with unfavorable clinical outcomes and poor prognosis . On top Due to financial constraints affecting African countries, there is limited research in developing effective treatment and management plans. For this reason, it is tough to eradicate these diseases. In all this, the only ray of hope is financial dependence and support from foreign aids, developed countries, and international bodies like WHO. Meanwhile, political instability in most African countries is another reason why there is poor health infrastructure in the region.For the past couple of decades, the African continent has been an area of serious concern in coping with different epidemics in the region. However, international bodies like WHO, with its volunteer network, are working tirelessly to help foreign governments in the African continent to come out of any unwanted situation. In the prior years of the Zika virus outbreak, it was thought of as restricted to the Americas, but the virus has spread to the islands of Cape Verde, off the coast of Africa. Africa border is volatile and weak, this in turn influence how viruses like the Zika virus, COVID-19 pandemic are spreading in various part of Africa .Africa CDC has prioritized educating the masses about the general preventive measures, including preventing mosquito bites and preventing sexual transmission. Part of the measures created by the healthcare system is preventing mosquito bites by wearing long sleeve shirts and long dresses, permethrin-impregnated clothes, indoor residual spraying of insecticide, screening of doors and windows against mosquitoes, and other environmental control measures aimed at decreasing the breeding of mosquitoes .When it comes to the COVID-19 pandemic, Africa has faced several challenges. The continent is especially vulnerable to disease outbreaks, especially during the COVID-19 pandemic; the disease outbreaks include Ebola, viral hepatitis, yellow fever, etc. –18. HoweThe public should be warned about leaving water containers lying around, and tanks and sewage areas need to be covered. Insecticides need to be used around the house. Pregnant women and those of childbearing age should also be warned about traveling to places where the Zika virus is endemic. It is important not to overuse insecticides in the fight against Zika and other mosquito-borne diseases to prevent insecticide resistance. However, when using them is inevitable, there are ways to limit the growth of resistance.Different insecticides of different classes and modes of action should be used in rotation instead of one insecticide. Interventions should also be combined when fighting an outbreak, i.e., both adult and larvae should be targeted, again with different insecticides. Another option is that when one compound is used in an area, a different one should be used in its neighboring regions. To implement these strategies in an outbreak, it is essential to have experts who know insecticide products and resistance mechanisms.Monitoring the mosquito population and its insecticide resistance is crucial on a large scale to prevent a Zika virus outbreak. Constant surveillance of resistance within the mosquito population is necessary to anticipate future outbreaks. A way to achieve this is if governments of developing countries work together with WHO to monitor the mosquito population.When it comes to the constantly evolving COVID-19 situation, much needs to be done. Governments need to allocate funds to deal with the pandemic effectively. Vaccination needs to be scaled up, as it is the only way to prevent new strains from mutating. Governments need to start allocating funds for booster doses required in the future as new strains emerge and vaccine immunity vanes.A proper online system for managing every citizen's dose schedule and tracking should be implemented, as soon as possible to keep track so non-compliant individuals with booster shots in the future can also be traced. Public service campaigns should be run on TVs and radios, and misinformation spread on social media should be addressed and disproved.Government officials should also look into fines or reducing access to public services for people who refuse to get vaccinated, such as reduced access to public transport. Stricter measures need to be taken throughout the continent to implement social distancing and masks, with fines in case of noncompliance.Free masks should be provided outside buildings before entry, and campaigns should be run emphasizing the correct mask-wearing method. Sanitizers should be delivered to areas where hand-washing facilities are not available.Overcrowding should be discouraged in indoor spaces, and offices and workplaces should not allow more than necessary employees to come to work. Working and studying from home should be adopted as part of the everyday lifestyle wherever possible. It is also crucial to discourage unnecessary travel and activities where lockdown measures cannot be implemented on a rigorous level. This will allow health practitioners and regulating bodies to design policies effective enough to cope with similar diseases. Conclusively, there is an inevitable need for further researches to understand better the correlation of such conditions with struggling health setups.


Urban parks positively affect the life quality and health of urban residents as well as the environment where they live. When it comes to the design of a future urban forest park, it is necessary to consider the protection of ecological environment, landscape sustainability and practicability. This study explored residents’ spatial preference for urban forest parks based on preference survey data. According to the rating scores obtained for four urban forest park routes during physical activities, this study used cognitive maps and multinomial logit models to figure out the potential influencing factors affecting residents’ spatial preference while they engage in physical activities. The results suggest that forest routes are still the primary choice for urban residents. Although familiarity with the spatial image preference for urban forest parks varied from person to person, residents’ choice of route shows certain commonalities, which was reflected in the sequential cognitive maps obtained from them. In addition, residents’ route preference is influenced by their exercise habits, environmental preference and residential location. There is also a certain correlation between residents’ preference and their characteristics. This study provides additional information for planners, developers, engineers, architects and foresters in building a more suitable environment that is aesthetically appealing and ecologically sound for physical exercising. Urban forest parks are important leisure areas for urban residents. They are generally used for physical and recreational activities. Studies have confirmed that these functions can positively affect residents’ mood, cognition, behavior and physical health . From thAs far as urban forest parks are concerned, people are more likely to engage in the form of physical or recreational activities when embrace nature. In this process, people’s behavior pattern in the environment is based on their cognition and understanding of the things around them, and it has been proven that participating in physical activities or exercise will be beneficial to people’s physical and mental health as well as their cognitive function. While engaging in physical activities, residents develop a deep or shallow preference for the images of things around their exercise route, which refers to people’s image cognition of the material environment ,9. This At present, residents’ preference for urban forest parks has expanded from traditional aesthetic and practical functions to deeper levels, such as pursing psychological and emotional satisfaction. Some studies believe that the simplified mathematical and statistical models constructed from the characteristics of residents and urban forest parks cannot effectively elucidate the complexity of real urban forest parks and the subjective initiative of residents. Since the subjectivity and objectivity of urban forest parks are equally important and the research object has been extended to the “subjective world” of the urban forest park, such as “perceptual space” and “image maps” , we beliSimilar to existing studies, this study posits that understanding public preference will help avoid misleading preference . ExtensiChanges in preference of residents affect the planning and decision-making processes related to urban forest parks . TherefoFrom the perspective of public cognition and choice, this study considered the Olympic Forest Park in Beijing as the research area. Further, we used cognitive maps and multivariate logit models to study the spatial image preference and preference characteristics of urban forest parks in different locations and for different individual characteristics. The data for this study were obtained from a field questionnaire survey and field interviews. The primary objective of this study was to understand residents’ preference for urban forest parks, especially to explore their preference for typical urban forest park routes when they engage in sports activities, as well as potential influencing factors. In this way, we can emphasize the importance of urban forest park in residents’ life, explore the reasonable form of urban forest park, provide planners, developers and government staff with more useful information about its design and lay the foundation for building a more reasonable and humanized park.As this study aimed at improving the understanding of public preference for urban forest parks, the Olympic Forest Park, a typical urban forest park, located in an urban area of Beijing was selected as the research site. Olympic Forest Park is located near the North Fifth Ring Road in Chaoyang District, Beijing, and covers an area of 680 hectares, including 380 ha in South Park and 300 ha in North Park. The Olympic Forest Park was built for the opening of the 2008 Beijing Olympic Games. At present, it is a national scenic spot and an important place for leisure, entertainment and exercise for Beijing residents. Olympic Forest Park is rich in forest resources, and boast a greening coverage rate of 95.61%, especially in South Park. Considering accessibility and the number of users, the South Park of Olympic Forest Park was selected as the primary research area .As mentioned in this study, a reasonable urban forest park design is often a trade-off between natural and artificial environments to achieve optimal results. Hence, we summarized four routes within the urban forest park to understand the trade-offs between residents’ preference of natural and built routes and to explore the needs of the residents concerning natural and artificial areas . It shouOf course, residents do not strictly follow the established route given in this study. What this study gives is only the most widely used route of residents. In other words, our definition of route comes from empirical investigation and interview conclusions, and of course, it is also based on the actual use of residents. We hope that we can refine conclusions and summarize laws through these more frequently used and typical routes.The forest route is located in the inner area of the urban forest park, and offers high vegetation coverage, pleasant scenery and fresh air. The forest route is widely distributed and it is suitable for long-distance sports and recreational activities. However, the terrain of the forest route fluctuates and there are many curves along the route, so it is not suitable for night activities. Meanwhile, if the roads become narrow and many people gather together, users will be easily disturbed by others during physical activities while in the forest route. In addition, forest routes are mostly paths and closed routes inside the park. Therefore, residents cannot exit at any time during the exercise ,40,41.The built route is situated outside the park, and primarily consists of sidewalks on both sides of the municipal roads. The built route is a circular road that forms the boundary of the urban forest park. The route offers a good field of vision during physical activities. At the same time, the road surface of the built route is relatively flat, which makes it conducive to all types of sports, such as running. Unlike the forest route, the built route has no restrictions on entry and exit. There are bus stops, subway stations, shops and other facilities on the roadside, which can meet the various needs of residents. However, the disadvantages of the built route lie in its relatively low vegetation coverage, monotonous landscape and residents’ direct exposure to the sun during exercise, resulting in great sunscreen pressure, especially when the body temperature in summer is relatively high. Besides, the built route is close to motorways, exposing the users to turbid air, loud noise, vehicle exhaust and smoke during exercise. Similarly, the safety of exercising in built route is relatively low due to high vehicle speed on the motorway ,43.The waterfront route is usually a short route around the lake and is characterized by rich elements (water environment and vegetation) on both sides of the road. Along this route, there are many entertainment facilities, such as cruise ships, boating and other entertainment facilities at the lakeside wharf, which enhance the ornamental and entertainment value of the waterfront route. However, similar to the forest route, this route undulates and thus has many curves, so it is easy to cause wrestling, sprains and other problems when residents perform exercises such as running .The mixed route incorporates the characteristics of the above three types of routes. Residents who exercise in this route do not have clear preferences or motives. The mixed route offers a wide range of space, flexible utilization methods and diverse landscapes, rendering it suitable for all people. Residents who exercise in the mixed route can experience different feelings when exercising and can also choose to enter or exit the park at any time, making exercise in this route rather universal and convenient. However, the mixed route also has the disadvantages of the three route types discussed above.In this study, we adopted a combination of questionnaire surveys and cognitive maps supplemented by interviews. First, we collected relevant data using a questionnaire; before that, the research group designed a unified questionnaire and survey scheme. A preliminary draft of the questionnaire was prepared based on existing literature, expert interviews, and group discussions. Further, cognitive map analysis was performed to evaluate the spatial preferences of residents using the Beijing urban forest park, and a multinomial logit model was applied to analyze residents’ preferences for four urban forest park routes. Hence, we applied this method to analysis the urban forest park in Beijing. Hand-drawn cognitive maps are considered to be one of the direct graphical methods, in which respondents are requested to draw the shape, location and structure layout of various objects . As resiOwing to difficulties in obtaining information from hand-drawn cognitive maps, we divided residents into two types: (1) residents with a deep preference for the spatial image of the park, who were requested to draw a hand-drawn cognitive map; and (2) residents with a vague preference for the spatial image of the park, who completed the hand-drawn map and were asked to select the most familiar elements on the map. The purpose of these two surveys was to obtain information on how familiar the spatial image preferences of residents were for different types of urban forest park routes. Frequency distribution statistics and comparative analyses were conducted based on the information obtained.On the other hand, this study used multivariate logit models to study the preference characteristics of urban forest parks in different locations conditions and for different individual characteristics. The multinomial logit model design serves two purposes: to compare the relative importance of different types of routes, and to compare the subjective spatial preferences of residents. In the setting of dependent variables, we take residents’ urban forest park route preferences as options. Based on this, we construct a disordered multivariate logit selection model for calculation, and compare the disordered selection of various types of urban forest park routes of individual residents; and in terms of independent variables, we collected information including gender, age, education level, location of residence, family size and frequency of visits, hoping to further analyze the influencing factors of residents’ choice through multiple logit regression method. Specifically, residents’ heterogeneity in personal characteristics and prior experience, such as gender, age, education level and other factors, will affect their preferences; at the same time, residents will have different preferences for different park forms in different time and space. For example, considering the openness and occlusion of information, the degree of citizenization and familiarity with parks will have an impact on residents’ preferences .The variables and rating scores are shown in As mentioned above, the questionnaire survey environment of this study is located in the Beijing Olympic Forest Park, and four exercise routes were extracted based on the actual situation of residents’ activities. The survey in this study was carried out on each established route. Among them, the road widths of the four routes were not significantly different. Based on selected research areas, questionnaires and corresponding survey methods, field surveys were conducted in September 2021 from 24 September to 28 September, the investigation starts from the opening of the park at 10 a.m. every day, and the end time is determined in combination with the real-time passenger flow in the park on different days. Based on this arrangement, data from Olympic Forest Park were collected. The investigators were all graduate students with professional learning backgrounds and experience in field investigations. Investigators underwent systematic training on research methods and data collection before conducting the survey. The core principles of this study are efficiency and comprehensiveness. These principles made the questionnaire as concise and clear as possible to improve residents’ responsiveness as well as the utility and accuracy of the obtained data. Considering the complex characteristics of Shanghai residents, we select the sample residents according to the combination of stratified sampling and random sampling, so as to improve the representativeness of the sample and reduce the sampling error. At the same time, we take a face-to-face approach in the specific survey links, supplemented by the investigators of the research group to properly explain the possible questions in the questionnaire. After the survey, the research group cross checked the questionnaire three times to ensure the quality of the survey data.After the survey, there are two main aspects for data sorting: one is to input the conventional paper questionnaire data into the computer and convert it into electronic data; the other is to manually identify the subjective data such as cognitive map and convert and input it into electronic data. These two tasks can be completed quickly with sufficient staff, including data verification and inspection. Overall, 874 questionnaires were collected, of which 803 questionnaires were validated, and 309 effective cognitive map sketches were obtained. The overall effective response rate was 91.88%. It should be noted that we adhere to the principle of random sampling when selecting the interviewed residents. Some residents refused the interview for personal reasons, such as managing children, dating, exercising and not wanting to be disturbed. There is no substantial or significant difference between non respondents and respondents, nor does it affect our random sampling process. The above empirical procedures are shown in In order to reduce the survey error, we have taken the following measures: first, combined with the research theme, we have correctly formulated the survey plan, scientifically designed the questionnaire, reasonably selected the survey methods, made our survey meet the actual situation of the respondents, and enabled the investigators to clearly implement the established plan.In this study, Y represents the routes of urban forest park. Y1 to Y4 are the four types of urban forest park routes, which is the basis for residents’ choice. Starting from this, we give two main reasons for using the disordered multiple-choice model for calculation: First, although the routes of urban forest park themselves as dependent variables are orderly, the four types of urban forest park routes are disorderly. For residents, which type of urban forest park route they choose is also disorderly; Secondly, the functions of the selection models used to calculate such problems are similar, but the multivariate probit model is more complex. Therefore, the multivariate logit model with multiple choices is used for calculation.j + 1) types of response variables, there will be j formulas, each of which is a binary logit regression process compared with the control group. In addition, in the multiple logit regression, the above j binary logit regressions are estimated simultaneously. If the last group is set as the control group and the other groups as the experimental group, P (iy = j) is the probability of the experimental group, and P (iy = 0) is the probability of the control group, β represents the log odds of the experimental group to the control group, the multivariate logit model of the study can be expressed as:Multiple logit regression involves more than two types of nominal response variables, and is composed of multiple formulas. For  and the likelihood function can be obtained. The final log-likelihood function is expressed as follows:There are also corresponding calculation methods in the parameter estimation process of the unordered multivariate logit selection model. For resident Based on this, we analyze the preference characteristics of urban forest parks under different location conditions and individual characteristics.Among the participants that took part in the survey, the proportion of females was slightly higher than that of males. About half of the respondents were between 20 and 40 years old and the residents sampled in the park were relatively older. More than 80% of the respondents had high school or higher educational backgrounds. More than half of the respondents lived within the Third Ring Road, which was consistent with the expected number and population density of residents residing in the core urban area of Beijing. The total family size of the respondents was three or fewer. The frequency of the respondents visiting the urban forest park was 6–10 times per week, which was related to place of residence .The cognitive maps represent the residents’ preference for the spatial image structure of the entire urban forest park. Based on the cognitive maps, an urban forest park image map was constructed through map type analysis and map element analysis, which were performed to intuitively understand the image composition of urban forest parks. This study used the cognitive map method to analyze residents’ familiarity with the spatial images of different urban forest park routes. Based on the classification criteria proposed by Appleyard (1970), the cognitive maps were roughly divided into sequential cognitive maps, including path elements , and spatial cognitive maps, including regional elements . Examples of hand-drawn cognitive maps in this study are shown in A linear cognitive map represented a branch map that included the main roads within and surrounding the urban forest park or a more detailed linear preference map. A branch cognitive map was a branch map that contained the elements of the urban forest park which were considered impressive by the interviewees and they could connect the elements through a path. A chain cognitive map was developed based on a chain map around the main roads of the urban forest park. A scattered cognitive map contained a combination of scenic spots or areas with specific impressions, which roughly reflected the preference for the spatial image of an urban forest park. A mosaic cognitive map included different areas of the urban forest park from the respondents’ memory that had to be combined into the preference for the spatial image of an urban forest park. Connected cognitive maps included the spatial segments of urban forest parks connected by the traffic roads and facilities .In this survey, 309 effective cognitive map sketches were obtained. However, only a few samples had good accuracy, while most of them do not form an overall impression of the Olympic Forest Park. When asked to complete the hand-drawn cognitive map, they all said that it was rather difficult. Meanwhile, most of the hand-drawn sketches had incomplete contents, blank areas and negligible additional information, indicating that most of the respondents had no clear understanding of the spatial structure of the Olympic Forest Park. The statistical results obtained from the cognitive maps are presented in Among the sequential cognitive maps, linear cognitive maps account for the largest proportion of 34.30% of the total sample, indicating that most of the residents could draw the main routes and some of the spatial elements and impressive places. Some residents could draw a more detailed linear cognitive map, which was closely related to the residents’ familiarity with the route. Branch cognitive maps obtained from the survey accounted for 20.39% of the total sample. Such maps generally reflected residents’ deep memories of specific places inside and outside the park. Certain scenic spots left a deep impression on residents, who were able to connect these places through various channels and lines to form a roughly branched cognitive map. Chain cognitive maps accounted for 14.24% of the total sample. Some residents could extract chain memory fragments of multiple roads or traffic routes and connect these fragments into a chain-perceptual space.The scattered cognitive maps accounted for 10.03% of the total sample. This type of map represented several memorable places that roughly reflected the residents’ preference for a certain space. In this case, residents could draw a certain regional boundary of the urban forest park and were able to mark the distribution of multiple important sites. In such maps, residents’ preference for the park’s external or internal element boundary was weak, which was reflected in the presence of scattered elements on the hand-drawn maps. At the same time, residents were able to draw familiar spaces, although there was no clear representation of the overall scope and structure of the park.In contrast, the mosaic cognitive maps contained more information and was drawn by the residents who are familiar with the park and its surroundings, which accounted for approximately 11.97% of the surveyed park users. Residents integrated memories of different regions into blocks and combined them into the perceived cognitive space. Finally, the connected cognitive map belonged to a higher level, accounting for only 9.06% of the total sample. In this case, residents provided effective connections between segments through necessary traffic lanes and spatial segments to form their perceptual space. According to the interview results, residents who often exercise in the park and live in the surrounding areas could draw various cognitive maps and more mosaic, connection and other complex cognitive maps. In contrast, residents who were not familiar with the park could only draw linear and scattered maps.The key elements of cognitive maps can be classified based on classification method proposed by Lynch (1960). In this method, maps are primarily and intuitively assessed based on the richness of certain elements, including landmarks, paths, nodes, regions, and boundaries. The cognitive map elements that residents can feed back are often the most familiar or frequently used parts. By extracting and integrating these elements, we can get the important information related to preferences fed back by residents on the basis of cognitive map. Specifically, landmarks in this study were reference points, including famous scenic spots and other elements that could potentially make an impression on residents. Landmarks which emphasize uniqueness are usually spots with specific and easily attractive objects, such as scenic spots, sculptures, buildings or rockeries. Some landmarks exist as symbols in urban forest parks, such as the open-air theater in the Olympic Forest Park. The road within the urban forest park connected different scenic spots or locations, such as greenways, footpaths and ropeways. Roads are an important part of the unconscious or conscious walking route of memory. Hence, it was the dominant element in the cognitive map for most people.A specific road can serve as an important image feature of parks. A node is a location where residents enter, which connects places, such as squares and parking lots. Nodes may also be the connection points in traffic lines, which play the role of aggregation and transformation. For example, in intersections, squares, bus stations and subway stations, residents can perceive the surrounding environment and make active choices at these nodes. In this study, memories of residents relating to nodes were vague and one of the reasons was the difficulty in remembering names. For example, there are several squares in the Olympic Forest Park, most of which are not well known by residents. Therefore, these squares should be named in a manner that is easily understood and recalled. A region is a morphological element on a two-dimensional plane. It divides space with common characteristics into a category. These features can be recognized internally and serve as external references. Boundaries are areas or locations between two regions, such as entrances and exits. Boundaries are often represented as linear elements that divide different areas. Most respondents in this study had vague memories of boundaries, indicating that the residents’ understanding of the Olympic Forest Park was not clear. Thus, it is necessary to consider boundaries while developing urban parks.The analyzed information was used to generate the frequency distribution statistics of the cognitive maps of residents based on familiar factors. This study evaluated the familiarity of residents with spatial image preference by integrating familiar elements in the cognitive maps of four urban forest park routes. By classifying the five dimensions of cognitive map image elements , the most prominent elements of the urban forest park were identified . In geneThe familiar units of residents who prefer the forest routes are mainly the landmarks and regions along the route, but most of them are scenic spots and various exercise places in the park, while residents usually pay less attention to the relevant contents outside the park. Generally long and simple, paths in the forest route are internal routes, which are suitable for residents preferring to exercise for long distances. Residents utilizing this route clearly understand the main entrance and exit nodes, but it is not comprehensive enough, which has a certain relationship with a resident’s working and residential location, living habits and exercise habits. According to the interview, the forest route is not only a traditional exercise route based on the resident’s impression, but also an inherent route choice. For such routes, elaborate development strategies should be adopted, which is related to the demand for continuous optimization of park functions, on the one hand, and to make the park more suitable for the core needs of residents, on the other hand.Residents who prefer the built route pay greater attention to the landmarks, regions and nodes outside the park, including nearby gymnasiums, shopping malls, schools and parking lots. This may be because residents have less contact with the scenic spots inside the park except for the entrance and exit areas of the park since the built routes are mostly outside the park fence. Hence, residents have a very clear understanding of boundaries, such as park entrances and exits. Meanwhile, residents are not familiar with paths inside the park but the municipal roads outside the park, such as the North Fifth Ring Road. They have relatively weak demand for the internal functions of urban forest parks. Their demands are mostly outside the park boundary and more diversified. The enlightenment from these residents is that the construction of urban forest park needs to take into account both the internal and external development so as to ensure that the residents’ all kinds of use will not be affected.Residents who prefer the waterfront route have a small range of activities centered on various lakes in the park. These residents are very acquainted with the landmarks and regions around the lake and they are more familiar than those who prefer forest routes. The action tracks of these residents are relatively single and their cognition of boundaries and nodes is mostly concentrated near the park’s south gate. Most of these residents go in and out of the park’s south gate because the largest lake (the Aohai Lake) in the Olympic Forest Park is very close to the south gate. In terms of paths, the residents who prefer the waterfront route pay more attention to the paths inside the park and could provide more details of these paths because the distribution of lakes in the park are relatively scattered, which is similar to the residents who prefer the forest route. At the same time, many river courses are in the same direction as the movement route of residents, which also deepens residents’ familiarity with such water areas. Considering the complexity of the geographical characteristics of the lake and the irregularity of the route around the lake, it is difficult to manage this route. We believe that some improvement measures should be taken from the perspective of strengthening safety guidance and highlighting the landscape characteristics along the route.Residents who prefer mixed routes have a comprehensive understanding of the internal and external elements of the park, but their cognition which is a combination of the above three types of routes is scattered. The movement tracks of these residents are relatively random, and their needs in the park are rather diverse. Therefore, these residents do not have a fixed and habitual exercise route. Conversely, it was understood from the interview that the urban forest park itself has a vivid landscape, but its internal road system was often chaotic, which is the reason why some residents preferred mixed routes. The mixed routes given in this study are also the most used in real life and do not represent all of these routes. When such routes are managed and maintained, it is necessary to fully consider the functions of the other three routes so as to achieve the coordination between their different characteristics.Model fitting and uncorrelation tests were performed for established multiple logit models. The results of both tests are shown in Based on the conclusions of the fitting and uncorrelation tests, this study used the maximum likelihood method to estimate the parameters of the influencing factors of the preferences of residents. Y1 (Forest route), Y2 (Built route) and Y3 (Waterfront route) were the experimental group, and Y4 (Mixed route) was the reference group. All explanatory variables were included in the model calculation, and then the variables with zero parameter estimation in each model were eliminated by the Wald test based on the reverse elimination method. The results of the maximum likelihood estimation are listed in This research showed that female residents prefer mixed routes, indicating that women’s demand for urban forest parks is more diversified, and their choice of exercise routes are more random than men’s. In terms of age, residents under the age of 20 and over 40 have a stronger preference for mixed routes. This can probably be attributed to more leisure time and more comprehensive needs for urban forest parks of residents in these age groups. Similarly, families with two people prefer the waterfront route, while families with three tend to choose the mixed route. In addition, residents who visit less than five times have a stronger preference for forest routes, while dwellers who visit more than six times have a stronger preference for mixed routes. What account for may be that the residents who visit the park less often prefer the natural functions of the park. In comparison, the demands of residents who visit the park more often will be more diversified. Hence, their route selection will also show the characteristics of diversity and variability.This study investigated four types of urban forest park routes to reveal the trade-off between residents’ preferences of natural and artificial exercise routes in urban forest parks and explored their needs for these two types of areas. These routes were based on actual usage of urban forest parks by residents and have strong practical significance. In general, residents preferred forest and built routes than waterfront and mixed routes for actual physical exercising. This showed that the traditional exercise route  was still the main choice for the residents. Some studies have pointed out that preference may be affected by media and education, which are potential means that can influence public preference through awareness and ecological education ,51,52,53Judging from the accuracy of hand-drawn sketch elements, most people did not form an overall impression of the Olympic Forest Park so it was difficult for most of them to draw the plan view of the park. Most of the hand-drawn sketches had incomplete contents, blank areas and less information, as residents did not have a clear understanding of the spatial structure of the park. At the same time, we found that the residents’ preference of the spatial images of urban forest parks varied from individual to individual. However, residents who exercise in the urban forest park usually chose a specific route for motion tracking; the preferred route selection might have affected their cognition of the park, which was reflected in the cognitive maps as most of them were sequential cognitive maps. The linear and branch cognitive maps accounted for 34.30% and 20.39% of the total sample, respectively. In these two types of cognitive maps, most residents could only draw the main routes of their actions, indicating that residents have adequate memories of some places inside and outside the park and could illustrate them as simple drawings. During the survey process, some residents with a vague preference for the spatial image of the urban forest park were supplemented with information regarding familiar elements apart from the hand-drawn map, which greatly expanded the sample size and improved the overall efficiency of the survey.In addition, the cognitive maps drawn by residents reflected their scope of action and their understanding of the main characteristics of urban forest parks. Residents often prefer their daily exercise routes and their preference for different urban forest park routes will be affected by their exercise habits, environmental preferences, residential location and other factors. Based on the different behavior patterns of residents, there is still scope for adjustment and optimization of the tour routes, commercial arrangements and public service facilities of the Olympic Forest Park. Specifically, the family units of residents who prefer forest routes are mainly the landmarks and regions along the route, but most of them are scenic spots and various exercise places in the park, and residents pay less attention to the relevant contents outside the park. This part has the largest number of residents, indicating that the current urban residents’ cognition of the function of urban forest parks remains the most basic aspect of providing natural and ecological products. Their understanding of the social service function of urban forest parks is not deep enough.In contrast, residents who prefer the built route pay more attention to landmarks, regions and nodes outside the urban forest park, including nearby gymnasiums, shopping malls, schools and parking lots. These residents have a more superficial understanding of the internal elements and functions of the park since their exercise routes are outside the scope of the urban forest park. The route of these residents is highly replaceable and their dependence on the internal elements of the park is low. In addition, the residents who prefer the waterfront route have a small range of activities and are quite familiar with the landmarks and regions around the lake. The number of such residents is small, and they represent a relatively small number of exercise habits and route selection preference. Residents who prefer mixed routes have a comprehensive understanding of the park’s internal and external elements, but they lack an in-depth understanding and their cognition that integrates the above three types is scattered. Notably, there is a certain correlation between preference of residents and their individual characteristics, such as gender, age, family size, visit frequency and other factors that affect their preference for urban forest park routes. In general, the conclusions given by the multinomial logit model are relatively limited, reflecting the relationship between residents’ individual characteristics and the waterfront route and mixed route.With the continuous development of China’s urbanization and the rising demands of urban residents for the ecological environment, increasing attention is being paid to the development of livable cities and towns by urban planners, policymakers, scholars and the public. From the perspective of public cognition and choice, this study examined the Beijing Olympic Forest Park as the research area and obtained data through questionnaires and interviews with residents. This study integrated cognitive map analysis and multivariate logit model to study urban forest parks spatial image preference and preference characteristics under different location conditions and individual characteristics. The results suggest that forest routes are still the primary choice for urban residents. Although familiarity with the spatial image preference for urban forest parks varied from person to person, residents’ choice of route shows certain commonalities, which was reflected in the sequential cognitive maps obtained from them. In addition, residents’ route preference is influenced by their exercise habits, environmental preference and residential location. There is also a certain correlation between residents’ preference and their characteristics. This study provides additional information for planners, developers, engineers, architects and foresters in building a more suitable environment that is aesthetically appealing and ecologically sound for physical exercising. Future research should adopt more combinations of methods to explore deep-seated preference of residents, expand the sample size and scope of the survey and conduct repeat and follow-up experiments when conditions permit to verify and expand the conclusions of relevant research ,55.


The training models in Finland have changed over the years and will continue to evolve. Specialization training can be organized by national societies or by universities. It can lead to an academic degree or a diploma. It can be linked to doctoral studies or form a parallel track. Financial model can involve student fees or be governed by ministries . This paper describes and compares different strategies in education that have impact on the output of professionals. One model does not fit all, or even one country at all times. The strategies of the stakeholder ministries can change over time. The experiences from Finland can be useful for other countries that are developing their models. The estimated need of practitioners and the educational resources including the available financial models for training differ between countries. The guiding principles in specialist training should focus on the advanced competencies expected from the neuropsychologist when entering the profession.This paper provides information on different training models within clinical neuropsychology in Finland. Systematic specialization training program began in Finland in 1983. It was first organized mainly by the Finnish Neuropsychological Society and since 1997 by the Finnish universities. At present, close to 400 clinical neuropsychologists have completed the training. The number of professionals still does not cover the needs of the country (population 5.5 million, area 338,440 km Neuropsychology in Finland has its roots in European research and practice, especially the nineteenth century German tradition of experimental psychology and psychophysics . ClinicaEducation and training of clinical neuropsychologists is heterogeneous ranging worldwide from master’s programs to post-doctoral training . One thiThis paper describes the models that have been in use in clinical neuropsychology training in Finland since early 1980s. The models and strategies have changed over the years, and the pros and cons of each are discussed.1 and EuroPsy model has been adopted, the academic studies are measured using the European Credit Transfer and Accumulation System (ECTS), where one academic year is defined as 60 ECTS-credits, corresponding to roughly 15:00–18:00 h of study; 1 ECTS means 27 h of study . The bachelor’s and master’s study program follows the guidelines in content and depth . The so-Training of professionals is based on continuing education (CE). The Finnish Neuropsychological Society has organized seminars and courses for psychologists in Finland ever since its foundation in 1979. The objective of the courses was to increase clinical skills in neuropsychological assessment, methodology, and interventions. Right from the start neuropsychologists in Finland have been an important provider of rehabilitation services and in 1982, in collaboration with the Social Insurance Institution of Finland (Kela) which reimburses rehabilitation, the Finnish Neuropsychological Society started to keep a record of certified psychologists qualified to carry out neuropsychological rehabilitation subsidized by Kela . This woContinuing education-courses however are not recommended as the way to specialize  and as tContinuing education-training in neuropsychology still continues and has an important role in health care. Many organizations and institutions offer courses that are useful for clinical psychologists who need additional information on neuropsychology, and they are very popular and in high demand. CE-courses do not qualify for the certification for neuropsychological rehabilitation or give the specialist diploma.The first curriculum-based program in clinical neuropsychology started as the activity of the Finnish Neuropsychological Society. Programs were approximately 4 years of length, 1983–1987, 1988–1992, and 1992–1995 . The cou3 In this model, students were able to enroll to any one of the Finnish universities to study in their chosen program regardless of where the teachers were employed. They chose their “home university” based on where they lived and the group they wanted to join to complete the research required. The network was ahead of its time organizing remote video- and web-based teaching already since 1997  consisted of one publishable article reporting an empirical study in clinical neuropsychology. Many papers were published in scientific peer reviewed journals, international or national. All thesis were evaluated, usually by two independent reviewers, before approval by the faculty as part of the degree. The work preceding publication was carried out in research groups with variable resources. Some were large active groups in university departments, while some were small  student , p. 54. The close link between theoretical study and clinical work was emphasized and achieved as the program was part-time. All students simultaneously worked as practitioners. The work experience, as well as supervision, was a requirement for the qualification and degree . In all,As the legislation related to specialist education in Finland changed in 2015 and the licentiate degree ceased to be supported by the ministry funding, the training model for clinical neuropsychology was modified. The degree status changed into a diploma status and the students were again required to pay a fee for their tuition.https://www.helsinki.fi/en/faculty-medicine/education-and-studying/postgraduate-professional-education/specialisation-programme-neuropsychology.The program is currently organized by the faculty of Medicine at the University of Helsinki in collaboration with the Psykonet network. Students still come from all over Finland, but they enroll to the University of Helsinki. Other universities in Finland have similar responsibility of other specialization fields. In its current form the program  is a 3-year program where students gain a time-limited access to the studies. The content is described in more detail by Eight to ten 2-days seminars are organized each academic year  but not all seminars are compulsory to all. The students can select courses based on their interests and personal emphasis on adult or on child neuropsychology, although a certain core content over the entire lifespan is obligatory. In addition to the seminars, there are regular groups for clinical work supervision and thesis supervision. The required literature is covered in various ways; in addition to book exams, students write essays and reviews based on recent relevant articles. Each student also prepares and presents a lecture on a topic of their choosing to other students and keeps a portfolio on professional development.Instead of the licentiate thesis, the students write a final thesis of a smaller scale (10 ECTS). It involves a systematic literature review on a question relevant to clinical practice or an empirical research paper. Research papers are preferred by students who simultaneously pursue doctoral studies and they are published in international peer-reviewed journals. The reviews are mostly published in a non-peer reviewed open access journal by the University of Helsinki, Neuropsy Open . The accompanying methodological studies (five ECTS) focus on skills in online literature search, systematic review practices, and critical appraisal of research quality. The specialist track in the current model does not expand to doctoral studies as easily as the previous degree model did, but content can be selectively shared between tracks see .Admission to the program is every 3 years. In 2016, 41 psychologists (out of 100 applicants) were admitted and additionally some transferred from the earlier degree program to the diploma program. In all, 52 psychologists have currently completed the diploma program. In 2019, 53 psychologists (out of 141 applicants) were admitted to the program and they will complete in 2022. All curriculum-based models combined the current number of trained clinical neuropsychologists is 373 . Most emIn Finland it is mandatory by law for everyone working in the health care sector to maintain their high level of expertise, and employers are required by law to allow adequate time for this (recommendation of at least 3–10 days of continuing education each year). Practitioners in general are very active in personal and professional development, and especially those working in clinical neuropsychology acknowledge the rapid turnout of new information in neurosciences and the need for continuous update of education. Hospital districts offer local training to their employees, and many participate in international conferences by e.g., International Neuropsychological Society, where CE-workshops and special lectures are available.Continuing personal development (CPD) for all practicing psychologists is recommended in the EuroPsy model . In FinlFor those wishing to serve as supervisors in clinical neuropsychology, special requirements apply and the supervisor certificate is awarded by the Certification Board . In addiSpecialist education and training in clinical neuropsychology can be organized in many ways. Finland has experience in four different models: CE-model, a program organized by a national neuropsychological society, a degree program organized by universities, and finally a diploma program organized by universities. All have had their pros and cons. When considering these models and trying to select the best for a particular country without an existing model, some points especially are worth discussing.One point to consider is the required efficiency of training, that is, the number or specialists needed to graduate per year. This should be compared to the estimated need of practitioners. In Europe, the numbers of clinical neuropsychologists have been reported to vary between 1 per 10,455 (Denmark) and 1 per 704,000 (Serbia) . FiguresThe desired number of practitioners will depend on the size of the population and the geographical area to be covered. It will also depend on the health care system and clinical practices. Preferably, the number of neuropsychologists should be in line with the number of other relevant professionals such as neurologist or psychiatrist see  thus rea2) disparities between different parts of the country are a concern. There is therefore a constant pressure to increase the intake and/or output of students. Short training times produce specialists quicker, but the quality of training is paramount. Enough time should be allowed for the development of the competencies expected from the graduating neuropsychologists as they enter the profession. Admitting more students in the program also produces specialists quicker, but the pedagogical quality should not be compromised. Higher intake requires more resources for teaching and supervision. The EuroPsy specialist certificate, currently available in work and organizational psychology and psychotherapy, require a 3-year post-master training with at least 90 ECTS of advanced study4 which suggests that acquisition of advanced skills requires time. Clinical neuropsychology tends to be a popular field among psychologists, so lack of motivated applicants is not a problem.In Finland, the current density of clinical neuropsychologists  is 1 per 14,745. While at the high end in global comparison, this amount of specialist has been considered inadequate  and espeThe costs of organizing a training program come from many sources. Paying the salaries of individual lecturers and renting the premises is a beginning. In universities, cost models are calculated to include variable size overheads e.g., for the use of offices and auditoriums, information technology, general administration, and secretarial assistance. Salaries for professors and university lecturers include time to plan the full curriculum, course syllabus, as well as the actual teaching and grading of the various written assignments. Costs should also include all work that is required for intake of students, whether to process application forms or grade intake exams if such are used. Work that is required for graduation, including updating the credits registries, checking the completion of all required studies, and processing the certificates should also be included. Students are expected to gain work experience and professional supervision. The costs for these need to be considered. Student may already be employed in a suitable position for practicing their skills, or they may participate in organized practicum/internship periods. If they have supervisors or mentors that are not part of the teaching faculty, there may be a need to cover the costs.A model where all costs fall upon the student is the least favorable from the student perspective. It can be problematic also from the society perspective because it leads to unfair disparity where only part of the psychologists have the financial opportunity to specialize. The selection may not lead into the best candidates getting trained. While health care providers need specialist expertise, employers in Finland have not been particularly active in covering program fees for their employees .From the organizer perspective the financial model should provide stability, and funding from the governmental level (relevant ministries) offers this best. As funding from the Ministry of Education for master level tuition is generally secure for universities, developing a master program in clinical neuropsychology has been seen as a solution in e.g., France . This, hThe work field of clinical neuropsychology is wide ranging from diagnostic assessment and consultation to interventions and rehabilitation across all ages. The core competency requirements for all clinical neuropsychologist include in-depth knowledge and skills in: (a) general psychology including clinical psychology, ethical, and legal standards, (b) clinically relevant brain-behavioral relationships, (c) related clinical disciplines, (d) neuropsychological assessment, including decision-making and diagnostic competency according to current classification of diseases, (e) diversity and culture in relation to clinical neuropsychology, (f) communication of neuropsychological findings and results to relevant and diverse audiences, and (g) psychological and neuropsychological interventions, including treatment and rehabilitation .To appreciate the implications of childhood conditions to adulthood and old age it is important that the competencies cover comprehensive expert knowledge of clinical neuropsychology throughout the lifespan. Yet, clinicians usually work within a subspeciality of either pediatric or adult neuropsychology. This calls for a training model that provides possibilities to achieve the knowledge and skills required for the given subspeciality. In Finland, pediatric and adult neuropsychology are incorporated into the same curriculum, but professional expertise within a subspeciality can be ensured via personal study plan, where the students have the opportunity to select part of the courses based on their individual interests and emphasis.Treatment and rehabilitation is an integral part of clinical neuropsychology along with assessment  and the In the United States (US), the clinical neuropsychology training has been built upon the scientist-practitioner model which poses that professional psychologist could and should be both scientist and practitioner . The iniThe doctorate requirement for specialists in clinical neuropsychology appears in a minority of countries, namely US, Canada, United Kingdom (UK), Ireland, and parts of Australia . In FinlRegardless of the associated degree requirements, the need for scientific bases of clinical action stems from the model of Evidence Based Practice (EBP) which, as applied in psychology and clinical neuropsychology, calls for empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention . In the If the doctorate track and the specialist track are separate, transfer from one to the other should be made as effortless as possible. If empirical research is a required competence in the specialist education taking a step further toward a doctorate is relatively small. And if the specialist program credits count also toward the doctoral degree, the step is made easier still. In Finland, the doctorate usually requires a minimum of three published research papers  and 40 ECTS of study, and some of these requirements can be shared between the doctoral and the specialist track programs . A stratAn established specialist training model strengthens the position of the profession in health care. Planning the specialist training for clinical neuropsychology never happens in a vacuum, however. The existing health care system, legislation related to health care and education, competencies provided by the bachelor and master level studies in psychology, and the strategies of the stakeholder ministries must be taken into account. As experienced in Finland, these building blocks can also change over time. This paper provides information on different training models within clinical neuropsychology in Finland in the past 40 years. The experiences can be useful for other countries that are developing their models. The estimated need of practitioners and the educational resources including the available financial models for training differ between countries. The guiding principles in specialist training should focus on the advanced competencies expected from the neuropsychologist when entering the profession.LH wrote the first draft of the manuscript and finalized it for submission. HJ, KR, TN, and EP had intellectual contributions to the content. All authors agreed to the submitted version of the publication.LH was the Professor responsible for the clinical neuropsychology specialist program at the University of Helsinki, Finland. HJ and KR had 50% positions as Senior Lecturers in the same program. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. 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